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Otambo WO, Onyango PO, Ochwedo K, Olumeh J, Onyango SA, Orondo P, Atieli H, Lee MC, Wang C, Zhong D, Githeko A, Zhou G, Githure J, Ouma C, Yan G, Kazura J. Clinical malaria incidence and health seeking pattern in geographically heterogeneous landscape of western Kenya. BMC Infect Dis 2022; 22:768. [PMID: 36192672 PMCID: PMC9528858 DOI: 10.1186/s12879-022-07757-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Malaria remains a public health problem in Kenya despite sustained interventions deployed by the government. One of the major impediments to effective malaria control is a lack of accurate diagnosis and effective treatment. This study was conducted to assess clinical malaria incidence and treatment seeking profiles of febrile cases in western Kenya. Methods Active case detection of malaria was carried out in three eco-epidemiologically distinct zones topologically characterized as lakeshore, hillside, and highland plateau in Kisumu County, western Kenya, from March 2020 to March 2021. Community Health Volunteers (CHVs) conducted biweekly visits to residents in their households to interview and examine for febrile illness. A febrile case was defined as an individual having fever (axillary temperature ≥ 37.5 °C) during examination or complaints of fever and other nonspecific malaria related symptoms 1–2 days before examination. Prior to the biweekly malaria testing by the CHVs, the participants' treatment seeking methods were based on their behaviors in response to febrile illness. In suspected malaria cases, finger-prick blood samples were taken and tested for malaria parasites with ultra-sensitive Alere® malaria rapid diagnostic tests (RDT) and subjected to real-time polymerase chain reaction (RT-PCR) for quality control examination. Results Of the total 5838 residents interviewed, 2205 residents had high temperature or reported febrile illness in the previous two days before the visit. Clinical malaria incidence (cases/1000people/month) was highest in the lakeshore zone (24.3), followed by the hillside (18.7) and the highland plateau zone (10.3). Clinical malaria incidence showed significant difference across gender (χ2 = 7.57; df = 2, p = 0.0227) and age group (χ2 = 58.34; df = 4, p < 0.0001). Treatment seeking patterns of malaria febrile cases showed significant difference with doing nothing (48.7%) and purchasing antimalarials from drug shops (38.1%) being the most common health-seeking pattern among the 2205 febrile residents (χ2 = 21.875; df = 4, p < 0.0001). Caregivers of 802 school-aged children aged 5–14 years with fever primarily sought treatment from drug shops (28.9%) and public hospitals (14.0%), with significant lower proportions of children receiving treatment from traditional medication (2.9%) and private hospital (4.4%) (p < 0.0001). There was no significant difference in care givers' treatment seeking patterns for feverish children under the age of five (p = 0.086). Residents with clinical malaria cases in the lakeshore and hillside zones sought treatment primarily from public hospitals (61.9%, 60/97) traditional medication (51.1%, 23/45) respectively (p < 0.0001). However, there was no significant difference in the treatment seeking patterns of highland plateau residents with clinical malaria (p = 0.431).The main factors associated with the decision to seek treatment were the travel distance to the health facility, the severity of the disease, confidence in the treatment, and affordability. Conclusion Clinical malaria incidence remains highest in the Lakeshore (24.3cases/1000 people/month) despite high LLINs coverage (90%). The travel distance to the health facility, severity of disease and affordability were mainly associated with 80% of residents either self-medicating or doing nothing to alleviate their illness. The findings of this study suggest that the Ministry of Health should strengthen community case management of malaria by providing supportive supervision of community health volunteers to advocate for community awareness, early diagnosis, and treatment of malaria. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07757-w.
