Search results for “Malaria

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15 articles

Malaria: A Driving Force to the Emergence and the Global Spread of Antibiotics Resistance

Mar 2025 DOI 10.14302/issn.2693-1176.ijgh-25-5429
O. Makanjuola RasheedCorresponding author

Malaria and bacteraemia are significant public health concerns and economic threats. In Africa, the intensity for simultaneous transmission and co-infection of Plasmodium spp and other bacteria pathogens are extremely high. It is believed that malaria suppress the immune system and enable the translocation of bacteria in the gastrointestinal tract to other cellular compartments in the body. Some of the factors that contributed to the co-emergence of these pathogens are poor access to clean water, sanitation and hygiene (WASH), poor infection control measures, inefficient health care systems. In addition, the similarities in the clinical signs and symptoms of these febrile diseases and the fact that the etiologic diagnostic testing can be complex, costly, and limited are the reasons why clinicians in resource-constrained setting often prescribe antibiotics empirically prior to or without laboratory testing to prevent severe outcomes in any patient hospitalized with malaria. However, this indiscriminate use of antibiotics has been identified as the driving force for antibiotic resistance, which is already at alarming rate in malaria endemic nations. In developed countries where malaria had been previously eradicated, there are increasing reports of imported malaria with concurrent bacteraemia. In this review, we emphasized the role of malaria in the indiscriminate use of antibiotics and the fact that eliminating malaria in Africa is one of the best strategies to address the emergence and the global spread of multi-drug resistance organisms.

Socio-Demographic Factors Responsible for Uptake of Intermittent Preventive Treatment and Health Seeking Behaviours for Malaria in Pregnancy among Women of Reproductive Ages in Nigeria

Oct 2022 DOI 10.14302/issn.2641-4538.jphi-22-4329
Adejoh Attah TimothyCorresponding author National Space Research and Development Agency, Obasanjo Space Centre, Umaru Musa Ydar'adua express way, P.M.B. 437, Lugbe, Abuja

Introduction Malaria in pregnancy is a serious public health concern that could result in detrimental health outcomes for pregnant women and their foetuses. In Nigeria, there is still a significant risk of the disease epidemic and adverse effects especially in pregnancy. The aim of this study is to assess the socio-demographic factors associated with Intermittent Preventive Treatment and health seeking behaviours for malaria in pregnancy among women of reproductive ages in Nigeria Methods Using the National Demographic Survey (NDHS) 2018 data, a cross sectional study was conducted to assess socio-demographic factors associated with Intermittent Preventive Treatment (IPT) for Malaria among Nigerian women of reproductive ages. Result Majority were between ages 30-39 years (39.5%), married/cohabiting (91.8%), Muslims (59.5%), from the north (68.9%), uneducated ( 49.9%), poor (47.5%), and grand parous (65.7%). 63.4% of the women had taken fansidar for malaria in pregnancy while only 6.1% had received healthcare for malaria from informal sources. Except for marital status, all socio-demographic variables (regions, highest educational level, wealth index, age group, religion and parity) were significantly associated with intake of IPT. Additionally, region, education, wealth index, age group, marital status and religion were associated with health seeking behaviour for malaria in pregnancy (P<.05). After control for other variables, wealth index, highest educational level, married/cohabiting marital status and religion was significantly associated with intake of IPT while region, primary and secondary education, poorer and richest wealth index, widowed/separation influenced health seeking for malaria in pregnancy (P<.05). Conclusion The National Malaria Elimination programme should evaluate existing policies that develop interventions that are centred on high risk population in order to prevent malaria in pregnancy while improving health seeking behaviours of women of reproductive ages.

Factors Associated with Persistent malaria transmission in urban Peripheral Areas Dar es Salaam Region, Tanzania

Oct 2020 DOI 10.14302/issn.2641-4538.jphi-19-3115
D Mwalimu CharlesCorresponding author Muhimbili University of Health and Allied Sciences - Dar es Salaam

