Abstract
BackgroundImported malaria is a major challenge for countries that are in malaria elimination stage such as Zambia. Legitimate cross-border activities add to the risk of transmission, necessitating determination of prevalence, characteristics and risk factors of imported and local malaria.MethodsThis cross-sectional study was conducted in 103 consented child and adult patients with clinical malaria symptoms, from selected health facilities in north-western Zambia. Patient demographic data and blood samples for malaria microscopy and full blood count were obtained. Chi-square and penalized logistic regression were performed to describe the characteristics and assess the risk factors of imported and local malaria in North-Western Province.ResultsOverall, malaria prevalence was 78.6% with 93.8% Plasmodium falciparum and 6.2% other species. The local cases were 72 (88.9%) while the imported were 9 (11.1%) out of the 81 positive participants. About 98.6% of the local cases were P. falciparum compared to 55.6% (χ2 = 52.4; p < 0.01) P. falciparum among the imported cases. Among the imported cases, 44% were species other than P. falciparum (χ2 = 48; p < 0.01) while among the local cases only 1.4% were. Gametocytes were present in 44% of the imported malaria cases and only in 2.8% of the local cases (χ2 = 48; p < 0.01). About 48.6% of local participants had severe anaemia compared to 33.3% of participants from the two neighbouring countries who had (χ2 = 4.9; p = 0.03). In the final model, only country of residence related positively to presence of species other than P. falciparum (OR = 39.0, CI [5.9, 445.9]; p < 0.01) and presence of gametocytes (OR = 23.1, CI [4.2, 161.6]; p < 0.01).ConclusionMalaria prevalence in North-Western Province is high, with P. falciparum as the predominant species although importation of Plasmodium ovale and Plasmodium malariae is happening as well. Country of residence of patients is a major risk factor for malaria species and gametocyte presence. The need for enhanced malaria control with specific focus on border controls to detect and treat, for specific diagnosis and treatment according to species obtaining, for further research in the role of species and gametocytaemia in imported malaria, cannot be overemphasized.
Highlights
Imported malaria is a major challenge for countries that are in malaria elimination stage such as Zambia
Based on the characteristics of both the local and imported malaria cases investigated, namely; species, gametocyte presence and severity of anaemia, this study shows that 71 of the 72 local cases (98.6%) were P. falciparum and only one (1.4%) was P. malariae; and five out of nine imported cases (55.6%) were P. falciparum one case was a mixed infection of P. falciparum and P. malariae
Importation of P. ovale and P. malariae is happening in the province through human travel across borders with the two neighbouring countries
Summary
Imported malaria is a major challenge for countries that are in malaria elimination stage such as Zambia. An estimated 228 million malaria cases and 405,000. Chipoya and Shimaponda‐Mataa Malar J (2020) 19:430 deaths were recorded in 2018 compared to 231 million cases and 416,000 deaths in 2017 [2]. The majority of this burden rests on sub-Saharan Africa and India, which carry almost 85% of it [2]. In Zambia, malaria is of concern as it is a major cause of mortality and morbidity [3] in highly endemic areas [4,5,6]. As of 2018, the Ministry of Health reported presumed and confirmed cases of up to 5,193,723 and deaths of up to 1209 [2]
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