Current Status and the Epidemiology of Malaria in the Middle East Region and Beyond

Defining indicators for disease burden, health outcomes, policies and barriers and facilitators to health services for migrant populations in the Middle East and North African region: a protocol for a suite of systematic reviews

INTRODUCTION

The Middle East and North African (MENA) region is characterised by high and complex migration flows, yet little is known about the health of migrant populations, their levels of underimmunisation and access to healthcare provision. Data are needed to support regional elimination and control targets for key diseases and the design and delivery of programmes to improve health outcomes in these groups. This protocol describes a suite of seven systematic reviews that aim to identify, appraise and synthesise the available evidence on the burden and health outcomes, policies and access (barriers and facilitators) related to these mobile populations in the region.

METHODS

Seven systematic reviews will cover three questions to explore the: (1) burden and health outcomes, (2) policies and (3) healthcare barriers and facilitators for the following seven disease areas in migrants in the MENA region: tuberculosis, HIV and hepatitis B and C, malaria and neglected tropical diseases, diabetes, mental health, maternal and neonatal health, and vaccine-preventable diseases. We will search electronic databases for studies in any language (year 2000-2023), reference-check relevant publications and cross-check included studies with experts. We will search for grey literature by hand searching key databases and websites (including regional organisations and MoH websites) for country-specific guidelines and talking to our network of experts for local and regional reports and key datasets. We will assess the studies and policies for their quality using appropriate tools. We will meta-analyse the data by disease outcome if they are of sufficient volume and similarity. Where meta-analysis is not possible and where data are on policy or access, we will narratively synthesise the evidence using summary tables, figures and text.

DISSEMINATION

We anticipate disseminating the findings through peer-reviewed publications, conferences and other formats relevant to all stakeholders. We are following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and protocols will be registered on International Prospective Register of Systematic Reviews.

Medical Students' Clinical Knowledge of Integrated Management of Childhood Illness: A cross-sectional comparative study

Objectives

This study aimed to investigate and compare the clinical knowledge implications of the integrated management of childhood illness (IMCI) preservice education between pre-clerkship and junior clerkship medical students.

Methods

This observational comparative cross-sectional study was conducted between June and August 2022 at Sultan Qaboos University, Muscat, Oman. A self-administered questionnaire was utilised and included questions on sociodemographic data, duration of IMCI preservice training, knowledge of the participants concerning the IMCI objectives and information on a range of childhood conditions.

Results

A total of 97 medical students were included in the study. The majority of students (42.3%) had received 2 lectures in IMCI preservice training. The role of the IMCI approach in reducing childhood morbidity and mortality was advocated by the majority of students (80.8% in the junior-clerkship [JCR] group and 73.3% in the pre-clerkship group). The awareness of the IMCI component of improving the health system was higher in JCR compared to pre-clerkship participants (P = 0.044). When compared to pre-clerkship students, the JCR participants demonstrated a slightly higher awareness of skin pinch (P = 0.038), chest indrawing (P = 0.008), anaemia assessment based on nail bed examination (P = 0.002), diagnostic assessment of malnutrition based on palm examination (P = 0.018), sucking capacity in breastfeeding (P = 0.025), and vaccines such as those for tuberculosis (P = 0.001), pneumococcal (P = 0.018) and rotavirus (P = 0.007).

Conclusion

The majority of students displayed good IMCI knowledge and JCR students showed better knowledge compared to pre-clerkship candidates.

Current Status of Malaria Control and Elimination in Africa: Epidemiology, Diagnosis, Treatment, Progress and Challenges

The African continent carries the greatest malaria burden in the world. Falciparum malaria especially has long been the leading cause of death in Africa. Climate, economic factors, geographical location, human intervention and unstable security are factors influencing malaria transmission. Due to repeated infections and early interventions, the proportion of clinically atypical malaria or asymptomatic plasmodium carriers has increased significantly, which easily lead to misdiagnosis and missed diagnosis. African countries have made certain progress in malaria control and elimination, including rapid diagnosis of malaria, promotion of mosquito nets and insecticides, intermittent prophylactic treatment in high-risk groups, artemisinin based combination therapies, and the development of vaccines. Between 2000 and 2022, there has been a 40% decrease in malaria incidence and a 60% reduction in mortality rate in the WHO African Region. However, many challenges are emerging in the fight against malaria in Africa, such as climate change, poverty, substandard health services and coverage, increased outdoor transmission and the emergence of new vectors, and the growing threat of resistance to antimalarial drugs and insecticides. Joint prevention and treatment, identifying molecular determinants of resistance, new drug development, expanding seasonal malaria chemo-prevention intervention population, and promoting the vaccination of RTS, S/AS01 and R21/Matrix-M may help to solve the dilemma. China's experience in eliminating malaria is conducive to Africa's malaria prevention and control, and China-Africa cooperation needs to be constantly deepened and advanced. Our review aims to help the global public develop a comprehensive understanding of malaria in Africa, thereby contributing to malaria control and elimination.

