***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Malaria transmission is highly heterogeneous , generating malaria hotspots that can fuel malaria transmission across a wider area . Targeting hotspots may represent an efficacious strategy for reducing malaria transmission . We determined the impact of interventions targeted to serologically defined malaria hotspots on malaria transmission both inside hotspots and in surrounding communities . Methods and Findings Twenty-seven serologically defined malaria hotspots were detected in a survey conducted from 24 June to 31 July 2011 that included 17,503 individuals from 3,213 compounds in a 100-km2 area in Rachuonyo South District , Kenya . In a cluster-r and omized trial from 22 March to 15 April 2012 , we r and omly allocated five clusters to hotspot-targeted interventions with larviciding , distribution of long-lasting insecticide-treated nets , indoor residual spraying , and focal mass drug administration ( 2,082 individuals in 432 compounds ) ; five control clusters received malaria control following Kenyan national policy ( 2,468 individuals in 512 compounds ) . Our primary outcome measure was parasite prevalence in evaluation zones up to 500 m outside hotspots , determined by nested PCR ( nPCR ) at baseline and 8 wk ( 16 June–6 July 2012 ) and 16 wk ( 21 August–10 September 2012 ) post-intervention by technicians blinded to the intervention arm . Secondary outcome measures were parasite prevalence inside hotpots , parasite prevalence in the evaluation zone as a function of distance from the hotspot boundary , Anopheles mosquito density , mosquito breeding site productivity , malaria incidence by passive case detection , and the safety and acceptability of the interventions . Intervention coverage exceeded 87 % for all interventions . Hotspot-targeted interventions did not result in a change in nPCR parasite prevalence outside hotspot boundaries ( p ≥ 0.187 ) . We observed an average reduction in nPCR parasite prevalence of 10.2 % ( 95 % CI −1.3 to 21.7 % ) inside hotspots 8 wk post-intervention that was statistically significant after adjustment for covariates ( p = 0.024 ) , but not 16 wk post-intervention ( p = 0.265 ) . We observed no statistically significant trend in the effect of the intervention on nPCR parasite prevalence in the evaluation zone in relation to distance from the hotspot boundary 8 wk ( p = 0.27 ) or 16 wk post-intervention ( p = 0.75 ) . Thirty-six patients with clinical malaria confirmed by rapid diagnostic test could be located to intervention or control clusters , with no apparent difference between the study arms . In intervention clusters we caught an average of 1.14 female anophelines inside hotspots and 0.47 in evaluation zones ; in control clusters we caught an average of 0.90 female anophelines inside hotspots and 0.50 in evaluation zones , with no apparent difference between study arms . Our trial was not powered to detect subtle effects of hotspot-targeted interventions nor design ed to detect effects of interventions over multiple transmission seasons . Conclusions Despite high coverage , the impact of interventions targeting malaria vectors and human infections on nPCR parasite prevalence was modest , transient , and restricted to the targeted hotspot areas . Our findings suggest that transmission may not primarily occur from hotspots to the surrounding areas and that areas with highly heterogeneous but widespread malaria transmission may currently benefit most from an untargeted community-wide approach . Hotspot-targeted approaches may have more validity in setting s where human settlement is more nuclear . Trial registration Clinical Trials.gov Objective We evaluate the effect of clinic-based support by HIV-positive Peer Mentors , in addition to st and ard clinic care , on  maternal and infant well-being among Women Living with HIV ( WLH ) from pregnancy through the infant 's first year of life . Methods In a cluster r and omized controlled trial in KwaZulu-Natal , South Africa , eight clinics were r and omized for pregnant WLH to receive either : a St and ard Care condition ( SC ; 4 clinics ; n = 656 WLH ) ; or an Enhanced Intervention ( EI ; 4 clinics ; n = 544 WLH ) . WLH in the EI