Paediatrics and Child Health

Incidence rates of malaria, meningitis, and mortality in children younger than 5 years: a prospective cohort study in Ghana and Kenya before the roll-out of the RTS,S/AS01E malaria vaccine from 2016 to 2022

Thu, 01 May 2025 00:00:00 GMT

Incidence rates of malaria, meningitis, and mortality in children younger than 5 years: a prospective cohort study in Ghana and Kenya before the roll-out of the RTS,S/AS01E malaria vaccine from 2016 to 2022 Asante, Kwaku Poku; Bozonnat, Marie-Cécile; Miloje, Savic.et.al. The RTS,S/AS01E malaria vaccine was introduced in selected communities of Ghana, Kenya, and Malawi in 2019 under a WHO-coordinated pilot programme. The scarcity of background disease incidence rates might hamper the assessment of vaccine safety and effectiveness. We aimed to determine the incidence rates of malaria, meningitis, and death, and health outcomes leading to hospital admission in children younger than 5 years enrolled before RTS,S/AS01E implementation. Interim results from EPI-MAL-002 up to Oct 5, 2018, were reported previously. Here, we report results from the final analysis of the pre-vaccine introduction study.

Safety of RTS, S/AS01E malaria vaccine up to 1 year after the third dose in Ghana, Kenya, and Malawi (EPI-MAL-003): a phase 4 cohort event monitoring study

Sun, 01 Jun 2025 00:00:00 GMT

Safety of RTS, S/AS01E malaria vaccine up to 1 year after the third dose in Ghana, Kenya, and Malawi (EPI-MAL-003): a phase 4 cohort event monitoring study Haine, Valérie; Oneko, Martina; Debois, Muriel.et .al. RTS,S/AS01E has been successfully administered to over two million children since 2019 through the Malaria Vaccine Implementation Programme (MVIP). In this Article, we report the safety results of a study evaluating RTS,S/AS01E safety and effectiveness in real-world settings. The Lancet Global Health

Plasmodium falciparum Parasitemia Does Not Diminish Neutralizing Antibody Responses After mRNA COVID-19 Booster Vaccination in HIV-infected Adults

Sat, 02 Aug 2025 00:00:00 GMT

Plasmodium falciparum Parasitemia Does Not Diminish Neutralizing Antibody Responses After mRNA COVID-19 Booster Vaccination in HIV-infected Adults Samandari, Taraz; Achola, Millicent; Hutter, N Jack. et.al mRNA vaccines have emerged as powerful tools for the prevention of infectious diseases, but subclinical malaria may reduce vaccine immunogenicity. We evaluated neutralizing antibody responses in asymptomatic HIV-infected adults with and without polymerase chain reaction-confirmed Plasmodium falciparum who received either monovalent mRNA-1273 or bivalent mRNA-1273.222 (WA-1 and BA.4/5) booster vaccines. In previous studies, a 50% pseudovirus inhibitory dose neutralizing antibody (ID50) titer of 1000 correlated with 96% efficacy in preventing COVID-19. We observed ID50 geometric mean titers >22 000 in both parasitemic and nonparasitemic participants 1 month after boosting. We conclude that COVID-19 mRNA vaccine antibody responses are unimpaired by concurrent asymptomatic parasitemia. The Journal of Infectious Diseases

Hybrid versus vaccine immunity of mRNA-1273 among people living with HIV in East and Southern Africa: a prospective cohort analysis from the multicentre CoVPN 3008 (Ubuntu) study

Sat, 01 Feb 2025 00:00:00 GMT

Hybrid versus vaccine immunity of mRNA-1273 among people living with HIV in East and Southern Africa: a prospective cohort analysis from the multicentre CoVPN 3008 (Ubuntu) study Garrett, Nigel; Tapley, Asa; Hudson, Aaron; Et al. With limited access to mRNA COVID-19 vaccines in lower income countries, and people living with HIV (PLWH) largely excluded from clinical trials, Part A of the multicentre CoVPN 3008 (Ubuntu) study aimed to assess the safety of mRNA-1273, the relative effectiveness of hybrid versus vaccine immunity, and SARS-CoV-2 viral persistence among PLWH in East and Southern Africa during the omicron outbreak. https://doi.org/10.1016/j.eclinm.2024. 103054

