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Dosoo DK, Adu GA, Kingsley K, Odei-Lartey E, Adomako K, Atuguba F, Gyaase S, Nuhu AR, Peprah NY, Ankrah L, Adu-Gyasi D, Atibilla D, Williams J, Malm KL, Asante KP. Prevalence and factors associated with malaria among children aged 6 months to 10 years in the Greater Accra Region of Ghana: a community-based cross-sectional survey. Malar J 2024; 23:289. [PMID: 39334170 PMCID: PMC11438078 DOI: 10.1186/s12936-024-05109-4] [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: 02/07/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Malaria remains a major public health problem, especially among children in sub-Saharan Africa. Knowledge of malaria parasite prevalence informs targeted interventions and helps to monitor the effectiveness of those interventions. This study aimed to determine prevalence and factors associated with malaria in children aged 6 months to 10 years in the Greater Accra Region of Ghana. METHODS A community-based cross-sectional study was conducted among 8,741 children aged 6-59 months and 8,292 children aged 5-10 years in all 29 districts of the Greater Accra Region of Ghana in October 2020. Systematic random sampling was used to select communities, households and study participants. A structured questionnaire was used to collect data from caregivers. Rapid diagnostic test kits were used to determine the presence of malaria parasites in blood samples collected by fingerprick. Factors associated with malaria RDT-positivity were determined using multivariate logistic regression analysis. RESULTS Of 8727 children aged 6-59 months and 8279 aged 5-10 years from whom blood samples were obtained, positive results were obtained for 289 (3.3%; 95% CI 3.0-3.7) and 406 (4.9%; 95% CI 4.5-5.4) respectively. Malaria parasite prevalence in the districts ranged from 0.9 to 10.7% and 1.4-15.0% in children aged 6-59 months and 5-10 years respectively. Factors associated with increased odds of malaria included higher age (AOR = 1.43; 95% CI 1.14-1.71), and living in households without nets on the windows (AOR 1.64; 95% CI 1.10-2.45). On the other hand, living in households located in urban communities was associated with a lower risk of malaria (AOR 0.56; 95% CI 0.40-0.78). CONCLUSION The average prevalence of malaria in the Greater Accra Region is low compared with other regions. However, there are potential hotspots that need to be targeted with appropriate interventions to accelerate the drive towards malaria elimination.
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Affiliation(s)
- David Kwame Dosoo
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana.
| | - George Asumah Adu
- National Malaria Elimination Programme, Ghana Health Service, Accra, Ghana
| | - Kayan Kingsley
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Eliezer Odei-Lartey
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Kofi Adomako
- National Malaria Elimination Programme, Ghana Health Service, Accra, Ghana
| | - Frank Atuguba
- Dodowa Health Research Centre, Research and Development Division, Ghana Health Service, Dodowa, Ghana
| | - Stephaney Gyaase
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Abdul Razak Nuhu
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Nana Yaw Peprah
- National Malaria Elimination Programme, Ghana Health Service, Accra, Ghana
| | - Love Ankrah
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Dennis Adu-Gyasi
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Dorcas Atibilla
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - John Williams
- Dodowa Health Research Centre, Research and Development Division, Ghana Health Service, Dodowa, Ghana
| | - Keziah L Malm
- National Malaria Elimination Programme, Ghana Health Service, Accra, Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana.
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Adebusuyi SA, Olorunfemi AB, Fagbemi KA, Nderu D, Amoo AOJ, Thomas BN, Velavan TP, Ojurongbe O. Performance of rapid diagnostic test, light microscopy, and polymerase chain reaction in pregnant women with asymptomatic malaria in Nigeria. IJID REGIONS 2024; 12:100416. [PMID: 39253688 PMCID: PMC11381904 DOI: 10.1016/j.ijregi.2024.100416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 09/11/2024]
Abstract
Objectives Rapid diagnostic tests (RDTs) offer an attractive tool for diagnosing malaria in pregnancy. This study assessed the effectiveness of a Plasmodium falciparum-specific RDT compared with microscopy and polymerase chain reaction (PCR) in diagnosing asymptomatic malaria in pregnant women in southwest Nigeria. Methods The study included 406 asymptomatic pregnant women seeking antenatal care. Blood samples were collected and tested using RDT (SD Bioline, Standard Diagnostics Inc. Korea) and light microscopy and confirmed using nested PCR. Results The study revealed that the malaria parasite positivity rate was 8.9% by RDT, 21% by microscopy, and 32% by nested PCR. RDT had a sensitivity of 51.4% and specificity of 69.5%, whereas microscopy had a sensitivity of 65.3% and specificity of 98.2%. The combined testing of microscopy and RDT had a sensitivity and specificity of 100%. The study also showed a high prevalence of mild anemia among participants. Conclusions Despite the RDT's low sensitivity, its high negative predictive value suggests it could be useful in combination with microscopy in ruling out asymptomatic malaria in pregnancy. Further study will help identify more suitable RDTs for routine malaria diagnosis in Nigeria and strengthen malaria prevention programs in pregnant women.
