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Molla E, Dugassa S, Alemayehu L, Ejigu LA, Deressa JD, Demisse M, Abdo M, Wolde Behaksra S, Keffale M, Tadesse FG, Gadisa E, Mamo H. Seasonal Dynamics of Symptomatic and Asymptomatic Plasmodium falciparum and Plasmodium vivax Infections in Coendemic Low-Transmission Settings, South Ethiopia. Am J Trop Med Hyg 2024; 111:481-489. [PMID: 38955195 PMCID: PMC11376164 DOI: 10.4269/ajtmh.24-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/24/2024] [Indexed: 07/04/2024] Open
Abstract
Ethiopia has a plan to eliminate malaria in selected low-transmission districts by 2025. However, complex factors such as seasonality, focal heterogeneity, and coendemicity of Plasmodium vivax and Plasmodium falciparum, and asymptomatic cases, along with other factors, pose challenges. This longitudinal study assessed these dynamics and associated factors in three elimination-targeted settings in southern Ethiopia. The study included rural districts (Wonago and Yirgacheffe) and an urban setting (Dilla town) with 504 participants from 168 households per season. The study covered the peak and minor malaria transmission seasons and the dry season. Finger-prick blood was collected for microscopy, rapid diagnostic tests, and 18S-rRNA-based quantitative polymerase chain reaction (qPCR). During the dry season, P. vivax accounted for most infections (64.5%, 71/110) and symptomatic malaria (50.9%, 29/57), whereas P. falciparum dominated during the peak transmission season (45.7%, 42/92 infections and 58.1%, 25/43 of symptomatic cases). Treatment-seeking behavior was low, with 65.3% (143/219) of symptomatic individuals not seeking treatment. Dilla town had significantly higher infection prevalence (29.6%, 149/504, P <0.001) in all seasons compared with the rural sites. The incidence rate was 12/1,000 person-seasons by qPCR and 5/1,000 person-seasons by microscopy. Urban residents, those with low hemoglobin levels, nonuse of mosquito nets, and proximity to stagnant water had a significantly higher risk of infection (P <0.001). Tailored approaches are needed in elimination-targeted areas, focusing on urban settings, Plasmodium species, and strengthening community-level interventions for behavioral change and active case detection.
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Affiliation(s)
- Eshetu Molla
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- Department of Microbial, Cellular and Molecular Biology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sisay Dugassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lina Alemayehu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | | | | | - Melat Abdo
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | | | | | | | - Hassen Mamo
- Department of Microbial, Cellular and Molecular Biology, Addis Ababa University, Addis Ababa, Ethiopia
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Holzschuh A, Ewnetu Y, Carlier L, Lerch A, Gerlovina I, Baker SC, Yewhalaw D, Haileselassie W, Berhane N, Lemma W, Koepfli C. Plasmodium falciparum transmission in the highlands of Ethiopia is driven by closely related and clonal parasites. Mol Ecol 2024; 33:e17292. [PMID: 38339833 DOI: 10.1111/mec.17292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/28/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
Malaria cases are frequently recorded in the Ethiopian highlands even at altitudes above 2000 m. The epidemiology of malaria in the Ethiopian highlands, and, in particular, the role of importation by human migration from the highly endemic lowlands is not well understood. We sequenced 187 Plasmodium falciparum samples from two sites in the Ethiopian highlands, Gondar (n = 159) and Ziway (n = 28), using a multiplexed droplet digital PCR (ddPCR)-based amplicon sequencing method targeting 35 microhaplotypes and drug resistance loci. Here, we characterize the parasite population structure and genetic relatedness. We identify moderate parasite diversity (mean HE : 0.54) and low infection complexity (74.9% monoclonal). A significant percentage of infections share microhaplotypes, even across transmission seasons and sites, indicating persistent local transmission. We identify multiple clusters of clonal or near-clonal infections, highlighting high genetic relatedness. Only 6.3% of individuals diagnosed with P. falciparum reported recent travel. Yet, in clonal or near-clonal clusters, infections of travellers were frequently observed first in time, suggesting that parasites may have been imported and then transmitted locally. 31.1% of infections are pfhrp2-deleted and 84.4% pfhrp3-deleted, and 28.7% have pfhrp2/3 double deletions. Parasites with pfhrp2/3 deletions and wild-type parasites are genetically distinct. Mutations associated with resistance to sulphadoxine-pyrimethamine or suggested to reduce sensitivity to lumefantrine are observed at near-fixation. In conclusion, genomic data corroborate local transmission and the importance of intensified control in the Ethiopian highlands.
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Affiliation(s)
- Aurel Holzschuh
- Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana, USA
| | - Yalemwork Ewnetu
- Department of Medical Biotechnology, University of Gondar, Gondar, Ethiopia
| | - Lise Carlier
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
- Noul Inc., Seoul, Republic of Korea
| | - Anita Lerch
- Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana, USA
| | - Inna Gerlovina
- Department of Medicine, Division of HIV, ID and Global Medicine, EPPIcenter Research Program, University of California, San Francisco, California, USA
| | - Sarah Cate Baker
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Delenasaw Yewhalaw
- Tropical and Infectious Disease Research Center, Jimma University, Jimma, Ethiopia
| | | | - Nega Berhane
- Department of Medical Biotechnology, University of Gondar, Gondar, Ethiopia
| | - Wossenseged Lemma
- Department of Medical Biotechnology, University of Gondar, Gondar, Ethiopia
| | - Cristian Koepfli
- Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana, USA
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Dabaro D, Birhanu Z, Adissu W, Yilma D, Yewhalaw D. Prevalence and predictors of asymptomatic malaria infection in Boricha District, Sidama Region, Ethiopia: implications for elimination strategies. Malar J 2023; 22:284. [PMID: 37752572 PMCID: PMC10521520 DOI: 10.1186/s12936-023-04722-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Malaria remains a major public health threat in Ethiopia despite the tremendous progress made towards the 2030 elimination targets. The silent transmission of asymptomatic infection is one of the factors that enhance the persistence of the disease as a public health issue and impedes efforts to eliminate malaria. Thus, this study aimed at investigating the prevalence and risk factors of asymptomatic malaria infection in Boricha district, Sidama region of Ethiopia. METHODS A community-based cross-sectional study was conducted in eight selected kebeles (smallest administrative unit) in Boricha district. Representative households were chosen using a multi-stage sampling technique. A total of 573 participants were included in the study. Malaria diagnosis was performed using rapid diagnostic test (RDT) and microscopy. A structured questionnaire was administered to collect socio-demographic information. Epi data 3.1 was employed for data entry, and SPSS version 25 was used for analysis. RESULTS Of the 573 asymptomatic participants tested, 6.1% were found to be positive by RDT and 4.0% by microscopy. Participants aged under 5 years (AOR = 1.57, 95% CI 0.46-5.39) and 5-14 years old (AOR = 2.42, 95% CI 1.08-5.40), Insecticide-treated net utilization (AOR = 8.41; 95% CI 1.09-65.08), travel history (AOR = 6.85, 95% CI 2.32-20.26) and living in a house with windows (AOR = 2.11, 95% CI 1.02-4.36) were significantly associated with the asymptomatic malaria infection. CONCLUSION The findings of this study revealed that prevalence of asymptomatic malaria infection was higher in the study area. As a result, rigorous implementation of existing interventions, such as vector control and anti-malaria drugs, is strongly recommended. In addition, devising new ones that are suited to the contextual situations is highly suggested.
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Affiliation(s)
- Desalegn Dabaro
- Yirgalem Hospital Medical College, Yirgalem, Ethiopia.
- Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia.
| | - Zewdie Birhanu
- Department of Health Education and Behavioral Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Wondimagegn Adissu
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
- Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| | - Daniel Yilma
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
- Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| | - Delenasaw Yewhalaw
- Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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Teka H, Golassa L, Medhin G, Balkew M, Sisay C, Gadisa E, Nekorchuk DM, Wimberly MC, Tadesse FG. Trend analysis of malaria in urban settings in Ethiopia from 2014 to 2019. Malar J 2023; 22:235. [PMID: 37580690 PMCID: PMC10426206 DOI: 10.1186/s12936-023-04656-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/24/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Urbanization generally improves health outcomes of residents and is one of the potential factors that might contribute to reducing malaria transmission. However, the expansion of Anopheles stephensi, an urban malaria vector, poses a threat for malaria control and elimination efforts in Africa. In this paper, malaria trends in urban settings in Ethiopia from 2014 to 2019 are reported with a focus on towns and cities where An. stephensi surveys were conducted. METHODS A retrospective study was conducted to determine malaria trends in urban districts using passive surveillance data collected at health facilities from 2014 to 2019. Data from 25 towns surveyed for An. stephensi were used in malaria trend analysis. Robust linear models were used to identify outliers and impute missing and anomalous data. The seasonal Mann-Kendal test was used to test for monotonic increasing or decreasing trends. RESULTS A total of 9,468,970 malaria cases were reported between 2014 and 2019 through the Public Health Emergency Management (PHEM) system. Of these, 1.45 million (15.3%) cases were reported from urban settings. The incidence of malaria declined by 62% between 2014 and 2018. In 2019, the incidence increased to 15 per 1000 population from 11 to 1000 in 2018. Both confirmed (microscopy or RDT) Plasmodium falciparum (67%) and Plasmodium vivax (28%) were reported with a higher proportion of P. vivax infections in urban areas. In 2019, An. stephensi was detected in 17 towns where more than 19,804 malaria cases were reported, with most of the cases (56%) being P. falciparum. Trend analysis revealed that malaria cases increased in five towns in Afar and Somali administrative regions, decreased in nine towns, and had no obvious trend in the remaining three towns. CONCLUSION The contribution of malaria in urban settings is not negligible in Ethiopia. With the rapid expansion of An. stephensi in the country, the receptivity is likely to be higher for malaria. Although the evidence presented in this study does not demonstrate a direct linkage between An. stephensi detection and an increase in urban malaria throughout the country, An. stephensi might contribute to an increase in malaria unless control measures are implemented as soon as possible. Targeted surveillance and effective response are needed to assess the contribution of this vector to malaria transmission and curb potential outbreaks.
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Affiliation(s)
- Hiwot Teka
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | - Lemu Golassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Meshesha Balkew
- Abt Associate PMI VectorLink Ethiopia Project, Addis Ababa, Ethiopia
| | | | | | - Dawn M Nekorchuk
- Department of Geography and Environmental Sustainability, University of Oklahoma, Norman, USA
| | - Michael C Wimberly
- Department of Geography and Environmental Sustainability, University of Oklahoma, Norman, USA
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Aidoo EK, Aboagye FT, Botchway FA, Osei-Adjei G, Appiah M, Duku-Takyi R, Sakyi SA, Amoah L, Badu K, Asmah RH, Lawson BW, Krogfelt KA. Reactive Case Detection Strategy for Malaria Control and Elimination: A 12 Year Systematic Review and Meta-Analysis from 25 Malaria-Endemic Countries. Trop Med Infect Dis 2023; 8:tropicalmed8030180. [PMID: 36977181 PMCID: PMC10058581 DOI: 10.3390/tropicalmed8030180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
Reactive case detection (RACD) is the screening of household members and neighbors of index cases reported in passive surveillance. This strategy seeks asymptomatic infections and provides treatment to break transmission without testing or treating the entire population. This review discusses and highlights RACD as a recommended strategy for the detection and elimination of asymptomatic malaria as it pertains in different countries. Relevant studies published between January 2010 and September 2022 were identified mainly through PubMed and Google Scholar. Search terms included "malaria and reactive case detection", "contact tracing", "focal screening", "case investigation", "focal screen and treat". MedCalc Software was used for data analysis, and the findings from the pooled studies were analyzed using a fixed-effect model. Summary outcomes were then presented using forest plots and tables. Fifty-four (54) studies were systematically reviewed. Of these studies, 7 met the eligibility criteria based on risk of malaria infection in individuals living with an index case < 5 years old, 13 met the eligibility criteria based on risk of malaria infection in an index case household member compared with a neighbor of an index case, and 29 met the eligibility criteria based on risk of malaria infection in individuals living with index cases, and were included in the meta-analysis. Individuals living in index case households with an average risk of 2.576 (2.540-2.612) were more at risk of malaria infection and showed pooled results of high variation heterogeneity chi-square = 235.600, (p < 0.0001) I2 = 98.88 [97.87-99.89]. The pooled results showed that neighbors of index cases were 0.352 [0.301-0.412] times more likely to have a malaria infection relative to index case household members, and this result was statistically significant (p < 0.001). The identification and treatment of infectious reservoirs is critical to successful malaria elimination. Evidence to support the clustering of infections in neighborhoods, which necessitates the inclusion of neighboring households as part of the RACD strategy, was presented in this review.
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Affiliation(s)
- Ebenezer Krampah Aidoo
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Frank Twum Aboagye
- Biomedical and Public Health Research Unit, Council for Scientific and Industrial Research-Water Research Institute, Accra AH 38, Ghana
| | - Felix Abekah Botchway
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - George Osei-Adjei
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Michael Appiah
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Ruth Duku-Takyi
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, Kwame Nkrumah University of Science & Technology, University Post Office, Kumasi AK 039, Ghana
| | - Linda Amoah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra LG 581, Ghana
| | - Kingsley Badu
- Department of Theoretical & Applied Biology, Kwame Nkrumah University of Science & Technology, University Post Office, Kumasi AK 039, Ghana
| | - Richard Harry Asmah
- Department of Biomedical Sciences, School of Basic and Biomedical Science, University of Health & Allied Sciences, Ho PMB 31, Ghana
| | - Bernard Walter Lawson
- Department of Theoretical & Applied Biology, Kwame Nkrumah University of Science & Technology, University Post Office, Kumasi AK 039, Ghana
| | - Karen Angeliki Krogfelt
- Department of Science and Environment, Unit of Molecular and Medical Biology, The PandemiX Center, Roskilde University, 4000 Roskilde, Denmark
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, 2300 Copenhagen, Denmark
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Huang F, Cui Y, Huang Z, Wang S, Li S, Guo X, Guo X, Xia ZG. Serological surveillance on potential Plasmodium vivax exposure risk in a post-elimination setting. Front Cell Infect Microbiol 2023; 13:1132917. [PMID: 36968112 PMCID: PMC10034364 DOI: 10.3389/fcimb.2023.1132917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
China was declared malaria free in June of 2021. In the post-elimination setting, vigilant surveillance is essential to sustain malaria free status. Serological surveillance has been recognized as an efficient tool for assessing the immunity levels and exposure risk in a population. In this study, a cross-sectional serological survey was conducted in Yingjiang County, China, in August–September, 2021. The study sites were villages along the borders with Myanmar, which have no local transmission since the last indigenous case registered in 2016. A total of 923 participants from six villages were enrolled. The majority was aged > 36 years (56.12%) and 12.46% (115/923) participants had experienced malaria infection at least once. A magnetic- bead-based assay was used to test antibodies against Plasmodium vivax antigen PvMSP-119 to evaluate the prevalence of antibody positive subjects. A reversible catalytic model was used to assess the risk of exposure. The prevalence of anti-PvMSP-119 IgG was 12.84% [95% confidence interval (CI): 9.22%–16.47%], 13.93% (95% CI: 10.11%–17.74%), and 3.57% (95% CI: 1.40%–5.75%) in three different line-of-defense areas, which differed significantly (P < 0.0001). The prevalence of anti-PvMSP-119 IgG increased with age and no statistically significant difference was detected between the sexes. The reversible catalytic model indicated that the seropositive conversion rate and seronegative reversion rate were 0.0042, 0.0034, 0.0032 and 0.0024, 0.0004, 0.0065 in the first-, second-line-of-defense area and total areas, respectively, and the fitted value did not differ significantly from the observed value (P > 0.1). Although this study found the prevalence of antibody-positive subjects and the seroconversion rate in this post-elimination setting were lower than that in transmission setting, the population still had an exposure risk. Serological surveillance should be considered in post-elimination settings to provide valuable information with which to evaluate the risk of malaria re-establishment.
