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Nandish P, B. M. S, N. SN, Shankar G, Tripathi PK, Kashyap H, Jain A, Anvikar A, Chalageri VH. Exploring the hidden mental health consequences of malaria beyond the fever. Front Hum Neurosci 2024; 18:1432441. [PMID: 39091401 PMCID: PMC11291252 DOI: 10.3389/fnhum.2024.1432441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/25/2024] [Indexed: 08/04/2024] Open
Abstract
Malaria morbidity has various presentations and the focus now shifts to uncommon signs and symptoms of malaria infection such as cognitive impairment to address the morbidity when the mortality declines. About 50% of children admitted to hospitals due to malaria experience neurological complications due to factors like low blood sugar, inflammation, elevated pressure, decreased oxygen levels, and excitotoxicity. Malaria during pregnancy negatively also impacts children's cognitive, behavioral, and executive function leading to neurodevelopmental delay due to increased susceptibility which can significantly affect maternal and child health, leading to higher rates of underestimated factors like anxiety, depression, and PTSD. Despite having the world's second-largest tribal population, India's indigenous and tribal communities and their mental health are less explored and less understood. Western psychological tools and neurocognitive assessment tools are not universally applicable, thus necessitating the development of tailored tools to investigate psychological or neurocognitive impairment. This paper has illuminated the hidden mental health consequences of malaria infection, emphasizing the prevalence, nature, and implications of psychological distress among affected individuals. The findings underscore the importance of recognizing and addressing these psychological consequences in the holistic management and prevention of malaria and its mental health consequences.
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Affiliation(s)
- Prerana Nandish
- Indian Council of Medical Research, National Institute of Malaria Research, Bengaluru, Karnataka, India
| | - Shrinivasa B. M.
- Indian Council of Medical Research, National Institute of Malaria Research, Bengaluru, Karnataka, India
| | - Sujith Nath N.
- Indian Council of Medical Research, National Institute of Malaria Research, Bengaluru, Karnataka, India
| | - G. Shankar
- Indian Council of Medical Research, National Institute of Malaria Research, Bengaluru, Karnataka, India
| | - Praveen Kumar Tripathi
- Indian Council of Medical Research, National Institute of Malaria Research, Ranchi, Jharkhand, India
| | - Himani Kashyap
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Animesh Jain
- Department of Community Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, India
| | - Anup Anvikar
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Vani H. Chalageri
- Indian Council of Medical Research, National Institute of Malaria Research, Bengaluru, Karnataka, India
- Associate Professor, The Academy of Scientific and Innovative Research, AcSIR, India
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Dabira ED, Fehr A, Beloum N, Van Geertruyden JP, Achan J, Erhart A, Martinez-Alvarez M, D'Alessandro U. Perceptions and acceptability of the controlled human malaria infection (CHMI) model in The Gambia: a qualitative study. Sci Rep 2023; 13:8708. [PMID: 37248260 DOI: 10.1038/s41598-023-35752-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/23/2023] [Indexed: 05/31/2023] Open
Abstract
Controlled human malaria infection (CHMI) studies, i.e. the deliberate infection of healthy volunteers with malaria parasites to study immune response and/or test drug or vaccine efficacy, are increasingly being conducted in malaria endemic countries, including in sub-Saharan Africa. However, there have been few studies on the perceptions and acceptability of CHMI by the local communities. This qualitative study assessed the perception and acceptability of such studies in The Gambia following the first CHMI study conducted in the country in March-May 2018. Data were collected through non-participant observation, in-depth interviews and focus group discussions and analyzed using NVivo 12 software with an inductive-deductive approach. Sixty-seven participants were involved, including volunteers enrolled in the CHMI, community stakeholders and members of the Gambian Ethics Committee. Respondents expressed a positive view about CHMI. Key motivating factors for participation were the financial compensation, comprehensive health checks, and willingness to support malaria research. Risks associated with participation were considered low. Concerns raised included the frequency of bleeding and the blood volume collected.
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Affiliation(s)
- Edgard Diniba Dabira
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia.
