The Role of the ATP-Binding Cassette A1 (ABCA1) in Human Disease.

Cholesterol homeostasis is essential in normal physiology of all cells. One of several proteins involved in cholesterol homeostasis is the ATP-binding cassette transporter A1 (ABCA1), a transmembrane protein widely expressed in many tissues. One of its main functions is the efflux of intracellular free cholesterol and phospholipids across the plasma membrane to combine with apolipoproteins, mainly apolipoprotein A-I (Apo A-I), forming nascent high-density lipoprotein-cholesterol (HDL-C) particles, the first step of reverse cholesterol transport (RCT). In addition, ABCA1 regulates cholesterol and phospholipid content in the plasma membrane affecting lipid rafts, microparticle (MP) formation and cell signaling. Thus, it is not surprising that impaired ABCA1 function and altered cholesterol homeostasis may affect many different organs and is involved in the pathophysiology of a broad array of diseases. This review describes evidence obtained from animal models, human studies and genetic variation explaining how ABCA1 is involved in dyslipidemia, coronary heart disease (CHD), type 2 diabetes (T2D), thrombosis, neurological disorders, age-related macular degeneration (AMD), glaucoma, viral infections and in cancer progression.

Antibiotic exposure among children younger than 5 years in low-income and middle-income countries: a cross-sectional study of nationally representative facility-based and household-based surveys.

BACKGROUND: Antibiotic resistance is a major threat to global health. Although detailed information about antibiotic use in high-income countries is available, little is known regarding the use of antibiotics and cumulative exposure to antibiotics in low-income and middle-income countries (LMICs). We aimed to quantify antibiotic exposure in children younger than 5 years in LMICs. METHODS: We did a cross-sectional study in sick children younger than 5 years who attended a health-care facility in eight LMICs (Haiti, Kenya, Malawi, Namibia, Nepal, Senegal, Tanzania, and Uganda) between May, 2006, and December, 2016. Demographic and Health Surveys were used to estimate the cumulative number of illnesses related to a fever or cough and the cumulative number of visits to a health-care facility because of these illnesses for each country. We also used clinical observation data from nationally representative health-care facility-based Service Provision Assessment (SPA) surveys to estimate the proportion of children who were prescribed an antibiotic during a visit to a health-care facility and the number of antibiotic prescriptions issued that were unrelated to fever or respiratory problems. By combining these estimates, and using bootstrap analysis to compute uncertainty intervals, we estimated cumulative antibiotic exposure in children from birth up to age 5 years in each LMIC. FINDINGS: From SPA surveys, we identified 22 519 clinical observations of children younger than 5 years who visited a health-care facility because of an illness between July, 2007, and December, 2016. From DHS surveys, we identified 68 826 children younger than 5 years who visited a health-care facility between May, 2006, and November, 2016. 85·4% of health-care facility visits were related to either a fever or cough. Antibiotics were prescribed to 80·5% of children diagnosed with respiratory illness, 50·1% with diarrhoea, and 28·3% with malaria. The mean number of antibiotic prescriptions issued to children between birth and age 5 years across the eight LMICs was 24·5 (95% CI 22·6-26·7), ranging from 7·1 (6·3-7·9) in Senegal to 59·1 (54·1-64·6) in Uganda. INTERPRETATION: Between birth and age 5 years, children in LMICs are prescribed a remarkably high number of antibiotics. A large proportion of these prescriptions appear to be unnecessary. National and local efforts to reduce unnecessary prescription of antibiotics to children would likely improve both patient wellbeing (in terms of preventing side-effects) and reduce the global threat of antimicrobial resistance. FUNDING: None.