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Affiliation(s)
- Fang Huang
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yanwen Cui
- Division of Tuberculosis Control and Prevention, Shanghai Pudong Center for Disease Control and Prevention, Shanghai, China
| | - Zhuoying Huang
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Siqi Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
- Department of Malaria, Chinese Center for Tropical Diseases Research, Shanghai, China
- NHC Key Laboratory of Parasite and Vector Biology, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
- WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, China
| | - Shigang Li
- Division of Endemic Disease Control and Prevention, Yingjiang County Center for Disease Control and Prevention, Yingjiang, China
| | - Xiangrui Guo
- Division of Endemic Disease Control and Prevention, Yingjiang County Center for Disease Control and Prevention, Yingjiang, China
| | - Xiang Guo
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- *Correspondence: Xiang Guo, ; Zhi-Gui Xia,
| | - Zhi-Gui Xia
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
- Department of Malaria, Chinese Center for Tropical Diseases Research, Shanghai, China
- NHC Key Laboratory of Parasite and Vector Biology, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
- WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, China
- *Correspondence: Xiang Guo, ; Zhi-Gui Xia,
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Wardle J, Bhatia S, Kraemer MUG, Nouvellet P, Cori A. Gaps in mobility data and implications for modelling epidemic spread: A scoping review and simulation study. Epidemics 2023; 42:100666. [PMID: 36689876 DOI: 10.1016/j.epidem.2023.100666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 11/18/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
Reliable estimates of human mobility are important for understanding the spatial spread of infectious diseases and the effective targeting of control measures. However, when modelling infectious disease dynamics, data on human mobility at an appropriate temporal or spatial resolution are not always available, leading to the common use of model-derived mobility proxies. In this study we reviewed the different data sources and mobility models that have been used to characterise human movement in Africa. We then conducted a simulation study to better understand the implications of using human mobility proxies when predicting the spatial spread and dynamics of infectious diseases. We found major gaps in the availability of empirical measures of human mobility in Africa, leading to mobility proxies being used in place of data. Empirical data on subnational mobility were only available for 17/54 countries, and in most instances, these data characterised long-term movement patterns, which were unsuitable for modelling the spread of pathogens with short generation times (time between infection of a case and their infector). Results from our simulation study demonstrated that using mobility proxies can have a substantial impact on the predicted epidemic dynamics, with complex and non-intuitive biases. In particular, the predicted times and order of epidemic invasion, and the time of epidemic peak in different locations can be underestimated or overestimated, depending on the types of proxies used and the country of interest. Our work underscores the need for regularly updated empirical measures of population movement within and between countries to aid the prevention and control of infectious disease outbreaks. At the same time, there is a need to establish an evidence base to help understand which types of mobility data are most appropriate for describing the spread of emerging infectious diseases in different settings.
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Affiliation(s)
- Jack Wardle
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, UK
| | - Sangeeta Bhatia
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, UK
| | | | - Pierre Nouvellet
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, UK; School of Life Sciences, University of Sussex, Brighton, UK
| | - Anne Cori
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, UK.
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Abdalal SA, Yukich J, Andrinopoulos K, Alghanmi M, Wakid MH, Zawawi A, Harakeh S, Altwaim SA, Gattan H, Baakdah F, Gaddoury MA, Niyazi HA, Mokhtar JA, Alruhaili MH, Alsaady I, Alhabbab R, Alfaleh M, Hashem AM, Alahmadey ZZ, Keating J. Livelihood activities, human mobility, and risk of malaria infection in elimination settings: a case-control study. Malar J 2023; 22:53. [PMID: 36782234 PMCID: PMC9926773 DOI: 10.1186/s12936-023-04470-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Livelihood activities and human movements participate in the epidemiology of vector-borne diseases and influence malaria risk in elimination settings. In Saudi Arabia, where malaria transmission intensity varies geographically, it is vital to understand the components driving transmission within specific areas. In addition, shared social, behavioural, and occupational characteristics within communities may provoke the risk of malaria infection. This study aims to understand the relationship between human mobility, livelihood activities, and the risk of malaria infection in the border region of Jazan to facilitate further strategic malaria interventions. In addition, the study will complement and reinforce the existing efforts to eliminate malaria on the Saudi and Yemen border by providing a deeper understanding of human movement and livelihood activities. METHODS An unmatched case-control study was conducted. A total of 261 participants were recruited for the study, including 81 cases of confirmed malaria through rapid diagnostic tests (RDTs) and microscopy and 180 controls in the Baish Governorate in Jazan Provinces, Saudi Arabia. Individuals who received malaria tests were interviewed regarding their livelihood activities and recent movement (travel history). A questionnaire was administered, and the data was captured electronically. STATA software version 16 was used to analyse the data. Bivariate and multivariate analyses were conducted to determine if engaging in agricultural activities such as farming and animal husbandry, recent travel history outside of the home village within the last 30 days and participating in spiritual gatherings were related to malaria infection status. RESULTS A logistical regression model was used to investigate components associated with malaria infection. After adjusting several confounding factors, individuals who reported travelling away from their home village in the last 30 days OR 11.5 (95% CI 4.43-29.9), and those who attended a seasonal night spiritual gathering OR 3.04 (95% CI 1.10-8.42), involved in animal husbandry OR 2.52 (95% CI 1.10-5.82), and identified as male OR 4.57 (95% CI 1.43-14.7), were more likely to test positive for malaria infection. CONCLUSION Human movement and livelihood activities, especially at nighttime, should be considered malaria risk factors in malaria elimination settings, mainly when the targeted area is limited to a confined borderland area.
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Affiliation(s)
- Shaymaa A. Abdalal
- grid.412125.10000 0001 0619 1117Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Joshua Yukich
- grid.265219.b0000 0001 2217 8588School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA USA
| | - Katherine Andrinopoulos
- grid.265219.b0000 0001 2217 8588School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA USA
| | - Maimonah Alghanmi
- grid.412125.10000 0001 0619 1117Vaccines and Immunotherapy Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Majed H. Wakid
- grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ayat Zawawi
- grid.412125.10000 0001 0619 1117Vaccines and Immunotherapy Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Steve Harakeh
- grid.412125.10000 0001 0619 1117King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sarah A. Altwaim
- grid.412125.10000 0001 0619 1117Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hattan Gattan
- grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fadi Baakdah
- grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mahmoud A. Gaddoury
- grid.412125.10000 0001 0619 1117Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatoon A. Niyazi
- grid.412125.10000 0001 0619 1117Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jawahir A. Mokhtar
- grid.412125.10000 0001 0619 1117Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed H. Alruhaili
- grid.412125.10000 0001 0619 1117Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Isra Alsaady
- grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rowa Alhabbab
- grid.412125.10000 0001 0619 1117Vaccines and Immunotherapy Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed Alfaleh
- grid.412125.10000 0001 0619 1117Vaccines and Immunotherapy Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, 21589 Saudi Arabia
| | - Anwar M. Hashem
- grid.412125.10000 0001 0619 1117Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Vaccines and Immunotherapy Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ziab Zakey Alahmadey
- grid.415696.90000 0004 0573 9824Microbiology and Serology Departments, Al-Ansar Hospital, Ministry of Health, Medina, Saudi Arabia
| | - Joseph Keating
- grid.265219.b0000 0001 2217 8588School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA USA
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9
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Abdalal SA, Yukich J, Andrinoplous K, Harakeh S, Altwaim SA, Gattan H, Carter B, Shammaky M, Niyazi HA, Alruhaili MH, Keating J. An insight to better understanding cross border malaria in Saudi Arabia. Malar J 2023; 22:37. [PMID: 36732819 PMCID: PMC9893606 DOI: 10.1186/s12936-023-04467-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 01/23/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Border malaria is a major obstacle for the malaria elimination in Saudi Arabia. Today, the southern border of Saudi Arabia is a region where malaria cases are resurging, and malaria control is dwindling mainly due to the humanitarian crisis and the conflict in Yemen. This study analyses the current border malaria epidemiology along the southern border of Saudi Arabia from 2015 to 2018. METHODS All reported cases maintained by the malaria elimination centres in Aledabi and Baish, Jazan Province, Saudi Arabia, from 2015 to 2018 were analysed to examine the epidemiological changes over time. Pearson's Chi-Square test of differences was utilized to assess differences between the characteristics of imported and local causes and between border cases. A logistic regression model was used to predict imported status was related to living along side of the border area. RESULTS A total of 3210 malaria cases were reported in Baish and Aledabi malaria centres between 2015 and 2018, of which 170 were classified as local cases and 3040 were classified as imported cases. Reported malaria cases were mainly among males, within the imported cases 61.5% (1868/3039) were residents of the border areas. CONCLUSIONS Given the complexity of cross-border malaria, creating a malaria buffer zone that covers a certain margin from both sides of the border would allow for a joint force, cross-border malaria elimination programme. To initiate a malaria elimination activity and cases reported as belonging to this zone, rather than being pushed from one country to the other, would allow malaria elimination staff to work collaboratively with local borderland residents and other stakeholders to come up with innovative solutions to combat malaria and reach malaria-free borders.
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Affiliation(s)
- Shaymaa A. Abdalal
- grid.412126.20000 0004 0607 9688Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Joshua Yukich
- grid.265219.b0000 0001 2217 8588Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
| | - Katherine Andrinoplous
- grid.265219.b0000 0001 2217 8588Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
| | - Steve Harakeh
- Saudi Arabia Ministry of Health, Jazan, Saudi Arabia
| | - Sarah A. Altwaim
- grid.412126.20000 0004 0607 9688Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Hattan Gattan
- grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Brendan Carter
- grid.265219.b0000 0001 2217 8588Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
| | | | - Hatoon A. Niyazi
- grid.412126.20000 0004 0607 9688Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mohammed H. Alruhaili
- grid.412126.20000 0004 0607 9688Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Joseph Keating
- grid.265219.b0000 0001 2217 8588Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
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Tilaye T, Tessema B, Alemu K. High asymptomatic malaria among seasonal migrant workers departing to home from malaria endemic areas in northwest Ethiopia. Malar J 2022; 21:184. [PMID: 35690823 PMCID: PMC9188248 DOI: 10.1186/s12936-022-04211-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 06/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background In Ethiopia, thousands of seasonal migrant workers travel from non-malaria or mild malaria transmission areas to malaria-endemic areas for seasonal farm activities. Most of these migrants stay in the farm areas for land preparation, plowing, planting, weeding, and harvesting for a specific period and return to their living areas. However, there is limited evidence of how seasonal migrant workers contribute to the transmission of malaria to new or less malaria transmission areas. Methods A cross-sectional study was conducted at the departure phase of seasonal migrant workers in the Metema district from September 2018 to October 2019. A total of 1208 seasonal migrant workers were interviewed during their departure from farm sites to their homes. The face-to-face interviews were performed using a pretested structured questionnaire. Moreover, blood samples were collected from each study participant for microscopic malaria parasite examination. The data were fitted with the logistic regression model to estimate the predictors of malaria transmission. Results At departure to home, the prevalence of malaria among seasonal migrant workers was 17.5% (15.6–19.45%). Approximately 71.80% (177/212) of the cases were Plasmodium falciparum, and 28.20% (35/212) were Plasmodium vivax. Most seasonal migrant workers 934 (77.4%) were from rural residences and highlanders 660 (55%). Most 661 (55.4%) of the migrants visited two and more farm sites during their stay at development corridors for harvesting activities. Approximately 116 (54.7%) asymptomatic malaria cases returned to the Dembia 46 (21.7%), Chilaga 46 (19.8%) and Metema 28 (13.2%) districts. Conclusion In this study, asymptomatic malaria remains high among seasonal migrant workers departing to home from malaria endemic areas. This may fuel a resurgence of malaria transmission in the high lands and cause challenges to the country's malaria prevention and elimination efforts. Hence, tailored interventions for seasonal migrant workers could be in place to enhance malaria control and elimination in Ethiopia, such as asymptomatic malaria test and treat positive cases at departure and transit, and integration between malaria officers at their origin and departure for further follow-up to decrease any risk of spread at the origin.
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Affiliation(s)
- Tesfaye Tilaye
- Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Belay Tessema
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
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11
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Factors related to long-lasting insecticidal net (LLIN) use during travel in western Kenya: A descriptive analysis. Travel Med Infect Dis 2022; 47:102291. [DOI: 10.1016/j.tmaid.2022.102291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 11/20/2022]
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12
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Dunning J, Aung NKZ, Ward A, Aye MM, Lourenço C, Gallalee S, Lavenberg S, Le Menach A, Tun MM, Thi A. Key factors associated with malaria infection among patients seeking care through the public sector in endemic townships of Ayeyarwady Region, Myanmar. Malar J 2022; 21:86. [PMID: 35292042 PMCID: PMC8922824 DOI: 10.1186/s12936-022-04088-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ayeyarwady Region in Myanmar has made significant progress towards malaria elimination, with cases decreasing from 12,312 in 2015 to 122 in 2019. As transmission declines, malaria becomes increasingly focalized both in geographic hotspots and among population groups sharing certain risk factors. Developing a thorough profile of high-risk activities associated with malaria infections is critical to ensure intervention approaches are evidence-based. Methods A test-negative study was conducted from September 2017 to May 2018 in Ngaputaw, Pathein and Thabaung townships in Ayeyarwady Region. Patients that presented to selected public facilities or community health volunteers with fever answered survey questions on demographic and behavioural risk factors, including exposure to malaria interventions, and were assigned to case and control groups based on the result of a malaria rapid diagnostic test. A random-effects logistic regression model adjusted for clustering at the facility level, as well as any variables along the causal pathway described by a directed acyclic graph, was used to determine odds ratios and association with malaria infections. Results A total of 119 cases and 1744 controls were recruited from 41 public facilities, with a mean age of 31.3 and 63.7% male. Higher risk groups were identified as males (aOR 1.8, 95% CI 1.2–2.9) and those with a worksite located within the forest (aOR 2.8, 95% CI 1.4–5.3), specifically working in the logging (aOR 2.7, 95% CI 1.5–4.6) and rubber plantation (aOR 3.0, 95% CI 1.4–6.8) industries. Additionally, links between forest travel and malaria were observed, with risk factors identified to be sleeping in the forest within the past month (aOR 2.6, 95% CI 1.1–6.3), and extended forest travel with durations from 3 to 14 days (aOR 8.6, 95% CI 3.5–21.4) or longer periods (aOR 8.4, 95% CI 3.2–21.6). Conclusion Malaria transmission is highly focalized in Ayeyarwady, and results illustrate the need to target interventions to the most at-risk populations of working males and forest goers. It will become increasingly necessary to ensure full intervention coverage of at-risk populations active in forested areas as Myanmar moves closer to malaria elimination goals. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04088-8.
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Affiliation(s)
| | | | - Abigail Ward
- Clinton Health Access Initiative, Boston, MA, USA
| | - Moe Moe Aye
- Clinton Health Access Initiative, Yangon, Myanmar
| | | | | | | | | | - Myat Min Tun
- Myanmar Vector Borne Disease Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aung Thi
- Myanmar Vector Borne Disease Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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13
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Alanazi A, Almusailhi BAH, Bamousa GK, Alhawashim NH, Alotaibi NM, AlShamekh S, Hunasemarada BC, Al Jindan RY, El-Badry AA. A decade of travel-associated malaria at King Fahad Hospital of the University in the Eastern Province of Saudi Arabia. Sci Rep 2022; 12:966. [PMID: 35046454 PMCID: PMC8770622 DOI: 10.1038/s41598-022-04996-4] [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: 06/02/2021] [Accepted: 01/05/2022] [Indexed: 11/09/2022] Open
Abstract
Travel-associated malaria is a health hazard, even in non-malaria endemic regions. This is a hospital-based retrospective study of 12,931 febrile patients who presented at King Fahad Hospital of the University (KFHU) from January 2009 to December 2019. Patients either returning from malaria endemic countries and/or for whom malaria was suspected, had blood films microscopically screened for malaria parasites. Malaria prevalence was very low in febrile patients attending KFHU. Out of the 12,931 febrile patients, 0.63% (n = 81) were malaria positive, all travel-related, except for one case of transfusion malaria. Indian nationals were the most infected (29.6%, n = 24), followed by Sudanese nationals (24.7%, n = 20). P. falciparum (47%, n = 38) and P. vivax (42%, n = 24) were the predominant species. The majority of P. falciparum (64.5%, n = 20) cases were from African nationals and the majority of P. vivax (72.7%, n = 24) cases were from Asia. The highest percentage of malaria patients were adult (90%, n = 73), males (85.2%, n = 69), ages ranged from 6 to 65, with a mean of 34.6 years. Most of the malaria cases presented at the emergency room (ER), only 3 required critical care. Only sex, hospitalized in-patient (IP) and attendance at ER were statistically associated with malaria. In the presence of a potential vector, travel-associated malaria in non-malaria endemic areas should be monitored to guide control strategies. Author summary: Malaria is a neglected potentially fatal tropical mosquito-born disease. Travel-associated malaria is a health hazard, even in non-malaria endemic regions. In spite of previous efforts to estimate malaria prevalence, morbidity and mortality in Saudi Arabia in the last decade, there have been no studies that determine the prevalence of malaria in Al-Khobar, Eastern Province of Saudi Arabia. Malaria prevalence was very low in febrile patients (81/12,931) attending King Fahad Hospital of the University over a decade. Cases were all travel-related, except for one case of transfusion malaria. Indian nationals were the most infected (29.6%), followed by Sudanese nationals (24.7%). P. falciparum (47%) and P. vivax (42%) were the predominant species. The majority of P. falciparum (64.5%) cases were from Africa and the majority of P. vivax (72.7%) cases were from Asia. No patient factors predicted malaria in febrile travelers. In non-malaria endemic areas, in the presence of a potential vector, patients with acute fever coming from endemic areas or having received blood transfusion, should be screened for travel-associated malaria to guide control strategies.
