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With global malaria cases on the rise, the WHO has placed increased emphasis on National Malaria Programmes to tailor interventions to country and programmatic needs. This paper presents the Plus Project’s experience of applying a codesign approach to design country-specific models of perennial malaria chemoprevention (PMC), a chemoprevention intervention aimed at reducing morbidity and mortality due to malaria and anaemia in children. Codesign workshops were held in each of the project’s focus countries (Benin, Cameroon, Côte d'Ivoire and Mozambique) with the primary objective of designing the country-specific PMC model. The three-and-a-half-day workshops were adapted to each country’s context and included stakeholders from national and subnational malaria, immunisation and child health programmes, as well as national and international development partners and research institutions. The meetings were iterative and collaborative, harnessing a variety of participatory methods including journey mapping and surveys to reach group consensus on the PMC models best suited to each country’s specific context. The Plus Project’s codesign approach resulted in four different PMC strategies, with a range from four to eight contact points and different codelivery interventions, each taking advantage of country-specific health system delivery platforms, operational logistics and political contexts. This collaborative, codesign process also helped gather additional programmatic insights to aid PMC implementation while providing an opportunity to increase stakeholder buy-in. With an emphasis on collaborative decision-making, the learnings collected through these workshops can be applied to a variety of programmatic applications, extending beyond malaria.

Progress in malaria control will rely on deployment and effective targeting of combinations of interventions, including malaria vaccines and perennial malaria chemoprevention (PMC). Several countries with PMC programmes have introduced malaria vaccination into their essential programmes on immunizations, but empirical evidence on the impact of combining these two interventions and how best to co-implement them are lacking. At the American Society of Tropical Medicine and Hygiene 2023 annual meeting, a stakeholder meeting was convened to identify key policy, operational and research gaps for co-implementation of malaria vaccines and PMC. Participants from 11 endemic countries, including representatives from national malaria and immunization programmes, the World Health Organization, researchers, implementing organizations and funders attended. Identified evidence gaps were prioritized to select urgent issues to inform co-implementation. The output of these activities is a strategic roadmap of priority malaria vaccine and PMC co-implementation evidence gaps, and solutions to address them. The roadmap was presented to stakeholders for feedback at the 2024 Multilateral Initiative on Malaria meeting and revised accordingly. The roadmap outlines four key areas of work to address urgent evidence gaps for co-implementation: (1) support to the global and national policy process, (2) implementation support and research, (3) clinical studies, and (4) modelling. Together, these areas will provide practical guidance on the co-implementation of the interventions, and robust evidence to inform decision-making on how best to design, optimize and scale-up co-implementation in different contexts, including if and in what contexts the co-implementation is cost-effective, and the optimal schedule for co-implementation. This will work towards supporting the policy process on co-implementation of malaria vaccines and PMC, and achieving the most impactful use of available resources for the prevention of malaria in children.

Background Accurate routine surveillance data are essential for malaria control and elimination. However, the multistep reporting process used in most malaria-affected countries can introduce discrepancies between health facility registers and national health management information systems, often based on the District Health Information System 2 (DHIS2). This study assessed the concordance of malaria rapid diagnostic test (RDT) data across facility registers, monthly summary forms (MSFs) and the DHIS2 in four sub-Saharan countries. Methods In 2023, we conducted an observational study in Benin, Côte d’Ivoire, Nigeria, and Uganda, using harmonized tools and methods. In each country, 16 public primary health care facilities were selected from two regions. The total number of RDTs and positive results from health facility registers, MSFs and the DHIS2 were compared over three to five months. We assessed concordance using Bland–Altman plots, weighted absolute percentage error (WAPE)-based aggregate data reporting accuracy (WADRA), and verification factors (VFs). System- and facility-level differences were examined by stratifying indicators by region, baseline outpatient volume and test positivity rate. Results Across 64 facilities, 104,396 RDTs (58,304 positives, 55.8%) were recorded in registers, compared to 112,435 (62,903 positives, 55.9%) in MSFs and 110,771 (62,761 positives, 56.7%) in DHIS2. Benin showed the highest concordance across data sources, while Nigeria and Uganda had the lowest. Positive RDT results were more likely to be reported than total RDTs, particularly in Nigeria, where VFs indicated consistent overreporting (mean VF 0.74, 95% CI: 0.61–0.89). WADRA analysis showed low reporting accuracy for positive RDTs in 6 (38%) Nigerian and 5 (31%) Ugandan facilities. Regional differences were notable in Nigeria and Uganda. In Nigeria, higher outpatient volume was associated with lower concordance; no trend was seen for baseline test positivity rate. Conclusions Substantial variation in RDT data concordance was observed across countries and facilities. Concordance was strongest between MSFs and DHIS2, suggesting data entry was not a significant issue. Strengthening routine data validation and using accuracy and direction-sensitive metrics, such as WADRA and VFs, could improve malaria data reliability. Further research should explore system-level factors influencing data quality and identify scalable solutions.