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Affiliation(s)
- Sunday A Adebusuyi
- Department of Medical Microbiology & Parasitology, Olabisi Onabanjo University, Ago-Iwoye, Nigeria
| | - Adedolapo Blessing Olorunfemi
- Humboldt Research Hub-Center for Emerging & Re-emerging Infectious Diseases (HRH-CERID), Ladoke Akintola University of Technology, Ogbomoso, Nigeria
- Department of Medical Microbiology & Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | | | - David Nderu
- School of Health Sciences, Kirinyaga University, Kirinyaga, Kenya
| | - Abimbola O J Amoo
- Department of Medical Microbiology & Parasitology, Olabisi Onabanjo University, Ago-Iwoye, Nigeria
| | - Bolaji N Thomas
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, USA
| | - Thirumalaisamy P Velavan
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Olusola Ojurongbe
- Humboldt Research Hub-Center for Emerging & Re-emerging Infectious Diseases (HRH-CERID), Ladoke Akintola University of Technology, Ogbomoso, Nigeria
- Department of Medical Microbiology & Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
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3
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Molina-de la Fuente I, Tahita MC, Bérenger K, Ta Tang TH, García L, González V, Benito A, Hübschen JM, Tinto H, Berzosa P. Malaria diagnosis challenges and pfhrp2 and pfhrp3 gene deletions using pregnant women as sentinel population in Nanoro region, Burkina Faso. Pathog Glob Health 2024; 118:481-491. [PMID: 39140699 PMCID: PMC11441055 DOI: 10.1080/20477724.2024.2388489] [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] [Indexed: 08/15/2024] Open
Abstract
Malaria in pregnancy causes adverse consequences and prompt and accurate diagnosis is essential for case management. In malaria endemic countries, diagnosis is mainly based on rapid diagnostic tests (RDT) and microscopy. However, increasing reports of false negatives caused by low parasitemia and pfhrp2/3 deletions raise concerns about HRP2-based RDT usefulness. This study aimed to assess RDT and microscopy performance and to describe pfhrp2/3 deletions in a cohort of 418 pregnant women in Burkina Faso. Malaria was diagnosed using RDT and microscopy and blood samples were collected during antenatal care visits. Diagnostic results were compared to PCR as gold standard. Pfhrp2 and pfhrp3 deletions were characterized for patients with confirmed P. falciparum infection. RDT had better sensitivity (76%) but lower specificity (83%) than microscopy (sensitivity = 57%; specificity = 98%). Low parasitemia (<150 parasites/µL), especially in multigravidae, was the principal factor causing false negatives by both methods. Moreover, pfhrp2 deletion frequency among overall false negatives by RDT was 21.43%. Higher frequency of deletions was found among all samples, independently of RDT result, for example around 2% of samples had double deletions meaning that the majority of deletions had no effect on RDT testing. Finally, it was found higher pfhrp2 deletion in women with lower uterine height during the first trimester. Wider and National surveillance study of deletions is recommended among pregnant women and in Burkina Faso.
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Affiliation(s)
- Irene Molina-de la Fuente
- Department of Biomedicine and Biotechnology, School of Pharmacy, University of Alcalá, Madrid, Spain
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- CIBERINFEC - CIBER Infectious Diseases (ISCIII), Madrid, Spain
| | - Marc Christian Tahita
- Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
- Institut de Recherche en Sciences de la Sante/Direction Régionale du Centre-Ouest, Bobo Dioulasso, Burkina Faso
| | - Kabore Bérenger
- Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
- Institut de Recherche en Sciences de la Sante/Direction Régionale du Centre-Ouest, Bobo Dioulasso, Burkina Faso
| | - Thuy Huong Ta Tang
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- CIBERINFEC - CIBER Infectious Diseases (ISCIII), Madrid, Spain
| | - Luz García
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- CIBERINFEC - CIBER Infectious Diseases (ISCIII), Madrid, Spain
| | - Vicenta González
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- CIBERINFEC - CIBER Infectious Diseases (ISCIII), Madrid, Spain
| | - Agustín Benito
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- CIBERINFEC - CIBER Infectious Diseases (ISCIII), Madrid, Spain
| | - Judith M Hübschen
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
- Institut de Recherche en Sciences de la Sante/Direction Régionale du Centre-Ouest, Bobo Dioulasso, Burkina Faso
| | - Pedro Berzosa
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- CIBERINFEC - CIBER Infectious Diseases (ISCIII), Madrid, Spain
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4
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Kayode TA, Addo AK, Addison TK, Tweneboah A, Afriyie SO, Abbas DA, Seth A, Badu-Tawiah AK, Badu K, Koepfli C. Comparison of three rapid diagnostic tests for Plasmodium falciparum diagnosis in Ghana. Malar J 2024; 23:265. [PMID: 39215297 PMCID: PMC11363606 DOI: 10.1186/s12936-024-05073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Accurate diagnosis and timely treatment are crucial in combating malaria. METHODS A total of 449 samples were screened for Plasmodium falciparum infection by expert microscopy, qPCR, and three RDTs, namely Rapigen Biocredit Malaria Ag Pf (detecting HRP2 and pLDH on separate bands), Abbott NxTek Eliminate Malaria Ag Pf (detecting HRP2), and SD Bioline Malaria Ag Pf (detecting HRP2). hrp2/3 deletion typing was done by digital PCR. RESULTS 45.7% (205/449) individuals tested positive by qPCR for P. falciparum with a mean parasite density of 12.5 parasites/μL. Using qPCR as reference, the sensitivity of microscopy was 28.3% (58/205), the Biocredit RDT was 52.2% (107/205), the NxTek RDT was 49.3% (101/205), and the Bioline RDT was 39.5% (81/205). When only samples with densities > 20 parasites/μL were included (n = 89), sensitivity of 62.9% (56/89) by microscopy, 88.8% (79/89) by Biocredit, 88.8% (79/89) by NxTek, and 78.7% (70/89) by Bioline were obtained. All three RDTs demonstrated specificities > 95%. The limits of detection (95% probability that a sample tested positive) was 4393 parasites/μL (microscopy), 56 parasites/μL (Biocredit, considering either HRP2 or pLDH), 84 parasites/μL (NxTek), and 331 parasites/μL (Bioline). None of the three qPCR-confirmed P. falciparum positive samples, identified solely through the pLDH target, or eight samples negative for all RDTs but qPCR-positive at densities > 20 parasites/µL carried hrp2/3 deletions. CONCLUSION The Biocredit and NxTek RDTs demonstrated comparable diagnostic efficacies. All three RDTs performed better than microscopy.
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Affiliation(s)
- Tolulope Adeyemi Kayode
- Eck Institute for Global Health and Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA
| | - Agyapong Kofi Addo
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thomas Kwame Addison
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Austine Tweneboah
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stephen Opoku Afriyie
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Dawood Ackom Abbas
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ayesha Seth
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, OH, USA
| | - Abraham K Badu-Tawiah
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, OH, USA
| | - Kingsley Badu
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Cristian Koepfli
- Eck Institute for Global Health and Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA.