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Alexandra Fehr
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nathalie Beloum
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | | | | | - Annette Erhart
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - Melisa Martinez-Alvarez
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
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Ford A, Hwang A, Mo AX, Baqar S, Touchette N, Deal C, King D, Earle K, Giersing B, Dull P, Hall BF. Meeting Summary: Global Vaccine and Immunization Research Forum, 2021. Vaccine 2023; 41:1799-1807. [PMID: 36803897 PMCID: PMC9938725 DOI: 10.1016/j.vaccine.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 02/21/2023]
Abstract
The 2021 Global Vaccine and Immunization Research Forum highlighted the considerable advances and recent progress in research and development for vaccines and immunization, critically reviewed lessons learned from COVID-19 vaccine programs, and looked ahead to opportunities for this decade. For COVID-19, decades of investments in basic and translational research, new technology platforms, and vaccines targeting prototype pathogens enabled a rapid, global response. Unprecedented global coordination and partnership have played an essential role in creating and delivering COVID-19 vaccines. More improvement is needed in product attributes such as deliverability, and in equitable access to vaccines. Developments in other priority areas included: the halting of two human immunodeficiency virus vaccine trials due to lack of efficacy in preventing infection; promising efficacy results in Phase 2 trials of two tuberculosis vaccines; pilot implementation of the most advanced malaria vaccine candidate in three countries; trials of human papillomavirus vaccines given in single-dose regimens; and emergency use listing of a novel, oral poliomyelitis type 2 vaccine. More systematic, proactive approaches are being developed for fostering vaccine uptake and demand, aligning on priorities for investment by the public and private sectors, and accelerating policy making. Participants emphasized that addressing endemic disease is intertwined with emergency preparedness and pandemic response, so that advances in one area create opportunities in the other. In this decade, advances made in response to the COVID-19 pandemic should accelerate availability of vaccines for other diseases, contribute to preparedness for future pandemics, and help to achieve impact and equity under Immunization Agenda 2030.
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Key Words
- bcg, bacille calmette-guérin
- bnab, broadly neutralizing antibody
- cepi, coalition for epidemic preparedness innovations
- chim, controlled human infection model
- ecvp, evidence considerations for vaccine policy
- eua, emergency use authorization
- eul, emergency use listing
- gvap, global vaccine action plan
- gvirf, global vaccine and immunization research forum
- hiv, human immunodeficiency virus
- hpv, human papillomavirus
- ia2030, immunization agenda 2030
- mers, middle east respiratory syndrome
- nopv-2, novel oral poliomyelitis type 2 vaccine
- ppp, public–private partnership
- r&d, research and development
- sars, severe acute respiratory syndrome
- vips, vaccine innovation prioritisation strategy
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Affiliation(s)
- Andrew Ford
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 9825, Bethesda, MD 20892-9825, USA.
| | - Angela Hwang
- Angela Hwang Consulting, PO Box 6601, Albany, CA 94706, USA.
| | - Annie X. Mo
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 9825, Bethesda, MD 20892-9825, USA
| | - Shahida Baqar
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 9825, Bethesda, MD 20892-9825, USA.
| | - Nancy Touchette
- Office of Global Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
| | - Carolyn Deal
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 9825, Bethesda, MD 20892-9825, USA.
| | - Deborah King
- Infectious Disease Health Challenge - Prevention, Wellcome Trust, London NW1 2BE, United Kingdom.
| | - Kristen Earle
- Vaccine Development & Surveillance, Bill & Melinda Gates Foundation, PO Box 23350, Seattle, Washington 98102, USA.
| | - Birgitte Giersing
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland.
| | - Peter Dull
- Vaccine Development & Surveillance, Bill & Melinda Gates Foundation, PO Box 23350, Seattle, Washington 98102, USA.
| | - B. Fenton Hall
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 9825, Bethesda, MD 20892-9825, USA
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Marsh AA, Magalhaes M, Peeler M, Rose SM, Darton TC, Eyal N, Morrison J, Shah SK, Schmit V. Characterizing altruistic motivation in potential volunteers for SARS-CoV-2 challenge trials. PLoS One 2022; 17:e0275823. [PMID: 36322529 PMCID: PMC9629635 DOI: 10.1371/journal.pone.0275823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
In human challenge trials (HCTs), volunteers are deliberately infected with an infectious agent. Such trials can be used to accelerate vaccine development and answer important scientific questions. Starting early in the COVID-19 pandemic, ethical concerns were raised about using HCTs to accelerate development and approval of a vaccine. Some of those concerns pertained to potential exploitation of and/or lack of truly informed consent from volunteers. Specific areas of concern arose around individuals who may be unusually risk-seeking or too economically vulnerable to refuse the payments these trials provide, as opposed to being motivated primarily by altruistic goals. This pre-registered study is the first large-scale survey to characterize people who, early in the pandemic, expressed interest and intention to volunteer to participate in COVID-19 HCTs. We found that individuals expressing interest in SARS-CoV-2 HCTs exhibit consistently altruistic motivations without any special indication of poor risk perception or economic vulnerability. In finding that, early in the pandemic, COVID-19 HCTs were able to attract volunteers whose values align with the nature of these trials, and who are not unusually vulnerable to exploitation, this study may allay some ethical concerns about the volunteers interested in participating in such trials.
