Background: Four years since the call to eradicate malaria and almost two years since the publication of the malaria eradication R&D agenda, the Malaria Eradication Scientific Alliance - MESA - is galvanizing research efforts. In collaboration with the scientific community, MESA identifies, prioritises and financially supports research projects testing hypotheses deemed critical to the science of malaria eradication. MESA aims to advance the science of malaria eradication. Methods: MESA is led by a nine member Steering Committee, chaired by the Barcelona Institute for Global Health (ISGlobal). The Steering Committee partners are the Bill and Melinda Gates Foundation, Ghana School of Public Health, International Centre for Genetic Engineering and Biotechnology, London School of Hygiene and Tropical Medicine, Mahidol Vivax Research Center, Nossal Institute for Global Health, Swiss Tropical and Public Health Institute and World Health Organization Global Malaria Program (WHO-GMP). The MESA Strategic Advisory Council provides high level governance and oversight of the MESA project and activities. The MESA Secretariat supports the running of the project. Topic-specific working groups, convened through MESA, undertake gap analysis of research activities, identify needs and advise on research project priorities. To date, MESA has convened working groups on 'Health Systems' Readiness' and 'Measurement of Transmission'. Results: MESA provides the necessary coordination of research projects testing hypotheses pertinent to the science of malaria eradication. Engagement with the scientific community synergizes research efforts and keeps MESA's priorities responsive to changing needs. Further, with active involvement of the WHO GMP, MESA integrates knowledge of health systems, socio-economic and cultural factors from the household to national levels such that tools are developed to achieve malaria elimination in different settings. Conclusion: As a meeting place for the malaria community, MESA facilitates the coordination of research efforts and dissemination of results. In parallel, MESA updates the R&D agenda, makes cost estimates of malaria eradication R&D activities and measures spending. This further informs priority-setting and further facilitates coordination.

Introduction Buruli ulcer (BU) disease is a chronic debilitating skin disease caused by Mycobacterium Ulcerans. The ulcer can be so extensive that it affects daily activities of the person affected, ulcers can heal and lead to disfiguring of the part of the body involved. Ghana is one of the countries in the West-Africa that buruli ulcer affects. Among the districts, our study area is affected. Unfortunately the exact way of getting the disease is not known. Our study set out to determine risk profile for transmission of M Ulcerans. Methods We conducted a case-control study with Spatial mapping, a case was defined as any person aged 2 years or more who resides in the Suhum-Kraboa-Coaltar and Akuapem South districts diagnosed of Buruli ulcer meeting the WHO clinical case definition for M ulcerans disease and a control is without the disease. We carried out active case search throughout all the communities in the study area (yet to finish) and took geographical positioning system (GPS) co-ordinates of the cases and control as well as significant features of the environment. Culture samples of the cases will be tested to show the various haplotypes. Results So far 50 cases and controls have been identified. GPS maps generated shows areas where buruli ulcer is most prevalent and its relation to the Densu River. Conclusion Our preliminary findings show that there is clustering of cases of buruli ulcer. Haplotypes of the various cases are yet to be done to throw more light on the mode of transmission.

