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Bhattarai S, Blackburn JK, Ryan SJ. Analyzing Spatial and Temporal Patterns of Designated Malaria Risk Areas in Nepal from 2018 to 2021. Vector Borne Zoonotic Dis 2023. [PMID: 37015081 DOI: 10.1089/vbz.2022.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
Background: Nepal is preparing to eliminate malaria by 2026. To evaluate the progress of vector control and prioritize areas for targeted intervention, understanding the recent changing distribution of high and moderate malaria risk areas is vital. Methods: Patterns of designated high and moderate malaria risk wards in Nepal between 2018 and 2021 were analyzed to identify stable and newly generated high- and moderate-risk (HaMR) wards, using the Spatial Temporal Analysis of Moving Polygons (STAMP) method. Results and Conclusions: High-risk and moderate-risk wards decreased by about 55% and the number of districts containing these wards also decreased from 20 to 14. However, several stable and new HaMR wards, mostly in the northwest and the southwest of the country, are apparent, despite intervention efforts. Public health officials should prioritize those wards for malaria surveillance and vector control, and future studies should explore the underlying reasons for persistent risk wards.
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Affiliation(s)
- Shreejana Bhattarai
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Jason K Blackburn
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
- Spatial Epidemiology and Ecology Research (SEER) Laboratory, Department of Geography, University of Florida, Gainesville, Florida, USA
| | - Sadie J Ryan
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
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Spatio-temporal patterns of malaria in Nepal from 2005 to 2018: a country progressing towards malaria elimination. Spat Spatiotemporal Epidemiol 2023. [DOI: 10.1016/j.sste.2023.100576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Mahato P, Adhikari B, Marahatta SB, Bhusal S, Kunwar K, Yadav RK, Baral S, Adhikari A, van Teijlingen E. Perceptions around COVID-19 and vaccine hesitancy: A qualitative study in Kaski district, Western Nepal. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000564. [PMID: 36962942 PMCID: PMC10022296 DOI: 10.1371/journal.pgph.0000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/28/2022] [Indexed: 02/19/2023]
Abstract
Burgeoning morbidity and mortality due to COVID-19 pandemic including the peaks in outbreaks due to different variants have attracted global attention. Although the development and rolling out of vaccines have been impressive, low- and middle-income countries suffer from a double burden: (1) lack of adequate vaccines; and (2) low vaccine uptake (vaccine hesitancy). The main objective of this study was to explore perceptions around COVID-19 and vaccine hesitancy among urban and rural population in Western Nepal. A qualitative study was conducted in six urban wards of Pokhara municipality and four rural municipalities in Kaski district of Nepal. A semi-structured interview guide was used to interview participants who were selected purposively to explore the perceived burden of COVID-19 pandemic, roles, and contributions of vaccine. Nineteen interviews were conducted by telephone following a government recommendation to avoid face-to-face meetings. Audio-recorded interviews were thematically analysed after transcription and translation into English. COVID-19 is a major (public) health concern and affects people at an individual, societal and national level. People dreaded its health hazards and consequences and seemed to be compliant with public health measures such as maintaining social distance, wearing masks and maintaining hygiene. Vaccine was considered to be a major intervention to fight the pandemic, nonetheless, the rationale and benefits of vaccines were blemished by the perceived lack of the vaccine's effectiveness, duration of protection, and its potential side-events. Expedited development of vaccine was embraced with suspicion that vaccine may have incurred compromise in quality. Science and rationale behind vaccine were smeared by misinformation and clearly counteracting the misinformation were deemed critical. Providing information about vaccines through government entities (who are trusted) and respected individuals may engender trust and uptake of vaccine. Fighting off misinformation of COVID-19 is critical to curb the course of pandemic. Increased attention towards monitoring and investing in legitimacy of information and offering information through trusted sources can help improve the vaccine coverage.
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Affiliation(s)
- Preeti Mahato
- Department of Health Studies, School of Life Sciences and the Environment, Royal Holloway University of London, Egham, United Kingdom
- Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth, United Kingdom
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom
| | | | - Susagya Bhusal
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Kshitij Kunwar
- Central Department of Public Health, Tribhuwan University, Kirtipur, Nepal
| | | | - Sushila Baral
- Provincial Health Training Centre, Gandaki Province, Nepal
| | - Anisha Adhikari
- School of Health and Allied Sciences, Pokhara University, Pokhara, Nepal
| | - Edwin van Teijlingen
- Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth, United Kingdom
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Spatial Variations and Determinants of Anemia among Under-five Children in Nepal, DHS (2006-2016). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148664. [PMID: 35886516 PMCID: PMC9323660 DOI: 10.3390/ijerph19148664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023]
Abstract
Anemia among under-five children is the major health problem in Nepal. The lack of nutritional supplementation and lack of healthcare facilities are influential factors of anemia. Thus, the main objective of this study is to explore spatial variations and determinants of anemia among under-five children in Nepal. Nepal Demographic and Health Survey (NDHS) data from 2006 to 2016 were used in this study, which includes: household and individual-level data of 8555 under-five children, whose anemia was measured. In addition, a total of 260 (2006), 281 (2011), and 383 DHS clusters (2016) were taken in consideration for spatial analysis. The overall prevalence of anemia was 48.9%, 46.4%, and 52.2% in 2006, 2011, and 2016 respectively. The spatial analysis revealed a nonrandom spatial distribution, where statistically significant hotspots and coldspots were detected in different parts of the country. The results also identified mother’s age, mother’s educational level, socioeconomic status of household, number of under-5 children, household size, birth weight, underweight, stunting, diarrhea, and fever as associated factors of anemia among under-5 children. These findings may provide assistance to concerned health officials in adopting anemia-related programs and policies to address the anemia problems that plague Nepalese children under the age of five.