Caracterización del paludismo como enfermedad endémica en Ecuador / Characterization of the malaria like endemic illness in Ecuador

Fundamento: el paludismo como problema de salud pública mundial, afecta a un elevado número de personas cada año. Congruente con evaluaciones de la Organización Mundial de la Salud y la Organización Panamericana de la Salud, cada año se presentan entre 50 y 100 millones de casos de la enfermedad. Objetivo: caracterizar el paludismo como enfermedad endémica en Ecuador. Métodos: se realizó una revisión bibliográfica de un total de 23 artículos en las bases de datos Scopus, Latindex y SciELO, mediante un gestor de búsqueda y administrador de referencias Endnote, de ellos 22 corresponden a los últimos cuatro años, 12 corresponden a artículos en diferentes revistas electrónicas y sitios web especializados en el tema y 11 a informes y documentos de organizaciones mundiales, de los cuales se utilizaron 72 citas seleccionadas para la revisión. Resultados: los diferentes documentos relacionados con las estadísticas, destacan el incremento del paludismo en diferentes áreas del planeta, por lo cual se intencionan acciones que contribuyen a su disminución e incluso erradicación, sin embargo en Ecuador, en los últimos dos años los resultados son desfavorables en este sentido. Conclusiones: es evidente que los directivos de la salud pública y factores comunitarios de cada país afectado por paludismo, deben asumir un enfoque preventivo que vele por los problemas de salud de las comunidades y favorezca el medio ambiente, fomenten en iniciativas que promuevan mayor responsabilidad ambiental a favor de erradicarla. En el caso de Ecuador, se muestran resultados desfavorables que tienden al incremento de esta enfermedad (AU)

Background: the malaria as problem of world public health, affects a high number of persons every year. Coherent with evaluations of the World Health Organization and the Pan-American Health Organization, between 50 and 100 million cases of the illness are presented every year. Objective: to characterize the malaria as an endemic illness in Ecuador. Methods: a bibliographical review of a whole of 23 articles was carried out in the Scopus, Latindex and SciELO databases, by means of a search engine and Endnote references manager, of them 22 correspond to last four years, 12 correspond to articles in different electronic magazines and web sites specializing in the topic and 11 to reports and documents of world organizations, of which 72 quotations selected for the review were used. Results: the different documents related to the statistics, emphasize the increase of the malaria in different areas of the planet, for which actions that contribute to its decrease and even eradication are carried out, nevertheless in Ecuador, in the last two years the results are unfavorable in this sense.Conclusions: it is clear that the managers of the public health and community factors of every country affected by malaria, must assume a preventive approach that looks over the problems of health of the communities and favors the environment, they encourage in initiatives that promote major environmental responsibility in favor of eradicating it. In case of Ecuador, there appear unfavorable results that tend to the increase of this illness (AU)

Aproximación a la relación entre la malaria y la economía de la coca en Guaviare, Colombia, 1979-1989 / Approach to the relationship between malaria and the coca economy in Guaviare, Colombia, 1979-1989

RESUMEN Objetivo Analizar el comportamiento de la malaria en relación con la economía de la coca en la región del Guaviare, Colombia entre 1978 y 1989. Métodos Revisión documental retrospectiva, a través del análisis de archivos históricos, entrevistas y fuentes secundarias. Resultados Se identificaron dos periodos de crisis de la bonanza coquera o cocalera durante el tiempo de estudio, con fluctuaciones en el número de habitantes. Al analizar la relación entre las variaciones del precio de la cocaína y los casos de malaria, se encontró que hay un incremento de casos en épocas de crisis. Conclusiones El aumento de casos de malaria en la región posiblemente se deba a que las personas que estaban en las zonas rurales se desplazaron a las cabeceras urbanas, motivadas por la baja producción de la pasta de coca. Esto incrementó la concentración de población susceptible y, por tanto, el aumento de casos, o probablemente existió un aumento en el registro de la enfermedad.(AU)

ABSTRACT Objective To analyze the relationship between malaria and coca economy in the region of Guaviare, Colombia between 1978 and 1989. Materials and Methods Retrospective documentary analysis using historical archives, interviews and secondary sources. Results Two critical periods for the coca bonanza, with population fluctuations, were identified between 1978 and 1989. After analyzing the relationship between variations in the price of cocaine and positive cases of malaria, an increase in cases was identified during those crises. Conclusions The increase of malaria cases in the region is possibly associated to the migration of people from rural areas to urban centers, motivated by the low production of coca paste. This increased the concentration of susceptible population and, therefore, the number of cases; however, it is possible that the report of these cases experienced an upsurge.(AU)

Minería de oro y aumento de la malaria: ¿qué ocurre en Chocó? / Gold mining and increased malaria: what happens in Chocó?

