Malaria Journal最新文献

Background: Malaria remains a major public health concern in Ethiopia, particularly in endemic settings like Arba Minch Town, where environmental and behavioural factors contribute to persistent malaria epidemic. Despite ongoing control efforts, malaria remains a substantial morbidity, mortality, and socio-economic disruption. The objective of the study was to examine epidemiological investigation of a possible malaria outbreak and risk factors in Arba Minch Town, Gamo Zone, Southern Ethiopia, 2023.

Methods: A descriptive epidemiological analysis was followed by a 1:1 unmatched community-based case-control study conducted from October 28, 2022, to December 28, 2023. Ninety-four rapid diagnostic test-confirmed cases and 94 neighbourhood controls were selected. Data were collected through structured questionnaires. Data were collected and entered into Epi Info 7.2.6, and then exported to the Statistical Package for the Social Sciences (SPSS) version 26 for statistical analysis. Bivariable logistic regression was conducted, and candidate variables (p-value ≤ 0.25) were selected for multivariable logistic regression analysis. The degree of the association was assessed by computing the adjusted odds ratio (AOR) with a 95% confidence interval (CI). Statistical significance was determined for variables in the final models with p-values < 0.05.

Results: A total of 5181 confirmed malaria cases were reported, with a positivity rate of 22.7% and an attack rate of 41.2 per 1000 population. Plasmodium falciparum accounted for 71% of infections, with the outbreak peaking in epidemiological week 3 of 2023. Significant risk factors included residence proximity to mosquito breeding sites [AOR = 5.45; 95% CI 2.11-14.08], presence of stagnant water [AOR = 5.69; 95% CI 2.22-14.55], poor housing [AOR = 4.40; 95% CI 1.83-10.54], inconsistent utilization of long lasting insecticidal nets (LLIN) [AOR = 0.30; 95% CI 0.13-0.71], and poor knowledge [AOR = 0.04; 95% CI 0.02-0.12].

Conclusion: The long-term malaria epidemic was primarily driven by P. falciparum. Poor housing, environmental conditions, inadequate LLIN distribution and inconsistent utilization, and knowledge of the malaria transmission and prevention were the predicting factors. Improving vector control, environmental management, community education, and robust surveillance are crucial to reduce the long period of malaria outbreaks.

Background: In 2019, the RTS,S/AS01_E malaria vaccine (RTS,S) was introduced into Ghana's routine health system as part of the Malaria Vaccine Implementation Programme (MVIP). Household surveys were conducted prior to vaccine introduction and approximately 18 and 30 months post-introduction. We present a description of the area in Ghana based on the baseline household survey including malaria prevalence, malnutrition, wealth, insecticide-treated net (ITN) coverage, other health interventions (deworming, Vitamin A supplementation (VAS)), coverage of Expanded Programme on Immunization (EPI) vaccines, and health-seeking behaviour for febrile children.

Methods: The baseline household survey was conducted between 25 February and 18 March 2019 in a representative sample of 6778 households across 66 districts (33 in each of the implementing and comparator areas) in Ghana. Caregivers of children aged 5-48 months were interviewed. For each child, vaccination details were transcribed from the maternal and child health record book, and we measured the mid-upper arm circumference and obtained a malaria Rapid Diagnostic Test (RDT). Survey-weighted coverage estimates were obtained using standard survey methods. Survey Poisson regression was used to estimate prevalence ratios.

Results: Overall, 7768 children were included in the study, and 21% (95% CI 18-23) tested positive for malaria parasitemia by RDT. About 87%, 95%CI (85-89) of all households owned at least one ITN, and 62%, 95%CI (59-64) of children aged 5-48 months slept under an insecticide-treated net (ITN) the night before the survey. Additionally, 22%, 95%CI (21-24) of children reported having fever in the two weeks preceding the survey; among those with reported fever, 72%, 95%CI (69-74) sought advice or treatment, 40%, 95%CI (37-44) were tested for malaria, and 42%, 95%CI (39-46) of those with fever took an antimalarial drug. Additionally, 17%, 95%CI (16-19) had a mid-upper arm circumference (MUAC) ≤ 13.5 cm, and 1%, 95%CI (0-1) had a (MUAC) ≤ 11.5 cm. The uptake of vitamin A VAS in the 6 months prior to the survey was 36%, based on routine delivery through EPI, and deworming coverage was 29%. Coverage of EPI vaccines was > 90%. Indicators in comparison and implementation areas were comparable.

