The very fact that providing a greater number of

The very fact that providing a greater number of doses of IPTp-SP is incrementally effective, even in settings where the parasite is sensitive, also highlights the potential benefit of interventions using more effective drugs. This finding means there is either scope to improve clearance of existing infections or, if the gain from more IPTp-SP courses is due to longer prophylaxis, a longer-acting drug might achieve similar benefits with fewer administrations. Data were also insufficient for Fernandes and colleagues to extend their analysis to areas of low or unstable transmission, a situation that will hopefully become more common as malaria control progresses across Africa. In such situations, symptomatic disease during pregnancy is likely to cause an increased proportion of the overall burden, and understanding how malaria-attributable risk of low birthweight and immunity to both placental infection and symptomatic disease change as transmission falls will become an increasingly important issue. Any alternative strategy to IPTp-SP is likely to have its own challenges: concerns remain about providing ACTs during pregnancy to uninfected women; testing using RDTs is likely to be more costly, might miss some infections, and means that uninfected women do not benefit from prophylaxis; and switching to case management of symptomatic women leaves many asymptomatic women unprotected from prolonged placental infection. The analysis by Fernandes and colleagues is a clear benchmark by which to judge these various merits and limitations and thus is an important step towards ensuring a much higher proportion of women receive adequate care for malaria in pregnancy.
Documenting the health-related harms associated with human trafficking is crucial for the development of strategies to protect and promote the health of individuals who experience this serious human rights violation. In , Ligia Kiss and colleagues report the results of a study of 1102 men, women, and children receiving post-trafficking services in Cambodia, Thailand, and Vietnam—the largest quantitative study of its kind. They document the health-related harms experienced by men, women, and children trafficked for sex work (32%), fishing (27%), and factory work (13%). Countering dominant portrayals of trafficked people as mainly women and girls trafficked for sexual labour, this study shows the at least of trafficked people (eg, both sexes, and adults and children) and that trafficking occurs across many sectors. Kiss and colleagues’ findings begin to address a gap in research pertaining to health outcomes associated with sex trafficking (ie, trafficking for sexual labour), as well as trafficking into other sectors (eg, fishing, manufacturing). Both contributions are important for informing interventions to protect and promote the health and wellbeing of trafficked people. Most research on the health of trafficked people has focused on trafficking for sexual labour, which has often been conflated with sex work (ie, the consensual sale or exchange of sexual services between adults adult), and the idea of migrant labour. The UN Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, defines human trafficking as involving actions by a third party (eg, recruitment, transportation); use of force, deception, or other fraudulent means; and purposes of exploitation (eg, forced labour). The conflation of sex trafficking and sex work on an ideological and political basis has historically fuelled repressive policies that have undermined efforts to advance the health and human rights of sex workers. For example, the clause requiring recipients of funding from the 2003 US President\'s Emergency Plan for AIDS Relief to explicitly oppose sex work, its legalisation, and sex trafficking (the so-called antiprostitution pledge) was instrumental in shaping international and bilateral policies that conflated sex work and trafficking over the past decade. As a result of such conflation, many countries—including Thailand, Cambodia, and Vietnam—implemented punitive measures targeting the sex industry, including laws criminalising aspects of sex work, and accompanying police crackdowns, raids, and rescue operations. Such enforcement-based measures contribute to unintended harms that exacerbate health inequities and human rights violations—for example, by displacing sex workers to isolated, unsafe work environments; undermining their access to health care; and increasing their vulnerability to police abuses. Although the clause was revoked in 2013, its legacy continues to warrant scrutiny to ensure that anti-trafficking efforts target those who commit trafficking, rather than consenting adults in the sex industry. About 40% of the women, men, and children participating in Kiss and colleagues’ study were trafficked for forced labour in fishing or factories. Conflation of trafficking with sex work risks overlooking opportunities to address the health and social needs of capsid diverse population.