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Background Antibodies targeting malaria blood-stage antigens are important targets of naturally acquired immunity, and may act as valuable biomarkers of malaria exposure. Methods Six-hundred and one young Malawian children from a randomized trial of prenatal nutrient supplementation with iron and folic acid or pre- and postnatal multiple micronutrients or lipid-based nutrient supplements were followed up weekly at home and febrile episodes were investigated for malaria from birth to 18 months of age. Antibodies were measured for 601 children against merozoite surface proteins (MSP1 19kD, MSP2), erythrocyte binding antigen 175 (EBA175), reticulocyte binding protein homologue 2 (Rh2A9), schizont extract and variant surface antigens expressed by Plasmodium falciparum -infected erythrocytes (IE) at 18 months of age. The antibody measurement data was related to concurrent malaria infection and to documented episodes of clinical malaria. Results At 18 months of age, antibodies were significantly higher among parasitaemic than aparasitaemic children. Antibody levels against MSP1 19kD, MSP2, schizont extract, and IE variant surface antigens were significantly higher in children who had documented episodes of malaria than in children who did not. Antibody levels did not differ between children with single or multiple malaria episodes before 18 months, nor between children who had malaria before 6 months of age or between 6 and 18 months. Conclusions Antibodies to merozoite and IE surface antigens increased following infection in early childhood, but neither age at first infection nor number of malaria episodes substantially affected antibody acquisition. These findings have implications for malaria surveillance during early childhood in the context of elimination. Trials registration Clinical Trials Registration: NCT01239693 (Date of registration: 11-10-2010). URL: http://www.ilins.org

Introduction: Malaria is a significant global health concern and adversely affects people in developing countries including Bangladesh. The causative agent Plasmodium falciparum is resistant to several currently available anti-malarial drugs, such as mefloquine, chloroquine, and artemisinin-based combination therapy (ACT), and this has been a major global challenge towards the control of the disease. There is urgent need for novel anti-malarial chemotherapeutic agents. Methodology: The present study aimed to evaluate antimalarial activity of methanolic extracts of three Bangladeshi medicinal plants- Acorus calamus, Dichapetalum gelonioides and Leucas aspera - against both chloroquine sensitive (3D7) and resistant (Dd2) strains of P. falciparum. Histidine-rich protein 2 (HRP2) based ELISA was used to evaluate the in vitro inhibitory activity of the extracts. Results: D. gelonioides extract showed moderate (IC50 = 19.15 µg/mL) and promising activity (IC50 = 10.43 µg/mL) against 3D7 and Dd2 strains respectively. A. calamus remained inactive against both 3D7 (IC50 = 72.29 µg/mL) and Dd2 strain (IC50 = 67.81 µg/mL). L. aspera initially remained inactive against 3D7 strain (IC50 = 60.51 µg/mL), but displayed promising activity (IC50 = 7.693) against Dd2 strain. Conclusions: This is the first time these plant materials have been assessed for their in vitro antimalarial properties. It is pivotal to conduct further phytochemical analysis of D. gelonioides and L. aspera to evaluate the presence of potential novel antimalarial drug compounds.

Background Maintaining the quality of teaching across India is a challenge. Teachers are equally responsible for patient care and administration. The importance of training medical teachers under the various faculty development programs (FDPs) is well accepted. A mechanism to evaluate the competencies acquired by medical teachers after attending FDPs becomes equally important. In the present study, we evaluate the impact of the various FDPs on medical teachers. Methodology A cross-sectional study was conducted for one year among 50 medical teachers attending FDPs. Ethical clearance was taken from the Institutional Ethical Committee. For quantitative data collection, the questionnaire was validated by the Scientific Approval Committee of the Institute. The study questionnaire was filled in by the participants just before and three months after attending FDPs. For qualitative data collection, in-depth Interviews (IDIs) using the Kirkpatrick model of learning evaluation were conducted. Descriptive statistics were presented as frequencies and percentages. The thematic areas of self-efficacy and teaching competency before and after FDPs were tested using the chi-square test. P-values <0.05 were considered significant. Results There was a significant increase in self-efficacy (300 vs. 426, p = <0.0001) and teaching competency (456 vs. 608, p = <0.0001) in the domains of teaching difficult students and motivating students for innovative projects. Improvement in communication skills and ability to engage the students were noteworthy in teaching competency. IDIs revealed that FDPs are essential for the efficient delivery of the competency-based medical curriculum. Conclusions FDPs play a key role in bringing about significant improvement in generating self-efficacy and teaching competencies among medical teachers. FDPs may be incorporated into the postgraduate medical curriculum itself.