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Rijal KR, Banjara MR, Dhungel B, Kafle S, Gautam K, Ghimire B, Ghimire P, Dhungel S, Adhikari N, Shrestha UT, Sunuwar DR, Adhikari B, Ghimire P. Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey. Sci Rep 2021; 11:11554. [PMID: 34078956 PMCID: PMC8172831 DOI: 10.1038/s41598-021-90812-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/18/2021] [Indexed: 01/21/2023] Open
Abstract
Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics. The main objective of this study was to explore knowledge, attitude and practices of antibiotics uses among patients, healthcare workers, laboratories, drug sellers and farmers in eight districts of Nepal. A cross-sectional survey was conducted between April and July 2017. A total of 516 individuals participated in a face-to-face interview that included clinicians, private drug dispensers, patients, laboratories, public health centers/hospitals and, livestock and poultry farmers. Out of 516 respondents, 62.8% (324/516) were patients, 16.9% (87/516) were clinicians, 6.4% (33/516) were private drug dispensers. A significant proportion of patients (42.9%; 139/324) thought that fever could be treated with antibiotics. Majority (79%; 256/324) of the patients purchased antibiotics over the counter. The knowledge of antibiotics used among patients increased proportionately with the level of education: literate only [AOR = 1.4 (95% Cl = 0.6-4.4)], versus secondary education (8-10 grade) [AOR = 1.8 (95% Cl = 1.0-3.4)]. Adult patients were more aware of antibiotic resistance. Use of antibiotics over the counter was found high in this study. Knowledge, attitude and practice related to antibiotic among respondents showed significant gaps and need an urgent effort to mitigate such practice.
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Affiliation(s)
- Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Binod Dhungel
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Samarpan Kafle
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Kedar Gautam
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Bindu Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | | | - Nabaraj Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | - Dev Ram Sunuwar
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
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Seroprevalence and Clinical Features of Scrub Typhus among Febrile Patients Attending a Referral Hospital in Kathmandu, Nepal. Trop Med Infect Dis 2021; 6:tropicalmed6020078. [PMID: 34068402 PMCID: PMC8163188 DOI: 10.3390/tropicalmed6020078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 01/10/2023] Open
Abstract
(1) Background: Scrub typhus (ST) is endemic to Nepal. It is often underdiagnosed and misdiagnosed due to non-specific clinical presentation coupled with limited microbiological facilities, leading to adverse clinical outcomes. This study aimed to assess the seroprevalence of scrub typhus in febrile patients attending Sukraraj Tropical and Infectious Disease Hospital (STIDH), Nepal, from August 2018 to April 2019. (2) Materials and Method: Blood/serum samples and clinical and demographic data of adult febrile patients (≥19 years) who attended or were referred to the hospital were collected after obtaining written informed consent from the participants excluding immunocompromised individuals. Collected blood/serum samples were subjected to hematological, biochemical, and serological tests. A serological test for scrub typhus was performed using the ImmuneMed scrub typhus rapid diagnostic test kit. Data generated were analyzed using SPSS software version 24.0. (3) Results: Amongst the 2070 febrile patients, 462 (22.3%) were seropositive to at least one etiological agent of febrile illnesses (scrub typhus: 253 cases, dengue: 101 cases, leptospirosis: 9, brucellosis: 52, malaria: 9 and kala-azar: 20 cases). Scrub typhus accounted for 12.2% (n = 253) of total febrile illnesses followed by dengue (4.9%, n = 101). Mixed seropositivity of scrub typhus with dengue, brucellosis, and typhoid was found in 12 (0.6%), 9 (0.4%), and 5 (0.2%) cases, respectively. Among 253 scrub typhus patients, 53.4% were female. Among the 154 patients, the most common symptoms were fever (100%), headache (79.2%), sweating (70.1%), breathing difficulty (51.3%), redness of the eye (43.5%), and pathognomonic eschar was observed in 9.1% patients. Fifty percent of scrub typhus patients had low platelet count and >30% of patients had an elevated level of liver enzymes (such as serum glutamic oxaloacetic transaminase (SGPT) and serum glutamic pyruvic transaminase (SGOT). (4) Conclusion: Scrub typhus is a considerable cause of febrile illness in Nepal. Females apparently have a higher chance of acquiring scrub typhus. ST presents nonspecific clinical presentation. The diagnostic dilemma of typhus patients can be minimized by the early monitoring of ST-associated symptoms. The country's health system needs to be strengthened for early outbreak detection, and immediate response actions against scrub typhus to control the future outbreak of ST.
