Genetic surveillance in the Greater Mekong subregion and South Asia to support malaria control and elimination

Background

National Malaria Control Programmes (NMCPs) currently make limited use of parasite genetic data. We have developed GenRe-Mekong, a platform for genetic surveillance of malaria in the Greater Mekong Subregion (GMS) that enables NMCPs to implement large-scale surveillance projects by integrating simple sample collection procedures in routine public health procedures.

Methods

Samples from symptomatic patients are processed by SpotMalaria, a high-throughput system that produces a comprehensive set of genotypes comprising several drug resistance markers, species markers and a genomic barcode. GenRe-Mekong delivers Genetic Report Cards, a compendium of genotypes and phenotype predictions used to map prevalence of resistance to multiple drugs.

Results

GenRe-Mekong has worked with NMCPs and research projects in eight countries, processing 9623 samples from clinical cases. Monitoring resistance markers has been valuable for tracking the rapid spread of parasites resistant to the dihydroartemisinin-piperaquine combination therapy. In Vietnam and Laos, GenRe-Mekong data have provided novel knowledge about the spread of these resistant strains into previously unaffected provinces, informing decision-making by NMCPs.

Conclusions

GenRe-Mekong provides detailed knowledge about drug resistance at a local level, and facilitates data sharing at a regional level, enabling cross-border resistance monitoring and providing the public health community with valuable insights. The project provides a rich open data resource to benefit the entire malaria community.

Funding

The GenRe-Mekong project is funded by the Bill and Melinda Gates Foundation (OPP11188166, OPP1204268). Genotyping and sequencing were funded by the Wellcome Trust (098051, 206194, 203141, 090770, 204911, 106698/B/14/Z) and Medical Research Council (G0600718). A proportion of samples were collected with the support of the UK Department for International Development (201900, M006212), and Intramural Research Program of the National Institute of Allergy and Infectious Diseases.

Mapping the travel patterns of people with malaria in Bangladesh

BACKGROUND

Spread of malaria and antimalarial resistance through human movement present major threats to current goals to eliminate the disease. Bordering the Greater Mekong Subregion, southeast Bangladesh is a potentially important route of spread to India and beyond, but information on travel patterns in this area are lacking.

METHODS

Using a standardised short survey tool, 2090 patients with malaria were interviewed at 57 study sites in 2015-2016 about their demographics and travel patterns in the preceding 2 months.

RESULTS

Most travel was in the south of the study region between Cox's Bazar district (coastal region) to forested areas in Bandarban (31% by days and 45% by nights), forming a source-sink route. Less than 1% of travel reported was between the north and south forested areas of the study area. Farmers (21%) and students (19%) were the top two occupations recorded, with 67 and 47% reporting travel to the forest respectively. Males aged 25-49 years accounted for 43% of cases visiting forests but only 24% of the study population. Children did not travel. Women, forest dwellers and farmers did not travel beyond union boundaries. Military personnel travelled the furthest especially to remote forested areas.

CONCLUSIONS

The approach demonstrated here provides a framework for identifying key traveller groups and their origins and destinations of travel in combination with knowledge of local epidemiology to inform malaria control and elimination efforts. Working with the NMEP, the findings were used to derive a set of policy recommendations to guide targeting of interventions for elimination.

Mapping imported malaria in Bangladesh using parasite genetic and human mobility data

For countries aiming for malaria elimination, travel of infected individuals between endemic areas undermines local interventions. Quantifying parasite importation has therefore become a priority for national control programs. We analyzed epidemiological surveillance data, travel surveys, parasite genetic data, and anonymized mobile phone data to measure the spatial spread of malaria parasites in southeast Bangladesh. We developed a genetic mixing index to estimate the likelihood of samples being local or imported from parasite genetic data and inferred the direction and intensity of parasite flow between locations using an epidemiological model integrating the travel survey and mobile phone calling data. Our approach indicates that, contrary to dogma, frequent mixing occurs in low transmission regions in the southwest, and elimination will require interventions in addition to reducing imported infections from forested regions. Unlike risk maps generated from clinical case counts alone, therefore, our approach distinguishes areas of frequent importation as well as high transmission.

Carcinoma of uterine cervix: Top ranking in our country

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Background: Carcinoma of cervix is worldwide, the most frequent gynecological cancer particularly in developing countries like ours. Carcinoma of the cervix uterine is the second commonest gynecological cancer in the developed countries and top ranking in the developing countries like ours. Methods: One hundred and fifty women having carcinoma of the cervix uteri were prospectively studied in the department of Gynaecology and Obstetrics and Radiotherapy department of Rajshahi Medical College Hospital from January 2004 to December 2007. The cases were diagnosed clinically and confirmed by histopathological examination. Results: In all 150 patients of carcinoma of the cervix were selected for this study. There mean age was 50.12 yrs. Most of the patients (78%) had marriage between the age of 10–15 years; 8% married below 10 years and 14% between 16–20 years of age.In this study the all were multipara; 30% patients had 6 pregnancies throughout life. 10% had more than 10 pregnancies, 8% had 8 pregnancies, 4% had 9 pregnancies, 14% had 5 pregnancies and 16% had 4 pregnancies.The study shows that the distribution of patients according to the staging of the carcinoma. 54 (36%) were of III A stage. 39 (26%) in II B stage, 21 (14%) in III B stage, 9 (6%) in IV A stage, 6 (4%) in I B stage, and 3 (2%) in IV B stage. No patient presented with O or IA stage. Conclusions: The study showed that the majority of the patients were between the ages of 40–50. HPV types 16/18 has a significant role for the development of the disease. Religious practices are of important role for its causation. It is less frequent in Jew and most frequent in Hindu. Histopathologically 90%-95% are squamous cell carcinoma and 1–5% are adnocarcinoma.From the findings it is observed that early marriage, creation of awareness about sex hygiene, discourage to have multiple sexual partners and marriages, discourage to have multiple pregnancies and providing adequate health care and health education to the women could reduce the development of carcinoma of cervix.

No significant financial relationships to disclose.

Bedside blood glucose determinations in critical care medicine: a comparative analysis of two techniques

The accuracy of a new reagent test strip (Chemstrip BG) for the quantitative estimation of whole blood glucose concentration was compared to that of a widely used test strip (Dextrostix). To perform the comparative study, venous blood specimens were obtained from 133 patients. Interpretations of reagent strip glucose readings were made by three observers who separately recorded their impressions from the two strips on each patient. These estimated levels were compared to quantitative (glucose oxidase) concentrations measured from the same specimen. Although there were significant correlations (p less than 0.001) between both reagent strips and the measured values, the Chemstrip BG results more closely approximately measured values for the range of glucose concentrations encountered (10-600 mg/dl). In addition, Chemstrip BG was easier to read and measured a wider range of values than Dextrostix and, unlike Dextrostix, Chemstrip BG strips could be stored for review at a later time. This new glucose test strip accurately and rapidly determines whole blood glucose concentration at the bedside.