From Endemic to Epidemic: A Qualitative District-Level Assessment of an Increase in Malaria Cases in the Elgon Region of Uganda.

Human malaria is a parasitic disease that affects about 500 million people in the world, causing nearly one million deaths each year. The main objective of this study was to reveal the epidemiological profile of malaria in municipality of Sinop based in fourteen years of analysis (2001 - 2015). The retrospective study was based on secondary data stored Malaria Epidemiological Surveillance System-Malaria (SIVEP-Malaria) of the Health Surveillance Office at the Ministry of Health, available online. Based on epidemiological analysis the results showed that the frequency of malaria decreased as from 2003 to 2012, where there was an expressive increase in malaria cases. Malaria was predominantly autochthonous in Sinop and P. vivax was predominant specie in all years under study. The study revealed areas with the highest incidence of malaria and the influence of factors related to maintenance and disease transmission. Based on epidemiological profile of malaria in Sinop, disease is not only a public health problem but political, environmental and socioeconomic. It is necessary maintain epidemiological surveillance through of rapid diagnosis and effective treatment of patients.

BackgroundProlonging net durability has important implications for reducing both malaria transmission and the frequency of net replacement. Protective behaviour, such as net care and repair, offers promise for improving net integrity and durability. Given the potential cost-savings and public health benefit associated with extending the useful life of long-lasting insecticidal nets (LLINs), prevention and mitigation of damage will become ever more critical to ensuring adequate net coverage at the population level.MethodsA qualitative assessment was conducted in two districts in central eastern Uganda in September 2013. Data on household net care and repair behaviour, attitudes and practices were collected from 30 respondents through in-depth interviews (IDIs), observations, photos, and video to gather an in-depth understanding of these behaviours.ResultsNet damage was common and the most cited causes were children and rodents. Responses revealed strong social norms about net cleanliness and aesthetics, and strong expectations that others should care for and repair their own nets. Respondents were receptive and able to repair nets, though longer-term repair methods, such as sewing and patching, were not as commonly reported or observed. Self-reported behaviour was not always consistent with observed or demonstrated behaviour, revealing potential misconceptions and the need for clear and consistent net care and repair messaging.ConclusionsRespondents considered both aesthetics and malaria protection important when deciding whether, when, and how to care for and repair nets. BCC should continue to emphasize the importance of maintaining net integrity for malaria prevention purposes as well as for maintaining aesthetic appeal. Additional research is needed, particularly surrounding washing, drying, daily storage routines, and gender roles in care and repair, in order to understand the complexity of these behaviours, and refine existing or develop new behaviour change communication (BCC) messages for net care and repair.

Introduction: Corona virus disease (COVID-19) is one of the topmost global hindrances to human existence. Rural settings have been reported to be more vulnerable in some parts of the world. In Uganda, community leaders in rural villages are among the immediate personnel mandated to support compliance with preventive guidelines, and to identify and report/deliver COVID-19 cases to health units. We examined the potential risks of COVID-19 transmission, knowledge levels, perceptions and opinions of Village Council Leaders (VCLs) in selected districts in Eastern Uganda, to support the design of risk-based COVID-19 control measures in rural settings, to protect lives better. Methodology: A convenience sample of ten VLCs were purposively selected in three districts in Eastern Uganda. Pretested questionnaires and in-depth interviews were used to assess the knowledge levels, perceptions, and opinions of respondents about COVID-19. An observational survey was also conducted to examine the barriers to effective control of COVID-19, with reference to health guidelines set by the Ugandan government and the World Health Organization. Data was analyzed using HyperRESEARCH 2.8 software, and STATA version-15.0. Results: Eighty percent of VCLs reported that they were formally engaged in the fight against COVID-19, and the common means of engagement were; dissemination of COVID-19 information by word of mouth, regulation of public events, and monitoring of visitors that come from distant places. All clients reported having received some information about this pandemic, but there was generally low knowledge on some vital aspects: 70% of the respondents did not know the meaning of COVID-19; 100% were uninformed on these common symptoms; headache, sore throat, nausea, and loss of taste & smell; 10% did not know if willingness to conform to health guidelines may affect COVID-19 prevention, and they believed that domestic animals are viable vectors. Radio was the commonest source of COVID-19 information, but it was confounded by poor quality of radio-signals. Most respondents were of the view that in the communities they lead; inaccessibility to authentic health information, financial constraints, and belief that COVID-19 is a fallacy, were some of the leading obstacles to the fight against the pandemic. Low awareness and misconceptions on COVID-19 could be explained by; technological challenges, low literacy levels, and dissemination of wrong information about this pandemic. From the observational survey, the major factors which might intensify the risk of COVID-19 spread were: scarcity of requirements for hand hygiene, face protection, violation of health guidelines and directives, porous borders, terrain, and use of potentially polluted open water sources. Conclusion: Communities in Eastern Uganda are vulnerable to the drastic spread of COVID-19 due to challenges related to: low awareness, poor compliance with preventive guidelines, finances, technology, terrain, illiteracy, scarcity of protective wear and hygiene resources. Awareness creation, material aid, execution of preventive rules, and more research on COVID-19 are warranted.