Background There is evidence that suggests that undernutrition has a detrimental effect on malarial immunity in children. The aim of the study was to discover whether nutrient supplementation improved development of malarial antibody immunity in children up to 18 months of age. Methods The study was conducted with a subset of 432 Malawian children from a randomized controlled trial of nutritional supplements. The arms included pre- and postnatal small-quantity lipid-based nutrient supplements for both mother and child; prenatal supplementation with iron and folic acid; and pre- and postnatal supplementation with multiple micronutrients. Paired plasma samples were collected at 6 and 18 months of age. The levels of antibodies against merozoite surface protein 1 (MSP1 19kD) and MSP2, erythrocyte binding antigen 175 (EBA175), reticulocyte binding protein homologue 2A (Rh2A9), schizont extract and variant antigens expressed on the surface of infected erythrocytes were measured. Results At 18 months of age, 5.4% of children were parasitaemic by microscopy and 49.1% were anaemic. Antibodies to the tested merozoite antigens and schizont extract increased between 6 and 18 months and this increase was statistically significant for MSP1, MSP2 and EBA175 (p < 0.0001) whereas IgG to variant surface antigens decreased with increasing age (p < 0.0001). However, the supplementation type did not have any impact on the prevalence or levels of antibodies at either 6 or 18 months of age to any of the tested malaria antigens in either univariate analysis or multivariate analysis after adjusting for covariates. Conclusions Pre- and postnatal lipid-based nutrient supplementation did not alter malaria antibody acquisition during infancy, compared to prenatal supplementation with iron and folic acid or pre- and postnatal supplementation with multiple micronutrients. Trail registeration Clinicaltrials.gov registration number NCT01239693

About 600 million people are estimated to be infected with Strongyloides stercoralis, the species that causes most of the human strongyloidiasis cases. S. stercoralis can also infect non-human primates (NHPs), dogs and cats, rendering these animals putative sources for zoonotic human S. stercoralis infection. S. fuelleborni is normally found in old world NHPs but occasionally also infects humans, mainly in Africa. Dogs in southeast Asia carry at least two types of Strongyloides, only one of which appears to be shared with humans (\"dog only\" and \"human and dog\" types). For S. stercoralis with molecular taxonomic information, there is a strong sampling bias towards southeast and east Asia and Australia. In order to extend the geographic range of sampling, we collected human and dog derived Strongyloides spp. and hookworms from two locations in Bangladesh and subjected them to molecular taxonomic and genomic analysis based on nuclear and mitochondrial sequences. All hookworms found were Necator americanus. Contrary to earlier studies in Asia, we noticed a rather high incidence of S. fuelleborni in humans. Also in this study, we found the two types of S. stercoralis and no indication for genetic isolation from the southeast Asian populations. However, we found one genomically \"dog only\" type S. stercoralis in a human sample and we found two worms in a dog sample that had a nuclear genome of the \"dog only\" but a mitochondrial genome of the \"human and dog\" type. S. fuelleborni may play a more prominent role as a human parasite in certain places in Asia than previously thought. The introgression of a mitochondria haplotype into the \"dog only\" population suggests that rare interbreeding between the two S. stercoralis types does occur and that exchange of genetic properties, for example a drug resistance, between the two types is conceivable.

Cortical Visual Impairment (CVI) is defined as impaired vision caused due to bilateral dysfunction of the optic radiations or visual cortex or both. It is a major cause of low vision in children in the developed and developing world due to increasing survival of babies during complicated deliveries in pediatric and neonatal care. Prevalence of CVI in developed countries is increasing due to successful management of childhood blindness resulting from cataract and retinopathy of prematurity. In addition, increasing survival of children with brain injury has contributed to increased cases of CVI. The prevalence of visual impairment in children under 16 years of age is between 10 and 22 cases per 10,000 births in developed countries and 40 per 10,000 births in developing countries but this may be an under-estimate owing to visual behavioral difficulties going undetected and undiagnosed cases. However, many children with CVI have improved their sight and mental and physical strength with proper care. Better quantitative tools for measuring vision are needed to assess these children, to allow measurement of their visual deficit, and to monitor their response to treatment and rehabilitation. In order to truly meet the unique learning needs of young children with cortical visual impairment (CVI), it is critical to accurately define the population to create and implement quality and responsive support services. The utmost important part of the CVI treatment are the daily exercises. Even if a child has possibility of improving his/her condition, missing out on the daily exercises might permanently take the chances away of acquiring better sight someday. This research is about finding a solution for the financially struggling families in developing countries like India which would help them do the daily exercises without having to travel to the hospital or meeting the Teacher for visually impaired on a regular basis.

