The Prognostic and Predictive Role of Chromogranin A in Gastroenteropancreatic Neuroendocrine Tumors – A Single-Center Experience

Chromogranin A (CgA) is a non-specific biomarker excreted by neuroendocrine tumor (NET) cells. Elevation of circulating CgA level can be detected in gastroenteropancreatic (GEP)-NET patients and has been shown to correlate with tumor burden. The prognostic and predictive roles of CgA level and the change of CgA level are controversial. In this study, we retrospectively analyzed 102 grade 1/2 GEP-NET patients with available baseline or serial follow-up CgA levels from the National Cheng Kung University Hospital to evaluate the association between circulating CgA level and the tumor extent, overall survival (OS), and tumor response prediction. The baseline characteristics, baseline CgA level, and change of CgA level during follow-up and their association was analyzed. Sixty cases had baseline CgA levels available prior to any treatment and ninety-four cases had serial follow-up CgA levels available during treatment or surveillance. Baseline CgA levels were associated with stage and sex. Higher baseline CgA levels were associated with worse OS after adjusting for sex, stage, grade, primary site, and functionality (hazard ratio=13.52, 95% confidence interval (CI), 1.06-172.47, P=0.045). The cross-sectional analysis for the change of CgA level during follow-up showed that a ≥ 40% increase of CgA meant a higher probability of developing tumor progression or recurrence than those with a < 40% increase of CgA level (odds ratio=5.04, 95% CI, 1.31-19.4, P=0.019) after adjusting for sex, age, grade, stage, and functionality. Our study results suggest that CgA may be a predictive marker for tumor burden, OS, and tumor progression in GEP-NET patients.

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CLINICAL FEATURES, INDICATIONS AND RESULT OF TRACHEOTOMY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.3.7 ◽

2017 ◽

pp. 50-55

Author(s):

Duc Luu Ngo ◽

Tu The Nguyen ◽

Manh Hung Ho ◽

Thanh Thai Le

Keyword(s):

Clinical Features ◽

University Hospital ◽

Female Ratio ◽

Tube Obstruction ◽

Level Ii ◽

Study Results ◽

Male Female Ratio ◽

Hospital Patients ◽

Level I

Background: This study aims to survey some clinical features, indications and results of tracheotomy at Hue Central Hospital and Hue University Hospital. Patients and method: Studying on 77 patients who underwent tracheotomy at all of departments and designed as an prospective, descriptive and interventional study. Results: Male-female ratio was 4/1. Mean age was 49 years. Career: farmer 44.2%, worker 27.2%, officials 14.3%, student 7.8%, other jobs 6.5%. Respiratory condition before tracheotomy: underwent intubation 62.3%, didn’t undergo intubation 37.7%. Period of stay of endotracheal tube: 1-5 days 29.2%, 6-14 days 52.1%, >14 days 18.7%. Levels of dyspnea before tracheotomy: level I 41.4%, level II 48.3%, level III 0%, 10.3% of cases didn’t have dyspnea. Twenty cases (26%) were performed as an emergency while fifty seven (74%) as elective produces. Classic indications (37.7%) and modern indications (62.3%). On the bases of the site, we divided tracheostomy into three groups: high (0%), mid (25.3%) and low (74.7%). During follow-up, 44 complications occurred in 29 patients (37.7%). Tracheobronchitis 14.3%, tube obstruction 13%, subcutaneous empysema 10.4%, hemorrhage 5%, diffcult decannulation 5.2%, tube displacement 3.9%, canule watery past 2.6%, wound infection 1.3%. The final result after tracheotomy 3 months: there are 33 patients (42.9%) were successfully decannulated. In the 33 patients who were successfully decannulated: the duration of tracheotomy ranged from 1 day to 90 days, beautiful scar (51.5%), medium scar (36.4%), bad scar (12.1%). Conclusions: In tracheotomy male were more than female, adult were more than children. The main indication was morden indication. Tracheobronchitis and tube obstruction were more common than other complications. Key words: Tracheotomy

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Intraoperative cone beam computed tomography for detecting residual stones in percutaneous nephrolithotomy: a feasibility study

Urolithiasis ◽

10.1007/s00240-021-01259-1 ◽

2021 ◽

Author(s):

