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The MalariaWorld Journal

Research: Performance evaluation of malaria microscopists working at rechecking laboratories in Ethiopia

June 11, 2017 - 20:51 -- MalariaWorld Journal
Author(s): 
Abnet Abebe, Meseret Belayneh, Habtamu Asrat, Wondwossen Kassa, Andargachew Gashu, Adino Desale, Getnet Hailu, Tesfaye Mekonnen, Feven Girmachew, Achamyeleh Mulugeta, Ebise Abose, Dereje Yenealem, Abeba G Tsadik, Adisu Kebede, Gonfa Ayana, Kassu Desta
Reference: 
MWJ2017,8,6
 
A cross-sectional study was conducted to assess the performance of 107 malaria microscopists working at 23 malaria rechecking laboratories in Ethiopia. A set of 12 blood film slides was distributed to each microscopist. Data was collected and exported to SPSS version 20 for analysis. Chi-square, sensitivity, specificity, percent agreement, and kappa scores were calculated to assess performance in detecting and identification of Plasmodium species. The mean age of the participants was 30 ± 5 yrs and most of them (54; 50.5%) were working at regional reference laboratories. Overall, the sensitivity of participants in detecting and identifying malaria parasite species was 96.8% and 56.7%, respectively. The overall agreement on detection and identification of malaria species was 96.8% (Kappa = 0.9) and 64.8% (Kappa = 0.33), respectively. The least accurately identified malaria parasite species was P. malariae (3/107; 2.8%) followed by P. ovale (35/107; 32.7%). Participants working at hospital laboratories had the highest percentage (72.3 %, Kappa=0.51) of accurate species identification. Study participants that had participated in malaria microscopy and quality assurance trainings were significantly better at quantifying parasite densities (P<0.001). The accuracy of parasite identification and quantification differed strongly between participants and expert microscopists. Therefore, regular competency assessment and training for malaria microscopists should be mandatory to assure proper diagnosis and management of malaria in Ethiopia. 

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Research: Utilization of health facilities and maternal malaria prevention strategies by pregnant women in Kajiado County, a highland pastoral area of Kenya with low malaria transmission

June 9, 2017 - 07:21 -- MalariaWorld Journal
Author(s): 
Jonathan C. Ngala, Erick K. Serem, Francis M. Gwama
Reference: 
MWJ2017, 8, 5
 
We assessed utilisation of health facilities and WHO-recommended maternal malaria control strategies in Kajiado County. A total of eleven health facilities were recruited, in which 6899 pregnant women were divided in three groups. Group 1 were women attending a clinic and used ITNs, group 2 did not attend a clinic but used ITNs and group 3, which did neither. 86% Of deliveries were assessed; 84% of these in clinics and 16% at home. Throughout pregnancy, data on abortion and premature births were collected. Upon delivery, data on stillbirths, birth weight and neonatal mortality was noted. Mother’s cord and placental blood was examined for malaria parasites and parasitaemia using microscopy; haemoglobin levels were determined. 86% Of the women visited a health facility, 97% used an ITN. Only 3% went without visits or bednet usage. Although the number of cases was low, attending a clinic and using a bednet increased maternal Hb and reduced maternal mortality. Use of nets decreased maternal malaria cases and mortality due to malaria whilst maternal Hb increased. Across the study groups, infant outcomes improved, with fewer abortions, premature births, still births, neonatal mortality and an increase in mean body weight at birth. Women should be sensitised to visit clinics and use ITNs for better maternal and new-born health outcomes.

