5 research outputs found
Outdoor Mosquito Control Using Odour-Baited Devices: Development and Evaluation of a Potential New Strategy to Complement Indoor Malaria Prevention Methods
Get PDFA considerable effort is currently underway to develop a malaria vaccine based on live Plasmodium falciparum sporozoites. The first requisite of a sporozoite vaccine is the guarantee of parasite arrest prior to the onset of the pathogenic blood stage. Immunisation with genetically attenuated parasites (GAP) that arrest in the liver forms a promising approach. Work in this thesis describes the development and characterisation of a P. berghei Δb9Δslarp GAP that fully arrests in the liver. Immunisation of multiple mouse strains with low numbers of Δb9Δslarp GAP resulted in sterile protection. The Δb9Δslarp GAP is there- fore the leading GAP vaccine candidate. Work in this the- sis further describes the effect of varying the parameters of sporozoite inoculation on parasite liver load. These findings provide a rationale for the design of clinical trials aimed at the administration of live attenuated P. falciparum sporozoites
Assessing malaria attributed mortality in west and southern Africa
Get PDFMalaria has persistently remained a serious health and socio-economic problem in developing nations particularly in Sub-Saharan Africa (SSA). There are approximately 500 million cases of malaria each year and close to one million deaths occurring mainly among children under five years. Developing countries spend a reasonable proportion of their gross domestic product (GDP) on malaria which in the end hinders their levels of development.
World Health Organizations (WHO) and partners through the Roll Back Malaria initiative (RBM) have targeted vector control, health promotion and case management (using rapid diagnostic tests and treatment with Artemisinin combination therapy) in order reduce malaria morbidity and mortality cases. Since 2002, funds for promoting malaria control activities have increased exponentially in SSA. Major donors include presidential malaria initiative (PMI) and Global fund to fight AIDS, tuberculosis and malaria (GFATM). Countries which have scaled up the recommended malaria control strategies such as insecticides-treat net (ITN) and treatment of confirmed cases have reported a decline in both morbidity and mortality especially among children. However, these statistics are based on health facilities data and yet in most developing countries many deaths occur at home and are never recorded due to inefficient vital registration systems. Monitoring the progress of such interventions requires reliable sources of data on both the transmission and infection outcome.
In malaria endemic areas, people acquire natural immunity during the early years of their life after getting exposed to repeated infections. This is observed from the reductions in the number of severe malaria-related morbidity and mortality cases especially in children >5 years. Due to the current undertakings that are aimed at reducing malaria exposure, there are concerns about shifting the disease burden to older children but the required to data to monitor this are not readily available in SSA. Low income countries have resorted to health and demographic surveillance systems (HDSS) to monitor routinely population changes and health outcomes within a defined geographical area.
In 2000, the INDEPTH, a network of HDSS integrated the Malaria Transmission Intensity and Mortality Burden Across Africa (MTIMBA) project into selected sites’ routine activities in order to assess the transmission-malaria mortality relationship taking into account the current interventions. Mortality data and other demographic characteristics were extracted from routinely collected HDSS databases. The entomological data were collected every fortnight from randomly sampled compounds over the 3 years MTIMBA period.
The MTIMBA project generated large geostatistical data that are correlated in space and time. Furthermore, the project captured longitudinal mosquito data that were characterized by many zeros especially during the dry periods. The zeros are due empty traps from a compound or when all the captured mosquitoes are not infectious. Appropriate data analysis therefore should apply models that account for spatial-temporal correlation and the excess zeros in order to avoid over or underestimation of parameters. Zero-inflated geostatistical models account for spatial-temporal correlation by introducing location-specific and time interval random effects which creates more parameters to estimate. Bayesian models implemented via Markov chain Monte Carlo simulation (MCMC) addresses fit of highly parameterized models.
This work applied zero-inflated Bayesian models to estimate malaria attributable mortality across all age-groups using large, correlated and sparse data collected from Navrongo and Manhiça HDSS between 2001 and 2004. The contributions of this thesis were (i) the description of the HDSS data characteristics and relevant methods for analysis; (ii) the spatially explicit estimates of malaria transmission intensity at monthly intervals; and (iii) the relationship between all-cause mortality and malaria transmission intensity across all age categories.