Africa Region has the highest burden of malaria with an estimated of 3.5 million more malaria cases in 2017 compared 212 million cases in reported in 2016. Data collected from 2015 to 2017, shown no global progress in reducing malaria cases. In Mainland Tanzania, malaria control interventions have significantly led to the reduction in malaria prevalence from 18.1% in 2008 to 7.3% in 2017. Despite of these achievements, malaria burden is still highly heterogonous with some regions including urban peripheral areas of Dar es Salaam, presenting persistent malaria transmission ranging from 2 to 57%. Material and Methods A cross- sectional population based survey was carried out in Ilala Municipality in Dar es Salaam; data was collected from 2nd to 31 April, 2019. Multistage cluster sampling was used to select the households where individual member were conveniently selected to participate in the study. Structured questionnaire were administered by the trained researcher assistants to assess individual risk factors for malaria. Rapid Malaria diagnostic test (mRDT) was used to identify individual exposed to malaria infection. Measure of association used was prevalence odds ratio (POR). Multivariate regression model used to determine prevalence odds ratio, variable with p- value < 0.05 were considered as independent risk factor for persistent malaria transmission. Results A total of 830 participants were recruited in the study, mean age was 24yrs ±20.4SD. Majority 489 (58.9%) were female, 459 (55.3%) were >18 yrs old, primary or no education were 687 (82.8%), farmer or unemployed were 639 (77%). Msongola ward contributed 406 (48.9%). Overall malaria prevalence in the study areas was (4.5%). Nets ownership was 141 (16.9%), usage was 121 (85.8%).Low proportion of net ownerships (POR: 7.67, 95% CI: 4.23, 24.6), residing in the households surrounded by mosquito breeding sites POR: 20.07, 95% CI: 7.03, 57.29) and residing in houses with unscreened windows (POR: 1.21, 95% CI: 1.26, 3.40) were independently associated with malaria infection. Conclusion Low nets ownership, residing in the households surrounded by mosquito breeding sites and in households with unscreened windows was independent factors associated with risk of malaria in the areas. Promotion of ITNs coverage, application of biolarvicides through community engagement and house screening was recommended to reduce the risk of malaria infection in the areas.

Invivo Impact of Malaria and HIV Co-Infection on CD4 Cell Count of Infected Patients of Niger Delta Extraction

May 2020 DOI 10.14302/issn.2328-0182.japst-20-3347
Obioma AzuonwuCorresponding author Department of Medical Laboratory Science, Medical Bacteriology / Virology / Parasitology Unit, Rivers State University, Nkpolu – Oroworukwo, Port Harcourt, Rivers State, Nigeria.

The study evaluated the impact of co-infection of malaria parasitaemia, and HIV positive indices on the CD4 cell count of 120 HIV infected subjects, who were already diagnosed and visiting Braithwaite Memorial Specialist Hospital Port Harcourt for routine Medical check-up. Also, a control group of 40 HIV negative were included as part of the study control group. The subjects were between the age ranges of ≤10–79 years respectively. A double check laboratory assay was conducted to detect the presence of antibody to HIV as confirmed using immunocomb 11 and Determine for HIV status. A thick Blood film stained with field stain (A and B) was used to detect the presence of malaria parasite in the subject’s blood. Furthermore, CD4 cell count was assayed using Partec cyflow counter (Partec, Germany). Excel and Graphpad statistical software were used for analysis of the data generated. The result among the HIV positive subjects and control subjects revealed that the highest positive for malaria infection was observed among ≤10 years age group as 2 (100%) and 11 (84.61%) respectively. In the HIV positive subjects, the distribution of malaria infection among sex revealed a high rate in male 42(77.78%) than in female 44 (66.67%). Similarly, the control recorded a high rate of malaria infection in male 11 (57.89%) than in female 7 (33.33%). However, 86 (71.67%) had malaria and HIV co-infection while 34 (65%) had only HIV mono infection. The positive HIV subjects who had CD4 cells count below 200 cells/mm3 were 15%, above 200-499cells/mm3 were 58.3% while 500 cells/mm3 and above had normal CD4 cells counts for 26%. Nonetheless, for the control subjects, no CD4 cells count of below 200cells/ mm was observed, 2.5% fell within the moderate category while 75% had normal CD4 cells count. Statistical analysis using ANOVA and t-test showed that there is significant difference between CD4 of seropositive and seronegative subjects infected with or without malaria (p=0.00). In addition, a t-test further demonstrated Comparison of Mean CD4 Cell Count among HIV and Malaria Infected and Non-Infected Subjects. MP/HIV Co-Infection and Mono Infection with No Infection showed strong mean difference (p=0.00) in the various CD4 counts while HIV Mono-Infection and others only had a non significant (p=0.44) mean difference between HIV Mono-Infection and No HIV or Malaria Infection. A robust and effective malaria and HIV control management programme should be strongly underpinned; so as to improve the quality of life of patients and HIV patients should be encouraged to live a healthy life style, through the provision of antiretroviral drugs and regular health education engagement, even as the provision of antimalarial treated net would be helpful to the subjects.

