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Sagna AB, Gebre Y, Vera-Arias CA, Traoré DF, Tchekoi BN, Assi SB, Koffi AA, Rogier C, Remoue F, Koepfli C. High prevalence of asymptomatic and subpatent Plasmodium falciparum infections but no histidine-rich protein 2 gene deletion in Bouaké, Côte d'Ivoire. Sci Rep 2024; 14:19060. [PMID: 39154104 PMCID: PMC11330520 DOI: 10.1038/s41598-024-70215-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024] Open
Abstract
This study aimed to estimate the prevalence of asymptomatic and subpatent P. falciparum infections in the city of Bouaké, Central Côte d'Ivoire, to compare the performance of three tests, and to investigate potential P. falciparum histidine-rich protein 2 (pfhrp2) gene deletions. A cross-sectional survey was conducted in nine neighborhoods in Bouaké in 2016. Matched light microscopy (LM), rapid diagnostic test (RDT), and quantitative PCR (qPCR) data were used to determine the prevalence of P. falciparum infection and compare the performance of the three diagnostic tests. Pfhrp2/3 deletions were genotyped by digital PCR. Among 2313 individuals, 97.2% were asymptomatic and 2.8% were symptomatic. P. falciparum prevalence among symptomatic individuals was 25.8%, 30.3%, and 40.9% by LM, RDT, and varATS qPCR, respectively, and among asymptomatic individuals, it was 10.3%, 12.5%, and 34.9%. Asymptomatic infections comprised 96.4% of all malaria infections, with 58.2% detectable only by varATS qPCR. Although the prevalence of asymptomatic P. falciparum infections was higher in school-age children (5-14 years: 42.0%) compared to < 5 years (17.3%) and ≥ 15 years (35.9%), subpatent infections were more likely in ≥ 15 years (70.4%) than in < 5 years (39.7%) and school-age children (41.2%). LM and RDTs were reliable only at parasite densities > 10,000 parasites/µL. Individuals who were positive according to all three tests had significantly greater parasite density (856.8 parasites/µL; 95% CI 707.3-1,038) than did those who were positive by varATS qPCR only (13.7 parasites/µL; 95% CI 11.4-16.3) (p < 0.0001). No pfhrp2 deletions were observed. The high prevalence of asymptomatic and subpatent infections highlights the need for targeted strategies to reduce malaria in urban Côte d'Ivoire.
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Affiliation(s)
- André Barembaye Sagna
- MIVEGEC, University of Montpellier, IRD, CNRS, Montpellier, France.
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre, Dame, Notre Dame, IN, USA.
- Institut Pierre Richet, Institut National de la Santé Publique, Bouaké, Côte d'Ivoire.
| | - Yilekal Gebre
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre, Dame, Notre Dame, IN, USA
| | - Claudia Abigail Vera-Arias
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre, Dame, Notre Dame, IN, USA
| | - Dipomin François Traoré
- Institut Pierre Richet, Institut National de la Santé Publique, Bouaké, Côte d'Ivoire
- Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Bertin N'cho Tchekoi
- Institut Pierre Richet, Institut National de la Santé Publique, Bouaké, Côte d'Ivoire
| | - Serge Brice Assi
- Programme National de Lutte Contre le Paludisme en Côte d'Ivoire, Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | | | - Christophe Rogier
- Primum Vitare, Paris, France
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Franck Remoue
- MIVEGEC, University of Montpellier, IRD, CNRS, Montpellier, France
| | - Cristian Koepfli
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre, Dame, Notre Dame, IN, USA.
