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Do clinicians in areas of declining malaria transmission adhere to malaria diagnosis guidelines? A cross-sectional study from Kampala, Uganda

April 21, 2021 - 14:38 -- Open Access
Angella Atukunda, Mwaka Amos Deogratius, Emmanuel Arinaitwe, Philip Orishaba, Moses R. Kamya and Joaniter I. Nankabirwa
Malaria Journal 2021 20:187, 15 April 2021

Uganda's clinical management guidelines recommend a malaria laboratory test in all patients presenting with fever (history of fever or an axillary temperature ≥ 37.5 °C), and only those with a positive test receive anti-malarial treatment. However, the current practice in areas with declining malaria transmission remains unknown. This study assessed the clinicians’ diagnostic practices, the factors associated with recommending a test, and the risk of missing a malaria case when a test is not recommended in patients presenting with fever in Kampala, an area of declining malaria transmission in Uganda.

Quality of care for adult in-patients with malaria in a tertiary hospital in Uganda

April 14, 2021 - 07:52 -- Open Access
Ronald Kiguba, Charles Karamagi and Sheila M. Bird
Malaria Journal 2021 20:178, 9 April 2021

Prompt detection and appropriate treatment of malaria prevents severe disease and death. The quality of care for adult malaria in-patients is not well documented in sub-Saharan Africa, particularly in Uganda. The study sought to describe the patterns of malaria diagnosis and treatment among adult in-patients admitted to the medical and gynaecological wards of Uganda’s 1790-bed Mulago National Referral Hospital from December 2013 to April 2014.

Efficacy and safety of dihydroartemisinin–piperaquine versus artemether–lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Ugandan children: a systematic review and meta-analysis of randomized control trials

April 7, 2021 - 12:49 -- Open Access
Dawit Getachew Assefa, Eden Dagnachew Zeleke, Delayehu Bekele, Hanna Amanuel Tesfahunei, Emnet Getachew, Michele Joseph and Tsegahun Manyazewal
Malaria Journal 2021 20:174, 1 April 2021

The emergence of artemisinin resistance in Southeast Asia and Plasmodium falciparum kelch13 propeller gene mutations in sub-Saharan African pose the greatest threat to global efforts to control malaria. This is a critical concern in Uganda, where artemisinin-based combination therapy (ACT) is the first-line treatment for uncomplicated falciparum. The objective of this study was to compare the efficacy and safety of dihydroartemisinin–piperaquine (DHA–PQ) and artemether–lumefantrine (AL) for the treatment of uncomplicated falciparum malaria in Ugandan children.

Age-related Changes in Malaria Clinical Phenotypes During Infancy are Modified by Sickle Cell Trait

March 23, 2021 - 14:47 -- Open Access
Zehner N, Adrama H, Jagannathan P, et al.
Clin Infect Dis. 2021 Mar 19:ciab245

Young infants are protected against Plasmodium falciparum malaria. Mechanisms driving this protection remain unclear due to a poor understanding of malaria clinical phenotypes during infancy.

Ugandan stakeholder hopes and concerns about gene drive mosquitoes for malaria control: new directions for gene drive risk governance

March 18, 2021 - 09:21 -- Open Access
Sarah Hartley, Robert D. J. Smith, Adam Kokotovich, Chris Opesen, Tibebu Habtewold, Katie Ledingham, Ben Raymond and Charles B. Rwabukwali
Malaria Journal 2021 20:149, 16 March 2021

The African Union’s High-Level Panel on Emerging Technologies identified gene drive mosquitoes as a priority technology for malaria elimination. The first field trials are expected in 5–10 years in Uganda, Mali or Burkina Faso. In preparation, regional and international actors are developing risk governance guidelines which will delineate the framework for identifying and evaluating risks. Scientists and bioethicists have called for African stakeholder involvement in these developments, arguing the knowledge and perspectives of those people living in malaria-afflicted countries is currently missing. However, few African stakeholders have been involved to date, leaving a knowledge gap about the local social-cultural as well as ecological context in which gene drive mosquitoes will be tested and deployed. This study investigates and analyses Ugandan stakeholders’ hopes and concerns about gene drive mosquitoes for malaria control and explores the new directions needed for risk governance.

