Search

Spain has been hit hard by COVID-19, with more than 300 000 cases, 28 498 confirmed deaths, and around 44 000 excess deaths, as of Aug 4, 2020. More than 50 000 health workers have been infected, and nearly 20 000 deaths were in nursing homes. With a population of 47 million, these data place Spain among the worst affected countries. Spain is also reported to have one of the best performing health systems in the world and ranks 15th in the Global Health Security index. So how is it possible that Spain now finds itself in this position?

A resurgence of COVID-19 infections is occurring in Spain, with some of the worst figures in Europe. In August, 2020, we urged the Spanish Central Government and regional governments to independently evaluate their COVID-19 response to identify areas where public health and the health and social care system need to be improved.

A resurgence of COVID-19 infections is occurring in Spain, with some of the worst figures in Europe. In August, 2020, we urged the Spanish Central Government and regional governments to independently evaluate their COVID-19 response to identify areas where public health and the health and social care system need to be improved.

Spain has been hit hard by COVID-19, with more than 300 000 cases, 28 498 confirmed deaths, and around 44 000 excess deaths, as of Aug 4, 2020. More than 50 000 health workers have been infected, and nearly 20 000 deaths were in nursing homes. With a population of 47 million, these data place Spain among the worst affected countries. Spain is also reported to have one of the best performing health systems in the world and ranks 15th in the Global Health Security index. So how is it possible that Spain now finds itself in this position?

A resurgence of COVID-19 infections is occurring in Spain, with some of the worst figures in Europe.1, 2 In August, 2020, we urged the Spanish Central Government and regional governments to independently evaluate their COVID-19 response to identify areas where public health and the health and social care system need to be improved.3 Although we received widespread support from more than 50 scientific societies and associations representing public health, medical, and nursing professional communities; there is now a need to define such an evaluation in terms of its timing, scope, and leadership. Here, we suggest three major requisites and four guiding principles, adapted from McKee and colleagues,4 which we believe would ensure a successful independent evaluation.

Spain has been hit hard by COVID-19, with more than 300 000 cases, 28 498 confirmed deaths,1 and around 44 000 excess deaths, as of Aug 4, 2020.2 More than 50 000 health workers have been infected, and nearly 20 000 deaths were in nursing homes.3 With a population of 47 million, these data place Spain among the worst affected countries. Spain is also reported to have one of the best performing health systems in the world4 and ranks 15th in the Global Health Security index.5 So how is it possible that Spain now finds itself in this position?

[Background] Congenital cytomegalovirus (cCMV) infection is the most prevalent congenital infection acquired worldwide, with higher incidence in developing countries and among HIV-exposed children. Less is known regarding vertical transmission of parvovirus B19 (B19V) and enterovirus (EV). We aimed to assess the prevalence of CMV, B19V and EV vertical transmission and compare results of screening of congenital CMV obtained from two different specimens in a semirural Mozambican maternity., [Methods] A cross sectional study was conducted among pregnant mothers attending Manhiça District Hospital upon delivery. Information on maternal risk factors was ascertained. Dried umbilical cord (DUC) samples were collected in filter paper for CMV, B19V and EV detection by real-time polymerase chain reaction (RT-PCR), and nasopharyngeal aspirates (NPA) to test for CMV by RT-PCR. Maternal blood samples and placental biopsy samples were also obtained to investigate CMV maternal serology, HIV status and immunopathology., [Results] From September 2014 to January 2015, 118 mothers/newborn pairs were recruited. Prevalence of maternal HIV infection was 31.4% (37/118). CMV RT-PCR was positive in 3/115 (2.6%) of DUC samples and in 3/96 (6.3%) of NPA samples obtained from neonates. The concordance of the RT-PCR assay through DUC with their correspondent NPA sample was moderate (Kappa = 0.42 and p<0.001. No differences on cCMV prevalence were found among HIV-exposed and unexposed. All (100%) mothers were seropositive for CMV IgG. RT-PCR of EV and B19V in DUC were both negative in all screened cases. No histological specific findings were found in placental tissues. No risk factors associated to vertical transmission of these viral infections were found., [Conclusions] This study indicates the significant occurrence of vertical transmission of CMV in southern Mozambique. Larger studies are needed to evaluate the true burden, clinical relevance and consequences of congenital infections with such pathogens in resource-constrained settings.