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Ouattara SM, Ouattara D, Badoum ES, Diarra A, Hien D, Ouedraogo AZ, Nébié I, Ouedraogo A, Tiono AB, Sirima SB. Malariometric Indices in the Context of Seasonal Malaria Chemoprevention in Children Aged 1.5 to 12 Years during the Period of High Malaria Transmission in the Suburban Area of Banfora, Burkina Faso. Trop Med Infect Dis 2023; 8:442. [PMID: 37755903 PMCID: PMC10535583 DOI: 10.3390/tropicalmed8090442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
Continuous monitoring of malaria epidemiology is needed in malaria-endemic settings to inform malaria control and elimination strategies. This study aimed to compare the malariometric indices between the under-fives and school-age children. We surveyed children aged 1.5 to 12 years for plasmodia carriage with the aim of including them in a longitudinal follow-up cohort. The survey took place from 7-11 September 2020 in a southwest area of Burkina Faso. Clinical and demographic data including malaria control measures were collected. A finger prick blood sample was taken for haemoglobin testing, and blood smears and dried blood spot preparation. The malariometric indices were calculated and compared between school-age children and those under the age of five. Multiple logistic regression was fitted to assess the association between malaria parasite carriage and age categories. Based on the PCR results, the parasite prevalence was 21.4% in the under-fives versus 44.2% in school-age children (p-value < 0.0001), with a pooled prevalence of 32.7% (CI = [28.8, 36.8]). The gametocyte prevalence was also significantly higher in school-age children (11.9%) compared to the under-fives (3.7%). Adjusted for covariates, school-age children were 2.9 times (IC = [2.0, 4.2]) more likely to carry the asexual parasite, compared to the under-fives. Malaria was moderate and stable endemic in this area and school-age children play a key role in the spread of the disease. The WHO conditional recommendation for intermittent preventive treatment of malaria in school-aged children living in malaria-endemic settings with moderate to high perennial or seasonal transmission should be implemented.
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Affiliation(s)
- San M Ouattara
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou 06 BP 10248, Burkina Faso
| | - Daouda Ouattara
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou 06 BP 10248, Burkina Faso
| | - Emilie S Badoum
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou 06 BP 10248, Burkina Faso
| | - Amidou Diarra
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou 06 BP 10248, Burkina Faso
| | - Denise Hien
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou 06 BP 10248, Burkina Faso
| | - Amidou Z Ouedraogo
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou 06 BP 10248, Burkina Faso
| | - Issa Nébié
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou 06 BP 10248, Burkina Faso
| | - Alphonse Ouedraogo
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou 06 BP 10248, Burkina Faso
| | - Alfred B Tiono
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou 06 BP 10248, Burkina Faso
| | - Sodiomon B Sirima
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou 06 BP 10248, Burkina Faso
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Mhango P, Malata MP, Chipeta E, Sixpence A, Taylor TE, Wilson ML, Cohee LM, Mangani C, Mathanga DP. Barriers to accessing malaria treatment amongst school-age children in rural Malawi. Malar J 2023; 22:258. [PMID: 37674177 PMCID: PMC10481490 DOI: 10.1186/s12936-023-04695-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Over the last two decades, many countries have moved from malaria control toward malaria elimination. However, some sub-Saharan African countries, like Malawi, have recently seen a reversal in malaria control progress with reported increases in confirmed malaria cases. This may be the result of inadequate access to effective malaria control interventions by key population groups that perpetuate transmission. This study aimed to assess the barriers to accessing malaria treatment among school-aged children (SAC) in Malawi. METHODS A qualitative study was conducted between September and October 2020, where data were gathered in rural Malawi using free-listing interviews, key-informant interviews, semi-structured interviews and focus group discussions. Purposively sampled participants included SAC, parents of SAC, health workers and key stakeholders at community and district levels. Interviews were digitally recorded and transcribed verbatim. Data were organized using NVivo 12 software and analysed using the thematic method. RESULTS The study recruited 252 participants, with 156 being SAC, equally divided between boys and girls. Health system barriers to malaria treatment included long waiting hours and queues at clinics, frequent stock-outs of medical supplies, and travel time to the facility. Provider barriers included negative attitude and limited service hours. Individual and cultural barriers included fear of malaria tests and beliefs associating witchcraft as the best treatment for malaria. In addition, COVID-19-related barriers included the inability to follow preventive measures, a shift in focus from malaria to COVID-19, and fear of contracting COVID-19 and/or being tested for COVID-19 at the facility. CONCLUSIONS This study shows most of the barriers to accessing malaria treatment among SAC are similar to those experienced by other population groups. Furthermore, COVID-19 adversely affected SAC's access to treatment. Interventions that support SAC access to prompt diagnosis and treatment are urgently needed to improve the effective control of malaria.