Malaria remains a significant public health challenge in Ethiopia, hindering the country's productivity and development. While malaria incidence had decreased by 2018, and Ethiopia is working towards eliminating the disease by 2030, outbreaks still occur even in areas of low endemicity. Therefore the aim of this study was to assess the ten-year trend in malaria prevalence from 2015 to 2024 at Bichena Primary Hospital in the Amhara region of northwestern Ethiopia. A retrospective review of malaria blood film examination results was conducted using laboratory registration logbooks at Bichena Primary Hospital. Data collection was carried out from December 30, to January 14. The data were collected using a data collection sheet and entered into the Statistical Package for Social Sciences (SPSS) version for analysis. Bi-variable and multi-variable regression analyses and Pearson's chi-square test were used to examine associations and differences in malaria prevalence trends across factors such as sex, age, year, and season and Plasmodium species. Descriptive statistics were also used to summarize the sociodemographic characteristics of the study participants and the results were presented in graphs, tables and texts. Out of the 24,107 malaria blood films examined, 4,322 (17.9%, 95% CI: 17.4%-18.4%) tested positive for Plasmodium infections. Of the confirmed cases, 58.7% were P. vivax, 28.6% were P. falciparum, and 12.2% were mixed infections. P. vivax was the predominant species throughout the study period (2015-2024), except for the years 2016 and 2018, when P. falciparum was more prevalent. Subsequently, an increase in malaria cases was reported, with the highest proportion recorded in 2024 (26.8%) and the lowest in 2018 (4%). The likelihood of malaria prevalence was 1.28 times higher in males than in females. Additionally, the chance of malaria prevalence was 1.27 times higher in the 15-24 age group compared to other age groups. The study revealed a significant rise in malaria prevalence, highlighting that malaria remains a major public health issue in the study area. There were also pronounced seasonal variations in malaria cases each year, with males and younger adults being more affected than females, older age groups, and children under five. Malaria prevention and control efforts need to be strengthened, focusing on regional differences. Ongoing research on diagnostic challenges, parasite elimination, and mosquito infectivity after malaria treatment is essential.

Quality laboratory services are a requisite to guide rational case management of malaria. Using a pre-tested, standardized assessment tool, we assessed laboratory diagnostic capacity in 69 primary, secondary and tertiary health facilities as well as specialized laboratories in five administrative zones in Oromia Regional State, Ethiopia, during February and March 2009. There was marked variability in laboratory diagnostic capacity among the facilities assessed. Of 69 facilities surveyed, 53 provided both comprehensive malaria laboratory diagnosis and outpatient treatment services, five provided malaria microscopy services (referring elsewhere for treatment), and 11 primary care health posts provided rapid diagnostic testing and outpatient malaria treatment. The facilities' median catchment population was 39, 562 and 3581 people for secondary/tertiary and primary health facilities, respectively. Depending on facility type, facilities provided services 24 hrs a day, had inpatient capacity, and access to water and electricity. Facilities were staffed by general practitioners, health officers, nurses or health extension workers. Of the 58 facilities providing laboratory services, 24% of the 159 laboratory staff had received malaria microscopy training in the year prior to this survey, and 72% of the facilities had at least one functional electric binocular microscope. Facilities had variable levels of equipment, materials and biosafety procedures necessary for laboratory diagnosis of malaria. The mean monthly number of malaria blood films processed at secondary/tertiary facilities was 225, with a mean monthly 56 confirmed parasitologically. In primary facilities, the mean monthly number of clinical malaria cases seen was 75, of which 57 were tested by rapid diagnostic test (RDTs). None of the surveyed laboratory facilities had formal quality assurance/quality control protocols for either microscopy or RDTs. This is the first published report on malaria diagnostic capacity in Ethiopia. While our assessment indicated that malaria laboratory diagnosis was available in most facilities surveyed, we observed significant gaps in laboratory services which could significantly impact quality and accessibility of malaria diagnosis, including laboratory infrastructure, equipment, laboratory supplies and human resources.

