Increasing dietary diversity may be an approach to reduce the burden of stunting and chronic malnutrition among young children in regions with seasonal food insecurity.

Objectives To assess the effect of two health systems approaches to distribute HIV self-tests on the number of female sex workers’ client and non-client sexual partners in a randomized controlled trial of HIV self-testing among female sex workers (FSW) in Zambia. Design Cluster randomized controlled trial. Methods Peer educators recruited 965 participants. Peer educator-participant groups were randomized 1:1:1 to one of three arms: 1) delivery of HIV self-tests directly from a peer educator, 2) free facility-based delivery of HIV-self tests in exchange for coupons, or 3) referral to standard HIV testing (standard of care). Participants in all three arms completed four peer educator intervention sessions, which included counseling and condom distribution. Participants were asked the average number of client partners they had per night at baseline, one and four months, and the number of non-client partners they had in the past 12 months (at baseline) and in the past month (at one month and four months). Results At four months, participants reported significantly fewer clients per night in the delivery arm (mean difference −0.78 clients, 95% CI −1.28 to −0.28, P=0.002) and the coupon arm (−0.71, 95% CI −1.21 to −0.21, P=0.005) compared to standard-of-care. Similarly, they reported fewer non-client partners in the delivery (−3.19, 95% CI −5.18 to −1.21, P=0.002) and in the coupon arm (−1.84, 95% CI −3.81 to 0.14, P=0.07) arm compared to standard-of-care. Conclusions Expansion of HIV self-testing may have positive spillover effects on HIV prevention efforts among FSW in Zambia. Trial Registration ClinicalTrials.gov NCT02827240

BackgroundSubpatent malaria infections, or low-density infections below the detection threshold of microscopy or standard rapid diagnostic testing (RDT), can perpetuate persistent transmission and, therefore, may be a barrier for countries like Namibia that are pursuing malaria elimination. This potential burden in Namibia has not been well characterized.MethodsUsing a two-stage cluster sampling, cross-sectional design, subjects of all age were enrolled during the end of the 2015 malaria transmission season in Zambezi region, located in northeast Namibia. Malaria RDTs were performed with subsequent gold standard testing by loop-mediated isothermal amplification (LAMP) using dried blood spots. Infection prevalence was measured and the diagnostic accuracy of RDT calculated. Relationships between recent fever, demographics, epidemiological factors, and infection were assessed.ResultsPrevalence of Plasmodium falciparum malaria infection was low: 0.8% (16/1919) by RDT and 2.2% (43/1919) by LAMP. All but one LAMP-positive infection was RDT-negative. Using LAMP as gold standard, the sensitivity and specificity of RDT were 2.3% and 99.2%, respectively. Compared to LAMP-negative infections, a higher portion LAMP-positive infections were associated with fever (45.2% vs. 30.4%, p = 0.04), though 55% of infections were not associated with fever. Agricultural occupations and cattle herding were significantly associated with LAMP-detectable infection (Adjusted ORs 5.02, 95% CI 1.77–14.23, and 11.82, 95% CI 1.06–131.81, respectively), while gender, travel, bed net use, and indoor residual spray coverage were not.ConclusionsThis study presents results from the first large-scale malaria cross-sectional survey from Namibia using molecular testing to characterize subpatent infections. Findings suggest that fever history and standard RDTs are not useful to address this burden. Achievement of malaria elimination may require active case detection using more sensitive point-of-care diagnostics or presumptive treatment and targeted to high-risk groups.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2626-5) contains supplementary material, which is available to authorized users.

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