2022
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Journal Articles
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| Biébo Bihoun, Serge Henri Zango, Maminata Traoré-Coulibaly, Innocent Valea, Raffaella Ravinetto, Jean Pierre Van Geertruyden, Umberto D’Alessandro, Halidou Tinto, Annie Robert Age-modified factors associated with placental malaria in rural Burkina Faso. (Journal Article) In: BMC pregnancy and childbirth, vol. 22, iss. 1, pp. 248, 2022, ISSN: 1471-2393. @article{nokey,
title = {Age-modified factors associated with placental malaria in rural Burkina Faso.},
author = {Bi\'{e}bo Bihoun and Serge Henri Zango and Maminata Traor\'{e}-Coulibaly and Innocent Valea and Raffaella Ravinetto and Jean Pierre Van Geertruyden and Umberto D'Alessandro and Halidou Tinto and Annie Robert},
doi = {10.1186/s12884-022-04568-4},
issn = {1471-2393},
year = {2022},
date = {2022-03-01},
urldate = {2022-03-01},
journal = {BMC pregnancy and childbirth},
volume = {22},
issue = {1},
pages = {248},
abstract = {BACKGROUND: Malaria in pregnancy can result in placental infection with fetal implications. This study aimed at assessing placental malaria (PM) prevalence and its associated factors in a cohort of pregnant women with peripheral malaria and their offspring. METHOD: The data were collected in the framework of a clinical trial on treatments for malaria in pregnant women . Placental malaria (PM) was diagnosed by histopathological detection of parasites and/or malaria pigment on placenta biopsies taken at delivery. Factors associated with PM were assessed using logistic regression. RESULTS: Out of 745 biopsies examined, PM was diagnosed in 86.8 % of women. Acute, chronic and past PM were retrieved in 11 (1.5 %), 170 (22.8 %), and 466 (62.6 %) women, respectively. A modifying effect was observed in the association of gravidity or anemia at the study start with pooled PM (presence of parasites and/or malaria pigment). In women under 30, gravidity ≤ 2 was associated with an increased prevalence of pooled PM but in women aged 30 years or more, gravidity was no more associated with pooled PM (OR 6.81, 95 % CI 3.18 - 14.60; and OR 0.52, 95 % CI 0.10 - 2.76, respectively). Anemia was associated with pooled PM in women under 30 (OR 1.96, 95 % CI 1.03 - 3.72) but not in women aged 30 years or more (OR 0.68, 95 % CI 0.31 - 1.49). Similarly, the association of gravidity with past-chronic PM depended also on age. A higher prevalence of active PM was observed in women under 30 presenting with symptomatic malaria (OR 3.79, 95 % CI 1.55 - 9.27), while there was no significant increase in the prevalence of active PM (presence of parasites only) in women with symptomatic malaria when aged 30 years or more (OR 0.42, 95 % CI 0.10 - 1.75). In women with chronic PM, the prevalence of low birth weight or prematurity was the highest (31.2 %) as compared with past PM or no PM. CONCLUSION: Despite the rapid diagnosis and efficacious treatment of peripheral infection, the prevalence of placental malaria remained high in women with P. falciparum peripheral infection in Nanoro, especially in younger women This underlines the importance of preventive measures in this specific group.},
keywords = {*Malaria, *Malaria/epidemiology, Adult, Burkina Faso, Burkina Faso/epidemiology, Falciparum/parasitology, Female, Gravidity, Humans, Malaria, placenta, Placenta/parasitology, Pregnancy, Risk Factors},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Malaria in pregnancy can result in placental infection with fetal implications. This study aimed at assessing placental malaria (PM) prevalence and its associated factors in a cohort of pregnant women with peripheral malaria and their offspring. METHOD: The data were collected in the framework of a clinical trial on treatments for malaria in pregnant women . Placental malaria (PM) was diagnosed by histopathological detection of parasites and/or malaria pigment on placenta biopsies taken at delivery. Factors associated with PM were assessed using logistic regression. RESULTS: Out of 745 biopsies examined, PM was diagnosed in 86.8 % of women. Acute, chronic and past PM were retrieved in 11 (1.5 %), 170 (22.8 %), and 466 (62.6 %) women, respectively. A modifying effect was observed in the association of gravidity or anemia at the study start with pooled PM (presence of parasites and/or malaria pigment). In women under 30, gravidity ≤ 2 was associated with an increased prevalence of pooled PM but in women aged 30 years or more, gravidity was no more associated with pooled PM (OR 6.81, 95 % CI 3.18 – 14.60; and OR 0.52, 95 % CI 0.10 – 2.76, respectively). Anemia was associated with pooled PM in women under 30 (OR 1.96, 95 % CI 1.03 – 3.72) but not in women aged 30 years or more (OR 0.68, 95 % CI 0.31 – 1.49). Similarly, the association of gravidity with past-chronic PM depended also on age. A higher prevalence of active PM was observed in women under 30 presenting with symptomatic malaria (OR 3.79, 95 % CI 1.55 – 9.27), while there was no significant increase in the prevalence of active PM (presence of parasites only) in women with symptomatic malaria when aged 30 years or more (OR 0.42, 95 % CI 0.10 – 1.75). In women with chronic PM, the prevalence of low birth weight or prematurity was the highest (31.2 %) as compared with past PM or no PM. CONCLUSION: Despite the rapid diagnosis and efficacious treatment of peripheral infection, the prevalence of placental malaria remained high in women with P. falciparum peripheral infection in Nanoro, especially in younger women This underlines the importance of preventive measures in this specific group. |
| Paul Sondo, Marc Christian Tahita, Hamidou Ilboudo, Toussaint Rouamba, Karim Derra, Gauthier Tougri, Florence Ouédraogo, Béatrice Marie Adélaïde Konseibo, Eli Roamba, Sabina Dahlström Otienoburu, Bérenger Kaboré, Kalynn Kennon, Kadija Ouédraogo, Wend-Timbe-Noma Arlette Raïssa Zongo, Fadima Yaya Bocoum, Kasia Stepniewska, Mehul Dhorda, Philippe J. Guérin, Halidou Tinto Boosting the impact of seasonal malaria chemoprevention (SMC) through simultaneous screening and treatment of household members of children receiving SMC in Burkina Faso: a protocol for a randomized open label trial (Journal Article) In: Archives of Public Health, vol. 80, iss. 1, pp. 41, 2022, ISSN: 2049-3258. @article{Sondo2022,
title = {Boosting the impact of seasonal malaria chemoprevention (SMC) through simultaneous screening and treatment of household members of children receiving SMC in Burkina Faso: a protocol for a randomized open label trial},
author = {Paul Sondo and Marc Christian Tahita and Hamidou Ilboudo and Toussaint Rouamba and Karim Derra and Gauthier Tougri and Florence Ou\'{e}draogo and B\'{e}atrice Marie Ad\'{e}la\"{i}de Konseibo and Eli Roamba and Sabina Dahlstr\"{o}m Otienoburu and B\'{e}renger Kabor\'{e} and Kalynn Kennon and Kadija Ou\'{e}draogo and Wend-Timbe-Noma Arlette Ra\"{i}ssa Zongo and Fadima Yaya Bocoum and Kasia Stepniewska and Mehul Dhorda and Philippe J. Gu\'{e}rin and Halidou Tinto},
url = {https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-022-00800-x},
doi = {10.1186/s13690-022-00800-x},
issn = {2049-3258},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
journal = {Archives of Public Health},
volume = {80},
issue = {1},
pages = {41},
abstract = {BACKGROUND Plasmodium falciparum malaria remains a major public health concern in sub-Sahara Africa. Seasonal malaria chemoprevention (SMC) with amodiaquine + sulfadoxine-pyrimethamine is one of the most important preventive interventions. Despite its implementation, the burden of malaria is still very high in children under five years old in Burkina Faso, suggesting that the expected impact of this promising strategy might not be attained. Development of innovative strategies to improve the efficacy of these existing malaria control measures is essential. In such context, we postulate that screening and treatment of malaria in household members of children receiving SMC could greatly improve the impact of SMC intervention and reduce malaria transmission in endemic settings. METHODS This randomized superiority trial will be carried out in the Nanoro health district, Burkina Faso. The unit of randomisation will be the household and all eligible children from a household will be allocated to the same study group. Households with 3-59 months old children will be assigned to either (i) control group (SMC alone) or (ii) intervention (SMC+ screening of household members with standard Histidin Rich Protein Rapid Diagnostic Test (HRP2-RDT) and treatment if positive). The sample size will be 526 isolated households per arm, i.e., around 1052 children under SMC coverage and an expected 1315 household members. Included children will be followed-up for 24 months to fully cover two consecutive malaria transmission seasons and two SMC cycles. Children will be actively followed-up during the malaria transmission seasons while in the dry seasons the follow-up will be passive. CONCLUSION The study will respond to a major public health concern by providing evidence of the efficacy of an innovative strategy to boost the impact of SMC intervention.},
keywords = {Africa, Amodiaquine, Burkina Faso, Chemoprevention, Dihydro artemisinin Piperaquine, Malaria, Plasmodium falciparum, Sulfadoxine-pyrimethamine},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND Plasmodium falciparum malaria remains a major public health concern in sub-Sahara Africa. Seasonal malaria chemoprevention (SMC) with amodiaquine + sulfadoxine-pyrimethamine is one of the most important preventive interventions. Despite its implementation, the burden of malaria is still very high in children under five years old in Burkina Faso, suggesting that the expected impact of this promising strategy might not be attained. Development of innovative strategies to improve the efficacy of these existing malaria control measures is essential. In such context, we postulate that screening and treatment of malaria in household members of children receiving SMC could greatly improve the impact of SMC intervention and reduce malaria transmission in endemic settings. METHODS This randomized superiority trial will be carried out in the Nanoro health district, Burkina Faso. The unit of randomisation will be the household and all eligible children from a household will be allocated to the same study group. Households with 3-59 months old children will be assigned to either (i) control group (SMC alone) or (ii) intervention (SMC+ screening of household members with standard Histidin Rich Protein Rapid Diagnostic Test (HRP2-RDT) and treatment if positive). The sample size will be 526 isolated households per arm, i.e., around 1052 children under SMC coverage and an expected 1315 household members. Included children will be followed-up for 24 months to fully cover two consecutive malaria transmission seasons and two SMC cycles. Children will be actively followed-up during the malaria transmission seasons while in the dry seasons the follow-up will be passive. CONCLUSION The study will respond to a major public health concern by providing evidence of the efficacy of an innovative strategy to boost the impact of SMC intervention. |
| Moussa Lingani, Serge H. Zango, Innocent Valéa, Maïmouna Sanou, Serge Ouoba, Sékou Samadoulougou, Annie Robert, Halidou Tinto, Michèle Dramaix, Philippe Donnen Prevalence and risk factors of malaria among first antenatal care attendees in rural Burkina Faso (Journal Article) In: Tropical Medicine and Health, vol. 50, iss. 1, pp. 49, 2022, ISSN: 1349-4147. @article{Lingani2022,
title = {Prevalence and risk factors of malaria among first antenatal care attendees in rural Burkina Faso},
author = {Moussa Lingani and Serge H. Zango and Innocent Val\'{e}a and Ma\"{i}mouna Sanou and Serge Ouoba and S\'{e}kou Samadoulougou and Annie Robert and Halidou Tinto and Mich\`{e}le Dramaix and Philippe Donnen},
url = {https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-022-00442-3},
doi = {10.1186/s41182-022-00442-3},
issn = {1349-4147},
year = {2022},
date = {2022-01-01},
journal = {Tropical Medicine and Health},
volume = {50},
issue = {1},
pages = {49},
abstract = {BACKGROUND The WHO recommends continuous surveillance of malaria in endemic countries to identify areas and populations most in need for targeted interventions. The aim of this study was to assess the prevalence of malaria and its associated factors among first antenatal care (ANC) attendees in rural Burkina Faso. METHODS A cross-sectional survey was conducted between August 2019 and September 2020 at the Yako health district and included 1067 first ANC attendees. Sociodemographic, gyneco-obstetric, and medical characteristics were collected. Malaria was diagnosed by standard microscopy and hemoglobin level was measured by spectrophotometry. A multivariate logistic regression analysis was used to identify factors associated with malaria infection. RESULTS Overall malaria infection prevalence was 16.1% (167/1039). Among malaria-positive women, the geometric mean parasite density was 1204 [95% confidence interval (CI) 934-1552] parasites/µL and the proportion of very low (1-199 parasites/µL), low (200-999 parasites/µL), medium (1000-9999 parasites/µL) and high (≥ 10,000 parasites/µL) parasite densities were 15.0%, 35.3%, 38.3% and 11.4%, respectively. Age \< 20 years (adjusted odds ratio (aOR): 2.2; 95% CI 1.4-3.5), anemia (hemoglobin \< 11 g/deciliter) (aOR: 3.4; 95% CI 2.2-5.5), the non-use of bed net (aOR: 1.8; 95% CI 1.1-2.8), and the absence of intermittent preventive treatment with sulfadoxine-pyrimethamine (aOR: 5.8; 95% CI 2.1-24.5) were positively associated with malaria infection. CONCLUSIONS The study showed that one out of six pregnant women had a microscopy-detected P. falciparum malaria infection at their first ANC visit. Strengthening malaria prevention strategies during the first ANC visit is needed to prevent unfavorable birth outcomes.},
keywords = {Burkina Faso, First antenatal care visit, Malaria, Pregnancy},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND The WHO recommends continuous surveillance of malaria in endemic countries to identify areas and populations most in need for targeted interventions. The aim of this study was to assess the prevalence of malaria and its associated factors among first antenatal care (ANC) attendees in rural Burkina Faso. METHODS A cross-sectional survey was conducted between August 2019 and September 2020 at the Yako health district and included 1067 first ANC attendees. Sociodemographic, gyneco-obstetric, and medical characteristics were collected. Malaria was diagnosed by standard microscopy and hemoglobin level was measured by spectrophotometry. A multivariate logistic regression analysis was used to identify factors associated with malaria infection. RESULTS Overall malaria infection prevalence was 16.1% (167/1039). Among malaria-positive women, the geometric mean parasite density was 1204 [95% confidence interval (CI) 934-1552] parasites/µL and the proportion of very low (1-199 parasites/µL), low (200-999 parasites/µL), medium (1000-9999 parasites/µL) and high (≥ 10,000 parasites/µL) parasite densities were 15.0%, 35.3%, 38.3% and 11.4%, respectively. Age < 20 years (adjusted odds ratio (aOR): 2.2; 95% CI 1.4-3.5), anemia (hemoglobin < 11 g/deciliter) (aOR: 3.4; 95% CI 2.2-5.5), the non-use of bed net (aOR: 1.8; 95% CI 1.1-2.8), and the absence of intermittent preventive treatment with sulfadoxine-pyrimethamine (aOR: 5.8; 95% CI 2.1-24.5) were positively associated with malaria infection. CONCLUSIONS The study showed that one out of six pregnant women had a microscopy-detected P. falciparum malaria infection at their first ANC visit. Strengthening malaria prevention strategies during the first ANC visit is needed to prevent unfavorable birth outcomes. |
