Factors affecting haemoglobin dynamics in African children with acute uncomplicated Plasmodium falciparum malaria treated with single low-dose primaquine or placebo.

BACKGROUND: Single low-dose primaquine (SLDPQ) effectively blocks the transmission of Plasmodium falciparum malaria, but anxiety remains regarding its haemolytic potential in patients with glucose-6-phopshate dehydrogenase (G6PD) deficiency. We, therefore, examined the independent effects of several factors on haemoglobin (Hb) dynamics in falciparum-infected children with a particular interest in SLDPQ and G6PD status. METHODS: This randomised, double-blind, placebo-controlled, safety trial was conducted in Congolese and Ugandan children aged 6 months-11 years with acute uncomplicated P. falciparum and day (D) 0 Hbs ≥ 6 g/dL who were treated with age-dosed SLDPQ/placebo and weight-dosed artemether lumefantrine (AL) or dihydroartemisinin piperaquine (DHAPP). Genotyping defined G6PD (G6PD c.202T allele), haemoglobin S (HbS), and α-thalassaemia status. Multivariable linear and logistic regression assessed factor independence for continuous Hb parameters and Hb recovery (D42 Hb > D0 Hb), respectively. RESULTS: One thousand one hundred thirty-seven children, whose median age was 5 years, were randomised to receive: AL + SLDPQ (n = 286), AL + placebo (286), DHAPP + SLDPQ (283), and DHAPP + placebo (282). By G6PD status, 284 were G6PD deficient (239 hemizygous males, 45 homozygous females), 119 were heterozygous females, 418 and 299 were normal males and females, respectively, and 17 were of unknown status. The mean D0 Hb was 10.6 (SD 1.6) g/dL and was lower in younger children with longer illnesses, lower mid-upper arm circumferences, splenomegaly, and α-thalassaemia trait, who were either G6PDd or heterozygous females. The initial fractional fall in Hb was greater in younger children with higher D0 Hbs and D0 parasitaemias and longer illnesses but less in sickle cell trait. Older G6PDd children with lower starting Hbs and greater factional falls were more likely to achieve Hb recovery, whilst lower D42 Hb concentrations were associated with younger G6PD normal children with lower fractional falls, sickle cell disease, α-thalassaemia silent carrier and trait, and late treatment failures. Ten blood transfusions were given in the first week (5 SLDPQ, 5 placebo). CONCLUSIONS: In these falciparum-infected African children, posttreatment Hb changes were unaffected by SLDPQ, and G6PDd patients had favourable posttreatment Hb changes and a higher probability of Hb recovery. These reassuring findings support SLDPQ deployment without G6PD screening in Africa. TRIAL REGISTRATION: The trial is registered at ISRCTN 11594437.

How West African countries prioritize health.

BACKGROUND: The goal of Universal Health Coverage (UHC) is to ensure that everyone is able to obtain the health services they need without suffering financial hardship. UHC remains a mirage if government health expenditure is not improved. Health priority refers to general government health expenditure as a percentage of general government expenditure. It indicates the priority of the government to spend on healthcare from its domestic public resources. Our study aimed to assess health priorities in the Economic Community of West African States (ECOWAS) using the health priority index from the WHO's Global Health Expenditure Database. METHOD: We extracted and analysed data on health priority in the WHO's Global Health Expenditure Database across the 15 members of the ECOWAS (Benin, Burkina Faso, Cabo Verde, Cote d'Ivoire, The Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone, and Togo) from 2010 to 2018 to assess how these countries prioritize health. The data are presented using descriptive statistics. RESULTS: Our findings revealed that no West African country beats the cutoff of a minimum of 15% health priority index. Ghana (8.43%), Carbo Verde (8.29%), and Burkina Faso (7.60%) were the top three countries with the highest average health priority index, while Guinea (3.05%), Liberia (3.46%), and Guinea-Bissau (3.56%) had the lowest average health priority in the West African region within the period of our analysis (2010 to 2018). CONCLUSION: Our study reiterates the need for West African governments and other relevant stakeholders to prioritize health in their political agenda towards achieving UHC.

COVID-19 and progress towards achieving universal health coverage in Africa: A case of Nigeria.

Universal Health Coverage (UHC) 2030 is a global health target, and countries are making efforts to convert plans into tangible results. Nigeria, the most populated country in Africa, has made commitments towards UHC2030 target but is underperforming across many building blocks of health and progress has been slow. The arrival of COVID-19 poses additional pressure on the already feeble health system causing the government to direct focus towards containing the pandemic. However, existing gaps in health workforce density, weak primary health care infrastructure and inadequate budgetary allocation have resulted in inequitable access to basic healthcare services. This situation weighs most heavily on the poor who are mostly part of the informal economy thereby pushing people further into poverty. On the other hand, COVID-19 has provided valuable insights into Nigeria's current health system status which hopefully can be helpful in strengthening efforts towards building resilient health system and preparing the country towards future pandemic. The pandemic has highlighted the importance of essential health services and the need to strengthen primary healthcare system. It is, therefore, important that stakeholders in Nigeria and other African countries carry out situation analysis of the current health systems towards achieving UHC2030.

Uneven power dynamics must be levelled in COVID-19 vaccines access and distribution.

COVID-19 is one of the major global health threats of the 21st century, causing unprecedented humanitarian crises worldwide. Despite concerted efforts to curb the spread of the disease, the pandemic continues to strain healthcare systems globally and a safe, highly effective, and globally acceptable and equitable vaccination program, together with pre-existing precautionary measures, is essential to effectively contain the outbreak. We commented on the need to level any uneven power dynamics in COVID-19 vaccines access and distribution. The COVID-19 vaccines distribution must not allow for sovereignty which is tightly linked to historical imbalances in power and resources to result into discrimination between rich and poor countries. Poor countries must be supported in ensuring access to COVID-19 vaccines by levelling the power dynamics that perpetuate inequality and fuel inequity. We must ensure equity, fairness and transparency in COVID-19 vaccines distribution and gain public trust in COVID-19 vaccines through participatory community engagement. COVID-19 vaccines distribution and access must be equitable and not politicized.