Effective Malaria Prevention Research Articles

Utilization of Insecticide Treated Bed Nets among Mothers Attending MCH/FP in Webuye District Hospital, Bungoma County, Kenya

Malaria is the leading cause of morbidity and mortality in Kenya, with close to 70 percent (24 million) of the population at risk of infection. It affects people of all age groups: children under five years of age and pregnant women living in malaria endemic regions who are vulnerable. The main objective was to assess the utilization of the insecticide treated bed nets among the mothers attending MCH/FP in Webuye District Hospital, Bungoma County, Kenya. This research was based at the Webuye District Hospital, Bungoma County, Kenya from February to May, 2013. Sample size included 40 adult mothers attending MCH/FP aged 18 years and above during the study period. The design of the study was cross-sectional where sampling technique employed was non-probabilistic, purposive sampling. Data was collected by interviews using structured questionnaire which was administered by the researchers. SPSS version 16 was employed in Data analysis. The association between the overall knowledge about ITN use and malaria attack and level of education was tested and correlation between knowledge about malaria and ITNs utilization was calculated. Nearly all mothers attending MCH/FP had knowledge about ITNs nets and used it, with majority, 82.5% of the respondents used it for protection and 75% knew the importance of ITNs which were for malaria prevention. A majority of mothers attending MCH/FP were aware of ITNs and used it. Malaria morbidity was influenced by various factors including frequency of ITN use and most respondents interviewed had contracted malaria once before. The difference was found to be highly statistically significant between the overall knowledge about ITN use and malaria attack and level of education (χ2 = 58.7, p = 0.000). There was a significantly moderate positive correlation between total knowledge and ITN utilization (r = 0.449 & p = 0.000). The same was for the frequency of use but it was found to be in a weak magnitude, (r = 0.223 & p = 0.000). There was a strong positive correlation between knowledge about risk which is exposed to the case of non-utilization and the overall knowledge (r = 0.853 & p = 0.000). Based on the above results, it’s recommended that the Ministry of Health increase knowledge of effective malaria prevention and treatment methods in communities where misconceptions and use of unproven prevention and treatment methods are common.

Preventive effect of permethrin-impregnated long-lasting insecticidal nets on the blood feeding of three major pyrethroid-resistant malaria vectors in western Kenya.

BackgroundSince the World Health Organization (WHO) adopted the use of long-lasting insecticidal nets (LLINs) as a principal strategy for effective malaria prevention and control, pyrethroids have been the only class of insecticides used for LLINs. The dramatic success of insecticide-treated nets (ITNs) and LLINs in African countries, however, has been threatened by the rapid development of pyrethroid resistance in vector mosquitoes. ITNs and LLINs are still used as effective self-protection measures, but there have been few studies on the effectiveness of ITNs and LLINs in areas where vector mosquitoes are pyrethroid-resistant.MethodsTo investigate the behavioral pattern of mosquitoes in the houses where LLINs were used, indoor mosquito trappings of Anopheles gambiae s.s., An. arabiensis, and An. funestus s.s. were performed with Centers for Disease Control and Prevention (CDC) miniature light trap equipped with a collection bottle rotator at 2-hour intervals between 4:00 pm and 8:00 am. The trapped female mosquitoes were identified and classified as unfed, blood fed, and gravid. The abdominal contents of fed female mosquitoes were used for DNA extractions to identify the blood source.ResultsA large proportion of human blood feeding of An. arabiensis and An. funestus s.s. (but not An. gambiae s.s.) took place during the time people were active outside LLINs. However, during the hours when people were beneath LLINs, these provided protective efficacy as indicated by reduced human blood feeding rates.ConclusionLLINs provided effective protection against pyrethroid-resistant malaria vector populations during bedtime hours. However, protection of LLINs was insufficient during the hours when people were active outside of the bed nets. Such limitation of LLINs will need to be intensively addressed in African countries in the near future.

Estimates of child deaths prevented from malaria prevention scale-up in Africa 2001-2010.