| Laetitia Duval, Elisa Sicuri, Susana Scott, Maminata Traoré, Bunja Daabo, Halidou Tinto, Koen Peeters Grietens, Umberto d’Alessando, Henk Schallig, Petra Mens, Lesong Conteh Household costs associated with seeking malaria treatment during pregnancy: evidence from Burkina Faso and The Gambia (Journal Article) In: Cost Effectiveness and Resource Allocation, vol. 20, iss. 1, pp. 42, 2022, ISSN: 1478-7547. @article{Duval2022,
title = {Household costs associated with seeking malaria treatment during pregnancy: evidence from Burkina Faso and The Gambia},
author = {Laetitia Duval and Elisa Sicuri and Susana Scott and Maminata Traor\'{e} and Bunja Daabo and Halidou Tinto and Koen Peeters Grietens and Umberto d’Alessando and Henk Schallig and Petra Mens and Lesong Conteh},
url = {https://resource-allocation.biomedcentral.com/articles/10.1186/s12962-022-00376-x},
doi = {10.1186/s12962-022-00376-x},
issn = {1478-7547},
year = {2022},
date = {2022-01-01},
journal = {Cost Effectiveness and Resource Allocation},
volume = {20},
issue = {1},
pages = {42},
abstract = {BACKGROUND Malaria in pregnancy remains a major health threat in sub-Saharan Africa to both expectant mothers and their unborn children. To date, there have been very few studies focused on the out of pocket costs associated with seeking treatment for malaria during pregnancy. METHODS A cross-sectional survey was undertaken in Burkina Faso and The Gambia to estimate the direct and indirect costs associated with outpatient consultations (OP) and inpatient admissions (IP). Direct costs were broken down into medical (admission fees, drug charges, and laboratory fees), and non-medical (transportation and food). Indirect costs reflected time lost due to illness. In total, 220 pregnant women in Burkina Faso and 263 in The Gambia were interviewed about their treatment seeking decisions, expenditure, time use and financial support associated with each malaria episode. RESULTS In Burkina Faso 6.7% sought treatment elsewhere before their OP visits, and 27.1% before their IP visits. This compares to 1.3% for OP and 25.92% for IP in The Gambia. Once at the facility, the average direct costs (out of pocket) were 3.91US$ for an OP visit and 15.38US$ of an IP visit in Burkina Faso, and 0.80US$ for an OP visit and 9.19US$ for an IP visit in The Gambia. Inpatient direct costs were driven by drug costs (9.27US$) and transportation costs (2.72US$) in Burkina Faso and drug costs (3.44 US$) and food costs (3.44 US$) in The Gambia. Indirect costs of IP visits, valued as the opportunity cost of time lost due to the illness, were estimated at 11.85US$ in Burkina Faso and 4.07US$ in The Gambia. The difference across the two countries was mainly due to the longer time of hospitalization in Burkina Faso compared to The Gambia. In The Gambia, the vast majority of pregnant women reported receiving financial support from family members living abroad, most commonly siblings (65%). CONCLUSIONS High malaria treatment costs are incurred by pregnant women in Burkina Faso and The Gambia. Beyond the medical costs of fees and drugs, costs in terms of transport, food and time are significant drivers. The role of remittances, particularly their effect on accessing health care, needs further investigation.},
keywords = {Burkina Faso, Cost, Gambia, Malaria, Pregnancy, Remittances, sub-Saharan Africa},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND Malaria in pregnancy remains a major health threat in sub-Saharan Africa to both expectant mothers and their unborn children. To date, there have been very few studies focused on the out of pocket costs associated with seeking treatment for malaria during pregnancy. METHODS A cross-sectional survey was undertaken in Burkina Faso and The Gambia to estimate the direct and indirect costs associated with outpatient consultations (OP) and inpatient admissions (IP). Direct costs were broken down into medical (admission fees, drug charges, and laboratory fees), and non-medical (transportation and food). Indirect costs reflected time lost due to illness. In total, 220 pregnant women in Burkina Faso and 263 in The Gambia were interviewed about their treatment seeking decisions, expenditure, time use and financial support associated with each malaria episode. RESULTS In Burkina Faso 6.7% sought treatment elsewhere before their OP visits, and 27.1% before their IP visits. This compares to 1.3% for OP and 25.92% for IP in The Gambia. Once at the facility, the average direct costs (out of pocket) were 3.91US$ for an OP visit and 15.38US$ of an IP visit in Burkina Faso, and 0.80US$ for an OP visit and 9.19US$ for an IP visit in The Gambia. Inpatient direct costs were driven by drug costs (9.27US$) and transportation costs (2.72US$) in Burkina Faso and drug costs (3.44 US$) and food costs (3.44 US$) in The Gambia. Indirect costs of IP visits, valued as the opportunity cost of time lost due to the illness, were estimated at 11.85US$ in Burkina Faso and 4.07US$ in The Gambia. The difference across the two countries was mainly due to the longer time of hospitalization in Burkina Faso compared to The Gambia. In The Gambia, the vast majority of pregnant women reported receiving financial support from family members living abroad, most commonly siblings (65%). CONCLUSIONS High malaria treatment costs are incurred by pregnant women in Burkina Faso and The Gambia. Beyond the medical costs of fees and drugs, costs in terms of transport, food and time are significant drivers. The role of remittances, particularly their effect on accessing health care, needs further investigation. |
| Matthew Cairns, Amadou Barry, Issaka Zongo, Issaka Sagara, Serge R. Yerbanga, Modibo Diarra, Charles Zoungrana, Djibrilla Issiaka, Abdoul Aziz Sienou, Amadou Tapily, Koualy Sanogo, Mahamadou Kaya, Seydou Traore, Kalifa Diarra, Hama Yalcouye, Youssoufa Sidibe, Alassane Haro, Ismaila Thera, Paul Snell, Jane Grant, Halidou Tinto, Paul Milligan, Daniel Chandramohan, Brian Greenwood, Alassane Dicko, Jean Bosco Ouedraogo The duration of protection against clinical malaria provided by the combination of seasonal RTS,S/AS01E vaccination and seasonal malaria chemoprevention versus either intervention given alone (Journal Article) In: BMC Medicine, vol. 20, iss. 1, pp. 352, 2022, ISSN: 1741-7015. @article{Cairns2022,
title = {The duration of protection against clinical malaria provided by the combination of seasonal RTS,S/AS01E vaccination and seasonal malaria chemoprevention versus either intervention given alone},
author = {Matthew Cairns and Amadou Barry and Issaka Zongo and Issaka Sagara and Serge R. Yerbanga and Modibo Diarra and Charles Zoungrana and Djibrilla Issiaka and Abdoul Aziz Sienou and Amadou Tapily and Koualy Sanogo and Mahamadou Kaya and Seydou Traore and Kalifa Diarra and Hama Yalcouye and Youssoufa Sidibe and Alassane Haro and Ismaila Thera and Paul Snell and Jane Grant and Halidou Tinto and Paul Milligan and Daniel Chandramohan and Brian Greenwood and Alassane Dicko and Jean Bosco Ouedraogo},
url = {https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-022-02536-5},
doi = {10.1186/s12916-022-02536-5},
issn = {1741-7015},
year = {2022},
date = {2022-01-01},
journal = {BMC Medicine},
volume = {20},
issue = {1},
pages = {352},
abstract = {BACKGROUND A recent trial of 5920 children in Burkina Faso and Mali showed that the combination of seasonal vaccination with the RTS,S/AS01E malaria vaccine (primary series and two seasonal boosters) and seasonal malaria chemoprevention (four monthly cycles per year) was markedly more effective than either intervention given alone in preventing clinical malaria, severe malaria, and deaths from malaria. METHODS In order to help optimise the timing of these two interventions, trial data were reanalysed to estimate the duration of protection against clinical malaria provided by RTS,S/AS01E when deployed seasonally, by comparing the group who received the combination of SMC and RTS,S/AS01E with the group who received SMC alone. The duration of protection from SMC was also estimated comparing the combined intervention group with the group who received RTS,S/AS01E alone. Three methods were used: Piecewise Cox regression, Flexible parametric survival models and Smoothed Schoenfeld residuals from Cox models, stratifying on the study area and using robust standard errors to control for within-child clustering of multiple episodes. RESULTS The overall protective efficacy from RTS,S/AS01E over 6 months was at least 60% following the primary series and the two seasonal booster doses and remained at a high level over the full malaria transmission season. Beyond 6 months, protective efficacy appeared to wane more rapidly, but the uncertainty around the estimates increases due to the lower number of cases during this period (coinciding with the onset of the dry season). Protection from SMC exceeded 90% in the first 2-3 weeks post-administration after several cycles, but was not 100%, even immediately post-administration. Efficacy begins to decline from approximately day 21 and then declines more sharply after day 28, indicating the importance of preserving the delivery interval for SMC cycles at a maximum of four weeks. CONCLUSIONS The efficacy of both interventions was highest immediately post-administration. Understanding differences between these interventions in their peak efficacy and how rapidly efficacy declines over time will help to optimise the scheduling of SMC, malaria vaccination and the combination in areas of seasonal transmission with differing epidemiology, and using different vaccine delivery systems. TRIAL REGISTRATION The RTS,S-SMC trial in which these data were collected was registered at clinicaltrials.gov: NCT03143218.},
keywords = {Malaria, Malaria vaccination, Plasmodium falciparum, RTS, S/AS01E, seasonal malaria chemoprevention},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND A recent trial of 5920 children in Burkina Faso and Mali showed that the combination of seasonal vaccination with the RTS,S/AS01E malaria vaccine (primary series and two seasonal boosters) and seasonal malaria chemoprevention (four monthly cycles per year) was markedly more effective than either intervention given alone in preventing clinical malaria, severe malaria, and deaths from malaria. METHODS In order to help optimise the timing of these two interventions, trial data were reanalysed to estimate the duration of protection against clinical malaria provided by RTS,S/AS01E when deployed seasonally, by comparing the group who received the combination of SMC and RTS,S/AS01E with the group who received SMC alone. The duration of protection from SMC was also estimated comparing the combined intervention group with the group who received RTS,S/AS01E alone. Three methods were used: Piecewise Cox regression, Flexible parametric survival models and Smoothed Schoenfeld residuals from Cox models, stratifying on the study area and using robust standard errors to control for within-child clustering of multiple episodes. RESULTS The overall protective efficacy from RTS,S/AS01E over 6 months was at least 60% following the primary series and the two seasonal booster doses and remained at a high level over the full malaria transmission season. Beyond 6 months, protective efficacy appeared to wane more rapidly, but the uncertainty around the estimates increases due to the lower number of cases during this period (coinciding with the onset of the dry season). Protection from SMC exceeded 90% in the first 2-3 weeks post-administration after several cycles, but was not 100%, even immediately post-administration. Efficacy begins to decline from approximately day 21 and then declines more sharply after day 28, indicating the importance of preserving the delivery interval for SMC cycles at a maximum of four weeks. CONCLUSIONS The efficacy of both interventions was highest immediately post-administration. Understanding differences between these interventions in their peak efficacy and how rapidly efficacy declines over time will help to optimise the scheduling of SMC, malaria vaccination and the combination in areas of seasonal transmission with differing epidemiology, and using different vaccine delivery systems. TRIAL REGISTRATION The RTS,S-SMC trial in which these data were collected was registered at clinicaltrials.gov: NCT03143218. |
| Vivi Maketa, Japhet Kabalu, Melissa Kabena, Flory Luzolo, Hypolite Muhindo-Mavoko, Henk D. F. H. Schallig, Kassoum Kayentao, Petra F. Mens, Pascal Lutumba, Halidou Tinto Comparison of intermittent screening (using ultra-sensitive malaria rapid diagnostic test) and treatment (using a newly registered antimalarial pyronaridine-artesunate—PYRAMAX®) to standard intermittent preventive treatment with sulfadoxine-pyrimethamine for the prevention of malaria in pregnant women living in endemic areas: ULTRAPYRAPREG (Journal Article) In: Trials, vol. 23, iss. 1, pp. 963, 2022, ISSN: 1745-6215. @article{Maketa2022,
title = {Comparison of intermittent screening (using ultra-sensitive malaria rapid diagnostic test) and treatment (using a newly registered antimalarial pyronaridine-artesunate\textemdashPYRAMAX®) to standard intermittent preventive treatment with sulfadoxine-pyrimethamine for the prevention of malaria in pregnant women living in endemic areas: ULTRAPYRAPREG},
author = {Vivi Maketa and Japhet Kabalu and Melissa Kabena and Flory Luzolo and Hypolite Muhindo-Mavoko and Henk D. F. H. Schallig and Kassoum Kayentao and Petra F. Mens and Pascal Lutumba and Halidou Tinto},
url = {https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-022-06884-8},
doi = {10.1186/s13063-022-06884-8},
issn = {1745-6215},
year = {2022},
date = {2022-01-01},
journal = {Trials},
volume = {23},
issue = {1},
pages = {963},
abstract = {BACKGROUND Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is an important malaria control strategy in sub-Saharan Africa. Indeed, it overcomes the risk of misdiagnosis due to low peripheral parasitemia during pregnancy by treating women with SP on predetermined schedules. However, over time, the spread of Plasmodium-resistant strains has threatened this strategy in many countries. As an alternative, the intermittent screening and treatment for pregnancy (ISTp) aims at a monthly screening of pregnant women, preferably by using very sensitive tests such as ultrasensitive rapid diagnostic tests (us-RDTs) and the treatment of positive cases with artemisinin-based combination therapy (ACT) regardless of the presence of symptoms. Unlike IPTp-SP, ISTp prevents overuse of antimalarials limiting the drug pressure on parasites, an advantage which can be potentiated by using an ACT like pyronaridine-artesunate (Pyramax®) that is not yet used in pregnant women in the field. METHODS This study aims to compare the non-inferiority of ISTp using us-RDTs and Pyramax® versus IPTp-SP on malaria in pregnancy through a randomized clinical trial performed in Kisenso, Kinshasa, the Democratic Republic of the Congo, a malaria perennial transmission area. DISCUSSION The results will be essential for the National Malaria Control Program to update the malaria prevention policy in pregnant women in the Democratic Republic of the Congo. TRIAL REGISTRATION ClinicalTrials.gov NCT04783051.},