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Research: Optimization of BeWo model to investigate placental responses to Plasmodium falciparum infected erythrocytes

March 18, 2017 - 09:32 -- MalariaWorld Journal
Author(s): 
Winifrida Kidima, Naveen Bobbili, Diane W. Taylor
Reference: 
MWJ2017, 8, 4
 
Establishment of an in vitro model to study placental malaria is essential for understanding the biology and pathogenesis of placental malaria. We defined experimental variables for obtaining responses of BeWo cells to placental binding Plasmodium falciparum infected erythrocytes (IE, CS2 parasites).
 Experimental variables included i) concentration of forskolin, a cyclic adenosine monophosphate inducer important in the induction of syncytialisation of BeWo, ii) suitable period of incubating BeWo with forskolin, and iii) ratio of IE to BeWo cells and length of incubation to induce physiological changes in BeWo cells, including the vasculogenic factors vascular endothelial growth factor A (VEGFA), endoglin, and angiopoietin-2; an anti-angiogenic factor (inhibin A); a regulator of cell growth, mammalian target of rapamycin (mTOR); a chemokine (IL-8); and the cytokine macrophage inhibition factor. The human hormone, chorionic gonadotrophin was used as a marker for syncytialisation. We showed that 72 hrs incubation of BeWo with 10 μm forskolin resulted in higher levels of syncytialisation and hCG secretion. Overall, the best condition was to co-culture syncytialised BeWo with a 10:1 ratio of IE for 48 hours. Under these conditions, when co-cultured with IE, BeWo produced increased amounts of IL-8 (p=0.0001), VEGF (p=0.001) and endoglin (p=0.001). The model can be used to evaluate the impact of IE, inflammatory cytokines and other factors associated with placental malaria on syncytiotrophoblast function.

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Research: Effect of antimalarial prophylaxis with sulphadoxine-pyrimethamine on pregnancy outcomes in Nsukka, Nigeria

March 5, 2017 - 11:46 -- MalariaWorld Journal
Author(s): 
Nneka U. Igboeli, Chinwe V. Ukwe, Cletus N. Aguwa
Reference: 
MWJ2017, 8, 3

 

We evaluated the association between the use of intermittent preventive treatment with sulphadoxine- pyrimethamine (IPTp-SP) on pregnancy outcomes among women who delivered at a secondary hospital in Nsukka, Enugu State, Nigeria. Relevant obstetric data (e.g. IPTp-SP use), matched against pregnancy outcome data such as delivery method, stillbirth, maternal haematocrit test results and babies’ birth weights, were collected retrospectively from antenatal care (ANC) case files of women who delivered within a one-year period (2013). The prevalence of adverse pregnancy outcomes recorded out of the 500 ANC case files analysed were: low birth weight (LBW) 3.6% (15), anaemia 54.3% (114), caesarean section 31.6% (156) and stillbirth 3.6% (67). A total of 342 (68.4%) of the women received IPTp-SP during ANC and the receipt of IPTp-SP was significantly associated with reductions in the following events: LBW [OR = 0.26, 95% CI = 0.09 – 0.75], moderate anaemia [OR = 0.33, 95% CI = 0.17 – 0.63], caesarean section [OR = 0.36, 95% CI = 0.24 – 0.53] and stillbirth [OR = 0.10, 95% CI = 0.06 – 0.18]. In this area of high malaria transmission we demonstrated significant reductions in unfavourable maternal and infant health outcomes when using IPT-SP.

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Research: Malaria chemoprophylaxis: cross-sectional study of use among air travellers departing from Accra, Ghana

February 28, 2017 - 13:17 -- MalariaWorld Journal
Author(s): 
Henry J.O. Lawson, Gerhard K. Ofori-Amankwah, Akye Essuman, Edwina B. Opare-Lokko, Charles Antwi-Boasiako, Andrew A. Adjei
Reference: 
MWJ2017, 8, 2
 