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Affiliation(s)
- Wilfred Ouma Otambo
- Department of Zoology, Maseno University, Kisumu, Kenya. .,International Centre of Excellence for Malaria Research, Tom Mboya University College-University of California Irvine Joint Lab, Homa Bay, Kenya.
| | | | - Kevin Ochwedo
- International Centre of Excellence for Malaria Research, Tom Mboya University College-University of California Irvine Joint Lab, Homa Bay, Kenya
| | - Julius Olumeh
- School of Natural and Environmental Science, Newcastle University, Newcastle Upon Tyne, UK
| | - Shirley A Onyango
- International Centre of Excellence for Malaria Research, Tom Mboya University College-University of California Irvine Joint Lab, Homa Bay, Kenya
| | - Pauline Orondo
- International Centre of Excellence for Malaria Research, Tom Mboya University College-University of California Irvine Joint Lab, Homa Bay, Kenya
| | - Harrysone Atieli
- International Centre of Excellence for Malaria Research, Tom Mboya University College-University of California Irvine Joint Lab, Homa Bay, Kenya
| | - Ming-Chieh Lee
- Program in Public Health, University of California Irvine, Irvine, CA, USA
| | - Chloe Wang
- Program in Public Health, University of California Irvine, Irvine, CA, USA
| | - Daibin Zhong
- Program in Public Health, University of California Irvine, Irvine, CA, USA
| | - Andrew Githeko
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Guofa Zhou
- Program in Public Health, University of California Irvine, Irvine, CA, USA
| | - John Githure
- International Centre of Excellence for Malaria Research, Tom Mboya University College-University of California Irvine Joint Lab, Homa Bay, Kenya
| | - Collins Ouma
- Department of Biomedical Sciences and Technology, Maseno University, Kisumu, Kenya
| | - Guiyun Yan
- Program in Public Health, University of California Irvine, Irvine, CA, USA
| | - James Kazura
- Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Aung PL, Soe MT, Oo TL, Aung KT, Lin KK, Thi A, Menezes L, Parker DM, Cui L, Kyaw MP. Spatiotemporal dynamics of malaria in Banmauk Township, Sagaing region of Northern Myanmar: characteristics, trends, and risk factors. BMC Infect Dis 2022; 22:653. [PMID: 35902825 PMCID: PMC9331130 DOI: 10.1186/s12879-022-07634-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While national malaria incidence has been declining in Myanmar, some subregions within the nation continue to have high burdens of malaria morbidity and mortality. This study assessed the malaria situation in one of these regions, Banmauk Township, located near the Myanmar-India border. Our goal was to provide a detailed description of the malaria epidemiology in this township and to provide some evidence-based recommendations to formulate a strategy for reaching the national malaria elimination plan. Banmauk consistently has one of the highest malaria burdens in Myanmar. METHODS With the implementation of strengthened malaria control and surveillance activities after the endorsement of a national malaria elimination plan in 2015, detailed incidence data were obtained for 2016-2018 for Banmauk Township. The data include patient demographics, parasite species, disease severity, and disease outcome. Data were analyzed to identify characteristics, trends, distribution, and risk factors. RESULTS During 2016-2018, 2,402 malaria cases were reported, with Plasmodium falciparum accounting for 83.4% of infections. Both P. falciparum and P. vivax were transmitted more frequently during the rainy season (May-October). Despite intensified control, the annual parasite incidence rate (API) in 2017 (11.0) almost doubled that in 2016 (6.5). In total, 2.5% (59/2042) of the cases, of which 54 P. falciparum and 5 P. vivax, were complicated cases, resulting in 5 deaths. Malaria morbidity was high in children < 15 years and accounted for 33.4% of all cases and about 47% of the complicated cases. Older age groups and males living with poor transportation conditions were more likely to test positive especially in rainy and cold seasons. Despite the clear seasonality of malaria, severe cases were found among young children even more common in the dry season, when malaria incidence was low. CONCLUSIONS Despite the declining trend, the malaria burden remained high in Banmauk Township. Our study also documented severe cases and deaths from both falciparum and vivax malaria. P. falciparum remained the predominant parasite species, demanding increased efforts to achieve the goal of elimination of P. falciparum by 2025. As P. falciparum cases decreased, the proportion of cases attributable to P. vivax increased. In order to eliminate malaria, it will likely be important to increasingly target this species as well.
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Affiliation(s)
| | - Myat Thu Soe
- Myanmar Health Network Organization, Yangon, Myanmar
| | - Thit Lwin Oo
- Myanmar Health Network Organization, Yangon, Myanmar
| | - Kyaw Thu Aung
- Township Health Department, Banmauk Township, Sagaing, Myanmar
| | - Kyaw Kyaw Lin
- Township Health Department, Banmauk Township, Sagaing, Myanmar
| | - Aung Thi
- Department of Public Health, Ministry of Health, NayPyiTaw, Myanmar
| | - Lynette Menezes
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA
| | - Daniel M Parker
- Department of Population Health and Disease Prevention, University of California, Irvine, CA, USA.
| | - Liwang Cui
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA.
