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Sady H, Chaima D, Hallamaa L, Kortekangas E, Ashorn U, Banda J, Mangani C, Maleta K, Ashorn P, Fan YM. Effect of dietary intervention on the prevalence of asymptomatic malaria among 6-18-month-old children in rural Malawi. Malar J 2023; 22:266. [PMID: 37697296 PMCID: PMC10496296 DOI: 10.1186/s12936-023-04701-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The complex interaction between malaria and undernutrition leads to increased mortality and morbidity rate among young children in malaria-endemic regions. Results from previous interventions suggest that improving nutritional status of young children may reduce the burden of malaria. This study tested a hypothesis that provision of lipid-based nutrient supplements (LNS) or corn-soy blend (CSB) supplementation to 6-18-month-old children in Malawi would reduce the prevalence of asymptomatic malaria among them. METHODS A total of 840 6-month-old children were enrolled in a randomized trial. The participants received 12-month supplementation with three different daily dietary supplementations: CSB, soy-LNS, or milk-LNS, and one control group without supplementation. The prevalence rate of asymptomatic Plasmodium falciparum was determined by real-time PCR from the participant's dried blood spots (DBS) collected at the baseline and every 3 months. The global null hypothesis was tested using modified Poisson regression to estimate the prevalence ratio (PR) between the control group and three intervention groups at all ages combined. All the models were adjusted for malaria at baseline, season of DBS sample collection, site of enrolment, and household asset Z-score. RESULTS All children combined, the prevalence of P. falciparum was 14.1% at enrollment, 8.7% at 9 months, 11.2% at 12 months, 13.0% at 15 months and 22.4% at 18 months of age. Among all samples that were taken after enrolment, the prevalence was 12.1% in control group, 12.2% in milk-LNS, 14.0% in soy-LNS, and 17.2% in CSB group. Compared to children in the control group the prevalence ratio of positive malaria tests was 1.19 (95% CI 0.81-1.74; P = 0.372) in the milk-LNS group, 1.32 (95% CI 0.88-1.96; P = 0.177) in the soy-LNS group and 1.72 (95% CI 1.19-2.49; P = 0.004) in the CSB group. CONCLUSION The study findings do not support a hypothesis that LNS or CSB supplementation would reduce the prevalence of asymptomatic malaria among Malawian children. In contrast, there was a signal of a possible increase in malaria prevalence among children supplemented with CSB.
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Affiliation(s)
- Hany Sady
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33014, Tampere, Finland.
- Faculty of Medicine and Health Sciences, Hodeidah University, Hodeidah, Yemen.
| | - David Chaima
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Lotta Hallamaa
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33014, Tampere, Finland
| | - Emma Kortekangas
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33014, Tampere, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33014, Tampere, Finland
| | - Jomo Banda
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33014, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Yue-Mei Fan
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33014, Tampere, Finland
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2
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Neyer PJ, Kaboré B, Nakas CT, Hartmann B, Post A, Diallo S, Tinto H, Hammerer-Lercher A, Largiadèr CR, van der Ven AJ, Huber AR. Exploring the host factors affecting asymptomatic Plasmodium falciparum infection: insights from a rural Burkina Faso study. Malar J 2023; 22:252. [PMID: 37658365 PMCID: PMC10474782 DOI: 10.1186/s12936-023-04686-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Asymptomatic Plasmodium falciparum parasitaemia forms a reservoir for the transmission of malaria disease in West Africa. Certain haemoglobin variants are known to protect against severe malaria infection. However, data on the potential roles of haemoglobin variants and nongenetic factors in asymptomatic malaria infection is scarce and controversial. Therefore, this study investigated the associations of iron homeostasis, inflammation, nutrition, and haemoglobin mutations with parasitaemia in an asymptomatic cohort from a P. falciparum-endemic region during the high transmission season. METHODS A sub-study population of 688 asymptomatic individuals (predominantly children and adolescents under 15 years, n = 516) from rural Burkina Faso previously recruited by the NOVAC trial (NCT03176719) between June and October 2017 was analysed. Parasitaemia was quantified with conventional haemocytometry. The haemoglobin genotype was determined by reverse hybridization assays targeting a selection of 21 HBA and 22 HBB mutations. Demographics, inflammatory markers (interleukins 6 and 10, hepcidin), nutritional status (mid upper-arm circumference and body mass index), and anaemia (total haemoglobin, ferritin, soluble transferrin receptor) were assessed as potential predictors through logistic regression. RESULTS Malaria parasites were detected in 56% of subjects. Parasitaemia was associated most strongly with malnutrition. The effect size increased with malnutrition severity (OR = 6.26, CI95: 2.45-19.4, p < 0.001). Furthermore, statistically significant associations (p < 0.05) with age, cytokines, hepcidin and heterozygous haemoglobin S were observed. CONCLUSIONS According to these findings, asymptomatic parasitaemia is attenuated by haemoglobin S, but not by any of the other detected genotypes. Aside from evidence for slight iron imbalance, overall undernutrition was found to predict parasitaemia; thus, further investigations are required to elucidate causality and inform strategies for interventions.
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Affiliation(s)
- Peter J Neyer
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland.
- Graduate School for Cellular & Biomedical Sciences, University of Bern, Bern, Switzerland.
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Bérenger Kaboré
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Christos T Nakas
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Laboratory of Biometry, Department of Agriculture Crop, Production and Rural Environment, University of Thessaly, Volos, Greece
| | - Britta Hartmann
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Annelies Post
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Salou Diallo
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Halidou Tinto
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | | | - Carlo R Largiadèr
- Graduate School for Cellular & Biomedical Sciences, University of Bern, Bern, Switzerland
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andre J van der Ven
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andreas R Huber
- Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
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3
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Sarfo JO, Amoadu M, Kordorwu PY, Adams AK, Gyan TB, Osman AG, Asiedu I, Ansah EW. Malaria amongst children under five in sub-Saharan Africa: a scoping review of prevalence, risk factors and preventive interventions. Eur J Med Res 2023; 28:80. [PMID: 36800986 PMCID: PMC9936673 DOI: 10.1186/s40001-023-01046-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Africa has a higher burden of malaria-related cases and deaths globally. Children under five accounted for over two-thirds of all malaria deaths in sub-Saharan Africa (SSA). This scoping review aims to map evidence of the prevalence, contextual factors and health education interventions of malaria amongst children under 5 years (UN5) in SSA. METHOD Four main databases (PubMed, Central, Dimensions and JSTOR) produced 27,841 records of literature. Additional searches in Google, Google Scholar and institutional repositories produced 37 records. Finally, 255 full-text records were further screened, and 100 records were used for this review. RESULTS Low or no formal education, poverty or low income and rural areas are risk factors for malaria amongst UN5. Evidence on age and malnutrition as risk factors for malaria in UN5 is inconsistent and inconclusive. Furthermore, the poor housing system in SSA and the unavailability of electricity in rural areas and unclean water make UN5 more susceptible to malaria. Health education and promotion interventions have significantly reduced the malaria burden on UN5 in SSA. CONCLUSION Well-planned and resourced health education and promotion interventions that focus on prevention, testing and treatment of malaria could reduce malaria burden amongst UN5 in SSA.
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Affiliation(s)
- Jacob Owusu Sarfo
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | | | - Peace Yaa Kordorwu
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | - Abdul Karim Adams
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | | | - Abdul-Ganiyu Osman
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | - Immanuel Asiedu
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
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4
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Luoma J, Adubra L, Ashorn P, Ashorn U, Bendabenda J, Dewey KG, Hallamaa L, Coghlan R, Horton WA, Hyöty H, Kortekangas E, Lehto KM, Maleta K, Matchado A, Nkhoma M, Oikarinen S, Parkkila S, Purmonen S, Fan YM. Association between asymptomatic infections and linear growth in 18-24-month-old Malawian children. MATERNAL & CHILD NUTRITION 2023; 19:e13417. [PMID: 36111423 DOI: 10.1111/mcn.13417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/22/2022] [Accepted: 07/13/2022] [Indexed: 12/15/2022]
Abstract
Inadequate diet and frequent symptomatic infections are considered major causes of growth stunting in low-income countries, but interventions targeting these risk factors have achieved limited success. Asymptomatic infections can restrict growth, but little is known about their role in global stunting prevalence. We investigated factors related to length-for-age Z-score (LAZ) at 24 months by constructing an interconnected network of various infections, biomarkers of inflammation (as assessed by alpha-1-acid glycoprotein [AGP]), and growth (insulin-like growth factor 1 [IGF-1] and collagen X biomarker [CXM]) at 18 months, as well as other children, maternal, and household level factors. Among 604 children, there was a continuous decline in mean LAZ and increased mean length deficit from birth to 24 months. At 18 months of age, the percentage of asymptomatic children who carried each pathogen was: 84.5% enterovirus, 15.5% parechovirus, 7.7% norovirus, 4.6% rhinovirus, 0.6% rotavirus, 69.6% Campylobacter, 53.8% Giardia lamblia, 11.9% malaria parasites, 10.2% Shigella, and 2.7% Cryptosporidium. The mean plasma IGF-1 concentration was 12.5 ng/ml and 68% of the children had systemic inflammation (plasma AGP concentration >1 g/L). Shigella infection was associated with lower LAZ at 24 months through both direct and indirect pathways, whereas enterovirus, norovirus, Campylobacter, Cryptosporidium, and malaria infections were associated with lower LAZ at 24 months indirectly, predominantly through increased systemic inflammation and reduced plasma IGF-1 and CXM concentration at 18 months.
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Affiliation(s)
- Juho Luoma
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Laura Adubra
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jaden Bendabenda
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kathryn G Dewey
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
| | - Lotta Hallamaa
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ryan Coghlan
- Research Center, Shriners Hospitals for Children, Portland, Oregon, USA.,Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - William A Horton
- Research Center, Shriners Hospitals for Children, Portland, Oregon, USA.,Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - Heikki Hyöty
- Department of Virology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Fimlab Ltd., Tampere University Hospital, Tampere, Finland
| | - Emma Kortekangas
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kirsi-Maarit Lehto
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kenneth Maleta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Andrew Matchado
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Minyanga Nkhoma
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sami Oikarinen
- Department of Virology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Seppo Parkkila
- Fimlab Ltd., Tampere University Hospital, Tampere, Finland.,Clinical Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sami Purmonen
- Clinical Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Yue-Mei Fan
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Futagbi G, Otu PS, Abdul-Rahman M, Aidoo EK, Lo AC, Gyan BA, Afrane YA, Amoah LE. Association of TNF-Alpha, MBL2, NOS2, and G6PD with Malaria Outcomes in People in Southern Ghana. Genet Res (Camb) 2022; 2022:6686406. [PMID: 35291755 PMCID: PMC8901335 DOI: 10.1155/2022/6686406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/11/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background One major issue that has set back the gains of the numerous malaria control interventions that national malaria control programs have implemented is asymptomatic malaria. Certain host genetic factors are known to influence symptomatic malaria; however, not much is known about how host genetics influences the acquisition of asymptomatic malaria. Methods Genomic DNA was extracted from whole blood collected from 60 symptomatic and 149 nonfebrile (asymptomatic, N = 109, and uninfected, N = 40) volunteers aged between 2 and 69 years from a high (Obom) and a low (Asutsuare) malaria transmission setting in Southern Ghana. Restriction fragment length polymorphism (RFLP) was used to determine polymorphisms at the MBL2 54, TNF-α 308, NOS2 954, and G6PD 202/376 gene loci. Results Polymorphisms at the MBL2 54 and TNF-α 308 loci were significantly different amongst the three categories of volunteers in both Asutsuare (p = 0.006) and Obom (p=0.05). In Asutsuare, a low malaria transmission area, the allele G has significantly higher odds (3.15) of supporting asymptomatic malaria as against symptomatic malaria. There were significantly higher odds of TNF-α genotype GA being associated with symptomatic malaria as against asymptomatic malaria in both sites, Obom (p=0.027) and Asutsuare (p=0.027). The allele B of the G6PD gene was more prevalent in symptomatic rather than asymptomatic parasite-infected individuals in both Obom (p=0.001) and Asutsuare (p=0.003). Conclusion Individuals in Southern Ghana carrying the TNF-α 308 GA genotype are more likely to exhibit symptoms of malaria when infected with the malaria parasite as opposed to harboring an asymptomatic infection. Also, the B allele of the G6PD gene is likely to prevent a P. falciparum-infected person from exhibiting symptoms and thereby promote asymptomatic parasite carriage.