R. A. Kingma ◽

M. J. H. Voskamp ◽

B. H. J. Doornweerd ◽

I. J. de Jong ◽

S. Roemeling

Keyword(s):

Computed Tomography ◽

Percutaneous Nephrolithotomy ◽

Cone Beam Computed Tomography ◽

University Hospital ◽

Cone Beam ◽

Cross Sectional ◽

The Mean ◽

Residual Stones ◽

Residual Fragments

AbstractCone beam computed tomography (CBCT) provides multiplanar cross-sectional imaging and three-dimensional reconstructions and can be used intraoperatively in a hybrid operating room. In this study, we investigated the feasibility of using a CBCT-scanner for detecting residual stones during percutaneous nephrolithotomy (PCNL). Intraoperative CBCT-scans were made during PCNL procedures from November 2018 until March 2019 in a university hospital. At the point where the urologist would have otherwise ended the procedure, a CBCT-scan was made to image any residual fragments that could not be detected by either nephroscopy or conventional C-arm fluoroscopy. Residual fragments that were visualized on the CBCT-scan were attempted to be extracted additionally. To evaluate the effect of this additional extraction, each CBCT-scan was compared with a regular follow-up CT-scan that was made 4 weeks postoperatively. A total of 19 procedures were analyzed in this study. The mean duration of performing the CBCT-scan, including preparation and interpretation, was 8 min. Additional stone extraction, if applicable, had a mean duration of 11 min. The mean effective dose per CBCT-scan was 7.25 mSv. Additional extraction of residual fragments as imaged on the CBCT-scan occurred in nine procedures (47%). Of the follow-up CT-scans, 63% showed a stone-free status as compared to 47% of the intraoperative CBCT-scans. We conclude that the use of CBCT for the detection of residual stones in PCNL is meaningful, safe, and feasible.

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Duration of response after DEB-TACE compared to lipiodol-TACE in HCC-naïve patients: a propensity score matching analysis

European Radiology ◽

10.1007/s00330-021-07905-x ◽

2021 ◽

Author(s):

Irene Bargellini ◽

Valentina Lorenzoni ◽

Giulia Lorenzoni ◽

Paola Scalise ◽

Gianni Andreozzi ◽

...

Keyword(s):

Propensity Score ◽

Tumor Progression ◽

Tumor Response ◽

Complete Response ◽

Tumor Burden ◽

Local Tumor Control ◽

Lower Number ◽

Tumor Control ◽

Duration Of Response

Abstract Objectives To retrospectively compare long-term outcomes of first-line drug-eluting particle (DEB)- transarterial chemoembolization (TACE) and lipiodol-TACE, in patients with unresectable hepatocellular (HCC). Methods We retrospectively reviewed our database to identify adult patients with treatment-naïve unresectable HCC, who underwent TACE from 2006 to 2013. Patients were excluded in the absence of complete medical records relative to first TACE, 1-month follow-up, and/or sufficient follow-up data. Periprocedural complications, duration of hospitalization, 1-month tumor response by mRECIST, time to tumor progression (TTP) and target tumor progression (TTTP), and overall survival (OS) were evaluated. Results Out of an initial series of 656 patients, 329 patients were excluded for unavailability of sufficient baseline and/or follow-up data. The remaining 327 patients underwent either lipiodol-TACE (n = 160) or DEB-TACE (n = 167). Patients treated with lipiodol-TACE had a significantly higher tumor burden. By propensity score, patients were matched according to baseline differences (BCLC stage, uninodular or multinodular HCC, and unilobar or bilobar HCC), resulting in 101 patients in each treatment group. Lipiodol-TACE was associated with a significantly higher incidence of adverse events (p = 0.03), and longer hospitalization (mean, 2.5 days vs 1.9 days; p = 0.03), while tumor response, TTP, and OS were comparable. In patients achieving 1-month complete response (CR) of target tumor, TTTP was significantly (p = 0.009) longer after DEB-TACE compared to lipiodol-TACE (median, 835 vs 353 days), resulting in a lower number of re-treatments during the entire follow-up (0.75 vs 1.6, p = 0.01). Conclusion Compared to lipiodol-TACE, DEB-TACE offers higher tolerability, reduced hospitalization, and more durable target tumor response after CR. Key Points • Compared to lipiodol-TACE, DEB-TACE is better tolerated and has reduced side effects, which translates into shorter hospitalization. • When complete radiological response according to the mRECIST is obtained 1 month after the procedure, DEB-TACE offers a more durable local tumor control compared to lipiodol-TACE. • In these patients, the longer duration of response after DEB-TACE translates into a lower number of re-interventions.

