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Factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital in northern Uganda. 乌干达北部古卢地区转诊医院产前护理母亲中与妊娠期疟疾相关的因素。
IF 2.4 3区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-18 DOI: 10.1186/s12936-024-05184-7
Solomon Oguta, Brian Serumaga, Lameck Odongo, Donald Otika, Jackline Ayikoru, Raymond Otim, Jimmyy Opee, Baifa Arwinyo, Francis Pebolo Pebalo, Vincentina Achora, Sande Ojara, Benard Abola, Silvia Awor

Background: All pregnant mothers in Uganda are given sulfadoxine-pyrimethamine (SP, Fansidar®) for presumptive treatment of malaria in pregnancy from 14 weeks of gestation, every four weeks, until delivery. However, prenatal mothers still fall sick of malaria. This study aimed to assess the factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital.

Methods: This was a cross-sectional study at Gulu Regional Referral Hospital antenatal clinic from July to August 2023. Consecutive sampling was used. An interviewer-administered questionnaire was used to collect sociodemographic characteristics, physical examination findings and blood samples taken for rapid diagnostic test (RDT) for malaria. A positive RDT was taken as the presence of malaria infection in pregnancy. Data was pre-processed in STATA®15, and logistic regression analysis was done in RStudio 4.2.2. Variables with p < 0.05 were taken as independently associated with malaria in pregnancy and reported as adjusted risk ratios (aRR).

Results: Three hundred fifty (350) pregnant women were recruited; 96% of them slept under mosquito nets daily, while more than half of them (51.7%) had not yet taken SP (IPTp) during their current pregnancy. Prevalence of anaemia (Hb < 11.0 g/dl) was 46.0%. Twenty-four per cent of the mothers were in the first trimester, 56.3% in the second and 19.7% in the third. The prevalence of malaria in pregnancy was 39.7% (95% CI 34.5-45.1%), equally distributed throughout the trimesters. Anaemia (aRR = 4.99, 95%CI 3.10-8.05, p < 0.001) and tertiary level of education (aRR = 0.29, 95% CI 0.14-0.62, p = 0.001) were significantly associated with malaria in pregnancy. Not sleeping under a mosquito net (aRR = 3.79, 95% CI 0.95-15.16, p = 0.059) may be a factor associated with malaria in pregnancy.

Conclusion: Four in every ten mothers had malaria infection, with anaemia being a risk factor, while a tertiary level of education was protective against malaria in pregnancy.

背景:在乌干达,所有孕妇从妊娠 14 周起都要服用磺胺乙胺嘧啶(SP,Fansidar®)来进行妊娠期疟疾的假定性治疗,每四周一次,直到分娩。然而,产前母亲仍会感染疟疾。本研究旨在评估古卢地区转诊医院产前护理母亲中与妊娠期疟疾相关的因素:这是一项横断面研究,于 2023 年 7 月至 8 月在古卢地区转诊医院产前门诊进行。采用连续抽样法。采用访谈者发放的调查问卷收集社会人口学特征、体检结果和疟疾快速诊断检测(RDT)血样。快速诊断检测呈阳性即为孕期感染疟疾。数据在 STATA®15 中进行了预处理,并在 RStudio 4.2.2 中进行了逻辑回归分析。变量 p 结果:共招募了 350 名孕妇,其中 96% 的孕妇每天都睡在蚊帐里,超过半数(51.7%)的孕妇在本次怀孕期间尚未服用 SP(IPTp)。贫血患病率(Hb 结论:每十位母亲中就有四位感染了疟疾,贫血是一个风险因素,而受过高等教育则对妊娠期疟疾有保护作用。
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引用次数: 0
Malaria, relationship with climatic variables and deforestation in Colombia, Latin America and the Caribbean from 2000 to 2020: a systematic review. 2000 年至 2020 年哥伦比亚、拉丁美洲和加勒比地区疟疾、气候变量与森林砍伐的关系:系统综述。
IF 2.4 3区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-18 DOI: 10.1186/s12936-024-05140-5
Carol B Colonia, Ana B Vásquez-Rodríguez, Neal Alexander, Fernando de la Hoz Restrepo

Background: This systematic review investigates the relationship between malaria incidence, climate variables, and deforestation in Colombia, Latin America, and the Caribbean from 2000 to 2020. Malaria, a significant public health issue in these regions, is influenced by ecological factors including climatic conditions and environmental changes, such as deforestation.

Methods: The review employs a comprehensive search strategy across PubMed, Web of Science, Embase, Scopus, Cochrane, and Scielo databases. It applies strict inclusion and exclusion criteria to ensure the relevance and quality of selected studies, focusing on analysing the relationship between climate variables, deforestation, and malaria incidence.

Results: Twenty-four articles were included in this review, fourteen of which assessed the relationship between climatic variables and malaria and ten between deforestation and malaria. The analysis reveals a nuanced understanding of malaria dynamics. A significant finding is the seasonal effect of climatic variables on malaria incidence. The study notes that increased rainfall is positively correlated with malaria incidence. Similarly, warmer temperatures are associated with increased malaria risks, and malaria rates can change by 10% to 80% for every degree of temperature increase, after adjusting for altitude. The impact of deforestation on malaria is complex, with positive and negative correlations observed, depending on the remaining forest cover.

Conclusions: The review highlights the multifaceted nature of malaria transmission, emphasizing the need for integrated approaches that consider both environmental and health perspectives. It underscores the importance of understanding the complex relationships between malaria incidence, climate variables, and deforestation.

