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Quaye IK, Aleksenko L, Paganotti GM, Peloewetse E, Haiyambo DH, Ntebela D, Oeuvray C, Greco B. Malaria Elimination in Africa: Rethinking Strategies for Plasmodium vivax and Lessons from Botswana. Trop Med Infect Dis 2023; 8:392. [PMID: 37624330 PMCID: PMC10458071 DOI: 10.3390/tropicalmed8080392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
The global malaria community has picked up the theme of malaria elimination in more than 90% of the world's population in the next decade. Recent reports of Plasmodium vivax (P. vivax) in sub-Saharan Africa, including in Duffy-negative individuals, threaten the efforts aimed at achieving elimination. This is not only in view of strategies that are tailored only to P. falciparum elimination but also due to currently revealed biological characteristics of P. vivax concerning the relapse patterns of hypnozoites and conservation of large biomasses in cryptic sites in the bone marrow and spleen. A typical scenario was observed in Botswana between 2008 and 2018, which palpably projects how P. vivax could endanger malaria elimination efforts where the two parasites co-exist. The need for the global malaria community, national malaria programs (NMPs), funding agencies and relevant stakeholders to engage in a forum to discuss and recommend clear pathways for elimination of malaria, including P. vivax, in sub-Saharan Africa is warranted.
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Affiliation(s)
- Isaac K. Quaye
- Pan African Vivax and Ovale Network, Faculty of Engineering Computer and Allied Sciences, Regent University College of Science and Technology, #1 Regent Ave, McCarthy Hill, Mendskrom, Dansoman, Accra P.O. Box DS1636, Ghana
| | - Larysa Aleksenko
- Department of Health Sciences, School of Public Health, College of Health, Medicine and Life Sciences, Brunel University, Kingston Lane, Uxbridge, Middlesex, London UB8 3PH, UK;
| | - Giacomo M. Paganotti
- Botswana-University of Pennsylvania Partnership, Riverwalk, Gaborone P.O. Box 45498, Botswana;
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Elias Peloewetse
- Department of Biological Sciences, Faculty of Sciences, University of Botswana, Gaborone Private Bag 00704, Botswana;
| | - Daniel H. Haiyambo
- Department of Human, Biological and Translational Medical Sciences, Faculty of Health Sciences and Veterinary Medicine, University of Namibia School of Medicine, Hage Geingob Campus, Windhoek Private Bag 13301, Namibia;
| | - Davies Ntebela
- National Malaria Program, Ministry of Health, Gaborone Private Bag 0038, Botswana;
| | - Claude Oeuvray
- Global Health Institute of Merck, Terre Bonne Building Z0, Route de Crassier 1, Eysin, 1266 Geneva, Switzerland; (C.O.); (B.G.)
| | - Beatrice Greco
- Global Health Institute of Merck, Terre Bonne Building Z0, Route de Crassier 1, Eysin, 1266 Geneva, Switzerland; (C.O.); (B.G.)
| | - the PAVON Consortium
- PAVON, Regent University College of Science and Technology, #1 Regent Avenue, McCarthy Hiil, Mendskrom, Dansoman, Accra P.O. Box DS1636, Ghana
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Oyegoke OO, Maharaj L, Akoniyon OP, Kwoji I, Roux AT, Adewumi TS, Maharaj R, Oyebola BT, Adeleke MA, Okpeku M. Malaria diagnostic methods with the elimination goal in view. Parasitol Res 2022; 121:1867-1885. [PMID: 35460369 PMCID: PMC9033523 DOI: 10.1007/s00436-022-07512-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/01/2022] [Indexed: 01/08/2023]
Abstract
Malaria control measures have been in use for years but have not completely curbed the spread of infection. Ultimately, global elimination is the goal. A major playmaker in the various approaches to reaching the goal is the issue of proper diagnosis. Various diagnostic techniques were adopted in different regions and geographical locations over the decades, and these have invariably produced diverse outcomes. In this review, we looked at the various approaches used in malaria diagnostics with a focus on methods favorably used during pre-elimination and elimination phases as well as in endemic regions. Microscopy, rapid diagnostic testing (RDT), loop-mediated isothermal amplification (LAMP), and polymerase chain reaction (PCR) are common methods applied depending on prevailing factors, each with its strengths and limitations. As the drive toward the elimination goal intensifies, the search for ideal, simple, fast, and reliable point-of-care diagnostic tools is needed more than ever before to be used in conjunction with a functional surveillance system supported by the ideal vaccine.