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Affiliation(s)
- Godfred Futagbi
- Department of Animal Biology and Conservation Science, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Paulina S Otu
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Mubarak Abdul-Rahman
- Department of Pathology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Ebenezer K Aidoo
- Department of Medical Laboratory, Accra Technical University, Accra, Ghana
| | - Aminata C Lo
- Immunology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Department of Medical Parasitology, Faculty of Medicine, University Cheikh Anta Diop, Dakar, Senegal
| | - Ben A Gyan
- Immunology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Yaw A Afrane
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Linda E Amoah
- Immunology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- West Africa Center for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
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6
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Mensah BA, Myers-Hansen JL, Obeng Amoako E, Opoku M, Abuaku BK, Ghansah A. Prevalence and risk factors associated with asymptomatic malaria among school children: repeated cross-sectional surveys of school children in two ecological zones in Ghana. BMC Public Health 2021; 21:1697. [PMID: 34535112 PMCID: PMC8447720 DOI: 10.1186/s12889-021-11714-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 08/29/2021] [Indexed: 11/27/2022] Open
Abstract
Background Asymptomatic Plasmodium infections significantly drive malaria transmission and impact control and elimination strategies, but are largely uncharacterized. We investigated the prevalence and risk factors of asymptomatic malaria infections to inform malaria control strategies in Ghana. Method Five cross-sectional surveys were conducted at the end of the peak transmission season (August–September) on 4892 school children aged between 6 and 14 years in two distinct ecological settings in Ghana between 2013 and 2017. The study sites were Begoro (forest ecology) and Cape Coast (coastal ecology). The children were screened for malaria parasites by microscopic examination of Giemsa-stained thin and thick blood films. Hemoglobin levels were measured using the Hemocue HB analyzer. In addition, height was measured and the height-for-age z-scores estimated from the reference population defined by WHO to determine children who were stunted. Proportions of categorical and means of continuous variables were compared using Chi-square test and Student’s t-test respectively, and multivariable logistic regression was done to assess risk factors associated with asymptomatic infections. Results The overall prevalence of asymptomatic malaria in the school children was higher in Begoro compared to Cape Coast (27% (95% CI: 17, 24%) vs. 24% (95% CI: 17, 24%), p value = 0.04). The study recorded three species of Plasmodium (Plasmodia falciparum, malariae, and ovale) in both sites. Plasmodium falciparum was the predominant species, accounting for about 85% of infections in both study sites. The asymptomatic school children were more likely to be anaemic (OR = 2.01, p value< 0.001) and stunted in growth (OR = 1.46, p value< 0.001). Males carried more asymptomatic infection than females (OR = 1.18, p value = 0.015). School children aged 12–14 years had more asymptomatic infections than those aged 6–8 years (OR = 1.28, p value = 0.005). Conclusion There is a considerable burden of asymptomatic malaria in the two regions of Ghana, which is associated with males, older children, anaemia, and stunted growth in children, and may have implications for malaria control and elimination strategies in Ghana.
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Affiliation(s)
- B A Mensah
- Department of Epidemiology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - J L Myers-Hansen
- Department of Epidemiology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.,Department of Parasitology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - E Obeng Amoako
- Department of Epidemiology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - M Opoku
- Department of Epidemiology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.,Department of Parasitology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - B K Abuaku
- Department of Epidemiology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - A Ghansah
- Department of Epidemiology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana. .,Department of Parasitology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
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7
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Dao F, Djonor SK, Ayin CTM, Adu GA, Sarfo B, Nortey P, Akuffo KO, Danso-Appiah A. Burden of malaria in children under five and caregivers' health-seeking behaviour for malaria-related symptoms in artisanal mining communities in Ghana. Parasit Vectors 2021; 14:418. [PMID: 34419123 PMCID: PMC8380373 DOI: 10.1186/s13071-021-04919-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/02/2021] [Indexed: 01/21/2023] Open
Abstract
Background Artisanal mining creates enabling breeding ground for the vector of malaria parasites. There is paucity of data on the effects of artisanal mining on malaria. This study assessed burden of malaria and caregivers’ health-seeking behaviour for children under five in artisanal mining communities in East Akim District in Ghana. Methods A cross-sectional study involving caregivers and their children under five was conducted in three artisanal mining communities in the East Akim District in Ghana. Caregivers were interviewed using a structured questionnaire. Finger prick blood samples were collected and analysed for haemoglobin concentration using a rapid diagnostic test, and thick and thin blood smears were analysed to confirm the presence of malaria parasites. Results Of the 372 children under 5 years included in the study, 197 (53.1%) were male, with a mean age (± SD) of 23.0 ± 12.7 months. The proportion of children with malaria (Plasmodium falciparum and P. malariae) was 98.1% and 1.9%, respectively, whilst the proportion with anaemia (Hb < 11.0 g/dl) was 39.5% (n = 147). Almost all caregivers were female (98.9%), and 28.6% (n = 106) did not have access to any malaria control information. Caregivers associated malaria infection with mosquito bites (68.3%, n = 254) and poor sanitation (21.2%, n = 79). Malaria in children under five was significantly associated with anaemia (OR 11.07, 95% CI 6.59–18.68, n = 111/160, 69.4%; P < 0.0001), residing close to stagnant water (≤ 25 m) from an artisanal mining site (AOR 2.91, 95% CI 1.47–5.76, P = 0.002) and caregiver age younger than 30 years (OR 0.44, 95% CI 0.208–0.917, n = 162, 43.55%, P = 0.001). Conclusions There is a high burden of malaria and anaemia among children under five in artisanal mining communities of the East Akim District, and far higher than in non-artisanal mining sites. Interventions are needed to effectively regulate mining activities in these communities, and strengthen malaria control and health education campaigns to curtail the high malaria burden and improve health-seeking behaviour. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-04919-8.
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Affiliation(s)
- Francois Dao
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana.,Malaria Research and Training Center, Department of Epidemiology and Infectious Diseases, University of Science Techniques and Technologies of Bamako, Bamako, Mali
| | - Sampson Kafui Djonor
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Christian Teye-Muno Ayin
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | | | - Bismark Sarfo
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Pricillia Nortey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana. .,University of Ghana Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Legon, Ghana.
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Efficacy of Mebendazole and Praziquantel against Soil-Transmitted Helminths and Schistosoma mansoni Infections among Schoolchildren in Northwest Ethiopia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6682418. [PMID: 34327236 PMCID: PMC8302392 DOI: 10.1155/2021/6682418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 07/04/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
Background Soil-transmitted helminths (STHs) and Schistosoma mansoni are the main causes of morbidity among schoolchildren in the tropics. A school-based deworming program was launched to control and eliminate the infection in endemic countries including Ethiopia. Although periodic deworming is conducted in endemic areas, the prevalence of the infection is high in the country. In addition, periodic evaluation of the efficacy of the anthelminthic drug is limited. Objective This study is aimed at checking the efficacy of mebendazole and praziquantel with the respective STHs and Schistosoma mansoni parasites. Methods A longitudinal study was conducted from February to March 2018 among 422 schoolchildren. Stool samples were collected at baseline and at 2 and 4 weeks posttreatment and were processed using the Kato-Katz technique. Schoolchildren positive for STHs were treated with mebendazole and those positive for Schistosoma mansoni with praziquantel. After two weeks, a second round of stool was collected and examined, and then, single-dose redosing was given to each positive child. Lastly, the third stool sample was collected two weeks after the initiation of the redosing and checked for STHs and S. mansoni parasites. A close follow-up of students who were treated was done. All the data were entered and analyzed using SPSS version 20 for analysis. Descriptive statistics was used to compute the cure rate and egg reduction rate of mebendazole and praziquantel. Results Among 422 participants, the prevalence of STHs, hookworm, Ascaris lumbricoides, and S. mansoni was 44.7%, 35.1%, 21.1%, and 13.9%, respectively. The cure rate of mebendazole against A. lumbricoides increased from 60% in the single dose to 100% in redosing after two weeks. The cure rate of mebendazole against hookworm also increased from 32.4% in the single dose to 91.0% in the redosing. The cure rate of praziquantel against S. mansoni-infected children was 91.5% in the first round and 100% in the redosing phase. There was a 98.6-100% egg reduction rate in the redosing regimen of both drugs. Conclusion The cure and egg reduction rates of single-dose mebendazole in the treatment of hookworm and A. lumbricoides are lower at week two than at redosing, while cure and egg reduction rates of single-dose praziquantel are satisfactory to treat S. mansoni. Therefore, single-dose praziquantel to S. mansoni and redosing of single-dose mebendazole to A. lumbricoides and hookworm infections can be used for treatment purposes.
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Donovan CV, McElroy P, Adair L, Pence BW, Oloo AJ, Lal A, Bloland P, Nahlen B, Juliano JJ, Meshnick S. Association of Malnutrition with Subsequent Malaria Parasitemia among Children Younger than Three years in Kenya: A Secondary Data Analysis of the Asembo Bay Cohort Study. Am J Trop Med Hyg 2021; 104:243-254. [PMID: 33200723 PMCID: PMC7790106 DOI: 10.4269/ajtmh.20-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 08/22/2020] [Indexed: 11/07/2022] Open
Abstract
Malaria and malnutrition remain primary causes of morbidity and mortality among children younger than 5 years in Africa. Studies investigating the association between malnutrition and subsequent malaria outcomes are inconsistent. We studied the effects of malnutrition on incidence and prevalence of malaria parasitemia in data from a cohort studied in the 1990s. Data came from the Asembo Bay cohort study, which collected malaria and health information on children from 1992 to 1996 in western Kenya. Infants were enrolled at birth and followed up until loss to follow-up, death, end of study, or 5 years old. Anthropometric measures and blood specimens were obtained monthly. Nutritional exposures included categorized Z-scores for height-for-age, weight-for-age, and weight-for-height. Febrile parasitemia and afebrile parasitemia were assessed with thick and thin blood films. Multiply imputed and weighted multinomial generalized estimating equation models estimated odds ratios (OR) for the association between exposures and outcomes. The sample included 1,182 children aged 0-30 months who contributed 18,028 follow-up visits. There was no significant association between malnutrition and either incident febrile parasitemia or prevalent febrile parasitemia. Prevalence ORs for afebrile parasitemia increased from 1.07 (95% CI: 0.89, 1.29) to 1.35 (1.03, 1.76) as stunting severity increased from mild to severe, and from 1.16 (1.02, 1.33) to 1.35 (1.09, 1.66) as underweight increased from mild to moderate. Stunting and underweight did not show a significant association with subsequent febrile parasitemia infections, but they did show a modest association with subsequent afebrile parasitemia. Consideration should be given to testing malnourished children for malaria, even if they present without fever.
