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SURFINs protein family expressed on surface of both infected red blood cell and merozoite surface making them as interesting vaccine candidate for erythrocytic stage of malaria infection. In this study, we analyze genetic variation of Pfsurf 4 . 1 gene, copy number variation, and frequency of SURFIN 4.1 variants of P . falciparum in clinical isolates. In addition, secondary structure prediction and immunoinformatic were employed to identify immunogenic epitopes in humoral response as proposed vaccine candidates. Overall, our data demonstrate extensive polymorphism of SURFIN 4.1 in both genetic and protein level. The surf 4 . 1 gene showed extensive genetic variation with total of 447 polymorphic sites with maximum of three variants as well as singlet/triplet bases indels and mini/microsatellites in the coding sequence. The exon1 encoding extracellular region exhibited higher variation compared to exon2 which coding for intracellular domain. Interestingly, selective pressure was detected on both extracellular region (Var1 and Var2) as well as intracellular region (WRD2 and WRD3). Importantly, extensive full gene analysis suggests adenosine insertion at three key points nucleotide bases (nt 2409/2410, 3809/3810, and 4439/4440) of exon2 could lead to frameshift mutation resulted in four different SURFIN 4.1 variants (TMs, WD1, WD2 and WD3). The SURFIN 4.1 variant TMs was the most observed type with 67% frequency (51/76). Along with more than one copy number of surf 4 . 1 gene was observed with frequency of 13% (9/70). Despite substantial polymorphism, analysis of relatedness within P . falciparum population using full coding sequence was able to group SURFIN 4.1 protein into five distinct clades and reduced into four clades when using only exon1 coding sequence. Also, predicted secondary structure revealed conserved structure of five helix domains of extracellular region which similar among four SURFIN 4.1 variant types. In addition, in silico design eight immunopeptides derived from SURFIN 4.1 , four of which are highly conserved and four of dimorphic epitopes, as potential vaccine candidates.

Retention in antiretroviral therapy (ART) services is critical to achieving positive health outcomes for individuals living with HIV, but accumulating evidence indicates that individuals are likely to miss ART appointments over time. Thus, it is important to understand why individuals miss appointments and how they re-engage in HIV care. We used in-depth interviews with 44 ART clients in Malawi who recently missed an ART appointment (> 14 days) but eventually re-engaged in care (within 60 days) to explore reasons for missed appointments and barriers and facilitators to re-engagement. We found that most individuals missed ART appointments due to unexpected life events such as funerals, work, and illness for both clients and their treatment guardians who were also unable to attend facilities. Several reasons differed by gender—work-related travel was common for men, while caring for sick family members was common for women. Barriers to re-engagement included continued travel, illness, and restricted clinic schedules and/or staff shortages that led to repeat facility visits before being able to re-engage in care. Strong internal motivation combined with social support and reminders from community health workers facilitated re-engagement in HIV care.

Background Malawi has a high fertility rate which is also characterized by a relatively high prevalence of unmet need for contraception. However, little is known about the influence of individual- and community- level characteristics on unmet need in Malawi. This study examined the individual- and community- level factors associated with unmet need for family planning (FP) among Malawian women. Methods Data from the 2015–16 Malawi demographic and health survey were used to analyze 15, 931 women. The association between individual- and community- level factors and unmet need was assessed using multilevel binary logistic regression models. Results The prevalence of total unmet need was 21.0%. Women aged ≥35 years were more likely to have total unmet need [adjusted odds ratio (aOR) = 1.19, 95% confidence interval (CI) = 1.04–1.35] compared with those aged 15–24 years. Women who were married [aOR = 0.41, 95% CI = 0.35–0.48], and those employed [aOR = 0.78, 95% CI = 0.71–0.85] were associated with less likelihood of having total unmet need compared with unmarried, and unemployed women, respectively. At community-level, women from communities with a high percentage of women from rich households [aOR = 0.81, 95% CI = 0.67–0.96], and those from communities with a middle and high percentage of educated women [aOR = 0.86, 95% CI = 0.76–0.96 and aOR = 0.81, 95% CI = 0.70–0.93, respectively] were less likely to have total unmet need for FP compared with those from communities with low percentages of rich and educated women, respectively. The proportional change in variance showed that about 36.0% of total variations in the odds of unmet need across the communities were explained by both individual- and community-level factors. Moreover, the intraclass correlation showed that about 3.0% of the total variation remained unexplained even after controlling for both individual- and community-level factors. Conclusion Both individual- and community- level factors influenced unmet need for FP in Malawi. Public health practitioners should conduct community profiling and consider individual and community factors when designing FP programs.

