Evaluation of Implementation of Intermittent Screening and Treatment for Control of Malaria in Pregnancy in Jharkhand, India.

This study evaluated intermittent screening and treatment during pregnancy (ISTp) for malaria using rapid diagnostic tests (RDTs) at antenatal care (ANC) compared with passive case detection within the routine health system. The mixed-method evaluation included two cross-sectional household surveys (pre- and post-implementation of ISTp), in-depth interviews with health workers, and focus group discussions (FGDs) with pregnant women. Differences in proportions between surveys for a number of outcomes were tested; 553 and 534 current and recently pregnant women were surveyed (pre- and post-implementation, respectively). In-depth interviews were conducted with 29 health providers, and 13 FGDs were held with pregnant women. The proportion of pregnant women who received an RDT for malaria at ANC at least once during their pregnancy increased from pre- to post-implementation (19.2%; 95% CI: 14.9, 24.3 versus 42.5%; 95% CI: 36.6, 48.7; P < 0.0001), and the proportion of women who had more than one RDT also increased (16.5%; 95% CI: 13.1, 20.5 versus 27.7%; 95% CI: 23.0, 33.0; P = 0.0008). Post-implementation, however, only 8% of women who had completed their pregnancy received an RDT on three visits to ANC. Health workers were positive about ISTp mainly because of their perception that many pregnant women with malaria were asymptomatic. Health workers perceived pregnant women to have reservations about ISTp because of their dislike of frequent blood withdrawal, but pregnant women themselves were more positive. Intermittent screening and treatment during pregnancy was not sufficiently adopted by health workers to ensure the increased detection of malaria infections achievable with this strategy in this setting.

Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India.

BACKGROUND: The control of malaria in pregnancy (MiP) in India relies on testing women who present with symptoms or signs suggestive of malaria. We hypothesised that intermittent screening and treatment for malaria at each antenatal care visit (ISTp) would improve on this approach and reduce the adverse effects of MiP. METHODS: A cluster randomised controlled trial comparing ISTp versus passive case detection (PCD) was conducted in Jharkhand state. Pregnant women of all parities with a gestational age of 18-28 weeks were enrolled. Women in the ISTp group were screened with a rapid diagnostic test (RDT) for malaria at each antenatal clinic visit and those in the PCD group were screened only if they had symptoms or signs suggestive of malaria. All RDT positive women were treated with artesunate/sulfadoxine-pyrimethamine. The primary endpoint was placental malaria, determined by placental histology, and the key secondary endpoints were birth weight, gestational age, vital status of the newborn baby and maternal anaemia. RESULTS: Between April 2012 and September 2015, 6868 women were enrolled; 3300 in 46 ISTp clusters and 3568 in 41 PCD clusters. In the ISTp arm, 4.9% of women were tested malaria positive and 0.6% in the PCD arm. There was no difference in the prevalence of placental malaria in the ISTp (87/1454, 6.0%) and PCD (65/1560, 4.2%) groups (6.0% vs 4.2%; OR 1.34, 95% CI 0.78 to 2.29, p=0.29) or in any of the secondary endpoints. CONCLUSION: ISTp detected more infections than PCD, but monthly ISTp with the current generation of RDT is unlikely to reduce placental malaria or impact on pregnancy outcomes. ISTp trials with more sensitive point-of-care diagnostic tests are needed.

Wintertime spatio-temporal variation of ultrafine particles in a Belgian city.

Simultaneous measurements of ultrafine particles (UFPs) were carried out at four sampling locations situated within a 1 km(2) grid area in a Belgian city, Borgerhout (Antwerp). All sampling sites had different orientation and height of buildings and dissimilar levels of anthropogenic activities (mainly traffic volume). The aims were to investigate: (i) the spatio-temporal variation of UFP within the area, (ii) the effect of wind direction with respect to the volume of traffic on UFP levels, and (iii) the spatial representativeness of the official monitoring station situated in the study area. All sampling sites followed similar diurnal patterns of UFP variation, but effects of local traffic emissions were evident. Wind direction also had a profound influence on UFP concentrations at certain sites. The results indicated a clear influence of local weather conditions and the more dominant effect of traffic volumes. Our analysis indicated that the regional air quality monitoring station represented the other sampling sites in the study area reasonably well; temporal patterns were found to be comparable though the absolute average concentrations showed differences of up to 35%.