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Affiliation(s)
- Catherine V. Donovan
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Peter McElroy
- U.S. President’s Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Linda Adair
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Brian W. Pence
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Aggrey James Oloo
- Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Altaf Lal
- Malaria Elimination Demonstration Project, Foundation for Disease Elimination and Control of India, Mandla, India
| | - Peter Bloland
- Global Immunization Division, U.S Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard Nahlen
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana
| | - Jonathan J. Juliano
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Steven Meshnick
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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Okyere B, Owusu-Ofori A, Ansong D, Buxton R, Benson S, Osei-Akoto A, Owiredu EW, Adjei C, Xorse Amuzu E, Marfo Boaheng J, Dickerson T. Point prevalence of asymptomatic Plasmodium infection and the comparison of microscopy, rapid diagnostic test and nested PCR for the diagnosis of asymptomatic malaria among children under 5 years in Ghana. PLoS One 2020; 15:e0232874. [PMID: 32716936 PMCID: PMC7384639 DOI: 10.1371/journal.pone.0232874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/23/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Plasmodium infection among children is a serious public health problem. Asymptomatic malaria infection among humans serves as a significant reservoir for transmitting Plasmodium to uninfected Anopheles mosquitoes, fueling malaria endemicity and asymptomatic malaria may progress to clinical malaria. Therefore, prompt and accurate diagnosis of malaria infection is crucial for the management and control of malaria, especially in endemic areas. This study assessed the point prevalence of asymptomatic malaria infection and evaluated the performance of malaria Rapid Diagnostic Tests (RDT), light microscopy and nested PCR (nPCR) for the diagnosis of asymptomatic malaria infection in a paediatric population in the Atwima Nwabiagya North district, Ghana. METHODS This cross-sectional study enrolled 500 asymptomatic children aged ≤ 5 years. After consent was obtained from a parent, blood samples were collected from each participant to assess for Plasmodium infection based on histidine rich protein-2 (pfHRP-2)-based malaria RDT, light microscopy and nPCR. RESULTS The point prevalence of asymptomatic malaria by microscopy, RDT, and nPCR were 116/500 (23.2%), 156/500 (31.2%), and 184/500 (36.8%), respectively. Using nPCR as the reference, RDT presented with a perfect sensitivity (100.0%), specificity (100.0%), accuracy (100.0%), and reliability (100.0%) in detecting asymptomatic P. falciparum infection. Likewise, microscopy presented with an excellent specificity and high accuracy in detecting both P. falciparum (100.0%; 85.6%) and P. malariae (100.0%; 100.0%). However, the sensitivity (56.4%) and reliability (56.4%) of microscopy was low for both P. falciparum. CONCLUSION The findings of this study indicate a high point prevalence of asymptomatic Plasmodium infection among children in Atwima Nwabiagya North district, Ghana. In the absence of the more sensitive PCR, pfHRP-2-based malaria RDT provides substantial diagnostic sensitivity, specificity, accuracy and reliability and is superior to microscopy.
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Affiliation(s)
- Bismark Okyere
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Alex Owusu-Ofori
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Daniel Ansong
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rebecca Buxton
- Medical Laboratory Science Division, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Scott Benson
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Alex Osei-Akoto
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eddie-Williams Owiredu
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Collins Adjei
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Evans Xorse Amuzu
- Research and Development Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Ty Dickerson
- Division of Pediatric Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- * E-mail:
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11
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The Human Spleen in Malaria: Filter or Shelter? Trends Parasitol 2020; 36:435-446. [PMID: 32298631 DOI: 10.1016/j.pt.2020.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/10/2020] [Accepted: 03/04/2020] [Indexed: 12/18/2022]
Abstract
The human spleen is an immune sentinel and controls red blood cell (RBC) quality. By mechanically retaining subsets of infected RBCs, the spleen may reduce the pace at which the parasite biomass increases before the adaptive immune response operates. Conversely, the spleen may contribute to malaria pathogenesis, particularly anemia that is associated with splenomegaly. Large spleens may also shelter parasites in chronic carriers. Upon treatment with artemisinins, the spleen clears circulating parasites by pitting and releases 'once-infected' RBCs in circulation. This triggers postartesunate delayed hemolysis and explains the long post-treatment positivity of histidine-rich protein 2 (HRP2)-based dipsticks. Importantly, splenic retention of RBCs also applies to gametocytes, the clearance of which may be enhanced by stiffening them with drugs, a potential way to block malaria transmission.
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12
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Seasonal malaria chemoprevention packaged with malnutrition prevention in northern Nigeria: A pragmatic trial (SMAMP study) with nested case-control. PLoS One 2019; 14:e0210692. [PMID: 30682069 PMCID: PMC6347255 DOI: 10.1371/journal.pone.0210692] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/25/2018] [Indexed: 11/19/2022] Open
Abstract
Integrating seasonal malaria chemoprevention (SMC), recommended by the WHO since 2012 to prevent malaria infection, with nutrition interventions may improve health outcomes and operational efficiencies. This study assessed the effects of co-packaging interventions on distribution coverage, nutrition, and clinical malaria outcomes in northern Nigeria. From August to November 2014, community volunteers delivered sulfadoxine-pyrimethamine and amodiaquine (SP-AQ) door-to-door each month to approximately 7,000 children aged 6–24 months in seven wards of Madobi, Kano State, Nigeria. In three of the wards children additionally received a lipid-based nutrient supplement (LNS–medium quantity), Plumpy Doz. Coverage, adherence, and anthropometric outcomes were assessed through baseline, midline, and endline household surveys. A facility-based case-control study was also conducted to estimate impact on clinical malaria outcomes. Coverage of SP-AQ was similar between arms at 89% (n = 2,409 child-months [88–90%]) in the SP-AQ only arm and 90% (n = 1,947 child-months [88–92%]) in the SP-AQ plus LNS arm (p = 0.52). Coverage of LNS was 83% (n = 2,409 child-months [81–84%]). Whilst there were marked changes in anthropometric status between baseline, midline and endline, these were largely accounted for by socioeconomic status and must be interpreted with care due to possible measurement issues, especially length-based indices. Overall nutritional status of our most robust measure, weight-for-age, does appear to have improved by endline, but was similar in the two study arms, suggesting no additional benefit of the LNS. While the odds of clinical malaria among those who received the intended intervention were lower in each study arm compared to children who did not receive interventions (SP-AQ only OR = 0.23 [0.09–0.6]; SP-AQ plus LNS OR = 0.22 [0.09–0.55]), LNS was not shown to have an additional impact. Coverage of SMC was high regardless of integrating LNS delivery into the SMC campaign. Supplementation with LNS did not appear to impact nutritional outcomes, but appeared to enhance the impact of SP-AQ on clinical odds of malaria. These results indicate that combining nutritional interventions with seasonal malaria chemoprevention in high-risk areas can be done successfully, warranting further exploration with other products or dosing. Trial Registration: ISRCTN 11413895
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13
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Das D, Grais RF, Okiro EA, Stepniewska K, Mansoor R, van der Kam S, Terlouw DJ, Tarning J, Barnes KI, Guerin PJ. Complex interactions between malaria and malnutrition: a systematic literature review. BMC Med 2018; 16:186. [PMID: 30371344 PMCID: PMC6205776 DOI: 10.1186/s12916-018-1177-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/20/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite substantial improvement in the control of malaria and decreased prevalence of malnutrition over the past two decades, both conditions remain heavy burdens that cause hundreds of thousands of deaths in children in resource-poor countries every year. Better understanding of the complex interactions between malaria and malnutrition is crucial for optimally targeting interventions where both conditions co-exist. This systematic review aimed to assess the evidence of the interplay between malaria and malnutrition. METHODS Database searches were conducted in PubMed, Global Health and Cochrane Libraries and articles published in English, French or Spanish between Jan 1980 and Feb 2018 were accessed and screened. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale and the risk of bias across studies was assessed using the GRADE approach. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline were followed. RESULTS Of 2945 articles screened from databases, a total of 33 articles were identified looking at the association between malnutrition and risk of malaria and/or the impact of malnutrition in antimalarial treatment efficacy. Large methodological heterogeneity of studies precluded conducting meaningful aggregated data meta-analysis. Divergent results were reported on the effect of malnutrition on malaria risk. While no consistent association between risk of malaria and acute malnutrition was found, chronic malnutrition was relatively consistently associated with severity of malaria such as high-density parasitemia and anaemia. Furthermore, there is little information on the effect of malnutrition on therapeutic responses to artemisinin combination therapies (ACTs) and their pharmacokinetic properties in malnourished children in published literature. CONCLUSIONS The evidence on the effect of malnutrition on malaria risk remains inconclusive. Further analyses using individual patient data could provide an important opportunity to better understand the variability observed in publications by standardising both malaria and nutritional metrics. Our findings highlight the need to improve our understanding of the pharmacodynamics and pharmacokinetics of ACTs in malnourished children. Further clarification on malaria-malnutrition interactions would also serve as a basis for designing future trials and provide an opportunity to optimise antimalarial treatment for this large, vulnerable and neglected population. TRIAL REGISTRATION PROSPERO CRD42017056934 .
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Affiliation(s)
- D Das
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - E A Okiro
- Kemri Wellcome Trust Research Programme, Kilifi, Kenya
| | - K Stepniewska
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - R Mansoor
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - D J Terlouw
- Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - J Tarning
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - K I Barnes
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,WorldWide Antimalarial Resistance Network (WWARN) Pharmacology, University of Cape Town, Cape Town, South Africa
| | - P J Guerin
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
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14
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Berzosa P, de Lucio A, Romay-Barja M, Herrador Z, González V, García L, Fernández-Martínez A, Santana-Morales M, Ncogo P, Valladares B, Riloha M, Benito A. Comparison of three diagnostic methods (microscopy, RDT, and PCR) for the detection of malaria parasites in representative samples from Equatorial Guinea. Malar J 2018; 17:333. [PMID: 30223852 PMCID: PMC6142353 DOI: 10.1186/s12936-018-2481-4] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/10/2018] [Indexed: 11/21/2022] Open
Abstract
Background Malaria in Equatorial Guinea remains a major public health problem. The country is a holo-endemic area with a year-round transmission pattern. In 2016, the prevalence of malaria was 12.09% and malaria caused 15% of deaths among children under 5 years. In the Continental Region, 95.2% of malaria infections were Plasmodium falciparum, 9.5% Plasmodium vivax, and eight cases mixed infection in 2011. The main strategy for malaria control is quick and accurate diagnosis followed by effective treatment. Early and accurate diagnosis of malaria is essential for both effective disease management and malaria surveillance. The quality of malaria diagnosis is important in all settings, as misdiagnosis can result in significant morbidity and mortality. Microscopy and RDTs are the primary choices for diagnosing malaria in the field. However, false-negative results may delay treatment and increase the number of persons capable of infecting mosquitoes in the community. The present study analysed the performance of microscopy and RDTs, the two main techniques used in Equatorial Guinea for the diagnosis of malaria, compared to semi-nested multiplex PCR (SnM-PCR). Results A total of 1724 samples tested by microscopy, RDT, and SnM-PCR were analysed. Among the negative samples detected by microscopy, 335 (19.4%) were false negatives. On the other hand, the negative samples detected by RDT, 128 (13.3%) were false negatives based on PCR. This finding is important, especially since it is a group of patients who did not receive antimalarial treatment. Conclusions Owing to the high number of false negatives in microscopy, it is necessary to reinforce training in microscopy, the “Gold Standard” in endemic areas. A network of reference centres could potentially support ongoing diagnostic and control efforts made by malaria control programmes in the long term, as the National Centre of Tropical Medicine currently supports the National Programme against Malaria of Equatorial Guinea to perform all of the molecular studies necessary for disease control. Taking into account the results obtained with the RDTs, an exhaustive study of the deletion of the hrp2 gene must be done in EG to help choose the correct RDT for this area.
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Affiliation(s)
- Pedro Berzosa
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029, Madrid, Spain. .,Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain.
| | - Aida de Lucio
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029, Madrid, Spain
| | - María Romay-Barja
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029, Madrid, Spain.,Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain
| | - Zaida Herrador
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029, Madrid, Spain.,Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain
| | - Vicenta González
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029, Madrid, Spain.,Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain
| | - Luz García
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029, Madrid, Spain.,Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain
| | - Amalia Fernández-Martínez
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029, Madrid, Spain.,Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain
| | - Maria Santana-Morales
- Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain.,Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de la Laguna, Tenerife, Spain
| | - Policarpo Ncogo
- Reference Centre for Control of Endemic Diseases (CRCE), Malabo, Equatorial Guinea
| | - Basilio Valladares
- Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain.,Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de la Laguna, Tenerife, Spain
| | - Matilde Riloha
- Ministry of Health and Social Welfare of Equatorial Guinea, Malabo, Equatorial Guinea
| | - Agustín Benito
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029, Madrid, Spain.,Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain
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15
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Roman DNR, Anne NNR, Singh V, Luther KMM, Chantal NEM, Albert MS. Role of genetic factors and ethnicity on the multiplicity of Plasmodium falciparum infection in children with asymptomatic malaria in Yaoundé, Cameroon. Heliyon 2018; 4:e00760. [PMID: 30186982 PMCID: PMC6120745 DOI: 10.1016/j.heliyon.2018.e00760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/10/2018] [Accepted: 08/23/2018] [Indexed: 12/22/2022] Open
Abstract
In this cross-sectional study, we investigated host genetic factors and ethnic variation in circulating Plasmodium falciparum merozoite surface protein 2 (msp-2) clones among children with asymptomatic malaria. Isolates from seventy two asymptomatic malaria children were used for genotyping block 3 of msp-2 gene by nested polymerase chain reaction (PCR). Sickle cell trait and glucose-6-phosphate dehydrogenase (G6PD) deficiency were analysed by restriction fragment length polymorphism of DNA products from PCR targeting codons 6 and 68 of the beta-globin (HBB) and G6PD genes respectively. ABO blood group was typed by agglutination method. A total of forty two msp-2 genotypes (20 for 3D7 and 22 for FC27) were detected for an average (standard error of mean) multiplicity of infection (MOI) of 2.45 (0.16). The MOI was statistically the same among the five identified ethnic groups (P = 0.83). The overall prevalence of sickle cell trait and G6PD deficiency were 12.50 % and 22.22 % respectively. MOI was similar between children with Hb AA and Hb AS genotypes (P = 0.42). MOI was significantly high among children with a mutant G6PD genotype (P = 0.017). MOI was significantly higher in blood group O than group A (P = 0.03). Our findings show that although ethnicity and sickle cell trait have no association with MOI, the association was observed with G6PD genotype and ABO group. The results suggest the need for extension and expansion of the current study in order to investigate the mechanisms involved.