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Affiliation(s)
- Olukunle O Oyegoke
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Leah Maharaj
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Oluwasegun P Akoniyon
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Illiya Kwoji
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Alexandra T Roux
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Taiye S Adewumi
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Rajendra Maharaj
- Office of Malaria Research, Medical Research Council, Durban, South Africa
| | | | - Matthew A Adeleke
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Moses Okpeku
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa.
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Ndlovu K, Mauco KL, Keetile M, Kadimo K, Senyatso RY, Ntebela D, Valela B, Murambi C. Acceptance of the District Health Information System Version 2 Platform for Malaria Case-Based Surveillance By Health Care Workers in Botswana: Web-Based Survey. JMIR Form Res 2022; 6:e32722. [PMID: 35289760 PMCID: PMC8965668 DOI: 10.2196/32722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/26/2021] [Accepted: 12/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background
Similar to many low- and middle-income countries, Botswana has identified eHealth as a means of improving health care service provision and delivery. The National Malaria Programme (NMP) in Botswana has implemented the District Health Information System version 2 (DHIS2) to support timely malaria case reporting across its 27 health districts; however, the implementation of an eHealth system is never without challenges. Barriers to the implementation of eHealth innovations within health care settings may arise at the individual or organizational levels. As such, the evaluation of user perceptions of the technology is an important step that can inform its sustainable implementation. The DHIS2 was implemented without evaluating user perceptions beforehand; therefore, the Botswana Ministry of Health and Wellness was uncertain about the likelihood of acceptance and use of the platform.
Objective
We aimed to determine the acceptance of the DHIS2 platform by the NMP in Botswana to gauge whether adoption would be successful.
Methods
The study’s design was informed by constructs of the technology acceptance model. A survey, with items assessed using a 7-point Likert scale, and focus group discussions were undertaken with DHIS2 core users from 27 health districts and NMP personnel at the Ministry of Health and Wellness. The web-based survey was administered from August 3, 2020 to September 30, 2020.
Results
Survey participants were core users (n=27). Focus group participants were NMP personnel (n=5). Overall, participants’ survey responses (frequently occurring scores of 7) showed their confidence in the DHIS2 platform for case-based surveillance of malaria; however, participants also noted some organizational issues that could compromise user acceptance of the DHIS2 platform.
Conclusions
Participants’ responses indicated their acceptance of the DHIS2 platform; however, the consideration of factors related to organizational readiness could further enhance successful acceptance, and consequently, successful adoption of the platform by the malaria program in Botswana.
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Affiliation(s)
- Kagiso Ndlovu
- Department of Computer Science, Faculty of Science, University of Botswana, Gaborone, Botswana
| | - Kabelo Leonard Mauco
- Department of Health Information Management, Faculty of Health and Education, Botho University, Gaborone, Botswana
| | - Mpho Keetile
- Department of Population Studies, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
| | - Khutsafalo Kadimo
- Department of Library Services, University of Botswana, Gaborone, Botswana
| | | | - Davies Ntebela
- National Malaria Programme, Ministry of Health and Wellness, Gaborone, Botswana
| | - Buthugwashe Valela
- National Malaria Programme, Ministry of Health and Wellness, Gaborone, Botswana
| | - Clement Murambi
- National Malaria Programme, Ministry of Health and Wellness, Gaborone, Botswana
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Okiring J, Epstein A, Namuganga JF, Kamya V, Sserwanga A, Kapisi J, Ebong C, Kigozi SP, Mpimbaza A, Wanzira H, Briggs J, Kamya MR, Nankabirwa JI, Dorsey G. Relationships between test positivity rate, total laboratory confirmed cases of malaria, and malaria incidence in high burden settings of Uganda: an ecological analysis. Malar J 2021; 20:42. [PMID: 33441121 PMCID: PMC7805073 DOI: 10.1186/s12936-021-03584-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/07/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Malaria surveillance is critical for monitoring changes in malaria morbidity over time. National Malaria Control Programmes often rely on surrogate measures of malaria incidence, including the test positivity rate (TPR) and total laboratory confirmed cases of malaria (TCM), to monitor trends in malaria morbidity. However, there are limited data on the accuracy of TPR and TCM for predicting temporal changes in malaria incidence, especially in high burden settings. METHODS