keywords = {IPTp-SP, ISTp, Malaria, Malaria indicators, Pregnancy, Ultra-sensitive RDTs},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is an important malaria control strategy in sub-Saharan Africa. Indeed, it overcomes the risk of misdiagnosis due to low peripheral parasitemia during pregnancy by treating women with SP on predetermined schedules. However, over time, the spread of Plasmodium-resistant strains has threatened this strategy in many countries. As an alternative, the intermittent screening and treatment for pregnancy (ISTp) aims at a monthly screening of pregnant women, preferably by using very sensitive tests such as ultrasensitive rapid diagnostic tests (us-RDTs) and the treatment of positive cases with artemisinin-based combination therapy (ACT) regardless of the presence of symptoms. Unlike IPTp-SP, ISTp prevents overuse of antimalarials limiting the drug pressure on parasites, an advantage which can be potentiated by using an ACT like pyronaridine-artesunate (Pyramax®) that is not yet used in pregnant women in the field. METHODS This study aims to compare the non-inferiority of ISTp using us-RDTs and Pyramax® versus IPTp-SP on malaria in pregnancy through a randomized clinical trial performed in Kisenso, Kinshasa, the Democratic Republic of the Congo, a malaria perennial transmission area. DISCUSSION The results will be essential for the National Malaria Control Program to update the malaria prevention policy in pregnant women in the Democratic Republic of the Congo. TRIAL REGISTRATION ClinicalTrials.gov NCT04783051. |
| Tim Starck, Peter Dambach, Toussaint Rouamba, Halidou Tinto, Faith Osier, Catherine E. Oldenburg, Maya Adam, Till Bärnighausen, Thomas Jaenisch, Caroline A. Bulstra The effect of malaria on childhood anemia in a quasi-experimental study of 7,384 twins from 23 Sub-Saharan African countries (Journal Article) In: Frontiers in Public Health, vol. 10, pp. 1009865, 2022, ISSN: 2296-2565. @article{Starck2022,
title = {The effect of malaria on childhood anemia in a quasi-experimental study of 7,384 twins from 23 Sub-Saharan African countries},
author = {Tim Starck and Peter Dambach and Toussaint Rouamba and Halidou Tinto and Faith Osier and Catherine E. Oldenburg and Maya Adam and Till B\"{a}rnighausen and Thomas Jaenisch and Caroline A. Bulstra},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2022.1009865/full},
doi = {10.3389/fpubh.2022.1009865},
issn = {2296-2565},
year = {2022},
date = {2022-01-01},
journal = {Frontiers in Public Health},
volume = {10},
pages = {1009865},
abstract = {BACKGROUND Young children in Sub-Saharan Africa (SSA), particularly those from resource-limited settings, are heavily burdened by anemia and malaria. While malaria infected children frequently become anemic (hemoglobin \< 110 g/L), anemia is a strongly multifactorial disease with many other risk factors than malaria. Due to the complex and often overlapping contributors to anemia, it remains challenging to isolate the true impact of malaria on population level hemoglobin concentrations. METHODS We quantified the malaria-induced effect on hemoglobin levels in children under 5 years of age, leveraging data from 7,384 twins and other multiples, aged 6 to 59 months, from 57 nationally representative Demographic and Health Surveys (DHSs) from 23 SSA countries from 2006 to 2019. The quasi-experimental twin fixed-effect design let us minimize the impact of potential confounders that do not vary between twins. RESULTS Our analyses of twins revealed a malaria-induced hemoglobin decrease in infected twins of 9 g/L (95% CI -10; -7, p\<0.001). The relative risk of severe anemia was higher (RR = 3.01, 95% CI 1.79; 5.1, p\<0.001) among malaria positive children, compared to malaria negative children. Conversely, malaria positive children are only half as likely to be non-anemic (RR = 0.51, 95% CI 0.43; 0.61, p\<0.001). CONCLUSION Even after rigorous control for confounding through a twin fixed-effects study design, malaria substantially decreased hemoglobin levels among SSA twins, rendering them much more susceptible to severe anemia. This effect reflects the population-level effect of malaria on anemia.},
keywords = {anemia-etiology, DHS, fixed-effect, hemoglobin, Malaria, multiples, Sub-Sahara Africa, twins},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND Young children in Sub-Saharan Africa (SSA), particularly those from resource-limited settings, are heavily burdened by anemia and malaria. While malaria infected children frequently become anemic (hemoglobin < 110 g/L), anemia is a strongly multifactorial disease with many other risk factors than malaria. Due to the complex and often overlapping contributors to anemia, it remains challenging to isolate the true impact of malaria on population level hemoglobin concentrations. METHODS We quantified the malaria-induced effect on hemoglobin levels in children under 5 years of age, leveraging data from 7,384 twins and other multiples, aged 6 to 59 months, from 57 nationally representative Demographic and Health Surveys (DHSs) from 23 SSA countries from 2006 to 2019. The quasi-experimental twin fixed-effect design let us minimize the impact of potential confounders that do not vary between twins. RESULTS Our analyses of twins revealed a malaria-induced hemoglobin decrease in infected twins of 9 g/L (95% CI -10; -7, p<0.001). The relative risk of severe anemia was higher (RR = 3.01, 95% CI 1.79; 5.1, p<0.001) among malaria positive children, compared to malaria negative children. Conversely, malaria positive children are only half as likely to be non-anemic (RR = 0.51, 95% CI 0.43; 0.61, p<0.001). CONCLUSION Even after rigorous control for confounding through a twin fixed-effects study design, malaria substantially decreased hemoglobin levels among SSA twins, rendering them much more susceptible to severe anemia. This effect reflects the population-level effect of malaria on anemia. |
| Massa Achille Bonko, Marc Christian Tahita, Francois Kiemde, Palpouguini Lompo, Petra F. Mens, Halidou Tinto, Henk. D. F. H. Schallig Diagnostic Performance of Plasmodium falciparum Histidine-Rich Protein-2 Antigen-Specific Rapid Diagnostic Test in Children at the Peripheral Health Care Level in Nanoro (Burkina Faso) (Journal Article) In: Tropical Medicine and Infectious Disease, vol. 7, iss. 12, pp. 440, 2022, ISSN: 2414-6366. @article{Bonko2022,
title = {Diagnostic Performance of Plasmodium falciparum Histidine-Rich Protein-2 Antigen-Specific Rapid Diagnostic Test in Children at the Peripheral Health Care Level in Nanoro (Burkina Faso)},
author = {Massa Achille Bonko and Marc Christian Tahita and Francois Kiemde and Palpouguini Lompo and Petra F. Mens and Halidou Tinto and Henk. D. F. H. Schallig},
url = {https://www.mdpi.com/2414-6366/7/12/440},
doi = {10.3390/tropicalmed7120440},
issn = {2414-6366},
year = {2022},
date = {2022-01-01},
journal = {Tropical Medicine and Infectious Disease},
volume = {7},
issue = {12},
pages = {440},
abstract = {\<p\>(1) Background: Malaria control has strongly benefited from the implementation of rapid diagnostic tests (RDTs). The malaria RDTs used in Burkina Faso, as per the recommendation of the National Malaria Control Program, are based on the detection of histidine-rich protein-2 (PfHRP2) specific to Plasmodium falciparum, which is the principal plasmodial species causing malaria in Burkina Faso. However, there is increasing concern about the diagnostic performance of these RDTs in field situations, and so constant monitoring of their accuracy is warranted. (2) Methods: A prospective study was performed in the health district of Nanoro, where 391 febrile children under 5 years with an axillary temperature ≥37.5 °C presenting at participating health facilities were subjected to testing for malaria. The HRP2-based RDT and expert microscopy were used to determine the diagnostic performance of the former. Retrospectively, the correctness of the antimalaria prescriptions was reviewed. (3) Results: Taking expert malaria microscopy as the gold standard, the sensitivity of the employed RDT was 98.5% and the specificity 40.5%, with a moderate agreement between the RDT testing and microscopy. In total, 21.7% of cases received an inappropriate antimalarial treatment based on a retrospective assessment with expert microscopy results. (4) Conclusion: Malaria remains one of the principal causes of febrile illness in Burkina Faso. Testing with HRP2-based RDTs is inaccurate, in particular, due to the low specificity, which results in an over-prescription of antimalarials, with emerging antimalarial drug resistance as an important risk and many children not being treated for potential other causes of fever.\</p\>},
keywords = {Burkina Faso, diagnostics, febrile diseases, Malaria},
pubstate = {published},
tppubtype = {article}
}
<p>(1) Background: Malaria control has strongly benefited from the implementation of rapid diagnostic tests (RDTs). The malaria RDTs used in Burkina Faso, as per the recommendation of the National Malaria Control Program, are based on the detection of histidine-rich protein-2 (PfHRP2) specific to Plasmodium falciparum, which is the principal plasmodial species causing malaria in Burkina Faso. However, there is increasing concern about the diagnostic performance of these RDTs in field situations, and so constant monitoring of their accuracy is warranted. (2) Methods: A prospective study was performed in the health district of Nanoro, where 391 febrile children under 5 years with an axillary temperature ≥37.5 °C presenting at participating health facilities were subjected to testing for malaria. The HRP2-based RDT and expert microscopy were used to determine the diagnostic performance of the former. Retrospectively, the correctness of the antimalaria prescriptions was reviewed. (3) Results: Taking expert malaria microscopy as the gold standard, the sensitivity of the employed RDT was 98.5% and the specificity 40.5%, with a moderate agreement between the RDT testing and microscopy. In total, 21.7% of cases received an inappropriate antimalarial treatment based on a retrospective assessment with expert microscopy results. (4) Conclusion: Malaria remains one of the principal causes of febrile illness in Burkina Faso. Testing with HRP2-based RDTs is inaccurate, in particular, due to the low specificity, which results in an over-prescription of antimalarials, with emerging antimalarial drug resistance as an important risk and many children not being treated for potential other causes of fever.</p> |
2021
|
Journal Articles
|
| Moussa Lingani, Serge H Zango, Innocent Valéa, Massa Dit A Bonko, Sékou O Samadoulougou, Toussaint Rouamba, Marc C Tahita, Ma"imouna Sanou, Annie Robert, Halidou Tinto, Philippe Donnen, Mich`ele Dramaix Malaria and curable sexually transmitted and reproductive tract coinfection among pregnant women in rural Burkina Faso (Journal Article) In: Trop. Med. Health, vol. 49, no. 1, pp. 90, 2021, ISSN: 1348-8945 1349-4147, (© 2021. The Author(s).
PMID: 34736524
PMCID: PMC8567650). @article{Lingani2021-is,
title = {Malaria and curable sexually transmitted and reproductive tract coinfection among pregnant women in rural Burkina Faso},
author = {Moussa Lingani and Serge H Zango and Innocent Val\'{e}a and Massa Dit A Bonko and S\'{e}kou O Samadoulougou and Toussaint Rouamba and Marc C Tahita and Ma"imouna Sanou and Annie Robert and Halidou Tinto and Philippe Donnen and Mich`ele Dramaix},
doi = {10.1186/s41182-021-00381-5},
issn = {1348-8945 1349-4147},
year = {2021},
date = {2021-11-01},
urldate = {2021-11-01},
journal = {Trop. Med. Health},
volume = {49},
number = {1},
pages = {90},
publisher = {Springer Science and Business Media LLC},
abstract = {BACKGROUND: Malaria and sexually transmitted/reproductive tract
infections (STI/RTI) are leading and preventable causes of low
birthweight in sub-Saharan Africa. Reducing their impact on
pregnancy outcomes requires efficient interventions that can be
easily integrated into the antenatal care package. The paucity
of data on malaria and STI/RTI coinfection, however, limits
efforts to control these infections. This study aimed to
determine the prevalence and associated factors of malaria and
STI/RTI coinfection among pregnant women in rural Burkina Faso.
METHODS: A cross-sectional survey was conducted among 402
pregnant women attending antenatal clinics at the Yako health
district. Sociodemographic and behavioral data were collected,
and pregnant women were tested for peripheral malaria by
microscopy. Hemoglobin levels were also measured by
spectrophotometry and curable bacterial STI/RTI were tested on
cervico-vaginal swabs using rapid diagnostic test for chlamydia
and syphilis, and Gram staining for bacterial vaginosis. A
multivariate logistic regression model was used to assess the
association of malaria and STI/RTI coinfection with the
characteristics of included pregnant women. RESULTS: The
prevalence of malaria and at least one STI/RTI coinfection was
12.9% (95% confidence interval, CI: [9.8-16.7]), malaria and
bacterial vaginosis coinfection was 12.2% (95% CI:
[9.3-15.9]), malaria and chlamydial coinfection was 1.6% (95%
CI: [0.6-3.8]). No coinfection was reported for malaria and
syphilis. The individual prevalence was 17.2%, 7.2%, 0.6%,
67.7% and 73.3%, respectively, for malaria infection,
chlamydia, syphilis, bacterial vaginosis and STI/RTI
combination. Only 10% of coinfections were symptomatic, and
thus, 90% of women with coinfection would have been missed by
the symptoms-based diagnostic approach. In the multivariate analysis, the first pregnancy (aOR = 2.4 [95% CI: 1.2-4.7]) was
the only factor significantly associated with malaria and
STI/RTI coinfection. Clinical symptoms were not associated with
malaria and STI/RTI coinfection. CONCLUSION: The prevalence of
malaria and curable STI/RTI coinfection was high among pregnant
women. The poor performance of the clinical symptoms to predict
coinfection suggests that alternative interventions are needed.},
note = {© 2021. The Author(s).
PMID: 34736524
PMCID: PMC8567650},
keywords = {Bacterial vaginosis, Burkina Faso, Chlamydia, Coinfection, Malaria, Pregnancy, Syphilis},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Malaria and sexually transmitted/reproductive tract
infections (STI/RTI) are leading and preventable causes of low
birthweight in sub-Saharan Africa. Reducing their impact on
pregnancy outcomes requires efficient interventions that can be
easily integrated into the antenatal care package. The paucity
of data on malaria and STI/RTI coinfection, however, limits
efforts to control these infections. This study aimed to
determine the prevalence and associated factors of malaria and
STI/RTI coinfection among pregnant women in rural Burkina Faso.