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Affiliation(s)
- Ashwaq Alanazi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Gheed K Bamousa
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nabaa H Alhawashim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nourah M Alotaibi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sumiyah AlShamekh
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Reem Y Al Jindan
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ayman A El-Badry
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
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McMahon A, Mihretie A, Ahmed AA, Lake M, Awoke W, Wimberly MC. Remote sensing of environmental risk factors for malaria in different geographic contexts. Int J Health Geogr 2021; 20:28. [PMID: 34120599 PMCID: PMC8201719 DOI: 10.1186/s12942-021-00282-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/03/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite global intervention efforts, malaria remains a major public health concern in many parts of the world. Understanding geographic variation in malaria patterns and their environmental determinants can support targeting of malaria control and development of elimination strategies. METHODS We used remotely sensed environmental data to analyze the influences of environmental risk factors on malaria cases caused by Plasmodium falciparum and Plasmodium vivax from 2014 to 2017 in two geographic settings in Ethiopia. Geospatial datasets were derived from multiple sources and characterized climate, vegetation, land use, topography, and surface water. All data were summarized annually at the sub-district (kebele) level for each of the two study areas. We analyzed the associations between environmental data and malaria cases with Boosted Regression Tree (BRT) models. RESULTS We found considerable spatial variation in malaria occurrence. Spectral indices related to land cover greenness (NDVI) and moisture (NDWI) showed negative associations with malaria, as the highest malaria rates were found in landscapes with low vegetation cover and moisture during the months that follow the rainy season. Climatic factors, including precipitation and land surface temperature, had positive associations with malaria. Settlement structure also played an important role, with different effects in the two study areas. Variables related to surface water, such as irrigated agriculture, wetlands, seasonally flooded waterbodies, and height above nearest drainage did not have strong influences on malaria. CONCLUSION We found different relationships between malaria and environmental conditions in two geographically distinctive areas. These results emphasize that studies of malaria-environmental relationships and predictive models of malaria occurrence should be context specific to account for such differences.
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Affiliation(s)
- Andrea McMahon
- Department of Geography and Environmental Sustainability, University of Oklahoma, Norman, OK USA
| | - Abere Mihretie
- Health, Development, and Anti-Malaria Association, Addis Ababa, Ethiopia
| | - Adem Agmas Ahmed
- Malaria Control and Elimination Partnership in Africa, Bahir Dar, Ethiopia
| | | | - Worku Awoke
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Michael Charles Wimberly
- Department of Geography and Environmental Sustainability, University of Oklahoma, Norman, OK USA
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15
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Tilaye T, Tessema B, Alemu K. Malaria Infection is High at Transit and Destination Phases Among Seasonal Migrant Workers in Development Corridors of Northwest Ethiopia: A Repeated Cross-Sectional Study. Res Rep Trop Med 2021; 12:107-121. [PMID: 34079425 PMCID: PMC8165298 DOI: 10.2147/rrtm.s306001] [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: 02/15/2021] [Accepted: 04/24/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose Malaria is a leading public health problem in Ethiopia. Every year, thousands of seasonal farm workers travel to farm corridors in Northwest Ethiopia and fall at risk of malaria infection. However, the magnitude of malaria infection and risk factors during harvest time were not well identified. This study aimed at estimating the prevalence and risk factors of malaria infection among seasonal migrant workers in Northwest Ethiopia. Methods A repeated cross-sectional study was conducted at transit and destination phases in Metema district from September 15, 2018 to October 30, 2019. Data were collected using a structured questionnaire. A capillary blood sample was collected to examine infection with malaria parasite using a microscope. A multivariate logistic regression technique was used to determine risk factors. Results The malaria prevalence at transit and destination phases among migrant workers was 13.5% (95% CI: 12.07–14.93%) and 18.7% (95% CI: 16.40–21.02%), respectively. The combined prevalence was 16.1% (95% CI: 14.67–17.63%). The odds of malaria infection among migrant workers at the destination phase was 1.5 (OR=1.5, 95% CI 1.167–1.846) times higher compared to the transit phase. Education (AOR=8.198; 95% CI: 4.318–15.564), knowledge of antimalarial drugs (AOR=2.4; 95% CI: 1.43–3.95), and use of long-lasting insecticidal nets (AOR=5.0; 95% CI: 3.34–4.43) were significantly associated with malaria infection at migration phases. Conclusion This study showed that the burden of malaria among seasonal migrant workers was high at transit and destination phases. Malaria prevalence was higher at the destination phase compared to the transit phase. A tailored malaria prevention intervention is needed including awareness creation, screening, treatment, repellent, and prophylaxis at both phases to reduce malaria infections.
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Affiliation(s)
- Tesfaye Tilaye
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belay Tessema
- Department of Medical Microbiology, School of Biomedical and Medical Laboratory, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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16
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Tadesse Y, Irish SR, Chibsa S, Dugassa S, Lorenz LM, Gebreyohannes A, Teka H, Solomon H, Gezahegn E, Petros Y, Haile M, Eshetu M, Murphy M. Malaria prevention and treatment in migrant agricultural workers in Dangur district, Benishangul-Gumuz, Ethiopia: social and behavioural aspects. Malar J 2021; 20:224. [PMID: 34011347 PMCID: PMC8135166 DOI: 10.1186/s12936-021-03766-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sixty percent of the Ethiopia population is at risk of malaria, with the highest prevalence reported in Gambella (6%) and Benishangul-Gumuz (3%) regions. Within these regions are large agricultural developments with high numbers of seasonal migrant workers. The migrant workers are believed to be at increased risk for malaria infection due to their poor living conditions and outdoor activities, but there is little information on their specific behaviours and health risks. This study was conducted to address this gap. METHODS Quantitative observations were conducted from September to December 2017 in the Benishangul-Gumuz Region. The nightly routines of mobile migrant workers were observed every month for 4 consecutive months. The study team collected quantitative data including nocturnal behavioural observations of worker living conditions, malaria prevention efforts, and work activities and surveys of worker representatives. Qualitative data was collected from migrant workers, farm managers and local health providers using focus group discussions and semi-structured interviews. RESULTS Migrant workers arrived in the study area during the peak malaria transmission season and the workers in focus groups reported repeated cases of malaria during their stay on the farms. Overall, less than a quarter of the migrant workers were sleeping under a mosquito net by midnight in all 4 observation months. Some work activities also took place outdoors at night. The study additionally found a lack of access to malaria prevention and treatment at the farms and challenges in utilizing local public health facilities. CONCLUSIONS There is a need to better address malaria prevention and treatment needs among migrant workers in Ethiopia through outreach from existing healthcare infrastructure and within the farms themselves. This will help prevent malaria transmission both within this population and prevent transmission of malaria back to home communities in lower burden areas in Ethiopia.
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Affiliation(s)
- Yehualashet Tadesse
- USAID
- Private Health Sector Project, Abt Associates Inc., Addis Ababa, Ethiopia.
| | - Seth R Irish
- The US President's Malaria Initiative, Bureau for Global Health, Office of Infectious Disease, United States Agency for International Development, 1300 Pennsylvania Ave NW, Washington, DC, 20523, USA.,Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329-4027, USA
| | - Sheleme Chibsa
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329-4027, USA.,U.S. Agency for International Development (USAID), Entoto Street, Addis Ababa, Ethiopia
| | - Sisay Dugassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lena M Lorenz
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,College of Medicine & Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Hiwot Teka
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329-4027, USA.,U.S. Agency for International Development (USAID), Entoto Street, Addis Ababa, Ethiopia
| | - Hiwot Solomon
- Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Eshetu Gezahegn
- USAID
- Private Health Sector Project, Abt Associates Inc., Addis Ababa, Ethiopia
| | - Yonas Petros
- USAID
- Private Health Sector Project, Abt Associates Inc., Addis Ababa, Ethiopia
| | - Mesfin Haile
- USAID
- Private Health Sector Project, Abt Associates Inc., Addis Ababa, Ethiopia
| | - Mesfin Eshetu
- USAID
- Private Health Sector Project, Abt Associates Inc., Addis Ababa, Ethiopia
| | - Matthew Murphy
- The US President's Malaria Initiative, Bureau for Global Health, Office of Infectious Disease, United States Agency for International Development, 1300 Pennsylvania Ave NW, Washington, DC, 20523, USA.,Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329-4027, USA
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17
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Rios-Zertuche D, Carter KH, Harris KP, Thom M, Zúñiga-Brenes MP, Bernal-Lara P, González-Marmol Á, Johanns CK, Hernández B, Palmisano E, Cogen R, Naik P, El Bcheraoui C, Smith DL, Mokdad AH, Iriarte E. Performance of passive case detection for malaria surveillance: results from nine countries in Mesoamerica and the Dominican Republic. Malar J 2021; 20:208. [PMID: 33931091 PMCID: PMC8085801 DOI: 10.1186/s12936-021-03645-x] [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: 10/06/2020] [Accepted: 02/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background In malaria elimination settings, available metrics for malaria surveillance have been insufficient to measure the performance of passive case detection adequately. An indicator for malaria suspected cases with malaria test (MSCT) is proposed to measure the rate of testing on persons presenting to health facilities who satisfy the definition of a suspected malaria case. This metric does not rely on prior knowledge of fever prevalence, seasonality, or external denominators, and can be used to compare detection rates in suspected cases within and between countries, including across settings with different levels of transmission. Methods To compute the MSCT, an operational definition for suspected malaria cases was established, including clinical and epidemiological criteria. In general, suspected cases included: (1) persons with fever detected in areas with active malaria transmission; (2) persons with fever identified in areas with no active transmission and travel history to, or residence in areas with active transmission (either national or international); and (3) persons presenting with fever, chills and sweating from any area. Data was collected from 9 countries: Belize, Colombia (in areas with active transmission), Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, and Panama (September–March 2020). A sample of eligible medical records for 2018 was selected from a sample of health facilities in each country. An algorithm was constructed to assess if a malaria test was ordered or performed for cases that met the suspected case definition. Results A sample of 5873 suspected malaria cases was obtained from 239 health facilities. Except for Nicaragua and Colombia, malaria tests were requested in less than 10% of all cases. More cases were tested in areas with active transmission than areas without cases. Travel history was not systematically recorded in any country. Conclusions A statistically comparable, replicable, and standardized metric was proposed to measure suspected malaria cases with a test (microscopy or rapid diagnostic test) that enables assessing the performance of passive case detection. Cross-country findings have important implications for malaria and infectious disease surveillance, which should be promptly addressed as countries progress towards malaria elimination. Local and easy-to-implement tools could be implemented to assess and improve passive case detection.
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Affiliation(s)
- Diego Rios-Zertuche
- Regional Malaria Elimination Initiative, Inter-American Development Bank, DC, Washington, USA.
| | - Keith H Carter
- Regional Malaria Elimination Initiative, Inter-American Development Bank, DC, Washington, USA
| | - Katie Panhorst Harris
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Max Thom
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Pedro Bernal-Lara
- Regional Malaria Elimination Initiative, Inter-American Development Bank, DC, Washington, USA
| | - Álvaro González-Marmol
- Regional Malaria Elimination Initiative, Inter-American Development Bank, Panama City, Panama
| | - Casey K Johanns
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Bernardo Hernández
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin Palmisano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Rebecca Cogen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Paulami Naik
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - David L Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Emma Iriarte
- Regional Malaria Elimination Initiative, Inter-American Development Bank, DC, Washington, USA
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18
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Argaw MD, Woldegiorgis AG, Workineh HA, Akelom BA, Abebe ME, Abate DT, Ashenafi EG. Access to malaria prevention and control interventions among seasonal migrant workers: A multi-region formative assessment in Ethiopia. PLoS One 2021; 16:e0246251. [PMID: 33621245 PMCID: PMC7901780 DOI: 10.1371/journal.pone.0246251] [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: 06/17/2020] [Accepted: 01/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mobile or seasonal migrant workers are at increased risk for acquiring malaria infections and can be the primary source of malaria reintroduction into receptive areas. The aim of this formative assessment was to describe access to malaria prevention and control interventions among seasonal migrant or mobile workers in seven regional states of Ethiopia. METHODS A cross-sectional formative assessment was conducted using a qualitative and quantitative mixed-method design, between October 2015 and October 2016. Quantitative data were collected from organizations that employ seasonal migrant workers and were analyzed using Microsoft Excel and ArcGIS 10.8 (Geo-spatial data). Qualitative data were collected using in-depth interview from 23 key informants (7 seasonal migrant workers, and 16 experts and managers of development projects who had hired seasonal migrant workers), which were recorded, transcribed, translated, coded, and thematically analyzed. RESULTS There were 1,017,888 seasonal migrant workers employed in different developmental organizations including large-scale crop cultivating farms, sugar cane plantations, horticulture, road and house construction work, and gold mining and panning. Seasonal migrant workers' housing facilities were poorly structured and overcrowded (30 people living per 64 square meter room) limiting the use of indoor residual spraying (IRS), and forcing seasonal migrant workers not to use long lasting insecticidal treated nets (LLINs). Seasonal migrant workers are engaged in nighttime activities when employment includes watering farmlands, harvesting sesame, and transporting sugar cane from the field to factories. Despite such high-risk living conditions, access and utilization of preventive and curative services by the seasonal workers were limited. Informal migrant worker employment systems by development organizations and inadequate technical and financial support coupled with poor supply chain management limited the planning and delivery of malaria prevention and treatment strategies targeting seasonal migrant workers. CONCLUSIONS Seasonal migrant workers in seven regions of Ethiopia were at substantial risk of acquiring malaria. Existing malaria prevention, control and management interventions were inadequate. This will contribute to the resurgence of outbreaks of malaria in areas where transmission has been lowered. A coordinated action is needed among all stakeholders to identify the size of seasonal migrant workers and develop and implement a comprehensive strategy to address their healthcare needs.
