Low Prevalence Of Malaria Research Articles

Why some countries but not others? Urbanisation, GDP and endemic disease predict global SARS-CoV-2 excess mortality patterns

ContextThe global impact of the SARS-CoV-2 pandemic has been uneven, with some regions experiencing significant excess mortality while others have been relatively unaffected. Yet factors which predict this variation remain enigmatic, particularly at large spatial scales.ObjectivesWe aimed to uncover the key drivers of excess mortality across countries and regions to help understand the factors contributing to the varied impacts of the pandemic worldwide.MethodsWe used spatially explicit Bayesian models that integrate environmental, socio-demographic and endemic disease data at the country level to provide robust global estimates of excess SARS-CoV-2 mortality (P-scores) for the years 2020 and 2021.ResultsWe find that urbanization, gross domestic product (GDP) and spatial patterns are strong predictors of excess mortality, with countries characterized by low GDP but high urbanization experiencing the highest levels of excess mortality. Intriguingly, we also observed that the prevalence of malaria and human immunodeficiency virus (HIV) are associated with country-level SARS-CoV-2 excess mortality in Africa and the Western Pacific, whereby countries with low HIV prevalence but high malaria prevalence tend to have lower levels of excess mortality. While these associations are correlative in nature at the macro-scale, they emphasize that patterns of endemic disease and socio-demographic factors are needed to understand the global dynamics of SARS-CoV-2.ConclusionsOur study identifies factors associated with variation in excess mortality across countries, providing insights into why some were more impacted by the pandemic than others. By understanding these predictors, we can better inform global outbreak management strategies, such as targeting medical resources to highly urban countries with low GDP and high HIV prevalence to reduce mortality during future outbreaks.

Antimalarial potential of Kerala Ayurvedic Water "Pathimugam".

The persistent threat of drug resistant malaria demands new cures. Low prevalence of malaria in the Indian state of Kerala compared with other proximal states led us to explore if there is any traditional practice in Kerala which may confer protection against malaria. In this context, our attention was drawn to "Pathimugam" i.e., Ceasalpinia sappan whose heartwood is used to prepare a red aqueous extract which is a uniquely popular drink all over Kerala. Aqueous and methanolic extracts of various organs of C. sappan were prepared and tested against Plasmodium falciparum grown in vitro culture using SYBR Green-I assay. The cytotoxicity of active extracts/fractions was studied using mammalian HeLa cell line. In vivo efficacy was determined using Plasmodium berghei ANKA infected mice. The highest antiplasmodial activities in the alcoholic and aqueous extracts were observed in leaf methanolic extract (IC 2 μg/ml) and heartwood aqueous extract (IC 12.5 μg/ml). C. sappan extracts were equipotent against both chloroquine sensitive Pf3D7 and resistant Pf INDO strains and showed suppression of % parasitemia in P. berghei infected mice. Activity guided chromatographic fractionation of aqueous wood extract led to the fortification of antiplasmodial activity (IC 5 μg/ml). Our results establish the antiplasmodial potential of C. sappan and suggest that its regular use might have prophylactic or curative actions that may assist in keeping check on malaria in the Indian state of Kerala.

Comprehensive Assessment of Factors Affecting Malaria Prevalence among Pregnant Women in Nyabubare Health Centre III, Bushenyi District, Uganda: Implications for Public Health Intervention

Malaria remains a significant global health burden, particularly among pregnant women, with adverse outcomes such as maternal mortality and low birth weight. This study comprehensively investigates the multifaceted factors influencing malaria prevalence among pregnant women attending Nyabubare Health Centre III in Bushenyi District, Uganda. Utilizing a mixed-methods approach, data were collected through structured interviews and documentary review from a sample of 86 respondents, including 80 pregnant women and 6 health workers. Descriptive analysis revealed poverty, deficiency in malaria control measures, low education levels, environmental factors such as swamps and floods, age, limited access to health facilities, and climatic changes as major determinants of malaria prevalence among pregnant women. Despite a relatively low malaria prevalence, knowledge gaps regarding malaria prevention were identified. The findings underscore the urgent need for targeted public health interventions, including subsidies for preventive equipment, sustained information campaigns, and improvements in healthcare services to enhance malaria prevention and control among pregnant women in the region. This study provides valuable insights for policymakers and healthcare practitioners to develop effective strategies to mitigate the impact of malaria on maternal and child health in resource-limited settings. Keywords: Prevalence of malaria, pregnant women, and knowledge

Antibody response to malaria vaccine candidates in pregnant women with Plasmodium falciparum and Schistosoma haematobium infections.

Malaria in pregnancy has severe consequences for the mother and foetus. Antibody response to specific malaria vaccine candidates (MVC) has been associated with a decreased risk of clinical malaria and its outcomes. We studied Plasmodium falciparum (Pf) and Schistosoma haematobium (Sh) infections and factors that could influence antibody responses to MVC in pregnant women. A total of 337 pregnant women receiving antenatal care (ANC) and 139 for delivery participated in this study. Pf infection was detected by qPCR and Sh infection using urine filtration method. Antibody levels against CSP, AMA-1, GLURP-R0, VAR2CSA and Pfs48/45 MVC were quantified by ELISA. Multivariable linear regression models identified factors associated with the modulation of antibody responses. The prevalence of Pf and Sh infections was 27% and 4% at ANC and 7% and 4% at delivery. Pf infection, residing in Adidome and multigravidae were positively associated with specific IgG response to CSP, AMA-1, GLURP-R0 and VAR2CSA. ITN use and IPTp were negatively associated with specific IgG response to GLURP-R0 and Pfs48/45. There was no association between Sh infection and antibody response to MVC at ANC or delivery. Pf infections in pregnant women were positively associated with antibody response to CSP, GLURP-R0 and AMA-1. Antibody response to GLURP-R0 and Pfs48/45 was low for IPTp and ITN users. This could indicate a lower exposure to Pf infection and low malaria prevalence observed at delivery.

