Malaria Journal最新文献

Background: To eliminate malaria by 2035, Brazil must address Plasmodium vivax. Previously, first-line treatment was chloroquine plus 7-day primaquine (PQ) without glucose-6-phosphate dehydrogenase (G6PD) deficiency testing. In 2021, point-of-care quantitative G6PD testing and single-dose tafenoquine (TQ) were piloted in two municipalities. This study evaluated healthcare professional (HCP) and patient perceptions of TQ implementation.

Methods: This qualitative observational study in Manaus and Porto Velho municipalities evaluated the pilot implementation of the new P. vivax malaria treatment algorithm in high/medium-complexity healthcare units (phase one), then low-complexity units (phase two). Qualitative data collection began 30 days after the first TQ treatment in each phase, i.e., October 2021 and March 2022. Perceptions of TQ were assessed using semi-structured in-depth interviews and field notes until saturation. Data were analysed through debriefing sessions, and systematic organization in Excel and MAXQDA, with themes derived by inductive and deductive analysis.

Results: The study included 55 patients who received TQ and 94 HCPs. HCPs viewed the TQ single-dose regimen as a significant advancement over 7-day PQ, enhancing adherence. Patients appreciated the shorter duration of treatment and perceived a rapid clinical recovery and fewer side effects. HCPs also noted that TQ resulted in fewer recurrences of P. vivax. The single-dose administration of TQ facilitated complete supervision of the treatment, reduced HCP workload and ensured that patients received the necessary care and did not share the medication with family members. TQ packaging instilled patient trust, though HCPs working in the community found the packaging too bulky. Prescription insecurities among HCPs after initial training prompted requests for additional training. While some patients initially doubted single-dose efficacy, confidence grew with experience. TQ implementation increased awareness of pharmacovigilance and enhanced patient communication, with HCPs adhering to protocols for monitoring haemolysis symptoms.

Conclusion: Single-dose TQ for P. vivax malaria in Brazil's Amazon region was positively received by HCPs and patients. Positive perceptions of the medication may aid in improving patient adherence to malaria treatment, thereby reducing malaria recurrences. The findings underscore the importance of adaptive training to optimize P. vivax radical cure implementation.

Studies on Plasmodium falciparum transmission require blood-feeding infectious gametocytes to mosquitoes using standard membrane-feeding assays (SMFAs). SMFAs are routinely performed using electric heating coils or glass membrane feeders connected to a circulatory water bath using tubing and clamps. Each of these approaches is expensive and requires a complex setup, hence restricting the number of assays that can be performed simultaneously. Furthermore, existing methods cannot be easily applied in low-resource field settings. This study presents a low-cost and simplified method for feeding mosquitoes with an infectious blood meal using 35 mm Petri dishes where temperature is maintained by using reusable gel warmers. The intensity and prevalence of infection in mosquitoes (Anopheles stephensi and Anopheles gambiae) fed via a Petri dish overlaid with gel warmers were comparable to mosquitoes fed using standard glass membrane feeders. The methodology described here can be easily applied in low-resource and field settings due to its low cost, ease of set up, and use of easily available supplies, such as Petri dishes, and reusable gel warmers. We believe a wide range of laboratories can easily adapt this method for P. falciparum transmission studies.

Background: Effective vector control interventions, notably insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are indispensable for malaria control in Tanzania and elsewhere. However, the emergence of widespread insecticide resistance threatens the efficacy of these interventions. Monitoring of insecticide resistance is, therefore, critical for the selection and assessment of the programmatic impact of insecticide-based interventions.

Methods: The study was conducted country-wide across 22 sentinel districts of Tanzania between May and July 2023 using standard World Health Organization susceptibility test with 1×, 5×, and 10× of deltamethrin, permethrin, and alpha-cypermethrin and discriminating concentrations of 0.25% pirimiphos-methyl. Synergist assays were conducted to explore the underlying mechanisms of the observed phenotypic pyrethroid-resistant mosquitoes. Three- to five-day-old wild adult females in the first filiar generation of Anopheles gambiae sensu lato (s.l.) were used for the susceptibility bioassays.

Results: Anopheles gambiae s.l. were resistant to all pyrethroids at the discriminating dose in most sentinel districts except in Rorya, which remains fully susceptible, and Ushetu, which remains susceptible to deltamethrin but not permethrin. In 5 sites (Bukombe, Ukerewe, Kilwa, Kibondo, and Kakonko), the An. gambiae s.l. species exhibited strong resistance to pyrethroids surviving the 10 X concentrations (mortality rate < 98%). However, they remained fully susceptible to pirimiphos-methyl in almost all the sites except in Kibondo and Shinyanga. Likewise, there was full restoration to susceptibility to pyrethroid following pre-exposure of An. gambiae s.l. to piperonyl-butoxide (PBO) in 13 out of 16 sites. The 3 sites that exhibited partial restoration include Kakonko, Tandahimba, and Newala.

Conclusion: The evidence of widespread pyrethroid resistance of the major malaria vector justifies the decision made by the Tanzania National Malaria Control Programme to transition to PBO-based ITNs. Without this switch, the gains achieved in malaria control could be compromised. Equally important, the lack of full restoration to susceptibility observed in three sentinel districts upon pre-exposure to PBO merits close monitoring, as there could be other underlying resistance mechanisms besides oxidase metabolic resistance.

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.