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Bhamani B, Martí Coma-Cros E, Tusell M, Mithi V, Serra-Casas E, Williams NA, Lindblade KA, Allen KC. Mass Testing and Treatment to Accelerate Malaria Elimination: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2024; 110:44-53. [PMID: 38471168 PMCID: PMC10993795 DOI: 10.4269/ajtmh.23-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 01/17/2024] [Indexed: 03/14/2024] Open
Abstract
In regions where malaria transmission persists, the implementation of approaches aimed at eliminating parasites from the population can effectively decrease both burden of disease and transmission of infection. Thus, mass strategies that target symptomatic and asymptomatic infections at the same time may help countries to reduce transmission. This systematic review assessed the potential benefits and harms of mass testing and treatment (MTaT) to reduce malaria transmission. Searches were conducted in March 2021 and updated in April 2022 and included cluster-randomized controlled trials (cRCTs) as well as nonrandomized studies (NRSs) using malaria infection incidence, clinical malaria incidence, or prevalence as outcomes. The risk of bias was assessed with Cochrane's risk of bias (RoB2) tool and Risk of Bias Tool in Nonrandomized Studies - of Interventions (ROBINS-I), and the certainty of evidence (CoE) was graded for each outcome. Of 4,462 citations identified, seven studies (four cRCTs and three NRSs) contributed outcome data. The analysis revealed that MTaT did not reduce the incidence (risk ratio [RR]: 0.95, 95% CI: 0.87-1.04; 1,181 participants; moderate CoE) or prevalence (RR: 0.83, 95% CI: 0.67-1.01; 7,522 participants; moderate CoE) of malaria infection but resulted in a small reduction in clinical malaria (RR: 0.82; 95% CI: 0.70-0.95; 334,944 participants; moderate CoE). Three studies contributing data on contextual factors concluded that MTaT is an acceptable, feasible, and cost-effective intervention. Mathematical modeling analyses (n = 10) suggested that MTaT effectiveness depends on the baseline transmission level, diagnostic test performance, number of rounds, and other co-interventions. Based on the limited evidence available, MTaT has little to no impact on reducing malaria transmission.
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Affiliation(s)
- Beena Bhamani
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Elisabet Martí Coma-Cros
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Maria Tusell
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Vita Mithi
- Armref Data for Action in Public Health Research Consultancy, Mzuzu, Malawi
- Society for Research on Nicotine and Tobacco-Genetics and Omics Network, Madison, Wisconsin
- Leaders of Africa Institute, Baltimore, Maryland
| | - Elisa Serra-Casas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Nana Aba Williams
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Kim A. Lindblade
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Koya C. Allen
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
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Orish VN, Kyeremateng C, Appiah BP, Addei IB, Ayaba MA, Kwadzokpui PK, Marinkovic A, Prakash S, Okorie C, Izurieta R, Sanyaolu A. Knowledge and perception of asymptomatic malaria in the Volta region of Ghana. Trans R Soc Trop Med Hyg 2024; 118:33-43. [PMID: 37534813 DOI: 10.1093/trstmh/trad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/19/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The control of asymptomatic malaria is considered a key aspect of malaria control. This study aimed to assess the knowledge and perception of asymptomatic malaria among people in Ho municipality of the Volta region. METHODS A descriptive cross-sectional study involving questionnaire administration was conducted among randomly sampled residents of the Ho municipality of the Volta region of Ghana. Using SPSS version 25 statistical software, frequency distributions and proportions were computed for sociodemographic variables while knowledge and perception about asymptomatic malaria were computed into percentages and categorized into three levels based on Bloom's cut-off for further analysis. Findings with p-values <0.05 were considered statistically significant. RESULTS Among the 200 participants, 197 (98.5%) were aware of malaria. The majority (116 [58.0%]) of the study participants agreed to the possibility of asymptomatic infection, but most (133 [66.5%]) of the community members did not know that asymptomatic individuals can still transmit infections. The majority of the participants (184 [92.0%]) showed interest in getting further education on asymptomatic malaria and a significant majority (180 [90.0%]) expressed a willingness to take treatment after testing positive without showing any symptoms. CONCLUSIONS Asymptomatic malaria control can be achieved through a mass testing and treatment strategy, therefore improving the knowledge and perception about asymptomatic malaria might improve malaria control.
