- Email: [email protected]
Malaria control in pregnancy: still a long way to go
Comment
least in patients who are haemodynamically stable. Overall, the triple-coverage approach in patients at risk of MDR seems insensitive to local variations of MDR prevalence and does not account for considerations about treatment restrictions in elderly and severely disabled patients. In particular, the notion of healthcare-associated pneumonia is poorly supported by available data, and implies overtreatment in many patients.12 All patients with septic shock, and probably severe sepsis, should receive dual coverage or triple coverage if MRSA is a concern. Whether all haemodynamically stable patients with nosocomial pneumonia need such a wide coverage is questionable; at least, de-escalation treatment is mandatory, since it reduces selection pressure, organ toxic effects, and saves money. After all, de-escalation is what matters. The definition of non-adherence to American Thoracic Society guidelines should not read “less than triple therapy” but rather “less than long-term prognosis and riskadjusted broad coverage and de-escalation according to culture and susceptibility results”. Santiago Ewig Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infetkiologie, Evangelisches Krankenhaus Herne und Augusta-Kranken-Anstalt Bochum, Bergstrasse 26, 44791 Bochum, Germany [email protected]
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Kett DH, Cano E, Quartin AA, et al, and the Improving Medicine through Pathway Assessment of Critical Therapy of Hospital-Acquired Pneumonia (IMPACT-HAP) Investigators. Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: an observational, multicentre cohort study. Lancet Infect Dis 2011; published online Jan 20. DOI:10.1016/S14733099(10)70314-5. Barrantes F, Tian J, Vazquez R, Amoateng-Adjepong Y, Manthous CA. Acute kidney injury criteria predict outcomes of critically ill patients. Crit Care Med 2008; 36: 1397–403. Chamot E, Boffi El Amari E, Rohner P, Van Delden C. Effectiveness of combination antimicrobial therapy for Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother 2003; 47: 2756–64. Garnacho-Montero J, Sa-Borges M, Sole-Violan J, et al. Optimal management therapy for Pseudomonas aeruginosa ventilator-associated pneumonia: an observational, multicenter study comparing monotherapy with combination antibiotic therapy. Crit Care Med 2007; 35: 1888–95. Martínez JA, Cobos-Trigueros N, Soriano A, et al. Influence of empiric therapy with a β-lactam alone or combined with an aminoglycoside on prognosis of bacteremia due to gram-negative microorganisms. Antimicrob Agents Chemother 2010; 54: 3590–96. Safdar N, Handelsman J, Maki DG. Does combination antimicrobial therapy reduced mortality in Gram-negative bacteraemia? A meta-analysis. Lancet Infect Dis 2004; 4: 519–27. Heyland DK, Dodek P, Muscedere J, Day A, Cook D; Canadian Critical Care Trials Group. Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator-associated pneumonia. Crit Care Med 2008; 36: 737–44. Aarts MA, Hancock JN, Heyland D, McLeod RS, Marshall JC. Empiric antibiotic therapy for suspected ventilator-associated pneumonia: a systematic review and meta-analysis of randomized trials. Crit Care Med 2008; 36: 108–17. Al-Hasan MN, Wilson JW, Lahr BD, et al. β-lactam and fluoroquinolone combination antibiotic therapy for bacteremia caused by gram-negative bacilli. Antimicrob Agents Chemother 2009; 53: 1386–94. Bliziotis IA, Samonis G, Vardakas KZ, Chrysanthopoulou S, Falagas ME. Effect of aminoglycoside and β-lactam combination therapy versus β-lactam monotherapy on the emergence of antimicrobial resistance: a meta-analysis of randomized, controlled trials. Clin Infect Dis 2005; 41: 149–581. Ewig S, Welte T, Chastre J, Torres A. Rethinking the concepts of community-acquired and health-care-associated pneumonia. Lancet Infect Dis 2010; 10: 279–87.
I declare that I have no conflicts of interest 1
American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171: 388–416.
