Noscapine shows antimalarial activity against Plasmodium falciparum 3D7,its clinical isolate Pf140/SS,and Plasmodium berghei ANKA

Objective:To evaluate the antimalarial activity of noscapine against Plasmodium falciparum 3D7 strain(Pf3D7),its clinical isolate(Pf140/SS),and Plasmodium berghei ANKA(PbA).Methods:Using ring-stage survival assay,phenotypic assessments,and SYBR-green-based fluorescence assay,the antimalarial activities of noscapine were assessed compared with dihydroartemisinin(DHA)in in vivo and in vitro studies.In addition,hemolysis and cytotoxicity tests were carried out to evaluate its safety.RT-PCR assay was also conducted to determine the effect of noscapine on papain-like cysteine protease Plasmodium falciparum falcipain-2(PfFP-2).Results:The antimalarial efficacy of noscapine against Pf3D7 and Pf140/SS was comparable to DHA,with IC50 values of(7.68±0.88)and(5.57±0.74)nM/mL,respectively,and>95%inhibition of PbA infected rats.Noscapine also showed a safe profile,as evidenced by low hemolysis and cytotoxicity even at high concentrations.Moreover,PfFP-2 expression was significantly inhibited in both noscapine-treated Pf3D7 and Pf140/SS(P<0.01).Conclusions:Noscapine has antimalarial properties comparable to standard antimalarial DHA with better safety profiles,which may be further explored as a therapeutic candidate for the treatment of malaria.

Treatment of a patient with severe cerebral malaria during the COVID-19 pandemic in China:A case report

BACKGROUND On June 30,2021,China received certification from the World Health Organization for malaria elimination.However,this certification does not signify the absence of malaria within China.Due to the increasing frequency of international exchanges and collaborations,the threat of imported malaria persists in China.Consequently,the prevention and control of imported malaria have become a primary focus for our country to maintain its malaria elimination status.CASE SUMMARY Herein,we present a case report of a 53-year-old Chinese man who worked in Africa for nearly two years.He was diagnosed with malaria in the Democratic Republic of the Congo between November 19 and November 23,2022.After receiving effective treatment with oral antimalarial drugs,his condition improved,allowing him to return to China.He was later admitted to our hospital on January 12,2023,during the coronavirus disease 2019 pandemic in Huangshi,China.Through a thorough evaluation of the patient's symptoms,clinical signs,imaging and laboratory test results,and epidemiological data,he was rapidly diagnosed with severe cerebral malaria.The patient underwent successful treatment through a series of intensive care unit interventions.CONCLUSION The successful treatment of this imported case of severe cerebral malaria provides a valuable reference for managing patients with similar malaria infections and has significant clinical implications.

Recent advances on vaccines against malaria: A review

This review aims to summarize the currently viable vaccine strategies including the approved vaccines and the those in trials for next-generation malaria vaccines.Data on malaria vaccine development was collected through a comprehensive review.The literature search was performed using databases including Google Scholar,PubMed,NIH,and Web of Science.Various novel approaches of vaccination are being developed,including those based on radiation-attenuated strategies,monoclonal antibodies,targeted immunogenic peptides,RNA and DNA vaccines,nanoparticle-based vaccines,protein-based vaccination protocols,and whole organism-based vaccination strategies.Trials on RTS,S have entered phase Ⅲtesting,and those based on blood-stage vaccines and vaccines to interrupt malarial transmission have advanced to higher stages of trials.Mathematical modeling,combined drug and vaccine strategies,mass drug administration,polyvalent vaccine formulations,and targeted vaccination campaigns is playing an important role in malarial prevention.Furthermore,assessing coverage,accessibility,acceptability,deployment,compilation,and adherence to specific vaccination strategies in endemic regions is essential for vaccination drives against malaria.