Conclusions: The pilot implementation and evaluation of the RTS,S malaria vaccine in Ghana was conducted in an area with substantial malaria transmission and illness, modest health-seeking behaviour and ITN use, and good EPI vaccine coverage. This study has established the baseline comparability between implementation and comparator areas, which serves as the foundation for future feasibility assessments.

Background: Malaria remains a significant public health challenge, and Plasmodium knowlesi malaria has become the predominant cause of malaria in Malaysia. Despite progress in eliminating nonzoonotic malaria species, Malaysia continues to face challenges in controlling P. knowlesi. While epidemiological and vector control studies are reported, less is known about the community-level sociocultural dynamics influencing prevention behaviours. Therefore, this qualitative evidence synthesis (QES) aims to consolidate existing evidence on community experiences and perceptions related to P. knowlesi malaria, as well as the social, cultural, and contextual factors influencing prevention and healthcare-seeking behaviours in Malaysia.

Methods: This QES protocol has been registered in PROSPERO (CRD 420251045457). A systematic literature search was conducted in electronic databases, and data analysis followed Thomas and Harden's thematic synthesis method.

Results: The QES included five qualitative and mixed-method studies published between 2022 and 2024 that explored community perspectives on P. knowlesi malaria in Malaysia. Three analytical themes were synthesized: (1) 'Knowledge and Lived Realities Shape Community Risk Perception of Knowlesi Malaria', suggesting community understanding of P. knowlesi, fear of hospitalization and income loss influencing health-seeking behaviours; (2) 'Environmental, Structural, and Social Barriers Constrain Community Engagement with Malaria Prevention and Healthcare Seeking', where environmental exposure, occupational risks, challenges to the use of personal protection, and access barriers were major determinants; and (3) 'Malaria Prevention Practices Reflect Local Knowledge, and Availability of Formal Prevention Measures', highlighting the application of natural and household remedies for prevention, while using formal preventive measures.

Conclusions: This QES consolidates the available evidence for P. knowlesi malaria control strategies including prevention and healthcare seeking. It highlights that malaria prevention behaviours are shaped not only by knowledge on transmission and diseases, but also by the social, environmental, and cultural realities in local context. Therefore, integrating local community perspectives and challenges into prevention and vector control programs could enhance the sustainability and equity in rural areas in Malaysia.

Cambodia has developed and deployed a comprehensive, real-time, case-based Malaria Information System (MIS) to support national malaria elimination goals. This locally built, user-centred digital platform integrates surveillance, diagnostics, treatment, logistics, entomology and operational monitoring into a single system accessible at all levels of the health system. Mobile and web-based applications enable village malaria workers and health facility staff to report cases and interventions in real time, even in offline settings. The system promotes decentralized decision-making through intuitive dashboards and customizable analytics, enhancing local ownership, accountability and responsiveness. It supports key strategies such as the 1-3-7 surveillance model, integrated drug efficacy surveillance and incidence-based stratification. Operational functionality and system sustainability is supported by MIS modules for device management, stock management, geolocation, training and quality assurance. Real-time analytics drive timely interventions and adaptive planning, while interoperability with regional and global databases facilitates cross-border coordination and external reporting. Challenges remain, such as limited technical support capacity and a need for predictive tools. However, the Cambodia MIS demonstrates that locally developed digital health systems can transform disease surveillance and accelerate elimination efforts when effectively integrated with community-based networks and supported by strong governance. This model provides valuable evidence for other countries aiming to transition from malaria control to elimination, while complying with elimination certification requirements, and preparing for the prevention of re-establishment of transmission once malaria elimination has been achieved.