Chapter 2 described the characteristics of the MTIMBA data. These are large geostatistical, temporal, seasonal and zero-inflated data. The mortality and mosquito data were misaligned because they were captured at different compounds and time periods. Zero-inflated Bayesian spatio-temporal models are the state-of-art in handling such data. The rigorous statistical process was demonstrated by modelling sporozoite rate (SR) data from Manhiça HDSS. The analysis of the MTIMBA data was used as an avenue for building SSA capacity through course work, seminars and mentorship. Site-specific analyses are still on-going. However, the project generated data that is relevant for assessing within and between site malaria transmission heterogeneity.
The Navrongo malaria exposure surfaces described in chapter 3 were obtained from zero-inflated geostatistical models fitting separately the binomial SR data and negative binomial count data by mosquito species. All the models included space and time correlation in addition to the Climate, environmental and seasonality covariates. The entomological inoculation rate (EIR) estimates were derived as a product of predicted man biting rate and SR. Observed EIR in this district was >100 infective bites/person/year. Distance to water to bodies, day temperatures and vegetation were the main predictors of mosquito densities for the two species. The EIR maps clearly indicated that the temporal heterogeneity was stronger than the spatial variation in this area. The same situation was also observed from the analyses of the two MTIMBA sites of Rufiji (Tanzania) and Kisumu (Kenya).
Monthly malaria exposure surfaces (chapter 3) were linked to the nearest compounds where mortality was observed as described in chapter 4. Time to death data were split at monthly intervals in order to generate Bernoulli and binomial data that were modelled via logistic regression formulations. Spatio-temporal models were fitted to obtain age-specific mortality risk estimates. The model considered 2 covariates; natural logarithm transformed EIR estimates with their measurement errors and age. ITN variable was only included in neonates, post-neonates and child models. The analysis showed a positive log-linear relationship between all-cause mortality and malaria exposure in all the age groups but the association was only important among children (1-4 years) and people >= 60 years. ITN use showed a protective effect among all the under five children, confirming what was observed in Rufiji and Kisumu HDSS.
The methods used in estimating malaria exposure surfaces and mortality risks in chapters 3 and 4 were extended to Manhiça HDSS (Mozambique) data to describe the mortality-malaria transmission relationship for this area (chapter 5). The spatio-temporal age-specific models considered EIR estimates with their measurement errors (to account for the predictive uncertainty) and age as model covariates.
The distance to the nearest water bodies was the only important common predictor of An. funestus and An. gambiae mosquito densities. Malaria transmission intensity declined consistently in this area. The Model-based results indicated a positive log-linear relationship between all-cause mortality and malaria exposure across all age groups namely; the neonates (0-28 days), post-neonates (1-11months), children (1-4years), young people (5-14 years), adults (15- 59years) and old age (>=60 years).
This work contributes to further understand of malaria-mortality relationships. A positive association between mortality and malaria exposure among the under fives is consistent with what was reported from the MTIMBA sites of Rufiji and Kisumu. Completion of the remaining site-specific analyses followed by a meta-analysis will make a great contribution to malaria epidemiology. Further work however, should consider cohort analysis in order to ascertain whether malaria control interventions have caused a shift in the age of acquired immunity
Hemorragia Digestiva Alta por Dieulafoy intradiverticular: Tratamiento Endoscópico
Get PDFLa Lesión de Dieulafoy es una malformación vascular caracterizada por la presencia de un vaso arterial de gran calibre en la submucosa, ocasionalmente en la mucosa que puede erosionarse, provocar una hemorragia grave, recurrente y, en ocasiones mortal. Es una causa rara de hemorragia gastrointestinal y corresponde a menos del 2% de los episodios de sangrado digestivo agudo. La Lesión de Dieulafoy duodenal ha sido comunicada en un número reducido de casos y, la intradiverticular es excepcional. La endoscopía constituye el método diagnóstico de elección y, en las últimas décadas la terapéutica endoscópica es la técnica preferida por su elevada efectividad y escasa incidencia de complicaciones. Presentamos el caso de un paciente de 82 años con hemorragia digestiva alta grave por lesión de Dieulafoy duodenal intradiverticular diagnosticado en la endoscopía de urgencia y, tratado eficazmente mediante ligadura con banda elástica
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FRIDAY. • SEPTEMBER 29, 1898
Local News.
J. F. Parkinson left for the East last
Monday.
The Tuesday evening lecture for
October 3, will be given by President
Jordan.
Mrs. B. Angerlh, Miss shaefter and
Mrs. Dugan, of Oakland, spout Sunday
with Mrs. Ostrander.
The Palo Alto high school team defeated tbo team from from Holtt's at
football Saturday by a score of 12 to 5.
