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Singh MP, Bharti PK, Rajvanshi H, Sahu RS, Jayswar H, Anvikar AR, Lal AA. Malaria elimination: situation analysis of cases in India, the state of Madhya Pradesh in central India, and district Mandla of Madhya Pradesh. Front Public Health 2024; 12:1363736. [PMID: 38655519 PMCID: PMC11035778 DOI: 10.3389/fpubh.2024.1363736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/11/2024] [Indexed: 04/26/2024] Open
Abstract
India contributed approximately 66% of the malaria cases in the WHO South-East Asia region in 2022. In India, approximately 44% of cases have been reported to be disproportionately contributed by approximately 27 districts. A comparative analysis of reported malaria cases between January 2017 and December 2022 was performed in Mandla district, which is the site of a model malaria elimination demonstration project (MEDP) in Madhya Pradesh (MP), India. Compared to 2017, the decrease in malaria cases in Mandla from 2018 to 2022 was higher than MP and the rest of the country. The reduction of cases was significant in 2018, 2019, and 2021 (p < 0.01) (Mandla vs. MP) and was highly significant during 2018-2022 (p < 0.001) (Mandla vs. India). Robust surveillance and real-time data-based decisions accompanied by appropriate management, operational controls, and independent reviews, all designed for resource optimisation, were the reasons for eliminating indigenous malaria in Mandla district. The increase in infection rates during the months immediately following rains suggests that surveillance, vector control, and case management efforts should be specifically intensified for eliminating imported and indigenous cases in the near-elimination districts to work towards achieving the national elimination goal of 2030.
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Affiliation(s)
- Mrigendra P. Singh
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Praveen K. Bharti
- Indian Council of Medical Research, National Institute of Malaria Research, New Delhi, India
| | - Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Ram S. Sahu
- Department of Health Services, Government of Madhya Pradesh, Mandla, Madhya Pradesh, India
| | - Himanshu Jayswar
- Directorate General of Health Services, Government of Madhya Pradesh, Bhopal, Madhya Pradesh, India
| | - Anup R. Anvikar
- Indian Council of Medical Research, National Institute of Malaria Research, New Delhi, India
| | - Altaf A. Lal
- Foundation for Disease Elimination and Control of India (FDEC India), Mumbai, Maharashtra, India
- Sun Pharmaceutical Industries Ltd., Mumbai, India
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Nain M, Dhorda M, Flegg JA, Gupta A, Harrison LE, Singh-Phulgenda S, Otienoburu SD, Harriss E, Bharti PK, Behera B, Rahi M, Guerin PJ, Sharma A. Systematic Review and Geospatial Modeling of Molecular Markers of Resistance to Artemisinins and Sulfadoxine-Pyrimethamine in Plasmodium falciparum in India. Am J Trop Med Hyg 2024:tpmd230631. [PMID: 38574550 DOI: 10.4269/ajtmh.23-0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/17/2023] [Indexed: 04/06/2024] Open
Abstract
Surveillance for genetic markers of resistance can provide valuable information on the likely efficacy of antimalarials but needs to be targeted to ensure optimal use of resources. We conducted a systematic search and review of publications in seven databases to compile resistance marker data from studies in India. The sample collection from the studies identified from this search was conducted between 1994 and 2020, and these studies were published between 1994 and 2022. In all, Plasmodium falciparum Kelch13 (PfK13), P. falciparum dihydropteroate synthase, and P. falciparum dihydrofolate reductase (PfDHPS) genotype data from 2,953, 4,148, and 4,222 blood samples from patients with laboratory-confirmed malaria, respectively, were extracted from these publications and uploaded onto the WorldWide Antimalarial Resistance Network molecular surveyors. These data were fed into hierarchical geostatistical models to produce maps with a predicted prevalence of the PfK13 and PfDHPS markers, and of the associated uncertainty. Zones with a predicted PfDHPS 540E prevalence of >15% were identified in central, eastern, and northeastern India. The predicted prevalence of PfK13 mutants was nonzero at only a few locations, but were within or adjacent to the zones with >15% prevalence of PfDHPS 540E. There may be a greater probability of artesunate-sulfadoxine-pyrimethamine failures in these regions, but these predictions need confirmation. This work can be applied in India and elsewhere to help identify the treatments most likely to be effective for malaria elimination.
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Affiliation(s)
- Minu Nain
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Mehul Dhorda
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Infectious Diseases Data Observatory, Oxford, United Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jennifer A Flegg
- School of Mathematics and Statistics, University of Melbourne, Parkville, Victoria, Australia
| | - Apoorv Gupta
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Lucinda E Harrison
- School of Mathematics and Statistics, University of Melbourne, Parkville, Victoria, Australia
| | - Sauman Singh-Phulgenda
- Infectious Diseases Data Observatory, Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sabina D Otienoburu
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Infectious Diseases Data Observatory, Oxford, United Kingdom
- College of STEM, Johnson C. Smith University, Charlotte, North Carolina
| | - Eli Harriss
- The Knowledge Centre, Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | | | - Beauty Behera
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Manju Rahi
- ICMR-National Institute of Malaria Research, New Delhi, India
- Indian Council of Medical Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh
| | - Philippe J Guerin
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Infectious Diseases Data Observatory, Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India
- Molecular Medicine, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Verma K, Chaturvedi R, Lahariya AK, Verma AK, Schneider KA, Anvikar AR, Bharti PK. Repurposing FDA-approved drugs to target malaria through inhibition of dihydrofolate reductase in the folate biosynthesis pathway: A prospective approach. J Cell Biochem 2024; 125:e30533. [PMID: 38345373 DOI: 10.1002/jcb.30533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 03/12/2024]
Abstract
Dihydrofolate reductase (DHFR) is a ubiquitous enzyme that regulates the biosynthesis of tetrahydrofolate among various species of Plasmodium parasite. It is a validated target of the antifolate drug pyrimethamine (Pyr) in Plasmodium falciparum (Pf), but its clinical efficacy has been hampered due to the emergence of drug resistance. This has made the attempt to screen Food & Drug Administration-approved drugs against wild- and mutant PfDHFR by employing an in-silico pipeline to identify potent candidates. The current study has followed a virtual screening approach for identifying potential DHFR inhibitors from DrugBank database, based on a structure similarity search of candidates, followed by absorption, distribution, metabolism, and excretion estimation. The screened drugs were subjected to various parameters like docking, molecular mechanics with generalized born and surface area solvation calculations, and molecular simulations. We have thus identified two potential drug candidates, duloxetine and guanethidine, which can be repurposed to be tested for their efficacy against wild type and drug resistant falciparum malaria.
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Affiliation(s)
- Kanika Verma
- Department of Molecular Epidemiology, National Institute of Malaria Research, New Delhi, India
| | - Rini Chaturvedi
- Structural Parasitology Lab, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush K Lahariya
- Division of Vector-Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Anil K Verma
- Division of Vector-Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Kristan A Schneider
- Department Applied Computer and Bio-Sciences, University of Applied Sciences, Mittweida, Germany
| | - Anup R Anvikar
- Department of Molecular Epidemiology, National Institute of Malaria Research, New Delhi, India
| | - Praveen K Bharti
- Department of Molecular Epidemiology, National Institute of Malaria Research, New Delhi, India
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Ahmad SS, Verma R, Commons RJ, Nitika, Singh-Phulgenda S, Chhajed R, Bharti PK, Behera B, Naser SM, Pal SK, Ranjit PH, Baharia RK, Solanki B, Upadhyay KJ, Guerin PJ, Sharma A, Price RN, Rahi M, Thriemer K. A randomised controlled trial to compare the efficacy, safety, and tolerability of low dose, short course primaquine in adults with uncomplicated P. vivax malaria in two hospitals in India. Trials 2024; 25:154. [PMID: 38424577 PMCID: PMC10905854 DOI: 10.1186/s13063-024-07987-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Plasmodium vivax remains a major challenge for malaria control and elimination due to its ability to cause relapsing illness. To prevent relapses the Indian National Center for Vector Borne Diseases Control (NCVBDC) recommends treatment with primaquine at a dose of 0.25 mg/kg/day provided over 14 days. Shorter treatment courses may improve adherence and treatment effectiveness. METHODS This is a hospital-based, randomised, controlled, open-label trial in two centres in India. Patients above the age of 16 years, with uncomplicated vivax malaria, G6PD activity of ≥ 30% of the adjusted male median (AMM) and haemoglobin levels ≥ 8 g/dL will be recruited into the study and randomised in a 1:1 ratio to receive standard schizonticidal treatment plus 7-day primaquine at 0.50 mg/kg/day or standard care with schizonticidal treatment plus 14-day primaquine at 0.25 mg/kg/day. Patients will be followed up for 6 months. The primary endpoint is the incidence risk of any P. vivax parasitaemia at 6 months. Safety outcomes include the incidence risk of severe anaemia (haemoglobin < 8 g/dL), the risk of blood transfusion, a > 25% fall in haemoglobin and an acute drop in haemoglobin of > 5 g/dL during primaquine treatment. DISCUSSION This study will evaluate the efficacy and safety of a 7-day primaquine regimen compared to the standard 14-day regimen in India. Results from this trial are likely to directly inform national treatment guidelines. TRIAL REGISTRATION Trial is registered on CTRI portal, Registration No: CTRI/2022/12/048283.
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Affiliation(s)
| | - Reena Verma
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Robert J Commons
- WorldWide Antimalarial Resistance Network, Asia-Pacific Regional Hub, Melbourne, Australia
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- General and Subspecialty Medicine, Grampians Health, Ballarat, Australia
| | - Nitika
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Sauman Singh-Phulgenda
- Infectious Diseases Data Observatory - IDDO, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - Rutuja Chhajed
- Infectious Diseases Data Observatory - IDDO, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | | | - Beauty Behera
- Delhi Skill and Entrepreneurship University, New Delhi, India
| | | | - Salil Kumar Pal
- Calcutta National Medical College, Kolkata, West Bengal, India
| | | | - Rajendra Kumar Baharia
- NIMR Field Unit, Academy of Scientific and Innovative Research, Ghaziabad, Gujarat, India
| | - Bhavin Solanki
- Ahmedabad Municipal Corporation, Ahmedabad, Gujarat, India
| | | | - Philippe J Guerin
- Infectious Diseases Data Observatory - IDDO, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - Amit Sharma
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Ric N Price
- WorldWide Antimalarial Resistance Network, Asia-Pacific Regional Hub, Melbourne, Australia
- 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, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Manju Rahi
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.
- Indian Council of Medical Research, New Delhi, India.
| | - Kamala Thriemer
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
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Singh MP, Rajvanshi H, Bharti PK, Anvikar AR, Lal AA. Time series analysis of malaria cases to assess the impact of various interventions over the last three decades and forecasting malaria in India towards the 2030 elimination goals. Malar J 2024; 23:50. [PMID: 38360708 PMCID: PMC10870538 DOI: 10.1186/s12936-024-04872-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Despite the progress made in this decade towards malaria elimination, it remains a significant public health concern in India and many other countries in South Asia and Asia Pacific region. Understanding the historical trends of malaria incidence in relation to various commodity and policy interventions and identifying the factors associated with its occurrence can inform future intervention strategies for malaria elimination goals. METHODS This study analysed historical malaria cases in India from 1990 to 2022 to assess the annual trends and the impact of key anti-malarial interventions on malaria incidence. Factors associated with malaria incidence were identified using univariate and multivariate linear regression analyses. Generalized linear, smoothing, autoregressive integrated moving averages (ARIMA) and Holt's models were used to forecast malaria cases from 2023 to 2030. RESULTS The reported annual malaria cases in India during 1990-2000 were 2.38 million, which dropped to 0.73 million cases annually during 2011-2022. The overall reduction from 1990 (2,018,783) to 2022 (176,522) was 91%. The key interventions of the Enhanced Malaria Control Project (EMCP), Intensified Malaria Control Project (IMCP), use of bivalent rapid diagnostic tests (RDT-Pf/Pv), artemisinin-based combination therapy (ACT), and involvement of the Accredited Social Health Activists (ASHAs) as front-line workers were found to result in the decline of malaria significantly. The ARIMA and Holt's models projected a continued decline in cases with the potential for reaching zero indigenous cases by 2027-2028. Important factors influencing malaria incidence included tribal population density, literacy rate, health infrastructure, and forested and hard-to-reach areas. CONCLUSIONS Studies aimed at assessing the impact of major commodity and policy interventions on the incidence of disease and studies of disease forecasting will inform programmes and policymakers of steps needed during the last mile phase to achieve malaria elimination. It is proposed that these time series and disease forecasting studies should be performed periodically using granular (monthly) and meteorological data to validate predictions of prior studies and suggest any changes needed for elimination efforts at national and sub-national levels.
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Affiliation(s)
- Mrigendra P Singh
- Foundation for Disease Elimination and Control of India, Mumbai, India
| | - Harsh Rajvanshi
- Foundation for Disease Elimination and Control of India, Mumbai, India
- Asia Pacific Leaders' Malaria Alliance, Singapore, Singapore
| | - Praveen K Bharti
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
| | - Anup R Anvikar
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
| | - Altaf A Lal
- Foundation for Disease Elimination and Control of India, Mumbai, India.
- Sun Pharmaceutical Industries Ltd, Mumbai, India.
- Global Health and Pharmaceuticals, Inc, Atlanta, GA, USA.
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Rajvanshi H, Singh MP, Bharti PK, Sahu RS, Jayswar H, Govil PJ, Anvikar A, Chan XX, Chebbi A, Das S, Lal AA. Science of malaria elimination: using knowledge of bottlenecks and enablers from the Malaria Elimination Demonstration Project in Central India for eliminating malaria in the Asia Pacific region. Front Public Health 2024; 11:1303095. [PMID: 38303961 PMCID: PMC10830794 DOI: 10.3389/fpubh.2023.1303095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/27/2023] [Indexed: 02/03/2024] Open
Abstract
Malaria poses a major public health challenge in the Asia Pacific. Malaria Elimination Demonstration Project was conducted as a public-private partnership initiative in Mandla between State government, ICMR, and FDEC India. The project employed controls for efficient operational and management decisions. IEC campaigns found crucial in schools and communities. Capacity building of local workers emphasized for better diagnosis and treatment. SOCH mobile app launched for complete digitalization. Better supervision for Indoor Residual Sprays and optimized Long Lasting Insecticidal Nets distribution. Significant malaria cases reduction in Mandla. Insights from MEDP crucial for malaria elimination strategies in other endemic regions of the Asia Pacific.
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Affiliation(s)
- Harsh Rajvanshi
- Asia Pacific Leaders' Malaria Alliance, Singapore, Singapore
| | - Mrigendra P. Singh
- Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
| | - Praveen K. Bharti
- Indian Council of Medical Research – National Institute of Malaria Research, New Delhi, India
| | | | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Pallavi Jain Govil
- Department of Tribal Welfare, Government of Madhya Pradesh, Bhopal, India
| | - Anup Anvikar
- Indian Council of Medical Research – National Institute of Malaria Research, New Delhi, India
| | | | - Amita Chebbi
- Asia Pacific Leaders' Malaria Alliance, Singapore, Singapore
| | - Sarthak Das
- Asia Pacific Leaders' Malaria Alliance, Singapore, Singapore
| | - Altaf A. Lal
- Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
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Verma R, Commons RJ, Gupta A, Rahi M, Nitika, Bharti PK, Thriemer K, Rajasekhar M, Singh-Phulgenda S, Adhikari B, Alam MS, Ghimire P, Khan WA, Kumar R, Leslie T, Ley B, Llanos-Cuentas A, Pukrittayakamee S, Rijal KR, Rowland M, Saravu K, Simpson JA, Guerin PJ, Price RN, Sharma A. Safety and efficacy of primaquine in patients with Plasmodium vivax malaria from South Asia: a systematic review and individual patient data meta-analysis. BMJ Glob Health 2023; 8:e012675. [PMID: 38123228 DOI: 10.1136/bmjgh-2023-012675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The optimal dosing of primaquine to prevent relapsing Plasmodium vivax malaria in South Asia remains unclear. We investigated the efficacy and safety of different primaquine regimens to prevent P. vivax relapse. METHODS A systematic review identified P. vivax efficacy studies from South Asia published between 1 January 2000 and 23 August 2021. In a one-stage meta-analysis of available individual patient data, the cumulative risks of P. vivax recurrence at day 42 and 180 were assessed by primaquine total mg/kg dose and duration. The risk of recurrence by day 180 was also determined in a two-stage meta-analysis. Patients with a >25% drop in haemoglobin to <70 g/L, or an absolute drop of >50 g/L between days 1 and 14 were categorised by daily mg/kg primaquine dose. RESULTS In 791 patients from 7 studies in the one-stage meta-analysis, the day 180 cumulative risk of recurrence was 61.1% (95% CI 42.2% to 80.4%; 201 patients; 25 recurrences) after treatment without primaquine, 28.8% (95% CI 8.2% to 74.1%; 398 patients; 4 recurrences) following low total (2 to <5 mg/kg) and 0% (96 patients; 0 recurrences) following high total dose primaquine (≥5 mg/kg). In the subsequent two-stage meta-analysis of nine studies (3529 patients), the pooled proportions of P. vivax recurrences by day 180 were 12.1% (95% CI 7.7% to 17.2%), 2.3% (95% CI 0.3% to 5.4%) and 0.7% (95% CI 0% to 6.1%), respectively. No patients had a >25% drop in haemoglobin to <70 g/L. CONCLUSIONS Primaquine treatment led to a marked decrease in P. vivax recurrences following low (~3.5 mg/kg) and high (~7 mg/kg) total doses, with no reported severe haemolytic events. PROSPERO REGISTRATION NUMBER CRD42022313730.