La minería de oro a cielo abierto se ha asociado a diversos problemas de salud en la población, entre esos la proliferación de enfermedades infecciosas como la malaria. El departamento del Chocó, uno de los más importantes productores de oro del país, ha venido siendo afectado por un aumento en el número de casos y muertes por Malaria. Con el fin de poner a prueba si estos dos eventos se encuentran relacionados el ONS llevó a cabo un estudio para evaluar la asociación entre los niveles de producción de oro en los municipios del Chocó y los casos de malaria. El estudio encontró que los municipios con mayor producción de oro también presentan en promedio el mayor número de casos de malaria anualmente. De acuerdo con los hallazgos de este y otros estudios es importante para el control de la malaria abrir los espacios necesarios para discutir la minería de oro como un factor determinante en la propagación de la malaria en el departamento del Chocó y probablemente otras regiones mineras de Colombia.

An analysis of the influence of the local effects of climatic and hydrological factors affecting new malaria cases in riverine areas along the Rio Negro and surrounding Puraquequara Lake, Amazonas, Brazil.

A study was conducted at three sampling regions along the Rio Negro and surrounding Puraquequara Lake, Amazonas, Brazil. The aim was to determine the influence of the local effects of climatic and hydrological variables on new malaria cases. Data was gathered on the river level, precipitation, air temperature, and the number of new cases of autochthonous malaria between January 2003 and December 2013. Monthly averages, time series decompositions, cross-correlations, and multiple regressions revealed different relationships at each location. The sampling region in the upper Rio Negro indicated no statistically significant results. However, monthly averages suggest that precipitation and air temperature correlate positively with the occurrence of new cases of malaria. In the mid Rio Negro and Puraquequara Lake, the river level positively correlated, and temperature negatively correlated with new transmissions, while precipitation correlated negatively in the mid Rio Negro and positively on the lake. Overall, the river level is a key variable affecting the formation of breeding sites, while precipitation may either develop or damage them. A negative temperature correlation is associated with the occurrence of new annual post-peak cases of malaria, when the monthly average exceeds 28.5 °C. This suggests that several factors contribute to the occurrence of new malaria cases as higher temperatures are reached at the same time as precipitation and the river levels are lowest. Differences between signals and correlation lags indicate that local characteristics have an impact on how different variables influence the disease vector's life cycle, pathogens, and consequently, new cases of malaria.

Dengue infection as a potential trigger of an imported Plasmodium ovale malaria relapse or a long incubation period in a non-endemic malaria region.

OBJECTIVES: To report that dengue fever (DF) could have triggered Plasmodium ovale wallikeri malaria. METHODS: A retrospective case report of P. ovale malaria and DF in a single patient in Rio de Janeiro, Brazil, who had lived in Angola, is presented. RESULTS: On the second week of illness, the patient was referred to our research service. As symptoms had persisted up to day 14, malaria was also considered, based on the patient's long-standing epidemiological history. On day 16 of illness, a thick blood smear was positive for P. ovale (3480 parasites/mm(3)), PCR for malaria was positive for P. ovale wallikeri, and the kinetics of dengue virus (DENV) antibodies suggested a recent primary dengue infection. CONCLUSIONS: Concurrent infections of DENV and malaria have rarely been reported; the actual impact of these sequential or simultaneous infections remains unknown. Therefore, DF must be considered as a potential co-morbidity for malaria, because of its influence on fluid electrolyte management. The case presented showed consistent temporal, clinical, and laboratory evidence that the relapse or the long incubation period of P. ovale malaria may have been triggered by a recent DF episode. To the authors' knowledge, this is the first report of DENV and P. ovale co-infection.

[Cost-effectiveness analysis (CEA) regarding vitamin A in children aged less than 5 years-old in Colombia]. / Análisis de costo efectividad de la vitamina A en niños menores de 5 años en Colombia.