Parasite Research Open Access

Malaria and Typhoid Fever Coinfection in the Hospital University of Bobo-Dioulasso, Burkina Faso

Dec 2019 DOI 10.14302/issn.2690-6759.jpar-19-3081
Ibrahim SangaréCorresponding author Institut Supérieur des Sciences de la Santé, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso

Malaria and typhoid fever are two endemic infectious diseases in developing tropical countries including Burkina Faso. There are two distinct infectious diseases with many similar clinical signs. In each sanitary area, it is important to describe the "typhomalaria" epidemiology to elaborate adequate diagnosis algorithm and efficient treatment protocol. A cross-sectional study was carried out from July to October 2014 in the lab department of University Hospital Souro SANOU, Bobo-Dioulasso. All microscopy positive malaria during the study period was included. Serodiagnosis of Widal and Felix was performed systematically in all Plasmodium spmalaria cases. Titers of antibodies anti-agglutinin O equal or higher than 1/400 and/or 1/800 for anti-agglutinin H antibodies were considered positive for Salmonella sp. A total of 283 malaria cases were included in this study, majority falciparum malaria. In this malaria cases, 91 patients were seropositive for Salmonella sp. "Typhomalaria" co-infection prevalence was 34.3% (CI 95% (28.8%; 40.1%)). The patient with the normal hemoglobin rate had the highest prevalence of co-infection (46.7% versus 30.9; p=0.02). Malaria and typhoid fever co-infection was high (approximately 1/3 of malaria cases) in University hospital of Bobo-Dioulasso. This study revealed the need to explore typhoid fever in malaria confirmed cases, especially in persistent fevers and non-anemic situation despite adapting antimalarial treatment.

Malaria: An Unseen Enemy Threatening to Mankind

Feb 2018
Shende PravinCorresponding author Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM’s NMIMS, Mumbai, India.

The research work on malarial infection and malarial treatment has been increased tremendously over the years due to increased resistance of parasites to antimalarial drugs. To overcome the developed resistance, antimalarial drugs are used in combination. But eventually the amount of drugs administered increase with the resistance and extend to adverse effects. Many innovative, sophisticated delivery systems have been developed to increase the adequacy, competency and efficiency of antimalarial drugs. But it is predicted that these new inventions will also acquire resistance with time. Globally, it is seen that the countries which have low standards of hygiene have high levels of malarial infection. There are various antimalarial techniques developed and are slowly being adopted worldwide. But the first step is to maintain the hygiene and cleanliness so that mosquitoes will not harvest.

Assessment of the Preferred Methods Used by Mothers to Prevent Malaria Infection among Children Under Five Years in the Hohoe Municipality Of Ghana

Sep 2017 DOI 10.14302/issn.2474-3585.jpmc-17-1739
Tarkang ElvisCorresponding author Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Ho, Ghana

Background: The use of Long Lasting Insecticide Nets (LLINs) is seen as a major public health intervention and has shown to have both direct and indirect effects on the dynamics of malaria transmission. This report assessed the methods used by mothers to prevent malaria infection among their children under five years in the Hohoe Municipality. Method: A cross-sectional survey carried out in February 2017 among 418 mothers with children under five. Data were collected in the form of interviews using questionnaires on the usage of LLIN alone, LLIN with other methods (LLIN+) and use of other methods only (OMs). Chi square test and multinomial logistic regression were used to determine the association between dependent and independent variables. Results: Of the 418 mothers, 28.5% used LLIN only, 50.7% used LLIN+ and 20.8% used OMs only to prevent malaria. Mothers aged 30-39 and 40-49 years were 3.87 and 5.55 times more likely to use LLIN only rather than OMs as compared to those aged less than 20 years (AOR=3.87, p=0.019) and (AOR=5.55, p=0.029) respectively. Similarly, mothers aged 30-39 and 40-49 years were 3.08 and 4.02 times more likely to use LLIN+ rather than OMs as compared to those aged less than 20 years (AOR=3.08, p=0.023) and (AOR=4.02, p=0.050) respectively. Mothers who attained a higher level of education were 2.08 times more likely to use LLIN+ rather than OMs as compared to those with no formal education (AOR=2.08, p=0.015). Those who resided in rural areas were 2.00 times more likely to use LLIN only and LLIN+ rather than OMs only as compared to urban dwellers (AOR=2.00, p=0.002) and (AOR=2.00, p=0.013) respectively. Conclusion: More than half of the mothers preferred using LLIN+. One out of 3 mothers used only LLIN while one out of 5 used OMs only to prevent malaria. Age, educational level and place of residence were significantly associated with methods used to prevent malaria. There is the need for targeted education on LLINs in order to improve usage among younger mothers and mothers residing in urban areas. Further investigations to determine reasons for using OMs only and also determine the added value of OMs to LLINs in preventing malaria are recommended.

