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The MalariaWorld Journal

Research: The current status of infrastructure for monitoring the efficacy of antimalarial therapeutics in Zambia

September 23, 2014 - 13:54 -- Bart G.J. Knols
Author(s): 
Ellah Zingani, Satoshi Inoue, Lungwani Tyson M. Muungo
Reference: 
MWJ2014, 5, 9
Access: 
Open Access 2.0
 
The purpose of this study was to evaluate the current status of malaria diagnosis and treatment, and to monitor the therapeutic efficacy of antimalarial drugs. A descriptive cross-sectional survey was conducted from 2011 to 2013 at 10 district hospitals in Zambia designated as malaria sentinel sites as well as at the National Malaria Control Centre. Although basic infrastructure necessary for monitoring antimalarial drug resistance (such as laboratory, dispensary, admission ward, database unit, administration offices, bed space, examination and emergency rooms) was present at all sites, there was a shortage of licensed healthcare personnel. At some sites, antimalarial drugs were prescribed for malaria-like symptoms without diagnostic confirmation by blood smear. There was no regular monitoring of antimalarial drug resistance: only one trial was conducted among all sites in the previous 24 months. A lack of antimalarial drug resistance monitoring might be associated with personnel and funding shortages. Additional financial support would be necessary to avoid the development and spread of drug-resistant malaria in Zambia.

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Research: Economic aspects of suppressing malaria in Africa

September 22, 2014 - 13:59 -- Bart G.J. Knols
Author(s): 
William R. Jobin
Reference: 
MWJ2014, 5, 8
Access: 
Open Access 2.0
 
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.

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Research: How well do malaria tests correlate with disease severity? Comparison of parasite density in children with mild and severe malaria

June 26, 2014 - 14:42 -- Bart G.J. Knols
Author(s): 
Sarah N. Kituyi, Nancy Nyakoe, Joseph N. Ngeranwa, Steven Runo, John N. Waitumbi
Reference: 
MWJ 2014, 5, 7
Access: 
Open Access 2.0
 
This study determined how well parasite density estimates by microscopy, qPCR and PfHRP-2 correlate to malaria severity. Patients aged ≤ 5 yrs with severe (n = 60, Hb ≤ 6 g/dl) and mild (n = 60, Hb > 6 g/dl) malaria were enrolled to take part in a case control study at Kisumu District Hospital, Western Kenya. Parasite load was determined by microscopy, qPCR targeting the 18s rRNA gene and PfHRP-2 antigen ELISA. The median parasite load and the 25th and the 75th percentile by microscopy in children with severe malaria (SM) was 49,958 parasites/μl (12,013-128,695) compared to 24,233 (6,122-103,886) in the group with mild malaria (MM), P = 0.10. By qPCR, the translated median parasite density was 31,550 parasites/μl (4,106-196,640) in the SM group compared to 24,365 parasites/μl (5,512-93,401) in the MM group (P = 0.73). According to PfHRP-2, the translated median parasite load in children with SM was 628,775 parasites/μl (332,222-1.165x106) compared to 150,453 (94,292-399,100) in children with MM (P < 0.0001). Unlike microscopy and qPCR, the parasite load detected by PfHRP-2 correlates with disease severity. Because of its unique attributes, PfHRP-2 is able to account for trophozoites and schizonts that are sequestered away from peripheral circulation. Because it persists in circulation, it also serves as an indicator of the magnitude of current and recent infections.

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Research: Misdiagnosis of malaria using wrong buffer substitutes for rapid diagnostic tests in poor resource setting in Enugu, southeast Nigeria

May 12, 2014 - 12:31 -- Bart G.J. Knols
Author(s): 
Johnbull S. Ogboi, Polycarp U. Agu, Adeniyi F. Fagbamigbe, Onyemocho Audu, Augustine Akubue, Ifeyinwa Obianwu
Reference: 
MWJ 2014, 5, 6
Access: 
Open Access 2.0
 
This study explored the phenomenon of using the wrong buffer vial (often a kit from another brand or buffer from HIV rapid test kits), dextrose, saline or distilled water among health care providers who used RDTs for malaria diagnosis in resource poor settings in Enugu South East, Nigeria. Of the 80 study participants that completed their questionnaires, 56.3% reported that malaria diagnosis was positive using non-buffer RDTs detection while others reported negative results. Among the various professionals who used RDTs, 76.2% reported to have run out of RDT buffer stock at least once. Of the study participants that ran out of RDT buffer solution, 73% declared to have used non-RDT alternatives (physiological saline, 0.9% NaCl), distilled water, HIV buffer or ordinary water). Only 30% had received formal training on the proper usage and application of RDTs while 70% had never received any formal training on RDTs but learnt the technique of using RDT on the job. This study demonstrated that at least three quarters of health care workers in a resource poor setting had run out of buffer when using malaria RDTs and that the majority of them had used buffer substitutes, which are known to generate inaccurate tests results. This has the consequence of misdiagnosis, thus potentially damaging the credibility of malaria control.

