Daniel Yilma

Introduction: Tafenoquine is used as a single-dose antirelapse treatment for Plasmodium vivax malaria. Current World Health Organization guidelines restrict tafenoquine use to South America. Recent studies now provide additional data from Africa and South Asia. This meta-analysis aimed to update evidence on the antirelapse efficacy of 300mg single-dose tafenoquine compared with low dose primaquine. Methods: Medline, Embase, Web of Science, Scopus and Cochrane Central were searched for randomised trials of patients with uncomplicated P. vivax malaria published before January 31, 2026 that compared 300 mg single-dose tafenoquine with 3.5mg/kg total dose primaquine, co-administered with chloroquine. The efficacy outcome was any microscopic P. vivax recurrence within 180 days. The safety outcome was serious adverse events related to antirelapse treatment within 28 days. Aggregated data were used to estimate pooled risk ratios by region and treatment supervision by random effects meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias tool. Results: Four trials enrolling 1,140 patients were included. The pooled risk ratios by region for P. vivax recurrence within 180 days following tafenoquine versus low dose primaquine were: 0.87 (95% confidence interval (CI) 0.65-1.17, τ2=0.009, I2=11.5%, 3 estimates) for the Americas, 0.75 (0.26-2.20, τ2=0.362, I2=53.8%, 2 estimates) for Africa, 0.50 (0.13-1.93, τ2=0, I2=0%, 1 estimate) for South Asia and 2.60 (1.01-6.73, τ2=0, I2=0%, 3 estimates) for Southeast Asia. Risk ratios were lower when tafenoquine was compared to unsupervised primaquine regimens (0.51, 0.30-0.86, τ2=0, I2=0%, 2 estimates from South Asia and Africa) in comparison with supervised primaquine regimens (1.03, 0.69-1.52, τ2=0.082, I2=34.3%, 7 estimates). The 1,140 patients had glucose-6-phosphate dehydrogenase activity ≥70% and 0 of 680 (0%) reported a serious adverse event related to tafenoquine versus 2 of 460 (0.4%) related to primaquine. Conclusions: In Southeast Asia, tafenoquine has lower antirelapse efficacy compared with supervised low dose primaquine co-administered with chloroquine (moderate certainty). In South Asia and Africa, tafenoquine has greater antirelapse efficacy compared with unsupervised low dose primaquine (moderate certainty). Results support the geographic extension of tafenoquine to South Asia and Africa. Funding: Royal Australasian College of Physicians, Australian National Health and Medical Research Council

Few women in research are able to advance into leadership positions in low-and middle-income countries (LMICs). Using evidence from a global crowdsourcing open call and scoping review we identified practical strategies to enhance gender equity and inclusivity in research mentorship in LMICs. The open call employed methods outlined in the WHO Special Programme for Research and Training in Tropical Diseases (TDR) Global practical guide on crowdsourcing in health research to solicit strategies to enhance equity in research mentorship programs, focusing on gender in LMICs. The scoping review followed the Arksey and O’Malley framework and PRISMA-ScR. Strategies synthesized from open call responses and existing literature were coded into themes. The quality of evidence for these themes was evaluated using the CERQual approach. The open call received 56 eligible submissions; the scoping review yielded 15 eligible studies focused on gender equity and inclusivity in research mentorship in LMICs. We identified the following four strategies to enhance gender equity in research mentorship: (1) take specific action to decrease implicit bias in research mentorship programs; (2) utilize asset-based approaches to increase mentees’ self-efficacy and confidence; (3) promote accomplishments, acknowledge wins, and appreciate mentee/mentor work efforts to sustain mentee interests and career progression; (4) utilize peer and reverse mentorship-built capacity for mentees serving as mentors and identify power imbalances. Increasing gender equity and inclusivity in research mentorship is a collective institutional responsibility. Addressing these barriers faced by underrepresented researchers play a critical role in fostering equity and inclusivity in research mentorship programs.

This study aimed to retrospectively assess the cost-effectiveness of various COVID-19 vaccination strategies in Ethiopia. It involved healthcare workers (HCWs) and community participants; and was conducted through interviews and serological tests. Local SARS-CoV-2 variants and seroprevalence rates, as well as national COVID-19 reports and vaccination status were also analyzed. A cost-effectiveness analysis was performed to determine the most economical vaccination strategies in settings with limited vaccine access and high SARS-CoV-2 seroprevalence. Before the arrival of the vaccines, 65% of HCWs had antibodies against SARS-CoV-2, indicating prior exposure to the virus. Individuals with prior infection exhibited a greater antibody response to COVID-19 vaccines and experienced fewer new infections compared to those without prior infection, regardless of vaccination status (5% vs. 24%, p < 0.001 for vaccinated; 3% vs. 48%, p < 0.001 for unvaccinated). The cost-effectiveness analysis indicated that a single-dose vaccination strategy is optimal in settings with high underlying seroprevalence and limited vaccine availability. This study underscores the need for pragmatic vaccination strategies tailored to local contexts, particularly in high-seroprevalence regions, to maximize vaccine impact and minimize the spread of COVID-19. Implementing a targeted approach based on local seroprevalence information could have helped Ethiopia achieve higher vaccination rates and prevent subsequent outbreaks.