Background2015 was the target year for malaria goals set by the World Health Assembly and other international institutions to reduce malaria incidence and mortality. A review of progress indicates that malaria programme financing and coverage have been transformed since the beginning of the millennium, and have contributed to substantial reductions in the burden of disease.FindingsInvestments in malaria programmes increased by more than 2.5 times between 2005 and 2014 from US$ 960 million to US$ 2.5 billion, allowing an expansion in malaria prevention, diagnostic testing and treatment programmes. In 2015 more than half of the population of sub-Saharan Africa slept under insecticide-treated mosquito nets, compared to just 2 % in 2000. Increased availability of rapid diagnostic tests and antimalarial medicines has allowed many more people to access timely and appropriate treatment. Malaria incidence rates have decreased by 37 % globally and mortality rates by 60 % since 2000. It is estimated that 70 % of the reductions in numbers of cases in sub-Saharan Africa can be attributed to malaria interventions.ConclusionsReductions in malaria incidence and mortality rates have been made in every WHO region and almost every country. However, decreases in malaria case incidence and mortality rates were slowest in countries that had the largest numbers of malaria cases and deaths in 2000; reductions in incidence need to be greatly accelerated in these countries to achieve future malaria targets. Progress is made challenging because malaria is concentrated in countries and areas with the least resourced health systems and the least ability to pay for system improvements. Malaria interventions are nevertheless highly cost-effective and have not only led to significant reductions in the incidence of the disease but are estimated to have saved about US$ 900 million in malaria case management costs to public providers in sub-Saharan Africa between 2000 and 2014. Investments in malaria programmes can not only reduce malaria morbidity and mortality, thereby contributing to the health targets of the Sustainable Development Goals, but they can also transform the well-being and livelihood of some of the poorest communities across the globe.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0151-8) contains supplementary material, which is available to authorized users.

BackgroundConsistent use of insecticide-treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp) have been recommended as cost-effective interventions for malaria prevention during pregnancy in endemic areas. However, the coverage and utilization of these interventions during pregnancy in sub-Saharan Africa is still suboptimal. This study aimed to determine the uptake of IPTp and ITNs and associated factors among women during their recent pregnancy in Eastern Uganda.MethodsThis was a cross-sectional study conducted among 2062 women who had delivered within the last 12 months prior to the start of the study in three districts of Eastern Uganda. The primary outcomes were consistent ITN use and optimal uptake (at least 3 doses) of IPTp. A modified Poisson regression was used to examine the association between consistent ITN use and the uptake of optimal doses of IPTp with independent variables. Data were analysed using Stata 14 software.ResultsThe level of uptake of IPTp3 (at least three doses) was 14.7%, while IPTp2 (at least two doses) was 60.0%. The majority (86.4%) of mothers reported regularly sleeping under mosquito nets for the full duration of pregnancy. Uptake of IPTp3 was associated with engaging in farming (adjusted PR = 1.71, 95% CI [1.28–2.28]) or business (adjusted PR = 1.60, 95% CI [1.05–2.44]), and attending at least 4 antenatal care (ANC) visits (adjusted PR = 1.72, 95% CI [1.34–2.22]). On the other hand, consistent ITN use was associated with belonging to the fourth wealth quintile (adjusted PR = 1.08, 95% CI [1.02–1.14]) or fifth wealth quintile (adjusted PR = 1.08, 95% CI [1.02–1.15]), and attending at least 4 ANC visits (adjusted PR = 1.07, 95% CI [1.03–1.11]).ConclusionUptake of IPTp3 and consistent ITN use during pregnancy were lower and higher than the current Ugandan national targets, respectively. Study findings highlight the need for more efforts to enhance utilization of ANC services, which is likely to increase the uptake of these two key malaria preventive measures during pregnancy.