This study leveraged data from 5 malaria reference centres (MRCs) located in high burden settings over a 15-month period from November 2018 through January 2020 as part of an enhanced health facility-based surveillance system established in Uganda. Individual level data were collected from all outpatients including demographics, laboratory test results, and village of residence. Estimates of malaria incidence were derived from catchment areas around the MRCs. Temporal relationships between monthly aggregate measures of TPR and TCM relative to estimates of malaria incidence were examined using linear and exponential regression models. RESULTS A total of 149,739 outpatient visits to the 5 MRCs were recorded. Overall, malaria was suspected in 73.4% of visits, 99.1% of patients with suspected malaria received a diagnostic test, and 69.7% of those tested for malaria were positive. Temporal correlations between monthly measures of TPR and malaria incidence using linear and exponential regression models were relatively poor, with small changes in TPR frequently associated with large changes in malaria incidence. Linear regression models of temporal changes in TCM provided the most parsimonious and accurate predictor of changes in malaria incidence, with adjusted R2 values ranging from 0.81 to 0.98 across the 5 MRCs. However, the slope of the regression lines indicating the change in malaria incidence per unit change in TCM varied from 0.57 to 2.13 across the 5 MRCs, and when combining data across all 5 sites, the R2 value reduced to 0.38. CONCLUSIONS In high malaria burden areas of Uganda, site-specific temporal changes in TCM had a strong linear relationship with malaria incidence and were a more useful metric than TPR. However, caution should be taken when comparing changes in TCM across sites.
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Affiliation(s)
- Jaffer Okiring
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Adrienne Epstein
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Jane F Namuganga
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Victor Kamya
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Asadu Sserwanga
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - James Kapisi
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Chris Ebong
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Simon P Kigozi
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Arthur Mpimbaza
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | | | - Jessica Briggs
- Department of Medicine, University of California, San Francisco, USA
| | - Moses R Kamya
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joaniter I Nankabirwa
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, USA
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Buxton M, Wasserman RJ, Nyamukondiwa C. Spatial Anopheles arabiensis (Diptera: Culicidae) insecticide resistance patterns across malaria-endemic regions of Botswana. Malar J 2020; 19:415. [PMID: 33213466 PMCID: PMC7678117 DOI: 10.1186/s12936-020-03487-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/09/2020] [Indexed: 12/25/2022] Open
Abstract
Background Since the advent of the Green Revolution, pesticides have played an important role in the global management of invertebrate pests including vector mosquitoes. Despite optimal efficacy, insects often display insensitivity to synthetic insecticides owing to prolonged exposure that may select for resistance development. Such insecticide insensitivity may regress national and regional coordination in mosquito vector management and indeed malaria control. In Botswana, prolonged use of synthetic insecticides against malaria vectors have been practiced without monitoring of targeted mosquito species susceptibility status. Methods Here, susceptibility status of a malaria vector (Anopheles arabiensis), was assessed against World Health Organization-recommended insecticides, across three malaria endemic districts. Adult virgin female mosquitoes (2–5 days old) emerging from wild-collected larvae were exposed to standardized insecticide-impregnated papers with discriminating doses. Results The results showed resistance dynamics were variable in space, presumably as a result of spatial differences in insecticide use across malaria endemic districts and the types of insecticides used in the country. Overall, there was a reduced susceptibility of An. arabiensis for the pyrethroid lambda-cyhalothrin and for dichloro diphenyl trichloroethane [DDT], which have similar modes of action and have been used in the country for many years. The Okavango district exhibited the greatest reduction in susceptibility, followed by Ngamiland and then Bobirwa, reflective of national intervention strategy spraying intensities. Vector mosquitoes were, however, highly susceptible to carbamates and organophosphates irrespective of region. Conclusions These results provide important findings of vector susceptibility to insecticides recommended for vector control. The results highlight the need to implement insecticide application regimes that more effectively including regionally integrated resistance management strategies for effective malaria control and elimination.