OBJECTIVE: Evaluating the relative cost-effectiveness of using vitamin A in children aged less than 5-years-old regarding the reduction of events involving diarrhoea, malaria and mortality from the Colombian health-related social security system (CHSSS). MATERIALS AND METHODS: A decision tree was constructed, using deaths averted as outcome. Probabilities were taken from the pertinent literature and costs from official sources. The cost-effectiveness threshold was three times greater than the per capita Colombian gross domestic product (GDP) in 2012. Probabilistic and deterministic sensitivity analyses were made and cost effectiveness acceptability curves were drawn. RESULTS: Providing a cohort of 100,000 children with vitamin A (as opposed to not doing so) would represent a saving regarding medical attention costs of $ 340,306,917 due to the number of events involving diarrhea (4,268) and malaria (76), having become reduced, as well as cases requiring hospitalization. A saving for the CHSSS was consistently obtained in sensitivity analysis. CONCLUSION: Providing vitamin supplements for children aged less than 5 years-old would seem to be the least costly and most effective (dominant) strategy for the CHSSS, i.e. compared to not doing so).

Another risk to US travelers--malaria.

To individualize preventive measures, rely on reported risk data for specific destinations, planned activities, and patient comorbidities.

Influence of deforestation, logging, and fire on malaria in the Brazilian Amazon.

Malaria is a significant public health threat in the Brazilian Amazon. Previous research has shown that deforestation creates breeding sites for the main malaria vector in Brazil, Anopheles darlingi, but the influence of selective logging, forest fires, and road construction on malaria risk has not been assessed. To understand these impacts, we constructed a negative binomial model of malaria counts at the municipality level controlling for human population and social and environmental risk factors. Both paved and unpaved roadways and fire zones in a municipality increased malaria risk. Within the timber production states where 90% of deforestation has occurred, compared with areas without selective logging, municipalities where 0-7% of the remaining forests were selectively logged had the highest malaria risk (1.72, 95% CI 1.18-2.51), and areas with higher rates of selective logging had the lowest risk (0.39, 95% CI 0.23-0.67). We show that roads, forest fires, and selective logging are previously unrecognized risk factors for malaria in the Brazilian Amazon and highlight the need for regulation and monitoring of sub-canopy forest disturbance.

Polimorfismo gênico das citocinas IFN-gama e IL-10 e da enzima Óxido Nítrico Sintase Induzida e sua influência nos níveis plasmáticos e susceptibilidade em indivíduos expostos à malária / Gene polymorphism of ifn- and il-10 citokynes and nitirc oxide synthase and their influence in the levels and susceptibility in individuals exposed to malaria

A compreensão da variabilidade da resposta do hospedeiro à infecção malárica continua a ser um grande desafio. Fatores genéticos, tanto do hospedeiro como ambientais, contribuem para essa variabilidade, conferindo resistência inata ou influindo na reposta imune. É possível destacar como fontes de variabilidade na susceptibilidade à malária, fatores inerentes ao hospedeiro, tais como polimorfismos genéticos que ocorrem em eritrócitos e células do sistema imune. Genes como os de citocinas e da enzima óxido nítrico sintase induzida têm um papel importante na regulação da resposta imune e na defesa contra agentes infecciosos. Portanto, nesse estudo avaliamos os polimorfismos nos genes das citocinas interferon gama (IFN-gama) e interleucina 10 (IL-10), e da enzima óxido nítrico sintase induzida e sua influência nos níveis plasmáticos e na susceptibilidade à malária em uma população da Amazônia brasileira exposta à infecção. Verificamos a frequência alélica e genotípica dos polimorfismos de nucleotídeo único (SNP) do IFNG+874T/A, IL10A-1082G/A, IL10A-592A/C, IL10A-819T/C e NOS2A-954G/C em 267 indivíduos residentes em áreas rurais e periferia do município de Porto Velho, Rondônia. Os fragmentos específicos de DNA foram amplificados pela reação em cadeia da polimerase (PCR), permitindo a detecção dos polimorfismos e determinação dos genótipos. O plasma dos indivíduos foi usado para mensurar os níveis das citocinas IFN-gama e IL-10, e dos radicais de nitrogênio, através do luminex e reação de Griess, respectivamente. Os polimorfismos IFNG+874T/A e NOS2A-954G/C não tiveram associação significativa entre ambos os grupos ou com nenhum dos parâmetros de susceptibilidade (doença clínica, níveis de IFN-gama ou radicais de nitrogênio e vi parasitemia), exceto uma fraca associação do polimorfismo IFNG+874T/A com o número de episódios anteriores de malária...