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Affiliation(s)
- Patani Mhango
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Monica Patricia Malata
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Effie Chipeta
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Alick Sixpence
- Malaria Alert Centre (MAC), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Terrie E Taylor
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Mark L Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lauren M Cohee
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Don P Mathanga
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
- Malaria Alert Centre (MAC), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
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Stanley CC, Chirombo J, Msuku H, Phiri VS, Patson N, Kazembe LN, Chinkhumba J, Kapito-Tembo A, Mathanga DP. Prompt treatment-seeking behaviour varies within communities among guardians of children with malaria-related fever in Malawi. Malar J 2023; 22:246. [PMID: 37633902 PMCID: PMC10463323 DOI: 10.1186/s12936-023-04680-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 08/18/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND In Malawi, malaria is responsible for 40% of hospital deaths. Prompt diagnosis and effective treatment within 24 h of fever onset is critical to prevent progression from uncomplicated to severe disease and to reduce transmission. METHODS As part of the large evaluation of the malaria vaccine implementation programme (MVIP), this study analysed survey data to investigate whether prompt treatment-seeking behaviour is clustered at community-level according to socio-economic demographics. RESULTS From 4563 households included in the survey, 4856 children aged 5-48 months were enrolled. Out of 4732 children with documented gender, 52.2% were female and 47.8% male. Among the 4856 children, 33.8% reported fever in the two weeks prior to the survey. Fever prevalence was high in communities with low socio-economic status (SES) (38.3% [95% CI: 33.7-43.5%]) and low in areas with high SES (29.8% [95% CI: 25.6-34.2%]). Among children with fever, 648 (39.5%) sought treatment promptly i.e., within 24 h from onset of fever symptoms. Children were more likely to be taken for prompt treatment among guardians with secondary education compared to those without formal education (aOR:1.37, 95% CI: 1.11-3.03); in communities with high compared to low SES [aOR: 2.78, 95% CI: 1.27-6.07]. Children were less likely to be taken for prompt treatment if were in communities far beyond 5 km to health facility than within 5 km [aOR: 0.44, 95% CI: 0.21-0.92]. CONCLUSION The high heterogeneity in prevalence of fever and levels of prompt treatment-seeking behaviour underscore the need to promote community-level malaria control interventions (such as use of long-lasting insecticide-treated nets (LLINs), indoor residual spraying (IRS), intermittent preventive therapy (IPT), presumptive treatment and education). Programmes aimed at improving treatment-seeking behaviour should consider targeting communities with low SES and those far from health facility.
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Affiliation(s)
- Christopher C Stanley
- MAC-Communicable Diseases Action Centre, Kamuzu University of Health Sciences, Chichiri, Private Bag 360, Blantyre, Malawi.
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
| | - James Chirombo
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Harrison Msuku
- MAC-Communicable Diseases Action Centre, Kamuzu University of Health Sciences, Chichiri, Private Bag 360, Blantyre, Malawi
| | - Vincent S Phiri
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Noel Patson
- MAC-Communicable Diseases Action Centre, Kamuzu University of Health Sciences, Chichiri, Private Bag 360, Blantyre, Malawi
| | - Lawrence N Kazembe
- Department of Computing, Mathematical and Statistical Sciences, University of Namibia, Windhoek, Namibia
| | - Jobiba Chinkhumba
- MAC-Communicable Diseases Action Centre, Kamuzu University of Health Sciences, Chichiri, Private Bag 360, Blantyre, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Atupele Kapito-Tembo
- MAC-Communicable Diseases Action Centre, Kamuzu University of Health Sciences, Chichiri, Private Bag 360, Blantyre, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Don P Mathanga
- MAC-Communicable Diseases Action Centre, Kamuzu University of Health Sciences, Chichiri, Private Bag 360, Blantyre, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Madera-Garcia V, Coalson JE, Subelj M, Bell ML, Hayden MH, Agawo M, Munga S, Ernst KC. Self-Reported Symptoms at Last Febrile Illness as a Predictor of Treatment-Seeking in Western Kenya: A Cross-Sectional Study. Am J Trop Med Hyg 2023; 108:212-220. [PMID: 36410323 PMCID: PMC9833091 DOI: 10.4269/ajtmh.21-0447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Timely treatment-seeking behavior can reduce morbidity and mortality due to infectious diseases. Patterns of treatment-seeking behavior can differ by access to health care, and perceptions of disease severity and symptoms. We evaluated the association between self-reported symptoms at last illness and the level of treatment-seeking behaviors. We analyzed cross-sectional data from 1,037 participants from the lowlands and highlands of Western Kenya from 2015 using logistic regression models. There was considerable heterogeneity in the symptoms and treatment-seeking behaviors reported among individuals who were febrile at their last illness. A greater number of self-reported categories of symptoms tended to be associated with a higher likelihood of treatment-seeking in both sites. Participants were significantly more likely to seek treatment if they reported fever, aches, and digestive symptoms at last illness than just fever and aches or fever alone, but the frequency of treatment-seeking for fever in combination with aches and respiratory symptoms did not follow a consistent pattern. Among those who sought treatment, most used a formal source, but the patterns were inconsistent across sites and by the number of symptoms categories. Understanding the drivers of treatment-seeking behavior after febrile illness is important to control and treat infectious diseases in Kenya.
