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The MalariaWorld Journal

Research: Diversity, resistance and vector competence of endophilic anophelines from southern Ghana

October 31, 2015 - 19:19 -- Bart G.J. Knols
Author(s): 
Michael Osae, Alessi Kwawukume, Michael Wilson, David Wilson, Lizette L. Koekemoer
Reference: 
MWJ2015, 6, 12
 
As part of efforts to monitor the impact of vector control strategies so that they can be improved and more targeted, we collected baseline data on aspects of the bionomics of endophilic anophelines in southern Ghana. Indoor resting anophelines were collected using mouth aspirators and pyrethroid spray catch. Anopheles females were identified to species level using morphological characteristics and sibling species were distinguished by PCR. The presence of the L1014F mutation, conferring resistance to insecticides, was determined in An. gambiae s.s. and An. coluzzii samples using TaqMan real-time PCR. Host blood meal sources were determined by PCR, and the presence of Plasmodium falciparum circumsporozoite proteins determined by ELISA. A total of 892 female Anopheles (31% An. gambiae, 41% An. coluzzii and 28% An. funestus) were collected from six villages. The L1014F mutation was almost fixed in all populations studied (allele frequencies: 0.87-1.00). Both An. gambiae s.l. and An. funestus fed mainly on humans, with a human blood index of 1, although some animal feeding was recorded in An. gambiae. P. falciparum was detected in all ecological zones and in all three major vector species, being 4.9% in An. funestus, 3.8% in An. gambiae s.s. and 1.1% in An. coluzzii. These findings suggest that the three major vectors of malaria are present in all ecological zones of southern Ghana and contribute to disease transmission. The near fixation of the L1014F mutation in southern Ghana poses a great threat to vector control, thus highlighting the urgent need to implement measures to maintain the efficacy of current control tools and to develop novel control strategies.

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Research: Malaria epidemic outbreaks in the Democratic Republic of Congo, part I: cross-sectional survey in Mweka District

September 10, 2015 - 13:00 -- Bart G.J. Knols
Author(s): 
Célestin N. Nsibu, Dieudonné N. Mumba, Gauthier K. Mesia, Thierry L. Bobanga, Célestin de P. Manianga, Clarisse M. Mbo, Samuel M. Mampunza, Gaston L. Tona
Reference: 
MWJ2015, 6, 11
 
A series of fever outbreaks has previously been reported in the DR Congo. The occurrence of similar outbreaks in Mweka district presented the opportunity to investigate these occurrences.
 Health facilities and communities were visited. Blood samples for malaria, salmonellosis, Chikungunya, dengue and filovirus testing were obtained both in health facilities and the communities. Capture of mosquitoes and larvae in breeding sites was done and used bednets were collected. An increase in the number of malaria cases beyond the expected number for the study period was observed in the two health districts located in the savannah zone (p<0.05) and in one health centre among sixteen located in the forest zone (p<0.05). In the health facilities and households visited (653 people), 141 persons had fever of which 82.2% was attributed to Plasmodium falciparum malaria. An incidence of 5.87% was recorded in the first half of 2013. Hundred and sixty patients (6.9%) died among 2,304 admitted for severe malaria in the three referral hospitals, 118 of them were children of under five years old. PCR testing of the blood samples obtained during home visits revealed malaria parasites in 63 (73.3%) of the 86 analysed samples. The test was negative for other parasites and bacteria and one dengue virus case was detected. Anopheles gambiae from Mweka were found to be resistant to permethrin using the WHO susceptibility test, with a knock down rate of ≤ 50% and mortality of ≤ 30%. These investigations confirmed epidemic outbreaks in Mweka District caused by malaria with a high mortality rate in children below five years of age.

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Research: Knowledge and practice on malaria diagnosis and treatment among healthcare providers working in private health facilities in Ethiopia: A cross-sectional facility-based survey

July 31, 2015 - 08:45 -- Bart G.J. Knols
Author(s): 
Mesele Damte Argaw
Reference: 
MWJ2015, 6, 10
 