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Rijal KR, Adhikari B, Ghimire B, Dhungel B, Pyakurel UR, Shah P, Bastola A, Lekhak B, Banjara MR, Pandey BD, Parker DM, Ghimire P. Epidemiology of dengue virus infections in Nepal, 2006-2019. Infect Dis Poverty 2021; 10:52. [PMID: 33858508 PMCID: PMC8047528 DOI: 10.1186/s40249-021-00837-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/03/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Dengue is one of the newest emerging diseases in Nepal with increasing burden and geographic spread over the years. The main objective of this study was to explore the epidemiological patterns of dengue since its first outbreak (2006) to 2019 in Nepal. METHODS This study is a retrospective analysis that covers the last 14 years (2006-2019) of reported dengue cases from Epidemiology Diseases Control Division (EDCD), Ministry of Health and Population, Government of Nepal. Reported cases were plotted over time and maps of reported case incidence were generated (from 2016 through 2019). An ecological analysis of environmental predictors of case incidence was conducted using negative binomial regression. RESULTS While endemic dengue has been reported in Nepal since 2006, the case load has increased over time and in 2019 a total of 17 992 dengue cases were reported from 68 districts (from all seven provinces). Compared to the case incidence in 2016, incidence was approximately five times higher in 2018 [incidence rate ratio (IRR): 4.8; 95% confidence interval (CI) 1.5-15.3] and over 140 times higher in 2019 (IRR: 141.6; 95% CI 45.8-438.4). A one standard deviation increase in elevation was associated with a 90% decrease in reported case incidence (IRR: 0.10; 95% CI 0.01-0.20). However, the association between elevation and reported cases varied across the years. In 2018 there was a cluster of cases reported from high elevation Kaski District of Gandaki Province. Our results suggest that dengue infections are increasing in magnitude and expanding out of the lowland areas to higher elevations over time. CONCLUSIONS There is a high risk of dengue outbreak in the lowland Terai region, with increasing spread towards the mid-mountains and beyond as seen over the last 14 years. Urgent measures are required to increase the availability of diagnostics and resources to mitigate future dengue epidemics.
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Affiliation(s)
- Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Bindu Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Binod Dhungel
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Uttam Raj Pyakurel
- Epidemiology and Diseases Control Division (EDCD), Department of Health Service, Ministry of Health and Population, Teku, Kathmandu, Nepal
| | - Prakash Shah
- Epidemiology and Diseases Control Division (EDCD), Department of Health Service, Ministry of Health and Population, Teku, Kathmandu, Nepal
| | - Anup Bastola
- Sukraraj Tropical and Infectious Disease Hospital Teku, Kathmandu, Nepal
| | - Binod Lekhak
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Basu Dev Pandey
- Epidemiology and Diseases Control Division (EDCD), Department of Health Service, Ministry of Health and Population, Teku, Kathmandu, Nepal
| | | | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
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Sunuwar DR, Singh DR, Adhikari B, Shrestha S, Pradhan PMS. Factors affecting anaemia among women of reproductive age in Nepal: a multilevel and spatial analysis. BMJ Open 2021; 11:e041982. [PMID: 33782019 PMCID: PMC8009228 DOI: 10.1136/bmjopen-2020-041982] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The main objective of this study was to explore the factors affecting anaemia among women of reproductive age (WRA) in Nepal using spatial and multilevel epidemiological analysis. DESIGN This cross-sectional study analysed data from the 2016 Nepal Demographic and Health Survey. Spatial analysis was performed using ArcGIS software V.10.8 to identify the hot and cold spots of anaemia among WRA (15-49 years). Data were analysed using multilevel mixed-effect logistic regression analysis. SETTING Nepal. PARTICIPANTS A total of 6414 WRA were included in the analysis. MAIN OUTCOME MEASURE Anaemia defined by WHO as haemoglobin level less than 120 g/L in non-pregnant women and less than 110 g/L in pregnant women. RESULTS The spatial analysis showed that statistically significant hotspots of anaemia were in the southern Terai region (four districts in province 1, eight districts in province 2, one district in Bagmati province, two districts in province 5 and one district in Sudurpaschim province) of Nepal. At the individual level, women who underwent female sterilisation (adjusted OR, aOR: 3.61, 95% CI 1.10 to 11.84), with no education (aOR: 1.99, 95% CI: 1.17 to 3.39), and from middle socioeconomic class families (aOR: 1.65, 95% CI: 1.02 to 2.68) were more likely to be anaemic, whereas, older women (>35 years) (aOR: 0.51, 95% CI: 0.26 to 0.97) and those women who were using hormonal contraceptives (aOR: 0.63, 95% CI: 0.43 to 0.90) were less likely to be anaemic. At the community level, women from province 2 (aOR=2.97, 95% CI: 1.52 to 5.82) had higher odds of being anaemic. CONCLUSION WRA had higher odds of developing anaemia, and it varied by the geographical regions. Nutrition-specific and nutrition-sensitive interventions can be tailored based on the factors identified in this study to curb the high burden of anaemia.