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Affiliation(s)
| | - Jenna E. Coalson
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana
| | - Maja Subelj
- National Institute of Public Health, University of Ljubljana, Ljubljana, Slovenia
| | - Melanie L. Bell
- College of Public Health, University of Arizona, Tucson, Arizona
| | - Mary H. Hayden
- Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, Colorado
| | - Maurice Agawo
- Kenya Medical Research Institute, Kisian Research Station, Kenya
| | - Stephen Munga
- Kenya Medical Research Institute, Kisian Research Station, Kenya
| | - Kacey C. Ernst
- College of Public Health, University of Arizona, Tucson, Arizona
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Cohee LM, Goupeyou-Youmsi J, Seydel KB, Mangani C, Ntenda P, Sixpence A, Mbewe RB, Matengeni A, Takala-Harrison S, Walker ED, Wilson ML, Mzilahowa T, Laufer MK, Valim C, Taylor TE, Mathanga DP. Understanding the Intransigence of Malaria in Malawi. Am J Trop Med Hyg 2022; 107:40-48. [PMID: 36228915 PMCID: PMC9662216 DOI: 10.4269/ajtmh.21-1263] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/19/2022] [Indexed: 01/29/2023] Open
Abstract
Despite the scale-up of interventions against malaria over the past decade, this disease remains a leading threat to health in Malawi. To evaluate the epidemiology of both Plasmodium falciparum infection and malaria disease, the Malawi International Center of Excellence for Malaria Research (ICEMR) has developed and implemented diverse and robust surveillance and research projects. Descriptive studies in ICEMR Phase 1 increased our understanding of the declining effectiveness of long-lasting insecticidal nets (LLINs), the role of school-age children in malaria parasite transmission, and the complexity of host-parasite interactions leading to disease. These findings informed the design of ICEMR Phase 2 to test hypotheses about LLIN use and effectiveness, vector resistance to insecticides, demographic targets of malaria control, patterns and causes of asymptomatic to life-threatening disease, and the impacts of RTS,S vaccination plus piperonyl butoxide-treated LLINs on infection and disease in young children. These investigations are helping us to understand mosquito-to-human and human-to-mosquito transmission in the context of Malawi's intransigent malaria problem.
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Affiliation(s)
- Lauren M. Cohee
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Karl B. Seydel
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Charles Mangani
- School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Peter Ntenda
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alick Sixpence
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Rex B. Mbewe
- Department of Physics and Biochemical Sciences, Malawi University of Business and Applied Sciences, Blantyre, Malawi
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan
| | - Alfred Matengeni
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Shannon Takala-Harrison
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Edward D. Walker
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan
| | - Mark L. Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Themba Mzilahowa
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Miriam K. Laufer
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Clarissa Valim
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Terrie E. Taylor
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Don P. Mathanga
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
- School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Mangani C, Mzilahowa T, Cohee L, Kayange M, Ntenda P, Sixpence A, Gumbo A, Lankhulani S, Goupeyou-Youmsi J, Walker E, Laufer M, Valim C, Seydel K, Wilson ML, Taylor T, Mathanga DP. Malawi ICEMR Malaria Research: Interactions and Results Influencing Health Policies and Practices. Am J Trop Med Hyg 2022; 107:49-54. [PMID: 36228911 PMCID: PMC9662217 DOI: 10.4269/ajtmh.21-1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/14/2022] [Indexed: 01/29/2023] Open
Abstract
Malaria remains a threat to public health in Malawi. It is well acknowledged that malaria research and robust evidence can have an impact on malaria policy and practice, resulting in positive population health gains. We report policy-relevant research contributions that the Malawi International Center of Excellence for Malaria Research (ICEMR) in partnership with local and international collaborators has made. Findings from our ICEMR studies have shown that long-lasting insecticide-treated bed nets (LLINs) impregnated with piperonyl butoxide reduced mosquito blood feeding more compared with conventional LLINs. On the other hand, we showed that few LLINs are maintained up to the end of their 3-year life span, and that older nets are less effective. These results support the policy change decisions by the Malawi National Malaria Control Program to switch from conventional LLINs to piperonyl butoxide LLINs, and to conduct mass LLIN distribution campaigns every 2 years. Our studies on epidemiological patterns of malaria infection showed that school-age children have higher malaria infection rates and lower use of control measures compared with younger children and adults. These findings added to the evidence base that influenced the National Malaria Control Program to endorse school-based malaria interventions as part of its national policy. Research supported by the Malawi ICEMR is contributing to in-country policy decisions and to the implementation of evidence-based interventions. Through our long-term studies we intend to continue providing practical and policy-relevant evidence necessary, ultimately, to eliminate malaria infection in Malawi.