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Research: High acceptance of artemisinin-based combination therapy for the home management of malaria in rural communities in southwest Nigeria

April 22, 2014 - 19:27 -- Bart G.J. Knols
Author(s): 
Catherine Olufunke Falade, Ikeoluwapo Oyeneye Ajayi, Oyindamola Bidemi Yusuf, Franco Pagnoni
Reference: 
MWJ 2014, 5, 5
Access: 
Open Access 2.0

In rural southwest Nigeria we set out to evaluate the feasibility and acceptability of using artemether-lumefantrine (AL) at the community level to treat acute uncomplicated malaria.Following advocacy and community mobilisation, 60 community medicine distributors (CMDs) were trained to recognise the signs and symptoms of childhood malaria and to treat febrile children aged 6–59 months with AL, after ruling out certain danger signs. Based on CMDs’ records, 97.6% (1019/1044) of the children treated with AL received the correct dose. Over half (52.3%) of the children (288/551) whose caregivers participated in the 2-week fever recall survey reportedly received AL from a CMD. Of the children treated with AL, 80.2% (231/288) received prompt treatment at the correct dose and for the correct length of time. Ninety-eight percent of the caregivers perceived AL to be effective and none reported severe adverse events. The use of AL at the community level is feasible and acceptable in the home management of malaria in rural southwest Nigeria. Challenges that must be addressed include avoiding stock outs, ensuring adequate number of CMDs and providing incentives to ensure their availability.

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Research: Suppression of malaria transmission and increases in economic productivity in African countries from 2007 to 2011

March 4, 2014 - 16:34 -- Bart G.J. Knols
Author(s): 
William R. Jobin
Reference: 
MWJ 2014, 5, 4
Access: 
Open Access 2.0
 
 
To test the assumption that reductions in malaria in Africa will increase economic productivity, a correlation-regression analysis was conducted to
evaluate the impact ofexpenditures by the US President’s Malaria Initiative for Africa (PMI), and increases in the economic productivity of countries included in the PMI. For the 12 most representative countries the per capita expenditures for malaria suppression in the 2011 budget of the PMI were compared with observed increases in per capita economic productivity. The measure of economic productivity used was the per capita Gross Domestic Product (GDP) for the period 2007 to 2011. With a mean annual expenditure for suppressing malaria slightly above 1 US dollar per capita (range 0.44-3.40), there was a positive but weak correlation of higher expenditures with increased economic productivity. The correlation coefficient r was 0.5. The increase in per capita GDP in these countries over the 4-year period varied between 60 and 200 USD. The slope of the regression line and thus the ratio of benefits to cost from this programme varied slightly between ecologic zones, but the mean was 6.75 to 1. This meant that there was an increase in per capita GDP of $6.75 for every $1 invested per capita in suppressing malaria. The high benefits to cost ratio from the PMI makes suppression of malaria by methods used by the initiative potentially an attractive investment, at least for the near future while the biocides and drugs deployed are still effective.

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Research: Persistence of markers of chloroquine resistance among P. falciparum isolates recovered from two Nigerian communities

February 26, 2014 - 09:30 -- Bart G.J. Knols
Author(s): 
Yetunde A. Olukosi, Muyiwa K. Oyebola, Olusola Ajibaye, Bassey A. Orok, Olugbenga O. Aina, Chimere O. Agomo, Bamidele A. Iwalokun, Samuel K. Akindele, Veronica N.V. Enya, Hilary I. Okoh
Reference: 
MWJ 2014, 5, 3
Access: 
Open Access 2.0
 
We investigated the prevalence of the major markers of chloroquine resistance years after the withdrawal of the drug in Nigeria.
 Finger prick blood samples were collected from participants presenting with symptoms of malaria in Lagos, Nigeria. Thick and thin blood smears were prepared for microscopy and dry blood spots made from malaria-positive participants for parasite DNA extraction. The detection of mutations in the Plasmodium falciparum chloroquine resistance transporter (pfcrt) and P. falciparum multidrug resistance (pfmdr1) genes was performed by nested polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Of the 1527 blood samples that were confirmed by PCR to be P. falciparum positive, 412 and 344 were typed for the molecular detection of pfcrt and pfmdr1 gene mutations, respectively. The mutant alleles of pfcrt were present among 290 (70%) parasite carriers while the pfmdr1 mutant allele was found in 117 (34%) of the total population. There were higher distributions of the mutant alleles for the two loci in Ijede than in Lekki. The observed frequencies of pfcrt mutant alleles in the two parasite populations were in agreement with the expected frequencies predicted by Hardy-Weinberg. In comparing data with studies conducted between 2000 and 2002 in Ijede, we observed an increase in the prevalence of mutant type pfcrt against a marginal decline in the pfmdr1 mutant type. The high frequencies of pfcrt mutation are suggestive of a persistent drug pressure and continuing inefficacy of chloroquine as an antimalarial drug.