Malaria elimination in West Java, Indonesia: A descriptive-and-qualitative study

BACKGROUND OBJECTIVES

Following World Health Organization (WHO) plans for thirty-five malaria-endemic countries, Indonesia will eliminate malaria by 2030. As one of the Indonesian provinces, West Java targeted subnational malaria elimination in 2022. This article aims to describe malaria surveillance data and elimination programs, including weaknesses in sustaining the program.

METHODS

This study used secondary data from malaria surveillance information system regencies/cities' case reports for 2019-2022 and achievement data of sub-national malaria elimination certification from each regency/city from 2014-2022. The data was confirmed from the evaluation study document, analysis of reported cases, and interviews.

RESULTS

Most cases were confirmed by microscopic examination (84.1% in 2021 and 94.4% in 2022) and rapid diagnostic tests (57% in 2019 and 58.1% in 2020). Malaria is more prevalent among men (93% in 2019, 95% in 2020, 96% in 2021, and 95.9% in 2022) and productive ages of 15-64 years (98.8% in 2019, 100% in 2020, 99.2% in 2021, and 98.8% in 2022), frequently occurs in the military (56.3% in 2019, 75.7% in 2020, 45.2% in 2021) and police (40.5% in 2022), often uses passive case detection for identifying cases (97.9% in 2019 and 2020, 95.2% in 2021, and 97.6% in 2022), and the majority undergo inpatient treatment (86.4% in 2019, 81.7% in 2021, and 82.6% in 2022). Most positive cases originated from imported cases, and last indigenous cases were still found in 2019. Plasmodium vivax dominated malaria cases and and relapses were high (55.0% in 2020, and 47.3% in 2022).

INTERPRETATION CONCLUSION

All regencies/cities have obtained sub-national malaria elimination certification in 2022. West Java has the potential to be verified for Java-Bali sub-national malaria elimination targeted in 2023, albeit cases of imported malaria still occur. It is imperative to address the issue of imported cases transitioning into locally transmitted cases (introduced) by effective coordination across all regencies/cities and inter-provincial efforts.

Spectrum and management of rare Candida/yeast infections in Kuwait in the Middle East

Invasive fungal infections (IFIs) are associated with high mortality rates and mostly affect patients with compromised immunity. The incidence of IFIs is increasing worldwide with the expanding population of susceptible patients. Candida and other yeast infections represent a major component of IFIs. Rare Candida/yeast infections have also increased in recent years and pose considerable diagnostic and management challenges as they are not easily recognized by routine phenotypic characteristic-based diagnostic methods and/or by the automated yeast identification systems. Rare Candida/yeasts also exhibit reduced susceptibility to antifungal drugs making proper management of invasive infections challenging. Here, we review the diagnosis and management of 60 cases of rare Candida/yeast IFIs described so far in Kuwait, an Arabian Gulf country in the Middle East. Interestingly, majority (34 of 60, 56.7%) of these rare Candida/yeast invasive infections occurred among neonates or premature, very-low-birth-weight neonates, usually following prior bacteremia episodes. The clinical details, treatment given, and outcome were available for 28 of 34 neonates. The crude mortality rate among these neonates was 32.2% as 19 of 28 (67.8%) survived the infection and were discharged in healthy condition, likely due to accurate diagnosis and frequent use of combination therapy. Physicians treating patients with extended stay under intensive care, on mechanical ventilation, receiving broad spectrum antibiotics and with gastrointestinal surgery/complications should proactively investigate IFIs. Timely diagnosis and early antifungal treatment are essential to decrease mortality. Understanding the epidemiology and spectrum of rare Candida/yeast invasive infections in different geographical regions, their susceptibility profiles and management will help to devise novel diagnostic and treatment approaches and formulate guidelines for improved patient outcome.

Tracking the geographical origin of Plasmodium falciparum causing a rare severe case of malaria imported into Palestine, a zero-indigenous case area

BACKGROUND

Malaria cases in non-endemic zero-indigenous case areas are most likely to have been imported whatever of the route of importation. In countries recently declared malaria-free and now without local transmission, imported cases remain a threat to re-introduction of the disease and a burden on the health system.