In 2018, WHO with the support of the Ministry of Health and Family Welfare, India and partner organisations launched a Learning Districts Initiative to strengthen the district-level application of the National Adolescent Health Programme and to draw out lessons. An assessment of this initiative from 2019 to 2023 using qualitative and quantitative programme monitoring data from interviews, discussions, observations and data from multiple secondary sources explored the evolution of the concept, the process of securing government agreement, operationalising the initiative and the feasibility, acceptability, effectiveness and the potential of sustainability and replicability within the government health system. As part of the process, WHO developed the concept with partners to address the challenges identified in a Rapid Programme Review requested by the Ministry. The Ministry concurred with the proposed participatory problem identification and problem-solving approach. A review-based process guided the implementation. Local non-government organisations supported District Health Management Units to strengthen planning, implementation and monitoring. An expert in adolescent health provided technical oversight. Three years later in 2022, adolescent health is on district agendas, staff capacity has been built, and clinic and community-based activities are carried out in a structured manner. The Initiative is feasible as it leverages local expertise. Its core interventions are acceptable to government officials. While there are improvements in inputs, processes and outputs, these need to be independently validated. Challenges such as unfilled vacancies, problems in supply procurement, inability of staff to discuss sensitive issues, weak intersectoral convergence and low engagement of adolescents in programme management remain to be addressed. Nevertheless, the overall experience augurs well for the future of the programme. En 2018, l’OMS, avec le soutien du Ministère indien de la santé et du bien-être familial ainsi que d’organisations partenaires, a lancé une initiative des districts d’apprentissage pour renforcer la mise en œuvre au niveau des districts du programme national de santé des adolescents et en tirer des enseignements. Une évaluation de cette initiative utilisant des données qualitatives et quantitatives provenant de multiples sources a étudié l’évolution du concept, le processus d’obtention de l’agrément des autorités, la mise en œuvre de l’initiative, ainsi que sa faisabilité, son acceptabilité, son efficacité et son potentiel de viabilité et de transposabilité au sein du système de santé public. L’OMS a développé le concept avec ses partenaires pour s’attaquer aux difficultés identifiées lors d’un examen rapide du programme réalisé à la demande du Ministère qui a approuvé l’approche participative proposée pour l’identification et la résolution des problèmes. Un processus fondé sur l’examen a guidé la mise en œuvre. Les organisations non gouvernementales locales ont aidé les unités de gestion sanitaire des districts à renforcer la planification, la mise en œuvre et le suivi. Un expert en santé des adolescents a assuré la supervision technique. Trois ans plus tard, la santé des adolescents figure à l’ordre du jour des districts, les capacités du personnel ont été renforcées et les activités cliniques et communautaires sont menées de manière structurée. L’initiative est faisable car elle exploite l’expertise locale. Ses principales interventions sont acceptables pour les responsables gouvernementaux. Bien que des améliorations aient été apportées dans les intrants, les processus et les résultats, celles-ci doivent être validées de manière indépendante. Les difficultés comme les postes vacants non pourvus, les problèmes d’approvisionnement en fournitures, l’incapacité du personnel à parler des questions sensibles, la faible convergence intersectorielle et la médiocre participation des adolescents à la gestion du programme doivent encore être résolues. Néanmoins, l’expérience globale est de bon augure pour l’avenir du programme. En 2018, la OMS, con el apoyo del Ministerio de Salud y Bienestar Familiar, India y organizaciones aliadas, lanzó una Iniciativa de Distritos en Aprendizaje para fortalecer la aplicación a nivel distrital del Programa Nacional de Salud de Adolescentes, y para extraer lecciones. Una evaluación de esta iniciativa utilizando datos cualitativos y cuantitativos de múltiples fuentes exploró la evolución del concepto, el proceso de obtener el acuerdo del gobierno, operacionalizando la iniciativa, y la viabilidad, la aceptabilidad, la eficacia y el potencial de sostenibilidad y replicabilidad en el sistema de salud del gobierno. La OMS creó el concepto con socios para encarar los retos identificados en una revisión rápida del programa realizada a instancias del ministerio. El Ministerio coincidió con el propuesto enfoque participativo de identificación y resolución de problemas. Un proceso basado en la revisión guió la ejecución. Organizaciones no gubernamentales locales apoyaron a las Unidades de Gestión de Salud Distrital para fortalecer la planificación, la ejecución y el monitoreo. Un experto en salud de adolescentes proporcionó supervisión técnica. Tres años después, la salud de adolescentes figura en las agendas distritales, la capacidad del personal se ha desarrollado, y las actividades en centros de salud y en comunidades se llevan a cabo de una manera estructurada. La Iniciativa es factible, ya que aprovecha la experiencia y los conocimientos locales. Sus intervenciones fundamentales son aceptadas por los funcionarios del gobierno. Aunque hay mejoras en insumos, procesos y productos, estos deben validarse independientemente. Aún falta encarar retos tales como puestos vacantes, problemas en la adquisición de suministros, la incapacidad del personal para discutir asuntos delicados, débil convergencia intersectorial y poca participación de adolescentes en la gestión de programas. No obstante, la experiencia general es un buen augurio para el futuro del programa.

