Malaria Journal最新文献

Background: Gestational malaria (GM) is a serious public health problem, control of GM requires guarantee universal access to prevention, diagnosis and treatment. In Colombia, no studies have been conducted on barriers to healthcare access for pregnant women exposed to GM. The objective of this study was to analyse the barriers to healthcare access for women at risk of GM in an endemic region of Colombia.

Methods: A mixed QUAN-QUAL study with 400 pregnant women; from this group, 28 were selected for the QUAL component, to which an interview with eight health workers was added. The barriers investigated were sociocultural, economic, institutional response capacity, knowledge of the actors, previous experiences and health financing. In the QUAN component, the frequency of the barriers and their associated factors were identified. In the QUAL component, a hermeneutic analysis was conducted to enhance the explanatory depth of the barriers, through open (description), axial (conceptual ordering) and selective (theorization) categorization.

Results: The most frequent barriers included delays in care from a physician (93%) or specialist (89%), and procedures with a Health-Promoting Entity (HPE) (84%); the least frequent barriers were the delivery of drugs (23%) and quality of care (23%). All pregnant women reported at least one barrier, 50% reported between 7 and 11 barriers, with the highest number of barriers among housewives, multigravida and poor pregnant women. The QUAL component included the intersection of GM with sociocultural and economic barriers, financial limitations of public health programmes, failure to fulfill responsibilities by health professionals, and a lack of knowledge regarding health rights among pregnant women.

Conclusion: Multiple access barriers were identified; the most affected subgroups were identified, and some sociocultural and economic explanations for this problem were explored in depth. It is important to expand the health action of GM control, and to improve the care of pregnant women and their quality of life.

Background: Despite significant efforts to control malaria infections in recent years, new infection rates continue to pose a major public health challenge in sub-Saharan Africa, including Ethiopia. This study aims to identify the key factors of malaria infection among children under five years (U5) in the Gursum district of Somali region, Eastern Ethiopia.

Methods: An institution-based case-control study was conducted over two months, from June to July 2020. The study included 247 participants, divided into 82 cases and 165 controls, with a case-to-control ratio of 1:2. It focused on households with children under the age of five who received care at three health centers within the district. The investigation involved identifying Plasmodium species using rapid diagnostic tests and microscopic blood film examination. A logistic regression model was employed to analyze the factors affecting the outcome, using statistical software STATA-13/15. Odds ratios and the corresponding confidence intervals were calculated to identify potential predictors in the logistic regression model.

Results: A multivariate analysis identified five exposures significantly associated with malaria positivity among children: living near a source of water [adjusted odds ratio (AOR) = 3.60 (1.73-7.48)], residing in rural areas [AOR = 3.58 (1.56-8.21)], living in houses with openings or holes in the walls that facilitate mosquito entry [AOR = 5.00 (2.22-11.28)], and not receiving malaria health information [AOR = 2.12 (1.06-4.21)]. Additionally, proximity to malaria vector breeding habitats [AOR = 4.74 (2.27-9.90)] was significant for malaria positivity. These five factors emerged as the primary determinants of malaria positivity among U5 children in the Gursum district.

Conclusion: The study indicates that critical factors contributing to malaria positivity among U5 children in the Gursum district are related to a lack of awareness, housing conditions, and proximity to vector breeding sites. Therefore, social mobilization and targeted malaria interventions at the community level are essential for reducing disease transmission, particularly among the most vulnerable children.

Background: Progress towards malaria elimination in the Greater Mekong Subregion has left much of the residual malaria transmission concentrated among forest-exposed populations for whom traditional domicile focused malaria vector control is unlikely to be effective. New tools to protect these populations from vector biting outdoors are needed.

Methods: Alongside implementation research on the deployment of a "forest pack" consisting of a volatile pyrethroid (transfluthrin)-based spatial repellent (VPSR), a picaridin-based topical repellent and etofenprox treatment of clothing, an assessment was made of participant willingness to pay for the forest packs and variants of the packs using a discrete choice experiment.