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Affiliation(s)
- Reena Verma
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Robert J Commons
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
- WorldWide Antimalarial Resistance Network, Asia Pacific Regional Hub - Australia, Melbourne, Victoria, Australia
- General and Subspecialty Medicine, Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Apoorv Gupta
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Manju Rahi
- ICMR-National Institute of Malaria Research, New Delhi, India
- Indian Council of Medical Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Nitika
- ICMR-National Institute of Malaria Research, New Delhi, India
| | | | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Megha Rajasekhar
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sauman Singh-Phulgenda
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mohammad Shafiul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal
| | - Wasif A Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rishikesh Kumar
- ICMR-National Institute of Malaria Research, New Delhi, India
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - Toby Leslie
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- HealthNet TPO, Kabul, Afghanistan
| | - Benedikt Ley
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Alejandro Llanos-Cuentas
- Unit of Leishmaniasis and Malaria, Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sasithon Pukrittayakamee
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mark Rowland
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Kavitha Saravu
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Manipal Centre for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Julie A Simpson
- WorldWide Antimalarial Resistance Network, Asia Pacific Regional Hub - Australia, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Philippe J Guerin
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Ric N Price
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
- WorldWide Antimalarial Resistance Network, Asia Pacific Regional Hub - Australia, Melbourne, Victoria, Australia
| | - Amit Sharma
- International Centre For Genetic Engineering and Biotechnology, New Delhi, India
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Singh A, Singh MP, Ali NA, Poriya R, Rajvanshi H, Nisar S, Bhandari S, Sahu RS, Jayswar H, Mishra AK, Das A, Kaur H, Anvikar AR, Escalante AA, Lal AA, Bharti PK. Assessment of Plasmodium falciparum drug resistance associated molecular markers in Mandla, Madhya Pradesh, India. Malar J 2023; 22:375. [PMID: 38072967 PMCID: PMC10712044 DOI: 10.1186/s12936-023-04817-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Resistance against artemisinin-based combination therapy is one of the challenges to malaria control and elimination globally. Mutations in different genes (Pfdhfr, Pfdhps, Pfk-13 and Pfmdr1) confer resistance to artesunate and sulfadoxine-pyrimethamine (AS + SP) were analysed from Mandla district, Madhya Pradesh, to assess the effectiveness of the current treatment regimen against uncomplicated Plasmodium falciparum. METHODS Dried blood spots were collected during the active fever survey and mass screening and treatment activities as part of the Malaria Elimination Demonstration Project (MEDP) from 2019 to 2020. Isolated DNA samples were used to amplify the Pfdhfr, Pfdhps, Pfk13 and Pfmdr1 genes using nested PCR and sequenced for mutation analysis using the Sanger sequencing method. RESULTS A total of 393 samples were subjected to PCR amplification, sequencing and sequence analysis; 199, 215, 235, and 141 samples were successfully sequenced for Pfdhfr, Pfdhps, Pfk13, Pfmdr1, respectively. Analysis revealed that the 53.3% double mutation (C59R, S108N) in Pfdhfr, 89.3% single mutation (G437A) in Pfdhps, 13.5% single mutants (N86Y), and 51.1% synonymous mutations in Pfmdr1 in the study area. Five different non-synonymous and two synonymous point mutations found in Pfk13, which were not associated to artemisinin resistance. CONCLUSION The study has found that mutations linked to SP resistance are increasing in frequency, which may reduce the effectiveness of this drug as a future partner in artemisinin-based combinations. No evidence of mutations linked to artemisinin resistance in Pfk13 was found, suggesting that parasites are sensitive to artemisinin derivatives in the study area. These findings are a baseline for routine molecular surveillance to proactively identify the emergence and spread of artemisinin-resistant parasites.
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Affiliation(s)
- Akansha Singh
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
- Indian Council of Medical Research-National Institute of Malaria Research (ICMR-NIMR), New Delhi, India
- University of Illinois, Urbana Champaign, Champaign, IL, USA
| | - Mrigendra P Singh
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Nazia Anwar Ali
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Rajan Poriya
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
- Asia Pacific Leaders Malaria Alliance (APLMA), Singapore, Singapore
| | - Sekh Nisar
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
- Department of Health and Family Welfare, NHM Raigarh, Chattisgarh, India
| | - Sneha Bhandari
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
- Indian Council of Medical Research-National Institute of Research in Environment Health (ICMR-NIREH), Bhopal, Madhya Pradesh, India
| | - Ram S Sahu
- Department of Health Services, Government of Madhya Pradesh, Mandla, Madhya Pradesh, India
| | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Ashok K Mishra
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Aparup Das
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Harpreet Kaur
- Department of Health Research, Ministry of Health and Family Welfare, Indian Council of Medical Research, New Delhi, India
| | - Anup R Anvikar
- Indian Council of Medical Research-National Institute of Malaria Research (ICMR-NIMR), New Delhi, India
| | - Ananias A Escalante
- Institute for Genomics and Evolutionary Medicine, Temple University, Philadelphia, PA, USA
| | - Altaf A Lal
- Indian Council of Medical Research-National Institute of Malaria Research (ICMR-NIMR), New Delhi, India
- Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
- Global Health and Pharmaceuticals Inc., Atlanta, USA
| | - Praveen K Bharti
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India.
- Indian Council of Medical Research-National Institute of Malaria Research (ICMR-NIMR), New Delhi, India.
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Ranjha R, Singh K, Baharia RK, Mohan M, Anvikar AR, Bharti PK. Age-specific malaria vulnerability and transmission reservoir among children. Glob Pediatr 2023; 6:None. [PMID: 38440360 PMCID: PMC10911094 DOI: 10.1016/j.gpeds.2023.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/03/2023] [Accepted: 10/16/2023] [Indexed: 03/06/2024]
Abstract
Purpose The pediatric population, especially under-five children, is highly susceptible to malaria and accounts for 76 % of global malaria deaths according to the World Malaria Report 2022. The purpose of this manuscript is to discuss the various factors involved in the susceptibility of the pediatric population to Malaria and the importance of this age group for malaria elimination. Methodology Data on pediatric malaria epidemiology that includes prevalence, risk factors, immune factors, socioeconomic factors, control methods, etc. were extracted from published literature using PubMed and Google Scholar. This data was further correlated with malaria incidence data from the World Health Organization (WHO) and the National Center for Vector Borne Diseases Control (NCVBDC). Results The younger age group is vulnerable to severe malaria due to an immature immune system. The risk of infection and clinical disease increases after the waning of maternal immunity. In the initial years of life, the developing brain is more susceptible to malaria infection and its after-effects. The pediatric population may act as a malaria transmission reservoir due to parasite density and asymptomatic infections. WHO recommended RTS,S/AS01 has limitations and may not be applicable in all settings to propel malaria elimination. Conclusion The diagnosis of malaria is based on clinical suspicion and confirmed with microscopy and/or rapid diagnostic testing. The school-age pediatric population serves as a transmission reservoir in the form of asymptomatic malaria since they have acquired some immunity due to exposure in early childhood. Targeting the hidden reservoir in the pediatric population and protecting this vulnerable group will be essential for malaria elimination from the countries targeting elimination.
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Affiliation(s)
- Ritesh Ranjha
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Kuldeep Singh
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | | | - Mradul Mohan
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Anup R Anvikar
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Praveen K. Bharti
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
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Singh MP, Rajvanshi H, Nisar S, Singh A, Jayswar H, Singh S, Mehra RK, Shrivastava SK, Sahu RS, Patel B, Bhalavi R, Saha KB, Sharma RK, Mishra AK, Kaur H, Das A, Bharti PK, Lal AA. A comparative assessment of the community frontline health workers for their knowledge and practices of malaria diagnosis and treatment in three contiguous districts Mandla, Balaghat, and Dindori of Madhya Pradesh, India. Malar J 2023; 22:62. [PMID: 36810077 PMCID: PMC9942041 DOI: 10.1186/s12936-023-04492-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Global malaria cases rose by 14 million, and deaths by 69,000, in 2020. In India, a 46% decline has been reported between 2020 and 2019. In 2017, the Malaria Elimination Demonstration Project conducted a needs-assessment of the Accredited Social Health Activists (ASHAs) of Mandla district. This survey revealed the inadequate level of knowledge in malaria diagnosis and treatment. Subsequently, a training programme was launched for enhancing malaria-related knowledge of ASHAs. The present study was conducted in 2021 to evaluate the impact of training on malaria-related knowledge and practices of ASHAs in Mandla. This assessment was also done in two adjoining districts: Balaghat and Dindori. METHODS A cross-sectional survey using a structured questionnaire was administered to ASHAs to measure their knowledge and practices related to malaria etiology, prevention, diagnosis, and treatment. A comparison of information collected from these three districts was performed using simple descriptive statistics, comparison of means and multivariate logistic regression analysis. RESULTS Significant improvement was noted amongst ASHAs of district Mandla between 2017 (baseline) and 2021 (endline) in knowledge related to malaria transmission, preventive measures, adherence to the national drug policy, diagnosis using rapid diagnostic tests, and identification of age group-specific, colour-coded artemisinin combination therapy blister packs (p < 0.05). The multivariate logistic regression analysis revealed that odds of Mandla baseline was 0.39, 0.48, 0.34, and 0.07 times lower for malaria-related knowledge on disease etiology, prevention, diagnosis, and treatment, respectively (p < 0.001). Further, participants in districts Balaghat and Dindori showed significantly lower odds for knowledge (p < 0.001) and treatment practices (p < 0.01) compared to Mandla endline. Education, attended training, having a malaria learner's guide, and minimum 10 years' work experience were potential predictors for good treatment practices. CONCLUSION The findings of the study unequivocally establishes significant improvement in overall malaria-related knowledge and practices of ASHAs in Mandla as a result of periodic training and capacity building efforts. The study suggests that learnings from Mandla district could be helpful in improving level of knowledge and practices among frontline health workers.
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Affiliation(s)
| | - Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India ,Present Address: Asia Pacific Leaders Malaria Alliance (APLMA), Singapore, Singapore
| | - Sekh Nisar
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India ,Present Address: Department of Health and Family Welfare, NHM Raigarh, Raigarh, Chattisgarh India
| | - Akansha Singh
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research – National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India
| | - Himanshu Jayswar
- Directorate General of Health Services, Government of Madhya Pradesh, Bhopal, Madhya Pradesh India
| | - Srinath Singh
- Department of Health Services, Government of Madhya Pradesh, Mandla, Madhya Pradesh India
| | - R. K. Mehra
- Department of Health Services, Government of Madhya Pradesh, Dindori, Madhya Pradesh India
| | - S. K. Shrivastava
- Department of Health Services, Government of Madhya Pradesh, Balaghat, Madhya Pradesh India
| | - Ram Shankar Sahu
- Department of Health Services, Government of Madhya Pradesh, Mandla, Madhya Pradesh India
| | - Brajesh Patel
- Department of Health Services, Government of Madhya Pradesh, Dindori, Madhya Pradesh India
| | - Ramji Bhalavi
- Department of Health Services, Government of Madhya Pradesh, Balaghat, Madhya Pradesh India
| | - Kalyan B. Saha
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research – National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India
| | - Ravendra K. Sharma
- grid.496666.d0000 0000 9698 7401Indian Council of Medical Research – National Institute of Medical Statistics (ICMR-NIMS), New Delhi, India ,grid.411141.00000 0001 0662 0591Present Address: Department of Economics, Chaudhary Charan Singh University, Meerut, India
| | - Ashok K. Mishra
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research – National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India
| | - Harpreet Kaur
- Indian Council of Medical Research (ICMR), Ministry of Health and Family Welfare, New Delhi, India
| | - Aparup Das
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research – National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India
| | - Praveen K. Bharti
- grid.419641.f0000 0000 9285 6594Indian Council of Medical Research – National Institute of Malaria Research (ICMR-NIMR), New Delhi, India
| | - Altaf A. Lal
- Foundation for Disease Elimination and Control of India (FDEC India), Mumbai, Maharashtra India
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Singh MP, Rajvanshi H, Bharti PK, Jayswar H, Singh S, Mehra RK, Pandey M, Sahu RS, Patel B, Bhalavi R, Nisar S, Kaur H, Das A, Hamer DH, Lal AA. Evaluation of the model malaria elimination strategy in Mandla district along with its neighbouring districts: a time series analysis from 2008 to 2020. Malar J 2023; 22:45. [PMID: 36747302 PMCID: PMC9901400 DOI: 10.1186/s12936-023-04477-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Compared to 2017, India achieved a significant reduction in malaria cases in 2020. Madhya Pradesh (MP) is a tribal dominated state of India with history of high malaria burden in some districts. District Mandla of MP state showed a considerable decline in malaria cases between 2000 and 2013, except in 2007. Subsequently, a resurgence of malaria cases was observed during 2014 and 2015. The Malaria Elimination Demonstration Project (MEDP) was launched in 2017 in Mandla with the goal to achieve zero indigenous malaria cases. This project used: (1) active surveillance and case management using T4 (Track fever, Test fever, Treat patient, and Track patient); (2) vector control using indoor residual sprays and long-lasting insecticidal nets; (3) information education communication and behaviour change communication; and (4) regular monitoring and evaluation with an emphasis on operational and management accountability. This study has investigated malaria prevalence trends from 2008 to 2020, and has predicted trends for the next 5 years for Mandla and its bordering districts. METHODS The malaria prevalence data of the district Mandla for the period of January 2008 to August 2017 was obtained from District Malaria Office (DMO) Mandla and data for the period of September 2017 to December 2020 was taken from MEDP data repository. Further, the malaria prevalence data for the period of January 2008 to December 2020 was collected from DMOs of the neighbouring districts of Mandla. A univariate time series and forecast analysis was performed using seasonal autoregressive integrated moving average model. FINDINGS Malaria prevalence in Mandla showed a sharp decline [- 87% (95% CI - 90%, - 84%)] from 2017 to 2020. The malaria forecast for Mandla predicts zero cases in the next 5 years (2021-2025), provided current interventions are sustained. By contrast, the model has forecasted a risk of resurgence of malaria in other districts in MP (Balaghat, Dindori, Jabalpur, Seoni, and Kawardha) that were not the part of MEDP. CONCLUSION The interventions deployed as part of MEDP have resulted in a sustainable zero indigenous malaria cases in Mandla. Use of similar strategies in neighbouring and other malaria-endemic districts in India could achieve similar results. However, without adding extra cost to the existing intervention, sincere efforts are needed to sustain these interventions and their impact using accountability framework, data transparency, and programme ownership from state to district level.
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Affiliation(s)
| | - Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India ,Present Address: Asia Pacific Leaders Malaria Alliance (APLMA), Singapore, Singapore
| | - Praveen K. Bharti
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research – National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India ,grid.419641.f0000 0000 9285 6594Present Address: Indian Council of Medical Research – National Institute of Malaria Research (ICMR-NIMR), New Delhi, India
| | - Himanshu Jayswar
- Directorate General of Health Services, Government of Madhya Pradesh, Bhopal, Madhya Pradesh India
| | - Srinath Singh
- Department of Health Services, Government of Madhya Pradesh, Mandla, Madhya Pradesh India
| | - R. K. Mehra
- Department of Health Services, Government of Madhya Pradesh, Dindori, Madhya Pradesh India
| | - Manoj Pandey
- Department of Health Services, Government of Madhya Pradesh, Balaghat, Madhya Pradesh India
| | - Ram Shankar Sahu
- Department of Health Services, Government of Madhya Pradesh, Mandla, Madhya Pradesh India
| | - Brajesh Patel
- Department of Health Services, Government of Madhya Pradesh, Dindori, Madhya Pradesh India
| | - Ramji Bhalavi
- Department of Health Services, Government of Madhya Pradesh, Balaghat, Madhya Pradesh India
| | - Sekh Nisar
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India ,Present Address: Department of Health and Family Welfare, NHM Raigarh, Chhattisgarh, India
| | - Harpreet Kaur
- grid.415820.aIndian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Aparup Das
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research – National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India
| | - Davidson H. Hamer
- grid.189504.10000 0004 1936 7558Department of Global Health, Boston University School of Public Health, Boston, MA USA ,grid.189504.10000 0004 1936 7558Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA USA
| | - Altaf A. Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India ,Foundation for Disease Elimination and Control of India (FDEC India), Mumbai, Maharashtra India
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Yadav CP, Hussain SSA, Pasi S, Sharma S, Bharti PK, Rahi M, Sharma A. Linkages between malaria and malnutrition in co-endemic regions of India. BMJ Glob Health 2023; 8:bmjgh-2022-010781. [PMID: 36653068 PMCID: PMC9853155 DOI: 10.1136/bmjgh-2022-010781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/28/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Malaria and malnutrition are key public health challenges in India. However, the relationship between them is poorly understood. Here, we aimed to elucidate the potential interactions between the two health conditions by identifying the areas of their spatial overlap. METHODS We have analysed the district-wise undernutrition and malaria data of 638 districts of India across 28 states and 8 union territories. Data on malnutrition parameters viz. stunting, wasting, underweight and anaemia, sourced from the fourth National Family Health Survey (2015-2016), and malaria Annual Parasite Index (API) data of the same year (i.e, 2015), sourced from National Center of Vector Borne Diseases Control were analysed using local Moran's I Index and logistic regression. RESULTS Among all the malnutrition parameters, we found underweight in children and anaemia in men to co-occur with malaria in the districts of Chhattisgarh, Jharkhand, Madhya Pradesh and Odisha. Further, districts with more than 36% underweight children (OR (95% CI): 2.31 (1.53 to 3.48)) and/or more than 23.6% male population with anaemia (OR (95% CI): 2.06 (1.37 to 3.11)) had higher odds of being malaria endemic districts (ie, Annual Parasite Index >1). CONCLUSION Malaria and malnutrition co-occur in the malaria-endemic parts of India. The high prevalence of undernutrition in children and anaemia among men may contribute to malaria endemicity in a particular region. Therefore, future research should be prioritised to generate data on the individual level. Further, malaria control interventions could be tailored to integrate nutrition programmes to disrupt indigenous malaria transmission in endemic districts.