Regulation of Expression of Reactive Oxygen Intermediates During Plasmodium Infection to Reduce Immunopathology Provides a Possible Antioxidant Adjuvant to Enhance Anti-Malarial Drug Therapy

Aug 2017 DOI 10.14302/issn.2690-4721.ijcm-17-1676
W. Taylor-Robinson AndrewCorresponding author School of Health, Medical & Applied Sciences, Central Queensland University, Brisbane, QLD 4000, Australia

Malaria is a mosquito-transmitted infectious disease caused by intracellular protozoan parasites of the genus Plasmodium. In the absence of prompt and appropriate treatment contraction of primary infection by a human being often represents a medical emergency since it may progress rapidly to life-threatening complications. Exposure to parasites activates the immune system resulting in, among other effects, the release of reactive oxygen intermediates (ROI). This has the potential to induce oxidative damage, thereby causing cellular destruction, and hence to have a severe effect on vital organs of the body. Overexpression of ROI leads to immunosuppression and is a causal factor in the development of malaria-related disease symptoms. However, the body possesses various defence mechanisms, notably including the production of antioxidants, which are capable of reducing the cellular effects of ROI. Antioxidants are either sourced exogenously from the diet or synthesized through different intracellular mechanisms. Antioxidants that include glutathione peroxidase, catalase, EDTA and vitamin C suppress the initial production of ROI. Others such as uric acid, superoxide dismutase and vitamin E may also inhibit potentially damaging products of ROI metabolism. Current anti-malarial drugs often have damaging side-effects, as exemplified by memory impairment following treatment for cerebral malaria. Recent studies have explored the potential use of antioxidants alone or in combination with anti-malarials as a therapeutic means to negate Plasmodium-induced oxidative stress and its associated metabolic complications. It is indicated that when utilized in an adjuvant capacity antioxidants of natural and synthetic origin may improve anti-malarial therapy by causing less damage to the host during malaria infection.

Development of Municipal Decision-Making Strategies as Management Tools to Combat Waterborne Diseases

May 2024
Mangueina DanielCorresponding author

Waterborne diseases pose a significant global public health threat, particularly in sub-Saharan Africa, where frequent outbreaks occur. These diseases stemming from contaminated drinking water, poor waste management, and insufficient hygiene contribute to high morbidity and mortality in children under 5 years old. A study addressed waterborne diseases in N'Djamena, Chad's 3rd and 9th districts, through decision-making strategies. The research employed various methods, including a household survey using questionnaires, workshops, semi-structured interviews, and focus group discussions. Additionally, documentary research provided essential data for analysing the situation of diseases in the community. Epidemiological data from 2019- 2022 indicated a substantial prevalence of diseases such as diarrhoea, dysentery, skin infections, typhoid, abdominal pain, and malaria, with notable mortality, especially among children. Among surveyed households, 50% believed the consumed water was contaminated, attributing it to faecal matter, while 28% and 22% linked the diseases to inadequate hygiene and unsanitary conditions, respectively. The study advocates for comprehensive strategies, including improving water treatment efficiency, implementing safe waste management, promoting hygiene, and vaccination. Active involvement of all stakeholders, with municipal authorities leading, is crucial for effective implementation and combating waterborne diseases.

Proportion of WaterBorne Diseases in Children Aged 0 To 5 Years in the Health Area of the Urban Dispensary in Ebolowa - Cameroon

Jul 2021 DOI 10.14302/issn.2641-4538.jphi-21-3897
Pamela NanaCorresponding author Interstate center in public health in Central Africa (CIESPAC)

