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In rural areas of South and Southeast Asia malaria is declining but febrile illnesses still account for substantial morbidity and mortality. Village health workers (VHWs) are often the first point of contact with the formal health system, and for patients with febrile illnesses they can provide early diagnosis and treatment of malaria. However, for the majority of febrile patients, VHWs lack the training, support and resources to provide further care. Consequently, treatable bacterial illnesses are missed, antibiotics are overused and poorly targeted, and patient attendance wanes along with declining malaria. This Open Letter announces the start of a new initiative, the Rural Febrile Illness (RFI) project, the first in a series of projects to be implemented as part of the South and Southeast Asian Community-based Trials Network (SEACTN) research programme. This multi-country, multi-site project will run in Bangladesh, Cambodia, Lao PDR, Thailand, and Myanmar. It will define the epidemiological baseline of febrile illness in nine remote and underserved areas of Asia where malaria endemicity is declining and access to health services is limited. The RFI project aims to determine the incidence, causes and outcomes of febrile illness; understand the opportunities, barriers and appetite for adjustment of the role of VHWs to include management of non-malarial febrile illnesses; and establish a network of community healthcare providers and facilities capable of implementing interventions designed to triage, diagnose and treat patients presenting with febrile illnesses within these communities in the future.

Safe and efficacious pan‐genotypic direct‐acting antiviral (DAA) regimens, such as sofosbuvir and daclatasvir (SOF + DCV), facilitate simplified models of care for hepatitis C virus (HCV). However, in Cambodia access to HCV testing and treatment has typically been low. In response, Médecins Sans Frontières (MSF) implemented a HCV testing and treatment pilot project in Phnom Penh, Cambodia in 2016. This project provides the first real‐world evidence of SOF + DCV effectiveness across a large patient cohort using a simplified care model in Cambodia. Patients treated with SOF + DCV from September 2016 to June 2019 were included in the analysis. Medical standard operational procedures (SOPs) were simplified significantly across the study period. Treatment effectiveness was assessed by sustained viral response at 12 weeks post‐treatment (SVR12) according to a modified intention‐to‐treat methodology. Treatment safety was assessed by clinical outcome and occurrence of serious and nonserious adverse events (S/AE). Of 9158 patients, median age was 57 years and 39.6% were male. At baseline assessment, 27.2% of patients had compensated cirrhosis and 2.9% had decompensated cirrhosis. Genotype 6 was predominant (53.0%). Among patients analysed according to modified intention to treat (n = 8525), treatment effectiveness was high, with 97.2% of patients achieving SVR12. Occurrence of SAE was low (0.7%). Treatment effectiveness and safety was not affected by the iterative simplification to treatment modality. In conclusion, in this large treatment cohort in Phnom Penh, Cambodia, the SOF + DCV regimen showed high rates of treatment effectiveness and safety across patient sub‐groups and during progressive simplification.

BackgroundGeographic differences in HIV, syphilis and condomless sex among men who have sex with men in China remained unknown. We aimed to elucidate these spatiotemporal changing patterns in China.MethodsWe conducted a spatiotemporal meta-analysis. We searched four databases for studies conducted between 2001 and 2015. We included studies that reported original data of HIV/syphilis prevalence in China, the study’s area/province, and period of data collection. We grouped studies into six regions and four time periods. We examined the changing patterns of national and regional prevalence of HIV, syphilis and condomless sex.ResultsSearch results yielded 2119 papers, and 272 were included in the meta-analysis. The sample sizes of the studies ranged from 19 to 47,231. National HIV prevalence increased from 3.8% (95% CI 3.0–4.8) in 2001–07 to 6.6% (5.6–7.7) in 2013–15. In most regions, the rise occurred before 2010 and the HIV prevalence remained relatively stable afterwards, except for the Northwest which showed a considerable increase since 2008. National syphilis prevalence decreased from 12.3% (10.2–14.9) in 2001–07 to 7.1% (5.6–8.9) in 2013–15.ConclusionsThe trends of HIV and syphilis infections have been effectively curbed in MSM in most regions of China. Continuous efforts, particularly promotion of condom use, are needed to further reduce these infections.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3532-8) contains supplementary material, which is available to authorized users.