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Sagna AB, Gebre Y, Vera-Arias CA, Traoré DF, Tchekoi BN, Assi SB, Koffi AA, Rogier C, Remoue F, Koepfli C. High prevalence of asymptomatic and subpatent Plasmodium falciparum infections but no histidine-rich protein 2 gene deletion in Bouaké, Côte d'Ivoire. Sci Rep 2024; 14:19060. [PMID: 39154104 PMCID: PMC11330520 DOI: 10.1038/s41598-024-70215-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024] Open
Abstract
This study aimed to estimate the prevalence of asymptomatic and subpatent P. falciparum infections in the city of Bouaké, Central Côte d'Ivoire, to compare the performance of three tests, and to investigate potential P. falciparum histidine-rich protein 2 (pfhrp2) gene deletions. A cross-sectional survey was conducted in nine neighborhoods in Bouaké in 2016. Matched light microscopy (LM), rapid diagnostic test (RDT), and quantitative PCR (qPCR) data were used to determine the prevalence of P. falciparum infection and compare the performance of the three diagnostic tests. Pfhrp2/3 deletions were genotyped by digital PCR. Among 2313 individuals, 97.2% were asymptomatic and 2.8% were symptomatic. P. falciparum prevalence among symptomatic individuals was 25.8%, 30.3%, and 40.9% by LM, RDT, and varATS qPCR, respectively, and among asymptomatic individuals, it was 10.3%, 12.5%, and 34.9%. Asymptomatic infections comprised 96.4% of all malaria infections, with 58.2% detectable only by varATS qPCR. Although the prevalence of asymptomatic P. falciparum infections was higher in school-age children (5-14 years: 42.0%) compared to < 5 years (17.3%) and ≥ 15 years (35.9%), subpatent infections were more likely in ≥ 15 years (70.4%) than in < 5 years (39.7%) and school-age children (41.2%). LM and RDTs were reliable only at parasite densities > 10,000 parasites/µL. Individuals who were positive according to all three tests had significantly greater parasite density (856.8 parasites/µL; 95% CI 707.3-1,038) than did those who were positive by varATS qPCR only (13.7 parasites/µL; 95% CI 11.4-16.3) (p < 0.0001). No pfhrp2 deletions were observed. The high prevalence of asymptomatic and subpatent infections highlights the need for targeted strategies to reduce malaria in urban Côte d'Ivoire.
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Affiliation(s)
- André Barembaye Sagna
- MIVEGEC, University of Montpellier, IRD, CNRS, Montpellier, France.
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre, Dame, Notre Dame, IN, USA.
- Institut Pierre Richet, Institut National de la Santé Publique, Bouaké, Côte d'Ivoire.
| | - Yilekal Gebre
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre, Dame, Notre Dame, IN, USA
| | - Claudia Abigail Vera-Arias
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre, Dame, Notre Dame, IN, USA
| | - Dipomin François Traoré
- Institut Pierre Richet, Institut National de la Santé Publique, Bouaké, Côte d'Ivoire
- Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Bertin N'cho Tchekoi
- Institut Pierre Richet, Institut National de la Santé Publique, Bouaké, Côte d'Ivoire
| | - Serge Brice Assi
- Programme National de Lutte Contre le Paludisme en Côte d'Ivoire, Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | | | - Christophe Rogier
- Primum Vitare, Paris, France
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Franck Remoue
- MIVEGEC, University of Montpellier, IRD, CNRS, Montpellier, France
| | - Cristian Koepfli
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre, Dame, Notre Dame, IN, USA.
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Lawal L, Buhari AO, Jaji TA, Alatare AS, Adeyemo AO, Olumoh AO, Yusuff YA, Osborn G, Mogaji AB, Adoto BH, Ibrahim NG, Saliu WO, Abdul‐Rahman T. Lingering challenges in malaria elimination efforts in sub-Saharan Africa: Insights and potential solutions. Health Sci Rep 2024; 7:e2122. [PMID: 38831778 PMCID: PMC11144596 DOI: 10.1002/hsr2.2122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 04/14/2024] [Accepted: 04/28/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Between 2000 and 2015, significant gains were recorded in reducing the global burden of malaria due to enhanced global collaboration and increased funding. However, progress has stagnated post-2015, and the COVID-19 pandemic seems to have reversed some of these gains, necessitating a critical reevaluation of interventions. This paper aims to analyze the setbacks and offer recommendations for advancement in malaria control and prevention in sub-Saharan Africa. Methods We conducted searches on Google Scholar, PubMed, and relevant organization websites to identify relevant studies on malaria control and prevention and associated challenges in sub-Saharan Africa from 2015 to the present. Additionally, studies on individual sub-Saharan African countries were reviewed to ensure comprehensiveness. Data from selected studies were extracted and analyzed using a narrative synthesis approach to offer a concise overview of the evidence. Findings We observe that the halt in progress of malaria control in sub-Saharan Africa has deep roots in socioeconomic, political, and environmental factors. These challenges are exacerbated by the population explosion in the region, low coverage of interventions due to funding deficits and incessant crises, and the degradation of the efficacy of existing malaria commodities. Conclusion Sub-Saharan Africa is at a crossroads in its fight against malaria. Promising new frontiers such as malaria vaccines, preventive monoclonal antibodies, new-generation insecticide-treated nets, and potentially artificial intelligence-driven technologies offer hope in advancing malaria control and prevention in the region. Through commitment and collaboration, leveraging these opportunities can help surmount challenges and ultimately eliminate malaria in sub-Saharan Africa.