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Affiliation(s)
- Dongang Nana Rodrigue Roman
- Department of Biochemistry, Faculty of Sciences, University of Douala, P.O Box 24157, Douala, Cameroon
- Institute of Medical Research and Medicinal Plants Studies (IMPM), P.O Box 13033, Yaoundé, Cameroon
- Cell Biology Laboratory and Malaria Parasite Bank, ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi 110077, India
| | - Ngono Ngane Rosalie Anne
- Department of Biochemistry, Faculty of Sciences, University of Douala, P.O Box 24157, Douala, Cameroon
| | - Vineeta Singh
- Cell Biology Laboratory and Malaria Parasite Bank, ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi 110077, India
- Corresponding author.
| | | | - Ngonde Essome Marie Chantal
- Institute of Medical Research and Medicinal Plants Studies (IMPM), P.O Box 13033, Yaoundé, Cameroon
- University Hospital Centre, P.O Box 1364, Yaoundé, Cameroon
| | - Mouelle Sone Albert
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, P.O Box 24157, Douala, Cameroon
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Kinyoki DK, Moloney GM, Uthman OA, Odundo EO, Kandala NB, Noor AM, Snow RW, Berkley JA. Co-morbidity of malnutrition with falciparum malaria parasitaemia among children under the aged 6-59 months in Somalia: a geostatistical analysis. Infect Dis Poverty 2018; 7:72. [PMID: 29986753 PMCID: PMC6036667 DOI: 10.1186/s40249-018-0449-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Malnutrition and malaria are both significant causes of morbidity and mortality in African children. However, the extent of their spatial comorbidity remains unexplored and an understanding of their spatial correlation structure would inform improvement of integrated interventions. We aimed to determine the spatial correlation between both wasting and low mid upper arm circumference (MUAC) and falciparum malaria among Somalian children aged 6–59 months. Methods Data were from 49 227 children living in 888 villages between 2007 to 2010. We developed a Bayesian geostatistical shared component model in order to determine the common spatial distributions of wasting and falciparum malaria; and low-MUAC and falciparum malaria at 1 × 1 km spatial resolution. Results The empirical correlations with malaria were 0.16 and 0.23 for wasting and low-MUAC respectively. Shared spatial residual effects were statistically significant for both wasting and low-MUAC. The posterior spatial relative risk was highest for low-MUAC and malaria (range: 0.19 to 5.40) and relatively lower between wasting and malaria (range: 0.11 to 3.55). Hotspots for both wasting and low-MUAC with malaria occurred in the South Central region in Somalia. Conclusions The findings demonstrate a relationship between nutritional status and falciparum malaria parasitaemia, and support the use of the relatively simpler MUAC measurement in surveys. Shared spatial distribution and distinct hotspots present opportunities for targeted seasonal chemoprophylaxis and other forms of malaria prevention integrated within nutrition programmes. Electronic supplementary material The online version of this article (10.1186/s40249-018-0449-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Damaris K Kinyoki
- Spatial Health Metrics Group, INFORM Project, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.
| | - Grainne M Moloney
- Nutrition Section, United Nations Children's Fund (UNICEF), Kenya Country Office, UN Complex Gigiri, Nairobi, Kenya
| | - Olalekan A Uthman
- Warwick Medical School, Health Sciences Research Institute, Warwick Evidence, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK
| | - Elijah O Odundo
- Food Security and Nutrition Analysis Unit (FSNAU) - Somalia, Food and Agriculture Organization of the United Nations, Ngecha Road Campus, Nairobi, Kenya
| | - Ngianga-Bakwin Kandala
- Department of Mathematics and Information sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK.,Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.,Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Abdisalan M Noor
- Spatial Health Metrics Group, INFORM Project, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX3 7LJ, UK
| | - Robert W Snow
- Spatial Health Metrics Group, INFORM Project, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX3 7LJ, UK
| | - James A Berkley
- Kenya Medical Research Institute/ Wellcome Trust Research Programme, Centre for Geographic Medicine Research (coast), Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX3 7LJ, UK
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17
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Berhe B, Bugssa G, Bayisa S, Alemu M. Foodborne intestinal protozoan infection and associated factors among patients with watery diarrhea in Northern Ethiopia; a cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:5. [PMID: 29499754 PMCID: PMC5834838 DOI: 10.1186/s41043-018-0137-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/24/2018] [Indexed: 05/14/2023]
Abstract
BACKGROUND Intestinal protozoa are parasites transmitted by consumption of contaminated water and food and mainly affect children and elder people and cause considerable health problems. They are the leading causes of outpatient morbidity due to diarrhea in the developing countries. So, assessing water and food source of diarrheal patients and identifying the main associated factors for transmission of protozoan parasitic infections help for effective control measures of protozoan infections. Hence, the current study was aimed at determining the prevalence of foodborne intestinal protozoa infections and associated factors among diarrheic patients in North Ethiopia. METHODS A health facility based cross-sectional study was conducted among 223 patients with watery diarrhea in four selected government health facilities in North Ethiopia from November 2016-June 2017. A structured questionnaire was used to collect data on socio-demography of study participants and factors associated with foodborne protozoa infections. The diarrheic stool samples were collected, transported, and processed using direct wet mount, formal-ether concentration and modified ZiehlNeelson staining methods. The data were analyzed using SPSS version 21 and descriptive statistics, bi-variate, and multivariate logistic regressions were computed. P-value < 0.05 at 95% confidence interval was considered statistically significant. RESULTS The overall prevalence of foodborne protozoa infection was 101 (45.3%). The predominant protozoa species identified was Entamoeba histolytica/dispar 55 (24.7%), followed by Giardia intestinalis 25 (11.2%) and Cryptosporidium species 5 (2.2%). The highest proportion of protozoa infection was observed among males (23.3%) and the age group 15-24 years (13.5%). Statistically significant associations were observed between foodborne protozoan infection and not using any type of recipe to decontaminate salads and fruits (AOR = 2.64, 95 CI: 1.34-5.19, P = 0.005) and using vinegar as a decontaminant (AOR = 2.83, 95 CI: 1.24-6.48, P = 0.014). Eating out (meals at a restaurant) on the other hand was found to be protective for foodborne protozoan infection (AOR = 0.43, 95 CI: 0.23-0.78, P = 0.006). CONCLUSION Our study revealed that foodborne protozoa infections are of public health significance in the study area. Vinegar, which is frequently used as a recipe for decontaminating salads and fruits, is inversely related to foodborne protozoa parasite infection .
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Affiliation(s)
- Birhane Berhe
- Department of Bio-Medical Laboratory Science, College of Health Science, Adigrat University, Adigrat, Ethiopia
| | - Gessessew Bugssa
- Department of Medical Parasitology and Entomology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Sena Bayisa
- Department of Medical Parasitology and Entomology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Megbaru Alemu
- Department of Medical Microbiology, Immunology and Parasitology, Bahir Dar University, Mekelle, Ethiopia
- Department of Microbiology, Immunology and Parasitology, Bahir Dar University, PO Box 79, Bahir Dar, Ethiopia
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18
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Arwati H, Yotopranoto S, Rohmah EA, Syafruddin D. Submicroscopic malaria cases play role in local transmission in Trenggalek district, East Java Province, Indonesia. Malar J 2018; 17:2. [PMID: 29301534 PMCID: PMC5755365 DOI: 10.1186/s12936-017-2147-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 12/19/2017] [Indexed: 12/24/2022] Open
Abstract
Background Trenggalek district is a hypoendemic malaria area with mainly imported cases brought by migrant workers from islands outside Java. During malaria surveillance in 2015, no malaria cases were found microscopically, but some cases were positive by PCR. Therefore, a study was conducted to prove that local malaria transmission still occur. Methods The adult villagers were invited to the house of the head of this village to be screened for malaria using aseptic venipuncture of 1 mL blood upon informed consent. Thin and thick blood films as well as blood spots on filter paper were made for each subject. The blood films were stained with Giemsa and the blood spots were used to extract DNA for polymerase chain reaction (PCR) amplification to determine the malaria infection. In addition, the history of malaria infection and travel to malaria endemic areas were recorded. Entomologic survey to detect the existence of anopheline vector was also conducted. Results Of the total 64 subjects that participated in the survey, no malaria parasites were found through microscopic examination of the blood films. The PCR analysis found six positive cases (two Plasmodium falciparum, one Plasmodium vivax and two mixed infection of both species), and two of them had no history of malaria and have never travelled to malaria endemic area. Entomologic survey using human bait trap detected the existence of Anopheles indefinitus that was found to be positive for P. vivax by PCR. Conclusions The results indicated that although we did not find any microscopically slide positive cases, six PCR positive subjects were found. The fact that 2 of the 6 malaria positive subjects have never travelled to malaria endemic area together with the existence of the vector confirm the occurence of local transmission of malaria in the area.
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Affiliation(s)
- Heny Arwati
- Department of Parasitology, Faculty of Medicine, Universitas Airlangga, Campus A, Jalan Prof. Moestopo No. 47, Surabaya, 60131, Indonesia.
| | - Subagyo Yotopranoto
- Department of Parasitology, Faculty of Medicine, Universitas Airlangga, Campus A, Jalan Prof. Moestopo No. 47, Surabaya, 60131, Indonesia
| | - Etik Ainun Rohmah
- Entomology Study Group, Institute of Tropical Diseases, Universitas Airlangga, Campus C, Jalan Ir. Soekarno, Surabaya, 60115, Indonesia
| | - Din Syafruddin
- Eijkman Institute for Molecular Biology, JalanDiponegoro 69, Jakarta, 10430, Indonesia.,Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, JalanPerintisKemerdekaan Km 10, Makassar, 90245, Indonesia
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19
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PIRAHMADI S, ZAKERI S, RAEISI A. Absence of Asymptomatic Malaria Infection in a Cross-sectional Study in Iranshahr District, Iran under Elimination Programmes. IRANIAN JOURNAL OF PARASITOLOGY 2017; 12:90-100. [PMID: 28761465 PMCID: PMC5522703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Asymptomatic malaria infection provides a reservoir of parasites, causing the persistence of malaria transmission. It accounts an important challenge for successful management of the control, elimination, and eradication programmes in any malaria-endemic region. This investigation was designed to assess the presence and the prevalence of asymptomatic carriers in Iranshahr district of Sistan and Baluchistan Province (2013-2014), with a considerable population movement, during the malaria elimination phase in Iran. METHODS Finger-prick blood samples were collected from symptomless (n=250) and febrile (n=50) individuals residing in Iranshahr district, easthern Iran (Hoodian, Mand, Chah-e Giji, Jolgehashem, Esfand, Dalgan and Chahshour) during Jan 2013 to Dec 2014, and Plasmodium infections were detected using light microscopic and highly sensitive nested-PCR techniques. RESULTS Thick and thin Giemsa-stained blood smears were negative for Plasmodium parasites. In addition, based on nested-PCR analysis, no P. vivax, P. falciparum, and P. malariae parasites were detected among the studied individuals. CONCLUSION Investigation the absence of asymptomatic carriers in Iranshahr district was illustrated and achieving malaria elimination in this area is feasible in a near future.