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Affiliation(s)
- Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Armed Police Force Hospital, Kathmandu, Nepal
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
| | - Devendra Raj Singh
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Santosh Shrestha
- Agriculture Research, Agricultural Technology Center, Lalitpur, Nepal
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal
- Nepalese Society of Community Medicine (NESCOM), Kathmandu, Nepal
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Adhikari B, Ozaki A, Marahatta SB, Rijal KR, Mishra SR. Earthquake rebuilding and response to COVID-19 in Nepal, a country nestled in multiple crises. J Glob Health 2020; 10:020367. [PMID: 33110561 PMCID: PMC7567410 DOI: 10.7189/jogh.10.020367] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Sujan Babu Marahatta
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal.,Nepal Open University, Lalitpur, Nepal
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
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Ghimire P, Rijal KR, Adhikari N, Thakur GD, Marasini B, Thapa Shrestha U, Banjara MR, Pant SK, Adhikari B, Dumre SP, Singh N, Pigeon O, Chareonviriyaphap T, Chavez I, Ortega L, Hii J. The durability of long-lasting insecticidal nets distributed to the households between 2009 and 2013 in Nepal. Trop Med Health 2020; 48:36. [PMID: 32476984 PMCID: PMC7236445 DOI: 10.1186/s41182-020-00223-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Understanding and improving the durability of long-lasting insecticidal nets (LLINs) in the field are critical for planning future implementation strategies including behavioral change for care and maintenance. LLIN distribution at high coverage is considered to be one of the adjunctive transmission reduction strategies in Nepal's Malaria Strategic Plan 2014-2025. The main objective of this study was to assess the durability through assessment of community usage, physical integrity, residual bio-efficacy, and chemical retention in LLINs: Interceptor®, Yorkool®, and PermaNet ®2.0 which were used in Nepal during 2009 through 2013. Methods Assessments were conducted on random samples (n = 440) of LLINs from the eleven districts representing four ecological zones: Terai plain region (Kailali and Kanchanpur districts), outer Terai fluvial ecosystem (Surkhet, Dang, and Rupandhei districts), inner Terai forest ecosystem (Mahhothari, Dhanusa, and Illam districts), and Hills and river valley (Kavrepalanchock and Sindhupalchok districts). For each LLIN, fabric integrity in terms of proportionate hole index (pHI) and residual bio-efficacy were assessed. However, for chemical retention, a representative sample of 44 nets (15 Yorkool®, 10 Permanet®2.0, and 19 Interceptor®) was evaluated. Data were analyzed using descriptive statistics stratified by LLINs brand, districts, and duration of exposure. Results On average, duration of use of LLINs was shortest for the Yorkool® samples, followed by PermaNet® 2.0 and Interceptor® with median ages of 8.9 (IQR = 0.4), 23.8 (IQR = 3.2), and 50.1 (IQR = 3.2) months, respectively. Over 80% of field distributed Yorkool® and PermaNet® 2.0 nets were in good condition (pHI< 25) compared to Interceptor® (66%). Bio-efficacy analysis showed that average mortality rates of Interceptor and Yorkool were below World Health Organization (WHO) optimal effectiveness of ≥ 80% compared to 2-year-old PermaNet 2.0 which attained 80%. Chemical retention analysis was consistent with bio-efficacy results. Conclusion This study shows that distribution of LLINs is effective for malaria control; however, serviceable life of LLINs should be considered in terms of waning residual bio-efficacy that warrants replacement. As an adjunctive malaria control tool, National Malaria Control Program of Nepal can benefit by renewing the distribution of LLINs in an appropriate time frame in addition to utilizing durable and effective LLINs.