Background: Many countries worldwide, particularly those in sub-Saharan Africa, suffer from malaria burden, both mortality and morbidity. Multiple funding agencies are investing to improve the health of populations. The aim of this study was to assess the impact of malaria funding on mortality and morbidity in children under 5 years of age over a 15-year period.

Methods: A retrospective study was conducted from 2009 to 2023 across the country. Analysis was based on a secondary analysis of routine data from health facilities via DHIS2. Financial data was assembled from the malaria programme and health accounts.

Results: Between 2009 and 2023, Burkina Faso's population grew by 50.7%, from 15.2 to 22.9 million. Children under 5 represented 19.1% of the population in 2009 and 17.9% in 2023 and increased in number by 41.4%. In fifteen years, Burkina Faso invested USD13,545 million in the health sector, including 15.3% against malaria. These efforts yielded several benefits in health services including: the reduction of distance travelled by the population to health facilities from 7.2 to 6.0 km; the number of new contacts per capita for children under 5 per year increased from 0.8 to 2.1; the malaria case fatality rate decreased from 3.4% to 1.3% in children under 5. Stratified analysis identified three regions out of thirteen [Sahel (IRR = 4.1), Boucle du Mouhoun (IRR = 3.5) and Nord (IRR = 3.4), where the risk of malaria mortality was three times higher than in the Centre.

Conclusion: The study demonstrated the impact of funding on malaria morbidity and mortality, and diverse local risk of death from malaria in children under 5.

Background: Malaria remains a major public health challenge in sub-Saharan Africa, with school-aged children (SAC) increasingly recognized as a high-risk group due to asymptomatic infections that sustain transmission. In Tanzania, where malaria prevalence varies widely by region, SAC experience substantial malaria-related school absenteeism yet are often overlooked in control strategies. To address this, the National Malaria Control Programme introduced Intermittent Preventive Treatment for schoolchildren (IPTsc) using dihydroartemisinin-piperaquine (DP) in high-endemic districts. Although trials show IPTsc reduces parasitaemia, its effect on school attendance is less clear. This study evaluated the impact of IPTsc on school absenteeism among SAC in Handeni District Council (DC).

Methods: A quasi-experimental pre-post design applied in which the same group is measured before and after an intervention, without random assignment to intervention and control groups. In this study within-pupil comparisons were used to assess school absenteeism before and after the introduction of IPTsc. The same pupils were followed from January-May 2024 (pre-intervention) and January-May 2025 (post-intervention) in Handeni DC, Tanzania. A multistage stratified sampling technique was used to select study participants and 346 pupils were selected through simple random sampling from 13 schools implementing IPTsc. Absenteeism and IPTsc dose data were extracted from school and IPTsc registers, and socioeconomic information was collected using structured questionnaires. Descriptive statistics (frequency, median, interquartile range) and inferential analyses (Wilcoxon Signed-Rank, Mann-Whitney, Kruskal-Wallis, chi-square, Stuart-Maxwell, Fisher's exact, and linear regression) were performed. Ethical approval was obtained from MUHAS, and written consent and assent were secured from guardians and pupils.

Results: Data from 346 SAC were analysed; most were aged 11-14 years 192 (55.5%) and 175 (50.6%) were female. The largest proportion were in class 3 [74 (21.4%)]. Overall absenteeism decreased from 13 to 10% after IPTsc (p = 0.001). Malaria-related absences declined from 27.8% to 11.3%, and attendance increased by 6.7%. Most pupils [318 (91.9%)] received all three IPTsc doses. SAC not engaged in economic activities had higher absenteeism (β = 0.26; 95% CI 0.17-0.36; p < 0.001).

Conclusion: IPTsc was associated with reduced overall and malaria-related school absenteeism among SAC, highlighting its dual benefit for health and education in malaria-endemic areas.