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Affiliation(s)
- Sakineh PIRAHMADI
- Malaria and Vector Research Group (MVRG), Biotechnology Research Center (BRC), Pasteur Institute of Iran, Tehran, Iran
| | - Sedigheh ZAKERI
- Malaria and Vector Research Group (MVRG), Biotechnology Research Center (BRC), Pasteur Institute of Iran, Tehran, Iran,Correspondence
| | - Ahmad RAEISI
- National Programme Manager for Malaria Control, Ministry of Health and Medical Education, Tehran, Iran
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20
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Akiyama T, Pongvongsa T, Phrommala S, Taniguchi T, Inamine Y, Takeuchi R, Watanabe T, Nishimoto F, Moji K, Kano S, Watanabe H, Kobayashi J. Asymptomatic malaria, growth status, and anaemia among children in Lao People's Democratic Republic: a cross-sectional study. Malar J 2016; 15:499. [PMID: 27756399 PMCID: PMC5070163 DOI: 10.1186/s12936-016-1548-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/05/2016] [Indexed: 12/20/2022] Open
Abstract
Background Asymptomatic malaria can be observed in both stable endemic areas and unstable transmission areas. However, although much attention has been given to acute malaria infections, relatively little attention has been paid to asymptomatic malaria. Nonetheless, because the asymptomatic host serves as a reservoir for the malaria parasite, asymptomatic malaria is now recognized as an important obstacle to malaria elimination. Asymptomatic malaria is also associated with anaemia, a global public health problem with serious consequences on human health as well as social and economic development. In Lao People’s Democratic Republic (Lao PDR), malaria, anaemia, and malnutrition are serious public health concerns. However, few studies have focused on the relationship between these variables. Therefore, this study investigated the relationship between asymptomatic malaria, growth status, and the prevalence of anaemia among children aged 120 months old or younger in rural villages in Lao PDR. Methods In December 2010 and March 2011, data were collected from five villages in Savannakhet province. Anthropometric measurements, blood samples, and malaria rapid diagnostic tests were conducted. The presence of malaria was confirmed with polymerase chain reaction assays for Plasmodium falciparum. Underweight status, stunting, and anaemia were defined according to World Health Organization standards. Results The mean age of participants (n = 319) was 88.3 months old (Standard Deviation: 20.6, ranged from 30–119 months old), and 20 participants (6.3 %) had an asymptomatic malaria infection, 92 (28.8 %) were anaemic, 123 (38.6 %) were underweight, and 137 (42.9 %) were stunted. Stunted children were more likely to be infected with asymptomatic malaria [odds ratio (OR) 3.34, 95 % confidence interval (CI) 1.25–8.93], and asymptomatic malaria was associated with anaemia [OR 5.17, 95 % CI 1.99–13.43]. Conclusions These results suggest a significant association between asymptomatic malaria and anaemia in children. Furthermore, stunted children were more likely to have lower Hb levels and to be infected with asymptomatic malaria than children without stunting. However, further studies examining the impact of asymptomatic malaria infection on children’s nutritional and development status are necessary.
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Affiliation(s)
- Takeshi Akiyama
- Center of Molecular Bioscineces, Tropical Biosphere Research Center, University of the Ryukyus, Senbaru 1, Nishihara, Okinawa, Japan. .,Nagano College of Nursing, Komagane, Nagano, Japan.
| | - Tiengkham Pongvongsa
- Station of Malariology, Parasitology and Entomology, Savannakhet Health Department, Savannakhet, Lao People's Democratic Republic
| | - Souraxay Phrommala
- National Institute of Public Health, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic
| | - Tomoyo Taniguchi
- Center for Medical Education, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Yuba Inamine
- Center of Molecular Bioscineces, Tropical Biosphere Research Center, University of the Ryukyus, Senbaru 1, Nishihara, Okinawa, Japan
| | - Rie Takeuchi
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Nagasaki, Japan
| | - Tadashi Watanabe
- Department of Cell Biology, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Futoshi Nishimoto
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Nagasaki, Japan
| | - Kazuhiko Moji
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Nagasaki, Japan
| | - Shigeyuki Kano
- Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hisami Watanabe
- Center of Molecular Bioscineces, Tropical Biosphere Research Center, University of the Ryukyus, Senbaru 1, Nishihara, Okinawa, Japan.,Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Niigata, Japan
| | - Jun Kobayashi
- Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
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21
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Kang H, Kreuels B, May J, Small DS. Full matching approach to instrumental variables estimation with application to the effect of malaria on stunting. Ann Appl Stat 2016. [DOI: 10.1214/15-aoas894] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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22
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Okebe J, Mwesigwa J, Agbla SC, Sanya-Isijola F, Abubakar I, D'Alessandro U, Jaye A, Bojang K. Seasonal variation in haematological and biochemical reference values for healthy young children in The Gambia. BMC Pediatr 2016; 16:5. [PMID: 26754650 PMCID: PMC4710011 DOI: 10.1186/s12887-016-0545-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 01/08/2016] [Indexed: 11/18/2022] Open
Abstract
Background Haematological and biochemistry reference values for children are important for interpreting clinical and research results however, differences in demography and environment poses a challenge when comparing results. The study defines reference intervals for haematological and biochemistry parameters and examines the effect of seasonality in malaria transmission. Methods Blood samples collected from clinically healthy children, aged 12–59 months, in two surveys during the dry and wet season in the Upper River region of The Gambia were processed and the data analysed to generate reference intervals based on the 2.5th and 97.5th percentiles of the data. Results Analysis was based on data from 1141 children with median age of 32 months. The mean values for the total white cell count and differentials; lymphocyte, monocyte and neutrophil decreased with increasing age, were lower in males and higher in the wet season survey. However, platelet values declined with age (p < 0.0001). There was no evidence of effect of gender on mean values of AST, ALT, lymphocytes, monocytes, platelets and haemoglobin. Conclusion Mean estimates for haematological and biochemistry reference intervals are affected by age and seasonality in the first five years of life. This consistency is important for harmonisation of reference values for clinical care and interpretation of trial results. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0545-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Umberto D'Alessandro
- Medical Research Council Unit, Fajara, Gambia.,Institute of Tropical Medicine, Antwerp, Belgium.,London school of Hygiene and Tropical Medicine, London, UK
| | - Assan Jaye
- Medical Research Council Unit, Fajara, Gambia
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23
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AMIRSHEKARI MB, NATEGHPOUR M, RAEISI A, MOTEVALLI HAGHI A, FARIVAR L, EDRISSIAN G. Determination of Asymptomatic Malaria among Afghani and Pakistani Immigrants and Native Population in South of Kerman Province, Iran. IRANIAN JOURNAL OF PARASITOLOGY 2016; 11:247-252. [PMID: 28096860 PMCID: PMC5236103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study was proposed to monitor the situation of asymptomatic malaria among the native population and Afghani and Pakistani immigrants in Kahnooj and Ghale-Ganj districts from Kerman Province, Southeastern Iran. METHODS A number of 180 and 120 individuals from Kahnooj and Ghale-Ganj respectively were registered and considered based on a cross-sectional surveillance method. From 300 registered cases, 200 individuals (66.7%) were selected among Afghani and Pakistani immigrants and the rest (33.3%) were native resident individuals. All samples were processed with employing microscopical examination, Rapid Diagnostic Tests (RDTs) and Semi- nested Multiplex PCR techniques. RESULTS None of the samples collected from native residents showed any malaria parasite, but among Afghani immigrants, one asymptomatic vivax malaria was detected in a 12 yr old girl with 280 parasites per microliter of blood. Moreover, one symptomatic vivax malaria was detected from a Pakistani immigrant with 47560 parasites per microliter of blood. All results obtained via microscopical method, confirmed by RDTs and PCR techniques. CONCLUSION To achieve the malaria elimination program different studies are needed that to be performed. Monitoring the asymptomatic malaria in all over the malaria endemic areas especially among the immigrant individuals is the most crucial necessity.
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Affiliation(s)
- Mohammad Bagher AMIRSHEKARI
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi NATEGHPOUR
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Center for Research of Endemic Parasites in Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran,Correspondence
| | - Ahmad RAEISI
- Center for Disease Control and Management, Ministry of Health &Medical Education, Tehran, Iran
| | - Afsaneh MOTEVALLI HAGHI
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila FARIVAR
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamhosein EDRISSIAN
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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24
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Kinyoki DK, Berkley JA, Moloney GM, Kandala NB, Noor AM. Predictors of the risk of malnutrition among children under the age of 5 years in Somalia. Public Health Nutr 2015; 18:3125-33. [PMID: 26091444 PMCID: PMC4697134 DOI: 10.1017/s1368980015001913] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the predictors of wasting, stunting and low mid-upper arm circumference among children aged 6-59 months in Somalia using data from household cross-sectional surveys from 2007 to 2010 in order to help inform better targeting of nutritional interventions. DESIGN Cross-sectional nutritional assessment surveys using structured interviews were conducted among communities in Somalia each year from 2007 to 2010. A two-stage cluster sampling methodology was used to select children aged 6-59 months from households across three livelihood zones (pastoral, agro-pastoral and riverine). Predictors of three anthropometric measures, weight-for-height (wasting), height-for-age (stunting) and mid-upper arm circumference, were analysed using Bayesian binomial regression, controlling for both spatial and temporal dependence in the data. SETTING The study was conducted in randomly sampled villages, representative of three livelihood zones in Somalia. SUBJECTS Children between the ages of 6 and 59 months in Somalia. RESULTS The estimated national prevalence of wasting, stunting and low mid-upper arm circumference in children aged 6-59 months was 21 %, 31 % and 36 %, respectively. Although fever, diarrhoea, sex and age of the child, household size and access to foods were significant predictors of malnutrition, the strongest association was observed between all three indicators of malnutrition and the enhanced vegetation index. A 1-unit increase in enhanced vegetation index was associated with a 38 %, 49 % and 59 % reduction in wasting, stunting and low mid-upper arm circumference, respectively. CONCLUSIONS Infection and climatic variations are likely to be key drivers of malnutrition in Somalia. Better health data and close monitoring and forecasting of droughts may provide valuable information for nutritional intervention planning in Somalia.
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Affiliation(s)
- Damaris K Kinyoki
- Department Public Health Research, Spatial Health Metris
Group, INFORM Project, Kenya Medical
Research Institute/Wellcome Trust Research Programme, PO Box
43640-00100, Nairobi, Kenya
- Corresponding author: Email
| | - James A Berkley
- Kenya Medical Research Institute/Wellcome Trust Research
Programme, Centre for Geographic Medicine Research
(coast), Kilifi, Kenya
- Centre for Clinical Vaccinology and Tropical Medicine,
Nuffield Department of Medicine, University of
Oxford, Churchill Hospital,
Oxford, UK
| | - Grainne M Moloney
- Nutrition Section, UNICEF,
Kenya Country Office, UN Complex Gigiri,
Nairobi, Kenya
| | - Ngianga-Bakwin Kandala
- Department Public Health Research, Spatial Health Metris
Group, INFORM Project, Kenya Medical
Research Institute/Wellcome Trust Research Programme, PO Box
43640-00100, Nairobi, Kenya
- Warwick Medical School, Health Sciences Research
Institute, University of Warwick,
Coventry, UK
- Division of Epidemiology and Biostatistics, School of
Public Health, University of Witwatersrand,
Johannesburg, South Africa
| | - Abdisalan M Noor
- Department Public Health Research, Spatial Health Metris
Group, INFORM Project, Kenya Medical
Research Institute/Wellcome Trust Research Programme, PO Box
43640-00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield
Department of Clinical Medicine, University of
Oxford, Oxford, UK
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Sumbele IUN, Bopda OSM, Kimbi HK, Ning TR, Nkuo-Akenji T. Influence of Plasmodium gametocyte carriage on the prevalence of fever, splenomegaly and cardiovascular parameters in children less than 15 years in the Mount Cameroon area: cross sectional study. BMC Infect Dis 2015; 15:547. [PMID: 26612502 PMCID: PMC4661959 DOI: 10.1186/s12879-015-1290-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 11/24/2015] [Indexed: 01/19/2023] Open
Abstract
Background Cardiovascular parameters can be impaired by repeated infections with P. falciparum. This study aimed at investigating the influence of gametocyte carriage on; the prevalence of fever and splenomegaly, blood pressure, heart rate and haematological indices in children <15 years, in the Mount Cameroon area. Methods A cross-sectional study was carried out, from February to July 2013. A child with axillary body temperature ≥37.5 °C was considered febrile and splenomegaly was investigated by palpation. Systolic and diastolic blood pressures as well as heart rate were assessed by non-invasive methods. Malaria parasites were detected and density assessed from Giemsa-stained thin and thick blood films. An auto haematology analyser was used to obtain complete blood count values such as haemoglobin (Hb), haematocrit (Hct), red blood cell (RBC) and white blood cell (WBC) counts, mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), and mean corpuscular haemoglobin (MCH). Univariate analyses were used to examine influence of gametocyte carriage on fever and splenomegaly while, multiple linear regression models were used to evaluate influence of independent variables on the dependent variables. Results Of a total of 454 children examined, malaria parasitaemia, fever, splenomegaly and gametocyte carriage were detected in 36.6, 21.6, 14.3 and 7.3 % of them respectively. Children who were asexual parasite and gametocyte positive (ASP + Gam Pos) had significantly highest (P = 0.03, P = 0.002) prevalence of fever and splenomegaly (39.4 %, 33.3 %) respectively than their aparasitaemic (AP) and asexual parasite positive (ASP Pos) equivalents (19.0 %, 10.9 % and 22.8 %, 16.9 % respectively). The presence of asexual malaria parasitaemia significantly influenced the MCV (P = 0.03), MCH (P = 0.03) and heart beats /min (0.03) while gametocytaemia significantly influenced the Hb (P < 0.001), Hct (P < 0.001), RBC (P < 0.001) and systolic blood pressure (P < 0.05). Conclusion Gametocyte carriage significantly influenced the prevalence of fever, splenomegaly and some cardiovascular indices. In effect, children concurrently having asexual parasitaemia and gametocytes had significantly lower, Hct, Hb levels, RBC and platelet counts and systolic blood pressure.
