Confirmed Malaria Cases Research Articles

Malaria notifications in Legal Amazon, Brazil (2003-2022): A Comprehensive Dataset for research & surveillance

Malaria, a life-threatening disease, is preventable and curable. However, the World Health Organization reported alarming statistics for the year 2021, estimating 247 million cases of malaria worldwide, resulting in 619,000 deaths. In Brazil, cases of malaria are concentrated in the region of the Amazon rainforest, known as the Legal Amazon. In response to calls for more research to adapt malaria mitigation and eradication strategies to local conditions, this article presents a dataset based on data collected from the Malaria Epidemiological Surveillance Information System (SIVEP-Malaria) for the period from January 2003 to December 2022 on patients diagnosed with malaria. The pre-processed data set is composed of 1,251,309 records of confirmed malaria cases and included four attributes (Date, Municipality, Test results, and Notifications), attributes considered essential for the development and application of series modeling techniques temporal. By making this dataset available, it is intended to provide researchers with the necessary tools to develop effective strategies for mitigating and eradicating malaria in the region.

Impact of Climate Variability and Interventions on Malaria Incidence and Forecasting in Burkina Faso

Background: Malaria remains a climate-driven public health issue in Burkina Faso, yet the interactions between climatic factors and malaria interventions across different zones are not well understood. This study estimates time delays in the effects of climatic factors on malaria incidence, develops forecasting models, and assesses their short-term forecasting performance across three distinct climatic zones: the Sahelian zone (hot/arid), the Sudano-Sahelian zone (moderate temperatures/rainfall); and the Sudanian zone (cooler/wet). Methods: Monthly confirmed malaria cases of children under five during the period 2015–2021 were analyzed using Bayesian generalized autoregressive moving average negative binomial models. The predictors included land surface temperature (LST), rainfall, the coverage of insecticide-treated net (ITN) use, and the coverage of artemisinin-based combination therapies (ACTs). Bayesian variable selection was used to identify the time delays between climatic suitability and malaria incidence. Wavelet analysis was conducted to understand better how fluctuations in climatic factors across different time scales and climatic zones affect malaria transmission dynamics. Results: Malaria incidence averaged 9.92 cases per 1000 persons per month from 2015 to 2021, with peak incidences in July and October in the cooler/wet zone and October in the other zones. Periodicities at 6-month and 12-month intervals were identified in malaria incidence and LST and at 12 months for rainfall from 2015 to 2021 in all climatic zones. Varying lag times in the effects of climatic factors were identified across the zones. The highest predictive power was observed at lead times of 3 months in the cooler/wet zone, followed by 2 months in the hot/arid and moderate zones. Forecasting accuracy, measured by the mean absolute percentage error (MAPE), varied across the zones: 28% in the cooler/wet zone, 53% in the moderate zone, and 45% in the hot/arid zone. ITNs were not statistically important in the hot/arid zone, while ACTs were not in the cooler/wet and moderate zones. Conclusions: The interaction between climatic factors and interventions varied across zones, with the best forecasting performance in the cooler/wet zone. Zone-specific intervention planning and model development adjustments are essential for more efficient early-warning systems.

Optimizing the Delivery of Routine Malaria Data Quality Assessments: A Two-Level Logistic Regression Model to Inform an Institutionalized Approach in Mozambique.

Mozambique has implemented routine data quality assessments (DQAs) to improve accuracy of health facility (HF) malaria reporting since 2019. However, despite this being a resource-intensive exercise, the impact of operational factors on DQAs has not yet been systematically investigated. This analysis aimed to provide insights into optimizing the operational delivery of routine DQAs. A two-level logistic regression model based on 1,354 DQAs conducted across 195 HFs (16 districts, November 2019-December 2022) was used to estimate the impact of relevant operational factors, namely number of DQAs received, baseline reporting accuracy, HF setting, workload, malaria transmission intensity, and the shift to digital reporting, on accurate reporting by HFs. A report was considered accurate if the deviation between number of confirmed malaria cases in reports and register books was less than 10%. A statistically significant interaction was observed between baseline reporting accuracy and number of DQAs. For HFs with a baseline accuracy of ≤90%, each additional DQA increased the odds of accurate reporting by 102.8% (95% CI: 71.1-140.2%). For HFs with inaccurate data at baseline, the probability of accurate reporting increased to >80% after five DQAs, whereas HFs with accurate baseline data did not improve beyond the baseline visit. Other operational factors did not significantly affect reporting accuracy. Prioritizing HFs with low baseline accuracy for more frequent DQAs (every 6 months) with at least one visit to all HFs every 3 years might optimize resource allocation in Mozambique. Similar analytic approaches can be applied in other countries to optimize resource allocations for the delivery of routine DQAs.