BackgroundFunding from external agencies for malaria control in Africa has increased dramatically over the past decade resulting in substantial increases in population coverage by effective malaria prevention interventions. This unprecedented effort to scale-up malaria interventions is likely improving child survival and will likely contribute to meeting Millennium Development Goal (MDG) 4 to reduce the < 5 mortality rate by two thirds between 1990 and 2015.MethodsThe Lives Saved Tool (LiST) model was used to quantify the likely impact that malaria prevention intervention scale-up has had on malaria mortality over the past decade (2001-2010) across 43 malaria endemic countries in sub-Saharan African. The likely impact of ITNs and malaria prevention interventions in pregnancy (intermittent preventive treatment [IPTp] and ITNs used during pregnancy) over this period was assessed.ResultsThe LiST model conservatively estimates that malaria prevention intervention scale-up over the past decade has prevented 842,800 (uncertainty: 562,800-1,364,645) child deaths due to malaria across 43 malaria-endemic countries in Africa, compared to a baseline of the year 2000. Over the entire decade, this represents an 8.2% decrease in the number of malaria-caused child deaths that would have occurred over this period had malaria prevention coverage remained unchanged since 2000. The biggest impact occurred in 2010 with a 24.4% decrease in malaria-caused child deaths compared to what would have happened had malaria prevention interventions not been scaled-up beyond 2000 coverage levels. ITNs accounted for 99% of the lives saved.ConclusionsThe results suggest that funding for malaria prevention in Africa over the past decade has had a substantial impact on decreasing child deaths due to malaria. Rapidly achieving and then maintaining universal coverage of these interventions should be an urgent priority for malaria control programmes in the future. Successful scale-up in many African countries will likely contribute substantially to meeting MDG 4, as well as succeed in meeting MDG 6 (Target 1) to halt and reverse malaria incidence by 2015.

Placental malaria prevalence of infestation amongst febrile pregnant women in central India: maternal and perinatal outcome.

To determine the prevalence and impact of placental malaria on maternal and fetal outcome. Cross sectional observational. The Department of Obstetrics of Government NSCB Medical College Hospital, Jabalpur (Madhya Pradesh). Five hundred parturient women with fever or history of fever during the present pregnancy. Subjects were tested for peripheral and placental malaria by thick and thin smear examination. Maternal and perinatal outcome correlated with malaria results. The mean age of the studied subjects was 24.5±2.6years, 60.6% were primigravida, 87.2% had unsatisfactory antenatal care. 89.2% were not using effective malaria prevention measures. Peripheral smear positivity for malaria was detected in 1.8% subjects and placental malaria positivity in 2.2% subjects. The mean Hb was lower in malaric subjects (χ(2)=14.47, p<0.05). Maternal mortality and prematurity was significantly higher in malaria +ve subjects (p<0.001). The mean birth weight in malaria +ve subjects was significantly less (p<0.001). Poor 5min APGAR (p<0.0001) and perinatal mortality (p<0.05) was significantly more common in malaria +ve subjects. Malaria, particularly placental infestation with malarial parasites significantly increases maternal and perinatal morbidity and mortality.

Peoples’ Belief, Attitude, and Practice in the Use of Insecticide Treated Bed Net (ITN): The Case of Serbo, Nada, and Asendabo Towns, Jimma Zone, Southwest Ethiopia.

The effort made to control malaria seems somewhat under the control of those people living in the malarious areas. Moreover, the tendency seems to shift from cure to prevention as malaria doesn’t have effective vaccine or effective drug for mass chemoprophylaxis. Thus, this study was designed to assess the belief, attitude, and practice of ITN use to prevent malaria by peoples of Serbo, Assendabo, and Nada Towns. Samples of 274 people were taken from Serbo, Assendabo, and Omo Nada towns through multi-stage random sampling of lottery method. The response of 264 respondents collected through questionnaire was analyzed and interpreted using SPSS software version 16. The result shows people that have lower perceived susceptibility to malaria (78.8%), lower perceived severity of the disease malaria (73.1%), lower perceived self-efficacy in the use of ITN (56.4%), higher perceived barriers in the use of ITN (68.9%), and lower perceived benefit of ITN (56.4%). In addition, the majority of the subjects (74.6%) were found to have negative attitude towards ITN. Moreover, households mentioned some unintended uses of ITN at home indicating abuse in the use of ITN. These all indicate that the households have misconceptions and misunderstandings about malaria, negative attitude towards ITN, and they don’t have firm belief in ITN to protect them from malaria. More or less, all subjects know that ITN is one of the malaria protection mechanisms. Thus, the majority of the subjects do not use ITN properly and consistently. The majority have low perceived susceptibility to malaria, severity of malaria, benefit of ITN, self-efficacy to use ITN and higher perceived barriers to use ITN properly and consistently. Moreover, the majority of the households have negative attitude for ITN. In addition, some households don’t know how malaria is transmitted and the right preventive measures. Thus, a balance of knowledge, belief, and positive attitude toward ITN should be maintained for effective malaria prevention. Keywords: ITN, Belief, Attitude, Serbo, Asandabo, Omonada

