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The MalariaWorld Journal

Research: Cost-effectiveness of malaria elimination in Sampov Loun Operational District, Cambodia

April 17, 2020 - 11:05 -- MalariaWorld Journal
Author(s): 
Ir Por, Siv Sovannaroth, Alexander Moran, Lek Dysoley, Sokomar Nguon, Om Bunthy, May Sak Meas, Lawrence Barat, Rida Slot, Sharon Thangadurai, Bryan K. Kapella, Saad El-Din Hassan, Ly Po, Sen Sam An, John E. Gimnig, Mary McDowell, Michael Thigpen, Jennifer Armistead, Hala Jassim AlMossawi, Soy Ty Kheang, Neeraj Kak
Reference: 
MWJ2020,11,2


Over the past decade, Cambodia has seen a significant decline in its malaria burden. The government has established the goal of eliminating malaria in the country by 2025. With PMI/USAID support, Cambodia is implementing a package of interventions as part of its efforts. This assessment aimed to describe the cost of malaria elimination activities in Sampov Loun Operational District (OD) between July 2015 and March 2018, to describe the cost per malaria case detected under PMI programming, and to estimate the incremental cost-effectiveness of the elimination programme per Plasmodium falciparum (Pf) or P. vivax (Pv)/Pf mixed case averted under the Cambodia Malaria Elimination Programme (CMEP) and the U.S. President’s Malaria Initiative. Opportunity costs of government workers were also assessed to understand the theoretical cost of sustaining this programme through government efforts alone. We conducted an empirical micro-costing analysis based on elimination activities alone using CMEP internal project implementation data and corresponding epidemiologic data from July 2015 to March 2018 and empirical findings from implementation to date. We then constructed a cost model in Microsoft Excel using empirical data and used a cost-effectiveness decision tree to describe programme effective-ness in the first three years of implementation and to estimate efficacy for the subsequent year. The total cost of malaria elimination activities in Sampov Loun OD from July 2015 to March 2018 was $883,096. The cost per case of malaria detected in 2017 was $1,304. Including opportunity costs for government staff from July 2015 to March 2018, the total cost was $926,000. Under continued CMEP implementation, the projected future total cost of the program would be about $110,000 per year, or $0.64 per Sampov Loun resident. The incremental cost-effectiveness of the elimination programme was $28 for every additional Pf or Pv/Pf mix malaria case averted, compared to the no-CMEP proxy. CMEP activities are cost effective compared to the no-CMEP proxy, as shown through an incremental cost-effectiveness of $28 for every additional Pf or Pv/Pf mix malaria case averted. The total cost of the project is 0.93% of the total per capita spending on health in Cambodia and about 5% of all government health expenditure. Continuing investments in malaria will be needed at national level for stewardship and governance and at local level for ensuring programme readiness in case of malaria outbreaks.

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Research: A murine malaria protocol for characterizing transmission blocking benefits of antimalarial drug combinations

April 16, 2020 - 16:13 -- MalariaWorld Journal
Author(s): 
Yehenew A Ebstie, Alain R. Tenoh Guedoung, Annette Habluetzel
Reference: 
MWJ2020,11,1


Current efforts towards malaria elimination include the discovery of new transmission blocking (TB) drugs and identification of compounds suitable to replace primaquine, recommended as transmission blocking post treatment after artemisinin combination therapy (ACT). High through put screening of compound libraries has allowed to identify numerous compounds active in vitro against gametocytes and insect early sporogonic stages, but few studies have been performed to characterize TB compounds in vivo. Here we propose a double TB drug Direct Feeding Assay (2TB-DFA), suitable to assess the combined effects of TB compounds. Plasmodium berghei GFPcon (PbGFPcon), BALB/c mice and Anopheles stephensi mosquitoes were used. Artemisinin (ART) and artesunate (AS) served as examples of artemisinins, NeemAzal® (NA), as a known TB-product with sporontocidal activity. DFA experiments were performed to assess the appropriate time point of administration before mosquito feeding and estimate suitable sub-optimal doses of the three compounds that allow combination effects to be appreciated. Suboptimal dosages, that reduce about 50% of oocyst development, were recorded with ART in the range of 16-30 mg/kg, AS 14-28 mg/kg and NA 31-38mg/kg. Ten hours before mosquito feeding (corresponding to 3.5 days after mouse infection) was determined as a suitable time point for mouse treatment with ART and AS and 1 hour for post-treatment with NA. ART given at 35 mg/kg in combination with NA at 40 mg/kg reduced oocyst density by 94% and prevalence of infection by 59%. Similarly, the combination of ART at 25 mg/kg plus NA at 35 mg/kg decreased oocyst density by 95% and prevalence of infection by 34%. In the 2TB-DFA, conducted with AS (20 mg/kg) and NA (35 mg/kg) the combination treatment reduced oocyst density by 71% and did not affect prevalence of infection. Applying ‘Highest Single Agent’ analysis and considering as readout oocyst density and prevalence of infection, cooperative effects of the combination treatments, compared with the single compound treatments emerged. This study suggests the 2TB-DFA to be suitable for the profiling of new TB candidates that could substitute primaquine as a post-treatment to ACT courses.