Results: Participants showed willingness to pay for forest packs consistent with full-cost recovery for VPSR devices. The inclusion of a full malaria season's worth of VPSR devices increased the willingness to pay for a forest pack by 15% (p = 0.061). At a price of approximately 10 USD, approximately 50% of participants were willing to pay for a forest pack which included a full season's worth of VPSR.

Conclusion: Forest packs which include VPSR are likely to be acceptable to the target forest-exposed populations, and those which include VPSR products may even have potential for commercial sales or some cost-recovery.

Background: Under-five mortality in Tanzania remains a persistent issue, significantly affecting both the health and economic sectors. Despite various interventions, the under-five mortality rate (U5MR) remains high, impeding progress toward global health targets. This study investigates the factors influencing under-five mortality in Tanzania, focusing on the gross domestic product (GDP), malaria incidence, access to water, and access to sanitation.

Methods: The study employed data sets for Tanzania U5MR, GDP, access to water and sanitation, and malaria incidences from the World Bank for the years 1960-2020. Missing values are generated through the linear trend at point method. To analyses the data, correlation analysis and Bayesian linear regression are employed.

Results: The analysis reveals significant relationships between the gross domestic product (GDP), malaria incidence, access to water, access to sanitation and under-five mortality. Furthermore, an increase in malaria incidences increase under-five mortality by 0.14 (14%), while access to water and sanitation exhibit an uncertain relationship. On the other hand, results show that an increase in the GDP lowers the likelihood of U5MR.

Conclusion: These findings underscore the importance of economic development and public health interventions in reducing the child mortality rate. The study provides valuable insights for policymakers aiming to achieve Sustainable Development Goal (SDG) Target 3.2 by 2030, which aims for all countries to accomplish U5MR of 25 or less deaths per 1000 live births. By highlighting the relationships between these variables, the study contributes practical evidence to support efforts towards SDG 3.2, emphasizing the need for targeted interventions in both health and infrastructure sectors.

Background: After almost 70 years of using indoor residual spraying (IRS) as the primary intervention for malaria vector control, the Republic of Panama wanted to evaluate the operational feasibility and acceptability of distributing long-lasting insecticidal hammock nets (LLIHNs) and long-lasting insecticidal nets (LLINs) in the country.

Methods: A pilot study conducted in 2019 distributed LLINs and LLIHNs to cover all sleeping spaces in 15 high burden localities of the indigenous Comarca of Guna Yala and measured retention, coverage, use and physical deterioration, washing and drying practices, as well as people's satisfaction with product characteristics post-distribution.

Results: Overall, 89.9% of enumerated sleeping spaces were covered during the campaign. Monitoring post-distribution showed that 82.7% of the population received messages about the campaign before it happened and 92.4% claimed to know the purpose of the net and how to care for and repair it. Mild adverse reactions, specifically skin irritation associated with the insecticide in LLINs and LLIHNs, were reported by 38.4% of households. Two years after distribution, 86.3% of the LLIHN/LLINs were retained. Use was very high right after distribution (85%) but decreased to 57% six months after distribution and to 38% two years after distribution. The main reason for not using the LLIHN/LLINs was the reported absence of mosquitoes. Two years post-distribution, LLIHN/LLINs were preserved in good physical condition (4% torn), very few were washed with insecticide-damaging products (chlorine or detergent) (9%) or dried under the sun (15%), and LLIHN/LLINs were washed on average less than once every two months. The average number of people per sleeping space was 1.34.

Conclusion: Although the distribution of LLIHN/LLINs was operationally feasible and LLIHN/LLINs were initially well-accepted and cared for by these communities, use decreased drastically over the two years of follow up after distribution. Hence, should there be future LLIHN/LLIN distributions in this area, sufficient resources and efforts need to be allocated to promoting LLIHN/LLIN use. Further investigation into the reasons for low LLIHN/LLIN use are needed to guide such efforts.