Extension programs in rural communities play a critical role in linking farmers and other actors in rural developmental agenda. The relevance of these programs in agriculture is largely dependent on their ability to meet farmers' needs since they are the stakeholders at the grassroots. This paper aimed to review studies on enhancing the role of rural agricultural extension programs in poverty alleviation. Various approaches and tools used in rural extension program delivery have been discussed, and ways in which their contribution to poverty alleviation can be enhanced have been highlighted. Extension programs have undergone many changes throughout the years in response to farmers' changing needs as well as the market they operate in. Therefore, there is no \"one-size-fits-all\" approach recommended for effective service delivery and outcome due to different farmer needs that are affected by their geographical location, social and economic structures. We conclude that rural extension programs can provide a sustainable solution to poverty, however, the appropriate approaches should be chosen taking into account the needs of the farmers and market dynamics of a particular area.

Background Facility HIV self-testing (HIVST) within outpatient departments can increase HIV testing coverage by facilitating HIVST use in outpatient waiting spaces while clients wait for routine care. Facility HIVST allows for the majority of outpatients to test with minimal health care worker time requirements. However, barriers and facilitators to outpatients’ use of facility HIVST are still unknown. Methods As part of a cluster randomized trial on facility HIVST in Malawi, we conducted in-depth interviews with 57 adult outpatients ( >  15 years) who were exposed to the HIVST intervention and collected observational journals that documented study staff observations from facility waiting spaces where HIVST was implemented. Translated and transcribed data were analyzed using constant comparison analysis in Atlas.ti. Results Facility HIVST was convenient, fast, and provided autonomy to outpatients. The strategy also had novel facilitators for testing, such as increased motivation to test due to seeing others test, immediate support for HIVST use, and easy access to additional HIV services in the health facility. Barriers to facility HIVST included fear of judgment from others and unwanted status disclosure due to lack of privacy. Desired changes to the intervention included private, separate spaces for kit use and interpretation and increased opportunity for disclosure and post-test counseling. Conclusions Facility HIVST was largely acceptable to outpatients in Malawi with novel facilitators that are unique to facility HIVST in OPD waiting spaces. Trial registration The parent trial is registered with ClinicalTrials.gov , NCT03271307 , and Pan African Clinical Trials, PACTR201711002697316.

Aedes mosquitoes severely affect the health and wellbeing of human populations by transmitting infectious diseases. In French Polynesia, Aedes aegypti is the main vector of dengue, chikungunya and Zika, and Aedes polynesiensis the primary vector of Bancroftian filariasis and a secondary vector of arboviruses. Tools for assessing the risk of disease transmission or for measuring the efficacy of vector control programmes are scarce. A promising approach to quantify the human-vector contact relies on the detection and the quantification of antibodies directed against mosquito salivary proteins. An ELISA test was developed to detect and quantify the presence of immunoglobulin G (IgG) directed against proteins from salivary gland extracts (SGE) of Ae. aegypti and Ae. polynesiensis in human populations exposed to either species, through a cross-sectional study. In Tahiti and Moorea islands where Ae. aegypti and Ae. polynesiensis are present, the test revealed that 98% and 68% of individuals have developed IgG directed against Ae. aegypti and Ae. polynesiensis SGE, respectively. By comparison, ELISA tests conducted on a cohort of people from metropolitan France, not exposed to these Aedes mosquitoes, indicated that 97% of individuals had no IgG directed against SGE of either mosquito species. The analysis of additional cohorts representing different entomological Aedes contexts showed no ELISA IgG cross-reactivity between Ae. aegypti and Ae. polynesiensis SGE. The IgG response to salivary gland extracts seems to be a valid and specific biomarker of human exposure to the bites of Ae. aegypti and Ae. polynesiensis. This new immuno-epidemiological tool will enhance our understanding of people exposure to mosquito bites, facilitate the identification of areas where disease transmission risk is high and permit to evaluate the efficacy of novel vector control strategies in Pacific islands and other tropical settings.

