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King M, George AE, Cisteró P, Tarr-Attia CK, Arregui B, Omeonga S, Chen H, Meyer García-Sípido A, Sarukhan A, Bassat Q, Lansana DP, Mayor A. No evidence of false-negative Plasmodium falciparum rapid diagnostic results in Monrovia, Liberia. Malar J 2021; 20:238. [PMID: 34039355 PMCID: PMC8157453 DOI: 10.1186/s12936-021-03774-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background Malaria diagnosis in many malaria-endemic countries relies mainly on the use of rapid diagnostic tests (RDTs). The majority of commercial RDTs used in Africa detect the Plasmodium falciparum histidine-rich protein 2 (PfHRP2). pfhrp2/3 gene deletions can therefore lead to false-negative RDT results. This study aimed to evaluate the frequency of PCR-confirmed, false-negative P. falciparum RDT results in Monrovia, Liberia. Methods PfHRP2-based RDT (Paracheck Pf®) and microscopy results from 1038 individuals with fever or history of fever (n = 951) and pregnant women at first antenatal care (ANC) visit (n = 87) enrolled in the Saint Joseph’s Catholic Hospital (Monrovia) from March to July 2019 were used to assess the frequency of false-negative RDT results. True–false negatives were confirmed by detecting the presence of P. falciparum DNA by quantitative PCR in samples from individuals with discrepant RDT and microscopy results. Samples that were positive by 18S rRNA qPCR but negative by PfHRP2-RDT were subjected to multiplex qPCR assay for detection of pfhrp2 and pfhrp3. Results One-hundred and eighty-six (19.6%) and 200 (21.0%) of the 951 febrile participants had a P. falciparum-positive result by RDT and microscopy, respectively. Positivity rate increased with age and the reporting of joint pain, chills and shivers, vomiting and weakness, and decreased with the presence of coughs and nausea. The positivity rate at first ANC visit was 5.7% (n = 5) and 8% (n = 7) by RDT and microscopy, respectively. Out of 207 Plasmodium infections detected by microscopy, 22 (11%) were negative by RDT. qPCR confirmed absence of P. falciparum DNA in the 16 RDT-negative but microscopy-positive samples which were available for molecular testing. Among the 14 samples that were positive by qPCR but negative by RDT and microscopy, 3 only amplified pfldh, and among these 3 all were positive for pfhrp2 and pfhrp3. Conclusion There is no qPCR-confirmed evidence of false-negative RDT results due to pfhrp2/pfhrp3 deletions in this study conducted in Monrovia (Liberia). This indicates that these deletions are not expected to affect the performance of PfHRP2-based RDTs for the diagnosis of malaria in Liberia. Nevertheless, active surveillance for the emergence of PfHRP2 deletions is required.
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Affiliation(s)
- Mandella King
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo, Town, PO Box 10512, 1100, Monrovia, Liberia
| | - Alexander E George
- Liberia Medicines & Health Products Regulatory Authority, VP Road, Old Road, Sinkor , PO Box 1994, Monrovia, Liberia
| | - Pau Cisteró
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Carrer Rosselló 153 (CEK Building), 08036, Barcelona, Spain
| | - Christine K Tarr-Attia
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo, Town, PO Box 10512, 1100, Monrovia, Liberia
| | - Beatriz Arregui
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Carrer Rosselló 153 (CEK Building), 08036, Barcelona, Spain
| | - Senga Omeonga
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo, Town, PO Box 10512, 1100, Monrovia, Liberia
| | - Haily Chen
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Carrer Rosselló 153 (CEK Building), 08036, Barcelona, Spain
| | | | - Adelaida Sarukhan
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Carrer Rosselló 153 (CEK Building), 08036, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Carrer Rosselló 153 (CEK Building), 08036, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues,, Barcelona, Spain
| | - Dawoh Peter Lansana
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo, Town, PO Box 10512, 1100, Monrovia, Liberia
| | - Alfredo Mayor
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Carrer Rosselló 153 (CEK Building), 08036, Barcelona, Spain. .,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique. .,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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Mayor A, Martínez-Pérez G, Tarr-Attia CK, Breeze-Barry B, Sarukhan A, García-Sípido AM, Hurtado JC, Lansana DP, Casamitjana N. Training through malaria research: building capacity in good clinical and laboratory practice in Liberia. Malar J 2019; 18:136. [PMID: 30999908 PMCID: PMC6471755 DOI: 10.1186/s12936-019-2767-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/04/2019] [Indexed: 11/20/2022] Open
Abstract