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Affiliation(s)
- Mesele Damte Argaw
- USAID Private Health Sector Project, Abt Associates Inc., Addis Ababa, Ethiopia
| | | | | | | | - Mesfin Eshetu Abebe
- USAID Private Health Sector Project, Abt Associates Inc., Addis Ababa, Ethiopia
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19
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Demissie GD, Ayele TA, Wami SD, Sisay MM, Fetene D, Wolde HF, Akalu TY, Gelaye KA. Low practice of malaria prevention among migrants and seasonal farmworkers in Metema and west Armacheho districts, Northwest Ethiopia. BMC Infect Dis 2021; 21:145. [PMID: 33541286 PMCID: PMC7863355 DOI: 10.1186/s12879-021-05853-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More than hundreds and thousands of migrants and seasonal farm workers move from the highlands (relatively low malaria endemicity areas) to the lowlands (higher malaria endemicity areas) for the development of the corridor of the Amhara region during planting, weeding, and harvesting seasons in each year. Seasonal migrant workers are at high risk of malaria infection. Therefore, evidence of their knowledge level and practice in the prevention of malaria during their stay would be important. OBJECTIVE The aims of this study was to assess the knowledge and practice of malaria prevention and associated factors among migrants and seasonal farm workers in Northwest Ethiopia. METHOD A cross-sectional study was conducted from October to November, 2018 in Metema and West Armacheho districts, northwest Ethiopia. A sample of about 950 migrants and seasonal farm workers were included using two stages of cluster sampling technique. Interview administered structured questionnaire was used. Both bi-variable and multivariable binary logistic regressions were applied to identify predictors of malaria prevention. RESULT The overall good knowledge of malaria (those participants who scored more than 60% of correct response for knowledge related questions) was 50.2% with 95% CI (47.0-53.0) and the overall good practice of malaria (those participants who practiced more than 60% for practice related questions) was 27.2% with 95% CI (244.3-29.9). Age (AOR = 0.51(95%CI; 0.33-0.80)), level of education (AOR = 0.55(95%CI; 0.32-0.94)), using mass media as a source of information (AOR = 2.25(95%CI; 1.52-3.32)) and length of stay at the farming site (AOR = 0.59(95%CI; 0.44-0.79)) were significantly associated with knowledge of malaria prevention. Knowledge (AOR = 6.62(95%CI; 4.46-9.83)), attitude (AOR = 2.17(95%CI1.40-3.37), use of mass media (AOR = 1.64(95%CI; 1.30-2.60)) and the length of stay (AOR = 1.93(95%CI; 1.35-2.77)) in the farming area were significantly associated with practice of malaria prevention. CONCLUSION The practice of malaria prevention among migrant and seasonal farm workers was low. The programmers and implementers should design tailored malaria intervention programs and strategies for these hard to reach population.
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Affiliation(s)
- Getu Debalkie Demissie
- Department of Health Education and Behavioral Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Sintayehu Daba Wami
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Destaw Fetene
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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20
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Arinaitwe E, Nankabirwa JI, Krezanoski P, Rek J, Kamya V, Epstein A, Rosenthal PJ, Drakeley C, Kamya MR, Dorsey G, Staedke SG. Association between recent overnight travel and use of long-lasting insecticidal nets in rural Uganda: a prospective cohort study in Tororo. Malar J 2020; 19:405. [PMID: 33176793 PMCID: PMC7661187 DOI: 10.1186/s12936-020-03475-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/31/2020] [Indexed: 11/25/2022] Open
Abstract
Background The burden of malaria in Uganda remains high, but has become increasingly heterogenous following intensified malaria control. Travel within Uganda is recognized as a risk factor for malaria, but behaviours associated with travel are not well-understood. To address this knowledge gap, malaria-relevant behaviours of cohort participants were assessed during travel and at home in Uganda. Methods Residents from 80 randomly selected households in Nagongera sub-county, Tororo district were enrolled into a cohort to study malaria in rural Uganda. All participants were given long-lasting insecticidal nets (LLINs) at enrolment and were evaluated every 4 weeks at the study clinic. Participants were asked if they had travelled overnight from their home, and if so, a questionnaire was administered to capture information on travel details and behaviours. Behaviour while travelling was assessed within 4 weeks following travel during the study clinic visit. Behaviour while at home was assessed using a similar questionnaire during two-weekly home visits. Behaviours while travelling vs at home were compared using log binomial regression models with generalized estimating equations adjusting for repeated measures in the same individual. Analysis of factors associated with LLIN adherence, such as destination and duration of travel, time to bed during travel, gender and age at time of travel, were assessed using log binomial regression models with generalized estimating equations adjusting for repeated measures in the same individual. Results Between October 2017 and October 2019, 527 participants were enrolled and assessed for travel. Of these, 123 (23.2%) reported taking 211 overnight trips; 149 (70.6%) trips were within Tororo. Participants were less likely to use LLINs when travelling than when at home (41.0% vs. 56.2%, relative risk [RR] 0.73, 95% CI 0.60–0.89, p = 0.002); this difference was noted for women (38.8% vs 59.2%, RR 0.66, 95% CI 0.52–0.83, p = 0.001) but not men (48.3% vs 46.6%, RR 0.96, 95% CI 0.67–1.40, p = 0.85). In an adjusted analysis, factors associated with LLIN use when travelling included destination (travelling to districts not receiving indoor residual spraying [IRS] 65.8% vs Tororo district 32.2%, RR 1.80, 95% CI 1.31–2.46, p < 0.001) and duration of travel (> 7 nights 60.3% vs one night 24.4%, RR 1.97, 95% CI 1.07–3.64, p = 0.03). Conclusions Travellers, particularly women, were less likely to use LLINs when travelling than when at home. LLIN adherence was higher among those who travelled to non-IRS districts and for more than 1 week, suggesting that perceived malaria risk influences LLIN use. Strategies are needed to raise awareness of the importance of using LLINs while travelling.
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Affiliation(s)
- Emmanuel Arinaitwe
- London School of Hygiene and Tropical Medicine, London, UK. .,Infectious Diseases Research Collaboration, Kampala, Uganda.
| | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University, Kampala, Uganda
| | - Paul Krezanoski
- Department of Medicine, University of California, San Francisco, CA, USA
| | - John Rek
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Victor Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Adrienne Epstein
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Philip J Rosenthal
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, CA, USA
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21
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Porter TR, Finn TP, Silumbe K, Chalwe V, Hamainza B, Kooma E, Moonga H, Bennett A, Yukich JO, Steketee RW, Keating J, Miller JM, Eisele TP. Recent Travel History and Plasmodium falciparum Malaria Infection in a Region of Heterogenous Transmission in Southern Province, Zambia. Am J Trop Med Hyg 2020; 103:74-81. [PMID: 32618250 PMCID: PMC7416974 DOI: 10.4269/ajtmh.19-0660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
As Zambia continues to reduce its malaria incidence and target elimination in Southern Province, there is a need to identify factors that can reintroduce parasites and sustain malaria transmission. To examine the relative contributions of types of human mobility on malaria prevalence, this analysis quantifies the proportion of the population having recently traveled during both peak and nonpeak transmission seasons over the course of 2 years and assesses the relationship between short-term travel and malaria infection status. Among all residents targeted by mass drug administration in the Lake Kariba region of Southern Province, 602,620 rapid diagnostic tests and recent travel histories were collected during four campaign rounds occurring between December 2014 and February 2016. Rates of short-term travel in the previous 2 weeks fluctuated seasonally from 0.3% to 1.2%. Travel was significantly associated with prevalent malaria infection both seasonally and overall (adjusted odds ratio [AOR]: 2.55; 95% CI: 2.28-2.85). The strength of association between travel and malaria infection varied by travelers' origin and destination, with those recently traveling to high-prevalence areas from low-prevalence areas experiencing the highest odds of malaria infection (AOR: 7.38). Long-lasting insecticidal net usage while traveling was associated with a relative reduction in infections (AOR: 0.74) compared with travelers not using a net. Although travel was directly associated with only a small fraction of infections, importation of malaria via human movement may play an increasingly important role in this elimination setting as transmission rates continue to decline.
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Affiliation(s)
- Travis R Porter
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Timothy P Finn
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Kafula Silumbe
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
| | - Victor Chalwe
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Busiku Hamainza
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Emmanuel Kooma
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Hawela Moonga
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California
| | - Joshua O Yukich
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Joseph Keating
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - John M Miller
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
| | - Thomas P Eisele
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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22
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Ahmed S, Reithinger R, Kaptoge SK, Ngondi JM. Travel Is a Key Risk Factor for Malaria Transmission in Pre-Elimination Settings in Sub-Saharan Africa: A Review of the Literature and Meta-Analysis. Am J Trop Med Hyg 2020; 103:1380-1387. [PMID: 32815497 PMCID: PMC7543864 DOI: 10.4269/ajtmh.18-0456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
By sustaining transmission or causing malaria outbreaks, imported malaria undermines malaria elimination efforts. Few studies have examined the impact of travel on malaria epidemiology. We conducted a literature review and meta-analysis of studies investigating travel as a risk factor for malaria infection in sub-Saharan Africa using PubMed. We identified 22 studies and calculated a random-effects meta-analysis pooled odds ratio (OR) of 3.77 (95% CI: 2.49–5.70), indicating that travel is a significant risk factor for malaria infection. Odds ratios were particularly high in urban locations when travel was to rural areas, to more endemic/high transmission areas, and in young children. Although there was substantial heterogeneity in the magnitude of association across the studies, the pooled estimate and directional consistency support travel as an important risk factor for malaria infection.
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Affiliation(s)
- Sundus Ahmed
- Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | | | - Stephen K Kaptoge
- Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
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23
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Daniels RF, Schaffner SF, Dieye Y, Dieng G, Hainsworth M, Fall FB, Diouf CN, Ndiop M, Cisse M, Gueye AB, Sarr O, Guinot P, Deme AB, Bei AK, Sy M, Thwing J, MacInnis B, Earle D, Guinovart C, Sene D, Hartl DL, Ndiaye D, Steketee RW, Wirth DF, Volkman SK. Genetic evidence for imported malaria and local transmission in Richard Toll, Senegal. Malar J 2020; 19:276. [PMID: 32746830 PMCID: PMC7397603 DOI: 10.1186/s12936-020-03346-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/25/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Malaria elimination efforts can be undermined by imported malaria infections. Imported infections are classified based on travel history. METHODS A genetic strategy was applied to better understand the contribution of imported infections and to test for local transmission in the very low prevalence region of Richard Toll, Senegal. RESULTS Genetic relatedness analysis, based upon molecular barcode genotyping data derived from diagnostic material, provided evidence for both imported infections and ongoing local transmission in Richard Toll. Evidence for imported malaria included finding that a large proportion of Richard Toll parasites were genetically related to parasites from Thiès, Senegal, a region of moderate transmission with extensive available genotyping data. Evidence for ongoing local transmission included finding parasites of identical genotype that persisted across multiple transmission seasons as well as enrichment of highly related infections within the households of non-travellers compared to travellers. CONCLUSIONS These data indicate that, while a large number of infections may have been imported, there remains ongoing local malaria transmission in Richard Toll. These proof-of-concept findings underscore the value of genetic data to identify parasite relatedness and patterns of transmission to inform optimal intervention selection and placement.
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Affiliation(s)
- Rachel F. Daniels
- grid.38142.3c000000041936754XHarvard T.H. Chan School of Public Health, Boston, MA USA ,grid.66859.34Broad Institute, Cambridge, MA USA
| | | | | | | | | | - Fatou B. Fall
- Senegal National Malaria Control Programme, Dakar, Senegal
| | | | - Medoune Ndiop
- Senegal National Malaria Control Programme, Dakar, Senegal
| | | | | | - Oumar Sarr
- Senegal National Malaria Control Programme, Dakar, Senegal
| | | | - Awa B. Deme
- Dantec Teaching and Research Hospital, Dakar, Senegal
| | - Amy K. Bei
- grid.38142.3c000000041936754XHarvard T.H. Chan School of Public Health, Boston, MA USA
| | - Mouhamad Sy
- Dantec Teaching and Research Hospital, Dakar, Senegal
| | - Julie Thwing
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | | | | | - Doudou Sene
- Senegal National Malaria Control Programme, Dakar, Senegal
| | - Daniel L. Hartl
- grid.38142.3c000000041936754XHarvard University, Cambridge, MA USA
| | - Daouda Ndiaye
- grid.8191.10000 0001 2186 9619Cheikh Anta Diop University, Dakar, Senegal
| | | | - Dyann F. Wirth
- grid.38142.3c000000041936754XHarvard T.H. Chan School of Public Health, Boston, MA USA ,grid.66859.34Broad Institute, Cambridge, MA USA
| | - Sarah K. Volkman
- grid.38142.3c000000041936754XHarvard T.H. Chan School of Public Health, Boston, MA USA ,grid.66859.34Broad Institute, Cambridge, MA USA ,grid.28203.3b0000 0004 0378 6053Simmons University, Boston, MA USA
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24
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Druetz T, Stresman G, Ashton RA, van den Hoogen LL, Joseph V, Fayette C, Monestime F, Hamre KE, Chang MA, Lemoine JF, Drakeley C, Eisele TP. Programmatic options for monitoring malaria in elimination settings: easy access group surveys to investigate Plasmodium falciparum epidemiology in two regions with differing endemicity in Haiti. BMC Med 2020; 18:141. [PMID: 32571323 PMCID: PMC7310408 DOI: 10.1186/s12916-020-01611-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/29/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND As in most eliminating countries, malaria transmission is highly focal in Haiti. More granular information, including identifying asymptomatic infections, is needed to inform programmatic efforts, monitor intervention effectiveness, and identify remaining foci. Easy access group (EAG) surveys can supplement routine surveillance with more granular information on malaria in a programmatically tractable way. This study assessed how and which type of venue for EAG surveys can improve understanding malaria epidemiology in two regions with different transmission profiles. METHODS EAG surveys were conducted within the departments of Artibonite and Grand'Anse (Haiti), in regions with different levels of transmission intensity. Surveys were conducted in three venue types: primary schools, health facilities, and churches. The sampling approach varied accordingly. Individuals present at the venues at the time of the survey were eligible whether they presented malaria symptoms or not. The participants completed a questionnaire and were tested for Plasmodium falciparum by a highly sensitive rapid diagnostic test (hsRDT). Factors associated with hsRDT positivity were assessed by negative binomial random-effects regression models. RESULTS Overall, 11,029 individuals were sampled across 39 venues in Artibonite and 41 in Grand'Anse. The targeted sample size per venue type (2100 in Artibonite and 2500 in Grand'Anse) was reached except for the churches in Artibonite, where some attendees left the venue before they could be approached or enrolled. Refusal rate and drop-out rate were < 1%. In total, 50/6003 (0.8%) and 355/5026 (7.1%) sampled individuals were hsRDT positive in Artibonite and Grand'Anse, respectively. Over half of all infections in both regions were identified at health facilities. Being male and having a current or reported fever in the previous 2 weeks were consistently identified with increased odds of being hsRDT positive. CONCLUSIONS Surveys in churches were problematic because of logistical and recruitment issues. However, EAG surveys in health facilities and primary schools provided granular information about malaria burden within two departments in Haiti. The EAG surveys were able to identify residual foci of transmission that were missed by recent national surveys. Non-care seeking and/or asymptomatic malaria infections can be identified in this alternative surveillance tool, facilitating data-driven decision-making for improved targeting of interventions.
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Affiliation(s)
- Thomas Druetz
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. .,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
| | - Gillian Stresman
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Ruth A Ashton
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Lotus L van den Hoogen
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.,Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Vena Joseph
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.,Malaria Zero Alliance, CDC Foundation, Port-Au-Prince, Haiti
| | | | | | - Karen E Hamre
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.,CDC Foundation, Atlanta, GA, USA
| | - Michelle A Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jean F Lemoine
- Programme National de Contrôle de la Malaria, Ministère de la Santé Publique et de la Population (MSPP), Port-au-Prince, Haiti
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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25
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Stuck L, Fakih BS, Al-Mafazy AWH, Hofmann NE, Holzschuh A, Grossenbacher B, Bennett A, Cotter C, Reaves E, Ali A, der Horst TV, Felger I, Hetzel MW, Yukich J. Malaria infection prevalence and sensitivity of reactive case detection in Zanzibar. Int J Infect Dis 2020; 97:337-346. [PMID: 32534138 PMCID: PMC8450816 DOI: 10.1016/j.ijid.2020.06.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Reactive case detection (RCD) is a commonly used strategy for malaria surveillance and response in elimination settings. Many approaches to RCD assume detectable infections are clustered within and around homes of passively detected cases (index households), which has been evaluated in a number of settings with disparate results. METHODS Household questionnaires and diagnostic testing were conducted following RCD investigations in Zanzibar, Tanzania, including the index household and up to 9 additional neighboring households. RESULTS Of 12,487 participants tested by malaria rapid diagnostic test (RDT), 3·2% of those residing in index households and 0·4% of those residing in non-index households tested positive (OR = 8·4; 95%CI: 5·7, 12·5). Of 6,281 participants tested by quantitative polymerase chain reaction (qPCR), 8·4% of those residing in index households and 1·3% of those residing in non-index households tested positive (OR = 7·1; 95%CI: 6·1, 10·9). Within households of index cases defined as imported, odds of qPCR-positivity amongst members reporting recent travel were 1·4 times higher than among those without travel history (95%CI: 0·2, 4·4). Amongst non-index households, odds of qPCR-detectable infection were no different between households located within 50 m of the index household as compared with those located farther away (OR = 0·8, 95%CI: 0·5, 1·4). Sensitivity of RDT to detect qPCR-detectable infections was 34% (95%CI: 26·4, 42·3). CONCLUSIONS Malaria prevalence in index households in Zanzibar is much higher than in non-index households, in which prevalence is very low. Travelers represent a high-risk population. Low sensitivity of RDTs due to a high prevalence of low-density infections results in an RCD system missing a large proportion of the parasite reservoir.