Background. Evidence of the presence of Plasmodium vivax in the placenta is scarce and inconclusive. This information is relevant to understanding whether P. vivax affects placental function and how it may contribute to poor pregnancy outcomes. Methods. Histopathologic examination of placental biopsies from 80 Papua New Guinean pregnant women was combined with quantitative polymerase chain reaction (qPCR) to confirm P. vivax infection and rule out coinfection with other Plasmodium species in placental and peripheral blood. Leukocytes and monocytes/macrophages were detected in placental sections by immunohistochemistry. Results. Monoinfection by P. vivax and Plasmodium falciparum was detected by qPCR in 8 and 10 placentas, respectively. Seven of the 8 women with P. vivax placental monoinfection were negative in peripheral blood. By histology, 3 placentas with P. vivax monoinfection showed parasitized erythrocytes in the intervillous space but no hemozoin in macrophages nor increased intervillous inflammatory cells. In contrast, 7 placentas positive for P. falciparum presented parasites and hemozoin in macrophages or fibrin as well as intervillous inflammatory infiltrates. Conclusions. Plasmodium vivax can be associated with placental infection. However, placental inflammation is not observed in P. vivax monoinfections, suggesting other causes of poor delivery outcomes associated with P. vivax infection

Objectives The objective of this study was to inform public health actions to limit first-line ART failure and HIV drug resistance in Mozambique. Methods This was a cross-sectional study. HIV-1-infected adults on first-line ART for at least 1 year attending routine visits in the Manhiça District Hospital, in a semi-rural area in southern Mozambique with no HIV-1 RNA monitoring available, were evaluated for clinical, socio-demographic, therapeutic, immunological and virological characteristics. Factors associated with HIV-1 RNA ≥1000 copies/mL and HIV drug resistance were determined using multivariate logistic regression. Results The study included 334 adults on first-line ART for a median of 3 years, of which 65% (214/332) had suppressed viraemia, 11% (37/332) had low-level viraemia (HIV-1 RNA 150-999 copies/mL) and 24% (81/332) had overt virological failure (HIV-1 RNA ≥1000 copies/mL). HIV drug resistance was detected in 89% of subjects with virological failure, but in none with low-level viraemia. Younger age [OR = 0.97 per additional year (95% CI = 0.94-1.00), P = 0.039], ART initiation at WHO stage III/IV [OR = 2.10 (95% CI = 1.23-3.57), P = 0.003] and low ART adherence [OR = 2.69 (95% CI = 1.39-5.19), P = 0.003] were associated with virological failure. Longer time on ART [OR = 1.55 per additional year (95% CI = 1.00-2.43), P = 0.052] and illiteracy [OR = 0.24 (95% CI = 0.07-0.89), P = 0.033] were associated with HIV drug resistance. Compared with HIV-1 RNA, clinician's judgement of ART failure, based on clinical and immunological outcomes, only achieved 29% sensitivity and misdiagnosed 1 out of every 4.5 subjects. Conclusions Public health programmes in Mozambique should focus on early HIV diagnosis, early ART initiation and adherence support. Virological monitoring drastically improves the diagnosis of ART failure, enabling a better use of resources