Understanding the variability of the host response to malaria infection remainsa major challenge. Genetic factors from host and environment, contribute to thisvariability, conferring innate resistance or affecting the immune response. It ispossible to highlight as sources of variability in the susceptibility to malaria, factorsinherent to the host, such as genetic polymorphisms that occur in erythrocytes andcells of the immune system. Some relevant genes such as cytokines and nitric oxidesynthase genes play a key role in the regulation of the immune response and to thedefense against infectious agents. Therefore, in this study we evaluated thepolymorphisms in the genes of interferon gama (IFN-gama) and interleukin 10 (IL-10),and nitric oxide synthase and their influence in serum levels and susceptibility tomalaria in a population from Brazilian Amazon exposed to infection. We verified theallelic and genotypic frequencies of the single nucleotide polymorphism (SNP),namely IFNG+874T/A, IL10A-1082G/A, IL10A-592A/C, IL10A-819T/C and NOS2A-954G/C in 268 individuals from rural areas of the municipality of Porto Velho,Rondonia State...

Variabilidade climática, vulnerabilidade ambiental e saúde: os níveis dorio Negro e as doenças relacionadas à água em Manaus / Climate variability, vulnerability and environmental health: levels of Negro river and water-related diseases in Manaus

Manaus apresenta peculiaridades em relação às mudanças ambientais e climáticas. A sazonalidade das chuvas, níveis dos rios, produção de alimentos, pesca e condições de transporte condicionam a economia regional e influem sobre a vida na cidade. O nível da água do Rio Negro tem sido um regulador da dinâmica econômica e social da cidade, desde sua fundação. A persistência de casas de madeira construídas sobre palafitas é um exemplo de adaptação da população local à variabilidade climática. A altura das casas, pontes e trapiches sobre estacas revela uma conformação dos habitantes locais a variações esperadas do regime dos rios, ao mesmo tempo em que impõe um limite aceitável, além do qual torna-se inviável a moradia e as atividades econômicas, e consequentemente geram agravos a saúde. Nos últimos anos, o regime de cheias e vazantes tem superado as marcas históricas registradas. O objetivo desse trabalho foi analisar o comportamento hidrológico da região e relacionar seu impacto com agravos à saúde. Foi realizado um estudo de séries temporais que analisou as decomposições das séries para observação da tendência e sazonalidade. Na análise estatística utilizaram-se modelos aditivos generalizados (GAM). Os modelos multivariados também contemplaram variáveis metrológicas e Índices de Oscilação Niño (ONI). Com base nos resultados obtidos pelos modelos finais foram construídos cenários segundo a variação dos níveis do rio Negro na região de Manaus. Os resultados apontam uma associação entre eventos hidrológicos extremos e a incidência de algumas doenças na cidade. Por exemplo, cotas do rio acima de 28 metros em períodos de chuva apresentaram associação positiva com as notificações de casos de leptospirose. Os casos de febre tifoide apresentaram associação com defasagem de um mês em relação ao nível do rio Negro, temperatura máxima e índice ONI. Os casos de malária apresentaram associação com defasagem de 2 meses com a chuva e cotas acima 27,5 metros durante o período de subida do nível do rio Negro. Os resultados obtidos apontam para limiares do rio Negro na região de Manaus que podem direcionar intervenções, monitoramento, planejamento e medidas de adaptação de saúde no município.

