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Bayode T, Siegmund A. Identifying childhood malaria hotspots and risk factors in a Nigerian city using geostatistical modelling approach. Sci Rep 2024; 14:5445. [PMID: 38443428 PMCID: PMC10914794 DOI: 10.1038/s41598-024-55003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
Malaria ranks high among prevalent and ravaging infectious diseases in sub-Saharan Africa (SSA). The negative impacts, disease burden, and risk are higher among children and pregnant women as part of the most vulnerable groups to malaria in Nigeria. However, the burden of malaria is not even in space and time. This study explores the spatial variability of malaria prevalence among children under five years (U5) in medium-sized rapidly growing city of Akure, Nigeria using model-based geostatistical modeling (MBG) technique to predict U5 malaria burden at a 100 × 100 m grid, while the parameter estimation was done using Monte Carlo maximum likelihood method. The non-spatial logistic regression model shows that U5 malaria prevalence is significantly influenced by the usage of insecticide-treated nets-ITNs, window protection, and water source. Furthermore, the MBG model shows predicted U5 malaria prevalence in Akure is greater than 35% at certain locations while we were able to ascertain places with U5 prevalence > 10% (i.e. hotspots) using exceedance probability modelling which is a vital tool for policy development. The map provides place-based evidence on the spatial variation of U5 malaria in Akure, and direction on where intensified interventions are crucial for the reduction of U5 malaria burden and improvement of urban health in Akure, Nigeria.
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Affiliation(s)
- Taye Bayode
- Institute of Geography & Heidelberg Centre for Environment (HCE), Heidelberg University, Heidelberg, Germany.
- Department of Geography-Research Group for Earth Observation (rgeo), UNESCO Chair on World Heritage and Biosphere Reserve Observation and Education, Heidelberg University of Education, Heidelberg, Germany.
| | - Alexander Siegmund
- Institute of Geography & Heidelberg Centre for Environment (HCE), Heidelberg University, Heidelberg, Germany
- Department of Geography-Research Group for Earth Observation (rgeo), UNESCO Chair on World Heritage and Biosphere Reserve Observation and Education, Heidelberg University of Education, Heidelberg, Germany
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van Loon W, Schallenberg E, Igiraneza C, Habarugira F, Mbarushimana D, Nshimiyimana F, Ngarambe C, Ntihumbya JB, Ndoli JM, Mockenhaupt FP. Escalating Plasmodium falciparum K13 marker prevalence indicative of artemisinin resistance in southern Rwanda. Antimicrob Agents Chemother 2024; 68:e0129923. [PMID: 38092677 PMCID: PMC10869333 DOI: 10.1128/aac.01299-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/10/2023] [Indexed: 12/20/2023] Open
Abstract
In 2023, we updated data collected since 2010 on Plasmodium falciparum K13 and MDR1 drug resistance markers in Huye district, southern Rwanda. Artemisinin resistance-associated PfK13 markers occurred in 17.5% of 212 malaria patients (561H, 9.0%; 675V, 5.7%; and 469F, 2.8%), nearly double the frequency from 2019. PfMDR1 N86, linked with lumefantrine tolerance, was close to fixation at 98%. In southern Rwanda, markers signaling resistance to artemisinin and lumefantrine are increasing, albeit at a relatively slow rate.
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Affiliation(s)
- Welmoed van Loon
- Charité Center for Global Health, Institute of International Health, Charité—Universitaetsmedizin Berlin, Berlin, Germany
| | - Emma Schallenberg
- Charité Center for Global Health, Institute of International Health, Charité—Universitaetsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | | | | - Frank P. Mockenhaupt
- Charité Center for Global Health, Institute of International Health, Charité—Universitaetsmedizin Berlin, Berlin, Germany
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Kibondo UA, Renju J, Lukole E, Mosha JF, Mosha FW, Manjurano A, Rowland M, Protopopoff N. Factors associated with malaria infection among children after distribution of PBO-pyrethroid synergist-treated nets and indoor residual spraying in north-western Tanzania. PLoS One 2023; 18:e0295800. [PMID: 38127909 PMCID: PMC10734997 DOI: 10.1371/journal.pone.0295800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND After a decade of successful control, malaria is on the rise again. The prevalence of malaria in Tanzania has increased from 7% in 2017 to 8% in 2022 and reached 18% in Kagera region in the North West of Tanzania. Malaria vectors in Muleba district Kagera have high level of pyrethroid resistance. The aim of this paper is to explore factors associated with malaria infection prevalence in children aged 6 months to 14 years in Muleba, where Long Lasting Insecticidal Net (LLIN) combining a pyrethroid insecticide and synergist piperonyl butoxide (PBO) that counteract resistance in the mosquitoes, was first distributed under trial conditions in 2015. METHODS The trial was a community randomized control in which there were two malaria prevalence cross-sectional household surveys each year (June and December) from 2015 to 2017 in Muleba. In this study we conducted a secondary data analysis of the December surveys only. Multilevel Poisson regression analysis was used to assess factors associated with malaria infection. RESULTS A total of 10,941 children and 4,611 households were included in this study. Overall malaria prevalence was 35.8%, 53.3% and 54.4% in the year 2015, 2016 and 2017 respectively. Living in an area with standard LLIN as opposed to the novel PBO synergist LLIN, being a male child, above 5 years of age, living in a house with open eaves, living in house without IRS, having head of household with no formal education, lower socioeconomic status and survey year were associated with increased risk of malaria infection. CONCLUSIONS Using PBO LLIN reduced the risk of malaria infection. However, additional measures could further reduce malaria infection in areas of insecticide resistance such as housing improvement.
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Affiliation(s)
- Ummi Abdul Kibondo
- Vector Control Product Testing Unit (VCPTU) Ifakara Health Institute, Environmental Health, and Ecological Sciences, Bagamoyo, Tanzania
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Jenny Renju
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eliud Lukole
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jacklin F. Mosha
- National Institute for Medical Research, Mwanza Medical Research Centre, Mwanza, Tanzania
| | | | - Alphaxard Manjurano
- National Institute for Medical Research, Mwanza Medical Research Centre, Mwanza, Tanzania
| | - Mark Rowland
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
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Arikawa S, Tchankoni MK, Gbeasor-Komlanvi FA, Atekpe SP, Atcha-Oubou T, Figueroa-Romero A, Fombah AE, Saute F, Samai M, Menendez C, Gonzalez R, Briand V, Ekouevi DK. Prevalence and risk factors associated with malaria infection in children under two years of age in southern Togo prior to perennial malaria chemoprevention implementation. Malar J 2023; 22:357. [PMID: 37990324 PMCID: PMC10664264 DOI: 10.1186/s12936-023-04793-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Malaria remains the leading cause of mortality and morbidity in young children in sub-Saharan Africa. To prevent malaria in children living in moderate-to-high malaria transmission areas, the World Health Organization has recommended perennial malaria chemoprevention (PMC). Prior to piloting PMC implementation in southern Togo, a household survey was conducted to estimate malaria infection prevalence in children under 2 years of age (U2). METHODS A cross-sectional community-based household survey was conducted in the Haho district in the Togo Plateaux region. A three-stage random sampling method was used to select study participants aged 10-23 months whose caretakers gave informed consent. The prevalence of Plasmodium infection, defined as a positive rapid diagnostic test (RDT), was estimated with 95% confidence interval (CI). Clinical malaria was defined as having a positive RDT plus fever (≥ 37.5 °C) or history of fever in the last 24 h. Mixed-effects logistic regression models were used to assess the child's, caretaker's, and household's factors associated with malaria infection. RESULTS A total of 685 children were included in the survey conducted January-February in 2022 (dry season). Median age was 17 months (interquartile range: 13-21). About 80% of the children slept under a bed net the night before the interview. Malaria infection prevalence was 32.1% (95% CI 27.7-37.0) with significant area variation (cluster range: 0.0-73.3). Prevalence of clinical malaria was 15.4% (95% CI 12.2-19.2). Children whose caretakers were animist (aOR: 1.71, 95% CI 1.19-2.46) and those living in mother-headed households (aOR: 2.39, 95% CI 1.43-3.99) were more likely to have a positive RDT. Living more than 5 km away from the nearest health facility (aOR: 1.60, 95% CI 1.04-2.44) and presence of two or more under-5-years children in the household (aOR: 1.44, 95% CI 1.01-2.07) were also associated with increased risk of infection. CONCLUSION One-third of the children U2 who participated in this survey had malaria infection, thus PMC could be a promising strategy to reduce malaria burden in young children in Plateaux region. Reinforcement of outreach services and targeting the poorest households should be prioritized to reduce the inequity in malaria prevention in children exposed to the infection.
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Affiliation(s)
- Shino Arikawa
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France.
| | - Martin Kouame Tchankoni
- Département de Santé Publique, Université de Lomé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Fifonsi A Gbeasor-Komlanvi
- Département de Santé Publique, Université de Lomé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Somiabalo P Atekpe
- Ministère de la Santé, de l'Hygiène Publique et de l'Accès Universel Aux Soins (MSHPAUS), District Sanitaire du Haho, Notsé, Togo
| | - Tinah Atcha-Oubou
- Ministère de la Santé, de l'Hygiène Publique et de l'Accès Universel aux Soins (MSHPAUS) Programme National de Lutte contre le Paludisme (PNLP), Lomé, Togo
| | - Antía Figueroa-Romero
- Barcelona Institute for Global Health, Hospital Clinic‑University of Barcelona, Barcelona, Spain
| | - Augustin E Fombah
- Barcelona Institute for Global Health, Hospital Clinic‑University of Barcelona, Barcelona, Spain
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Directorate of Research and Training, Ministry of Health, Freetown, Sierra Leone
| | - Clara Menendez
- Barcelona Institute for Global Health, Hospital Clinic‑University of Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
| | - Raquel Gonzalez
- Barcelona Institute for Global Health, Hospital Clinic‑University of Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
| | - Valérie Briand
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
- Epicentre, Paris, France
| | - Didier K Ekouevi
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
- Département de Santé Publique, Université de Lomé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
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Sarfo JO, Amoadu M, Kordorwu PY, Adams AK, Gyan TB, Osman AG, Asiedu I, Ansah EW. Malaria amongst children under five in sub-Saharan Africa: a scoping review of prevalence, risk factors and preventive interventions. Eur J Med Res 2023; 28:80. [PMID: 36800986 PMCID: PMC9936673 DOI: 10.1186/s40001-023-01046-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Africa has a higher burden of malaria-related cases and deaths globally. Children under five accounted for over two-thirds of all malaria deaths in sub-Saharan Africa (SSA). This scoping review aims to map evidence of the prevalence, contextual factors and health education interventions of malaria amongst children under 5 years (UN5) in SSA. METHOD Four main databases (PubMed, Central, Dimensions and JSTOR) produced 27,841 records of literature. Additional searches in Google, Google Scholar and institutional repositories produced 37 records. Finally, 255 full-text records were further screened, and 100 records were used for this review. RESULTS Low or no formal education, poverty or low income and rural areas are risk factors for malaria amongst UN5. Evidence on age and malnutrition as risk factors for malaria in UN5 is inconsistent and inconclusive. Furthermore, the poor housing system in SSA and the unavailability of electricity in rural areas and unclean water make UN5 more susceptible to malaria. Health education and promotion interventions have significantly reduced the malaria burden on UN5 in SSA. CONCLUSION Well-planned and resourced health education and promotion interventions that focus on prevention, testing and treatment of malaria could reduce malaria burden amongst UN5 in SSA.
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Affiliation(s)
- Jacob Owusu Sarfo
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | | | - Peace Yaa Kordorwu
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | - Abdul Karim Adams
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | | | - Abdul-Ganiyu Osman
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | - Immanuel Asiedu
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
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Aliyo A, Golicha W, Fikrie A. Pastoral Community Malaria Prevention Practice and Associated Factors Among Households in Three Districts of the Borena Zone, Southern Ethiopia. Health Serv Res Manag Epidemiol 2023; 10:23333928221144555. [PMID: 36654730 PMCID: PMC9841874 DOI: 10.1177/23333928221144555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 01/15/2023] Open
Abstract
Background Malaria infection remains one of the major global and national public health threats, affecting millions of people yearly by causing substantial morbidity and mortality. In developing countries, higher proportions of poor malaria prevention and control measure both regionally and nationally, particularly in pastoral community areas of southern Ethiopia. Objective The study aimed to assess malaria preventive practices and associated factors among households of pastoral communities in Borena zone, Oromia regional state, Southern Ethiopia, 2022. Methodology A community-based cross-sectional study design was used from March first to 30, 2022, among 421 selected simple random sampling households in pastoral communities of the Borena zone. Data were collected through face-to-face interviews with a structured pretested questionnaire and visual observation for household malaria prevention practices. Then, the data were analyzed using SPSS version 25. Bivariate and multivariable logistic regression analyses were used to identify factors associated with malaria preventive practices. Finally, adjusted odd ratio (AOR) together with 95% confidence intervals was used, and a P value of less than 0.05 indicated an overall statistical association. Result The overall malaria prevention rate among pastoral community households was 31.6%(133) [95%; CI = 27.2-36.4]. The factors significantly associated with malaria prevention practice were malaria prevention knowledge [AOR = 1.6, 95% CI = 1.1-2.5] and the absence of plasmodium parasites among children [AOR = 4.3, 95% CI = 2.8-8.7]. However, households staying outdoors at night [AOR = 0.5, 95% CI = 0.3-1.0] were negatively associated with household malaria prevention. A total of 200 (47.5%) households had used insecticide-treated mosquito nets (ITN) and 5(1.2%) households had indoor residual sprays (IRS). Conclusion The study revealed lower malaria prevention practices among households of the pastoral community. The government and other concerned bodies should contribute to malaria prevention measures in pastoral remote areas. Health extension workers should have to create awareness in the communities to avoid incorrect use of the ITN.