Background: Due to the overlapping endemic regions and the high burden of both infections, coinfection with Plasmodium falciparum and Schistosoma mansoni poses distinct public health concerns that require coordinated, multifaceted interventions. There are epidemiological studies on the coinfection of these two parasites in Ethiopia, and the results differ and are inconsistent from one region to another. Thus, the goal of this systematic review and meta-analysis was to ascertain Ethiopia's pooled prevalence of P. falciparum and S. mansoni coinfection.

Methods: The preferred reporting item review and meta-analysis guidelines were followed in this study. PubMed, Google Scholar, Research4Life, Scopus, African-Wider, and EMBASE were the primary search databases. The final analysis included six studies in total. Stata software version 11 was used for analysis after Microsoft Excel was used to extract the data. The critical appraisal tool developed by the Joanna Briggs Institute was used to evaluate the methodological quality of the studies. Publication bias was checked via a funnel plot, Begg's test, and Egger's test. The pooled prevalence of P. falciparum and S. mansoni coinfection was estimated via a random effect model via the Der Simonian-Laird method. The heterogeneity of the studies was evaluated via I² statistical tests.

Results: The pooled prevalence of P. falciparum and S. mansoni coinfections in Ethiopia was 10.496% (95% CI 6.134, 14.859). Subgroup analysis of geopolitical regions revealed that the highest and lowest pooled prevalence rates of coinfection were 11.808% (95% CI 0.304, 23.312) and 8.600% (95% CI 5.755, 11.445), respectively, in the Amhara and Benishangul Gumuz regions.

Conclusions: This study highlights the substantial prevalence of P. falciparum and S. mansoni coinfection in Ethiopia's general population, with considerable geographical variation. Targeted and intensive public health interventions are necessary because it has the highest incidence in the Amhara region, and ongoing efforts are needed to address the relatively lower but still considerable prevalence in the Benishangul Gumuz region. These results direct future research, integrated control strategy design, and resource allocation to successfully manage Ethiopia's combined burden of malaria and schistosomiasis.

Background: Malaria remains a critical public health challenge globally, particularly in sub-Saharan Africa where it significantly contributes to morbidity and mortality among children under-five. In Ghana, efforts to promote the use of insecticide-treated nets (ITNs) as a preventive measure have been substantial but utilization rates remain suboptimal. This study examines the influence of caregivers' malaria-related knowledge on ITN use among children under the age of five years in a rural district of Ghana.

Methods: A community-based cross-sectional study was conducted in the Ahafo Ano South West District, Ghana, between June and October 2023. A total of 442 caregivers (mothers) of children under-five were selected using a two-stage sampling process. Data were collected through structured interviews and analysed using bivariate and multivariable logistic regression models to determine the association between caregivers' malaria-related knowledge and ITN use among children.

Results: Out of 442 caregivers, 436 (98.6%) completed the survey. ITN use among children under-five the night before the survey was reported by 73.8% of caregivers. Overall, 36.8% of caregivers had good malaria-related knowledge, 41.2% had satisfactory knowledge, and 21.9% had poor knowledge. Multivariable analysis showed that caregivers with good malaria-related knowledge were 12 times more likely to use ITNs for their children (AOR = 12.06, 95% CI 2.30-53.20) compared to those with poor knowledge. Other significant predictors included education on ITN use, ITN ownership, child's age, and use of alternative malaria prevention methods.

Conclusion: This study highlights the critical role of caregiver malaria-related knowledge in promoting ITN use among children under-five in rural Ghana. Caregivers with better knowledge were significantly more likely to use ITNs, emphasizing the need for targeted health education programs. Such interventions should enhance awareness of malaria risks and ITN benefits, empower caregivers to use ITNs effectively, and reduce barriers to ITN access. These findings provide valuable insights for policymakers aiming to improve ITN utilization and reduce malaria morbidity and mortality in vulnerable populations.