An observational analysis of the impact of indoor residual spraying in two distinct contexts of Burkina Faso

BackgroundIndoor residual spraying (IRS) is a cornerstone malaria control intervention in Burkina Faso. From 2018 to 2021, non-pyrethroid IRS was implemented annually in two regions of Burkina Faso with distinct malaria transmission patterns, concurrently with annual seasonal malaria chemoprevention (SMC), and a mass insecticide-treated net (ITN) distribution in 2019.MethodsA retrospective quasi-experimental approach was used to evaluate the impact of the 2018, 2020, and 2021 IRS campaigns on routinely reported confirmed malaria case incidence at health facilities. The 2019 campaign was excluded due to lack of data reporting during a health sector strike. Controlled interrupted time series models were fit to detect changes in level and trend in malaria case incidence rates following each IRS campaign when compared to the baseline period 24-months before IRS. IRS districts Solenzo (Sudano-Sahelien climate), and Kampti (tropical climate) were compared with neighbouring control districts and the analyses were stratified by region. Modelled health facility catchment population estimates based on travel time to health facilities and weighted by non-malaria outpatient visits were used as an offset. The study period encompassed July 2016 through June 2022, excluding July 2018 to June 2019.ResultsDistrict-level population and structure coverage achieved by IRS campaigns was greater than 85% in 2018, 2020, and 2021 in Solenzo and Kampti. In Solenzo a significant difference in malaria case incidence rates was detected after the 2018 campaign (IRR = 0.683; 95% CI 0.564–0.827) when compared to the control district. The effect was not detected following the 2020 or 2021 IRS campaigns. In Kampti, estimated malaria incidence rates were between 36 and 38% lower than in the control district following all three IRS campaigns compared to the baseline period.ConclusionsImplementation of IRS in Kampti, a tropical region of Burkina Faso, appeared to have a consistent significant beneficial impact on malaria case rates. An initial positive impact in Solenzo after the first IRS campaign was not sustained in the successive evaluated IRS campaigns. This study points to a differential effect of IRS in different malaria transmission settings and in combination with ITN and SMC implementation.

Spatiotemporal, Demographic, and Climatic Drivers of Malaria Transmission in the Endemic Setting of Jazan, Saudi Arabia: A Retrospective Study.

Despite progress, malaria remains endemic in Jazan, Saudi Arabia necessitating updated epidemiological research to guide elimination strategies. This study analyzed recent surveillance data to elucidate drivers of sustained transmission. A retrospective, epidemiological study was conducted using malaria surveillance data from the Jazan region of Saudi Arabia over a 3-year period from January 2018 to December 2020. Deidentified records of all confirmed malaria cases reported across Jazan during the study period were obtained from the Jazan Department of Health infectious disease surveillance system. Additional meteorological data was acquired to assess climatic correlates. The final analysis included 5255 confirmed cases meeting completeness criteria for key variables. Descriptive statistics characterized cases across demographic factors and spatial and temporal distributions. Correlations and linear regression modeling identified associations between monthly cases and weather parameters. Mapping visualized geographic patterns. Of 5255 confirmed cases, most were concentrated in Baish sector (50.8-72.0% annually), affected adult male foreigners (93.8-97.0%), peaked inconsistently across seasons, and were imported (85.4-94.9%). Non-Saudi nationality had 6-fold higher incidence versus Saudi citizens in 2020 (677.6 vs 23.1 per 100,000). Monthly cases associated negatively with temperature (p=0.015) and positively with windspeed (p=0.005). Malaria persistence in Jazan involves geographic and demographic hotspots driven by imported infections and climate effects on vectors. Tailored programming aligned with evolving local dynamics will be essential to sustain elimination gains. Surveillance, optimized interventions, and flexible adaptation to high-risk locations/populations and meteorological influences are key priorities.

Modeling the Impact of Proactive Community Case Management on Reducing Confirmed Malaria Cases in Sub-Saharan African Countries.