Background Water-related diseases are water-related disorders of the body. They are a public health problem as they are responsible for 60% of infant mortality in our developing countries. There are few studies in South Cameroon on the subject. Overall Objective of this work was to study the explanatory behavioral factors of waterborne diseases in children aged 0 to 5 years in the health area of the urban dispensary in Ebolowa in Cameroon in 2020. Methodology This was an analytical cross-sectional study comparing two groups of children (group 1: children affected by waterborne diseases group 2: children unaffected by waterborne diseases) within the health area of the Ebolowa urban area. It lasted 21 months and the study period was from 28 December 2020 to 22 January 2021. We included children aged 0 to 5 years present in households where parents/guardians gave their informed consent. Sampling was probabilistic and cluster sampling. Using the Kelsey formula, we obtained a sample of 420 households and 566 children. Data was collected using a questionnaire and stored in the Excel spreadsheet and analyzed with CDC USA's epi info software 7.2.2.6. The calculation p value was done with Stat Calc at the significance threshold of 0.05. Bold The proportion of waterborne diseases was 97% (549/566) among the children aged 0 to 5 years surveyed. The most common reasons for using the health service for children aged 0-5 years were diarrhea 78.62% (IC75.06-81.80), and malaria 78.09% (74.09-81.30). The median age of children suffering from these pathologies was 36 months (24; 60). The gender ratio (Boys/Girls) was 2.06/1. Conclusion We propose to increase the awareness of mothers/guardians on good practices; also, to increase health promotion in the fight against waterborne diseases.

Educational Needs of Mothers about using Oral Rehydration Salt (ORS) at Home During Acute Diarrhea in Children under 5 at Urmia Population Research Center

Apr 2020 DOI 10.14302/issn.2641-4538.jphi-20-3296
Rezapour BarataliCorresponding author Department of Public Health, Faculty of Health, Assistant Professor, PhD in Health education and promotion, Urmia University of Medical Sciences, Urmia, Iran

Preventable factors such as infectious diseases (pneumonia, diarrhea, and malaria), malnutrition and neonatal complications are still the leading cause of child mortality worldwide 1 In 2013, it is estimated that 6.3 million babies born worldwide died before the age of 5, and approximately 9.2% of these deaths were due to diarrheal diseases 23 in simple, accessible ways, and effective treatment can reduce diarrhea-related mortality and make hospital admissions unnecessary, and the role of mothers is the most important 4. Since the presentation of Oral Rehydration Therapy (ORT) in 1979, mortality has reduced. Diarrhea has had a steady downward trend 5. If mothers who have children under 5 years of age, used correctly ORS, they could easily resolve the problem of dehydration in acute diarrhea 6. Mothers didn’t use correctly ORS because of their Low literacy and lack of knowledge and wrong attitude about ORT7. Some health care workers provide mothers’ required equipments, regardless of their educational needs, and mothers may not use ORS. In this study, health workers identified mothers' educational needs and subsequently they trained them about using ORS at home in acute diarrhea in children under 5 years of age.

Biolarvicidal Potentials of the Methanolic-Leaf-Extracts of Selected Tropical Plant Species

Apr 2019 DOI 10.14302/issn.2641-7669.ject-19-2730
A. Oyedeji AyodeleCorresponding author Department of Biological Sciences, Niger Delta University, Wilberforce Island, Nigeria

The global impact of malaria and challenges encountered during its control have necessitated the application of multifaceted strategies, including the application of plant-derived agents. Amidst these challenges the proliferation of the vector is becoming hyperendemic in tropical region. This research is focused on the biolarvicidal activities of the methanolic leaf-extracts of Cassia alata, Microdesmispuberula¸ and Spilanthesfilicaulis against mosquito larva. The mosquito larva were assayed in a static non-renewal test. Results showed no mortality for the negative control, and total mortality for the positive control (p<0.05). The C. alata bioassay was the most active with LC50 value of 13.73 ppm, followed by; M. puberula(21.24 ppm), and S. filicaulis (28.86 ppm). This study concludes that methanolic-leaf-extracts of C. alata, M. puberula¸ and S. filicaulis can be recommended for the formulation of biolarvicide for the control of malaria.

In Silico Inhibition of Essential Candida albicans Proteins by Arenicin, a Marine Antifungal Peptide

Jan 2019 DOI 10.14302/issn.2643-0282.imsj-18-2448
Santiago Freitas e Silva KleberCorresponding author Biological Sciences Institute, Federal University of Goiás, Brazil