Rockfill is a coarse material widely used in geotechnical works such as earth-fill dams (shoulders and toe drains), as well as in embankments and well-graded quarry materials for railway infrastructures. These structures are usually submitted to significant changes in water content and to the permanent action of water during the different stages of construction and along the long-term behaviour after construction. Despite being coarse materials they are very sensitive to the action of water, undergoing collapse deformations on wetting, as well as time-dependent deformations associated with particle breakage (sub-critical crack propagation) and their subsequent rearrangement. This experimental study evaluates some important aspects of these coarse aggregates (slate gravels from Lechago dam, Teruel) in relation to their interaction with water. Particularly, it addresses the long-term volumetric deformations of the material with emphasis placed on particle size, the effect of stress history, and on the current state of stresses and suctions (overconsolidation ratio), as well as on the effect of void ratio (cumulative volumetric deformation). Different phenomenological constitutive expressions have been proposed, which take into account all the aspects mentioned above and allow properly reproducing the long-term experimental results. As an alternative to the control of total suction through the relative humidity of vapour, this research has explored the effect of controlling the activity of the liquid (water molecules available to induce environmental action on crack propagation) on the hydraulic and mechanical response of the coarse slate aggregates. Experimental protocols have been developed that have allowed the gravel skeleton to be flooded with different saline solutions, as well as performing particle splitting tests (indirect tensile tests). These tests have allowed comparing the kinetics and steady-state conditions of the response at both particle and material s, Las escolleras son materiales gruesos ampliamente utilizados en obras geotécnicas como por ejemplo en presas de materiales sueltos (espaldones, bloques de cuñas, repiés), así como en pedraplenes y todo-uno de obras ferroviarias. Estas estructuras están sometidas a cambios de humedad importantes y a la acción permanente del agua durante las distintas etapas constructivas y en el comportamiento a largo plazo post-construcción. A pesar de ser materiales gruesos son muy sensibles a la acción del agua, presentando deformaciones volumétricas de colapso por humedecimiento, así como deformaciones diferidas en el tiempo, que están asociadas con la rotura de partículas (propagación sub-crítica de fisuras) y su reacomodo posterior. Este estudio, de carácter eminentemente experimental, evalúa algunos aspectos importantes de estos agregados gruesos (gravas de pizarra de los espaldones de la presa de Lechago, Teruel) y su interacción con el agua. Particularmente se enfoca en las deformaciones volumétricas a largo plazo de estos materiales con énfasis en el tamaño de las partículas, el efecto de la historia y el valor actual de tensiones y succiones (relación de sobreconsolidación), del mismo modo que en el efecto del índice de poros (deformación volumétrica acumulada). Se han propuesto expresiones constitutivas fenomenológicas que toman en cuenta todos los aspectos anteriormente señalados y que permiten reproducir adecuadamente los resultados experimentales a largo plazo. Como alternativa al control de la succión total a través de la humedad relativa del vapor, esta investigación ha explorado el efecto de controlar la actividad del líquido (moléculas de agua disponibles para inducir la acción ambiental sobre la propagación de fisuras) en la respuesta hidráulica y mecánica de las gravas de pizarra. Se han desarrollado protocolos experimentales que han permitido inundar al esqueleto de gravas con diferentes soluciones salinas, además de realizar ensayos de rotura de partículas (ens, Postprint (published version)

BackgroundArtesunate-amodiaquine (AS-AQ) is one of the most widely used artemisinin-based combination therapies (ACTs) to treat uncomplicated Plasmodium falciparum malaria in Africa. We investigated the impact of different dosing strategies on the efficacy of this combination for the treatment of falciparum malaria.MethodsIndividual patient data from AS-AQ clinical trials were pooled using the WorldWide Antimalarial Resistance Network (WWARN) standardised methodology. Risk factors for treatment failure were identified using a Cox regression model with shared frailty across study sites.ResultsForty-three studies representing 9,106 treatments from 1999-2012 were included in the analysis; 4,138 (45.4%) treatments were with a fixed dose combination with an AQ target dose of 30 mg/kg (FDC), 1,293 (14.2%) with a non-fixed dose combination with an AQ target dose of 25 mg/kg (loose NFDC-25), 2,418 (26.6%) with a non-fixed dose combination with an AQ target dose of 30 mg/kg (loose NFDC-30), and the remaining 1,257 (13.8%) with a co-blistered non-fixed dose combination with an AQ target dose of 30 mg/kg (co-blistered NFDC). The median dose of AQ administered was 32.1 mg/kg [IQR: 25.9-38.2], the highest dose being administered to patients treated with co-blistered NFDC (median = 35.3 mg/kg [IQR: 30.6-43.7]) and the lowest to those treated with loose NFDC-25 (median = 25.0 mg/kg [IQR: 22.7-25.0]). Patients treated with FDC received a median dose of 32.4 mg/kg [IQR: 27-39.0]. After adjusting for reinfections, the corrected antimalarial efficacy on day 28 after treatment was similar for co-blistered NFDC (97.9% [95% confidence interval (CI): 97.0-98.8%]) and FDC (98.1% [95% CI: 97.6%-98.5%]; P = 0.799), but significantly lower for the loose NFDC-25 (93.4% [95% CI: 91.9%-94.9%]), and loose NFDC-30 (95.0% [95% CI: 94.1%-95.9%]) (P < 0.001 for all comparisons). After controlling for age, AQ dose, baseline parasitemia and region; treatment with loose NFDC-25 was associated with a