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Affiliation(s)
- Alqeer Aliyo
- Medical Laboratory Science Department, Institute of Health, Bule Hora University, Bule Hora, Ethiopia,Alqeer Aliyo, Medical Laboratory Science Department, Institute of Health, Bule Hora University, Bule Hora, Ethiopia.
| | - Wako Golicha
- School of Public Health, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
| | - Anteneh Fikrie
- School of Public Health, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
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Al-Quhaiti MAA, Abdul-Ghani R, Mahdy MAK, Assada MA. Malaria among under-five children in rural communities of Al-Mahweet governorate, Yemen. Malar J 2022; 21:344. [PMID: 36401272 PMCID: PMC9675118 DOI: 10.1186/s12936-022-04371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background Malaria burden among under-five children living in endemic areas of Yemen is largely unknown due to the lack of community-based studies. Therefore, this study determined the prevalence and risk factors associated with falciparum malaria among under-five children in rural communities of Al-Mahweet governorate, Yemen. Methods This community-based, cross-sectional study recruited 400 under-five children from two rural districts of Al-Mahweet governorate in December 2019. Demographic characteristics (gender, age, education and occupation of the child’s parents, and household size) and risk factors associated with malaria were collected through interviews with children’s caregivers using a structured questionnaire. Finger-prick blood was screened for Plasmodium falciparum and non-falciparum species using rapid diagnostic tests (RDTs), and duplicate Giemsa-stained thick and thin blood films were examined for malaria parasites. The density of asexual P. falciparum stages was also estimated. Data were then analysed, and the agreement between the results of thick-film microscopy and RDTs for diagnosing falciparum malaria was assessed using the kappa index. Statistical significance was set at a P-value of < 0.05. Results Plasmodium falciparum was prevalent among 9.8% (95% CI 7.0–13.1) of under-five children in the rural communities of Al-Mahweet, with a median asexual parasite density of 763 ± 2606 parasites/μl of blood (range: 132–4280) and low-to-moderate parasitaemia levels. Approximately one-third of microscopy-confirmed cases were gametocyte carriers. Multivariable logistic regression analysis confirmed that age of three years or older (AOR = 5.6, 95% CI 1.6–19.8; P = 0.007), not sleeping under a mosquito net the previous night of the survey (AOR = 8.0, 95% CI 2.4–27.4; P = 0.001), sleeping outdoors at night (AOR = 4.4, 95% CI 2.0–10.0; P < 0.001), and absence of indoor residual spraying (IRS) during the last year (AOR = 4.2, 95% CI 1.9–9.4; P < 0.001) were the independent predictors of falciparum malaria among under-five children in the rural communities of Al-Mahweet. The observed percentage agreement between thick-film microscopy and RDTs was 98.5%, with a very good agreement (k-index = 0.9) between the two methods for falciparum malaria diagnosis that was statistically significant. Conclusion Approximately one in ten under-five children in rural communities of Al-Mahweet is infected with P. falciparum based on microscopy and RDTs. Age of three years or older, not sleeping under mosquito nets, sleeping outdoors at night and absence of IRS can independently predict falciparum malaria among them. The very good agreement between thick-film microscopy and RDTs for diagnosing falciparum malaria in children supports the usefulness of using RDTs in such resource-limited rural communities.
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Ujuju CN, Okoronkwo C, Okoko OO, Akerele A, Okorie CN, Adebayo SB. Use of insecticide treated nets in children under five and children of school age in Nigeria: Evidence from a secondary data analysis of demographic health survey. PLoS One 2022; 17:e0274160. [PMID: 36174025 PMCID: PMC9521839 DOI: 10.1371/journal.pone.0274160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background and objective Use of insecticide treated nets (ITN), one of the most cost-effective malaria interventions contributes to malaria cases averted and reduction in child mortality. We explored the use of ITN in children under five (CU5) and children of school age to understand factors contributing to ITN use. Methods A cross-sectional study analyzed 2018 Nigeria Demographic and Health Survey data. The outcome variable was CU5 or children of school age who slept under ITN the night before the survey. Independent variables include child sex, head of household’s sex, place of residence, state, household owning radio and television, number of household members, wealth quintile, years since ITN was obtained and level of malaria endemicity. Multi-level logistic regression model was used to access factors associated with ITN use among children. Results In total, 32,087 CU5 and 54,692 children of school age were examined with 74.3% of CU5 and 57.8% of children of school age using ITN the night before the survey. While seven states had more than 80% of CU5 who used ITN, only one state had over 80% of school children who used ITN. ITN use in CU5 is associated with living in rural area (aOR = 1.20, 95% CI 1.14 to 1.26) and residing in meso endemic area (aOR = 3.1, 95% CI 2.89 to 3.54). While In children of school age, use of ITN was associated with female headed households (aOR = 1.14, 95% CI 1.09 to 1.19), meso (aOR = 3.17, 95% CI 2.89 to 3.47) and hyper (aOR = 14.9, 95% CI 12.99 to 17.07) endemic areas. Children residing in larger households were less likely to use ITN. Conclusions This study demonstrated increased use of ITN in CU5 from poor households and children living in rural and malaria endemic areas. Findings provide some policy recommendations for increasing ITN use in school children.
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Affiliation(s)
| | - Chukwu Okoronkwo
- National Malaria Elimination Programme (NMEP), Federal Ministry of Health, Abuja, Nigeria
| | - Okefu Oyale Okoko
- National Malaria Elimination Programme (NMEP), Federal Ministry of Health, Abuja, Nigeria
| | - Adekunle Akerele
- Department of Medical Statistics and Epidemiology, University of Ibadan, Ibadan, Nigeria
| | - Chibundo N. Okorie
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Enugu, Nigeria
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Carrasco-Escobar G, Matta-Chuquisapon J, Manrique E, Ruiz-Cabrejos J, Barboza JL, Wong D, Henostroza G, Llanos-Cuentas A, Benmarhnia T. Quantifying the effect of human population mobility on malaria risk in the Peruvian Amazon. ROYAL SOCIETY OPEN SCIENCE 2022; 9:211611. [PMID: 35875474 PMCID: PMC9297009 DOI: 10.1098/rsos.211611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
The impact of human population movement (HPM) on the epidemiology of vector-borne diseases, such as malaria, has been described. However, there are limited data on the use of new technologies for the study of HPM in endemic areas with difficult access such as the Amazon. In this study conducted in rural Peruvian Amazon, we used self-reported travel surveys and GPS trackers coupled with a Bayesian spatial model to quantify the role of HPM on malaria risk. By using a densely sampled population cohort, this study highlighted the elevated malaria transmission in a riverine community of the Peruvian Amazon. We also found that the high connectivity between Amazon communities for reasons such as work, trading or family plausibly sustains such transmission levels. Finally, by using multiple human mobility metrics including GPS trackers, and adapted causal inference methods we identified for the first time the effect of human mobility patterns on malaria risk in rural Peruvian Amazon. This study provides evidence of the causal effect of HPM on malaria that may help to adapt current malaria control programmes in the Amazon.
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Affiliation(s)
- Gabriel Carrasco-Escobar
- Health Innovation Lab, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Jose Matta-Chuquisapon
- Health Innovation Lab, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Edgar Manrique
- Health Innovation Lab, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jorge Ruiz-Cabrejos
- Health Innovation Lab, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jose Luis Barboza
- Health Innovation Lab, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel Wong
- Health Innovation Lab, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Alejandro Llanos-Cuentas
- Instituto de Medicinal Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
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Geographical distribution of falciparum malaria in the world and its relationship with the human development index (HDI): countries based on the WHO report in 2017. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01336-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Stan MH, Singh MA, Doshi SP, Bartels SA. Malaria amongst febrile children: call for a pediatric malaria assessment tool. Pan Afr Med J 2021; 40:84. [PMID: 34909073 PMCID: PMC8607947 DOI: 10.11604/pamj.2021.40.84.21165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/19/2020] [Indexed: 11/11/2022] Open
Abstract
In 2017, malaria accounted for 435 000 deaths worldwide. Eleven percent (11%) of these deaths occurred in the Democratic Republic of Congo (DRC), where malaria continues to be a leading cause of morbidity and mortality. Children are amongst the most vulnerable to malaria, which causes 40% of childhood deaths in the country. Although many risk factors for developing malaria have been identified, there is a paucity of data available on the sociodemographic risk factors for pediatric malaria. A cross-sectional study including 131 febrile children aged 2 months to 14 years presenting to Heal Africa Hospital due to febrile illness. Guardians of participants answered a questionnaire about household and maternal characteristics, as well as child symptomatology. Malaria status was confirmed via blood smear. Results were analyzed using the chi-square test, likelihood ratios and a logistic regression. The absence of father as head of household (p=0.011) and gestational malaria (p=0.044) were significantly associated with pediatric malaria. This study provides insight into sociodemographic risk factors associated with pediatric malaria in the DRC. While further investigation is required, this study highlights the benefit of considering these factors when approaching the febrile child. A pediatric malaria assessment tool incorporating socio-demographics, symptoms and physical exam findings may guide investigations to reduce unnecessary testing and provide better patient-centred care.
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Affiliation(s)
- Mumbere Hangi Stan
- Department of Pediatrics, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | | | | | - Susan Andrea Bartels
- Departments of Emergency Medicine and Public Health Sciences, Queen´s University, Kingston, Canada
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Mwaiswelo RO, Mmbando BP, Chacky F, Molteni F, Mohamed A, Lazaro S, Mkalla SF, Samuel B, Ngasala B. Malaria infection and anemia status in under-five children from Southern Tanzania where seasonal malaria chemoprevention is being implemented. PLoS One 2021; 16:e0260785. [PMID: 34855878 PMCID: PMC8638878 DOI: 10.1371/journal.pone.0260785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Malaria and anemia remain major public health challenges in Tanzania. Household socioeconomic factors are known to influence these conditions. However, it is not clear how these factors influence malaria transmission and anemia in Masasi and Nanyumbu Districts. This study presents findings on malaria and anemia situation in under-five children and its influencing socioeconomic factors in Masasi and Nanyumbu Districts, surveyed as part of an ongoing seasonal malaria chemoprevention operational study. METHODS A community-based cross-sectional survey was conducted between August and September 2020. Finger-prick blood samples collected from children aged 3-59 months were used to test for malaria infection using malaria rapid diagnostic test (mRDT), thick smears for determination of asexual and sexual parasitemia, and thin smear for parasite speciation. Hemoglobin concentration was measured using a HemoCue spectrophotometer. A structured questionnaire was used to collect household socioeconomic information from parents/caregivers of screened children. The prevalence of malaria was the primary outcome. Chi-square tests, t-tests, and logistic regression models were used appropriately. RESULTS Overall mRDT-based malaria prevalence was 15.9% (373/2340), and was significantly higher in Nanyumbu (23.7% (167/705) than Masasi District (12.6% (206/1635), p<0.001. Location (Nanyumbu), no formal education, household number of people, household number of under-fives, not having a bed net, thatched roof, open/partially open eave, sand/soil floor, and low socioeconomic status were major risks for malaria infection. Some 53.9% (1196/2218) children had anemia, and the majority were in Nanyumbu (63.5% (458/705), p<0.001. Location (Nanyumbu), mRDT positive, not owning a bed net, not sleeping under bed net, open/partially open eave, thatched window, sex of the child, and age of the child were major risk factors for anemia. CONCLUSION Prevalence of malaria and anemia was high and was strongly associated with household socioeconomic factors. Improving household socioeconomic status is expected to reduce the prevalence of the conditions in the area.
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Affiliation(s)
- Richard O. Mwaiswelo
- Department of Microbiology, Immunology and Parasitology, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Bruno P. Mmbando
- Tanga Research Centre, National Institute for Medical Research, Tanga, Tanzania
| | - Frank Chacky
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Fabrizio Molteni
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Ally Mohamed
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Samwel Lazaro
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Sylvia F. Mkalla
- Directorate of Research, Coordination, and Promotion, Tanzania Commission for Science and Technology, Dar es Salaam, Tanzania
| | - Bushukatale Samuel
- Department of Medical Parasitology and Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Billy Ngasala
- Department of Medical Parasitology and Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Tsegaye AT, Ayele A, Birhanu S. Prevalence and associated factors of malaria in children under the age of five years in Wogera district, northwest Ethiopia: A cross-sectional study. PLoS One 2021; 16:e0257944. [PMID: 34634041 PMCID: PMC8504743 DOI: 10.1371/journal.pone.0257944] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Malaria is a major public health problem in sub-Saharan Africa, and children are especially vulnerable. In 2019, an estimated 409,000 people died of malaria, most (274,000) were young children and 94% of the cases and deaths were in Africa. Prior studies in Ethiopia focused on the adult population and high transmission areas. Hence, this study aimed to determine the prevalence and associated factors of malaria in children under five years in low transmission areas. Method A facility-based cross-sectional study was conducted among 585 under-five children who attended public health facilities in the Wogera district from September to October, 2017. Health facilities were selected by stratified cluster sampling, and systematic random sampling was held to select study participants from the selected facilities. Multivariable logistic regression was used to identify correlates of malaria. Result Of 585 children who provided blood samples, 51 (8.7%) had malaria. The predominant Plasmodium species were P. falciparum 33 (65%) and P. vivax 18 (35%). Regularly sleeping under long-lasting insecticide treated nets (LLIN) was associated with decreased odds of malaria (AOR = 0.08, 95% CI: 0.01–0.09), and an increased odds of malaria was observed among children who live in households with stagnant water in the compound (AOR = 6.7, 95% CI: 3.6–12.6) and children who stay outdoors during the night (AOR = 5.5, 95% CI: 2.7–11.1). Conclusion The prevalence of malaria in the study population was high. Environmental and behavioral factors related to LLIN use remain potential determinants of malaria. Continued public health interventions targeting proper utilization of bed nets, drainage of stagnant water, and improved public awareness about reducing the risk of insect bites have the potential to minimize the prevalence of malaria and improve the health of children.