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Affiliation(s)
- Mmabaledi Buxton
- Department of Biological Sciences and Biotechnology, Botswana International University of Science and Technology, Palapye, Botswana
| | - Ryan J Wasserman
- Department of Biological Sciences and Biotechnology, Botswana International University of Science and Technology, Palapye, Botswana.,Department of Zoology and Entomology, Rhodes University, Makhanda, 6140, South Africa
| | - Casper Nyamukondiwa
- Department of Biological Sciences and Biotechnology, Botswana International University of Science and Technology, Palapye, Botswana.
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6
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Bango ZA, Tawe L, Muthoga CW, Paganotti GM. Past and current biological factors affecting malaria in the low transmission setting of Botswana: A review. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2020; 85:104458. [PMID: 32668367 PMCID: PMC7354381 DOI: 10.1016/j.meegid.2020.104458] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022]
Abstract
Malaria continues to be one of the top infectious agents contributing to morbidity and mortality in sub-Saharan Africa. Annually, Botswana accounts only for a small proportion of cases (<<1%). Despite significantly reduced incidence rate, the country still experiences sporadic outbreaks that hamper the goal of malaria elimination. This review evaluated previous and current biological factors that impact malaria in Botswana, specifically focussing on the vectors, the parasite and the host. This was accomplished via a literature review evaluating these variables in Botswana. Current literature suggests that Anopheles arabiensis is the main malaria vector in the country. Several other potential vectors have been found widely distributed throughout Botswana in high numbers, yet remain largely unstudied with regards to their contribution to the country's malaria burden. We also report the most up to date list of all Anopheles species that have been found in Botswana. Plasmodium falciparum is responsible for the vast majority of symptomatic malaria in the country and some drug resistance markers have been documented for this species. Plasmodium vivax has been reported in asymptomatic subjects, even though a large proportion of the Botswana population appears to be Duffy antigen negative. Very little is known about the true distribution of P. vivax and no point of care testing infrastructure for this species exists in Botswana, making it difficult to tailor treatment to address possible recrudescence or relapse. Due to a genetically diverse population with a substantial Khoisan contribution into the Bantu genetic background, several phenotypes that potentially impact prevalence and severity of malaria exist within the country. These include sickle cell trait, Glucose-6-Phosphate Dehydrogenase deficiency, and Duffy negativity. This review highlights the information that currently exists on malaria in Botswana. It also postulates that a comprehensive understanding of these aforementioned biological factors may help to explain malaria persistence in Botswana.
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Affiliation(s)
| | - Leabaneng Tawe
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | | | - Giacomo Maria Paganotti
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, PA, USA; Department of Biomedical Sciences, University of Botswana, Gaborone, Botswana.
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Vector control for malaria elimination in Botswana: progress, gaps and opportunities. Malar J 2020; 19:301. [PMID: 32843037 PMCID: PMC7449088 DOI: 10.1186/s12936-020-03375-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/13/2020] [Indexed: 12/29/2022] Open
Abstract
Botswana has in the recent past 10 years made tremendous progress in the control of malaria and this informed re-orientation from malaria control to malaria elimination by the year 2020. This progress is attributed to improved case management, and scale-up of key vector control interventions; indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs). However, insecticide resistance, outdoor biting and resting, and predisposing human behaviour, such as staying outdoors or sleeping outdoors without the use of protective measures, pose a challenge to the realization of the full impact of LLINs and IRS. This, together with the paucity of entomological data, inadequate resources and weak community participation for vector control programme implementation delayed attainment of Botswana’s goal of malaria elimination. Also, the Botswana National Malaria Programme (NMP) experiences the lack of intersectoral collaborations and operational research for evidence-based decision making. This case study focuses on the vector control aspect of malaria elimination by identifying challenges and explores opportunities that could be taken advantage of to benefit the NMP to optimize and augment the current vector control interventions to achieve malaria elimination by the year 2030 as per the Global Technical Strategy for Malaria 2016–2030 targets. The authors emphasize the need for timely and quality entomological surveillance, operational research and integrated vector management.
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Quality evaluation of malaria diagnosis in the local laboratories network and in intermediate laboratories in a setting towards the disease elimination in Ecuador. ACTA ACUST UNITED AC 2019; 39:101-116. [PMID: 31529838 DOI: 10.7705/biomedica.v39i4.4686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Indexed: 11/21/2022]
Abstract
Introduction: To reach the goal of malaria elimination in Ecuador for the year 2020, it is necessary to have a laboratory network with the capacity to perform microscopic diagnosis according to the WHO/PAHO quality standards and to provide the adequate treatment of cases.