Although the Three Gorges Project (TGP) may have affected the population structure and distribution of plant and animal communities, few studies have analyzed the effect of this project on small mammal communities. Therefore, the present paper compares the small mammal communities inhabiting the beaches of Dongting Lake using field investigations spanning a 20-year period, both before and after the TGP was implemented. Snap traps were used throughout the census. The results indicate that the TGP caused major changes to the structure of the small mammal community at a lake downstream of the dam. First, species abundance on the beaches increased after the project commenced. The striped field mouse (Apodemus agrarius) and the Norway rat (Rattus norvegicus), which rarely inhabited the beach before the TGP, became abundant (with marked population growth) once water was impounded by the Three Gorges Reservoir. Second, dominant species concentration indices exhibited a stepwise decline, indicating that the community structure changed from a single dominant species to a more diverse species mix after TGP implementation. Third, the regulation of water discharge release by the TGP might have caused an increase in the species diversity of the animal community on the beaches. A significant difference in diversity indices was obtained before and after the TGP operation. Similarity indices also indicate a gradual increase in species numbers. Hence, a long-term project should be established to monitor the population fluctuations of the Yangtze vole (Microtus fortis), the striped field mouse and the Norway rat to safeguard against population outbreaks (similar to the Yangtze vole outbreak in 2007), which could cause crop damage to adjacent farmland, in addition to documenting the succession process of the small mammal community inhabiting the beaches of Dongting Lake.

Current knowledge about the relationship between psychological characteristics and metabolic syndrome components is limited in Asian populations. The purpose of this study is to investigate linkages between physiological markers of metabolic syndrome and life satisfaction, hostility, and depression in Chinese adults. Secondary analyses were conducted using cross-sectional data from parents of randomly selected middle school students participating in a pilot study in Qingdao, China. Among 440 parents who consented to participate (237 women, 203 men), 368 provided valid responses in all three categories of psychological characteristics, and only those subjects were included in these analyses. General linear models and logistic regressions were run separately by gender, controlling for covariates. Among women, life satisfaction was inversely associated with triglyceride levels (p=0.04), LDL-C (p<0.01), risk of hypertriglyceridemia (OR[0.53], p<0.01), HDL-C (OR[0.78], p=0.03), and MetS (OR[0.52], p=0.03). No associations were found between life satisfaction and any psychological characteristics among men. Among women, hostility was positively associated with triglyceride level (p=0.04) and risk of hypertriglyceridemia (OR[2.12], p<0.05). Among men, hostility was positively associated with waist circumference (p=0.04), waist-hip ratio (p<0.05), and fasting plasma insulin (p<0.01). Depression was not associated with any physiological measurement in either gender. These findings indicate that relationships exist between certain psychological characteristics and physiological indicators of MetS among Chinese adults, although there may be important differences between genders.

Fertility control agents for the management of rodent populations are developing and maturing. Investigating the impacts on non-target species of consumption of these agents is essential. The present study assessed the nontarget toxicity effects of quinestrol, a synthetic estrogen-based antifertility agent for managing rodent populations. Various quinestrol doses administered to male and female (n = 60 each) chickens through single oral gavage were 0 (A), 10 (B), 50 (C), and 150 (D) mg/kg body weight. Chickens were assessed for effect on body weight, weight of vital and reproductive organs, reproductive hormones, histology of reproductive organs and egg laying rates after 15, 30, and 135 days of treatment. Quinestrol did not induce mortality in chickens and its effects were time and dose dependent. The 90% egg-laying rates were delayed by 30, 60 for groups B and C compared with the control group, and group D did not reach the 90% egg-laying rate by 135 days. Reproductive organs in males and females returned to normal levels within 30 and 135 days, respectively. With the exception of the FSH concentration in group D, reproductive hormones of both sexes were similar to controls by 30 days. No other significant effects were found. The present research demonstrated the safety of quinestrol on non-target species and facilitates recommendations for the general administration of quinestrol for rodent pest management.

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