CASE PRESENTATION

Three days after returning from a long trip to malaria- endemic countries; Abyei-Sudan, Chad and Uganda, a 41-year-old male resident from Jericho, Palestine, suffered paroxysms of fever, general fatigue, myalgia, arthralgia, headache, and a strong desire to vomit. Thin and thick Giemsa-stained blood smears were prepared and examined microscopically using oil immersion. Immature trophozoites (ring forms) were seen to parasitize approximately 10% of the erythrocytes revealing hyperparasitemia equivalent to > 100,000 parasites/ µl indicating severe malaria [1, 2]. The double chromatin configuration (headphones) and accolé (applique) position are both indicative of Plasmodium falciparum infection. The 18S rRNA- PCR targeting the rPLU6-rPLU5 region was used to confirm the diagnosis. The next-generation sequencing (NGS) method was carried out according to the manufacturer's instructions (Illumina® DNA Prep, (M) Tagmentation kit (20060060), Illumina) to identify Plasmodium spp. Furthermore, NGS produced a whole-genome sequence of 22.8Mbp of the 14 chromosomes and 25Kbp of the apicoplast. A BLAST search of the apicoplast DNA and selected chromosomal DNA revealed that P. falciparum was the causative agent. The merozoite surface protein-1 (msp-1) was used to construct a phylogenetic tree of 26 P. falciparum, including the one isolated from the patient from Jericho, which clustered with the Sudanese isolate indicating genetic relatedness between the two.

CONCLUSION

The travel history together with signs and symptoms of malaria, followed by prompt diagnosis using conventional microscopic inspection of Giemsa-stained films together with molecular DNA tracking tools like msp-1 were key means in tracking the place of origin of infection in the case of travel to multiple destination.

Molecular fingerprinting by multi-locus sequence typing identifies microevolution and nosocomial transmission of Candida glabrata in Kuwait

Backgrounds

Candida glabrata is a frequently isolated non-albicans Candida species and invasive C. glabrata infections in older patients are associated with high mortality rates. Opportunistic Candida infections in critically ill patients may be either endogenous or nosocomial in origin and this distinction is critical for effective intervention strategies. This study performed multi-locus sequence typing (MLST) to study genotypic relatedness among clinical C. glabrata isolates in Kuwait.

Methods

Candida glabrata isolates (n = 91) cultured from 91 patients were analyzed by MLST. Repeat isolates (n = 16) from 9 patients were also used. Antifungal susceptibility testing for fluconazole, voriconazole, caspofungin and amphotericin B (AMB) was determined by Etest. Genetic relatedness was determined by constructing phylogenetic tree and minimum spanning tree by using BioNumerics software.

Results

Resistance to fluconazole, voriconazole and AMB was detected in 7, 2 and 10 C. glabrata isolates, respectively. MLST identified 28 sequence types (STs), including 12 new STs. ST46 (n = 33), ST3 (n = 8), ST7 (n = 6) and ST55 (n = 6) were prevalent in ≥4 hospitals. Repeat isolates obtained from same or different site yielded identical ST. No association of ST46 with source of isolation or resistance to antifungals was apparent. Microevolution and cross-transmission of infection was indicated in two hospitals that yielded majority (57 of 91, 67%) of C. glabrata.

Conclusion

Our data suggest that C. glabrata undergoes microevolution in hospital environment and can be nosocomially transmitted to other susceptible patients. Thus, proper infection control practices during routine procedures on C. glabrata-infected patients may prevent transmission of this pathogen to other hospitalized patients.

Antimalarial Efficacy and Antioxidant Activity of Lophira lanceolata Stem Bark Ethanol Extract Using Plasmodium berghei Induced-Malaria in Swiss Albino's Mice

Background

Malaria remains a major public health problem in the tropical and subtropical regions. This study aimed of investigating the antimalarial and antioxidant activities of ethanol extract of Lophira lanceolata stem bark. Methodology. The antimalarial activity was determined using the Peter 4-days' suppressive and Rane's curative tests on Swiss albino: these mice were infected with 1 × 107 parasitized red blood cells. The percentage reduction of parasitemia was related to each test, and the liver homogenate was used to assay malondialdehyde, superoxide dismutase, nitrogen monoxide, catalase, and glutathione for the evaluation of oxidative stress. During the curative test, blood was collected for hematological parameters, alanine aminotransferase and aspartate aminotransferase to evaluate liver function.

Result

The ethanol extract of L. lanceolata showed a dose-dependent suppressive activity with the highest suppression of 88.22% at 500 mg/kg. Suppression produced by the extract was not significantly higher than that of the reference drug with 96.1%. Similarly, the extract at doses 125, 250, and 500 mg/kg showed significant decreases (P < 0.05) in a dose-dependent manner during the curative test. The ethanol extract of L. lanceolata caused a reduction of tissue markers, such as hepatic oxidative stress, as it increased the enzymatic activity of antioxidant enzymes.

Conclusion

The ethanol extract of L. lanceolata possesses both antimalarial and antioxidant activities. However, further in vivo toxicity tests are required to guarantee their safety.

