Malaria Journal最新文献

Introduction: Malaria remains a significant public health challenge, particularly in high-burden settings such as Uganda. Social and Behaviour Change Communication (SBCC) interventions play a vital role in influencing knowledge, attitudes, and practices related to malaria prevention. However, despite the widespread promotion of mosquito bed net (MBN) use, there is limited evidence on the comparative effectiveness of different media platforms in encouraging their adoption. This study estimated the effect of exposure to malaria messages from different media platforms on MBN use among women of reproductive age in Uganda using propensity score-matched analysis.

Methods: We conducted a secondary analysis of nationally representative data from the 2018-2019 Uganda Malaria Indicator Survey (UMIS), restricted to 3488 women aged 15-49 years who reported exposure to at least one malaria message. The primary outcome was MBN use, and the key exposures were nine distinct SBCC platforms. One-to-one nearest neighbour propensity score matching was applied, adjusting for key socio-demographic characteristics including age, education level, household wealth index, place of residence, and region. Propensity score matching analysis (PSMA) was applied to estimate the average treatment effect on the treated (ATT) for each platform, with ATT chosen to quantify effects among women who were actually exposed to malaria-related messages, adjusting for relevant observed covariates. Data analysis was done in Stata V14.0.

Results: Of the 3488 women included in the study, 73.2% reported using MBN the previous night before the survey. Propensity score matched analysis revealed that exposure to malaria messages through community health workers (ATT = 0.322, 95% CI 0.111, 0.533), community events (ATT = 0.296, 95% CI 0.085, 0.507), and social mobilization (ATT = 0.185, 95% CI 0.008, 0.362) significantly increased MBN use. Other effective channels included social media, radio, interpersonal communication, and billboards. Television exposure (ATT = 0.051; 95% CI  - 0.062, 0.164) and exposure from other unspecified sources were not significantly associated with MBN use.

Conclusion: Among women exposed to malaria messages, exposure through community health workers and community events showed the strongest associations MBN use, followed by exposure through social mobilisation and other SBCC platforms. Exposure through television was not significantly associated with MBN use, suggesting that community-based and interpersonal communication channels may be more strongly associated with MBN utilisation than some mass media platforms.

Background: Malaria remains a significant public health challenge, particularly in the Khyber Pakhtunkhwa (KP) province, where transmission patterns vary across districts. This study aimed to identify the determinants of malaria transmission using model selection techniques.

Methods: A cross-sectional study was conducted among general population across various districts in KP, including northern, central, and southern zones. A total of 768 participants across the province were surveyed using a structured questionnaire having socio-demographic variables, housing conditions, access to healthcare, and preventive practices. Malaria infection was diagnosed using the combo rapid diagnostic test. Logistic regression models, including automated model selection techniques, were employed to identify significant predictors of malaria.

Results: The overall proportion of malaria among respondents was 24.5%. Bivariate analysis showed that male gender, younger age (16-30 years), joint family system, low education, poor housing conditions, low income, long distance to health centers, and non-use of bed nets were significantly associated with malaria (p < 0.05). Final multivariate model results identified gender (AOR 1.8, CI 1.1-2.8, P < 0.05), age group 16-30 years (AOR 4.2, CI 2.1-8.5, P < 0.01), age group 31-50 years (AOR 8.3, CI 4.2-16.3, P < 0.01), age group > 50 years (AOR 3.6, CI 1.9-6.7, P < 0.01), family type (AOR 2.6, CI 1.47-4.61, P = 0.001), education level (AOR 3.9, CI 2.6-5.9, P < 0.01), income level (10,000-50000 rupees) (AOR 17.8, CI 8.1-38.9, P < 0.05), large family size (AOR 11.3, CI 5.9-21.7, P < 0.05), distance of > 3 km to healthcare facilities (AOR 3.1, CI 1.8-5.3, P < 0.01), and lack of modern toilets (AOR 4.8, CI 2.4-9.4, P < 0.01) as independent risk factors of malaria prevalence.

