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      Development of a data collection and management system in West Africa: challenges and sustainability

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          Abstract

          Background

          Developing and sustaining a data collection and management system (DCMS) is difficult in malaria-endemic countries because of limitations in internet bandwidth, computer resources and numbers of trained personnel. The premise of this paper is that development of a DCMS in West Africa was a critically important outcome of the West African International Centers of Excellence for Malaria Research. The purposes of this paper are to make that information available to other investigators and to encourage the linkage of DCMSs to international research and Ministry of Health data systems and repositories.

          Methods

          We designed and implemented a DCMS to link study sites in Mali, Senegal and The Gambia. This system was based on case report forms for epidemiologic, entomologic, clinical and laboratory aspects of plasmodial infection and malarial disease for a longitudinal cohort study and included on-site training for Principal Investigators and Data Managers. Based on this experience, we propose guidelines for the design and sustainability of DCMSs in environments with limited resources and personnel.

          Results

          From 2012 to 2017, we performed biannual thick smear surveys for plasmodial infection, mosquito collections for anopheline biting rates and sporozoite rates and year-round passive case detection for malarial disease in four longitudinal cohorts with 7708 individuals and 918 households in Senegal, The Gambia and Mali. Major challenges included the development of uniform definitions and reporting, assessment of data entry error rates, unstable and limited internet access and software and technology maintenance. Strengths included entomologic collections linked to longitudinal cohort studies, on-site data centres and a cloud-based data repository.

          Conclusions

          At a time when research on diseases of poverty in low and middle-income countries is a global priority, the resources available to ensure accurate data collection and the electronic availability of those data remain severely limited. Based on our experience, we suggest the development of a regional DCMS. This approach is more economical than separate data centres and has the potential to improve data quality by encouraging shared case definitions, data validation strategies and analytic approaches including the molecular analysis of treatment successes and failures.

          Electronic supplementary material

          The online version of this article (10.1186/s40249-018-0494-4) contains supplementary material, which is available to authorized users.

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          Most cited references20

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          Short report: entomologic inoculation rates and Plasmodium falciparum malaria prevalence in Africa.

          Epidemiologic patterns of malaria infection are governed by environmental parameters that regulate vector populations of Anopheles mosquitoes. The intensity of malaria parasite transmission is normally expressed as the entomologic inoculation rate (EIR), the product of the vector biting rate times the proportion of mosquitoes infected with sporozoite-stage malaria parasites. Malaria transmission intensity in Africa is highly variable with annual EIRs ranging from 1,000 infective bites per person per year. Malaria control programs often seek to reduce morbidity and mortality due to malaria by reducing or eliminating malaria parasite transmission by mosquitoes. This report evaluates data from 31 sites throughout Africa to establish fundamental relationships between annual EIRs and the prevalence of Plasmodium falciparum malaria infection. The majority of sites fitted a linear relationship (r2 = 0.71) between malaria prevalence and the logarithm of the annual EIR. Some sites with EIRs 80%. The basic relationship between EIR and P. falciparum prevalence, which likely holds in east and west Africa, and across different ecologic zones, shows convincingly that substantial reductions in malaria prevalence are likely to be achieved only when EIRs are reduced to levels less than 1 infective bite per person per year. The analysis also highlights that the EIR is a more direct measure of transmission intensity than traditional measures of malaria prevalence or hospital-based measures of infection or disease incidence. As such, malaria field programs need to consider both entomologic and clinical assessments of the efficacy of transmission control measures.
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            Building capacity in health research in the developing world.