背景:本系统综述调查了 2000 年至 2020 年哥伦比亚、拉丁美洲和加勒比地区疟疾发病率、气候变量和森林砍伐之间的关系。疟疾是这些地区的一个重要公共卫生问题,受到包括气候条件和环境变化(如森林砍伐)在内的生态因素的影响:方法:本综述在 PubMed、Web of Science、Embase、Scopus、Cochrane 和 Scielo 数据库中采用了全面的检索策略。研究采用了严格的纳入和排除标准,以确保所选研究的相关性和质量,重点分析气候变量、森林砍伐和疟疾发病率之间的关系:本综述收录了 24 篇文章,其中 14 篇评估了气候变量与疟疾之间的关系,10 篇评估了森林砍伐与疟疾之间的关系。分析显示了对疟疾动态的细微理解。一个重要发现是气候变量对疟疾发病率的季节性影响。研究指出,降雨量增加与疟疾发病率呈正相关。同样,气温升高也与疟疾风险增加有关,气温每升高一度,疟疾发病率就会增加 10%到 80%(根据海拔高度进行调整)。砍伐森林对疟疾的影响非常复杂,根据剩余森林覆盖率的不同,可以观察到正相关和负相关关系:本综述突出了疟疾传播的多面性,强调需要从环境和健康两个角度综合考虑。它强调了了解疟疾发病率、气候变量和森林砍伐之间复杂关系的重要性。
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引用次数: 0
Chloroquine-primaquine therapeutic response and safety in patients with uncomplicated Plasmodium vivax malaria in the Colombian Amazon region. 哥伦比亚亚马逊地区无并发症间日疟原虫疟疾患者对氯喹-伯氨喹的治疗反应和安全性。
IF 2.4 3区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-18 DOI: 10.1186/s12936-024-05170-z
Paula Calderón-Ruiz, Gabriel Velez-Tobón, Sebastian Bolívar-Hernández, Luz Mila Murcia-Montaño, Alberto Tobón-Castaño

Background: In Colombia, published studies on the treatment of uncomplicated Plasmodium vivax malaria with chloroquine-primaquine are scarce. The aim of this study was to evaluate the therapeutic response to two treatment regimens at the 28-day follow-up and the occurrence of adverse events in patients with P. vivax malaria.

Methods: A quasi-experimental clinical trial was conducted at 3 sites in the Department of Amazonas. Patients received supervised or unsupervised anti-malarial treatment (chloroquine plus primaquine), and the primary effectiveness endpoint was the clinical and parasitological response. Safety was assessed through adverse event surveillance.

Results: A total of 103 patients were included: 53 in the 7-day primaquine group (Group I) and 50 in the group receiving primaquine for 14 days (Group II). Among the patients in group I, an adequate treatment response of 100% and 89.5% was found in patients who received supervised and unsupervised treatment, respectively. In Group II, adequate responses of 100% and 95% were reported for patients who received supervised and unsupervised treatment, respectively. No adverse events were detected.

Conclusions: The response to combined treatment with chloroquine plus primaquine continues to be adequate for treating P. vivax malaria in the Colombian Amazon region; however, a response to unsupervised treatment in the region is recommended.

背景:在哥伦比亚,有关氯喹-伯氨喹治疗无并发症间日疟原虫疟疾的公开研究很少。本研究旨在评估两种治疗方案在 28 天随访期间的治疗反应以及间日疟原虫疟疾患者不良反应的发生情况:在亚马孙省的 3 个地点开展了一项准实验性临床试验。患者接受有监督或无监督的抗疟治疗(氯喹加伯氨喹),主要疗效终点是临床和寄生虫学反应。安全性通过不良事件监测进行评估:共纳入 103 名患者:结果:共纳入103名患者:53名患者接受为期7天的伯氨喹治疗(I组),50名患者接受为期14天的伯氨喹治疗(II组)。在 I 组患者中,接受监督治疗和非监督治疗的患者的充分治疗反应分别为 100%和 89.5%。在第二组中,接受监督治疗和未接受监督治疗的患者的充分治疗反应分别为 100%和 95%。未发现任何不良反应:结论:在哥伦比亚亚马逊地区,氯喹加伯氨喹联合治疗的反应仍足以治疗间日疟原虫性疟疾;不过,建议该地区的患者接受无监督治疗。
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引用次数: 0
Kidney involvement in Plasmodium falciparum infection in a pregnant patient. 一名孕妇感染恶性疟原虫后肾脏受累。
IF 2.4 3区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-18 DOI: 10.1186/s12936-024-05182-9
Octavio René García-Flores, Mayra Eugenia Avilés-Ramírez, Sabrina Vianey Castillo-Paniagua, Edgar Misael Pérez-Jiménez, José Carlos Gasca-Aldama, María Virgilia Soto-Abraham, Juan Carlos Bravata-Alcántara, Juan Manuel Bello-López, Giorgina Barbara Piccoli, Enzo Vásquez-Jiménez

Background: The course of kidney function and outcomes of severe malaria infection in pregnant women is poorly understood. The indications for renal replacement therapy in pregnant patients with AKI are similar to the general population. This is the case of a pregnant patient with severe Plasmodium falciparum infection that caused cerebral malaria, acute kidney injury (AKI) who required renal replacement therapy and kidney biopsy during her hospitalization.