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Affiliation(s)
- Verner N Orish
- Department of Microbiology and Immunology, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Caleb Kyeremateng
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Baffoe P Appiah
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Isaac B Addei
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Moses A Ayaba
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | | | | | | | - Chuku Okorie
- Department of Allied Health Sciences, Union College of Union County, Plainfield Campus, NJ, USA
| | - Ricardo Izurieta
- Department of Global Communicable Diseases, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Adekunle Sanyaolu
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
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Mumali RK, Okolimong C, Kabuuka T, Lubaale YM, Okibure A, Okello F, Soita D, Olupot-Olupot P. Health workers' adherence to the malaria test, treat and track strategy during the COVID-19 pandemic in malaria high transmission area in Eastern Uganda. Malar J 2023; 22:360. [PMID: 38012638 PMCID: PMC10680176 DOI: 10.1186/s12936-023-04786-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic affected malaria control activities in sub-Saharan Africa (SSA) resulting in 690,000 excess deaths in the year 2021. The authors hypothesized that COVID-19 affected the World Health Organization (WHO) Test, Treat and Track (T3) strategy that has been implemented in Uganda since 2010. In this study, health worker's adherence to the T3 strategy during COVID-19 pandemic in Eastern Uganda was studied by assessing their knowledge, skills and practices. METHODS A cross-sectional study utilizing mixed quantitative and qualitative data collections methods was conducted at Mbale Regional Referral Hospital in Eastern Uganda between November and December in 2020. Data were captured on demographics, knowledge, skills and practices for both health workers (HWs) and patients. Quantitative data were analysed using STATA 15.0 and reported as descriptive statistics, proportions and statistical associations. Moreover, qualitative data were collected via key informant interviews (KII) among purposively sampled study participants and analysed thematically using NVIVO software. Ethical approval was obtained prior to the study. RESULTS A total of 436 study participants, of whom 103/436 (24%) and 333/436 (76%) were HWs and patients, respectively were studied. Among the HWs with mean age of 34 years (SD = 8.8 years), 81/103 (79%) had good practices, most 63/103 (61%) had good knowledge, and only 11/103 (10.7%) had good skills. Specifically, on the cadres, the laboratory personnel 19/103 (18%) had good knowledge 14/19 (74%) OR: 2.0 (95% CI 0.7-6) and were highly skilled OR: 4.6 (95% CI 1.2-18.1; P < 0.0150) compared to other cadres, respectively. Among the patients whose age ranged 3 months to 80 years (mean 17.8 years) and females 177/333 (53%); a majority 257/333 (77%) were tested, of whom 139/333 (42%) tested positive. Out of the positive cases, 115/333 (35%) were treated and tracked. About 75/333 (23%) were not tested but treated for malaria. Of the 168/239 (70.3%) patients tested, 115/168 (68.5%) were positive and treated, P = 0.0001. The KII revealed low level of In-service training, overwhelming number of patients and stock-out of supplies as a key factor for poor HW adherence to T3 strategy. CONCLUSIONS During COVID-19 pandemic period HWs adherence to T3 initiative was low as 27% malaria patients did not receive treatment.
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Affiliation(s)
- Richard Kabaka Mumali
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda.