Malaria continues to be a major source of morbidity and mortality in sub-Saharan Africa. Timely, accurate, and effective case management is critical to malaria control. Proactive community case management (ProCCM) is a new strategy in which a community health worker "sweeps" a village, visiting households at defined intervals to proactively provide diagnostic testing and treatment if indicated. Pilot experiments have shown the potential of ProCCM for controlling malaria transmission; identifying the best strategy for administering ProCCM in terms of interval timings and number of sweeps could lead to further reductions in malaria infections. We developed an agent-based simulation to model malaria transmission and the impact of various ProCCM strategies. The model was validated using symptomatic prevalence data from a ProCCM pilot study in Senegal. Various ProCCM strategies were tested to evaluate the potential for reducing parasitologically confirmed symptomatic malaria cases in the Senegal setting. We found that weekly ProCCM sweeps during a 21-week transmission season could reduce cases by 36.3% per year compared with no sweeps. Alternatively, two initial fortnightly sweeps, seven weekly sweeps, and finally four fortnightly sweeps (13 sweeps total) could reduce confirmed malaria cases by 30.5% per year while reducing the number of diagnostic tests and corresponding costs by about 33%. Under a highly seasonal transmission setting, starting the sweeps early with longer duration and higher frequency would increase the impact of ProCCM, though with diminishing returns. The model is flexible and allows decision-makers to evaluate implementation strategies incorporating sweep frequency, time of year, and available budget.

A cluster-randomized trial of client and provider directed financial interventions to align incentives with appropriate case management in private medicine retailers: Results of the TESTsmART trial in Lagos, Nigeria.

Malaria remains a major health priority in Nigeria. Among children with fever who seek care, less than a quarter gets tested for malaria, leading to inappropriate use of the recommended treatment for malaria; Artemisinin-based Combination Therapy (ACT). Here we test an innovative strategy to target ACT subsidies to clients seeking care in Nigeria's private retail health sector who have a confirmed malaria diagnosis. We supported point-of-care malaria testing (mRDTs) in 48 Private Medicine Retailers (PMRs) in the city of Lagos, Nigeria and randomized them to two study arms; a control arm offering subsidized mRDT testing for USD $0.66, and an intervention arm where, in addition to access to subsidized testing as in the control arm, clients who received a positive mRDT at the PMR were eligible for a free (fully subsidized) first-line ACT and PMRs received USD $0.2 for every mRDT performed. Our primary outcome was the proportion of ACTs dispensed to individuals with a positive diagnostic test. Secondary outcomes included proportion of clients who were tested at the PMR and adherence to diagnostic test results. Overall, 23% of clients chose to test at the PMR. Test results seemed to inform treatment decisions and resulted in enhanced targeting of ACTs to confirmed malaria cases with only 26% of test-negative clients purchasing an ACT compared to 58% of untested clients. However, the intervention did not offer further improvements, compared to the control arm, in testing rates or dispensing of ACTs to test-positive clients. We found that ACT subsidies were not passed on to clients testing positive in the intervention arm. We conclude that mRDTs could reduce ACT overconsumption in Nigeria's private retail health sector, but PMR-oriented incentive structures are difficult to implement and may need to be complemented with interventions targeting clients of PMRs to increase test uptake and adherence. Trials registration: Clinical Trials Registration Number: NCT04428307. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816435/ Correction: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9476591/.

Impact of seasonal malaria chemoprevention based on the number of medicines doses received on malaria burden among children aged 3-59 months in Nigeria: A propensity score-matched analysis.