Background: Numerous biomarkers are used as diagnostic, prognostic, and predictive indicators of myocardial ischemia. The most commonly used biomarkers are cardiac troponin I (Tn-I) and creatinine kinase (CK-MB). However, in developing nations, their availability in primary care settings is extremely limited. In such situations, easily available assays such as complete blood count (CBC) should be investigated as prognostic indicators in individuals with acute coronary syndrome (ACS). Objective: This study aimed to compare the pattern of haematological indices and blood cell ratios of ACS patients compared with apparently healthy controls. Methods: Patients diagnosed with ACS were recruited consecutively between 01 May 2022 and 31 October 2023 at Jimma Medical Center (JMC). Biochemical analyses and complete blood counts were performed. Analysis of variance was performed to compare the continuous variables. Spearman correlation coefficient tests were performed to correlate hematologic parameters with high sensitive troponin-I (hs-Tn-I) levels. Results: This study enrolled 220 participants (110 patients with ACS and age, sex, and place of residence matched 110 non-ACS controls). From ACS group 99 (90%) were diagnosed with ST-elevated myocardial infarction. The ACS group had a significantly greater mean platelet volume (MPV), white blood cell count, red cell distribution width (RDW), neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. The RDW (r = 0.248, p = 0.009) and MPV (r = 0.245, p = 0.009) were significantly positively correlated with hs-Tn-I levels in the ACS group. MPV, RDW, and monocyte count were significantly higher in non-survivor ACS patients (p < 0.05). Conclusion: The significant differences observed in haematological parameters between individuals with ACS and healthy controls suggest the potential utility of these easily accessible and cost-effective diagnostics in predicting future morbidity and ACS risk. Incorporating these routine evaluations into clinical practice could enhance risk assessment and improve patient outcomes.

Under-reporting of COVID-19 and the limited information about circulating SARS-CoV-2 variants remain major challenges for many African countries. We analyzed SARS-CoV-2 infection dynamics in Addis Ababa and Jimma, Ethiopia, focusing on reinfection, immunity, and vaccination effects. We conducted an antibody serology study spanning August 2020 to July 2022 with five rounds of data collection across a population of 4723, sequenced PCR-test positive samples, used available test positivity rates, and constructed two mathematical models integrating this data. A multivariant model explores variant dynamics identifying wildtype, alpha, delta, and omicron BA.4/5 as key variants in the study population, and cross-immunity between variants, revealing risk reductions between 24% and 69%. An antibody-level model predicts slow decay leading to sustained high antibody levels. Retrospectively, increased early vaccination might have substantially reduced infections during the delta and omicron waves in the considered group of individuals, though further vaccination now seems less impactful.

: Primaquine (PQ) kills Plasmodium vivax hypnozoites but can cause severe hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. We conducted two systematic reviews. The first used data from clinical trials to determine the variety of definitions and frequency of hematological serious adverse events (SAEs) related to PQ treatment of vivax malaria. The second used data from prospective studies and case reports to describe the clinical presentation, management, and outcome of severe PQ-associated hemolysis necessitating hospitalization. In the first review, SAEs were reported in 70 of 249 clinical trials. There were 34 hematological SAEs among 9,824 patients with P. vivax malaria treated with PQ, nine of which necessitated hospitalization or blood transfusion. Criteria used to define SAEs were diverse. In the second review, 21 of 8,487 articles screened reported 163 patients hospitalized after PQ radical cure; 79.9% of whom (123 of 154) were prescribed PQ at ≥ 0.5 mg/kg/day. Overall, 101 patients were categorized as having probable or possible severe PQ-associated hemolysis, 96.8% of whom were G6PD deficient (< 30% activity). The first symptoms of hemolysis were reported primarily on day 2 or 3 (45.5%), and all patients were hospitalized within 7 days of PQ commencement. A total of 57.9% of patients (77 of 133) had blood transfusion. Seven patients (6.9%) with probable or possible hemolysis died. Even when G6PD testing is available, enhanced monitoring for hemolysis is warranted after PQ treatment. Clinical review within the first 5 days of treatment may facilitate early detection and management of hemolysis. More robust definitions of severe PQ-associated hemolysis are required.