Malaria in the first trimester of pregnancy is associated with adverse pregnancy outcomes. Artemisinin-based combination therapies (ACTs) are a highly effective, first-line treatment for uncomplicated Plasmodium falciparum malaria, except in the first trimester of pregnancy, when quinine with clindamycin is recommended due to concerns about the potential embryotoxicity of artemisinins. We compared adverse pregnancy outcomes after artemisinin-based treatment (ABT) versus non-ABTs in the first trimester of pregnancy.For this systematic review and individual patient data (IPD) meta-analysis, we searched MEDLINE, Embase, and the Malaria in Pregnancy Library for prospective cohort studies published between Nov 1, 2015, and Dec 21, 2021, containing data on outcomes of pregnancies exposed to ABT and non-ABT in the first trimester. The results of this search were added to those of a previous systematic review that included publications published up until November, 2015. We included pregnancies enrolled before the pregnancy outcome was known. We excluded pregnancies with missing estimated gestational age or exposure information, multiple gestation pregnancies, and if the fetus was confirmed to be unviable before antimalarial treatment. The primary endpoint was adverse pregnancy outcome, defined as a composite of either miscarriage, stillbirth, or major congenital anomalies. A one-stage IPD meta-analysis was done by use of shared-frailty Cox models. This study is registered with PROSPERO, number CRD42015032371.We identified seven eligible studies that included 12 cohorts. All 12 cohorts contributed IPD, including 34 178 pregnancies, 737 with confirmed first-trimester exposure to ABTs and 1076 with confirmed first-trimester exposure to non-ABTs. Adverse pregnancy outcomes occurred in 42 (5·7%) of 736 ABT-exposed pregnancies compared with 96 (8·9%) of 1074 non-ABT-exposed pregnancies in the first trimester (adjusted hazard ratio [aHR] 0·71, 95% CI 0·49–1·03). Similar results were seen for the individual components of miscarriage (aHR=0·74, 0·47–1·17), stillbirth (aHR=0·71, 0·32–1·57), and major congenital anomalies (aHR=0·60, 0·13–2·87). The risk of adverse pregnancy outcomes was lower with artemether–lumefantrine than with oral quinine in the first trimester of pregnancy (25 [4·8%] of 524 vs 84 [9·2%] of 915; aHR 0·58, 0·36–0·92).We found no evidence of embryotoxicity or teratogenicity based on the risk of miscarriage, stillbirth, or major congenital anomalies associated with ABT during the first trimester of pregnancy. Given that treatment with artemether–lumefantrine was associated with fewer adverse pregnancy outcomes than quinine, and because of the known superior tolerability and antimalarial effectiveness of ACTs, artemether–lumefantrine should be considered the preferred treatment for uncomplicated P falciparum malaria in the first trimester. If artemether–lumefantrine is unavailable, other ACTs (except artesunate–sulfadoxine–pyrimethamine) should be preferred to quinine. Continued active pharmacovigilance is warranted.Medicines for Malaria Venture, WHO, and the Worldwide Antimalarial Resistance Network funded by the Bill & Melinda Gates Foundation.

Background Most malaria deaths occur in rural areas. Rapid progression from illness to death can be interrupted by prompt, effective medication. Antimalarial treatment cannot rescue terminally ill patients but could be effective if given earlier. If patients who cannot be treated orally are several hours from facilities for injections, rectal artesunate can be given before referral and acts rapidly on parasites. We investigated whether this intervention reduced mortality and permanent disability.Methods In Bangladesh, Ghana, and Tanzania, patients with suspected severe malaria who could not be treated orally were allocated randomly to a single artesunate (n=8954) or placebo (n=8872) suppository by taking the next numbered box, then referred to clinics at which injections could be given. Those with antimalarial injections or negative blood smears before randomisation were excluded, leaving 12068 patients (6072 artesunate, 5996 placebo) for analysis. Primary endpoints were mortality, assessed 7-30 days later, and permanent disability, reassessed periodically. All investigators were masked to group assignment. Analysis was by intention to treat. This study is registered in all three countries, numbers ISRCTN83979018, 46343627, and 76987662.Results Mortality was 154 of 6072 artesunate versus 177 of 5996 placebo (2.5% vs 3 . 0%, p=0 . 1). Two versus 13 (0 . 03% vs 0 . 22%, p=0 . 0020) were permanently disabled; total dead or disabled: 156 versus 190 (2 . 6% vs 3.2%, p=0 . 0484). There was no reduction in early mortality (56 vs 51 deaths within 6 h; median 2 h). In patients reaching clinic within 6 h (median 3 h), pre-referral artesunate had no significant effect on death after 6 h or permanent disability (71/4450 [1.6%] vs 82/4426 [1.9%], risk ratio 0.86 [95% Cl 0.63-1.18], p=0.35). In patients still not in clinic after more than 6 h, however, half were still not there after more than 15 h, and pre-referral rectal artesurate significantly reduced death or permanent disability (29/1566 [1.9%] vs 57/1519 [3.8%], risk ratio 0.49 [95% CI 0.32-0.77], p=0 . 0013).Interpretation If patients with severe malaria cannot be treated orally and access to injections will take several hours, a single inexpensive artesunate suppository at the time of referral substantially reduces the risk of death or permanent disability.Funding UNICEF/UNDP/World Bank Special Programme for Research and Training in Tropical Diseases (WHO/TDR); WHO Global Malaria Programme (WHO/GMP); Sall Family Poundation; the European Union (QLRT-2000-01430); the UK Medical Research Council; USAID; Irish Aid; the Karolinska Institute; and the University of Oxford Clinical Trial Service Unit (CTSU).