Seasonal malaria chemoprevention using sulfadoxine-pyrimethamine plus amodiaquine (sulfadoxine-pyrimethamine plus amodiaquine on Day 1 and amodiaquine on both Day 2 and Day 3) is delivered to children aged 3-59 months in areas of highly season malaria transmission. While the overall population-level impact of seasonal malaria chemoprevention on malaria control has been documented in various countries and time periods, there is no clear evidence regarding seasonal malaria chemoprevention impact based on the number of medicine doses children receive in one cycle in routine programmatic conditions. Data were extracted from Nigeria's routinely collected seasonal malaria chemoprevention end-of-round coverage surveys (2021, 2022). We matched seasonal malaria chemoprevention-targeted children who received specific numbers of seasonal malaria chemoprevention medicines with those who did not receive any doses of seasonal malaria chemoprevention medicines (non-sulfadoxine-pyrimethamine plus amodiaquine) using multiple sets of propensity score matches. We performed multilevel logistic regression for each matched group to evaluate the association between the number of doses of seasonal malaria chemoprevention medicines and monthly confirmed malaria cases (caregiver-reported malaria infection diagnosed by rapid diagnostic test at a health facility following the penultimate cycle of seasonal malaria chemoprevention). Among 21,621 SMC-targeted children, 9.7% received non-sulfadoxine-pyrimethamine plus amodiaquine, 0.5% received only Day 1 sulfadoxine-pyrimethamine plus amodiaquine, 1.0% received Day 1 sulfadoxine-pyrimethamine plus amodiaquine and either Day 2 amodiaquine or Day 3 amodiaquine (sulfadoxine-pyrimethamine plus amodiaquine + amodiaquine), and 88.8% received Day 1 sulfadoxine-pyrimethamine plus amodiaquine and both Day 2 and Day 3 amodiaquine (sulfadoxine-pyrimethamine plus amodiaquine + amodiaquine + amodiaquine). Children receiving only Day 1 sulfadoxine-pyrimethamine plus amodiaquine did not have significant lower odds of rapid diagnostic tests-confirmed malaria than those receiving non-sulfadoxine-pyrimethamine plus amodiaquine (OR 0.77, 0.42-1.42). However, children receiving sulfadoxine-pyrimethamine plus amodiaquine + amodiaquine had significantly lower odds of rapid diagnostic tests-confirmed malaria than those receiving non-sulfadoxine-pyrimethamine plus amodiaquine (OR 0.42, 95% CI 0.28-0.63). Similarly, children receiving sulfadoxine-pyrimethamine plus amodiaquine + amodiaquine + amodiaquine also had significantly lower odds of rapid diagnostic test-confirmed malaria than those receiving non-sulfadoxine-pyrimethamine plus amodiaquine (OR 0.54, 95% CI 0.47-0.62). Adherence to at least one daily dose of amodiaquine administration following receipt of Day 1 sulfadoxine-pyrimethamine plus amodiaquine by eligible children is crucial to ensure the effectiveness of seasonal malaria chemoprevention. This demonstrates the importance of enhancing caregiver awareness regarding the importance of amodiaquine and identifying barriers toward amodiaquine administration at the community level.

The effect of COVID-19 on malaria cases in Zambia: a mixed effect multilevel analysis

BackgroundThe burden of Malaria in Zambia remains a challenge, with the entire population at risk of contracting this infectious disease. Despite concerted efforts by African countries, including Zambia, to implement malaria policies and strategies aimed at reducing case incidence, the region faces significant hurdles, especially with emerging pandemics such as COVID-19. The efforts to control malaria were impacted by the constraints imposed to curb its transmission during the COVID-19 pandemic. The aim of the study was to assess the effect of the COVID-19 pandemic on malaria cases in Zambia and the factors associated by comparing the COVID-19 period and the pre-COVID-19 era.MethodsThis was a cross-sectional panel study in which routinely collected programmatic data on malaria was used. The data were extracted from the Health Management Information System (HMIS) for the period January 2018 to January 2022. The period 2018 to 2022 was selected purely due to the availability of data and to avoid the problem of extrapolating too far away from the period of interest of the study. A summary of descriptive statistics was performed in which the number of cases were stratified by province, age group, and malaria cases. The association of these variables with the COVID-19 era was checked using the Wilcoxon rank-sum test and Kruskal‒Wallis test as applicable. In establishing the factors associated with the number of malaria cases, a mixed-effect multilevel model using the Poisson random intercept and random slope of the COVID-19 panel. The model was employed to deal with the possible correlation of the number of cases in the non-COVID-19 panel and the expected correlation of the number of cases in the COVID-19 panel.ResultsA total of 18,216 records were extracted from HMIS from January 2018 to January 2022. Stratifying this by the COVID-19 period/era, it was established that 8,852 malaria cases were recorded in the non-COVID-19 period, whereas 9,364 cases were recorded in the COVID-19 era. Most of the people with malaria were above the age of 15 years. Furthermore, the study found a significant increase in the relative incidence of the COVID-19 panel period compared to the non-COVID-19 panel period of 1.32, 95% CI (1.18, 1.48, p < 0.0001). The observed numbers, as well as the incident rate ratio, align with the hypothesis of this study, indicating an elevated incidence rate ratio of malaria during the COVID-19 period.ConclusionThis study found that there was an increase in confirmed malaria cases during the COVID-19 period compared to the non-COVID-19 period. The study also found Age, Province, and COVID-19 period to be significantly associated with malaria cases.