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Affiliation(s)
- Chander Prakash Yadav
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India,Epidemiology and Biostatistics, ICMR-National Institute of Cancer Prevention & Reserch, Noida, Uttar Pradesh, India
| | - Syed Shah Areeb Hussain
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Shweta Pasi
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Shweta Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Praveen K Bharti
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Manju Rahi
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India,Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India .,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India.,Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Yadav CP, Hussain SSA, Gupta S, Bharti PK, Rahi M, Sharma A. Tracking district-level performance in the context of achieving zero indigenous case status by 2027. PLOS Glob Public Health 2023; 3:e0001292. [PMID: 36962890 PMCID: PMC10021673 DOI: 10.1371/journal.pgph.0001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/25/2022] [Indexed: 01/09/2023]
Abstract
India has committed to zero indigenous malaria cases by 2027 and elimination by 2030. Of 28 states and 8 union territories of India, eleven states were targeted to reach the elimination phase by 2020. However, state-level epidemiology indicates that several states of India may not be on the optimum track, and few goals set in National Framework for Malaria Elimination (NFME) for 2020 remain to be addressed. Therefore, tracking the current progress of malaria elimination in India at the district level, and identifying districts that are off track is important in understanding possible shortfalls to malaria elimination. Annual malaria case data from 2017-20 of 686 districts of India were obtained from the National Center for Vector-Borne Diseases Control (NCVBDC) and analysed to evaluate the performance of districts to achieve zero case status by 2027. A district's performance was evaluated by calculating the annual percentage change in the total number of malaria cases for the years 2018, 2019 and 2020 considering the previous year as a base year. The mean, median and maximum of these annual changes were then used to project the number of malaria cases in 2027. Based on these, districts were classified into four groups: 1) districts that are expected to reach zero case status by 2027, 2) districts that would achieve zero case status between 2028 and 2030, 3) districts that would arrive at zero case status after 2030, and 4) districts where malaria cases are on the rise. Analysis suggest, a cohort of fifteen districts require urgent modification or improvement in their malaria control strategies by identifying foci of infection and customizing interventions. They may also require new interventional tools that are being developed recently so that malaria case reduction over the years may be increased.
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Affiliation(s)
- Chander Prakash Yadav
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, UP, India
- ICMR-National Institute of Cancer Prevention and Research, Noida, UP, India
| | - Syed Shah Areeb Hussain
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, UP, India
| | - Sanjeev Gupta
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Praveen K Bharti
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, UP, India
| | - Manju Rahi
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, UP, India
- Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, UP, India
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Singh A, Rajvanshi H, Singh MP, Bhandari S, Nisar S, Poriya R, Telasey V, Jayswar H, Mishra AK, Das A, Kaur H, Lal AA, Bharti PK. Mass screening and treatment (MSaT) for identifying and treating asymptomatic cases of malaria-malaria elimination demonstration project (MEDP), Mandla, Madhya Pradesh. Malar J 2022; 21:395. [PMID: 36575544 PMCID: PMC9793628 DOI: 10.1186/s12936-022-04423-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Mass screening and treatment (MSaT) aims at reducing the spread of malaria in communities by identifying and treating infected persons regardless of the symptoms. This study was conducted to identify and treat asymptomatic cases using MSaT approaches in the community. METHODS Three rounds of MSaT using cluster combination approaches were carried out during September 2018 to December 2019 to identify and treat asymptomatic malaria cases in the community. All individuals who were present in the household were screened using RDT irrespective of malaria related symptoms. Simultaneously thick and thin blood smear and blood spot were collected for further analysis using microscopy and diagnostic PCR done in a subset of the samples. RESULTS Logistic regression analysis revealed that asymptomatic malaria cases significantly less among the older age groups compared with < 5 years children (OR ranged between 0.52 and 0.61; p < 0.05), lowest in cluster 4 (OR = 0.01; p < 0.0001); during third round of MSaT survey (OR = 0.11; p < 0.0001) and significantly higher in moderate to high endemic areas (OR = 88.30; p < 0.0001). CONCLUSION Over the three rounds of MSaT, the number of asymptomatic cases were significantly less in the older age groups, and during third round. Similarly, the asymptomatic cases were significantly less in the low endemic area with API < 1 (cluster four). Therefore, the malaria elimination programme may consider the MSaT strategy to identify asymptomatic cases that would be otherwise missed by routine fever based surveillance. This MSaT strategy would help accomplish the malaria elimination goal in an expedited manner.
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Affiliation(s)
- Akansha Singh
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India ,grid.419641.f0000 0000 9285 6594Indian Council of Medical Research - National Institute of Malaria Research (ICMR-NIMR), New Delhi, India
| | - Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India ,Present Address: Asia Pacific Leaders Malaria Alliance (APLMA), Singapore, Singapore
| | | | - Sneha Bhandari
- grid.19096.370000 0004 1767 225XIndian Council of Medical Research - National Institute of Research in Environment Health (ICMR-NIREH), Bhopal, Madhya Pradesh India
| | - Sekh Nisar
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India ,Present Address: Department of Health and Family Welfare, NHM Raigarh, Raigarh, Chattisgarh India
| | - Rajan Poriya
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India
| | - Vinay Telasey
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India
| | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Ashok K. Mishra
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India
| | - Aparup Das
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India
| | - Harpreet Kaur
- grid.19096.370000 0004 1767 225XDepartment of Health Research, Ministry of Health and Family Welfare, Indian Council of Medical Research, New Delhi, India
| | - Altaf A. Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India ,Foundation for Disease Elimination and Control of India, Mumbai, 482003 Maharashtra India
| | - Praveen K. Bharti
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India ,grid.419641.f0000 0000 9285 6594Indian Council of Medical Research - National Institute of Malaria Research (ICMR-NIMR), New Delhi, India
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Sharma S, Ahmed N, Faizi N, Bharti PK, Sharma A, Srivastava B. A case report of late treatment failure in Plasmodium falciparum malaria in a traveler from the Democratic Republic of the Congo to India. IDCases 2022; 31:e01653. [PMID: 36589765 PMCID: PMC9795509 DOI: 10.1016/j.idcr.2022.e01653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/09/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
A young male returned from the Democratic Republic of the Congo (DRC) to India after four months during his official work. Within a week of his arrival, he developed a high-grade fever with nausea and was hospitalized in a private hospital in New Delhi. He was diagnosed with malaria, treated with an artesunate injection as antimalarial, and discharged on day 5th from the hospital. A week later, he was diagnosed with malaria and dengue positive at ICMR-National Institute of Malaria Research, New Delhi. Artesunate with sulphadoxine and pyrimethamine (AS+SP) was administered following India's malaria treatment policy. However, high-grade fever, along with the asexual stage of the P. falciparum parasite, was observed within 28 days of treatment with AS+SP, signifying late treatment failure (LTF). Further, the molecular analysis from both the days of episodes was analyzed using genomic DNA from dried blood spots, revealing resistance to sulphadoxine-pyrimethamine with mutations at codons pfdhfr 51I, pfdhfr 59 R, pfdhfr 108 N, pfdhps 437 A, pfdhps 581 G. No functional mutation associated was found in pfKelch13, but interestingly the sensitive codons to chloroquine (CQ) (wild type pfcrtK76 and pfmdrN86) revealed the probably reversible CQ sensitivity in the sample from DRC.
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Affiliation(s)
- Supriya Sharma
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi 110077, India
| | - Naseem Ahmed
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi 110077, India
| | - Nafis Faizi
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi 110077, India,Jawaharlal Nehru Medical College, AMU, Aligarh, India
| | - Praveen K. Bharti
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi 110077, India,Academy of Scientific and Innovative Research, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi 110077, India,Molecular Medicine, International Centre for Genetic Engineering and Biotechnology, New Delhi, India,Academy of Scientific and Innovative Research, India
| | - Bina Srivastava
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi 110077, India,Corresponding author.
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Singh MP, Rajvanshi H, Bharti PK, Das A, Thakre V, Jayswar H, Sahu RS, Telasey VK, Lal AA. A qualitative study on community perceptions on quality of healthcare services they received in the Malaria Elimination Demonstration Project in district Mandla, India. Malar J 2022; 21:368. [PMID: 36463136 PMCID: PMC9719226 DOI: 10.1186/s12936-022-04400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The utilization and impact of the healthcare services depend on the perceived quality, appropriateness, ease of availability, and cost of the services. This study aimed to understand the community's perception of the quality of healthcare services delivered as part of the Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh, India. METHODS The study used qualitative techniques to analyze the community perceptions that emerged from the participants' narratives during the Focus Group Discussions (FGDs) and in-depth Interviews with Key Informants (IKIs) on the promptness and quality of healthcare service delivery, the behaviour of MEDP staff, Information, Education and Communication, and Behavioural Change Communication activities, coordination with community members and other health personnel, and capacity building of healthcare workers and the community. RESULTS 36 FGDs and 63 IKIs with 419 respondents were conducted in nine blocks of district Mandla. Overall, 97% to 100% of beneficiaries associated MEDP with regularity and prompt service delivery, availability of diagnostics and drugs, friendly behaviour, good coordination, and community mobilization to enhance treatment-seeking behaviour. CONCLUSIONS The study's findings highlighted the importance of building and maintaining the community's participation and promoting the demand for optimal utilization of healthcare services inside the village to promptly achieve the malaria elimination goal.
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Affiliation(s)
| | - Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India ,Present Address: Asia Pacific Leaders Malaria Alliance (APLMA), Singapore, Singapore
| | - Praveen K. Bharti
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research – National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India ,grid.419641.f0000 0000 9285 6594Present Address: Indian Council of Medical Research – National Institute of Malaria Research (ICMR-NIMR), New Delhi, India
| | - Aparup Das
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research – National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India
| | - Vikesh Thakre
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India
| | - Himanshu Jayswar
- Directorate General of Health Services, Government of Madhya Pradesh, Bhopal, Madhya Pradesh India
| | - Ram Shankar Sahu
- Department of Health Services, Government of Madhya Pradesh, Mandla, Madhya Pradesh India
| | - Vinay K. Telasey
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India
| | - Altaf A. Lal
- Foundation for Disease Elimination and Control of India (FDEC India), Mumbai, Maharashtra India
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Singh A, Singh MP, Bhandari S, Rajvanshi H, Nisar S, Telasey V, Jayswar H, Mishra AK, Das A, Kaur H, Lal AA, Bharti PK. Significance of nested PCR testing for the detection of low-density malaria infection amongst febrile patients from the Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh, India. Malar J 2022; 21:341. [PMCID: PMC9669540 DOI: 10.1186/s12936-022-04355-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Low-density malaria infections (LDMI) are defined as infections that are missed by the rapid diagnostic test (RDT) and/or microscopy which can lead to continued transmission and poses a challenge in malaria elimination efforts. This study was conducted to investigate the prevalence of LDMI in febrile cases using species-specific nested Polymerase Chain Reaction (PCR) tests in the Malaria Elimination Demonstration Project, where routine diagnosis was conducted using RDT.
Methods
Every 10th fever case from a cross-sectional community based fever surveillance was tested with RDT, microscopy and nested PCR. Parasite DNA was isolated from the filter paper using Chelex based method. Molecular diagnosis by nested PCR was performed targeting 18SrRNA gene for Plasmodium species.
Results
The prevalence of malaria was 2.50% (436/17405) diagnosed by PCR, 1.13% (196/17405) by RDT, and 0.68% (118/ 17,405) by microscopy. Amongst 17,405 febrile samples, the prevalence of LDMI was 1.51% (263/17405) (95% CI 1.33–1.70), which were missed by conventional methods. Logistic regression analysis revealed that illness during summer season [OR = 1.90 (p < 0.05)] and cases screened within three days of febrile illness [OR = 5.27 (p < 0.001)] were the statistically significant predictors of LDMI.
Conclusion
The prevalence of malaria among febrile cases using PCR was 2.50% (436/17405) as compared to 1.13% (196/17405) by RDT. Higher number of the LDMI cases were found in subjects with ≤ 3 days mean duration of reported fever, which was statistically significant (p < 0.001). This observation suggests that an early detection of malaria with a more sensitive diagnostic method or repeat testing of the all negative cases may be useful for curtailing malaria transmission. Therefore, malaria elimination programme would benefit from using more sensitive and specific diagnostic methods, such as PCR.
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Yadav CP, Gupta S, Bharti PK, Rahi M, Faizi N, Sharma A. India may need an additional metric to assess the endemicity of malaria in low surveillance districts. PLOS Glob Public Health 2022; 2:e0000326. [PMID: 36962502 PMCID: PMC10021988 DOI: 10.1371/journal.pgph.0000326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 10/19/2022] [Indexed: 06/18/2023]
Abstract
India's National Framework for malaria elimination is essentially dependent on Annual Parasite Incidence (API). API is the primary criterion for classifying states and districts into different categories: intensified control, pre-elimination, elimination, prevention and re-establishment of malaria. However, API's validity is critically dependent on multiple factors, one such important factor is Annual Blood Examination Rate (ABER) and is often considered as indicator of operational efficiency. Therefore, the present study aimed to determine whether the API is a sufficiently good malaria index to assess malaria endemicity in India. An in-depth analysis of malaria data (2017-19) was done to determine the appropriateness of API as a sole indicator of malaria endemicity. We stratified the Indian districts into three strata based on Annual Blood Examination Rate (ABER): <5, 5.0-5.0, >15, further APIs was compared with Slide Positivity Rates (SPRs) using sign rank test, independently in each stratum. API and SPR were found comparable (p-value 0.323) in stratum 2 only. However, in the case of lower ABER (<5%, strata 1), the API was significantly lower than the SPR, and higher ABER (>15%), the API was found substantially higher than the SPR. Thus, ABER tunes the validity of API and should avoid to use as a single indicator of malaria endemicity. API is an appropriate measure of malaria endemicity in high and moderate transmission areas where surveillance is good (ABER≥5%). However, it is vitally dependent upon surveillance rate and other factors such as population size, the selection of individuals for malaria testing. Therefore, where surveillance is poor (<5%), we propose that API should be complemented with SPR and the number of cases. It will significantly aid the design and deployment of interventions in India.
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Affiliation(s)
- Chander Prakash Yadav
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Sanjeev Gupta
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
| | - Praveen K. Bharti
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
| | - Manju Rahi
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- Indian Council of Medical Research (ICMR), New Delhi, India
| | - Nafis Faizi
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Jawaharlal Nehru Medical College, AMU, Aligarh, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- Molecular Medicine, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
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Bharti PK, BISWAL PRACHURYA, KAMAL REENA, DEVI BHANITA, DUTT TRIVENI. Effect of weaning on performance of dairy buffaloes in tropical conditions - A review. Indian J of Anim Sci 2022. [DOI: 10.56093/ijans.v92i11.100971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Weaning is one of the important management practices, which is mostly followed at organized dairy farms in India and abroad. Generally breeding programme at buffalo farms focusses on milk production, however weaning can additionally boost the total milk production of the dairy farm, apart from increasing the reproductive potential of adults and promoting scientific rearing of young calves. There is little information on early weaning of buffalo calves and its effect on production and reproduction performances of dams during post-partum in Indian buffaloes. However, early weaning may be associated with the restriction of colostrum feeding and essential nutrients for dairy buffalo calves. Breaking the maternal bond is stressful to the calf and lactating buffaloes, which can be evaluated by biochemical indicators of stress in bovine models. Although, weaning at birth is well established in dairy cattle, in case of buffaloes, it may yield significant outcomes in terms of estimating actual milk production and increasing precious buffalo milk in the market for human consumption. On the other hand, weaning practice in dairy buffaloes has been limitedly investigated and not reviewed properly under variable conditions. Keeping in view the impact of weaning, the present paper has been aimed to review the effect of weaning on performance of dairy buffaloes under tropical conditions. The weaning practices in dairy buffaloes can reduce the feeding cost of calves and increase the reproductive potential of the dairy animals through early resumption of post-partum ovarian cyclicity. However, more trials need to be conducted in dairy buffaloes for understanding the relationship between the behaviour of weaned animals and age of weaning towards better adaptability and optimum production at dairy farms.