Case presentation: A 29-year-old pregnant woman from Equatorial Guinea was admitted to the hospital with haemolytic anaemia, hyperbilirubinaemia and thrombocytopenia. During hospitalization, a thick blood smear was performed where parasitaemia by P. falciparum were observed and confirmed by real-time PCR assay. The patient developed cerebral malaria secondary to an ischaemic-type cerebral vascular event, hypotension and severe. After confirming diagnosis of P. falciparum infection, artesunate, artemether/lumefantrine and primaquine were started. Kidney biopsy revealed an active tubulointerstitial nephritis with acute tubular lesion and pigment tubulopathy with negative immunofluorescence. After CVVHDF, the patient received intermittent haemodialysis until the recovery of kidney function. After discharge, follow-up was carried until the successful resolution of the pregnancy by cesarean delivery and not shown deterioration in kidney function or proteinuria.

Conclusion: In this case, intensive dialysis was started and dialysis intensity progressively reduced when kidney function improved. Due to the evolution of kidney function, a kidney biopsy was performed which showed tubulointerstitial nephritis as a manifestation of the infection. While the kidney biopsy was of interest for discriminating between tubular and glomerular involvement, the availability of placental biomarkers (sflt1-PlGF) would have been of help for ruling out preeclampsia and placental damage. The multidisciplinary approach to AKI during pregnancy should be the rule, with diligent care of maternal-fetal well-being during pregnancy and monitoring of kidney function after delivery.

背景:人们对孕妇严重疟疾感染后的肾功能变化和预后知之甚少。患有 AKI 的孕妇肾脏替代治疗的适应症与普通人群相似。这是一例严重恶性疟原虫感染导致脑疟疾和急性肾损伤(AKI)的孕妇患者,她在住院期间需要进行肾替代治疗和肾活检:一名来自赤道几内亚的 29 岁孕妇因溶血性贫血、高胆红素血症和血小板减少症入院。住院期间进行了血液浓涂片检查,观察到恶性疟原虫寄生虫血症,并通过实时 PCR 检测进行了确诊。患者继发缺血性脑血管事件、低血压和严重的脑疟疾。确诊为恶性疟原虫感染后,患者开始服用青蒿琥酯、蒿甲醚/本芴醇和伯氨喹。肾活检显示,患者患有活动性肾小管间质性肾炎,伴有急性肾小管病变和色素性肾小管病变,免疫荧光呈阴性。CVVHDF 后,患者接受了间歇性血液透析,直至肾功能恢复。出院后,进行了随访,直到剖宫产成功结束妊娠,且未发现肾功能或蛋白尿恶化:结论:在这个病例中,开始进行强化透析,当肾功能改善后,透析强度逐渐降低。由于肾功能的变化,患者接受了肾活检,结果显示肾小管间质性肾炎是感染的一种表现形式。肾活检有助于区分肾小管和肾小球受累,而胎盘生物标记物(sslt1-PlGF)则有助于排除子痫前期和胎盘损伤。妊娠期 AKI 的多学科治疗方法应成为一项规则,在妊娠期间应努力关注母婴健康,并在分娩后监测肾功能。
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引用次数: 0
Field surveys in rural Tanzania reveal key opportunities for targeted larval source management and species sanitation to control malaria in areas dominated by Anopheles funestus. 坦桑尼亚农村地区的实地调查揭示了有针对性的幼虫源管理和物种卫生的关键机会,以控制以按蚊为主的地区的疟疾。
IF 2.4 3区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-16 DOI: 10.1186/s12936-024-05172-x
Betwel J Msugupakulya, Nicolaus S Mhumbira, Dawson T Mziray, Masoud Kilalangongono, Mohamed Jumanne, Halfan S Ngowo, Najat F Kahamba, Alex J Limwagu, Meleji L Mollel, Prashanth Selvaraj, Anne L Wilson, Fredros O Okumu

Background: Larval source management (LSM) is re-emerging as a critical malaria intervention to address challenges associated with core vector control tools, such as insecticide-treated nets (ITNs), and to accelerate progress towards elimination. Presently, LSM is not widely used in rural settings and is instead more commonly applied in urban and arid settings. A systematic entomological assessment was conducted in rural communities of southeastern Tanzania, where insecticide-treated nets (ITNs) are widely used, to explore opportunities for deploying LSM to improve malaria control.

Methods: Aquatic habitat surveys were conducted in 2022 and 2023 to understand habitat usage by different mosquito vectors, covering five villages during the rainy season and seven villages during the dry season. Additionally, samples of adult mosquitoes were collected to assess the role of various Anopheles species in malaria transmission in the area, and to explore opportunities for species sanitation using targeted LSM.

Results: Adult mosquito surveys showed that in this area, the total entomological inoculation rates (EIR) for indoor collections were 20.1 and 6.5 infectious bites per person per year for outdoors. Anopheles funestus and Anopheles arabiensis were the only Anopheles vectors identified. Anopheles funestus was responsible for over 97.6% of the malaria transmission indoors and 95.4% outdoors. The concurrent larval surveys found that habitats with late instar An. arabiensis and An. funestus comprised only a small subset of 11.2%-16.5% of all water bodies in the rainy season, and 9.7%-15.2% in the dry season. In terms of size, these habitats covered 66.4%-68.2% of the total habitat areas in the wet season, reducing to 33.9%-40.6% in the dry season. From the rainy season to the dry season, the surface area of habitats occupied by An. arabiensis and An. funestus decreased by 92.0% to 97.5%, while the number of habitats occupied by An. arabiensis and An. funestus decreased by 38.0% to 57.3%. Anopheles funestus preferred large, permanent habitats with clear water and vegetation year-round, while An. arabiensis showed contrasting seasonal preferences, favouring sunlit still waters in the rainy season and larger, opaque habitats in the dry season.