- National Agricultural Research Organization (NARO), National Livestock Resources Research Institute (NaLIRRI), P.O. Box 5704, Kampala, Uganda.
| | - Charles Okolimong
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Tonny Kabuuka
- National Agricultural Research Organization (NARO), National Livestock Resources Research Institute (NaLIRRI), P.O. Box 5704, Kampala, Uganda
| | - Yovani Moses Lubaale
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | | | - Francis Okello
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Varimetrics Group Limited, Mbale, Uganda
| | - David Soita
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Peter Olupot-Olupot
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
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Ohene-Adjei K, Asante KP, Akuffo KO, Tounaikok N, Asiamah M, Owiredu D, Manu AA, Danso-Appiah A. Malaria vaccine-related adverse events among children under 5 in sub-Saharan Africa: systematic review and meta-analysis protocol. BMJ Open 2023; 13:e076985. [PMID: 37793915 PMCID: PMC10551995 DOI: 10.1136/bmjopen-2023-076985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION The RTS,S vaccine has been approved for use in children under 5 living in moderate to high malaria transmission areas. However, clinically important adverse events have been reported in countries in sub-Saharan Africa. This systematic review aims to assess the frequency, severity and clinical importance of vaccine-related adverse events. METHODS AND ANALYSIS This systematic review protocol has been prepared following robust methods and reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for protocols guidelines. We will search PubMed, CINAHL, LILACS, Google Scholar, SCOPUS, WEB OF SCIENCE, Cochrane library, HINARI, African Journals Online, Trip Pro and TOXNET from 2000 to 30 September 2023, without language restrictions. We will also search conference proceedings, dissertations, World Bank Open Knowledge Repository, and WHO, PATH, UNICEF, Food and Drugs Authorities and European Medicines Agency databases, preprint repositories and reference lists of relevant studies for additional studies. Experts in the field will be contacted for unpublished or published studies missed by our searches. At least two reviewers will independently select studies and extract data using pretested tools and assess risk of bias in the included studies using the Cochrane risk of bias tool. Any disagreements will be resolved through discussion between the reviewers. Heterogeneity will be explored graphically, and statistically using the I2 statistic. We will conduct random-effects meta-analysis when heterogeneity is appreciable, and express dichotomous outcomes (serious adverse events, cerebral malaria and febrile convulsion) as risk ratio (RR) with their 95% CI. We will perform subgroup analysis to assess the impact of heterogeneity and sensitivity analyses to test the robustness of the effect estimates. The overall level of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION Ethical approval is not required for a systematic review. The findings of this study will be disseminated through stakeholder forums, conferences and peer-review publications. PROSPERO REGISTRATION NUMBER CRD42021275155.
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Affiliation(s)
- Kennedy Ohene-Adjei
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- Tain District Health Directorate, Ghana Health Service, Tain, Ghana
| | - Kwaku Poku Asante
- Research and Development Division, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Kintampo North Municipality, Bono East Region, Ghana
| | - Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Narcisse Tounaikok
- Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Accra, Ghana
- Department of Human and Animal Health, University of Emi Koussi, N'Djamena, Chad
| | - Morrison Asiamah
- Department of Electron Microscopy and Histopathology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - David Owiredu
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Accra, Ghana
| | - Alexander Ansah Manu
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Accra, Ghana
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Liang S, Guo R, Zhuang J, Li P, Chang Z, Zhu W, Jin Z. Analysis of epidemiological changes and elimination effects for malaria in Handan city, the north China. Medicine (Baltimore) 2022; 101:e31722. [PMID: 36550922 PMCID: PMC9771291 DOI: 10.1097/md.0000000000031722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The elimination of malaria requires high-quality surveillance data to quickly detect and respond to individual cases. This study aims to analyze the epidemiological characteristics of malaria and ascertain the long-term epidemic trends of malaria by 2020 in Handan China. Case-level data for the period 2011 to 2020 were extracted from Chinese Information System for Disease Control and Prevention. The lamp trap method was used to capture mosquitoes so that the characteristics of mosquitoes can be analyzed. The incidence, accuracy, and timeliness of malaria case diagnosis, reporting and investigation were evaluated at the elimination stage (2011-2020) in Handan City, China. Between 2011 and 2020, 94 malaria cases were reported in Handan City, of which 93 malaria cases were male and all of which were imported from abroad. The annual average incidence decreased from 622.33/100,000 to 0.11/100,000 in the elimination stage. Since the initiation of the National Malaria Elimination Program in 2010, malaria cases have been consistent with the increase in overseas export channels and labor personnel service. There is a need to strengthen malaria surveillance of returning workers from Africa and to conduct timely blood tests to diagnose and treat imported infections. Local authorities ensure that imported malaria cases can be timely diagnosed, reported, treated and investigated at local level.