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20
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Bharti PK, Husai A. Mining and analysis of microsatellites in human coronavirus genomes using the in-house built Java pipeline. Genomics Inform 2022; 20:e35. [PMID: 36239112 PMCID: PMC9576472 DOI: 10.5808/gi.20033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/14/2022] [Indexed: 11/20/2022] Open
Abstract
Microsatellites or simple sequence repeats are motifs of 1 to 6 nucleotides in length present in both coding and non-coding regions of DNA. These are found widely distributed in the whole genome of prokaryotes, eukaryotes, bacteria, and viruses and are used as molecular markers in studying DNA variations, gene regulation, genetic diversity and evolutionary studies, etc. However, in vitro microsatellite identification proves to be time-consuming and expensive. Therefore, the present research has been focused on using an in-house built java pipeline to identify, analyse, design primers and find related statistics of perfect and compound microsatellites in the seven complete genome sequences of coronavirus, including the genome of coronavirus disease 2019, where the host is Homo sapiens. Based on search criteria among seven genomic sequences, it was revealed that the total number of perfect simple sequence repeats (SSRs) found to be in the range of 76 to 118 and compound SSRs from 01 to10, thus reflecting the low conversion of perfect simple sequence to compound repeats. Furthermore, the incidence of SSRs was insignificant but positively correlated with genome size (R2 = 0.45, p > 0.05), with simple sequence repeats relative abundance (R2 = 0.18, p > 0.05) and relative density (R2 = 0.23, p > 0.05). Dinucleotide repeats were the most abundant in the coding region of the genome, followed by tri, mono, and tetra. This comparative study would help us understand the evolutionary relationship, genetic diversity, and hypervariability in minimal time and cost.
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Affiliation(s)
- P K Bharti
- School of Computer Science, Shri Venkateshwara University, Gajraula 244236, Uttar Pradesh, India
| | - Akhtar Husai
- Department of Computer Science & IT, MJP Rohilkhand University, Bareilly 243006, Uttar Pradesh, India
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21
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Somanathan A, Mian SY, Chaddha K, Uchoi S, Bharti PK, Tandon R, Gaur D, Chauhan VS. Process development and preclinical evaluation of a major Plasmodium falciparum blood stage vaccine candidate, Cysteine-Rich Protective Antigen (CyRPA). Front Immunol 2022; 13:1005332. [PMID: 36211427 PMCID: PMC9535676 DOI: 10.3389/fimmu.2022.1005332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Plasmodium falciparum Cysteine-Rich Protective Antigen (CyRPA) is an essential, highly conserved merozoite antigen that forms an important multi-protein complex (RH5/Ripr/CyRPA) necessary for erythrocyte invasion. CyRPA is a promising blood-stage vaccine target that has been shown to elicit potent strain-transcending parasite neutralizing antibodies. Recently, we demonstrated that naturally acquired immune anti-CyRPA antibodies are invasion-inhibitory and therefore a correlate of protection against malaria. Here, we describe a process for the large-scale production of tag-free CyRPA vaccine in E. coli and demonstrate its parasite neutralizing efficacy with commonly used adjuvants. CyRPA was purified from inclusion bodies using a one-step purification method with high purity (>90%). Biochemical and biophysical characterization showed that the purified tag-free CyRPA interacted with RH5, readily detected by a conformation-specific CyRPA monoclonal antibody and recognized by sera from malaria infected individuals thus indicating that the recombinant antigen was correctly folded and retained its native conformation. Tag-free CyRPA formulated with Freund’s adjuvant elicited highly potent parasite neutralizing antibodies achieving inhibition of >90% across diverse parasite strains. Importantly, we identified tag-free CyRPA/Alhydrogel formulation as most effective in inducing a highly immunogenic antibody response that exhibited efficacious, cross-strain in vitro parasite neutralization achieving ~80% at 10 mg/ml. Further, CyRPA/Alhydrogel vaccine induced anti-parasite cytokine response in mice. In summary, our study provides a simple, scalable, cost-effective process for the production of tag-free CyRPA that in combination with human-compatible adjuvant induces efficacious humoral and cell-mediated immune response.
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Affiliation(s)
- Anjali Somanathan
- Laboratory of Malaria and Vaccine Research, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Syed Yusuf Mian
- Laboratory of Malaria and Vaccine Research, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Kritika Chaddha
- Laboratory of Malaria and Vaccine Research, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Seemalata Uchoi
- Laboratory of Malaria and Vaccine Research, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Praveen K. Bharti
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, India
| | - Ravi Tandon
- Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Deepak Gaur
- Laboratory of Malaria and Vaccine Research, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Virander Singh Chauhan
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
- *Correspondence: Virander Singh Chauhan,
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22
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Kochewad SA, Gaur GK, Maurya VP, Bharti PK, Sahoo NR, Pandey HO, Singh M, Verma MR. Effect of milking environment enrichment through music on production performance and behaviour in cattle. Trop Anim Health Prod 2022; 54:219. [PMID: 35760924 DOI: 10.1007/s11250-022-03217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
Enrichment of milking environment through music has been proposed to help animals to cope with divergent stressors. In sight of the above, a study was conducted to evaluate the effect of Indian instrumental music-based environmental enrichment played in yaman raga on milk production performance and behaviour in cattle. A total of 21 lactating dairy cattle (Vrindavani crossbred cows) having similar parity and stage of lactation were selected in three groups - T1, T2 and T3, each consisting of seven animals. The T1 and T2 groups were exposed to instrumental flute and sitar, respectively, 10 min prior to the start of milking and continued till completion of milking; while the T3 group served as control. Musical enrichment of the environment was done using recorded-tape of flute and sitar was played in yamen raga at 40-60 (dB) decibel intensity. The results revealed a non-significant difference in milk yield, rectal temperature, respiration rate, T3 (triiodothyronine) and T4 (thyroxine) hormones. However, there exhibited a significant (p < 0.05) difference in milking time, milking speed, cortisol hormones and behavioural parameters such as milk let-down in the animals exposed to music compared to the control group. Thus, the results have significant implications relating to the behavioural fitness and welfare of dairy animals and reducing residual milk.
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Affiliation(s)
- S A Kochewad
- ICAR-National Institute for Abiotic Stress Management, Baramati, Maharashtra, India.
| | - G K Gaur
- ICAR-Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
| | - V P Maurya
- ICAR-Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
| | - P K Bharti
- ICAR-Mahatma Gandhi Integrated Farming Research Institute, Motihari, India
| | - N R Sahoo
- ICAR-Directorate of Foot and Mouth Disease (ICFMD), Bhubaneswar, India
| | - H O Pandey
- ICAR-Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
| | - Mukesh Singh
- ICAR-Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
| | - M R Verma
- ICAR-Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
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23
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Rahi M, Sharma R, Saroha P, Chaturvedi R, Bharti PK, Sharma A. Polymerase Chain Reaction-Based Malaria Diagnosis Can Be Increasingly Adopted during Current Phase of Malaria Elimination in India. Am J Trop Med Hyg 2022; 106:1005-1012. [PMID: 35130488 PMCID: PMC8991334 DOI: 10.4269/ajtmh.21-0966] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/09/2021] [Indexed: 11/07/2022] Open
Abstract
Despite commendable progress in control of malaria in India and other countries, there are hidden reservoirs of parasites in human hosts that continually feed malaria transmission. Submicroscopic infections are a significant proportion in low-endemic settings like India, and these infections possess transmission potential. Hence, these reservoirs of infection add to the existing roadblocks for malaria elimination. It is crucial that this submerged burden of malaria is detected and treated to curtail further transmission. The currently used diagnostic tools, including the so-called "gold standard" microscopy, are incapable of detecting these submicroscopic infections and thus are suboptimal. It is an opportune time to usher in more sensitive molecular tools like polymerase chain reaction (PCR) for routine diagnosis at all levels of healthcare as an additional diagnostic tool in routine settings. PCR assays have been developed into user-friendly formats for field diagnostics and are near-point-of-collection. Because of the COVID-19 pandemic in India, these are being used rampantly across the country. The facilities created for COVID-19 diagnosis can easily be co-opted and harnessed for malaria diagnosis to augment surveillance by the inclusion of molecular techniques like PCR in the routine national malaria control program.
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Affiliation(s)
- Manju Rahi
- Indian Council of Medical Research, New Delhi, India
- AcSIR, New Delhi, India
| | - Rishu Sharma
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
- AcSIR, New Delhi, India
| | - Poonam Saroha
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
| | - Rini Chaturvedi
- International Center for Genetic Engineering and Biotechnology, New Delhi, India
| | - Praveen K. Bharti
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
| | - Amit Sharma
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
- International Center for Genetic Engineering and Biotechnology, New Delhi, India
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24
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Nirmolia T, Ahmed MA, Sathishkumar V, Sarma NP, Bhattacharyya DR, Mohapatra PK, Bansal D, Bharti PK, Sehgal R, Mahanta J, Sultan AA, Narain K, Patgiri SJ. Genetic diversity of Plasmodium falciparum AMA-1 antigen from the Northeast Indian state of Tripura and comparison with global sequences: implications for vaccine development. Malar J 2022; 21:62. [PMID: 35193607 PMCID: PMC8861999 DOI: 10.1186/s12936-022-04081-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/10/2021] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Malaria continues to be a major public health problem in the Northeastern part of India despite the implementation of vector control measures and changes in drug policies. To develop successful vaccines against malaria, it is important to assess the diversity of vaccine candidate antigens in field isolates. This study was done to assess the diversity of Plasmodium falciparum AMA-1 vaccine candidate antigen in a malaria-endemic region of Tripura in Northeast India and compare it with previously reported global isolates with a view to assess the feasibility of developing a universal vaccine based on this antigen. Methods Patients with fever and malaria-like illness were screened for malaria and P. falciparum positive cases were recruited for the current study. The diversity of PfAMA-1 vaccine candidate antigen was evaluated by nested PCR and RFLP. A selected number of samples were sequenced using the Sanger technique. Results Among 56 P. falciparum positive isolates, Pfama-1 was successfully amplified in 75% (n = 42) isolates. Allele frequencies of PfAMA-1 antigen were 16.6% (n = 7) for 3D7 allele and 33.3% (n = 14) in both K1 and HB3 alleles. DNA sequencing revealed 13 haplotypes in the Pfama-1 gene including three unique haplotypes not reported earlier. No unique amino-acid substitutions were found. Global analysis with 2761 sequences revealed 435 haplotypes with a very complex network composition and few clusters. Nucleotide diversity for Tripura (0.02582 ± 0.00160) showed concordance with South-East Asian isolates while recombination parameter (Rm = 8) was lower than previous reports from India. Population genetic structure showed moderate differentiation. Conclusions Besides documenting all previously reported allelic forms of the vaccine candidate PfAMA-1 antigen of P. falciparum, new haplotypes not reported earlier, were found in Tripura. Neutrality tests indicate that the Pfama-1 population in Tripura is under balancing selection. This is consistent with global patterns. However, the high haplotype diversity observed in the global Pfama-1 network analysis indicates that designing a universal vaccine based on this antigen may be difficult. This information adds to the existing database of genetic diversity of field isolates of P. falciparum and may be helpful in the development of more effective vaccines against the parasite. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04081-1.
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Affiliation(s)
- Tulika Nirmolia
- ICMR - Regional Medical Research Centre, North East Region, Dibrugarh, Assam, 786001, India
| | - Md Atique Ahmed
- ICMR - Regional Medical Research Centre, North East Region, Dibrugarh, Assam, 786001, India
| | - Vinayagam Sathishkumar
- ICMR - Regional Medical Research Centre, North East Region, Dibrugarh, Assam, 786001, India
| | - Nilanju P Sarma
- ICMR - Regional Medical Research Centre, North East Region, Dibrugarh, Assam, 786001, India.,SRL Reference Laboratory, Mumbai, 400060, India
| | - Dibya R Bhattacharyya
- ICMR - Regional Medical Research Centre, North East Region, Dibrugarh, Assam, 786001, India
| | - Pradyumna K Mohapatra
- ICMR - Regional Medical Research Centre, North East Region, Dibrugarh, Assam, 786001, India
| | - Devendra Bansal
- Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Cornell University, Doha, Qatar.,Ministry of Public Health, Doha, Qatar
| | - Praveen K Bharti
- ICMR - National Institute for Research in Tribal Health, Jabalpur, Madhya Pradesh, 482003, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, 160012, India
| | - Jagadish Mahanta
- ICMR - Regional Medical Research Centre, North East Region, Dibrugarh, Assam, 786001, India
| | - Ali A Sultan
- Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Cornell University, Doha, Qatar
| | - Kanwar Narain
- ICMR - Regional Medical Research Centre, North East Region, Dibrugarh, Assam, 786001, India
| | - Saurav J Patgiri
- ICMR - Regional Medical Research Centre, North East Region, Dibrugarh, Assam, 786001, India.
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Rajvanshi H, Bharti PK, Sharma RK, Nisar S, Saha KB, Jayswar H, Mishra AK, Das A, Kaur H, Lal AA. Monitoring of the Village Malaria Workers to conduct activities of Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh. Malar J 2022; 21:18. [PMID: 34998397 PMCID: PMC8742915 DOI: 10.1186/s12936-021-04040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/27/2021] [Accepted: 12/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background The capacity of the field staff to conduct activities related to disease surveillance, case management, and vector control has been one of the key components for successfully achieving malaria elimination. India has committed to eliminate malaria by 2030, and it has placed significance on monitoring and evaluation at the district level as one of the key strategies in its national framework. To support and guide the country’s malaria elimination objectives, the Malaria Elimination Demonstration Project was conducted in the tribal district of Mandla, Madhya Pradesh. Robust monitoring of human resources received special attention to help the national programme formulate a strategy to plug the gaps in its supply chain and monitoring and evaluation systems. Methods A monitoring tool was developed to test the capabilities of field workers to conduct activities related to malaria elimination work. Between November 2018 to February 2021, twenty-five Malaria Field Coordinators (MFCs) of the project utilized this tool everyday during the supervisory visits for their respective Village Malaria Workers (VMWs). The data was analysed and the scores were tested for variations against different blocks, educational status, duration of monitoring, and post-training scores. Results During the study period, the VMWs were monitored a total of 8974 times using the monitoring tool. Each VMW was supervised an average of 1.8 times each month. The critical monitoring indicators scored well in all seven quarters of the study as monitored by the MFCs. Monitoring by MFCs remained stable at 97.3% in all quarters. Contrary to expectations, the study observed longer diagnosis to treatment initiation time in urban areas of the district. Conclusion This study demonstrated the significance of a robust monitoring tool as an instrument to determine the capacity of the field workers in conducting surveillance, case management, and vector control related work for the malaria elimination programme. Similar tools can be replicated not only for malaria elimination, but other public health interventions as well. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-04040-2.
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Affiliation(s)
- Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.,Asia Pacific Leaders Malaria Alliance (APLMA), Helios, Singapore
| | - Praveen K Bharti
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India.,Indian Council of Medical Research-National Institute of Malaria Research (ICMR-NIMR), New Delhi, India
| | - Ravendra K Sharma
- Indian Council of Medical Research-National Institute of Medical Statistics (ICMR-NIMS), New Delhi, India.,Ch. Charan Singh University, Meerut, Uttar Pradesh, India
| | - Sekh Nisar
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.,State Vector Borne Disease Control Programme, Raigarh, Chattisgarh, India
| | - Kalyan B Saha
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Ashok K Mishra
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Aparup Das
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Harpreet Kaur
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India. .,Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India.
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26
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Rajvanshi H, Mishra K, Bharti PK, Sandhibigraha D, Nisar S, Jayswar H, Das A, Pradhan MM, Mohapatra PK, Govil PJ, Kshirsagar N, Dash AP, Singh S, Sahu RS, Kaur H, Dhingra N, Khan A, Lal AA. Learnings from two independent malaria elimination demonstration projects in India. Trans R Soc Trop Med Hyg 2021; 115:1229-1233. [PMID: 34563095 DOI: 10.1093/trstmh/trab148] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/13/2021] [Accepted: 09/07/2021] [Indexed: 11/14/2022] Open
Abstract
PROBLEM India and sub-Saharan Africa contributes about 85% of the global malaria burden, and India is committed to eliminating malaria by 2030. APPROACH Two novel initiatives-the Malaria Elimination Demonstration Project (MEDP) in Madhya Pradesh and Durgama Anchalare Malaria Nirakaran (DAMaN) in Odisha-were initiated independently to demonstrate that indigenous malaria can be eliminated in a short period of time. LOCAL SETTING These initiatives focused on rural, tribal areas where there is a high malaria burden and complex epidemiology. RELEVANT CHANGES The case management and vector control strategies used in these programmes were based on the national guidelines, with context-specific changes and introduction of accountability at management, operational, technical and financial levels. The MEDP achieved a 91% reduction in malaria cases and recorded zero transmission for 6 consecutive and a total of 9 mo. The DAMaN project brought about an 88% reduction in malaria cases. LESSONS LEARNED Malaria elimination will require robust surveillance and case management, monitoring of vector control interventions, community-centric information education communication and behaviour change communication initiatives and management controls, as well as regular internal and external reviews.