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Opinion: Fatalism and malaria elimination: A historical perspective from Palestine 100 years ago

May 8, 2018 - 08:50 -- MalariaWorld Journal
Author(s): 
Anton Alexander
Reference: 
MWJ2018,9,4
 
Fatalism is the acceptance of all things and events as inevitable. This sense of inevitability about malaria has obstructed malaria elimination from the outset and this article examines how this attitude was overcome in Palestine a century ago to enable the first start anywhere in the world of a successful malaria elimination campaign. The Balfour Declaration had been issued by the British Government in 1917 in support of a Jewish homeland in Palestine even though the British would have been aware Palestine was drenched in malaria and that Palestine was either uninhabitable in many areas or otherwise generally thinly populated. The only experience at that date of dealing with malaria control anywhere in the world had been demonstrated by General Gorgas at the Panama Canal together with his employment of thousands of men at vast expense, thus making it a method too costly to adopt for most countries. Notwithstanding this, Louis Brandeis, president of the American Zionists, had a strong commitment to grasp the moment provided by the Balfour Declaration, and to bring about a habitable Jewish homeland. Despite the pessimism and negativity of the rest of the Zionist establishment, which viewed malaria as a natural incident of Palestinian life, Brandeis prevailed upon Dr. Israel Kligler, a Zionist and also a brilliant public health scientist, to consider a fresh affordable method of controlling and eliminating malaria, and to thereby render Palestine habitable for Jewish settlement. Kligler’s significant change in approach against the disease was to think not of malaria control and use of thousands of employed personnel, but to seek instead malaria elimination through involvement of the community through culturally-sensitive education. Only absence of fatalism made this possible.
 
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Research: Decomposition of changes in malaria prevalence amongst under-five children in Nigeria

April 13, 2018 - 10:48 -- MalariaWorld Journal
Author(s): 
Deborah O. Owoeye, Joshua O. Akinyemi, Oyindamola B. Yusuf
Reference: 
MWJ2018, 9, 3
 
Malaria remains a major public health problem in Nigeria. Changes in malaria prevalence can be attributed to three major control interventions: insecticide treated nets (ITNs), indoor residual spraying (IRS) and intermittent preventive treatment in pregnancy (IPTp). Use of ITNs has proven to be a practical, highly effective, and cost-effective intervention against malaria. Although, several studies have assessed the utilisation of ITNs, its impact on the prevalence of malaria over time is yet to be documented in Nigeria. Therefore, this study was conducted to decompose changes in malaria prevalence amongst under- five children between 2003 and 2013. A retrospective analysis of the 2003 and 2013 Nigeria Demographic Health Survey (NDHS) dataset was conducted. Occurrence of fever was used as a proxy for malaria. Percentage change in both outcome and explanatory variables between 2003 and 2013 was estimated. A multivariate decomposition technique was used to partition changes in malaria prevalence into two components: contribution of changes in determinants and changes in the effect of determinants. A total of 5204 and 28634 records of children under-five were available in 2003 and 2013 respectively. Malaria prevalence declined from 31.8% to 13.1% between 2003 and 2013 (p<0.001). Changes in determinants contributed 4.7% and changes in the effect of determinants contributed 95.3% to the change in malaria prevalence. There was a decline in the prevalence of malaria amongst children under five in Nigeria in the last ten years. Ownership of ITNs and their utilisation were the most contributing factors to the decline in malaria prevalence. Continued efforts should be made in promoting ITNs and their consistent and appropriate utilisation.
 