Trends in access to anti‐malarial treatment in the formal private sector in Uganda: an assessment of availability and affordability of first‐line anti‐malarials and diagnostics between 2007 and 2018

March 10, 2021 - 15:23 -- Open Access
Denis Kibira, Anthony Ssebagereka, Hendrika A. van den Ham, Jimmy Opigo, Henry Katamba, Morries Seru, Tim Reed, Hubert G. Leufkens and Aukje K. Mantel-Teeuwisse
Malaria Journal 2021 20:142, 10 March 2021

Malaria is the single largest cause of illness in Uganda. Since the year 2008, the Global Fund has rolled out several funding streams for malaria control in Uganda. Among these are mechanisms aimed at increasing the availability and affordability of artemisinin-based combination therapy (ACT). This paper examines the availability and affordability of first-line malaria treatment and diagnostics in the private sector, which is the preferred first point of contact for 61% of households in Uganda between 2007 and 2018.

Impact of seasonality and malaria control interventions on Anopheles density and species composition from three areas of Uganda with differing malaria endemicity

March 10, 2021 - 15:14 -- Open Access
Henry Ddumba Mawejje, Maxwell Kilama, Sarah G. Staedke, et al.
Malaria Journal 2021 20:138, 7 March 2021

Long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are the malaria control interventions primarily responsible for reductions in transmission intensity across sub-Saharan Africa. These interventions, however, may have differential impact on Anopheles species composition and density. This study examined the changing pattern of Anopheles species in three areas of Uganda with markedly different transmission intensities and different levels of vector control.

Surveillance of Plasmodium falciparum pfcrt haplotypes in southwestern uganda by high‐resolution melt analysis

March 3, 2021 - 15:30 -- Open Access
Kennedy Kassaza, Anna C. Long, Yap Boum II, et al.
Malaria Journal 2021 20:114, 25 February 2021

Chloroquine (CQ) resistance is conferred by mutations in the Plasmodium falciparum CQ resistance transporter (pfcrt). Following CQ withdrawal for anti-malarial treatment, studies across malaria-endemic countries have shown a range of responses. In some areas, CQ sensitive parasites re-emerge, and in others, mutant haplotypes persist. Active surveillance of resistance mutations in clinical parasites is essential to inform treatment regimens; this effort requires fast, reliable, and cost-effective methods that work on a variety of sample types with reagents accessible in malaria-endemic countries.

Diversity of KIR genes and their HLA-C ligands in Ugandan populations with historically varied malaria transmission intensity

March 3, 2021 - 15:24 -- Open Access
Stephen Tukwasibwe, James A. Traherne, Annettee Nakimuli, et al.
Malaria Journal 2021 20:111, 25 February 2021

Malaria is one of the most serious infectious diseases in the world. The malaria burden is greatly affected by human immunity, and immune responses vary between populations. Genetic diversity in KIR and HLA-C genes, which are important in immunity to infectious diseases, is likely to play a role in this heterogeneity. Several studies have shown that KIR and HLA-C genes influence the immune response to viral infections, but few studies have examined the role of KIR and HLA-C in malaria infection, and these have used low-resolution genotyping. The aim of this study was to determine whether genetic variation in KIR and their HLA-C ligands differ in Ugandan populations with historically varied malaria transmission intensity using more comprehensive genotyping approaches.

Effect of intermittent preventive treatment for malaria with dihydroartemisinin-piperaquine on immune responses to vaccines among rural Ugandan adolescents: randomised controlled trial protocol B for the 'POPulation differences in VACcine responses' (POPV

February 25, 2021 - 10:09 -- Open Access
Natukunda A, Nkurunungi G, Elliott AM, et al.
BMJ Open. 2021 Feb 16;11(2):e040427

Drivers of lower vaccine efficacy and impaired vaccine-specific immune responses in low-income versus high-income countries, and in rural compared with urban settings, are not fully elucidated. Repeated exposure to and immunomodulation by parasite infections may be important. We focus on Plasmodium falciparum malaria, aiming to determine whether there are reversible effects of malaria infection on vaccine responses.


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