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Affiliation(s)
- Shuang Liang
- School of Medicine, Hebei University of Engineering, Handan, China
- Handan Key Laboratory of Integrated Medical and Industrial Application in Basic Medicine, Handan, China
| | - Ruiling Guo
- Handan Municipal Centre for Disease Control and Prevention, Handan, China
| | - Jing Zhuang
- Handan Municipal Centre for Disease Control and Prevention, Handan, China
| | - Penghui Li
- School of Medicine, Hebei University of Engineering, Handan, China
- Handan Key Laboratory of Integrated Medical and Industrial Application in Basic Medicine, Handan, China
| | - Zhongzheng Chang
- School of Medicine, Hebei University of Engineering, Handan, China
- Handan Key Laboratory of Integrated Medical and Industrial Application in Basic Medicine, Handan, China
| | - Wangdong Zhu
- School of Medicine, Hebei University of Engineering, Handan, China
- Handan Key Laboratory of Integrated Medical and Industrial Application in Basic Medicine, Handan, China
| | - Zengjun Jin
- School of Medicine, Hebei University of Engineering, Handan, China
- Handan Key Laboratory of Integrated Medical and Industrial Application in Basic Medicine, Handan, China
- Handan Municipal Centre for Disease Control and Prevention, Handan, China
- * Correspondence: Zengjun Jin, School of Medicine, Hebei University of Engineering, Handan, Hebei 056038, China (e-mail: )
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Cheng NI, Tabong PTN, Netongo PM, Mensah BA, Chu CE, Yaw EB, Enos JY, Malm K, Ahorlu CS. The impact of COVID-19 on implementation of mass testing, treatment and tracking of malaria in rural communities in Ghana: A qualitative study. PLoS One 2022; 17:e0275976. [PMID: 36227933 PMCID: PMC9560137 DOI: 10.1371/journal.pone.0275976] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/27/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mass test, treat and track (MTTT) of malaria is ongoing in the Pakro sub district of Ghana. In the delivery of MTTT of malaria, community health volunteers are trained to routinely provide this service through a door-to-door strategy. Following the report of the first cases of COVID-19 in Ghana, we conducted this study to explore the effects of the pandemic on the implementation of the MTTT of malaria intervention. METHODS Using qualitative methodology, we conducted ten focus groups discussions (FGDs) in eight communities: eight with community members (N = 49); one with health workers (N = 6), and one with MTTT of malaria volunteers. In addition, two in-depth interviews (IDI) were conducted, one with health worker and another with a health manager. All interviews were recorded, translated into English during transcription and analysed using QSR NVivo 12. Thematic content analysis was used in this study. RESULTS The findings of the study showed an increase in the number of people reporting with complications of malaria in health facilities in the study communities during the COVID-19 period. Some participants were of the view that COVID-19 rumours and misinformation could largely be responsible for the low coverage and uptake of the MTTT of malaria intervention. To sustain the uptake of the MTTT intervention, community engagement strategies were employed to identify and respond to these rumours. Also, incentive schemes were introduced to encourage parents and children to participate in the MTTT intervention during this period of COVID-19. CONCLUSION Findings suggest that the COVID-19 pandemic has adversely affected the provision and uptake of malaria prevention and treatment services, especially the MTTT of malaria being implemented at the community level. These observations underscore the need to find innovative ways to address the challenges encountered in providing essential services during public health emergencies.