Seasonal Trends with the Comparison of Venous and Capillary Blood for Diagnosis of Malaria among Children in Karachi, Pakistan

Background

More than 250 million people are infected by malaria parasites annually while around one million children less than 5 years of age die every year due to malaria. We aimed to assess the seasonal trends and usefulness of capillary and venous blood for rapid diagnosis of malaria.

Methods

This cross-sectional study of 18 months duration was conducted at the National Institute of Child Health (NICH), Karachi. All patients reporting fever as chief complaint were recruited as study subjects. A semi-structured questionnaire was used to collect demographic information, presenting complaints, awareness of caregivers regarding malaria, preventive measures and history of malaria fever. Three ml Venous (2-3ml) as well as peripheral blood (3-4 drops) samples of all patients were collected for microscopy and rapid diagnostic tests (RDTs).

Results

Out of total 477 patients with fever Venous and Capillary Blood RDTs methods detected 33(6.9%) and 30(6.3%) as the malaria positive while Venous and Capillary Blood Microscopy detected 30(6.1%) and 32(6.7%) cases respectively. Plasmodium Vivax infection was the most prevalent (87.9%) and majority (39.39%) of the cases occurred in the quarter, July to September.

Conclusion

July to September is the peak season for malaria and P. Vivax (87.9%) is the predominant strain in Karachi. Venous and capillary blood are equally useful for malaria diagnosis however, convenience and less invasiveness may justify the preference of capillary blood over venous blood for early diagnosis of malaria.

Bioprospection of Selected Plant Secondary Metabolites as Modulators of the Proteolytic Activity of Plasmodium falciparum Plasmepsin V

Malaria is a devastating disease, and its management is only achieved through chemotherapy. However, resistance to available medication is still a challenge; therefore, there is an urgent need for the discovery and development of therapeutics with a novel mechanism of action to counter the resistance scourge consistent with the currently available antimalarials. Recently, plasmepsin V was validated as a therapeutic target for the treatment of malaria. The pepsin-like aspartic protease anchored in the endoplasmic reticulum is responsible for the trafficking of parasite-derived proteins to the erythrocytic surface of the host cells. In this study, a small library of compounds was preliminarily screened in vitro to identify novel modulators of Plasmodium falciparum plasmepsin V (PfPMV). The results obtained revealed kaempferol, quercetin, and shikonin as possible PfPMV inhibitors, and these compounds were subsequently probed for their inhibitory potentials using in vitro and in silico methods. Kaempferol and shikonin noncompetitively and competitively inhibited the specific activity of PfPMV in vitro with IC₅₀ values of 22.4 and 43.34 μM, respectively, relative to 62.6 μM obtained for pepstatin, a known aspartic protease inhibitor. Further insight into the structure-activity relationship of the compounds through a 100 ns molecular dynamic (MD) simulation showed that all the test compounds had a significant affinity for PfPMV, with quercetin (-36.56 kcal/mol) being the most prominent metabolite displaying comparable activity to pepstatin (-35.72 kcal/mol). This observation was further supported by the compactness and flexibility of the resulting complexes where the compounds do not compromise the structural integrity of PfPMV but rather stabilized and interacted with the active site amino acid residues critical to PfPMV modulation. Considering the findings in this study, quercetin, kaempferol, and shikonin could be proposed as novel aspartic protease inhibitors worthy of further investigation in the treatment of malaria.

Magnitude and patterns of severe Plasmodium vivax monoinfection in Vietnam: a 4-year single-center retrospective study

Introduction

Infection with Plasmodium vivax is a recognized cause of severe malaria including deaths. The exact burden and patterns of severe P. vivax monoinfections is however still not well quantified, especially in P. vivax endemic regions. We examined the magnitude and patterns of severe malaria caused by monoinfections of P. vivax and associated predictors among patients admitted to a tertiary care center for malaria in Vietnam.

Methods

A retrospective cohort study was conducted based on the patients' medical records at the Hospital for Tropical Diseases from January 2015 to December 2018. Extracted information included demographic, epidemiologic, clinical, laboratory and treatment characteristics.

Results

Monoinfections with P. vivax were found in 153 (34.5, 95% CI 30.3-39.1%) patients of whom, uncomplicated and severe malaria were documented in 89.5% (137/153, 95% CI 83.7-93.5%) and 10.5% (16/153, 95% CI 6.5-16.3%), respectively. Patterns of severe malaria included jaundice (8 cases), hypoglycemia (3 cases), shock (2 cases), anemia (2 cases), and cerebral malaria (1 case). Among 153 patients, 73 (47.7%) had classic malaria paroxysm, 57 (37.3%) had >7 days of illness at the time of admission, and 40 (26.1%) were referred from other hospitals. A misdiagnosis as having other diseases from malaria cases coming from other hospitals was up to 32.5% (13/40). Being admitted to hospital after day 7th of illness (AOR = 6.33, 95% CI 1.14-35.30, p = 0.035) was a predictor of severe malaria. Severe malaria was statistically associated with longer hospital length of stay (p = 0.035). Early and late treatment failures and recrudescence were not recorded. All patients recovered completely.

