Methylene blue (MB) was the first synthetic antimalarial to be discovered and was used during the late 19th and early 20th centuries against all types of malaria. MB has been shown to be effective in inhibiting Plasmodium falciparum in culture, in the mouse model and in rhesus monkeys. MB was also shown to have a potent ex vivo activity against drug-resistant isolates of P. falciparum and P. vivax. In preclinical studies, MB acted synergistically with artemisinin derivates and demonstrated a strong effect on gametocyte reduction in P. falciparum. MB has, thus, been considered a potentially useful partner drug for artemisinin-based combination therapy (ACT), particularly when elimination is the final goal. The aim of this study was to review the scientific literature published until early 2017 to summarise existing knowledge on the efficacy and safety of MB in the treatment of malaria. This systematic review followed PRISMA guidelines. Studies reporting on the efficacy and safety of MB were systematically searched for in relevant electronic databases according to a pre-designed search strategy. The search (without language restrictions) was limited to studies of humans published until February 2017. Out of 474 studies retrieved, a total of 22 articles reporting on 21 studies were eligible for analysis. The 21 included studies that reported data on 1504 malaria patients (2/3 were children). Older studies were case series and reports on MB monotherapy while recent studies were mainly controlled trials of combination regimens. MB was consistently shown to be highly effective in all endemic areas and demonstrated a strong effect on P. falciparum gametocyte reduction and synergy with ACT. MB treatment was associated with mild urogenital and gastrointestinal symptoms as well as blue coloration of urine. In G6PD-deficient African individuals, MB caused a slight but clinically non-significant haemoglobin reduction. More studies are needed to define the effects of MB in P. falciparum malaria in areas outside Africa and against P. vivax malaria. Adding MB to ACT could be a valuable approach for the prevention of resistance development and for transmission reduction in control and elimination programs. This study is registered at PROSPERO (registration number CRD42017062349 ).

Outpatient care is made up of medical procedures, tests, and services that can be provided to the patient in a setting that doesn’t involve an overnight hospital stay. In China, tertiary hospitals are medical services centers of health care systems, and some tertiary hospitals had more than 20,000 outpatient visits per day. However, a systematic review of existed evidence on factors influencing the outpatient satisfaction in tertiary hospitals in China could inform the efforts and does not yet exist. Therefore, in order to better understand the outpatient satisfaction provided by tertiary hospitals in China, we carried out a systematic review following PRISMA guidelines. Studies reporting on the level of and factors associated with outpatient satisfaction in Chinese tertiary hospitals were systematically searched in both Chinese and English electronic databases. A total of 36 articles reported 35 studies that met the inclusion criteria. Out of these eight were household surveys covering 12,119 residents, and another 27 directly interviewed 45,930 outpatients during their hospital visits from 185 hospitals. The included studies generally used self-designed questionnaire and indicated there is a lack of standardized questionnaire for investigating outpatient satisfaction in China. The outpatients showed the highest satisfaction with the doctors and nurses and the lowest satisfaction with the hospital hygiene and outpatient procedures, especially with the long waiting time. The socio-demographic characteristics (e.g., age, marital status, income and education levels), professional skills and service attitudes of medical staff were reported to be associated with outpatient satisfaction. The results indicated that in China, the outpatient satisfaction can be largely improved. Firstly, the attitude of medical service providers, especially the pre-diagnosis nurses, registration officers, and pharmaceutical counters should be improved. Furthermore, to shorten the waiting time, policies should be developed to guide patients with common diseases and slight discomforts to community health systems to alleviate the overload in tertiary hospitals. Considering the strained relations between the doctors and patients in the clinical practice, improving patient satisfaction in China deserves more attention and research.

Background: The COVID-19 pandemic shows variable dynamics in WHO Regions, with lowest disease burden in the Western-Pacific Region. While China has been able to rapidly eliminate transmission of SARS-CoV-2, Germany – as well as most of Europe and the Americas – is struggling with high numbers of cases and deaths. Objective: We analyse COVID-19 epidemiology and control strategies in China and in Germany, two countries which have chosen profoundly different approaches to deal with the epidemic. Methods: In this narrative review, we searched the literature from 1 December 2019, to 4 December 2020. Results: China and several neighbours (e.g. Australia, Japan, South Korea, New Zealand, Thailand) have achieved COVID-19 elimination or sustained low case numbers. This can be attributed to: (1) experience with previous coronavirus outbreaks; (2) classification of SARS-CoV-2 in the highest risk category and consequent early employment of aggressive control measures; (3) mandatory isolation of cases and contacts in institutions; (4) broad employment of modern contact tracking technology; (5) travel restrictions to prevent SARS-CoV-2 re-importation; (6) cohesive communities with varying levels of social control. Conclusions: Early implementation of intense and sustained control measures is key to achieving a near normal social and economic life.

Antibiotic resistance (ABR) threatens the effectiveness of infectious disease treatments and contributes to increasing global morbidity and mortality. In this study, we systematically reviewed the identified risk factors for ABR among people in the healthcare system of mainland China. Five databases were systematically searched to identify relevant articles published in either English and Chinese between 1 January 2003 and 30 June 2019. A total of 176 facility-based references were reviewed for this study, ranging across 31 provinces in mainland China and reporting information from over 50 000 patients. Four major ABR risk factor domains were identified: (1) sociodemographic factors (includes migrant status, low income and urban residence), (2) patient clinical information (includes disease status and certain laboratory results), (3) admission to healthcare settings (includes length of hospitalisation and performance of invasive procedures) and (4) drug exposure (includes current or prior antibiotic therapy). ABR constitutes an ongoing major public health challenge in China. The healthcare sector-associated risk factors was the most important aspect identified in this review and need to be addressed. Primary health care system and ABR surveillance networks need to be further strengthened to prevent and control the communicable diseases, over-prescription and overuse of antibiotics.

China has made great progress in malaria control over the last century and now aims to eliminate malaria by 2020. In 2012, the country launched its 1-3-7 surveillance and response strategy for malaria elimination. The strategy involves to case reporting within 1 day, case investigation within 3 days, and focus investigation and public health actions within 7 days. The aim of this study was to evaluate the challenges in and lessons learned during the implementation of the 1-3-7 strategy in China so far. This qualitative study was conducted in two provinces in China: Gansu province (northwestern China) and Jiangsu province (southeastern China) in 2014. Key informant interviews (n = 6) and in-depth interviews (n = 36) about the implementation aspects of the 1-3-7 strategy were conducted with malaria experts, health staff, laboratory practitioners, and village doctors at the provincial, city, county, township, and village levels. Broad themes related to the challenges in and lessons learned during the implementation of the 1-3-7 strategy were identified according to: case reporting within 1 day, case investigation within 3 days, focus investigation within 7 days, and the overall strategy. The major challenges outlined were related to respecting the timeline of surveillance procedures, the absence of or difficulties in following guidelines on conducting focus investigations, diagnostics, and the increasing number of returning migrant workers from malaria-endemic countries. Important lessons learned revolve around the importance of continuous capacity building, supervision and motivation, quality control, information technology support, applied research, governmental commitment, and intersectoral collaboration. Surveillance is a key intervention in malaria elimination programs. The Chinese 1-3-7 strategy has already proven to be successful but still needs to be improved. In particular, dealing appropriately with imported malaria cases through the screening of migrant workers from malaria-endemic countries is essential for achieving and sustaining malaria elimination in China. China has perfect preconditions for successful malaria elimination provided political commitment and financial investment are guaranteed. The 1-3-7 strategy may also be considered as a model for other countries.