Prevalence and Individual-Level Determinants of Uptake of Three or More Doses of Sulphadoxine-Pyrimethamine for Intermittent Preventive Treatment of Malaria in Pregnancy in Busia County, Kenya

Background: Malaria in pregnancy causes maternal anemia, low birth weight, intrauterine growth retardation, and preterm deliveries. In malaria-endemic regions in Kenya, percentage of pregnant women hospitalized with malaria reach up to 60%. WHO recommends at least three doses of sulphadoxine pyrimethamine for Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp) antenatally. This study sought to ascertain the prevalence and individual-level factors influencing the uptake of IPTp-SP3+. Methods: A facility-based cross-sectional study at Busia County Referral Hospital. 384 mothers were consecutively sampled at the maternity unit during delivery. Semi-structured questionnaires were used to collect data. Odds ratio (OR) and adjusted OR were used to determine statistical significance of individual factors influencing uptake of three or more IPTp-SP. Results: 43.0% of participants took IPTp-SP3+. Individual factors that affected the uptake of IPTp-SP3+ included starting ANC visits in the first trimester (adjusted odds ratio (aOR) = 2.1, 95% CI: 1.23 – 3.67, p = 0.046), having more than four ANC visits (aOR = 3.1, 95% CI: 1.49 – 6.50, p = 0.002), having a higher monthly income (aOR = 2.6, 95% CI: 1.24 – 5.36, p = 0.012), being aware of the advantages of IPTp-SP medications (aOR = 3.7, 95% CI: 1.40 – 9.74, p = 0.008), and having a positive attitude toward ANC services (aOR = 3.2, 95% CI: 1.61 – 6.31, p = 0.001). Conclusion: Less than half of the pregnant mothers are complyingIPTp-SP3+. There should be aggressive efforts by the County and National Ministries of Health promoting initiation of ANC attendance early and attendance of all the recommended eight visits together with ensuring availability of the drugs.

CRX-527 as a candidate adjuvant in a recombinant BCG-based malaria vaccine

Objective:To investigate the role of CRX-527,a Toll-like receptor 4 agonist,as the possible adjuvant for recombinant Mycobacterium bovis Bacillus Calmette-Guerin expressing merozoite surface protein 1C(BCG-MSP-1C).Methods:The mice were immunized with BCG and BCG-MSP-1C in the presence and absence of CRX-527.The untreated mice(injected with PBS-T80 only)were the negative control.The ability of CRX-527 to enhance IgG and its subclasses,as well as IL-4 and IFN-γproduction in the serum and spleen supernatant was evaluated using ELISA.Results:Mice immunized with BCG-MSP-1C exhibited the highest production of IgGs,IL-4 and IFN-γafter third immunization.In addition,CRX-527 further promoted the production of total IgG and IgG subclasses as well as IFN-γand IL-4 in the serum and splenocytes of immunized mice.Conclusions:CRX-527 has the potential as an adjuvant candidate for the candidate vaccines.Further study is needed to verify appropriate dosage for immunization and its efficacy.

Determinants of malaria from environmental and poverty aspects in Indonesia:A spatiotemporal perspective,2016-2020

Objective:To investigate the environmental and social aspects of poverty contributing to malaria incidence in Indonesia from 2016 to 2020.Methods:Random forest regression was used to analyse the independent variables contributing to malaria incidence.Environmental conditions were extracted from remotely sensed data,including vegetation,land temperature,soil moisture,precipitation,and elevation.In contrast,the social aspects of poverty were obtained from government statistical reports.Results:From 2016 to 2020,the contribution of each environmental and social aspect of poverty to malaria incidence fluctuated annually.Generally,the top three essential variables were people aged 15 years and above,experiencing poverty(variable importance/VI=32.0%),people experiencing poverty who work in the agricultural sector(VI=14.4%),and precipitation(VI=9.8%).It was followed by people experiencing poverty who are unemployed(VI=9.2%),land temperature(VI=5.2%),people experiencing poverty who have low education(VI=8.0%),soil moisture(VI=7.4%),elevation(VI=6.0%),and vegetation(VI=3.8%).Conclusions:Poverty and variables related to climate have become the crucial determinants of malaria in Indonesia.The government must strengthen malaria surveillance through climate change mitigation and adaptation programs and accelerate poverty alleviation programs to support malaria elimination.