METHODS: A cross-sectional survey was conducted among 402
pregnant women attending antenatal clinics at the Yako health
district. Sociodemographic and behavioral data were collected,
and pregnant women were tested for peripheral malaria by
microscopy. Hemoglobin levels were also measured by
spectrophotometry and curable bacterial STI/RTI were tested on
cervico-vaginal swabs using rapid diagnostic test for chlamydia
and syphilis, and Gram staining for bacterial vaginosis. A
multivariate logistic regression model was used to assess the
association of malaria and STI/RTI coinfection with the
characteristics of included pregnant women. RESULTS: The
prevalence of malaria and at least one STI/RTI coinfection was
12.9% (95% confidence interval, CI: [9.8-16.7]), malaria and
bacterial vaginosis coinfection was 12.2% (95% CI:
[9.3-15.9]), malaria and chlamydial coinfection was 1.6% (95%
CI: [0.6-3.8]). No coinfection was reported for malaria and
syphilis. The individual prevalence was 17.2%, 7.2%, 0.6%,
67.7% and 73.3%, respectively, for malaria infection,
chlamydia, syphilis, bacterial vaginosis and STI/RTI
combination. Only 10% of coinfections were symptomatic, and
thus, 90% of women with coinfection would have been missed by
the symptoms-based diagnostic approach. In the multivariate analysis, the first pregnancy (aOR = 2.4 [95% CI: 1.2-4.7]) was
the only factor significantly associated with malaria and
STI/RTI coinfection. Clinical symptoms were not associated with
malaria and STI/RTI coinfection. CONCLUSION: The prevalence of
malaria and curable STI/RTI coinfection was high among pregnant
women. The poor performance of the clinical symptoms to predict
coinfection suggests that alternative interventions are needed. |
| Serge Henri Zango, Moussa Lingani, Innocent Valea, Ouindpanga Sekou Samadoulougou, Biebo Bihoun, Diagniagou Lankoande, Phillipe Donnen, Michele Dramaix, Halidou Tinto, Annie Robert Association of malaria and curable sexually transmitted infections with pregnancy outcomes in rural Burkina Faso (Journal Article) In: BMC Pregnancy Childbirth, vol. 21, no. 1, pp. 722, 2021, ISSN: 1471-2393, (© 2021. The Author(s).
PMID: 34706705
PMCID: PMC8549350). @article{Zango2021-ti,
title = {Association of malaria and curable sexually transmitted infections with pregnancy outcomes in rural Burkina Faso},
author = {Serge Henri Zango and Moussa Lingani and Innocent Valea and Ouindpanga Sekou Samadoulougou and Biebo Bihoun and Diagniagou Lankoande and Phillipe Donnen and Michele Dramaix and Halidou Tinto and Annie Robert},
doi = {10.1186/s12884-021-04205-6},
issn = {1471-2393},
year = {2021},
date = {2021-10-27},
urldate = {2021-10-27},
journal = {BMC Pregnancy Childbirth},
volume = {21},
number = {1},
pages = {722},
publisher = {Springer Science and Business Media LLC},
abstract = {BACKGROUND: Malaria and curable sexually transmitted infections
(STIs) are severe infections associated with poor pregnancy
outcomes in sub-Saharan countries. These infections are
responsible for low birth weight, preterm birth, and
miscarriage. In Burkina Faso, many interventions recommended by
the World Health Organization were implemented to control the
impact of these infections. After decades of intervention, we
assessed the impact of these infections on pregnancy outcomes in
rural setting of Burkina Faso. METHODS: Antenatal care and
delivery data of pregnant women attending health facilities in
2016 and 2017 were collected in two rural districts namely
Nanoro and Yako, in Burkina Faso. Regression models with
likelihood ratio test were used to assess the association
between infections and pregnancy outcomes. RESULTS: During the
two years, 31639 pregnant women received antenatal care. Malaria
without STI, STI without malaria, and their coinfections were
reported for 7359 (23.3%), 881 (2.8 %), and 388 (1.2%) women,
respectively. Low birth weight, miscarriage, and stillbirth were
observed in 2754 (10.5 %), 547 (2.0 %), and 373 (1.3 %)
women, respectively. Our data did not show an association
between low birth weight and malaria [Adjusted OR: 0.91 (0.78 -
1.07)], STIs [Adjusted OR: 0.74 (0.51 - 1.07)] and coinfection
[Adjusted OR: 1.15 (0.75 - 1.78)]. Low birth weight was strongly
associated with primigravidae [Adjusted OR: 3.53 (3.12 - 4.00)].
Both miscarriage and stillbirth were associated with malaria
[Adjusted OR: 1.31 (1.07 - 1.59)], curable STI [Adjusted OR:
1.65 (1.06 - 2.59)], and coinfection [Adjusted OR: 2.00 (1.13 -
3.52)]. CONCLUSION: Poor pregnancy outcomes remained frequent in
rural Burkina Faso. Malaria, curable STIs, and their
coinfections were associated with both miscarriage and
stillbirth in rural Burkina. More effort should be done to
reduce the proportion of pregnancies lost associated with these
curable infections by targeting interventions in primigravidae
women.},
note = {© 2021. The Author(s).
PMID: 34706705
PMCID: PMC8549350},
keywords = {Coinfection, Impact, Malaria, Outcome, Pregnancy, STI},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Malaria and curable sexually transmitted infections
(STIs) are severe infections associated with poor pregnancy
outcomes in sub-Saharan countries. These infections are
responsible for low birth weight, preterm birth, and
miscarriage. In Burkina Faso, many interventions recommended by
the World Health Organization were implemented to control the
impact of these infections. After decades of intervention, we
assessed the impact of these infections on pregnancy outcomes in
rural setting of Burkina Faso. METHODS: Antenatal care and
delivery data of pregnant women attending health facilities in
2016 and 2017 were collected in two rural districts namely
Nanoro and Yako, in Burkina Faso. Regression models with
likelihood ratio test were used to assess the association
between infections and pregnancy outcomes. RESULTS: During the
two years, 31639 pregnant women received antenatal care. Malaria
without STI, STI without malaria, and their coinfections were
reported for 7359 (23.3%), 881 (2.8 %), and 388 (1.2%) women,
respectively. Low birth weight, miscarriage, and stillbirth were
observed in 2754 (10.5 %), 547 (2.0 %), and 373 (1.3 %)
women, respectively. Our data did not show an association
between low birth weight and malaria [Adjusted OR: 0.91 (0.78 –
1.07)], STIs [Adjusted OR: 0.74 (0.51 – 1.07)] and coinfection
[Adjusted OR: 1.15 (0.75 – 1.78)]. Low birth weight was strongly
associated with primigravidae [Adjusted OR: 3.53 (3.12 – 4.00)].
Both miscarriage and stillbirth were associated with malaria
[Adjusted OR: 1.31 (1.07 – 1.59)], curable STI [Adjusted OR:
1.65 (1.06 – 2.59)], and coinfection [Adjusted OR: 2.00 (1.13 –
3.52)]. CONCLUSION: Poor pregnancy outcomes remained frequent in
rural Burkina Faso. Malaria, curable STIs, and their
coinfections were associated with both miscarriage and
stillbirth in rural Burkina. More effort should be done to
reduce the proportion of pregnancies lost associated with these
curable infections by targeting interventions in primigravidae
women. |
| Tim Starck, Caroline A Bulstra, Halidou Tinto, Toussaint Rouamba, Ali Sie, Thomas Jaenisch, Till Bärnighausen The effect of malaria on haemoglobin concentrations: a nationally representative household fixed-effects study of 17,599 children under 5 years of age in Burkina Faso (Journal Article) In: Malar. J., vol. 20, no. 1, pp. 416, 2021, ISSN: 1475-2875, (© 2021. The Author(s).
PMID: 34688294
PMCID: PMC8542337). @article{Starck2021-mb,
title = {The effect of malaria on haemoglobin concentrations: a nationally representative household fixed-effects study of 17,599 children under 5 years of age in Burkina Faso},
author = {Tim Starck and Caroline A Bulstra and Halidou Tinto and Toussaint Rouamba and Ali Sie and Thomas Jaenisch and Till B\"{a}rnighausen},
doi = {10.1186/s12936-021-03948-z},
issn = {1475-2875},
year = {2021},
date = {2021-10-23},
urldate = {2021-10-23},
journal = {Malar. J.},
volume = {20},
number = {1},
pages = {416},
publisher = {Springer Science and Business Media LLC},
abstract = {BACKGROUND: Although the association between malaria and anaemia
is widely studied in patient cohorts, the
population-representative causal effects of malaria on anaemia
remain unknown. This study estimated the malaria-induced
decrease in haemoglobin levels among young children in
malaria-endemic Burkina Faso. METHODS: The study was based on
pooled individual-level nationally representative health survey
data (2010-2011, 2014, 2017-2018) from 17 599 children under 5
years of age. This data was used to estimate the effects of
malaria on haemoglobin concentration, controlling for household
fixed-effects, age, and sex in a series of regression analyses.
The fixed-effects controlled for observed and unobserved
confounding on the household level and allowed to determine the
impact of malaria infection status on haemoglobin levels and
anaemia prevalence. Furthermore, the diagnostic results from
microscopy and rapid diagnostic tests were leveraged to provide
a quasi-longitudinal perspective of acute and prolonged effects
after malaria infection. RESULTS: The prevalence of both malaria
(survey prevalence ranging from 17.4% to 65.2%) and anaemia
(survey prevalence ranging from 74% to 88.2%) was very high in
the included surveys. Malaria was estimated to significantly
reduce haemoglobin levels, with an overall effect of - 7.5 g/dL
(95% CI - 8.5, - 6.5). Acute malaria resulted in a - 7.7 g/dL
(95% CI - 8.8, - 6.6) decrease in haemoglobin levels. Recent
malaria without current parasitaemia decreased haemoglobin
concentration by - 7.1 g/dL (95% CI - 8.3, - 5.9). The
in-sample predicted prevalence of severe anaemia was 9.4% among
malaria positives, but only 2.2% among children without
malaria. CONCLUSION: Malaria infection has a strong detrimental
effect on haemoglobin levels among young children in Burkina
Faso. This effect seems to carry over even after acute
infection, indicating prolonged haemoglobin reductions even
after successful parasite-elimination. The quasi-experimental
fixed-effect approach adds a population level perspective to
existing clinical evidence.},
note = {© 2021. The Author(s).
PMID: 34688294
PMCID: PMC8542337},
keywords = {Anaemia, Burkina Faso, Haemoglobin, Household fixed-effects, Malaria, Microscopy, Rapid diagnostic tests},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Although the association between malaria and anaemia
is widely studied in patient cohorts, the
population-representative causal effects of malaria on anaemia
remain unknown. This study estimated the malaria-induced
decrease in haemoglobin levels among young children in
malaria-endemic Burkina Faso. METHODS: The study was based on
pooled individual-level nationally representative health survey
data (2010-2011, 2014, 2017-2018) from 17 599 children under 5
years of age. This data was used to estimate the effects of
malaria on haemoglobin concentration, controlling for household
fixed-effects, age, and sex in a series of regression analyses.
The fixed-effects controlled for observed and unobserved
confounding on the household level and allowed to determine the
impact of malaria infection status on haemoglobin levels and
anaemia prevalence. Furthermore, the diagnostic results from
microscopy and rapid diagnostic tests were leveraged to provide
a quasi-longitudinal perspective of acute and prolonged effects
after malaria infection. RESULTS: The prevalence of both malaria
(survey prevalence ranging from 17.4% to 65.2%) and anaemia
(survey prevalence ranging from 74% to 88.2%) was very high in
the included surveys. Malaria was estimated to significantly
reduce haemoglobin levels, with an overall effect of – 7.5 g/dL
(95% CI – 8.5, – 6.5). Acute malaria resulted in a – 7.7 g/dL
(95% CI – 8.8, – 6.6) decrease in haemoglobin levels. Recent
malaria without current parasitaemia decreased haemoglobin
concentration by – 7.1 g/dL (95% CI – 8.3, – 5.9). The
in-sample predicted prevalence of severe anaemia was 9.4% among
malaria positives, but only 2.2% among children without
malaria. CONCLUSION: Malaria infection has a strong detrimental
effect on haemoglobin levels among young children in Burkina
Faso. This effect seems to carry over even after acute
infection, indicating prolonged haemoglobin reductions even
after successful parasite-elimination. The quasi-experimental
fixed-effect approach adds a population level perspective to
existing clinical evidence. |
| Daniel Chandramohan, Issaka Zongo, Issaka Sagara, Matthew Cairns, Rakiswendé-Serge Yerbanga, Modibo Diarra, Frédéric Niki`ema, Amadou Tapily, Frédéric Sompougdou, Djibrilla Issiaka, Charles Zoungrana, Koualy Sanogo, Alassane Haro, Mahamadou Kaya, Abdoul-Aziz Sienou, Seydou Traore, Almahamoudou Mahamar, Ismaila Thera, Kalifa Diarra, Amagana Dolo, Irene Kuepfer, Paul Snell, Paul Milligan, Christian Ockenhouse, Opokua Ofori-Anyinam, Halidou Tinto, Abdoulaye Djimde, Jean-Bosco Ouédraogo, Alassane Dicko, Brian Greenwood Seasonal malaria vaccination with or without seasonal malaria chemoprevention (Journal Article) In: N. Engl. J. Med., vol. 385, no. 11, pp. 1005–1017, 2021, ISSN: 1533-4406 0028-4793, (Copyright © 2021 Massachusetts Medical Society.