Background Limited health research capacities (HRC) undermine a country’s ability to identify and adequately respond to local health needs. Although numerous interventions to strengthen HRC have been conducted in Africa, there is a need to share the lessons learnt by funding organizations, institutes and researchers. The aim of this report is to identify best practices in HRC strengthening by describing a training programme conducted between 2016 and 2017 at the Saint Joseph’s Catholic Hospital (SJCH) in Monrovia (Liberia). Methods A call for trainees was launched at the SJCH, the Liberia Medicines and Health Products Regulatory Authority (LMHRA), the Ministry of Health and Social Welfare, the Mother Pattern College of Health Sciences (MPCHS) and community members. Selected trainees participated in four workshops on Good Clinical Laboratory Practice (GCLP), standard operating procedures (SOP) and scientific communication, as well as in a 5-months eLearning mentoring programme. After the training, a collectively-designed research project on malaria was conducted. Results Twenty-one of the 28 trainees (14 from the SJCH, 3 from LMHRA, one from MPCHS, and 10 community representatives) completed the programme satisfactorily. Pre- and post-training questionnaires completed by 9 of the trainees showed a 14% increase in the percentage of correct answers. Trainees participated in a mixed-methods cross-sectional study of Plasmodium falciparum infection among pregnant women at the SJCH. Selected trainees disseminated activities and research outcomes in three international meetings and three scientific publications. Conclusion This training-through-research programme successfully involved SJCH staff and community members in a practical research exercise on malaria during pregnancy. The challenge is to ensure that the SJCH remains active in research. Harmonization of effectiveness indicators for HRC initiatives would strengthen the case for investing in such efforts. Electronic supplementary material The online version of this article (10.1186/s12936-019-2767-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alfredo Mayor
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
| | | | | | | | - Adelaida Sarukhan
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Núria Casamitjana
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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Tarr-Attia CK, Bassat Q, Breeze-Barry B, Lansana DP, Meyer García-Sípido A, Sarukhan A, Maixenchs M, Mayor A, Martínez-Pérez G. Community-informed research on malaria in pregnancy in Monrovia, Liberia: a grounded theory study. Malar J 2018; 17:382. [PMID: 30352592 PMCID: PMC6199789 DOI: 10.1186/s12936-018-2529-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/15/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Liberia is a West African country that needs substantial investment to strengthen its National Malaria Control Programme (NMCP), which was disrupted during the 2014-2016 Ebola epidemic. As elsewhere, Liberian pregnant women are especially vulnerable to malaria. Understanding prevention and treatment-seeking behaviours among the population is crucial to strategize context-specific and women-centred actions, including locally-led malaria research, to improve women's demand, access and use of NMCP strategies against malaria in pregnancy. METHODS In 2016, after the Ebola crisis, a qualitative inquiry was conducted in Monrovia to explore populations' insights on the aetiology, prevention and therapeutics of malaria, as well as the community and health workers' perceptions on the utility of malaria research for pregnant women. In-depth interviews and focus group discussions were conducted among pregnant women, traditional community representatives and hospital staff (n = 38), using a feminist interpretation of grounded theory. RESULTS The narratives indicate that some Liberians believed in elements other than mosquito bites as causes of malaria; many had a low malaria risk perception and disliked current effective prevention methods, such as insecticide-treated nets; and some would resort to traditional medicine and spiritual care to cure malaria. Access to clinic-based malaria care for pregnant women was reportedly hindered by lack of financial means, by unofficial user fees requested by healthcare workers, and by male partners' preference for traditional medicine. The participants suggested that malaria research in Liberia could help to design evidence-based education to change current malaria prevention, diagnostic and treatment-seeking attitudes, and to develop more acceptable prevention technologies. CONCLUSION Poverty, insufficient education on malaria, corruption, and poor trust in healthcare establishment are structural factors that may play a greater role than local traditional beliefs in deterring Liberians from seeking, accessing and using government-endorsed malaria control strategies. To increase access to and uptake of preventive and biomedical care by pregnant women, future malaria research must be informed by people's expressed needs and constructed meanings and values on health, ill health and healthcare.
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Affiliation(s)
- Christine K Tarr-Attia
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Barcelona, Spain
- Hospital San Joan de Déu, Barcelona, Spain
| | - Bondey Breeze-Barry
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Dawoh Peter Lansana
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | | | - Adelaida Sarukhan
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Guillermo Martínez-Pérez
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia.