Determinants of insecticide treated nets use among youth corp members in Edo State, Nigeria

BackgroundThe Africa Malaria Report shows that many countries are quite far from reaching the universal coverage targets of 80% coverage by 2010 and maintain it at this level. This paper examines ITN use and the factors associated with its adoption among the youths in Nigeria. This information will help in the design of effective methods of providing and distributing the nets in order to enhance its adoption and maximize the public health benefits of ITNs.MethodsThis cross-sectional survey was carried out in 2006 among university leavers serving compulsory national service (youth corpers) using total sampling technique. The study was conducted using a self-administered questionnaire.ResultsA total of 656 youth corp members were interviewed. Only 23.8% of these youths ever use ITN while 4.3% currently use ITN before reporting in camp. A significant proportion of the youths acquired information on ITN from Mass Media (p = 0.0001). Other statistically significant factors that encourage the use of ITN include inexpensive market price of ITN (p = 0.0001), frequency of Malaria infestation (p = 0.019) and perceived malaria preventive action of ITN ( p = 0.000).Following logistic regression analysis, perceived effective malaria preventive action of ITN [OR = 29.3, C.I = 17.17-50.0] and high frequency of Malaria infestation [OR = 1.55, C.I = 0.97-2.47] were predictors of ITN use.ConclusionThe study shows that the use of ITN for the prevention of Malaria is low among these Nigerian youths. The major factors determining the adoption of ITN among the youths were perceived effective Malaria prevention action of ITN and high frequency of Malaria attack. These factors should be considered in the design of sustainable and effective locally relevant strategies for scale-up adoption of ITNs among a youthful African population.

The clinical burden of malaria in Nairobi: a historical review and contemporary audit

BackgroundWidespread urbanization over the next 20 years has the potential to drastically change the risk of malaria within Africa. The burden of the disease, its management, risk factors and appropriateness of targeted intervention across varied urban environments in Africa remain largely undefined. This paper presents a combined historical and contemporary review of the clinical burden of malaria within one of Africa's largest urban settlements, Nairobi, Kenya.MethodsA review of historical reported malaria case burdens since 1911 within Nairobi was undertaken using archived government and city council reports. Contemporary information on out-patient case burdens due to malaria were assembled from the National Health Management and Information System (HMIS). Finally, an audit of 22 randomly selected health facilities within Nairobi was undertaken covering 12 months 2009-2010. The audit included interviews with health workers, and a checklist of commodities and guidelines necessary to diagnose, treat and record malaria.ResultsFrom the 1930's through to the mid-1960's malaria incidence declined coincidental with rapid population growth. During this period malaria notification and prevention were a priority for the city council. From 2001-2008 reporting systems for malaria were inadequate to define the extent or distribution of malaria risk within Nairobi. A more detailed facility review suggests, however that malaria remains a common diagnosis (11% of all paediatric diagnoses made) and where laboratories (n = 15) exist slide positivity rates are on average 15%. Information on the quality of diagnosis, slide reading and whether those reported as positive were imported infections was not established. The facilities and health workers included in this study were not universally prepared to treat malaria according to national guidelines or identify foci of risks due to shortages of national first-line drugs, inadequate record keeping and a view among some health workers (17%) that slide negative patients could still have malaria.ConclusionCombined with historical evidence there is a strong suggestion that very low risks of locally acquired malaria exist today within Nairobi's city limits and this requires further investigation. To be prepared for effective prevention and case-management of malaria among a diverse, mobile population in Nairobi requires a major paradigm shift and investment in improved quality of malaria diagnosis and case management, health system strengthening and case reporting.

