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Center For Disease Dynamics, Economics & Policy

Weekly digest: Parental education significantly reduces child mortality; Antimicrobial stewardship curriculum increases confidence among medical undergraduates

Parental education significantly reduces child mortality. A comprehensive global systematic review and meta-analysis combined with Demographic and Health Survey (DHS) data revealed that child mortality dropped significantly with increasing parental education. Under-5 mortality was reduced by 31% (95% CI 29.0 to 32.6) and 17.3% (15.0 to 18.8) for children born to mothers and fathers who had completed secondary education. Overall, every year of parental schooling was associated with a 1.5%-3.0% reduction in child mortality. [The Lancet]

New antimicrobial stewardship curriculum increases confidence among medical undergraduates. A new multi-faceted antimicrobial stewardship (AS) curriculum developed at the University of Pennsylvania led to drastic improvements in the level of confidence undergraduate students had concerning antibiotic use. Before the course, only a minority of them felt confident on topics such as antibiotic selection (19%), dosing for agents requiring therapeutic drug monitoring (6%), and adverse effects (19%). However, upon course completion, confidence levels increased for all students and in all domains. [Open Forum Infectious Diseases]

Typhoid vaccine is cost-effective in urban areas of India. A cost-effectiveness study assessing the typhoid conjugate vaccine (TCV) in India used three different scenarios of vaccine efficacy ranging from five to 15 years, assuming the highest incidence of infection until 15 years of age. The study showed that the vaccine could prevent up to 36% of typhoid cases and deaths in urban and rural areas; however, due to the low incidence of typhoid in rural areas, cost-effectiveness was restricted to urban areas only. [Vaccine

HIV testing fell significantly in Guatemala during the pandemic. During the COVID-19 pandemic in Guatemala, HIV testing rates dropped by 54.7%, while the number of newly diagnosed HIV patients decreased by only 10.7%. In contrast, deaths from opportunistic infections increased by 10% compared with 2019, reversing a declining trend observed since 2017. These findings suggest that pandemic-related disruptions have impacted the diagnosis and treatment of HIV-positive patients. Maintaining essential health services is crucial to reducing adverse outcomes. [IJID]

Decline in tuberculosis notifications during the COVID-19 pandemic in Malawi. A study by CDC showed that tuberculosis (TB) notifications fell significantly in Malawi due to the pandemic, with an average of 196 notifications per 100,000 in April 2020, representing a 23.7% reduction compared to the number of notifications expected in the absence of COVID-19. Additionally, males were over-represented among the 333 estimated missed cases between April 2020 and December 2020. Limited access to healthcare and fear of COVID-19 diagnosis and subsequent isolation were cited as some of the reasons for the decline in the notification of new TB cases. [CDC]

Secondary HIV testing kit distribution improves testing rates. A study found that the secondary distribution of HIV testing kits from pregnant women attending antenatal care to their sexual contacts increased the rate of partner testing: 73% of partners were tested in the antenatal group compared to the 35% tested in the standard of care group. Secondary distribution improved accessibility to HIV testing and treatment, representing a useful strategy in low- and middle-income countries. [The Lancet Global Health]

Antibiotic use reduces overall survival in cancer patients receiving immunotherapy. A study assessing the effects of antibiotic use on renal cell carcinoma patients treated with immunotherapy showed that the percentage of patients with a complete or partial response was significantly lower in the group that received antibiotics (24.1% vs. 50%). Additionally, patients treated with multiple courses of antibiotics had a lower median overall survival than those receiving one course (9.43 months vs. 20.20 months).  [Current problems in Cancer]

RH5 malaria vaccine reduces blood-stage malaria growth. Researchers in the United Kingdom conducted a first-in-human, open-label, non-randomized, multi-center, dose-escalation Phase I/IIa clinical trial to evaluate the safety, immunogenicity, and efficacy of a recombinant blood-stage malaria protein vaccine (RH5.1/AS01B). The study showed that the vaccine regimen was safe; it led to a significant in vivo reduction in blood-stage P. falciparum growth rate and greater antibody response in participants receiving the fourth booster. [Med]

Improved survival among hospitalized patients with COVID-19 treated with remdesivir and dexamethasone. According to a study involving two population-based cohorts of COVID-19 patients hospitalized between February and December 2020 in Denmark, the standard of care treatment (SOC) plus remdesivir and dexamethasone was associated with reductions in 30-day mortality and the need for mechanical ventilation compared to SOC treatment alone. The large majority of the patient population included individuals with hypoxemic COVID-19, suggesting that the treatment may benefit this patient sub-group. [Clinical Infectious Diseases]

Vaccination and prior SARS-CoV-2 infection associated with reduced risk of a positive PCR test. Between February and April 2021, the government of Qatar implemented a pilot program to facilitate air travel amid the pandemic by waiving the quarantine requirement for vaccinated residents who received their second vaccine dose at least 14 days before arrival but still requiring a Sars-Cov-2 RT-test. Compared to those unvaccinated or without a prior infection, the relative risk of RT-PCR positivity was 0.22 (95% CI, 0.17 to 0.28) for vaccinated individuals and 0.26 (95% CI, 0.21 to 0.34) for individuals with prior infection. [JAMA]

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