The mombers of the Christian
church will give a reception to students at lower Nortree hall this evening.
Jordan Bros, have nearly completed
fitting up tho Pitman building for their
now grocery, which will open in a lew
days.
All Saints Church Leaflet was Issued
from the Live Oak press room at noon
today. Accordingly, we are a Httle
late with the paper.
We have just printed a technical
pamphlet for engineering students, entitled "Directions for Linear Drawing"
by Prof. J. C. L. Fish.
The Sunday sermon for October 1,
will be glvuu by Prof. Henry V. Rolfe,
of tho University of Chicago, Subject,
"The American Spirit."
Mr. and Mrs. J. R. South worth, of
San Francisco, visited Mrs. Ostrander
recently and were delighted with Palo
Alto und surroundings.
Mrs. Cornelia Haven and her daughter Nell uf Sun Friinuis-O, visited Mrs.
and Miss Abbott last Sunday. Miss
Haven Is a well-known artist.
Christian Science services will be held
as usual next Sunday morning at 11
o'clock, in Fraternity hall. Subject:
"Are Sin, Disease and Health Real-"
It is said that our genial butcher,
Jamos Brophy, . will be married next
Wednesday at San Rafael, to Mrs.
Moffatt. Wo offer our congratulations.
A Christmas Fair Is promised in December at which will be sold dolls galore for prices which will discount old
Santa Chum himself. Watt for this
before you buy your dolls.
G. H. Alton is busy figuring out
house numbers in accordance with Ordinance f>7. Tho numb-rs will be here
about tbe middle of October. When
up they will look llko thirty cents.
Mr. F. J. Ryan of Stockton, the
father of Miss Jessie Ryan, '97, visited
Palo Alto yesterday. He Is tbe. author of a book on Protestant Miracles
that Is of special Interest to christian
scientists.
-Tbo question of-legal rcsidooco in-
vol veil In tho rules of charging tuition
.by our school trustees, haa been submitted to the district attorney for decision. After this point of law is de-
elded there will lie a more intelligent
basis for discussion of the merits of tbe
case.
Last Tuesday's Mercury contained
an editorial on "Pettlopated Sociology"
which betrays a deep lack of knowledge of Mrs. Mary Roberts Smith and
her.work. The glllinesa with whiob it
speaks of "Miss-Smith" and "a young
woman full of that profoundly practical knowledge of mankind and of the
world to be gained from text books on
sociology," shows that although Mrs.
Smith is kuown as- far as professional
circle* extend, ber fame has not yet
reached the Mercury office.
To* Old Melodeon.
Among coming musical events a
charming little operetta is promised,
under tbe direction of Mrs. Jagger.
It Is called "Tbe Old Melodeon," and
sets forth In vocal form a re-unlon of
old friends who sang together In bygone years around a melodeon.
■ In addition to the operetta, other
musical numbers will be given including vocal solos, a fine cello solo, and
several ensomblo pieces. The evening,
set is Saturday night, October 14th,
and tho performance will take place in
Nortree hall.
Down went setjer prices. See Parkinson, tbis Is your opportunity to buy
your sewer below any and all former
quotations. *
ORDINANCE NO 56.
An Ordinance Fixing the Rate of
Taxes for the Town of Palo Alto
for the Fiscal Year 1899-1900.
The Board of Trustees of the Town ot Palo
Alto do ordain un follows :
The rate of Town Taxes for the Town of Palo
Alto for the Ducal year 18MM0OO la hereby Used
and the number of cents on each [hundred dollars of property levied for each fund hereby
designated respectively as follows, to-wtt;
W ii ter bond fund AS. 4530 cents
Sewer bond fund :fi.ai 35 cents
General fund 7.8335cents
And the taxes for said town for the said fiscal
year are hereby levied for each of said funds
respectively at tbe safd respective rates upon
alt tbe taxable property within said Town.
Passed as oo verinj? a case of emergency at
first reading by tbe unanimous vote of the
Trustees present at the ad)ourned regular
meeting of the Hoard of Trustees of said Town
tblS-Sth day or Soptembor, A. D. IflWO. by the
following vote:
AYES— J. S. livrs.r.%, JoSKPH HtTTcniWHOH,
CHAD. I). MAKX, O. W. MOSHIK, l>. L. SU>AN.
NOES-Nome.
ABSENT—NORK.
