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  • mek inhibitor br Malaria is a major public health

    2019-04-15


    Malaria is a major public health problem and a leading cause of mortality worldwide, especially in sub-Saharan Africa, where 90% of the world\'s 627 000 malaria deaths occur every year. However, the disease is usually curable if diagnosed quickly. Diagnosis is often made on the basis of clinical symptoms, but this method is alarmingly inaccurate. Presumptive treatment of malaria is often used for all patients with fever to reduce malaria morbidity and mortality, particularly in resource-poor health facilities. Microscopy is the gold standard for diagnosis of malaria, but its effectiveness is affected by several factors, including quality of sample preparation, level of parasitaemia, and the skill of the laboratory technician. Rapid diagnostic tests provide an alternative to microscopy and give results accurately and promptly. With the introduction of artemisinin-based combination therapy, treatment should be provided only to patients with confirmed malaria infection to avoid overuse and reduce the cost of treatment, reduce drug wastage, and delay the emergence of resistance. However, for various reasons, clinicians and health providers rely more on their own clinical judgment than on the results of diagnostic tests, and antimalarial treatment is often given to patients with negative results on rapid diagnostic tests. To improve the situation, various intervention programmes to encourage behavioural change by clinicians and health providers have been developed and tested in different African countries. In , Wilfred Mbacham and colleagues report the results of a cluster-randomised trial to assess the introduction of rapid diagnostic tests when packaged with basic or enhanced clinician training interventions in two regions in Cameroon. Compared with control, neither the basic (1 day of training in malaria diagnosis, rapid diagnostic testing, and malaria treatment) nor the enhanced (3 days of training, including the basic modules plus three additional modules about adapting to change, professionalism, and effective communication) training programmes improved the proportion of patients treated in accordance with malaria treatment guidelines (the primary outcome; adjusted risk ratio 1·04 [95% CI 0·53–2·07; p=0·90] for basic and 1·17 [0·61–2·25; p=0·62] for enhanced training). However, the enhanced training programme was effective at reducing the proportion of patients with a negative test result receiving antimalarial drugs. This finding is encouraging and in line with those from similar studies done in other parts of the world. A study by Mbonye and colleagues done in Uganda similarly showed a significant mek inhibitor in the proportion of patients with a negative diagnostic test result for malaria who were prescribed antimalarial drugs after the training of health providers. However, in Mbacham and his colleagues\' study, neither of the training programmes significantly affected the proportion of patients with suspected malaria being tested or the proportion of patients with positive test results receiving artemisinin-based combination therapy. Conversely, results from the study in Uganda showed a significant improvement in the proportion of patients who received an appropriate antimalarial drug among those prescribed any antimalarial treatment. Although the investigators of the present study used a stratified cluster-randomised design and appropriate statistical techniques to analyse the data, limitations exist with respect to the sample size and unequal clusters in different study groups. Furthermore, the post-intervention survey was done 3 months after the intervention; the changes in clinicians\' behaviour with respect to the treatment of patients with negative test results might lose significance if measured again after 6 months or a year. Sustainability of behaviour change is crucial if such interventions are to provide any lasting benefits.
    Gambiense human African trypanosomiasis (HAT), or sleeping sickness, is a neglected tropical disease that has been targeted for elimination as a public health problem by 2020. Although this goal is challenging, it now seems achievable. Control efforts, sustained mainly by mobile teams who screen populations at risk with the Card Agglutination Test for Trypanosomiasis (CATT) and treat patients if confirmed by microscopic parasitological tests, have led to a rapid decrease in disease prevalence. Incidence passed below the symbolic number of 10 000 newly reported cases in 2009 and reached 7216 in 2012. Furthermore, important innovations in terms of diagnosis and treatment are now in development, generating great hopes that sustainable control strategies could be implemented. Among these achievements is the forthcoming availability of lateral flow rapid diagnostic tests that might be used for serodiagnosis of infection in place of CATT, which requires an electrical supply, a cold chain, and trained personnel. Alongside the elimination process, decreased disease prevalence means that screening by mobile teams will become less and less cost effective. Thus, integration of HAT diagnosis into the endemic country health systems needs to be promoted. Rapid diagnostic tests that do not require any specific equipment and are easy to use should help greatly in the development of an effective passive surveillance system in primary health-care centres.