Reduction of malaria case incidence following the introduction of clothianidin-based indoor residual spraying in previously unsprayed districts: an observational analysis using health facility register data from Côte d’Ivoire, 2018–2022

BackgroundIndoor residual spraying (IRS) using neonicotinoid-based insecticides (clothianidin and combined clothianidin with deltamethrin) was deployed in two previously unsprayed districts of Côte d’Ivoire in 2020 and 2021 to complement standard...

The Declined Trend of Malaria over a Ten-year Period in the Rural East Nusa Tenggara Province, Indonesia: A Medical Record Analysis

BACKGROUND: Malaria still remains a major public health problem globally including in Indonesia. At present, most of malaria cases are in the eastern part of the country. However, there is no information yet regarding the trends of malaria prevalence at rural health institution particularly at Mangili Public Health Centre. AIM: This study aims to explore the trend of malaria prevalence over a 10-year period. METHODS: A retrospective study was carried out in the center. The laboratory record books from January 2013 to December 2022 were carefully reviewed to identify malaria cases based on the sex, age, type of Plasmodium, year, and month when the patients diagnosed malaria microscopically. The trend analysis was applied to identify the trend of malaria over the period under review. RESULTS: Over the past 10 years, 19,938 blood films were requested for malaria diagnosis at the health center. From this number, 3.679 (18.5%, with 95% confidence interval (CI): 17.2–19.7) were microscopically confirmed malaria cases. From the total cases, prevalence of Plasmodium falciparum (Pf), vivax and mix infection was 85.5% with 95% CI: 84.3–86.8; 6.39% with 95% CI: 3.26–9.51; and 7.58% with 95% CI: 4.48–10.7, respectively. The number of malaria cases reached a peak in January, while it was the lowest in October. Overall trend on the prevalence of malaria decreased significantly; however, the prevalence of Pf increased considerably during COVID-19 pandemic. The prevalence of Pf, vivax, and mixed infection was higher in male, age group ≥ 15, and student than their counterpart. CONCLUSION: Malaria remains high in this area with Pf that is the dominant species followed by mixed infection. Scaling up malaria control and prevention activities is very crucial to significantly reduce the burden of malaria and to boost malaria elimination in this region.

A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: Results of the TESTsmART Trial in western Kenya.

ACTs are responsible for a substantial proportion of the global reduction in malaria mortality over the last ten years, made possible by publicly-funded subsidies making these drugs accessible and affordable in the private sector. However, inexpensive ACTs available in retail outlets have contributed substantially to overconsumption. We test an innovative, scalable strategy to target ACT-subsidies to clients with a confirmatory diagnosis. We supported malaria testing(mRDTs) in 39 medicine outlets in western Kenya, randomized to three study arms; control arm offering subsidized mRDT testing (0.4USD), client-directed intervention where all clients who received a positive RDT at the outlet were eligible for a free (fully-subsidized) ACT, and a combined client and provider directed intervention where clients with a positive RDT were eligible for free ACT and outlets received 0.1USD for every RDT performed. Our primary outcome was the proportion of ACT dispensed to individuals with a positive diagnostic test. Secondary outcomes included proportion of clients tested at the outlet and adherence to diagnostic test results. 43% of clients chose to test at the outlet. Test results informed treatment decisions, resulting in targeting of ACTs to confirmed malaria cases- 25.3% of test-negative clients purchased an ACT compared to 75% of untested clients. Client-directed and client+provider-directed interventions did not offer further improvements, compared to the control arm, in testing rates(RD = 0.09, 95%CI:-0.08,0.26) or dispensing of ACTs to test-positive clients(RD = 0.01,95% CI:-0.14, 0.16). Clients were often unaware of the price they paid for the ACT leading to uncertainty in whether the ACT subsidy was passed on to the client. This uncertainty undermines our ability to definitively conclude that client-directed subsidies are not effective for improving testing and appropriate treatment. We conclude that mRDTs could reduce ACT overconsumption in the private retail sector, but incentive structures are difficult to scale and their value to private providers is uncertain. Trial registration: ClinicalTrials.gov NCT04428307.