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Affiliation(s)
- Logan Stuck
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Bakar S Fakih
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Abdul-Wahid H Al-Mafazy
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, United Republic of Tanzania
| | - Natalie E Hofmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Aurel Holzschuh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Benjamin Grossenbacher
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, USA
| | - Chris Cotter
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, USA
| | - Erik Reaves
- U.S. President's Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Abdullah Ali
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, United Republic of Tanzania
| | - Tina van der Horst
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Ingrid Felger
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Joshua Yukich
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Ashton RA, Joseph V, van den Hoogen LL, Tetteh KKA, Stresman G, Worges M, Druetz T, Chang MA, Rogier E, Lemoine JF, Drakeley C, Eisele TP. Risk Factors for Malaria Infection and Seropositivity in the Elimination Area of Grand'Anse, Haiti: A Case-Control Study among Febrile Individuals Seeking Treatment at Public Health Facilities. Am J Trop Med Hyg 2020; 103:767-777. [PMID: 32458784 PMCID: PMC7410432 DOI: 10.4269/ajtmh.20-0097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The island of Hispaniola aims to eliminate malaria by 2025; however, there are limited data to describe epidemiologic risk factors for malaria in this setting. A prospective case–control study was conducted at four health facilities in southwest Haiti, aiming to describe factors influencing the risk of current and past malaria infection. Cases were defined as individuals attending facilities with current or recent fever and positive malaria rapid diagnostic test (RDT), while controls were those with current or recent fever and RDT negative. Serological markers of recent and cumulative exposure to Plasmodium were assessed using the multiplex bead assay from dried blood spots and used for alternate case definitions. Kuldorff’s spatial scan statistic was used to identify local clusters of infection or exposure. Logistic regression models were used to assess potential risk factors for RDT positivity and recent exposure markers, including age-group, gender, and recruiting health facility as group-matching variables. A total of 192 cases (RDT positive) and 915 controls (RDT negative) were recruited. Consistent spatial clusters were identified for all three infection and exposure metrics, indicating temporal stability of malaria transmission at these sites. Risk factors included remoteness from health facilities and household construction, furthermore, insecticide-treated net ownership or use was associated with reduced odds of RDT positivity. These findings indicate the malaria risk in Grand’Anse is driven primarily by location. Travel, occupation, and other behavioral factors were not associated with malaria. These data can support the National Malaria Program to refine and target their intervention approaches, and to move toward elimination.
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Affiliation(s)
- Ruth A Ashton
- Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Vena Joseph
- Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Lotus L van den Hoogen
- Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Kevin K A Tetteh
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gillian Stresman
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matt Worges
- Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Thomas Druetz
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, Canada.,Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Michelle A Chang
- Division of Parasitic Diseases and Malaria, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric Rogier
- Division of Parasitic Diseases and Malaria, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean Frantz Lemoine
- Programme National de Contrôle de la Malaria, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
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Krezanoski PJ, Santorino D, Agaba A, Dorsey G, Bangsberg DR, Carroll RW. How Are Insecticide-Treated Bednets Used in Ugandan Households? A Comprehensive Characterization of Bednet Adherence Using a Remote Monitor. Am J Trop Med Hyg 2020; 101:404-411. [PMID: 31287045 DOI: 10.4269/ajtmh.19-0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Long-lasting insecticide-treated bednets are widely used and promoted for malaria control. Limitations in measurement methods have resulted in a poor understanding of how bednets are used in practice. We deployed a novel remote monitoring tool in Uganda to obtain, for the first time, a comprehensive characterization of bednet use in households at risk for malaria. Ten households each used one SmartNet adherence monitor over a commonly used sleeping area for 6 weeks. SmartNet continuously measures and records bednet use every 15 minutes. Bednet use was monitored for a total of 9,258 hours overall, with an average of 42 nights per household (SD: 3.5). Average duration of bednet use was 9 hours 49 minutes per night (SD: 1 hour 56 minutes), and adherence was 85-90% from 2100 to 0600. Bednets were not used at all on 4.5% (19/418) of observation nights. Overall, the average clock time that bednets were unfurled was 2034 (SD: 1 hour 25 minutes) and they were folded up at 0743 (SD: 43 minutes). The rate of interruptions per night observed in all households was 0.23 (86/369), with an average duration of 48 minutes (SD: 49 minutes). There was substantial heterogeneity between households, and some households had consistently poorer adherence relative to others. Variations in bednet use behaviors are a potentially important, and under-researched, component of long-lasting insecticide-treated bednet effectiveness. Remote bednet use monitors can provide novel insights into how bednets are used in practice, helping identify both households at risk of malaria due to poor adherence and also potentially novel targets for improving malaria prevention.
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Affiliation(s)
| | - Data Santorino
- Consortium for Affordable Medical Technologies, Mbarara, Uganda.,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alfred Agaba
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Grant Dorsey
- University of California, San Francisco, San Francisco, California
| | - David R Bangsberg
- Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon
| | - Ryan W Carroll
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
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Arinaitwe E, Dorsey G, Nankabirwa JI, Kigozi SP, Katureebe A, Kakande E, Rek J, Rosenthal PJ, Drakeley C, Kamya MR, Staedke SG. Association Between Recent Overnight Travel and Risk of Malaria: A Prospective Cohort Study at 3 Sites in Uganda. Clin Infect Dis 2020; 68:313-320. [PMID: 29868722 DOI: 10.1093/cid/ciy478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/31/2018] [Indexed: 11/14/2022] Open
Abstract
Background Human movement can undermine malaria control efforts. However, understanding of the association between travel and malaria infection in Africa is limited. We evaluated the association between recent overnight travel and malaria incidence in Uganda. Methods All children aged 0.5-10 years and 1 adult living in 266 randomly selected households within 3 different regions of Uganda were followed up prospectively. Information on overnight travel was collected in 2015-2016. Malaria, defined as fever with parasites detected by microscopy, was measured using passive surveillance. Results At least 1 overnight trip was reported by 64 of 275 (23.3%) participants in Walukuba, 37 of 317 (11.7%) in Nagongera, and 19 of 314 (6.1%) in Kihihi. Among individuals who traveled, the incidence of malaria was higher in the first 60 days after traveling, compared with periods without recent travel at all 3 sites (overall, 1.15 vs 0.33 episodes per person-year; incidence rate ratio, 3.53; 95% confidence interval, 1.85-6.73; P < .001). Risk factors for malaria within 60 days after overnight travel included young age (19.5% in children vs 4.9% in adults; odds ratio, 5.29; 95% confidence interval, 1.34-21.0; P = .02) and not using an insecticide-treated net during travel (18.0% for no use vs 4.1% for any use; 5.10; 1.07-24.5; P = .04). Conclusions Recent overnight travel was associated with a higher incidence of malaria. Individuals who travel may represent a high-risk group that could be targeted for malaria control interventions, particularly use of insecticide-treated nets.
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Affiliation(s)
- Emmanuel Arinaitwe
- London School of Hygiene and Tropical Medicine, United Kingdom.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco
| | | | - Simon P Kigozi
- London School of Hygiene and Tropical Medicine, United Kingdom.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Elijah Kakande
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - John Rek
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, United Kingdom
| | - Moses R Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sarah G Staedke
- London School of Hygiene and Tropical Medicine, United Kingdom
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Assefa A, Ali Ahmed A, Deressa W, Sime H, Mohammed H, Kebede A, Solomon H, Teka H, Gurrala K, Matei B, Wakeman B, Wilson GG, Sinha I, Maude RJ, Ashton R, Cook J, Shi YP, Drakeley C, von Seidlein L, Rogier E, Hwang J. Multiplex serology demonstrate cumulative prevalence and spatial distribution of malaria in Ethiopia. Malar J 2019; 18:246. [PMID: 31331340 PMCID: PMC6647069 DOI: 10.1186/s12936-019-2874-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/07/2019] [Indexed: 11/26/2022] Open
Abstract
Background Measures of malaria burden using microscopy and rapid diagnostic tests (RDTs) in cross-sectional household surveys may incompletely describe the burden of malaria in low-transmission settings. This study describes the pattern of malaria transmission in Ethiopia using serological antibody estimates derived from a nationwide household survey completed in 2015. Methods Dried blood spot (DBS) samples were collected during the Ethiopian Malaria Indicator Survey in 2015 from malarious areas across Ethiopia. Samples were analysed using bead-based multiplex assays for IgG antibodies for six Plasmodium antigens: four human malaria species-specific merozoite surface protein-1 19kD antigens (MSP-1) and Apical Membrane Antigen-1 (AMA-1) for Plasmodium falciparum and Plasmodium vivax. Seroprevalence was estimated by age, elevation and region. The seroconversion rate was estimated using a reversible catalytic model fitted with maximum likelihood methods. Results Of the 10,278 DBS samples available, 93.6% (9622/10,278) had valid serological results. The mean age of participants was 15.8 years and 53.3% were female. National seroprevalence for antibodies to P. falciparum was 32.1% (95% confidence interval (CI) 29.8–34.4) and 25.0% (95% CI 22.7–27.3) to P. vivax. Estimated seroprevalences for Plasmodium malariae and Plasmodium ovale were 8.6% (95% CI 7.6–9.7) and 3.1% (95% CI 2.5–3.8), respectively. For P. falciparum seroprevalence estimates were significantly higher at lower elevations (< 2000 m) compared to higher (2000–2500 m) (aOR 4.4; p < 0.01). Among regions, P. falciparum seroprevalence ranged from 11.0% (95% CI 8.8–13.7) in Somali to 65.0% (95% CI 58.0–71.4) in Gambela Region and for P. vivax from 4.0% (95% CI 2.6–6.2) in Somali to 36.7% (95% CI 30.0–44.1) in Amhara Region. Models fitted to measure seroconversion rates showed variation nationally and by elevation, region, antigen type, and within species. Conclusion Using multiplex serology assays, this study explored the cumulative malaria burden and regional dynamics of the four human malarias in Ethiopia. High malaria burden was observed in the northwest compared to the east. High transmission in the Gambela and Benishangul-Gumuz Regions and the neglected presence of P. malariae and P. ovale may require programmatic attention. The use of a multiplex assay for antibody detection in low transmission settings has the potential to act as a more sensitive biomarker. Electronic supplementary material The online version of this article (10.1186/s12936-019-2874-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ashenafi Assefa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia. .,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Ahmed Ali Ahmed
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wakgari Deressa
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heven Sime
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Amha Kebede
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Hiwot Solomon
- Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Hiwot Teka
- U.S. President's Malaria Initiative, United States Agency for International Development, Addis Ababa, Ethiopia
| | - Kevin Gurrala
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brian Matei
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brian Wakeman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - G Glenn Wilson
- Department of Biology, University of Southern Denmark, 5230, Odense M, Denmark
| | - Ipsita Sinha
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Richard J Maude
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Harvard TH Chan School of Public Health, Harvard University, Boston, USA
| | - Ruth Ashton
- Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Jackie Cook
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ya Ping Shi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Lorenz von Seidlein
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Eric Rogier
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jimee Hwang
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Monroe A, Mihayo K, Okumu F, Finda M, Moore S, Koenker H, Lynch M, Haji K, Abbas F, Ali A, Greer G, Harvey S. Human behaviour and residual malaria transmission in Zanzibar: findings from in-depth interviews and direct observation of community events. Malar J 2019; 18:220. [PMID: 31262306 PMCID: PMC6604484 DOI: 10.1186/s12936-019-2855-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background Zanzibar has maintained malaria prevalence below 1% for the past decade, yet elimination remains elusive despite high coverage of core vector control interventions. As part of a study investigating the magnitude and drivers of residual transmission in Zanzibar, qualitative methods were utilized to better understand night time activities and sleeping patterns, individual and community-level risk perceptions, and malaria prevention practices. Methods A total of 62 in-depth interviews were conducted with community members and local leaders across six sites on Unguja Island, Zanzibar. Twenty semi-structured community observations of night-time activities and special events were conducted to complement interview findings. Data were transcribed verbatim, coded, and analysed using a thematic approach. Results Participants reported high levels of ITN use, but noted gaps in protection, particularly when outdoors or away from home. Routine household and community activities were common in evenings before bed and early mornings, while livelihood activities and special events lasted all or most of the night. Gender variation was reported, with men routinely spending more time away from home than women and children. Outdoor sleeping was reported during special events, such as weddings, funerals, and religious ceremonies. Participants described having difficulty preventing mosquito bites while outdoors, travelling, or away from home, and perceived higher risk of malaria infection during these times. Travel and migration emerged as a crucial issue and participants viewed seasonal workers coming from mainland Tanzania as more likely to have a malaria infection and less likely to be connected to prevention and treatment services in Zanzibar. Some community leaders reported taking the initiative to register seasonal workers coming into their community and linking them to testing and treatment services. Conclusions Targeting malaria interventions effectively is critical and should be informed by a clear understanding of relevant human behaviour. These findings highlight malaria prevention gaps in Zanzibar, and the importance of identifying new approaches to complement current interventions and accelerate the final phases of malaria elimination. Development and deployment of complementary interventions should consider human behaviour, including gender norms, that can influence exposure to malaria vectors and prevention practices. Expansion of community-level programmes targeting travellers and seasonal workers should also be explored.
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Affiliation(s)
- April Monroe
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA. .,University of Basel, Basel, Switzerland. .,Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Kimberly Mihayo
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Fredros Okumu
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Republic of South Africa.,Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Marceline Finda
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Sarah Moore
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Hannah Koenker
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Matthew Lynch
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Khamis Haji
- Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania
| | - Faiza Abbas
- Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania
| | - Abdullah Ali
- Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania
| | - George Greer
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Dar Es Salaam, Tanzania
| | - Steven Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Tesfahunegn A, Berhe G, Gebregziabher E. Risk factors associated with malaria outbreak in Laelay Adyabo district northern Ethiopia, 2017: case-control study design. BMC Public Health 2019; 19:484. [PMID: 31046711 PMCID: PMC6498533 DOI: 10.1186/s12889-019-6798-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/11/2019] [Indexed: 11/14/2022] Open
Abstract
Background Globally in 2015 about 214 million malaria cases and 438,000 deaths were reported with 75% were from Sub-Saharan Africa. Malaria transmission in Ethiopia is unstable, and outbreaks are considered public health emergencies. Understanding the trigger for outbreaks in low-transmission areas can help facilitate malaria elimination. On July 8th malaria outbreak was reported from Laelay Adyabo district. The objective was to investigate the magnitude and associated factors with malaria outbreak. Methods We defined a case as confirmed malaria using microscopy or a rapid diagnostic test for Plasmodium parasites in a resident of Laelay-Adyabo District from July 9–28, 2017. We identified cases by reviewing health facility records and conducted a case-control study using randomly-selected cases from a line list, and two neighborhood controls per case. A pretested semi-structured questionnaire adapted from WHO malaria guidelines was used to collect data from case-patients and controls. We calculated crude (COR) and adjusted (AOR) odds ratios to identify factors associated with malaria. Result A total of 145 confirmed malaria cases (57.9% males) were identified with village attack rate (AR) of 12.1/1000. The AR was higher among males than females (14.1 verses 10.1/1000), children aged 5–14 years (12.9/1000), and in Zelazle Kebelle (13.6/1000 population). Wearing protective clothing (AOR = 0.27, 95% CI 0.11–0.66), having good knowledge of malaria transmission (AOR = 0.25, 95% CI 0.08–0.75), having waste collection material at home (AOR = 0.25 95% CI 0.11–0.61), availability of mosquito breeding sites around home (AOR = 9.08, 95% CI 3.6–22.93), and staying outdoor overnight (AOR = 3.7, 95% CI 1.44–9.56) were independently associated with malaria. Conclusion The overall attack rate for malaria during this outbreak was high affecting > 1% of the population. Wearing protective clothing at night, knowing about malaria transmission, having mosquito breeding sites around the home, staying outdoors overnight, and having waste collection material in their house were predictors of the infection. Laelay Adyabo district health office should provide health education on malaria transmission and prevention measures and how to clear mosquito breeding sites. Electronic supplementary material The online version of this article (10.1186/s12889-019-6798-x) contains supplementary material, which is available to authorized users.