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Affiliation(s)
- Charles Mangani
- Department of Epidemiology and Biostatistics, School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi;,Address correspondence to Charles Mangani, Department of Epidemiology and Biostatistics, Kamuzu University of Health Sciences, P/Bag 360 Chichiri, Blantyre 3. E-mail:
| | - Themba Mzilahowa
- Malaria Alert Center, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Lauren Cohee
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael Kayange
- National Malaria Control Program, Ministry of Health, Lilongwe, Malawi
| | - Peter Ntenda
- Malaria Alert Center, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alick Sixpence
- Malaria Alert Center, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Austin Gumbo
- National Malaria Control Program, Ministry of Health, Lilongwe, Malawi
| | - Sosten Lankhulani
- National Malaria Control Program, Ministry of Health, Lilongwe, Malawi
| | | | - Edward Walker
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan
| | - Miriam Laufer
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Clarissa Valim
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Karl Seydel
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Mark L. Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Terrie Taylor
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Don P. Mathanga
- Department of Epidemiology and Biostatistics, School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi;,Malaria Alert Center, Kamuzu University of Health Sciences, Blantyre, Malawi
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8
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Zerdo Z, Anthierens S, Van Geertruyden JP, Massebo F, Biresaw G, Shewangizaw M, Endashaw G, Tunje A, Masne M, Bastiaens H. Implementation of a malaria prevention education intervention in Southern Ethiopia: a qualitative evaluation. BMC Public Health 2022; 22:1811. [PMID: 36151537 PMCID: PMC9508754 DOI: 10.1186/s12889-022-14200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though school-aged children (SAC) are at high risk of malaria, they are the ones that benefit the least from malaria prevention measures. A cluster randomized controlled trial was conducted to evaluate the effect of malaria prevention education (MPE) on insecticide-treated bed net (ITN) utilization and prompt diagnosis, reported incidence and treatment (PDAT) of malaria. Qualitative evaluation of the implementation of such interventions is vital to explain its effectiveness and will serve as guidance for future interventions. Therefore, this study aimed to evaluate the implementation of the MPE in southern Ethiopia. METHODS: The trial was registered in Pan African Clinical Trials Registry (PACTR202001837195738) on 21/01/2020. A descriptive qualitative study using semi-structured interview with participants of the MPE was conducted in January 2020 and January 2021. The collected data were transcribed verbatim and analyzed thematically. The analysis of the data was supported by NVivo. RESULTS The four themes identified after evaluation of MPE training were the setup of the training, challenges for the success of the training, anticipated challenges for practice as per the protocol and experienced immediate influences of the training. Participants appreciated the training: content covered, way of delivery and the mix of the participants. The context specific facilitators to bed net use were the collateral benefits of ITN and perceived at high risk of malaria while its barriers were quality and quantity of the bed nets, bed net associated discomforts, malaria health literacy and housing condition. Severeness of malaria symptoms and malaria health literacy were reported as both barriers and facilitators of the PDAT of malaria. The identified facilitators of PDAT of malaria were health professionals' attitude and exposure to MPE while its barriers were poverty, use of traditional medicine, health facility problems and Coronavirus Disease 2019 (COVID-19) pandemic. CONCLUSION Low attendance of parents in the training was the major challenge for the success of MPE. National malaria program should ensure the access to malaria prevention measures; and future studies using increased frequency of the intervention embedded with monitoring adherence to the intervention protocol shall be conducted to improve the gains from existing malaria interventions.
