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Economic and demographic change across Central Africa exacerbates the risk of infectious disease epidemics. But population growth and increasing income and education can also spur demand for infrastructure to support sustainable development, including basic health services.

Enhancing the clinical trial capabilities within Africa is essential to augment the continent’s pandemic prevention, preparedness and response efforts. Here, we describe the critical challenges of clinical trials in Africa and draw upon the lessons learnt from the Con sortium for C OVID-19 Va ccine C linical T rials (CONCVACT) experience, such as the importance of regional collaboration, capacity building and establishing standardized protocols.

This study aimed to analyze polymorphisms in Pfcrt , Pfmdr1 , and Pfk13 genes’ markers of resistance to Artemisinin-based combination therapy (ACT), in Plasmodium falciparum isolates from southern Brazzaville, 15 years after the adoption of ACT in the Republic of Congo. A total of 369 microscopy-confirmed malaria-infected individuals were enrolled from March to October 2021 in the community and in health facilities during a cross-sectional study. The K76 T mutation in the Pfcrt gene, N86 Y and Y184 F mutations in the Pfmdr1 gene were investigated using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) while the codons region (1005–1300) of the Pfmdr1 gene, and Pfk13 gene were sequenced. The prevalences of K76 T , N86 Y , Y184 F mutations were 26.0%, 6.8%, and 27.7%, respectively. However, no mutations were detected in codons 1034, 1042, and 1246 of the Pfmdr1 gene. None of the mutations previously associated with artemisinin-based resistance were detected in the Pfk13 gene. The results reveal a significant decrease in the prevalence of K76 T , N86 Y , Y184 F mutations, in Plasmodium falciparum isolates following the change of therapeutic policy. As artemisinin resistance is emerging throughout Africa, continued surveillance for early detection of these mutations and relevant partner markers of drug resistance are recommended in the Republic of Congo.

Background Although interactions between human immunodeficiency virus ( HIV) and Plasmodium falciparum infections may lead to an exponential rise in their harmful impact on human health, few data exist on the prevalence of Plamodium species, the multiplicity of infection and molecular markers of antimalarial drug resistance, as well as clinical presentation of malaria infections in Congolese people living with HIV (PLWH). The aim of this study was to characterize malaria infection among PLWH receiving antiretroviral treatment (ART) and co-trimoxazole prophylaxis in Brazzaville, Republic of Congo. Method As part of follow-up activities, blood samples, socio-demographic and clinical data were collected from 683 PLWH aged from 1 month to 84 years (sex ratio male/female of 0.4) under ART and co-trimoxazole prophylaxis. This heath facility-based cross-sectional study was conducted from January to September 2022 at the Outpatient Treatment Center of the National HIV Program, located in Brazzaville. Malaria infection was diagnosed by microscopy and nested PCR. Single nucleotide polymorphisms (SNP) were detected by RFLP-PCR for the Pfdhfr , Pfdhps , Pfcrt genes and by sequencing for the PfK13 and Pfmdr1 genes. Plasmodium falciparum genetic diversity was investigated by nested PCR using gene markers ( msp1 , msp2 and glurp ). Results All the Plasmodium infected participants were asymptomatic. By microscopy, 1.2% (8/683) were found to be infected, whereas 9.2% (62/675) carried submicroscopic infections detected by PCR. P. falciparum mono-infection was the most common (69/70, 98.6%), but single separate cases of P. malariae alone, and of co-infection, P. falciparum with P. ovale , were also detected. The mean multiplicity of P. falciparum infection was 2.1 ± 1.09, with 68.1% of infections being polyclonal. Overall, a high prevalence of mutations was found within the Pfdhfr gene: 51 I (78.2%), 59 R (84.2%), 108 N (84.0%); Pfdhps gene: 437 G (72.0%, 540 E (30.8%), 581 G (48.5%); Pfcrt gene: 76 T (46.9%) and Pfmdr1 gene: 184 F (42.1%). None of the Pfmdr1 86 Y , 1034 C , 1042 D , and 1246 Y mutant alleles or of the 12 significant mutations known to confer artemisinin partial resistance, were detected. Conclusion The results of this study show a very low prevalence of malaria infection and a comparatively low genetic diversity of P. falciparum in isolates from PLWH under antiretroviral therapy and co-trimoxazole-based chemoprophylaxis in Brazzaville.

