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Engel N, Ghergu C, Matin MA, Kibria MG, Thriemer K, Price RN, Ding XC, Howes RE, Ley B, Incardona S, Alam MS. Implementing radical cure diagnostics for malaria: user perspectives on G6PD testing in Bangladesh. Malar J 2021; 20:217. [PMID: 33980257 PMCID: PMC8114691 DOI: 10.1186/s12936-021-03743-w] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/20/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The radical cure of Plasmodium vivax requires treatment with an 8-aminoquinoline drug, such as primaquine and tafenoquine, to eradicate liver hypnozoite stages, which can reactivate to cause relapsing infections. Safe treatment regimens require prior screening of patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency to avoid potential life-threatening drug induced haemolysis. Testing is rarely available in malaria endemic countries, but will be needed to support routine use of radical cure. This study investigates end-user perspectives in Bangladesh on the introduction of a quantitative G6PD test (SD Biosensor STANDARD™ G6PD analyser) to support malaria elimination. METHODS The perspectives of users on the SD Biosensor test were analysed using semi-structured interviews and focus group discussions with health care providers and malaria programme officers in Bangladesh. Key emerging themes regarding the feasibility of introducing this test into routine practice, including perceived barriers, were analysed. RESULTS In total 63 participants were interviewed. Participants emphasized the life-saving potential of the biosensor, but raised concerns including the impact of limited staff time, high workload and some technical aspects of the device. Participants highlighted that there are both too few and too many P. vivax patients to implement G6PD testing owing to challenges of funding, workload and complex testing infrastructure. Implementing the biosensor would require flexibility and improvisation to deal with remote sites, overcoming a low index of suspicion and mutual interplay of declining patient numbers and reluctance to test. This approach would generate new forms of evidence to justify introduction in policy and carefully consider questions of deployment given declining patient numbers. CONCLUSIONS The results of the study show that, in an elimination context, the importance of malaria needs to be maintained for both policy makers and the affected communities, in this case by ensuring P. vivax, PQ treatment, and G6PD deficiency remain visible. Availability of new technologies, such as the biosensor, will fuel ongoing debates about priorities for allocating resources that must be adapted to a constantly evolving target. Technical and logistical concerns regarding the biosensor should be addressed by future product designs, adequate training, strengthened supply chains, and careful planning of communication, advocacy and staff interactions at all health system levels.
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Affiliation(s)
- Nora Engel
- Department of Health, Ethics & Society, Research School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, Netherlands.
| | - Cristian Ghergu
- Department of Health, Ethics & Society, Research School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Mohammad Abdul Matin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Golam Kibria
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Xavier C Ding
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Rosalind E Howes
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Sandra Incardona
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Mohammad Shafiul Alam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Tong MX, Hansen A, Hanson-Easey S, Cameron S, Xiang J, Liu Q, Liu X, Sun Y, Weinstein P, Han GS, Williams C, Bi P. Perceptions of malaria control and prevention in an era of climate change: a cross-sectional survey among CDC staff in China. Malar J 2017; 16:136. [PMID: 28359315 PMCID: PMC5374624 DOI: 10.1186/s12936-017-1790-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/24/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Though there was the significant decrease in the incidence of malaria in central and southwest China during the 1980s and 1990s, there has been a re-emergence of malaria since 2000. METHODS A cross-sectional survey was conducted amongst the staff of eleven Centers for Disease Control and Prevention (CDC) in China to gauge their perceptions regarding the impacts of climate change on malaria transmission and its control and prevention. Descriptive analysis was performed to study CDC staff's knowledge, attitudes, perceptions and suggestions for malaria control in the face of climate change. RESULTS A majority (79.8%) of CDC staff were concerned about climate change and 79.7% believed the weather was becoming warmer. Most participants (90.3%) indicated climate change had a negative effect on population health, 92.6 and 86.8% considered that increasing temperatures and precipitation would influence the transmission of vector-borne diseases including malaria. About half (50.9%) of the surveyed staff indicated malaria had re-emerged in recent years, and some outbreaks were occurring in new geographic areas. The main reasons for such re-emergence were perceived to be: mosquitoes in high-density, numerous imported cases, climate change, poor environmental conditions, internal migrant populations, and lack of health awareness. CONCLUSIONS This study found most CDC staff endorsed the statement that climate change had a negative impact on infectious disease transmission. Malaria had re-emerged in some areas of China, and most of the staff believed that this can be managed. However, high densities of mosquitoes and the continuous increase in imported cases of malaria in local areas, together with environmental changes are bringing about critical challenges to malaria control in China. This study contributes to an understanding of climate change related perceptions of malaria control and prevention amongst CDC staff. It may help to formulate in-house training guidelines, community health promotion programmes and policies to improve the capacity of malaria control and prevention in the face of climate change in China.