Iron supplementation during malaria infection in pregnancy and childhood:A review

Malaria presents a significant global public health challenge,with severe malarial anaemia being a primary manifestation of the disease.The understanding of anaemia caused by malaria remains incomplete,making the treatment more complex.Iron is a crucial micronutrient essential for haemoglobin synthesis,oxygen delivery,and other vital metabolic functions in the body.It is indispensable for the growth of human beings,as well as bacteria,protozoa,and viruses in vitro and in vivo.Iron deficiency is among the most common nutritional deficiencies and can have detrimental effects during developmental stages of life.Malaria-induced iron deficiency occurs due to the hemolysis of erythrocytes and the suppression of erythropoiesis,leading to anaemia.Meeting iron requirements is particularly critical during pivotal life stages such as pregnancy,infancy,and childhood.Dietary intake alone may not suffice to meet adequate iron requirements,thus highlighting the vital role of iron supplementation.While iron supplementation can alleviate iron deficiency,it can exacerbate malaria infection by providing additional iron for the parasites.However,in the context of pregnancy and childhood,iron supplementation combined with malaria prevention and treatment has been shown to be beneficial in improving birth outcomes and ensuring proper growth and development,respectively.This review aims to identify the role and impact of iron supplementation in malaria infection during the life stages of pregnancy and childhood.

Navigating the future of malaria control:Insights from India's pioneering malaria slide bank

We applaud the authors for their illuminating perspective on India's malaria slide bank(MSB),featured in the recent publication in your esteemed journal[1].The article provides a comprehensive overview of the establishment,challenges,and future potential of MSBs,offering valuable insights into the complexities and opportunities inherent in this critical asset for India's malaria elimination program.

Evaluation of the Care of Children Aged 0 to 10 Years Hospitalized for Severe Malaria at the Tambacounda Health Center, Senegal

Introduction: Malaria remains a public health priority in Senegal, particularly in Tambacounda, where it is one of the main causes of child mortality. The objective of this work was to evaluate the care of children under 10 years of age hospitalized at the Tambacounda Health Center and the factors associated with recovery. Methods: An analytical, retrospective, and descriptive cross-sectional study with exhaustive recruitment of children 0 to 120 months hospitalized at the Tambacounda reference health center for severe malaria (according to WHO criteria) between 1 January 2018 and 31 December 2021 was performed. Data collection was done through a questionnaire. Records, hospitalization records, and treatment records were the sources of collection. Data entry and analysis were performed on Epi Info 7.2 and R. Results: A total of 481 children hospitalized with severe malaria were recruited. The highest number of cases was recorded in 2018 (33.05%). In the four years of the study, peaks were always observed between October and November and the highest peak in November 2020 with 95 cases. The mean age was 65.64 months with a standard deviation of 29.28 months and a predominance of male (53.43%). The majority of people were admitted from the outpatient clinic (57.79%) and the rest (42.21%) on the recommendation of a peripheral health post. All hospitalized patients had a positive RDT and/or a positive thick drop. However, the sharp decline at admission or during hospitalization was positive in 93.80% of patients in our series, negative in 5.20% and not achieved in 1.00%. Seizures and severe anemia topped the list of signs of severity with 45.94% and 8.11%, respectively. In terms of evolution, for all hospitalized patients, there were 81.29% recovery, 10.19% referral to the Tambacounda regional hospital center for hospitalization, 4.99% death, 0.83% discharge and 2.70% unknown evolution. There was a statistically significant association between recovery without referral from a health post (OR = 1.85), absence of 2 or more signs of severity (OR = 1.82), absence of seizures (OR = 1.51), prostration (OR = 2.78), cardiovascular shock (OR = 6.67), coma (OR = 7.69), lack of evidence of biological severity (OR = 3.70), and hypoglycemia with blood glucose less than 0.4 g/L (OR = 5.88). Conclusion: In addition to the routine malaria prevention and management strategies implemented in Tambacounda, and the early referral of cases of severe malaria from health posts to the health center, all children hospitalized for severe malaria with certain symptomatology such as coma, prostration, cardiovascular shock, etc. Seizures and/or hypoglycemia should be systematically referred to the regional hospital to increase their chance of recovery.