Place: United States
PMID: 34432975). @article{Chandramohan2021-qm,
title = {Seasonal malaria vaccination with or without seasonal malaria chemoprevention},
author = {Daniel Chandramohan and Issaka Zongo and Issaka Sagara and Matthew Cairns and Rakiswend\'{e}-Serge Yerbanga and Modibo Diarra and Fr\'{e}d\'{e}ric Niki`ema and Amadou Tapily and Fr\'{e}d\'{e}ric Sompougdou and Djibrilla Issiaka and Charles Zoungrana and Koualy Sanogo and Alassane Haro and Mahamadou Kaya and Abdoul-Aziz Sienou and Seydou Traore and Almahamoudou Mahamar and Ismaila Thera and Kalifa Diarra and Amagana Dolo and Irene Kuepfer and Paul Snell and Paul Milligan and Christian Ockenhouse and Opokua Ofori-Anyinam and Halidou Tinto and Abdoulaye Djimde and Jean-Bosco Ou\'{e}draogo and Alassane Dicko and Brian Greenwood},
doi = {10.1056/NEJMoa2026330},
issn = {1533-4406 0028-4793},
year = {2021},
date = {2021-09-09},
urldate = {2021-09-09},
journal = {N. Engl. J. Med.},
volume = {385},
number = {11},
pages = {1005--1017},
publisher = {Massachusetts Medical Society},
abstract = {BACKGROUND: Malaria control remains a challenge in many parts of
the Sahel and sub-Sahel regions of Africa. METHODS: We conducted
an individually randomized, controlled trial to assess whether
seasonal vaccination with RTS,S/AS01E was noninferior to
chemoprevention in preventing uncomplicated malaria and whether
the two interventions combined were superior to either one alone
in preventing uncomplicated malaria and severe malaria-related
outcomes. RESULTS: We randomly assigned 6861 children 5 to 17
months of age to receive sulfadoxine-pyrimethamine and
amodiaquine (2287 children [chemoprevention-alone group]),
RTS,S/AS01E (2288 children [vaccine-alone group]), or
chemoprevention and RTS,S/AS01E (2286 children [combination
group]). Of these, 1965, 1988, and 1967 children in the three
groups, respectively, received the first dose of the assigned
intervention and were followed for 3 years. Febrile seizure
developed in 5 children the day after receipt of the vaccine,
but the children recovered and had no sequelae. There were 305
events of uncomplicated clinical malaria per 1000 person-years
at risk in the chemoprevention-alone group, 278 events per 1000
person-years in the vaccine-alone group, and 113 events per 1000
person-years in the combination group. The hazard ratio for the
protective efficacy of RTS,S/AS01E as compared with
chemoprevention was 0.92 (95% confidence interval [CI], 0.84 to
1.01), which excluded the prespecified noninferiority margin of
1.20. The protective efficacy of the combination as compared
with chemoprevention alone was 62.8% (95% CI, 58.4 to 66.8)
against clinical malaria, 70.5% (95% CI, 41.9 to 85.0) against
hospital admission with severe malaria according to the World
Health Organization definition, and 72.9% (95% CI, 2.9 to
92.4) against death from malaria. The protective efficacy of the
combination as compared with the vaccine alone against these
outcomes was 59.6% (95% CI, 54.7 to 64.0), 70.6% (95% CI,
42.3 to 85.0), and 75.3% (95% CI, 12.5 to 93.0), respectively.
CONCLUSIONS: Administration of RTS,S/AS01E was noninferior to
chemoprevention in preventing uncomplicated malaria. The
combination of these interventions resulted in a substantially
lower incidence of uncomplicated malaria, severe malaria, and
death from malaria than either intervention alone. (Funded by
the Joint Global Health Trials and PATH; ClinicalTrials.gov
number, NCT03143218.).},
note = {Copyright © 2021 Massachusetts Medical Society.
Place: United States
PMID: 34432975},
keywords = {Amodiaquine/therapeutic use, Antimalarials/adverse effects/therapeutic use, Burkina Faso/epidemiology, Chemoprevention, Combination, Combined Modality Therapy, Double-Blind Method, Drug Combinations, Drug Therapy, Falciparum/epidemiology/mortality/prevention \& control, Febrile/etiology, Female, Hospitalization/statistics \& numerical data, Humans, Infant, Malaria, Malaria Vaccines/administration \& dosage/adverse effects, Male, Mali/epidemiology, Pyrimethamine/therapeutic use, Seasons, Seizures, Sulfadoxine/therapeutic use},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Malaria control remains a challenge in many parts of
the Sahel and sub-Sahel regions of Africa. METHODS: We conducted
an individually randomized, controlled trial to assess whether
seasonal vaccination with RTS,S/AS01E was noninferior to
chemoprevention in preventing uncomplicated malaria and whether
the two interventions combined were superior to either one alone
in preventing uncomplicated malaria and severe malaria-related
outcomes. RESULTS: We randomly assigned 6861 children 5 to 17
months of age to receive sulfadoxine-pyrimethamine and
amodiaquine (2287 children [chemoprevention-alone group]),
RTS,S/AS01E (2288 children [vaccine-alone group]), or
chemoprevention and RTS,S/AS01E (2286 children [combination
group]). Of these, 1965, 1988, and 1967 children in the three
groups, respectively, received the first dose of the assigned
intervention and were followed for 3 years. Febrile seizure
developed in 5 children the day after receipt of the vaccine,
but the children recovered and had no sequelae. There were 305
events of uncomplicated clinical malaria per 1000 person-years
at risk in the chemoprevention-alone group, 278 events per 1000
person-years in the vaccine-alone group, and 113 events per 1000
person-years in the combination group. The hazard ratio for the
protective efficacy of RTS,S/AS01E as compared with
chemoprevention was 0.92 (95% confidence interval [CI], 0.84 to
1.01), which excluded the prespecified noninferiority margin of
1.20. The protective efficacy of the combination as compared
with chemoprevention alone was 62.8% (95% CI, 58.4 to 66.8)
against clinical malaria, 70.5% (95% CI, 41.9 to 85.0) against
hospital admission with severe malaria according to the World
Health Organization definition, and 72.9% (95% CI, 2.9 to
92.4) against death from malaria. The protective efficacy of the
combination as compared with the vaccine alone against these
outcomes was 59.6% (95% CI, 54.7 to 64.0), 70.6% (95% CI,
42.3 to 85.0), and 75.3% (95% CI, 12.5 to 93.0), respectively.
CONCLUSIONS: Administration of RTS,S/AS01E was noninferior to
chemoprevention in preventing uncomplicated malaria. The
combination of these interventions resulted in a substantially
lower incidence of uncomplicated malaria, severe malaria, and
death from malaria than either intervention alone. (Funded by
the Joint Global Health Trials and PATH; ClinicalTrials.gov
number, NCT03143218.). |
| Stephen A Roberts, Loretta Brabin, Halidou Tinto, Sabine Gies, Salou Diallo, Bernard Brabin Seasonal patterns of malaria, genital infection, nutritional and iron status in non-pregnant and pregnant adolescents in Burkina Faso: a secondary analysis of trial data (Journal Article) In: BMC Public Health, vol. 21, no. 1, pp. 1764, 2021, ISSN: 1471-2458, (© 2021. The Author(s).
PMID: 34579679
PMCID: PMC8477466). @article{Roberts2021-gg,
title = {Seasonal patterns of malaria, genital infection, nutritional and iron status in non-pregnant and pregnant adolescents in Burkina Faso: a secondary analysis of trial data},
author = {Stephen A Roberts and Loretta Brabin and Halidou Tinto and Sabine Gies and Salou Diallo and Bernard Brabin},
doi = {10.1186/s12889-021-11819-0},
issn = {1471-2458},
year = {2021},
date = {2021-09-01},
urldate = {2021-09-01},
journal = {BMC Public Health},
volume = {21},
number = {1},
pages = {1764},
publisher = {Springer Science and Business Media LLC},
abstract = {BACKGROUND: Adolescents are considered at high risk of developing iron deficiency. Studies in children indicate that the prevalence of iron deficiency increased with malaria transmission, suggesting malaria seasonally may drive iron deficiency. This paper examines monthly seasonal infection patterns of malaria, abnormal vaginal flora, chorioamnionitis, antibiotic and antimalarial prescriptions, in relation to changes in iron biomarkers and nutritional indices in adolescents living in a rural area of Burkina Faso, in order to assess the requirement for seasonal infection control and nutrition interventions. METHODS: Data collected between April 2011 and January 2014 were available for an observational seasonal analysis, comprising scheduled visits for 1949 non-pregnant adolescents (≤19 years), (315 of whom subsequently became pregnant), enrolled in a randomised trial of periconceptional iron supplementation. Data from trial arms were combined. Body Iron Stores (BIS) were calculated using an internal regression for ferritin to allow for inflammation. At recruitment 11% had low BIS (\< 0 mg/kg). Continuous outcomes were fitted to a mixed-effects linear model with month, age and pregnancy status as fixed effect covariates and woman as a random effect. Dichotomous infection outcomes were fitted with analogous logistic regression models. RESULTS: Seasonal variation in malaria parasitaemia prevalence ranged between 18 and 70% in non-pregnant adolescents (P \< 0.001), peaking at 81% in those who became pregnant. Seasonal variation occurred in antibiotic prescription rates (0.7-1.8 prescriptions/100 weekly visits, P \< 0.001) and chorioamnionitis prevalence (range 15-68%, P = 0.026). Mucosal vaginal lactoferrin concentration was lower at the end of the wet season (range 2-22 μg/ml, P \< 0.016), when chorioamnionitis was least frequent. BIS fluctuated annually by up to 53.2% per year around the mean BIS (5.1 mg/kg(2), range 4.1-6.8 mg/kg), with low BIS (\< 0 mg/kg) of 8.7% in the dry and 9.8% in the wet seasons (P = 0.36). Median serum transferrin receptor increased during the wet season (P \< 0.001). Higher hepcidin concentration in the wet season corresponded with rising malaria prevalence and use of prescriptions, but with no change in BIS. Mean Body Mass Index and Mid-Upper-Arm-Circumference values peaked mid-dry season (both P \< 0.001). CONCLUSIONS: Our analysis supports preventive treatment of malaria among adolescents 15-19 years to decrease their disease burden, especially asymptomatic malaria. As BIS were adequate in most adolescents despite seasonal malaria, a requirement for programmatic iron supplementation was not substantiated.},
note = {© 2021. The Author(s).
PMID: 34579679
PMCID: PMC8477466},
keywords = {Abnormal vaginal flora, Adolescents, Bacterial vaginosis, Body Mass Index, Burkina Faso/epidemiology, Child, Female, Humans, Iron, iron biomarkers, Malaria, Malaria/drug therapy/epidemiology, MUAC, Pregnancy, Seasons, Vagina},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Adolescents are considered at high risk of developing iron deficiency. Studies in children indicate that the prevalence of iron deficiency increased with malaria transmission, suggesting malaria seasonally may drive iron deficiency. This paper examines monthly seasonal infection patterns of malaria, abnormal vaginal flora, chorioamnionitis, antibiotic and antimalarial prescriptions, in relation to changes in iron biomarkers and nutritional indices in adolescents living in a rural area of Burkina Faso, in order to assess the requirement for seasonal infection control and nutrition interventions. METHODS: Data collected between April 2011 and January 2014 were available for an observational seasonal analysis, comprising scheduled visits for 1949 non-pregnant adolescents (≤19 years), (315 of whom subsequently became pregnant), enrolled in a randomised trial of periconceptional iron supplementation. Data from trial arms were combined. Body Iron Stores (BIS) were calculated using an internal regression for ferritin to allow for inflammation. At recruitment 11% had low BIS (< 0 mg/kg). Continuous outcomes were fitted to a mixed-effects linear model with month, age and pregnancy status as fixed effect covariates and woman as a random effect. Dichotomous infection outcomes were fitted with analogous logistic regression models. RESULTS: Seasonal variation in malaria parasitaemia prevalence ranged between 18 and 70% in non-pregnant adolescents (P < 0.001), peaking at 81% in those who became pregnant. Seasonal variation occurred in antibiotic prescription rates (0.7-1.8 prescriptions/100 weekly visits, P < 0.001) and chorioamnionitis prevalence (range 15-68%, P = 0.026). Mucosal vaginal lactoferrin concentration was lower at the end of the wet season (range 2-22 μg/ml, P < 0.016), when chorioamnionitis was least frequent. BIS fluctuated annually by up to 53.2% per year around the mean BIS (5.1 mg/kg(2), range 4.1-6.8 mg/kg), with low BIS (< 0 mg/kg) of 8.7% in the dry and 9.8% in the wet seasons (P = 0.36). Median serum transferrin receptor increased during the wet season (P < 0.001). Higher hepcidin concentration in the wet season corresponded with rising malaria prevalence and use of prescriptions, but with no change in BIS. Mean Body Mass Index and Mid-Upper-Arm-Circumference values peaked mid-dry season (both P < 0.001). CONCLUSIONS: Our analysis supports preventive treatment of malaria among adolescents 15-19 years to decrease their disease burden, especially asymptomatic malaria. As BIS were adequate in most adolescents despite seasonal malaria, a requirement for programmatic iron supplementation was not substantiated. |
| Koudraogo Bienvenue Yaméogo, Rakiswendé Serge Yerbanga, Seydou Bienvenu Ouattara, Franck A Yao, Thierry Lef`evre, Issaka Zongo, Frederic Niki`ema, Yves Daniel Compaoré, Halidou Tinto, Daniel Chandramohan, Brian Greenwood, Adrien M G Belem, Anna Cohuet, Jean Bosco Ouédraogo Effect of seasonal malaria chemoprevention plus azithromycin on Plasmodium falciparum transmission: gametocyte infectivity and mosquito fitness (Journal Article) In: Malar. J., vol. 20, no. 1, pp. 326, 2021, ISSN: 1475-2875, (© 2021. The Author(s).