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Affiliation(s)
- Lukman Lawal
- Centre for Malaria and Other Tropical DiseasesIlorinNigeria
- Faculty of Clinical SciencesUniversity of IlorinIlorinNigeria
| | | | | | | | | | | | | | - Gabriel Osborn
- Faculty of Clinical SciencesUniversity of IlorinIlorinNigeria
| | | | | | | | | | - Toufik Abdul‐Rahman
- Medical InstituteSumy State UniversitySumyUkraine
- Toufik's World Medical AssociationSumyUkraine
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Rogier E, Battle N, Bakari C, Seth MD, Nace D, Herman C, Barakoti A, Madebe RA, Mandara CI, Lyimo BM, Giesbrecht DJ, Popkin-Hall ZR, Francis F, Mbwambo D, Garimo I, Aaron S, Lusasi A, Molteni F, Njau R, Cunningham JA, Lazaro S, Mohamed A, Juliano JJ, Bailey JA, Udhayakumar V, Ishengoma DS. Plasmodium falciparum pfhrp2 and pfhrp3 gene deletions among patients enrolled at 100 health facilities throughout Tanzania: February to July 2021. Sci Rep 2024; 14:8158. [PMID: 38589477 PMCID: PMC11001933 DOI: 10.1038/s41598-024-58455-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024] Open
Abstract
Plasmodium falciparum with the histidine rich protein 2 gene (pfhrp2) deleted from its genome can escape diagnosis by HRP2-based rapid diagnostic tests (HRP2-RDTs). The World Health Organization (WHO) recommends switching to a non-HRP2 RDT for P. falciparum clinical case diagnosis when pfhrp2 deletion prevalence causes ≥ 5% of RDTs to return false negative results. Tanzania is a country of heterogenous P. falciparum transmission, with some regions approaching elimination and others at varying levels of control. In concordance with the current recommended WHO pfhrp2 deletion surveillance strategy, 100 health facilities encompassing 10 regions of Tanzania enrolled malaria-suspected patients between February and July 2021. Of 7863 persons of all ages enrolled and providing RDT result and blood sample, 3777 (48.0%) were positive by the national RDT testing for Plasmodium lactate dehydrogenase (pLDH) and/or HRP2. A second RDT testing specifically for the P. falciparum LDH (Pf-pLDH) antigen found 95 persons (2.5% of all RDT positives) were positive, though negative by the national RDT for HRP2, and were selected for pfhrp2 and pfhrp3 (pfhrp2/3) genotyping. Multiplex antigen detection by laboratory bead assay found 135/7847 (1.7%) of all blood samples positive for Plasmodium antigens but very low or no HRP2, and these were selected for genotyping as well. Of the samples selected for genotyping based on RDT or laboratory multiplex result, 158 were P. falciparum DNA positive, and 140 had sufficient DNA to be genotyped for pfhrp2/3. Most of these (125/140) were found to be pfhrp2+/pfhrp3+, with smaller numbers deleted for only pfhrp2 (n = 9) or only pfhrp3 (n = 6). No dual pfhrp2/3 deleted parasites were observed. This survey found that parasites with these gene deletions are rare in Tanzania, and estimated that 0.24% (95% confidence interval: 0.08% to 0.39%) of false-negative HRP2-RDTs for symptomatic persons were due to pfhrp2 deletions in this 2021 Tanzania survey. These data provide evidence for HRP2-based diagnostics as currently accurate for P. falciparum diagnosis in Tanzania.
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Affiliation(s)
- Eric Rogier
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Catherine Bakari
- National Institute for Medical Research, Dar Es Salaam, Tanzania
| | - Misago D Seth
- National Institute for Medical Research, Dar Es Salaam, Tanzania
| | - Douglas Nace
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Camelia Herman
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Achut Barakoti
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
- CDC Foundation, Atlanta, GA, USA
| | - Rashid A Madebe
- National Institute for Medical Research, Dar Es Salaam, Tanzania
| | - Celine I Mandara
- National Institute for Medical Research, Dar Es Salaam, Tanzania
| | - Beatus M Lyimo
- National Institute for Medical Research, Dar Es Salaam, Tanzania
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | | | | | | | | | - Issa Garimo
- National Malaria Control Programme, Dodoma, Tanzania
| | | | | | | | - Ritha Njau
- World Health Organization, Country Office, Dar Es Salaam, Tanzania
| | | | - Samwel Lazaro
- National Malaria Control Programme, Dodoma, Tanzania
| | - Ally Mohamed
- National Malaria Control Programme, Dodoma, Tanzania
| | | | | | | | - Deus S Ishengoma
- National Institute for Medical Research, Dar Es Salaam, Tanzania.
- Faculty of Pharmaceutical Sciences, Monash University, Melbourne, Australia.
- Harvard T.H Chan School of Public Health, Boston, MA, USA.
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8
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Kayode TA, Addo AKA, Addison TK, Tweneboah A, Afriyie SO, Abass DA, Seth A, Badu-Tawiah AK, Badu K, Koepfli C. Welcome to the next generation of Malaria Rapid Diagnostic Tests: Comparative Analysis of NxTek Eliminate Malaria P.f, Biocredit Malaria Ag Pf, and SD Bioline Malaria Ag Pf for Plasmodium falciparum Diagnosis in Ghana. RESEARCH SQUARE 2023:rs.3.rs-3459263. [PMID: 37886535 PMCID: PMC10602185 DOI: 10.21203/rs.3.rs-3459263/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background Accurate diagnosis and timely treatment are crucial in combating malaria. Methods We evaluated the diagnostic performance of three Rapid Diagnostic Tests (RDTs) in diagnosing febrile patients, namely: Abbott NxTek Eliminate Malaria Ag Pf (detecting HRP2), Rapigen Biocredit Malaria Ag Pf (detecting HRP2 and LDH on separate bands), and SD Bioline Malaria Ag Pf (detecting HRP2). Results were compared to qPCR. Results Among 449 clinical patients, 45.7% (205/449) tested positive by qPCR for P. falciparum with a mean parasite density of 12.5parasites/μL. The sensitivity of the Biocredit RDT was 52.2% (107/205), NxTek RDT was 49.3% (101/205), and Bioline RDT was 40.5% (83/205). When samples with parasite densities lower than 20 parasites/uL were excluded (n=116), a sensitivity of 88.8% (79/89, NxTek), 89.9% (80/89, Biocredit), and 78.7% (70/89, Bioline) was obtained. All three RDTs demonstrated specificity above 95%. The limits of detection was 84 parasites/μL (NxTek), 56 parasites/μL (Biocredit, considering either HRP2 or LDH), and 331 parasites/μL (Bioline). None of the three qPCR-confirmed P. falciparum positive samples, identified solely through the LDH target, carried hrp2/3 deletions. Conclusion The Biocredit and NxTek RDTs demonstrated comparable diagnostic efficacies and both RDTs performed better than Bioline RDT.