The knowledge and practice of malaria diagnosis and treatment among healthcare providers (HCPs) working in Private Health Facilities (PHFs) in Ethiopia was assessed. A facility-based cross-sectional study was conducted from April to June 2012. Quantitative and qualitative data were collected and 264 HCPs from 264 PHFs in malaria-endemic towns were enrolled. The majority (84.5%) of the HCPs were males, 106 (40%) were nurses and 135 (51.0%) had practiced for more than seven years. The knowledge of HCPs about the malaria programme was scored (from 1-5), and the mean was 2.52 (95% CI: 2.32-2.72), with 40.5% of the HCPs scoring above the mean. The majority knew the recommended treatment following confirmed diagnosis (91.3% for Plasmodium vivax, 88.6% for P. falciparum). 73.1% of suspected cases were investigated for parasitological diagnosis. The malaria slide positivity rate was 37.6%; however, only 60.0% of the confirmed cases were treated for malaria. Presumptive malaria treatment was offered to about 40% of patients. The adherence rate of HCPs towards prescribing the recommended first line drugs was 44.2% for chloroquine, 47.9% for ACTs and 77.9% for quinine. The study revealed that in Ethiopia HCPs in private practices have major gaps in knowledge and practice related to malaria case management. Therefore, provision of malaria diagnosis and case management training, supportive supervision and job aids is recommended for private healthcare providers, especially for nurses and for younger healthcare professionals.

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Research: A formative study of disposal and re-use of old mosquito nets by communities in Malindi, Kenya

June 29, 2015 - 12:58 -- Bart G.J. Knols
Author(s): 
Lydiah W. Kibe, Anne W. Kamau, John K. Gachigi, Annette Habluetzel, Charles M. Mbogo
Reference: 
MWJ2015, 6, 9
 
About 30 million insecticide treated bednets have been distributed in Kenya since 2001 and ownership is approaching full coverage. As a consequence of this achievement, Kenya is faced with the challenge of disposing old nets that are no longer in use. The study aimed at investigating ways of disposal and re-use of old and torn nets by end users. A formative study was conducted in the former Malindi District in Coastal Kenya. A total of 6 Focus Group Discussions, 10 Key Informant Interviews and 9 transect walks/drives were undertaken. There were variations in disposal and re-use of old nets between urban and rural or peri-urban residents. In all settings, people adopted innovative and beneficial ways of re-using old, expired nets, and those that were damaged beyond repair. Common causes of damage were fire, children, domestic animals sharing the sleeping room and friction from the bed poles while hanging or tacking it in under a sleeping mat. Re-use was most prominent in farming activities (78%) and less to for use in mosquito control, like window screening (15%). The remaining 8% was related to making ropes, swings, footballs, goal posts and fishing nets. Advantageous texture and nature of the netting material, perceived economic benefit and lack of guidelines for disposal were the main reasons cited by residents for re-using old nets. It is important that re-use and disposal of old nets is distinguished from misuse of newly distributed nets. Alternative uses of old nets as opposed to misuse of new nets was found to be common in our study.

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Research: Risk factors associated with occurrence of placental malaria in a population of parturients in Abeokuta, Ogun State, Nigeria

June 22, 2015 - 07:45 -- Bart G.J. Knols
Author(s): 
Ayodele S. Babalola, Oluwafunmilayo A. Idowu, Sammy O. Sam-Wobo, Eniola Fabusoro
Reference: 
MWJ2015, 6, 8
 
Placental malaria has long been acknowledged as a complication of malaria in pregnancy, and has been associated with poor pregnancy outcome in malaria-endemic areas. This study was conducted to determine the risk factors associated with occurrence of placental malaria in a population of parturients in Abeokuta Ogun State, Nigeria. Maternal and placenta blood samples were collected from 211 parturients. Blood films were prepared, stained with 10% Giemsa and microscopically analysed for the presence of parasites. Demographic characteristics were recorded in case record forms. Chi-square tests and a regression model were computed to analyse risks, using SPSS version 16.0. Overall, 40.8% (86 of 211) of the parturients had malaria at the time of delivery, with 19.0% (40 of 211) having placental malaria. We identified being within the age range of 18-22 years [OR = 4.4, 95% CL = 1.1-17.4, P = 0.046], being primigravid [OR = 2.1, 95% CL = 0.9-5.1, P = 0.028] and living in a congested apartment [OR = 1.6, 95% CL = 0.4-6.0, P = 0.029] as significant risk factors for placental malaria. Non-usage of intermittent preventive treatment (IPT) [OR = 2.6, 95% CL = 1.2-5.4, P = 0.018], long-lasting insecticidal nets (LLINs) [OR = 2.7, 95% CL = 1.3-5.5, P = 0.005] were also risk factors for placental malaria. In Abeokuta, the proper use of LLIN and IPT for pregnant women is essential to curb the scourge of malaria, associated risks and poor pregnancy outcomes.