PMID: 34315475
PMCID: PMC8314489). @article{Yameogo2021-bb,
title = {Effect of seasonal malaria chemoprevention plus azithromycin on Plasmodium falciparum transmission: gametocyte infectivity and mosquito fitness},
author = {Koudraogo Bienvenue Yam\'{e}ogo and Rakiswend\'{e} Serge Yerbanga and Seydou Bienvenu Ouattara and Franck A Yao and Thierry Lef`evre and Issaka Zongo and Frederic Niki`ema and Yves Daniel Compaor\'{e} and Halidou Tinto and Daniel Chandramohan and Brian Greenwood and Adrien M G Belem and Anna Cohuet and Jean Bosco Ou\'{e}draogo},
doi = {10.1186/s12936-021-03855-3},
issn = {1475-2875},
year = {2021},
date = {2021-07-27},
urldate = {2021-07-27},
journal = {Malar. J.},
volume = {20},
number = {1},
pages = {326},
publisher = {Springer Science and Business Media LLC},
abstract = {BACKGROUND: Seasonal malaria chemoprevention (SMC) consists of administration of sulfadoxine-pyrimethamine (SP) + amodiaquine (AQ) at monthly intervals to children during the malaria transmission period. Whether the addition of azithromycin (AZ) to SMC could potentiate the benefit of the intervention was tested through a double-blind, randomized, placebo-controlled trial. The effect of SMC and the addition of AZ, on malaria transmission and on the life history traits of Anopheles gambiae mosquitoes have been investigated. METHODS: The study included 438 children randomly selected from among participants in the SMC + AZ trial and 198 children from the same area who did not receive chemoprevention. For each participant in the SMC + AZ trial, blood was collected 14 to 21 days post treatment, examined for the presence of malaria sexual and asexual stages and provided as a blood meal to An. gambiae females using a direct membrane-feeding assay. RESULTS: The SMC treatment, with or without AZ, significantly reduced the prevalence of asexual Plasmodium falciparum (LRT X(2)(2) = 69, P \< 0.0001) and the gametocyte prevalence (LRT X(2)(2) = 54, P \< 0.0001). In addition, the proportion of infectious feeds (LRT X(2)(2) = 61, P \< 0.0001) and the prevalence of oocysts among exposed mosquitoes (LRT X(2)(2) = 22.8, P \< 0.001) was reduced when mosquitoes were fed on blood from treated children compared to untreated controls. The addition of AZ to SPAQ was associated with an increased proportion of infectious feeds (LRT X(2)(1) = 5.2, P = 0.02), suggesting a significant effect of AZ on gametocyte infectivity. There was a slight negative effect of SPAQ and SPAQ + AZ on mosquito survival compared to mosquitoes fed with blood from control children (LRTX(2)(2) = 330, P \< 0.0001). CONCLUSION: This study demonstrates that SMC may contribute to a reduction in human to mosquito transmission of P. falciparum, and the reduced mosquito longevity observed for females fed on treated blood may increase the benefit of this intervention in control of malaria. The addition of AZ to SPAQ in SMC appeared to enhance the infectivity of gametocytes providing further evidence that this combination is not an appropriate intervention.},
note = {© 2021. The Author(s).
PMID: 34315475
PMCID: PMC8314489},
keywords = {Amodiaquine/administration \& dosage, Animals, Antimalarials/administration \& dosage, Chemoprevention, Child, Culicidae/physiology, Drug Combinations, Falciparum/prevention \& control/transmission, Gametocytes, Genetic Fitness, Humans, Malaria, Plasmodium falciparum/physiology, Preschool, Pyrimethamine/administration \& dosage, seasonal malaria chemoprevention, Seasons, Sulfadoxine/administration \& dosage, Transmission},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Seasonal malaria chemoprevention (SMC) consists of administration of sulfadoxine-pyrimethamine (SP) + amodiaquine (AQ) at monthly intervals to children during the malaria transmission period. Whether the addition of azithromycin (AZ) to SMC could potentiate the benefit of the intervention was tested through a double-blind, randomized, placebo-controlled trial. The effect of SMC and the addition of AZ, on malaria transmission and on the life history traits of Anopheles gambiae mosquitoes have been investigated. METHODS: The study included 438 children randomly selected from among participants in the SMC + AZ trial and 198 children from the same area who did not receive chemoprevention. For each participant in the SMC + AZ trial, blood was collected 14 to 21 days post treatment, examined for the presence of malaria sexual and asexual stages and provided as a blood meal to An. gambiae females using a direct membrane-feeding assay. RESULTS: The SMC treatment, with or without AZ, significantly reduced the prevalence of asexual Plasmodium falciparum (LRT X(2)(2) = 69, P < 0.0001) and the gametocyte prevalence (LRT X(2)(2) = 54, P < 0.0001). In addition, the proportion of infectious feeds (LRT X(2)(2) = 61, P < 0.0001) and the prevalence of oocysts among exposed mosquitoes (LRT X(2)(2) = 22.8, P < 0.001) was reduced when mosquitoes were fed on blood from treated children compared to untreated controls. The addition of AZ to SPAQ was associated with an increased proportion of infectious feeds (LRT X(2)(1) = 5.2, P = 0.02), suggesting a significant effect of AZ on gametocyte infectivity. There was a slight negative effect of SPAQ and SPAQ + AZ on mosquito survival compared to mosquitoes fed with blood from control children (LRTX(2)(2) = 330, P < 0.0001). CONCLUSION: This study demonstrates that SMC may contribute to a reduction in human to mosquito transmission of P. falciparum, and the reduced mosquito longevity observed for females fed on treated blood may increase the benefit of this intervention in control of malaria. The addition of AZ to SPAQ in SMC appeared to enhance the infectivity of gametocytes providing further evidence that this combination is not an appropriate intervention. |
| Navideh Noori, Karim Derra, Innocent Valea, Assaf P Oron, Aminata Welgo, Toussaint Rouamba, Palwende Romuald Boua, Athanase M Somé, Eli Rouamba, Edward Wenger, Hermann Sorgho, Halidou Tinto, Andre Lin Ouédraogo Patterns of child mortality in rural area of Burkina Faso: evidence from the Nanoro health and demographic surveillance system (HDSS) (Journal Article) In: BMC Public Health, vol. 21, no. 1, pp. 1425, 2021, ISSN: 1471-2458, (© 2021. The Author(s).
PMID: 34281547
PMCID: PMC8287796). @article{Noori2021-te,
title = {Patterns of child mortality in rural area of Burkina Faso: evidence from the Nanoro health and demographic surveillance system (HDSS)},
author = {Navideh Noori and Karim Derra and Innocent Valea and Assaf P Oron and Aminata Welgo and Toussaint Rouamba and Palwende Romuald Boua and Athanase M Som\'{e} and Eli Rouamba and Edward Wenger and Hermann Sorgho and Halidou Tinto and Andre Lin Ou\'{e}draogo},
doi = {10.1186/s12889-021-11483-4},
issn = {1471-2458},
year = {2021},
date = {2021-07-19},
urldate = {2021-07-19},
journal = {BMC Public Health},
volume = {21},
number = {1},
pages = {1425},
publisher = {Springer Science and Business Media LLC},
abstract = {BACKGROUND: Half of global child deaths occur in sub-Saharan
Africa. Understanding child mortality patterns and risk factors
will help inform interventions to reduce this heavy toll. The
Nanoro Health and Demographic Surveillance System (HDSS),
Burkina Faso was described previously, but patterns and
potential drivers of heterogeneity in child mortality in the
district had not been studied. Similar studies in other
districts indicated proximity to health facilities as a risk
factor, usually without distinction between facility types.
METHODS: Using Nanoro HDSS data from 2009 to 2013, we estimated
the association between under-5 mortality and proximity to
inpatient and outpatient health facilities, seasonality of
death, age group, and standard demographic risk factors.
RESULTS: Living in homes 40-60 min and \> 60 min travel time from
an inpatient facility was associated with 1.52 (95% CI:
1.13-2.06) and 1.74 (95% CI: 1.27-2.40) greater hazard of
under-5 mortality, respectively, than living in homes \< 20 min
from an inpatient facility. No such association was found for
outpatient facilities. The wet season (July-November) was
associated with 1.28 (95% CI: 1.07, 1.53) higher under-5
mortality than the dry season (December-June), likely reflecting
the malaria season. CONCLUSIONS: Our results emphasize the
importance of geographical proximity to health care, distinguish
between inpatient and outpatient facilities, and also show a
seasonal effect, probably driven by malaria.},
note = {© 2021. The Author(s).
PMID: 34281547
PMCID: PMC8287796},
keywords = {Burkina Faso, Burkina Faso/epidemiology, child mortality, ChildHealth Facilities, Children under 5, Demographic surveillance, HDSS, Humans, Infant, Malaria, Nanoro, Spatial analysis, Travel},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Half of global child deaths occur in sub-Saharan
Africa. Understanding child mortality patterns and risk factors
will help inform interventions to reduce this heavy toll. The
Nanoro Health and Demographic Surveillance System (HDSS),
Burkina Faso was described previously, but patterns and
potential drivers of heterogeneity in child mortality in the
district had not been studied. Similar studies in other
districts indicated proximity to health facilities as a risk
factor, usually without distinction between facility types.
METHODS: Using Nanoro HDSS data from 2009 to 2013, we estimated
the association between under-5 mortality and proximity to
inpatient and outpatient health facilities, seasonality of
death, age group, and standard demographic risk factors.
RESULTS: Living in homes 40-60 min and > 60 min travel time from
an inpatient facility was associated with 1.52 (95% CI:
1.13-2.06) and 1.74 (95% CI: 1.27-2.40) greater hazard of
under-5 mortality, respectively, than living in homes < 20 min
from an inpatient facility. No such association was found for
outpatient facilities. The wet season (July-November) was
associated with 1.28 (95% CI: 1.07, 1.53) higher under-5
mortality than the dry season (December-June), likely reflecting
the malaria season. CONCLUSIONS: Our results emphasize the
importance of geographical proximity to health care, distinguish
between inpatient and outpatient facilities, and also show a
seasonal effect, probably driven by malaria. |
| Mariken Wit, Matthew Cairns, Yves Daniel Compaoré, Issaka Sagara, Irene Kuepfer, Issaka Zongo, Amadou Barry, Modibo Diarra, Amadou Tapily, Samba Coumare, Ismaila Thera, Frederic Nikiema, R Serge Yerbanga, Rosemonde M Guissou, Halidou Tinto, Alassane Dicko, Daniel Chandramohan, Brian Greenwood, Jean Bosco Ouedraogo Nutritional status in young children prior to the malaria transmission season in Burkina Faso and Mali, and its impact on the incidence of clinical malaria (Journal Article) In: Malar. J., vol. 20, no. 1, pp. 274, 2021, ISSN: 1475-2875, (PMID: 34158054
PMCID: PMC8220741). @article{De_Wit2021-yi,
title = {Nutritional status in young children prior to the malaria transmission season in Burkina Faso and Mali, and its impact on the incidence of clinical malaria},
author = {Mariken Wit and Matthew Cairns and Yves Daniel Compaor\'{e} and Issaka Sagara and Irene Kuepfer and Issaka Zongo and Amadou Barry and Modibo Diarra and Amadou Tapily and Samba Coumare and Ismaila Thera and Frederic Nikiema and R Serge Yerbanga and Rosemonde M Guissou and Halidou Tinto and Alassane Dicko and Daniel Chandramohan and Brian Greenwood and Jean Bosco Ouedraogo},
doi = {10.1186/s12936-021-03802-2},
issn = {1475-2875},
year = {2021},
date = {2021-06-22},
urldate = {2021-06-22},
journal = {Malar. J.},
volume = {20},
number = {1},
pages = {274},
publisher = {Springer Science and Business Media LLC},
abstract = {BACKGROUND: Malaria and malnutrition remain major problems in
Sahel countries, especially in young children. The direct effect
of malnutrition on malaria remains poorly understood, and may
have important implications for malaria control. In this study,
nutritional status and the association between malnutrition and
subsequent incidence of symptomatic malaria were examined in
children in Burkina Faso and Mali who received either
azithromycin or placebo, alongside seasonal malaria
chemoprevention. METHODS: Mid-upper arm circumference (MUAC) was
measured in all 20,185 children who attended a screening visit
prior to the malaria transmission season in 2015. Prior to the
2016 malaria season, weight, height and MUAC were measured among
4149 randomly selected children. Height-for-age, weight-for-age,
weight-for-height, and MUAC-for-age were calculated as
indicators of nutritional status. Malaria incidence was measured
during the following rainy seasons. Multivariable random effects
Poisson models were created for each nutritional indicator to
study the effect of malnutrition on clinical malaria incidence
for each country. RESULTS: In both 2015 and 2016, nutritional
status prior to the malaria season was poor. The most prevalent
form of malnutrition in Burkina Faso was being underweight
(30.5%; 95% CI 28.6-32.6), whereas in Mali stunting was most
prevalent (27.5%; 95% CI 25.6-29.5). In 2016, clinical malaria
incidence was 675 per 1000 person-years (95% CI 613-744) in
Burkina Faso, and 1245 per 1000 person-years (95% CI 1152-1347)
in Mali. There was some evidence that severe stunting was
associated with lower incidence of malaria in Mali (RR 0.81; 95% CI 0.64-1.02; p = 0.08), but this association was not seen
in Burkina Faso. Being moderately underweight tended to be
associated with higher incidence of clinical malaria in Burkina Faso (RR 1.27; 95% CI 0.98-1.64; p = 0.07), while this was the
case in Mali for moderate wasting (RR 1.27; 95% CI 0.98-1.64; p = 0.07). However, these associations were not observed in
severely affected children, nor consistent between countries.
MUAC-for-age was not associated with malaria risk. CONCLUSIONS:
Both malnutrition and malaria were common in the study areas,
high despite high coverage of seasonal malaria chemoprevention
and long-lasting insecticidal nets. However, no strong or
consistent evidence was found for an association between any of
the nutritional indicators and the subsequent incidence of
clinical malaria.},
note = {PMID: 34158054
PMCID: PMC8220741},
keywords = {Acute malnutrition, Antimalarials/administration \& dosage, Azithromycin/administration \& dosage, Burkina Faso, Burkina Faso/epidemiology, Child, Chronic malnutrition, Female, Humans, Incidence, Infant, Malaria, Malaria/epidemiology/transmission, Male, Nutritional Status, Preschool, seasonal malaria chemoprevention, Seasons},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Malaria and malnutrition remain major problems in
Sahel countries, especially in young children. The direct effect
of malnutrition on malaria remains poorly understood, and may
have important implications for malaria control. In this study,
nutritional status and the association between malnutrition and
subsequent incidence of symptomatic malaria were examined in
children in Burkina Faso and Mali who received either
azithromycin or placebo, alongside seasonal malaria
chemoprevention. METHODS: Mid-upper arm circumference (MUAC) was
measured in all 20,185 children who attended a screening visit
prior to the malaria transmission season in 2015. Prior to the
2016 malaria season, weight, height and MUAC were measured among
4149 randomly selected children. Height-for-age, weight-for-age,
weight-for-height, and MUAC-for-age were calculated as
indicators of nutritional status. Malaria incidence was measured
during the following rainy seasons. Multivariable random effects
Poisson models were created for each nutritional indicator to
study the effect of malnutrition on clinical malaria incidence
for each country. RESULTS: In both 2015 and 2016, nutritional
status prior to the malaria season was poor. The most prevalent
form of malnutrition in Burkina Faso was being underweight
(30.5%; 95% CI 28.6-32.6), whereas in Mali stunting was most
prevalent (27.5%; 95% CI 25.6-29.5). In 2016, clinical malaria
incidence was 675 per 1000 person-years (95% CI 613-744) in
Burkina Faso, and 1245 per 1000 person-years (95% CI 1152-1347)
in Mali. There was some evidence that severe stunting was
associated with lower incidence of malaria in Mali (RR 0.81; 95% CI 0.64-1.02; p = 0.08), but this association was not seen
in Burkina Faso. Being moderately underweight tended to be
associated with higher incidence of clinical malaria in Burkina Faso (RR 1.27; 95% CI 0.98-1.64; p = 0.07), while this was the
case in Mali for moderate wasting (RR 1.27; 95% CI 0.98-1.64; p = 0.07). However, these associations were not observed in
severely affected children, nor consistent between countries.