            Strong national health research systems are needed to improve health systems and attain better health. For developing countries to indigenize health research systems, it is essential to build research capacity. We review the positive features and weaknesses of various approaches to capacity building, emphasizing that complementary approaches to human resource development work best in the context of a systems and long-term perspective. As a key element of capacity building, countries must also address issues related to the enabling environment, in particular: leadership, career structure, critical mass, infrastructure, information access and interfaces between research producers and users. The success of efforts to build capacity in developing countries will ultimately depend on political will and credibility, adequate financing, and a responsive capacity-building plan that is based on a thorough situational analysis of the resources needed for health research and the inequities and gaps in health care. Greater national and international investment in capacity building in developing countries has the greatest potential for securing dynamic and agile knowledge systems that can deliver better health and equity, now and in the future.
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              Field evaluation of an enzyme-linked immunosorbent assay (ELISA) for Plasmodium falciparum sporozoite detection in anopheline mosquitoes from Kenya.

              An enzyme-linked immunosorbent assay (ELISA) using a monoclonal antibody that recognizes a repetitive epitope on the circumsporozoite protein of Plasmodium falciparum was used in Kenya to assess malaria infections in Anopheles gambiae s.l. and An. funestus. The ELISA confirmed that 88% of 44 sporozoite-positive gland dissections were P. falciparum. The ELISA infection rate of 18.6% (n = 736) for individually tested mosquitoes for both species was significantly higher than the 10.4% (n = 537) salivary gland sporozoite rate determined by dissection. This difference was due to ELISA detection of medium and large sized oocysts on the midguts of infected mosquitoes which did not contain salivary gland sporozoites. From a series of 379 Anopheles that were cut at the thorax, ELISA tests on "head" and "body" portions showed that 29.5% of 95 positive mosquitoes contained circumsporozoite antigen in the body portion in the absence of salivary gland infections. This field evaluation demonstrates that the ELISA can most accurately be used to estimate sporozoite rates by cutting mosquitoes at the thorax and testing anterior portions.
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                Author and article information

                Contributors
                jkeating@tulane.edu
                sdoumbi@icermali.org
                daouda.ndiaye@ucad.edu.sn
                adiarra@icemrwaf.org
                jules.gomis@gmail.com
                dnwakanma@mrc.gm
                iabubakar@lstmed.ac.uk
                aahmad@mrc.gm
                affara@bnitm.de
                mary.lukowski@sciencetrax.com
                cvalim@hsph.harvard.edu
                jwelty@tulane.edu
                mather@tulane.edu
                jshaffer@tulane.edu
                504-296-4763 , donkrogstad@gmail.com
                Journal
                Infect Dis Poverty
                Infect Dis Poverty
                Infectious Diseases of Poverty
                BioMed Central (London )
                2095-5162
                2049-9957
                16 November 2018
                16 November 2018
                2018
                : 7
                : 125
                Affiliations
                [1 ]Departments of Biostatistics (1440 Canal St., Suite 1610) and Tropical Medicine, (#8317 1430 Tulane Avenue, J.B. Johnston Building, Room 510), New Orleans, LA 70112-2699 USA
                [2 ]ISNI 0000 0004 0567 336X, GRID grid.461088.3, University of the Sciences, Techniques and Technologies of Bamako, ; Bamako, Mali
                [3 ]ISNI 0000 0001 2186 9619, GRID grid.8191.1, University Cheikh Anta Diop, ; Dakar, Senegal
                [4 ]ISNI 0000 0004 0606 294X, GRID grid.415063.5, Medical Research Council Unit, ; Fajara, The Gambia
                [5 ]ScienceTRAX LLC, Macon, GA USA
                [6 ]ISNI 000000041936754X, GRID grid.38142.3c, Harvard T.H. Chan School of Public Health, ; Boston, MA USA
                Author information
                http://orcid.org/0000-0002-7972-9667
                Article
                494
                10.1186/s40249-018-0494-4
                6292095
                30541626
                597bea1f-f0d0-425f-a6cb-765600f01e27
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 21 June 2018
                : 17 October 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000060, National Institute of Allergy and Infectious Diseases;
                Award ID: U19 AI 089696
                Award ID: U19 AI 129387
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                data collection,data (database) management system,diseases of poverty,malaria,plasmodium falciparum

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