The Lobo reservoir, designed to supply water to the Daloa city population (central west of Côte d’Ivoire), is facing the phenomenon of eutrophication due to the agricultural plots located upstream of the reservoir inputs. Studies have highlighted the reservoir pollution and sedimentation problems. This study was initiated to test the effectiveness of a transfer model in the fight against the eutrophication problem. The objective of this study was to determine the optimal width of a vegetative filter strip on the banks of the Lobo reservoir, where the water intake installations of the drunk water company SODECI are located, using the VFSMOD model. The methodological approach is structured into four (4) main stages: 1—Evaluation of runoff from the source of pollution (contributing surface) during a rainy episode; 2—Calculation of the incoming runoff volume and the sediment load; 3—Simulation of runoff reduction and incoming sediments within the grassy filter strip; and 4—Determination of the optimal width of the grassy strip. The results obtained showed a contributing source area of 13.5 ha and 2% as the average slope. A runoff volume of 4680 m3 coming from the source of pollution is reduced by 1119 m3 (24%) through a grassy strip that is 3 m wide. The sediment load goes from 132 kg to 33 kg, a reduction of 75% in the quantity of sediment entering. The scenarios tested showed that a grassy strip width equal to 3 m should allow for a reduction of 75% of upstream sediments. This grassy strip width of 3 m should be considered for implementing a vegetative filter strip around the Lobo reservoir.

Important control efforts have led to a significant reduction of the prevalence of human African trypanosomiasis (HAT) in Côte d'Ivoire, but the disease is still present in several foci. The existence of an animal reservoir of Trypanosoma brucei gambiense may explain disease persistence in these foci where animal breeding is an important source of income but where the prevalence of animal African trypanosomiasis (AAT) is unknown. The aim of this study was to identify the trypanosome species circulating in domestic animals in both Bonon and Sinfra HAT endemic foci. 552 domestic animals (goats, pigs, cattle and sheep) were included. Blood samples were tested for trypanosomes by microscopic observation, species-specific PCR for T. brucei sl, T. congolense, T. vivax and subspecies-specific PCR for T. b. gambiense and T. b. gambiense immune trypanolysis (TL). Infection rates varied significantly between animal species and were by far the highest in pigs (30%). T. brucei s.l was the most prevalent trypanosome species (13.7%) followed by T. congolense. No T. b. gambiense was identified by PCR while high TL positivity rates were observed using T. b. gambiense specific variants (up to 27.6% for pigs in the Bonon focus). This study shows that domestic animals are highly infected by trypanosomes in the studied foci. This was particularly true for pigs, possibly due to a higher exposure of these animals to tsetse flies. Whereas T. brucei s.l. was the most prevalent species, discordant results were obtained between PCR and TL regarding T. b. gambiense identification. It is therefore crucial to develop better tools to study the epidemiological role of potential animal reservoir for T. b. gambiense. Our study illustrates the importance of \"one health\" approaches to reach HAT elimination and contribute to AAT control in the studied foci.

The existence of an animal reservoir of Trypanosoma brucei gambiense (T. b. gambiense), the agent of human African trypanosomiasis (HAT), may compromise the interruption of transmission targeted by World Health Organization. The aim of this study was to investigate the presence of trypanosomes in pigs and people in the Vavoua HAT historical focus where cases were still diagnosed in the early 2010's. For the human survey, we used the CATT, mini-anion exchange centrifugation technique and immune trypanolysis tests. For the animal survey, the buffy coat technique was also used as well as the PCR using Trypanosoma species specific, including the T. b. gambiense TgsGP detection using single round and nested PCRs, performed from animal blood samples and from strains isolated from subjects positive for parasitological investigations. No HAT cases were detected among 345 people tested. A total of 167 pigs were investigated. Free-ranging pigs appeared significantly more infected than pigs in pen. Over 70% of free-ranging pigs were positive for CATT and parasitological investigations and 27-43% were positive to trypanolysis depending on the antigen used. T. brucei was the most prevalent species (57%) followed by T. congolense (24%). Blood sample extracted DNA of T. brucei positive subjects were negative to single round TgsGP PCR. However, 1/22 and 6/22 isolated strains were positive with single round and nested TgsGP PCRs, respectively. Free-ranging pigs were identified as a multi-reservoir of T. brucei and/or T. congolense with mixed infections of different strains. This trypanosome diversity hinders the easy and direct detection of T. b. gambiense. We highlight the lack of tools to prove or exclude with certainty the presence of T. b. gambiense. This study once more highlights the need of technical improvements to explore the role of animals in the epidemiology of HAT.