Advancing Malaria Prediction in Uganda through AI and Geospatial Analysis Models

The resurgence of locally acquired malaria cases in the USA and the persistent global challenge of malaria transmission highlight the urgent need for research to prevent this disease. Despite significant eradication efforts, malaria remains a serious threat, particularly in regions like Africa. This study explores how integrating Gregor’s Type IV theory with Geographic Information Systems (GIS) improves our understanding of disease dynamics, especially Malaria transmission patterns in Uganda. By combining data-driven algorithms, artificial intelligence, and geospatial analysis, the research aims to determine the most reliable predictors of Malaria incident rates and assess the impact of different factors on transmission. Using diverse predictive modeling techniques including Linear Regression, K-Nearest Neighbor, Neural Network, and Random Forest, the study found that;Random Forest model outperformed the others, demonstrating superior predictive accuracy with an R2 of approximately 0.88 and a Mean Squared Error (MSE) of 0.0534, Antimalarial treatment was identified as the most influential factor, with mosquito net access associated with a significant reduction in incident rates, while higher temperatures correlated with increased rates. Our study concluded that the Random Forest model was effective in predicting malaria incident rates in Uganda and highlighted the significance of climate factors and preventive measures such as mosquito nets and antimalarial drugs. We recommended that districts with malaria hotspots lacking Indoor Residual Spraying (IRS) coverage prioritize its implementation to mitigate incident rates, while those with high malaria rates in 2020 require immediate attention. By advocating for the use of appropriate predictive models, our research emphasized the importance of evidence-based decision-making in malaria control strategies, aiming to reduce transmission rates and save lives.

Genetic Disposition: Susceptibility of Human Blood Groups and Abo Analysis to Malaria and Typhoid Infections

Background: Malaria and typhoid have remained major infectious tropical diseases. Clinically, whenever there is severe malaria, cough is always an associating symptom owing to typhoid infection arising from poor hygiene in respect to drinking water and food. There is a strong association between human blood group and disease. Residual malaria transmission, effect of climate change on malaria vector composition, environmental management targeted at malaria breeding control as an intervention strategy are areas of interest to WHO in malaria control in Sub-saharan Africa. A body of data is been built on susceptibility of human blood groups to malaria, HIV and HBV and presently malaria and typhoid. If climate change warrants a change in composition of vectors and as well resistance to ACT therapy, the susceptibility or vulnerability of the human blood group is also called to question. The link between susceptibility of human blood group to malaria and typhoid has not been previously investigated. Purpose: The present study assesses the genetic disposition (susceptibility of human blood groups and abo analysis) to malaria and typhoid infections. Patients and Methods: One hundred (100) patients were screened for malaria and typhoid infections in a tertiary health facility—His glory hospital Lagos, Nigeria. Blood samples were collected by venu-puncture from 53 females and 47 males adults aged between 15 – 47 years, who were infected either singly or coinfected with malaria and typhoid. Microscopic detection of P. falciparum, widal serological technique for salmonella antibody presence and genotypic determination were all done using standard WHO methods. Human material or data were analyzed or performed in accordance with the declaration of Helsinki (2000). Ethical clearance was obtained from the ethic and research committee of the Ministry of Health via the Faculty of the Basic Medical Sciences, University of Calabar (Ethical Certificate number CRS/MOH/HRP/2023/396). Results: The results obtained expressed in percentage frequency show that genotype AA were more susceptible to typhoid and malaria infections compared to AS and SS, also blood group O was more susceptible to malaria and typhoid infection compared to blood groups A, AB and B, although, there is no significant difference between male and female gender, susceptibility to malaria infection, the female gender is more susceptible to typhoid than the male. The finding may be relevant to malaria susceptibility and genetics and thus provide baseline information on management of the scourge. Conclusion: We conclude that genotype AA and blood group 0+ are more susceptible to malaria and typhoid infection in humans.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Coinfection with Malaria in Selected States in Nigeria

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Plasmodium species are the causative agents of coronavirus disease 2019 (COVID-19) and malaria respectively with similar clinical presentations. The objective of this study is to determine the burden of co-infection of SARS-CoV-2 and malaria in the general population. Five (5 mLs) of blood samples were collected for SARS-CoV-2 and malaria parasite test. The malaria test was performed using a commercially available one-step malaria antigen Plasmodium falciparum histidine-rich protein 2 (Pf HRP-II) rapid test kit. The results of the study showed that the participants that were coinfected with SARS-CoV-2 IgG and malaria were 13 (2.5%) in Lagos, 1114 (39.1%) in Delta and 49 (2.3%) in Sokoto States. The prevalence of coinfection of SARS-CoV-2 and malaria in urban areas in Lagos, Delta and Sokoto States were 7 (2.2%), 1373 (48.1%), and 5 (0.2%) respectively. In rural areas, the prevalence of coinfection of SARS-CoV-2 and malaria in Lagos, Delta and Sokoto States were 6 (0.3%), 365 (12.8%), and 44 (2.1%) respectively in this study. This suggests that participants in the urban areas were more prone to co-infections than the rural areas in Lagos and Delta states, while it was otherwise in Sokoto State. In conclusion, the co-infection of SARS-CoV-2 and malaria was very high in Delta State compared to the other States. It is important for clinics to screen for both diseases when patients present with symptoms of malaria. This is because the infections have similar symptoms and the public is quick to assume malaria infection without diagnosing for COVID-19 and vice versa.