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Affiliation(s)
- Michael Xiaoliang Tong
- School of Public Health, The University of Adelaide, Level 8, Hughes Building, North Terrace Campus, Adelaide, SA 5005 Australia
| | - Alana Hansen
- School of Public Health, The University of Adelaide, Level 8, Hughes Building, North Terrace Campus, Adelaide, SA 5005 Australia
| | - Scott Hanson-Easey
- School of Public Health, The University of Adelaide, Level 8, Hughes Building, North Terrace Campus, Adelaide, SA 5005 Australia
| | - Scott Cameron
- School of Public Health, The University of Adelaide, Level 8, Hughes Building, North Terrace Campus, Adelaide, SA 5005 Australia
| | - Jianjun Xiang
- School of Public Health, The University of Adelaide, Level 8, Hughes Building, North Terrace Campus, Adelaide, SA 5005 Australia
| | - Qiyong Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206 China
| | - Xiaobo Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206 China
| | - Yehuan Sun
- Department of Epidemiology, Anhui Medical University, Hefei, 230032 Anhui China
| | - Philip Weinstein
- School of Biological Sciences, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Gil-Soo Han
- Communications and Media Studies, School of Media, Film and Journalism, Monash University, Clayton, VIC 3800 Australia
| | - Craig Williams
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5001 Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Level 8, Hughes Building, North Terrace Campus, Adelaide, SA 5005 Australia
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Carter KL, Baiteke T, Teea T, Tabunga T, Itienang M, Rao C, Lopez AD, Taylor R. Mortality and life expectancy in Kiribati based on analysis of reported deaths. Popul Health Metr 2016; 14:3. [PMID: 26933387 PMCID: PMC4772294 DOI: 10.1186/s12963-016-0072-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 02/11/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Kiribati is an atoll country of 103,058 (2010 Census) situated in the central Pacific. Previous mortality estimates have been derived from demographic analyses of census data. This is the first mortality analysis based on reported deaths. METHODS Recorded deaths were from the Ministry of Health and the Civil Registration Office for 2000-2009; populations were from the 2000, 2005, and 2010 censuses. Duplicate death records were removed by matching deaths within and between data sources using a combination of names, date of death, age, sex, island of residence, and cause of death. Probability of dying <5 years (5q0) and 15-59 years (45q15), and life expectancy (LE) at birth, were computed with 95 % confidence intervals. These data were compared with previous census analyses. RESULTS There were 8,681 unique deaths reported over the decade 2000-2009 in Kiribati. The reconciled mortality data indicate 5q0 for both sexes of 64 per 1,000 live births in 2000-2004, and 51 for 2005-2009 (assuming no under-enumeration), compared with 69 and 59 for comparable periods from the 2005 and 2010 census analyses (children ever-born/children surviving method). Based on reconciled deaths, LE at birth (e0) for males was 54 years for 2000-2004 and 55 years in 2005-2009, five years lower than the 2005 and 2010 census estimates for comparable periods of 59 and 58 years. Female LE was 62 years for 2000-2004 and 63 years for 2005-2009, two-three years less than estimates for comparable periods of 63 and 66 years from the 2005 and 2010 census analyses. Adult mortality (45q15) was 47-48 % in males and 27-28 % in females from reconciled mortality over 2000-2009, higher than census estimates of 34-38 % in males and 21-26 % in females for the same periods. The reconciled data are very likely to be incomplete and actual mortality higher and life expectancy lower than reported here. CONCLUSION This analysis indicates higher mortality than indirect demographic methods from the 2005 and 2010 Censuses. Reported deaths are most likely under-reported; especially 5q0, as many early neonatal deaths are probably classified as stillbirths. These analyses suggest that the health situation in Kiribati is more serious and urgent than previously appreciated.
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Affiliation(s)
- Karen L. Carter
- />School of Population Health, Faculty of Health Sciences, University of Queensland, St Lucia, Brisbane, Queensland 4072 Australia
- />Secretariat of the Pacific Community (SPC), B.P. D5 Noumea Cedex, 98848 New Caledonia
| | | | - Tiensi Teea
- />Kiribati Civil Registration Office (CRO), Ministry of Women, Youth and Communities, Tarawa, Kiribati
| | | | - Mantarae Itienang
- />Kiribati Civil Registration Office (CRO), Ministry of Women, Youth and Communities, Tarawa, Kiribati
| | - Chalapati Rao
- />Global Health Division, Research School of Population Health, Australian National University (ANU), Acton, Canberra, Australian Capital Territory (ACT), 2601 Australia
| | - Alan D. Lopez
- />Melbourne School of Population and Global Health, University of Melbourne, Parkville, Melbourne, Victoria, 3010 Australia
| | - Richard Taylor
- />School of Public Health and Community Medicine (SPHCM), University of New South Wales (UNSW), Randwick, Sydney, New South Wales 2052 Australia
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