Conclusion: These findings suggest that An. funestus, which is the dominant malaria vector in the area, mediating over 95% of malaria transmission, preferentially occupies only a small subset of uniquely identifiable aquatic habitats in both wet and dry seasons. This presents an opportunity to expand LSM in rural settings by carefully targeting An. funestus habitats, which might be effective and logistically feasible as a complementary approach alongside existing interventions. Further research should assess the impact of targeted LSM for species sanitation compared to blanket LSM.

背景:幼虫源管理(LSM)正在重新成为一项重要的疟疾干预措施,以应对与驱虫蚊帐(ITNs)等核心病媒控制工具相关的挑战,并加快消灭疟疾的进程。目前,LSM 并未在农村地区广泛使用,而是更多地在城市和干旱地区使用。在广泛使用驱虫蚊帐的坦桑尼亚东南部农村社区进行了一次系统的昆虫学评估,以探索部署 LSM 以改善疟疾控制的机会:方法:2022 年和 2023 年进行了水生栖息地调查,以了解不同蚊子媒介对栖息地的使用情况,调查范围包括雨季的 5 个村庄和旱季的 7 个村庄。此外,还收集了成蚊样本,以评估不同按蚊种类在该地区疟疾传播中的作用,并探索使用定向低毒性喷雾杀虫剂进行物种净化的机会:成蚊调查显示,在该地区,室内采集的昆虫学总接种率(EIR)为 20.1,室外为每人每年 6.5 次感染性叮咬。已发现的按蚊媒介只有 funestus 按蚊和阿拉伯按蚊。按蚊在室内传播疟疾的比例超过 97.6%,在室外传播疟疾的比例为 95.4%。同时进行的幼虫调查发现,在雨季,有阿拉伯疟蚊和真疟蚊晚龄幼虫的栖息地只占所有水体的一小部分(11.2%-16.5%),在旱季占 9.7%-15.2%。就面积而言,这些栖息地在雨季占栖息地总面积的66.4%-68.2%,而在旱季则减少到33.9%-40.6%。从雨季到旱季,阿拉伯按蚊(An. arabiensis)和真按蚊(An. funestus)占据的栖息地表面积减少了 92.0% 到 97.5%,而阿拉伯按蚊(An. arabiensis)和真按蚊(An. funestus)占据的栖息地数量减少了 38.0% 到 57.3%。按蚊全年都喜欢水质清澈、植被丰富的大型永久性栖息地,而阿拉伯按蚊则表现出截然不同的季节性偏好,雨季喜欢有阳光的静水,旱季则喜欢较大、不透明的栖息地:这些研究结果表明,疟原虫是该地区最主要的疟疾病媒,介导了 95% 以上的疟疾传播,但在雨季和旱季,疟原虫只偏好占据一小部分独特的可识别水生栖息地。这就提供了一个机会,通过仔细瞄准疟原虫的栖息地,在农村环境中扩大 LSM,作为现有干预措施的补充方法,这可能是有效的,在后勤上也是可行的。进一步的研究应该评估有针对性的无害环境管理与全面无害环境管理相比对物种卫生的影响。
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引用次数: 0
Efficacy of attractive targeted sugar bait stations against malaria in Western Province Zambia: epidemiological findings from a two-arm cluster randomized phase III trial. 赞比亚西部省有吸引力的定向糖饵站防治疟疾的效果:双臂群组随机 III 期试验的流行病学发现。
IF 2.4 3区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-15 DOI: 10.1186/s12936-024-05175-8
Ruth A Ashton, Kochelani Saili, Chama Chishya, Handrinah Banda Yikona, Annie Arnzen, Erica Orange, Chanda Chitoshi, John Chulu, Titus Tobolo, Frank Ndalama, Irene Kyomuhangi, Willy Ngulube, Hawela Moonga, Jacob Chirwa, Laurence Slutsker, Joseph Wagman, Javan Chanda, John Miller, Kafula Silumbe, Busiku Hamainza, Thomas P Eisele, Joshua Yukich, Megan Littrell

Background: Attractive targeted sugar bait (ATSB) stations containing bait (to attract) and ingestion toxicant (to kill) sugar-foraging mosquitoes are hypothesized to reduce malaria transmission by shortening the lifespan of Anopheles vectors.

Methods: A two-arm cluster-randomized controlled trial (cRCT) was conducted in Western Province Zambia. Seventy clusters of 250-350 households were assigned (1:1) by restricted randomization to an intervention arm (ATSB) or control arm (no ATSB) in the context of standard of care vector control (insecticide-treated nets and/or indoor residual spraying). Two ATSB stations (Westham Sarabi, 0.11% dinotefuran w/w) were maintained on exterior walls of eligible household structures for a 7-month deployment period (December-June) during the high malaria transmission season. The primary outcome was clinical malaria incidence among two consecutive seasonal cohorts of children aged 1-14 years, followed-up monthly from January-June in 2022 and 2023. Secondary outcome was Plasmodium falciparum prevalence among individuals aged over six months. Analysis compared clinical malaria incidence and prevalence between arms among the intention-to-treat population.

Results: ATSB coverage, assessed by cross-sectional survey, was 98.3% in March-April 2022 and 89.5% in March-April 2023. 4494 children contributed any follow-up time to the cohort, with 2313 incident malaria cases in the intervention arm (1.28 per child per six-month transmission season), and 2449 in the control arm (1.38 per child-season). The incidence rate ratio between the two arms was 0.91 (95% CI 0.72-1.15, p = 0.42). 2536 individuals participated in cross-sectional surveys, with prevalence of P. falciparum 50.7% in the intervention arm and 53.5% in the control arm. The odds ratio between the two arms was 0.89 (95% CI 0.66-1.18, p = 0.42). Secondary covariable-adjusted and subgroup analyses did not substantially alter the findings. No serious adverse events associated with the intervention were reported.