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Affiliation(s)
- Adino Tesfahun Tsegaye
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Andualem Ayele
- Wogera District Health Office, North Gondar Zone, Gondar, Ethiopia
| | - Simon Birhanu
- School of Nursing and Midwifery, Haramaya University, Harar, Ethiopia
- * E-mail:
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Ndikumukiza C, Yunusa I, Nkurunziza J, Chinaeke E, Alshammari FH, Abahuje E, Alsahali S. Adoption of RTS, S malaria vaccine for children younger than 5 years in Rwanda: A budget impact analysis. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100063. [PMID: 35480603 PMCID: PMC9031682 DOI: 10.1016/j.rcsop.2021.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/07/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background In Rwanda, malaria affects one in six children under five years old. Despite being preventable and treatable, malaria causes substantial morbidity, mortality, and economic burden on the Rwandan government and healthcare donors. Recently, the World Health Organization (WHO) agreed to consider the new malaria vaccine (RTS, S) as an additional prevention strategy. The Global Fund, a healthcare donor, is committed to donating more than fifty million US dollars over four years (2018–2021) to fight malaria in Rwanda. We estimated the potential budget impact of the adoption of RTS, S, into the Global Fund budget (as a case study) for malaria prevention in Rwanda. Methods We developed a static budget impact model based on clinical, epidemiological, and cost (in US dollars) data from the literature, to assess the financial consequences of adding RTS, S to existing prevention strategies. Cost of treatment and prevention for the first year (without vaccine) was estimated and compared to the total cost after the fifth year (with vaccine). A one-way sensitivity analysis evaluated the robustness of the model. Results For the 283,931children under 5 years at risk of malaria in Rwanda every year, the expected budget for first year (without vaccine) was $1,328,377.71 and for the fifth year (with vaccine) was $3,837,804, yielding a potential budget impact of $2,509,427. The cost of treating un-prevented malaria for the first year was $736,959 and for the fifth year was $61,413. The annual number of malaria treatments avoided increased from 10,095 children in the first year after introduction of vaccine to 36,701 children at the fifth year. Conclusion With a potential budget impact of $2,509,427, the introduction of malaria vaccine for children under 5 years by Global Fund in Rwanda may be affordable when compared to the amount spent on treating children with malaria. Given that Malaria causes more harm than most parasitic diseases and disproportionally affects low-income populations, it is ethical to deploy all measures to control or eliminate Malaria, including vaccination.
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Awosolu OB, Yahaya ZS, Farah Haziqah MT. Prevalence, Parasite Density and Determinants of Falciparum Malaria Among Febrile Children in Some Peri-Urban Communities in Southwestern Nigeria: A Cross-Sectional Study. Infect Drug Resist 2021; 14:3219-3232. [PMID: 34434052 PMCID: PMC8380643 DOI: 10.2147/idr.s312519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Malaria remains a serious public health problem worldwide, particularly in tropical and subtropical regions, including Nigeria. This study investigates the prevalence, parasite density and determinants of malaria among symptomatic children in some peri-urban communities in southwestern Nigeria. Methods This was a randomized cross-sectional and hospital-based study. The standard method of microscopy was employed. Thick and thin films were prepared and viewed under a light microscope to identify and quantify malaria parasites. A well-structured and pre-tested questionnaire was used to obtain the subject’s information on the demographic, socio-economic and environmental variables. Results A total of 380 (71.7%) participants were infected with Plasmodium falciparum with a mean parasite density of 1857.11 parasite/µL of blood. Malaria prevalence and mean parasite density were significantly higher among male compared to their female counterparts [80.3% vs 61.4% and 2026.46 vs 1619.63 parasite/µL of blood]. Similarly, age group ≤5 years had the highest malaria prevalence (92.2%) and mean parasite density (2031.66 parasite/µL of blood) than other age groups (AOR 2.281, 95% CI: 1.187–4.384, P < 0.05). The multivariate logistic analysis showed that malaria disease is significantly associated with having mother with no formal education (AOR 12.235, 95% CI: 3.253–46.021, P < 0.05), having well and river as a major source of household water supply (AOR 13.810, 95% CI: 3.012–63.314, P < 0.05 vs AOR 5.639, 95% CI: 1.455–21.853, P < 0.05) and presence of stagnant water around home (AOR 5.22, 95% CI: 2.921–9.332, P < 0.05). Furthermore, protective factors observed include ownership of mosquito bed net (AOR 0.474, 95% CI: 0.223–1.008, P < 0.05) and distance of home to hospital (AOR 0.279, 95% CI: 0.158–0.493, P < 0.05). Conclusion Malaria remains a serious public health problem in the study area. Adopting integrated malaria control measures including educating parents on malaria prevention and control strategies, distributing mosquito bed nets, and establishing larvae source management program is highly imperative.
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Affiliation(s)
- Oluwaseun Bunmi Awosolu
- School of Biological Sciences, Universiti Sains Malaysia, Penang, 11800 USM, Malaysia.,Department of Biology, Federal University of Technology, Akure, Nigeria
| | - Zary Shariman Yahaya
- School of Biological Sciences, Universiti Sains Malaysia, Penang, 11800 USM, Malaysia
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Ferreira Vieira MVD, Vieira JLF. Exposure to chloroquine in male adults and children aged 9-11 years with malaria due to Plasmodium vivax. Trans R Soc Trop Med Hyg 2021; 115:38-42. [PMID: 32838422 DOI: 10.1093/trstmh/traa079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/21/2020] [Accepted: 08/06/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chloroquine is effective against the asexual blood stage of Plasmodium vivax. A high proportion of children are underdosed with the drug, but there are no studies comparing chloroquine exposure in adults and children aged 8-11 years old. The present study intends to compare these populations using the area under the curve (AUC) derived from the plasma concentration-time profile in patients with P. vivax. METHODS A prospective study of cases was performed on male children (aged 9-11 years) and adults with vivax malaria. Blood samples were collected after several days of treatment. Chloroquine was measured by high-performance liquid chromatography. A non-compartmental pharmacokinetic model was used to calculate the pharmacokinetic parameters of the drug. RESULTS A total of 20 children and 25 adults were included in the study. Plasma concentrations of chloroquine in older children ranged from 67 to 1112 ng/ml, and in adults the value ranged from 74 to 1147 ng/ml. The AUC to the last measurable concentration and to infinite was significantly lower in children than in adults, indicating a lower exposure to the drug. CONCLUSION These data demonstrate lower exposure to chloroquine in children, which corroborates the importance of optimising the doses of chloroquine in the study age band to ensure adequate exposure to the drug.
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The Prevalence of Malaria among Children in Ethiopia: A Systematic Review and Meta-Analysis. J Parasitol Res 2021; 2021:6697294. [PMID: 33936806 PMCID: PMC8060095 DOI: 10.1155/2021/6697294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/15/2021] [Accepted: 04/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background Malaria is one of the most public health important and life-threatening parasitic infections caused by the protozoan parasite. Since children are immunologically naive to the malaria parasite, they are the main vulnerable groups. During malaria infection, they might have a complication of anemia, cerebral malaria, coma, respiratory distress, and a decrease in cognitive and behavioral improvement. Therefore, this review was aimed at determining the pooled prevalence of malaria among children in Ethiopia. Methods The current systematic review and meta-analysis were conducted based on the guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline. Electronic bibliographic databases such as Google Scholar, PubMed, and Science Direct were used for searching relevant literature. Besides, the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. Using the STATA 14 software, the pooled Meta logistic regression was computed to present the pooled prevalence with a 95% confidence interval (CI). Result The overall estimated pooled prevalence of malaria among children in Ethiopia was 9.07 (95% CI: 6.32, 11.82). Subgroup analysis based on malaria signs and symptoms showed that the pooled prevalence of malaria among asymptomatic and symptomatic children was 6.67% (95% CI: 0.36, 12.98) and 27.17% (95% CI: 18.59, 35.76), respectively. Conclusion The findings revealed a high prevalence of malaria among children in Ethiopia. As a result, still there is a need of improving and rechecking the existing malaria prevention and control measures of the country.
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Nzabakiriraho JD, Gayawan E. Geostatistical modeling of malaria prevalence among under-five children in Rwanda. BMC Public Health 2021; 21:369. [PMID: 33596876 PMCID: PMC7890836 DOI: 10.1186/s12889-021-10305-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria has continued to be a life-threatening disease among under-five children in sub-Saharan Africa. Recent data indicate rising cases in Rwanda after some years of decline. We aimed at estimating the spatial variations in malaria prevalence at a continuous spatial scale and to quantify locations where the prevalence exceeds the thresholds of 5% and 10% across the country. We also consider the effects of some socioeconomic and climate variables. METHODS Using data from the 2014-2015 Rwanda Demographic and Health Survey, a geostatistical modeling technique based on stochastic partial differential equation approach was used to analyze the geospatial prevalence of malaria among under-five children in Rwanda. Bayesian inference was based on integrated nested Laplace approximation. RESULTS The results demonstrate the uneven spatial variation of malaria prevalence with some districts including Kayonza and Kirehe from Eastern province; Huye and Nyanza from Southern province; and Nyamasheke and Rusizi from Western province having higher chances of recording prevalence exceeding 5%. Malaria prevalence was found to increase with rising temperature but decreases with increasing volume for rainfall. The findings also revealed a significant association between malaria and demographic factors including place of residence, mother's educational level, and child's age and sex. CONCLUSIONS Potential intervention programs that focus on individuals living in rural areas, lowest wealth quintile, and the locations with high risks should be reinforced. Variations in climatic factors particularly temperature and rainfall should be taken into account when formulating malaria intervention programs in Rwanda.
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Affiliation(s)
| | - Ezra Gayawan
- Department of Statistics, Federal University of Technology, Akure, Nigeria
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Bergmann C, van Loon W, Habarugira F, Tacoli C, Jäger JC, Savelsberg D, Nshimiyimana F, Rwamugema E, Mbarushimana D, Ndoli J, Sendegeya A, Bayingana C, Mockenhaupt FP. Increase in Kelch 13 Polymorphisms in Plasmodium falciparum, Southern Rwanda. Emerg Infect Dis 2021; 27:294-296. [PMID: 33350925 PMCID: PMC7774571 DOI: 10.3201/eid2701.203527] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Artemisinin resistance in Plasmodium falciparum is associated with nonsynonymous mutations in the Kelch 13 (K13) propeller domain. We found that 12.1% (8/66) of clinical P. falciparum isolates from Huye district, Rwanda, exhibited K13 mutations, including R561H, a validated resistance marker. K13 mutations appear to be increasing in this region.
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Lufungulo Bahati Y, Delanghe J, Bisimwa Balaluka G, Sadiki Kishabongo A, Philippé J. Asymptomatic Submicroscopic Plasmodium Infection Is Highly Prevalent and Is Associated with Anemia in Children Younger than 5 Years in South Kivu/Democratic Republic of Congo. Am J Trop Med Hyg 2020; 102:1048-1055. [PMID: 32124722 DOI: 10.4269/ajtmh.19-0878] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
One of the most important problems in controlling malaria is the limited access to effective and accurate diagnosis of malaria parasitemia. In the Democratic Republic of Congo (DRC), malaria is one of the leading causes of morbidity and mortality. The purpose of this study was to assess the prevalence of anemia and the relationship with asymptomatic submicroscopic Plasmodium infection. A cross-sectional study was carried out among 1,088 apparently healthy children aged between 6 and 59 months selected at random in the health zone of Miti Murhesa in South Kivu/DRC. Capillary blood was obtained for hemoglobin (Hb) concentration measurement by Hemocue® Hb 301. Malaria detection was performed by microscopy and the loop-mediated isothermal amplification (LAMP) assay. Anemia was defined as Hb < 11g/dL. We applied the chi-square test for comparisons, and multiple logistic regression was used to identify the risk factors for anemia and submicroscopic Plasmodium infection. The prevalence of anemia was 39.6%, and the prevalence of parasitemia was 15.9% and 34.0% using microscopy and LAMP test, respectively. Submicroscopic Plasmodium infection was found in 22.3% of the children. The independent risk factors for anemia are Plasmodium infection, children younger than 24 months, low middle-upper arm circumference, and history of illness two weeks before. Otherwise, children with submicroscopic malaria infection have a significantly increased risk for anemia, with a need of transfusion. The prevalence of malaria infection was underestimated, when microscopy was used to diagnose malaria. Children with low parasitemia detected by LAMP but not by microscopy showed a significantly increased prevalence of anemia.
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Affiliation(s)
- Yvette Lufungulo Bahati
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.,Department of Pediatrics, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Joris Delanghe
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | | | | | - Jan Philippé
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
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Siya A, Kalule BJ, Ssentongo B, Lukwa AT, Egeru A. Malaria patterns across altitudinal zones of Mount Elgon following intensified control and prevention programs in Uganda. BMC Infect Dis 2020; 20:425. [PMID: 32552870 PMCID: PMC7301530 DOI: 10.1186/s12879-020-05158-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/12/2020] [Indexed: 12/22/2022] Open
Abstract
Background Malaria remains a major tropical vector-borne disease of immense public health concern owing to its debilitating effects in sub-Saharan Africa. Over the past 30 years, the high altitude areas in Eastern Africa have been reported to experience increased cases of malaria. Governments including that of the Republic of Uganda have responded through intensifying programs that can potentially minimize malaria transmission while reducing associated fatalities. However, malaria patterns following these intensified control and prevention interventions in the changing climate remains widely unexplored in East African highland regions. This study thus analyzed malaria patterns across altitudinal zones of Mount Elgon, Uganda. Methods Times-series data on malaria cases (2011–2017) from five level III local health centers occurring across three altitudinal zones; low, mid and high altitude was utilized. Inverse Distance Weighted (IDW) interpolation regression and Mann Kendall trend test were used to analyze malaria patterns. Vegetation attributes from the three altitudinal zones were analyzed using Normalized Difference Vegetation Index (NDVI) was used to determine the Autoregressive Integrated Moving Average (ARIMA) model was used to project malaria patterns for a 7 year period. Results Malaria across the three zones declined over the study period. The hotspots for malaria were highly variable over time in all the three zones. Rainfall played a significant role in influencing malaria burdens across the three zones. Vegetation had a significant influence on malaria in the higher altitudes. Meanwhile, in the lower altitude, human population had a significant positive correlation with malaria cases. Conclusions Despite observed decline in malaria cases across the three altitudinal zones, the high altitude zone became a malaria hotspot as cases variably occurred in the zone. Rainfall played the biggest role in malaria trends. Human population appeared to influence malaria incidences in the low altitude areas partly due to population concentration in this zone. Malaria control interventions ought to be strengthened and strategically designed to achieve no malaria cases across all the altitudinal zones. Integration of climate information within malaria interventions can also strengthen eradication strategies of malaria in such differentiated altitudinal zones.