Impact of Malaria at the End of Pregnancy on Infant Mortality and Morbidity

Background. There is some consensus that malaria in pregnancy may negatively affect infant's mortality and malaria morbidity, but there is less evidence concerning the factors involved.Methods. A total of 1030 Mozambican pregnant women were enrolled in a randomized, placebo-controlled trial of intermittent preventive treatment with sulfadoxine-pyrimethamine, and their infants were followed up throughout infancy. Overall mortality and malaria morbidity rates were recorded. The association of maternal and fetal risk factors with infant mortality and malaria morbidity was assessed.Results. There were 58 infant deaths among 997 live-born infants. The risk of dying during infancy was increased among infants born to women with acute placental infection (odds ratio [OR], 5.08 [95% confidence interval (CI), 1.77–14.53)], parasitemia in cord blood (OR, 19.31 [95% CI, 4.44–84.02]), low birth weight (OR, 2.82 [95% CI, 1.27–6.28]) or prematurity (OR, 3.19 [95% CI, 1.14–8.95]). Infants born to women who had clinical malaria during pregnancy (OR, 1.96 [95% CI, 1.13–3.41]) or acute placental infection (OR, 4.63 [95% CI, 2.10–10.24]) had an increased risk of clinical malaria during infancy.Conclusions. Malaria infection at the end of pregnancy and maternal clinical malaria negatively impact survival and malaria morbidity in infancy. Effective clinical management and prevention of malaria in pregnancy may improve infant's health and survival.

Comparison of anaemia and parasitaemia as indicators of malaria control in household and EPI-health facility surveys in Malawi

BackgroundThe World Health Organization has recommended that anaemia be used as an additional indicator to monitor malaria burden at the community level as malaria interventions are nationally scaled up. To date, there are no published evaluations of this recommendation.MethodsTo evaluate this recommendation, a comparison of anaemia and parasitaemia among 6-30 month old children was made during two repeated cross-sectional household (HH) and health facility (HF) surveys in six districts across Malawi at baseline (2005) and in a follow-up survey (2008) after a scale up of malaria control interventions.ResultsHH net ownership did not increase between the years (50.5% vs. 49.8%), but insecticide treated net (ITN) ownership increased modestly from 41.5% (95% CI: 37.2%-45.8%) in 2005 to 45.3% (95% CI: 42.6%-48.0%) in 2008. ITN use by children 6-30 months old, who were living in HH with at least one net, increased from 73.6% (95% CI:68.2%-79.1%) to 80.0% (95% CI:75.9%-84.1%) over the three-year period. This modest increase in ITN use was associated with a decrease in moderate to severe anaemia (Hb <8 g/dl) from 18.4% (95% CI:14.9%-21.8%) in 2005 to 15.4% (13.2%-17.7%) in 2008, while parasitaemia, measured as positive-slide microscopy, decreased from 18.9% (95% CI:14.7%-23.2%) to 16.9% (95% CI:13.8%-20.0%), a relative reduction of 16% and 11%, respectively. In HF surveys, anaemia prevalence decreased from 18.3% (95% CI: 14.9%-21.7%) to 15.4% (95% CI: 12.7%-18.2%), while parasitaemia decreased from 30.6% (95% CI: 25.7%-35.5%) to 13.2% (95% CI: 10.6%-15.8%), a relative reduction of 15% and 57%, respectively.ConclusionIncreasing access to effective malaria prevention was associated with a reduced burden of malaria in young Malawian children. Anaemia measured at the HF level at time of routine vaccination may be a good surrogate indicator for its measurement at the HH level in evaluating national malaria control programmes.

Barriers to the effective treatment and prevention of malaria in Africa: A systematic review of qualitative studies.