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Affiliation(s)
- Ndong Ignatius Cheng
- Faculty of Science, Department of Biochemistry, Catholic University of Cameroon, Bamenda, Cameroon
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- * E-mail: , (NIC); (CSA)
| | - Philip Teg-Nefaah Tabong
- Department of Social and Behavioural Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Palmer Masumbe Netongo
- Navajo Technical University Crownpoint, Crownpoint, New Mexico, United States of America
- Molecular Diagnostics Research Group, Biotechnology Center, University of Yaounde I, Yaounde, Cameroon
| | | | - Chuo Ennestine Chu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Effah-Baafi Yaw
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Juliana Yartey Enos
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Keziah Malm
- Ghana National Malaria Control Programme, Accra, Ghana
| | - Collins Stephen Ahorlu
- Faculty of Science, Department of Biochemistry, Catholic University of Cameroon, Bamenda, Cameroon
- * E-mail: , (NIC); (CSA)
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Ahorlu CS, Ndong IC, Okyere D, Mensah BA, Chu CE, Enos JY, Abuaku B. The Effect of Mass Testing, Treatment and Tracking on the Prevalence of Febrile Illness in Children under 15 in Ghana. Pathogens 2022; 11:pathogens11101118. [PMID: 36297175 PMCID: PMC9609179 DOI: 10.3390/pathogens11101118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/16/2022] [Accepted: 09/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Malaria remains a serious threat to children under 15 years of age in sub-Sahara Africa. Mass testing, treatment and tracking (MTTT) of malaria has been reported to reduce parasite load significantly. However, the impact of MTTT on the prevalence of febrile illnesses in children under 15 is not yet clear. This study explores the impact of MTTT complemented by prompt home-based management of malaria on febrile illnesses and their treatment in children under 15 years old. Methods: A cohort of 460 children under 15 years were recruited from the Pakro subdistrict in Ghana during a community-wide implementation of a quarterly MTTT intervention. The MTTT implementation involved testing all household members for malaria using RDTs, and positive cases were treated with Artemisinin-based combination therapy (ACT). Febrile illnesses among this cohort in the two weeks prior to the prevalence survey at baseline and endline were recorded to constitute date for analysis. Results: The prevalence of febrile illnesses, such chills, convulsion, fever, diarrhoea, headache, vomit, cough/rashes or stomachache, etc., were recorded). Asymptomatic parasitaemia prevalence at baseline was 53.3%, which dropped to 44.1% at evaluation. An overall decrease in the parasitaemia prevalence of 33.0% (OR = 0.67, CI = 0.50, 0.89) was observed at evaluation compared to baseline after adjusting for age, ITN use and temperature. A 67% decrease in severe anaemia cases (Hb < 7) was observed at evaluation. Conclusion: Our findings suggest that implementing MTTT complemented by home-based timely management of malaria does not only reduce febrile illnesses and for that matter malaria prevalence, but could also reduce severe anaemia in children under 15 years old.
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Affiliation(s)
- Collins Stephen Ahorlu
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra P.O. Box LG 581, Ghana
- Correspondence:
| | - Ignatius Cheng Ndong
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra P.O. Box LG 581, Ghana
- Department of Biochemistry, Faculty of Science, Catholic University of Cameroon, Bamenda P.O. Box 572, Cameroon
| | - Daniel Okyere
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra P.O. Box LG 581, Ghana
| | - Benedicta A. Mensah
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra P.O. Box LG 581, Ghana
| | - Chuo Ennestine Chu
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra P.O. Box LG 581, Ghana
- Department of Biochemistry, Faculty of Science, Catholic University of Cameroon, Bamenda P.O. Box 572, Cameroon
| | - Juliana Y. Enos
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra P.O. Box LG 581, Ghana
| | - Benjamin Abuaku
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra P.O. Box LG 581, Ghana
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Umunnakwe FA, Idowu ET, Ajibaye O, Etoketim B, Akindele S, Shokunbi AO, Otubanjo OA, Awandare GA, Amambua-Ngwa A, Oyebola KM. High cases of submicroscopic Plasmodium falciparum infections in a suburban population of Lagos, Nigeria. Malar J 2019; 18:433. [PMID: 31856852 PMCID: PMC6924037 DOI: 10.1186/s12936-019-3073-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asymptomatic malaria parasites are significant sources of infections for onward malaria transmission. Conventional tools for malaria diagnosis such as microscopy and rapid diagnostic test kits (RDT) have relatively low sensitivity, hence the need for alternative tools for active screening of such low-density infections. METHODS This study tested var acidic terminal sequence-based (varATS) quantitative polymerase chain reaction (qPCR) for screening asymptomatic Plasmodium falciparum infections among dwellers of a sub-urban community in Lagos, Nigeria. Clinically healthy participants were screened for malaria using microscopy, RDT and varATS qPCR techniques. Participants were stratified into three age groups: 1-5, 6-14 and > 14 years old. RESULTS Of the 316 participants screened for asymptomatic malaria infection, 78 (24.68%) were positive by microscopy, 99 (31.33%) were positive by RDT and 112 (35.44%) by varATS qPCR. Participants aged 6-14 years had the highest prevalence of asymptomatic malaria, with geometric means of ~ 116 parasites/µL and ~ 6689 parasites/µL as detected by microscopy and varATS, respectively. CONCLUSION This study has revealed high prevalence of asymptomatic malaria in the study population, with varATS detecting additional sub-microscopic infections. The highest concentration of asymptomatic malaria was observed among school-age children between 6 and 14 years old. A large-scale screening to identify other potential hotspots of asymptomatic parasites in the country is recommended.