The use of insecticide treated nets is effective in reducing all cause malaria mortality and morbidity between 17 and 43% in children under five years and provides protection to pregnant women who are most susceptible to malaria. ITNs (Insecticide Treated Nets) are easy to use and require less technical and capital outlay to implement compared with other vector control methods. They are cost-effective, which has led to widespread implementation of ITNs by countries on a large scale. ITN use has however been limited due to the cost outlay households require to make towards the purchase of nets, households' inability to associate the effectiveness of the net with the insecticide leading to low re-treatment rates in most settings and the seasonality associated with the spread of malaria. This chapter provides a review of research on ITN, strategies of improving the availability and effectiveness of the nets and a comparison of ITNs and other malaria preventive methods. The review highlights inequity in ITN use among various socio-economic groups with the poorest being the least to benefit from ITNs even where they are highly subsidized. It discusses the break through in the production of PermaNet (R) to resolve the problem of low re-treatment of nets.

OBJECTIVES To describe the trend and causes of neonatal deaths in a rural district in northern Ghana.METHODS Descriptive analysis of data collected from the Navrongo Demographic Surveillance System and verbal autopsies conducted on all neonatal deaths from 1995-2002.RESULTS Of 1118 recorded neonatal deaths 1068 (95.5%) could be analysed. Only 13.2% of deaths occurred at the health facility; 62.7% occurred in the early neonatal period, with prematurity (38%) and birth injuries (19%) as leading causes. Infectious causes (66%) were the major contributors to late neonatal deaths. Infanticide accounted for 4.9% of all neonatal deaths. The cause-specific mortality rate for neonatal tetanus remained under 2.5% throughout the 8-year period. Overall, the neonatal mortality rate declined at an average of 2.5 per 1000 live births per year: Down by nearly 50% from 40.9 (95%C.I. 34.1-46.8) in 1995 to 20.5 (95%C.I.17.3-22.7) in 2002.CONCLUSION The various health interventions undertaken in this district have had the collateral effect of causing decline in neonatal mortality. Neonatal mortality could be further reduced by preventing and treating neonatal infections, having skilled attendance at delivery and the elimination of infanticide. Data from demographic surveillance sites may be useful in monitoring trends in child mortality.

After decades of debate about the need to improve the quality of basic health statistics in developing countries, there is at last substantial progress on the horizon. The recently created Health Metrics Network and the Ellison Institute for World Health offer the potential for strengthened health information systems to inform better policy development. 1 The Lancet Stumbling around in the dark. Lancet. 2005; 365: 1983 Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 2 Horton R The Ellison Institute: monitoring health, challenging WHO. Lancet. 2005; 366: 179-181 Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar , 3 Stansfield S Structuring information and incentives to improve health. Bull World Health Organ. 2005; 83: 562-563 PubMed Google Scholar WHOFirst consultation of the high-level advisory panel on health statistics. World Health Organization, Geneva2005http://www.who.int/healthinfo/statistics/programmeconsultationreport1/en/index.html Google Scholar Both initiatives are backed by new funding. Both will lead to new secretariats and partnerships between academics, governments, and intergovernmental agencies.

OBJECTIVE To provide internationally comparable data on the frequencies of different causes of death. METHODS We analysed verbal autopsies obtained during 1999 -2002 from 12 demographic surveillance sites in sub-Saharan Africa and Bangladesh to find cause-specific and age-specific mortality rates. The cause-of-death codes used by the sites were harmonized to conform to the ICD-10 system, and summarized with the classification system of the Global Burden of Disease 2000 (Version 2). FINDINGS Causes of death in the African sites differ strongly from those in Bangladesh, where there is some evidence of a health transition from communicable to noncommunicable diseases, and little malaria. HIV dominates in causes of mortality in the South African sites, which contrast with those in highly malaria endemic sites elsewhere in sub-Saharan Africa (even in neighbouring Mozambique). The contributions of measles and diarrhoeal diseases to mortality in sub-Saharan Africa are lower than has been previously suggested, while malaria is of relatively greater importance. CONCLUSION The different patterns of mortality we identified may be a result of recent changes in the availability and effectiveness of health interventions against childhood cluster diseases.

Africa's scientists tell industrialized nations what they need to hear.

Tropical Medicine & International HealthVolume 10, Issue 3 p. 207-209 Free Access Editorial: North–South research collaborations: a move towards a true partnership? Fred Binka, Fred Binka INDEPTH Network, Accra, GhanaSearch for more papers by this author Fred Binka, Fred Binka INDEPTH Network, Accra, GhanaSearch for more papers by this author First published: 23 February 2005 https://doi.org/10.1111/j.1365-3156.2004.01373.xCitations: 67 Author Fred Binka, INDEPTH Network, PO Box KD 213, Kanda, Accra, Ghana. E-mail: fred.binka@indepth-network.org This editorial is a keynote speech given during the workshop "Communicable disease research in Sub-Saharan Africa – from the African bench to patients and populations". The workshop, which took place in Accra, 18–22 April 2004, was coordinated by F. Binka from the INDEPTH Network in Accra and T. Junghanss from the University Hospital Heidelberg, and funded by the Volkswagen Foundation. This meeting was unique in that it brought together research institutions of the South and the North with research foundation representatives before launching a call for proposals for a new funding initiative ("Knowledge for Tomorrow. Cooperative Research Projects in Sub-Saharan Africa"), thereby giving the South a voice in shaping it. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume10, Issue3March 2005Pages 207-209 RelatedInformation