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Bannister-Tyrrell M, Krit M, Sluydts V, Tho S, Sokny M, Mean V, Kim S, Menard D, Grietens KP, Abrams S, Hens N, Coosemans M, Bassat Q, van Hensbroek MB, Durnez L, Van Bortel W. Households or Hotspots? Defining Intervention Targets for Malaria Elimination in Ratanakiri Province, Eastern Cambodia. J Infect Dis 2020; 220:1034-1043. [PMID: 31028393 PMCID: PMC6688056 DOI: 10.1093/infdis/jiz211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Malaria "hotspots" have been proposed as potential intervention units for targeted malaria elimination. Little is known about hotspot formation and stability in settings outside sub-Saharan Africa. METHODS Clustering of Plasmodium infections at the household and hotspot level was assessed over 2 years in 3 villages in eastern Cambodia. Social and spatial autocorrelation statistics were calculated to assess clustering of malaria risk, and logistic regression was used to assess the effect of living in a malaria hotspot compared to living in a malaria-positive household in the first year of the study on risk of malaria infection in the second year. RESULTS The crude prevalence of Plasmodium infection was 8.4% in 2016 and 3.6% in 2017. Living in a hotspot in 2016 did not predict Plasmodium risk at the individual or household level in 2017 overall, but living in a Plasmodium-positive household in 2016 strongly predicted living in a Plasmodium-positive household in 2017 (Risk Ratio, 5.00 [95% confidence interval, 2.09-11.96], P < .0001). There was no consistent evidence that malaria risk clustered in groups of socially connected individuals from different households. CONCLUSIONS Malaria risk clustered more clearly in households than in hotspots over 2 years. Household-based strategies should be prioritized in malaria elimination programs in this region.
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Affiliation(s)
| | | | - Vincent Sluydts
- Institute of Tropical Medicine, Antwerp.,University of Antwerp, Belgium
| | - Sochantha Tho
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh
| | - Mao Sokny
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh
| | - Vanna Mean
- Ratanakiri Provincial Health Department, Banlung
| | | | | | | | - Steven Abrams
- University of Antwerp, Belgium.,University of Hasselt, Belgium
| | - Niel Hens
- University of Antwerp, Belgium.,University of Hasselt, Belgium
| | | | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | | | - Lies Durnez
- Institute of Tropical Medicine, Antwerp.,University of Antwerp, Belgium
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Gryseels C, Bannister-Tyrrell M, Uk S, Set S, Suon S, Gerrets R, Peeters Grietens K. A Critical Enquiry into Variability of Insecticidal Net Use in Cambodia: Implications for Assessing Appropriateness of Malaria Elimination Interventions. Am J Trop Med Hyg 2020; 100:1424-1432. [PMID: 30994087 PMCID: PMC6553892 DOI: 10.4269/ajtmh.18-0730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Distributing long-lasting insecticidal nets (LLINs) to individuals living in malaria-endemic regions is a cornerstone of global malaria control. National malaria control programs aim to achieve "universal coverage" of at-risk populations to reach LLINs' full potential to reduce malaria, progress of which is then measured by indicators constructed from standardized questionnaires. Through an exploration of variability in LLIN use in Cambodia, we argue that indicators of universal coverage of LLINs are not sufficiently commensurate with the realities they are intended to measure, limiting the suitability of the data to serve program and policy purposes in a malaria elimination era. Reflecting on the various sources of variability in LLIN use, we apply and extend the concept of "appropriateness" as a third prong to the widely used "efficacy" and "effectiveness" criteria for evaluating LLINs as a tool for malaria prevention. Describing first the different dimensions of the intervention and the sociocultural context separately, we will further show how the variability underlying both is affected and induced by inappropriate aspects of the intervention and the measurements of its impact. We consider the gap between "net use" and the numerical representations of such local net use justifies further exploration of potential strategies to improve LLIN use in subgroups where persisting malaria transmission clusters.