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Affiliation(s)
- Aggrey Siya
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda. .,Centre for Invasion Biology, Department of Botany and Zoology, Stellenbosch University, Stellenbosch, South Africa.
| | - Bosco John Kalule
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Benard Ssentongo
- College of Agricultural and Environmental Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Akim Tafadzwa Lukwa
- Faculty of Health Sciences, School of Public Health and Family Medicine, Health Economics Unit, University of Cape Town, Cape Town, South Africa
| | - Anthony Egeru
- College of Agricultural and Environmental Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
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Evans DR, Higgins CR, Laing SK, Awor P, Ozawa S. Poor-quality antimalarials further health inequities in Uganda. Health Policy Plan 2020; 34:iii36-iii47. [PMID: 31816072 PMCID: PMC6901073 DOI: 10.1093/heapol/czz012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/13/2018] [Accepted: 02/13/2019] [Indexed: 12/16/2022] Open
Abstract
Substandard and falsified medications are a major threat to public health, directly increasing the risk of treatment failure, antimicrobial resistance, morbidity, mortality and health expenditures. While antimalarial medicines are one of the most common to be of poor quality in low- and middle-income countries, their distributional impact has not been examined. This study assessed the health equity impact of substandard and falsified antimalarials among children under five in Uganda. Using a probabilistic agent-based model of paediatric malaria infection (Substandard and Falsified Antimalarial Research Impact, SAFARI model), we examine the present day distribution of the burden of poor-quality antimalarials by socio-economic status and urban/rural settings, and simulate supply chain, policy and patient education interventions. Patients incur US$26.1 million (7.8%) of the estimated total annual economic burden of substandard and falsified antimalarials, including $2.3 million (9.1%) in direct costs and $23.8 million (7.7%) in productivity losses due to early death. Poor-quality antimalarials annually cost $2.9 million to the government. The burden of the health and economic impact of malaria and poor-quality antimalarials predominantly rests on the poor (concentration index −0.28) and rural populations (98%). The number of deaths among the poorest wealth quintile due to substandard and falsified antimalarials was 12.7 times that of the wealthiest quintile, and the poor paid 12.1 times as much per person in out-of-pocket payments. Rural populations experienced 97.9% of the deaths due to poor-quality antimalarials, and paid 10.7 times as much annually in out-of-pocket expenses compared with urban populations. Our simulations demonstrated that interventions to improve medicine quality could have the greatest impact at reducing inequities, and improving adherence to antimalarials could have the largest economic impact. Substandard and falsified antimalarials have a significant health and economic impact, with greater burden of deaths, disability and costs on poor and rural populations, contributing to health inequities in Uganda.
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Affiliation(s)
- Daniel R Evans
- Duke University School of Medicine, DUMC 3710 Durham, NC 27710, USA
| | - Colleen R Higgins
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB#7574, Beard Hall 115H, Chapel Hill, NC 27599, USA
| | - Sarah K Laing
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB#7574, Beard Hall 115H, Chapel Hill, NC 27599, USA
| | - Phyllis Awor
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Mulago Hospital Complex, Mulago Hill, P.O. Box 7072, Kampala, Uganda
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB#7574, Beard Hall 115H, Chapel Hill, NC 27599, USA
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC 27599, USA
- Corresponding author. Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB#7574, Beard Hall 115H, Chapel Hill, NC 27599, USA. E-mail:
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Nelson CS, Sumner KM, Freedman E, Saelens JW, Obala AA, Mangeni JN, Taylor SM, O'Meara WP. High-resolution micro-epidemiology of parasite spatial and temporal dynamics in a high malaria transmission setting in Kenya. Nat Commun 2019; 10:5615. [PMID: 31819062 PMCID: PMC6901486 DOI: 10.1038/s41467-019-13578-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 11/14/2019] [Indexed: 01/03/2023] Open
Abstract
Novel interventions that leverage the heterogeneity of parasite transmission are needed to achieve malaria elimination. To better understand spatial and temporal dynamics of transmission, we applied amplicon next-generation sequencing of two polymorphic gene regions (csp and ama1) to a cohort identified via reactive case detection in a high-transmission setting in western Kenya. From April 2013 to July 2014, we enrolled 442 symptomatic children with malaria, 442 matched controls, and all household members of both groups. Here, we evaluate genetic similarity between infected individuals using three indices: sharing of parasite haplotypes on binary and proportional scales and the L1 norm. Symptomatic children more commonly share haplotypes with their own household members. Furthermore, we observe robust temporal structuring of parasite genetic similarity and identify the unique molecular signature of an outbreak. These findings of both micro- and macro-scale organization of parasite populations might be harnessed to inform next-generation malaria control measures. Here, Nelson et al. use amplicon next-generation sequencing of two P. falciparum polymorphic gene regions to investigate the genetic similarity of parasite populations across time and space in a pediatric cohort in Kenya. They identify both micro- and macro-scale structuring of malaria parasites in this high-transmission setting, which could inform future intervention strategies.
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Affiliation(s)
- Cody S Nelson
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.
| | - Kelsey M Sumner
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elizabeth Freedman
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joseph W Saelens
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Andrew A Obala
- School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Judith N Mangeni
- School of Nursing, Moi University College of Health Sciences, Eldoret, Kenya
| | - Steve M Taylor
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Wendy P O'Meara
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
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24
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Essendi WM, Vardo-Zalik AM, Lo E, Machani MG, Zhou G, Githeko AK, Yan G, Afrane YA. Epidemiological risk factors for clinical malaria infection in the highlands of Western Kenya. Malar J 2019; 18:211. [PMID: 31234879 PMCID: PMC6591804 DOI: 10.1186/s12936-019-2845-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 06/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background Understanding the complex heterogeneity of risk factors that can contribute to an increased risk of malaria at the individual and household level will enable more effective use of control measures. The objective of this study was to understand individual and household factors that influence clinical malaria infection among individuals in the highlands of Western Kenya. Methods This was a matched case–control study undertaken in the Western Kenya highlands. Clinical malaria cases were recruited from health facilities and matched to asymptomatic individuals from the community who served as controls. Each participant was screened for malaria using microscopy. Follow-up surveys were conducted with individual households to collect socio-economic data. The houses were also checked using pyrethrum spray catches to collect mosquitoes. Results A total of 302 malaria cases were matched to 604 controls during the surveillance period. Mosquito densities were similar in the houses of both groups. A greater percentage of people in the control group (64.6%) used insecticide-treated bed nets (ITNs) compared to the families of malaria cases (48.3%). Use of ITNs was associated with lower level of clinical malaria episodes (odds ratio 0.51; 95% CI 0.39–0.68; P < 0.0001). Low income was the most important factor associated with higher malaria infections (adj. OR 4.70). Use of malaria prophylaxis was the most important factor associated with less malaria infections (adj OR 0.36). Mother’s (not fathers) employment status (adj OR 0.48) and education level (adj OR 0.54) was important malaria risk factor. Houses with open eaves was an important malaria risk factor (adj OR 1.72). Conclusion The identification of risk factors for clinical malaria infection provides information on the local malaria epidemiology and has the potential to lead to a more effective and targeted use of malaria control measures. These risk factors could be used to assess why some individuals acquire clinical malaria whilst others do not and to inform how intervention could be scaled at the local level.
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Affiliation(s)
| | - Anne M Vardo-Zalik
- The Pennsylvania State University, 1031 Edgecomb Avenue, York, PA, 1740, USA
| | - Eugenia Lo
- Department of Biological Sciences, University of North Carolina at Charlotte, Woodward Hall 380C, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Maxwell G Machani
- Climate and Human Health Research Unit, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Guofa Zhou
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA, 92697, USA
| | - Andrew K Githeko
- Climate and Human Health Research Unit, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Guiyun Yan
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA, 92697, USA
| | - Yaw A Afrane
- Department of Medical Microbiology, College of Health Sciences, University of Ghana, Accra, Ghana.
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25
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Geus D, Sifft KC, Habarugira F, Mugisha JC, Mukampunga C, Ndoli J, Bayingana C, Sendegeya A, Martus P, Fraundorfer K, Samson‐Himmelstjerna G, Gahutu JB, Klotz C, Aebischer A, Mockenhaupt FP. Co‐infections with
Plasmodium
,
Ascaris
and
Giardia
among Rwandan schoolchildren. Trop Med Int Health 2019; 24:409-420. [DOI: 10.1111/tmi.13206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Dominik Geus
- Charité – Universitätsmedizin Institute of Tropical Medicine and International Health Berlin Germany
| | - Kevin C. Sifft
- Charité – Universitätsmedizin Institute of Tropical Medicine and International Health Berlin Germany
| | - Felix Habarugira
- University Teaching Hospital of Butare University of Rwanda Butare Rwanda
| | | | - Caritas Mukampunga
- University Teaching Hospital of Butare University of Rwanda Butare Rwanda
| | - Jules Ndoli
- University Teaching Hospital of Butare University of Rwanda Butare Rwanda
| | - Claude Bayingana
- University Teaching Hospital of Butare University of Rwanda Butare Rwanda
| | - Augustin Sendegeya
- University Teaching Hospital of Butare University of Rwanda Butare Rwanda
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry University Hospital Tübingen Germany
| | - Kira Fraundorfer
- Institute for Parasitology and Tropical Veterinary Medicine Freie Universität Berlin Berlin Germany
| | | | - Jean Bosco Gahutu
- University Teaching Hospital of Butare University of Rwanda Butare Rwanda
| | - Christian Klotz
- Unit for Mycotic and Parasitic Agents and Mycobacteria Robert Koch‐Institute Berlin Germany
| | - Anton Aebischer
- Unit for Mycotic and Parasitic Agents and Mycobacteria Robert Koch‐Institute Berlin Germany
| | - Frank P. Mockenhaupt
- Charité – Universitätsmedizin Institute of Tropical Medicine and International Health Berlin Germany
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26
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Degarege A, Fennie K, Degarege D, Chennupati S, Madhivanan P. Improving socioeconomic status may reduce the burden of malaria in sub Saharan Africa: A systematic review and meta-analysis. PLoS One 2019; 14:e0211205. [PMID: 30677102 PMCID: PMC6345497 DOI: 10.1371/journal.pone.0211205] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/09/2019] [Indexed: 11/18/2022] Open
Abstract
Background A clear understanding of the effects of housing structure, education, occupation, income, and wealth on malaria can help to better design socioeconomic interventions to control the disease. This literature review summarizes the relationship of housing structure, educational level, occupation, income, and wealth with the epidemiology of malaria in sub-Saharan Africa (SSA). Methods A systematic review and meta-analysis was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. The protocol for this study is registered in PROSPERO (ID=CRD42017056070), an international database of prospectively registered systematic reviews. On January 16, 2016, available literature was searched in PubMed, Embase, CINAHL, and Cochrane Library. All but case studies, which reported prevalence or incidence of Plasmodium infection stratified by socioeconomic status among individuals living in SSA, were included without any limits. Odds Ratio (OR) and Relative Risk (RR), together with 95% CI and p-values were used as effect measures. Heterogeneity was assessed using chi-square, Moran’s I2, and tau2 tests. Fixed (I2<30%), random (I2≥30%) or log-linear dose-response model was used to estimate the summary OR or RR. Results After removing duplicates and screening of titles, abstracts, and full text, 84 articles were found eligible for systematic review, and 75 of them were included in the meta-analyses. Fifty-seven studies were cross-sectional, 12 were prospective cohort, 10 were case-control, and five were randomized control trials. The odds of Plasmodium infection increased among individuals who were living in poor quality houses (OR 2.13, 95% CI 1.56–3.23, I2 = 27.7), were uneducated (OR 1.36, 95% CI 1.19–1.54, I2 = 72.4.0%), and were farmers by occupation (OR 1.48, 95% CI 1.11–1.85, I2 = 0.0%) [p<0.01 for all]. The odds of Plasmodium infection also increased with a decrease in the income (OR 1.02, 95% CI 1.01–1.03, tau2<0.001), and wealth index of individuals (OR 1.25, 95% CI 1.18–1.35, tau2 = 0.028) [p<0.001 for both]. Longitudinal studies also showed an increased risk of Plasmodium infection among individuals who were living in poor quality houses (RR 1.86, 95% CI 1.47–2.25, I2 = 0.0%), were uneducated (OR 1.27, 1.03–1.50, I2 = 0.0%), and were farmers (OR 1.36, 1.18–1.58) [p<0.01 for all]. Conclusions Lack of education, low income, low wealth, living in poorly constructed houses, and having an occupation in farming may increase risk of Plasmodium infection among people in SSA. Public policy measures that can reduce inequity in health coverage, as well as improve economic and educational opportunities for the poor, will help in reducing the burden of malaria in SSA.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States of America
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Kristopher Fennie
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States of America
| | - Dawit Degarege
- Ethiopian Ministry of Health Office, Addis Ababa, Ethiopia
| | - Shasank Chennupati
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States of America
| | - Purnima Madhivanan
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States of America
- Public Health Research Institute of India, Mysore, India
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27
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Ugwu CLJ, Zewotir TT. Using mixed effects logistic regression models for complex survey data on malaria rapid diagnostic test results. Malar J 2018; 17:453. [PMID: 30518399 PMCID: PMC6282337 DOI: 10.1186/s12936-018-2604-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
Background The effect of malaria in Nigeria is still worrisome and has remained a leading public health issue in the country. In 2016, Nigeria was the highest malaria burden country among the 15 countries in sub-Saharan Africa that accounted for the 80% global malaria cases. The purpose of this study is to utilize appropriate statistical models in identifying socio-economic, demographic and geographic risk factors that have influenced malaria transmission in Nigeria, based on malaria rapid diagnostic test survey results. This study contributes towards re-designing intervention strategies to achieve the target of meeting the Sustainable Development Goals 2030 Agenda for total malaria elimination. Methods This study adopted the generalized linear mixed models approach which accounts for the complexity of the sample survey design associated with the data. The 2015 Nigeria malaria indicator survey data of children between 6 and 59 months are used in the study. Results From the findings of this study, the cluster effect is significant \documentclass[12pt]{minimal}
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\begin{document}$$(P<0.0001)$$\end{document}(P<0.0001) which has suggested evidence of heterogeneity among the clusters. It was found that the vulnerability of a child to malaria infection increases as the child advances in age. Other major significant factors were; the presence of anaemia in a child, an area where a child resides (urban or rural), the level of the mother’s education, poverty level, number of household members, sanitation, age of head of household, availability of electricity and the type of material for roofing. Moreover, children from Northern and South-West regions were also found to be at higher risk of malaria disease and re-infection. Conclusion Improvement of socio-economic development and quality of life is paramount to achieving malaria free Nigeria. There is a strong link of malaria risk with poverty, under-development and the mother’s educational level.