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Research: Qualitative Assessment of rural health workers’ management of malaria in sick children

June 18, 2015 - 09:39 -- Bart G.J. Knols
Author(s): 
Ayodele S. Jegede, Ikeoluwapo O. Ajayi, Frederick O. Oshiname, Catherine O. Falade, Daniel Chandramohan, Hamade Prudence, Jayne Webster, Ebenezer Baba
Reference: 
MWJ2015, 6, 7
 
Febrile illnesses are common causes of morbidity and mortality among under-five children in sub-Saharan Africa. The recommended strategy for effective case management of uncomplicated malaria is parasitological confirmation prior to use of artemisinin-based combination therapy (ACT). There is a lack of qualitative information explaining factors, which influence malaria case management practices among health workers. This study explores the perceptions of health managers and health care providers on the case management of uncomplicated malaria among under-fives in selected primary health care (PHC) facilities of two Local Government Areas (LGAs), Katcha and Gbako, as part of baselines for capacity-building interventions planned in Niger State, Nigeria. Interviewees included state- and LGA-level health programme managers, and frontline health workers purposively selected to cover a range of cadres involved in case management of sick children. Issues explored were history taking, diagnosis, appropriate diagnosis of malaria, prescription for malaria, referrals and adherence to referral. Data coding was carried out with Nvivo qualitative software (version 8) and content analysed. History taking was often not carried out appropriately by the health workers. Treatment of malaria was not based on parasite-based diagnosis. Most of the health workers reported that they prescribed ACTs for treating presumed uncomplicated malaria. Care givers’ preferences, poor transportation systems and lack of financial resources led to poor adherence to referral advice. Absence of health workers from their duty post hindered effective service delivery. Prescription of ACTs as a first line of treatment for uncomplicated malaria without a parasite-based diagnosis was the standard case management practice. Parasite-based diagnosis for malaria will invariably lead to better treatment for non-malaria fever cases among the studied age group. Continuous capacity building aimed at improving adherence to current recommendations on parasite- based diagnosis and good clinical practice would be required to support the paradigm shift to parasite-based diagnosis of malaria.

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Research: Assessment of competence of participants before and after 7-day intensive malaria microscopy training courses in Nigeria

June 9, 2015 - 11:36 -- Bart G.J. Knols
Author(s): 
Yetunde A. Olukosi, Chimere O. Agomo, Oluwagbemiga O. Aina, Samuel K. Akindele, Hilary I. Okoh, Margaret O. Akinyele, Olusola Ajibaye, Bassey A. Orok, Bamidele A. Iwalokun, Veronica Enya, Uche T. Igbasi, Samson Awolola
Reference: 
MWJ2015, 6, 6
 
Accuracy of malaria diagnosis by microscopy has been a challenge in Nigeria due to poor competence of microscopists and inability to report on malaria species other than Plasmodium falciparum. Short courses were conducted to improve the skills of laboratory personnel to perform malaria microscopy in public health facilities. Seven-day malaria microscopy courses were conducted annually between 2011 and 2013.The training courses contained theoretical and practical sessions. Impact of the training was evaluated by practical and theoretical pre- and post-training assessments on malaria slide reading, parasite enumeration and basic malariology. The 102 participants who completed the training consisted of medical laboratory scientists (62; 60.8%), medical laboratory technicians (24; 23.5%) and other healthcare workers (16; 15.7%). The knowledge of basic malariology (theory) at pre- and post-tests were 34% (95% CI 31.7-36.3%) and 74.9% (95% CI 71.8-78.0%), respectively (P<0.001). The mean slide reading detection, species and counting agreements in pre-training assessment were 48.9%, 27.9% and 0%, respectively, and in post-training 56.8%, 39.2% and 25%, respectively. The mean species agreements in picture test pre- and post-training were 21.9% and 55.1%, respectively. There were significant differences (P<0.05) in the median pre-test scores in picture tests and basic malariology of the three categories of participants but not in malaria slide reading and parasite counting tests. However, post-training, a significant difference in test scores of the three categories of participants was recorded only for basic malariology (P=0.0003). The 7-day malaria microscopy courses significantly increased the knowledge and microscopy skills of the trainees and were sufficient to bridge the significant difference in baseline microscopy skills of the different categories of trainees that participated in the training courses.