Discussion

This study confirms the emergence of severe vivax malaria in Vietnam which is associated with delayed hospital admission and increased hospital length of stay. Clinical manifestations of P. vivax infection can be misdiagnosed which results in delayed treatment. To meet the goal of malaria elimination by 2030, it is crucial that the non-tertiary hospitals have the capacity to quickly and correctly diagnose malaria and then provide treatment for malaria including P. vivax infections. More robust studies need to be conducted to fully elucidate the magnitude of severe P. vivax in Vietnam.

Antimalarial potential of Moringa oleifera Lam. (Moringaceae): A review of the ethnomedicinal, pharmacological, toxicological, and phytochemical evidence

Several regions of the world frequently use the species Moringa oleifera Lam. (Moringaceae) in traditional medicine. This situation is even more common in African countries. Many literature reports point to the antimalarial potential of this species, indicating the efficacy of its chemical compounds against malaria-causing parasites of the genus Plasmodium. From this perspective, the present study reviews the ethnobotanical, pharmacological, toxicological, and phytochemical (flavonoids) evidence of M. oleifera, focusing on the treatment of malaria. Scientific articles were retrieved from Google Scholar, PubMed^®, ScienceDirect^®, and SciELO databases. Only articles published between 2002 and 2022 were selected. After applying the inclusion and exclusion criteria, this review used a total of 72 articles. These documents mention a large use of M. oleifera for the treatment of malaria in African and Asian countries. The leaves (63%) of this plant are the main parts used in the preparation of herbal medicines. The in vivo antimalarial activity of M. oleifera was confirmed through several studies using polar and nonpolar extracts, fractions obtained from the extracts, infusion, pellets, and oils obtained from this plant and tested in rodents infected by the following parasites of the genus Plasmodium: P. berghei, P. falciparum, P. yoelii, and P. chabaudi. Extracts obtained from M. oleifera showed no toxicity in preclinical tests. A total of 46 flavonoids were identified in the leaves and seeds of M. oleifera by different chromatography and mass spectrometry methods. Despite the scarcity of research on the antimalarial potential of compounds isolated from M. oleifera, the positive effects against malaria-causing parasites in previous studies are likely to correlate with the flavonoids that occur in this species.

Climate change and communicable diseases in the Gulf Cooperation Council (GCC) countries

A review of the extant literature reveals the extent to which the spread of communicable diseases will be significantly impacted by climate change. Specific research into how this will likely be observed in the countries of the Gulf Cooperation Council (GCC) is, however, greatly lacking. This report summarises the unique public health challenges faced by the GCC countries in the coming century, and outlines the need for greater investment in public health research and disease surveillance to better forecast the imminent epidemiological landscape. Significant data gaps currently exist regarding vector occurrence, spatial climate measures, and communicable disease case counts in the GCC - presenting an immediate research priority for the region. We outline policy work necessary to strengthen public health interventions, and to facilitate evidence-driven mitigation strategies. Such research will require a transdisciplinary approach, utilising existing cross-border public health initiatives, to ensure that such investigations are well-targeted and effectively communicated.

Malaria and leishmaniasis: Updates on co-infection

Malaria and leishmaniasis are endemic parasitic diseases in tropical and subtropical countries. Although the overlap of these diseases in the same host is frequently described, co-infection remains a neglected issue in the medical and scientific community. The complex relationship of concomitant infections with Plasmodium spp. and Leishmania spp. is highlighted in studies of natural and experimental co-infections, showing how this "dual" infection can exacerbate or suppress an effective immune response to these protozoa. Thus, a Plasmodium infection preceding or following Leishmania infection can impact the clinical course, accurate diagnosis, and management of leishmaniasis, and vice versa. The concept that in nature we are affected by concomitant infections reinforces the need to address the theme and ensure its due importance. In this review we explore and describe the studies available in the literature on Plasmodium spp. and Leishmania spp. co-infection, the scenarios, and the factors that may influence the course of these diseases.

The Defensive Interactions of Prominent Infectious Protozoan Parasites: The Host's Complement System

The complement system exerts crucial functions both in innate immune responses and adaptive humoral immunity. This pivotal system plays a major role dealing with pathogen invasions including protozoan parasites. Different pathogens including parasites have developed sophisticated strategies to defend themselves against complement killing. Some of these strategies include the employment, mimicking or inhibition of host's complement regulatory proteins, leading to complement evasion. Therefore, parasites are proven to use the manipulation of the complement system to assist them during infection and persistence. Herein, we attempt to study the interaction´s mechanisms of some prominent infectious protozoan parasites including Plasmodium, Toxoplasma, Trypanosoma, and Leishmania dealing with the complement system. Moreover, several crucial proteins that are expressed, recruited or hijacked by parasites and are involved in the modulation of the host´s complement system are selected and their role for efficient complement killing or lysis evasion is discussed. In addition, parasite's complement regulatory proteins appear as plausible therapeutic and vaccine targets in protozoan parasitic infections. Accordingly, we also suggest some perspectives and insights useful in guiding future investigations.

