Agency: European Commission | Branch: FP7 | Program: CP-FP | Phase: HEALTH-2007-2.3.2-3 | Award Amount: 3.74M | Year: 2008
This project aims to assess specific P. falciparum genetic markers for resistance to artemisinin-based combinations (ACT), and to develop innovative, rapid and simple diagnostics for malaria and these markers. Specific objectives are: To develop and evaluate in disease endemic countries accurate low-tech molecular diagnostic tests. To identify alleles of candidate resistance genes associated with increased transmission success of P. falciparum after ACT treatment in completed clinical trials (endpoints at gametocyte or infected mosquito level). To conduct ACT treatment trials with transmission endpoints, and measure impact of resistance-associated alleles on gametocyte emergence, and on the infectiousness of gametocyte-positive or randomly-selected treated individuals to Anopheles mosquitoes. To measure ACT efficacy using in vivo treatment trials, and in vitro drug sensitivity testing of natural parasite isolates. The impact of candidate resistance markers will be measured in patients with treatment failure, and in parasites with reduced in vitro sensitivity. To develop new low-tech diagnostic tools able to demonstrate the presence of mutations conferring drug resistance in the Plasmodium population, particularly those markers validated by the project. To investigate commercial value aspects of developed tests. The project will move our knowledge of ACT resistance forward in 2 complementary ways: 1) In order to identify and validate genetic markers for ACT resistance, we will use our unprecedented access to parasites isolated both from ACT-treated individuals and from mosquitoes fed on blood from ACT-treated individuals. 2) we will develop and validate simple tests in new formats for detection of these and other markers of relevance, and for rapid detection of persisting parasites in treated patients. The work is a balanced mix of clinical field work, laboratory research and (commercial) test development and linked to EU initiative EDCTP.
Agency: European Commission | Branch: FP7 | Program: CP-FP | Phase: HEALTH.2012.2.3.2-4 | Award Amount: 3.94M | Year: 2012
Pregnant women are very susceptible to malaria infection and Malaria in Pregnancy (MiP) is a major cause of maternal anaemia and low birth weight (LBW) that leads to infant mortality, poor growth and development. In low transmission areas, malaria can become severe, resulting in maternal and foetal death. In sub-Saharan Africa (SSA) MiP is responsible for 814% of LBW, 38% of infant deaths, higher risk of post-partum haemorrhage and >10,000 maternal deaths/year. Prevention like, bed nets and intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp/SP), is cheap and cost-effective, but coverage achieved by these interventions is low. Therefore, we propose Community Health Workers (CHW) to implement scheduled intermittent screening at community level with RDT of pregnant women and if positive treat with anti-malarials (SST). In addition CHWs will encourage pregnant women to attend antenatal clinics (ANC) for other pregnancy-targeted interventions and IPTp/SP, thereby improving its coverage. This approach combines existing IPTp/SP with SST at village level as an extension of Home based management of malaria (HMM). This low cost (based on existing practice) and simple (diagnosis by RDTs) intervention improves maternal and newborn health and capitalise on an already existing intervention (HMM). The aim of this proposal is to determine the added value (as compared to IPTp/SP alone implemented in health facilities) of community SST of pregnant women implemented through the CHW involved in HMM. Objectives are: 1) Identify bottlenecks for implementation by CHW involved in HMM of SST; 2) determine impact of introducing SST in pregnancy on quality of HMM; 3) determine the impact of SST on ANC attendance and IPTp/SP coverage; 4) determine the impact of SST on LBW, anaemia and placenta malaria; 5) estimate cost-effectiveness of SST as compared to IPTp/SP alone and 6) formulate recommendations for possible implementation of the intervention.
Hounton S.,Center MURAZ |
Hounton S.,University of Aberdeen |
Newlands D.,University of Aberdeen
PLoS ONE | Year: 2012
Background: Coverage of maternal and newborn health (MNH) interventions is often influenced by important determinants and decision makers are often concerned with equity issues. The net-benefit framework developed and applied alongside clinical trials and in pharmacoeconomics offers the potential for exploring how cost-effectiveness of MNH interventions varies at the margin by important covariates as well as for handling uncertainties around the ICER estimate. Aim: We applied the net-benefit framework to analyze cost-effectiveness of the Skilled Care Initiative and assessed relative advantages over a standard computation of incremental cost effectiveness ratios. Methods: Household and facility surveys were carried out from January to July 2006 in Ouargaye district (where the Skilled Care Initiative was implemented) and Diapaga (comparison site) district in Burkina Faso. Pregnancy-related and perinatal mortality were retrospectively assessed and data were collected on place of delivery, education, asset ownership, place, and distance to health facilities, costs borne by households for institutional delivery, and cost of standard provision of maternal care. Descriptive and regression analyses were performed. Results: There was a 30% increase in institutional births in the intervention district compared to 10% increase in comparison district, and a significant reduction of perinatal mortality rates (OR 0.75, CI 0.70-0.80) in intervention district. The incremental cost for achieving one additional institutional delivery in Ouargaye district compared to Diapaga district was estimated to be 170 international dollars and varied significantly by covariates. However, the joint probability distribution (net-benefit framework) of the effectiveness measure (institutional delivery), the cost data and covariates indicated distance to health facilities as the single most important determinant of the cost-effectiveness analysis with implications for policy making. Conclusion: The net-benefit framework, the application of which requires household-level effects and cost data, has proven more insightful (than traditional ICER) in presenting and interpreting cost-effectiveness results of the Skilled Care Initiative. © 2012 Hounton, Newlands.