Conclusions: Two ATSB stations deployed per eligible structure for two consecutive transmission seasons did not result in a statistically significant reduction in clinical malaria incidence among children aged 1-14 years or in P. falciparum prevalence in rural western Zambia. Further studies are needed to assess the efficacy of ATSB stations in different settings and with different deployment strategies.

Trial registration: The trial is registered with Clinicaltrials.gov (NCT04800055).

背景:据推测,含有诱饵(吸引)和摄入毒药(杀死)的诱食性糖诱饵站(ATSB)可通过缩短按蚊病媒的寿命来减少疟疾传播:在赞比亚西部省开展了一项双臂群集随机对照试验(cRCT)。在病媒控制标准护理(驱虫蚊帐和/或室内滞留喷洒)的背景下,70 个群组的 250-350 户家庭通过限制性随机分配(1:1)被分配到干预组(ATSB)或对照组(无 ATSB)。在疟疾传播高发季节(12 月至次年 6 月),在符合条件的住户建筑外墙上维护两个 ATSB 喷洒站(Westham Sarabi,0.11% 的克百威),部署期为 7 个月(12 月至次年 6 月)。主要结果是 2022 年和 2023 年 1 月至 6 月期间连续两组 1-14 岁儿童的临床疟疾发病率,每月随访一次。次要结果是六个月以上儿童的恶性疟原虫感染率。分析比较了意向治疗人群的临床疟疾发病率和感染率:通过横断面调查评估的 ATSB 覆盖率在 2022 年 3-4 月为 98.3%,在 2023 年 3-4 月为 89.5%。4494名儿童参与了队列随访,其中干预组有2313例疟疾病例(每6个月传播季节每名儿童1.28例),对照组有2449例(每6个月传播季节每名儿童1.38例)。两组之间的发病率比为 0.91(95% CI 0.72-1.15,p = 0.42)。2536 人参加了横断面调查,干预组恶性疟原虫感染率为 50.7%,对照组为 53.5%。两组之间的几率比为 0.89(95% CI 0.66-1.18,p = 0.42)。二次协变量调整分析和亚组分析未对研究结果造成重大改变。没有与干预相关的严重不良事件报告:在连续两个传播季节中,在每个符合条件的建筑物中部署两个 ATSB 站,并没有在统计学上显著降低赞比亚西部农村地区 1-14 岁儿童的临床疟疾发病率或恶性疟原虫感染率。还需要进一步研究,以评估在不同环境和不同部署策略下 ATSB 站的功效:试验已在 Clinicaltrials.gov 注册(NCT04800055)。
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引用次数: 0
Declining genetic polymorphism of the C-terminus Merozoite Surface Protein-1 amidst increased Plasmodium knowlesi transmission in Thailand. 在泰国,随着克雷西疟原虫传播的增加,C端Merozoite表面蛋白-1的遗传多态性也在下降。
IF 2.4 3区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-13 DOI: 10.1186/s12936-024-05162-z
Parsakorn Tapaopong, Sittinont Chainarin, Abdulrohman Mala, Arnuwat Rannarong, Nikom Kangkasikorn, Teera Kusolsuk, Wanlapa Roobsoong, Liwang Cui, Wang Nguitragool, Jetsumon Sattabongkot, Sirasate Bantuchai

Background: Recent reports from Thailand reveal a substantial surge in Plasmodium knowlesi cases over the past decades, with a more than eightfold increase in incidence by 2023 compared to 2018. This study investigates temporal changes in genetic polymorphism associated with the escalating transmission of P. knowlesi malaria in Thailand over time using the prominent vaccine candidate, pkmsp1 as a marker.

Methods: Twenty-five P. knowlesi samples collected in 2018-2023 were sequenced for the 42-kDa region of pkmsp1 and compared with 24 retrieved sequences in 2000-2009, focusing on nucleotide diversity, natural selection, recombination rate, and population differentiation.

Results: Seven unique haplotypes were identified in recent samples, compared to 15 in earlier samples. Nucleotide and haplotype diversity were lower in recent samples (π = 0.016, Hd = 0.817) than in earlier samples (π = 0.018, Hd = 0.942). Significantly higher synonymous substitution rates were observed in both sample sets (dS-dN = 2.77 and 2.43, p < 0.05), indicating purifying selection and reduced genetic diversity over time. Additionally, 8 out of 17 mutation points were located on predicted B-cell epitopes, suggesting an adaptive response by the parasites to evade immune recognition. Population differentiation analysis using the fixation index (Fst) revealed high genetic differentiation between parasite populations in central and southern Thailand or Malaysia. Conversely, the relatively lower Fst value between southern Thailand and Malaysia suggests a closer genetic relationship, possibly reflecting historical gene flow.

Conclusion: This study highlights a decline in genetic diversity and evidence of purifying selection associated with the recently increased incidence of P. knowlesi malaria in Thailand. The minor genetic differentiation between P. knowlesi populations from southern Thailand and Malaysia suggests a shared recent ancestry of these parasites and underscores the need for coordinated efforts between the two countries for the elimination of P. knowlesi.