SURFINs protein family expressed on surface of both infected red blood cell and merozoite surface making them as interesting vaccine candidate for erythrocytic stage of malaria infection. In this study, we analyze genetic variation of Pfsurf.sub.4.1 gene, copy number variation, and frequency of SURFIN.sub.4.1 variants of P. falciparum in clinical isolates. In addition, secondary structure prediction and immunoinformatic were employed to identify immunogenic epitopes in humoral response as proposed vaccine candidates. Overall, our data demonstrate extensive polymorphism of SURFIN.sub.4.1 in both genetic and protein level. The surf.sub.4.1 gene showed extensive genetic variation with total of 447 polymorphic sites with maximum of three variants as well as singlet/triplet bases indels and mini/microsatellites in the coding sequence. The exon1 encoding extracellular region exhibited higher variation compared to exon2 which coding for intracellular domain. Interestingly, selective pressure was detected on both extracellular region (Var1 and Var2) as well as intracellular region (WRD2 and WRD3). Importantly, extensive full gene analysis suggests adenosine insertion at three key points nucleotide bases (nt 2409/2410, 3809/3810, and 4439/4440) of exon2 could lead to frameshift mutation resulted in four different SURFIN.sub.4.1 variants (TMs, WD1, WD2 and WD3). The SURFIN.sub.4.1 variant TMs was the most observed type with 67% frequency (51/76). Along with more than one copy number of surf.sub.4.1 gene was observed with frequency of 13% (9/70). Despite substantial polymorphism, analysis of relatedness within P. falciparum population using full coding sequence was able to group SURFIN.sub.4.1 protein into five distinct clades and reduced into four clades when using only exon1 coding sequence. Also, predicted secondary structure revealed conserved structure of five helix domains of extracellular region which similar among four SURFIN.sub.4.1 variant types. In addition, in silico design eight immunopeptides derived from SURFIN.sub.4.1, four of which are highly conserved and four of dimorphic epitopes, as potential vaccine candidates.

Men experience twice the mortality of women while on ART in sub-Saharan Africa (SSA) largely due to late HIV diagnosis and poor retention. Here we propose to conduct an individually randomized control trial (RCT) to investigate the impact of three-month home-based ART (hbART) on viral suppression among men who were not engaged in care. A programmatic, individually randomized non-blinded, non-inferiority-controlled trial design (ClinicalTrials.org NCT04858243). Through medical chart reviews we will identify \"non-engaged\" men living with HIV, ≥15years of age who are not currently engaged in ART care, including (1) men who have tested HIV-positive and have not initiated ART within 7 days; (2) men who have initiated ART but are at risk of immediate default; and (3) men who have defaulted from ART. With 1:1 computer block randomization to either hbART or facility-based ART (fbART) arms, we will recruit men from 10-15 high-burden health facilities in central and southern Malawi. The hbART intervention will consist of 3 home-visits in a 3-month period by a certified male study nurse ART provider. In the fbART arm, male participants will be offered counselling at male participant's home, or a nearby location that is preferred by participants, followed with an escort to the local health facility and facility navigation. The primary outcome is the proportion of men who are virally suppressed at 6-months after ART initiation. Assuming primary outcome achievement of 24.0% and 33.6% in the two arms, 350 men per arm will provide 80% power to detect the stated difference. Identifying effective ART strategies that are convenient and accessible for men in SSA is a priority in the HIV world. Men may not (re-)engage in facility-based care due to a myriad of barriers. Two previous trials investigated the impact of hbART on viral suppression in the general population whereas this trial focuses on men. Additionally, this trial involves a longer duration of hbART i.e., three months compared to two weeks allowing men more time to overcome the initial psychological denial of taking ART.

In Mediterranean-type climates, terminal drought induces grain yield losses in wheat. Antitranspirants can reduce the impacts of terminal drought and improve yield, but the mechanisms involved are not fully understood. Among other impacts, drought elevates endogenous abscisic acid (ABA) concentration. Here, the effectiveness of a film antitranspirant (di-1- p -menthene) was studied in relation to plant water status and spike ABA. The objective was to determine whether drought amelioration with di-1- p -menthene was solely mediated through a reduction in ABA by comparing its effects to that of fluridone (an ABA inhibitor). The treatments were assessed in a randomized complete block design in two field experiments in spring and summer of 2020, with six and eight replicate blocks, respectively, at Harper Adams University, UK, to compare their effects on spike ABA, gas exchange and agronomic traits under progressive drought conditions. Di-1- p -menthene was applied at 1 l/ha; and fluridone at 10, 20 and 50 μM concentrations, at flag leaf emergence, growth stage 37 (GS37). Drought increased spike ABA and downregulated photosynthesis. Di-1- p -menthene and fluridone at some concentrations, reduced spike ABA and photosynthesis. Di-1- p -menthene suppressed transpiration and spike ABA, each by 21% but increased grain yield by 27%. In contrast, although fluridone (at 10 and 50 μM) also reduced spike ABA (by 16%), overall, it did not alter transpiration or grain yield. The results suggest that yield improvement with di-1- p -methene is mediated through mechanisms that involve conservation of plant water linked to reduced transpiration, with inhibition of spike ABA playing a secondary role.

The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.