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Affiliation(s)
- Florence A Umunnakwe
- Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Akoka, Lagos, Nigeria
| | - Emmanuel T Idowu
- Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Akoka, Lagos, Nigeria
| | - Olusola Ajibaye
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Blessed Etoketim
- Medical Research Council at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Samuel Akindele
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Aminat O Shokunbi
- Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Akoka, Lagos, Nigeria
| | - Olubunmi A Otubanjo
- Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Akoka, Lagos, Nigeria
| | - Gordon A Awandare
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana
| | - Alfred Amambua-Ngwa
- Medical Research Council at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Kolapo M Oyebola
- Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Akoka, Lagos, Nigeria. .,Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria. .,Medical Research Council at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia. .,West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana.
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Ndong IC, Okyere D, Enos JY, Mensah BA, Nyarko A, Abuaku B, Amambua-Ngwa A, Merle CSC, Koram KA, Ahorlu CS. Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana. BMC Public Health 2019; 19:1622. [PMID: 31795981 PMCID: PMC6889629 DOI: 10.1186/s12889-019-7986-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/21/2019] [Indexed: 11/22/2022] Open
Abstract
Background Global efforts to scale-up malaria control interventions are gaining steam. These include the use of Long-Lasting Insecticide Nets, Indoor Residual Spraying, Intermittent Preventive Treatment and Test, Treat and Track. Despite these, the drive for malaria elimination is far from being realistic in endemic communities in Africa. This is partly due to the fact that asymptomatic parasite carriage, not specifically targeted by most interventions, remains the bedrock that fuels transmission. This has led to mass testing, treatment and tracking (MTTT) as an alternative strategy to target asymptomatic individuals. We report the impact of MTTT on the prevalence of asymptomatic malaria parasitaemia over a one-year period in Ghana, hypothesizing that implementing MTTT could reduce the rate of asymptomatic parasitaemia. Methods A population of about 5000 individuals in seven communities in the Pakro sub-district of Ghana participated in this study. A register was developed for each community following a census. MTTT engaged trained community-based health volunteers who conducted house-to-house testing using RDTs every 4 months and treated positive cases with Artemisinin–based Combination Therapy. Between interventions, community-based management of malaria was implemented for symptomatic cases. Results MTTT Coverage was 98.8% in July 2017 and 79.3% in July 2018. Of those tested, asymptomatic infection with malaria parasites reduced from 36.3% (1795/4941) in July 2017 to 32.9% (1303/3966) in July 2018 (p = 0.001). Prevalence of asymptomatic parasitaemia among children under 15 years declined from 52.6% (1043/1984) in July 2017 to 47.5% (820/1728) in July 2018 (p = 0.002). Implementing MTTT significantly reduced asymptomatic parasitaemia by 24% from July 2017 to July 2018 after adjusting for age, ITN use and axillary temperature (OR = 0.76, CI = 0.67, 0.85 p ≤ 0.001). Conclusion This study has demonstrated that implementing MTTT is feasible and could reduce the prevalence of asymptomatic malaria parasitaemia in children under 15 years of age. Furthermore, the use of community-based health volunteers could ensure high coverage at lower cost of implementation. Trial registration NCT04167566, Date 14/11/2019. Retrospective registration.