背景:泰国的最新报告显示,在过去几十年中,克雷西疟原虫病例大幅增加,到2023年,发病率将比2018年增加8倍多。本研究以著名的候选疫苗 pkmsp1 为标记物,调查了与泰国诺雷氏疟原虫疟疾传播升级相关的基因多态性的时间变化:对 2018-2023 年收集的 25 份柯莱西疟原虫样本进行了 pkmsp1 42-kDa 区域测序,并与 2000-2009 年检索到的 24 份序列进行了比较,重点关注核苷酸多样性、自然选择、重组率和种群分化:结果:在近期样本中发现了 7 个独特的单倍型,而在早期样本中发现了 15 个单倍型。近期样本的核苷酸和单倍型多样性(π = 0.016,Hd = 0.817)低于早期样本(π = 0.018,Hd = 0.942)。在两组样本中都观察到了显著较高的同义替换率(dS-dN = 2.77 和 2.43,p st),这表明泰国中部和南部或马来西亚的寄生虫种群之间存在较高的遗传分化。相反,泰国南部和马来西亚之间的 Fst 值相对较低,这表明遗传关系更为密切,可能反映了历史上的基因流动:本研究强调了遗传多样性的下降,以及与最近泰国克雷西氏疟原虫疟疾发病率上升有关的净化选择的证据。泰国南部和马来西亚的克雷勒氏疟原虫种群之间的遗传差异较小,这表明这些寄生虫的祖先在近代是相同的,并强调两国需要协调努力以消灭克雷勒氏疟原虫。
{"title":"Declining genetic polymorphism of the C-terminus Merozoite Surface Protein-1 amidst increased Plasmodium knowlesi transmission in Thailand.","authors":"Parsakorn Tapaopong, Sittinont Chainarin, Abdulrohman Mala, Arnuwat Rannarong, Nikom Kangkasikorn, Teera Kusolsuk, Wanlapa Roobsoong, Liwang Cui, Wang Nguitragool, Jetsumon Sattabongkot, Sirasate Bantuchai","doi":"10.1186/s12936-024-05162-z","DOIUrl":"10.1186/s12936-024-05162-z","url":null,"abstract":"<p><strong>Background: </strong>Recent reports from Thailand reveal a substantial surge in Plasmodium knowlesi cases over the past decades, with a more than eightfold increase in incidence by 2023 compared to 2018. This study investigates temporal changes in genetic polymorphism associated with the escalating transmission of P. knowlesi malaria in Thailand over time using the prominent vaccine candidate, pkmsp1 as a marker.</p><p><strong>Methods: </strong>Twenty-five P. knowlesi samples collected in 2018-2023 were sequenced for the 42-kDa region of pkmsp1 and compared with 24 retrieved sequences in 2000-2009, focusing on nucleotide diversity, natural selection, recombination rate, and population differentiation.</p><p><strong>Results: </strong>Seven unique haplotypes were identified in recent samples, compared to 15 in earlier samples. Nucleotide and haplotype diversity were lower in recent samples (π = 0.016, Hd = 0.817) than in earlier samples (π = 0.018, Hd = 0.942). Significantly higher synonymous substitution rates were observed in both sample sets (d<sub>S</sub>-d<sub>N</sub> = 2.77 and 2.43, p < 0.05), indicating purifying selection and reduced genetic diversity over time. Additionally, 8 out of 17 mutation points were located on predicted B-cell epitopes, suggesting an adaptive response by the parasites to evade immune recognition. Population differentiation analysis using the fixation index (F<sub>st</sub>) revealed high genetic differentiation between parasite populations in central and southern Thailand or Malaysia. Conversely, the relatively lower F<sub>st</sub> value between southern Thailand and Malaysia suggests a closer genetic relationship, possibly reflecting historical gene flow.</p><p><strong>Conclusion: </strong>This study highlights a decline in genetic diversity and evidence of purifying selection associated with the recently increased incidence of P. knowlesi malaria in Thailand. The minor genetic differentiation between P. knowlesi populations from southern Thailand and Malaysia suggests a shared recent ancestry of these parasites and underscores the need for coordinated efforts between the two countries for the elimination of P. knowlesi.</p>","PeriodicalId":18317,"journal":{"name":"Malaria Journal","volume":"23 1","pages":"342"},"PeriodicalIF":2.4,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Perception of caregivers on ITNs utilisation and its effectiveness among children under 5 years of age in Chikwawa district, Malawi. 马拉维奇夸瓦地区 5 岁以下儿童中照顾者对驱虫蚊帐使用情况及其有效性的看法。
IF 2.4 3区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-12 DOI: 10.1186/s12936-024-05167-8
Enock Benito, Praveen Suthar, Godfrey Banda, Parthasarthi Ganguly, Wamaka Msopole

Background: In 2020, Malawi had 6.9 million malaria cases and 2551 deaths, mainly in children under five years of age. The 2017-2022 Malawi malaria control strategic plan promoted the consistent use of insecticide-treated nets through free distribution and mass campaigns. Despite widespread availability of the control strategy plan, Chikwawa District continues to suffer from high malaria burden especially among under five children, due to inconsistent insecticide-treated (ITN) net usage. For this reason, this study aimed at exploring caregivers' perceptions on insecticide-treated net utilisation and also find out about its effectiveness among those who consistently use them.

Methods: This study used a sequential exploratory mixed methods design. The data used for quantitative analysis was drawn from the population of under-five children's caregivers within the catchment area of Chikwawa district hospital. The sample size was 96 participants, as determined by Cochran's formula. The data collection lasted from December 2023 to April 2024 and included four in-depth interviews and three focus group discussions to address the objectives qualitatively.