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Affiliation(s)
- Abigail A. Marsh
- Department of Psychology, Georgetown University, Washington, DC, United States of America
- * E-mail:
| | - Monica Magalhaes
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, New Jersey, United States of America
| | - Matthew Peeler
- Department of Mathematics, Rowan-Cabarrus Community College, Salisbury, North Carolina, United States of America
| | - Sophie M. Rose
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Thomas C. Darton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Nir Eyal
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, New Jersey, United States of America
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, United States of America
- Department of Philosophy, Rutgers University, New Brunswick, New Jersey, United States of America
| | - Josh Morrison
- 1Day Sooner, Claymont, Delaware, United States of America
| | - Seema K. Shah
- Smith Child Health Outcomes, Research and Evaluation Center, Lurie Children’s Hospital, Chicago, Illinois, United States of America
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Abstract
"The Primate Malarias" book has been a uniquely important resource for multiple generations of scientists, since its debut in 1971, and remains pertinent to the present day. Indeed, nonhuman primates (NHPs) have been instrumental for major breakthroughs in basic and pre-clinical research on malaria for over 50 years. Research involving NHPs have provided critical insights and data that have been essential for malaria research on many parasite species, drugs, vaccines, pathogenesis, and transmission, leading to improved clinical care and advancing research goals for malaria control, elimination, and eradication. Whilst most malaria scientists over the decades have been studying Plasmodium falciparum, with NHP infections, in clinical studies with humans, or using in vitro culture or rodent model systems, others have been dedicated to advancing research on Plasmodium vivax, as well as on phylogenetically related simian species, including Plasmodium cynomolgi, Plasmodium coatneyi, and Plasmodium knowlesi. In-depth study of these four phylogenetically related species over the years has spawned the design of NHP longitudinal infection strategies for gathering information about ongoing infections, which can be related to human infections. These Plasmodium-NHP infection model systems are reviewed here, with emphasis on modern systems biological approaches to studying longitudinal infections, pathogenesis, immunity, and vaccines. Recent discoveries capitalizing on NHP longitudinal infections include an advanced understanding of chronic infections, relapses, anaemia, and immune memory. With quickly emerging new technological advances, more in-depth research and mechanistic discoveries can be anticipated on these and additional critical topics, including hypnozoite biology, antigenic variation, gametocyte transmission, bone marrow dysfunction, and loss of uninfected RBCs. New strategies and insights published by the Malaria Host-Pathogen Interaction Center (MaHPIC) are recapped here along with a vision that stresses the importance of educating future experts well trained in utilizing NHP infection model systems for the pursuit of innovative, effective interventions against malaria.
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Affiliation(s)
- Mary R Galinski
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
- Emory Vaccine Center, Emory University, Atlanta, GA, USA.
- Emory National Primate Research Center (Yerkes National Primate Research Center), Emory University, Atlanta, GA, USA.