Mathematical Modelling of Malaria Transmission Dynamics with Optimal Control Strategies in Kebri Dehar District, Somali Regional State, Ethiopia

Malaria is an infectious disease caused by the Plasmodium parasite and transmitted between humans through bites of female anopheles mosquito. In this study, we present a mathematical model of malaria transmission dynamics with optimal control. We estimated the basic reproduction number for the infected cases in Kebri Dehar district from September 2011 - June 2015 E.C is . The parameters of the model are estimated by using the confirmed malaria cases of Kebri Dehar district, Ethiopia. We formulated the model for malaria and present its dynamics in details. Initially, we present the basic mathematical results and then show briefly the stability results for the model. Further, we formulate an optimal control problem with control functions and obtain the optimal control characterization. The optimal control problem is solved numerically and the results comprised of controls system for different strategies. The controls such as prevention, treatment and insecticide could use the best role in the disease eradication from the community. Our results suggest that the prevention of humans from the mosquitoes, treatment of infected humans and the insecticide spray on mosquitoes can significantly reduce the infection of malaria and may reduce further spread of infection in the community.

Cooperative Sentinel Surveillance of Malaria in Laiza and Nearby Areas of Myanmar and Importation Threat Monitoring - China, 2019-2023.

Laiza and nearby areas (LNA) in Myanmar are identified as the primary malaria hotspots in the bordering regions of Yunnan Province, China. Six sentinel surveillance sites were established at the China-Myanmar border in LNA to monitor malaria. Data from 2019 was used as a baseline to analyze malaria incidence and trends in LNA and Myanmar, as well as the importation of malaria cases into China from 2019 to 2023. Plasmodium vivax was the predominant species, representing 99.95% (14,060/14,066) of confirmed malaria cases in LNA. A total of 8,356 malaria cases were identified in 2023, with an annual parasite incidence (API) of 19.78 per 100 person-years. Compared to 2019, the incidence rate ratio was 21.47 (95% confidence interval: 18.84, 24.48), indicating that the API in 2023 was 21.47 times higher than that in 2019. In Yunnan, out of 1,016 reported cases, 545 imported cases (53.64%) originated from LNA and spread to 18 (13.95%) out of 129 counties. Ten provinces in China, including Yunnan, reported imported malaria cases from LNA in Myanmar. The increase in population, particularly among internally displaced persons, along with inadequate healthcare services, has led to a notable resurgence of malaria in LNA. This resurgence poses a risk to preventing the re-emergence of malaria transmission in China. There is an urgent need for novel collaborative policies, as well as financial and technical assistance, to enhance malaria control efforts in LNA, Myanmar.

Enhancing Understanding of the Impact of Climate Change on Malaria in West Africa Using the Vector-Borne Disease Community Model of the International Center for Theoretical Physics (VECTRI) and the Bias-Corrected Phase 6 Coupled Model Intercomparison Project Data (CMIP6)

In sub-Saharan Africa, temperatures are generally conducive to malaria transmission, and rainfall provides mosquitoes with optimal breeding conditions. The objective of this study is to assess the impact of future climate change on malaria transmission in West Africa using community-based vector-borne disease models, TRIeste (VECTRI). This VECTRI model, based on bias-corrected data from the Phase 6 Coupled Model Intercomparison Project (CMIP6), was used to simulate malaria parameters, such as the entomological inoculation rate (EIR). Due to the lack of data on confirmed malaria cases throughout West Africa, we first validated the forced VECTRI model with CMIP6 data in Senegal. This comparative study between observed malaria data from the National Malaria Control Program in Senegal (Programme National de Lutte contre le Paludisme, PNLP, PNLP) and malaria simulation data with the VECTRI (EIR) model has shown the ability of the biological model to simulate malaria transmission in Senegal. We then used the VECTRI model to reproduce the historical characteristics of malaria in West Africa and quantify the projected changes with two Shared Socio-economic Pathways (SSPs). The method adopted consists of first studying the climate in West Africa for a historical period (1950–2014), then evaluating the performance of VECTRI to simulate malaria over the same period (1950–2014), and finally studying the impact of projected climate change on malaria in a future period (2015–2100) according to the ssp245 ssp585 scenario. The results showed that low-latitude (southern) regions with abundant rainfall are the areas most affected by malaria transmission. Two transmission peaks are observed in June and October, with a period of high transmission extending from May to November. In contrast to regions with high latitudes in the north, semi-arid zones experience a relatively brief transmission period that occurs between August, September, and October, with the peak observed in September. Regarding projections based on the ssp585 scenario, the results indicate that, in general, malaria prevalence will gradually decrease in West Africa in the distant future. But the period of high transmission will tend to expand in the future. In addition, the shift of malaria prevalence from already affected areas to more suitable areas due to climate change is observed. Similar results were also observed with the ssp245 scenario regarding the projection of malaria prevalence. In contrast, the ssp245 scenario predicts an increase in malaria prevalence in the distant future, while the ssp585 scenario predicts a decrease. These findings are valuable for decision makers in developing public health initiatives in West Africa to mitigate the impact of this disease in the region in the context of climate change.