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Cook J, Sternberg E, Aoura CJ, N'Guessan R, Kleinschmidt I, Koffi AA, Thomas MB, Assi SB. Housing modification for malaria control: impact of a "lethal house lure" intervention on malaria infection prevalence in a cluster randomised control trial in Côte d'Ivoire. BMC Med 2023; 21:168. [PMID: 37143050 PMCID: PMC10161487 DOI: 10.1186/s12916-023-02871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/19/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND In recent years, the downward trajectory of malaria transmission has slowed and, in some places, reversed. New tools are needed to further reduce malaria transmission. One approach that has received recent attention is a novel house-based intervention comprising window screening (S) and general house repairs to make the house more mosquito proof, together with EaveTubes (ET) that provide an innovative way of targeting mosquitoes with insecticides as they search for human hosts at night. The combined approach of Screening + EaveTubes (SET) essentially turns the house into a 'lure and kill' device. METHODS This study evaluated the impact of SET on malaria infection prevalence in Côte d'Ivoire and compares the result in the primary outcome, malaria case incidence. Malaria infection prevalence was measured in a cross-sectional survey in 40 villages, as part of a cluster-randomised trial evaluating the impact of SET on malaria case incidence. RESULTS Infection prevalence, measured by rapid diagnostic test (RDT), was 50.4% and 36.7% in the control arm and intervention arm, respectively, corresponding to an odds ratio of 0.57 (0.45-0.71), p < 0.0001). There was moderate agreement between RDT and microscopy results, with a reduction in odds of infection of 36% recorded when infection was measured by microscopy. Prevalence measured by RDT correlated strongly with incidence at a cluster level. CONCLUSIONS In addition to reducing malaria case incidence, house screening and EaveTubes substantially reduced malaria infection prevalence 18 months after installation. Infection prevalence may be a good metric to use for evaluating malaria interventions in areas of similar transmission levels to this setting. TRIAL REGISTRATION ISRCTN18145556, registered 1 February 2017.
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Affiliation(s)
- Jackie Cook
- International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | - Raphael N'Guessan
- Institut Pierre Richet, Bouaké, Côte d'Ivoire
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Immo Kleinschmidt
- International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- Wits Research Institute for Malaria, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
- Southern African Development Community Malaria Elimination Eight Secretariat, Windhoek, Namibia
| | | | - Matthew B Thomas
- Department of Entomology & Nematology and the Invasion Science Research Institute, University of Florida, Gainesville, USA
| | - Serge-Brice Assi
- Institut Pierre Richet, Bouaké, Côte d'Ivoire
- Institut National de Sante Publique, Abidjan, Côte d'Ivoire
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Low Prevalence of Plasmodium falciparum Histidine-Rich Protein 2 and 3 Gene Deletions—A Multiregional Study in Central and West Africa. Pathogens 2023; 12:pathogens12030455. [PMID: 36986377 PMCID: PMC10054520 DOI: 10.3390/pathogens12030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023] Open
Abstract
Plasmodium falciparum parasites carrying deletions of histidine-rich protein 2 and 3 genes, pfhrp2 and pfhrp3, respectively, are likely to escape detection via HRP2-based rapid diagnostic tests (RDTs) and, consequently, treatment, posing a major risk to both the health of the infected individual and malaria control efforts. This study assessed the frequency of pfhrp2- and pfhrp3-deleted strains at four different study sites in Central Africa (number of samples analyzed: Gabon N = 534 and the Republic of Congo N = 917) and West Africa (number of samples analyzed: Nigeria N = 466 and Benin N = 120) using a highly sensitive multiplex qPCR. We found low prevalences for pfhrp2 (1%, 0%, 0.03% and 0) and pfhrp3 single deletions (0%, 0%, 0.03% and 0%) at all study sites (Gabon, the Republic of Congo, Nigeria and Benin, respectively). Double-deleted P. falciparum were only found in Nigeria in 1.6% of all internally controlled samples. The results of this pilot investigation do not point towards a high risk for false-negative RDT results due to pfhrp2/pfhrp3 deletions in Central and West African regions. However, as this scenario can change rapidly, continuous monitoring is essential to ensure that RDTs remain a suitable tool for the malaria diagnostic strategy.
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Opoku Afriyie S, Addison TK, Gebre Y, Mutala AH, Antwi KB, Abbas DA, Addo KA, Tweneboah A, Ayisi-Boateng NK, Koepfli C, Badu K. Accuracy of diagnosis among clinical malaria patients: comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections. Malar J 2023; 22:76. [PMID: 36870966 PMCID: PMC9985253 DOI: 10.1186/s12936-023-04506-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 02/18/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND The World Health Organization recommends parasitological confirmation of all suspected malaria cases by microscopy or rapid diagnostic tests (RDTs) before treatment. These conventional tools are widely used for point-of-care diagnosis in spite of their poor sensitivity at low parasite density. Previous studies in Ghana have compared microscopy and RDT using standard 18S rRNA PCR as reference with varying outcomes. However, how these conventional tools compare with ultrasensitive varATS qPCR has not been studied. This study, therefore, sought to investigate the clinical performance of microscopy and RDT assuming highly sensitive varATS qPCR as gold standard. METHODS 1040 suspected malaria patients were recruited from two primary health care centers in the Ashanti Region of Ghana and tested for malaria by microscopy, RDT, and varATS qPCR. The sensitivity, specificity, and predictive values were assessed using varATS qPCR as gold standard. RESULTS Parasite prevalence was 17.5%, 24.5%, and 42.1% by microscopy, RDT, and varATS qPCR respectively. Using varATS qPCR as the standard, RDT was more sensitive (55.7% vs 39.3%), equally specific (98.2% vs 98.3%), and reported higher positive (95.7% vs 94.5%) and negative predictive values (75.3% vs 69.0%) than microscopy. Consequently, RDT recorded better diagnostic agreement (kappa = 0.571) with varATS qPCR than microscopy (kappa = 0.409) for clinical detection of malaria. CONCLUSIONS RDT outperformed microscopy for the diagnosis of Plasmodium falciparum malaria in the study. However, both tests missed over 40% of infections that were detected by varATS qPCR. Novel tools are needed to ensure prompt diagnosis of all clinical malaria cases.