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Psychological Morbidity Among Post-COVID-19 Patients: A Cross-sectional Study from Chennai, South India

INDIAN JOURNAL OF MENTAL HEALTH AND NEUROSCIENCES ◽

10.32746/10.32746/ijmhns.2021.v4.i1.48 ◽

2021 ◽

Vol 4 (01) ◽

pp. 10-17

Author(s):

D. Devi ◽

V. Monica ◽

Ravi Santhosh ◽

Vijaya Raghavan ◽

P. Poornachandrika

Keyword(s):

Cross Sectional Study ◽

Physical Symptoms ◽

Panic Attacks ◽

Psychological Morbidity ◽

Care Hospital ◽

Depression And Anxiety ◽

Sectional Study ◽

Cross Sectional ◽

Study Results

Background: The COVID-19 pandemic is a global health threat and is by far the largest outbreak of atypical pneumonia, since the SARS outbreak in 2003. A range of psychiatric morbidities such as persistent depression, anxiety, panic attacks, delirium and suicidality were observed in the post infectious state across the world. Hence, the aim of the study was to understand the psychological status of the patients affected by COVID during their post-COVID follow-up period and to examine the socio-demographic and clinical factors associated with high psychological morbidity. Materials and Methods: A cross sectional study conducted in the post-COVID follow up clinic, at a tertiary care hospital between the months of August - November 2020, using a semi structured proforma and rating scales such as Patient Health Questionnaire-9 (PHQ-9), Hospital Anxiety and Depression Scale (HADS) and Insomnia Severity Index (ISI) for depression, anxiety and insomnia, respectively. Results: The study results indicate that the prevalence of depression and anxiety among post-COVID-19 patients was 21.9% and 11.9%, respectively. Insomnia was observed among 21.7%Among various sociodemographic and clinical variables examined, it was observed that female gender, patients with ongoing stressors and patients with post-COVID-19 persistent physical symptoms were found to be associated with greater depression and anxiety among the study population. Conclusions: Persistent physical symptoms and ongoing life stressors are found to be associated with depression and anxiety among post-COVID-19 patients. Hence, periodic screening for individuals with persisting physical symptoms and care for the vulnerable population such as those with ongoing stressors will provide a significant advantage in the follow up of the mental health of the patients affected with COVID-19.

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Chromogranin a Measurement in Metastatic Well-Differentiated Gastroenteropancreatic Neuroendocrine Carcinoma: Screening for False Positives and a Prospective Follow-Up Study

The International Journal of Biological Markers ◽

10.5301/jbm.2011.8327 ◽

2011 ◽

Vol 26 (2) ◽

pp. 94-101 ◽

Cited By ~ 24

Author(s):

Delphine Vezzosi ◽

Thomas Walter ◽

Agnès Laplanche ◽

Jean Luc Raoul ◽

Clarisse Dromain ◽

...

Keyword(s):

False Positive ◽

Chromogranin A ◽

Morphological Changes ◽

Surrogate Marker ◽

False Positive Result ◽

Gastroenteropancreatic Neuroendocrine Tumors ◽

Follow Up Study ◽

Well Differentiated ◽

Positive Results

Background Multiple causes of false-positive chromogranin A (CgA) measurement have been reported that may affect its impact as a surrogate marker of RECIST progression in well-differentiated gastroenteropancreatic neuroendocrine tumors (WDGEPNET). Aims 1) To evaluate the frequency of false-positive CgA results. 2) To prospectively compare CgA variations with RECIST morphological changes in patients without known causes of false-positive CgA measurements. Methods First, the conditions responsible for potentially false-positive CgA measurements were screened in 184 consecutive patients with metastatic WDGEPNET. Secondly, a variation in CgA at a 6-month interval was compared to RECIST results at 6 months in 46 patients. Results Among 184 patients, elevated CgA was found in 130 cases (71%) including 99 patients with at least one cause of a false-positive result. Impaired kidney function as well as medication with proton pump inhibitors were found to be the 2 major causes of false-positive results. The sensitivity and specificity of CgA measurements compared with morphological tumor changes according to the RECIST criteria were 71% and 50%, respectively, at 6 months. Conclusion Routine screening for the causes of false-positive CgA measurements is mandatory in WDGEPNET patients. Our study does not validate the use of CgA as a surrogate marker of tumor progression.