Survival and Risk Factors for Late Preterm and Early Term Neonates Compared to Full-Term Infants at Garissa County Referral Hospital, Kenya

Thu, 31 Oct 2024 00:00:00 GMT

Survival and Risk Factors for Late Preterm and Early Term Neonates Compared to Full-Term Infants at Garissa County Referral Hospital, Kenya Amolo, Tom; Raballah, Evans; Olayo, Rose; Esendi, C.Gladys; Otieno, Walter Preterm birth constitutes a significant health burden in Kenya, yet there is hardly any targeted research looking at the survival and specific risk factors associated with birth of late preterm neonates (LPNs) and early term neonates (ETNs), particularly in Garissa County. While studies on preterm birth determinants have been done in Kenya, factors specifically influencing LPNs and ETNs births and their survival relative to their full-term counterparts remain understudied. Studies done on preterm in general have identified maternal age, history of preterm birth, pregnancy-induced hypertension, and prolonged premature rapture of the membrane among others as significant risk factors, but their relevance to LPNs and ETNs specifically has not been fully investigated. This study aimed to address these gaps by determining maternal as well as fetal risk factors associated with LPN and ETN births compared to full-term neonates (FTNs) born at Garissa County Referral Hospital. Further, it sought to identify predictors of survival across these neonatal groups. The study conducted at Garissa County Referral Hospital employed a prospective cohort design. Mother-neonate dyads were enrolled using convenience sampling method until the required sample was achieved. Data was collected using pretested and validated questionnaires. STATA version 17 was used for analysis. Multinomial logistic regression analysis was performed to determine Relative Risk Ratio. The P-value was set α=0.05 and P<0.05 was considered statistically significant. Survival rates were estimated using Kaplan-Meier survival analysis. Bivariate Cox regression analysis was employed to identify independent predictors at p<0.20. However, since all variables had p-values >0.02, multivariate Cox regression was not conducted. The study revealed that maternal age (P=0.042), occupation (P=0.024), ethnicity (P=0.021), religion (P=0.016) and absence of previous abortion/still birth/premature deliveries (P=0.015) were maternal related factors associated with birth of LPN, ETN and FTN. Birth weight was associated with LPN (P<0.001), while FTN had higher likelihood of delayed initiation of breastfeeding (P=0.038) but were less likely to have feeding difficulties compared to LPN and ETN (P=0.012). A comparison of fit model with the complete set of predictors with an intercept-only, or null model revealed that P-values for maternal (P=0.0175) and fetal (P<0.001) related risk factors were less than Fisher’s value of 0.05, hence the null hypothesis was rejected. The Kaplan-Meier survival analysis revealed high survival rates across all gestational age categories, with 100% survival among LPNs. In conclusion, the study showed that maternal- and fetal-related risk factors associated with LPNs and ETNs are distinct from those of FTNs.

The Walter Reed Project, Kisumu Field Station: Impact of Research on Malaria Policy, Management, and Prevention.

