3 research outputs found
Seasonal malaria chemoprevention in children aged 3–59 months in Mali: parents’ perceptions, attitudes and beliefs regarding drug administration
No full textAbstract Background In Mali, malaria remains the major endemic and leading cause of morbidity and mortality in the most vulnerable groups, notably children under five years of age and pregnant women. Achieving the goal of eliminating malaria by 2030 would be difficult, if not impossible, if we do not identify all the dimensions that influence the persistence of the disease within communities. This is why this study was conducted to assess the perceptions, attitudes and beliefs of parents regarding seasonal malaria chemoprevention in children under 5 years of age. Methods This study focused on 10 villages in the M’pessoba health area. Community consent was obtained in each village before starting the survey. Moreover, free and informed individual consent was obtained before starting to administer the questions. A questionnaire on parents’ knowledge, attitudes and beliefs about SMC was administered randomly to at least 25 parents per village. Results Of the 333 parents interviewed, nearly 97.9% (n = 333) thought that SMC should be taken by children aged 3–59 months. According to the majority of the participants, SMC protects against malaria (75.7%). The majority of parents interviewed (79.3%) were aware that SMC was administered over 3 days. Most of the participants (97.3%) thought that even under SMC, children must continue to sleep under mosquito nets. A total of 61.9% of parents experienced side effects following the administration SMC medications. During our survey, 90.7% of parents confirmed that the children had taken the second dose, compared with 85.3% for the third dose. A minority of participants (33.6%) thought that taking SMC only once had a protective effect for 3 months. A total of 93.4% of the 333 parents interviewed were in favor of administering SMC to their children the following year. Conclusion The study showed limited community perception regarding the protection period of SMC after taking a full dose
Genes, culture and agriculture : an example of human niche construction
No full textK. N. Laland was supported by an ERC Advanced Grant (EVOCULTURE).Theory and empirical data from a variety of disciplines strongly imply that recent human history involves extensive gene-culture coevolution, much of it as a direct result of human agricultural practices. Here we draw on niche-construction theory (NCT) and gene-culture coevolutionary theory (GCT) to propose a broad theoretical framework (NCT-GCT) with which archaeologists and anthropologists can explore coevolutionary dynamics. Humans are enormously potent niche constructors, and understanding how niche construction regulates ecosystem dynamics is central to understanding the impact of human populations on their ecological and developmental environments. We use as primary examples the evolution of dairying by Neolithic groups in Europe and Africa and the rise of the “sickle-cell allele” among certain agricultural groups in West Africa and suggest that these examples are broadly representative of much of human recent history. Although the core aspects of these case studies are familiar, we lay out the examples with a specific NCT-GCT focus, which allows us to highlight how archaeology, when coupled with genetic research, can play an important role in better understanding human history. Finally, we suggest that the NCT-GCT perspective is likely to be of widespread general utility because it inherently promotes consideration of the active agency of humans, and other organisms, in modifying their ecological and developmental niches and naturally draws attention to the various forms of feedback that flow from human activities at multiple levels, in multiple populations, and across multiple species.Peer reviewe
The long-term effectiveness of efavirenz-based combination antiretroviral therapy, the impact of pharmacogenomics and pharmacokinetic interaction of artemisinin-based antimalarial therapy on efavirenz exposure among Ghanaian HIV-infected patients
No full textDr. Fred Stephen Sarfo, The long-term effectiveness of efavirenz-based combination antiretroviral therapy, the impact of pharmacogenomics and pharmacokinetic interaction of artemisinin-based antimalarial therapy on efavirenz exposure among Ghanaian HIV-infected patients. PhD dissertation, Durham University, January 2013.
Introduction: In sub-Saharan Africa, HIV treatment is initiated with combination of antiretroviral medications comprising of a backbone of either stavudine or zidovudine plus lamivudine with a non-nucleoside reverse transcriptase inhibitor of either efavirenz or nevirapine. Efavirenz is highly efficacious, durable and well tolerated. The risk for toxicity of efavirenz is determined by several factors including single nucleotide polymorphisms in the hepatic enzymes responsible for its metabolism and concurrently administered medications such as antimalarials, which share common metabolic pathways. The aims of this dissertation are to assess the long-term effectiveness of efavirenz-based antiretroviral therapy and the impact of pharmogenomics and pharmacokinetic interactions of artemisinin-based antimalarial therapy on efavirenz exposure among Ghanaian HIV-infected patients.
Methods: The effectiveness of efavirenz- compared with nevirapine-based antiretroviral therapy was assessed retrospectively in nearly 4000 patients starting treatment between 2004 and 2010. The main outcome measure was a composite of toxicity, disease progression and attrition, and CD4 count changes. A prospective pharmacokinetic study of artesunate and efavirenz was conducted among 22 HIV-infected and 21 controls. Plasma efavirenz and artesunate/ dihydroartemisinin concentrations were measured using validated and standardised methods. Genotyping for single nucleotide polymorphisms in CYP2B6 G516T, T983C; CYP2A6*9B, UGT2B7*735 and *802 as well as CAR rs2307424 were performed for 800 patients with real-time polymerase chain reaction with allelic discrimination.
Results: Antiretroviral therapy was associated with robust CD4 increases. Efavirenz was comparable with nevirapine in composite outcomes but better tolerated. Artesunate was well tolerated when administered to HIV-infected patients on efavirenz. Single nucleotide polymorphisms in the CYP2B6 G516T and T983C were associated with increased plasma efavirenz concentrations.
Conclusions/Recommendation: Among this Ghanaian cohort, both efavirenz and nevirapine-based antiretroviral therapy were effective. The better tolerability of efavirenz compared with nevirapine means it can be safely used as the preferred first line non-nucleoside reverse transcriptase inhibitor in sub-Saharan Africa