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Affiliation(s)
| | | | - Sambunny Uk
- National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Srun Set
- National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Sokha Suon
- National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia
| | - René Gerrets
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
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5
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Stresman G, Bousema T, Cook J. Malaria Hotspots: Is There Epidemiological Evidence for Fine-Scale Spatial Targeting of Interventions? Trends Parasitol 2019; 35:822-834. [PMID: 31474558 DOI: 10.1016/j.pt.2019.07.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 12/20/2022]
Abstract
As data at progressively granular spatial scales become available, the temptation is to target interventions to areas with higher malaria transmission - so-called hotspots - with the aim of reducing transmission in the wider community. This paper reviews literature to determine if hotspots are an intrinsic feature of malaria epidemiology and whether current evidence supports hotspot-targeted interventions. Hotspots are a consistent feature of malaria transmission at all endemicities. The smallest spatial unit capable of supporting transmission is the household, where peri-domestic transmission occurs. Whilst the value of focusing interventions to high-burden areas is evident, there is currently limited evidence that local-scale hotspots fuel transmission. As boundaries are often uncertain, there is no conclusive evidence that hotspot-targeted interventions accelerate malaria elimination.
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Affiliation(s)
- Gillian Stresman
- Infection Biology Department, London School of Hygiene and Tropical Medicine, London, UK.
| | - Teun Bousema
- Radboud University Medical Centre, Department of Microbiology, HB Nijmegen, The Netherlands.
| | - Jackie Cook
- Medical Research Council (MRC) Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
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6
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Rejeki DSS, Fuad A, Widartono BS, Murhandarwati EEH, Kusnanto H. Spatiotemporal patterns of malaria at cross-boundaries area in Menoreh Hills, Java, Indonesia. Malar J 2019; 18:80. [PMID: 30876422 PMCID: PMC6419851 DOI: 10.1186/s12936-019-2717-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Comprehensive reports of malaria in Menoreh Hills, Central Java, Indonesia, a unique district cross-boundaries area under three districts and two provinces have been published previously. However, no study was performed to identify the hotspots of malaria in this cross-boundaries area, Kaligesing and Bagelen Subdistricts in Purworejo, Jawa Tengah Province and Kokap Subdistrict in Kulon Progo, Yogyakarta Province, using a longitudinal spatial data. Methods Monthly reports of malaria cases at primary health centres during 2005–2015 were collected and processed with ArcGIS and SaTScan to identify the malaria distribution at the village level. Malaria distribution was analysed using global spatial autocorrelation (Moran index) in ArcGIS. Cluster analysis was conducted using SaTScan purely spatial clustering and purely temporal clustering. Cluster characteristics resulted from three different approach were compared and analysed. Results During the last 11 years, 3812 malaria cases were reported and the number of high case incidence (HCI) villages were increased continuously. Malaria spatial distribution in Menoreh Hills was clustered spatially. Using three different approaches of time period ranges, consistent conclusion was found i.e. most likely clusters always occurred in the Purworejo district while the secondary clusters appeared later in the cross-boundaries districts. Conclusion Spatiotemporal analysis of an 11 years surveillance data showed that hotspots of malaria cases in Menoreh Hills were continuously located in Purworejo district. The success of malaria elimination in the cross boundaries area of Menoreh Hills might be depended on the success in malaria case management and surveillance in this hotspot area.