From March to June 2021, India experienced a deadly second wave of COVID-19, with an increased number of post-vaccination breakthrough infections reported across the country. To understand the possible reason for these breakthroughs, we collected 677 clinical samples (throat swab/nasal swabs) of individuals from 17 states/Union Territories of the country who had received two doses (n = 592) and one dose (n = 85) of vaccines and tested positive for COVID-19. These cases were telephonically interviewed and clinical data were analyzed. A total of 511 SARS-CoV-2 genomes were recovered with genome coverage of higher than 98% from both groups. Analysis of both groups determined that 86.69% (n = 443) of them belonged to the Delta variant, along with Alpha, Kappa, Delta AY.1, and Delta AY.2. The Delta variant clustered into four distinct sub-lineages. Sub-lineage I had mutations in ORF1ab A1306S, P2046L, P2287S, V2930L, T3255I, T3446A, G5063S, P5401L, and A6319V, and in N G215C; Sub-lineage II had mutations in ORF1ab P309L, A3209V, V3718A, G5063S, P5401L, and ORF7a L116F; Sub-lineage III had mutations in ORF1ab A3209V, V3718A, T3750I, G5063S, and P5401L and in spike A222V; Sub-lineage IV had mutations in ORF1ab P309L, D2980N, and F3138S and spike K77T. This study indicates that majority of the breakthrough COVID-19 clinical cases were infected with the Delta variant, and only 9.8% cases required hospitalization, while fatality was observed in only 0.4% cases. This clearly suggests that the vaccination does provide reduction in hospital admission and mortality.

Background Although the need for multi-faceted and multi-sectoral approaches to address the multidimensional issue of child marriage is well-acknowledged, there is a dearth of documented experience on the process of implementing and managing such programmes. Methods WHO evaluated a district-level, government-led multi-sectoral intervention to address child marriage in Jamui, Bihar and Sawai Madhopur, Rajasthan, implemented by MAMTA Health Institute for Mother and Child (MAMTA). We evaluated the intervention’s design, implementation, monitoring, and outputs and identified key challenges and successes. Results Through actions at the state and district levels, the intervention succeeded in creating a cascade effect to stimulate more concerted action at block and village levels, with tangible intersectoral convergence occurring at the village level. The success factors we identified included an experienced partner NGO that was committed to supporting this effort, context-specific design and implementation, and a flexible and responsive approach. However, despite contributing to informal coordination between various stakeholders, the intervention did not succeed in developing a sustained joint-working mechanism at the district level. Shared ownership for prioritization of child marriage across national- and state-level sectors was not established, due in part to lack of directives transcending ministerial/departmental boundaries. Nevertheless, due to its efforts at the district-level, the intervention was able to enlist leadership from the District Magistrates and Child Marriage Prohibition Officers, in line with their duties outlined in the 2006 Prohibition of Child Marriage Act. The challenges we identified included lack of clear directives and institutional support for collaboration, obstacles to monitoring, administrative challenges, differing perspectives on strategy among district leaders, community resistance, and intervention over-commitment. Conclusions The findings of this evaluation reveal the potential of multi-sectoral approaches to prevent and respond to child marriage and provide insight into obstacles that affect multi-sectoral coordination. We point to actions that MAMTA could take to strengthen collaboration on this and other initiatives. We also recommend further documentation and evaluation of projects and programmes in this area.