JOSEPH HUTCHINSON. >
Prusldent of tbejloard ofTrusteea
[Attest]
I HE A 1,1
of the Town ofPa lo< Alio.
H. W. Simklns, Town dork.
ORDINANCE NO. 57.
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Palace Pharmacy
Fraternal Hall Building
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IN SUMMER keep cool witb our IGB
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We can furnish you tbe very beat WOOD and COAL for both cooking' and
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or on tbe Cain pus.
F\ _U. WrOr*F«__DI_l__-
Thors'
Photographic
Co.
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Kodaks Dereloped aod Printed.
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Eleg
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Homo Industry
Built up and encouraged tbe Interests of
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Stanford French Laundry Ramona St. Palo Alto
Local Telephone .. Wain UM Office. ■ ■ Blade's Shaving Parlor
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An Ordinance Providing a System for
House Numbering in tbe Town of
Palo Alto.
The Board of Trustees of the Town of Palo
Alto do ordain as.follows:
Within sixty days after the passage of this
ordinance all houses within thu Town of Palo
Alto already constructed, and all nduses within
said Town hereafter oonatmitied, as soon as
oompleted, must bo numbered In aooordanoe
with tbe following system:
Beginning at tbe Palo Alto tree near the railroad bridge crossing the San Frunelsqulto
oreek, the first full block on Alma street shall
be the 100 block, tbe soeond, tbe 800 blook; and
so on; and tbu corresponding bloeks on all
streets parallel to Alma street shall have corresponding numbers,
Beginning at the point of Interseotlon of
Alma street with University avenue, tbe Hrat
full block on University avenue shall be the
100block; the second, the_)00 block; and soon;
and the corresponding blocks on all streets running parallel to University avenue shall bave
corresponding numbers.
Each twelve and one-half feet shall have a
separate number.
The odd numbers shall boon tbe Northwest
and the even on the southeast side of all streets
parallel to University avenue; the odd numbers on the northeast side and the even numbers on thesontbwest side of all atreets running parallel to Ainu, street. a
The numbers must be of tbo style, size and
material shown In aluminum sample "l" so
tagged and on tile with tbe Cierk.
Any villi...fou of this ordinance shall be punished by a floe of *...
Passed as covering a case of emergenoy, at
first reading, at tbe adjourned regular meeting of the Board of Trustees of thu Town of
Palo Alto; by the unanimou. vote of the Trustees present this asth day of September, A. D.
1809, namely:
AY1„S~-J. S. HtlTLMM, JOHSI-H HOTCtUMSON,
Csub. d. Mabi, Oho. W.Mohhih, D. L. Sloan.
NOKS~No.«k.
ABSENT-NOME.
JOSEPH HUTCHINSON.
President of the Board of Trustees.
attest: H. W. Siskins,
Cleric of the Town of Palo Alto.
[•HULL]
NEXT^
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GROCERIES
Are new and of the best quality.
Do you like good butter? If so, try us on Creamery.
A trial of our Teas and Coffees will convince tbat tbey are the best In .town
G. W. LA PIERE V SOTi
Mayfield
Palo Alto
Louis Dahl SSp,umblng
Tin and Sheet Iron Work
UNIVERSITY AVENUE
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Fancy Woods r r
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Office at Nattier. KHUrd P.rior.
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Modelling the seasonal and spatial variation of malaria transmission in relation to mortality in Africa
Get PDFAbout three billion people worldwide are estimated to be at risk of malaria transmission. In developing countries, malaria is believed to be a major cause of morbidity and mortality, mostly in children under five years. It is among the indirect causes of maternal mortality and infants’ deaths due to low-birth-weights. Malaria brings huge economic burden due to number of days lost during sickness and deaths, sustaining a vicious cycle of disease and poverty in sub Saharan Africa (SSA) and high attribute of disability-adjusted life years.
A number of malaria control interventions to reduce intensity of transmission have been successfully implemented in the regions of SSA, however, elimination of malaria is still a dream in many developing countries today. Failures in global eradication are related to resistance in insecticides and anti-malarial drugs, and health systems related factors. The Roll Back Malaria (RBM) partnership reinforced new strategies to combat malaria with long-term goal of eradicating the disease globally. This was facilitated by increasing funding for malaria research, improve multi disciplinary initiatives and make malaria among the main agenda of all international health and development forums. The reduction in mortality, especially in children has been reported recently and is associated with achievements in intervention strategies, improvements in malaria diagnosis and treatment. However, poor natural acquisition of malaria immunity in children as a consequence of weak or no exposure is a major epidemiological concern and brings a fear of higher mortality rates or shifting of age of death to older children. Understanding and quantify links between transmission, intervention, immunity and mortality is key for sustainable progress towards malaria control targets.