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Malede A, Alemu K, Aemero M, Robele S, Kloos H. Travel to farms in the lowlands and inadequate malaria information significantly predict malaria in villages around Lake Tana, northwest Ethiopia: a matched case-control study. Malar J 2018; 17:290. [PMID: 30097037 PMCID: PMC6086053 DOI: 10.1186/s12936-018-2434-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022] Open
Abstract
Background In Ethiopia, malaria has declined in the last decade; only a small number of cases have been reported, primarily from hotspots. The contribution of house proximity to water bodies and the role of migration in malaria transmission has not yet been examined in detail in northwest Ethiopia. Individual and household-level environmental and socio-demographic drivers of malaria heterogeneity were explored contextually in meso-endemic villages around Lake Tana, northwest Ethiopia. Methods A health facility-based paired age-sex matched case–control study involving 303 matched pairs was undertaken from 10 October 2016, to 30 June 2017. Geo-referencing of case households, control households, proximate water bodies, and health centres was carried out. A pretested and structured questionnaire was used to collect data on socio-demography, household assets, housing, travel history, and malaria intervention measures. Medians (interquartile range) were computed for continuous variables. Pearson’s Chi square/Fisher’s exact test was used to detect significant differences in proportions. Principal component analysis was performed to estimate household wealth. Stratified analysis was used to confirm confounding and interaction. A multivariable conditional logistic regression model was used to detect risk factors for malaria. Results Of 303 malaria cases, 59 (19.5% [15.4–24.3]) were imported malaria cases whereas 244 (80.5% [75.7–84.6]) were locally acquired malaria cases. In bivariate analysis, marital status, educational status, and bed net ownership were significantly associated with malaria cases. In multivariable adjustment, travel to malarious lowlands in the preceding month (adjusted mOR = 7.32; 95% CI 2.40–22.34), household member’s travel to malarious lowlands (adjusted mOR = 2.75; 95% CI 1.02–7.44), and inadequate health information on malaria (adjusted mOR = 1.57; 95% CI 1.03–2.41) were predictors of malaria. Stratified analysis confirmed that elevation of households and travel to malarious lowlands were not effect modifiers. Travel to malarious lowlands had a confounding effect on malaria but elevation of households did not. Conclusions In this study, travel to farms in the lowlands and inadequate health information on malaria were risk factors for malaria in villages around Lake Tana. This evidence is critical for the design of improved strategic interventions that consider imported malaria cases and approaches for accessing health information on malaria control in northwest Ethiopia. Electronic supplementary material The online version of this article (10.1186/s12936-018-2434-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Asmamaw Malede
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Aemero
- Department of Medical Parasitology, School of Biomedical & Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Sirak Robele
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
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Ruktanonchai NW, Ruktanonchai CW, Floyd JR, Tatem AJ. Using Google Location History data to quantify fine-scale human mobility. Int J Health Geogr 2018; 17:28. [PMID: 30049275 PMCID: PMC6062973 DOI: 10.1186/s12942-018-0150-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/18/2018] [Indexed: 11/17/2022] Open
Abstract
Background Human mobility is fundamental to understanding global issues in the health and social sciences such as disease spread and displacements from disasters and conflicts. Detailed mobility data across spatial and temporal scales are difficult to collect, however, with movements varying from short, repeated movements to work or school, to rare migratory movements across national borders. While typical sources of mobility data such as travel history surveys and GPS tracker data can inform different typologies of movement, almost no source of readily obtainable data can address all types of movement at once. Methods Here, we collect Google Location History (GLH) data and examine it as a novel source of information that could link fine scale mobility with rare, long distance and international trips, as it uniquely spans large temporal scales with high spatial granularity. These data are passively collected by Android smartphones, which reach increasingly broad audiences, becoming the most common operating system for accessing the Internet worldwide in 2017. We validate GLH data against GPS tracker data collected from Android users in the United Kingdom to assess the feasibility of using GLH data to inform human movement. Results We find that GLH data span very long temporal periods (over a year on average in our sample), are spatially equivalent to GPS tracker data within 100 m, and capture more international movement than survey data. We also find GLH data avoid compliance concerns seen with GPS trackers and bias in self-reported travel, as GLH is passively collected. We discuss some settings where GLH data could provide novel insights, including infrastructure planning, infectious disease control, and response to catastrophic events, and discuss advantages and disadvantages of using GLH data to inform human mobility patterns. Conclusions GLH data are a greatly underutilized and novel dataset for understanding human movement. While biases exist in populations with GLH data, Android phones are becoming the first and only device purchased to access the Internet and various web services in many middle and lower income settings, making these data increasingly appropriate for a wide range of scientific questions. Electronic supplementary material The online version of this article (10.1186/s12942-018-0150-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nick Warren Ruktanonchai
- WorldPop Project, Geography and Environment, University of Southampton, Southampton, SO17 1BJ, UK. .,Flowminder Foundation, Roslagsgatan 17, 11355, Stockholm, Sweden.
| | - Corrine Warren Ruktanonchai
- WorldPop Project, Geography and Environment, University of Southampton, Southampton, SO17 1BJ, UK.,Flowminder Foundation, Roslagsgatan 17, 11355, Stockholm, Sweden
| | - Jessica Rhona Floyd
- WorldPop Project, Geography and Environment, University of Southampton, Southampton, SO17 1BJ, UK.,Flowminder Foundation, Roslagsgatan 17, 11355, Stockholm, Sweden
| | - Andrew J Tatem
- WorldPop Project, Geography and Environment, University of Southampton, Southampton, SO17 1BJ, UK.,Flowminder Foundation, Roslagsgatan 17, 11355, Stockholm, Sweden
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Agegnehu F, Shimeka A, Berihun F, Tamir M. Determinants of malaria infection in Dembia district, Northwest Ethiopia: a case-control study. BMC Public Health 2018; 18:480. [PMID: 29642899 PMCID: PMC5896134 DOI: 10.1186/s12889-018-5370-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the progress in reducing malaria infections and related deaths, the disease remains a major global public health problem. The problem is among the top five leading causes of outpatient visits in Dembia district of the northwest Ethiopia. Therefore, this study aimed to assess the determinants of malaria infections in the district. METHODS An institution-based case-control study was conducted in Dembia district from October to November 2016. Out of the ten health centers in the district, four were randomly selected for the study in which 370 participants (185 cases and 185 controls) were enrolled. Data were collected using a pretested structured questionnaire. Factors associated with malaria infections were determined using logistic regression analysis. Odds ratio with 95% CI was used as a measure of association, and variables with a p-value of ≤0.05 were considered as statistically significant. RESULTS The median age of all participants was 26 years, while that of cases and controls was 22 and 30 with a range of 1 to 80 and 2 to 71, respectively. In the multivariable logistic regression, over 15 years of age adjusted odds ratio(AOR) and confidence interval (CI) of (AOR = 18; 95% CI: 2.1, 161.5), being male (AOR = 2.2; 95% CI: 1.2, 3.9), outdoor activities at night (AOR = 5.7; 95% CI: 2.5, 12.7), bed net sharing (AOR = 3.9; 95% CI: 2.0, 7.7), and proximity to stagnant water sources (AOR = 2.7; 95% CI: 1.3, 5.4) were independent predictors. CONCLUSION Being in over 15 years of age group, male gender, night time activity, bed net sharing and proximity to stagnant water sources were determinant factors of malaria infection in Dembia district. Additional interventions and strategies which focus on men, outdoor work at night, household net utilization, and nearby stagnant water sources are essential to reduce malaria infections in the area.
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Affiliation(s)
| | - Alemayehu Shimeka
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Firnus Berihun
- Clinical Psychology and Counseling Unit, University of Gondar Specialized Hospital, Gondar, Ethiopia
| | - Melkamu Tamir
- Departement of Human Nutrition, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Cohen JM, Le Menach A, Pothin E, Eisele TP, Gething PW, Eckhoff PA, Moonen B, Schapira A, Smith DL. Mapping multiple components of malaria risk for improved targeting of elimination interventions. Malar J 2017; 16:459. [PMID: 29132357 PMCID: PMC5683539 DOI: 10.1186/s12936-017-2106-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/02/2017] [Indexed: 11/13/2022] Open
Abstract
There is a long history of considering the constituent components of malaria risk and the malaria transmission cycle via the use of mathematical models, yet strategic planning in endemic countries tends not to take full advantage of available disease intelligence to tailor interventions. National malaria programmes typically make operational decisions about where to implement vector control and surveillance activities based upon simple categorizations of annual parasite incidence. With technological advances, an enormous opportunity exists to better target specific malaria interventions to the places where they will have greatest impact by mapping and evaluating metrics related to a variety of risk components, each of which describes a different facet of the transmission cycle. Here, these components and their implications for operational decision-making are reviewed. For each component, related mappable malaria metrics are also described which may be measured and evaluated by malaria programmes seeking to better understand the determinants of malaria risk. Implementing tailored programmes based on knowledge of the heterogeneous distribution of the drivers of malaria transmission rather than only consideration of traditional metrics such as case incidence has the potential to result in substantial improvements in decision-making. As programmes improve their ability to prioritize their available tools to the places where evidence suggests they will be most effective, elimination aspirations may become increasingly feasible.
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Affiliation(s)
- Justin M Cohen
- Clinton Health Access Initiative, 383 Dorchester Ave., Suite 400, Boston, MA, 02127, USA.
| | - Arnaud Le Menach
- Clinton Health Access Initiative, 383 Dorchester Ave., Suite 400, Boston, MA, 02127, USA
| | - Emilie Pothin
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St (2300), New Orleans, LA, 70112, USA
| | - Peter W Gething
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LF, UK
| | - Philip A Eckhoff
- Institute for Disease Modeling, Building IV, 3150 139th Ave SE, Bellevue, WA, 98005, USA
| | - Bruno Moonen
- Bill & Melinda Gates Foundation, PO Box 23350, Seattle, WA, 98102, USA
| | | | - David L Smith
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA
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Ippolito MM, Searle KM, Hamapumbu H, Shields TM, Stevenson JC, Thuma PE, Moss WJ, For The Southern Africa International Center Of Excellence For Malaria Research. House Structure Is Associated with Plasmodium falciparum Infection in a Low-Transmission Setting in Southern Zambia. Am J Trop Med Hyg 2017; 97:1561-1567. [PMID: 28820722 DOI: 10.4269/ajtmh.17-0299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
House structure may influence the risk of malaria by affecting mosquito entry and indoor resting. Identification of construction features associated with protective benefits could inform vector control approaches, even in low-transmission settings. We examined the association between house structure and malaria prevalence in a cross-sectional analysis of 2,788 children and adults residing in 866 houses in a low-transmission area of Southern Province, Zambia, over the period 2008-2012. Houses were categorized according to wall (brick/cement block or mud/grass) and roof (metal or grass) material. Malaria was assessed by point-of-care rapid diagnostic test (RDT) for Plasmodium falciparum. We identified 52 RDT-positive individuals residing in 41 houses, indicating an overall prevalence in the sample of 1.9%, ranging from 1.4% to 8.8% among the different house types. Occupants of higher quality houses had reduced odds of P. falciparum malaria compared with those in the lowest quality houses after controlling for bed net use, indoor insecticide spraying, clustering by house, cohabitation with another RDT-positive individual, transmission season, ecologic risk defined as nearest distance to a Strahler-classified third-order stream, education, age, and gender (adjusted odds ratio [OR]: 0.26, 95% confidence interval [CI]: 0.09-0.73, P = 0.01 for houses with brick/cement block walls and metal roof; OR: 0.22, 95% CI: 0.09-0.52, P < 0.01 for houses with brick/cement block walls and grass roof). Housing improvements offer a promising approach to vector control in low-transmission settings that circumvents the threat posed by insecticide resistance, and may confer a protective benefit of similar magnitude to current vector control strategies.
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Affiliation(s)
- Matthew M Ippolito
- Divisions of Infectious Diseases and Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly M Searle
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Harry Hamapumbu
- Macha Research Trust, Macha Hospital, Choma District, Zambia
| | - Timothy M Shields
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer C Stevenson
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Macha Research Trust, Macha Hospital, Choma District, Zambia
| | - Philip E Thuma
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William J Moss
- Macha Research Trust, Macha Hospital, Choma District, Zambia
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Lo E, Hemming-Schroeder E, Yewhalaw D, Nguyen J, Kebede E, Zemene E, Getachew S, Tushune K, Zhong D, Zhou G, Petros B, Yan G. Transmission dynamics of co-endemic Plasmodium vivax and P. falciparum in Ethiopia and prevalence of antimalarial resistant genotypes. PLoS Negl Trop Dis 2017; 11:e0005806. [PMID: 28746333 PMCID: PMC5546713 DOI: 10.1371/journal.pntd.0005806] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 08/07/2017] [Accepted: 07/13/2017] [Indexed: 11/19/2022] Open
Abstract
Ethiopia is one of the few African countries where Plasmodium vivax is co-endemic with P. falciparum. Malaria transmission is seasonal and transmission intensity varies mainly by landscape and climate. Although the recent emergence of drug resistant parasites presents a major issue to malaria control in Ethiopia, little is known about the transmission pathways of parasite species and prevalence of resistant markers. This study used microsatellites to determine population diversity and gene flow patterns of P. falciparum (N = 226) and P. vivax (N = 205), as well as prevalence of drug resistant markers to infer the impact of gene flow and existing malaria treatment regimes. Plasmodium falciparum indicated a higher rate of polyclonal infections than P. vivax. Both species revealed moderate genetic diversity and similar population structure. Populations in the northern highlands were closely related to the eastern Rift Valley, but slightly distinct from the southern basin area. Gene flow via human migrations between the northern and eastern populations were frequent and mostly bidirectional. Landscape genetic analyses indicated that environmental heterogeneity and geographical distance did not constrain parasite gene flow. This may partly explain similar patterns of resistant marker prevalence. In P. falciparum, a high prevalence of mutant alleles was detected in codons related to chloroquine (pfcrt and pfmdr1) and sulfadoxine-pyrimethamine (pfdhps and pfdhfr) resistance. Over 60% of the samples showed pfmdr1 duplications. Nevertheless, no mutation was detected in pfK13 that relates to artemisinin resistance. In P. vivax, while sequences of pvcrt-o were highly conserved and less than 5% of the samples showed pvmdr duplications, over 50% of the samples had pvmdr1 976F mutation. It remains to be tested if this mutation relates to chloroquine resistance. Monitoring the extent of malaria spread and markers of drug resistance is imperative to inform policy for evidence-based antimalarial choice and interventions. To effectively reduce malaria burden in Ethiopia, control efforts should focus on seasonal migrant populations.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antimalarials/pharmacology
- Child
- Child, Preschool
- Drug Resistance
- Endemic Diseases
- Ethiopia/epidemiology
- Female
- Gene Flow
- Genes, Protozoan
- Genetics, Population
- Genotype
- Humans
- Infant
- Infant, Newborn
- Malaria, Falciparum/epidemiology
- Malaria, Falciparum/parasitology
- Malaria, Falciparum/transmission
- Malaria, Vivax/epidemiology
- Malaria, Vivax/parasitology
- Malaria, Vivax/transmission
- Male
- Microsatellite Repeats
- Middle Aged
- Plasmodium falciparum/drug effects
- Plasmodium falciparum/genetics
- Plasmodium falciparum/isolation & purification
- Plasmodium vivax/drug effects
- Plasmodium vivax/genetics
- Plasmodium vivax/isolation & purification
- Prevalence
- Young Adult
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Affiliation(s)
- Eugenia Lo
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
- * E-mail: (EL); (GY)
| | | | - Delenasaw Yewhalaw
- Department of Medical Laboratory Sciences and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Jennifer Nguyen
- Program in Public Health, University of California, Irvine, California, United States of America
| | - Estifanos Kebede
- Department of Medical Laboratory Sciences and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Endalew Zemene
- Department of Medical Laboratory Sciences and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Sisay Getachew
- College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kora Tushune
- Department of Health Services Management, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Daibin Zhong
- Program in Public Health, University of California, Irvine, California, United States of America
| | - Guofa Zhou
- Program in Public Health, University of California, Irvine, California, United States of America
| | - Beyene Petros
- College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Guiyun Yan
- Program in Public Health, University of California, Irvine, California, United States of America
- * E-mail: (EL); (GY)
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Haile M, Lemma H, Weldu Y. Population Movement as a Risk Factor for Malaria Infection in High-Altitude Villages of Tahtay-Maychew District, Tigray, Northern Ethiopia: A Case-Control Study. Am J Trop Med Hyg 2017; 97:726-732. [PMID: 28722582 DOI: 10.4269/ajtmh.17-0129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Key goal and targets of the Ethiopia National Malaria Control Program are to achieve malaria elimination within specific geographical areas with historically low malaria transmission and to reach near-zero malaria transmission in the remaining malarious areas by 2020. However, back and forth population movement between high-transmission and low-transmission area imposes challenge on the success of national malaria control programs. Therefore, examining the effect of human movement and identification of at-risk populations is crucial in an elimination setting. A matched case-control study was conducted among 520 study participants at a community level in low malaria transmission settings in northern Ethiopia. Study participants who received a malaria test were interviewed regarding their recent travel history. Bivariate and multivariate analyses were carried out to determine if the reported travel was related to malaria infection. Younger age (adjusted odds ratio [AOR] = 3.20, 95% confidence interval [CI]: 1.73, 5.89) and travel in the previous month (AOR = 11.40, 95% CI: 6.91, 18.82) were statistically significant risk factors for malaria infection. Other statistically significant factors, including lower educational level (AOR = 2.21, 95% CI: 1.26, 3.86) and nonagricultural in occupation (AOR = 2.0, 95% CI: 1.02, 3.94), were also found as risk factors for malaria infection. Generally, travel history was found to be a strong predictor for malaria acquisition in the high-altitude villages. Therefore, besides the existing efforts in endemic areas, targeting those who frequently travel to malarious areas is crucial to reduce malaria infection risks and possibility of local transmissions in high-altitude areas of northern Ethiopia.