Manaus has important specificities in the context of environmental and climate changes. Rainfall, the level of rivers, food production, the dynamic of fisheries, and transportation have a marked seasonal pattern, influencing regional economy and urban life. Rio Negro’s water level has modulated the economic and social dynamics of the city since its inception. The persistence of wood houses built on stilts is an example of how the local population has adapted to climate variability over the years. The high height of the houses, the fact bridges and piers have been built on high wooden pillars document the way local inhabitants have did their best to face the challenges posed by the rivers’ variable regimens. Despite all such flexibility, pronounced variations may exceed inhabitants’ buffering initiatives, beyond a point housing and economic activities may be no longer viable. In consequence, social and health hazards may emerge. In recent years, the cycle of ebbs and flows has exceeded historical trademarks. This study analyzed the hydrology of the region and assessed its impact on health of the local population. Time series were fitted in order to discern their overall trends and seasonal patterns. Statistical analyses used generalized additive models (GAM). Multivariate models incorporated metrological data and the Niño Oscillation Index (ONI). Models’ findings help to build scenarios focusing on the varying levels of the Rio Negro and their impact on the Manaus region. The results highlighted the association between extreme hydrological events and the incidence of different diseases in the city of Manaus.

For example, when the watermark is located 28 meters above the river’s reference level, during the rainy season, cases of leptospirosis to the surveillance systems have increased. Cases of typhoid fever were found to be associated with a one-month lagged variation of Rio Negro, maximum temperatures and variations of the ONI index. Malaria cases were associated with a two-months lagged variation of rain and a watermark 27.5 meters above Rio Negro’s reference level. Results helped to define the thresholds of Rio Negro in the Manaus region that may ask for targeted interventions, monitoring, planning, as well as to initiatives aiming to tailor health preservation to the actual conditions prevailing in the municipality.

Analyzing actual risk in malaria-deferred donors through selective serologic testing.

BACKGROUND: Approximately 150,000 US blood donors are deferred annually for travel to malaria-endemic areas. However, the majority do not travel to the high-risk areas of Africa associated with transfusion-transmitted malaria (TTM) but visit low-risk areas such as Mexico. This study tests for Plasmodium infection among malaria-deferred donors, particularly those visiting Mexico. STUDY DESIGN AND METHODS: Blood donors deferred for malaria risk (travel, residence, or previous infection) provided blood samples and completed a questionnaire. Plasma was tested for Plasmodium antibodies by enzyme immunoassay (EIA); repeat-reactive (RR) samples were considered positive and tested by real-time polymerase chain reaction (PCR). Accepted donors provided background testing data. RESULTS: During 2005 to 2011, a total of 5610 malaria-deferred donors were tested by EIA, including 5412 travel deferrals. Overall, 88 (1.6%) were EIA RR; none were PCR positive. Forty-nine (55.7%) RR donors previously had malaria irrespective of deferral category, including 34 deferred for travel. Among 1121 travelers to Mexico, 90% visited Quintana Roo (no or very low risk), but just 2.2% visited Oaxaca/Chiapas (moderate or high risk). Only two Mexican travelers tested RR; both previously had malaria not acquired in Mexico. CONCLUSIONS: Travel to Mexico represents a large percentage of US donors deferred for malaria risk; however, these donors primarily visit no- or very-low-risk areas. No malaria cases acquired in Mexico were identified thereby supporting previous risk estimates. Consideration should be given to allowing blood donations from U.S. donors who travel to Quintana Roo and other low-risk areas in Mexico. A more effective approach to preventing TTM would be to defer all donors with a history of malaria, even if remote.

Análisis de costo efectividad de la vitamina A en niños menores de 5 años en Colombia / Cost-effectiveness analysis (CEA) regarding vitamin A in children aged less than 5 years-old in Colombia

Objetivo evaluar la costo-efectividad relativa del uso de vitamina a en los niños menores de 5 años en la disminución de eventos de diarrea, malaria y la mortalidad, bajo la perspectiva del sistema de salud colombiano (SGSSS). Materiales y Métodos se construyó unárbol de decisión con muertes evitadas como desenlace. Las probabilidades se extrajeron de la literatura y los costos de fuentes oficiales. El umbral de costo-efectividad fue tres veces el producto interno bruto (PIB) per cápita colombiano de 2012. Se realizaron análisis de sensibilidad determinísticos, probabilísticos y curva de aceptabilidad. Resultados En una cohorte de cien mil niños, la administración de vitamina a, frente no hacerlo, representaría un ahorro en costos de atención médica de $ 340.306.917, debido a que reduce el número de eventos de diarrea (4.268) y de malaria (76), así como los casos en los que se requiere hospitalización. En todos los análisis de sensibilidad se obtuvo un ahorro para el sistema. Conclusión Dentro del sistema de salud colombiano, la suplementación con vitamina a para niños menores de 5 años, comparado con no hacerlo, es la estrategia menos costosa y más efectiva (dominante).