BackgroundIn Africa, an estimated 300-500 million cases of malaria occur each year resulting in approximately 1 million deaths. More than 90% of these are in children under 5 years of age. To identify commonly held beliefs about malaria that might present barriers to its successful treatment and prevention, we conducted a systematic review of qualitative studies examining beliefs and practices concerning malaria in sub-Saharan African countries.MethodsWe searched Medline and Scopus (1966-2009) and identified 39 studies that employed qualitative methods (focus groups and interviews) to examine the knowledge, attitudes, and practices of people living in African countries where malaria is endemic. Data were extracted relating to study characteristics, and themes pertaining to barriers to malaria treatment and prevention.ResultsThe majority of studies were conducted in rural areas, and focused mostly or entirely on children. Major barriers to prevention reported included a lack of understanding of the cause and transmission of malaria (29/39), the belief that malaria cannot be prevented (7/39), and the use of ineffective prevention measures (12/39). Thirty-seven of 39 articles identified barriers to malaria treatment, including concerns about the safety and efficacy of conventional medicines (15/39), logistical obstacles, and reliance on traditional remedies. Specific barriers to the treatment of childhood malaria identified included the belief that a child with convulsions could die if given an injection or taken to hospital (10/39).ConclusionThese findings suggest that large-scale malaria prevention and treatment programs must account for the social and cultural contexts in which they are deployed. Further quantitative research should be undertaken to more precisely measure the impact of the themes uncovered by this exploratory analysis.

MALARIA-RELATED HEALTH-SEEKING BEHAVIOUR AND CHALLENGES FOR CARE PROVIDERS IN RURAL ETHIOPIA: IMPLICATIONS FOR CONTROL

A range of activities are currently underway to improve access to malaria prevention and control interventions. As disease control strategies change over time, it is crucial to understand the health-seeking behaviour and the local socio-cultural context in which the changes in interventions operate. This paper reflects on how people in an area of seasonal malaria perceive the causes and transmission of the disease, and what prevention and treatment measures they practise to cope with the disease. It also highlights some of the challenges of malaria treatment for health care providers. The study was undertaken in 2003 in Adami Tulu District in south-central Ethiopia, where malaria is a major health problem. Pre-tested structured questionnaires and focus group discussions were conducted among men and women. Malaria, locally known as busa, was perceived as the most important cause of ill health in the area. Respondent's perception and knowledge about the cause and transmission of the disease were relatively high. The newly introduced insecticide-treated nets were not popular in the area, and only 6.4% of households possessed at least one. The results showed that patients use multiple sources of health care for malaria treatment. Public health facilities, private clinics and community health workers were the main providers of malaria treatment. Despite higher treatment costs, people preferred to use private health care providers for malaria treatment due to the higher perceived quality of care they offer. In conclusion, effort in the prevention and control of malaria should be intensified through addressing not only public facilities, but also the private sector and community-based control interventions. Appropriate and relevant information on malaria should be disseminated to the local community. The authors propose the provision of effective antimalarial drugs and malaria prevention tools such as subsidized or free insecticide-treated nets.

Interactions between HIV and malaria in non-pregnant adults: evidence and implications

Interactions between HIV and malaria in non-pregnant adults: evidence and implications

Accessibility of Insecticide Treated Bed Nets and Intermittent Presumptive Treatment of Malaria to Mozambicans obtaining Healthcare in Southern Malawi: A Case Study of International Disease Control and Equity in Health

This qualitative study utilizing in-depth interviews was carried out to determine whether the Malawian public health system provides equitable access to malaria prevention and treatment facilities for Mozambican nationals attending health care services in three Malawian border districts of Nwanza, Mulanje and Nsanje. Majority of Malawian health workers reported non-discrimination of Mozambican nationals accessing insecticide-treated bed nets (ITNs) and presumptive intermittent treatment for malaria among pregnant women attending antenatal care. In one district however, nets provided by one non-goverbnmental organization were reported to being provided to Malawians only, thus excluding Mozambicans on instruction from the non-governmental organization (NGO) who had supplied the nets. Both Malawian and Mozambican nationals were required to present the ‘Health passport' in order to access ITNs and presumptive intermittent treatment of malaria from the health facilities. For effective prevention and control of malaria in border of Malawi and Mozambique, there is need for the collaboration between governments, including national malaria control programs, non-governmental organizations and civil society. Key Words: insecticide-treated bed nets; border districts, malaria Mary Slessor Journal of Medicine Vol.4(1) 2004: 76-80

Delayed onset of malaria--implications for chemoprophylaxis in travelers.