MUAC-for-age was not associated with malaria risk. CONCLUSIONS:
Both malnutrition and malaria were common in the study areas,
high despite high coverage of seasonal malaria chemoprevention
and long-lasting insecticidal nets. However, no strong or
consistent evidence was found for an association between any of
the nutritional indicators and the subsequent incidence of
clinical malaria. |
| Paul Sondo, Biebo Bihoun, Bérenger Kabore, Marc Christian Tahita, Karim Derra, Toussaint Rouamba, Seydou Nakanabo Diallo, Adama Kazienga, Hamidou Ilboudo, Innocent Valea, Zekiba Tarnagda, Hermann Sorgho, Thierry Lefevre, Halidou Tinto Polymorphisms in Plasmodium falciparum parasites and mutations in the resistance genes Pfcrt and Pfmdr1 in Nanoro area, Burkina Faso. (Journal Article) In: Pan Afr. Med. J., vol. 39, pp. 118, 2021, ISSN: 1937-8688, (Copyright: Paul Sondo et al.
PMID: 34512854
PMCID: PMC8396377). @article{Sondo2021-qe,
title = {Polymorphisms in Plasmodium falciparum parasites and mutations in the resistance genes Pfcrt and Pfmdr1 in Nanoro area, Burkina Faso.},
author = {Paul Sondo and Biebo Bihoun and B\'{e}renger Kabore and Marc Christian Tahita and Karim Derra and Toussaint Rouamba and Seydou Nakanabo Diallo and Adama Kazienga and Hamidou Ilboudo and Innocent Valea and Zekiba Tarnagda and Hermann Sorgho and Thierry Lefevre and Halidou Tinto},
doi = {10.11604/pamj.2021.39.118.26959},
issn = {1937-8688},
year = {2021},
date = {2021-06-10},
urldate = {2021-06-10},
journal = {Pan Afr. Med. J.},
volume = {39},
pages = {118},
publisher = {Pan African Medical Journal},
abstract = {Introduction: from a genetic point of view P. falciparumis
extremely polymorphic. There is a variety of parasite strains
infesting individuals living in malaria endemic areas. The
purpose of this study is to investigate the relationship between
polymorphisms in Plasmodium falciparum parasites and Pfcrt and
Pfmdr1 gene mutations in Nanoro area, Burkina Faso. Methods:
blood samples from plasmodium carriers residing in the Nanoro
Health District were genotyped using nested PCR. Parasite gene
mutations associated with resistance to antimalarial drugs were
detected by PCR-RFLP. Results: samples of 672 patients were
successfully genotyped. No msp1and msp2allelic families
exhibited an increase in developing mutations in resistance
genes. However, mutant strains of these genes were present at
greater levels in monoclonal infections than in multi-clonal
infections. Conclusion: this study provides an overview of the
relationship between polymorphisms in Plasmodium falciparum
parasites and mutations in resistance genes. These data will
undoubtedly contribute to improving knowledge of the parasite´s
biology and its mechanisms of resistance to antimalarial drugs.},
note = {Copyright: Paul Sondo et al.
PMID: 34512854
PMCID: PMC8396377},
keywords = {Antimalarials/pharmacology, Burkina Faso, Drug Resistance, Falciparum/drug therapy/parasitology, GeneticRestriction Fragment Length, Genotype, Humans, Malaria, Membrane Transport Proteins/genetics, msp1, msp2, Multidrug Resistance-Associated Proteins/genetics, Mutation, Pfcrt, Pfmdr1, Plasmodium falciparum, Plasmodium falciparum/drug effects/genetics/isolation \& purification, Polymerase Chain Reaction, Polymorphism, Protozoan Proteins/genetics},
pubstate = {published},
tppubtype = {article}
}
Introduction: from a genetic point of view P. falciparumis
extremely polymorphic. There is a variety of parasite strains
infesting individuals living in malaria endemic areas. The
purpose of this study is to investigate the relationship between
polymorphisms in Plasmodium falciparum parasites and Pfcrt and
Pfmdr1 gene mutations in Nanoro area, Burkina Faso. Methods:
blood samples from plasmodium carriers residing in the Nanoro
Health District were genotyped using nested PCR. Parasite gene
mutations associated with resistance to antimalarial drugs were
detected by PCR-RFLP. Results: samples of 672 patients were
successfully genotyped. No msp1and msp2allelic families
exhibited an increase in developing mutations in resistance
genes. However, mutant strains of these genes were present at
greater levels in monoclonal infections than in multi-clonal
infections. Conclusion: this study provides an overview of the
relationship between polymorphisms in Plasmodium falciparum
parasites and mutations in resistance genes. These data will
undoubtedly contribute to improving knowledge of the parasite´s
biology and its mechanisms of resistance to antimalarial drugs. |
| Paul Sondo, Marc Christian Tahita, Toussaint Rouamba, Karim Derra, Bérenger Kaboré, Cheick Sa"id Compaoré, Florence Ouédraogo, Eli Rouamba, Hamidou Ilboudo, Estelle A"issa Bambara, Macaire Nana, Edmond Yabré Sawadogo, Hermann Sorgho, Athanase Mwinessobaonfou Somé, Innocent Valéa, Prabin Dahal, Maminata Traoré/Coulibaly, Halidou Tinto Assessment of a combined strategy of seasonal malaria chemoprevention and supplementation with vitamin A, zinc and Plumpy’Doz™ to prevent malaria and malnutrition in children under 5 years old in Burkina Faso: a randomized open-label trial (SMC-NUT) (Journal Article) In: Trials, vol. 22, no. 1, pp. 360, 2021, ISSN: 1745-6215, (PMID: 34030705
PMCID: PMC8142067). @article{Sondo2021-kc,
title = {Assessment of a combined strategy of seasonal malaria chemoprevention and supplementation with vitamin A, zinc and Plumpy'Doz™ to prevent malaria and malnutrition in children under 5 years old in Burkina Faso: a randomized open-label trial (SMC-NUT)},
author = {Paul Sondo and Marc Christian Tahita and Toussaint Rouamba and Karim Derra and B\'{e}renger Kabor\'{e} and Cheick Sa"id Compaor\'{e} and Florence Ou\'{e}draogo and Eli Rouamba and Hamidou Ilboudo and Estelle A"issa Bambara and Macaire Nana and Edmond Yabr\'{e} Sawadogo and Hermann Sorgho and Athanase Mwinessobaonfou Som\'{e} and Innocent Val\'{e}a and Prabin Dahal and Maminata Traor\'{e}/Coulibaly and Halidou Tinto},
doi = {10.1186/s13063-021-05320-7},
issn = {1745-6215},
year = {2021},
date = {2021-05-24},
urldate = {2021-05-24},
journal = {Trials},
volume = {22},
number = {1},
pages = {360},
publisher = {Springer Science and Business Media LLC},
abstract = {BACKGROUND: Malaria and malnutrition represent major public
health concerns worldwide especially in Sub-Sahara Africa.
Despite implementation of seasonal malaria chemoprophylaxis
(SMC), an intervention aimed at reducing malaria incidence among
children aged 3-59 months, the burden of malaria and associated
mortality among children below age 5 years remains high in
Burkina Faso. Malnutrition, in particular micronutrient
deficiency, appears to be one of the potential factors that can
negatively affect the effectiveness of SMC. Treating
micronutrient deficiencies is known to reduce the incidence of
malaria in highly prevalent malaria zone such as rural settings.
Therefore, we hypothesized that a combined strategy of SMC
together with a daily oral nutrients supplement will enhance the
immune response and decrease the incidence of malaria and
malnutrition among children under SMC coverage. METHODS:
Children (6-59 months) under SMC coverage receiving vitamin A
supplementation will be randomly assigned to one of the three
study arms (a) SMC + vitamin A alone, (b) SMC + vitamin A +
zinc, or (c) SMC + vitamin A + Plumpy'Doz™ using 1:1:1
allocation ratio. After each SMC monthly distribution, children
will be visited at home to confirm drug administration and
followed-up for 1 year. Anthropometric indicators will be
recorded at each visit and blood samples will be collected for
microscopy slides, haemoglobin measurement, and spotted onto
filter paper for further PCR analyses. The primary outcome
measure is the incidence of malaria in each arm. Secondary
outcome measures will include mid-upper arm circumference and
weight gain from baseline measurements, coverage and compliance
to SMC, occurrence of adverse events (AEs), and prevalence of
molecular markers of antimalarial resistance comprising Pfcrt,
Pfmdr1, Pfdhfr, and Pfdhps. DISCUSSION: This study will
demonstrate an integrated strategy of malaria and malnutrition
programmes in order to mutualize resources for best impact. By
relying on existing strategies, the policy implementation of
this joint intervention will be scalable at country and regional
levels. TRIAL REGISTRATION: ClinicalTrials.gov NCT04238845 .
Registered on 23 January 2020
https://clinicaltrials.gov/ct2/show/NCT04238845.},
note = {PMID: 34030705
PMCID: PMC8142067},
keywords = {Antimalarials/adverse effects, Burkina Faso/epidemiology, Chemoprevention, Child, Child Nutrition Disorders, Dietary Supplements, Humans, Infant, Malaria, Malaria/diagnosis/epidemiology/prevention \& control, Malnutrition, Malnutrition/diagnosis/drug therapy/prevention \& control, Pharmaceutical Preparations, Plumpy’Doz™, Preschool, Randomized controlled trial, Seasonal chemoprevention, Seasons, Vitamin A, Vitamin A/adverse effects, Zinc},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Malaria and malnutrition represent major public
health concerns worldwide especially in Sub-Sahara Africa.
Despite implementation of seasonal malaria chemoprophylaxis
(SMC), an intervention aimed at reducing malaria incidence among
children aged 3-59 months, the burden of malaria and associated
mortality among children below age 5 years remains high in
Burkina Faso. Malnutrition, in particular micronutrient
deficiency, appears to be one of the potential factors that can
negatively affect the effectiveness of SMC. Treating
micronutrient deficiencies is known to reduce the incidence of
malaria in highly prevalent malaria zone such as rural settings.
Therefore, we hypothesized that a combined strategy of SMC
together with a daily oral nutrients supplement will enhance the
immune response and decrease the incidence of malaria and
malnutrition among children under SMC coverage. METHODS:
Children (6-59 months) under SMC coverage receiving vitamin A
supplementation will be randomly assigned to one of the three
study arms (a) SMC + vitamin A alone, (b) SMC + vitamin A +
zinc, or (c) SMC + vitamin A + Plumpy’Doz™ using 1:1:1
allocation ratio. After each SMC monthly distribution, children
will be visited at home to confirm drug administration and
followed-up for 1 year. Anthropometric indicators will be
recorded at each visit and blood samples will be collected for
microscopy slides, haemoglobin measurement, and spotted onto
filter paper for further PCR analyses. The primary outcome
measure is the incidence of malaria in each arm. Secondary
outcome measures will include mid-upper arm circumference and
weight gain from baseline measurements, coverage and compliance
to SMC, occurrence of adverse events (AEs), and prevalence of
molecular markers of antimalarial resistance comprising Pfcrt,
Pfmdr1, Pfdhfr, and Pfdhps. DISCUSSION: This study will
demonstrate an integrated strategy of malaria and malnutrition
programmes in order to mutualize resources for best impact. By
relying on existing strategies, the policy implementation of
this joint intervention will be scalable at country and regional
levels. TRIAL REGISTRATION: ClinicalTrials.gov NCT04238845 .