Conclusion: The study highlights multiple risk factors contributing to malaria prevalence in KP. Tailored interventions, including improved access to education, healthcare, sanitation, and preventive tools like bed nets, are critical. Future studies incorporating geographic mapping and seasonal trends are recommended to strengthen targeted malaria control strategies.

Background: The R21 malaria vaccine has recently been rolled out in Uganda and other endemic settings across sub-Saharan Africa. Its implementation, faces many potential challenges. We assessed caregivers' awareness, knowledge, attitude, and perceptions towards the vaccine in northern Uganda.

Methods: A sequential explanatory mixed methods study was conducted in Kole and Kwania districts, Northern Uganda. Quantitative data were collected through a structured survey of 574 randomly selected caregivers of age-eligible children. Qualitative data were gathered through follow-up focus group discussions with caregivers. Descriptive statistics and exploratory factor analysis were used to assess knowledge and latent dimensions of attitudes and perceptions. Qualitative data were transcribed verbatim, anonymized, organized within ATLAS.ti version 25, and analysed using deductive thematic analysis.

Results: Among the 574 caregivers 90.1%, (95% CI 87.3-92.4) were aware of malaria vaccine. However, only 13.9% (95% CI 11.2-17.0) demonstrated factual knowledge regarding key aspects of malaria vaccine including; number of doses required (16.4%), dosing intervals (21.0%), and age eligibility (34.2%). Overall, 57.4% of the caregivers expressed positive attitudes and 57.5% reported positive perceptions towards the vaccine. Common factor analysis (CFA) revealed two key dimensions of vaccine attitudes: caregiver confidence (54.9%) and safety concerns (49.7%). Regarding perceptions, three factors emerged: vaccine confidence (56.5%), trust in delivery (54.9%), and safety concerns. While most caregivers stated confidence and trust, nearly half reported lingering concerns. Qualitative data reinforced these results and revealed five central themes: caregivers' knowledge and awareness of the malaria vaccine; enduring community misconceptions; mixed attitudes reflecting trust, and fear; and perceptions related to vaccine's safety, effectiveness, and value for child-health.

Conclusion: Although, factual knowledge was limited, caregivers reported high awareness of malaria vaccine, alongside positive attitudes and perceptions tempered by safety concerns. The Ministry of Health needs to implement regular, nationwide community education campaigns anchored in locally tailored communication strategies.

Background: Despite significant progress in malaria control, malaria remains a major public health issue in Ethiopia. Regular trend analysis is essential for assessing the effectiveness of interventions.

Methods: A retrospective study was conducted from 2020 to 2024 at Mattu Karl Comprehensive Specialized Hospital. Laboratory records of patients tested for malaria were reviewed to assess annual trends and Plasmodium species distribution.

Results: Out of 100,760 patients tested by microscope over the five years, 14,303 (14.2%) were positive for malaria. Plasmodium vivax accounted for 49.1% of cases, Plasmodium falciparum; for 37.8%, and mixed infections for 13.1%. Females represented 51.4% 0f the suspected patients and 51.8% of the confirmed cases. The positivity rate rose from 9.2% in 2020 to 17.7% in 2024.

Conclusion: Malaria incidence increased over the study period with a concerning rise in mixed infections. The results underscore the need for enhanced malaria control strategies tailored to species dynamics.

Introduction: Malaria remains a major public health issue in Southeast Asia, with Plasmodium knowlesi (P. knowlesi) emerging as a growing threat. Despite intensified prevention and control efforts, populations in this region remain highly vulnerable to this zoonotic disease, driven by the complex interactions between primates, mosquitoes, and humans. This study aims to explore understanding of the factors affecting communities vulnerable to P. knowlesi malaria and their preventive behaviours, tailored to the local context.