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Affiliation(s)
| | | | - Helen Kuokuo Kimbi
- Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon.
| | - Teh Rene Ning
- Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon.
| | - Theresa Nkuo-Akenji
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
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26
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Sumbele IUN, Bopda OSM, Kimbi HK, Ning TR, Nkuo-Akenji T. Nutritional status of children in a malaria meso endemic area: cross sectional study on prevalence, intensity, predictors, influence on malaria parasitaemia and anaemia severity. BMC Public Health 2015; 15:1099. [PMID: 26541669 PMCID: PMC4635657 DOI: 10.1186/s12889-015-2462-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 10/30/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The contradictory results on the interaction between nutritional status and malaria warrants further investigation in various epidemiological settings, to assert the antagonistic or synergistic relationship. This study examines the prevalence, severity and predictors of malnutrition and its influence on malaria parasitaemia and anaemia severity in children in the Mount Cameroon area. METHODS A cross-sectional study involving 454 children ≤ 14 years was carried out from February to May 2013 in Muea community. Anthropometric measures of malnutrition (z-scores < -2 standard deviations below mean) were obtained and spleen size assessed. The prevalence and density of malaria parasites were determined and haemoglobin concentration and white blood cell count obtained using an automated haematology analyzer. Univariate and multivariate analyses were used to evaluate influence of malnutrition on anaemia, malaria parasitaemia and predictors respectively. RESULTS The overall prevalence of malnutrition was 22.8 %, with stunting being the most common form (17.1 %), followed by underweight (8.2 %) and wasting (5.5 %). Stunting was significantly higher (P < 0.01) in males (23.1 %) than in females (11.9 %). The prevalence of malnutrition was significantly highest (P = 0.03) in children ≤5 years old (29.5 %) than their counterparts. Severe stunting, wasting and underweight were prevalent in 4.9 %, 1.6 % and 1.8 % of the children respectively. Clinical malaria parasitaemia was significantly higher (P = 0.01) in children who were stunted (16.9 %) and underweight (21.6 %) than their normal counterparts (7.5 %; 8.2 % respectively). The model demonstrated sex (P = 0.006) and age group 1.1-3 years (P = 0.03) as significant predictors of malnutrition. In children who were malaria parasite negative, the prevalence of anaemia as well as severities were significantly higher (P = 0.04 and P = 0.001 respectively) in those malnourished. CONCLUSIONS The presence of stunting in the community significantly augmented the prevalence and clinical presentation of Plasmodium infection. Malnutrition enhanced the severity of anaemia in malaria parasite negative children hence, their health and growth potential needs to be improved upon.
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Affiliation(s)
| | | | - Helen Kuokuo Kimbi
- Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon.
| | - Teh Rene Ning
- Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon.
| | - Theresa Nkuo-Akenji
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
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Oni T, Unwin N. Why the communicable/non-communicable disease dichotomy is problematic for public health control strategies: implications of multimorbidity for health systems in an era of health transition. Int Health 2015; 7:390-9. [PMID: 26103981 PMCID: PMC4638105 DOI: 10.1093/inthealth/ihv040] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/23/2015] [Accepted: 05/05/2015] [Indexed: 01/09/2023] Open
Abstract
In today's globalized world, rapid urbanization, mechanization of the rural economy, and the activities of trans-national food, drink and tobacco corporations are associated with behavioral changes that increase the risk of chronic non-communicable diseases (NCDs). These changes include less healthy diet, lower physical activity, tobacco smoking and increased alcohol consumption. As a result, population health profiles are rapidly changing. For example, the global burden of type 2 diabetes mellitus is expected to double by 2030, with 80% of adult cases occurring in low and middle-income countries (LMIC). Many LMIC are undergoing rapid changes associated with developing high rates of NCD while concomitantly battling high levels of certain communicable diseases, including HIV, TB and malaria. This has population health, health systems and economic implications for these countries. This critical review synthesizes evidence on the overlap and interactions between established communicable and emerging NCD epidemics in LMIC. The review focuses on HIV, TB and malaria and explores the disease-specific interactions with prevalent NCDs in LMIC including diabetes, cardiovascular disease, chronic obstructive pulmonary disease, chronic renal disease, epilepsy and neurocognitive diseases. We highlight the complexity, bi-directionality and heterogeneity of these interactions and discuss the implications for health systems.
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Affiliation(s)
- Tolu Oni
- Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, South Africa Clinical Infectious Disease Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa
| | - Nigel Unwin
- Chronic Disease Research Centre, Tropical Medicine Research Institute, University of the West Indies, Bridgetown, Barbados MRC Epidemiology Unit, University of Cambridge, UK
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de Mast Q, Brouwers J, Syafruddin D, Bousema T, Baidjoe AY, de Groot PG, van der Ven AJ, Fijnheer R. Is asymptomatic malaria really asymptomatic? Hematological, vascular and inflammatory effects of asymptomatic malaria parasitemia. J Infect 2015; 71:587-96. [PMID: 26304688 DOI: 10.1016/j.jinf.2015.08.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/04/2015] [Accepted: 08/06/2015] [Indexed: 12/17/2022]
Abstract
Asymptomatic malaria infections are highly prevalent in malaria endemic regions and most of these infections remain undiagnosed and untreated. Whereas conventional malaria symptoms are by definition absent, little is known on the more subtle health consequences of these infections. The aim of our study was to analyze the hematologic, vascular and inflammatory effects of patent and subpatent asymptomatic malaria parasitemia in children and adults on the Indonesian island Sumba. Both children and adults with parasitemia had increased high-sensitive C-reactive protein levels compared to aparasitemic individuals. In addition, children, but not adults with parasitemia also had lower platelet counts and Hb levels and higher levels of von Willebrand factor and platelet factor-4, markers of endothelial and platelet activation, respectively. These findings suggest that asymptomatic malaria infections have subtle health consequences, especially in children, and should be regarded as potentially harmful.
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Affiliation(s)
- Quirijn de Mast
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, The Netherlands.
| | - Judith Brouwers
- Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Din Syafruddin
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Amrish Y Baidjoe
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip G de Groot
- Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Andre J van der Ven
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob Fijnheer
- Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, The Netherlands
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Mwesigwa J, Okebe J, Affara M, Di Tanna GL, Nwakanma D, Janha O, Opondo K, Grietens KP, Achan J, D'Alessandro U. On-going malaria transmission in The Gambia despite high coverage of control interventions: a nationwide cross-sectional survey. Malar J 2015; 14:314. [PMID: 26268225 PMCID: PMC4535679 DOI: 10.1186/s12936-015-0829-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/03/2015] [Indexed: 11/13/2022] Open
Abstract
Background As indicators of burden of malaria have substantially decreased in The Gambia, reaching a pre-elimination status may be attainable. Achieving this goal requires in-depth understanding of the current burden of Plasmodium falciparum infection. Methods A nationwide cross-sectional survey was conducted in 2012 to determine the prevalence of P.falciparum infection, and to describe its heterogeneity and associated risk factors. Finger-prick blood samples were collected for microscopy, species-specific PCR and haemoglobin measurement. Results A total of 9,094 participants were included and median
age was 11.9 years (IQR 5, 28). Overall prevalence of P. falciparum was 16.01 % with marked heterogeneity between sites (4.32–36.75 %) and within villages in each site (1.63–49.13 %). Across all sites, 51.17 % (745/1,456) of infections were asymptomatic and 35.61 % (448/1,258) were sub-microscopic. The odds of P. falciparum infection were higher in older children; 5–15 years (OR = 1.90; 95 % CI 1.60–2.26), adults (OR = 1.48; 95 % CI 1.24–1.78) and participants with moderate anaemia (OR = 1.62; 95 % CI 1.32–1.99). Conclusions The current malaria control interventions are not sufficient to interrupt transmission in The Gambia as malaria prevalence is still relatively high in the eastern part of the country. New interventions aiming at interrupting transmission are needed and should be urgently evaluated.
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Affiliation(s)
- Julia Mwesigwa
- Medical Research Council Unit, PO Box 273, Banjul, The Gambia.
| | - Joseph Okebe
- Medical Research Council Unit, PO Box 273, Banjul, The Gambia.
| | - Muna Affara
- Medical Research Council Unit, PO Box 273, Banjul, The Gambia.
| | | | - Davis Nwakanma
- Medical Research Council Unit, PO Box 273, Banjul, The Gambia.
| | - Omar Janha
- Medical Research Council Unit, PO Box 273, Banjul, The Gambia.
| | - Kevin Opondo
- Medical Research Council Unit, PO Box 273, Banjul, The Gambia.
| | - Koen Peeters Grietens
- Institute of Tropical Medicine, Antwerp, Belgium. .,School of International Health Development, Nagasaki University, Nagasaki, Japan. .,Partners for Applied Social Sciences (PASS) International, Tessenderlo, Belgium.
| | - Jane Achan
- Medical Research Council Unit, PO Box 273, Banjul, The Gambia.
| | - Umberto D'Alessandro
- Medical Research Council Unit, PO Box 273, Banjul, The Gambia. .,London School of Hygiene and Tropical Medicine, London, UK. .,Institute of Tropical Medicine, Antwerp, Belgium.