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Perspective: Sustainable financing to fight HIV/AIDS, TB and malaria: lessons learned from the African Union’s Abuja Declaration

March 17, 2018 - 09:28 -- MalariaWorld Journal
Author(s): 
Mabvuto Kango
Reference: 
MWJ2018,9,2
 
Investment in malaria control has been proven to contribute to socio-economic development. Concomitant investment in HIV/AIDS and Tuberculosis further augments these socio-economic gains. Africa has used this evidence to guide policy-making, especially for investment in the control of malaria and other infectious diseases. Pursuant to the objective of developing Africa, the Heads of State and Government of the OAU met in 2001 to address the challenges of HIV/AIDS, Tuberculosis and Malaria, a scourge that was ravaging the continent. Noting that the health sector in Africa needed more financial investment, the African leaders adopted a declaration that pledged to allocate at least 15% of their national annual budgets to the health sector. Data was collected through review of documents and observations.
 The implementation of the Abuja declaration drew a number of mixed results, positive ones which could be scaled up and some challenges that could be used as lessons for improvement.
 Taking everything into account, the Abuja Call was a relatively unprecedented success for Africa. With continuous improvement, the initiative could even do better. The African Union should consider revising the Abuja Call, based on lessons learned and emerging issues.

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Perspective: End malaria for good: a review of current strategies and future novelties for malaria elimination in Nigeria

March 15, 2018 - 16:30 -- MalariaWorld Journal
Author(s): 
Omosivie Maduka
Reference: 
MWJ2018,9,1

Malaria is endemic in 91 countries and territories. Currently, over half of the world’s population is at risk for malaria with malaria prevalence in sub-Saharan Africa remaining the highest in the world. Nigeria accounts for 56% of malaria cases in the West African sub-region. Malaria control is historically the oldest control programme in Nigeria, having been in existence since 1948. Malaria control in Nigeria is guided by National Malaria Strategic Plans. The goal of the NMSP (2014-2020) is ‘to reduce malaria burden to pre-elimination levels and bring malaria-related mortality to zero’ using strategies under seven strategic objectives. The theme for the 2017 World Malaria Day activities was ‘End Malaria for Good’. This theme indicates a sustained push for national and international commitments toward goal zero. Although the prevalence of malaria has dropped significantly, from 42% in 2010 to 27.4% in 2015, a lot of effort needs to be made to actualise a malaria-free Nigeria. This review discusses the current strategies in place to control and eliminate malaria. It also describes some future novelties available to sub-Saharan Africa and Nigeria to ‘End Malaria for Good.’

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Research: Malaria trends in Silt’i district from 2009-2015 and current childhood malaria in K’ibbet hospital, south-central Ethiopia

December 9, 2017 - 17:35 -- MalariaWorld Journal
Author(s): 
Sani Dedgeba, Hassen Mamo
Reference: 
MWJ2017,8,22
 
Regular evaluation of the magnitude of malaria in children in a given locality is important to devise targeted control interventions. This study was conducted to assess current malaria infection among children (0 - 14 yrs) and trends in malaria between 2009 and 2015 in Silt’i district in south - central Ethiopia. Febrile children (body temperature ≥37.5 ºC) visiting the K’ibbet hospital between September 2015 and January 2016 were enrolled. Finger - prick blood samples were collected, smears prepared, Giemsa - stained and examined. In addition, past (2009 - 2015) retrospective malaria data was reviewed. Descriptive statistics was used to analyse the data. In the current cross - sectional survey, 43 (4.3%) children (n=1007) were diagnosed with malaria. Of these, 35 (81.4%) were Plasmodium vivax and only 8 (18.6%) P. falciparum. All cases were mono-infections. Concerning health data on record, overall 47,467 malaria - slide - confirmed cases were recorded (45.8% P. vivax and 54.2% P. falciparum), with a substantial decline in malaria between the baseline in 2009 (15,141 cases) and 2015 (821 cases). Conclusions. The findings demonstrated that malaria in children was continuously declining in the study area. However, control interventions must be maintained and scaled - up to sustainably protect children as well as the general population and eventually eliminate the disease from the locali ty and country as a whole. 

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Research: Exploring communities’ and health workers’ perceptions of indicators and drivers of malaria decline in Malindi, Kenya

December 8, 2017 - 10:02 -- MalariaWorld Journal
Author(s): 
Lydiah W. Kibe, Annette Habluetzel, John K. Gachigi, Anne W. Kamau, Charles M. Mbogo
Reference: 
MWJ2017,8,21
 