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Affiliation(s)
- Stephen Opoku Afriyie
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Thomas Kwame Addison
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Yilekal Gebre
- Department of Biological Sciences, University of Notre Dame, South Bend, IN, USA
| | - Abdul-Hakim Mutala
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Kwasi Baako Antwi
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Dawood Ackom Abbas
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Kofi Agyapong Addo
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Austine Tweneboah
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | | | - Cristian Koepfli
- Department of Biological Sciences, University of Notre Dame, South Bend, IN, USA.
| | - Kingsley Badu
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
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Duah-Quashie NO, Opoku-Agyeman P, Bruku S, Adams T, Tandoh KZ, Ennuson NA, Matrevi SA, Abuaku B, Quashie NB, Watters C, Wolfe D, Quijada HM, Sanders T. Genetic deletions and high diversity of Plasmodium falciparum histidine-rich proteins 2 and 3 genes in parasite populations in Ghana. FRONTIERS IN EPIDEMIOLOGY 2022; 2:1011938. [PMID: 38455301 PMCID: PMC10911008 DOI: 10.3389/fepid.2022.1011938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/22/2022] [Indexed: 03/09/2024]
Abstract
Rapid diagnostic tests (RDTs) are used to diagnose malaria in Ghana and other malaria endemic countries. Plasmodium falciparum histidine-rich protein 2 (PFHRP2) based RDTs are widely used, however the occurrence of deletions of the pfhrp2 gene in some parasites have resulted in false negative test results. Monoclonal antibodies of PFHRP2 cross reacts with PFHRP3 because they share structural similarities and this complements the detection of the parasites by RDT. These two genes were investigated in Ghanaian P. falciparum parasite population to detect deletions and the polymorphisms in exon 2 of the pfhrp2 and pfhrp3 genes. Parasite isolates (2,540) from children ≤ 12 years with uncomplicated malaria from 2015 to 2020 transmission seasons were used. Both genes were amplified using nested PCR and negative results indicated the presence of the deletion of genes. Amplified genes were sequenced for the detection of the amino acid repeats. Deletions were observed in 30.7% (780/2,540) and 17.2% (438/2,540) of the samples for pfhrp2 and pfhrp3 respectively with increasing trends over the three time periods (χ2 -10.305, p = 0.001). A total of 1,632 amplicons were sequenced for each gene, analysis was done on 1,124 and 1,307 good quality sequences for pfhrp2 and pfhrp3 respectively. Pfhrp2 repeat polymorphisms were dominantly of types 2 (AHHAHHAAD) and 7 (AHHAAD) with large numbers of variants. A novel variant of type 14 (AHHANHATD) was seen for pfhrp2. For the pfhrp3 repeat types, 16 (AHHAAN), 17 (AHHDG) and 18 (AHHDD) were the dominant types observed. Variants of type 16 (AHHAAH) and (AHHASH) were also dominant. Repeat types 1, 2, 3, 4, 5, 6, 7, 8, 11, 13, 15, 16, and 19 were observed be shared by both genes. The haplotype diversity of both genes ranged between 0.872 and 1 indicating high diversity of the polymorphisms in the isolates. The implication of the findings of the frequencies of the pfhrp2 and pfhrp3 deletions as well as the variants of the main epitopes of the monoclonal antibodies for the RDT (types 2 and 7) in our isolates is an indication of decreased sensitivity of the RDTs in diagnosing malaria infections in Ghana.
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Affiliation(s)
- Nancy Odurowah Duah-Quashie
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Philip Opoku-Agyeman
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Selassie Bruku
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Tryphena Adams
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kwesi Zandoh Tandoh
- West African Center for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Nana Aba Ennuson
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Sena Adzoa Matrevi
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Benjamin Abuaku
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Neils Ben Quashie
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Chaselynn Watters
- US Naval Medical Research Unit No. 3, Ghana Detachment, Accra, Ghana
| | - David Wolfe
- US Naval Medical Research Unit No. 3, Ghana Detachment, Accra, Ghana
| | | | - Terrel Sanders
- US Naval Medical Research Unit No. 3, Ghana Detachment, Accra, Ghana
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13
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Aninagyei E, Boakye AA, Tettey CO, Ntiri KA, Ofori SO, Tetteh CD, Aphour TT, Rufai T. Utilization of 18s ribosomal RNA LAMP for detecting Plasmodium falciparum in microscopy and rapid diagnostic test negative patients. PLoS One 2022; 17:e0275052. [PMID: 36201568 PMCID: PMC9536604 DOI: 10.1371/journal.pone.0275052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/11/2022] [Indexed: 11/24/2022] Open
Abstract
In this study, Plasmodium falciparum was detected in patients that were declared negative for malaria microscopy and rapid diagnostic test kit (mRDT), using Plasmodium 18s rRNA loop-mediated isothermal amplification (LAMP) technique. The main aim of this study was to assess the usefulness of LAMP assay for detecting pre-clinical malaria, when microscopy and mRDT were less sensitive. DNA was obtained from 100 μL of whole blood using the boil and spin method. Subsequently, the Plasmodium 18s rRNA LAMP assay was performed to amplify the specific Plasmodium 18s rRNA gene. Microscopy and mRDT negative samples [697/2223 (31.2%)] were used for this study. Compared to frequencies obtained for the other demographic variables, most of the patients were < 6 years (37.7%), females (59.0%), peri-urban dwellers (39.0%) and patients that sought outpatient department services (39.3%). Overall, the prevalence of Plasmodium 18s rRNA was 17.5%. when stratified by study variables, Plasmodium 18s rRNA LAMP positivity was higher in patients over 30 years [58/122 (54.2%)], males [69/122 (56.5%)], rural dwellers [69/122 (56.5%)] and patients that sought OPD services [68/122 (55.7%)]. The risk of being infected with Plasmodium when routine tests were negative was higher in 15-30-year group (OR = 3.03, 95% CI: 1.6-5.8, p = 0.0007), patients > 30 years (OR = 15.2, 95% CI: 8.3-27.7, p<0.001), males (OR = 2.1, 95% CI: 1.4-3.2, p = 0.0002) and rural dwellers (OR = 2.2, 95% CI:1.4-3.6, p = 0.0009). However, risk was lower in post-natal children (OR = 0.3, 95% CI: 0.18-0.51, p<0.001). Majority (81.5%) of the infected patients presented with headache, herpes labialis, diarrhea and vomiting. We demonstrated the lack of sensitivities of microscopy and mRDT for one-time diagnosis of malaria. Therefore, it is essential to utilize a sensitive technique such as Plasmodium 18s rRNA LAMP to increase the detection rate of Plasmodium infection.