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The relationship between Plasmodium infection, anaemia and nutritional status in asymptomatic children aged under five years living in stable transmission zones in Kinshasa, Democratic Republic of Congo. Malar J 2015; 14:83. [PMID: 25880427 PMCID: PMC4336722 DOI: 10.1186/s12936-015-0595-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is preventable and treatable when recommended interventions are properly implemented. Thus, diagnosis and treatment focus on symptomatic individuals while asymptomatic Plasmodium infection (PI) plays a role in the sustainability of the transmission and may also have an impact on the morbidity of the disease in terms of anaemia, nutritional status and even cognitive development of children. The objective of this study was to assess PI prevalence and its relationship with known morbidity factors in a vulnerable but asymptomatic stratum of the population. METHODS A simple random sample, household survey in asymptomatic children under the age of five was conducted from April to September 2012 in two health areas of the health zone of Mont Ngafula 1, Kinshasa, Democratic Republic of Congo. RESULTS The PI prevalence were 30.9% (95% CI: 26.5-35.9) and 14.3% (95% CI: 10.5-18.1) in Cité Pumbu and Kindele health areas, respectively, (OR: 2.7; p <0.001). All were Plasmodium falciparum infected and 4% were co-infected with Plasmodium malariae. In Cité Pumbu and Kindele, the prevalence of anaemia (haemoglobin <11 g/dL) was 61.6% (95% CI: 56.6-66.5) and 39.3% (95% CI: 34.0-44.6), respectively, (OR: 2.5; p <0.001). The health area of Cité Pumbu had 32% (95% CI: 27.5-37.0) of chronic malnutrition (HAZ score ≤ -2SD) compared to 5.1% (95% CI: 2.8-7.6) in Kindele. PI was predictor factor for anaemia (aOR: 3.5, p =0.01) and within infected children, there was an inverse relationship between parasite density and haemoglobin level (β = -5*10(-5), p <0.001). Age older than 12 months (aOR: 3.8, p = 0.01), presence of anaemia (aOR: 3.4, p =0.001), chronic malnutrition (aOR: 1.8, p = 0.01), having a single parent/guardian (aOR: 1.6, p =0.04), and the non-use of insecticide-treated nets (aOR: 1.7, p = 0.04) were all predictors for PI in the overall population. CONCLUSION PI in asymptomatic children was correlated with anaemia and chronic malnutrition and was thus a harmful condition in the study population. Malaria control initiatives should not only focus on treatment of symptomatic infections but also take into consideration asymptomatic but infected children.
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Abstract
Linear growth failure is the most common form of undernutrition globally. With an estimated 165 million children below 5 years of age affected, stunting has been identified as a major public health priority, and there are ambitious targets to reduce the prevalence of stunting by 40% between 2010 and 2025. We view this condition as a 'stunting syndrome' in which multiple pathological changes marked by linear growth retardation in early life are associated with increased morbidity and mortality, reduced physical, neurodevelopmental and economic capacity and an elevated risk of metabolic disease into adulthood. Stunting is a cyclical process because women who were themselves stunted in childhood tend to have stunted offspring, creating an intergenerational cycle of poverty and reduced human capital that is difficult to break. In this review, the mechanisms underlying linear growth failure at different ages are described, the short-, medium- and long-term consequences of stunting are discussed, and the evidence for windows of opportunity during the life cycle to target interventions at the stunting syndrome are evaluated.
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Affiliation(s)
- Andrew J Prendergast
- Centre for Paediatrics, Blizard Institute, Queen Mary University of London, UK,Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jean H Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Manortey S, Alder S, Crookston B, Dickerson T, VanDerslice J, Benson S. Social Deterministic Factors to Participation in the National Health Insurance Scheme in the Context of Rural Ghanaian Setting. J Public Health Afr 2014; 5:352. [PMID: 28299120 PMCID: PMC5345465 DOI: 10.4081/jphia.2014.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 02/06/2014] [Accepted: 02/06/2014] [Indexed: 11/22/2022] Open
Abstract
The primary purpose of this study is to identify predictors of complete household enrollment into the National Health Insurance Scheme (NHIS) among inhabitants of the Barekese sub-district in the Ashanti Region of Ghana. Heads of households in 20 communities from the Barekuma Collaborative Community Project site were interviewed to gather data on demographic, socioeconomic status (SES) indicators and complete household subscription in the NHIS. Logistic regression model was used to predict enrollment in the NHIS. Of the 3228 heads of households interviewed, 60 percent reported having all members of their respective households enrolled in the NHIS. Residents in the classified Middle and High SES brackets had 1.47 (95% CI: 1.21-1.77) and 1.66 (95% CI: 1.27-2.16) times higher odds, respectively, of complete household enrollment compared to their counterparts in the Low SES category. The odds of enrolling in the program tend to increase progressively with the highest level of education attained by the head of the family unit. Eight years after the introduction of the national health insurance policy in Ghana, the reported subscription rate for complete households was about 60 percent in the 20 rural communities that participated in the study. This finding calls for the need to step up further national strategies that will help increase enrollment coverage, especially among the poor and less educated in the rural communities.
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Affiliation(s)
- Stephen Manortey
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, USA
| | - Steve Alder
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, USA
| | | | - Ty Dickerson
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - James VanDerslice
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, USA
| | - Scott Benson
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, USA
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Lindblade KA, Steinhardt L, Samuels A, Kachur SP, Slutsker L. The silent threat: asymptomatic parasitemia and malaria transmission. Expert Rev Anti Infect Ther 2014; 11:623-39. [PMID: 23750733 DOI: 10.1586/eri.13.45] [Citation(s) in RCA: 349] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Scale-up of malaria control interventions has resulted in a substantial decline in global malaria morbidity and mortality. Despite this achievement, there is evidence that current interventions alone will not lead to malaria elimination in most malaria-endemic areas and additional strategies need to be considered. Use of antimalarial drugs to target the reservoir of malaria infection is an option to reduce the transmission of malaria between humans and mosquito vectors. However, a large proportion of human malaria infections are asymptomatic, requiring treatment that is not triggered by care-seeking for clinical illness. This article reviews the evidence that asymptomatic malaria infection plays an important role in malaria transmission and that interventions to target this parasite reservoir may be needed to achieve malaria elimination in both low- and high-transmission areas.
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Affiliation(s)
- Kim A Lindblade
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS A-06, Atlanta, GA 30333, USA.
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Kang H, Kreuels B, Adjei O, Krumkamp R, May J, Small DS. The causal effect of malaria on stunting: a Mendelian randomization and matching approach. Int J Epidemiol 2013; 42:1390-8. [DOI: 10.1093/ije/dyt116] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Detecting Foci of Malaria Transmission with School Surveys: A Pilot Study in the Gambia. PLoS One 2013; 8:e67108. [PMID: 23826205 PMCID: PMC3694932 DOI: 10.1371/journal.pone.0067108] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/16/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In areas of declining malaria transmission such as in The Gambia, the identification of malaria infected individuals becomes increasingly harder. School surveys may be used to identify foci of malaria transmission in the community. METHODS The survey was carried out in May-June 2011, before the beginning of the malaria transmission season. Thirty two schools in the Upper River Region of The Gambia were selected with probability proportional to size; in each school approximately 100 children were randomly chosen for inclusion in the study. Each child had a finger prick blood sample collected for the determination of antimalarial antibodies by ELISA, malaria infection by microscopy and PCR, and for haemoglobin measurement. In addition, a simple questionnaire on socio-demographic variables and the use of insecticide-treated bed nets was completed. The cut-off for positivity for antimalarial antibodies was obtained using finite mixture models. The clustered nature of the data was taken into account in the analyses. RESULTS A total of 3,277 children were included in the survey. The mean age was 10 years (SD = 2.7) [range 4-21], with males and females evenly distributed. The prevalence of malaria infection as determined by PCR was 13.6% (426/3124) [95% CI = 12.2-16.3] with marked variation between schools (range 3-25%, p<0.001), while the seroprevalence was 7.8% (234/2994) [95%CI = 6.4-9.8] for MSP119, 11.6% (364/2997) [95%CI = 9.4-14.5] for MSP2, and 20.0% (593/2973) [95% CI = 16.5-23.2) for AMA1. The prevalence of all the three antimalarial antibodies positive was 2.7% (79/2920). CONCLUSIONS This survey shows that malaria prevalence and seroprevalence before the transmission season were highly heterogeneous.
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Smith DL, Cohen JM, Chiyaka C, Johnston G, Gething PW, Gosling R, Buckee CO, Laxminarayan R, Hay SI, Tatem AJ. A sticky situation: the unexpected stability of malaria elimination. Philos Trans R Soc Lond B Biol Sci 2013; 368:20120145. [PMID: 23798693 PMCID: PMC3720043 DOI: 10.1098/rstb.2012.0145] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Malaria eradication involves eliminating malaria from every country where transmission occurs. Current theory suggests that the post-elimination challenges of remaining malaria-free by stopping transmission from imported malaria will have onerous operational and financial requirements. Although resurgent malaria has occurred in a majority of countries that tried but failed to eliminate malaria, a review of resurgence in countries that successfully eliminated finds only four such failures out of 50 successful programmes. Data documenting malaria importation and onwards transmission in these countries suggests malaria transmission potential has declined by more than 50-fold (i.e. more than 98%) since before elimination. These outcomes suggest that elimination is a surprisingly stable state. Elimination's ‘stickiness’ must be explained either by eliminating countries starting off qualitatively different from non-eliminating countries or becoming different once elimination was achieved. Countries that successfully eliminated were wealthier and had lower baseline endemicity than those that were unsuccessful, but our analysis shows that those same variables were at best incomplete predictors of the patterns of resurgence. Stability is reinforced by the loss of immunity to disease and by the health system's increasing capacity to control malaria transmission after elimination through routine treatment of cases with antimalarial drugs supplemented by malaria outbreak control. Human travel patterns reinforce these patterns; as malaria recedes, fewer people carry malaria from remote endemic areas to remote areas where transmission potential remains high. Establishment of an international resource with backup capacity to control large outbreaks can make elimination stickier, increase the incentives for countries to eliminate, and ensure steady progress towards global eradication. Although available evidence supports malaria elimination's stickiness at moderate-to-low transmission in areas with well-developed health systems, it is not yet clear if such patterns will hold in all areas. The sticky endpoint changes the projected costs of maintaining elimination and makes it substantially more attractive for countries acting alone, and it makes spatially progressive elimination a sensible strategy for a malaria eradication endgame.
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Affiliation(s)
- David L Smith
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Mitangala PN, D'Alessandro U, Donnen P, Hennart P, Porignon D, Bisimwa Balaluka G, Zozo Nyarukweba D, Cobohwa Mbiribindi N, Dramaix Wilmet M. [Malaria infection and nutritional status: results from a cohort survey of children from 6-59 months old in the Kivu province, Democratic Republic of the Congo]. Rev Epidemiol Sante Publique 2013; 61:111-20. [PMID: 23489948 DOI: 10.1016/j.respe.2012.06.404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 06/16/2012] [Accepted: 06/21/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite a reduction in the magnitude of endemic malaria reported in recent years, malaria and protein-energy malnutrition (PEM) still remain major causes of morbidity and mortality in sub-Saharan Africa among children under five. The relationship between malaria and malnutrition remains a topic of controversy. We aimed to investigate malaria infection according to nutritional status in a community-based survey. METHODS A cohort of 790 children aged 6 to 59 months and residing in eastern Democratic Republic of the Congo was followed-up from April 2009 to March 2010 with monthly visits. Data on nutritional status, morbidity between visits, use of insecticide-treated nets and malaria parasitemia were collected at each visit. The Z scores height for age, weight for age and weight for height were computed using the reference population defined by the WHO in 2006. Thresholds for Z scores were defined at -3 and -2. A binary logistic model of the generalized estimating equation (GEE) was used to quantify the association between PEM indicators and malaria parasitemia. Odds ratio (OR) and their 95% confidence interval (95% CI) were computed. RESULTS After adjustment for season, children with severe stunting (height for age Z score<-3) were at lower risk of malaria parasitemia greater or equal to 5000 trophozoits/μL of blood as compared to those in with a better nutritional status (height for age Z score≥-2) (OR=0.48, 95% CI: 0.25-0.91). CONCLUSION Severely stunted children are at a lower risk of high-level malaria parasitemia.
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Affiliation(s)
- P N Mitangala
- École de santé publique, département de biostatistique, Université libre de Bruxelles, campus Erasme, route de Lennik 808, 1070 Brussels, Belgium.