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Research: Impact of malaria rapid diagnostic tests on prescription patterns of artemisinin-based combination therapy in Oyo State, Nigeria

February 4, 2014 - 20:10 -- Bart G.J. Knols
Author(s): 
Olusimbo K. Ige, Esther O. Ayandipo
Reference: 
MWJ 2014, 5, 2
Access: 
Open Access 2.0

It has been recommended that the use of ACTs is restricted to only those with confirmed positive malaria diagnosis. The potential benefits of rapid diagnostic tests (RDTs) on anti-malarial drug consumption have been demonstrated in a number of clinical trials. ACT prescribing patterns for febrile patients were compared pre- and post-RDT introduction in 106 Nigerian primary health care facilities. Routine data from the national malaria control programme monthly facility summary forms were extracted for three months before and after the RDT intervention and compared using a ‘before and after’ design. RDT testing rates for patients with fever revealed no trend; mean testing rate in the post RDT period was 64.5%. The mean malaria positivity rate was 71.3%, which equalled a proportional morbidity rate of 45.9% of all fever cases. ACT treatment to confirmed case ratio was consistently above the expected value of one and the ratio of treatment to tested patient exceeded one (mean ratio of 1.1) for the three months post RDT. The absolute number of ACT doses prescribed increased remarkably after the introduction of RDTs. There is notable non-adherence to RDT results, with an increase in ACT prescriptions after the initial introductory period for RDTs. This over reliance on ACTs for the management of non-malaria illness could compromise gains from reducing malaria morbidity and mortality and needs to be addressed urgently.

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Research: Malaria and respiratory syncytial virus as causes of acute febrile illness in an urban paediatric population in Ghana

February 1, 2014 - 19:57 -- Bart G.J. Knols
Author(s): 
Keziah L. Malm, Kofi M. Nyarko, Ernest Kenu, Constance Bart-Plange, Kojo Koram, Gyapong J.O., Seth Owusu-Agyei, George Armah, Fred N. Binka
Reference: 
MWJ 2014, 5, 1
Access: 
Open Access 2.0
 
This study determined the proportion of acute febrile illness in an urban paediatric population that was due to malaria or respiratory syncytial virus (RSV). A hospital based surveillance system recruited children below five years of age reporting with fever (axillary temperature ≥ 37.5°C). Thick blood film from capillary blood taken through a finger prick, was Giemsa-stained and microscopically examined for malaria parasites to confirm malaria diagnosis. Nasopharyngeal aspirate was also examined for RSV by polymerase chain reaction. Out of 481 febrile children, 51(10.8%) were positive for malaria whilst 75 (15.4%) were positive for RSV. Seven of the 75 RSV-positive cases (9.3%) were co-infected with malaria. Based on judgement by clinicians, over 80% of the febrile children were diagnosed and treated as having malaria either alone or in combination with other diseases. It is concluded that the diagnosis and subsequent treatment of patients based solely on clinical diagnosis leads to an over diagnosis of malaria. Improvement in the guidelines and facilities for the diagnosis of non-malaria febrile illness leads to improved malaria diagnosis. 
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Review: Towards malaria elimination and its implication for vector control, disease management and livelihoods in Tanzania

December 30, 2013 - 15:12 -- Bart G.J. Knols
Author(s): 
Leonard E.G. Mboera, Humphrey D. Mazigo, Susan F. Rumisha, Randall A. Kramer
Reference: 
MWJ 2013, 4, 19
Access: 
Open Access 2.0

The objective of this paper was to review the changing landscape of malaria and its implication for disease management, vector control, and livelihoods in Tanzania. It seeks to examine the links within a broad framework that considers the different pathways given the multiplicity of interactions that can produce unexpected outcomes and trade-offs. Despite the remarkable decline in malaria burden, Tanzania is faced with a number of challenges. These include the development of resistance of malaria vectors to pyrethroids, changing mosquito behaviour and livelihood activities that increase mosquito productivity and exposure to mosquito bites. In addition, there are challenges related to health systems, community perceptions, community involvement and sustainability of funding to the national malaria control programme. This review indicates that malaria remains an important and challenging disease that illustrates the interactions among ecosystems, livelihoods, and health systems. Livelihoods and several sectoral development activities including construction, water resource development and agricultural practices contribute significantly to malaria mosquito productivity and transmission. Consequently, these situations require innovative and integrative re-thinking of the strategies to prevent and control malaria. In conclusion, to accelerate and sustain malaria control in Tanzania, the prevention strategies must go hand in hand with an intersectoral participation approach that takes into account ecosystems and livelihoods that have the potential to increase or decrease malaria transmission.

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