BackgroundArtesunate-amodiaquine (AS-AQ) is one of the most widely used artemisinin-based combination therapies (ACTs) to treat uncomplicated Plasmodium falciparum malaria in Africa. We investigated the impact of different dosing strategies on the efficacy of this combination for the treatment of falciparum malaria.MethodsIndividual patient data from AS-AQ clinical trials were pooled using the WorldWide Antimalarial Resistance Network (WWARN) standardised methodology. Risk factors for treatment failure were identified using a Cox regression model with shared frailty across study sites.ResultsForty-three studies representing 9,106 treatments from 1999-2012 were included in the analysis; 4,138 (45.4%) treatments were with a fixed dose combination with an AQ target dose of 30 mg/kg (FDC), 1,293 (14.2%) with a non-fixed dose combination with an AQ target dose of 25 mg/kg (loose NFDC-25), 2,418 (26.6%) with a non-fixed dose combination with an AQ target dose of 30 mg/kg (loose NFDC-30), and the remaining 1,257 (13.8%) with a co-blistered non-fixed dose combination with an AQ target dose of 30 mg/kg (co-blistered NFDC). The median dose of AQ administered was 32.1 mg/kg [IQR: 25.9-38.2], the highest dose being administered to patients treated with co-blistered NFDC (median = 35.3 mg/kg [IQR: 30.6-43.7]) and the lowest to those treated with loose NFDC-25 (median = 25.0 mg/kg [IQR: 22.7-25.0]). Patients treated with FDC received a median dose of 32.4 mg/kg [IQR: 27-39.0]. After adjusting for reinfections, the corrected antimalarial efficacy on day 28 after treatment was similar for co-blistered NFDC (97.9% [95% confidence interval (CI): 97.0-98.8%]) and FDC (98.1% [95% CI: 97.6%-98.5%]; P = 0.799), but significantly lower for the loose NFDC-25 (93.4% [95% CI: 91.9%-94.9%]), and loose NFDC-30 (95.0% [95% CI: 94.1%-95.9%]) (P < 0.001 for all comparisons). After controlling for age, AQ dose, baseline parasitemia and region; treatment w

Mild cognitive impairment is understood as a cognitive deficit of insufficient severity to fulfil the criteria for Alzheimer's disease. Many studies have attempted to identify which cognitive functions are most affected by this type of impairment and which is the most sensitive neuropsychological test for early detection. This study investigated sustained and selective attention, processing speed, and the inhibition process using a sample of people divided into three groups mild cognitive impairment, Alzheimer disease and cognitively healthy controls selected and grouped based on their scores in the Mini Mental State Examination and Cambridge Cognitive Examination-revised. Three tests from the Cambridge Neuropsychological Test Automated Battery (Motor Screening Task, Stop Signal Task and Reaction time) were used as well as the d2 attention test. The results show that that participants with mild cognitive impairment and Alzheimer disease showed lower levels of concentration compared with the cognitively healthy controls group in the d2 test and longer reaction times in the Cambridge Neuropsychological Test Automated Battery, although the differences were not marked in the latter test. The impairments in basic cognitive processes, such as reaction time and sustained attention, indicate the need to take these functions into account in the test protocols when discriminating between normal aging and early and preclinical dementia processes., El Deterioro Cognitivo Leve es entendido como un déficit cognitivo de curso insuficiente para cumplir criterios de demencia o Enfermedad de Alzheimer. Muchos estudios tratan de averiguar cuáles son las funciones cognitivas más afectadas en este tipo de deterioro, así como las pruebas neuropsicológicas más sensibles a la hora de detectarlos tempranamente. Este estudio tratará de estudiar la atención sostenida y selectiva, velocidad de procesamiento, así como el factor de inhibición, en una muestra de sujetos divididos en tres grupos (Deterioro Cognitivo leve, Demencia de Alzheimer y sujetos cognitivamente sanos), mediante el Mini Mental State Examination y la batería Cambridge Cognitive Examination-revised. Para ello utilizaremos las pruebas Cambridge Neuropsychological Test Automated Battery (Motor Screening Task, Stop Signal Task, Reaction Time) así como el test de atención d2. Los resultados muestran que aquellos sujetos con Deterioro Cognitivo Leve y Demencia de Alzheimer obtienen índices menores de concentración en comparación con los sujetos cognitivamente sanos en el test d2, así como mayores tiempos de reacción en las pruebas del Cambridge Neuropsychological Test Automated Battery, aunque estos no muestran diferencias tan marcadas. Este deterioro en los procesos cognitivos básicos, tales como el tiempo de reacción o la atención sostenida, nos indica la necesidad de tener en cuenta estas funciones en los protocolos de evaluación a la hora de discriminar entre el envejecimiento normal y los procesos tempranos de demencia.