Background Antimicrobial resistance (AMR) poses a complex threat to global health security and universal health coverage. Recently, nosocomial infections with carbapenemase-producing Gram-negative bacilli (GNB) is increasing worldwide. We report the molecular characterization and detection of genes associated with carbapenemase producing Gram negative bacteria isolated from hospitalized patients at Soba University Hospital (SUH) in Khartoum State, Sudan. Results Between October 2016 and February 2017, a total of 206 GNB clinical specimens were collected from hospitalized patients in SUH. Of 206 carbapenem resistance isolates, 171 (83 %) were confirmed as phenotypically resistant and 121 (58.7 %) isolates harboured one or more carbapenemase genes. New Delhi metallo-β-lactamase (NDM) types were the most predominant genes, bla NDM 107(52 %), followed by bla IMP 7 (3.4 %), bla OXA-48 5(2.4 %) and bla VIM 2 (0.9 %). Co-resistance genes with NDM producing GNB were detected in 87 (81.3 %) of all bla NDM producing isolates. NDM-1 was the most frequent subtype observed in 75 (70 %) bla NDM producing isolates. The highest percentage of resistance was recorded in ampicillin (98 %), cephalexin (93.5 %) amoxicillin clavulanic acid (90 %), cefotaxime (89.7 %), ceftriaxone (88.4 %), ceftazidime (84.2 %), sulfamethoxazole-trimethoprim (78.4 %) and nitrofurantoin (75.2 %), aztreonam (66 %) and temocillin (64 %). A close correlation between phenotypic and carbapenemase genes detection in all GNB was observed. Conclusions The frequency of carbapenemase producing bacilli was found to be high in SUH. NDM was found to be the most prevalent carbapenemase gene among clinical isolates. Close surveillance across all hospitals in Sudan is required. The relative distribution of carbapenemase genes among GNB in nosocomial infections in Africa needs to be defined.

Since March, three-quarters of our time has been spent on COVID-19. In October, the World Health Organization (WHO) reported that progress against TB might stall: in the countries with the highest rates of the disease, the number of people diagnosed and directed to care dropped by one-quarter compared with last year's figure. Because many countries have implemented lockdowns, hospitals and health centres have seen a significant drop in the number of people coming for treatment. During the lockdown, researchers and engineers developed prototypes of respirators made in Congo using recycled components, showing initiative and creativity that should flow into other areas of health research.

Background Investigating whether the multiplicity of Plasmodium falciparum infection (MOI) is related to pregnancy outcomes, is of interest in sub-Saharan area where malaria is highly endemic. The present study aimed to characterize the genetic diversity of P. falciparum in women at delivery from Southern Brazzaville, and investigate whether the MOI is associated with maternal anaemia, preterm delivery, or low birth weight. Methods This was a cross sectional study carried out with samples collected between March 2014 and April 2015 from 371 women recruited at delivery at a Health Centre in southern Brazzaville, Republic of Congo. Matched peripheral, placental, and cord blood collected from each of the women at delivery were used for the detection of P. falciparum microscopic and submicroscopic parasitaemia, and parasite DNA genotyping by nested PCR. Results From 371 recruited women, 27 were positive to microscopic malaria parasitaemia while 223 women harboured submicroscopic parasitaemia. All msp - 1 block 2 family allelic types (K1, MAD20 and RO33) were observed in all the three compartments of blood, with K1 being most abundant. K1 (with 12, 10, and 08 alleles in the peripheral, placental, and cord blood respectively) and MAD20 (with 10, 09, and 06 alleles in the respective blood compartments) were more diverse compared to RO33 (with 06, 06, and 05 alleles in the respective blood compartments). From the 250 women with microscopic and/or submicroscopic parasitaemia, 38.5%, 30.5%, and 18.4% of peripheral, placental and cord blood sample, respectively, harboured more than one parasite clone, and polyclonal infection was more prevalent in the peripheral blood of women with microscopic parasitaemia (54.5%) compared to those with submicroscopic parasitaemia (36.7%) ( p  = 0.02). The mean multiplicity of genotypes per microscopic and submicroscopic infection in peripheral blood was higher in anemic women (2.00 ± 0.23 and 1.66 ± 0.11, respectively) than in non-anaemic women (1.36 ± 0.15 and 1.45 ± 0.06, respectively) ( p  = 0.03 and 0.06). In logistic regression, women infected with four or more clones of the parasite were 9.4 times more likely to be anaemic than women harbouring one clone. This association, however, was only observed with the peripheral blood infection. No significant association was found between the MOI and low birth weight or preterm delivery. Conclusions These results indicate that the genetic diversity of P. falciparum is high in pregnant women from southern Brazzaville in the Republic of Congo, and the multiplicity of the infection might represent a risk for maternal anaemia.