Methodology: A group of participants with substantial expertise and experience in malaria programme implementation and field operations were assembled. Utilizing the Nominal Group Technique (NGT), a validated and systematic approach for facilitating group discussions aimed at consensus, we identified the essential points to prioritize factors affecting at-risk communities and their malaria prevention behaviours. NGT were conducted through virtual platforms in October 2024, achieving consensus when 80% of the experts concurred on specific ideas. Final rankings were established based on descending acceptance percentages.

Result: Of the 21 items presented for voting, 20 were retained for final ranking, demonstrating a strong panel consensus on key factors influencing malaria risk and prevention behaviours. The voting response rate was 100%, and consensus was achieved in a single NGT round. The 20 selected items, endorsed by the expert panel, were categorized into four overarching themes: environmental risks, human-related risks, policy and organizational factors, and vector-related risks.

Conclusion: These findings provide a valuable foundation for refining malaria prevention strategies. Future research can leverage this consensus to deepen the understanding of malaria-prevention behaviours and enhance P. knowlesi malaria programs tailored to at-risk communities.

Background: Despite substantial investments in malaria control, the disease remains a major burden in sub-Saharan Africa, particularly Uganda. Novel tools such as gene drive systems are being developed to suppress malaria vector populations, but their deployment requires detailed knowledge of mosquito population genetics.

Methods: The genetic structure, diversity, and demographic history of Anopheles gambiae and Anopheles arabiensis were assessed at six sites in Uganda: three islands in Lake Victoria and three mainland sites. A total of 2918 An, gambiae and 173 An. arabiensis were genotyped using targeted amplicon sequencing of 62 loci across coding and non-coding regions of the genome.

Results: Population structure analyses revealed clear separation between the two species but little differentiation within each species across sites. Pairwise F_ST values among An. gambiae populations were low (0.00054-0.028) but often statistically significant, with mainland populations showing higher connectivity and island populations exhibiting greater isolation. Anopheles arabiensis mainland populations showed no statistically significant differentiation, suggesting panmixia. Principal component analysis and Bayesian clustering similarly distinguished species-level structure but no obvious substructure within sites. Mainland An. gambiae populations displayed higher nucleotide diversity than island populations, while An. arabiensis showed the lowest diversity overall. Tajima's D values were negative across sites, consistent with recent population expansions. Effective population size estimates indicated small populations at the islands (146-249) compared to large mainland populations (4054-8190).

Discussion: These findings demonstrate strong genetic differentiation between An. gambiae and An. arabiensis, and subtle but meaningful structure between island and mainland An. gambiae populations. The reduced diversity and small effective population sizes at island sites suggest stronger genetic drift and limited gene flow, in contrast to the highly connected mainland populations.

Conclusion: This study highlights how geographic and ecological factors shape mosquito population structure and provides critical evidence for the design and monitoring of genetic-based vector control interventions, including the planning and evaluation of field trials.

Background: Malaria-bacteremia co-infection significantly increases mortality and the risk of ICU admission. Diagnostic overlap with bacterial infections often results in misdiagnosis, impacting outcomes. While pediatric data exists, adult studies in Uganda are limited. This study aimed to determine the prevalence, bacterial isolates, and associated factors of bacteremia in adults with severe malaria at Kayunga Regional Referral Hospital.

Methods: A cross-sectional study enrolled 207 adults with severe malaria. Blood samples were cultured, and isolates tested for antimicrobial susceptibility. Sociodemographic, clinical, and laboratory data were collected using structured tools. Logistic regression in SPSS version 26 was done to determine the significant factors. The outcome predicted was the presence of bacterium. P < 0.05 was considered significant.

Results: Of the 207 participants, 14.5% had bacteremia. Central nervous system (CNS) symptoms, low peripheral oxygen saturation (SPO2), hyperparasitaemia, and leucocytosis were significantly associated with bacteremia. Salmonella typhi (33.3%), Staph aureus (30%), and Streptococcus spp. (16.7%) were the most common isolates. Ciprofloxacin and penicillin derivatives showed strong coverage.