Objective: To determine the level of competence for parasitological diagnosis of the microscopists from the local public network and the performance of intermediate reference laboratories.
Materials and methods: We conducted a cross-sectional study based on the information collected in workshops carried out to appraise the competence for microscopic diagnosis of the local laboratory network (zonal health coordinating offices 1 to 8) using a slide panel to evaluate diagnosis agreement, as well as the diagnostic performance of the intermediate laboratories using an external quality assessment program. The results were compared against the reference standards of the supranational laboratory in Perú.
Results: We evaluated the competencies of 191 microscopists in 11 workshops and 153 (80.1%) of them were approved. The medians of the indicators were the following: concordance for parasite detection, 100% (Q1- Q3: 96-100), concordance for species identification, 100% (Q1- Q3: 93-100), and concordances for stage identification, 93.0% (Q1- Q3: 86-95) and parasite counting, 77.0% (Q1- Q3: 71-82). In the external quality assessment, the three intermediate laboratories obtained 100% in parasite detection concordance and 96% for species detection concordance.
Conclusions: The results for the primary network and the performance indicators for the intermediate laboratories showed the high-quality standards of the training program implemented in the country.
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Twohig KA, Pfeffer DA, Baird JK, Price RN, Zimmerman PA, Hay SI, Gething PW, Battle KE, Howes RE. Growing evidence of Plasmodium vivax across malaria-endemic Africa. PLoS Negl Trop Dis 2019; 13:e0007140. [PMID: 30703083 PMCID: PMC6372205 DOI: 10.1371/journal.pntd.0007140] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/12/2019] [Accepted: 01/07/2019] [Indexed: 01/12/2023] Open
Abstract
Effective malaria control strategies require an accurate understanding of the epidemiology of locally transmitted Plasmodium species. Compared to Plasmodium falciparum infection, Plasmodium vivax has a lower asexual parasitaemia, forms dormant liver-stages (hypnozoites), and is more transmissible. Hence, treatment and diagnostic policies aimed exclusively at P. falciparum are far less efficient against endemic P. vivax. Within sub-Saharan Africa, malaria control programmes justly focus on reducing the morbidity and mortality associated with P. falciparum. However, the recent emphasis on malaria elimination and increased accessibility of more sensitive diagnostic tools have revealed greater intricacies in malaria epidemiology across the continent. Since 2010, the number of studies identifying P. vivax endemic to Africa has expanded considerably, with 88 new scientific reports published since a review of evidence in 2015, approximately doubling the available data. There is evidence of P. vivax in all regions of Africa, apparent from infected vectors, clinical cases, serological indicators, parasite prevalence, exported infections, and P. vivax-infected Duffy-negative individuals. Where the prevalence of microscopic parasitaemia is low, a greater proportion of P. vivax infections were observed relative to P. falciparum. This evidence highlights an underlying widespread presence of P. vivax across all malaria-endemic regions of Africa, further complicating the current practical understanding of malaria epidemiology in this region. Thus, ultimate elimination of malaria in Africa will require national malaria control programmes to adopt policy and practice aimed at all human species of malaria.
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Affiliation(s)
- Katherine A. Twohig
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom,* E-mail: (KAT); (REH)
| | - Daniel A. Pfeffer
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom,Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - J. Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta, Indonesia,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Peter A. Zimmerman
- The Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Peter W. Gething
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Katherine E. Battle
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rosalind E. Howes
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom,* E-mail: (KAT); (REH)
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Motshoge T, Ababio G, Aleksenko L, Souda S, Muthoga CW, Mutukwa N, Tawe L, Ramatlho P, Gabaitiri L, Chihanga S, Mosweunyane T, Hamda S, Moakofhi K, Ntebela D, Peloewetse E, Mazhani L, Pernica JM, Read J, Quaye IK, Paganotti GM. Prevalence of G6PD deficiency and associated haematological parameters in children from Botswana. INFECTION GENETICS AND EVOLUTION 2018; 63:73-78. [PMID: 29778768 DOI: 10.1016/j.meegid.2018.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 11/16/2022]
Abstract
Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is commonly seen in malaria endemic areas as it is known to confer a selective advantage against malaria. Recently, we reported a high proportion of asymptomatic reservoir of Plasmodium vivax in Botswana, that calls for intervention with primaquine to achieve radical cure of vivax malaria. Considering that individuals with this enzyme deficiency are at risk of haemolysis following primaquine treatment, assessment of the population for the relative frequency of G6PD deficiency is imperative. Samples from 3019 children from all the districts of Botswana were successfully genotyped for polymorphisms at positions 202 and 376 of the G6PD gene. Haematological parameters were also measured. The overall population allele frequency (based on the hemizygous male frequency) was 2.30% (95% CI, 1.77-2.83), while the overall frequency of G6PD-deficient genotypes A- (hemizygote and homozygote genotypes only) was 1.26% (95% CI, 0.86-1.66). G6PD deficiency is spread in Botswana according to the historical prevalence of malaria with a North-West to South-East decreasing gradient trend. There was no association between G6PD status and P. vivax infection. G6PD A- form was found to be associated with decreased RBC count and haemoglobin levels without a known cause or illness. In conclusion, we report for the first time the prevalence of G6PD deficiency in Botswana which is relevant for strategies in the malaria elimination campaign. Further work to examine the activities of the enzyme in the Botswana population at risk for malaria is warranted.