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Affiliation(s)
- Dwi Sarwani Sri Rejeki
- Department of Public Health, Faculty of Health Sciences, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Anis Fuad
- Graduate Program of Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Barandi Sapta Widartono
- Cartography and Remote Sensing Study Program, Department of Geographic Information Science, Faculty of Geography, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - E Elsa Herdiana Murhandarwati
- Department of Parasitology and Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Hari Kusnanto
- Graduate Program of Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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7
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Dysoley L, Kim S, Lopes S, Khim N, Bjorges S, Top S, Huch C, Rekol H, Westercamp N, Fukuda MM, Hwang J, Roca-Feltrer A, Mukaka M, Menard D, Taylor WR. The tolerability of single low dose primaquine in glucose-6-phosphate deficient and normal falciparum-infected Cambodians. BMC Infect Dis 2019; 19:250. [PMID: 30871496 PMCID: PMC6419451 DOI: 10.1186/s12879-019-3862-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/01/2019] [Indexed: 12/18/2022] Open
Abstract
Background The WHO recommends single low-dose primaquine (SLDPQ, 0.25 mg/kg body weight) in falciparum-infected patients to block malaria transmission and contribute to eliminating multidrug resistant Plasmodium falciparum from the Greater Mekong Sub region (GMS). However, the anxiety regarding PQ-induced acute haemolytic anaemia in glucose-6-phosphate dehydrogenase deficiency (G6PDd) has hindered its use. Therefore, we assessed the tolerability of SLDPQ in Cambodia to inform national policy. Methods This open randomised trial of dihydroartemisinin-piperaquine (DHAPP) + SLDPQ vs. DHAPP alone recruited Cambodians aged ≥1 year with acute uncomplicated P. falciparum. Randomisation was 4:1 DHAPP+SLDPQ: DHAPP for G6PDd patients and 1:1 for G6PDn patients, according to the results of the qualitative fluorescent spot test. Definitive G6PD status was determined by genotyping. Day (D) 7 haemoglobin (Hb) concentration was the primary outcome measure. Results One hundred nine patients (88 males, 21 females), aged 4–76 years (median 23) were enrolled; 12 were G6PDd Viangchan (9 hemizygous males, 3 heterozygous females). Mean nadir Hb occurred on D7 [11.6 (range 6.4 ─ 15.6) g/dL] and was significantly lower (p = 0.040) in G6PDd (n = 9) vs. G6PDn (n = 46) DHAPP+SLDPQ recipients: 10.9 vs. 12.05 g/dL, Δ = -1.15 (95% CI: -2.24 ─ -0.05) g/dL. Three G6PDn patients had D7 Hb concentrations < 8 g/dL; D7-D0 Hbs were 6.4 ─ 6.9, 7.4 ─ 7.4, and 7.5 ─ 8.2 g/dL. For all patients, mean (range) D7-D0 Hb decline was -1.45 (-4.8 ─ 2.4) g/dL, associated significantly with higher D0 Hb, higher D0 parasitaemia, and receiving DHAPP; G6PDd was not a factor. No patient required a blood transfusion. Conclusions DHAPP+SLDPQ was associated with modest Hb declines in G6PD Viangchan, a moderately severe variant. Our data augment growing evidence that SLDPQ in SE Asia is well tolerated and appears safe in G6PDd patients. Cambodia is now deploying SLDPQ and this should encourage other GMS countries to follow suit. Trial registration The clinicaltrials.gov reference number is NCT02434952. Electronic supplementary material The online version of this article (10.1186/s12879-019-3862-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lek Dysoley
- National Center for National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Saorin Kim
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Nimol Khim
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Steven Bjorges
- WHO Cambodia country office, Pasteur Street, Phnom Penh, Cambodia
| | | | - Chea Huch
- National Center for National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Huy Rekol
- National Center for National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Nelli Westercamp
- Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Mark M Fukuda
- U.S. President's Malaria Initiative, Malaria Branch, Division Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Bangkok, Thailand
| | - Jimee Hwang
- U.S. President's Malaria Initiative, Malaria Branch, Division Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research unit (MORU), 420/60 Rajvithi Road, Bangkok, 10400, Thailand.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Didier Menard
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia.,Biology of Host-Parasite Interactions Unit, Malaria Genetics and Resistance Group, Institut Pasteur - INSERM U1201 - CNRS ERL9195, Paris, France
| | - Walter R Taylor
- Mahidol Oxford Tropical Medicine Research unit (MORU), 420/60 Rajvithi Road, Bangkok, 10400, Thailand. .,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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8