Since 2000, a decrease in malaria burden has been observed in most endemic countries. Declining infection rates and disease burden and reduction in asymptomatic carriers are the outcome of improved quality of care and related health syst em factors. These include improved case management through better diagnosis, implementation of highly effective antimalarial drugs and increased use of bednets. We studied communities ’ and health workers ’ perceptions of indicators and drivers in the context of decreasing malaria transmission in Malindi, Kenya. A variety of qualitative methods that included participatory rural appraisal (PRA) tools such as community river of life and trend lines, focus group discussions (FGDs) and key informant interviews were used. Studies took place between November 2013 and April 2014. Providing residents with bednets contributed to malaria reduction, and increasing community awareness on the causes and symptoms of malaria and improved malaria treatment were also perceived to contribute to the decline of malaria. The study identified three perceived drivers to the reported decline in malaria: a) community health workers ’ enhanced awareness creation towards household owners regarding malaria - related activities through visitations and awareness sessions, b) Women involvement in Savings Internal Lending Community was perceived to have increased their financial base, thereby improving their decision - making power towards the care of their sick child(ren), c) Non Governmental Organizations (NGOs) and partners played a promoter part in health and general economic development initiatives. To achieve the goal of malaria elimination, collaboration between governmental and NGOs will be crucial when improving the financial base of women and enhancing participation of community health workers. 
 
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Research: Evaluation of demand and supply predictors of uptake of intermittent preventive treatment for malaria in pregnancy in Malawi

December 8, 2017 - 05:03 -- MalariaWorld Journal
Author(s): 
Emmanuel N. Odjidja, Predrag Duric
Reference: 
MWJ2017,8,20
 
The intermittent preventive treatment (IPTp) policy of Malawi (2002) stipulates that IPTp is administered during antenatal care as a direct observation therapy (DOT). The policy further recommends that IPT should be administered monthly after 16 weeks of pregnancy until delivery. This study assessed both the demand and supply factors contributing to higher dropout of IPT after the first dose. Optimal number of doses was pegged at a minimum of three in accordance with WHO recommendation. Data were analysed from the Malawi multiple indicator cluster survey (2015) and the service provision assessment (2014) of 6637 women (aged 15 – 49 yrs), 763 facilities and 2105 health workers. The sample was made up of pregnant women, health facilities and workers involved in routine antenatal services across all regions of Malawi. A composit e indicator was constructed to report integration of IPTp with ANC services and administration of IPTp - SP as DOT. Multivariate and logistic regression were conducted to determine associations. Regression analysis found that: 1. Age of women (women 35 – 49 yrs, AOR 1.98; 95% CI 1.42 – 2.13, number of children as well as the number of ANC visits were associated with optimal uptake of IPTp. 2. Administering IPT as DOT was higher in facilities in rural areas (AOR 1.86; 95% CI 1.54 – 1.92) than in urban areas. 3. Administration of IPTp as DOT was relatively lower in across all facilities with highest being facilities managed by CHAM (72.8%, AOR 1.40; 95% CI 1.22 – 1.54). Health system bottlenecks were found to present the main cause of low coverage with optimal doses of IPTp. Incorporating these results into strategic policy IPTp formulation could help improve coverage to desired levels. This study could serve as plausible evidence for government and donors when planning malaria in pregnancy interventions, especially in remote parts of Malawi.

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Research: Long lasting impregnated mosquito net (LLIN) utilisation, incidence of fever and therapeutic itineraries: the case of Mifi health district in western Cameroon

November 24, 2017 - 08:18 -- MalariaWorld Journal
Author(s): 
Patrick P. Nkamedjie, Ghyslaine B. Dongho, Rodrigue B. Mabvouna, Gianluca Russo, Martin S. Sobze
Reference: 
MWJ2017,8,19
 
Long Lasting Impregnated mosquito Net (LLIN) use is effective against malaria in endemic tropical areas. However, its utilisation remains limited. Among the most common clinical signs of malaria is fever and many studies have reported the existence of different local ways of handling fever; amongst which uncontrolled use of antimalarial drugs. We investigated LLIN use and its impact on fever outcomes and the various therapeutic measures used to deal with fever episodes. Data was extracted from a cross sectional descriptive and analytic study performed between January and April 2014 in Mifi health district. Data was collected in households through a face to face interview with standard house hold questionnaires, treated and analysed using Epi Info statistical software version 3.5.3. A total of 317 participants were interviewed with average age of 33.2 years (SD = 10.8). Female respondents were predominant (85.2%; n=270). Most participants attended secondary education (53.6%; n= 170). Married marital status was most represented (58.1%; n= 185). 75.4% (n=239) of households owned at least 1 LLIN against an estimated average district coverage of 1 LLIN for 3.3 persons. Average bednet usage for households owning at least 1 LLIN was 57.9%. Utilisation of LLINs in households reduced fever episodes by 5.3%, (p=0.36). To handle fever episodes, roadside medicines represented priority therapeutic itinerary for most of our respondents (95.0%; n=301). Although LLINs are effective in reducing fever episodes, their utilisation remains low. Self-medication to treat fever seems to be prominent. There is a need to optimise communication for behavioural change strategies to promote consistent LLIN use and anti-malarial therapy, assisted by qualified health personnel.

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