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Affiliation(s)
- Chigozie Louisa J Ugwu
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Westville Campus, Durban, South Africa.
| | - Temesgen T Zewotir
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
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28
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Das D, Grais RF, Okiro EA, Stepniewska K, Mansoor R, van der Kam S, Terlouw DJ, Tarning J, Barnes KI, Guerin PJ. Complex interactions between malaria and malnutrition: a systematic literature review. BMC Med 2018; 16:186. [PMID: 30371344 PMCID: PMC6205776 DOI: 10.1186/s12916-018-1177-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/20/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite substantial improvement in the control of malaria and decreased prevalence of malnutrition over the past two decades, both conditions remain heavy burdens that cause hundreds of thousands of deaths in children in resource-poor countries every year. Better understanding of the complex interactions between malaria and malnutrition is crucial for optimally targeting interventions where both conditions co-exist. This systematic review aimed to assess the evidence of the interplay between malaria and malnutrition. METHODS Database searches were conducted in PubMed, Global Health and Cochrane Libraries and articles published in English, French or Spanish between Jan 1980 and Feb 2018 were accessed and screened. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale and the risk of bias across studies was assessed using the GRADE approach. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline were followed. RESULTS Of 2945 articles screened from databases, a total of 33 articles were identified looking at the association between malnutrition and risk of malaria and/or the impact of malnutrition in antimalarial treatment efficacy. Large methodological heterogeneity of studies precluded conducting meaningful aggregated data meta-analysis. Divergent results were reported on the effect of malnutrition on malaria risk. While no consistent association between risk of malaria and acute malnutrition was found, chronic malnutrition was relatively consistently associated with severity of malaria such as high-density parasitemia and anaemia. Furthermore, there is little information on the effect of malnutrition on therapeutic responses to artemisinin combination therapies (ACTs) and their pharmacokinetic properties in malnourished children in published literature. CONCLUSIONS The evidence on the effect of malnutrition on malaria risk remains inconclusive. Further analyses using individual patient data could provide an important opportunity to better understand the variability observed in publications by standardising both malaria and nutritional metrics. Our findings highlight the need to improve our understanding of the pharmacodynamics and pharmacokinetics of ACTs in malnourished children. Further clarification on malaria-malnutrition interactions would also serve as a basis for designing future trials and provide an opportunity to optimise antimalarial treatment for this large, vulnerable and neglected population. TRIAL REGISTRATION PROSPERO CRD42017056934 .
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Affiliation(s)
- D Das
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - E A Okiro
- Kemri Wellcome Trust Research Programme, Kilifi, Kenya
| | - K Stepniewska
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - R Mansoor
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - D J Terlouw
- Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - J Tarning
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - K I Barnes
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,WorldWide Antimalarial Resistance Network (WWARN) Pharmacology, University of Cape Town, Cape Town, South Africa
| | - P J Guerin
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
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29
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Birhanu Z, Yihdego YYE, Yewhalaw D. Quantifying malaria endemicity in Ethiopia through combined application of classical methods and enzyme-linked immunosorbent assay: an initial step for countries with low transmission initiating elimination programme. Malar J 2018; 17:152. [PMID: 29618357 PMCID: PMC5885372 DOI: 10.1186/s12936-018-2282-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/21/2018] [Indexed: 01/09/2023] Open
Abstract
Background In the context of reduced transmission of malaria, it is essential to re-evaluate and determine the level of transmission as it guides re-orientation of control measures which is appropriate to local disease epidemiology. However, little is known about level of malaria transmission in Ethiopia. The present study aimed to investigate the level of malaria transmission through combined application of classical methods and enzyme-linked immunosorbent assay (EIA) in low transmission settings of Ethiopia. Methods This study was conducted in June 2016 on 763 apparently healthy children 2–9 years of age. Children were recruited from ten sites representing different malaria transmission settings in Ethiopia. Splenomegaly rate, infection rate and EIA antibody test were used to determine endemicity. The data were analysed using SPSS 21.0 and Stata 12.0. Results The overall prevalence of malaria parasitaemia was 2.49% (95% CI 1.38–3.59) and 2.36% (95% CI 1.28–3.44) as detected using rapid diagnostic test and microscopy, respectively. Plasmodium falciparum accounted for 62.63% of the infections. The prevalence of parasitaemia significantly varied by altitude and localities; the highest (5.8%) in areas below 1500 m above sea level. Overall, splenomegaly rate was 1.70% (95% CI 0.78–0.2.66%), making the overall malaria transmission hypoendemic. Infection rate was higher among males (2.7%), but rate of splenomegaly was higher in females. Incongruent with spleen rate and parasitaemia, EIA showed a higher level of cumulative exposure to malaria with spatially localized and highly heterogeneous transmission. Overall, 126 (18.75%, 95% CI 15.79–21.71) of the children were positive for total malaria antibodies with significant variations with altitude, age and sex; the higher in areas of < 1500 m asl (25.8%), children ≥ 5 years (22.1%) and among males (20.9%). Conclusions Splenomegaly and parasitaemia are not good measures to show variations in the levels of malaria transmission in reduced and/or low endemic settings. The malaria antibody (i.e. serological) test seems to be a good measure of malaria endemicity showing greater degree of heterogeneity and localized risk of transmission. Thus, malaria elimination efforts need to be supported with serological indicators to identify patterns of foci of transmission to set priorities for interventions.
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Affiliation(s)
- Zewdie Birhanu
- Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia.
| | | | - Delenasaw Yewhalaw
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.,Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia
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30
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Bahizire E, Bahwere P, Donnen P, Tugirimana PL, Balol'ebwami S, Dramaix M, Nfundiko C, Chirimwami R, Mubagwa K. High Prevalence of Anemia but Low Level of Iron Deficiency in Preschool Children during a Low Transmission Period of Malaria in Rural Kivu, Democratic Republic of the Congo. Am J Trop Med Hyg 2017; 97:489-496. [PMID: 28829731 DOI: 10.4269/ajtmh.17-0030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Anemia is a worldwide public health concern especially in preschool children in developing countries and iron deficiency (ID) is generally assumed to cause at least 50% of the cases. However, data on this contribution are scarce. To close this gap, we determined in 2013 the contribution of ID in the etiology of anemia and measured others factors associated to noniron deficiency anemia (NIDA) in 900 preschool children randomly selected during a two-stage cluster nutritional survey in the Miti-Murhesa health zone, in eastern Democratic Republic of the Congo. In these children, we collected sociodemographic, clinical, and biological parameters and determined the nutritional status according to the World Health Organization 2006 standards. Anemia was defined as altitude-adjusted hemoglobin < 110 g/L and ID was defined as serum ferritin < 12 μg/L or < 30 μg/L in the absence or presence of inflammation, respectively. Median (interquartile range) age was 29.4 (12-45) months. The prevalence of anemia was 46.6% (391/838) among whom only 16.5% (62/377) had ID. Among children without signs of inflammation, only 4.4% (11/251) met the ferritin-based (unadjusted) definition of ID. Logistic regression analysis identified ID, history of fever during the last 2 weeks and mid-upper arm circumference < 125 mm as the only independent factors associated to anemia. In conclusion, anemia is a severe public health problem in the Miti-Murhesa health zone, but NIDA is mostly predominant and needs to be further studied. Control of infections and prevention of acute undernutrition (wasting) are some of appropriate interventions to reduce the burden anemia in this region.
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Affiliation(s)
- Esto Bahizire
- Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium.,Centre de Recherche en Sciences Naturelles de Lwiro, Bukavu, Democratic Republic of the Congo
| | - Paluku Bahwere
- Valid International, Oxford, United Kingdom.,Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Donnen
- Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium
| | - P Lundimu Tugirimana
- Faculty of Medicine, Université de Goma, Goma, Democratic Republic of the Congo.,Department of Clinical Biology, National University of Rwanda, Kigali, Rwanda
| | - Serge Balol'ebwami
- Department of Pediatrics, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Michèle Dramaix
- Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium
| | - Chouchou Nfundiko
- National Program of Nutrition, Division Provinciale de la Santé du Sud-Kivu, Bukavu, Democratic Republic of the Congo
| | - Raphaël Chirimwami
- Department of Pathology, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Kanigula Mubagwa
- Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium
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31
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Sesay SSS, Giorgi E, Diggle PJ, Schellenberg D, Lalloo DG, Terlouw DJ. Surveillance in easy to access population subgroups as a tool for evaluating malaria control progress: A systematic review. PLoS One 2017; 12:e0183330. [PMID: 28813522 PMCID: PMC5558981 DOI: 10.1371/journal.pone.0183330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 08/02/2017] [Indexed: 11/29/2022] Open
Abstract
Background The need for surveillance systems generating targeted, data-driven, responsive control efforts to accelerate and sustain malaria transmission reduction has been emphasized by programme managers, policy makers and scientists. Surveillance using easy-to-access population subgroups (EAGs) may result in considerable cost saving compared to household surveys as the identification and selection of individuals to be surveyed is simplified, fewer personnel are needed, and logistics are simpler. We reviewed available literature on the validation of estimates of key indicators of malaria control progress derived from EAGs, and describe the options to deal with the context specific bias that may occur. Methods A literature search was conducted of all documents reporting validation of estimates of malaria control indicators from EAG surveys before the 31st of December 2016. Additional records were identified through cross-reference from selected records, other applicable policy documents and grey literature. After removal of duplicates, 13, 180 abstracts were evaluated and 2,653 eligible abstracts were identified mentioning surveillance in EAGs, of which 29 full text articles were selected for detailed review. The nine articles selected for systematic review compared estimates from health facility and school surveys with those of a contemporaneous sample of the same population in the same geographic area. Results Review of the available literature on EAGs suitable for surveillance of malaria control progress revealed that little effort has been made to explore the potential approach and settings for use of EAGs; and that there was wide variation in the precision of estimates of control progress between and within studies, particularly for estimates of control intervention coverage. Only one of the studies evaluated the geospatial representativeness of EAG samples, or carried out geospatial analyses to assess or control for lack of geospatial representativeness. Two studies attempted to measure the degree of bias or improve the precision of estimates by controlling for bias in a multivariate analysis; and this was only successful in one study. The observed variability in accuracy of estimates is likely to be caused by selection and/or information bias due to the inherent nature of EAGs. The reviewed studies provided insight into the design and analytical approaches that could be used to limit bias. Conclusion The utility EAGs for routine surveillance of progress in malaria control at the district or sub-district programmatic level will be driven by several factors including whether serial point estimates to measure transmission reduction or more precise geospatial distribution to track ‘hot-spots’ is required, the acceptable degree of precision, the target population, and the resources available for surveillance. The opportunities offered by novel geostatistical analyses and hybrid sampling frames to overcome bias justify a renewed exploration of use of EAGs for malaria monitoring and evaluation.
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Affiliation(s)
- Sanie S. S. Sesay
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Emanuele Giorgi
- Medical School, Lancaster University, Lancaster, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Peter J. Diggle
- Medical School, Lancaster University, Lancaster, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | | | - David G. Lalloo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Dianne J. Terlouw
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Wanzira H, Katamba H, Okullo AE, Agaba B, Kasule M, Rubahika D. Factors associated with malaria parasitaemia among children under 5 years in Uganda: a secondary data analysis of the 2014 Malaria Indicator Survey dataset. Malar J 2017; 16:191. [PMID: 28482832 PMCID: PMC5423009 DOI: 10.1186/s12936-017-1847-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/02/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the midst of success with malaria reduction in Uganda, there are areas that still have high prevalence of malaria parasitaemia. This project aimed at investigating factors associated with this prevalence and its relationship with anaemia. METHODS This is a secondary data analysis of the 2014 Malaria Indicator Survey dataset of children under 5 years. All had a blood sample taken by finger or heel prick for determination of malaria parasitaemia and estimation of haemoglobin level for anaemia status. The main outcome was the presence of malaria parasitaemia by microscopy and independent variables included: age, gender, residence (urban vs rural), use of a long-lasting, insecticidal-treated net, indoor residual spraying (IRS) of household in the past 6 months, mother's highest education level, mother heard malaria prevention message in the past 6 months, and household wealth status. RESULTS The analysis included 4930 children and of these, 938 (19.04%: 95% CI 16.63-21.71) tested positive for malaria parasites. Malaria parasite prevalence significantly increased from 11.08 (95% CI 9.12-13.40) among children with no anaemia to 50.99% (95% CI 39.13-62.74) with severe anaemia (Chi-square p-value = 0.001). Additionally, prevalence significantly rose from the youngest age group (under 6 months) by 1.62 times (95% CI 1.04-2.52, p = 0.033) among the age group of 7-12 months and to four times (95% CI 2.57-6.45, p = 0.001) among those who were between 49 and 59 months. The following were associated with reduced parasitaemia: IRS use (AOR 0.23 [0.08-0.61], p = 0.004), educated mothers (primary AOR 0.75 [0.59-0.96], p = 0.023 to tertiary AOR 0.11 [0.02-0.53], 0.006), mother heard malaria message (AOR 0.78 [0.62-0.99], p = 0.037), and wealthier households (richest AOR 0.17 [0.08-0.36], p = 0.001). CONCLUSIONS Increasing malaria parasite prevalence among children under 5 years is still related to increasing age and severity of anaemia even in the context of decreasing malaria prevalence. Designing interventions that include the use of IRS and behaviour change communication tailored to include older children, especially in areas with high malaria prevalence, could be of added value. All this should be done in an environment that improves the socio-economic status and equity of such populations.