Malaria control in pregnancy: still a long way to go Pregnant women, especially those pregnant for the first time, are at increased risk of more frequent and more severe malaria infections than are non-pregnant women.1–3 In endemic areas, malaria in pregnancy is a major preventable cause of maternal morbidity and poor birth outcomes. Use of insecticide-treated nets can decrease maternal anaemia and parasitaemia, resulting in improved pregnancy outcomes.4,5 Furthermore, the use of intermittent preventive treatment with sulfadoxine–pyrimethemine during pregnancy can reduce maternal anaemia, placental www.thelancet.com/infection Vol 11 March 2011
malaria, and the number of infants born with low birthweight.6,7 In the Lancet Infectious Diseases today, Anna Maria van Eijk and colleagues8 report the progress of coverage with malaria control interventions in pregnant women in sub-Saharan Africa. The report is a substantial effort on the part of the investigators to compile data from all the countries in the sub-Saharan region. The findings emphasise that, although progress has been made in the scaling up of malaria-control interventions, the goals set by the Roll Back Malaria Partnership
Published Online January 26, 2011 DOI:10.1016/S14733099(10)70311-X See Articles page 190
157
Comment
(80% population coverage of insecticide-treated nets in at-risk areas and 100% coverage of intermittent preventive treatment in pregnancy by 2010) have not been reached.9 On the basis of available data, the investigators estimated an overall coverage of treated nets among pregnant women of only 17%. The biggest impediment to use of nets is ownership.10,11 Between 2000 and 2004, distribution of nets occurred mainly through social marketing with subsidies to susceptible groups, leading to slow uptake, especially in poor, rural households.12 Subsequently, several studies showed that free distribution of nets increases coverage and use,12–14 and multiple mass-distribution campaigns have improved coverage. Because nearly half of the data in van Eijk and colleagues’ report8 were derived from surveys done before 2007, and because production and procurement of insecticide-treated nets increased strikingly from 2004 to 2007,9 present coverage in women probably exceeds 17%. Nonetheless, countries fell far short of stated goals. Provision of free nets via mass distribution campaigns and through distribution at antenatal clinics will help to move countries towards the targeted goals. Although reported attendance to antenatal clinics was quite high (median 88·4%, IQR 68·1–95·2),8 coverage of intermittent preventive treatment was dismal, with a median coverage of 17·8% (IQR 5·7–47·9). However, there were some notable exceptions, with five countries coming close to or exceeding 80% coverage of this intervention. As the investigators note, uptake of intermittent preventive treatment in pregnancy might be affected by multiple factors, including health-worker confusion about timing of doses, drug stockouts, late attendance at antenatal clinics, and provider underachievement. In a study by Sangaré and colleagues,15 missed opportunities for intermittent preventive treatment with sulfadoxine– pyrimethamine were reported in nearly 70% of women attending an antenatal clinic. The main reasons were that the drug was not offered to 35% of women and 49% did not know about it to ask.15 Stockouts led to only 5·6% of the missed doses. These findings suggest that barriers to improvement in intermittent preventive treatment coverage can be overcome by improved health-worker training and targeted health promotion. Interventions such as provision of clear and simplified instructions to health-care providers about 158
when to give such treatment might be associated with increased uptake.16 Increasing resistance of Plasmodium falciparum to sulfadoxine–pyrimethamine has heightened concern that, in the short-term to medium-term, this drug will not be effective as intermittent preventive treatment, and new drugs are being sought. Because the dosing regimen for drugs to replace sulfadoxine– pyrimethamine for such treatment might be different, improvement in implementation measures at antenatal clinic is crucially important. van Eijk and colleagues’ analysis8 is a reminder that cost-effective techniques to scale up malaria control interventions are needed. High rates of attendance at antenatal clinic can provide an effective platform to deliver these services; success will require strengthened systems through training of health workers, education of clients, and robust supply chains to ensure goals are achieved. *Julie Gutman, Laurence Slutsker Malaria Branch, Centers for Disease Control and Prevention; Department of Pediatric Infectious Disease, Emory University School of Medicine; and Children’s Healthcare of Atlanta, Atlanta, GA, USA (JG); Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA (LS) [email protected] We declare that we have no conflicts of interest. JG was supported in part by Public Health Service grants UL1 RR025008 and KL2 RR025009 from the Clinical and Translational Science Award Program, US National Institutes of Health, National Center for Research Resources. 1 2 3
