Pediatric asthma is a growing public health issue, disproportionately affecting low-income people and people of color. Exposure to indoor asthma triggers plays an important role in the development and exacerbation of asthma. We describe the implementation of the Seattle-King County Healthy Homes Project, a randomized, controlled trial of an outreach/education intervention to improve asthma-related health status by reducing exposure to allergens and irritants in the home. We randomly assigned 274 low-income children with asthma ages 4-12 to either a high- or a low-intensity group. In the high-intensity group, community health workers called Community Home Environmental Specialists (CHES) conducted initial home environmental assessments, provided individualized action plans, and made additional visits over a 12-month period to provide education and social support, encouragement of participant actions, provision of materials to reduce exposures (including bedding encasements), assistance with roach and rodent eradication, and advocacy for improved housing conditions. Members of the low-intensity group received the initial assessment, home action plan, limited education during the assessment visit, and bedding encasements. We describe the recruitment and training of CHES and challenges they faced and explain the assessment and exposure reduction protocols addressing dust mites, mold, tobacco smoke, pets, cockroaches, rodents, dust, moisture, and toxic or hazardous chemicals. We also discuss the gap between the practices recommended in the literature and what is feasible in the home. We accomplished home interventions and participants found the project very useful. The project was limited in resolving structural housing quality issues that contributed to exposure to indoor triggers.

Abstract. Pregnancy-associated malaria is one of the leading causes of low birth weight in malaria endemic areas. In this study, 145 parturient women residing in areas endemic for Plasmodium falciparum in Lambaréné, Gabon, were recruited into the study after delivery, and the association of maternal P. falciparum infection, inflammatory response, and birth weight was studied. At delivery, 10% (15) of the mothers (12 were positive in both peripheral and placental blood smears, 1 was positive in peripheral blood only, and 2 were positive in placenta blood only) were positive for P. falciparum by microscopy and 23% (30) by real-time polymerase chain reaction (PCR). The level of C-reactive protein (CRP) was significantly elevated in microscopically P. falciparum-positive pregnant women (34 mg/L; 95% CI: 3-458) but not in those with sub-microscopic infections (6 mg/L; 95% CI: 1-40) compared with those free of P. falciparum infection (7 mg/L; 95% CI: 1-43). In a multivariate analysis, the presence of microscopic (adjusted OR ‫ס‬ 28.6, 95% CI ‫ס‬ 4.8-169.0) or sub-microscopic (adjusted OR ‫ס‬ 13.2, 95% CI ‫ס‬ 2.4-73.0) P. falciparum infection in pregnant women and age of mothers < 21 years (adjusted OR ‫ס‬ 9.7 CI ‫ס‬ 1.0-89.7), but not CRP levels, were independent predictors for low birth weight. This finding may have important operational implications and emphasizes the need for appropriate diagnostic methods in studies evaluating the outcome of pregnancy-associated malaria.

P. falciparum infection history during pregnancy appears to have a pronounced effect on neonatal innate immune responses. The observed effects may have profound implications for the outcome of newly encountered infections in early life.

Gestation is a unique physiologic state that carries with it several immunologic consequences and results in changing susceptibility to various diseases. In contrast to the well recognized excess vulnerability of primiparous women to Plasmodium falciparum infection in areas of high malaria transmission, it is not known whether pregnancy is associated with a higher prevalence of helminth infection. In Lambaréné, Gabon, 105 pregnant women were recruited and matched with non-gravid female controls. The prevalence of intestinal helminths was 66% (n=58) in the pregnant participants and 36% (n=32) in the non-pregnant controls (P<0.001). In multivariate analysis the pregnancy status was an independent risk factor for being infected with intestinal helminths (AOR and 95% CI: 3.0 [1.4-5.9]). These data show a previously undescribed susceptibility pattern of pregnant women to intestinal helminth infection in a sub-Saharan African community.