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Affiliation(s)
- Humphrey Wanzira
- National Malaria Control Programme, Ministry of Health, Kampala, Uganda
| | - Henry Katamba
- National Malaria Control Programme, Ministry of Health, Kampala, Uganda
| | - Allen Eva Okullo
- Makerere University, School of Public Health, Fellowship Programme, Kampala, Uganda
| | - Bosco Agaba
- National Malaria Control Programme, Ministry of Health, Kampala, Uganda
| | - Mathias Kasule
- National Malaria Control Programme, Ministry of Health, Kampala, Uganda
| | - Denis Rubahika
- National Malaria Control Programme, Ministry of Health, Kampala, Uganda
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Kateera F, Nsobya SL, Tukwasibwe S, Hakizimana E, Mutesa L, Mens PF, Grobusch MP, van Vugt M, Kumar N. Molecular surveillance of Plasmodium falciparum drug resistance markers reveals partial recovery of chloroquine susceptibility but sustained sulfadoxine-pyrimethamine resistance at two sites of different malaria transmission intensities in Rwanda. Acta Trop 2016; 164:329-336. [PMID: 27647575 PMCID: PMC10600949 DOI: 10.1016/j.actatropica.2016.09.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 09/01/2016] [Accepted: 09/05/2016] [Indexed: 12/23/2022]
Abstract
Faced with intense levels of chloroquine (CQ) resistance in Plasmodium falciparum malaria, Rwanda replaced CQ with amodiaquine (AQ)+sulfadoxine-pyrimethamine (SP) in 2001, and subsequently with artemether-lumefantrine (AL) in 2006, as first-line treatments for uncomplicated malaria. Following years of discontinuation of CQ use, re-emergence of CQ-susceptible parasites has been reported in countries including Malawi, Kenya and Tanzania. In contrast, high levels of SP resistant mutant parasites continue to be reported even in countries of presumed reduced SP drug selection pressure. The prevalence and distributions of genetic polymorphisms linked with CQ and SP resistance at two sites of different malaria transmission intensities are described here to better understand drug-related genomic adaptations over time and exposure to varying drug pressures in Rwanda. Using filter paper blood isolates collected from P. falciparum infected patients, DNA was extracted and a nested PCR performed to identify resistance-mediating polymorphisms in the pfcrt, pfmdr1, pfdhps and pfdhfr genes. Amplicons from a total of 399 genotyped samples were analysed by ligase detection reaction fluorescent microsphere assay. CQ susceptible pfcrt 76K and pfmdr1 86N wild-type parasites were found in about 50% and 81% of isolates, respectively. Concurrently, SP susceptible pfdhps double (437G-540E), pfdhfr triple (108N-51I-59R), quintuple pfdhps 437G-540E/pfdhfr 51I-59R-108N and sextuple haplotypes were found in about 84%, 85%, 74% and 18% of isolates, respectively. High-level SP resistance associated pfdhfr 164L and pfdhps 581G mutant prevalences were noted to decline. Mutations pfcrt 76T, pfdhfr 59R and pfdhfr 164L were found differentially distributed between the two study sites with the pfdhfr 164L mutants found only at Ruhuha site, eastern Rwanda. Overall, sustained intense levels of SP resistance mutations and a recovery of CQ susceptible parasites were found in this study following 7 years and 14 years of drug withdrawal from use, respectively. Most likely, the sustained high prevalence of resistant parasites is due to the use of DHFR/DHPS inhibitors like trimethoprim-sulfamethoxazole (TS) for the treatment of and prophylaxis against bacterial infections among HIV infected individuals as well as the continued use of IPTp-SP within the East and Central African regions for malaria prevention among pregnant women. With regard to CQ, the slow recovery of CQ susceptible parasites may have been caused partly by the continued use of CQ and/or CQ mimicking antimalarial drugs like AQ in spite of policies to withdraw it from Rwanda and the neighbouring countries of Uganda and Tanzania. Continued surveillance of P. falciparum CQ and SP associated polymorphisms is recommended for guiding future rational drug policy-making and mitigation of future risk of anti-malaria drug resistance development.
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Affiliation(s)
- Fredrick Kateera
- Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda; Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
| | - Sam L Nsobya
- Molecular Research Laboratory, Infectious Disease Research Collaboration (IDRC), New Mulago Hospital Complex, PO Box 7051, Kampala, Uganda; School of Biomedical Science, College of Medicine, Makerere University, Uganda.
| | - Steven Tukwasibwe
- Molecular Research Laboratory, Infectious Disease Research Collaboration (IDRC), New Mulago Hospital Complex, PO Box 7051, Kampala, Uganda.
| | - Emmanuel Hakizimana
- Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda; Malaria & Other Parasitic Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda.
| | - Leon Mutesa
- College of Medicine & Health Sciences, University of Rwanda, PO Box 3286, Kigali, Rwanda.
| | - Petra F Mens
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands; Royal Tropical Institute/Koninklijk Instituutvoor de Tropen, KIT Biomedical Research, Meibergdreef 39, 1105 AZ, Amsterdam, The Netherlands.
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
| | - Michèle van Vugt
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
| | - Nirbhay Kumar
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Vector-Borne Infectious Disease Research Centre, Tulane University, 333S Liberty Street, Mail code 8317, New Orleans, LA 70112, United States.
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Sifft KC, Geus D, Mukampunga C, Mugisha JC, Habarugira F, Fraundorfer K, Bayingana C, Ndoli J, Umulisa I, Karema C, von Samson-Himmelstjerna G, Aebischer T, Martus P, Sendegeya A, Gahutu JB, Mockenhaupt FP. Asymptomatic only at first sight: malaria infection among schoolchildren in highland Rwanda. Malar J 2016; 15:553. [PMID: 27842542 PMCID: PMC5109732 DOI: 10.1186/s12936-016-1606-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Plasmodium infection and malaria in school children are increasingly recognized as a relevant public health problem, but data on actual prevalence and health consequences are insufficient. The present study from highland southern Rwanda aimed at estimating infection prevalence among children attending school, at identifying associated factors and at assessing the clinical consequences of these infections. Methods In a survey including 12 schools in the Huye district of Rwanda, 1089 children aged 6–10 years were clinically and anthropometrically examined, malaria parasites were diagnosed by microscopy and PCR, haemoglobin concentrations were measured, and socio-economic and behavioural parameters as well as medical histories were obtained. Results Upon examination, the vast majority of children was asymptomatic (fever 2.7%). Plasmodium infection was detected in 22.4% (Plasmodium falciparum, 18.8%); 41% of these were submicroscopic. Independent predictors of infection included low altitude, higher age, preceding antimalarial treatment, and absence of electricity or a bicycle in the household. Plasmodium infection was associated with anaemia (mean haemoglobin difference of −1.2 g/dL; 95% CI, −0.8 to −1.5 g/dL), fever, underweight, clinically assessed malnutrition and histories of fever, tiredness, weakness, poor appetite, abdominal pain, and vomiting. With the exception of underweight, these conditions were also increased at submicroscopic infection. Conclusion Malaria infection is frequent among children attending school in southern highland Rwanda. Although seemingly asymptomatic in the vast majority of cases, infection is associated with a number of non-specific symptoms in the children´s histories, in addition to the impact on anaemia. This argues for improved malaria surveillance and control activities among school children.
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Affiliation(s)
- Kevin C Sifft
- Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Berlin, Germany
| | - Dominik Geus
- Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Berlin, Germany
| | - Caritas Mukampunga
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Jean Claude Mugisha
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Felix Habarugira
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Kira Fraundorfer
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Claude Bayingana
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Jules Ndoli
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Irenee Umulisa
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Corine Karema
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Toni Aebischer
- Mycotic and Parasitic Agents and Mycobacteria, Department of Infectious Diseases, Robert Koch-Institute, Berlin, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital, Tuebingen, Germany
| | - Augustin Sendegeya
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Jean Bosco Gahutu
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Berlin, Germany.
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Tacoli C, Gai PP, Bayingana C, Sifft K, Geus D, Ndoli J, Sendegeya A, Gahutu JB, Mockenhaupt FP. Artemisinin Resistance-Associated K13 Polymorphisms of Plasmodium falciparum in Southern Rwanda, 2010-2015. Am J Trop Med Hyg 2016; 95:1090-1093. [PMID: 27573632 PMCID: PMC5094222 DOI: 10.4269/ajtmh.16-0483] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/22/2016] [Indexed: 01/09/2023] Open
Abstract
Emerging artemisinin resistance is a threat to global malaria control. Mutations in the Plasmodium falciparum Kelch 13 (K13) propeller domain confer artemisinin resistance and constitute molecular markers for its detection and monitoring. We sequenced 222 P. falciparum isolates obtained from community children in the Huye District of southern Rwanda in 2010, 2014, and 2015 to investigate the presence of K13 polymorphisms. No polymorphisms were observed in 2010 but they were present in 2.5% and 4.5% in 2014 and 2015, respectively. In 2015, two isolates showed candidate K13 resistance mutations (P574L and A675V), which are common in southeast Asia and associated with delayed parasite clearance. K13 polymorphisms in southern Rwanda are infrequent but include variants associated with artemisinin resistance. Establishing correlations with local treatment response and in vitro resistance assays are needed in addition to further monitoring K13 polymorphisms in the study area.
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Affiliation(s)
- Costanza Tacoli
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedzin Berlin, Berlin, Germany
| | - Prabhanjan P Gai
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedzin Berlin, Berlin, Germany
| | - Claude Bayingana
- University Teaching Hospital of Butare, Butare, Rwanda
- School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda
| | - Kevin Sifft
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedzin Berlin, Berlin, Germany
| | - Dominik Geus
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedzin Berlin, Berlin, Germany
| | - Jules Ndoli
- University Teaching Hospital of Butare, Butare, Rwanda
- School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda
| | - Augustin Sendegeya
- University Teaching Hospital of Butare, Butare, Rwanda
- School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda
| | - Jean Bosco Gahutu
- University Teaching Hospital of Butare, Butare, Rwanda
- School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedzin Berlin, Berlin, Germany.
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Ferrari G, Ntuku HMT, Ross A, Schmidlin S, Kalemwa DM, Tshefu AK, Lengeler C. Identifying risk factors for Plasmodium infection and anaemia in Kinshasa, Democratic Republic of Congo. Malar J 2016; 15:362. [PMID: 27417676 PMCID: PMC4946241 DOI: 10.1186/s12936-016-1412-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/01/2016] [Indexed: 12/02/2022] Open
Abstract
Background There is little data on the risk factors for malaria infection in large cities in central Africa and in all age groups. There may be different associations with the risk factors for areas with different malaria transmission intensities such as the effect of fever or age. This study aimed at identifying risk factors associated with Plasmodium infection and anaemia among children 6–59 months and individuals aged older than 5 years in Kinshasa, a large city with heterogeneity in malaria prevalence. Methods This study analysed data from 3342 children aged 6–59 months from 25 non-rural health zones (HZs) and for 816 individuals aged older than 5 years from two HZs in Kinshasa (non-rural), collected during a cross sectional malaria survey in 2011. Logistic regression with random effects was used to investigate predictors for malaria and anaemia. Differences in risk factors in areas with a prevalence of less than 10 and 10 % or greater were investigated. Results There was evidence of a different age-pattern in the two transmission settings. For children under 5 years, the highest prevalence of malaria was observed in the 48–59 months group in both transmission settings, but it increased more gently for the lower transmission HZs (p = 0.009). In a separate analysis in children over 5 years in two selected HZs, the peak prevalence was in 5–9 years old in the higher transmission setting and in 15–19 years old in the lower transmission setting. Reported fever was associated with malaria in both transmission strata, with no evidence of a difference in these associations (p = 0.71); however in children older than 5 years there was a significant interaction with a stronger association in the low transmission HZ. Insecticide-treated net (ITN) use was associated with a lower risk of malaria infection in children 6–59 months in the high transmission HZs. Similar estimates were found in children over 5 years and the lower transmission HZ but the associations there were not significant. There was no evidence of a difference in these associations by strata. The risk of anaemia decreased with increasing age in all strata, whereas it increased with malaria infection and reported fever. ITN use did not show evidence of protection against anaemia. Low socio-economic status was associated with malaria in high transmission setting in children 6–59 months and anaemia in low transmission setting. Conclusions This study shows that in areas of low transmission in Kinshasa, the peak prevalence occurs in older age groups however ITN use was highest in children under 5 years. Targeted distribution of ITN to all age groups should be continued. For most risk factors, there was no evidence of an interaction with transmission intensity however the associations with age and with fever in the last 2 weeks did vary significantly.
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Affiliation(s)
- Giovanfrancesco Ferrari
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Henry M T Ntuku
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Amanda Ross
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Sandro Schmidlin
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Didier M Kalemwa
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Antoinette K Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Mukomena SE, Philipe CM, Désiré MK, Pascal LT, Ali MM, Oscar LN. [Asymptomatic Parasitemia in under five, school age children and households self-medication, Lubumbashi, Democratic Republic of Congo]. Pan Afr Med J 2016; 24:94. [PMID: 27642433 PMCID: PMC5012784 DOI: 10.11604/pamj.2016.24.94.9350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/26/2016] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Long neglected, asymptomatic malaria is currently recognized as a potential threat and obstacle to malaria control. In DR Congo, the prevalence of this parasite is poorly documented. This study aims to determine the prevalence of asymptomatic parasitaemia in children less than 5 years of age as well as in those aged over five years for what concerns ongoing mass control interventions (LLINs). METHODS This is a cross-sectional study conducted among school age children, children less than 5 years of age living in the household of Lubumbashi. Schools, students and children less than 5 years of age were selected randomly. Thick and thin blood smears and rapid tests were performed and read. RESULTS Out of 350 examined students, 43 (12, 3%), IC 95% (9, 14-16, 04) had positive thick smear. Only plasmodium falciparum was identified in all the 43 cases. 314 households (90.5%) declared that they had administered anti-malarial drugs to their children to treat fever at home. More than one-third of households (39.9%) declared that they had administered antipyretics to their children to relieve fever, 19.7% administered quinine and only less than 2% artemether-lumefantrine. Considering the use of the TDR technique, the prevalence of asymptomatic parasitaemia was 3%, IC 95% (from 2.075 to 4.44), but if we consider microscopy as the gold standard, the prevalence was 1.9%, IC 95% (from 1.13 to 3.01). CONCLUSION Asymptomatic malaria is not without health consequences, so it is important to conduct such investigations to detect new malaria device programmes.