Cairns M.,London School of Hygiene and Tropical Medicine |
Roca-Feltrer A.,Malawi Liverpool Wellcome Trust Clinical Research Programme |
Garske T.,London School of Hygiene and Tropical Medicine |
Wilson A.L.,Center Muraz |
And 4 more authors.
Nature Communications | Year: 2012
Seasonal malaria chemoprevention, previously known as intermittent preventive treatment in children, is highly effective in areas with a short malaria transmission season. Here we assess seasonality in malaria incidence data and define a predictor of seasonality based on rainfall. We then use spatial rainfall, malaria endemicity and population data to identify areas likely to have highly seasonal malaria incidence, and estimate the population at risk and malaria burden in areas where seasonal malaria chemoprevention would be appropriate. We estimate that in areas suitable for seasonal malaria chemoprevention, there are 39 million children under 5 years of age, who experience 33.7 million malaria episodes and 152,000 childhood deaths from malaria each year. The majority of this burden occurs in the Sahelian or sub-Sahelian regions of Africa. Our data suggest that seasonal malaria chemoprevention has the potential to avert several million malaria cases and tens of thousands of childhood deaths each year if successfully delivered to the populations at risk. © 2012 Macmillan Publishers Limited. All rights reserved.
Lefevre T.,IRD Montpellier |
Vantaux A.,IRD Montpellier |
Dabire K.R.,Institute Of Recherche En Science Of La Sante |
Dabire K.R.,Center Muraz |
And 4 more authors.
PLoS Pathogens | Year: 2013
Understanding how mosquito vectors and malaria parasites interact is of fundamental interest, and it also offers novel perspectives for disease control. Both the genetic and environmental contexts are known to affect the ability of mosquitoes to support malaria development and transmission, i.e., vector competence. Although the role of environment has long been recognized, much work has focused on host and parasite genetic effects. However, the last few years have seen a surge of studies revealing a great diversity of ways in which non-genetic factors can interfere with mosquito-Plasmodium interactions. Here, we review the current evidence for such environmentally mediated effects, including ambient temperature, mosquito diet, microbial gut flora, and infection history, and we identify additional factors previously overlooked in mosquito-Plasmodium interactions. We also discuss epidemiological implications, and the evolutionary consequences for vector immunity and parasite transmission strategies. Finally, we propose directions for further research and argue that an improved knowledge of non-genetic influences on mosquito-Plasmodium interactions could aid in implementing conventional malaria control measures and contribute to the design of novel strategies. © 2013 Lefèvre et al.
Maheu-Giroux M.,Harvard University |
Filippi V.,London School of Hygiene and Tropical Medicine |
Samadoulougou S.,Catholic University of Louvain |
Castro M.C.,Harvard University |
And 4 more authors.
The Lancet Global Health | Year: 2015
Background: Vaginal fistula is a serious medical disorder characterised by an abnormal opening between the vagina and the bladder or rectum, which results in continuous leakage of urine or stool. The burden of this disorder in sub-Saharan Africa is uncertain. We estimated the lifetime and point prevalence of symptoms of vaginal fistula in this region using national household surveys based on self-report of symptoms. Methods: We considered all Demographic and Health Surveys (DHS) and Multiple Indicators Cluster Surveys (MICS) from sub-Saharan Africa and included data for women of reproductive age (15-49 years). We estimated lifetime prevalence and point prevalence of vaginal fistula with use of Bayesian hierarchical meta-analysis. Findings: We included 19 surveys in our analysis, including 262 100 respondents. Lifetime prevalence was 3·0 cases (95% credible interval 1·3-5·5) per 1000 women of reproductive age. After imputation of missing data, point prevalence was 1·0 case (0·3-2·4) per 1000 women of reproductive age. Ethiopia had the largest number of women who presently have symptoms of vaginal fistula. Interpretation: This study is the first to estimate the burden of vaginal fistula in 19 sub-Saharan Africa countries using nationally representative survey data. Point prevalence was slightly lower than previously estimated but these earlier estimates are within the prevalence's credible intervals. Although vaginal fistula is relatively rare, it is still too common in sub-Saharan Africa. Funding: None. © 2015 Maheu-Giroux et al. Open access article published under the terms of CC BY.