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Research: Effect of the Affordable Medicines Facility for malaria (AMFm) on the availability of antimalarials in Nigeria

May 9, 2015 - 09:41 -- Bart G.J. Knols
Author(s): 
Arinola Joda, Nnenna Ezeigwe, Lilian Oguguo, Ogori Taylor, Godwin Ntadom
Reference: 
MWJ2015, 6, 5
 
The aim of this study was to document the availability of ACTs and RDTs provided under the National Malaria Elimination Programme via the AMFm financing strategy. Investigators were systematically selected and trained on the data collection tool from the World Health Organization/Health Action International (WHO/HAI) Workbook. Data was collected from public and private facilities in 12 states in the six geopolitical zones of Nigeria in April and May 2014. Data analysis was carried out using the embedded analysis toolkit in the WHO/HAI Workbook after double-entry and auto-checking of data. Seven AMFm products are available in the country, and include AL (IPCA), Artemef (Cipla), Coartem AMFm (Novartis), Combisunate (Ajanta), Lumartem (Cipla) as well as Arsuamoon (Guilin) and Coarsucam (Sanofi-Winthrop). The results reveal that antimalarials are largely concentrated in the private sector (private pharmacies and PPMVs). About 86% of the surveyed facilities had at least one AMFm AL product whereas only 18% had any AMFm AA product. Results show that the availability of the various AMFm AL products varies across the country. Lumartem by Cipla has the highest national availability with 26.4%, closely followed by AL (IPCA) with 25.7%. Twenty seven (%) of the facilities had an RDT in stock. The results obtained in this survey show that continuous monitoring of the antimalarial drug landscape is required to track progress in the fight against malaria in the country.

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Research: Buthionine sulfoximine increases the efficacy of arteether antimalarial activity in arteether-resistant Plasmodium vinckei by glutathione depletion

April 30, 2015 - 07:57 -- Bart G.J. Knols
Author(s): 
Ramesh Chandra, Santosh Kumar, Sunil Kumar Puri
Reference: 
MWJ 2015, 6, 4
 
We tested in vivo effects of L-buthionine (S,R)-sulfoximine (BSO) on glutathione (GSH) and hemozoin formation in arteether-sensitive and - resistant strains of Plasmodium vinckei. Groups of 7-8 Swiss mice were inoculated by intraperitoneal injection (i.p.) with 1×106 parasitized erythrocytes of PvAS (sensitive) or PvAR (resistant) strain of P. vinckei. The infected mice were treated with BSO (Sigma) 400 mg/kg twice a day for four days and blood was collected after the last injection with BSO. A relatively stronger inhibition of GSH level was observed in the blood of mice infected with resistant parasites (62.64%; p<0.0001), whereas inhibition in sensitive strain-infected mice and uninfected mice was 32% (p=0.034) and 35% (p=0.034), respectively. The results also show an inverse relationship between GSH and hemozoin in the arteether-sensitive and -resistant strains. The hemozoin contents in the resistant strain are 0.27±0.09, 0.69±0.14 and 5.30±0.79 μmol/109 cells at 5, 10 and 20% parasitemia, respectively, whereas hemozoin contents in the sensitive strain at the same parasitemia levels are 0.59±0.29, 12.38±1.96 and 30.80±2.27 μmol/109 cells. Moreover, hemozoin formation increased by 80% through the administration of BSO in the arteether-resistant strain, whereas insignificant changes occurred in the sensitive strain. BSO was also found to increase the efficacy of arteether antimalarial activity against the resistant strain in vivo. It is concluded that treatment with BSO significantly reduces the level of GSH, which leads to insufficient growth of resistant parasites. These results suggest that BSO might be helpful in prolonging the persistence of the drug, and pose a promising lead to help reducing the chance of resistance development against artemisinin and its derivatives.
 
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Research: Inhibitory effect of deltorphin-II on development of malaria in Plasmodium berghei-infected mice

March 23, 2015 - 21:47 -- Bart G.J. Knols
Author(s): 
Garasiya A. Ajitbhai, Prati P. Singh, Mukesh Kumar, Rajinder Singh, Vandana Dhiman
Reference: 
MWJ2015, 6, 3
Drug resistance has been one of the main obstacles in the fight against vector-borne infectious diseases. Among these diseases, malaria represents a serious public health challenge, mainly in the tropics, where vector-favourable climates are a crucial factor. Each of the various anti-malarial drugs currently used against this disease, such as quinolones, sulphonamides and artemisinins are inadequate and new strategies are required. Peptides are known to have a huge number of biological effects. Antimicrobial peptides (AMPs) have been proven to be effective against bacterial, fungal and viral infections. This study explored the effect of the peptide ‘deltorphin-II’ in Plasmodium berghei-infected mice. Mean percentage parasitaemia was calculated by studying infected erythrocytes after microscopic examination of 104 erythrocytes from infected mice on days 4, 7, 10, 14 and 21 after infection in all groups. Deltorphin-II shows maximum activity at a dose of 0.8 mg/kg/day from day 4 to day 21. Pre-treatment of infected mice with naltriben abrogates the deltorphin-II-mediated effect. Deltorphin-II inhibits the development of malaria, most probably via activation of the δ2 receptor.

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