Background: Insecticide-based malaria vector control has been implemented on the islands of São Tomé and Príncipe (STP) for more than 20 years. During this period malaria incidence was significantly reduced to pre-elimination levels. While cases remained low since 2015, these have significantly increased in the last year, challenging the commitment of the country to achieve malaria elimination by 2025. To better understand the reasons for increasing malaria cases, levels and underlying mechanisms of insecticide resistance in the local Anopheles coluzzii populations were characterized.

Methods: Mosquito larval collections were performed in the rainy and dry seasons, between 2022 and 2024, in two localities of São Tomé and one locality in Príncipe. Susceptibility to permethrin, α-cypermethrin, pirimiphos-methyl and DDT was assessed using WHO bioassays and protocols. Intensity of resistance and reversal by PBO pre-exposure were determined for pyrethroid insecticides. The kdr locus was genotyped by PCR assays in subsamples of the mosquitoes tested.

Results: Anopheles coluzzii populations were fully susceptible to pirimiphos-methyl, but high levels of resistance to pyrethroids and DDT were detected, particularly in São Tomé rainy season collections. Increasing the pyrethroid and DDT dosages to 5 $\times$ and 10 $\times$ did not restore full susceptibility in all populations. Pre-exposure to PBO resulted into partial reversal of the resistance phenotype suggesting the presence of cytochrome P450 oxidases-mediated metabolic resistance. The L1014F knockdown resistance mutation was present in An. coluzzii on both islands but at much higher frequency in São Tomé where it was associated with the resistant phenotype.

Conclusions: Future vector control interventions should consider the use of non-pyrethroid insecticides or combination with synergists to overcome the high levels of pyrethroid resistance. Alternative control methods not dependent on the use of insecticides should be additionally implemented to achieve malaria elimination in STP.

Background: Approximately 70% of the Kenyan population is at risk for malaria, including 19 million people in highland epidemic-prone and seasonal transmission areas. Surveillance data showed a 288% increase in malaria cases and an incidence rate of 10.5 per 1000 population between January and May 2021 in Nandi County. We investigated the increased incidence of malaria in Nandi County.

Methods: We abstracted demographic and clinical data from the laboratory register in health facilities with high malaria burden. Key informant interviews using a structured questionnaire collected healthcare worker perceptions on malaria interventions and personnel capacity. We calculated means and medians for continuous variables and frequency and proportions for categorical variables. Data quality assessment (DQA) was conducted to evaluate timeliness and completeness, data accuracy, and overall system assessment.

Results: We reviewed 19,526 records from 12 health facilities. Females contributed 61% cases (11,862). A majority of cases, 21% (4111), were between the age group 15-24 years. Of the 19,498 tested, 2662 tested positive (test positivity rate, TPR = 13.7%). Microscopy accounted for 39% (1041) and RDT for 61% (1620) of tests conducted, with some patients being double tested using both tests. Kapsabet County Referral contributed 26% (5051) suspected cases, TPR 3.2%, and Chemase Health Centre TPR was 33.2%. Facilities experienced major RDTs stock-outs in the preceding 3 months while three (30%) of the 10 facilities assessed conducted laboratory Internal Quality Control (IQC) programmes. Of the 12 facilities assessed, four (33%) facilities had an over-reporting of suspected cases in the monthly summary, while three (25%) facilities were over-reported in the online tool. On reporting confirmed malaria cases, over-reporting was noted in three (25%) facilities in both the monthly summaries and the online tool. Data completeness was 77% and timeliness 93%.

Conclusion: The increase in malaria cases in Nandi County displayed a seasonal pattern that coincided with either the long or short rainy seasons, the investigation did not reveal an active outbreak at the time of the inquiry. Sub-county hospitals in Tinderet and Aldai sub-counties had malaria cases exceeding both the alert and action thresholds at specific times during the year under review, suggesting a potential occurrence of unidentified outbreaks, while several other facilities had an increase of cases reaching alert thresholds, indicating upsurges. In healthcare settings, we noted there were problems with data quality. We advised routine data review, analysis, and feedback; mentorships for data analysis and on the job and support supervision; mentorships for malaria diagnosis; and installation of laboratory quality assurance.