Effects of COVID-19-Associated Infection Control on the Pattern of Infections Imported by German Soldiers and Police Officers Returning from Predominantly Tropical Deployment Sites.

In response to the COVID-19 pandemic, German public health authorities launched various infection control procedures. In line with this, anti-pandemic infection control was also implemented for German military and police deployments. The presented study assessed the impact of this increased infection control effort on deployment-associated infections in a holistic approach. To do so, the results of post-deployment assessments offered to German soldiers and police officers at the Department of Tropical Medicine and Infectious Diseases of the Bundeswehr Hospital Hamburg obtained during the pandemic period were compared to the results recorded during the pre-pandemic period in an exploratory, hypothesis-forming comparative study. In total, data from 1010 military deployments and 134 police deployments, predominantly to the African or the Eastern Mediterranean WHO regions, were included in the analyses. In the main results, a significant decrease in gastroenteritis in deployed soldiers (20.1% versus 61.3%, p < 0.0001) and at least a trend in the same direction in deployed police officers (25.7% versus 35.4%, p = 0.4026) were shown for the pandemic period, while no consistent tendency into the one or the other direction was detectable for febrile illness on deployment. In contrast to the finding of less frequently reported deployment-associated gastroenteritis, the detection rates of enteric microorganisms after deployment, including poor hygiene-related colonization with apathogenic protozoa, remained unchanged. Regarding non-enteric infections, the numbers of serologically confirmed malaria cases on deployment and as expected, due to increased airway protection, Mycobacterium tuberculosis-specific immune-conversion dropped significantly with p = 0.0037 and p = 0.009, respectively. As a side finding, soldiers and police officers with post-deployment medical assessments were more likely to be older and male during the pandemic compared to the pre-pandemic period. In summary, only minor changes in deployment-associated infection and colonization rates were seen in response to the increased infection control procedures during the pandemic period, apart from respiratory infections. In particular, the clinical finding of less gastroenteritis on deployment was not matched by a concordant decline in poor hygiene-related enteric colonization with apathogenic protozoa in the soldiers' guts, indicating that the fecal-oral transmission risk remained basically the same.

Barriers to accessing malaria treatment amongst school-age children in rural Malawi

BackgroundOver the last two decades, many countries have moved from malaria control toward malaria elimination. However, some sub-Saharan African countries, like Malawi, have recently seen a reversal in malaria control progress with reported increases in confirmed malaria cases. This may be the result of inadequate access to effective malaria control interventions by key population groups that perpetuate transmission. This study aimed to assess the barriers to accessing malaria treatment among school-aged children (SAC) in Malawi.MethodsA qualitative study was conducted between September and October 2020, where data were gathered in rural Malawi using free-listing interviews, key-informant interviews, semi-structured interviews and focus group discussions. Purposively sampled participants included SAC, parents of SAC, health workers and key stakeholders at community and district levels. Interviews were digitally recorded and transcribed verbatim. Data were organized using NVivo 12 software and analysed using the thematic method.ResultsThe study recruited 252 participants, with 156 being SAC, equally divided between boys and girls. Health system barriers to malaria treatment included long waiting hours and queues at clinics, frequent stock-outs of medical supplies, and travel time to the facility. Provider barriers included negative attitude and limited service hours. Individual and cultural barriers included fear of malaria tests and beliefs associating witchcraft as the best treatment for malaria. In addition, COVID-19-related barriers included the inability to follow preventive measures, a shift in focus from malaria to COVID-19, and fear of contracting COVID-19 and/or being tested for COVID-19 at the facility.ConclusionsThis study shows most of the barriers to accessing malaria treatment among SAC are similar to those experienced by other population groups. Furthermore, COVID-19 adversely affected SAC’s access to treatment. Interventions that support SAC access to prompt diagnosis and treatment are urgently needed to improve the effective control of malaria.