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Affiliation(s)
- Thato Motshoge
- Ministry of Health and Wellness, Private Bag 0038, Gaborone, Botswana; Department of Biological Sciences, University of Botswana, Private Bag 00704, Gaborone, Botswana
| | - Grace Ababio
- Department of Medical Biochemistry, University of Ghana, P.O. Box 143, Korle-Bu, Accra, Ghana
| | - Larysa Aleksenko
- Department of Pathology, University of Namibia, Private Bag 13301, Windhoek, Namibia; Department of Obstetrics and Gynaecology, Lund University, Kvinnokliniken, SUS, 221 85 Lund, Sweden
| | - Sajini Souda
- Department of Pathology, University of Botswana, Private Bag UB 713, Gaborone, Botswana
| | | | - Naledi Mutukwa
- Department of Pathology, University of Botswana, Private Bag UB 713, Gaborone, Botswana
| | - Leabaneng Tawe
- Department of Medical Laboratory Sciences, University of Botswana, Private Bag 00712, Gaborone, Botswana; Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE), Private Bag BO 320, Gaborone, Botswana
| | - Pleasure Ramatlho
- Department of Biological Sciences, University of Botswana, Private Bag 00704, Gaborone, Botswana
| | - Lesego Gabaitiri
- Department of Statistics, University of Botswana, Private Bag 00705, Gaborone, Botswana
| | - Simon Chihanga
- Ministry of Health and Wellness, Private Bag 0038, Gaborone, Botswana
| | | | - Shimeles Hamda
- Ministry of Health and Wellness, Private Bag 0038, Gaborone, Botswana; Department of Family Medicine and Public Health, University of Botswana, Private Bag 0022, Gaborone, Botswana
| | - Kentse Moakofhi
- World Health Organisation, Botswana country office, P.O. Box 1355, Gaborone, Botswana
| | - Davies Ntebela
- Ministry of Health and Wellness, Private Bag 0038, Gaborone, Botswana
| | - Elias Peloewetse
- Department of Biological Sciences, University of Botswana, Private Bag 00704, Gaborone, Botswana
| | - Loeto Mazhani
- Department of Pediatrics and Adolescent Health, University of Botswana, Private Bag 00713, Gaborone, Botswana
| | - Jeffrey M Pernica
- Department of Pediatrics, McMaster University, 1280 Main Street West, Room 3A, Hamilton, Ontario L8S 4K1, Canada
| | - John Read
- Department of Biomedical Sciences, University of Botswana, Private Bag 00713, Gaborone, Botswana
| | - Isaac Kweku Quaye
- Department of Biochemistry and Microbiology, University of Namibia, Private Bag 13301, Windhoek, Namibia
| | - Giacomo Maria Paganotti
- Botswana-University of Pennsylvania Partnership, P.O. Box AC 157, ACH, Gaborone, Botswana; Department of Biomedical Sciences, University of Botswana, Private Bag 00713, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard Building 421, Philadelphia, PA 19104, USA.
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11
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Whittaker M. To reach elimination one needs to think and act locally, to support the global vision. Public Health Action 2018; 8:S1-S2. [PMID: 29713585 DOI: 10.5588/pha.18.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Maxine Whittaker
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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