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Affiliation(s)
- Prakash Ghimire
- 1Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal.,World Health Organization Country Office for Nepal, Pulchowk, Lalitpur, Nepal
| | - Komal Raj Rijal
- 1Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Nabaraj Adhikari
- 1Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Garib Das Thakur
- 3Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Baburam Marasini
- 3Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | | | - Megha Raj Banjara
- 1Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Shishir Kumar Pant
- 4VectorBorne Disease Research and Training Center, Ministry of Health and Population, Hetauda, Nepal
| | - Bipin Adhikari
- 5Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Shyam Prakash Dumre
- 6Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Nihal Singh
- World Health Organization Country Office for Nepal, Pulchowk, Lalitpur, Nepal
| | - Olivier Pigeon
- 7Agriculture and Natural Environment Department, Plant Protection Products and Biocides Physico-chemistry and Residues Unit, Walloon Agricultural Research Centre (CRA-W), Carson Building, Rue du Bordia, 11, B-5030 Gembloux, Belgium
| | | | - Irwin Chavez
- 9Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400 Thailand
| | - Leonard Ortega
- 10South-East Asia Regional Office, World Health Organization, New Delhi, India.,11Global Malaria Programme World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Jeffrey Hii
- 12Malaria Consortium, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400 Thailand.,13College of Public Health, Medical & Veterinary Sciences, James Cook University, Townville, QLD 4811 Australia
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11
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Ghimire PG, Ghimire P, Adhikari J, Chapagain A. A case report of visceral leishmaniasis and malaria co-infection with pancytopenia and splenomegaly - a diagnostic challenge. BMC Infect Dis 2019; 19:849. [PMID: 31615428 PMCID: PMC6794867 DOI: 10.1186/s12879-019-4478-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 09/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background Leishmaniasis and malaria are tropical diseases with more than half of the world population at risk of infection resulting in significant morbidity and mortality. Co-infection of Leishmaniasis and malaria pose a great challenge in the diagnosis as well as overall management. Case presentation In this case report, we present a rare case of a 5 years old child hailing from non-endemic region of Nepal with history of fever for a period of 3 months who was diagnosed as co-infection of malaria due to Plasmodium vivax and visceral Leishmaniasis with pancytopenia that subsequently improved after a course of treatment. Conclusions A high index of suspicion for a possibility of co-infection with Leishmaniasis and malaria should be borne in mind when an individual hailing from or having history of travel to endemic countries presents with prolonged fever.
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Affiliation(s)
- Pragya Gautam Ghimire
- Department of Pathology, Nepalgunj Medical College and Teaching Hospital, Kohalpur, Banke, 21904, Nepal.
| | - Prasanna Ghimire
- Department of Radiology, Nepalgunj Medical College and Teaching Hospital, Banke, 21904, Banke, Nepal
| | - Jyoti Adhikari
- Department of Pediatrics, Nepalgunj Medical College and Teaching Hospital, Banke, 21904, Banke, Nepal
| | - Anurag Chapagain
- Department of Emergency, Bheri Provincial Hospital, Banke, Banke, Nepal
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Rijal KR, Adhikari B, Ghimire P, Banjara MR, Das Thakur G, Hanboonkunupakarn B, Imwong M, Chotivanich K, Day NPJ, White NJ, Pukrittayakamee S. Efficacy of Primaquine in Preventing Short- and Long-Latency Plasmodium vivax Relapses in Nepal. J Infect Dis 2019; 220:448-456. [PMID: 30882150 PMCID: PMC6603971 DOI: 10.1093/infdis/jiz126] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/15/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Plasmodium vivax is the main cause of malaria in Nepal. Relapse patterns have not been characterized previously. METHODS Patients with P. vivax malaria were randomized to receive chloroquine (CQ; 25 mg base/kg given over 3 days) alone or together with primaquine (PQ; 0.25 mg base/kg/day for 14 days) and followed intensively for 1 month, then at 1- to 2-month intervals for 1 year. Parasite isolates were genotyped. RESULTS One hundred and one (49%) patients received CQ and 105 (51%) received CQ + PQ. In the CQ + PQ arm, there were 3 (4.1%) recurrences in the 73 patients who completed 1 year of follow-up compared with 22 of 78 (28.2%) in the CQ-only arm (risk ratio, 0.146 [95% confidence interval, .046-.467]; P < .0001). Microsatellite genotyping showed relatively high P. vivax genetic diversity (mean heterozygosity, 0.843 [range 0.570-0.989] with low multiplicity of infection (mean, 1.05) reflecting a low transmission preelimination setting. Of the 12 genetically homologous relapses, 5 (42%) occurred in a cluster after 9 months, indicating long latency. CONCLUSIONS Although there may be emerging CQ resistance, the combination of CQ and the standard-dose 14-day PQ regimen is highly efficacious in providing radical cure of short- and long-latency P. vivax malaria in Nepal.