Results: The study revealed that 91.67% of households used ITNs, with 87.50% using them daily. The significant factors influencing ITN utilisation included the number of nets, user satisfaction, perceived impact, user habits, acquisition method, and usage frequency (all p values < 0.001). Under-five malaria cases were also significant (p = 0.025). The odds of the perceived net impact influencing utilisation were 4.956 times greater. Non-usage was due to heat, quality concerns, limited access, breathing difficulties, health conditions such as asthma, and misconceptions about net treatment.

Conclusion: The study revealed a strong belief in insecticide-treated net efficacy. However, some challenges such as access, durability, and misinformation of insecticide-treated nets were discovered. These challenges affected utilisation of insecticide-treated nets in agreement with some literature reviewed. The insights found in this study will help policymakers in addressing health interventions for the reduction of malaria cases in Malawi.

背景:2020 年,马拉维有 690 万疟疾病例,2551 人死亡,主要是五岁以下儿童。2017-2022 年马拉维疟疾防控战略计划通过免费发放和大规模宣传活动,提倡坚持使用驱虫蚊帐。尽管该控制战略计划得到了广泛传播,但由于驱虫蚊帐的使用不一致,奇夸瓦区的疟疾负担仍然很重,尤其是五岁以下儿童。因此,本研究旨在探讨护理人员对驱虫蚊帐使用情况的看法,并了解驱虫蚊帐在坚持使用驱虫蚊帐的护理人员中的效果:本研究采用顺序探索性混合方法设计。用于定量分析的数据来自奇夸瓦地区医院服务区内的五岁以下儿童看护人群。根据科克伦公式,样本量为 96 人。数据收集工作从 2023 年 12 月持续到 2024 年 4 月,其中包括四次深入访谈和三次焦点小组讨论,以从质量上实现目标:研究显示,91.67%的家庭使用驱虫蚊帐,其中 87.50%的家庭每天使用。影响驱虫蚊帐使用率的重要因素包括蚊帐数量、用户满意度、感知影响、用户习惯、购买方法和使用频率(均为 p 值):研究表明,人们对驱虫蚊帐的功效深信不疑。然而,也发现了一些挑战,如驱虫蚊帐的获取、耐用性和错误信息。这些挑战影响了驱虫蚊帐的使用,这与查阅的一些文献一致。这项研究中发现的见解将有助于决策者采取卫生干预措施,减少马拉维的疟疾病例。
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引用次数: 0
Investigation on chemical composition and insecticidal activity against Anopheles gambiae of essential oil obtained by co-distillation of Cymbopogon citratus and Hyptis suaveolens from Western Burkina Faso. 通过对布基纳法索西部的柠檬香蒲(Cymbopogon citratus)和鼠尾草(Hyptis suaveolens)进行联合蒸馏获得的精油的化学成分和对冈比亚按蚊的杀虫活性研究。
IF 2.4 3区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-11 DOI: 10.1186/s12936-024-05177-6
Bily Nebié, Constantin M Dabiré, Remy K Bationo, Dieudonné D Soma, Moussa Namountougou, Siaka Sosso, Roger C H Nebié, Roch K Dabiré, Eloi Palé, Pierre Duez

Background: Essential oils of Cymbopogon citratus and Hyptis suaveolens are known for their insecticidal properties, but remain ineffective against mosquitoes resistant to synthetic insecticides. In order to improve insecticidal properties of these plants, this study aimed to investigate the chemical composition and insecticidal activity against Anopheles gambiae mosquitoes of essential oil obtained by co-distillation of dry leaves of C. citratus and H. suaveolens.

Methods: Essential oils were extracted by hydrodistillation from dry leaves of C. citratus and H. suaveolens, separately, then from the mixture of the dry leaves of the two plants in mass ratio 50/50. Each pure essential oil and the mixture obtained either by co-distillation or by combining pure essential oils in volume ratio 50/50 were then analysed by GC/MS. All essential oils and Deltamethrin 0.05% (positive control) were tested on two species of mosquitoes of the genus Anopheles gambiae according to the World Health Organization standard methods.

Results: Essential oil obtained by co-distillation mainly contained piperitone (40.80%), 1,8-cineole (24.64%), p-menth-4(8)-ene (13.20%), limonene (6.09%) and α-pinene (4.73%). However, the mixture of pure essential oils of these two plants mostly contained geranial (20.74%), neral (16.42%), 1,8-cineole (19.79%), sabinene (6.03%) and β-pinene (3.87%). The essential oil of C. citratus mainly contained geranial (41.49%), neral (32.83%), β-myrcene (13.66%) and geraniol (3.49%) while the major constituents of essential oil of H. suaveolens were 1,8-cineole (39.58%), sabinene (12.06%), β-pinene (7.73%), α-terpinolene (6.72%) and (E)-caryophyllene (7.49%). At the dose of 1%, all essential oils, except that of H. suaveolens, induced about 100% of mortality on the sensitive species of An. gambiae. However, on the resistant species at the same dose, the essential oil obtained by co-distillation induced the highest mortality (53.44%). The essential oils of C. citratus, H. suaveolens and the mixture of the two pure essential oils caused respectively 2.47, 15.28 and 18.33% of mortality. The synthetic insecticide caused 100 and 14.84% of mortality respectively on the sensitive and resistant species of An. gambiae.

Conclusion: Essential oil obtained by co-distillation showed good insecticidal efficacy against a resistant species of An. gambiae and might constitute a new solution to fight against mosquitoes resistant to synthetic insecticides.