were invited to attend four antenatal and four postnatal meetings led by HIV-positive Peer Mentors , in addition to SC . WLH were recruited during pregnancy , and at least two post-birth assessment interviews were completed by 57 % of WLH at 1.5 , 6 or 12 months . EI 's effect was ascertained on 19 measures of maternal and infant well-being using r and om effects regressions to control for clinic clustering . A binomial test for correlated outcomes evaluated EI 's overall efficacy . Findings WLH attended an average of 4.1 sessions ( SD = 2.0 ) ; 13 % did not attend any sessions . Significant overall benefits were found in EI compared to SC using the binomial test . Secondarily , over time , WLH in the EI reported significantly fewer depressive symptoms and fewer underweight infants than WLH in the SC condition . EI WLH were significantly more likely to use one feeding method for six months and exclusively breastfeed their infants for at least 6 months . Conclusions WLH benefit by support from HIV-positive Peer Mentors , even though EI participation was partial , with incomplete follow-up rates from 6–12 months . Trial Registration Clinical Trials.gov David Osrin and colleagues report findings from a cluster-r and omized trial conducted in Mumbai slums ; the trial aim ed to evaluate whether  facilitator-supported women 's groups  could improve perinatal outcomes OBJECTIVE To evaluate the effectiveness of Sprinkles alongside infant and young child feeding ( IYCF ) education compared with IYCF education alone on anemia , deficiencies in iron , vitamin A , and zinc , and growth  in Cambodian infants . DESIGN Cluster-r and omized effectiveness study . SETTING Cambodian rural health district . PARTICIPANTS Among 3112 infants aged 6 months , a r and om sub sample ( n = 1350 ) was surveyed at baseline and 6-month intervals to age 24 months . INTERVENTION Daily micronutrient Sprinkles alongside IYCF education vs IYCF education alone for 6 months from ages 6 to 11 months . MAIN OUTCOME MEASURES Prevalence of anemia ; iron , vitamin A , and zinc deficiencies ; and growth via biomarkers and anthropometry . RESULTS Anemia prevalence ( hemoglobin level < 11.0 g/dL [ to convert to grams per liter , multiply by 10.0 ] ) was reduced in the intervention arm compared with the control arm by 20.6 % at 12 months ( 95 % CI , 9.4 - 30.2 ; P = .001 ) , and the prevalence of moderate anemia ( hemoglobin level < 10.0 g/dL ) was reduced by 27.1 % ( 95 % CI , 21.0 - 31.8 ; P < .001 ) . At 12 and 18 months , iron deficiency prevalence was reduced by 23.5 % ( 95 % CI , 15.6 - 29.1 ; P < .001 ) and 11.6 % ( 95 % CI , 2.6 - 17.9 ; P = .02 ) , respectively . The mean serum zinc concentration was increased at 12 months ( 2.88 μg/dL [ to convert to micromoles per liter , multiply by 0.153 ] ; 95 % CI , 0.26 - 5.42 ; P = .03 ) . There was no statistically significant difference in the prevalence of zinc and vitamin A deficiencies or in growth at any time . CONCLUSIONS Sprinkles reduced anemia and iron deficiency and increased the  mean serum zinc concentration in Cambodian infants . Anemia and zinc effects did not persist beyond the intervention period . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12608000069358 Objective To evaluate the efficacy of the program Keep Moving toward Healthy Heart and Healthy Brain ( KM2H2 ) in encouraging physical activities for the prevention of heart attack and stroke among hypertensive patients enrolled in the Community-Based Hypertension Control Program ( CBHCP ) . Design Cluster r and omized controlled trial with three waves of longitudinal assessment s at baseline , 3 and 6 months post intervention . Setting Community-based and patient-centered self-care for behavioral intervention in urban setting s of China . Participants A total of 450 participants diagnosed with hypertension from 12 community health centers in Wuhan , China were recruited , and were r and omly assigned by center to receive either  KM2H2 plus st and ard CBHCP care  ( 6 centers and 232 patients ) or the st and ard care only ( 6 centers and 218 patients ) . Intervention KM2H2 is a behavioral intervention guided by the Transtheoretical Model , the Model of Personalized Medicine and Social Capital Theory . It consists of six intervention sessions and two booster sessions engineered in a progressive manner . The purpose is to motivate and maintain physical activities for the prevention of heart attack and stroke . Outcome Measures Heart attack and stroke ( clinical ly diagnosed , primary outcome ) , blood pressure ( measured , secondary outcome ) , and physical activity ( self-report , tertiary outcome ) were assessed at the individual level during the baseline , 3- and 6-month post-intervention . Results Relative to the st and ard care , receiving KM2H2 was associated with significant reductions in the incidence of heart attack ( 3.60 % vs. 7.03 % , p < .05 ) and stroke ( 5.11 % vs. 9.90 % , p<0.05 ) , and moderate reduction in blood pressure ( -3.72mmHg in DBP and -2.92 mmHg in DBP ) at 6-month post-intervention ; and significant increases in physical activity at 3- ( d = 0.53 , 95 % CI : 0.21 , 0.85 ) and 6-month ( d = 0.45 , 95 % CI : 0.04 , 0.85 ) post-intervention , respectively . Conclusion The program KM2H2 is efficacious to reduce the risk of heart attack and stroke among senior patients who are on anti-hypertensive medication . Findings of this study provide solid data supporting a formal phase-III trial to establish the effectiveness of KM2H2 for use in community setting s for prevention . Trial Registration IS RCT N Register IS RCT Objective To test whether community mobilization adds effectiveness to conventional dengue control . Design Pragmatic open label parallel group cluster r and omized controlled trial . Those assessing the outcomes and analyzing the data were blinded to group assignment . Central ized computerized r and omization after the baseline study allocated half the sites to intervention , stratified by country , evidence of recent dengue virus infection in children aged 3 - 9 , and vector indices . Setting R and om sample of communities in Managua , capital of Nicaragua , and three coastal regions in Guerrero State in the south of Mexico . Participants Residents in a r and om sample of census enumeration areas across both countries : 75 intervention and 75 control clusters ( about 140 households each ) were r and omized and analyzed ( 60 clusters in Nicaragua and 90 in Mexico ) , including 85 182 residents in 18 838 households . Interventions A community mobilization protocol began with community discussion of baseline results . Each intervention cluster adapted the basic intervention — chemical-free prevention of mosquito reproduction — to its own circumstances . All clusters continued the government run dengue control program . Main outcome measures Primary outcomes per protocol were self reported cases of dengue , serological evidence of recent dengue virus infection , and conventional entomological indices ( house index : households with larvae or pupae/households examined ; container index : containers with larvae or pupae/containers examined ; Breteau index : containers with larvae or pupae/households examined ; and pupae per person : pupae found/number of residents ) . Per protocol secondary analysis examined the effect of Camino Verde in the context of temephos use . Results With cluster as the unit of analysis , serological evidence from intervention sites showed a lower risk of infection with dengue virus in children ( relative risk reduction 29.5 % , 95 % confidence interval 3.8 % to 55.3 % ) , fewer reports of dengue illness ( 24.7 % , 1.8 % to 51.2 % ) , fewer houses with larvae or pupae among houses visited ( house index ) ( 44.1 % , 13.6 % to 74.7 % ) , fewer containers with larvae or pupae among containers examined ( container index ) ( 36.7 % , 24.5 % to 44.8 % ) , fewer containers with larvae or pupae among houses visited ( Breteau index ) ( 35.1 % , 16.7 % to 55.5 % ) , and fewer pupae per person ( 51.7 % , 36.2 % to 76.1 % ) . The numbers needed to treat were 30 ( 95 % confidence interval 20 to 59 ) for a lower risk of infection in children , 71 ( 48 to 143 ) for fewer reports of dengue illness , 17 ( 14 to 20 ) for the house index , 37 ( 35 to 67 ) for the container index , 10 ( 6 to 2 
    Output:
    
Conclusions IF assessment is not currently a systematic practice in CRTs of public health interventions carried out in LMICs .