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Affiliation(s)
- Harsh Rajvanshi
- Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh 481661, India
| | - Kirti Mishra
- Directorate of Public Health, Government of Odisha, Bhubaneshwar 751001, India
| | - Praveen K Bharti
- National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh 482003, India
| | | | - Sekh Nisar
- Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh 481661, India
| | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal 462002, India
| | - Aparup Das
- National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh 482003, India
| | - Madan M Pradhan
- Directorate of Public Health, Government of Odisha, Bhubaneshwar 751001, India
| | - Pradipta K Mohapatra
- Health and Family Welfare Department, Government of Odisha, Bhubaneswar 751001, India
| | - Pallavi Jain Govil
- Scheduled Tribes and Scheduled Caste Welfare Department, Government of Madhya Pradesh, Bhopal 462001, India
| | - Nilima Kshirsagar
- Department of Health Research, Indian Council of Medical Research, Ministry of Health and Family Welfare, New Delhi 110029, India
| | - Aditya P Dash
- Asian Institute of Public Health University, Odisha, Bhubaneswar 751001, India
| | - Shrinath Singh
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal 462002, India
| | - Ram Shankar Sahu
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal 462002, India
| | - Harpreet Kaur
- Department of Health Research, Indian Council of Medical Research, Ministry of Health and Family Welfare, New Delhi 110029, India
| | - Neeraj Dhingra
- Directorate General of Health Services, National Vector Borne Disease Control Programme (NVBDCP), Ministry of Health and Family Welfare, New Delhi 110054, India
| | - Azadar Khan
- Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh 481661, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh 481661, India
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Singh A, Bhandari S, Das A, Bharti PK. Asymptomatic low-density Plasmodium falciparum infections: A challenge in malaria elimination in India. J Infect Public Health 2021; 14:1600-1602. [PMID: 34624713 DOI: 10.1016/j.jiph.2021.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/16/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Akansha Singh
- Division of Vector-Borne Diseases, ICMR-National Institute of Research in Tribal Health, PO Garha, Nagpur Road, Jabalpur, 482003, M.P., India.
| | - Sneha Bhandari
- Division of Vector-Borne Diseases, ICMR-National Institute of Research in Tribal Health, PO Garha, Nagpur Road, Jabalpur, 482003, M.P., India.
| | - Aparup Das
- Division of Vector-Borne Diseases, ICMR-National Institute of Research in Tribal Health, PO Garha, Nagpur Road, Jabalpur, 482003, M.P., India.
| | - Praveen K Bharti
- Division of Vector-Borne Diseases, ICMR-National Institute of Research in Tribal Health, PO Garha, Nagpur Road, Jabalpur, 482003, M.P., India.
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Rajvanshi H, Saha KB, Sharma RK, Bharti PK, Nisar S, Jayswar H, Mishra AK, Shukla MM, Das A, Kaur H, Wattal SL, Lal AA. Assessing community knowledge, attitude and practices to strengthen communication strategy for Malaria Elimination Demonstration Project in Mandla. Malar J 2021; 20:354. [PMID: 34454483 PMCID: PMC8403442 DOI: 10.1186/s12936-021-03884-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Changes in social, belief, and behavioural practices are essential for the success of any public health delivery programme. In the planning stages of the Malaria Elimination Demonstration Project (MEDP), priority was given to communication with a goal to develop capacity of health workers and to improve the knowledge, attitude and practices (KAP) of the people of Mandla. This paper describes the level of community knowledge on malaria, including its prevention, diagnosis, treatment-seeking behaviour, and the level of satisfaction with the services provided by the project. METHODS A cross sectional survey was undertaken in 1233 villages of Mandla to study the KAP and self-assessed improvement in knowledge and satisfaction level of the community. The goal of the study was to understand whether there is need for strengthening communication strategy of MEDP for better impact. The survey was conducted amongst the head/eligible members of the 733 households located in the nine blocks of the district using clustered random sampling. RESULTS Though four-fifths of the respondents were able to correlate the transmission of malaria with mosquitoes, misconceptions existed among them. The types of malaria were not known to everyone. Only 39% were aware of the Indoor Residual Spray (IRS) and 41% understood the value of Long-Lasting Insecticidal Nets (LLIN). Around 71% of subjects surveyed were aware of the proper diagnostic tests for malaria. A total of 87% of the respondents knew about the MEDP staff working in their respective villages. CONCLUSION The study reported gaps in knowledge on malaria at community level. The self-assessment of the community revealed that the communication strategy established by MEDP in Mandla district has been useful to them as they are becoming better informed about the prevention and treatment aspects of disease. The lessons learned as revealed in the KAP survey will improve malaria elimination outcomes in a timely manner.
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Affiliation(s)
- Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Kalyan B Saha
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India.
| | - Ravendra K Sharma
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Praveen K Bharti
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Sekh Nisar
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Ashok K Mishra
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Man Mohan Shukla
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Aparup Das
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Harpreet Kaur
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Suman L Wattal
- National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, New Delhi, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.,Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
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Kareemi TI, Mishra AK, Chand SK, Nirankar JK, Vishwakarma AK, Tiwari A, Bharti PK. Analysis of the insecticide resistance mechanism in Anopheles culicifacies sensu lato from a malaria-endemic state in India. Trans R Soc Trop Med Hyg 2021; 116:252-260. [PMID: 34423836 DOI: 10.1093/trstmh/trab110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/26/2021] [Accepted: 07/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Understanding the dynamics and mechanisms of insecticide resistance in malaria vectors is crucial for vector control activities. The present study investigates the level of insecticide resistance in Anopheles culicifacies and explores the role of two main mechanisms in conferring resistance target site insensitivity and metabolic resistance. METHODS A. culicifacies mosquitoes were collected and the voltage-gated sodium channel (VGSC) gene was amplified and sequenced to analyse the knockdown resistance (kdr) mutations. Further, a non-experimental homology model was generated to investigate the effect of kdr mutations on the conformation of protein. Metabolic resistance was determined using bioassay-based resistant and susceptible mosquitoes and the expression levels of the genes CYP6Z1 and GSTe2 were compared between the two groups. RESULTS Sequence analysis of the VGSC gene revealed the presence of L1014F (n=48 [17%]), L1014S and V1010L (n=5 [1.7%]) mutations in the study area. In gene expression studies, a significant upregulation of CYP6Z1 in deltamethrin-resistant (fold change 243.62; p=0.02) mosquitoes and that of GSTe2 in dichlorodiphenyltrichloroethane (fold change 403.45; p=0.01) and alpha-cypemethrin resistant (fold change 217.51; p=0.0005) mosquitoes was observed. CONCLUSIONS The study revealed that expression of the genes (CYP6Z1 and GSTe2) conferring metabolic resistance play a key role in insecticide resistance in A. culicifacies populations in central India. However, mutations L101F, L10104S and V10101L also have a role to some extent in spreading resistance. GeneBank accession numbers: MW559058, MW559059 and MW559060 Cover Image: Workflow of Chimera-Modeller interface. In the top window of Chimera's multi-align viewer the sequence alignment of VGSC proteins of human (pdb id_6AGF), cockroach (pdb id 5XOM) and A. culicifacies (ACT176122.1) is shown. The dialog box in the middle is of the comparative modelling tool of Modeller. The A. culicifacies sequence is designated as the target while human and cockroach sequences are templates. Upon selection of the template sequences in the dialog box, the structures of the respective proteins are displayed in the Chimera window. As the run is completed, the results are displayed in the form of a list of models with their scores in a table.
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Affiliation(s)
- Tazeen I Kareemi
- Division of Vector Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, 482003, Madhya Pradesh, India.,School of Biotechnology, Rajeev Gandhi Technical University, Airport Bypass Road, Bhopal, 462033, Madhya Pradesh, India
| | - Ashok K Mishra
- Division of Vector Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, 482003, Madhya Pradesh, India
| | - Sunil K Chand
- Division of Vector Borne Diseases, ICMR-National Institute of Malaria Research, Field Unit, Nagpur Road, Garha Jabalpur, 482003, Madhya Pradesh, India
| | - Jitendra K Nirankar
- Division of Vector Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, 482003, Madhya Pradesh, India
| | - Anup K Vishwakarma
- Division of Vector Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, 482003, Madhya Pradesh, India
| | - Archana Tiwari
- School of Biotechnology, Rajeev Gandhi Technical University, Airport Bypass Road, Bhopal, 462033, Madhya Pradesh, India
| | - Praveen K Bharti
- Division of Vector Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, 482003, Madhya Pradesh, India
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30
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Krishna S, Mishra S, Tiwari P, Vishwakarma AK, Khandai S, Shrivastava S, Verma AK, Tiwari S, Barman H, Jhariya S, Tiwari P, Tidgam AS, Varun BM, Singh S, Yerane N, Tembhurne CR, Mandavi PL, Tekam SS, Malik M, Behera KP, Jayswar H, Sonwani K, Diggikar MS, Pradhan MM, Khasotiya SS, Kumar A, Dhingra N, Bustos MDG, Christophel EM, Ringwald P, Kumari R, Shukla MM, Singh N, Das A, Bharti PK. Therapeutic efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in four malaria endemic states of India. Malar J 2021; 20:229. [PMID: 34020652 PMCID: PMC8139028 DOI: 10.1186/s12936-021-03762-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/10/2021] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Malaria is a major public health problem in India and accounts for about 88% of malaria burden in South-East Asia. India alone accounted for 2% of total malaria cases globally. Anti-malarial drug resistance is one of the major problems for malaria control and elimination programme. Artemether-lumefantrine (AL) is the first-line treatment of uncomplicated Plasmodium falciparum in north eastern states of India since 2013 after confirming the resistance against sulfadoxine-pyrimethamine. In the present study, therapeutic efficacy of artemether-lumefantrine and k13 polymorphism was assessed in uncomplicated P. falciparum malaria. Methods This study was conducted at four community health centres located in Koraput district of Odisha, Bastar district of Chhattisgarh, Balaghat district of Madhya Pradesh and Gondia district of Maharashtra state. Patients with uncomplicated P. falciparum malaria were administered with fixed dose combination (6 doses) of artemether-lumefantrine for 3days and clinical and parasitological response was recorded up to 28days as per World Health Organization protocol. Nucleotide sequencing of msp1 and msp2 gene was performed to differentiate between recrudescence and reinfection. Amplification and sequencing of k13 propeller gene region covering codon 450680 was also carried out to identify the polymorphism. Results A total 376 malaria patients who fulfilled the enrolment criteria as well as consented for the study were enrolled. Total 356 patients were followed up successfully up to 28days. Overall, the adequate clinical and parasitological response was 98.9% and 99.4% with and without PCR correction respectively. No case of early treatment failure was observed. However, four cases (1.1%) of late parasitological failure were found from the Bastar district of Chhattisgarh. Genotyping of msp1 and msp2 confirmed 2 cases each of recrudescence and reinfection, respectively. Mutation analysis of k13 propeller gene showed one non-synonymous mutation Q613H in one isolate from Bastar. Conclusions The study results showed that artemether-lumefantrine is highly effective in the treatment of uncomplicated P. falciparum malaria among all age groups. No functional mutation in k13 was found in the study area. The data from this study will be helpful in implementation of artemether-lumefantrine in case of treatment failure by artesunate plus sulfadoxine-pyrimethamine.
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Affiliation(s)
- Sri Krishna
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Sweta Mishra
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Prakash Tiwari
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Anup K Vishwakarma
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Sushrikanta Khandai
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Suyesh Shrivastava
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Anil K Verma
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Shashikant Tiwari
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Hari Barman
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Surendra Jhariya
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Pradeep Tiwari
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | | | - Brij M Varun
- District Malaria Office, Balaghat, Madhya Pradesh, India
| | - Sunil Singh
- Community Health Centre Damoh, Balaghat, Madhya Pradesh, India
| | - Naresh Yerane
- Community Health Centre Darekasa, Gondia, Maharashtra, India
| | | | - Prem L Mandavi
- Community Health Centre, District Bastar, Darbha, Chhattisgarh, India
| | - Shyam S Tekam
- District Malaria Office, District Bastar, Jagdalpur, Chhattisgarh, India
| | - Manas Malik
- Community Health Centre Bandhgram, District Koraput, Dasmantpur, Odisha, India
| | - Kali P Behera
- District Malaria Office, District Koraput, Dasmantpur, Odisha, India
| | - Himanshu Jayswar
- Directorate of Health Services, Satpura Bhawan, Bhopal, Madhya Pradesh, India
| | - Khemraj Sonwani
- Directorate of Health Services, Indravati Bhawan, Raipur, Chhattisgarh, India
| | | | - Madan M Pradhan
- State NVBDCP, Public Health Directorate, Bhubaneswar, Odisha, India
| | - Sher S Khasotiya
- National Vector Borne Disease Control Programme (NVBDCP), New Delhi, India
| | - Avdhesh Kumar
- National Vector Borne Disease Control Programme (NVBDCP), New Delhi, India
| | - Neeraj Dhingra
- National Vector Borne Disease Control Programme (NVBDCP), New Delhi, India
| | | | | | - Pascal Ringwald
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Roop Kumari
- World Health Organization, Country Office for India, New Delhi, India
| | - Man M Shukla
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Neeru Singh
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Aparup Das
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Praveen K Bharti
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India.
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Verma K, Lahariya AK, Dubey S, Verma AK, Das A, Schneider KA, Bharti PK. An integrated virtual screening and drug repurposing strategy for the discovery of new antimalarial drugs against Plasmodium falciparum phosphatidylinositol 3-kinase. J Cell Biochem 2021; 122:1326-1336. [PMID: 33998049 DOI: 10.1002/jcb.29954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 11/10/2022]
Abstract
The emergence and spread of drug resistance in Plasmodium falciparum, the parasite causing the most severe form of human malaria, is a major threat to malaria control and elimination programs around the globe. With P. falciparum having evolved widespread resistance against a number of previously widely used drugs, currently, artemisinin (ART) and its derivatives are the cornerstones of first-line treatments of uncomplicated malaria. However, growing incidences of ART failure reflect the spread of ART-resistant P. falciparum strains. Despite current efforts to understand the primary cause of ART resistance due to mutations in the Kelch 13 gene (PfK13), the mechanism underlying ART resistance is still not completely unclear and no feasible strategies to counteract the causes and thereby restoring the efficiency of ART have been developed. We use a polypharmacology approach to identify potential drugs that can be used for the novel purpose (target). Of note, we have designed a multimodal stratagem to identify approved drugs with a potential antimalarial activity using computational drug reprofiling. Our investigations suggest that oxetacaine, simvastatin, repaglinide, aclidinium, propafenone, and lovastatin could be repurposed for malaria control and prevention.
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Affiliation(s)
- Kanika Verma
- Division of Vector-Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | - Ayush K Lahariya
- Division of Vector-Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | - Shivangee Dubey
- Division of Vector-Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | - Anil K Verma
- Division of Vector-Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | - Aparup Das
- Division of Vector-Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | | | - Praveen K Bharti
- Division of Vector-Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, India
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Mishra AK, Nisar S, Rajvanshi H, Bharti PK, Saha KB, Shukla MM, Sharma RK, Jayswar H, Das A, Kaur H, Wattal SL, Lal AA. Improvement of Indoor Residual Spraying and Long-Lasting Insecticidal Net services through structured monitoring and supervision as part of the Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh. Malar J 2021; 20:101. [PMID: 33602216 PMCID: PMC7890615 DOI: 10.1186/s12936-021-03639-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background The Government of Madhya Pradesh employed Indoor Residual Spraying (IRS) with alpha-cypermethrin synthetic pyrethroids in sub-centres with Annual Parasite Incidence (API) from 2 to 4.99. In sub-centres with API more than 5, Long-Lasting Insecticidal Nets (LLINs) were distributed. At the request of the State Government, the Malaria Elimination Demonstration Project (MEDP) staff observed and provided support to both IRS and LLINs campaigns. In the year 2017, the study team monitored only the IRS campaigns, however, in the year 2018, the supportive supervision was provided to the IRS campaign teams along with post-distribution monitoring of the LLINs. Methods The study was carried out during IRS spraying using a pre-tested, closed-ended monitoring checklist which consisted of two parts- observations of spraying team and observation of sprayed houses. For LLINs, a sample of the households that received the bed nets was taken for the study. For IRS, the spraying teams were monitored for quality and technique for a total of 159 times in 2017 and 183 times in the year 2018, respectively. For post spraying observations, a total of 1261 and 1791 households were observed in the years 2017 and 2018, respectively. The use of LLINs was observed in 5 % of the households in 2018 and 2020, which is about 2,000 houses in each survey where each house received about 2.5 LLINs per household. The results of surveys were compared to assess impact of supportive supervision and monitoring. Results Significant improvement was noted after supportive supervision in year 2018 in various aspects of spraying. Preparedness of spraying, such as advance information to villagers, presence of equipment and records improved by up to 70 %. The methodology of spraying preparation improved from 50 to 90 %, spraying technique improved from 54 to 80 %, and proper use equipment during spraying improved from 51 to 92 %. After eight months post distribution of the LLINs in 2019, improvement was seen in regular usage of LLINs by 28 %. It was found that on-spot demonstrations during distribution and carrying of LLINs when sleeping outside homes increased by 56 %. Results of IEC campaigns revealed the reduction in adverse effects by 64 % and increase in awareness by 97 %. Conclusions Effective supervision improved the quality of IRS and usage of LLINs in the study area. Based on these results, continued training and monitoring of staff that is deployed to spraying houses and distribute bed nets was suggested. The study also revealed that proper IEC/BCC drives help increase community acceptance of vector control measures and their rational usage.