Association between Placental Malaria and Severe Pre-Eclampsia in Two University Hospitals of Yaounde City

Context: Pre-eclampsia and placental malaria, are two diseases that share pathophysiological similarities, such as placental ischemia, endothelial dysfunction and production of pro-inflammatory cytokines. Objective: The objective of our study was to investigate the association between placental malaria lesions and severe pre-eclampsia. Methodology: We conducted a prospective analytical cross-sectional study in two University Hospitals in the city of Yaounde (Yaounde Central Hospital and the Gynaecological Obstetrics and Paediatrics Hospital), and in the laboratory of the Centre Pasteur in Yaounde over an eight-month period (1st January 2021 – 1st September 2021). All patients with pre-eclampsia diagnosed according to the criteria of the International Society for the Study of Hypertension (ISSHP) and free of chronic metabolic or infectious pathology were included in this study. The patients were divided into two groups: group 1 (mild pre-eclampsia) and group 2: severe pre-eclampsia. Socio-demographic, clinical and histopathological characteristics specific to pre-eclampsia and placental malaria were investigated. Statistical analysis was performed with SPSS 23.0 software, Chi 2 was used to compare categorical variables, Student t-test was used to compare means, and logistic regression was used to assess the association between placental malaria lesions and PES. Results: The mean age of our study population was 29.93 ± 7.36 years versus 28.28 ± 7.18 years in patients with mild and severe pre-eclampsia respectively. Pre-eclampsia placental lesions (accelerated villous maturation, infarction) were significantly greater in patients with severe pre-eclampsia (p Conclusion: Placental malaria lesions were significantly associated with severe pre-eclampsia and increased the risk of developing severe pre-eclampsia placental lesions by a factor of 10.

Low Birth Weight and Intermittent Preventive Treatment of Malaria in Pregnant Women in Lomé (Togo) in 2021: A Cross-Sectional Study

Background: Since 2012, the World Health Organization has recommended intermittent preventive treatment with sulfadoxine-pyrimethamine (IPT-SP) to prevent malaria-related complications in pregnant women. Ten years following these recommendations, we conducted this study to estimate the coverage for three doses of IPT-SP (IPT3) as well as the prevalence of low birth weight (LBW), and its associated factors in Lomé (Togo) in 2021. Methods: A cross-sectional study was conducted between January and March 2021. An exhaustive recruitment of women and their newborns was carried out in the maternity wards of the Sylvanus Olympio University Hospital Center. Data from antenatal consultations and clinical data of the newborns were collected. Multivariate logistic regression was carried out to determine factors associated with LBW. Results: A total of 252 mother-child pairs were included in this study. Median age of the mothers was 27 years, IQR [24-31]. More than a third (35.3%) of the mothers were primigravida. IPT3 coverage was 66.7% and 14.7% of newborns had a LBW. The prevalence of LBW was 33.3% [23.3-43.4] in women who had received fewer than 3 doses of IPT-SP and 5.4% [2.0-8.8] in those who had received at least 3 doses of IPT-SP (p Conclusion: Ten years following recommendations of the WHO on IPT-SP, malaria prevention based on IPT-SP is not optimal among pregnant women in Lomé, and the proportion of LBW children remains high. Actions to strengthen the three-dose IPT-SP policy are needed to prevent malaria and its consequences among newborns in Togo.