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Affiliation(s)
- Zerihun Zerdo
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia. .,Global Health Institute, Antwerp University, Antwerp, Belgium.
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | | | - Fekadu Massebo
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gelila Biresaw
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Misgun Shewangizaw
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gesila Endashaw
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abayneh Tunje
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Matewos Masne
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Hilde Bastiaens
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
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9
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Sayre D, Steinhardt LC, Irinantenaina J, Dentinger C, Rasoanaivo TF, Kapesa L, Razafindrakoto J, Legrand A, Prada N, Gutman J, Lewis L, Mangahasimbola RT, Andriamananjara M, Ravaoarinosy AV, Ralemary N, Garchitorena A, Harimanana A. Baseline malaria prevalence and care-seeking behaviours in rural Madagascar prior to a trial to expand malaria community case management to all ages. Malar J 2021; 20:422. [PMID: 34702255 PMCID: PMC8549293 DOI: 10.1186/s12936-021-03956-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrated community case management of malaria, pneumonia, and diarrhoea can reduce mortality in children under five years (CU5) in resource-poor countries. There is growing interest in expanding malaria community case management (mCCM) to older individuals, but limited empirical evidence exists to guide this expansion. As part of a two-year cluster-randomized trial of mCCM expansion to all ages in southeastern Madagascar, a cross-sectional survey was conducted to assess baseline malaria prevalence and healthcare-seeking behaviours. METHODS Two enumeration areas (EAs) were randomly chosen from each catchment area of the 30 health facilities (HFs) in Farafangana district designated for the mCCM age expansion trial; 28 households were randomly selected from each EA for the survey. All household members were asked about recent illness and care-seeking, and malaria prevalence was assessed by rapid diagnostic test (RDT) among children < 15 years of age. Weighted population estimates and Rao-Scott chi-squared tests were used to examine illness, care-seeking, malaria case management, and malaria prevalence patterns. RESULTS Illness in the two weeks prior to the survey was reported by 459 (6.7%) of 8050 respondents in 334 of 1458 households surveyed. Most individuals noting illness (375/459; 82.3%) reported fever. Of those reporting fever, 28.7% (112/375) sought care; this did not vary by participant age (p = 0.66). Most participants seeking care for fever visited public HFs (48/112, 46.8%), or community healthcare volunteers (CHVs) (40/112, 31.0%). Of those presenting with fever at HFs or to CHVs, 87.0% and 71.0%, respectively, reported being tested for malaria. RDT positivity among 3,316 tested children < 15 years was 25.4% (CI: 21.5-29.4%) and increased with age: 16.9% in CU5 versus 31.8% in 5-14-year-olds (p < 0.0001). Among RDT-positive individuals, 28.4% of CU5 and 18.5% of 5-14-year-olds reported fever in the two weeks prior to survey (p = 0.044). CONCLUSIONS The higher prevalence of malaria among older individuals coupled with high rates of malaria testing for those who sought care at CHVs suggest that expanding mCCM to older individuals may substantially increase the number of infected individuals with improved access to care, which could have additional favorable effects on malaria transmission.
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Affiliation(s)
- Dean Sayre
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA. .,Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC Atlanta, 1600 Clifton Rd, Atlanta, GA, USA.