4
5
6
7
8
9
Gilles H, Lawson J, Sibelas M, Voller A, Allan N. Malaria, anaemia and pregnancy. Ann Trop Med Parasitol 1969; 63: 245–63. Brabin B. An analysis of malaria in pregnancy in Africa. Bull World Health Organ 1983; 61: 1005–16. Brabin L, Brabin BJ, van der Kaay HJ. High and low spleen rates distinguish two populations of women living under the same malaria endemic conditions in Madang, Papua New Guinea. Trans R Soc Trop Med Hyg 1988; 82: 671–76. Marchant T, Schellenberg JA, Edgar T, et al. Socially marketed insecticide-treated nets improve malaria and anaemia in pregnancy in southern Tanzania. Trop Med Int Health 2002; 7: 149–58. D’Alessandro U, Langerock P, Bennet S, Francis N, Cham K, Greenwood BM. The impact of a national impregnated bed net programme on the outcome of pregnancy in primigravidae in The Gambia. Trans R Soc Trop Med Hyg 1996; 90: 487–92. van Eijk AM, Ayisi JG, ter Kuile FO, et al. Effectiveness of intermittent preventive treatment with sulphadoxine–pyrimethamine for control of malaria in pregnancy in western Kenya: a hospital-based study. Trop Med Int Health 2004; 9: 351–60. Shulman CE, Dorman EK, Cutts F, et al. Intermittent sulphadoxine– pyrimethamine to prevent severe anaemia secondary to malaria in pregnancy: a randomised placebo-controlled trial. Lancet 1999; 353: 632–36. van Eijk AM, Hill J, Alegana VA, et al. Coverage of malaria protection in pregnant women in sub-Saharan Africa: a synthesis and analysis of national survey data. Lancet Infect Dis 2011; published online Jan 26. DOI:10.1016/S1473-3099(10)70295-4. Roll Back Malaria Partnership. The Global Malaria Action Plan, 2008. http:// www.rollbackmalaria.org/gmap/gmap.pdf (accessed Dec 11, 2010).
www.thelancet.com/infection Vol 11 March 2011
Comment
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12
13
Vanden Eng JL, Thwing J, Wolkon A, et al. Assessing bed net use and non-use after long-lasting insecticidal net distribution: a simple framework to guide programmatic strategies. Malar J 2010; 9: 133. Eisele TP, Keating J, Littrell M, Larsen D, Macintyre K. Assessment of insecticide-treated bednet use among children and pregnant women across 15 countries using standardized national surveys. Am J Trop Med Hyg 2009; 80: 209–14. Maxwell CA, Rwegoshora RT, Magesa SM, Curtis CF. Comparison of coverage with insecticide-treated nets in a Tanzanian town and villages where nets and insecticide are either marketed or provided free of charge. Malar J 2006; 5: 44. Pettifor A, Taylor E, Nku D, et al. Bed net ownership, use and perceptions among women seeking antenatal care in Kinshasa, Democratic Republic of the Congo (DRC): opportunities for improved maternal and child health. BMC Public Health 2008; 8: 331.
14
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Noor AM, Amin AA, Akhwale WS, Snow RW. Increasing coverage and decreasing inequity in insecticide-treated bed net use among rural Kenyan children. PLoS Med 2007; 4: e255. Sangaré LR, Stergachis A, Brentlinger PE, et al. Determinants of use of intermittent preventive treatment of malaria in pregnancy: Jinja, Uganda. PLoS One 2010; 5: e15066. Ouma PO, Calhoun L, Akudian J, et al. A simple, low cost method to increase intermittent treatment for malaria in pregnancy (IPTp) coverage. American Society of Tropical Medicine and Hygiene 59th Annual Meeting; Atlanta, GA, USA; Nov 3–7, 2010. LB-2264.
Errata The Kesho Bora Study Group. Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial. Lancet Infect Dis 2010; DOI:10.1016/S14733099(10)70288-7—In the Contributors section of this Article (published Online First on Jan 14, 2011), the name of the last contributor was incorrect. The correct name is Jennifer Read. This correction has been made to the online version as of Jan 27, 2011, and will be made to the printed Article.
Published Online January 27, 2011 DOI:10.1016/S14733099(11)70009-3
Olotu A, Lusingu J, Leach A, et al. Efficacy of RTS,S/AS01E malaria vaccine and exploratory analysis on anti-circumsporozoite antibody titres and protection in children aged 5-17 months in Kenya and Tanzania: a randomised controlled trial. Lancet Infect Dis 2011; 11: 102–09. The following statement was not included in the Acknowledgments section: “PB is supported by the NIHR Biomedical Centre, Oxford”. A correction has been made to the online version as of Feb 28, 2011. Le Vu S, Le Strat Y, Barin F, et al. Population-based HIV-1 incidence in France, 2003–08: a modelling analysis. Lancet Infect Dis 2010; 10: 682–87. The equation on page 684 of the print issue should have been:
Nr=
Or–N(false-recent rate) 1–false-recent rate
This correction has been made to the online version as of Feb 28, 2011.