Conclusion: The prevalence of bacteremia among patients with malaria was high, seen in over one of every seven patients with malaria. Malaria patients with CNS symptoms, low peripheral oxygen saturation, malaria hyperparasitaemia and leucocytosis should be considered to be at high risk for bacteremia. If bacteria co-infection is suspected among patients with malaria, in the absence of culture and sensitivity results, a combination of ciprofloxacin and a penicillin can be considered since these two can provide an acceptable cover of the most common isolates, yet readily available in our resource limited setting.

Background: According to the World Health Organization (WHO), Afghanistan has the world's seventh-highest reported malaria burden, outside Africa. The objectives of this study were to determine the historical trend of malaria in Afghanistan over the past three decades, conduct a forecast analysis using best-fitted predictive models based on historical data, and conduct district-level stratification of malaria-endemicity to inform customised control and elimination intervention strategies for ending malaria in Afghanistan.

Methods: District-level monthly malaria incidence data from 2018 to 2023 were obtained from the Afghanistan Ministry of Public Health. The annual malaria cases from 1990 to 2023 were obtained from the WHO.

Results: From 2018 to 2023, the test positivity rate (TPR) was 15.2%, with 96.5% of cases being Plasmodium vivax, 3.2% being P. falciparum, and 0.3% having mixed infections of P. vivax and P. falciparum. The mean annual malaria cases from 2018 to 2023 were 153,295 per year. Nearly one-fourth of total malaria cases occurred in districts along the Pakistan border, which also comprised most of the country's highly endemic areas. In contrast, districts bordering Iran, Turkmenistan, Uzbekistan, Tajikistan, and China together contributed less than 1% of cases. The annual trends of the time series data on malaria cases in Afghanistan from 1990 to 2023 exhibited a non-linear cyclic trend, with the highest cases reported in 2002. The number of cases then steadily declined until 2013, after which they further increased in the following 4 years, 2014-2017. Forecasting analysis suggests that the country is unlikely to achieve malaria elimination by 2035 under the current intervention policy.

Conclusions: About 43% of the districts with zero or low malaria endemicity are ready for sub-national malaria elimination. There is a need for context-specific strategies of vector control and case management to eliminate malaria in moderate- and high-endemic districts. The districts along the Afghan-Pakistan border are hosting the majority of infections and require effective cross-border collaboration between the two countries to meet their malaria elimination goals.

Background: Effective interventions for controlling Anopheles malaria vectors depend on accurately identifying the species. Venezuela has the highest malaria prevalence in the region of the Americas; however, there is very limited knowledge about the vectors, especially regarding species complexes and their distribution.

Objectives: To conduct molecular taxonomy and phylogenetic analysis of the Albitarsis, Nuneztovari, and Oswaldoi complexes from malaria-endemic regions of Guyana and Venezuela using mtCOI sequences.

Methods: Anopheles were collected in Guyana (Potaro-Siparuni Region) and Venezuela (five municipalities). Species identification was carried out by analyzing mitochondrial cytochrome C oxidase (mtCOI) gene data using MrBayes, TCS, Posterior Probabilities of Correct Identification (P ID), Rosenberg's P (AB) values, and P (Randomly Distinct) as species delimitation approaches.

Findings: Four distinct taxa were identified: An. albitarsis F, An. goeldii, An. oswaldoi A and An. oswaldoi B. Anopheles oswaldoi A and An. oswaldoi B occurred sympatrically in Boca de Nichare, Bolívar State, Venezuela.

Conclusion: Anopheles goeldii is reported for the first time from Guyana and Venezuela, and discuss its role as vector of malaria parasites in both countries and its relative recent colonization. Anopheles oswaldoi A is reported for the first time from Venezuela. Anopheles albitarsis F, an important malaria vector in Colombia and Venezuela, is confirmed as the only species of the Albitarsis complex widely distributed in Venezuela. Our results will be valuable for future research aimed at clarifying the status of these significant species complexes in the region.