Introduction: In remote communities in the Greater Mekong Subregion, maintaining community-based malaria care is vital to achieving the goal of malaria elimination. This project aimed to collaborate with the community members and implementers of malaria and health programmes, our key stakeholders, to co-create engagement activities that promote the integration of community-based malaria activities that best fit the local context. This article describes the design, implementation and results of this co-creation process, and highlights key learnings and insights, enabling factors and challenges.

Method: In Buntharik district, Ubon Ratchathani province bordering Laos in northeastern Thailand, we adopted a co-creation framework to design and develop iterative and responsive engagement activities, and used a theory of change framework to outline the necessary steps and conditions to achieve the desired co-creation outcomes. Data were recorded in engagement logs, meeting minutes, observation notes, and participant evaluation to measure the results of engagement and extract key learnings from implementation.

Findings: Between April 2023 and June 2024, 36 in-person engagement activities were conducted with approximately 550 participants, to co-create and evaluate locally-owned health education materials-the 2024 Buntharik health calendar-that integrates malaria information with priority local health issues. The co-created calendar offered one potential entry point to maintain malaria awareness in low transmission areas, but future initiatives ideally should secure additional funding sources to maintain the capacity of local health workers. We found that responding to local health concerns and expectations of the communities and stakeholders is the key enabler to co-creation. However, in the context of changing policy, careful thought about the range of scenarios in which co-creation is applied is crucial to plan for sustainability of the integration. Learning from the context of this engagement, new champions could emerge from involving additional stakeholders beyond those involved in malaria service implementation.

Conclusion: Drawing from this stakeholder engagement work, the co-creation process showed strong potential for ensuring the sustainability of community-based health care in the context of declining awareness and advocacy, such as in the case of malaria elimination. The process and its learning can be adopted to any ongoing local collaborative partnership and future participatory action research and community-informed policy considerations.

Background: Malaria continues to rank among the most concerning vector-borne infectious diseases affecting sub-Saharan Africa, including Ethiopia. Effective malaria case management largely depends on the timing of treatment seeking. Patients who sought care more than 24 h after symptoms began were more likely to develop severe malaria. Concrete evidence can be generated by systematic reviews and meta-analyses, which may assist programme managers and policymakers in designing effective interventions. Therefore, the goal of this study was to assess the pooled prevalence and determinants of delay in treatment-seeking among malaria patients attending health facilities in Ethiopia.

Methods: Literature searches were conducted in Medline (PubMed), EMBASE, HINARI, Google Scholar, Science Direct, CINAHL, the Cochrane Library, and African Journals Online (AJOL) to find the pertinent studies. A standardized data extraction format created in Microsoft Excel was used to extract data from a chosen set of studies. The studies included in the analysis were evaluated for heterogeneity using inverse variance (I²) testing. A random-effects meta-analysis estimated the pooled prevalence of delay in treatment-seeking due to significant heterogeneity among studies. Determinants of delay in treatment-seeking among malaria patients were also examined.

Results: This systematic review considered a total of twelve studies, which included 4511 study subjects. The pooled prevalence of delay in treatment-seeking among malaria patients in Ethiopia was 62.00% (95% CI 46.00, 77.00). Lack of malaria knowledge, living far from a health facility, expensive health care costs, lack of transportation access, being a farmer, the practice of self-medication, not having a previous history of malaria infection, low family income, not being a member of community-based health insurance, large family size, having no formal education, fear of side effects of malaria treatment drugs, and no history of death from malaria among their family members were determinants of delay in treatment-seeking among malaria patients.

Conclusions: The pooled prevalence of delay in treatment-seeking among malaria patients was high. Health literacy, behavioural factors, accessibility, infrastructure, clinical factors, financial barriers, and socio-demographic factors were significantly associated with delay in treatment-seeking. To reduce delay in treatment-seeking, it is recommended to strengthen malaria education campaigns, target fear of drug side effects, expand community health outreach services, reduce out-of-pocket health care expenses, integrate community-level data, and engage with affected communities and families.