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Affiliation(s)
- Sompwe Eric Mukomena
- Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo; Ecole de Santé Publique, Université de Lubumbashi, République Démocratique du Congo
| | - Cilundika Mulenga Philipe
- Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | | | - Lutumba Tshindele Pascal
- Département de Médecine Tropicale, Faculté de Médecine, Université de Kinshasa, République Démocratique du Congo
| | - Mapatano Mala Ali
- Ecole de Santé Publique, Université de Kinshasa, République Démocratique du Congo
| | - Luboya Numbi Oscar
- Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo; Ecole de Santé Publique, Université de Lubumbashi, République Démocratique du Congo
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Roberts D, Matthews G. Risk factors of malaria in children under the age of five years old in Uganda. Malar J 2016; 15:246. [PMID: 27121122 PMCID: PMC4848810 DOI: 10.1186/s12936-016-1290-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is the leading cause of morbidity in Uganda with 90-95 % of the population at risk and it contributing to approximately 13 % of under-five mortality. The aim of this study was to investigate the relationship between the malaria status of children under the age of 5 years old in Uganda and selected socio-economic, demographic and environmental factors, as well as to identify significant risk factors associated with malaria. METHODS This study made use of data collected from the 2014 Malaria Indicator Survey conducted in Uganda. Two test procedures for malaria in children under the age of 5 years old were carried out. Due to the complex survey design, a generalized linear mixed model was used to test for associations between several independent variables and the response variable, which was whether a child tested positive or negative for malaria according to the microscopy test. RESULTS The sample in this study was made up of 4939 children. Of those children, 974 tested positive for malaria, resulting in an observed malaria prevalence of 19.7 %. The socio-economic factors closely related to the risk of malaria were main floor material, main wall material and availability of electricity in the household. The event of indoor residual spraying (IRS) significantly reduced a child's risk of malaria. An older child was associated with a higher risk of malaria, however their risk decreased with an increase in cluster altitude and an increase in their caregiver's education level. CONCLUSION Although there has been a significant increase in the use of mosquito nets since the previous Malaria Indicator Survey done in 2009, particularly in the use of insecticide-treated nets (ITNs) and long-lasting insecticidal nets (LLINs), these control measures alone may not be sufficient. IRS will be a key strategy in reaching the malaria goals set by the government of Uganda. Supplementing these control measures with education of appropriate and consistent use of ITNs and LLINs, as well as education of practicing safe living habits, such as reducing outdoor activities during peak biting hours of a mosquito, can go a long way in aiding the reduction of the burden of malaria in Uganda.
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Affiliation(s)
- Danielle Roberts
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Westville, Private Bag X 54001, 4000, Durban, South Africa.
| | - Glenda Matthews
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Westville, Private Bag X 54001, 4000, Durban, South Africa
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Wahid S, Stresman GH, Kamal SS, Sepulveda N, Kleinschmidt I, Bousema T, Drakeley C. Heterogeneous malaria transmission in long-term Afghan refugee populations: a cross-sectional study in five refugee camps in northern Pakistan. Malar J 2016; 15:245. [PMID: 27121196 PMCID: PMC4847188 DOI: 10.1186/s12936-016-1305-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Afghan refugees in northern Pakistan have been resident for over 30 years and current information on malaria in this population is sparse. Understanding malaria risk and distribution in refugee camps is important for effective management both in camps and on return to Afghanistan. Methods Cross-sectional malariometric surveys were conducted in five Afghan refugee camps to determine infection and exposure to both Plasmodium falciparum and Plasmodium vivax. Factors associated with malaria infection and exposure were analysed using logistic regression, and spatial heterogeneity within camps was investigated with SatScan. Results In this low-transmission setting, prevalence of infection in the five camps ranged from 0–0.2 to 0.4–9 % by rapid diagnostic test and 0–1.39 and 5–15 % by polymerase chain reaction for P. falciparum and P. vivax, respectively. Prevalence of anti-malarial antibodies to P. falciparum antigens was 3–11 and 17–45 % for P. vivax antigens. Significant foci of P. vivax infection and exposure were detected in three of the five camps. Hotspots of P. falciparum were also detected in three camps, only one of which also showed evidence of P. vivax hotspots. Conclusions There is low and spatially heterogeneous malaria transmission in the refugee camps in northern Pakistan. Understanding malaria risk in refugee camps is important so the malaria risk faced by these populations in the camps and upon their return to Afghanistan can be effectively managed.
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Affiliation(s)
- Sobia Wahid
- Department of Zoology, University of Peshawar, Peshawar, Pakistan
| | - Gillian H Stresman
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, Keppel Street, London, WCIE 7HT, UK
| | - Syed Sajid Kamal
- Vector Control Department, Merlin Malaria Control Programme, Khyber Pakhtunkhwa, Pakistan
| | - Nuno Sepulveda
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, Keppel Street, London, WCIE 7HT, UK
| | - Immo Kleinschmidt
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WCIE 7HT, UK
| | - Teun Bousema
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, Keppel Street, London, WCIE 7HT, UK.,Department of Medical Microbiology, Radboud University Medical Center, 6500, Nijmegen, The Netherlands
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, Keppel Street, London, WCIE 7HT, UK.
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Association between malaria and malnutrition among children aged under-five years in Adami Tulu District, south-central Ethiopia: a case-control study. BMC Public Health 2016; 16:174. [PMID: 26895759 PMCID: PMC4759858 DOI: 10.1186/s12889-016-2838-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 02/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria and malnutrition are the major causes of morbidity and mortality in under-five children in developing countries such as Ethiopia. Malnutrition is the associated cause for about half of the deaths that occur among under-five children in developing countries. However, the relationship between malnutrition and malaria is controversial still, and it has also not been well documented in Ethiopia. The aim of this study was to assess whether malnutrition is associated with malaria among under-five children. METHODS A case-control study was conducted in Adami Tulu District of East Shewa Zone in Oromia Regional State, Ethiopia. Cases were all under-five children who are diagnosed with malaria at health posts and health centres. The diagnosis was made using either rapid diagnostic tests or microscopy. Controls were apparently healthy under-five children recruited from the community where cases resided. The selection of the controls was based on World Health Organization (WHO) cluster sampling method. A total of 428 children were included. Mothers/caretakers of under-five children were interviewed using pre-tested structured questionnaire prepared for this purpose. The nutritional status of the children was assessed using an anthropometric method and analyzed using WHO Anthro software. A multivariate logistic analysis model was used to determine predictors of malaria. RESULTS Four hundred twenty eight under-five children comprising 107 cases and 321 controls were included in this study. Prevalence of wasting was higher among cases (17.8%) than the controls (9.3%). Similarly, the prevalence of stunting was 50.5% and 45.2% among cases and controls, respectively. Severe wasting [Adjusted Odds Ratio (AOR) =2.9, 95% CI (1.14, 7.61)] and caretakers who had no education [AOR = 3, 95% CI (1.27, 7.10)] were independently associated with malarial attack among under-five children. CONCLUSION Children who were severely wasted and had uneducated caretakers had higher odds of malarial attack. Therefore, special attention should be given for severely wasted children in the prevention and control of malaria.
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Prompt access to effective malaria treatment among children under five in sub-Saharan Africa: a multi-country analysis of national household survey data. Malar J 2015; 14:329. [PMID: 26303581 PMCID: PMC4549012 DOI: 10.1186/s12936-015-0844-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/10/2015] [Indexed: 11/26/2022] Open
Abstract
Background Scaling up diagnostic testing and treatment is a key strategy to reduce the burden of malaria. Delays in accessing treatment can have fatal consequences; however, few studies have systematically assessed these delays among children under five years of age in malaria-endemic countries of sub-Saharan Africa. This study identifies predictors of prompt treatment with first-line artemisinin combination therapy (ACT) and describes profiles of children who received this recommended treatment. Methods This study uses data from the most recent Demographic and Health Survey, Malaria Indicator Survey, or Anaemia and Parasite Prevalence Survey conducted in 13 countries. A Chi square automatic interaction detector (CHAID) model was used to identify factors associated with prompt and effective treatment among children under five years of age. Results The percentage of children with fever who received any anti-malarial treatment varies from 3.6 % (95 % CI 2.8–4.4 %) in Ethiopia to 64.5 % (95 % CI 62.7–66.2 %) in Uganda. Among those who received prompt treatment with any anti-malarial medicine, the percentage who received ACT ranged from 32.2 % (95 % CI 26.1–38.4 %) in Zambia to nearly 100 % in Tanzania mainland and Zanzibar. The CHAID analysis revealed that country of residence is the best predictor of prompt and effective treatment (p < 0.001). Depending on the country, the second best predictor was maternal education (p = 0.004), place of residence (p = 0.008), or household wealth index (p < 0.001). Conclusions This study reveals that country of residence, maternal education, place of residence, and socio-economic status are key predictors of prompt access to malaria treatment. Achieving universal coverage and the elimination agenda will require effective monitoring to detect disparities early and sustained investments in routine data collection and policy formulation.
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Hagenlocher M, Castro MC. Mapping malaria risk and vulnerability in the United Republic of Tanzania: a spatial explicit model. Popul Health Metr 2015; 13:2. [PMID: 25674040 PMCID: PMC4324856 DOI: 10.1186/s12963-015-0036-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 01/21/2015] [Indexed: 12/02/2022] Open
Abstract
Background Outbreaks of vector-borne diseases (VBDs) impose a heavy burden on vulnerable populations. Despite recent progress in eradication and control, malaria remains the most prevalent VBD. Integrative approaches that take into account environmental, socioeconomic, demographic, biological, cultural, and political factors contributing to malaria risk and vulnerability are needed to effectively reduce malaria burden. Although the focus on malaria risk has increasingly gained ground, little emphasis has been given to develop quantitative methods for assessing malaria risk including malaria vulnerability in a spatial explicit manner. Methods Building on a conceptual risk and vulnerability framework, we propose a spatial explicit approach for modeling relative levels of malaria risk - as a function of hazard, exposure, and vulnerability - in the United Republic of Tanzania. A logistic regression model was employed to identify a final set of risk factors and their contribution to malaria endemicity based on multidisciplinary geospatial information. We utilized a Geographic Information System for the construction and visualization of a malaria vulnerability index and its integration into a spatially explicit malaria risk map. Results The spatial pattern of malaria risk was very heterogeneous across the country. Malaria risk was higher in Mainland areas than in Zanzibar, which is a result of differences in both malaria entomological inoculation rate and prevailing vulnerabilities. Areas of high malaria risk were identified in the southeastern part of the country, as well as in two distinct “hotspots” in the northwestern part of the country bordering Lake Victoria, while concentrations of high malaria vulnerability seem to occur in the northwestern, western, and southeastern parts of the mainland. Results were visualized using both 10×10 km2 grids and subnational administrative units. Conclusions The presented approach makes an important contribution toward a decision support tool. By decomposing malaria risk into its components, the approach offers evidence on which factors could be targeted for reducing malaria risk and vulnerability to the disease. Ultimately, results offer relevant information for place-based intervention planning and more effective spatial allocation of resources. Electronic supplementary material The online version of this article (doi:10.1186/s12963-015-0036-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Hagenlocher
- Interfaculty Department of Geoinformatics - Z_GIS, University of Salzburg, Schillerstr. 30, 5020 Salzburg, Austria
| | - Marcia C Castro
- Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
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Bizimana JP, Twarabamenye E, Kienberger S. Assessing the social vulnerability to malaria in Rwanda. Malar J 2015; 14:2. [PMID: 25566988 PMCID: PMC4326441 DOI: 10.1186/1475-2875-14-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 12/15/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Since 2004, malaria interventions in Rwanda have resulted in substantial decline of malaria incidence. However, this achievement is fragile as potentials for local malaria transmissions remain. The risk of getting malaria infection is partially explained by social conditions of vulnerable populations. Since vulnerability to malaria is both influenced by social and environmental factors, its complexity cannot be measured by a single value. The aim of this paper is, therefore, to apply a composite indicator approach for assessing social vulnerability to malaria in Rwanda. This assessment informs the decision-makers in targeting malaria interventions and allocating limited resources to reduce malaria burden in Rwanda. METHODS A literature review was used to conceptualize the social vulnerability to malaria and to select the appropriate vulnerability indicators. Indicators used in the index creation were classified into susceptibility and lack of resilience vulnerability domains. The main steps followed include selection of indicators and datasets, imputation of missing values, descriptive statistics, normalization and weighting of indicators, local sensitivity analysis and indicators aggregation. Correlation analysis helped to empirically evidence the association between the indicators and malaria incidence. RESULTS The high values of social vulnerability to malaria are found in Gicumbi, Rusizi, Nyaruguru and Gisagara, and low values in Muhanga, Nyarugenge, Kicukiro and Nyanza. The most influential susceptibility indicators to increase malaria are population change (r = 0.729), average number of persons per bedroom (r = 0.531), number of households affected by droughts and famines (r = 0.591), and area used for irrigation (r = 0.611). The bed net ownership (r = -0.398) and poor housing wall materials (0.378) are the lack of resilience indicators that significantly correlate with malaria incidence. CONCLUSIONS The developed composite index social vulnerability to malaria indicates which indicators need to be addressed and in which districts. The results from this study are salient for public health policy- and decision makers in malaria control in Rwanda and timely support the national integrated malaria initiative. Future research development should focus on spatial explicit vulnerability assessment by combining environmental and social drivers to achieve an integrated and complete assessment of vulnerability to malaria.