Fungal infections increased substantially in the last years, becoming a relevant public health problem. Many of these infections account for high rates of morbidity and mortality. The emergence of resistant fungal clinical isolates have also motivate studies to find new antifungal therapies. Candida albicans is an oportunistic pathogen and affects a great number of immunocompromised patients worldwide. The marine ecosystem has been considered a rich source of bioactive metabolites due to the complexity and originality of its structures. Proteins and peptides from marine organisms have been shown to have antiviral, anti-inflammatory, antimalarial, anticancer, antimicrobial and antifungal properties. Arenicins are antimicrobial peptides isolated from the marine lugworm Arenicola marina with 21 amino acid residues in a β-hairpin structure. Dihydrofolate reductase, exo-b-(1,3)-glucanase and sterol 14α-demethylase are essential C. albincas enzymes that take part in DNA, cell wall and membrane metabolism, respectively. The present study evaluates the interaction of arenicin with important enzymes of C. albicans related to cell wall, ergosterol and DNA metabolism in order to elucidate possible molecular targets. We showed through an in silico approach, that a single compound from a marine worm (A. marina), can bind to three C. albicans essential proteins. The interaction occurs in regions inside the active site or at least near, with amino acid residues evaluated as hot spots. Arenicin is a new promising antifugal drug. The next step is to investigate protein-protein interactions performed by DHFR, EBG and CYP51 and assess whether arenicin is able to disrupt essential interaction or not.

Morpho-Anatomical and Physicochemical Standardization of Diospyros malabarica (Desr.) Kostel Stem Bark

Jul 2018 DOI 10.14302/issn.2638-4469.japb-18-2166
Chandra Gupta PrakashCorresponding author University Institute of Pharmacy, Chhatrapati shahu Ji Maharaj University, Kanpur-208024, Uttar Pradesh India

Diospyros malabarica (Desr.) Kostel synonym Diospyros peregrina Gurke (Family: Ebenaceae) is a medium sized evergreen tree commonly known as Kendu in Assamese. The plant has ethnomedicinal significance and used by various ethnic communities of North-East India to treat various disorders like dysentery, diabetes, diarrhea malaria, ulcer and wounds. However, detailed scientific information is not available to identify the plant material, in order to ascertain its quality and purity. Therefore, the present work was carried out to perform morpho-anatomical and physicochemical analysis of D. malabarica stem bark. The bark is externally dark brown to black in color and rough having characteristics odor and astringent taste. The microscopy of bark reveals the presence of polygonal thick walled cork, 3-4 layered phellogen, 7-8 layered phelloderm, stone cells, phloem fibers and medullary rays. Stem bark powder showed thick walled cork cells, thick walled elongated phloem fibers, lignified stone cells and rhomboidal crystals of calcium oxalate. Further, physicochemical analysis of the bark power showed loss on drying, total ash, water soluble ash, and acid insoluble ash as 6.2, 5.6, 1.1, 2.45, and 5.7% w/w respectively. The alcohol and water soluble extractives values of the stem bark were 10.6 and 16.8% w/w respectively. The result of preliminary phytochemical screening indicates presence of triterpenoids, saponins, tannins, flavonoids and sterols. The findings of this study will facilitate pharmacognostic standardization of the plant material and aid in the preparation of an herbal monograph for the species.

Implementing a Cold-Chain System for Nutritional Assessment in Rural Uganda; Field Experiences from FtF Nutrition Innovation Lab Cohort Study

Feb 2018 DOI 10.14302/issn.2379-7835.ijn-17-1872
Agaba EdgarCorresponding author FTF Nutrition Innovation Lab, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA

Objective: To elaborate on the procedures undertaken to establish blood draws and cold chain for nutrition assessments. Setting: A total of 5,044 birth cohort households were enrolled and assessed using household questionnaires, anthropometry, and blood sampling to assess nutritional issues and exposures to environmental contaminants. The challenge was to obtain, transport, process, store, and analyze tens of thousands of serum samples obtained in sites that were often difficult to reach. Approach:  Before enrollment began, 24 healthcare facilities in the North and Southwest of Uganda were assessed for suitability as local nodes for processing and storage. Equipment needs included functional centrifuges, refrigeration, ice machines, and -20oC freezers. Other important physical infrastructure included the presence of backup power (generator or solar generated) in the event of electricity failure. Once samples were obtained, they were transported within 5 hours to the facility laboratories, where serum was separated and aliquoted into properly labelled storage tubes and then frozen. Relevant Changes: At community level, our team visited households or small group of household members close to their homes to reduce on travel time hence contributed to high retention rates. Our immediate testing for anemia and malaria results benefited enrollees and enhanced community acceptance. By using Village Health Teams (VHTs), we could accommodate household preferences for the timing of sample collection. Our engagement with phlebotomists transformed their role from a simple service into active team members. Lessons Learned: Our first lesson was that in our setting, the success of this nutrition biological sampling system required community engagement and acceptance. By combining an immediately actionable set of tests (for anemia and malaria), and visiting cohort households, we greatly enhanced the success of the system.

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