www.thelancet.com/infection Vol 11 March 2011
159
least in patients who are haemodynamically stable. Overall, the triple-coverage approach in patients at risk of MDR seems insensitive to local variations of MDR prevalence and does not account for considerations about treatment restrictions in elderly and severely disabled patients. In particular, the notion of healthcare-associated pneumonia is poorly supported by available data, and implies overtreatment in many patients.12 All patients with septic shock, and probably severe sepsis, should receive dual coverage or triple coverage if MRSA is a concern. Whether all haemodynamically stable patients with nosocomial pneumonia need such a wide coverage is questionable; at least, de-escalation treatment is mandatory, since it reduces selection pressure, organ toxic effects, and saves money. After all, de-escalation is what matters. The definition of non-adherence to American Thoracic Society guidelines should not read “less than triple therapy” but rather “less than long-term prognosis and riskadjusted broad coverage and de-escalation according to culture and susceptibility results”. Santiago Ewig Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infetkiologie, Evangelisches Krankenhaus Herne und Augusta-Kranken-Anstalt Bochum, Bergstrasse 26, 44791 Bochum, Germany [email protected]
2
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Kett DH, Cano E, Quartin AA, et al, and the Improving Medicine through Pathway Assessment of Critical Therapy of Hospital-Acquired Pneumonia (IMPACT-HAP) Investigators. Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: an observational, multicentre cohort study. Lancet Infect Dis 2011; published online Jan 20. DOI:10.1016/S14733099(10)70314-5. Barrantes F, Tian J, Vazquez R, Amoateng-Adjepong Y, Manthous CA. Acute kidney injury criteria predict outcomes of critically ill patients. Crit Care Med 2008; 36: 1397–403. Chamot E, Boffi El Amari E, Rohner P, Van Delden C. Effectiveness of combination antimicrobial therapy for Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother 2003; 47: 2756–64. Garnacho-Montero J, Sa-Borges M, Sole-Violan J, et al. Optimal management therapy for Pseudomonas aeruginosa ventilator-associated pneumonia: an observational, multicenter study comparing monotherapy with combination antibiotic therapy. Crit Care Med 2007; 35: 1888–95. Martínez JA, Cobos-Trigueros N, Soriano A, et al. Influence of empiric therapy with a β-lactam alone or combined with an aminoglycoside on prognosis of bacteremia due to gram-negative microorganisms. Antimicrob Agents Chemother 2010; 54: 3590–96. Safdar N, Handelsman J, Maki DG. Does combination antimicrobial therapy reduced mortality in Gram-negative bacteraemia? A meta-analysis. Lancet Infect Dis 2004; 4: 519–27. Heyland DK, Dodek P, Muscedere J, Day A, Cook D; Canadian Critical Care Trials Group. Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator-associated pneumonia. Crit Care Med 2008; 36: 737–44. Aarts MA, Hancock JN, Heyland D, McLeod RS, Marshall JC. Empiric antibiotic therapy for suspected ventilator-associated pneumonia: a systematic review and meta-analysis of randomized trials. Crit Care Med 2008; 36: 108–17. Al-Hasan MN, Wilson JW, Lahr BD, et al. β-lactam and fluoroquinolone combination antibiotic therapy for bacteremia caused by gram-negative bacilli. Antimicrob Agents Chemother 2009; 53: 1386–94. Bliziotis IA, Samonis G, Vardakas KZ, Chrysanthopoulou S, Falagas ME. Effect of aminoglycoside and β-lactam combination therapy versus β-lactam monotherapy on the emergence of antimicrobial resistance: a meta-analysis of randomized, controlled trials. Clin Infect Dis 2005; 41: 149–581. Ewig S, Welte T, Chastre J, Torres A. Rethinking the concepts of community-acquired and health-care-associated pneumonia. Lancet Infect Dis 2010; 10: 279–87.
I declare that I have no conflicts of interest 1
American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171: 388–416.