背景:柠檬香蒲(Cymbopogon citratus)和苏合香(Hyptis suaveolens)的精油以其杀虫特性而闻名,但对耐合成杀虫剂的蚊子仍然无效。为了改善这些植物的杀虫特性,本研究旨在调查通过对柠檬香蒲和苏合香蒲的干叶进行共蒸馏而获得的精油的化学成分和对冈比亚按蚊的杀虫活性:通过水蒸馏法分别从 C. citratus 和 H. suaveolens 的干叶中提取精油,然后再从这两种植物干叶的混合物中以 50/50 的质量比提取精油。然后用气相色谱/质谱法分析每种纯精油和通过共蒸馏或以 50/50 的体积比混合纯精油得到的混合物。根据世界卫生组织的标准方法,对所有精油和 0.05% 的溴氰菊酯(阳性对照)在冈比亚按蚊属的两种蚊子身上进行了测试:共蒸馏得到的精油主要含有胡椒酮(40.80%)、1,8-蒎烯(24.64%)、对薄荷-4(8)-烯(13.20%)、柠檬烯(6.09%)和α-蒎烯(4.73%)。然而,这两种植物的纯精油混合物主要含有香叶醇(20.74%)、矿物油(16.42%)、1,8-蒎烯(19.79%)、沙比利烯(6.03%)和β-蒎烯(3.87%)。C. citratus 的精油主要含有香叶醇(41.49%)、萘(32.83%)、β-月桂烯(13.66%)和香叶醇(3.49%)。而 H. suaveolens 精油的主要成分是 1,8-蒎烯(39.58%)、沙比利烯(12.06%)、β-蒎烯(7.73%)、α-松油醇烯(6.72%)和(E)-石竹烯(7.49%)。在 1%的剂量下,除 H. suaveolens 外,所有精油都能诱导冈比亚蚂蚁敏感种 100%死亡。然而,在相同剂量下,通过共蒸馏获得的精油对抗性物种的致死率最高(53.44%)。C. citratus、H. suaveolens 的精油和两种纯精油的混合物分别导致 2.47%、15.28% 和 18.33% 的死亡率。合成杀虫剂对冈比亚蚂蚁的敏感种和抗性种分别造成 100% 和 14.84% 的死亡:通过共蒸馏得到的精油对冈比亚蚁的抗药性物种有很好的杀虫效果,可能是对付对合成杀虫剂有抗药性的蚊子的一种新方法。
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引用次数: 0
Factors associated with severe malaria-related mortality among hospitalized children under five years of age in Eastern Province of Rwanda: a cross-sectional study using hospital records from 2017 to 2021. 卢旺达东部省五岁以下住院儿童与严重疟疾相关死亡率的相关因素:一项利用 2017 年至 2021 年医院记录进行的横断面研究。
IF 2.4 3区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-11 DOI: 10.1186/s12936-024-05159-8
Jean Paul Hategekimana, Clarisse Marie Claudine Simbi, Theoneste Ntakirutimana, Laetitia Nyirazinyoye

Background: Malaria remains a significant concern for children under five in malaria-endemic regions. Rwanda's successful efforts in malaria treatment reduced nationwide cases, but high mortality persists in the Eastern and Southern provinces. This study aimed to investigate the clinical features of severe malaria and to identify the death risk factors among under-five children in Eastern province Hospitals.

Methods: This cross-sectional study assessed severe malaria-related mortality and associated factors among children aged under five years in hospitals of Eastern Province, Rwanda, from 2017 to 2021. Data were collected from hospital records, and descriptive statistics and logistic regression were used for data analysis.

Results: Factors associated with severe malaria-related mortality included coma (aOR: 10, 95% CI: 1.2-82.5, p = 0.03), Vomiting (aOR: 5.2, 95% CI: 1.0-26.0, p = 0.04), four or more days of illness before consultation (aOR: 30.9, 95% CI: 8.7-109.9, p < 0.01). On the other hand, a low parasitaemia level (aOR: 0.01, 95% CI: 0.0-0.1, p < 0.01).

Conclusion: In conclusion, coma, vomiting, and healthcare delays increased mortality in children with severe malaria. Prompt treatment, proper assessments, protocol adherence, and caregiver education on early symptom recognition are crucial for improving outcomes.

背景:疟疾仍然是疟疾流行地区五岁以下儿童的一个重大问题。卢旺达在疟疾治疗方面的成功努力减少了全国范围内的病例,但东部省和南部省的死亡率仍然很高。这项研究旨在调查严重疟疾的临床特征,并确定东部省医院五岁以下儿童的死亡风险因素:这项横断面研究评估了2017年至2021年卢旺达东部省医院中5岁以下儿童与重症疟疾相关的死亡率和相关因素。数据来自医院记录,数据分析采用描述性统计和逻辑回归:与严重疟疾相关死亡率相关的因素包括昏迷(aOR:10,95% CI:1.2-82.5,p = 0.03)、呕吐(aOR:5.2,95% CI:1.0-26.0,p = 0.04)、就诊前患病四天或四天以上(aOR:30.9,95% CI:8.7-109.9,p 结论:与严重疟疾相关死亡率相关的因素包括昏迷(aOR:10,95% CI:1.2-82.5,p = 0.03)、呕吐(aOR:5.2,95% CI:1.0-26.0,p = 0.04)、就诊前患病四天或四天以上(aOR:30.9,95% CI:8.7-109.9,p总之,昏迷、呕吐和医疗延误会增加重症疟疾患儿的死亡率。及时治疗、正确评估、遵守治疗方案以及对护理人员进行早期症状识别教育对改善预后至关重要。
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引用次数: 0
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Malaria Journal
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