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Affiliation(s)
- Komal Raj Rijal
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Garib Das Thakur
- Ministry of Health and Population, Ramshahpath, Kathmandu, Nepal
| | - Borimas Hanboonkunupakarn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mallika Imwong
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University
| | - Kesinee Chotivanich
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Sasithon Pukrittayakamee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- The Royal Institute, Grand Palace, Bangkok, Thailand
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13
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Kaehler N, Adhikari B, Cheah PY, von Seidlein L, Day NPJ, Paris DH, Tanner M, Pell C. Prospects and strategies for malaria elimination in the Greater Mekong Sub-region: a qualitative study. Malar J 2019; 18:203. [PMID: 31221145 PMCID: PMC6585139 DOI: 10.1186/s12936-019-2835-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 06/09/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND As malaria elimination becomes a goal in malaria-endemic nations, questions of feasibility become critical. This article explores the potential challenges associated with this goal and future strategies for malaria elimination in the Greater Mekong Sub-region. METHODS Thirty-two semi-structured interviews were conducted with policy makers (n = 17) and principal investigators (n = 15) selected based on their involvement in malaria prevention, control and elimination in the GMS. Interviews were audio-recorded and transcribed for qualitative content (thematic) analysis using QSR NVivo. RESULTS All respondents described current malaria control and elimination strategies, such as case detection and management, prevention and strengthening of surveillance systems as critical and of equal priority. Aware of the emergence of multi-drug resistance in the GMS, researchers and policy makers outlined the need for additional elimination tools. As opposed to a centralized strategy, more targeted and tailored approaches to elimination were recommended. These included targeting endemic areas, consideration for local epidemiology and malaria species, and strengthening the peripheral health system. A decline in malaria transmission could lead to complacency amongst funders and policy makers resulting in a reduction or discontinuation of support for malaria elimination. Strong commitment of policymakers combined with strict monitoring and supervision by funders were considered pivotal to successful elimination programmes. CONCLUSION Against a backdrop of increasing anti-malarial resistance and decreasing choices of anti-malarial regimens, policy makers and researchers stressed the urgency of finding new malaria elimination strategies. There was consensus that multi-pronged strategies and approaches are needed, that no single potential tool/strategy can be appropriate to all settings. Hence there is a need to customize malaria control and elimination strategies based on the better surveillance data.
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Affiliation(s)
- Nils Kaehler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, 4051, Basel, Switzerland.
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Bipin Adhikari
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK
| | - Phaik Yeong Cheah
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Lorenz von Seidlein
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK
| | - Nicholas P J Day
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK
| | - Daniel H Paris
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, 4051, Basel, Switzerland
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, 4051, Basel, Switzerland
| | - Christopher Pell
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
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14
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Smith JL, Ghimire P, Rijal KR, Maglior A, Hollis S, Andrade-Pacheco R, Das Thakur G, Adhikari N, Thapa Shrestha U, Banjara MR, Lal BK, Jacobson JO, Bennett A. Designing malaria surveillance strategies for mobile and migrant populations in Nepal: a mixed-methods study. Malar J 2019; 18:158. [PMID: 31053075 PMCID: PMC6500027 DOI: 10.1186/s12936-019-2791-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background As malaria cases have declined throughout Nepal, imported cases comprise an increasing share of the remaining malaria caseload, yet how to effectively target mobile and migrant populations (MMPs) at greatest risk is not well understood. This formative research aimed to confirm the link between imported and indigenous cases, characterize high-risk MMPs, and identify opportunities to adapt surveillance and intervention strategies to them. Methods The study used a mixed-methods approach in three districts in far and mid-western Nepal, including (i) a retrospective analysis of passive surveillance data, (ii) a quantitative health facility-based survey of imported cases and their MMP social contacts recruited by peer-referral, and (iii) focus group (FG) discussions and key informant interviews (KIIs) with a subset of survey participants. Retrospective case data were summarised and the association between monthly indigenous case counts and importation rates in the previous month was investigated using Bayesian spatio-temporal regression models. Quantitative data from structured interviews were summarised to develop profiles of imported cases and MMP contacts, including travel characteristics and malaria knowledge, attitudes and practice. Descriptive statistics of the size of cases’ MMP social networks are presented as a measure of potential programme reach. To explore opportunities and barriers for targeted malaria surveillance, data from FGs and KIIs were formally analysed using a thematic content analysis approach. Results More than half (54.1%) of malaria cases between 2013 and 2016 were classified as imported and there was a positive association between monthly indigenous cases (incidence rate ratio (IRR) 1.02 95% CI 1.01–1.03) and the previous month’s case importation rate. High-risk MMPs were identified as predominantly adult male labourers, who travel to malaria endemic areas of India, often lack a basic understanding of malaria transmission and prevention, rarely use ITNs while travelling and tend not to seek treatment when ill or prefer informal private providers. Important obstacles were identified to accessing Nepali MMPs at border crossings and at workplaces within India. However, strong social connectivity during travel and while in India, as well as return to Nepal for large seasonal festivals, provide opportunities for peer-referral-based and venue-based surveillance and intervention approaches, respectively. Conclusions Population mobility and imported malaria cases from India may help to drive local transmission in border areas of far and mid-western Nepal. Enhanced surveillance targeting high-risk MMP subgroups would improve early malaria diagnosis and treatment, as well as provide a platform for education and intervention campaigns. A combination of community-based approaches is likely necessary to achieve malaria elimination in Nepal. Electronic supplementary material The online version of this article (10.1186/s12936-019-2791-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer L Smith