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Yasuoka J, Kikuchi K, Nanishi K, Ly P, Thavrin B, Omatsu T, Mizutani T. Malaria knowledge, preventive actions, and treatment-seeking behavior among ethnic minorities in Ratanakiri Province, Cambodia: a community-based cross-sectional survey. BMC Public Health 2018; 18:1206. [PMID: 30367615 PMCID: PMC6203989 DOI: 10.1186/s12889-018-6123-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022] Open
Abstract
Background Malaria incidence has been steadily declining in Cambodia, where the government is aiming to eliminate malaria by 2025. Successful malaria elimination requires active engagement and participation of communities to recognize malaria symptoms and the development of prompt treatment-seeking behavior for early diagnosis and appropriate treatment. This study examined malaria knowledge, preventive actions, and treatment-seeking behavior among different groups of ethnic minorities and Khmer in Ratanakiri Province, Cambodia. Methods Face-to-face interviews were conducted in December 2015, targeting 388 mothers with children under 2 years old, who belonged to ten ethnic minority groups or the Khmer group living in 62 rural villages in Ratanakiri. In addition to describing mothers’ knowledge and actions for malaria prevention, logistic regression analysis was performed to identify determinants of fever during the most recent pregnancy and among children under two. Results Overall 388 mothers were identified for enrollment into the study of which 377 (97.2%) were included in analyses. The majority of mothers slept under bed nets at home (95.8%) and wore long-sleeved clothes (83.8%) for malaria prevention. However, knowledge of malaria was limited: 44.6% were aware of malaria symptoms, 40.6% knew the malaria transmission route precisely, and 29.2% knew of mosquito breeding places. Staying overnight at a farm hut was significantly associated with having fever during the most recent pregnancy (adjusted odds ratio [AOR] 2.008, 95% confidence interval [CI]: 1.215–3.321) and a child having fever (AOR 3.681, 95% CI 1.943–6.972). Mothers’ partaking in a variety of malaria preventive actions was protective against fever in children (AOR 0.292, 95% CI: 0.136–0.650). Among those who had fever during pregnancy, 39.4% did not seek treatment. Conclusion Although the majority of mothers took malaria preventive actions, knowledge of malaria epidemiology and vector ecology and treatment-seeking behavior for fever were limited. Staying overnight at farm huts, regardless of the differences in socio-demographic and socio-cultural characteristics, was strongly associated with fever episodes during pregnancy and childhood. This study indicates the necessity of spreading accurate malaria knowledge, raising awareness of health risks related to agricultural practices, and promoting treatment-seeking behavior among ethnic minorities to strengthen their engagement in malaria elimination.
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Affiliation(s)
- Junko Yasuoka
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo, 183-8508, Japan.
| | - Kimiyo Kikuchi
- Graduate Education and Research Training Program in Decision Science for Sustainable Society, Kyushu University, Motooka 744, Nishi-ku, Fukuoka-shi, Fukuoka, 819-0395, Japan
| | - Keiko Nanishi
- Office of International Academic Affairs, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Po Ly
- National center for Parasitology, Entomology & Malaria Control (CNM), Ministry of Health, #477 Betong Street (Corner St.92), Village Trapangsvay, Sanakat Phnom Penh Thmey, Khan Sen Sok, Phnom Penh, Cambodia
| | - Boukheng Thavrin
- National center for Parasitology, Entomology & Malaria Control (CNM), Ministry of Health, #477 Betong Street (Corner St.92), Village Trapangsvay, Sanakat Phnom Penh Thmey, Khan Sen Sok, Phnom Penh, Cambodia
| | - Tsutomu Omatsu
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo, 183-8508, Japan
| | - Tetsuya Mizutani
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo, 183-8508, Japan
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9
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Wangdi K, Canavati SE, Ngo TD, Tran LK, Nguyen TM, Tran DT, Martin NJ, Clements ACA. Analysis of clinical malaria disease patterns and trends in Vietnam 2009-2015. Malar J 2018; 17:332. [PMID: 30223843 PMCID: PMC6142383 DOI: 10.1186/s12936-018-2478-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Viet Nam has made tremendous progress towards reducing mortality and morbidity associated with malaria in recent years. Despite the success in malaria control, there has been a recent increase in cases in some provinces. In order to understand the changing malaria dynamics in Viet Nam and measure progress towards elimination, the aim of this study was to describe and quantify spatial and temporal trends of malaria by species at district level across the country. METHODS Malaria case reports at the Viet Nam National Institute of Malariology, Parasitology, and Entomology were reviewed for the period of January 2009 to December 2015. The population of each district was obtained from the Population and Housing Census-2009. A multivariate (insecticide-treated mosquito nets [ITN], indoor residual spraying [IRS], maximum temperature), zero-inflated, Poisson regression model