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Affiliation(s)
- Ashok K Mishra
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR- NIRTH), Jabalpur, Madhya Pradesh, India.
| | - Sekh Nisar
- Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh, India
| | - Harsh Rajvanshi
- Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh, India
| | - Praveen K Bharti
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR- NIRTH), Jabalpur, Madhya Pradesh, India
| | - Kalyan B Saha
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR- NIRTH), Jabalpur, Madhya Pradesh, India
| | - Man Mohan Shukla
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR- NIRTH), Jabalpur, Madhya Pradesh, India
| | - Ravendra K Sharma
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR- NIRTH), Jabalpur, Madhya Pradesh, India
| | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, Madhya Pradesh, India
| | - Aparup Das
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR- NIRTH), Jabalpur, Madhya Pradesh, India
| | - Harpreet Kaur
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Suman L Wattal
- National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, New Delhi, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh, India.,Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
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Rajvanshi H, Jain Y, Kaintura N, Soni C, Chandramohan R, Srinivasan R, Telasey V, Bharti PK, Jain D, Surve M, Saxena S, Gangamwar V, Anand MS, Lal AA. A comprehensive mobile application tool for disease surveillance, workforce management and supply chain management for Malaria Elimination Demonstration Project. Malar J 2021; 20:91. [PMID: 33593359 PMCID: PMC7885520 DOI: 10.1186/s12936-021-03623-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health care technologies are now offering accountability, quality, robustness, and accuracy in disease surveillance and health care delivery programmes. With the advent of mobile hand-held devices, these technologies have become more accessible and adaptable for use by field staff working in remote areas. The Malaria Elimination Demonstration Project started collection of data and conduct of routine operations using paper-based reporting systems. Observing the need for a robust and quality digital mobile application, a comprehensive mobile application tool was developed that allowed the project to conduct disease surveillance, workforce management and supply chain management. METHODS In June 2017, the project conceptualized a comprehensive mobile application tool in the local language (Hindi) for disease surveillance, human resources management, and supply chain management. The tool is also available in English. Solution for Community Health-workers (SOCH) mobile app is an android native application developed using android SDK and web-based tool using MVC.net framework. Construction of the application started in November 2017 and rolled out its pilot in April 2018, followed by pan-district roll out in July 2018. The application uses self-validation tools to ensure high level of data quality and integrity. RESULTS The software is available in android based hand-held devices and web-screens with built-in data analytical capabilities. Using SOCH, the project has now successfully digitized its routine surveillance, attendance, tour plans, supply chain management components. The project has documented a reduction in 91% indigenous cases in the district, 60% improvement in stock accountability, and 99.6% accuracy in data collected through the mobile application. CONCLUSION SOCH is an excellent and user-friendly tool, which can be customized for any public health management programme. The system ensures accountability and data robustness, which is needed for malaria elimination efforts throughout the country. The mobile application can be adapted for English or any other Indian or international language for use for malaria or any other disease surveillance and control programme. Another expansion feature of this mobile application is incorporation of indicators for Indoor Residual Spraying (IRS), Long-Lasting Insecticidal Nets (LLINs), and minor engineering by the residents of community under surveillance. The authors believe that it would be highly desirable and appropriate for an international organization, such as the World Health Organization (WHO), to conduct an independent comparison of all available mobile e-surveillance tools, so that a high-performing and globally suitable system can be selected for use in malaria elimination programmes. The Foundation of Disease Elimination and Controlof India has decided to make the SOCH mobile application available to anyone who would like to use it for disease surveillance and health care programmes.
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Affiliation(s)
- Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.
| | | | | | - Chaitanya Soni
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | | | | | - Vinay Telasey
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Praveen K Bharti
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Deepak Jain
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | - Mangeshi Surve
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | | | - Vilas Gangamwar
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | - M S Anand
- Swaas Systems Pvt Ltd, Chennai, Tamil Nadu, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
- Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
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Rajvanshi H, Bharti PK, Nisar S, Jayswar H, Mishra AK, Sharma RK, Saha KB, Shukla MM, Wattal SL, Das A, Kaur H, Anvikar AR, Khan A, Kshirsagar N, Dash AP, Lal AA. A model for malaria elimination based on learnings from the Malaria Elimination Demonstration Project, Mandla district, Madhya Pradesh. Malar J 2021; 20:98. [PMID: 33593368 PMCID: PMC7888092 DOI: 10.1186/s12936-021-03607-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/15/2021] [Revised: 01/23/2021] [Accepted: 01/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background Malaria Elimination Demonstration Project (MEDP) was started as a Public-Private-Partnership between the Indian Council of Medical Research through National Institute of Research in Tribal Health, Govt. of Madhya Pradesh and Foundation of Disease Elimination and Control of India, which is a Corporate Social Responsibility (CSR) initiative of the Sun Pharmaceutical Industries Limited. The project’s goal was to demonstrate that malaria can be eliminated from a high malaria endemic district along with prevention of re-establishment of malaria and to develop a model for malaria elimination using the lessons learned and knowledge acquired from the demonstration project. Methods The project employed tested protocols of robust surveillance, case management, vector control, and capacity building through continuous evaluation and training. The model was developed using the learnings from the operational plan, surveillance and case management, monitoring and feedback, entomological investigations and vector control, IEC and capacity building, supply chain management, mobile application (SOCH), and independent reviews of MEDP. Results The MEDP has been operational since April 2017 with field operations from August 2017, and has observed: (1) reduction in indigenous cases of malaria by about 91 %; (2) need for training and capacity building of field staff for diagnosis and treatment of malaria; (3) need for improvement insecticide spraying and for distribution and usage of bed-nets; (4) need for robust surveillance system that captures and documents information on febrile cases, RDT positive individuals, and treatments provided; (5) need for effective supervision of field staff based on advance tour plan; (6) accountability and controls from the highest level to field workers; and (7) need for context-specific IEC. Conclusions Malaria elimination is a high-priority public health goal of the Indian Government with a committed deadline of 2030. In order to achieve this goal, built-in systems of accountability, ownership, effective management, operational, technical, and financial controls will be crucial components for malaria elimination in India. This manuscript presents a model for malaria elimination with district as an operational unit, which may be considered for malaria elimination in India and other countries with similar geography, topography, climate, endemicity, health infrastructure, and socio-economic characteristics.
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Affiliation(s)
- Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Praveen K Bharti
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR- NIRTH), Jabalpur, Madhya Pradesh, India
| | - Sekh Nisar
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Ashok K Mishra
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR- NIRTH), Jabalpur, Madhya Pradesh, India
| | - Ravendra K Sharma
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR- NIRTH), Jabalpur, Madhya Pradesh, India
| | - Kalyan B Saha
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR- NIRTH), Jabalpur, Madhya Pradesh, India
| | - Man Mohan Shukla
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR- NIRTH), Jabalpur, Madhya Pradesh, India
| | - Suman L Wattal
- National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, New Delhi, India
| | - Aparup Das
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR- NIRTH), Jabalpur, Madhya Pradesh, India
| | - Harpreet Kaur
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Anupkumar R Anvikar
- Indian Council of Medical Research-National Institute of Malaria Research (ICMR-NIMR), New Delhi, India
| | - Azadar Khan
- Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
| | - Nilima Kshirsagar
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Aditya P Dash
- Asian Institute of Public Health University, Odisha, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India. .,Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India.
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Rajvanshi H, Saha KB, Shukla MM, Nisar S, Jayswar H, Mishra AK, Sharma RK, Bharti PK, Saxena N, Verma A, Das A, Kaur H, Wattal SL, Lal AA. Assessment of ASHA for knowledge, diagnosis and treatment on malaria in Mandla district of Madhya Pradesh as part of the malaria elimination demonstration project. Malar J 2021; 20:78. [PMID: 33557826 PMCID: PMC7871633 DOI: 10.1186/s12936-021-03610-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/27/2020] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 12/24/2022] Open
Abstract
Background The role of Accredited Social Health Activist (ASHA) in the health care delivery services at the periphery level is crucial for achieving disease prevention, control and elimination goals. The objective of the study was to assess the knowledge, attitude, practices, priorities and capability of ASHA related to malaria diagnosis and treatment as part of the Malaria Elimination Demonstration Project in 1233 villages of district Mandla, Madhya Pradesh. Methods A cross sectional study was conducted using a fully structured, pre-tested interview schedule during June and July 2017 (before the field operations of MEDP were started). Two hundred twenty (17%) of the total ASHAs were selected for the interview from the 9 developmental blocks of Mandla district. Results Knowledge, Attitude and Practices (KAP) study revealed that most ASHAs knew that mosquitoes are the main agent for spread of malaria (97.7%). They mostly used Rapid Diagnostic Test (RDT) for diagnosis (91.8%). The majority (87.3%) correctly identified negative RDT result while only 15% and 10.5%, respectively, identified Plasmodium vivax and Plasmodium falciparum positive cases correctly. Further analysis showed that 85% ASHAs used chloroquine, 44.5% used artemisinin-based combination therapy (ACT), and 55.5% used primaquine for treatment of malaria. It was also found that only 38.2% ASHA gave PQ for 14 days in cases of P. vivax. At the time of the interview, 19.1% ASHAs did not have any RDTs for diagnosis and 47.7% reported not having ACT for treatment of P. falciparum malaria. Conclusions This study has revealed that ASHAs in the test district were not adequately trained or stocked for malaria parasite species identification and treatment, which are the major components of malaria elimination programme. This study has, therefore, revealed a need for training ASHAs on testing by RDT and proper treatment regimen for P. vivax and P. falciparum.
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Affiliation(s)
- Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Kalyan B Saha
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Man Mohan Shukla
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Sekh Nisar
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Ashok K Mishra
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Ravendra K Sharma
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Praveen K Bharti
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Nishant Saxena
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Arvind Verma
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Aparup Das
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Harpreet Kaur
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Suman L Wattal
- National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, New Delhi, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India. .,Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India.
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Rajvanshi H, Nisar S, Bharti PK, Jayswar H, Mishra AK, Sharma RK, Saha KB, Shukla MM, Das A, Kaur H, Wattal SL, Lal AA. Significance of training, monitoring and assessment of malaria workers in achieving malaria elimination goal of Malaria Elimination Demonstration Project. Malar J 2021; 20:27. [PMID: 33413408 PMCID: PMC7789890 DOI: 10.1186/s12936-020-03534-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 12/07/2020] [Indexed: 01/10/2023] Open
Abstract
Background The Malaria Elimination Demonstration Project (MEDP) maintained a workforce of 235 Village Malaria Workers (VMWs) and 25 Malaria Field Coordinators (MFCs) to conduct disease surveillance, case management, IEC/BCC activities, capacity building, and monitoring of vector control activities in 1233 villages of Mandla, a high malaria endemic district of Madhya Pradesh in central India. Methods The induction training was conducted for 3 days on malaria diagnosis, treatment, prevention, and ethics. All trainings were assessed using a pre and post-training assessment questionnaire, with 70% marks as qualifying threshold. The questionnaire was divided into three thematic areas viz. general knowledge related to malaria (KAP), diagnosis and treatment (DXRX), and vector control (PVC). Results In 2017, the project trained 330 candidates, followed by 243 and 247 candidates in 2018 and 2019, respectively. 94.3% candidates passed after a single training session. Almost all (95%) candidates showed improvement in knowledge after the training with 4% showing no effect and 1% showing deterioration. Progressive improvement in scores of 2017 cohort was seen along with significant improvement in performance of candidates in 2019 after the introduction of systematic monitoring and ‘shadowing’ training exercises. Conclusion The project has successfully demonstrated the value of recruitment of workers from the study area, outcome of training, and performance evaluation of field staff in malaria elimination programme. This careful strategy of recruitment and training resulted in a work-force that was capable of independently conducting surveillance, case management, vector control, and Information Education Communication/Behaviour Change Communication (IEC/BCC). The learnings of this study, including the training modules and monitoring processes, can be used to train the health delivery staff for achieving national goal for malaria elimination by 2030. Similar training and monitoring programmes could also be used for other public health delivery programmes.
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Affiliation(s)
- Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.
| | - Sekh Nisar
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Praveen K Bharti
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Ashok K Mishra
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Ravendra K Sharma
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Kalyan B Saha
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Man Mohan Shukla
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Aparup Das
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Harpreet Kaur
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Suman L Wattal
- Ministry of Health and Family Welfare, National Vector Borne Disease Control Programme, New Delhi, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.,Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
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Sharma RK, Rajvanshi H, Bharti PK, Nisar S, Jayswar H, Mishra AK, Saha KB, Shukla MM, Das A, Kaur H, Wattal SL, Lal AA. Socio-economic determinants of malaria in tribal dominated Mandla district enrolled in Malaria Elimination Demonstration Project in Madhya Pradesh. Malar J 2021; 20:7. [PMID: 33402186 PMCID: PMC7786971 DOI: 10.1186/s12936-020-03540-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 03/27/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023] Open
Abstract
Background Malaria is known as a disease of poverty because of its dominance in poverty-stricken areas. Madhya Pradesh state in central India is one of the most vulnerable states for malaria morbidity and mortality. Socio-economic, environmental and demographic factors present challenges in malaria control and elimination. As part of the Malaria Elimination Demonstration Project in the tribal district of Mandla in Madhya Pradesh, this study was undertaken to assess the role of different social-economic factors contributing to malaria incidence. Methods The study was conducted in the 1233 villages of district Mandla, where 87% population resides in rural areas. The data was collected using the android based mobile application—SOCH for a period of 2 years (September 2017 to August 2019). A wealth index was computed along with analysis of the socio-economic characteristics of houses with malaria cases. Variables with significant variation in malaria cases were used in logistic regression. Results More than 70% of houses in Mandla are Kuccha (made of thatched roof or mud), 20% do not have any toilet facilities, and only 11% had an annual income of more than 50,000 INR, which converts to about $700 per year. Households with younger heads, male heads, more number of family members were more likely to have malaria cases. Kuccha construction, improper water supply, low household income houses were also more likely to have a malaria case and the odds doubled in houses with no toilet facilities. Conclusion Based on the results of the study, it has been found that there is an association between the odds of having malaria cases and different household variables such as age, gender, number of members, number of rooms, caste, type of house, toilet facilities, water supply, cattle sheds, agricultural land, income, and vector control interventions. Therefore, a better understanding of the association of various risk factors that influence the incidence of malaria is required to design and/or deploy effective policies and strategies for malaria elimination. The results of this study suggest that appropriate economic and environmental interventions even in low-income and poverty-stricken tribal areas could have huge impact on the success of the national malaria elimination goals.
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Affiliation(s)
- Ravendra K Sharma
- Indian Council of Medical Research-National Institute of Research in Tribal Health, (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India.
| | - Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Praveen K Bharti
- Indian Council of Medical Research-National Institute of Research in Tribal Health, (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Sekh Nisar
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Ashok K Mishra
- Indian Council of Medical Research-National Institute of Research in Tribal Health, (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Kalyan B Saha
- Indian Council of Medical Research-National Institute of Research in Tribal Health, (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Man Mohan Shukla
- Indian Council of Medical Research-National Institute of Research in Tribal Health, (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Aparup Das
- Indian Council of Medical Research-National Institute of Research in Tribal Health, (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Harpreet Kaur
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Suman L Wattal
- National Vector Borne Disease Control Program, Ministry of Health and Family Welfare, New Delhi, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.,Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
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Kumar R, Yadav R, Mishra S, Singh MPSS, Gwal A, Bharti PK, Rajasubramaniam S. Krüppel-like factor 1 (KLF1) gene single nucleotide polymorphisms in sickle cell disease and its association with disease-related morbidities. Ann Hematol 2021; 100:365-373. [PMID: 33388857 DOI: 10.1007/s00277-020-04381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Sickle cell disease has varied clinical symptoms, and patients having high fetal hemoglobin (HbF) have milder symptoms. Various genetic factors are known to modulate the HbF levels. Krüppel-like factor 1 (KLF1) is a transcription factor that regulates the beta-like globin gene expression. Any variation in KLF1 gene may alter the sickle cell disease phenotype. Xmn-I polymorphism is also known to regulate the gamma globin gene expression. Present studies were carried out to investigate the effect of KLF1 gene mutations and Xmn-I polymorphism on the sickle cell disease severity and to ascertain the genotype-phenotype correlation. One hundred and eighteen sickle cell disease patients having a median follow-up of 5 years (3-10 years) were recruited. Clinical details were recorded from their retrospective medical records. Xmn-I polymorphism were analyzed using PCR-RFLP method. Variations in KLF1 gene were identified using Sanger sequencing. Out of 118 patients, 24 had acute chest syndrome and 21 patients had more than 2 pain episodes per year. There were no significant differences in sickle cell disease-related morbidities in male and females barring leg ulcers. A total of 6 polymorphism were observed in KLF1 gene, out of which 3 are novel (c.-304G > C, c.*141A > G and c.*178A > G). No statistically significant association of any of SNPs identified in KLF1 gene or Xmn-I polymorphism was seen with HbF levels as well as the sickle cell disease-related morbidities. No association exists between fetal hemoglobin or sickle cell disease-related morbidities and Xmn-I polymorphism or with SNPs identified in KLF1 gene in the studied cohort.