Most antimalarial agents used by travelers act on the parasite's blood stage and therefore do not prevent late-onset illness, particularly that due to species that cause relapsing malaria. We examined the magnitude of this problem among Israeli and American travelers. We examined malaria surveillance data from Israel and the United States to determine the traveler's destination, the infecting species, the type of chemoprophylaxis used, and the incubation period. In Israel, from 1994 through 1999, there were 300 cases of malaria among returning travelers in which one species of plasmodium could be identified. In 134 of these cases (44.7 percent), the illness developed more than two months after the traveler's return; nearly all of these cases were due to infection with Plasmodium vivax or P. ovale. In 108 of the 134 cases (80.6 percent), the patient had used an antimalarial regimen according to national guidelines. In the United States, from 1992 through 1998, there were 2822 cases of malaria among travelers in which the cause could be evaluated. Late illness developed in 987 (35.0 percent) of these travelers. The infection was due to P. vivax in 811 travelers, P. ovale in 66, P. falciparum in 59, and P. malariae in 51; 614 (62.2 percent) of those with late-onset illness had appropriately taken an effective antimalarial agent. In more than one third of malaria-infected travelers, the illness developed more than two months after their return. Most of these late-onset illnesses are not prevented by the commonly used and effective blood schizonticides. Agents that act on the liver phase of malaria parasites are needed for more effective prevention of malaria in travelers.

Malaria morbidity, treatment-seeking behaviour, and mortality in a cohort of young children in rural Burkina Faso.

To describe the pattern of fever-associated morbidity, treatment-seeking behaviour for fever episodes, and cause-specific mortality in young children of a malaria-holoendemic area in rural Burkina Faso. In a longitudinal community-based intervention study, 709 representative children aged 6-31 months were followed daily over 6 months (including the main malaria transmission period) through village-based field staff. Of 1848 disease episodes, 1640 (89%) were fever episodes, and of those, 894 (55%) were attributed to malaria (fever + > or =5000 parasites/microl). Eighty-five percent of fever episodes were treated, mainly with chloroquine and paracetamol, 69% of treatments took place in households, 16% in local health centres, 13% in villages, and 1% in hospitals. Treatment-seeking in a health centre or hospital was associated with accessibility and disease severity. Cerebral malaria and malnutrition-associated diarrhoea were the most frequently diagnosed causes of death. While most children with a post-mortem diagnosis of diarrhoea had not received any treatment, children who died of malaria had often received insufficient treatment. In particular, there was a lack of an appropriate second-line treatment at formal health services after chloroquine treatment had failed to resolve symptoms. These findings call for more effective prevention and treatment of malaria, malnutrition and diarrhoea in rural African communities, as well as for better supervision of existing malaria treatment guidelines in formal health services.

Malaria epidemiology and control in refugee camps and complex emergencies

Owing to the breakdown of health systems, mass population displacements, and resettlement of vulnerable refugees in camps or locations prone to vector breeding, malaria is often a major health problem during war and the aftermath of war. During the initial acute phase of the emergency, before health services become properly established, mortality rates may rise to alarming levels. Establishing good case management and effective malaria prevention are important priorities for international agencies responsible for emergency health services. The operational strategies and control methods used in peacetime must be adapted to emergency conditions, and should be regularly re-assessed as social, political and epidemiological conditions evolve. During the last decade, research on malaria in refugee camps on the Pakistan-Afghanistan and Thailand-Burma borders has led to new methods and strategies for malaria prevention and case management, and these are now being taken up by international health agencies. This experience has shown that integration of research within control programmes is an efficient and dynamic mode of working that can lead to innovation and hopefully sustainable malaria control. United Nations' humanitarian and non-governmental agencies can play a significant part in resolving the outstanding research issues in malaria control.