was developed with spatial and spatiotemporal random effects modelled using a conditional autoregressive prior structure, and with posterior parameters estimated using Bayesian Markov chain Monte Carlo simulation with Gibbs sampling. Covariates included in the models were coverage of intervention (ITN and IRS) and maximum temperature. RESULTS There was a total of 57,713 Plasmodium falciparum and 32,386 Plasmodium vivax cases during the study period. The ratio of P. falciparum to P. vivax decreased from 4.3 (81.0% P. falciparum; 11,121 cases) in 2009 to 0.8 (45.0% P. falciparum; 3325 cases) in 2015. Coverage of ITN was associated with decreased P. falciparum incidence, with a 1.1% (95% credible interval [CrI] 0.009%, 1.2%) decrease in incidence for 1% increase in the ITN coverage, but this was not the case for P. vivax, nor was it the case for IRS coverage. Maximum temperature was associated with increased incidence of both species, with a 4% (95% CrI 3.5%, 4.3%) and 1.6% (95% CrI 0.9%, 2.0%) increase in P. falciparum and P. vivax incidence for a temperature increase of 1 °C, respectively. Temporal trends of P. falciparum and P. vivax incidence were significantly higher than the national average in Central and Central-Southern districts. CONCLUSION Interventions (ITN distribution) and environmental factors (increased temperature) were associated with incidence of P. falciparum and P. vivax during the study period. The factors reviewed were not exhaustive, however the data suggest distribution of resources can be targeted to areas and times of increased malaria transmission. Additionally, changing distribution of the two predominant malaria species in Viet Nam will require different programmatic approaches for control and elimination.
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Affiliation(s)
- Kinley Wangdi
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia.
| | | | | | | | | | - Duong Thanh Tran
- National Institute of Malariology, Parasitology, and Entomology, Hanoi, Viet Nam
| | - Nicholas J Martin
- U.S. Naval Medical Research Unit No. 2, PSA Sembawang Deptford Rd, Building 7-4, 759657, Singapore, Singapore
| | - Archie C A Clements
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia.,Faculty of Health Sciences, Curtin University, Bentley, Perth, Australia
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10
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Bannister-Tyrrell M, Srun S, Sluydts V, Gryseels C, Mean V, Kim S, Sokny M, Peeters Grietens K, Coosemans M, Menard D, Tho S, Van Bortel W, Durnez L. Importance of household-level risk factors in explaining micro-epidemiology of asymptomatic malaria infections in Ratanakiri Province, Cambodia. Sci Rep 2018; 8:11643. [PMID: 30076361 PMCID: PMC6076298 DOI: 10.1038/s41598-018-30193-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/20/2018] [Indexed: 11/09/2022] Open
Abstract
Heterogeneity in malaria risk is considered a challenge for malaria elimination. A cross-sectional study was conducted to describe and explain micro-epidemiological variation in Plasmodium infection prevalence at household and village level in three villages in Ratanakiri Province, Cambodia. A two-level logistic regression model with a random intercept fitted for each household was used to model the odds of Plasmodium infection, with sequential adjustment for individual-level then household-level risk factors. Individual-level risk factors for Plasmodium infection included hammock net use and frequency of evening outdoor farm gatherings in adults, and older age in children. Household-level risk factors included house wall material, crop types, and satellite dish and farm machine ownership. Individual-level risk factors did not explain differences in odds of Plasmodium infection between households or between villages. In contrast, once household-level risk factors were taken into account, there was no significant difference in odds of Plasmodium infection between households and between villages. This study shows the importance of ongoing indoor and peridomestic transmission in a region where forest workers and mobile populations have previously been the focus of attention. Interventions targeting malaria risk at household level should be further explored.
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Affiliation(s)
| | - Set Srun
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Vincent Sluydts
- Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
- University of Antwerp, Antwerpm, Belgium
| | | | - Vanna Mean
- Ratanakiri Provincial Health Department, Banlung, Cambodia
| | - Saorin Kim
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Mao Sokny
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - Marc Coosemans
- Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
| | | | - Sochantha Tho
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Wim Van Bortel
- Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
| | - Lies Durnez
- Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
- University of Antwerp, Antwerpm, Belgium
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