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Affiliation(s)
- Ravindra Kumar
- ICMR-National Institute of Research in Tribal Health, Nagpur Road, P.O. Garha, Jabalpur, 482003, India
| | - Rajiv Yadav
- ICMR-National Institute of Research in Tribal Health, Nagpur Road, P.O. Garha, Jabalpur, 482003, India
| | - Sweta Mishra
- ICMR-National Institute of Research in Tribal Health, Nagpur Road, P.O. Garha, Jabalpur, 482003, India
| | - M P S S Singh
- ICMR-National Institute of Research in Tribal Health, Nagpur Road, P.O. Garha, Jabalpur, 482003, India
| | - Anil Gwal
- ICMR-National Institute of Research in Tribal Health, Nagpur Road, P.O. Garha, Jabalpur, 482003, India
| | - Praveen K Bharti
- ICMR-National Institute of Research in Tribal Health, Nagpur Road, P.O. Garha, Jabalpur, 482003, India
| | - Shanmugam Rajasubramaniam
- ICMR-National Institute of Research in Tribal Health, Nagpur Road, P.O. Garha, Jabalpur, 482003, India.
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Bhandari S, Krishna S, Patel PP, Singh MP, Singh N, Sharma A, Bharti PK. Diversity and expression of Plasmodium falciparum var gene in severe and mild malaria cases from Central India. Int J Infect Dis 2020; 103:552-559. [PMID: 33326872 DOI: 10.1016/j.ijid.2020.12.022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Plasmodium falciparum erythrocyte membrane protein is encoded by a highly variable multicopy var gene family known to play a key role in malaria pathogenicity. Therefore, we investigated sequence variation, expression profile and immune response of the Duffy binding-like domain (DBLα) region of the var gene. METHODS Blood samples were collected from patients with cerebral, severe and mild malaria in Chhattisgarh, India, a region with endemic malaria. Polymerase chain reaction amplicons were cloned and sequenced to determine sequence variation. The expression level was analyzed targeting the upstream region of var gene using the Delta-Delta-Ct method. Immunoglobulin G (IgG) level was determined against the 6 synthetic peptides of the DBLα region. RESULTS The study identified that group 1 and group 5 sequences (cysteine/position of limited variability (cys/PoLV) classification) along with cys2/cys4 and MFK*/REY motifs and short amino acid length were significantly associated with malaria severity. The specific PoLV (MFKS, LREA, PTNL) were restricted to cerebral malaria. The expression level of var group A was higher than var groups B and C, demonstrating its prognostic characteristic. All peptides showed high-quality IgG response, while VAR P5 appeared to be a good marker for severity. CONCLUSIONS The present study illustrates the presence of specific sequences of DBLα tags involved in severe malaria that could be targeted in future interventions for malaria control and elimination.
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Affiliation(s)
- Sneha Bhandari
- ICMR-National Institute of Research in Tribal Health, Nagpur Road, Garha, Jabalpur, 482003, Madhya Pradesh, India.
| | - Sri Krishna
- ICMR-National Institute of Research in Tribal Health, Nagpur Road, Garha, Jabalpur, 482003, Madhya Pradesh, India.
| | - Priyanka P Patel
- ICMR-National Institute of Research in Tribal Health, Nagpur Road, Garha, Jabalpur, 482003, Madhya Pradesh, India.
| | - Mrigendra P Singh
- ICMR-National Institute of Malaria Research, Field Unit, Nagpur Road, Garha, Jabalpur, 482003, Madhya Pradesh, India.
| | - Neeru Singh
- ICMR-National Institute of Research in Tribal Health, Nagpur Road, Garha, Jabalpur, 482003, Madhya Pradesh, India.
| | - Anjana Sharma
- Department of Post Graduate Studies and Research in Biological Sciences, Rani Durgavati Vishwavidyalaya, Jabalpur, Madhya Pradesh, India.
| | - Praveen K Bharti
- ICMR-National Institute of Research in Tribal Health, Nagpur Road, Garha, Jabalpur, 482003, Madhya Pradesh, India.
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Mishra AK, Bharti PK, Vishwakarma A, Nisar S, Rajvanshi H, Sharma RK, Saha KB, Shukla MM, Jayswar H, Das A, Kaur H, Wattal SL, Lal AA. A study of malaria vector surveillance as part of the Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh. Malar J 2020; 19:447. [PMID: 33267870 PMCID: PMC7709422 DOI: 10.1186/s12936-020-03517-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/20/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Understanding of malaria vector density, distribution, insecticide resistance, vector incrimination, infection status, and identification of sibling species are some of the essential components of vector control measures for achieving malaria elimination goals. METHODS As part of the malaria elimination demonstration project, entomological surveillance was carried out from October 2017 to October 2019 by collecting indoor resting mosquitoes using hand catch method. Susceptibility test was done for determining the insecticide resistance status of vector mosquito Anopheles culicifacies using standard protocols by the World Health Organization. The cone bioassay method was used for determining the efficacy and quality of insecticide sprayed. Mosquitoes collected from different ecotypes were identified and processed for parasite identification, vector incrimination and sibling species determination. RESULTS The two known malaria vector species (Anopheles culicifacies and Anopheles fluviatilis) were found in the study area, which have been previously reported in this and adjoining areas of the State of Madhya Pradesh. The prevalence of An. culicifacies was significantly higher in all study villages with peak in July while lowest number was recorded in May. Proportion of vector density was observed to be low in foothill terrains. The other anopheline species viz, Anopheles subpictus, Anopheles annularis, Anopheles vagus, Anopheles splendidus, Anopheles pallidus, Anopheles nigerrimus and Anopheles barbirostris were also recorded in the study area, although their prevalence was significantly less compared to the An. culicifacies. In 2017, An. culicifacies was found to be resistant to dichloro-diphenyl-trichloroethane (DDT) and malathion, with possible resistance to alphacypermethrin and susceptible to deltamethrin. However, in 2019, the species was found to be resistant to alphacypermethrin, DDT, malathion, with possible resistance to deltamethrin. The bioassays revealed 82 to > 98% corrected % mortality of An. culicifacies on day-one post-spraying and 35 to 62% on follow-up day-30. Anopheles culicifacies sibling species C was most prevalent (38.5%) followed by A/D and E while B was least pre-dominant (11.9%). Anopheles fluviatilis sibling species T was most prevalent (74.6%) followed by U (25.4%) while species S was not recorded. One An.culicifacies (sibling species C) was found positive for Plasmodium falciparum by PCR tests in the mosquitoes sampled from the test areas. CONCLUSION Based on the nine entomologic investigations conducted between 2017-2019, it was concluded that An. culicifacies was present throughout the year while An. fluviatilis had seasonal presence in the study areas. Anopheles culicifacies was resistant to alphacypermethrin and emerging resistance to deltamethrin was observed in this area. Anopheles culicifacies was confirmed as the malaria vector. This type of information on indigenous malaria vectors and insecticide resistance is important in implementation of vector control through indoor residual spraying (IRS) and use of insecticide-impregnated bed nets for achieving the malaria elimination goals.
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Affiliation(s)
- Ashok K Mishra
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India.
| | - Praveen K Bharti
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Anup Vishwakarma
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Sekh Nisar
- Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh, India
| | - Harsh Rajvanshi
- Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh, India
| | - Ravendra K Sharma
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Kalyan B Saha
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Man Mohan Shukla
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Aparup Das
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Harpreet Kaur
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Suman L Wattal
- National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, New Delhi, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh, India
- Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
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Rajvanshi H, Bharti PK, Nisar S, Jain Y, Jayswar H, Mishra AK, Sharma RK, Saha KB, Shukla MM, Das A, Kaur H, Wattal SL, Singh N, Lal AA. Study design and operational framework for a community-based Malaria Elimination Demonstration Project (MEDP) in 1233 villages of district Mandla, Madhya Pradesh. Malar J 2020; 19:410. [PMID: 33198754 PMCID: PMC7667481 DOI: 10.1186/s12936-020-03458-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 03/27/2020] [Accepted: 10/21/2020] [Indexed: 02/05/2023] Open
Abstract
Background In the past decade substantial reduction in malaria morbidity and mortality has been observed through well-implemented case management and vector control strategies. India has also achieved a significant reduction in malaria burden in 2018 and has committed to eliminate malaria by 2030. The Mandla Malaria Elimination Demonstration Project (MEDP) was started in 2017 in 1233 villages of District Mandla to demonstrate malaria elimination in a tribal district with hard-to-reach areas was possible using active and passive surveillance, case management, vector control, and targeted information, education and communication campaigns. An operational plan was developed to strengthen the existing surveillance and malaria elimination systems, through fortnightly active case detection to ensure that all cases including those that are introduced into the communities are rapidly identified and treated promptly. The plan also focused on the reduction of human-mosquito contact through the use of Long-Lasting Insecticial Nets (LLINs) and Indoor Residual Spray (IRS). The operational plan was modified in view of the present COVID-19 pandemic by creating systems of assistance for the local administration for COVID-related work while ensuring the operational integrity of malaria elimination efforts. Results The use of MEDP study design and operational plan, with its built-in management control systems, has yielded significant (91%) reduction of indigenous cases of malaria during the period from June 2017 to May 2020. The malaria positivity rate was 0.33% in 2017–18, 0.13% in 2018–19, and 0.06% in 2019–20. Mass screening revealed 0.18% malaria positivity in September–October 2018, followed by 0.06% in June 2019, and 0.03% in December 2019, and these were mostly asymptomatic cases in the community. The project has been able to sustain the gains of the past three years during the ongoing COVID-19 pandemic. Conclusion This paper provides the study design and the operational plan for malaria elimination in a high-burden district of Central India, which presented difficulties of hard to reach areas, forest malaria, and complex epidemiology of urban and rural malaria. The lessons learned could be used for malaria elimination efforts in rest of the country and other parts of South Asia with comparable demography and epidemiology.
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Affiliation(s)
- Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.
| | - Praveen K Bharti
- Indian Council of Medical Research, National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Sekh Nisar
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Yashpal Jain
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.,Jhpiego, Jaipur, Rajasthan, India
| | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Ashok K Mishra
- Indian Council of Medical Research, National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Ravendra K Sharma
- Indian Council of Medical Research, National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Kalyan B Saha
- Indian Council of Medical Research, National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Man Mohan Shukla
- Indian Council of Medical Research, National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Aparup Das
- Indian Council of Medical Research, National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Harpreet Kaur
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Suman L Wattal
- National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, New Delhi, India
| | - Neeru Singh
- Indian Council of Medical Research, National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.,Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
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Singh H, Mian SY, Pandey AK, Krishna S, Anand G, Reddy KS, Chaturvedi N, Bahl V, Hans N, Shukla MM, Bassat Q, Mayor A, Miura K, Bharti PK, Long C, Singh N, Chauhan VS, Gaur D. Antibody Combinations Targeting the Essential Antigens CyRPA, RH5, and MSP-119 Potently Neutralize Plasmodium falciparum Clinical Isolates From India and Africa. J Infect Dis 2020; 223:1953-1964. [PMID: 32989463 DOI: 10.1093/infdis/jiaa608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/24/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Targeting multiple key antigens that mediate distinct Plasmodium falciparum erythrocyte invasion pathways is an attractive approach for the development of blood-stage malaria vaccines. However, the challenge is to identify antigen cocktails that elicit potent strain-transcending parasite-neutralizing antibodies efficacious at low immunoglobulin G concentrations feasible to achieve through vaccination. Previous reports have screened inhibitory antibodies primarily against well adapted laboratory parasite clones. However, validation of the parasite-neutralizing efficacy against clinical isolates with minimal in vitro cultivation is equally significant to better ascertain their prospective in vivo potency. METHODS We evaluated the parasite-neutralizing activity of different antibodies individually and in combinations against laboratory adapted clones and clinical isolates. Clinical isolates were collected from Central India and Mozambique, Africa, and characterized for their invasion properties and genetic diversity of invasion ligands. RESULTS In our portfolio, we evaluated 25 triple antibody combinations and identified the MSP-Fu+CyRPA+RH5 antibody combination to elicit maximal parasite neutralization against P. falciparum clinical isolates with variable properties that underwent minimal in vitro cultivation. CONCLUSIONS The MSP-Fu+CyRPA+RH5 combination exhibited highly robust parasite neutralization against P. falciparum clones and clinical isolates, thus substantiating them as promising candidate antigens and establishing a proof of principle for the development of a combinatorial P. falciparum blood-stage malaria vaccine.
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Affiliation(s)
- Hina Singh
- Laboratory of Malaria and Vaccine Research, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India.,Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Syed Yusuf Mian
- Laboratory of Malaria and Vaccine Research, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Alok K Pandey
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Sri Krishna
- National Institute for Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Gaurav Anand
- Laboratory of Malaria and Vaccine Research, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India.,Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - K Sony Reddy
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India.,School of Biotechnology, Kalinga Institute of Industrial Technology (KIIT), Bhubaneswar, Odisha, India
| | - Neha Chaturvedi
- National Institute for Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Vanndita Bahl
- Laboratory of Malaria and Vaccine Research, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Nidhi Hans
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Man Mohan Shukla
- National Institute for Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ICREA, Barcelona, Spain
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Kazutoyo Miura
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville Maryland, USA
| | - Praveen K Bharti
- National Institute for Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Carole Long
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville Maryland, USA
| | - Neeru Singh
- National Institute for Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Virander Singh Chauhan
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Deepak Gaur
- Laboratory of Malaria and Vaccine Research, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India.,Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
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Bharti PK, Rajvanshi H, Nisar S, Jayswar H, Saha KB, Shukla MM, Mishra AK, Sharma RK, Das A, Kaur H, Wattal SL, Lal AA. Demonstration of indigenous malaria elimination through Track-Test-Treat-Track (T4) strategy in a Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh. Malar J 2020; 19:339. [PMID: 32943065 PMCID: PMC7499908 DOI: 10.1186/s12936-020-03402-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many malaria endemic countries are heading towards malaria elimination through the use of case management and vector control strategies, which employ surveillance, improving access to early diagnosis, prompt treatment., and integrated vector control measures. There is a consensus that elimination of malaria is feasible when rapid detection and prompt treatment is combined with mosquito-human contact interruption in an efficient and sustainable manner at community levels. This paper describes results of an integrated case management and vector control strategy for reducing malaria cases in 1233 villages over 3 years in district Mandla, Madhya Pradesh, India. METHODS The project enrolled the entire population (1,143,126) of Mandla district for fever surveillance followed by testing of febrile cases and treatment of positive subjects using T4 strategy, which is Track (by fever), Test (by RDTs), Treat (by ACT) and Track (for completion of treatment). In addition to the active and passive surveillance for detection and treatment of febrile cases, the project conducted mass screening and treatment to clear the asymptomatic reservoirs of infection. Febrile cases were also tested in the out-patient department of the District Hospital from June 2018 to September, 2018 and in a community-based medical camp from November 7 to 14, 2019. The project also used vector control measures for interrupting human-mosquito contact, and information, education and communication (IEC) campaigns to increase demand for malaria services at community level. RESULTS This project has revealed about 91% reduction of indigenous cases of malaria during the period from June 2017 to May 2020, through case management and vector control strategies. A total 357,143 febrile cases were screened, out of which 0.19% were found positive for the presence of malaria parasites, with Plasmodium falciparum and Plasmodium vivax ratio of 62:38. The prevalence of malaria was higher in individuals > 15 years of age (69% cases). The positivity rate was 0.33% in 2017-18, 0.13% in 2018-19, and 0.06% in 2019-20. In all of the 3 years of the project, the peak transmission correlated with rains. Mass screening revealed 0.18% positivity in Sep-Oct 2018, followed by 0.06% in June 2019, and 0.03% in December 2019, and these were mostly asymptomatic cases in the community. Imported cases into the district were mostly contributed by the distant state of Telangana (51.13%). Fever patients tested for malaria parasites in the District Hospital and medical camp revealed zero cases. CONCLUSION Using the current intervention and prevention tools along with optimum utilization of human resources, a 91% reduction in indigenous cases of malaria was seen in the district in 3 years. The reduction was similar in the three high prevalence blocks of the district. These results reveal that malaria elimination is achievable in India within a stipulated time frame. The reduction of malaria at the community level was further validated when zero malaria cases were diagnosed during hospital and community-based studies in Mandla. Prompt detection and treatment of imported/migratory cases may have prevented outbreaks in the district. This project has demonstrated that field programmes backed by adequate technical, management, operational, and financial controls with robust monitoring are needed for achieving malaria elimination.