A comprehensive analysis of information on malaria transmission, vital events, drivers of transmission and mortality-related risk factors is required to achieve that. Lack of vital registration systems in developing countries hinders availability of appropriate data to conduct such analysis. Establishment of Demographic Surveillance Systems (DSS) in many developing countries aims to fill these information gaps. One of the initiatives integrated within DSSs is the Malaria Transmission Intensity and Mortality Burden across Africa (MTIMBA) project. The project compiled a database of mosquito collections at selected sites in Africa over a large number of locations, using standardized methodologies for a period of three years. The entomological parameters were linked with routinely monitored vital events within the DSS. The MTIMBA database is the most comprehensive entomological database ever collected in Africa which allows studying spatial-temporal variation in malaria transmission in relation to mortality.
Malaria is an environmental disease hence transmission varies with climate as it modifies population, survival, distribution and infectivity of malaria vectors. Quantification of association between climate and transmission is important to allow prediction of risk even in areas that field data cannot be easily obtained. Development in geographical information systems (GIS) and availability of remote sensing (RS) data facilitates availability of environment and climate data at high space and time resolutions allowing accurate estimation of outcome-factor relationship.
However, DSS data are large, sparse, zero-inflated and are characterized by seasonal patterns, spatial and temporal correlations. Standard models assume independence between observations, an assumption which do not hold for correlated data, hence utilizing these models might result into biased estimates. Geostatistical modeling of large, sparse and zero inflated space-time data is computational challenging specifically in the estimation of the spatial processes. The spatial correlation is accounted by introducing location-specific random effect parameters which are assumed to arise from a spatial process quantified by a multivariate normal distribution. The models are highly parameterized and their fit is computationally intensive. Bayesian computational algorithms such as Markov Chain Monte Carlo (MCMC) can be used to fit these models. Estimation of the spatial process requires inversion of the covariance matrix at each simulation point. The dimension of the matrix increases exponentially with number of locations and the inversion becomes infeasible when the size is too large. Recent techniques overcome this problem by approximating the spatial process from a subset of locations. These methods have been applied on Gaussian outcomes observed over a grid. Extension and formulation of rigorous methods to efficient model MTIMBA data are needed to allow precise prediction of malaria transmission at locations with mortality data to enhance studying the association. Lastly, seasonality in climatic conditions which introduces seasonal patterns in transmission and mortality data, should be accounted for when modelling such data.
The objectives of this thesis were to i) develop Bayesian geostatistical models to analyze very large and sparse geostatistical and temporal non-Gaussian data with seasonal patterns and ii) apply these models to (a) estimate space-time heterogeneity in malaria transmission (b) assess mortality variations between different ages during the first year of life while adjusting for seasonality and (c) determine the relation between transmission intensity and risk of mortality in children and adult population after taking into account control interventions. This work used an extract of MTIMBA data from the Rufiji DSS (RDSS) collected between October 2001 and September 2004.
Evaluation of approaches to capture seasonal pattern is discussed in Chapter 2 and applied to estimate mortality peaks at different stages of infant life. In Chapter 3, models approximating the spatial process from a subset of locations were developed to assess effect of climate, seasonal and spatial pattern of sporozoite rate (SR) of An. funestus and An. gambiae in RDSS. A rigorous approach to analyze malaria transmission data using Entomology Inoculation Rate (EIR) data, which is the product of mosquito density and SR, is discussed in Chapter 4. Zero-inflated models were used to account for over-dispersion and zero-inflation in the data. High resolution EIR estimates were produced for the RDSS. Exposure surfaces obtained in Chapter 4, were aligned with mortality events to assess the relationship between all-cause mortality and malaria transmission. Geostatistical Bernoulli discrete-time regression models adjusted for age and ITN possession were used for that analysis. The results of these analyses are presented in Chapters 5 and 6. The EIR was incorporated in the model as a covariate with measure of uncertainty.
This work is a building block on the insight and understanding of association between malaria transmission and all-cause mortality. The strength of results of this work relies on EIR estimates predicted at high spatial (household level) and temporal resolution by employing rigorous geostatistical models fitted on large entomological data. The better exposure estimates obtained are able to more accurately estimate the mortality-transmission relation