Malaria control in pregnancy: still a long way to go Pregnant women, especially those pregnant for the first time, are at increased risk of more frequent and more severe malaria infections than are non-pregnant women.1–3 In endemic areas, malaria in pregnancy is a major preventable cause of maternal morbidity and poor birth outcomes. Use of insecticide-treated nets can decrease maternal anaemia and parasitaemia, resulting in improved pregnancy outcomes.4,5 Furthermore, the use of intermittent preventive treatment with sulfadoxine–pyrimethemine during pregnancy can reduce maternal anaemia, placental www.thelancet.com/infection Vol 11 March 2011
malaria, and the number of infants born with low birthweight.6,7 In the Lancet Infectious Diseases today, Anna Maria van Eijk and colleagues8 report the progress of coverage with malaria control interventions in pregnant women in sub-Saharan Africa. The report is a substantial effort on the part of the investigators to compile data from all the countries in the sub-Saharan region. The findings emphasise that, although progress has been made in the scaling up of malaria-control interventions, the goals set by the Roll Back Malaria Partnership
Published Online January 26, 2011 DOI:10.1016/S14733099(10)70311-X See Articles page 190
157
Comment
(80% population coverage of insecticide-treated nets in at-risk areas and 100% coverage of intermittent preventive treatment in pregnancy by 2010) have not been reached.9 On the basis of available data, the investigators estimated an overall coverage of treated nets among pregnant women of only 17%. The biggest impediment to use of nets is ownership.10,11 Between 2000 and 2004, distribution of nets occurred mainly through social marketing with subsidies to susceptible groups, leading to slow uptake, especially in poor, rural households.12 Subsequently, several studies showed that free distribution of nets increases coverage and use,12–14 and multiple mass-distribution campaigns have improved coverage. Because nearly half of the data in van Eijk and colleagues’ report8 were derived from surveys done before 2007, and because production and procurement of insecticide-treated nets increased strikingly from 2004 to 2007,9 present coverage in women probably exceeds 17%. Nonetheless, countries fell far short of stated goals. Provision of free nets via mass distribution campaigns and through distribution at antenatal clinics will help to move countries towards the targeted goals. Although reported attendance to antenatal clinics was quite high (median 88·4%, IQR 68·1–95·2),8 coverage of intermittent preventive treatment was dismal, with a median coverage of 17·8% (IQR 5·7–47·9). However, there were some notable exceptions, with five countries coming close to or exceeding 80% coverage of this intervention. As the investigators note, uptake of intermittent preventive treatment in pregnancy might be affected by multiple factors, including health-worker confusion about timing of doses, drug stockouts, late attendance at antenatal clinics, and provider underachievement. In a study by Sangaré and colleagues,15 missed opportunities for intermittent preventive treatment with sulfadoxine– pyrimethamine were reported in nearly 70% of women attending an antenatal clinic. The main reasons were that the drug was not offered to 35% of women and 49% did not know about it to ask.15 Stockouts led to only 5·6% of the missed doses. These findings suggest that barriers to improvement in intermittent preventive treatment coverage can be overcome by improved health-worker training and targeted health promotion. Interventions such as provision of clear and simplified instructions to health-care providers about 158
when to give such treatment might be associated with increased uptake.16 Increasing resistance of Plasmodium falciparum to sulfadoxine–pyrimethamine has heightened concern that, in the short-term to medium-term, this drug will not be effective as intermittent preventive treatment, and new drugs are being sought. Because the dosing regimen for drugs to replace sulfadoxine– pyrimethamine for such treatment might be different, improvement in implementation measures at antenatal clinic is crucially important. van Eijk and colleagues’ analysis8 is a reminder that cost-effective techniques to scale up malaria control interventions are needed. High rates of attendance at antenatal clinic can provide an effective platform to deliver these services; success will require strengthened systems through training of health workers, education of clients, and robust supply chains to ensure goals are achieved. *Julie Gutman, Laurence Slutsker Malaria Branch, Centers for Disease Control and Prevention; Department of Pediatric Infectious Disease, Emory University School of Medicine; and Children’s Healthcare of Atlanta, Atlanta, GA, USA (JG); Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA (LS) [email protected] We declare that we have no conflicts of interest. JG was supported in part by Public Health Service grants UL1 RR025008 and KL2 RR025009 from the Clinical and Translational Science Award Program, US National Institutes of Health, National Center for Research Resources. 1 2 3