This study investigated the use of chemoprophylaxis for malaria prevention in air travellers departing from Kotoka International Airport (KIA) in Accra, Ghana. A cross-sectional study was conducted in the departure lounge of the KIA between February and May 2012. A total of 424 respondents voluntarily completed a semi-structured questionnaire, which included socio- demographic characteristics, duration of stay, nationality, country of permanent residence, chemoprophylaxis used, number of doses missed, cost and side effects experienced, and cost of treatment. The mean age of respondents was 37 ± 0.84 years with a male:female ratio of 1.2:1.The mean duration of stay in Ghana was 47.9 days [SD 56.8] and 73.5% had made one trip to the country in the preceding year. Of the respondents, 50.7% were from Europe, 24.1% from North America and 17.5% from Africa. The most popular malaria prevention method used was prophylactics (37%) with atovaquone/proguanil used most frequently (34.9%), followed by mefloquine (11.6%) and doxycycline (7.8%). Compliance was high: 73.8% of respondents did not miss a single dose. The most commonly reported side effects were dreams, abdominal discomfort and headaches. Malaria incidence was 7.1% with 80% of them receiving treatment in a hospital or clinic; incurring a cost of up to $30 to treat a person. Most air travellers from Accra take atovaquone/proguanil. Malaria incidence was low and most travellers were compliant with their chemoprophylaxis with very few side effects. The cost of chemoprophylaxis is low and is thus recommended for all travellers to Accra, Ghana.

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Research: Antimalarial medicine preference and usage in rural and peri-urban communities in Lagos and Osun states in southwestern Nigeria

February 22, 2017 - 15:39 -- MalariaWorld Journal
Author(s): 
Monday Tola, Ojo Oreoluwa, Emmanuel T. Idowu, Esther O. Iyede, Olusesan Omidiji, Taiwo S. Awolola
Reference: 
MWJ2017, 8, 1
 
Medicine preference, usage and health-seeking behaviour are very important in the treatment of malaria and prevention and management of drug resistance.
 A descriptive cross-sectional study, using a semi-structured questionnaire administered to 135 respondents, was carried out to assess antimalarial drug preference and usage among rural dwellers in Alajue, Ede, Osun State and peri-urban dwellers in Ajara, Badagry, Lagos State, Nigeria. Loss of appetite, fever, chill and rigour, headache and vomiting were the most frequently reported symptoms (83.3%, 78.6%, 71.4%, 69.0% and 64.3%, respectively). More than half (57.1%) of the respondents had their drugs prescribed by a qualified health practitioner. Sixty-eight (50.3%) respondents treated malaria with Artemisinin-based Combination Therapy (ACT) while Sulphadoxine-Pyrimethamine (SP), paracetamol and herbal medicine usage was reported by 11.9%, 9.6% and 4.4% of the respondents, respectively. Thirty-two respondents (23.7%) took nothing to treat the infection. Of them, only 64.3% completed their drugs regimen during their last episode with 35.7% reporting that fever subsided on/before day 2 of treatment and 64.3% reported that fever subsided two days post treatment. The majority (83.3%) of respondents had no adverse reaction to the drugs used (16.7% reported drowsiness, nausea, headaches and vomiting) with 64% of the respondents reporting that they will use ACT again anytime they have malaria and about 65% reported that the drug was very convenient for them (χ2 = 18.192, p = 0.001). The control of drug resistance in malaria parasites requires reducing the overall drug pressure, improving the ways the drugs are used and prescribing follow-up practices. The use of drug combinations that are not likely to foster resistance like ACT is also a good measure of resistance control. ACT would be expected to remain the key anti- malarial drug for treatment of multidrug resistance P. falciparum since there are no alternative drugs available at present.

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Research: Evaluation of cost of treatment of malaria in adults in Benin City, Nigeria: patients’ perspective

September 16, 2016 - 12:59 -- MalariaWorld Journal
Author(s): 
Obumneke A. Obieche, Valentine U. Odili
Reference: 
MWJ2016, 7, 12
 