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Affiliation(s)
- Mebrahtom Haile
- Federal Ministry of Health, Addis Ababa, Ethiopia.,School of Water and Public Health, Ethiopian Institute of Water Resource, Addis Ababa University, Ethiopia
| | - Hailemariam Lemma
- Public Health Department, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.,Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Yemane Weldu
- Department of Medical Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Yalew WG, Pal S, Bansil P, Dabbs R, Tetteh K, Guinovart C, Kalnoky M, Serda BA, Tesfay BH, Beyene BB, Seneviratne C, Littrell M, Yokobe L, Noland GS, Domingo GJ, Getachew A, Drakeley C, Steketee RW. Current and cumulative malaria infections in a setting embarking on elimination: Amhara, Ethiopia. Malar J 2017; 16:242. [PMID: 28595603 PMCID: PMC5465535 DOI: 10.1186/s12936-017-1884-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background Since 2005, Ethiopia has aggressively scaled up malaria prevention and case management. As a result, the number of malaria cases and deaths has significantly declined. In order to track progress towards the elimination of malaria in Amhara Region, coverage of malaria control tools and current malaria transmission need to be documented. Methods A cross-sectional household survey oversampling children under 5 years of age was conducted during the dry season in 2013. A bivalent rapid diagnostic test (RDT) detecting both Plasmodium falciparum and Plasmodium vivax and serology assays using merozoite antigens from both these species were used to assess the prevalence of malaria infections and exposure to malaria parasites in 16 woredas (districts) in Amhara Region. Results 7878 participants were included, with a mean age of 16.8 years (range 0.5–102.8 years) and 42.0% being children under 5 years of age. The age-adjusted RDT-positivity for P. falciparum and P. vivax infection was 1.5 and 0.4%, respectively, of which 0.05% presented as co-infections. Overall age-adjusted seroprevalence was 30.0% for P. falciparum, 21.8% for P. vivax, and seroprevalence for any malaria species was 39.4%. The prevalence of RDT-positive infections varied by woreda, ranging from 0.0 to 8.3% and by altitude with rates of 3.2, 0.7, and 0.4% at under 2000, 2000–2500, and >2500 m, respectively. Serological analysis showed heterogeneity in transmission intensity by area and altitude and evidence for a change in the force of infection in the mid-2000s. Conclusions Current and historic malaria transmission across Amhara Region show substantial variation by age and altitude with some settings showing very low or near-zero transmission. Plasmodium vivax infections appear to be lower but relatively more stable across geography and altitude, while P. falciparum is the dominant infection in the higher transmission, low-altitude areas. Age-dependent seroprevalence analyses indicates a drop in transmission occurred in the mid-2000s, coinciding with malaria control scale-up efforts. As malaria parasitaemia rates get very low with elimination efforts, serological evaluation may help track progress to elimination. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1884-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Woyneshet G Yalew
- Regional Health Research Laboratory Center, Amhara National Regional State Health Bureau, P.O. Box 495, Bahir Dar, Ethiopia
| | - Sampa Pal
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Pooja Bansil
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Rebecca Dabbs
- Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine and Hygiene, Keppel Street, London, WCIE 7HT, UK
| | - Kevin Tetteh
- Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine and Hygiene, Keppel Street, London, WCIE 7HT, UK
| | | | - Michael Kalnoky
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | | | | | - Belay B Beyene
- Regional Health Research Laboratory Center, Amhara National Regional State Health Bureau, P.O. Box 495, Bahir Dar, Ethiopia
| | | | - Megan Littrell
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Lindsay Yokobe
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | | | | | - Asefaw Getachew
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Chris Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine and Hygiene, Keppel Street, London, WCIE 7HT, UK
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Assessing the Risk Factors Associated with Malaria in the Highlands of Ethiopia: What Do We Need to Know? Trop Med Infect Dis 2017; 2:tropicalmed2010004. [PMID: 30270863 PMCID: PMC6082051 DOI: 10.3390/tropicalmed2010004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/23/2017] [Accepted: 02/25/2017] [Indexed: 12/13/2022] Open
Abstract
Malaria has been Ethiopia's predominant communicable disease for decades. Following the catastrophic malaria outbreak in 2003⁻2004, the Federal Ministry of Health (FMoH) took drastic public health actions to lower the burden of malaria. The FMoH achieved significant declines in malaria mortality and incidence, and recently declared its objective to achieve malaria elimination in low malaria transmission areas of Ethiopia by 2020. However, while the overall malaria prevalence has decreased, unpredictable outbreaks increasingly occur irregularly in regions previously considered "malaria-free". Such outbreaks have disastrous consequences on populations of these regions as they have no immunity against malaria. The Amhara Region accounts for 31% of Ethiopia's malaria burden and is targeted for malaria elimination by the FMoH. Amhara's epidemiological surveillance system faces many challenges to detect in a timely manner the unpredictable and irregular malaria outbreaks that occur in areas of otherwise low transmission. Despite the evidence of a shift in malaria transmission patterns, Amhara's malaria control interventions remain constrained to areas that are historically known to have stable malaria transmission. This paper discusses the influence of temperature and precipitation variability, entomological parameters, and human population mobility on malaria transmission patterns across the Amhara Region, and in particular, in areas of unstable transmission. We argue that malaria epidemiological surveillance systems can be improved by accounting for population movements in addition to environmental and entomological factors. However, to date, no study has statistically analyzed the interplay of population dynamics on environmental and entomological drivers of malaria transmission.
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Smith JL, Auala J, Haindongo E, Uusiku P, Gosling R, Kleinschmidt I, Mumbengegwi D, Sturrock HJW. Malaria risk in young male travellers but local transmission persists: a case-control study in low transmission Namibia. Malar J 2017; 16:70. [PMID: 28187770 PMCID: PMC5303241 DOI: 10.1186/s12936-017-1719-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/03/2017] [Indexed: 11/24/2022] Open
Abstract
Background A key component of malaria elimination campaigns is the identification and targeting of high risk populations. To characterize high risk populations in north central Namibia, a prospective health facility-based case–control study was conducted from December 2012–July 2014. Cases (n = 107) were all patients presenting to any of the 46 health clinics located in the study districts with a confirmed Plasmodium infection by multi-species rapid diagnostic test (RDT). Population controls (n = 679) for each district were RDT negative individuals residing within a household that was randomly selected from a census listing using a two-stage sampling procedure. Demographic, travel, socio-economic, behavioural, climate and vegetation data were also collected. Spatial patterns of malaria risk were analysed. Multivariate logistic regression was used to identify risk factors for malaria. Results Malaria risk was observed to cluster along the border with Angola, and travel patterns among cases were comparatively restricted to northern Namibia and Angola. Travel to Angola was associated with excessive risk of malaria in males (OR 43.58 95% CI 2.12–896), but there was no corresponding risk associated with travel by females. This is the first study to reveal that gender can modify the effect of travel on risk of malaria. Amongst non-travellers, male gender was also associated with a higher risk of malaria compared with females (OR 1.95 95% CI 1.25–3.04). Other strong risk factors were sleeping away from the household the previous night, lower socioeconomic status, living in an area with moderate vegetation around their house, experiencing moderate rainfall in the month prior to diagnosis and living <15 km from the Angolan border. Conclusions These findings highlight the critical need to target malaria interventions to young male travellers, who have a disproportionate risk of malaria in northern Namibia, to coordinate cross-border regional malaria prevention initiatives and to scale up coverage of prevention measures such as indoor residual spraying and long-lasting insecticide nets in high risk areas if malaria elimination is to be realized. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1719-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer L Smith
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, USA.
| | - Joyce Auala
- Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia
| | - Erastus Haindongo
- Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia
| | - Petrina Uusiku
- National Vector-Borne Disease Control Programme, Ministry of Health and Social Services, Windhoek, Namibia
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, USA
| | - Immo Kleinschmidt
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Davis Mumbengegwi
- Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia
| | - Hugh J W Sturrock
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, USA
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Wang D, Cotter C, Sun X, Bennett A, Gosling RD, Xiao N. Adapting the local response for malaria elimination through evaluation of the 1-3-7 system performance in the China-Myanmar border region. Malar J 2017; 16:54. [PMID: 28137293 PMCID: PMC5282924 DOI: 10.1186/s12936-017-1707-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Assessing the essential components of ‘1-3-7’ strategy along the China–Myanmar border is critical to identify gaps and challenges to support evidence-based decision making. Methods A mixed-method retrospective study including quantitative and qualitative analysis of the 1-3-7 system components was conducted. Sampled counties were chosen based on malaria incidence from 1 January 2012 to 31 December 2014. Results All 260 confirmed malaria cases from sampled counties were reported within 1 day and had completed case investigations. 70.0% of all Reactive Case Detection (RACD) events were conducted and 90.1% of those were within 7 days. Only ten additional individuals were found malaria positive out of 3662 individuals tested (0.3%) by rapid diagnostic test during RACD events. Conclusions Key gaps were identified in case investigation and RACD activities in Yunnan Province border counties. This evidence supports improving the RACD (or “7”) response strategy in this setting. Given the challenges in this border region, it will be critical to adapt the RACD response to promote the malaria elimination along the China border. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1707-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duoquan Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Pathology, World Health Organization Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, People's Republic of China
| | - Chris Cotter
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Xiaodong Sun
- Yunnan Institute of Parasitic Diseases, Puer, 665000, People's Republic of China
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Roly D Gosling
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Ning Xiao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Pathology, World Health Organization Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, People's Republic of China.
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Siraj AS, Bouma MJ, Santos-Vega M, Yeshiwondim AK, Rothman DS, Yadeta D, Sutton PC, Pascual M. Temperature and population density determine reservoir regions of seasonal persistence in highland malaria. Proc Biol Sci 2017; 282:20151383. [PMID: 26631558 DOI: 10.1098/rspb.2015.1383] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A better understanding of malaria persistence in highly seasonal environments such as highlands and desert fringes requires identifying the factors behind the spatial reservoir of the pathogen in the low season. In these 'unstable' malaria regions, such reservoirs play a critical role by allowing persistence during the low transmission season and therefore, between seasonal outbreaks. In the highlands of East Africa, the most populated epidemic regions in Africa, temperature is expected to be intimately connected to where in space the disease is able to persist because of pronounced altitudinal gradients. Here, we explore other environmental and demographic factors that may contribute to malaria's highland reservoir. We use an extensive spatio-temporal dataset of confirmed monthly Plasmodium falciparum cases from 1995 to 2005 that finely resolves space in an Ethiopian highland. With a Bayesian approach for parameter estimation and a generalized linear mixed model that includes a spatially structured random effect, we demonstrate that population density is important to disease persistence during the low transmission season. This population effect is not accounted for in typical models for the transmission dynamics of the disease, but is consistent in part with a more complex functional form of the force of infection proposed by theory for vector-borne infections, only during the low season as we discuss. As malaria risk usually decreases in more urban environments with increased human densities, the opposite counterintuitive finding identifies novel control targets during the low transmission season in African highlands.
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Affiliation(s)
- Amir S Siraj
- Department of Geography and the Environment, University of Denver, 235 Boettcher West, 2050 East Iliff Avenue, Denver, CO 80208-0710, USA Frederick S. Pardee Center for International Futures, Josef Korbel School of International Studies, University of Denver, 2201 South Gaylord Street, Denver, CO 80208-0500, USA
| | - Menno J Bouma
- London School of Hygiene and Tropical Medicine, University of London, London WC1 E7HT, UK Catalan Institute of Climate Sciences (IC3), University of Barcelona, Doctor Trueta, 203 3a planta 08005 Barcelona, Spain
| | - Mauricio Santos-Vega
- Department of Ecology and Evolution, University of Chicago, 1101 East 57th Street, Chicago, IL 60637, USA
| | - Asnakew K Yeshiwondim
- PATH/ Malaria Control and Elimination Partnership in Africa, Africa Avenue, Getu Commercial Center, PO Box 493, Addis Ababa 1110, Ethiopia
| | - Dale S Rothman
- Frederick S. Pardee Center for International Futures, Josef Korbel School of International Studies, University of Denver, 2201 South Gaylord Street, Denver, CO 80208-0500, USA
| | - Damtew Yadeta
- Oromia Regional Health Bureau, PO Box 24341, Addis Ababa, Ethiopia
| | - Paul C Sutton
- Department of Geography and the Environment, University of Denver, 235 Boettcher West, 2050 East Iliff Avenue, Denver, CO 80208-0710, USA School of Natural and Built Environments, University of South Australia, P Building, Mawson Lakes Campus, Mawson Lakes, South Australia 5095, Australia
| | - Mercedes Pascual
- Department of Ecology and Evolution, University of Chicago, 1101 East 57th Street, Chicago, IL 60637, USA Howard Hughes Medical Institute, Chevy Chase, MD 20815-6789, USA
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Jacobson JO, Cueto C, Smith JL, Hwang J, Gosling R, Bennett A. Surveillance and response for high-risk populations: what can malaria elimination programmes learn from the experience of HIV? Malar J 2017; 16:33. [PMID: 28100237 PMCID: PMC5241929 DOI: 10.1186/s12936-017-1679-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/04/2017] [Indexed: 11/24/2022] Open
Abstract
To eliminate malaria, malaria programmes need to develop new strategies for surveillance and response appropriate for the changing epidemiology that accompanies transmission decline, in which transmission is increasingly driven by population subgroups whose behaviours place them at increased exposure. Conventional tools of malaria surveillance and response are likely not sufficient in many elimination settings for accessing high-risk population subgroups, such as mobile and migrant populations (MMPs), given their greater likelihood of asymptomatic infections, illegal risk behaviours, limited access to public health facilities, and high mobility including extended periods travelling away from home. More adaptive, targeted strategies are needed to monitor transmission and intervention coverage effectively in these groups. Much can be learned from HIV programmes’ experience with “second generation surveillance”, including how to rapidly adapt surveillance and response strategies to changing transmission patterns, biological and behavioural surveys that utilize targeted sampling methods for specific behavioural subgroups, and methods for population size estimation. This paper reviews the strategies employed effectively for HIV programmes and offers considerations and recommendations for adapting them to the malaria elimination context.