Infectivity of Symptomatic Patients and Their Contribution for Infectiousness of Mosquitoes following a Membrane Feeding Assay in Ethiopia

The membrane feeding assay is widely used to evaluate the efficacy of transmission-blocking interventions (TBIs) and identify the reservoir of malaria. This study aimed to determine the infectivity of blood meals from symptomatic Plasmodium-infected patients to an Anopheles arabiensis colony in Ethiopia. A membrane feeding assay was conducted on a total of 63 Plasmodium falciparum- and/or Plasmodium vivax-infected clinical patients in East Shoa Zone, Ethiopia. Detection of P. falciparum and P. vivax in blood samples was done using microscopy. Mosquito infection rates were determined by dissection of mosquitoes' midguts, while mosquito infectiousness was observed by dissection of their salivary glands. The proportion of infectious symptomatic patients was 68.3% (43/63). Using the chi-square or Fisher's exact test, the oocyst infection levels were higher among patients infected with P. vivax, females, and rural residents. Nearly 57% (56.7%, 17/30) of assays produced sporozoites in the salivary glands of mosquitoes. Both oocyst and sporozoite infection rates had positive correlations with parasitemia and gametocytemia. High infectiousness of symptomatic patients was observed, with a greater proportion of infectious mosquitoes per assay. Demonstrating oocyst infection in the mosquitoes might confirm estimates of the infectiousness of mosquitoes, although some of the oocyst-infected mosquitoes failed to produce sporozoites. IMPORTANCE Malaria remains one of the most devastating infectious diseases globally, and transmission-blocking activities are needed. Plasmodium transmission from human to mosquitoes is poorly studied, particularly in endemic countries, and the membrane feeding assay allows it to be determined. In this study, we demonstrated human infectious reservoirs of malaria. Moreover, the effect of Plasmodium-infected patients on the infectiousness of mosquitoes was also observed. These findings are therefore important for designing future evaluation of transmission-blocking interventions that will support the malaria elimination program.

Epstein-Barr virus and Burkitt's lymphoma. Associations in Iraqi Kurdistan and twenty-two countries assessed in the International Incidence of Childhood Cancer

Background

Burkitt's lymphoma (BL) has worldwide variations in incidence that are related to the age of Epstein-Barr virus (EBV) infection. This study examined the age-specific incidence rate (ASIR) of BL and community EBV seropositivity in Iraqi Kurdistan and compared results with data from countries tabulated in the International Incidence of Childhood Cancer volume 3 (IICC-3).

Methods

The ASIR (95% confidence intervals) of BL in Sulaimani Governorate of Iraqi Kurdistan were calculated for the years 2010–2020. Specimens from 515 outpatients were tested for IgG and IgM antibodies to EBV viral capsid antigen.

Results

In Sulaimani, 84% of BL occurred under 20 years of age, with an ASIR of 6.2 (4.7–7.7) per million children. This ASIR was not significantly different than that of Egypt, Morocco, Israel, Spain, or France. It was slightly higher than the ASIR of the United States, the United Kingdom, and Germany and markedly higher than for Asia and South Africa. In Africa and much of Asia, early childhood EBV exposure predominates, with nearly all children being infected by 5 years of age. In Sulaimani, just over 50% of children were EBV seropositive at 3 years old and 90% seropositivity was reached at 15 years of age. In Europe and North America, seropositivity is commonly delayed until adolescence or young adulthood and adult predominates over childhood BL.

Conclusion

In the Middle East, childhood BL is relatively common and adult BL is rare. In Sulaimani, EBV seropositivity increases progressively throughout childhood and reaches 92% at mid-adolescence. This may reflect the Mid East more widely. We suggest that the high childhood and low adult BL rates may be a regional effect of a pattern of EBV exposure intermediate between early childhood and adolescent and young adult infections.

Malaria Threatens to Bounce Back in Abergele District, Northeast Ethiopia: Five-Year Retrospective Trend Analysis from 2016-2020 in Nirak Health Center

Background

In Sub-Saharan African countries, malaria is a leading cause of morbidity and mortality. In Ethiopia, malaria is found in three-fourths of its land mass with more than 63 million people living in malaria endemic areas. Nowadays, Ethiopia is implementing a malaria elimination program with the goal of eliminating the disease by 2030. To assist this goal, the trends of malaria cases should be evaluated with a function of time in different areas of the country to develop area-specific evidence-based interventions. Therefore, this study was aimed at analysing a five year trend of malaria in Nirak Health Center, Abergele District, Northeast Ethiopia, from 2016 to 2020.