| | - Laura C Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC Atlanta, 1600 Clifton Rd, Atlanta, GA, USA
| | | | - Catherine Dentinger
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC Atlanta, 1600 Clifton Rd, Atlanta, GA, USA.,U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, Lot 207A, Point Liberty, Andranoro, Antehiroka, 105, Antananarivo, Madagascar
| | | | - Laurent Kapesa
- U.S. President's Malaria Initiative, USAID, Lot 207A, Point Liberty, Andranoro, Antehiroka, 105, Antananarivo, Madagascar
| | - Jocelyn Razafindrakoto
- U.S. President's Malaria Initiative, USAID, Lot 207A, Point Liberty, Andranoro, Antehiroka, 105, Antananarivo, Madagascar
| | - Agathe Legrand
- Institut Pasteur de Madagascar , BP 1274 Ambatofotsikely, 101, Antananarivo, Madagascar
| | - Nicole Prada
- Institut Pasteur de Madagascar , BP 1274 Ambatofotsikely, 101, Antananarivo, Madagascar
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC Atlanta, 1600 Clifton Rd, Atlanta, GA, USA
| | - Lauren Lewis
- U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA.,Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC Atlanta, 1600 Clifton Rd, Atlanta, GA, USA
| | | | | | | | - Nicolas Ralemary
- Ministry of Public Health, Farafangana District Office, Farafangana, Madagascar
| | - Andres Garchitorena
- Institut Pasteur de Madagascar , BP 1274 Ambatofotsikely, 101, Antananarivo, Madagascar.,MIVEGEC, Univ. Montpellier, CNRS, IRD, 911 Av Agropolis, Montpellier, France
| | - Aina Harimanana
- Institut Pasteur de Madagascar , BP 1274 Ambatofotsikely, 101, Antananarivo, Madagascar
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10
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Cohee LM, Nankabirwa JI, Greenwood B, Djimde A, Mathanga DP. Time for malaria control in school-age children. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:537-538. [PMID: 34051141 DOI: 10.1016/s2352-4642(21)00158-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Lauren M Cohee
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Joaniter I Nankabirwa
- Makerere University College of Health Sciences and Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Abdoulaye Djimde
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Don P Mathanga
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
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11
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Yimgang DP, Buchwald AG, Coalson JE, Walldorf JA, Bauleni A, Kapito-Tembo A, Mathanga DP, Taylor TE, Laufer MK, Cohee LM. Population Attributable Fraction of Anemia Associated with P. falciparum Infection in Children in Southern Malawi. Am J Trop Med Hyg 2021; 104:1013-1017. [PMID: 33399043 DOI: 10.4269/ajtmh.20-1120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/16/2020] [Indexed: 01/09/2023] Open
Abstract
Anemia is a leading cause of morbidity in sub-Saharan Africa. The etiologies of anemia are multifactorial, and it is unclear what proportion of anemia is attributable to malaria in children of different ages in Malawi. We evaluated the population attributable fraction (PAF) of anemia due to malaria using multiple cross-sectional surveys in southern Malawi. We found a high prevalence of anemia, with the greatest proportion attributable to malaria among school-age children (5-15 years) in the rainy season (PAF = 18.8% [95% CI: 16.3, 21.0], compared with PAF = 5.2% [95% CI: 4.0, 6.2] among young children pooled across season [< 5 years] and PAF = 9.7% [95% CI: 6.5, 12.4] among school-age children in the dry season). Malaria control interventions will likely lead to decreases in anemia, especially among school-age children.
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Affiliation(s)
- Doris P Yimgang
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrea G Buchwald
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jenna E Coalson
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jenny A Walldorf
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Andy Bauleni
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Atupele Kapito-Tembo
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Don P Mathanga
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Terrie E Taylor
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Miriam K Laufer
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lauren M Cohee
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
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12
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Coalson JE, Santos EM, Little AC, Anderson EJ, Stroupe N, Agawo M, Hayden M, Munga S, Ernst KC. Insufficient Ratio of Long-Lasting Insecticidal Nets to Household Members Limited Universal Usage in Western Kenya: A 2015 Cross-Sectional Study. Am J Trop Med Hyg 2020; 102:1328-1342. [PMID: 32314696 PMCID: PMC7941599 DOI: 10.4269/ajtmh.19-0119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 01/22/2020] [Indexed: 11/07/2022] Open
Abstract
Universal "coverage" with long-lasting insecticidal nets (LLINs) is recommended for malaria control in endemic areas, but ownership does not ensure usage. We evaluated relationships between household-level ownership and individual-level usage in western Kenya in 2015. Low-prevalence highland (> 1,500 m) and highly endemic lowland (< 1,200 m) sites were surveyed from July to August 2015. Household members reported long-lasting insecticidal net ownership, use, and barriers to use. Net ownership was categorized as sufficient (≤ 2 people/net), insufficient (> 2 people/net), or none. Each LLIN was assumed to provide access to two people. We surveyed 574 lowland and 643 highland households, with 1,677 and 2,742 members, respectively. More than 98% of lowland households owned LLIN(s); 72.1% owned a sufficient number. Only 37.5% of highland households had sufficient nets. More people used LLINs than were estimated to have access in the lowlands (94.2% versus 85.3%), but proportions were similar in the highlands (54.3% versus 53.3%). Insufficient ownership was most common for larger households in both areas and strongly predicted LLIN usage. In households with insufficient nets, men, school-age children (aged 5-15 years), and nonnuclear family members were less likely to use LLINs; only relationship to the head of the household significantly predicted use in households with sufficient nets. Long-lasting insecticidal nets were widespread in western Kenya in 2015, but insufficient household ownership remained common in the epidemic highlands and in large households. Access seemed to be the primary driver of individual use. To interrupt transmission, LLIN campaigns should improve distribution to large households and promote use among men, school-age children, and nonnuclear family members.