Abstract Objective To evaluate the effects of intermittent preventive treatment for malaria in infants (IPTi) with sulfadoxine-pyrimethamine in an area of intense, seasonal transmission. Design Cluster randomised placebo controlled trial, with 96 clusters allocated randomly to sulfadoxine-pyrimethamine or placebo in blocks of eight. Interventions Children received sulfadoxine-pyrimethamine or placebo and one month of iron supplementation when they received DPT-2, DPT-3, or measles vaccinations and at 12 months of age. Main outcome measures Incidence of malaria and of anaemia determined through passive case detection. Results 89% (1103/1242) of children in the placebo group and 88% (1088/1243) in the IPTi group completed follow-up to 24 months of age. The protective efficacy of IPTi against all episodes of malaria was 24.8% (95% confidence interval 14.3% to 34.0%) up to 15 months of age. IPTi had no protective effect against malaria between 16 and 24 months of age (protective efficacy −4.9%, −21.3% to 9.3%). The incidence of high parasite density malaria (≥ 5000 parasites/μl) was higher in the IPTi group than in the placebo group between 16 and 24 months of age (protective efficacy −19.5%, −39.8% to −2.2%). IPTi reduced hospital admissions with anaemia by 35.1% (10.5% to 52.9%) up to 15 months of age. IPTi had no significant effect on anaemia between 16 and 24 months of age (protective efficacy −6.4%, −76.8% to 35.9%). The relative risk of death up to 15 months of age in the IPTi group was 1.26 (95% confidence interval 0.81 to 1.96; P =0.31), and from 16 to 24 months it was 1.28 (0.77 to 2.14; P =0.35). Conclusions Intermittent preventive treatment for malaria with sulfadoxine-pyrimethamine can reduce malaria and anaemia in infants even in seasonal, high transmission areas, but concern exists about possible rebound in the incidence of malaria in the second year of life.

Ambitious new goals for control of malaria have been set and significant additional resources for malaria control are being mobilized. Yet for many of the countries most severely burdened by malaria, both baseline data and reliable monitoring of key impact indicators is lacking. For such countries, it will be difficult to know when targets are met or whether to make mid-course corrections if progress is inadequate. The new investments in malaria control have triggered resurgence in demand for health information, both for performance-based resource allocation and for health impact. We argue here that some of these resources will need to be diverted to support more integrated information systems able to monitor change and guide approaches, not just for malaria, but also for other important health and poverty related interventions. This paper urges a re-thinking of the nature of management information systems and sources in resource poor settings. A pathway is suggested that helps situate monitoring and evaluation more strategically in a framework of other information management steps for longitudinal, iterative, evidence-based decision making. Health Information Systems of the future will need much greater coherence in the use of information from disparate sources and much greater influence on action.

A cohort of 197 adults in Kassena-Nankana District (northern Ghana) was radically cured of malaria parasites to study subsequent incidence of malaria infection. During the following 20 weeks of the malaria transmission season, 49% experienced clinical attacks associated with Plasmodium falciparum parasitaemia. In a group of 202 adults identically followed-up 1 year later without being treated, only 38% experienced such episodes (log-rank test for equality of survivor functions, P=0.035). Clinical attacks in radically cured individuals presented with lower parasite densities but more symptoms. Randomized studies are needed to test the hypothesis that radical cure of P. falciparum enhances the risk and severity of subsequent clinical malaria attacks.

Rolling back malaria is possible. Tools are available but they are not used. Several countries deploy, as their national malaria control treatment policy, drugs that are no longer effective. New and innovative methods of vector control, diagnosis, and treatment should be developed, and work towards development of new drugs and a vaccine should receive much greater support. But the pressing need, in the face of increasing global mortality and general lack of progress in malaria control, is research into the best methods of deploying and using existing approaches, particularly insecticide-treated mosquito nets, rapid methods of diagnosis, and artemisinin-based combination treatments. Evidence on these approaches should provide national governments and international donors with the cost-benefit information that would justify much-needed increases in global support for appropriate and effective malaria control.