Role of vector control in fighting against malaria: Evidence from Ethiopian health-related indicators

Malaria is a leading cause of morbidity and mortality in Uganda. In June 2019, the Uganda Ministry of Health through routine surveillance data analysis was notified of an increase in malaria cases in Bumbobi and Nyondo Sub-counties, Mbale District, which exceeded the action thresholds. We investigated to assess outbreak magnitude, identify transmission risk factors, and recommend evidence-based control measures. We defined a confirmed case as a positive malaria result using malaria Rapid Diagnostic Test or microscopy from 1 Jan 2019 to 30 Jun 2019 in a resident or visitor of Bumbobi or Nyondo Sub-county, Mbale District. We reviewed medical records to develop a line list for descriptive epidemiology. In a case-control study, we compared exposures between 150 case-persons and 150 age- and village-matched asymptomatic controls. We conducted environmental and entomological assessments on vector dynamics and behavior. We identified 7,891 case-persons (attack rate [AR]=26%). Females (AR=36%) were more affected than males (AR=25%). The 5-18 year age group (AR=26%) was most affected. The epidemic curve showed steady increase in malaria cases from March following intermittent rainfall from January, with short spells of no rainfall up to June. In the matched pair case-control analysis, 95% (143/150) of case-patients and 49% (73/150) of controls had soil erosion control pits near their homes that held stagnant water for several days following rainfall (AOR=18, 95%CI=7-50); Active breeding sites were found near and within homesteads with Anopheles gambiaeas the predominant vector. Increased vector breeding sites due to erosion control pits sustained by the intermittent rainfall caused this outbreak. We recommended draining of pits immediately after the rains and increasing coverage for bed-nets.

Machine learning models for predicting residual malaria infections using environmental factors: A case study of the Jazan region, Kingdom of Saudi Arabia

There has been a conspicuous increase in malaria cases since 2016/2017 over the three malaria-endemic provinces of South Africa. This increase has been linked to climatic and environmental factors. In the absence of adequate traditional environmental/climatic data covering ideal spatial and temporal extent for a reliable warning system, remotely sensed data are useful for the investigation of the relationship with, and the prediction of, malaria cases. Monthly environmental variables such as the normalised difference vegetation index (NDVI), the enhanced vegetation index (EVI), the normalised difference water index (NDWI), the land surface temperature for night (LSTN) and day (LSTD), and rainfall were derived and evaluated using seasonal autoregressive integrated moving average (SARIMA) models with different lag periods. Predictions were made for the last 56 months of the time series and were compared to the observed malaria cases from January 2013 to August 2017. All these factors were found to be statistically significant in predicting malaria transmission at a 2-months lag period except for LSTD which impact the number of malaria cases negatively. Rainfall showed the highest association at the two-month lag time (r=0.74; P<0.001), followed by EVI (r=0.69; P<0.001), NDVI (r=0.65; P<0.001), NDWI (r=0.63; P<0.001) and LSTN (r=0.60; P<0.001). SARIMA without environmental variables had an adjusted R2 of 0.41, while SARIMA with total monthly rainfall, EVI, NDVI, NDWI and LSTN were able to explain about 65% of the variation in malaria cases. The prediction indicated a general increase in malaria cases, predicting about 711 against 648 observed malaria cases. The development of a predictive early warning system is imperative for effective malaria control, prevention of outbreaks and its subsequent elimination in the region.

The city of Sabang has become a model for Indonesia in malaria elimination. However, currently, there is an increase in malaria cases again in Sabang City and the emergence of a new parasite species, namely Plasmodium knowlesi was transmitted through Macaca fascicularis. This study aims to analyze the influence of environmental, physical, chemical, and biological factors on the prevalence of malaria in Sabang City. This type of research is an observational survey with a cross-sectional design with a sampling technique using cluster-random sampling with a total sample of 100 houses in four research villages. Data was collected using interviews, inspections, and environmental observations carried out on 100 selected houses. Data was analyzed using statistics, univariate in the form of percentage distribution, Chi-square bivariate, and multivariate using logistic regression with the Stepwise method. Surveys of adult mosquitoes were caught at night, from 19.00 to 07.00 once in three houses in 4 villages in the research location. The results of this study showed that the physical environment (p=0.0001), the biological environment (p=0.021), and the chemical environment (p=0.011) were significantly associated with malaria cases. The physical environment was the most influential predictor of malaria cases (OR: 11.096).

In Gabon, a new national malaria control policy was implemented in 2003. It resulted in a decrease in the number of malaria cases in the country. In March 2020, the disruption of routine health services due to the COVID-19 pandemic has led to an increase in cases and deaths due to malaria. However, in Franceville, south-east Gabon, no data on malaria cases recorded before, during and after the COVID-19 epidemic has been published. Thus, the objective of this study was to determine the epidemiological characteristics of malaria in Franceville from 2019 to 2021. A retrospectively study of malaria cases was performed at the Hôpital de l'Amitié Sino-Gabonaise (HASG). Information regarding age, gender, malaria diagnosis by microscopy and hematology cell count were collected from laboratory registers from June 2019 to December 2021. Malaria data were analyzed and correlated with seasonal variations. The data of 12,695 febrile patients were collected from the laboratory registers of the HASG, among which 4252 (33.5%) patients were found positive for malaria. The malaria prevalence was 37.5% in 2020 year. This prevalence was highest compared to the 2019 (29.6%) and 2021 (31.5%) year (p < 0.001). During the short rainy season (October to December), a large increase in malaria cases was observed all three year, from 2019 to 2021 (p > 0.05). The prevalence of malaria in Franceville was very high during COVID-19 pandemic. It is therefore necessary to strengthen existing interventions and implement more effective interventions.