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Functional Outcome of Intracapsular Femoral Neck Fractures Treated by Bipolar Hemiarthroplasty

10.53350/pjmhs21155988 ◽

2021 ◽

Vol 15 (5) ◽

pp. 988-991

Author(s):

Zamir Hussain Tunioi ◽

Rizwan Ali Jhatiyal ◽

M Azeem Akhund ◽

M Kashif Abbasi ◽

L Das Maheshwari ◽

...

Keyword(s):

Femoral Neck ◽

Functional Outcome ◽

Femoral Neck Fractures ◽

University Hospital ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Cross Sectional ◽

Average Hospital

Aim: To evaluate the functional outcome of bipolar hemiarthroplasty in intracapsular fracture neck of femur. Study design: Descriptive cross sectional study. Place and duration of study: Department of Orthopaedic Surgery & Traumatology, Peoples Medical University Hospital, Shaheed Benazir Abad from 1st December 2017 to 31st December 2020. Methodology: Sixty six cases of intracapsular femoral neck fractures with age ranging from 50 year to 75 year of either gender who were ambulatory before injury were included; while basicervical, younger than 50 years, with neuromuscular disorder, unfit for surgery, open fracture, bilateral injuries, osteoarthritis of hip, Rheumatoid, Gouty, pathological fractures, bedridden & who did not give consent for study, were excluded from the study. Functional outcome assessed by Harris hip score & data analyzed by SPSS version 23. Results: Twenty six (59.09%) were male and 40 (40.91%) were female with mean age of 64.3±7.77 year. Average time from injury to hospital arrival was 14.7±6.8 hours. Average time from hospitalization to surgery was 4.67±2.23 days. Average time of surgery was 55.67±9.9 minutes. Average hospital stay was 9.7±4.3 days. The average time of follow-up was 18.45±7.63 months. Conclusion: Bipolar implant is safe, effective, reliable, stable and cost effective implant for intracpsular fracture of femoral neck in elderly populace. The 66.66% of patients have satisfactory Harris hip score in follow up duration of 18.45±7.63 months. Keywords: Functional, Outcome, Femoral neck fractures, FNF, Bipolar, Hemiarthroplasty, HHS

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Evaluating effectiveness of screening house eaves as a potential intervention for reducing indoor vector densities and malaria prevalence in Nyabondo, western Kenya

Malaria Journal ◽

10.1186/s12936-020-03413-3 ◽

2020 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Peter Njoroge Ng’ang’a ◽

Collins Okoyo ◽

Charles Mbogo ◽

Clifford Maina Mutero

Keyword(s):