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Affiliation(s)
- Jenna E. Coalson
- Center for Insect Science, University of Arizona, Tucson, Arizona
| | - Ellen M. Santos
- College of Public Health, University of Arizona, Tucson, Arizona
| | - Ashley C. Little
- College of Public Health, University of Arizona, Tucson, Arizona
| | | | - Nancy Stroupe
- College of Public Health, University of Arizona, Tucson, Arizona
| | | | - Mary Hayden
- Trauma, Health and Hazards Center, University of Colorado Colorado Springs, Colorado Springs, Colorado
| | | | - Kacey C. Ernst
- College of Public Health, University of Arizona, Tucson, Arizona
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13
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Halliday KE, Witek-McManus SS, Opondo C, Mtali A, Allen E, Bauleni A, Ndau S, Phondiwa E, Ali D, Kachigunda V, Sande JH, Jawati M, Verney A, Chimuna T, Melody D, Moestue H, Roschnik N, Brooker SJ, Mathanga DP. Impact of school-based malaria case management on school attendance, health and education outcomes: a cluster randomised trial in southern Malawi. BMJ Glob Health 2020; 5:e001666. [PMID: 32133163 PMCID: PMC7042571 DOI: 10.1136/bmjgh-2019-001666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Evidence indicates children who suffer from ill-health are less likely to attend or complete schooling. Malaria is an important cause of morbidity and mortality in school-age children. However, they are less likely to receive malaria treatment at health facilities and evidence for how to improve schoolchildren's access to care is limited. This study aimed to evaluate the impact of a programme of school-based malaria case management on schoolchildren's attendance, health and education. Methods A cluster randomised controlled trial was conducted in 58 primary schools in Zomba District, Malawi, 2011-2015. The intervention, implemented in 29 randomly selected schools, provided malaria rapid diagnostic tests and artemisinin-based combination therapy to diagnose and treat uncomplicated malaria as part of basic first aid kits known as 'Learner Treatment Kits' (LTK). The primary outcome was school attendance, assessed through teacher-recorded daily attendance registers and independent periodic attendance spot checks. Secondary outcomes included prevalence of Plasmodium spp infection, anaemia, educational performance, self-reported child well-being and health-seeking behaviour. A total of 9571 children from standards 1-7 were randomly selected for assessment of school attendance, with subsamples assessed for the secondary outcomes. Results Between November 2013 and March 2015, 97 trained teachers in 29 schools provided 32 685 unique consultations. Female schoolchildren were significantly more likely than male to seek a consultation (unadjusted OR=1.78 (95% CI 1.58 to 2.00). No significant intervention effect was observed on the proportion of child-days recorded as absent in teacher registers (n=9017 OR=0.90 (95% CI 0.77 to 1.05), p=0.173) or of children absent during random school visits-spot checks (n=5791 OR=1.09 (95% CI 0.87 to 1.36), p=0.474). There was no significant impact on child-reported well-being, prevalence of Plasmodium spp, anaemia or education scores. Conclusion Despite high community demand, the LTK programme did not reduce schoolchildren's absenteeism or improve health or education outcomes in this study setting. Trial registration number ClinicalTrials.gov NCT02213211.
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Affiliation(s)
- Katherine E Halliday
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Stefan S Witek-McManus
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | | | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Andrew Bauleni
- Malaria Alert Centre, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Saidi Ndau
- Zomba District Health Office, Ministry of Health, Zomba, Malawi
| | - Emmanuel Phondiwa
- District Education Office, Ministry of Education, Science and Technology, Zomba, Malawi
| | - Doreen Ali
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Virginia Kachigunda
- Department of School Health, Nutrition, HIV & AIDS, Ministry of Education, Science and Technology, Lilongwe, Malawi
| | - John H Sande
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | | | | | | | - David Melody
- Save the Children International, Lilongwe, Malawi
| | | | | | - Simon J Brooker
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Don P Mathanga
- Malaria Alert Centre, College of Medicine, University of Malawi, Blantyre, Malawi
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