Improved Pregnancy Outcomes in a Prospective Study of Pregnant Women Enrolling in an Antenatal Clinic in Western Kenya

In areas of sub-Saharan Africa where malaria is endemic, pregnant women are at a greater risk of malaria than non-pregnant women leading to significant adverse consequences including anemia, intrauterine growth retardation, low birth weight (LBW), and pre-term delivery. The Kenya Ministry of Health adopted Intermittent Preventive Treatment (IPT) and use of insecticide-treated nets (ITN) as a National strategy for malaria prevention in pregnancy. In this report, we evaluated the prevalence of malaria, the anthropometric measures of birth outcomes and the reasons for loss to follow up among pregnant women participating in an ongoing cohort study in Western Kenya. A total of 175 HIV-negative pregnant women enrolled at antenatal clinic of Chulaimbo sub-District hospital were longitudinally evaluated in a monthly follow-up visits through antenatal visits (up to 4 per mother) and delivery. Thirty three percent and 15% of the pregnant women were malaria positive by real-time quantitative (Q)-PCR and microscopy respectively at enrolment, while 54% and 23% of the pregnant women had malaria by Q-PCR and microscopy respectively at any time during follow-up. Of the enrolled study participants, 65% delivered at Chulaimbo hospital. Overall, 39% (69) of the pregnant women were lost to follow-up. The major reasons for loss to follow up were relocation from the study area (26%) and delivery at alternative health facilities (25%). The mean birth weight of the newborn infants was 3202 g (range, 2000 g - 4000 g). Only 5.3% of the infants weighed less than 2500 g (low birth weight). The mean head circumference was 34 cm (range, 30 cm - 39 cm) with mean Apgar score (at 10 minutes) ± S.D. of 9.8 ± 0.97. In conclusion, we observed decreased adverse pregnancy outcomes among our study population. We recommend a larger study of all pregnant women attending the Chulaimbo hospital so as to assess whether effectiveness of malaria and anemia control programs lead to improved birth outcomes.

Molluscicidal effectiveness of Luo-Wei,a novel plant-derived molluscicide,against Oncomelania hupensis,Biomphalaria alexandrina and Bulinus truncatus

Background:Control of snail intermediate hosts has been proved to be a fast and efficient approach for interrupting the transmission of schistosomiasis.Some plant extracts have shown obvious molluscicidal activity,and a new compound Luo-Wei,also named tea-seed distilled saponin(TDS),was developed based on the saponins extracted from Camellia oleifera seeds.We aimed to test the molluscicidal activity of 4%TDS against the intermediate host snails in China and Egypt,and evaluate its environmental safety to non-target organisms.Methods:In the laboratory,Oncomelania hupensis,Biomphalaria alexandrina and Bulinus truncatus were exposed to 4%TDS,and the median lethal concentration(LC5o)was estimated at 24,48 and 72 h.In the field,snail mortalities were assessed 1,2,3 and 7 d post-immersion with 2.5 g/m34%TDS and 1,3,7 and 15 d post-spraying with 5 g/m24%TDS.in addition,the acute toxicity of 4%TDS to Japanese quail(Coturnixjaponica),zebrafish(Brachydanio rerio)and freshwater shrimp(Macrobrachium nipponense)was assessed by estimations of LC5o or median lethal dose(LD5o).Results:In the laboratory,the LC5o values of 4%TDS for O.hupensis were 0.701,0.371 and 0.33 mg/L at 24,48 and 72 h,respectively,and 4%TDS showed a 0.33 mg/L 24 h LC5o against B.alexandrina,and a 1.396 mg/L 24 h LCs0 against B.truncatus.Across all study regions,the pooled mortalities of O.hupensis were 72,86,94 and 98%at 1,2,3 and 7 d,following field immersion of 4%TDS at a dose of 2.5 g/m3,and were 69,77,85 and 88%at 1,3,7 and 15 d,following field spraying at 5 g/m2,respectively.4%TDS had moderate toxicity to Japanese quail(7 d LD5o>60 mg/kg)and to shrimp(96 h LCs0=6.28 mg/L;95%CI:3.53-11.2 mg/L),whereas its toxicity to zebrafish was high(96 h LCso--0.15 mg/L;95%CI:0.14-0.17 mg/L).Conclusions:4%TDS is active against O.hupensis,B.alexandrina and B.truncatus under laboratory and field conditions,and it may be a candidate molluscicide of plant origin.

Malaria epidemiology and interventions in Ethiopia from 2001 to 2016

Background:Ethiopia is one of the African countries where Plasmodium falciparum and P.vivax co-exist.Monitoring and evaluation of current malaria transmission status is an important component of malaria control as it is a measure of the success of ongoing interventions and guides the planning of future control and elimination efforts.Main text:We evaluated changes in malaria control policy in Ethiopia,and reviewed dynamics of country-wide confirmed and clinical malaria cases by Plasmodium species and reported deaths for all ages and less than five years from 2001 to 2016.Districts level annual parasite incidence was analysed to characterize the malaria transmission stratification as implemented by the Ministry of Health.We found that Ethiopia has experienced major changes from 2003 to 2005 and subsequent adjustment in malaria diagnosis,treatment and vector control policy.Malaria interventions have been intensified represented by the increased insecticide treated net(ITN)and indoor residual spraying(IRS)coverage,improved health services and improved malaria diagnosis.However,countrywide ITN and IRS coverages were low,with 64%ITN coverage in 2016 and IRS coverage of 92.5%in 2016 and only implemented in epidemic-prone areas of>2500 m elevation.Clinical malaria incidence rate dropped from an average of 43.1 cases per 1000 population annually between 2001 and 2010 to 29.0 cases per 1000 population annually between 2011 and 2016.Malaria deaths decreased from 2.1 deaths per 100000 people annually between 2001 and 2010 to 1.1 deaths per 100000 people annually between 2011 to 2016.There was shrinkage in the malaria transmission map and high transmission is limited mainly to the western international border area.Proportion of P.falciparum malaria remained nearly unchanged from 2000 to 2016 indicating further efforts are needed to suppress transmission.Conclusions:Malaria morbidity and mortality have been significantly reduced in Ethiopia since 2001,however,malaria case incidence is still high,and there were major gaps between ITN ownership and compliance in malarious areas.Additional efforts are needed to target the high transmission area of western Ethiopia to sustain the achievements made to date.