Malaria Parasite ◽

Parasite Prevalence ◽

Malaria Prevalence ◽

Wire Mesh ◽

Control Group ◽

Light Traps ◽

Cross Sectional ◽

Western Kenya ◽

Study Results

Abstract Background Mosquito-proofing of houses using wire mesh screens is gaining greater recognition as a practical intervention for reducing exposure to malaria transmitting mosquitoes. Screening potentially protects all persons sleeping inside the house against transmission of mosquito-borne diseases indoors. The study assessed the effectiveness of house eaves screening in reducing indoor vector densities and malaria prevalence in Nyabondo, western Kenya. Methods 160 houses were selected for the study, with half of them randomly chosen for eaves screening with fibre-glass coated wire mesh (experimental group) and the other half left without screening (control group). Randomization was carried out by use of computer-generated list in permuted blocks of ten houses and 16 village blocks, with half of them allocated treatment in a ratio of 1:1. Cross-sectional baseline entomological and parasitological data were collected before eave screening. After baseline data collection, series of sampling of indoor adult mosquitoes were conducted once a month in each village using CDC light traps. Three cross-sectional malaria parasitological surveys were conducted at three month intervals after installation of the screens. The primary outcome measures were indoor Anopheles mosquito density and malaria parasite prevalence. Results A total of 15,286 mosquitoes were collected over the two year period using CDC light traps in 160 houses distributed over 16 study villages (mean mosquitoes = 4.35, SD = 11.48). Of all mosquitoes collected, 2,872 (18.8%) were anophelines (2,869 Anopheles gambiae sensu lato, 1 Anopheles funestus and 2 other Anopheles spp). Overall, among An. gambiae collected, 92.6% were non-blood fed, 3.57% were blood fed and the remaining 0.47% were composed of gravid and half gravid females. More indoor adult mosquitoes were collected in the control than experimental arms of the study. Results from cross-sectional parasitological surveys showed that screened houses recorded relatively low malaria parasite prevalence rates compared to the control houses. Overall, malaria prevalence was 5.6% (95% CI: 4.2–7.5) n = 1,918, with baseline prevalence rate of 6.1% (95% CI: 3.9–9.4), n = 481 and 3rd follow-up survey prevalence of 3.6% (95% CI: 2.0–6.8) n = 494. At all the three parasitological follow-up survey points, house screening significantly reduced the malaria prevalence by 100% (p < 0.001), 63.6% (p = 0.026), and 100% (p < 0.001) in the 1st, 2nd and 3rd follow-up surveys respectively. Conclusions The study demonstrated that house eave screening has potential to reduce indoor vector densities and malaria prevalence in high transmission areas.

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Residual Pulmonary Hypertension More than 20 Years after Repair of Shunt Lesions

Medicina ◽

10.3390/medicina56060297 ◽

2020 ◽

Vol 56 (6) ◽

pp. 297

Author(s):

Dovilė Jančauskaitė ◽

Virginija Rudienė ◽

Gabrielius Jakutis ◽

Laurie W Geenen ◽

Jolien W Roos-Hesselink ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Surgical Repair ◽

Significant Proportion ◽

University Hospital ◽

Right Heart ◽

Long Term Outcome ◽

Right Heart Catheterisation ◽

Study Results

Background and Objectives: After successful surgical repair of a congenital shunt lesion, pulmonary hypertension (PH) often disappears. However, PH can persist long-term after the closure. This study aimed to assess the prevalence of PH long-term after surgical repair of congenital heart disease (CHD), and to evaluate the outcomes and preoperative factors related to residual PH. Materials and Methods: In this retrospective cohort study, we reviewed patients who underwent right heart catheterisation in Vilnius University Hospital Santaros Klinikos during the period of 1985–2007. Among 4118 right heart catheterisations performed, 160 patients underwent congenital systemic-to-pulmonary shunt repair at a young age (<18 years) and had pre-operative PH. Half of the patients were foreigners whose follow-up data were unavailable. Eventually, 88 patients with available follow-up data were included in this study. Results: The median age at diagnosis of CHD with PH was 0.8 (0.6–3.0) and 1.1 (0.6–3.9) years at surgery (50% females). Residual PH was assessed 9.5 years after surgery and observed in 30.7% (n = 27) of the patients. It was associated with having more than one shunt (44.4% (n = 12), p = 0.016) and higher median pulmonary vascular resistance (3.4 (2.5–6.5) vs. 2.2 (1.0–3.7), p = 0.035) at baseline. After a median follow-up of 21 (15–24) years, 9.1% of the patients were deceased. Kaplan–Meier survival analysis revealed significantly higher mortality in the residual PH group (p = 0.035). Conclusions: Residual PH affects a significant proportion of patients after surgical repair of a shunt lesion and is associated with worse long-term outcome.

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Reference values for Lactate Pro 2™ in fetal blood sampling during labor: a cross-sectional study

Journal of Perinatal Medicine ◽

10.1515/jpm-2016-0027 ◽

2017 ◽

Vol 45 (3) ◽

Cited By ~ 2

Author(s):

Brynhildur Tinna Birgisdottir ◽

Malin Holzmann ◽

Ingela Hulthén Varli ◽

Sofie Graner ◽

Sissel Saltvedt ◽

...