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Affiliation(s)
- Jerry O Jacobson
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Carmen Cueto
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Jennifer L Smith
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Jimee Hwang
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,US President's Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
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SantoDomingo AF, Castro-Díaz L, González-Uribe C. Ecosystem Research Experience with Two Indigenous Communities of Colombia: The Ecohealth Calendar as a Participatory and Innovative Methodological Tool. ECOHEALTH 2016; 13:687-697. [PMID: 27638473 DOI: 10.1007/s10393-016-1165-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 06/06/2023]
Abstract
Eco-bio-social factors may increase or decrease a community's susceptibility to vector-borne disease transmission. Traditional studies have contributed information about the association between eco-bio-social factors and health outcomes, but few have provided this information in an integrative way characterizing annual dynamics among indigenous communities. Transdisciplinary research was conducted with the Bari of Karikachaboquira and the Wayúu of Marbacella and El Horno, using qualitative and participatory methods, including seasonal graphics, semi-structured interviews, geo-referencing routes, and participatory observation. The information was triangulated and discussed with local actors in order to validate and complement the results. An ecohealth calendar was obtained for each community, linking the socioecological dynamics to specific diseases, especially malaria. Local dynamics can change, depending on environmental conditions, and these determine the presence or absence of diseases. For both communities, the rainy season is the period with the greatest proliferation of mosquitoes (including Anopheles spp.), during which malaria cases occur. The ecohealth calendar integrates eco-bio-social information from local communities, through participatory and potentially empowering processes, into a comprehensive layout. This can break down the conceptual, demographic, and cultural barriers in the context of community-based interventions and research to action based on an ecosystem framework.
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Affiliation(s)
| | - Laura Castro-Díaz
- Eje de Salud Pública, Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia
- Department of Community Sustainability, Michigan State University, East Lansing, MI, USA
| | - Catalina González-Uribe
- Eje de Salud Pública, Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia.
- School of Medicine, Universidad de los Andes, Bogotá, D.C., Colombia.
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Sorichetta A, Bird TJ, Ruktanonchai NW, zu Erbach-Schoenberg E, Pezzulo C, Tejedor N, Waldock IC, Sadler JD, Garcia AJ, Sedda L, Tatem AJ. Mapping internal connectivity through human migration in malaria endemic countries. Sci Data 2016; 3:160066. [PMID: 27529469 PMCID: PMC5127488 DOI: 10.1038/sdata.2016.66] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/01/2016] [Indexed: 12/22/2022] Open
Abstract
Human mobility continues to increase in terms of volumes and reach, producing growing global connectivity. This connectivity hampers efforts to eliminate infectious diseases such as malaria through reintroductions of pathogens, and thus accounting for it becomes important in designing global, continental, regional, and national strategies. Recent works have shown that census-derived migration data provides a good proxy for internal connectivity, in terms of relative strengths of movement between administrative units, across temporal scales. To support global malaria eradication strategy efforts, here we describe the construction of an open access archive of estimated internal migration flows in endemic countries built through pooling of census microdata. These connectivity datasets, described here along with the approaches and methods used to create and validate them, are available both through the WorldPop website and the WorldPop Dataverse Repository.
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Affiliation(s)
- Alessandro Sorichetta
- WorldPop, Geography and Environment, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK
- Flowminder Foundation, Roslagsgatan 17, Stockholm SE-11355, Sweden
- Institute for Life Sciences, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK
| | - Tom J. Bird
- WorldPop, Geography and Environment, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK
- Flowminder Foundation, Roslagsgatan 17, Stockholm SE-11355, Sweden
| | - Nick W. Ruktanonchai
- WorldPop, Geography and Environment, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK
- Flowminder Foundation, Roslagsgatan 17, Stockholm SE-11355, Sweden
| | - Elisabeth zu Erbach-Schoenberg
- WorldPop, Geography and Environment, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK
- Flowminder Foundation, Roslagsgatan 17, Stockholm SE-11355, Sweden
| | - Carla Pezzulo
- WorldPop, Geography and Environment, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK
- Flowminder Foundation, Roslagsgatan 17, Stockholm SE-11355, Sweden
| | - Natalia Tejedor
- WorldPop, Geography and Environment, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK
- Flowminder Foundation, Roslagsgatan 17, Stockholm SE-11355, Sweden
- GeoData, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK
| | - Ian C. Waldock
- GeoData, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK
| | - Jason D. Sadler
- GeoData, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK
| | - Andres J. Garcia
- Bill and Melinda Gates Foundation, 440 5th Ave N., Seattle, Washington 98109, USA
| | - Luigi Sedda
- CHICAS, Lancaster Medical School, Lancaster University, Lancaster LA1 4YG, UK
| | - Andrew J. Tatem
- WorldPop, Geography and Environment, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK
- Flowminder Foundation, Roslagsgatan 17, Stockholm SE-11355, Sweden
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Argaw MD, Woldegiorgis AGY, Abate DT, Abebe ME. Improved malaria case management in formal private sector through public private partnership in Ethiopia: retrospective descriptive study. Malar J 2016; 15:352. [PMID: 27401095 PMCID: PMC4940756 DOI: 10.1186/s12936-016-1402-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is a major public health problem and still reported among the 10 top causes of morbidity and mortality in Ethiopia. More than one-third of the people sought treatment from the private health sector. Evaluating adherences of health care providers to standards are paramount importance to determine the quality and the effectiveness of service delivery. Therefore, the aim of this study was to evaluate the contribution of public private mix (PPM) approach in improving quality of malaria case management among formal private providers. METHODS A retrospective data analysis was conducted using 2959 facility-months data collected from 110 PPM for malaria care facilities located in Amhara, Dire Dawa, Hareri, Oromia, Southern Nation Nationalities and Peoples and Tigray regions. Data abstraction formats were used to collect and collate the data on quarterly bases. The data were manually cleaned and analysed using Microsoft Office Excel 2010. To claim statistical significance non-parametric McNemar test was done and decision accepted at P < 0.05. RESULTS From April 2012-September 2015, a total of 873,707 malaria suspected patients were identified, of which one-fourth (25.6 %) were treated as malaria cases. Among malaria suspected cases the proportion of malaria investigation improved from recorded in first quarter 87.7-100.0 % in last quarter (X(2) = 66.84, P < 0.001). The majority (96.0 %) were parasitologically-confirmed cases either by using microscopy or rapid diagnostic tests. The overall slid positivity rate was 25.1 % of which half (50.7 %) were positive for Plasmodium falciparum and slightly lower than half (45.2 %) for Plasmodium vivax; the remaining 8790 (4.1 %) showed mixed infections of P. falciparum and P. vivax. Adherence to appropriate treatment using artemether-lumefantrine (AL) was improved from 47.8 % in the first quarter to 95.7 % in the last quarter (X(2) = 12.89, P < 0.001). Similarly, proper patient management using chloroquine (CQ) was improved from 44.1 % in the first quarter to 98.12 % in the last quarter (X(2) = 11.62, P < 0.001). CONCLUSIONS This study documented the chronological changes of adherence of health care providers with the national recommended standards to treat malaria. The PPM for malaria care services significantly improved the malaria case management practice of health care providers at the formal private health facilities. Therefore, regional health bureaus and partners shall closely work to scale up the initiated PPM for malaria care service.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Child, Preschool
- Coinfection/diagnosis
- Coinfection/drug therapy
- Coinfection/epidemiology
- Coinfection/parasitology
- Disease Management
- Ethiopia
- Female
- Health Services Research
- Humans
- Infant
- Infant, Newborn
- Malaria, Falciparum/diagnosis
- Malaria, Falciparum/drug therapy
- Malaria, Falciparum/epidemiology
- Malaria, Falciparum/parasitology
- Malaria, Vivax/diagnosis
- Malaria, Vivax/drug therapy
- Malaria, Vivax/epidemiology
- Malaria, Vivax/parasitology
- Male
- Middle Aged
- Plasmodium falciparum/isolation & purification
- Plasmodium vivax/isolation & purification
- Public-Private Sector Partnerships
- Retrospective Studies
- Young Adult
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Affiliation(s)
- Mesele D. Argaw
- Private Health Sector Project, Abt Associates Inc. In Ethiopia, P. O. Box 2372, 1250 Addis Ababa, Ethiopia
| | - Asfawesen GY. Woldegiorgis
- Private Health Sector Project, Abt Associates Inc. In Ethiopia, P. O. Box 2372, 1250 Addis Ababa, Ethiopia
| | - Derebe T. Abate
- Private Health Sector Project, Abt Associates Inc. In Ethiopia, P. O. Box 2372, 1250 Addis Ababa, Ethiopia
| | - Mesfin E. Abebe
- Private Health Sector Project, Abt Associates Inc. In Ethiopia, P. O. Box 2372, 1250 Addis Ababa, Ethiopia
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Scott CA, Yeshiwondim AK, Serda B, Guinovart C, Tesfay BH, Agmas A, Zeleke MT, Guesses GS, Ayenew AL, Workie WM, Steketee RW, Earle D, Bezabih B, Getachew A. Mass testing and treatment for malaria in low transmission areas in Amhara Region, Ethiopia. Malar J 2016; 15:305. [PMID: 27255330 PMCID: PMC4890322 DOI: 10.1186/s12936-016-1333-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/10/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In areas with ongoing malaria transmission, strategies to clear parasites from populations can reduce infection and transmission. The objective of this paper was to describe a malaria mass testing and treatment (MTAT) intervention implemented in six kebeles (villages) in Amhara Region, Ethiopia, at the beginning of the 2014 transmission season. METHODS Intervention kebeles were selected based on incidence of passively detected Plasmodium falciparum and mixed (P. falciparum and P. vivax) malaria cases during the 2013 malaria transmission season. All households in intervention kebeles were targeted; consenting residents received a rapid diagnostic test (RDT) and RDT-positive individuals received artemether-lumefantrine for P. falciparum/mixed infections or chloroquine for P. vivax. Data were collected on MTAT participation, sociodemographic characteristics, malaria risk factors, and RDT positivity. RESULTS Of 9162 households targeted, 7974 (87.0 %) participated in the MTAT. Among the 35,389 residents of these households, 30,712 (86.8 %) received an RDT. RDT-positivity was 1.4 % (0.3 % P. vivax, 0.7 % P. falciparum, 0.3 % mixed), ranging from 0.3 to 5.1 % by kebele; 39.4 % of RDT-positive individuals were febrile, 28.5 % resided in the same household with another RDT-positive individual, 23.0 % were not protected by vector control interventions [mosquito net or indoor residual spray (IRS)], and 7.1 % had travel history. For individuals under 10 years of age, the odds of being RDT-positive was significantly higher for those with fever, recent use of anti-malarial drugs or residing in the same household with another RDT-positive individual; 59.0 % of RDT-positive individuals had at least one of these risk factors. For individuals 10 years of age and older, the odds of being RDT positive was significantly higher for those with reported travel, fever, recent use of anti-malarial drugs, no use of vector control, and those residing in the same household as another RDT-positive individual; 71.2 % of RDT-positive individuals had at least one of these risk factors. CONCLUSIONS In the Ethiopia setting, an MTAT intervention is operationally feasible and can be conducted with high coverage. RDT-positivity is low and varies widely by kebele. While several risk factors are significantly associated with RDT-positivity, there are still many RDT-positive individuals who do not have any of these risk factors. Strategies that target populations for testing and treatment based on these risk factors alone are likely to leave many infections undetected.
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Affiliation(s)
- Callie A Scott
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Asnakew K Yeshiwondim
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Belendia Serda
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Caterina Guinovart
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA.
| | - Berhane H Tesfay
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Adem Agmas
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Melkamu T Zeleke
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Girma S Guesses
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Asmamaw L Ayenew
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Worku M Workie
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Richard W Steketee
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Duncan Earle
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Stand #16806, Trinity Park, Alick Nkhata Road, Mass Media Area, Lusaka, 10101, Zambia
| | - Belay Bezabih
- Amhara National Regional State Health Bureau, P.O. Box 495, Bahir Dar, Ethiopia
| | - Asefaw Getachew
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
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Magnitude of Malaria and Factors among Febrile Cases in Low Transmission Areas of Hadiya Zone, Ethiopia: A Facility Based Cross Sectional Study. PLoS One 2016; 11:e0154277. [PMID: 27137913 PMCID: PMC4854449 DOI: 10.1371/journal.pone.0154277] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/10/2016] [Indexed: 11/21/2022] Open
Abstract
Background Despite a remarkable decline in morbidity and mortality since the era of malaria roll back strategy, it still poses a huge challenge in Ethiopia in general and in Hadiya Zone in particular. Although, there are data from routine health management information on few indicators, there is scarcity of data showing magnitude of malaria and associated factors including knowledge and practice in the study area. Therefore, the aim of this study was to assess magnitude and factors affecting malaria in low transmission areas among febrile cases attending public health facilities in Hadiya Zone, Ethiopia. Methods A facility based cross-sectional study was conducted in Hadiya Zone from May 15 to June 15, 2014. Simple random sampling was used to select the health facility while systematic random sampling technique was used to reach febrile patients attending public health facilities. Data were collected by a pre-tested structured questionnaire containing sections of socio demographic risk factors and knowledge and prevention practices of malaria. Data were entered to Epi-Info software version 3.5.4 and exported to SPSS version 16 for descriptive and logistic regression analysis. Results One hundred six (25.8%) of participating febrile patients attending at sampled health facilities were found to have malaria by microscopy. Of which, P.vivax, P.falciparum and mixed infection accounted for 76(71. 7%), 27 (25.5%) and 3 (2.8%), respectively. History of travel to malaria endemic area, [AOR: 2.59, 95% CI: (1.24, 5.38)], not using bed net, [AOR: 4.67, 95%CI:, (2.11, 10.37)], poor practice related to malaria prevention and control, [AOR: 2.28, (95%CI: (1.10, 4.74)], poor knowledge about malaria, [AOR: 5.09,95%CI: (2.26,11.50)] and estimated distance of stagnant water near to the residence, [AOR: 3.32, (95%CI: (1.13, 9.76)] were significantly associated factors of malaria positivity in the study. Conclusion The present study revealed that malaria is still a major source of morbidity in the study area among febrile illnesses. Poor level of knowledge, poor prevention practices, not using bed net, travel history to endemic areas and residing near stagnant water were associated factors with malaria positivity in the study area. Therefore, implementers, policy makers and stakeholders should strengthen the services provided by the community health development army, health extension service and health facilities services focusing on increasing malaria intervention coverage and mobilization of information, education and communication to increase knowledge about malaria transmission, prevention and control practices.
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A Venue-Based Survey of Malaria, Anemia and Mobility Patterns among Migrant Farm Workers in Amhara Region, Ethiopia. PLoS One 2015; 10:e0143829. [PMID: 26619114 PMCID: PMC4664424 DOI: 10.1371/journal.pone.0143829] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/10/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mobile populations present unique challenges to malaria control and elimination efforts. Each year, a large number of individuals travel to northwest Amhara Region, Ethiopia to seek seasonal employment on large-scale farms. Agricultural areas typically report the heaviest malaria burden within Amhara thereby placing migrants at high risk of infection. Yet little is known about these seasonal migrants and their malaria-related risk factors. METHODS AND FINDINGS In July 2013, a venue-based survey of 605 migrant laborers 18 years or older was conducted in two districts of North Gondar zone, Amhara. The study population was predominantly male (97.7%) and young (mean age 22.8 years). Plasmodium prevalence by rapid diagnostic test (RDT) was 12.0%; One quarter (28.3%) of individuals were anemic (hemoglobin <13 g/dl). Nearly all participants (95.6%) originated from within Amhara Region, with half (51.6%) coming from within North Gondar zone. Around half (51.2%) slept in temporary shelters, while 20.5% regularly slept outside. Only 11.9% of participants had access to a long lasting insecticidal net (LLIN). Reported net use the previous night was 8.8% overall but 74.6% among those with LLIN access. Nearly one-third (30.1%) reported having fever within the past two weeks, of whom 31.3% sought care. Cost and distance were the main reported barriers to seeking care. LLIN access (odds ratio [OR] = 0.30, P = 0.04) and malaria knowledge (OR = 0.50, P = 0.02) were significantly associated with reduced Plasmodium infection among migrants, with a similar but non-significant trend observed for reported net use the previous night (OR = 0.16, P = 0.14). CONCLUSIONS High prevalence of malaria and anemia were observed among a young population that originated from relatively proximate areas. Low access to care and low IRS and LLIN coverage likely place migrant workers at significant risk of malaria in this area and their return home may facilitate parasite transport to other areas. Strategies specifically tailored to migrant farm workers are needed to support malaria control and elimination activities in Ethiopia.
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