Malaria remains a disease of immense clinical and economic significance. Limited research has been carried out to estimate malaria treatment costs at the health care facility level using the patient’s perspective. The objectives of this study were therefore to determine the direct and indirect costs of malaria treatment among adult outpatients and to assess the patients’ perception of treatment costs. A cross-sectional study was conducted at the Pharmacy section of the General Practice Clinic, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria. It involved adult outpatients diagnosed with malaria and who received a prescription of one or more anti-malarial medications. A cost-of-illness approach was employed in the assessment of costs of treatment of malaria per sick adult patient. Pre-tested semi-structured questionnaires were used in the study. Furthermore, self-reported incidence of malaria per year was assessed. The mean direct and indirect cost of treating malaria illness per adult outpatient was Nigerian Naira (NGN) 3417.70 ($ 20.34) and NGN 4870 ($ 29.0), respectively, giving a ratio of 0.7:1. Medications and laboratory tests for detection of malaria parasites contributed about 52 and 22% of the total direct cost, respectively. A total of 1592 malaria episodes were self-reported to occur annually, giving a mean value of 3.35 episodes per adult. Having a health care insurance was associated with the response that the cost of malaria treatment was low (P< 0.001). The mean values of direct cost and indirect cost of treatment of malaria illness per adult outpatient were $ 20.34 and $ 29.0, respectively. Respondents who had health insurance perceived malaria treatment cost to be low, whereas those without such insurance felt otherwise.

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Research: Supplementary effect and durability of prototype insecticide-treated eave curtains on indoor resting mosquitoes in Kadibo division, Western Kenya

August 16, 2016 - 01:27 -- MalariaWorld Journal
Author(s): 
Martin T.O. Odhiambo, John M. Vulule, Yaw A. Afrane, Maurice Ombok, Rune Bosselmann, Ole Skovmand
Reference: 
MWJ 2016, 7, 11
 
A field trial was conducted to investigate the effect and longevity of prototypes of long lasting impregnated UV protected eave nets, curtains and door hangers (fully screened houses), compared to houses with bednets only, in traditional East African houses. A randomised controlled trial was carried out in the Ahero rice irrigation scheme in Nyando district, Western Kenya. Eighty houses with open eaves were randomly selected. Forty of these houses were fully screened (FSH+LLINs) with long lasting insecticide-treated nets/curtains used to screen the eaves, windows and doors. The FSH materials were produced with anti-UV additives. The other 40 houses served as controls. Long lasting insecticide-treated bednets (LLINs) were suspended over all sleeping areas in the control and intervention houses. Indoor resting Anopheles mosquitoes were collected using pyrethrum spray catches (PSC) during both dry and wet seasons. Indoor population densities of anophelines were compared between intervention (FSH+LLINs) and control (LLINs) houses. Loss of insecticide (deltamethrin) was compared after 12 and 24 months for both the FSH materials and LLINs through bioassays and chemical analyses. In the FSH+LLINs houses densities of indoor resting Anopheles funestus and An. arabiensis were reduced by 82% (RR=0.18, 95% CI 0.09-0.36, P<0.0001) and 70% (RR=0.30, 95% CI 0.15-0.58, P<0.0001), respectively. No significant difference was recorded for indoor resting Culex spp. (RR=0.95, 95% CI 0.48-1.86, P=0.8). The population of indoor resting bloodfed An. arabiensis and An. funestus was reduced by 72% (RR=0.22, 95% CI 0.09-0.51, P<0.0001) and 84% (RR=0.16, 95% CI 0.07-0.33, P<0.0001) in the FSH+LLINs houses and LLIN houses, respectively. Insecticide loss in eave nets did not depend on the side of the house where the nets were placed. The eave nets showed little loss of bio efficacy over the 12-24 months period. The study revealed that the use of insecticide-treated nets on the eaves and windows combined with door hangers largely impeded entrance of anopheline mosquitoes into houses and can be used to compliment LLINs for household protection. The eave nets were suspended from wood structures near the eave and remained in place when walls were re- plastered. The nets are therefore not depending on daily compliance behaviour and provide protection for the entire household.