Dispersion modelling of traffic induced ultrafine particles in a street canyon in Antwerp, Belgium and comparison with observations.

The aim of this study is to investigate the dispersion of ultrafine particles and its spatial distribution in a street canyon and its neighbourhood with the 3D CFD model ENVI-met®. The performance of the model at street scale is evaluated and the importance of the boundary conditions like wind field and traffic emissions on the UFP concentration is demonstrated. To support and validate the modelled results, a short-term measurement campaign was conducted in a street canyon in Antwerp, Belgium. The UFP concentration was measured simultaneously with P-TRACK (TSI Model 8525) at four different locations in the canyon. The modelled UFP concentrations compare well with the measured data (correlation coefficient R from 0.44 to 0.93) within the standard deviation of the measurements. Despite the moderate traffic flow in the street canyon, UFP concentrations in the canyon are in general double of the background concentrations, indicating the high local contribution for this particle number concentration. Some of the observed concentration profiles are not resembled by the model simulations. For these specific anomalies, further analysis is performed and plausible explanations are put forward. The role of wind direction and traffic emissions is investigated. The performance evaluation of ENVI-met® shows that in general the model qualitatively and quantitatively describes the dispersion of UFP in the street canyon study.

Size resolved ultrafine particles emission model--a continues size distribution approach.

A new parameterization for size resolved ultrafine particles (UFP) traffic emissions is proposed based on the results of PARTICULATES project (Samaras et al., 2005). It includes the emission factors from the Emission Inventory Guidebook (2006) (total number of particles, #/km/veh), the shape of the corresponding particle size distribution given in PARTICULATES and data for the traffic activity. The output of the model UFPEM (UltraFine Particle Emission Model) is a sum of continuous distributions of ultrafine particles emissions per vehicle type (passenger cars and heavy duty vehicles), fuel (petrol and diesel) and average speed representative for urban, rural and highway driving. The results from the parameterization are compared with measured total number of ultrafine particles and size distributions in a tunnel in Antwerp (Belgium). The measured UFP concentration over the entire campaign shows a close relation to the traffic activity. The modelled concentration is found to be lower than the measured in the campaign. The average emission factor from the measurement is 4.29E+14 #/km/veh whereas the calculated is around 30% lower. A comparison of emission factors with literature is done as well and in overall a good agreement is found. For the size distributions it is found that the measured distributions consist of three modes--Nucleation, Aitken and accumulation and most of the ultrafine particles belong to the Nucleation and the Aitken modes. The modelled Aitken mode (peak around 0.04-0.05 µm) is found in a good agreement both as amplitude of the peak and the number of particles whereas the modelled Nucleation mode is shifted to smaller diameters and the peak is much lower that the observed. Time scale analysis shows that at 300 m in the tunnel coagulation and deposition are slow and therefore neglected. The UFPEM emission model can be used as a source term in dispersion models.

The ionic compositions of fine and coarse particle fractions in the two urban areas of Korea.

The ionic composition of PM2.5 and PM10 was investigated using PM samples collected from Seoul and Busan during the winter of 2002. Based on the measurement data, we attempted to investigate the relative roles of different source processes in the composition of airborne particles at the two distinct urban areas. According to our measurements, the major components of both PM fractions were clearly distinguished from each other at the two different sites. It was found that the ionic concentrations in coarse fractions were generally compatible with each other at the two sites (NH(4)(+), NO(3)(-), NSSS, etc.). However, differences in their concentration levels were significant in the fine fractions and their mass concentration levels in Seoul exhibit threefold enhancement relative to Busan. The results further indicated that anthropogenic signatures were generally more evident in the fine rather than coarse fractions at both sites. However, a comparison of the coarse fraction data indicated the dominance of natural (oceanic) processes at the Busan site and conservative relationships among the different ionic components. The results of the back trajectory analysis confirmed that air mass movement patterns influence the ionic compositions of PM across different particle fractions and between different study sites.