Background The first WHO-approved malaria vaccines (RTS, S/AS01, and R21/Matrix M) target part of the Plasmodium falciparum circumsporozoite protein (PfCSP), displays a degree of polymorphism that may raise concerns about vaccine efficacy. As a prelude to vaccine implementation, the study here reports investigation on Pfcsp gene polymorphisms in isolates from Congolese individuals in the Republic of Congo. Methods Blood samples were collected from 202 children infected with P. falciparum during a cross-sectional study from March to October 2021. The full-length Pfcsp gene was amplified by nested PCR and sequenced using the Oxford Nanopore platform. Results Overall, 30 haplotypes were identified in the N-terminal region of the protein. The A98G mutation was the most frequent (25.6%), while KLKQP was the most conserved motif. In the central repeat region, 50 haplotypes were found, with a predominance of the NANP motif, although some haplotypes contained the NVDP, NEDP and NVNP variants. C-terminal region was highly polymorphic, with 76 haplotypes identified among the 174 sequenced samples. In the C-terminal Th2R region, the major mutations identified included K317E (87.4%) and N321K (83.9%), with a nucleotide diversity of π = 0.16. In the Th3R region, the E357Q (75.9%) mutation was predominant, with a nucleotide diversity of π = 0.08. Neutrality tests revealed contrasting patterns of evolution between the Th2R and Th3R regions. Conclusion This study provides baseline data on Pfcsp genetic diversity in a defined area of the Republic of Congo. The results highlight the degree of variation in natural parasite populations at gene loci relevant to vaccine-targeted epitopes of (PfCSP) antigen. Further research incorporating immunological data will be needed to conduct in-depth assessments of vaccine efficacy.

As the COVID-19 pandemic threatens to erode huge gains against much more devastating infections, I look for silver linings. As the COVID-19 pandemic threatens to erode huge gains against much more devastating infections, I look for silver linings. “What if the world had tackled malaria with the energy now dedicated to the coronavirus?”

Malaria is a significant public health challenge in Gabon, with high prevalence rates in rural and semi-urban areas. This study investigated Plasmodium infection prevalence among outpatients at a medical laboratory in Franceville, Gabon, in 2020. Data from 500 patients were analyzed, revealing an overall infection rate of 33.2% and the presence of four Plasmodium species: P. falciparum , P. malariae , P. ovale , and possibly P. vivax for the first time in Gabon. Co-infections were common, with P. falciparum and P. ovale spp. being the most prevalent at 23.5%. Asymptomatic infections accounted for 81.3% of cases, while symptomatic infections were 18.7%. P. falciparum was associated with symptomatic cases, while non-falciparum species were linked to asymptomatic infections. The findings suggest Franceville has perennial malaria transmission, highlighting the role of Plasmodium species diversity in disease severity and clinical presentation, including the first report of P. vivax infection in the Gabonese population.