BACKGROUND Artemisinin resistance in Plasmodium falciparum has emerged in Southeast Asia and now poses a threat to the control and elimination of malaria. Mapping the geographic extent of resistance is essential for planning containment and elimination strategies. METHODS Between May 2011 and April 2013, we enrolled 1241 adults and children with acute, uncomplicated falciparum malaria in an open-label trial at 15 sites in 10 countries (7 in Asia and 3 in Africa). Patients received artesunate, administered orally at a daily dose of either 2 mg per kilogram of body weight per day or 4 mg per kilogram, for 3 days, followed by a standard 3-day course of artemisinin-based combination therapy. Parasite counts in peripheral-blood samples were measured every 6 hours, and the parasite clearance half-lives were determined. RESULTS The median parasite clearance half-lives ranged from 1.9 hours in the Democratic Republic of Congo to 7.0 hours at the Thailand–Cambodia border. Slowly clearing in fections (parasite clearance half-life >5 hours), strongly associated with single point mutations in the “propeller” region of the P. falciparum kelch protein gene on chromosome 13 (kelch13), were detected throughout mainland Southeast Asia from southern Vietnam to central Myanmar. The incidence of pretreatment and post-treatment gametocytemia was higher among patients with slow parasite clearance, suggesting greater potential for transmission. In western Cambodia, where artemisinin-based combination therapies are failing, the 6-day course of antimalarial therapy was associated with a cure rate of 97.7% (95% confidence interval, 90.9 to 99.4) at 42 days. CONCLUSIONS Artemisinin resistance to P. falciparum, which is now prevalent across mainland Southeast Asia, is associated with mutations in kelch13. Prolonged courses of artemisinin-based combination therapies are currently efficacious in areas where standard 3-day treatments are failing. (Funded by the U.K. Department of International Development and others; ClinicalTrials.gov number, NCT01350856.)
Our findings highlight the need for improved anticipatory care of the macrosomic fetus at delivery, in Africa.
Nigeria is a lower middle-income country and is ranked as the largest economy in Africa with a gross domestic product of 444.92 billion (www.imf.org). The country is located on the western coast of Africa, has an area of 923, 763 km 2 and is bounded by Benin Republic in the west, Niger Republic in the north, Cameroun in the east and Gulf of Guinea in the south.
Glucose 6 phosphate dehydrogenase levels in babies delivered at the University of Ilorin teaching hospital. babies with normal enzyme levels were significantly higher than in male babies with normal enzyme levels (5.72 2.45 U/gHb versus 4.99 2.3 U/gHb, p = 0.002). Enzyme levels in babies with G6PD deficiency was comparable in both males and females (2.05 ± 0.60 u/gHb in females and 2.1 0.66 U/gHb in males, p = 0.66). The prevalence of G6PD deficiency was comparable among males and females (p = 0.
Among areas prone to flood disaster yearly in Ilorin is Isale koko. The study involved the reconnaissance survey to ascertain the current capacity of the existing drainage in the flood disaster prone area of Isale Koko, Ilorin, Kwara State, Nigeria. The dimension of the drainage network of the area was taken at eight (8) various points and the average area of the drainage was obtained to be 0.44m². The already existing drainage in the area was divided into 3 sections for easy computations of flow value, length, depth and width. The rainfall intensity for the study area was found to be 98.49mm/hr. The rational method and Manning’s equation were used for the surface runoff and the proposed drainage respectively. The peak flow of the area and maximum flow velocity in the drains were determined to be 48.46mᶟ/s and 2.21mᶟ/s respectively. The best hydraulic section method was employed to obtain new drainage dimensions for both rectangular and trapezoidal channels. The new designed rectangular channel had dimensions of 1.16m × 0.812m while the trapezoidal channel had dimensions of 1.43m×0.72m×0.87m. The area of both channels was obtained to be 0.67m². A comparative analysis was carried against the average area of the pre-existing drainage that showed a 53.3% increase in drainage area; proving that the current drainage infrastructure of the area is grossly inadequate. Sequel to the analysis, the trapezoidal shaped drainage was recommended for the study area. Keywords—Drainage, Flood, Infrastructure, Runoff, Storm water
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