The final outcome of infection by Trypanosoma brucei gambiense, the main agent of sleeping sickness, has always been considered as invariably fatal. While scarce and old reports have mentioned cases of self-cure in untreated patients, these studies suffered from the lack of accurate diagnostic tools available at that time. Here, using the most specific and sensitive tools available to date, we report on a long-term follow-up (15 years) of a cohort of 50 human African trypanosomiasis (HAT) patients from the Ivory Coast among whom 11 refused treatment after their initial diagnosis. In 10 out of 11 subjects who continued to refuse treatment despite repeated visits, parasite clearance was observed using both microscopy and polymerase chain reaction (PCR). Most of these subjects (7/10) also displayed decreasing serological responses, becoming progressively negative to trypanosome variable antigens (LiTat 1.3, 1.5 and 1.6). Hence, in addition to the \"classic\" lethal outcome of HAT, we show that alternative natural progressions of HAT may occur: progression to an apparently aparasitaemic and asymptomatic infection associated with strong long-lasting serological responses and progression to an apparently spontaneous resolution of infection (with negative results in parasitological tests and PCR) associated with a progressive drop in antibody titres as observed in treated cases. While this study does not precisely estimate the frequency of the alternative courses for this infection, it is noteworthy that in the field national control programs encounter a significant proportion of subjects displaying positive serologic test results but negative results in parasitological testing. These findings demonstrate that a number of these subjects display such infection courses. From our point of view, recognising that trypanotolerance exists in humans, as is now widely accepted for animals, is a major step forward for future research in the field of HAT.

Coastal flooding is a growing concern for many communities worldwide due to climate change. This study focuses on the Port-Bouët Bay, located in Abidjan, Côte d’Ivoire. A coastal flood model based on the enhanced bathtub model was used to map the present and future flood extent and assess exposure to quantify the likely affected populations, buildings, and land uses for different scenarios. The model incorporated a digital elevation model, surface roughness, flood water source, and the once a century extreme sea-level scenarios. Validation was conducted against GPS coordinates of recently flooded zones. The analysis revealed that, under current conditions, around 21.58 hectares are vulnerable to flooding, and approximately 2465 people and 544 buildings are exposed to flooding today. Based on future projections, the extent of flooding is anticipated to increase by different ranges depending on the time period and the climate change conditions. By the end of the century, the increase in flooding extent could reach a percentage of 27%, 37%, and 90% under SSP1-2.6, SSP2-4.5, and SSP5-8.5, respectively. The impacts would consequently be worsened with greater number of people and assets exposed to future coastal flood hazard. The land use analysis showed that informal settlements are the occupation most exposed, followed by residential settlements, commercial and industrial land, in that order. The spatial disaggregation of this exposure across neighborhoods indicates that Sogefiha is the most exposed, followed by Petit-Bassam and Vridi. However, a substantial increase in coastal flooding in Vridi by 2100 under the SSP5-8.5 scenario could lead to significant exposure level change for this scenario. This information is critical for evaluating and managing present and future coastal flood risks in the Port-Bouët Bay area and for informing decision-making processes.

Faecal microbiota plays a critical role in human health, but its relationship with nutritional status among schoolchildren remains under-explored. Here, in a double-blinded cluster-randomized controlled trial on 380 Cambodian schoolchildren, we characterize the impact of six months consumption of two types of rice fortified with different levels of vitamins and minerals on pre-specified outcomes. We investigate the association between the faecal microbiota (16SrRNA sequencing) and age, sex, nutritional status (underweight, stunting), micronutrient status (iron, zinc and vitamin A deficiencies, anaemia, iron deficient anaemia, hemoglobinopathy), inflammation (systemic, gut), and parasitic infection. We show that the faecal microbiota is characterised by a surprisingly high proportion of Lactobacillaceae . We discover that deficiencies in specific micronutrients, such as iron and vitamin A, correlate with particular microbiota profiles, whereas zinc deficiency shows no such association. The nutritional intervention with the two rice treatments impacts both the composition and functions predicted from compositional analysis in different ways. (ClinicalTrials.gov (Identifier: NCT01706419))

In Guinea, a subset of patients were treated with either fexinidazole or acoziborole, as part of ongoing clinical trials. Besides active and passive surveillance, and in order to ensure effective coverage of the population at risk, the Trypa-NO! [...]initial geographical surveys are carried out and the tsetse control area mapped. [...]local communities are sensitised on the use of targets for tsetse control. The DSA specifies that all data in the CIR that originated from a partner country remain property of that country and that country partners hold the rights to determine how their data are used and by whom and have a right to veto any particular use of the data. [...]alongside the CIR, Trypa-NO! maintains a dialogue between the country that originated data and the users of the data.