The paper presents the results of an experimental investigation aimed at evaluating the time-dependent compressibility of coarse crushed quartzitic slate, focusing on the effects of the previ- ous loading and hydraulic history. Long-term and large diameter compression tests under oedometer conditions were performed at different total suctions (relative humidity values) and vertical stresses but following different loading and hydraulic paths. A finding, which has practical implications in earthwork constructions, is that pre-compressing at increasing overconsolidation ratios or pre-soaking the crushed material at constant and elevated stresses leads to the progressive vanishing of long-term deformations., Postprint (published version)

The concentrations of dichlorodiphenyltrichloroethane (DDT) compounds in cord blood of 214 children born between 2003 and 2006 in Manhiça (Mozambique) have been determined. In this time interval, corresponding to the period before DDT reintroduction for indoor residual spraying, the observed values averaged 0.8 and 0.4 ng/ml for 4,4′-dichlorodiphenyldichloroethylene (4,4′-DDE) and 4,4′-DDT, respectively, and were similar to those found in western countries. However, the 4,4′-DDT/4,4′-DDE ratio was high indicating that the inputs of these compounds arriving to children in utero originated from recent uses of the insecticide. The strongest factor affecting DDT concentration was parity. A well-defined decreasing concentration trend was observed for the cord blood concentrations in the period of study. The trend was also observed for multiparae and primiparae mothers independently. Children from multiparae women showed much lower concentrations than primiparae women. Children from mothers with secondary school level exhibited lower concentrations of these pesticides than mothers with lower degree of education.

The paper presents the results of an experimental investigation aimed at evaluating the time-dependent compressibility of a coarse crushed quartzitic slate, focusing on the effects of the previous loading and hydraulic history. Long-term and large diameter compression tests under oedometer conditions were performed at different relative humidity (total suctions) and vertical stresses but following different loading and hydraulic paths. A finding is that pre-compressing at increasing overconsolidation ratios or pre-soaking the crushed material at constant and elevated stresses leads to the progressive vanishing of long-term deformations., Postprint (published version)

The paper explores the time-dependent compressibility of coarse crushed quartzitic slate, focusing on the effects of the previous loading history. Large diameter oedometer tests were performed at different relative humidity (or total suctions) and different overconsolidation ratios (OCR). Preliminary results suggested that pre-compressing the rockfill material at increasing OCRs lead to the progressive vanishing of rockfill delayed deformations., Postprint (published version)

[Introduction] We report on the analysis of 4,4′-dichlorodiphenyltrichloroethane (4,4′-DDT) and its metabolites in thatch and branch samples constituting the wall materials of dwellings from South African subtropical areas. This approach was used to assess the exposure to DDT in the residents of the dwellings after indoor residual spraying (IRS) following recommended sanitation practices against malaria vectors., [Discussion] Examination of the distributions of DDT compounds (2,4′-DDT, 4,4′-DDT and its metabolites) in 43 dwellings from the area of Manhiça (Mozambique) has shown median concentrations of 19, 130, and 23 ng/g for 2,4′-DDT, 4,4′-DDT, and 4,4′-DDE, respectively, in 2007 when IRS implementation was extensive. The concentrations of these compounds at the onset of the IRS campaign (n = 48) were 5. 5, 47, and 2. 2 ng/g, respectively. The differences were statistically significant and showed an increase in the concentration of this insecticide and its metabolites. Calculation of 4,4′-DDT in the indoor air resulting from the observed concentrations in the wall materials led to the characteristic values of environments polluted with this insecticide. © 2011 The Author(s).