4
5
6
7
8
9
Gilles H, Lawson J, Sibelas M, Voller A, Allan N. Malaria, anaemia and pregnancy. Ann Trop Med Parasitol 1969; 63: 245–63. Brabin B. An analysis of malaria in pregnancy in Africa. Bull World Health Organ 1983; 61: 1005–16. Brabin L, Brabin BJ, van der Kaay HJ. High and low spleen rates distinguish two populations of women living under the same malaria endemic conditions in Madang, Papua New Guinea. Trans R Soc Trop Med Hyg 1988; 82: 671–76. Marchant T, Schellenberg JA, Edgar T, et al. Socially marketed insecticide-treated nets improve malaria and anaemia in pregnancy in southern Tanzania. Trop Med Int Health 2002; 7: 149–58. D’Alessandro U, Langerock P, Bennet S, Francis N, Cham K, Greenwood BM. The impact of a national impregnated bed net programme on the outcome of pregnancy in primigravidae in The Gambia. Trans R Soc Trop Med Hyg 1996; 90: 487–92. van Eijk AM, Ayisi JG, ter Kuile FO, et al. Effectiveness of intermittent preventive treatment with sulphadoxine–pyrimethamine for control of malaria in pregnancy in western Kenya: a hospital-based study. Trop Med Int Health 2004; 9: 351–60. Shulman CE, Dorman EK, Cutts F, et al. Intermittent sulphadoxine– pyrimethamine to prevent severe anaemia secondary to malaria in pregnancy: a randomised placebo-controlled trial. Lancet 1999; 353: 632–36. van Eijk AM, Hill J, Alegana VA, et al. Coverage of malaria protection in pregnant women in sub-Saharan Africa: a synthesis and analysis of national survey data. Lancet Infect Dis 2011; published online Jan 26. DOI:10.1016/S1473-3099(10)70295-4. Roll Back Malaria Partnership. The Global Malaria Action Plan, 2008. http:// www.rollbackmalaria.org/gmap/gmap.pdf (accessed Dec 11, 2010).
www.thelancet.com/infection Vol 11 March 2011
Comment
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13
Vanden Eng JL, Thwing J, Wolkon A, et al. Assessing bed net use and non-use after long-lasting insecticidal net distribution: a simple framework to guide programmatic strategies. Malar J 2010; 9: 133. Eisele TP, Keating J, Littrell M, Larsen D, Macintyre K. Assessment of insecticide-treated bednet use among children and pregnant women across 15 countries using standardized national surveys. Am J Trop Med Hyg 2009; 80: 209–14. Maxwell CA, Rwegoshora RT, Magesa SM, Curtis CF. Comparison of coverage with insecticide-treated nets in a Tanzanian town and villages where nets and insecticide are either marketed or provided free of charge. Malar J 2006; 5: 44. Pettifor A, Taylor E, Nku D, et al. Bed net ownership, use and perceptions among women seeking antenatal care in Kinshasa, Democratic Republic of the Congo (DRC): opportunities for improved maternal and child health. BMC Public Health 2008; 8: 331.
14
15
16
Noor AM, Amin AA, Akhwale WS, Snow RW. Increasing coverage and decreasing inequity in insecticide-treated bed net use among rural Kenyan children. PLoS Med 2007; 4: e255. Sangaré LR, Stergachis A, Brentlinger PE, et al. Determinants of use of intermittent preventive treatment of malaria in pregnancy: Jinja, Uganda. PLoS One 2010; 5: e15066. Ouma PO, Calhoun L, Akudian J, et al. A simple, low cost method to increase intermittent treatment for malaria in pregnancy (IPTp) coverage. American Society of Tropical Medicine and Hygiene 59th Annual Meeting; Atlanta, GA, USA; Nov 3–7, 2010. LB-2264.
Errata The Kesho Bora Study Group. Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial. Lancet Infect Dis 2010; DOI:10.1016/S14733099(10)70288-7—In the Contributors section of this Article (published Online First on Jan 14, 2011), the name of the last contributor was incorrect. The correct name is Jennifer Read. This correction has been made to the online version as of Jan 27, 2011, and will be made to the printed Article.
Published Online January 27, 2011 DOI:10.1016/S14733099(11)70009-3
Olotu A, Lusingu J, Leach A, et al. Efficacy of RTS,S/AS01E malaria vaccine and exploratory analysis on anti-circumsporozoite antibody titres and protection in children aged 5-17 months in Kenya and Tanzania: a randomised controlled trial. Lancet Infect Dis 2011; 11: 102–09. The following statement was not included in the Acknowledgments section: “PB is supported by the NIHR Biomedical Centre, Oxford”. A correction has been made to the online version as of Feb 28, 2011. Le Vu S, Le Strat Y, Barin F, et al. Population-based HIV-1 incidence in France, 2003–08: a modelling analysis. Lancet Infect Dis 2010; 10: 682–87. The equation on page 684 of the print issue should have been:
Nr=
Or–N(false-recent rate) 1–false-recent rate
This correction has been made to the online version as of Feb 28, 2011.
www.thelancet.com/infection Vol 11 March 2011
159