Spatial econometric modeling of malaria distribution in Burkina Faso

This study focuses on the spatial distribution of malaria rate in Burkina Faso. For this purpose, we used 2020 geographical and confirmed malaria cases data from the National Institute of Statistics and Demography of Burkina Faso. We also accessed climate data on the French weather history website. We deployed relevant spatial statistical tools to address the notions of neighborhood matrix, spatial autocorrelation, and spatial heterogeneity between geographical observations. Ordinary Least Squares (OLS) regression model, Spatial Error Model (SEM), Spatial Autoregressive model (SAR), and the spatial Durbin Model (SDM) were computed using cross-validation to ensure the reliability of our findings. The Akaike information criterion (AIC) was used to select the most appropriate model for our study. The specification tests conclude that there is a spatial dependence between the observations. The SDM was chosen as the best-fitting data for modeling geolocated malaria rates. This outcome reveals that environmental indicators, population literacy rate, and rural population size by region significantly affect the country’s geolocated malaria rate. Policymakers can use these findings to make informed decisions related to malaria spread.

Confirmed Malaria Cases in Children under Five Years: The Influence of Suspected Cases, Tested Cases, and Climatic Conditions

Tropical and potentially fatal malaria is brought on by the parasite Plasmodium spp which spreads through infected female anopheles mosquitoes within the human populations. In Ghana, malaria is endemic and perennial, with distinct seasonal fluctuations in the northern part. Children aged below five years are among the population most vulnerable to malaria in Ghana. This study’s goal is to establish how suspected malaria cases, tested malaria cases, and climatic conditions impact confirmed malaria cases in children under five years in the Sunyani Municipality, Bono Region, Ghana. The dependent variable, monthly number of confirmed cases of malaria in children under five years, was modelled with the independent variables, monthly number of tested cases of malaria in children under five years, mean monthly relative humidity, mean monthly rainfall, and mean monthly temperature, in the Sunyani Municipality. We employed multiple linear regression after data transformation, exploratory data analysis, and correlation analysis. Results show that tested malaria cases and climatic factors significantly influence confirmed malaria cases in children under 5 years. About 41.8% of variations in confirmed malaria cases among children under 5 years is attributed to climatic factors and the number of tested cases. Moreover, results show that increase in tested cases and rainfall leads to more confirmed malaria cases among children under 5 years, while increase in temperature reduces malaria infections. To reduce the incidence of malaria in children under five years, the government and its stakeholders should encourage parent to let their children sleep in treated mosquito nets, distil stagnant waters during raining seasons, spray bushes with antimosquito insecticides, and destroy all breeding grounds of mosquitoes at all times. We proposed that all malaria cases should be laboratory tested and properly confirmed.

Malaria prevalence in Mauritania: a systematic review and meta-analysis

BackgroundUnderstanding malaria epidemiology is a critical step toward efficient malaria control and elimination. The objective of this meta-analysis was to derive robust estimates of malaria prevalence and Plasmodium species from studies conducted in Mauritania and published since 2000.MethodsThe present review followed the PRISMA guidelines. Searches were conducted in various electronic databases such as PubMed, Web of Science, and Scopus. To obtain pooled prevalence of malaria, meta-analysis was performed using the DerSimonian-Laird random-effects model. Methodological quality of eligible prevalence studies was assessed using Joanna Briggs Institute tool. Inconsistency and heterogeneity between studies were quantified by the I2 index and Cochran’s Q test. Publication bias was assessed with funnel plots and Egger’s regression tests.ResultsA total of 16 studies with a good individual methodological quality were included and analysed in this study. The overall random effects pooled prevalence of malaria infection (symptomatic and asymptomatic) across all included studies was 14.9% (95% confidence interval [95% CI]: 6.64, 25.80, I2 = 99.8%, P < 0.0001) by microscopy, 25.6% (95% CI: 8.74, 47.62, I2 = 99.6%, P < 0.0001) by PCR and 24.3% (95% CI: 12.05 to 39.14, I2 = 99.7%, P < 0.0001) by rapid diagnostic test. Using microscopy, the prevalence of asymptomatic malaria was 1.0% (95% CI: 0.00, 3.48) against 21.46% (95% CI: 11.03, 34.21) in symptomatic malaria. The overall prevalence of Plasmodium falciparum and Plasmodium vivax was 51.14% and 37.55%, respectively. Subgroup analysis showed significant variation (P = 0.039) in the prevalence of malaria between asymptomatic and symptomatic cases.ConclusionPlasmodium falciparum and P. vivax are widespread in Mauritania. Results of this meta-analysis implies that distinct intervention measures including accurate parasite-based diagnosis and appropriate treatment of confirmed malaria cases are critical for a successful malaria control and elimination programme in Mauritania.