Methods

A retrospective study was conducted at Nirak Health Center, Abergele District, Northeast Ethiopia from February to April 2021. Five-year (2016 to 2020) retrospective data were reviewed from the malaria registration laboratory logbook. The sociodemographic and malaria data were collected using a predesigned data collection sheet. Data were entered, cleaned, and analysed using SPSS version 26.

Results

In the five-year period, a total of 19,433 malaria suspected patients were diagnosed by microscopic examination. Of these, 6,473 (33.3%) were positive for malaria parasites. Of the total confirmed cases, 5,900 (91.2%) were P. falciparum and 474 (7.2%) were P. vivax. Majority of the cases were males (62.2%) and in the age group of 15-45 years old (52.8%). The findings of this study showed an increasing trend in malaria cases in the past five years (2016-2020). The maximum number of confirmed malaria cases reported was in the year 2020, while the minimum number of confirmed malaria cases registered was in 2016. Regarding the seasonal distribution of malaria, the highest number of malaria cases (55.2%) was observed in Dry season (September to January) and also the least (15.9%) was observed in Autumn (March to May) replaced by the least (21.6%) was observed in Rainy season (June to August), that is, the major malaria transmission season in Ethiopia and the least (15.9%) was observed in autumn (March to May).

Conclusion

The trends of malaria in Nirak Health Center showed steadily increasing from the year 2016–2020, and the predominant species isolated was P. falciparum. This showed that the malaria control and elimination strategy in the area were not properly implemented or failed to achieve its designed goal. Therefore, this finding alarms the local governments and other stack holders urgently to revise their intervention strategies and take action in the locality.

Treatment-seeking behaviour, awareness and preventive practice toward malaria in Abu Ushar, Gezira state, Sudan: a household survey experience from a rural area

Background

Usage of mosquito bed nets and the practice of other prevention methods are essential for the prevention of malaria in endemic areas. Proper community knowledge about malaria and prompt treatment-seeking behaviour for early diagnosis and treatment are crucial for eliminating the disease. This study aimed to assess the awareness, treatment-seeking behaviour, and prevention practices towards malaria in Abu Ushar, Gezira State, Sudan.

Methods

A community-based, cross-sectional study was conducted in March 2021, including 310 households in Abu Ushar, Aljazeera, Sudan. Data were collected through face-to-face interviews with head of the household using an interviewer-administered questionnaire. Data were entered and analysed using R software.

Results

A total of 310 households were enrolled in this study. Sixty per cent had children under the age of 5 years. The majority of these households (94.8%) had a history of malaria in the past 12 months. Overall, awareness of malaria was good; 197 (63.5%) households had bed nets in their houses; 75.8% of total households identified fever with shivering as a symptom of malaria. Regarding treatment-seeking behaviour, 77.9% seek treatment from the nearby primary health centre, and 60% seek treatment within the first day. Only 45.3% stated that everyone in the household sleeps under bed nets.

Conclusion

High awareness about malaria and preventive measures was found among participants in households. Most households had previous infections with malaria. Therefore, an interventional programme should be established in this area to reduce this high rate of malaria.

Malaria diagnostic methods with the elimination goal in view

Malaria control measures have been in use for years but have not completely curbed the spread of infection. Ultimately, global elimination is the goal. A major playmaker in the various approaches to reaching the goal is the issue of proper diagnosis. Various diagnostic techniques were adopted in different regions and geographical locations over the decades, and these have invariably produced diverse outcomes. In this review, we looked at the various approaches used in malaria diagnostics with a focus on methods favorably used during pre-elimination and elimination phases as well as in endemic regions. Microscopy, rapid diagnostic testing (RDT), loop-mediated isothermal amplification (LAMP), and polymerase chain reaction (PCR) are common methods applied depending on prevailing factors, each with its strengths and limitations. As the drive toward the elimination goal intensifies, the search for ideal, simple, fast, and reliable point-of-care diagnostic tools is needed more than ever before to be used in conjunction with a functional surveillance system supported by the ideal vaccine.

Could a culturally and age-appropriate song contribute towards malaria prevention in primary school learners?

Background

Although it is a preventable disease, malaria continues to present one of the major global health challenges. The disease is especially deadly to children under the age of 5 years. This is partly due to the fact that they have yet to build up an immune system to help protect them against malaria. As a prevention strategy, music is one way of communicating knowledge to young children and could therefore potentially be used to change children’s behaviour in order to avoid getting sick from malaria. This exploratory study aimed to compare intervention strategies designed to educate and improve knowledge growth about malaria and its prevention in Grade 3 learners in a high-risk malaria region in Vhembe District, Limpopo Province, South Africa.