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Affiliation(s)
- Enoch Aninagyei
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Adjoa Agyemang Boakye
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Clement Okraku Tettey
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Kofi Adjei Ntiri
- Ghana Health Service, Greater Accra Region, Mayera-Faase Health Centre, Mayera-Faase, Ghana
| | | | - Comfort Dede Tetteh
- Ghana Health Service, Municipal Health Directorate, Ga West Municipal, Amasaman, Ghana
| | - Thelma Teley Aphour
- Ghana Health Service, Greater Accra Region, Ablekuma North Health Directorate, Accra, Ghana
| | - Tanko Rufai
- Ghana Health Service, Eastern Region, New Juaben South Municipal Health Directorate, Koforidua, Ghana
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
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Bredu DG, Ahadzi GK, Donu D, Peprah NY, Asamoah A, Asumah GA, Abuaku B, Asare KK, Obiri-Yeboah D, Ford CT, Lo E, Malm KL, Amoah LE. Nationwide Surveillance of Pfhrp2 Exon 2 Diversity in Plasmodium falciparum Circulating in Symptomatic Malaria Patients Living in Ghana. Am J Trop Med Hyg 2022; 106:tpmd211342. [PMID: 35500587 PMCID: PMC9209901 DOI: 10.4269/ajtmh.21-1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/15/2022] [Indexed: 11/07/2022] Open
Abstract
Reports of increasing false-negative HRP2-based rapid diagnostic test results across Africa require constant monitoring of factors associated with these false-negative outcomes, as failure of this diagnostic tool will have severe consequences on malaria treatment and control programs. This study characterized the extent of genetic diversity in the Plasmodium falciparum histidine-rich protein 2 (Pfhrp2) gene in P. falciparum isolates from symptomatic malaria patients across the regions of Ghana. Exon 2 of Pfhrp2 was amplified from gDNA using polymerase chain reaction. All Pfhrp2-negative samples were subjected to Pf18S rRNA and Pfmsp2 gene amplifications. The amplified Pfhrp2 exon 2 fragments from clonal samples were sent for commercial Sanger sequencing. The type and number of PfHRP2 repeats, classified based on repeat types previously reported, were estimated from the sequence data and compared among geographical regions. About 81% (2,333/2,890) of the original microscopy positive DBS were available and used in this study. The Pfhrp2 exon 2 amplification was successful in 98.5% (2,297/2,333) of the tested samples, with band size ranging from 400 bp to 1,050 bp. A total of 13 out of the 24 previously reported repeat types were identified among the samples, with three samples lacking both type 2 and type 7 repeat motifs. This study suggested that the genetic diversity of Pfhrp2 exon 2 identified in P. falciparum circulating in symptomatic malaria patients in Ghana is unlikely to influence the sensitivity and specificity of HRP2 RDT-based diagnosis.
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Affiliation(s)
- Dorcas G. Bredu
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - George K. Ahadzi
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Dickson Donu
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Nana Y. Peprah
- National Malaria Control Program, Ghana Health Services, Accra, Ghana
| | - Alexander Asamoah
- National Malaria Control Program, Ghana Health Services, Accra, Ghana
| | - George A. Asumah
- National Malaria Control Program, Ghana Health Services, Accra, Ghana
| | - Benjamin Abuaku
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Kwame K. Asare
- Department of Biomedical Science, School of Allied Health Sciences, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
| | - Colby T. Ford
- Department of Biological Sciences, University of North Carolina, Charlotte, North Carolina
- School of Data Science, University of North Carolina, Charlotte, North Carolina
| | - Eugenia Lo
- Department of Bioinformatics and Genomics, University of North Carolina, Charlotte, North Carolina
- School of Data Science, University of North Carolina, Charlotte, North Carolina
| | - Keziah L. Malm
- National Malaria Control Program, Ghana Health Services, Accra, Ghana
| | - Linda E. Amoah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Agbana HB, Rogier E, Lo A, Abukari Z, Jones S, Gyan B, Aidoo M, Amoah LE. Detecting asymptomatic carriage of Plasmodium falciparum in southern Ghana: utility of molecular and serological diagnostic tools. Malar J 2022; 21:57. [PMID: 35183178 PMCID: PMC8858553 DOI: 10.1186/s12936-022-04078-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background Asymptomatic malaria infections can serve as potential reservoirs for malaria transmission. The density of parasites contained in these infections range from microscopic to submicroscopic densities, making the accurate detection of asymptomatic parasite carriage highly dependent on the sensitivity of the tools used for the diagnosis. This study sought to evaluate the sensitivities of a variety of molecular and serological diagnostic tools at determining the prevalence of asymptomatic Plasmodium falciparum parasite infections in two communities with varying malaria parasite prevalence. Methods Whole blood was collected from 194 afebrile participants aged between 6 and 70 years old living in a high (Obom) and a low (Asutsuare) malaria transmission setting of Ghana. Thick and thin blood smears, HRP2 based malaria rapid diagnostic test (RDT) and filter paper dried blood spots (DBS) were prepared from each blood sample. Genomic DNA was extracted from the remaining blood and used in Plasmodium specific photo-induced electron transfer polymerase chain reaction (PET-PCR) and Nested PCR, whilst the HRP2 antigen content of the DBS was estimated using a bead immunoassay. A comparison of malaria parasite prevalence as determined by each method was performed. Results Parasite prevalence in the high transmission site of Obom was estimated at 71.4%, 61.9%, 60%, 37.8% and 19.1% by Nested PCR, the HRP2 bead assay, PET-PCR, HRP2-RDT and microscopy respectively. Parasite prevalence in the low transmission site of Asutsuare was estimated at 50.1%, 11.2%, 5.6%, 0% and 2.2% by Nested PCR, the HRP2 bead assay, PET-PCR, RDT and microscopy, respectively. The diagnostic performance of Nested PCR, PET-PCR and the HRP2 bead assay was similar in Obom but in Asutsuare, Nested PCR had a significantly higher sensitivity than PET-PCR and the HRP2 bead assay, which had similar sensitivity. Conclusions Nested PCR exhibited the highest sensitivity by identifying the highest prevalence of asymptomatic P. falciparum in both the high and low parasite prevalence settings. However, parasite prevalence estimated by the HRP2 bead assay and PET-PCR had the highest level of inter-rater agreement relative to all the other tools tested and have the advantage of requiring fewer processing steps relative to Nested PCR and producing quantitative results. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04078-w.