Predicting Malaria Dynamics in Burundi Using Deep Learning Models

Malaria continues to be a major public health problem on the African continent, particularly in Sub-Saharan Africa despite the ongoing efforts and significant progress that has been made. In the case of Burundi, malaria remains a major public health concern in the general population. In the literature, there are limited malaria prediction models for Burundi knowing that such tools are much needed for intervention design. In this study, deep-learning models are built to estimate malaria cases in Burundi. The forecast of malaria cases was carried out both at the provincial and national levels. Long short term memory (LSTM) model, a type of deep learning model, has been used to achieve best results using climate-change related factors such as temperature, rainfall, relative humidity, together with malaria historical data and human population. With this model, the results showed that different parameter tuning can be used to determine the minimum and maximum expected malaria cases. The univariate version of that model (LSTM), which learns from previous dynamics of malaria cases, gives more precise estimates, but both univariate and multivariate models have the same overall trends at the province level and country level.

Global Stability Analysis of the Mathematical Model for Malaria Transmission between Vector and Host Population

In this paper, we discuss a mathematical model of malaria transmission between vector and host population. We study the basic qualitative properties of the model, the boundedness and non-negativity, calculate all equilibria, and prove the global stability of them and the behaviour of the model when the basic reproduction ratio R0 is greater than one or less than one. The global stability of equilibria is established by using Lyapunov method. Graphical representations of the calculated parameters and their effects on disease eradication are provided.

Towards A Malaria-Free Future Eleven African countries join hands to put an end to the deaths caused by malaria by#$%$

Malaria is a fatal disease transmitted by certain species of mosquitos,causing over 600,000 deaths annually,mainly in Africa,according to the World Health Organisation(WHO).At a ministerial conference held in Yaoundé,capital of Cameroon,representatives from 11 out of the 12 nations most severely impacted by the disease,including Ghana,Mali,Mozambique,and the Democratic Republic of the Congo,vowed to reduce malaria-related mortality by at least 90 percent compared to 2015 levels.

Malaria slide bank plays a crucial role in achieving and sustaining malaria elimination in India

India's healthcare system continues to place the highest priority on the fight against malaria[1].Malaria elimination program has received considerable attention from both the public and private sectors,resulting in a significant drop in malaria cases[2].In 2022,a total of 176000 million cases of malaria were reported in India,in which Plasmodium(P.)falciparum has contributed 57.0%and 42.3%were P.vivax cases and limited cases of P.malariae and P.ovale.

Dengue and falciparum malaria co-infection in travelers returning from Burkina Faso:Report of two cases in Northeastern Italy

Rationale: Malaria and dengue are the most prevalent vector-borne diseases in tropical countries. Plasmodium parasite and dengue virus(DENV) concurrent infection is possible and often under-recognized in geographical areas where these infections are both endemic.Patients concern and diagnosis: We describe the first two cases of Plasmodium falciparum and DENV-3 co-infection in travelers returning to northeastern Italy from Burkina Faso during 2013-2014.Interventions: Malaria infection in both patients was treated with mefloquine. Due to the persistence of symptoms despite of the antimalaria treatment, dengue was also investigated;the treatment of dengue was symptomatic.Outcomes: The patients were discharged in good general condition.Lessons: The need for surveillance of potential malaria and dengue co-infection in travelers returning to Europe from endemic areas is highlighted, as infection with Plasmodium does not exclude arboviral co-infection.

Acceptance,availability and feasibility of RTS,S/AS01 malaria vaccine:A review of literature

Malaria remains the most serious infectious disease and is one of the leading causes of death among children in malaria endemic areas.The development of malaria vaccines has been underway since 1960s.Significant progress in the development of vaccine has been made in the last decade.On 6 October 2021,World Health Organization recommended widespread use of the RTS,S/AS01 malaria vaccine.The level of acceptance of RTS,S/AS01 malaria vaccine is relatively low in middle-income countries.This might be because of lack of information regarding vaccine implementation in such countries.The proper and efficient execution of the malaria vaccination program necessitates careful consideration of each community's socio-cultural setting.The most prominent RTS,S/AS01 vaccine trial was conducted from 2009 to 2011 in which eleven sites in seven African countries participated.Results of the trial,published in 2015,provided a promising advance in the development of a malaria vaccine for African children.As of 2019,large-scale pilot studies of the vaccine have been conducted in Ghana,Kenya,and Malawi,involving several hundreds of thousands of infants.The RTS,S/AS01 vaccine shows modest efficacy against malaria and has a feasible mode of administration.Although there is increased risk of meningitis,cerebral malaria,pneumonia,anemia,febrile convulsions and gastroenteritis,the vaccine still has a feasible mode of administration and high cost effectiveness and can be easily implemented in resource-limited settings.