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
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Martínez-Pérez G, Lansana DP, Omeonga S, Gupta H, Breeze-Barry B, González R, Bardají A, Sarukhan A, Goteh JDK, Tody E, Cisteró P, Benda B, Kercula JD, Kibungu FD, Meyer García-Sípido A, Bassat Q, Tarr-Attia CK, Mayor A. Prevalence of Plasmodium falciparum infection among pregnant women at first antenatal visit in post-Ebola Monrovia, Liberia. Malar J 2018; 17:357. [PMID: 30314489 PMCID: PMC6186138 DOI: 10.1186/s12936-018-2506-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 10/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disruption of malaria control strategies during the West African 2014-2016 Ebola epidemic led to an increase in malaria-attributable mortality. However, recent data on malaria infection in vulnerable groups, such as pregnant women, are lacking in this post-Ebola scenario. This cross-sectional study aimed to assess the prevalence of Plasmodium falciparum infection and of molecular markers of drug resistance among pregnant women attending antenatal care in Monrovia, capital of Liberia. METHODS From October 2016 to June 2017, all pregnant women attending their first antenatal care visit at the Saint Joseph's Catholic Hospital, Monrovia, were invited to participate in the study. In addition to their routine antenatal care tests, capillary blood spotted onto filter papers were collected from all consenting participants to determine presence of P. falciparum by real-time quantitative PCR. Molecular markers of anti-malarial drug resistance were assessed through Sanger sequencing and quantitative PCR in specimens positive for P. falciparum analysis. RESULTS Of the 195 women participants, 24 (12.3%) were P. falciparum-positive by qPCR. Infected women tended to be more commonly primigravidae and younger than uninfected ones. Parasite densities were higher in primigravidae. Fever was more frequently detected among the infected women. No statistically significant association between P. falciparum infection and haemoglobin levels or insecticide-treated net use was found. While high prevalence of genetic polymorphisms associated with chloroquine and amodiaquine resistance were detected, no molecular markers of artemisinin resistance were observed. CONCLUSION Plasmodium falciparum infections are expected to occur in at least one in every eight women attending first ANC at private clinics in Monrovia and outside the peak of the rainy season. Young primigravidae are at increased risk of P. falciparum infection. Molecular analyses did not provide evidence of resistance to artemisinins among the P. falciparum isolates tested. Further epidemiological studies involving pregnant women are necessary to describe the risk of malaria in this highly susceptible group outside Monrovia, as well as to closely monitor the emergence of resistance to anti-malarials, as recommended by the Liberian National Malaria Control Programme.
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Affiliation(s)
- Guillermo Martínez-Pérez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain. .,Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia.
| | - Dawoh Peter Lansana
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Senga Omeonga
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Himanshu Gupta
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Bondey Breeze-Barry
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Raquel González
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Adelaida Sarukhan
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - James D K Goteh
- Liberia Medicines and Health Products Regulatory Authority, Monrovia, Liberia
| | - Edith Tody
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Pau Cisteró
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Benard Benda
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Juwe D Kercula
- Liberia Medicines and Health Products Regulatory Authority, Monrovia, Liberia
| | - Fanta D Kibungu
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | | | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatrics Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Christine K Tarr-Attia
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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Martínez Pérez G, Tarr-Attia CK, Breeze-Barry B, Sarukhan A, Lansana DP, Meyer García-Sípido A, Rosés A, Maixenchs M, Bassat Q, Mayor A. 'Researchers have love for life': opportunities and barriers to engage pregnant women in malaria research in post-Ebola Liberia. Malar J 2018; 17:132. [PMID: 29606141 PMCID: PMC5880008 DOI: 10.1186/s12936-018-2292-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adoption of prevention and therapeutic innovations to ensure that National Malaria Control Programmes meet their incidence reduction targets is highly dependent on the conduct of rigorous clinical trials. In Liberia, malaria control virtually halted during the recent Ebola epidemic, and could enormously benefit from innovations to protect its most vulnerable populations, including pregnant women, against malaria. Health policy-planners could feel more inclined to adopt novel interventions with demonstrated safety and efficacy when trialled among their women population. However, pregnant women are especially vulnerable when targeted as research participants. Whilst some studies in the region attempted to understand the ethical issues around the conduct of clinical research, there is need of such information from Liberia to inform future malaria research. METHODS This is a grounded theory study that aims to understand the barriers and opportunities for pregnant women to consent to participate in malaria research in Liberia. The study was conducted between November 2016 and May 2017 at the St Joseph's Catholic Hospital, Monrovia. In-depth interviews and focus group discussions were held with hospital staff, traditional community representatives, and pregnant women. RESULTS According to the participants, useful strategies to motivate pregnant women to consent to participate in malaria research could be providing evidence-based education on malaria and research to the general population and encouraging engagement of traditional leaders in research design and community mobilization. Fears and suspicions towards research and researchers, which were amplified during the conduct of Ebola vaccine and drug clinical trials, may influence women's acceptance and willingness to engage in malaria research. Population's mistrust in the public healthcare system might hinder their acceptance of research, undermining the probability of their benefiting from any improved malaria control intervention. CONCLUSION Benchmarking for acceptable practices from previous public health interventions; building community discussion and dissemination platforms; and mapping communication and information errors from how previous research interventions were explained to the Liberian population, are strategies that might help ensure a safe and fully informed participation of pregnant women in malaria research. Inequity issues impeding access and use of biomedical care for women must be tackled urgently.
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Affiliation(s)
- Guillermo Martínez Pérez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. .,Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia.
| | - Christine K Tarr-Attia
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Bondey Breeze-Barry
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Adelaida Sarukhan
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Dawoh Peter Lansana
- Saint Joseph's Catholic Hospital, Tubman Boulevard, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | | | - Anna Rosés
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - María Maixenchs
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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