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Amoah LE, Asare KK, Dickson D, Anang SF, Busayo A, Bredu D, Asumah G, Peprah N, Asamoah A, Abuaku B, Malm KL. Nationwide molecular surveillance of three Plasmodium species harboured by symptomatic malaria patients living in Ghana. Parasit Vectors 2022; 15:40. [PMID: 35090545 PMCID: PMC8796507 DOI: 10.1186/s13071-022-05153-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical presentations of malaria in Ghana are primarily caused by infections containing microscopic densities of Plasmodium falciparum, with a minor contribution from Plasmodium malariae and Plasmodium ovale. However, infections containing submicroscopic parasite densities can result in clinical disease. In this study, we used PCR to determine the prevalence of three human malaria parasite species harboured by suspected malaria patients attending healthcare facilities across the country. METHODS Archived dried blood spots on filter paper that had been prepared from whole blood collected from 5260 patients with suspected malaria attending healthcare facilities across the country in 2018 were used as experimental material. Plasmodium species-specific PCR was performed on DNA extracted from the dried blood spots. Demographic data and microscopy data for the subset of samples tested were available from the original study on these specimens. RESULTS The overall frequency of P. falciparum, P. malariae and P. ovale detected by PCR was 74.9, 1.4 and 0.9%, respectively. Of the suspected symptomatic P. falciparum malaria cases, 33.5% contained submicroscopic densities of parasites. For all regions, molecular diagnosis of P. falciparum, P. malariae and P. ovale was significantly higher than diagnosis using microscopy: up to 98.7% (75/76) of P. malariae and 97.8% (45/46) of P. ovale infections detected by PCR were missed by microscopy. CONCLUSION Plasmodium malariae and P. ovale contributed to clinical malaria infections, with children aged between 5 and 15 years harbouring a higher frequency of P. falciparum and P. ovale, whilst P. malariae was more predominant in individuals aged between 10 and 20 years. More sensitive point-of-care tools are needed to detect the presence of low-density (submicroscopic) Plasmodium infections, which may be responsible for symptomatic infections.
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Affiliation(s)
- Linda E Amoah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
| | - Kwame K Asare
- Department of Biomedical Science, School of Allied Health Sciences, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Donu Dickson
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Sherik-Fa Anang
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Abena Busayo
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Dorcas Bredu
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Nana Peprah
- National Malaria Control Program, Accra, Ghana
| | | | - Benjamin Abuaku
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Amoah LE, Asare KK, Dickson D, Abankwa J, Busayo A, Bredu D, Annan S, Asumah GA, Peprah NY, Asamoah A, Laurencia Malm K. Genotypic glucose-6-phosphate dehydrogenase (G6PD) deficiency protects against Plasmodium falciparum infection in individuals living in Ghana. PLoS One 2021; 16:e0257562. [PMID: 34570821 PMCID: PMC8476035 DOI: 10.1371/journal.pone.0257562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/05/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The global effort to eradicate malaria requires a drastic measure to terminate relapse from hypnozoites as well as transmission via gametocytes in malaria-endemic areas. Primaquine has been recommended for the treatment of P. falciparum gametocytes and P. vivax hypnozoites, however, its implementation is challenged by the high prevalence of G6PD deficient (G6PDd) genotypes in malaria endemic countries. The objective of this study was to profile G6PDd genotypic variants and correlate them with malaria prevalence in Ghana. METHODS A cross-sectional survey of G6PDd genotypic variants was conducted amongst suspected malaria patients attending health care facilities across the entire country. Malaria was diagnosed using microscopy whilst G6PD deficiency was determined using restriction fragment length polymorphisms at position 376 and 202 of the G6PD gene. The results were analysed using GraphPad prism. RESULTS A total of 6108 subjects were enrolled in the study with females representing 65.59% of the population. The overall prevalence of malaria was 36.31%, with malaria prevalence among G6PDd genotypic variants were 0.07% for A-A- homozygous deficient females, 1.31% and 3.03% for AA- and BA- heterozygous deficient females respectively and 2.03% for A- hemizygous deficient males. The odd ratio (OR) for detecting P. falciparum malaria infection in the A-A- genotypic variant was 0.0784 (95% CI: 0.0265-0.2319, p<0.0001). Also, P. malariae and P. ovale parasites frequently were observed in G6PD B variants relative to G6PD A- variants. CONCLUSION G6PDd genotypic variants, A-A-, AA- and A- protect against P. falciparum, P. ovale and P. malariae infection in Ghana.
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Affiliation(s)
- Linda Eva Amoah
- Dept. of Immunology, Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Kwame Kumi Asare
- Dept. of Biomedical Science, School of Allied Health Sciences, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Donu Dickson
- Dept. of Immunology, Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Joana Abankwa
- Dept. of Immunology, Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Abena Busayo
- Dept. of Immunology, Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Dorcas Bredu
- Dept. of Immunology, Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Sherifa Annan
- Dept. of Immunology, Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
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