Breast milk concentrations of 4,4'-DDT and its related compounds were studied in samples collected in 2002 and 2006 from two populations of mothers in Manhiça, Mozambique. The 2006 samples were obtained several months after implementation of indoor residual spraying (IRS) with DDT for malaria vector control in dwellings and those from 2002 were taken as reference prior to DDT use. A significant increase in 4,4'-DDT and its main metabolite, 4,4'-DDE, was observed between the 2002 (median values 2.4 and 0.9 ng/ml, respectively) and the 2006 samples (7.3 and 2.6 ng/ml, respectively, p< 0.001 and 0.019, respectively). This observation identifies higher body burden intakes of these compounds in pregnant women already in these initial stages of the IRS program. The increase in both 4,4'-DDT and 4,4'-DDE suggest a rapid transformation of DDT into DDE after incorporation of the insecticide residues. The median baseline concentrations in breast milk in 2002 were low, and the median concentrations in 2006 (280 ng/g lipid) were still lower than in other world populations. However, the observed increases were not uniform and in some individuals high values (5100 ng/g lipid) were determined. Significant differences were found between the concentrations of DDT and related compounds in breast milk according to parity, with higher concentrations in primiparae than multiparae women. These differences overcome the age effect in DDT accumulation between the two groups and evidence that women transfer a significant proportion of their body burden of DDT and its metabolites to their infants. © 2011 Elsevier Ltd.

Introduction Malaria in pregnancy is a major driver of maternal and infant mortality in sub-Saharan Africa. The WHO recommends the administration of intermittent preventive treatment with sulfadoxine pyrimethamine (IPTp-SP) at antenatal care (ANC) visits. Despite being a highly cost-effective strategy, IPTp-SP coverage and uptake remains low. A pilot project was conducted to assess the cost-effectiveness (CE) of community-based delivery of IPTp (C-IPTp) in addition to ANC delivery to increase IPTp uptake in the Democratic Republic of Congo (DRC), Madagascar (MDG), Mozambique (MOZ) and Nigeria (NGA). Methods Costs and CE estimates of C-IPTp were calculated according to two scenarios: (1) costs in 'programmatic mode' (ie, costs if C-IPTp was to be implemented by national health systems) and (2) costs from the pilot project. The effectiveness of C-IPTp was obtained through estimates of the averted disability-adjusted life-years (DALYs) associated with maternal clinical malaria and anaemia, low birth weight and neonatal mortality. Results Net incremental costs of C-IPTp ranged between US$6138-US$47 177 (DRC), US$5552-US$31 552 (MDG), US$10 202-US$53 221 (MOZ) and US$667-US$28 645 (NGA) per 1000 pregnant women, under scenarios (1) and (2), respectively. Incremental cost-effectiveness ratios (ICERs) ranged between US$15-US$119 in DRC, US$9-US$53 in MDG, US$104-US$543 in MOZ and US$2-US$66 in NGA per DALY averted, under scenarios (1) and (2), respectively. ICERs fall below the WHO recommended CE threshold based on the gross domestic product per capita. Conclusion Findings suggest that C-IPTp is a highly cost-effective intervention. Results can inform policy decisions on adopting and optimising effective interventions for preventing malaria in pregnancy.