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, USA
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Alysse Maglior
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, USA
| | - Sara Hollis
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, USA
| | - Ricardo Andrade-Pacheco
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, USA
| | - Garib Das Thakur
- Epidemiology and Diseases Control Division, Ministry of Health and Population, Teku, Kathmandu, Nepal
| | - Nabaraj Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Bibek Kumar Lal
- Epidemiology and Diseases Control Division, Ministry of Health and Population, Teku, Kathmandu, Nepal
| | - Jerry O Jacobson
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, USA
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, USA
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15
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Rijal KR, Adhikari B, Adhikari N, Dumre SP, Banjara MS, Shrestha UT, Banjara MR, Singh N, Ortegea L, Lal BK, Thakur GD, Ghimire P. Micro-stratification of malaria risk in Nepal: implications for malaria control and elimination. Trop Med Health 2019; 47:21. [PMID: 30976192 PMCID: PMC6437900 DOI: 10.1186/s41182-019-0148-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background A significant reduction in malaria cases over the recent years in Nepal has encouraged the government to adopt a goal of "malaria-free nation by 2025." Nevertheless, to achieve this goal, it is critical to identify the epidemiological burden of malaria by specific regions and areas for an effective targeted intervention. The main objective of this study was to estimate the risk of malaria at Village Development Committee (VDC) level in Nepal based on disease, vector, parasite, and geography. Methods In 2012, the micro-stratification of malaria risk was carried out in 75 districts of Nepal. Instruments such as a questionnaire, case record forms, and guidelines for malaria micro-stratification were developed and pre-tested for necessary adaptations. Village Development Committee (VDC)-wise malaria data were analyzed using exploratory statistics and were stratified by geographical variables that contributed to the risk of malaria. To understand the transmission risk at VDC level, overlay analysis was done using ArcGIS 10. To ensure transparent, reproducible, and comprehensible risk assessment, standard scoring method was selected and utilized for data from 2009 to 2011. Thus identified, three major variables (key determinants) were given weights (wt.) accordingly to stratification of the malaria risk (disease burden, "0.3" wt.; ecology/vector transmission, "0.5" wt.; and vulnerability-population movement, "0.2" wt.). Malaria risk in a VDC was determined based on the overall scores and classified into four categories: no risk, low risk, moderate risk, and high risk. Results Analyzing the overall risk based on scoring of the total VDCs (n = 3976), 54 (1.36%), 201 (5.06%), 999 (25.13%), and 2718 (68.36%) were identified as high-, moderate-, low-, and no-risk categories for malaria, respectively. Based on the population statistics, 3.62%, 9.79%, 34.52%, and 52.05% of the country's total population live in high-risk, moderate-risk, low-risk, and no-risk VDCs for malaria, respectively. Our micro-stratification study estimates are 100,000 population at high risk. Regional distribution showed that the majority of the high-risk VDCs were identified in the Far- and Mid-western regions (19 and 18 VDCs) followed by Central and Western regions (10 and 7 VDCs) with no high-risk VDCs in the Eastern region. Similarly, 77, 59, 27, 24, and 14 VDCs of the Central, Mid-western, Western, Eastern, and Far-western regions, respectively, were found under moderate malaria risk. Of the low-risk VDCs, 353, 215, 191, 148, and 92 were respectively from the Central, Eastern, Western, Far-western, and Mid-western regions. Conclusions The current micro-stratification study provides insights on malaria risk up to the VDC level. This will help the malaria elimination program to target interventions at the local level thereby ensuring the best utilization of available resources to substantially narrowed-down target areas. With further updates and refinement, the micro-stratification approach can be employed to identify the risk areas up to smaller units within the VDCs (ward and villages).
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Affiliation(s)
- Komal Raj Rijal
- 1Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Bipin Adhikari
- 2Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nabaraj Adhikari
- 1Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Shyam Prakash Dumre
- 3Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | | | | | - Megha Raj Banjara
- 1Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Nihal Singh
- World Health Organization (WHO), Country Office, Kathmandu, Nepal
| | - Leonard Ortegea
- 6Global Malaria Program, World Health Organization Headquarters, Geneva, Switzerland
| | - Bibek Kumar Lal
- 7Epidemiology and Disease Control Division (EDCD), Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Garib Das Thakur
- 7Epidemiology and Disease Control Division (EDCD), Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Prakash Ghimire
- 1Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.,World Health Organization (WHO), Country Office, Kathmandu, Nepal
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16
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Adhikari B, Phommasone K, Pongvongsa T, Soundala X, Koummarasy P, Henriques G, Peto TJ, von Seidlein L, White NJ, Day NPJ, Dondorp AM, Newton PN, Cheah PY, Mayxay M, Pell C. Perceptions of asymptomatic malaria infection and their implications for malaria control and elimination in Laos. PLoS One 2018; 13:e0208912. [PMID: 30533024 PMCID: PMC6289463 DOI: 10.1371/journal.pone.0208912] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/26/2018] [Indexed: 11/29/2022] Open
Abstract