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Affiliation(s)
- Praveen K Bharti
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India.
| | - Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Sekh Nisar
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Himanshu Jayswar
- Government of Madhya Pradesh, Directorate of Health Services, Bhopal, India
| | - Kalyan B Saha
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Man Mohan Shukla
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Ashok K Mishra
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Ravendra K Sharma
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Aparup Das
- Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Harpreet Kaur
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Suman L Wattal
- National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, New Delhi, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
- Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
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Kaur H, Sehgal R, Kumar A, Bharti PK, Bansal D, Mohapatra PK, Mahanta J, Sultan AA. Distribution pattern of amino acid mutations in chloroquine and antifolate drug resistance associated genes in complicated and uncomplicated Plasmodium vivax isolates from Chandigarh, North India. BMC Infect Dis 2020; 20:671. [PMID: 32933490 PMCID: PMC7493319 DOI: 10.1186/s12879-020-05397-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/22/2020] [Accepted: 09/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increasing antimalarial drug resistance is a significant hindrance to malaria control and elimination programs. For the last six decades, chloroquine (CQ) plus pyrimethamine remains the first-line treatment for P. vivax malaria. Regions where both P. falciparum and P. vivax co-exist, P. vivax is exposed to antifolate drugs due to either misdiagnosis or improper treatment that causes selective drug pressure to evolve. Therefore, the present study aims to estimate antimalarial drug resistance among the complicated and uncomplicated P. vivax patients. METHODS A total of 143 P. vivax malaria positive patients were enrolled in this study, and DNA was isolated from their blood samples. Pvcrt-o, Pvmdr-1, Pvdhps, and Pvdhfr genes were PCRs amplified, and drug resistance-associated gene mutations were analyzed. Statistical analysis of the drug resistance genes and population diversity was performed using MEGA vs. 7.0.21 and DnaSP v software. RESULTS Among the CQ resistance marker gene Pvcrt-o, the prevalence of K10 insertion was 17.5% (7/40) and 9.5% (7/73) of complicated and uncomplicated P vivax group isolates respectively. In Pvmdr-1, double mutant haplotype (M958/L1076) was found in 99% of the clinical isolates. Among the pyrimethamine resistance-associated gene Pvdhfr, the double mutant haplotype I13P33F57R58T61N117I173 was detected in 23% (11/48) in complicated and 20% (17/85) in uncomplicated group isolates. In the sulphadoxine resistance-associated Pvdhps gene, limited polymorphism was observed with the presence of a single mutant (D459A) among 16 and 5% of the clinical isolates in the complicated and uncomplicated group respectively. CONCLUSION The study presents the situations of polymorphism in the antimalarial drug resistance-associated genes and emphasizes the need for regular surveillance. It is imperative for the development of suitable antimalarial drug policy in India.
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Affiliation(s)
- Hargobinder Kaur
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Archit Kumar
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen K Bharti
- National Institute for Research in Tribal Health, Indian Council of Medical Research, Nagpur Road, Garha, Jabalpur, Madhya Pradesh, India
| | - Devendra Bansal
- Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar.,Present address: Ministry of Public Health, Doha, Qatar
| | - Pradyumna K Mohapatra
- Regional Medical Research Centre, NE, Indian Council of Medical Research, Post Box no.105, Dibrugarh, Assam, India
| | - Jagadish Mahanta
- Regional Medical Research Centre, NE, Indian Council of Medical Research, Post Box no.105, Dibrugarh, Assam, India
| | - Ali A Sultan
- Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar
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Kumar R, Mishra S, Uikey RS, Gwal A, Mun A, Bharti PK, Shanmugam R. De novo heterozygous Hb G-Waimanalo (α64(E13)Asp>Asn, CTG>CCG; HBA1:c.193G>A) variant in a sickle cell disease patient of an Indian tribe. J Clin Pathol 2020; 74:336-338. [PMID: 32817264 DOI: 10.1136/jclinpath-2020-206589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Ravindra Kumar
- Genetic Disorders, ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | - Sweta Mishra
- Genetic Disorders, ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | - Ram Swaroop Uikey
- Genetic Disorders, ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | - Anil Gwal
- Genetic Disorders, ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | - Amol Mun
- Genetic Disorders, ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | - Praveen K Bharti
- Vector Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, India
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Kumar R, Verma AK, Shrivas S, Thota P, Singh MP, Rajasubramaniam S, Das A, Bharti PK. First successful field evaluation of new, one-minute haemozoin-based malaria diagnostic device. EClinicalMedicine 2020; 22:100347. [PMID: 32490369 PMCID: PMC7256309 DOI: 10.1016/j.eclinm.2020.100347] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/21/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Early and accurate diagnosis of malaria is critical to the success of malaria elimination. However, the current mainstay of malaria diagnosis in the field, such as light microscopy and rapid diagnostic tests (RDTs), have limitations due to low parasite density or mutation in diagnostic markers. METHODS We evaluated an inexpensive, robust, rapid, malaria diagnostic device, called Gazelle, that employs magneto-optical detection to identify haemozoin crystals (Hz) produced by all species of human malaria parasites in infected individuals. A beam of polarised light is passed through the lysed diluted blood sample under the influence of high (~.55T) and low magnetic fields. The difference in light transmission through the sample between the high and low magnetic fields indicates presence of Hz, suggesting possible malarial infection. A total of 300 febrile patients were screened at the malaria clinic of Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, India, from August 2018 to November 2018. Malaria diagnosis was done using four diagnostic methods: Gazelle, light microscopy, RDT, and malaria specific Polymerase Chain Reaction (PCR). Measures of diagnostic accuracy were compared. FINDINGS Out of 300 febrile patients enroled and tested for the presence of malaria parasites, 262 patient samples were included in the final analysis. The sensitivity and specificity of Gazelle was 98% and 97% in comparison to light microscopy, 82% and 99% to PCR and 78% and 99% to RDT, respectively. The results of the four diagnostic methods were comparable and statistically no significant differences in sensitivity or specificity was observed between these methods. Enhanced diagnostic accuracy of Gazelle in malaria patients with no prior history of malaria treatment was observed in this study. INTERPRETATION The diagnostic ability of Gazelle was comparable to light microscopy and better than RDTs even in low parasitemia and in presence of pfhrp2/3 deletion mutant parasites. Gazelle may be a novel valuable diagnostic tool in resource poor settings where (i) microscopy is not feasible and (ii) pfhrp2/3gene deleted parasite are present. Its speed, cost-efficiency, and alternative to lack of microscopists makes it an important adjunct in field settings. FUNDING HemexDx, India.
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Affiliation(s)
- Rajat Kumar
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Anil K. Verma
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Shweta Shrivas
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | | | - Mrigendra P. Singh
- National Institute of Malaria Research-Field station (NIMR-FS), Jabalpur, Madhya Pradesh, India
| | - S. Rajasubramaniam
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Aparup Das
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Praveen K. Bharti
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
- Corresponding author.
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Cespedes JC, Hibbert J, Krishna S, Yan F, Bharti PK, Stiles JK, Liu M. Association of EPCR Polymorphism rs867186-GG With Severity of Human Malaria. Front Genet 2020; 11:56. [PMID: 32153634 PMCID: PMC7050639 DOI: 10.3389/fgene.2020.00056] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 01/17/2020] [Indexed: 11/14/2022] Open
Abstract
Background Cerebral malaria (CM) is characterized by the sequestration of Plasmodium-infected erythrocytes (pRBCs) to host brain microvasculature beds via P. falciparum erythrocyte membrane protein 1 (PfEMP1). Under normal conditions, activated protein C (APC) bound to endothelial protein C receptor (EPCR) has cytoprotective properties via the activation of protease-activated receptor 1 (PAR1). During malaria infection, pRBCs transports PfEMP1 to the membranes to bind EPCR in the same region as APC. As a result, APC is less capable of inducing cytoprotective effects via PAR1. Two studies involving adult malaria patients revealed that EPCR rs867186-GG allele is associated with protection against severe malaria, while three other studies involving child malaria patients could not show association between EPCR rs867186-GG genotype and severe malaria or increased mortality among children with CM. Methods We examined the association between the EPCR rs867186-GG genotype and the protection against cerebral malaria. Peripheral blood samples were collected from 47 malaria patients and 34 healthy individuals from a study conducted from 2004 to 2007 at the NSCB Medical College Hospital in India. CM and malaria-associated complications were defined based on WHO criteria. Genomic DNA was isolated from the peripheral blood mononuclear cells. Primer sequences were designed to contain rs867186 of the PROCR gene (NM 006404) and were used to amplify a 660 bp product as described before. PCR products were purified, and DNA sequences were determined by Sanger Sequencing (Genewiz, NJ). Nonparametric tests were used to compare the groups. To analyze differences in allele frequencies, we used chi-squared or Fisher's exact tests for categorical variables if the expected values were less than 5. P-value <0.05 was considered statistically significant. Results Our results showed significantly higher rates of AG and GG genotypes in CM patients compared to mild malaria (P = 0.0034). Conclusion Our results indicate that rs867186-GG or rs867186-AG genotypes are not associated with protection against HCM.
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Affiliation(s)
- Juan Carlos Cespedes
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, United States
| | - Jacqueline Hibbert
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, United States
| | - Sri Krishna
- National Institute for Research in Tribal Health (NIRTH), Jabalpur, India
| | - Fengxia Yan
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, United States
| | - Praveen K Bharti
- National Institute for Research in Tribal Health (NIRTH), Jabalpur, India
| | - Jonathan K Stiles
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, United States
| | - Mingli Liu
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, United States
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Hasan MN, Fraiwan A, An R, Alapan Y, Ung R, Akkus A, Xu JZ, Rezac AJ, Kocmich NJ, Creary MS, Oginni T, Olanipekun GM, Hassan-Hanga F, Jibir BW, Gambo S, Verma AK, Bharti PK, Riolueang S, Ngimhung T, Suksangpleng T, Thota P, Werner G, Shanmugam R, Das A, Viprakasit V, Piccone CM, Little JA, Obaro SK, Gurkan UA. Paper-based microchip electrophoresis for point-of-care hemoglobin testing. Analyst 2020; 145:2525-2542. [PMID: 32123889 DOI: 10.1039/c9an02250c] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Nearly 7% of the world's population live with a hemoglobin variant. Hemoglobins S, C, and E are the most common and significant hemoglobin variants worldwide. Sickle cell disease, caused by hemoglobin S, is highly prevalent in sub-Saharan Africa and in tribal populations of Central India. Hemoglobin C is common in West Africa, and hemoglobin E is common in Southeast Asia. Screening for significant hemoglobin disorders is not currently feasible in many low-income countries with the high disease burden. Lack of early diagnosis leads to preventable high morbidity and mortality in children born with hemoglobin variants in low-resource settings. Here, we describe HemeChip, the first miniaturized, paper-based, microchip electrophoresis platform for identifying the most common hemoglobin variants easily and affordably at the point-of-care in low-resource settings. HemeChip test works with a drop of blood. HemeChip system guides the user step-by-step through the test procedure with animated on-screen instructions. Hemoglobin identification and quantification is automatically performed, and hemoglobin types and percentages are displayed in an easily understandable, objective way. We show the feasibility and high accuracy of HemeChip via testing 768 subjects by clinical sites in the United States, Central India, sub-Saharan Africa, and Southeast Asia. Validation studies include hemoglobin E testing in Bangkok, Thailand, and hemoglobin S testing in Chhattisgarh, India, and in Kano, Nigeria, where the sickle cell disease burden is the highest in the world. Tests were performed by local users, including healthcare workers and clinical laboratory personnel. Study design, methods, and results are presented according to the Standards for Reporting Diagnostic Accuracy (STARD). HemeChip correctly identified all subjects with hemoglobin S, C, and E variants with 100% sensitivity, and displayed an overall diagnostic accuracy of 98.4% in comparison to reference standard methods. HemeChip is a versatile, mass-producible microchip electrophoresis platform that addresses a major unmet need of decentralized hemoglobin analysis in resource-limited settings.
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Affiliation(s)
- Muhammad Noman Hasan
- Case Biomanufacturing and Microfabrication Laboratory, Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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Mishra AK, Bharti PK, Kareemi TI, Chand SK, Tidgam AS, Sharma RK, Singh N. Field evaluation of zero vector durable lining to assess its efficacy against malaria vectors and malaria transmission in tribal areas of the Balaghat district of central India. Trans R Soc Trop Med Hyg 2019; 113:623-631. [PMID: 31251386 DOI: 10.1093/trstmh/trz046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 03/22/2019] [Accepted: 06/20/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Indoor residual spray (IRS) and long-lasting insecticidal nets are the two principal intervention methods of vector control. Zero vector durable lining (ZVDL), a relatively new vector control method, was evaluated to assess its efficacy against malaria vectors in hard to reach areas in the Balaghat district, where malaria transmission is perennial. METHODS ZVDL was installed in six experimental villages during November-December 2012. In control villages, IRS was carried out with Alphacypermethrin. Cone bioassays were performed to assess the efficacy and persistence of insecticide-treated ZVDL following WHO bioassays. RESULTS The mean per man hour density of Anopheles caught during 2013 was 12.1 in experimental villages and 16.2 in control villages. No sporozoite-positive Anopheles culicifacies were found in experimental villages; however, in control villages, four sporozoite-positive A. culicifacies were found (two Plasmodium vivax and two P. falciparum). The knock-down rate of A. culicifacies was 95-100% with 100% mortality during the 24 h recovery period. Malaria declined sharply in experimental villages showing a slide positivity rate of 22.3% compared with control villages (36.4%) (p<0.05). CONCLUSIONS A supplementary vector control intervention such as ZVDL has the potential to become a viable alternative to IRS in malaria endemic areas.
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Affiliation(s)
- Ashok K Mishra
- National Institute of Research in Tribal Health (NIRTH), Nagpur Road, Garha, Jabalpur, Madhya Pradesh, India
| | - Praveen K Bharti
- National Institute of Research in Tribal Health (NIRTH), Nagpur Road, Garha, Jabalpur, Madhya Pradesh, India
| | - Tazeen Iram Kareemi
- National Institute of Research in Tribal Health (NIRTH), Nagpur Road, Garha, Jabalpur, Madhya Pradesh, India
| | - Sunil K Chand
- National Institute of Malaria Research, Field Unit, Nagpur Road, Garha Jabalpur, Madhya Pradesh, India
| | - Anup Singh Tidgam
- District Malaria Office, Balaghat, District Balaghat, Madhya Pradesh, India
| | - Ravendra K Sharma
- National Institute of Research in Tribal Health (NIRTH), Nagpur Road, Garha, Jabalpur, Madhya Pradesh, India
| | - Neeru Singh
- National Institute of Research in Tribal Health (NIRTH), Nagpur Road, Garha, Jabalpur, Madhya Pradesh, India
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Kaur H, Sehgal R, Kumar A, Sehgal A, Bharti PK, Bansal D, Mohapatra PK, Mahanta J, Sultan AA. Exploration of genetic diversity of Plasmodium vivax circumsporozoite protein (Pvcsp) and Plasmodium vivax sexual stage antigen (Pvs25) among North Indian isolates. Malar J 2019; 18:308. [PMID: 31492135 PMCID: PMC6731556 DOI: 10.1186/s12936-019-2939-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/27/2019] [Accepted: 08/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is one of the important vector-borne diseases with high fatality rates in tropical countries. The pattern of emergence and spread of novel antigenic variants, leading to escape of vaccine-induced immunity might be factors responsible for severe malaria. A high level of polymorphism has been reported among malarial antigens which are under selection pressure imposed by host immunity. There are limited reports available on comparative stage-specific genetic diversity among Plasmodium vivax candidate genes in complicated vivax malaria. The present study was planned to study genetic diversity (Pvcsp and Pvs25) among complicated and uncomplicated P. vivax isolates. METHODS Pvcsp and Pvs2-specific PCRs and DNA sequencing were performed on P. vivax PCR positive samples. Genetic diversity was analysed using appropriate software. RESULTS The present study was carried out on 143 P. vivax clinical isolates, collected from Postgraduate Institute of Medical Education and Research, Chandigarh. Among the classic and variant types of Pvcsp, the VK210 (99%; 115/116) was found to be predominant in both complicated and uncomplicated group isolates. Out of the various peptide repeat motifs (PRMs) observed, GDRADGQPA (PRM1) and GDRAAGQPA (PRM2) was the most widely distributed among the P. vivax isolates. Whereas among the Pvs25 isolates, 100% of double mutants (E97Q/I130T) in both the complicated (45/45) as well as in the uncomplicated (81/81) group was observed. CONCLUSION An analysis of genetic variability enables an understanding of the role of genetic variants in severe vivax malaria.
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Affiliation(s)
- Hargobinder Kaur
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Archit Kumar
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Sehgal
- Department of Obstt. & Gynae, Government Medical College and Hospital, Chandigarh, India
| | - Praveen K Bharti
- National Institute for Research in Tribal Health, Indian Council of Medical Research, Nagpur Road, Garha, Jabalpur, Madhya Pradesh, India
| | - Devendra Bansal
- Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar.,Ministry of Public Health, Doha, Qatar
| | - Pradyumna K Mohapatra
- Regional Medical Research Centre, NE, Indian Council of Medical Research, Post Box no.105, Dibrugarh, Assam, India
| | - Jagadish Mahanta
- Regional Medical Research Centre, NE, Indian Council of Medical Research, Post Box no.105, Dibrugarh, Assam, India
| | - Ali A Sultan
- Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
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