Background Malaria in pregnancy is a major public health problem in sub-Saharan Africa (SSA), which imposes a significant economic burden. We provide evidence on the costs of malaria care in pregnancy to households and the health system in four high-burden countries in SSA. Methods Household and health system economic costs associated with malaria control in pregnancy were estimated in selected areas of the Democratic Republic of Congo (DRC), Madagascar (MDG), Mozambique (MOZ) and Nigeria (NGA). An exit survey was administered to 2,031 pregnant women when leaving the antenatal care (ANC) clinic from October 2020 to June 2021. Women reported the direct and indirect costs associated to malaria prevention and treatment in pregnancy. To estimate health system costs, we interviewed health workers from 133 randomly selected health facilities. Costs were estimated using an ingredients-based approach. Results Average household costs of malaria prevention per pregnancy were USD6.33 in DRC, USD10.06 in MDG, USD15.03 in MOZ and USD13.33 in NGA. Household costs of treating an episode of uncomplicated/complicated malaria were USD22.78/USD46 in DRC, USD16.65/USD35.65 in MDG, USD30.54/USD61.25 in MOZ and USD18.92/USD44.71 in NGA, respectively. Average health system costs of malaria prevention per pregnancy were USD10.74 in DRC, USD16.95 in MDG, USD11.17 in MOZ and USD15.64 in NGA. Health system costs associated with treating an episode of uncomplicated/complicated malaria were USD4.69/USD101.41 in DRC, USD3.61/USD63.33 in MDG, USD4.68/USD83.70 in MOZ and USD4.09/USD92.64 in NGA. These estimates resulted in societal costs of malaria prevention and treatment per pregnancy of USD31.72 in DRC, USD29.77 in MDG, USD31.98 in MOZ and USD46.16 in NGA. Conclusions Malaria in pregnancy imposes a high economic burden on households and the health system. Findings emphasize the importance of investing in effective strategies that improve access to malaria control and reduce the burden of the i

Background. Evidence of the presence of Plasmodium vivax in the placenta is scarce and inconclusive. This information is relevant to understanding whether P. vivax affects placental function and how it may contribute to poor pregnancy outcomes. Methods. Histopathologic examination of placental biopsies from 80 Papua New Guinean pregnant women was combined with quantitative polymerase chain reaction (qPCR) to confirm P. vivax infection and rule out coinfection with other Plasmodium species in placental and peripheral blood. Leukocytes and monocytes/macrophages were detected in placental sections by immunohistochemistry. Results. Monoinfection by P. vivax and Plasmodium falciparum was detected by qPCR in 8 and 10 placentas, respectively. Seven of the 8 women with P. vivax placental monoinfection were negative in peripheral blood. By histology, 3 placentas with P. vivax monoinfection showed parasitized erythrocytes in the intervillous space but no hemozoin in macrophages nor increased intervillous inflammatory cells. In contrast, 7 placentas positive for P. falciparum presented parasites and hemozoin in macrophages or fibrin as well as intervillous inflammatory infiltrates. Conclusions. Plasmodium vivax can be associated with placental infection. However, placental inflammation is not observed in P. vivax monoinfections, suggesting other causes of poor delivery outcomes associated with P. vivax infection

Objectives The objective of this study was to inform public health actions to limit first-line ART failure and HIV drug resistance in Mozambique. Methods This was a cross-sectional study. HIV-1-infected adults on first-line ART for at least 1 year attending routine visits in the Manhiça District Hospital, in a semi-rural area in southern Mozambique with no HIV-1 RNA monitoring available, were evaluated for clinical, socio-demographic, therapeutic, immunological and virological characteristics. Factors associated with HIV-1 RNA ≥1000 copies/mL and HIV drug resistance were determined using multivariate logistic regression. Results The study included 334 adults on first-line ART for a median of 3 years, of which 65% (214/332) had suppressed viraemia, 11% (37/332) had low-level viraemia (HIV-1 RNA 150-999 copies/mL) and 24% (81/332) had overt virological failure (HIV-1 RNA ≥1000 copies/mL). HIV drug resistance was detected in 89% of subjects with virological failure, but in none with low-level viraemia. Younger age [OR = 0.97 per additional year (95% CI = 0.94-1.00), P = 0.039], ART initiation at WHO stage III/IV [OR = 2.10 (95% CI = 1.23-3.57), P = 0.003] and low ART adherence [OR = 2.69 (95% CI = 1.39-5.19), P = 0.003] were associated with virological failure. Longer time on ART [OR = 1.55 per additional year (95% CI = 1.00-2.43), P = 0.052] and illiteracy [OR = 0.24 (95% CI = 0.07-0.89), P = 0.033] were associated with HIV drug resistance. Compared with HIV-1 RNA, clinician's judgement of ART failure, based on clinical and immunological outcomes, only achieved 29% sensitivity and misdiagnosed 1 out of every 4.5 subjects. Conclusions Public health programmes in Mozambique should focus on early HIV diagnosis, early ART initiation and adherence support. Virological monitoring drastically improves the diagnosis of ART failure, enabling a better use of resources