Methods

Various intervention strategies were employed and evaluated to determine the most effective intervention method. The study was split into two Phases. Phase 1 used a culturally and age-appropriate song as an intervention, along with a drama piece, a song and drama piece combination, and a control group. The most effective intervention strategy determined during Phase 1 was then subjected to Phase 2, against a control group to validate its efficacy. Questionnaires were used during pre-intervention and post-intervention interviews to evaluate the knowledge growth, if any, of the learners of selected primary schools in two different areas in Vhembe District. Pre-intervention interviews were followed by a specific intervention, based on the respective study groups. After 6 weeks, the post-intervention interviews were done to determine how much learners managed to learn and retain from the intervention received.

Results

The study found that the group that had only the song as intervention was the most effective learning intervention method in both Phases 1 and 2. Both phases showed that there was statistical significance in almost all of the nine questions asked on the questionnaires.

Conclusions

The study concluded that a culturally and age-appropriate song can play a significant role in developing behavioural changes and spreading awareness against disease in a high-risk malaria region.

Optimal control analysis of hepatocytic-erythrocytic dynamics of Plasmodium falciparum malaria

This paper presents an in-host malaria model subject to anti-malarial drug treatment and malaria vaccine antigens combinations. Pontryagin's Maximum Principle is applied to establish optimal control strategies against infected erythrocytes, infected hepatocytes and malaria parasites. Results from numerical simulation reveal that a combination of pre-erythrocytic vaccine antigen, blood schizontocide and gametocytocide drugs would offer the best strategy to eradicate clinical P. falciparum malaria. Sensitivity analysis, further reveal that the efficacy of blood schizontocides and blood stage vaccines are crucial in the control of clinical malaria infection. Futhermore, we found that an effective blood schizontocide should be used alongside efficacious blood stage vaccine for rapid eradication of infective malaria parasites. The authors hope that the results of this study will help accelerate malaria elimination efforts by combining malaria vaccines and anti-malarial drugs against the deadly P. falciparum malaria.

Current Epidemiological Characteristics of Imported Malaria, Vector Control Status and Malaria Elimination Prospects in the Gulf Cooperation Council (GCC) Countries

Malaria is the most common vector-borne parasitic infection causing significant human morbidity and mortality in nearly 90 tropical/sub-tropical countries worldwide. Significant differences exist in the incidence of malaria cases, dominant Plasmodium species, drug-resistant strains and mortality rates in different countries. Six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and United Arab Emirates, UAE) in the Middle East region with similar climates, population demographics and economic prosperity are aiming to achieve malaria elimination. In this narrative review, all studies indexed in PubMed describing epidemiological characteristics of indigenous and imported malaria cases, vector control status and how malaria infections can be controlled to achieve malaria elimination in GCC countries were reviewed and discussed. These studies have shown that indigenous malaria cases are absent in Bahrain, Kuwait, Qatar and UAE and have progressively declined in Oman and Saudi Arabia. However, imported malaria cases continue to occur as GCC countries have large expatriate populations originating from malaria-endemic countries. Various malaria control and prevention strategies adopted by GCC countries including more stringent measures to reduce the likelihood of importing malaria cases by prior screening of newly arriving expatriates and vector elimination programs are likely to lead to malaria elimination in this region.

A Large Case Series of Neurocysticercosis in Kuwait, a Nonendemic Arabian Gulf Country in the Middle East Region

Neurocysticercosis (NCC), a leading global cause of severe progressive headache and epilepsy, in developed or affluent countries is mostly diagnosed among immigrants from poor or developing Taenia solium taeniasis-endemic countries. Taeniasis carriers in Kuwait are routinely screened by insensitive stool microscopy. In this study, enzyme-linked immunoelectrotransfer blot (EITB) was used as a confirmatory test for NCC. Screening was performed on 970 patients referred for suspected NCC on the basis of relevant history and/or ring-enhancing lesions on computed tomography and/or magnetic resonance imaging during a 14-year period in Kuwait. Demographic data and clinical details were retrieved from laboratory or hospital records. EITB was positive in 150 subjects (15.5%), including 98 expatriates mostly originating from taeniasis-endemic countries and, surprisingly, 52 Kuwaiti nationals. The clinical details of 48 of 50 NCC cases diagnosed during 2014–2019 were available. Most common symptoms included seizures, persistent headache with/without fever, and fits or loss of consciousness. Cysticercal lesions were located at various brain regions in 39 of 48 patients. Multiple members of 3 families with NCC were identified; infection was linked to domestic workers from taeniasis-endemic countries and confirmed in at least 1 family. Our data show that NCC is predominantly imported in Kuwait by expatriates originating from taeniasis-endemic countries who transmit the infection to Kuwaiti citizens.