Objective Evaluating the relative cost-effectiveness of using vitamin A in children aged less than 5-years-old regarding the reduction of events involving diarrhoea, malaria and mortality from the Colombian health-related social security system (CHSSS). Materials and Methods A decision tree was constructed, using deaths averted as outcome. Probabilities were taken from the pertinent literature and costs from official sources. The cost-effectiveness threshold was three times greater than the per capita Colombian gross domestic product (GDP) in 2012. Probabilistic and deterministic sensitivity analyses were made and cost effectiveness acceptability curves were drawn. Results Providing a cohort of 100,000 children with vitamin A (as opposed to not doing so) would represent a saving regarding medical attention costs of $ 340,306,917 due to the number of events involving diarrhea (4,268) and malaria (76), having become reduced, as well as cases requiring hospitalization. A saving for the CHSSS was consistently obtained in sensitivity analysis. Conclusion Providing vitamin supplements for children aged less than 5 years-old would seem to be the least costly and most effective (dominant) strategy for the CHSSS, i.e. compared to not doing so).

Enhanced understanding of infectious diseases by fusing multiple datasets: a case study on malaria in the Western Brazilian Amazon region.

BACKGROUND: A common challenge to the study of several infectious diseases consists in combining limited cross-sectional survey data, collected with a more sensitive detection method, with a more extensive (but biased) syndromic sentinel surveillance data, collected with a less sensitive method. Our article describes a novel modeling framework that overcomes this challenge, resulting in enhanced understanding of malaria in the Western Brazilian Amazon. METHODOLOGY/PRINCIPAL FINDINGS: A cohort of 486 individuals was monitored using four cross-sectional surveys, where all participants were sampled regardless of symptoms (aggressive-active case detection), resulting in 1,383 microscopy and 1,400 polymerase chain reaction tests. Data on the same individuals were also obtained from the local surveillance facility (i.e., passive and active case detection), totaling 1,694 microscopy tests. Our model accommodates these multiple pathogen and case detection methods. This model is shown to outperform logistic regression in terms of interpretability of its parameters, ability to recover the true parameter values, and predictive performance. We reveal that the main infection determinant was the extent of forest, particularly during the rainy season and in close proximity to water bodies, and participation on forest activities. We find that time residing in Acrelandia (as a proxy for past malaria exposure) decreases infection risk but surprisingly increases the likelihood of reporting symptoms once infected, possibly because non-naïve settlers are only susceptible to more virulent Plasmodium strains. We suggest that the search for asymptomatic carriers should focus on those at greater risk of being infected but lower risk of reporting symptoms once infected. CONCLUSIONS/SIGNIFICANCE: The modeling framework presented here combines cross-sectional survey data and syndromic sentinel surveillance data to shed light on several aspects of malaria that are critical for public health policy. This framework can be adapted to enhance inference on infectious diseases whenever asymptomatic carriers are important and multiple datasets are available.

Deforestation and malaria in Mâncio Lima County, Brazil.

Malaria is the most prevalent vector-borne disease in the Amazon. We used malaria reports for health districts collected in 2006 by the Programa Nacional de Controle da Malaria to determine whether deforestation is associated with malaria incidence in the county (municipio) of Mancio Lima, Acre State, Brazil. Cumulative percent deforestation was calculated for the spatial catchment area of each health district by using 60 x 60-meter, resolution-classified imagery. Statistical associations were identified with univariate and multivariate general additive negative binomial models adjusted for spatial effects. Our cross-sectional study shows malaria incidence across health districts in 2006 is positively associated with greater changes in percentage of cumulative deforestation within respective health districts. After adjusting for access to care, health district size, and spatial trends, we show that a 4.2%, or 1 SD, change in deforestation from August 1997 through August 2001 is associated with a 48% increase of malaria incidence.