The MalariaWorld Journal

 

A malaria vaccine is a potentially effective addition to the armamentarium for malaria control. The candidate RTS,S malaria vaccine has undergone phase III clinical trials and WHO has indicated that a policy recommendation is possible in 2015. Given the delays with adoption of other novel interventions including vaccines, there is a need to ensure that all elements that will inform the decision to adopt a malaria vaccine, including community willingness, will be available on time. This study was carried out to assess the willingness of caregivers of under-5 children to accept a malaria vaccine once available and recommended for use. 427 consenting caregivers, selected using a cluster sampling technique, from five communities in Ibadan, Nigeria, participated in a questionnaire. In-depth interviews (IDIs) were conducted among 47 key community members. Data were analysed using descriptive statistics, Chi-square and logistic regression at p≤0.05. Thematic content analysis was used to analyse the transcribed IDI data. The mean age of survey respondents was 29.8±5.8 years. Only 20.1% of the respondents had ever heard of malaria vaccine; 87.0% showed willingness to accept a malaria vaccine. Reasons stated for not willing included ‘husband did not want immunisation’ (73.6%), ‘felt it might be expensive’ (47.2%) and ‘felt it might paralyse children’ (24.5%). Nearly half (48.7%) of the respondents said that if vaccine is not given orally like polio vaccine it might not be accepted. Influence of community health workers was found to predict willingness to accept a malaria vaccine (OR: 0.316, 95% CI: 0.142-0.705). IDI participants were favourably disposed to introduction of a vaccine against malaria, although they had concerns about the formulation of the vaccine and possible adverse events. Well-designed communication strategies implemented prior to the introduction of a malaria vaccine would be essential to foster a supportive environment for eventual adoption and acceptance thereof. 

This study aimed at determining the performances of the Optimal-IT® test in the strategy for the exclusive treatment of uncomplicated malaria in rural areas in the forest region of San Pedro, Côte d’Ivoire. Patients exhibiting clinical signs of uncomplicated malaria who gave their consent benefited from thick blood film (TBF), blood smear (BS) and Optimal-IT® (pLDH-based) tests. Rapid diagnostic test (RDT) results were taken into consideration to decide on malaria treatment and then compared with TBF/BS results (reference) to assess the performances and clinical usefulness of the RDT. TBF/BS and Optimal-IT® were concordant in 92% of patients but discordant in 10 false negative (3%) and 19 false- positive patients (5%). The performances calculated were: sensitivity=95%, specificity=91%, positive predictive value=90%, negative predictive value=95%, positive likelihood ratio=10, negative likelihood ratio=0.06 and diagnostic odds ratio=166, indicating that Optimal-IT® is a powerful and credible diagnostic tool. The Optimal-IT® test, which is already used in the field, showed good performances to effectively detect patients with and without malaria. It is therefore adapted to the malaria treatment strategy limited to confirmed cases. 

 

The purpose of this study was to determine whether investments in suppressing malaria might produce significant benefits for African nations. Two epidemiologic analyses wereused in parallel to evaluate data from Africa: a before-after comparison of countries treated under the US President’s Malaria Initiative for Africa (PMI), and a simultaneous comparison of treated-untreated countries. From 2007 to 2012, relative increases in population and gross domestic product (GDP) were greater in 14 countries treated as part of PMI than in 9 similar, but untreated countries. In the treated countries the relative increase in the GDP of 0.61 before malaria suppression rose to 0.64 afterwards; whereas in the untreated countries it fell from 0.67 to 0.56. The increase in GDP in the 14 treated countries that was attributable to malaria suppression over the 5-year interval was about $4.77 billion. During that period, the mean cost of suppressing malaria had been about $1.43 billion, indicating a return on the investment of 3.4 to 1. However, the costs began rising steeply in 2012. Malaria suppression might be worthwhile for African countries to undertake themselves, as long as the biocides and drugs in current use remain effective.