Head R.,Development Media International |
Murray J.,Development Media International |
Sarrassat S.,University of Ouagadougou |
Snell W.,Development Media International |
And 4 more authors.
The Lancet | Year: 2015
Many people recognise that mass media is important in promoting public health but there have been few attempts to measure how important. An ongoing trial in Burkina Faso (ClinicalTrials.gov, NCT01517230) is an attempt to bring together the very different worlds of mass media and epidemiology: to measure rigorously, using a cluster-randomised design, how many lives mass media can save in a low-income country, and at what cost. Application of the Lives Saved Tool predicts that saturation-based media campaigns could reduce child mortality by 10-20%, at a cost per disability-adjusted life-year that is as low as any existing health intervention. In this Viewpoint we explain the scientific reasoning behind the trial, while stressing the importance of the media methodology used. © 2015 Elsevier Ltd.
Some D.T.,Societe dEtudes et de Recherche en Sante Publique SERSAP |
Sombie I.,West African Health Organization WAHO |
Meda N.,Center Muraz
Reproductive Health | Year: 2013
Background: Delay in decision-making to use skilled care during pregnancy and childbirth is an important factor for maternal death in many developing countries. This paper examines how decisions for maternal care are made in two rural communities in Burkina Faso. Methods. Focus group discussions (FGDs) and individual interviews (IDIs)) were used to collect information with 30 women in Ouargaye and Diapaga medical districts. All interviews were tape recorded and analyzed using QSR Nvivo 2.0. Results: Decision-making for use of obstetric care in the family follows the logic of the family's management. Husbands, brothers-in-law and parents-in-law make the decision about whether to use a health facility for antenatal care or for delivery. In general, decision-makers are those who can pay, including the woman herself. Payment of care is the responsibility of men, according to women interviewed, because of their social role and status. Conclusions: To increase use of health facilities in Ouargaye and Diapaga, the empowerment of women could be helpful as well as exemption of fees or cost sharing for care. © 2013 Somé et al.; licensee BioMed Central Ltd.
Steele A.D.,University of South Africa |
Page N.,University of South Africa |
De Beer M.,University of South Africa |
Sawadogo S.,Center Muraz
Journal of Infectious Diseases | Year: 2010
Thirty-six of 37 rotavirus strains recovered from the diarrheal stools of 166 children <3 years of age in Burkina Faso were characterized at both the antigenic and molecular levels. The rotavirus strains were confirmed by polyacrylamide gel electrophoresis; 30 displayed predominantly short electropherotype patterns, and 6 had a long RNA pattern. The strains were subgrouped by monoclonal antibody enzyme immunoassay for VP6 and were typed as subgroup I (29 of 30 short rotavirus strains) and subgroup II (5 of 6 long strains). The VP7 serotyping and genotyping showed that all 6 viruses with long electropherotype patterns were G1. The short strains were determined to be VP7 serotype G2 by reverse-transcription polymerase chain reaction (PCR) in 27 strains and nucleic acid sequencing of selected strains, although only 1 reacted with the G2-specific monoclonal antibodies. Finally, the short patterns were shown by the PCR genotyping method to be VP4 genotype P, and the long patterns were shown to be P. The predominant strain found in Burkina Faso in this small study was an unusual G2P strain that showed a short RNA electropherotype and VP6 subgroup I specificity and failed to react with a panel of G2-specific monoclonal antibodies. © 2010 by the Infectious Diseases Society of America. All rights reserved.
Some T.D.,Center Muraz |
Sombie I.,Center Muraz |
Meda N.,Center Muraz
Reproductive Health | Year: 2011
Background: In developing countries, most childbirth occurs at home and is not assisted by skilled attendants. The situation increases the risk of death for both mother and child and has severe maternal complications. The purpose of this study was to describe women's perceptions of homebirths in the medical districts of Ouargaye and Diapaga. Methods. A qualitative approach was used to gather information. This information was collected by using focus group discussions and individual interviews with 30 women. All the interviews were tape recorded and managed by using QSR NVIVO 2.0, qualitative data management software. Results: The findings show that homebirths are frequent because of prohibitive distance to health facilities, fast labour and easy labour, financial constraints, lack of decision making power to reach health facilities. Conclusion: The study echoes the need for policy makers to make health facilities easily available to rural inhabitants to forestall maternal and child deaths in the two districts. © 2011 Some et al; licensee BioMed Central Ltd.