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Affiliation(s)
- Ignatius Cheng Ndong
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana. .,Department of Biochemistry, Faculty of Science, Catholic University of Cameroon, Bamenda, Cameroon.
| | - Daniel Okyere
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Juliana Yartey Enos
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Benedicta A Mensah
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Alexander Nyarko
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Benjamin Abuaku
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Alfred Amambua-Ngwa
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, Gambia
| | - Corinne Simone C Merle
- Special Programme for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Kwadwo Ansah Koram
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Collins Stephen Ahorlu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
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Amoah LE, Donu D, Abuaku B, Ahorlu C, Arhinful D, Afari E, Malm K, Koram KA. Probing the composition of Plasmodium species contained in malaria infections in the Eastern region of Ghana. BMC Public Health 2019; 19:1617. [PMID: 31791319 PMCID: PMC6889690 DOI: 10.1186/s12889-019-7989-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/21/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Asymptomatic falciparum and non-falciparum malaria infections are major challenges to malaria control interventions, as they remain a source of continual infection in the community. This becomes even more important as the debate moves towards elimination and eradication. This study sought to quantify the burden of Plasmodium malaria infection in seven communities in the Eastern Region of Ghana. METHODS The cross-sectional study recruited 729 participants aged 85 years old and below from 7 closely linked communities. Finger pricked blood was used to prepare thick and thin blood smears as well as spot filter paper and an histidine rich protein 2 (HRP2) rapid diagnostic test kit (RDT). Genomic DNA was extracted from the filter paper dry blood spot (DBS) and used in PCR to amplify the Plasmodium 18S rRNA gene using species specific PCR. RESULTS 96.6% of the participants were identified as afebrile, with axillary temperatures below 37.5 °C. PCR identified 66% of the participants to harbor malaria parasites, with 9 P. malariae and 7 P. ovale mono-infections accounting for 2.2% and P. falciparum combined with either 36 P. malariae or 25 P. ovale infections, accounting for 13.3%. Parasite prevalence by microscopy (32%) was similar to the RDT positivity rate (33%). False positive RDT results ranged from 64.6% in children aged between 5 and 9 years to 10% in adults aged 20 years and above. No significant differences were observed in falciparum and non-falciparum parasite carriage at the community level, however young adults aged between 15 and 19 years had the highest prevalence (34.8% (16/46)) of P. falciparum and P. malariae parasite carriage whilst children aged between 5 and 9 years had the highest level (11.4% (14/123)) of P. ovale carriage. CONCLUSION The high rate of misidentification of non-falciparum parasites and the total absence of detection of P. ovale by microscopy suggests that more sensitive malaria diagnostic tools including molecular assays are required to accurately determine the prevalence of carriers of non-falciparum parasites and low density P. falciparum infections, especially during national surveillance exercises. Additionally, malaria control interventions targeting the non-falciparum species P. malariae and P. ovale parasites are needed.
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Affiliation(s)
- Linda Eva Amoah
- Immunology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana. .,West Africa Center for Cell biology of Infectious Pathogens (WACCBIP), College of Basic and Applied Sciences, University of Ghana, Accra, Ghana.
| | - Dickson Donu
- Immunology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Benjamin Abuaku
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Colins Ahorlu
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Daniel Arhinful
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Edwin Afari
- School of Public Health, University of Ghana, Accra, Ghana
| | - Keziah Malm
- National Malaria Control Program, Accra, Ghana
| | - Kwadwo Ansah Koram
- West Africa Center for Cell biology of Infectious Pathogens (WACCBIP), College of Basic and Applied Sciences, University of Ghana, Accra, Ghana.,Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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