Effectiveness of artemether-lumefantrine provided by community health workers in under-five children with uncomplicated malaria in rural Tanzania : an open label prospective study

Background: Home-management of malaria (HMM) strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa. However, limited data are available on the effectiveness of using artemisinin-based combination therapy (ACT) within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine (AL), presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania, when provided by community health workers (CHWs) and administered unsupervised by parents or guardians at home. Methods: An open label, single arm prospective study was conducted in two rural villages with high malaria transmission in Kibaha District, Tanzania. Children presenting to CHWs with uncomplicated fever and a positive rapid malaria diagnostic test (RDT) were provisionally enrolled and provided AL for unsupervised treatment at home. Patients with microscopy confirmed P. falciparum parasitaemia were definitely enrolled and reviewed weekly by the CHWs during 42 days. Primary outcome measure was PCR corrected parasitological cure rate by day 42, as estimated by Kaplan-Meier survival analysis. This trial is registered with ClinicalTrials.gov, number NCT00454961. Results: A total of 244 febrile children were enrolled between March-August 2007. Two patients were lost to follow up on day 14, and one patient withdrew consent on day 21. Some 141/241 (58.5%) patients had recurrent infection during follow-up, of whom 14 had recrudescence. The PCR corrected cure rate by day 42 was 93.0% (95% CI 88.3%-95.9%). The median lumefantrine concentration was statistically significantly lower in patients with recrudescence (97 ng/mL [IQR 0-234]; n = 10) compared with reinfections (205 ng/mL [114-390]; n = 92), or no parasite reappearance (217 [121-374] ng/mL; n = 70; p <= 0.046). Conclusions: Provision of AL by CHWs for unsupervised malaria treatment at home was highly effective, which provides evidence base for scaling-up implementation of HMM with AL in Tanzania.

Children's Vocabulary Development : The role of parental input, vocabulary composition and early communicative skills

The aim of this thesis is to examine the early vocabulary development of a sample of Swedish children in relation to parental input and early communicative skills. Three studies are situated in an overall description of early language development in children. The data analyzed in the thesis was collected within a larger project at Stockholm University (SPRINT- “Effects of enhanced parental input on young children’s vocabulary development and subsequent literacy development” [VR 2008-5094]). Data analysis was based on parental report via SECDI, the Swedish version of the MacArthur-Bates Communicative Development Inventories, and audio recordings. One study examined parental verbal interaction characteristics in three groups of children with varying vocabulary size at 18 months. The stability of vocabulary development at 18 and 24 months was investigated in a larger study, with focus on children’s vocabulary composition and grammatical abilities. The third study examined interrelations among early gestures, receptive and productive vocabulary, and grammar measured with M3L, i.e. three longest utterances, from 12 to 30 months. Overall results of the thesis highlight the importance of early language development. Variability in different characteristics in parental input is associated with variability in child vocabulary size. Children with large early vocabularies exhibit the most stability in vocabulary composition and the earliest grammatical development. Children’s vocabulary composition may reflect individual stylistic variation. Use of early gestures is associated differentially with receptive and productive vocabulary. Results of the thesis have implications for parents, child- and healthcare personnel, as well as researchers and educational practitioners. The results underscore the importance of high quality in adult-child interaction, with rich input fine-tuned to children’s developmental levels and age, together with high awareness of early language development.

Children's recall of words spoken in their first and second language : Effects of Signal-to-Noise Ratio and Reverberation Time

Speech perception runs smoothly and automatically when there is silence in the background, but when the speech signal is degraded by background noise or by reverberation, effortful cognitive processing is needed to compensate for the signal distortion. Previous research has typically investigated the effects of signal-to-noise ratio (SNR) and reverberation time in isolation, whilst few have looked at their interaction. In this study, we probed how reverberation time and SNR influence recall of words presented in participants' first- (L1) and second-language (L2). A total of 72 children (10 years old) participated in this study. The to-be-recalled wordlists were played back with two different reverberation times (0.3 and 1.2 s) crossed with two different SNRs (+3 dBA and +12 dBA). Children recalled fewer words when the spoken words were presented in L2 in comparison with recall of spoken words presented in L1. Words that were presented with a high SNR (+12 dBA) improved recall compared to a low SNR (+3 dBA). Reverberation time interacted with SNR to the effect that at +12 dB the shorter reverberation time improved recall, but at +3 dB it impaired recall. The effects of the physical sound variables (SNR and reverberation time) did not interact with language. © 2016 Hurtig, Keus van de Poll, Pekkola, Hygge, Ljung and Sörqvist.