Malaria epidemiology and control in refugee camps and complex emergencies

Owing to the breakdown of health systems, mass population displacements, and resettlement of vulnerable refugees in camps or locations prone to vector breeding, malaria is often a major health problem during war and the aftermath of war. During the initial acute phase of the emergency, before health services become properly established, mortality rates may rise to alarming levels. Establishing good case management and effective malaria prevention are important priorities for international agencies responsible for emergency health services. The operational strategies and control methods used in peacetime must be adapted to emergency conditions, and should be regularly re-assessed as social, political and epidemiological conditions evolve. During the last decade, research on malaria in refugee camps on the Pakistan-Afghanistan and Thailand-Burma borders has led to new methods and strategies for malaria prevention and case management, and these are now being taken up by international health agencies. This experience has shown that integration of research within control programmes is an efficient and dynamic mode of working that can lead to innovation and hopefully sustainable malaria control. United Nations' humanitarian and non-governmental agencies can play a significant part in resolving the outstanding research issues in malaria control.

Randomized comparison of mefloquine-artesunate versus quinine in the treatment of multidrug-resistant falciparum malaria in pregnancy

Since no effective malaria prevention measures have been identified for pregnant women living on the western border of Thailand, prompt diagnosis and efficient treatment are paramount, although drug resistance in Plasmodium falciparum has narrowed the treatment options. An open randomized comparison of supervised quinine (10 mg salt/kg every 8 h) for 7 days (Q7) versus mefloquine 25 mg base/kg (total dose) plus artesunate 4 mg/kg per day for 3 days (MAS3) was conducted in 1995–1997 in 108 Karen women with acute uncomplicated falciparum malaria in the second or third trimesters of pregnancy. The MAS3 regimen was more effective than the Q7 regimen: day 63 cure rates were 98·2% (95% CI 94·7·100) ( n = 65) for MAS3 and 67·0% (95% CI 43·3·90·8) ( n = 41) for Q7, P = 0·001. The MAS3 regimen was also associated with less gametocyte carriage; the average person-gametocyte-weeks for MAS3 was 2·3 (95% CI 0–11) and for Q7 was 46·9 (95% CI 26–78) per 1000 person-weeks, respectively ( P < 0·001). MAS3 was significantly better tolerated. These evident advantages must be balanced against a possible increased risk of stillbirth with the use of mefloquine in pregnancy. Further randomized studies assessing the safety and efficacy of other artemisinin-containing combination regimens in pregnancy are needed urgently.

Delayed Neuropsychiatric Effects of Malaria in Ghana

This study investigated the long-term emotional and cognitive effects of malaria infection in a sample of community resident nonmigratory Ghanaian adults, comparing 142 individuals with a documented history of clinical falciparum malaria and 30 controls without a lifetime medical diagnosis of malaria. Results were based on self-report inventory and interview-based approaches to assessment of emotional status as well as individual administration of the Mini-Mental State Examination. Our findings indicated the presence of an enduring, albeit subclinical, mixed anxiety-depression syndrome after medical recovery from falciparum malaria. There were, however, no significant neurocognitive deficits associated with malaria status on the objective screening instrument, nor were there reports of subjective attention, concentration, memory, or other cognitive complaints by self-report. Malaria may be a risk factor for psychiatric morbidity. We therefore recommend a search for effective malaria prevention and intervention strategies to avert the more serious clinical manifestations of mental disorder likely to evolve in this imminently lethal infectious disease.

MALARIA: Principles of Prevention and Treatment

In the United States, effective malaria prevention strategies for short-term travelers are available. Monitoring trends in imported malaria and continued evaluation of the effectiveness and chemoprophylaxis will allow prevention recommendations to evolve as the risk of infection and effectiveness of antimalarial drugs change. Our challenge is to increase the number of prospective travelers receiving pre-travel advice, to disseminate this information to health care providers, and to improve the quality of the advice given. The early recognition of Plasmodium infection and the institution of prompt and effective treatment will reduce morbidity and mortality from malaria in this country.