Introduction : South Africa (SA) has set a goal of malaria elimination by 2018. Malaria remains a major public health challenge in Vhembe and Mopani districts, Limpopo province-two of the five malaria endemic districts in SA. On 2 May 2017, health facilities in the two districts reported an unusual increase of malaria cases. Investigations were conducted to establish existence, magnitude and cause of the outbreak, to recommend control measures for the current outbreak and future prevention. Methods : a cross-sectional investigation was conducted. Discussions with key stakeholders were held. We reviewed malaria case data collected through the Limpopo provincial malaria information system from April to May 2017. We defined a case as a person with malaria confirmation by microscopy or a rapid diagnostic test (RDT) in health facilities of the two districts from April to May 2017. Results : a total of 5 662 cases, 55.3% in Mopani, were reported with a peak in May 2017.Investigation of likely origin revealed that 5 574 (98.4%) were local cases in both districts. Fifty-four malaria deaths were reported, majority 42 (77.8%) in Mopani district. The median age of the patients who died was 44 years (IQR 35-60) with 0.95% case fatality rate (CFR). 99.9% of all cases were Plasmodium Falciparum. Indoor residual spraying (IRS) coverage was less than WHO recommended 80% universal coverage for control. An environmental assessment revealed that 2016/17 season recorded higher levels of rainfall and temperature compared to previous malaria season. Key stakeholder interviews revealed that the outbreak in the province was associated with late commencement of IRS due to late appointment of spray teams; reduced use of Dichlorodiphenyltrichloroethane (DDT) which was replaced by pyrethroids (K-Othrine and Deltamethrine); and stock outs of RDTS and anti-malaria drugs in clinics. Conclusion : the investigation established that the marked increase in malaria cases in Vhembe and Mopani districts was not a seasonal phenomenon but rather an outbreak. We recommended a community awareness program through local radio stations on malaria prevention and treatment; improved supply chain of RDTs and antimalarial drugs to prevent stock outs; budget allocation for procurement of DDT and advance appointment of IRS teams.

BackgroundThe World Health Organization recommends cervical cancer screening and vaccination programmes as measures to combat cervical cancer. The uptake of these measures remains low in Uganda, most especially in rural areas. An understanding of the factors that influence women’s decision to attend screening, and willingness to have their daughters vaccinated against cervical cancer is essential for any attempts to increase uptake of these services. This study assessed the factors associated with intention to screen for cervical cancer among women in eastern Uganda, and willingness to have their daughters vaccinated against the disease.MethodsThis cross sectional study involved 900 females aged 25 to 49 years in Bugiri and Mayuge districts in eastern Uganda. Data were collected using a pretested semi-structured questionnaire, entered in Epidata version 3.02 and analysed in STATA version 12.0. Unadjusted and adjusted prevalence ratios (PR) were computed using a generalized linear model with Poisson family, and a log link with robust standard errors.ResultsMajority 819 (91.0%) of respondents stated that they intended to go for cervical cancer screening in the subsequent six months. Among them, 603 (73.6%) wanted to know their status, 256 (31.3%) thought it was important, 202 (24.7%) wanted to reduce their chances of getting the disease, and 20 (2.4%) had been told to do so by a health worker. Majority 813 (90.4%) of respondents were willing to vaccinate their daughters against cervical cancer. Higher income (adjusted PR = 1.11, 95% CI: 1.03–1.20), cervical cancer screening status (adjusted PR = 0.81, 95% CI: 0.67–0.99) and knowledge of at least one test for cervical cancer (adjusted PR = 0.92, 95% CI: 0.85–0.98) were significantly associated with intention to screen for cervical cancer. No socio-demographic characteristic was associated with willingness to vaccinate daughters among women.ConclusionThere is a very high intention to screen and willingness to vaccinate daughters against cervical cancer among women in eastern Uganda. To take advantage of this, there is need to avail opportunities for women to access cervical cancer screening and vaccinations particularly among rural communities.