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Affiliation(s)
- Jean-Pierre Bizimana
- />College of Science and Technology, Geography Department, University of Rwanda, PO Box 212, Butare, Rwanda
| | - Emmanuel Twarabamenye
- />College of Science and Technology, Geography Department, University of Rwanda, PO Box 212, Butare, Rwanda
| | - Stefan Kienberger
- />Interfaculty Department of Geoinformatics - Z_GIS, University of Salzburg, Schillerstrasse, 305020 Salzburg, Austria
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Sonko ST, Jaiteh M, Jafali J, Jarju LBS, D'Alessandro U, Camara A, Komma-Bah M, Saho A. Does socio-economic status explain the differentials in malaria parasite prevalence? Evidence from The Gambia. Malar J 2014; 13:449. [PMID: 25416303 PMCID: PMC4289203 DOI: 10.1186/1475-2875-13-449] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 09/27/2014] [Indexed: 11/21/2022] Open
Abstract
Background Malaria is commonly associated with poverty. Macro-level estimates show strong links between malaria and poverty, and increasing evidence suggests that the causal link between malaria and poverty runs in both directions. However, micro-level (household and population) analyses on the linkages between malaria and poverty have often produced mixed results. Methods The Gambia Malaria Indicator Survey (MIS) 2010/11 was carried out between November 2010 and January 2011. Laboratory-confirmed malaria and wealth quintiles were used to assess the association of socio-economic status and malaria infection in children and the general population. Simple and multiple logistic regressions and survey data analysis procedures, including linearized standard errors to account for cluster sampling and unequal selection probabilities were applied. Results Children (six to 59 months) from the second, third, fourth and richest quintiles were significantly less likely to have malaria compared to children from the poorest quintiles. Children (five to 14 years) from the fourth and richest quintiles were also significantly less likely to have malaria compared to those from the poorest quintiles. The malaria burden has shifted from the under-five children (six to 59 months) to children aged five to 14 years. Malaria prevalence was significantly higher in the Central River Region compared to the Upper River Region; and males bear the malaria brunt more than females. Children (six to 59 months) and children (five to 14 years) living in houses with poor walls, floors, roofs and windows were significant associated with higher prevalence of malaria. However, in the general population, only poor wall housing materials were associated with higher prevalence of malaria. Conclusions Investments in strategies that address socio-economic disparities and improvements in the quality of housing could, in the long term, significantly reduce the malaria burden in the poorest communities.
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Affiliation(s)
- Sheriff T Sonko
- National Malaria Control Programme, Kanifing Institutional Layout, Plot # 17, Kanifing, The Gambia.
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Kienberger S, Hagenlocher M. Spatial-explicit modeling of social vulnerability to malaria in East Africa. Int J Health Geogr 2014; 13:29. [PMID: 25127688 PMCID: PMC4152278 DOI: 10.1186/1476-072x-13-29] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/06/2014] [Indexed: 11/16/2022] Open
Abstract
Background Despite efforts in eradication and control, malaria remains a global challenge, particularly affecting vulnerable groups. Despite the recession in malaria cases, previously malaria free areas are increasingly confronted with epidemics as a result of changing environmental and socioeconomic conditions. Next to modeling transmission intensities and probabilities, integrated spatial methods targeting the complex interplay of factors that contribute to social vulnerability are required to effectively reduce malaria burden. We propose an integrative method for mapping relative levels of social vulnerability in a spatially explicit manner to support the identification of intervention measures. Methods Based on a literature review, a holistic risk and vulnerability framework has been developed to guide the assessment of social vulnerability to water-related vector-borne diseases (VBDs) in the context of changing environmental and societal conditions. Building on the framework, this paper applies spatially explicit modeling for delineating homogeneous regions of social vulnerability to malaria in eastern Africa, while taking into account expert knowledge for weighting the single vulnerability indicators. To assess the influence of the selected indicators on the final index a local sensitivity analysis is carried out. Results Results indicate that high levels of malaria vulnerability are concentrated in the highlands, where immunity within the population is currently low. Additionally, regions with a lack of access to education and health services aggravate vulnerability. Lower values can be found in regions with relatively low poverty, low population pressure, low conflict density and reduced contributions from the biological susceptibility domain. Overall, the factors characterizing vulnerability vary spatially in the region. The vulnerability index reveals a high level of robustness in regard to the final choice of input datasets, with the exception of the immunity indicator which has a marked impact on the composite vulnerability index. Conclusions We introduce a conceptual framework for modeling risk and vulnerability to VBDs. Drawing on the framework we modeled social vulnerability to malaria in the context of global change using a spatially explicit approach. The results provide decision makers with place-specific options for targeting interventions that aim at reducing the burden of the disease amongst the different vulnerable population groups.
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Affiliation(s)
- Stefan Kienberger
- Interfaculty Department of Geoinformatics - Z_GIS, University of Salzburg, Schillerstraße 30, Salzburg 5020, Austria.
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Gai PP, Meese S, Bedu-Addo G, Gahutu JB, Mockenhaupt FP. No association of the p53 codon 72 polymorphism with malaria in Ghanaian primiparae and Rwandan children. Am J Trop Med Hyg 2014; 90:1133-4. [PMID: 24710610 DOI: 10.4269/ajtmh.14-0050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The p53 protein is a key cell-signaling mediator integrating host responses to various types of stress. A common polymorphism of the encoding TP53 gene (codon 72, Pro > Arg, rs1042522) is associated with susceptibility to virus-related and other cancers. The p53 has also been shown to be central for successful Plasmodium liver stage infection. We examined whether the polymorphism is associated with P. falciparum infection in Ghanaian primiparae and Rwandan children. The allele frequency of TP53 codon 72 Arg was 0.30 among 314 Ghanaian primiparae and 0.31 among 545 Rwandan children, respectively, and it was not associated with infection prevalence or parasite density. This does not exclude p53 to be of pathophysiological relevance in malaria but argues against a major respective role of the TP53 codon 72 polymorphism.
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Affiliation(s)
- Prabhanjan P Gai
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Medicine, Komfo Anoyke Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Teaching Hospital of Butare, School of Medicine, University of Rwanda, Huye, Rwanda
| | - Stefanie Meese
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Medicine, Komfo Anoyke Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Teaching Hospital of Butare, School of Medicine, University of Rwanda, Huye, Rwanda
| | - George Bedu-Addo
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Medicine, Komfo Anoyke Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Teaching Hospital of Butare, School of Medicine, University of Rwanda, Huye, Rwanda
| | - Jean Bosco Gahutu
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Medicine, Komfo Anoyke Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Teaching Hospital of Butare, School of Medicine, University of Rwanda, Huye, Rwanda
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Medicine, Komfo Anoyke Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Teaching Hospital of Butare, School of Medicine, University of Rwanda, Huye, Rwanda
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Danquah I, Gahutu JB, Ignatius R, Musemakweri A, Mockenhaupt FP. Reduced prevalence of Giardia duodenalis in iron-deficient Rwandan children. Trop Med Int Health 2014; 19:563-7. [PMID: 24898273 DOI: 10.1111/tmi.12284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Acute symptomatic infection with Giardia duodenalis impairs iron absorption, but iron deficiency may protect against infections caused by various micro-organisms including parasites. We therefore examined the association of G. duodenalis infection and iron deficiency in 575 Rwandan children under 5 years of age. METHODS Giardia duodenalis infection was diagnosed by triplicate microscopy and PCR assays, and iron deficiency was defined as a ferritin concentration <12 ng/ml. RESULTS Largely asymptomatic G. duodenalis infection was seen in 65.3% of the children and iron deficiency in 17.4%. G. duodenalis infection was less common in iron-deficient children (51%) than in non-deficient children (68%, P = 0.002). In multivariate analysis, the odds of G. duodenalis infection were almost halved in iron-deficient children (adjusted odds ratio, 0.54; 95% confidence interval, 0.33-0.86). CONCLUSION In this highly endemic setting, there was no evidence that Giardia infection impairs iron status. Rather, iron deficiency appeared to protect against infection with this parasite.
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Affiliation(s)
- Ina Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
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Lindblade KA, Steinhardt L, Samuels A, Kachur SP, Slutsker L. The silent threat: asymptomatic parasitemia and malaria transmission. Expert Rev Anti Infect Ther 2014; 11:623-39. [PMID: 23750733 DOI: 10.1586/eri.13.45] [Citation(s) in RCA: 349] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Scale-up of malaria control interventions has resulted in a substantial decline in global malaria morbidity and mortality. Despite this achievement, there is evidence that current interventions alone will not lead to malaria elimination in most malaria-endemic areas and additional strategies need to be considered. Use of antimalarial drugs to target the reservoir of malaria infection is an option to reduce the transmission of malaria between humans and mosquito vectors. However, a large proportion of human malaria infections are asymptomatic, requiring treatment that is not triggered by care-seeking for clinical illness. This article reviews the evidence that asymptomatic malaria infection plays an important role in malaria transmission and that interventions to target this parasite reservoir may be needed to achieve malaria elimination in both low- and high-transmission areas.
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Affiliation(s)
- Kim A Lindblade
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS A-06, Atlanta, GA 30333, USA.
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Reithinger R, Ngondi J, Graves P, Hwang J, Getachew A, Jima D. Risk factors for anemia in children under 6 years of age in Ethiopia: analysis of the data from the cross-sectional Malaria IndicatorSurvey, 2007. Trans R Soc Trop Med Hyg 2013; 107:769-76. [PMID: 24218415 PMCID: PMC10563508 DOI: 10.1093/trstmh/trt096] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Malaria is a leading cause of morbidity in Ethiopia. However, its transmission varies in both space and time, and large areas of the country are hypoendemic and epidemic-prone. The Ethiopia National Malaria Indicator Survey 2007 is a cross-sectional, nationally-representative household survey. The objective of the analyses presented here were to use the survey's data to identify factors associated with anemia presence in children under 6 years of age (U6); specifically, investigate the association between malaria and anemia; and discuss using anemia as a malaria proxy biomarker in the Ethiopian hypo-endemic transmission setting. METHODS The survey sampled 4185 households in 347 enumeration areas ≤2500 m above sea level. Primary outcome was increasing anemia severity in sampled children: no anemia (Hb: ≥11g/dl); mild anemia (Hb: ≥8g/dl and <11g/dl); and moderate-severe anemia (Hb: <8g/dl). Secondary outcomes were positive malaria rapid diagnostic test (RDT) or blood slide microscopy. RESULTS The analysis included 6054 (92.0%) children U6 in 3962 households. The proportion of children with no anemia, mild anemia, and moderate-severe anemia was 63.6%, 31.3%, and 5.1%, respectively. The overall prevalence of anemia (Hb <11g/dl) was 36.4% (95% CI 34.4-38.4). Factors independently associated with reduced relative odds of anemia categories were age (OR=0.7, 95% CI 0.7-0.7) and female sex (OR=0.9, 95% CI 0.8-1.0); malaria RDT positivity was associated with increased relative odds of a more severe anemia category (OR=5.8, 95% CI 3.7-9.2). CONCLUSIONS We conclude that at altitudes ≤2500 m malaria appears to be a significant risk factor for anemia; potentially anemia could be used as a useful proxy biomarker for malaria and its control in Ethiopia.
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Affiliation(s)
- R. Reithinger
- U.S. Agency for International Development, Addis Ababa, Ethiopia
- RTI International, Washington, DC, USA
| | - J.M. Ngondi
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
- RTI International, Dar-es-Salaam, Tanzania
- The Carter Center, Atlanta, GA, USA
| | - P.M. Graves
- The Carter Center, Atlanta, GA, USA
- School of Public Health, Tropical Medicine & Rehabilitation Sciences, James Cook University, Australia
| | - J. Hwang
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Global Health Group, University of California San Francisco, CA, USA
| | - A. Getachew
- Malaria Control and Evaluation Partnership in Africa (MACEPA), PATH, Addis Ababa, Ethiopia
| | - D. Jima
- Federal Ministry of Health, Addis Ababa, Ethiopia
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Sena LD, Deressa WA, Ali AA. Predictors of long-lasting insecticide-treated bed net ownership and utilization: evidence from community-based cross-sectional comparative study, Southwest Ethiopia. Malar J 2013; 12:406. [PMID: 24206749 PMCID: PMC3827849 DOI: 10.1186/1475-2875-12-406] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 11/04/2013] [Indexed: 11/21/2022] Open
Abstract
Background Malaria is the notorious impediment of public health and economic development. Long-lasting insecticide-treated bed nets/insecticide-treated bed nets (LLINs/ITNs) are among major intervention strategies to avert the impact the disease. However, effectiveness of LLINs/ITNs depends on, inter alia, possessing sufficient number, proper utilization and timely replacement of nets. Thus, the World Health Organization (WHO) recommends surveys to evaluate possession and proper use of LLINs/ITNs by households. Methods A cross-sectional comparative household survey was conducted during peak malaria transmission season using interviewer-introduced questionnaires in southwest Ethiopia. A study site was selected from villages around a man-made lake, Gilgel-Gibe (GG) and a control site, with similar geographic and socio-economic features but far away from the lake, was identified. A total of 2,373 households from randomly selected cluster of households were included into the study and heads/spouses of the households responded to interviews. Binary and multinomial logistic regressions were used to identify predictors of LLIN ownership and utilization. Results LLIN/ITN ownership among the study populations was 56.6%, while 43.4% of households did not own a net. A higher proportion of households in GG reported owning at least one LLITN/ITN compared to control village (OR =2. 2, P <0.001) and more households in GG reported having only one LLITN/ITN in contrast to households in the control village (OR = 2.1, P <0.001). The mean number of LLINs/ITNs owned was 1.6 for GG residents and 1.8 for control village with a mean difference of -0.26 (95% CI = - 0.34, -0.19). The age of household heads, household relative wealth index (RWI), distance to nearest health service and accessibility to transportation showed a significant association with ownership of LLINs/ITNs. The probability of owning two or more LLINs/ITNs was positively associated with age of household head. Marital status of household heads, RWI, distance to nearest health service, accessibility to transport, residence and household size showed a significant association with utilization of LLINs/ITNs. Conclusion Attention needs to be given to the poor, distant and inaccessible households in the efforts of malaria intervention programmes, such as free distribution of LLINs/ITNs. Well-tailored information, education and communication is needed to address the problem of non-users.
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Affiliation(s)
- Lelisa D Sena
- Department of Epidemiology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia.
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