Tue, 23 Apr 2024 00:00:00 GMT

The Walter Reed Project, Kisumu Field Station: Impact of Research on Malaria Policy, Management, and Prevention. Peter M Sifuna, Michal Mbinji, Tina O Lucas, Irene Onyango, Hoseah M Akala, John N Waitumbi, Bernhards R Ogutu, Jack N Hutter, Walter Otieno The Walter Reed Project is a collaboration between the Walter Reed Army Institute of Research of the United States Department of Defense and the Kenya Medical Research Institute. The Kisumu field station, comprising four campuses, has until recently been devoted primarily to research on malaria countermeasures. The Kombewa Clinical Research Center is dedicated to conducting regulated clinical trials of therapeutic and vaccine candidates in development. The center's robust population-based surveillance platform, along with an active community engagement strategy, guarantees consistent recruitment and retention of participants in clinical trials. The Malaria Diagnostic Center, backed by WHO-certified microscopists and a large malaria blood film collection, champions high-quality malaria diagnosis and strict quality assurance through standardized microscopy trainings. The Malaria Drug Resistance Laboratory leverages cutting-edge technology such as real-time Polymerase Chain Reaction (qPCR) to conduct comprehensive research on resistance markers and obtain information on drug efficacy. The laboratory has been working on validating artemisinin resistance markers and improving tracking methods for current and future antimalarial compounds. Finally, the Basic Science Laboratory employs advanced genomic technology to examine endpoints such as immunogenicity and genomic fingerprinting for candidate drugs and vaccine efficacy. Herein, we examine the site's significant contributions to malaria policy, management, and prevention practices in Kenya and around the world. https://doi.org/10.4269/ajtmh.23-0115

A genomic appraisal of invasive Salmonella Typhimurium and associated antibiotic resistance in sub-Saharan Africa

Mon, 23 Oct 2023 00:00:00 GMT

A genomic appraisal of invasive Salmonella Typhimurium and associated antibiotic resistance in sub-Saharan Africa Sandra Van Puyvelde, Tessa De Block, Sushmita Sridhar, Matt Bawn, Robert A Kingsley, Brecht Ingelbeen, Mathew A Beale, Barbara Barbé, Hyon Jin Jeon, Lisette Mbuyi-Kalonji, Marie-France Phoba, Dadi Falay, Delphine Martiny, Olivier Vandenberg, Dissou Affolabi, Jean Pierre Rutanga, Pieter-Jan Ceyssens, Wesley Mattheus, Wim L Cuypers, Marianne AB Van Der Sande, Se Eun Park, Simon Kariuki, Kephas Otieno, John PA Lusingu, Joyce R Mbwana, Samuel Adjei, Anima Sarfo, Seth O Agyei, Kwaku P Asante, Walter Otieno, Lucas Otieno, Marc C Tahita, Palpouguini Lompo, Irving F Hoffman, Tisungane Mvalo, Chisomo Msefula, Fatimah Hassan-Hanga, Stephen Obaro, Grant Mackenzie, Stijn Deborggraeve, Nicholas Feasey, Florian Marks, Calman A MacLennan, Nicholas R Thomson, Jan Jacobs, Gordon Dougan, Samuel Kariuki, Octavie Lunguya Invasive non-typhoidal Salmonella (iNTS) disease manifesting as bloodstream infection with high mortality is responsible for a huge public health burden in sub-Saharan Africa. Salmonella enterica serovar Typhimurium (S. Typhimurium) is the main cause of iNTS disease in Africa. By analysing whole genome sequence data from 1303 S. Typhimurium isolates originating from 19 African countries and isolated between 1979 and 2017, here we show a thorough scaled appraisal of the population structure of iNTS disease caused by S. Typhimurium across many of Africa’s most impacted countries. At least six invasive S. Typhimurium clades have already emerged, with ST313 lineage 2 or ST313-L2 driving the current pandemic. ST313-L2 likely emerged in the Democratic Republic of Congo around 1980 and further spread in the mid 1990s. We observed plasmid-borne as well as chromosomally encoded fluoroquinolone resistance underlying emergences of extensive-drug and pan-drug resistance. Our work provides an overview of the evolution of invasive S. Typhimurium disease, and can be exploited to target control measures. https://doi.org/10.1038/s41467-023-41152-6

Time to full enteral feeds in hospitalised preterm and very low birth weight infants in Nigeria and Kenya