Keyword(s):

Lactate Concentration ◽

Rank Correlation ◽

Cross Sectional Study ◽

University Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Spearman’S Rank Correlation ◽

Fetal Blood Sampling ◽

Conversion Equation

AbstractObjective:Lactate ProStudy design:A cross-sectional study was conducted at a university hospital in Sweden. A total of 113 laboring women with fetal heart rate abnormalities on cardiotocography (CTG) had FBS carried out. Lactate concentration was measured bedside with both LP1 and LP2 from the same blood sample capillary. A linear regression model was constructed to retrieve a conversion equation to convert LP2 values to LP1 values.Results:LP2 measured higher values than LP1 in all analyses. We found that 4.2 mmol/L with LP1 corresponded to 6.4 mmol/L with LP2. Likewise, 4.8 mmol/L with LP1 corresponded to 7.3 mmol/L with LP2. The correlation between the analyses was excellent (Spearman’s rank correlation, r=0.97).Conclusion:We recommend the following guidelines when interpreting lactate concentration in FBS with LP2: <6.4 mmol/L to be interpreted as normal, 6.4–7.3 mmol/L as preacidemia indicating a follow-up FBS within 20–30 min, and >7.3 mmol/L as acidemia indicating intervention.

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Evaluating effectiveness of screening house eaves as an intervention for integrated vector management for malaria control in Nyabondo, Western Kenya.

10.21203/rs.2.18504/v1 ◽

2019 ◽

Author(s):

Peter Njoroge Ng'ang'a ◽

Collins Okoyo ◽

Charles Mbogo ◽

Clifford Maina Mutero

Keyword(s):

Malaria Transmission ◽

Malaria Prevalence ◽

Wire Mesh ◽

Control Group ◽

Cross Sectional ◽

Western Kenya ◽

Study Results ◽

Entry Points ◽

Mosquito Entry

Abstract BackgroundMosquito-proofing of houses with appropriate screens fixed at potential mosquito entry points is gaining greater recognition as a practical intervention for reducing malaria transmission indoors. The study aimed at evaluating the effectiveness of house eaves screening in preventing mosquito entry and malaria prevalence in Nyabondo, western Kenya. Methods160 houses were selected for the study, with half of them randomly chosen for screening at the eaves with fibre-glass coated wire mesh (experimental group) and the other half left without screening (control group). Randomization was carried out by use of computer-generated list, in permuted blocks of ten houses and 16 village blocks in the study site, with treatments in the ratio of 1:1. Cross-sectional baseline entomological and malaria parasitological data were collected before house eave screening. After the baseline period, series of sampling of indoor adult mosquitoes were conducted once a month in each village using CDC light traps. Three cross-sectional malaria parasitological surveys were also conducted at three month intervals after installation of the screens. The primary outcome measures were indoor Anopheles mosquito density and malaria parasite prevalence. ResultsA total of 15,286 mosquitoes were collected over the two years period using CDC light trap in 160 houses distributed over 16 study villages (mean = 4.35, SD = 11.48). Of all mosquitoes collected, 2,872 were anophelines (2,869 An. gambiae s.l., 1 An. funestus and 2 other anopheles). Overall, among An. gambiae collected, 92.6% were non-blood fed, 3.57% were blood fed and the remaining 0.47% were composed of gravid and half gravid females. Overall more mosquitoes were collected in the control than experimental arms of the study. Results from four cross-sectional prevalence surveys showed that screened houses recorded relatively low malaria prevalence rates compared to the control houses. Overall, malaria prevalence was 5.6% (95%CI: 4.2-7.5) N=1,918, with baseline survey recording 6.1% prevalence (95%CI: 3.9-9.4), n=481 and third follow-up survey recording 3.6% prevalence (95%CI: 2.0-6.8) n=494. At all the three follow-up survey points, house screening significantly reduced the malaria prevalence by 100% (p<0.001), 63.6% (p=0.026), and 100% (p<0.001) for first, second and third follow-ups surveys respectively. The house screening significantly reduced malaria prevalence by 54% (OR = 0.46, 95%CI: 0.24-0.87, p = 0.017). ConclusionsThe study demonstrated that house eave screening has potential to reduce indoor vector densities and malaria transmission in high transmission areas in Kenya.

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