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Mumba N, Njuguna P, Chi P, Marsh V, Awuor E, Hamaluba M, Mauncho C, Mwalukore S, Masha J, Mwangoma M, Kalama B, Alphan H, Wambua J, Bejon P, Kamuya D, Kapulu MC. Undertaking Community Engagement for a Controlled Human Malaria Infection Study in Kenya: Approaches and Lessons Learnt. Front Public Health 2022; 10:793913. [PMID: 35570883 PMCID: PMC9099019 DOI: 10.3389/fpubh.2022.793913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Human infection studies (HIS) involve deliberately infecting healthy volunteers with disease-causing pathogens under controlled conditions. These studies are "controlled" by way of using specific types of pathogens, including dose, and the availability of emergency medical facilities to research volunteers. Most HIS involve diseases whose treatment is known and are done to accelerate the development of novel therapeutics such as vaccines, to address emerging and existing infectious diseases. Traditionally, HIS have been conducted primarily in high-income countries (HICs) but are now increasingly being conducted in low-and-middle income countries (LMICs). In LMICs settings, HIS are likely to raise concerns among various stakeholders including participating populations and regulatory bodies, that are unfamiliar with this type of research. Deliberately infecting a healthy individual with a disease-causing pathogen seems to go against the normal practice of medicine of "do no harm". Such types of studies can give rise to increased rumors and jeopardize research participation in study activities, including non-HIS research. Community engagement can be one approach to address particular issues that HIS studies raise through meaningfully engaging with communities, where views and voices inform the conduct of HIS studies. In addition, engagement can inform the ethical conduct and acceptability of HIS studies in LMICs settings and provide opportunities for sharing information, listening to, and responding to concerns and views from potential participants, and the larger community in which the study would be conducted. Despite community engagement being an important aspect to consider, very few published and gray literature cover the types of approaches that have been used, and lessons learnt in engagement for HIS. This article outlinesthe community engagement approaches that were used to engage stakeholders and communities for malaria HIS-controlled human malaria infection (CHMI), undertaken in Kilifi, Kenya. It outlines the engagement activities across the research cycle, from activities conducted during protocol development, to planning, and implementation of the study. We discuss the challenges experienced, lessons learnt, and provide some recommendations for engagement around HIS.
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Affiliation(s)
- Noni Mumba
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Patricia Njuguna
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya.,PATH Centre for Vaccine Innovation and Access, Nairobi, Kenya
| | - Primus Chi
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Vicki Marsh
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Esther Awuor
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mainga Hamaluba
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Cynthia Mauncho
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Salim Mwalukore
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Johnson Masha
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mary Mwangoma
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Betty Kalama
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Hassan Alphan
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Juliana Wambua
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Dorcas Kamuya
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Melissa C Kapulu
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
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Chi PC, Owino EA, Jao I, Bejon P, Kapulu M, Marsh V, Kamuya D. Ethical considerations around volunteer payments in a malaria human infection study in Kenya: an embedded empirical ethics study. BMC Med Ethics 2022; 23:46. [PMID: 35443642 PMCID: PMC9019790 DOI: 10.1186/s12910-022-00783-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
Human Infection Studies (HIS) have emerged as an important research approach with the potential to fast track the global development of vaccines and treatments for infectious diseases, including in low resource settings. Given the high level of burdens involved in many HIS, particularly prolonged residency and biological sampling requirements, it can be challenging to identify levels of study payments that provide adequate compensation but avoid 'undue' levels of inducement to participate. Through this embedded ethics study, involving 97 healthy volunteers and other research stakeholders in a malaria HIS programme in Kenya, and using in-depth interviews, focus group discussions and observations during and after a malaria HIS, we give a grounded account of ethical issues emerging in relation to study payments in this setting. While careful community, national, international scientific and ethics review processes meant that risks of serious harm were highly unlikely, the levels of motivation to join HIS seen could raise concerns about study payments being too high. Particular value was placed on the reliability, rather than level, of study payment in this setting, where subsistence livelihoods are common. Study volunteers were generally clear about the study aims at the point of recruitment, and this knowledge was retained over a year later, although most reported experiencing more burdens than anticipated at enrolment. Strict study screening procedures, regular clinical and laboratory monitoring of volunteers, with prompt treatment with antimalarial at predetermined endpoints suggested that the risks of serious harm were highly unlikely. Ethical concerns emerged in relation to volunteers' attempts to conceal symptoms, hoping to prolong residency periods and increase study payments; and volunteers making decisions that compromised important family relationships and personal values. Our findings support an interpretation that, although study volunteers were keen to join the study to access cash payments, they also paid attention to other features of the study and the general clinical research landscape, including levels of risk associated with study participation. Overall, our analysis shows that the ethical concerns emerging from the study payments can be addressed through practical measures, hinged on reducing burdens and strengthening communication, raising important issues for research policy and planning.
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Affiliation(s)
- Primus Che Chi
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
| | - Esther Awuor Owino
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Irene Jao
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
| | - Melissa Kapulu
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
| | - Vicki Marsh
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
| | - Dorcas Kamuya
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
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