Fri, 08 Mar 2024 00:00:00 GMT

Time to full enteral feeds in hospitalised preterm and very low birth weight infants in Nigeria and Kenya Zainab O Imam, Helen M Nabwera, Olukemi O Tongo, Pauline EA Andang’o, Isa Abdulkadir, Chinyere V Ezeaka, Beatrice N Ezenwa, Iretiola B Fajolu, Martha K Mwangome, Dominic D Umoru, Abimbola E Akindolire, Walter Otieno, Macrine Olwala, Grace M Nalwa, Alison W Talbert, Ismaela Abubakar, Nicholas D Embleton, Stephen J Allen, Neonatal Nutrition Network (NeoNuNet) Preterm (born < 37 weeks’ gestation) and very low birthweight (VLBW; <1.5kg) infants are at the greatest risk of morbidity and mortality within the first 28 days of life. Establishing full enteral feeds is a vital aspect of their clinical care. Evidence predominantly from high income countries shows that early and rapid advancement of feeds is safe and reduces length of hospital stay and adverse health outcomes. However, there are limited data on feeding practices and factors that influence the attainment of full enteral feeds among these vulnerable infants in sub-Saharan Africa. . https:// doi.org/10.1371/journal.pone.0277847

Deployment of Rotavirus Vaccine in Western Kenya Coincides with a Reduction in All-Cause Child Mortality: A Retrospective Cohort Study

Sat, 29 Jul 2023 00:00:00 GMT

Deployment of Rotavirus Vaccine in Western Kenya Coincides with a Reduction in All-Cause Child Mortality: A Retrospective Cohort Study Sifuna, Peter; Shaw, Andrea V; Lucas, Tina; Ogutu, Bernards; Otieno, Walter; Larsen, David A Rotavirus is an important cause of fatal pediatric diarrhea worldwide. Many national immunization programs began adding rotavirus vaccine following a 2009 World Health Organization recommendation. Kenya added rotavirus vaccine to their immunization program at the end of 2014. From a cohort of 38,463 children in the Kisumu health and demographic surveillance site in western Kenya, we assessed how the implementation of the rotavirus vaccine affected mortality in children under 3 years of age. Following its introduction in late 2014, the span of rotavirus vaccine coverage for children increased to 75% by 2017. Receiving the rotavirus vaccine was associated with a 44% reduction in all-cause child mortality (95% confidence interval = 28–68%, p < 0.0001), but not diarrhea-specific mortality (p = 0.401). All-cause child mortality declined 2% per month following the implementation of the rotavirus vaccine (p = 0.002) among both vaccinated and unvaccinated children, but diarrhea-specific mortality was not associated with the implementation of the rotavirus vaccine independent of individual vaccine status (p = 0.125). The incidence of acute diarrhea decreased over the study period, and the introduction of the rotavirus vaccine was not associated with population-wide trends (p = 0.452). The receipt of the rotavirus vaccine was associated with a 34% reduction in the incidence of diarrhea (95% confidence interval = 24–43% reduction). These results suggest that rotavirus vaccine may have had an impact on all-cause child mortality. The analyses of diarrhea-specific mortality were limited by relatively few deaths (n = 57), as others have found a strong reduction in diarrhea-specific mortality. Selection bias may have played a part in these results—children receiving rotavirus vaccine were more likely to be fully immunized than children not receiving the rotavirus vaccine. https://doi.org/10.3390/vaccines11081299

Prostration and the prognosis of death in African children with severe malaria

Fri, 01 Sep 2023 00:00:00 GMT

Prostration and the prognosis of death in African children with severe malaria Selidji T Agnandji, Mario Recker, Benjamin Mordmüller, Stephan Glöckner, Akim A Adegnika, Bertrand Lell, Lucas Otieno, Walter Otieno, Seth Owusu-Agyei, Kwaku P Asante, Tsiri Agbenyega, Daniel Ansong, Eusebio Macete, Pedro Aide, Hermann Sorgho, Halidou Tinto, Neema Mturi, John PA Lusingu, Samwel Gesase, Irving Hoffman, Nahya Salim Masoud, Charles R Newton, Kalifa Bojang, Gérard Krause, Peter Gottfried Kremsner Malaria is still one of the main reasons for hospitalization in children living in sub-Saharan Africa. Rapid risk stratification at admission is essential for optimal medical care and improved prognosis. Whereas coma, deep breathing, and, to a lesser degree, severe anemia are established predictors of malaria-related death, the value of assessing prostration for risk stratification is less certain. https://doi.org/10.1016/j.ijid.2023.06.022