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Cucunubá ZM, Guerra ÁP, Rivera JA, Nicholls RS. Comparison of asymptomatic Plasmodium spp. infection in two malaria-endemic Colombian locations. Trans R Soc Trop Med Hyg 2012; 107:129-36. [DOI: 10.1093/trstmh/trs021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Survey for asymptomatic malaria cases in low transmission settings of Iran under elimination programme. Malar J 2012; 11:126. [PMID: 22533733 PMCID: PMC3464154 DOI: 10.1186/1475-2875-11-126] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 04/25/2012] [Indexed: 11/16/2022] Open
Abstract
Background In malaria endemic areas, continuous exposure to Plasmodium parasites leads to asymptomatic carriers that provide a fundamental reservoir of parasites, contributing to the persistence of malaria transmission. Therefore, in the present investigation, the presence and prevalence of malaria asymptomatic cases were determined to evaluate the reservoir of infection in two malaria endemic areas with a previous history of malaria transmission in the south of Iran, Bashagard and Ghale-Ganj districts of Hormozgan and Kerman provinces, respectively, where malaria transmission has been drastically reduced in the recent years. Methods The population samples (n=500 from each of the studied areas) were randomly collected from non-febrile, long-term residing, aged two to over 60years, during 20092010. Three identical surveys were carried out in both study areas and in each phase all the consent participants were interviewed and clinically examined. In all, three surveys to detect hidden parasite reservoirs (both Plasmodium falciparum and Plasmodium vivax), thick and thin blood smears and a highly sensitive nested-PCR were applied. In addition, the sero-prevalence survey for detecting malaria exposure was done by using a serological marker. Results In this study, P. vivax and P. falciparum parasites were not detected by light microscopy and nested-PCR assay in all three surveys of samples. Antibody responses against P. vivax and P. falciparum were detected in 1 % and 0.2 % of the total examined individuals, respectively, in Bashagard district. Regarding to Ghale-Ganj district, about 0.9% of the individuals had IgG -specific antibody to P. vivax at the first and second surveys, but at the third survey 0.45% of the participants had positive antibody to P. vivax parasite. IgG -specific antibody to P. falciparum was detected in 0.2% of the participants at the first and follow-up surveys. The overall regional differences were not statistically significant (P>0.05). Conclusion Taken together, the lack of asymptomatic carrier with the evidence of extremely low sero-positive to both P. vivax and P. falciparum among examined individuals supported the limited recent transmission in the studied areas and, therefore, these parts of Iran have potential to eliminate the disease in the next few years. However, continued follow up and action are still needed in both studied areas and also in their neighbouring province, Sistan and Baluchistan, which has the highest reported cases of malaria in Iran and also, has the largest border line with Afghanistan and Pakistan, with no elimination activities. This data will provide useful information for managing elimination activities in Iran.
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Ahmad J, Niazi U, Mansoor S, Siddique U, Bibby J. Formal modeling and analysis of the MAL-associated biological regulatory network: insight into cerebral malaria. PLoS One 2012; 7:e33532. [PMID: 22479409 PMCID: PMC3316585 DOI: 10.1371/journal.pone.0033532] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 02/10/2012] [Indexed: 11/19/2022] Open
Abstract
The discrete modeling formalism of René Thomas is a well known approach for the modeling and analysis of Biological Regulatory Networks (BRNs). This formalism uses a set of parameters which reflect the dynamics of the BRN under study. These parameters are initially unknown but may be deduced from the appropriately chosen observed dynamics of a BRN. The discrete model can be further enriched by using the model checking tool HyTech along with delay parameters. This paves the way to accurately analyse a BRN and to make predictions about critical trajectories which lead to a normal or diseased response. In this paper, we apply the formal discrete and hybrid (discrete and continuous) modeling approaches to characterize behavior of the BRN associated with MyD88-adapter-like (MAL)--a key protein involved with innate immune response to infections. In order to demonstrate the practical effectiveness of our current work, different trajectories and corresponding conditions that may lead to the development of cerebral malaria (CM) are identified. Our results suggest that the system converges towards hyperinflammation if Bruton's tyrosine kinase (BTK) remains constitutively active along with pre-existing high cytokine levels which may play an important role in CM pathogenesis.
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Affiliation(s)
- Jamil Ahmad
- Research Centre for Modeling and Simulation, National University of Sciences and Technology, Islamabad, Pakistan.
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Asante KP, Zandoh C, Dery DB, Brown C, Adjei G, Antwi-Dadzie Y, Adjuik M, Tchum K, Dosoo D, Amenga-Etego S, Mensah C, Owusu-Sekyere KB, Anderson C, Krieger G, Owusu-Agyei S. Malaria epidemiology in the Ahafo area of Ghana. Malar J 2011; 10:211. [PMID: 21801344 PMCID: PMC3171375 DOI: 10.1186/1475-2875-10-211] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 07/29/2011] [Indexed: 11/17/2022] Open
Abstract
Background Plasmodium falciparum malaria remains endemic in sub-Saharan Africa including Ghana. The epidemiology of malaria in special areas, such as mining areas needs to be monitored and controlled. Newmont Ghana Gold Limited is conducting mining activities in the Brong Ahafo Region of Ghana that may have an impact on the diseases such as malaria in the mining area. Methods Prior to the start of mining activities, a cross-sectional survey was conducted in 2006/2007 to determine malaria epidemiology, including malaria parasitaemia and anaemia among children < 5 years and monthly malaria transmission in a mining area of Ghana. Results A total of 1,671 households with a child less than five years were selected. About 50% of the household heads were males. The prevalence of any malaria parasitaemia was 22.8% (95% CI 20.8 - 24.9). Plasmodium falciparum represented 98.1% (95% CI 96.2 - 99.2) of parasitaemia. The geometric mean P. falciparum asexual parasite count was 1,602 (95% CI 1,140 - 2,252) and 1,195 (95% CI 985 - 1,449) among children < 24 months and ≥ 24 months respectively. Health insurance membership (OR 0.60, 95% CI 0.45 - 0.80, p = 0.001) and the least poor (OR 0.57, 95% CI 0.37 - 0.90, p = 0.001) were protected against malaria parasitaemia. The prevalence of anaemia was high among children < 24 months compared to children ≥ 24 months (44.1% (95% CI 40.0 - 48.3) and 23.8% (95% CI 21.2 - 26.5) respectively. About 69% (95% CI 66.3 - 70.9) of households own at least one ITN. The highest EIRs were record in May 2007 (669 ib/p/m) and June 2007 (826 ib/p/m). The EIR of Anopheles gambiae were generally higher than Anopheles funestus. Conclusion The baseline malaria epidemiology suggests a high malaria transmission in the mining area prior to the start of mining activities. Efforts at controlling malaria in this mining area have been intensified but could be enhanced with increased resources and partnerships between the government and the private sector.
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Affiliation(s)
- Kwaku P Asante
- Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, P.O. Box 200, Kintampo, Ghana.
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42
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Manortey S, Carey A, Ansong D, Harvey R, Good B, Boaheng J, Crookston B, Dickerson T. Verbal autopsy: an analysis of the common causes of childhood death in the Barekese sub-district of Ghana. J Public Health Afr 2011; 2:e18. [PMID: 28299059 PMCID: PMC5345491 DOI: 10.4081/jphia.2011.e18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 04/24/2011] [Indexed: 12/30/2022] Open
Abstract
The availability of mortality data for any society plays an essential role in health monitoring and evaluation, as well as in the design of health interventions. However, most resource-poor countries such as Ghana have no reliable vital registration system. In these instances, verbal autopsy (VA) may be used as an alternative method to gather mortality data. In rural Ghana, the research team utilized a VA questionnaire to interview caretakers who were present with a child under the age of five prior to death. The data was given to two physicians who independently assigned the most probable cause of death for the child. A third, blinded physician analyzed the data in the cases where the first two physicians disagreed. When there was agreement between physicians, this was assigned as the cause of death for the individual child. During the study period, we recorded 118 deaths from 92 households. Twenty-nine (24.6%) were neonatal deaths with the leading causes of death being neonatal sepsis, birth asphyxia and pneumonia. The remaining 89 (75.4%) were post-neonatal deaths with the most common causes of death being pneumonia, malaria and malnutrition. While 63/118 (53.4%) deaths occurred in the home, there is no statistically significant relationship between the location of the home and the time of travel to the nearest health facility (P=0.132). VA is an important epidemiological tool for obtaining mortality data in communities that lack reliable vital registration systems. Improvement in health care is necessary to address the large number of deaths occurring in the home.
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Affiliation(s)
- Stephen Manortey
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City
| | | | - Daniel Ansong
- Department of Child Health, Kwame Nkrumah University of Science & Technology, Kumasi
| | - Ryan Harvey
- College of Nursing, University of Utah, Salt Lake City
| | - Brian Good
- Department of Pediatrics, University of Utah, Salt Lake City
| | - Joseph Boaheng
- Research and Development Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Benjamin Crookston
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City
| | - Ty Dickerson
- Department of Pediatrics, University of Utah, Salt Lake City
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Were T, Davenport GC, Hittner JB, Ouma C, Vulule JM, Ong'echa JM, Perkins DJ. Bacteremia in Kenyan children presenting with malaria. J Clin Microbiol 2011; 49:671-6. [PMID: 21106789 PMCID: PMC3043473 DOI: 10.1128/jcm.01864-10] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 11/15/2010] [Indexed: 11/20/2022] Open
Abstract
Since the etiologies and clinical outcomes of bacteremia in children with Plasmodium falciparum infections, particularly in areas of holoendemic malaria transmission, are largely unexplored, blood cultures and comprehensive clinical, laboratory, hematological, and nutritional parameters for malaria-infected children (aged 1 to 36 months, n = 585 patients) were investigated at a rural hospital in western Kenya. After the exclusion of contaminant microorganisms, the prevalence of bacteremia was 11.7% in the cohort (n = 506), with nontyphoidal Salmonella spp. being the most common isolates (42.4%). Bacteremia was found to occur in a significantly higher proportion of females than males and was associated with elevated blood glucose concentrations and lowered malaria parasite and hemoglobin (Hb) levels compared to those in abacteremic participants. In addition, the incidences of respiratory distress and severe malarial anemia (SMA; Hb level of <6.0 g/dl) were nonsignificantly greater in children with bacteremia. Mortality was 8.5-fold higher in children with bacteremia. Multivariate logistic regression analyses revealed that bacteremia was significantly associated with reduced incidences of high-density parasitemia (HDP; ≥ 10,000/μl) and increased incidences of malnutrition (i.e., underweight; weight-for-age Z score of <-2 using the NCHS system). Since previous studies showed that bacteremia caused by Gram-negative organisms is associated with enhanced anemia and mortality, multivariate logistic regression was also performed separately for randomly age- and gender-matched children with bacteremia caused by Gram-negative organisms (n = 37) and for children found to be abacteremic (n = 74). These results revealed that the presence of bacteremia caused by Gram-negative organisms was significantly associated with reduced HDP, enhanced susceptibility to respiratory distress, SMA (Hb level of <6.0 g/dl), and being underweight (Z score, <-2). Data presented here from a region of holoendemic P. falciparum transmission demonstrate that although bacteremia is associated with reduced malaria parasitemia, a number of unfavorable clinical outcomes, including malnutrition, respiratory distress, anemia, and mortality, are elevated in children with bacteremia, particularly in cases of Gram-negative origin.
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Affiliation(s)
- T. Were
- University of New Mexico/Kenya Medical Research Institute, Laboratories of Parasitic and Viral Diseases, Centre for Global Health Research, Kisumu, Kenya
- Department of Pathology, School of Health Sciences, Kenyatta University, Nairobi, Kenya
| | - G. C. Davenport
- University of New Mexico/Kenya Medical Research Institute, Laboratories of Parasitic and Viral Diseases, Centre for Global Health Research, Kisumu, Kenya
- Center for Global Health, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
- Center for Infectious Diseases and Immunity, University of New Mexico Health Sciences, Albuquerque, New Mexico
| | - J. B. Hittner
- University of New Mexico/Kenya Medical Research Institute, Laboratories of Parasitic and Viral Diseases, Centre for Global Health Research, Kisumu, Kenya
- Department of Psychology, College of Charleston, Charleston, South Carolina
| | - C. Ouma
- University of New Mexico/Kenya Medical Research Institute, Laboratories of Parasitic and Viral Diseases, Centre for Global Health Research, Kisumu, Kenya
- Department of Biomedical Sciences and Technology, Maseno University, Kisumu, Kenya
| | - J. M. Vulule
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - J. M. Ong'echa
- University of New Mexico/Kenya Medical Research Institute, Laboratories of Parasitic and Viral Diseases, Centre for Global Health Research, Kisumu, Kenya
- Center for Global Health, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - D. J. Perkins
- University of New Mexico/Kenya Medical Research Institute, Laboratories of Parasitic and Viral Diseases, Centre for Global Health Research, Kisumu, Kenya
- Center for Global Health, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
- Center for Infectious Diseases and Immunity, University of New Mexico Health Sciences, Albuquerque, New Mexico
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