Registered on 23 January 2020
https://clinicaltrials.gov/ct2/show/NCT04238845. |
| Yeka Adoke, Rella Zoleko-Manego, Serge Ouoba, Alfred B Tiono, Grace Kaguthi, Juv^encio Eduardo Bonzela, Tran Thanh Duong, Alain Nahum, Marielle Bouyou-Akotet, Bernhards Ogutu, Alphonse Ouedraogo, Fiona Macintyre, Andreas Jessel, Bart Laurijssens, Mohammed H Cherkaoui-Rbati, Cathy Cantalloube, Anne Claire Marrast, Rapha"el Bejuit, David White, Timothy N C Wells, Florian Wartha, Didier Leroy, Afizi Kibuuka, Ghyslain Mombo-Ngoma, Daouda Ouattara, Ir`ene Mugenya, Bui Quang Phuc, Francis Bohissou, Denise P Mawili-Mboumba, Fredrick Olewe, Issiaka Soulama, Halidou Tinto, FALCI Study Group A randomized, double-blind, phase 2b study to investigate the efficacy, safety, tolerability and pharmacokinetics of a single-dose regimen of ferroquine with artefenomel in adults and children with uncomplicated Plasmodium falciparum malaria (Journal Article) In: Malar. J., vol. 20, no. 1, pp. 222, 2021, ISSN: 1475-2875, (PMID: 34011358
PMCID: PMC8135182). @article{Adoke2021-el,
title = {A randomized, double-blind, phase 2b study to investigate the efficacy, safety, tolerability and pharmacokinetics of a single-dose regimen of ferroquine with artefenomel in adults and children with uncomplicated Plasmodium falciparum malaria},
author = {Yeka Adoke and Rella Zoleko-Manego and Serge Ouoba and Alfred B Tiono and Grace Kaguthi and Juv^encio Eduardo Bonzela and Tran Thanh Duong and Alain Nahum and Marielle Bouyou-Akotet and Bernhards Ogutu and Alphonse Ouedraogo and Fiona Macintyre and Andreas Jessel and Bart Laurijssens and Mohammed H Cherkaoui-Rbati and Cathy Cantalloube and Anne Claire Marrast and Rapha"el Bejuit and David White and Timothy N C Wells and Florian Wartha and Didier Leroy and Afizi Kibuuka and Ghyslain Mombo-Ngoma and Daouda Ouattara and Ir`ene Mugenya and Bui Quang Phuc and Francis Bohissou and Denise P Mawili-Mboumba and Fredrick Olewe and Issiaka Soulama and Halidou Tinto and FALCI Study Group},
doi = {10.1186/s12936-021-03749-4},
issn = {1475-2875},
year = {2021},
date = {2021-05-19},
urldate = {2021-05-19},
journal = {Malar. J.},
volume = {20},
number = {1},
pages = {222},
publisher = {Springer Science and Business Media LLC},
abstract = {BACKGROUND: For uncomplicated Plasmodium falciparum malaria,
highly efficacious single-dose treatments are expected to
increase compliance and improve treatment outcomes, and thereby
may slow the development of resistance. The efficacy and safety
of a single-dose combination of artefenomel (800 mg) plus
ferroquine (400/600/900/1200 mg doses) for the treatment of
uncomplicated P. falciparum malaria were evaluated in Africa
(focusing on children $\leq$ 5 years) and Asia. METHODS: The
study was a randomized, double-blind, single-dose, multi-arm
clinical trial in patients aged \> 6 months to 5 years and 20
Asian patients. None of the treatment arms met the target
efficacy criterion for PCR-adjusted ACPR at Day 28 (lower limit
of 95% confidence interval [CI] \> 90%). PCR-adjusted ACPR at
Day 28 [95% CI] in the PP Set ranged from 78.4% [64.7; 88.7%]
to 91.7% [81.6; 97.2%] for the 400 mg to 1200 mg ferroquine
dose. Efficacy rates were low in Vietnamese patients, ranging
from 20 to 40%. A clear relationship was found between drug
exposure (artefenomel and ferroquine concentrations at Day 7)
and efficacy (primary endpoint), with higher concentrations of
both drugs resulting in higher efficacy. Six distinct kelch-13
mutations were detected in parasite isolates from 10/272 African
patients (with 2 mutations known to be associated with
artemisinin resistance) and 18/20 Asian patients (all C580Y
mutation). Vomiting within 6 h of initial artefenomel
administration was common (24.6%) and associated with lower
drug exposures. CONCLUSION: The efficacy of
artefenomel/ferroquine combination was suboptimal in African
children aged $\leq$ 5 years, the population of interest, and
vomiting most likely had a negative impact on efficacy. Trial
registration ClinicalTrials.gov, NCT02497612. Registered 14 Jul
2015, https://clinicaltrials.gov/ct2/show/NCT02497612?term=NCT02497612\&draw=2\&rank=1.},
note = {PMID: 34011358
PMCID: PMC8135182},
keywords = {Adamantane/administration \& dosage/analogs \& derivatives, Adolescent, Adult, Aged, Aminoquinolines/administration \& dosage, Benin, Burkina Faso, C580Y, Child, Combination treatment, Double-Blind Method, Drug Combinations, Exposure\textendashresponse, Falciparum/prevention \& control, Female, Ferroquine, Ferrous Compounds/administration \& dosage, Gabon, Humans, Infant, Kelch-13 mutation, Kenya, Malaria, Male, Metallocenes/administration \& dosage, Middle Aged, Mozambique, Parasite clearance, Peroxides/administration \& dosage, Pharmacokinetics/pharmacodynamics, Plasmodium falciparum/drug effects, Preschool, resistance, Uganda, Vietnam, Vomiting, Young Adult},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: For uncomplicated Plasmodium falciparum malaria,
highly efficacious single-dose treatments are expected to
increase compliance and improve treatment outcomes, and thereby
may slow the development of resistance. The efficacy and safety
of a single-dose combination of artefenomel (800 mg) plus
ferroquine (400/600/900/1200 mg doses) for the treatment of
uncomplicated P. falciparum malaria were evaluated in Africa
(focusing on children $łeq$ 5 years) and Asia. METHODS: The
study was a randomized, double-blind, single-dose, multi-arm
clinical trial in patients aged > 6 months to 5 years and 20
Asian patients. None of the treatment arms met the target
efficacy criterion for PCR-adjusted ACPR at Day 28 (lower limit
of 95% confidence interval [CI] > 90%). PCR-adjusted ACPR at
Day 28 [95% CI] in the PP Set ranged from 78.4% [64.7; 88.7%]
to 91.7% [81.6; 97.2%] for the 400 mg to 1200 mg ferroquine
dose. Efficacy rates were low in Vietnamese patients, ranging
from 20 to 40%. A clear relationship was found between drug
exposure (artefenomel and ferroquine concentrations at Day 7)
and efficacy (primary endpoint), with higher concentrations of
both drugs resulting in higher efficacy. Six distinct kelch-13
mutations were detected in parasite isolates from 10/272 African
patients (with 2 mutations known to be associated with
artemisinin resistance) and 18/20 Asian patients (all C580Y
mutation). Vomiting within 6 h of initial artefenomel
administration was common (24.6%) and associated with lower
drug exposures. CONCLUSION: The efficacy of
artefenomel/ferroquine combination was suboptimal in African
children aged $łeq$ 5 years, the population of interest, and
vomiting most likely had a negative impact on efficacy. Trial
registration ClinicalTrials.gov, NCT02497612. Registered 14 Jul
2015, https://clinicaltrials.gov/ct2/show/NCT02497612?term=NCT02497612&draw=2&rank=1. |
| Mehreen S Datoo, Magloire H Natama, Athanase Somé, Ousmane Traoré, Toussaint Rouamba, Duncan Bellamy, Prisca Yameogo, Daniel Valia, Moubarak Tegneri, Florence Ouedraogo, Rachidatou Soma, Seydou Sawadogo, Faizatou Sorgho, Karim Derra, Eli Rouamba, Benedict Orindi, Fernando Ramos Lopez, Amy Flaxman, Federica Cappuccini, Reshma Kailath, Sean Elias, Ekta Mukhopadhyay, Andres Noe, Matthew Cairns, Alison Lawrie, Rachel Roberts, Innocent Valéa, Hermann Sorgho, Nicola Williams, Gregory Glenn, Louis Fries, Jenny Reimer, Katie J Ewer, Umesh Shaligram, Adrian V S Hill, Halidou Tinto Efficacy of a low-dose candidate malaria vaccine, R21 in adjuvant Matrix-M, with seasonal administration to children in Burkina Faso: a randomised controlled trial (Journal Article) In: Lancet, vol. 397, no. 10287, pp. 1809–1818, 2021, ISSN: 1474-547X 0140-6736, (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
PMID: 33964223
PMCID: PMC8121760). @article{Datoo2021-dk,
title = {Efficacy of a low-dose candidate malaria vaccine, R21 in adjuvant Matrix-M, with seasonal administration to children in Burkina Faso: a randomised controlled trial},
author = {Mehreen S Datoo and Magloire H Natama and Athanase Som\'{e} and Ousmane Traor\'{e} and Toussaint Rouamba and Duncan Bellamy and Prisca Yameogo and Daniel Valia and Moubarak Tegneri and Florence Ouedraogo and Rachidatou Soma and Seydou Sawadogo and Faizatou Sorgho and Karim Derra and Eli Rouamba and Benedict Orindi and Fernando Ramos Lopez and Amy Flaxman and Federica Cappuccini and Reshma Kailath and Sean Elias and Ekta Mukhopadhyay and Andres Noe and Matthew Cairns and Alison Lawrie and Rachel Roberts and Innocent Val\'{e}a and Hermann Sorgho and Nicola Williams and Gregory Glenn and Louis Fries and Jenny Reimer and Katie J Ewer and Umesh Shaligram and Adrian V S Hill and Halidou Tinto},
doi = {10.1016/S0140-6736(21)00943-0},
issn = {1474-547X 0140-6736},
year = {2021},
date = {2021-05-15},
urldate = {2021-05-15},
journal = {Lancet},
volume = {397},
number = {10287},
pages = {1809--1818},
publisher = {Elsevier BV},
abstract = {BACKGROUND: Stalled progress in controlling Plasmodium
falciparum malaria highlights the need for an effective and
deployable vaccine. RTS,S/AS01, the most effective malaria
vaccine candidate to date, demonstrated 56% efficacy over 12
months in African children. We therefore assessed a new
candidate vaccine for safety and efficacy. METHODS: In this
double-blind, randomised, controlled, phase 2b trial, the
low-dose circumsporozoite protein-based vaccine R21, with two
different doses of adjuvant Matrix-M (MM), was given to children
aged 5-17 months in Nanoro, Burkina Faso-a highly seasonal
malaria transmission setting. Three vaccinations were
administered at 4-week intervals before the malaria season, with
a fourth dose 1 year later. All vaccines were administered
intramuscularly into the thigh. Group 1 received 5 $mu$g R21
plus 25 $mu$g MM, group 2 received 5 $mu$g R21 plus 50 $mu$g
MM, and group 3, the control group, received rabies
vaccinations. Children were randomly assigned (1:1:1) to groups
1-3. An independent statistician generated a random allocation
list, using block randomisation with variable block sizes, which
was used to assign participants. Participants, their families,
and the local study team were all masked to group allocation.
Only the pharmacists preparing the vaccine were unmasked to
group allocation. Vaccine safety, immunogenicity, and efficacy
were evaluated over 1 year. The primary objective assessed
protective efficacy of R21 plus MM (R21/MM) from 14 days after
the third vaccination to 6 months. Primary analyses of vaccine
efficacy were based on a modified intention-to-treat population,
which included all participants who received three vaccinations,
allowing for inclusion of participants who received the wrong
vaccine at any timepoint. This trial is registered with
ClinicalTrials.gov, NCT03896724. FINDINGS: From May 7 to June
13, 2019, 498 children aged 5-17 months were screened, and 48
were excluded. 450 children were enrolled and received at least
one vaccination. 150 children were allocated to group 1, 150
children were allocated to group 2, and 150 children were
allocated to group 3. The final vaccination of the primary
series was administered on Aug 7, 2019. R21/MM had a favourable
safety profile and was well tolerated. The majority of adverse
events were mild, with the most common event being fever. None
of the seven serious adverse events were attributed to the
vaccine. At the 6-month primary efficacy analysis, 43 (29%) of
146 participants in group 1, 38 (26%) of 146 participants in
group 2, and 105 (71%) of 147 participants in group 3 developed
clinical malaria. Vaccine efficacy was 74% (95% CI 63-82) in
group 1 and 77% (67-84) in group 2 at 6 months. At 1 year,
vaccine efficacy remained high, at 77% (67-84) in group 1.
Participants vaccinated with R21/MM showed high titres of
malaria-specific anti-Asn-Ala-Asn-Pro (NANP) antibodies 28 days
after the third vaccination, which were almost doubled with the
higher adjuvant dose. Titres waned but were boosted to levels
similar to peak titres after the primary series of vaccinations
after a fourth dose administered 1 year later. INTERPRETATION:
R21/MM appears safe and very immunogenic in African children,
and shows promising high-level efficacy. FUNDING: The European
\& Developing Countries Clinical Trials Partnership, Wellcome
Trust, and National Institute for Health Research Oxford
Biomedical Research Centre.},
note = {Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
PMID: 33964223
PMCID: PMC8121760},
keywords = {Adjuvants, Burkina Faso, Double-Blind Method, Falciparum/prevention \& control, Female, Hepatitis B Surface Antigens, Humans, Immunogenicity, Immunologic/administration \& dosage, Infant, Malaria, Malaria Vaccines/therapeutic use, Malaria/prevention \& control, Male, Nanoparticles/administration \& dosage, Proportional Hazards Models, Protozoan Proteins/immunology, Saponins/administration \& dosage, Treatment Outcome, Vaccine, Vaccines, Virus-Like Particle/therapeutic use},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Stalled progress in controlling Plasmodium
falciparum malaria highlights the need for an effective and
deployable vaccine. RTS,S/AS01, the most effective malaria
vaccine candidate to date, demonstrated 56% efficacy over 12
months in African children. We therefore assessed a new
candidate vaccine for safety and efficacy. METHODS: In this
double-blind, randomised, controlled, phase 2b trial, the
low-dose circumsporozoite protein-based vaccine R21, with two
different doses of adjuvant Matrix-M (MM), was given to children
aged 5-17 months in Nanoro, Burkina Faso-a highly seasonal
malaria transmission setting. Three vaccinations were
administered at 4-week intervals before the malaria season, with
a fourth dose 1 year later. All vaccines were administered
intramuscularly into the thigh. Group 1 received 5 $mu$g R21
plus 25 $mu$g MM, group 2 received 5 $mu$g R21 plus 50 $mu$g
MM, and group 3, the control group, received rabies
vaccinations. Children were randomly assigned (1:1:1) to groups
1-3. An independent statistician generated a random allocation
list, using block randomisation with variable block sizes, which
was used to assign participants. Participants, their families,
and the local study team were all masked to group allocation.
Only the pharmacists preparing the vaccine were unmasked to
group allocation. Vaccine safety, immunogenicity, and efficacy
were evaluated over 1 year. The primary objective assessed
protective efficacy of R21 plus MM (R21/MM) from 14 days after
the third vaccination to 6 months. Primary analyses of vaccine
efficacy were based on a modified intention-to-treat population,
which included all participants who received three vaccinations,
allowing for inclusion of participants who received the wrong
vaccine at any timepoint. This trial is registered with
ClinicalTrials.gov, NCT03896724. FINDINGS: From May 7 to June
13, 2019, 498 children aged 5-17 months were screened, and 48
were excluded. 450 children were enrolled and received at least
one vaccination. 150 children were allocated to group 1, 150
children were allocated to group 2, and 150 children were
allocated to group 3. The final vaccination of the primary
series was administered on Aug 7, 2019. R21/MM had a favourable
safety profile and was well tolerated. The majority of adverse
events were mild, with the most common event being fever. None
of the seven serious adverse events were attributed to the
vaccine. At the 6-month primary efficacy analysis, 43 (29%) of
146 participants in group 1, 38 (26%) of 146 participants in
group 2, and 105 (71%) of 147 participants in group 3 developed
clinical malaria. Vaccine efficacy was 74% (95% CI 63-82) in
group 1 and 77% (67-84) in group 2 at 6 months. At 1 year,
vaccine efficacy remained high, at 77% (67-84) in group 1.
Participants vaccinated with R21/MM showed high titres of
malaria-specific anti-Asn-Ala-Asn-Pro (NANP) antibodies 28 days
after the third vaccination, which were almost doubled with the
higher adjuvant dose. Titres waned but were boosted to levels
similar to peak titres after the primary series of vaccinations
after a fourth dose administered 1 year later. INTERPRETATION:
R21/MM appears safe and very immunogenic in African children,
and shows promising high-level efficacy. FUNDING: The European
& Developing Countries Clinical Trials Partnership, Wellcome
Trust, and National Institute for Health Research Oxford
Biomedical Research Centre. |