Background In the Greater Mekong Sub-region (GMS), malaria elimination efforts are targeting the asymptomatic parasite reservoirs. Understanding community perceptions about asymptomatic malaria infections and interventions that target this reservoir is critical to the design of community engagement. This article examines knowledge, attitudes, perceptions and practices related to asymptomatic malaria infections and mass drug administration (MDA) in malaria-endemic villages in southern Savannakhet Province, Laos. Methods A questionnaire consisting of questions on socio-demographic characteristics, knowledge, attitudes, perceptions and practices on malaria and MDA was administered to each household head or representative (n = 281) in four villages. These topics were also further discussed in 12 single-gender focus group discussions (FGDs). The FGDs were conducted in all four villages and consisted of eight to 10 participants. Results A minority (14.2%; 40/281) of respondents agreed that a seemingly healthy person could have malaria parasite in his or her blood. Half (52%; 146/281) disagreed and one third (33.8%, 95/281) were unsure. Respondents who responded that “MDA aims to cure everyone” [AOR = 4.6; CI: 1.6–13.1], “MDA is to make our community malaria free” [AOR = 3.3; CI: 1.3–8.1] and “I will take part in future MDA” [AOR = 9.9; CI: 1.2–78.8] were more likely to accept the idea of asymptomatic malaria. During FGDs, respondents recalled signs and symptoms of malaria (fever, chills and headache), and described malaria as a major health problem. Symptomatic and asymptomatic malaria infections were associated with their work in the forest and living conditions. Measures described to eliminate malaria included using mosquito nets, wearing long-sleeved clothes and taking medicine when symptomatic. Most respondents were unaware of MDA as a tool to eliminate malaria. Conclusions Awareness of asymptomatic malaria infections, and MDA as a tool to eliminate malaria, was low. With the need to target asymptomatic malaria carriers for elimination efforts in the GMS, as well as informing target groups about asymptomatic infection, accompanying community engagement must build trust in interventions through the active collaboration of government stakeholders, key local persons and community members. This entails training and devolving responsibilities to the community members to implement and sustain the control and elimination efforts.
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Affiliation(s)
- Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, United Kingdom
- Kellogg College, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Tiengkham Pongvongsa
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Savannakhet Provincial Health Department, Savannakhet Province, Laos
| | - Xayaphone Soundala
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Palingnaphone Koummarasy
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Gisela Henriques
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Life Science, Imperial College London, London, United Kingdom
| | - Thomas J. Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Nicholas J. White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Nicholas P. J. Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Arjen M. Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Paul N. Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Phaik Yeong Cheah
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mayfong Mayxay
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Institute of Research and Educational Development, University of Health Sciences, Vientiane, Laos
| | - Christopher Pell
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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17
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Ghimire P, Rijal KR, Kafle C, Karki BS, Singh N, Ortega L, Thakur GD, Adhikari B. Efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Nepal. Trop Dis Travel Med Vaccines 2018; 4:9. [PMID: 30123520 PMCID: PMC6092778 DOI: 10.1186/s40794-018-0068-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/05/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The national treatment guidelines of Nepal have adopted Artemisinin Combination Therapies (ACTs) for the treatment of uncomplicated falciparum malaria since 2004. Emergence of Artemisinin resistance in the Greater Mekong Sub-region (GMS) and beyond may become a threat for Nepal as well. The main objective of this study was to assess the therapeutic efficacy of antimalarial drug artemether-lumefantrine in uncomplicated P. falciparum infected patients at health centers/hospitals treated over the period of 2 years (2013-2014). METHODS Giemsa stained thick and thin smears, prepared from uncomplicated falciparum malaria patients who visited the selected sentinel sites in Nepal during 2013 to 2014 and met the inclusion criteria that included parasitemia (1000-10,000 /μL of blood), were evaluated until 28 days after ACTs treatment, following a World Health Organization (WHO) therapeutic efficacy protocol. Based on the re-occurrence of fever and resurge in parasitemia, the study patients were classified as resistant or susceptible. Blood specimens on filter papers were further analyzed by Polymerase Chain Reaction (PCR), specifically for the K13 propeller gene mutation (a recently identified molecular marker for ACT resistance). RESULTS A total of 56,013 suspected malaria cases were screened for this study. Of which, 120 (0.21%) were infected with falciparum malaria. Out of 120, 28 cases of P. falciparum (28/120; 23.33%) were enrolled in the study, of which 24 cases completed the post-treatment follow up for 28 days. Only one case out of 24 (4%) was identified as a late treatment failure (LTF). K13 mutation, a proxy indicator for ACT resistance in parasites, was not detected on the day 1, which indicates resistance had not yet reached the molecular level. CONCLUSION Only one case of late treatment failure was identified in this study. ACT combination using artemether-lumefantrine was still effective for the treatment of uncomplicated falciparum malaria in Nepal. A close monitoring and supervision for ACT resistance is essential for future malaria treatment in Nepal.
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Affiliation(s)
- Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Chandramani Kafle
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | - Nihal Singh
- World Health Organization, Country office Nepal, UN House, Pulchowk, Lalitpur, Nepal
| | - Leonard Ortega
- Global Malaria Program, World Health Organization headquarters, Geneva, Switzerland
| | | | - Bipin Adhikari
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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