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Research: In vitro sensitivity of Plasmodium falciparum clinical isolates to 4-aminoquinolines in Northeast Nigeria

July 29, 2016 - 05:34 -- MalariaWorld Journal
Author(s): 
Sulayman T. Balogun, Umar K. Sandabe, Isah A. Waziri, Justus Jibrin, Fatai A. Fehintola
Reference: 
MWJ2016, 7, 10
 
Widespread drug-resistant Plasmodium falciparum strains have challenged the pivotal role played by 4- aminoquinolines, including chloroquine (CQ), which has been delisted for the treatment of malaria in most parts of the world. This study assessed the in vitro sensitivity of P. falciparum clinical isolates (PfCIs) to amodiaquine (AQ) and CQ in Northeast Nigeria. PfCIs were collected from subjects with uncomplicated P. falciparum malaria in Azare, Bauchi State and Maiduguri, Borno State following an informed consent. The in vitro sensitivity was assessed by micro-test (Mark III) method and the IC50 of AQ and CQ was determined using HN-NonLin Version VI.1 software. The reference standard cut-off values for in vitro AQ and CQ resistance of 80 and 160 nmol/l, respectively, were used. Isolates that were inhibited by lower AQ and CQ concentrations were referred to as sensitive. Valid in vitro assay results were obtained for 88.9% (80/90) of the PfCIs; Azare had 93.3% (28/30) and Maiduguri had 86.7% (52/60) [χ2 = 0.35; df = 1; p = 0.486]. The geometric mean (GM) IC50 of AQ and CQ were 24.2 nmol/l (95% CI, 10.5 – 49.6 nmol/l) and 39.5 nmol/l (95% CI, 34.5 – 49.6 nmol/l), respectively. The AQ (p = 0.922) and CQ (p = 0.085) GM IC50 were similar between Azare and Maiduguri PfCIs. Only one isolate showed in vitro resistance to AQ giving a sensitivity of 98.8% (79/80) while 17 PfCIs showed in vitro resistance to CQ giving a sensitivity of 78.8% (63/80). The CQ sensitivity was similar between Azare (67.9%; 19/28) and Maiduguri (84.6%; 44/52) PfCIs (χ2 = 3.05; df = 1; p = 0.081). The findings may suggest that the AQ in vitro sensitivity remains high and the isolates in Northeast Nigeria may appear more sensitive to CQ than isolates from other parts. These findings may affect malaria treatment and control policy in Nigeria.

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Research: Controlling malaria in pregnancy: how far from the Abuja targets?

July 8, 2016 - 07:44 -- MalariaWorld Journal
Author(s): 
Oyindamola B. Yusuf, Joshua O. Akinyemi, Adeniyi F. Fagbamigbe, IkeOluwapo O. Ajayi, Elijah A. Bamgboye, Evelyn Ngige, Kawu Issa, Emmanuel Abatta, Onoride Ezire, Perpertual Amida, Adebobola Bashorun
Reference: 
MWJ2016, 7, 7
 
We evaluated ITN/IPTp coverage, explored its associated factors, and estimated the number of pregnancies protected from malaria. This analysis was based on data from the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS Plus). To assess ITN coverage, we used the population of women that was pregnant (n=22,438) at the time of the survey. For IPTp coverage, we used women that had a live birth in the 5 years preceding the survey (n= 118,187) and extracted the population of pregnant women that, during their last pregnancy, received drugs for protection against malaria. We estimated the number of live births using the projected population of females in each state, population of women of child -bearing age and the total fertility rate. The estimated number of pregnancies covered/protected by ITN and IPTp was obtained from a product of the estimated live births and the reported coverage. Multivariate logistic regression was used to determine factors associated with ITN and IPTp use. We estimated that there were 5,798,897 live births in Nigeria in 2012, of which 3,537,327 and 2,302,162 pregnancies were protected by ITN and IPTp, respectively. Four of 36 states achieved the 80% RBM target for ITN coverage. No state achieved the 100% target for IPTp. Education and socio-economic status were associated with IPTp use. ITN coverage was higher than in previous estimates even though it is still below the RBM targets. However, IPTp coverage remained low in 2012 and was not likely to increase to match the 2015 target coverage of 100%.

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