Background: Accurate malaria diagnosis and reporting are critical for effective case management and surveillance. In sub-Saharan Africa, rapid diagnostic tests (RDTs) are widely used to support clinical decision-making. However, limited data exist on the accuracy of recorded RDT results reported to health information systems. This study assessed the accuracy of recording of malaria RDT results documented in health facility registers in Côte d'Ivoire, as part of a multi-country evaluation.

Methods: A mixed-methods, observational study was conducted across 16 primary health care facilities in two regions of Côte d'Ivoire between August and December 2023. For each patient tested for malaria, a digital image of the RDT cassette was captured and linked to the corresponding register entry. An independent panel of trained reviewers interpreted the RDT images, which served as the reference standard. Agreement between panel and register results was assessed using percent agreement and Cohen's kappa (κ). The positive predictive value (PPV) and negative predictive value (NPV) were calculated for the register result. Meta-regression was used to identify facility, healthcare worker (HCW), and patient characteristics associated with agreement.

Results: Of 11,161 matched RDT images and register entries, 57.9% were interpreted as positive by the external panel. Overall agreement between panel and register results was strong (κ = 0.83, 95% CI 0.77, 0.88), with a PPV of 90.7% and NPV of 94.8%. However, negative or invalid results were more frequently incorrectly recorded as positive (5.9%) than the reverse (2.0%). Recording errors occurred more often among patients noted in the register with a diagnosis of malaria or antimalarial prescription, suggesting potential systematic bias. District, patient volume, HCW cadre, and education level of the health worker were associated with agreement. Notably, HCWs who frequently performed or recorded RDTs had lower agreement levels. Most HCWs believed that a negative RDT could miss malaria and that treatment could still be warranted.

Conclusion: The results from the study demonstrate that RDT results are recorded fairly accurately in Côte d'Ivoire. However, the disproportionate misclassification of negative results as positive may distort malaria surveillance data and test positivity rates. Strategies such as regular comparison of RDT cassettes with register entries, enhanced HCW training, and reinforcement of adherence to diagnostic guidelines may improve data quality and support evidence-based decision-making.

Background: Malaria is a primary cause of morbidity and mortality in Mali, with women at high risk for malaria infection during pregnancy. Placental malaria (PM) has been linked to adverse neonatal outcomes such as low birth weight, decreased birth length, and decreased placental weight, but few studies have tested for associations between PM and postnatal growth. This study examined the relationship between PM and linear growth, weight, and body mass index (BMI) from birth to age 5 years.

Methods: The study participants (N = 317) were members of the F2 generation of the Dogon Longitudinal Study, a multigenerational prospective cohort study conducted in the District of Bamako and on the Bandiagara Escarpment in central Mali. Placental samples were collected for each participant and evaluated by histology to determine PM infection stage and parasite density. Participant's height, weight, and BMI were measured approximately twice per year from birth until a median age of 6.8 years (maximum age 12.3 years). Linear mixed models were used to investigate the relationship between PM and height, weight, and BMI from birth to age 5 years.

Results: Linear growth in height at age 6 months was lower in infants from placentas with severe parasite density compared to infants from placentas in which no parasites were detected (-0.83 cm; 95% CI -1.63, - 0.03; p = 0.042), with a trend of decreased height continuing to age 5 years. Severe parasite density was also associated with a statistically significant increase in BMI at 2 years (0.56 kg/m²; 95% CI 0.13, 1.00; p = 0.011), 3 years (0.82 kg/m²; 95% CI 0.35, 1.30; p = 0.001), 4 years (1.09 kg/m²; 95% CI 0.53, 1.65; p > 0.001), and 5 years (1.35 kg/m²; 95% CI 0.68, 2.01; p > 0.001) of age when controlling for birth weight. No statistically significant associations were observed between parasite density and weight.

Conclusions: Severe malaria parasite density in the placenta was associated with birth length, as shown in previous studies, and, in addition, was associated with decreased linear growth to age 5 years. Moreover, this study provided the first evidence that PM is associated with increased postnatal BMI.