Placenta and Cord Blood Malaria in Mothers and Neonates Attending Federal University Teaching Hospital, Owerri, Imo State South East Nigeria

Introduction: In Malaria endemic countries, gestational and cord blood malaria prevalence are highly variable. A comprehensive study to determine the prevalence of placental and cord malaria has not been undertaken in Imo state, south eastern Nigeria. Thus, the need to determine prevalence of placenta and chord blood with Plasmodium falciparum infection among pregnant mothers and their neonates in Federal university teaching hospital Owerri, Imo State, Nigeria.
 Methodology: A hospital based cross sectional study was carried out between the months of July 2021 and June, 2022 in some public and private hospitals in Owerri, south eastern Nigeria. Malaria transmission is stable with a high seasonal transmission from July to October. Placental and umbilical cord blood was collected into an EDTA bottle from mothers who consented and their neonates respectively at delivery. The presence of Plasmodium speciewas assessed microscopically and quantified by WHO Certified Malaria Microscopists. Parasite density was determined using WHO malaria microscopy protocol. Malaria parasite density was grouped as 1-500parasites/µl, 501-5,000parasites/µl (low), 5,001–10,000 parasites/µl (high), and >10,000 parasites/µl (very high) respectively for ease of analysis. Data was analyzed considering the parasite density grouping and parity while placenta and cord malaria prevalence were determined.
 Results: Placental and congenital malaria prevalence by microscopy was 21.3% vs. 8.2%. The primigravid had the highest infection rate of 33.0%. Considering the relationship between infection prevalence and parity of pregnancy, there was a significant difference P=.001. 4.2% of 119 neonate and 13.6% of 88 neonates from multigravid and primigravid mothers respectively examined had cord malaria. There was significant difference P=.002 comparing cord malaria infection prevalence and parity of pregnancy of matched mothers. The relationship between parasite malaria density and parity of pregnancy both in placental and cord malaria were not significant. Age group 20-25 years (45%) had the highest Prevalence while age groups 26-30 years recorded a prevalence of 33.3% for the primigravid and multigravid groups, respectively (P<0.05). The Geo mean range of 220 (3-8,250) vs. 23(2-6,412) parasite/µl of blood were recorded in primipare vrs multipare group. The result of this study showed moderate placental malaria infection and a low prevalence of cord malaria by microscopy. The presence of malaria parasites in cord blood at delivery and non in maternal placental blood was also demonstrated. There is a significant association between ITN (Insecticide-Treated Net) usage compliance rate and gravidity (primigravid vs. multigravid) among pregnant mothers. There is also a statistically significant relationship between age and gravidity in the occurrence of placenta malaria, as indicated by the chi-square test results.
 Conclusion: Antenatal exposure to malaria parasites may have profound effects on the fetus therefore prevention of malaria infection during pregnancy which may reduce the incidence of adverse perinatal outcomes should be strongly advocated.

Synthesis of Health Policies in the Fight against Malaria in Two Countries at Different Stages of Intervention in the Progress Towards Malaria Elimination, using Data from Surveys and Literature

Aims: The aim of our study was to provide a synthesis of successful policies applied in the fight against malaria in African countries at different stages of intervention; Burkina Faso and Senegal. Background: Malaria is a global public health problem with many cases each year in the world (241 million cases with 247,000 deaths; 67% were under five children) in 2020. Most malaria cases occur in Sub-Saharan African countries (93%). Objective: The objective of our study was to present policies implemented against malaria (with the best results) in these two African countries (Burkina Faso and Senegal) which are at different stages of intervention. These could serve as an example to others malaria endemics countries. To achieve our purpose, we used DHS survey data and information from a literature synthesis. Methods: Data used for analysis are from Demographics and Health Surveys (DHS) 2017-2018 for Burkina Faso and DHS 2017 for Senegal. We added information from a synthesis of the literature. Linear regression models were performed with an estimation of the mean number of persons using insecticide-treated nets among groups (urban or rural areas, wealth level, highest education level in the household and age of household head) in each country. We evaluated the importance of co-factors in the relationship between the number of ITNs in a household and the number of household members by calculating the R-squared. A criteria grid used for this synthesis of literature included eight important sub-groups: funding sources, entomological monitoring, use of ITNs, use of insecticide, malaria case management, health system organization, communication and surveillance. Results: Senegal and Burkina Faso have the same proportion (51%) of households in which all children under 5 sleep under ITNs. We found R-squared (R2=0.007 in Burkina Faso and R2=0.16 in Senegal) for the relationship between the number of ITNs in a household and household size. When wealth level, age of head of household, area of residence (rural or urban), education level in the household and number of bedrooms in the household were controlled for, we found R2=0.106 for Burkina Faso and R2=0.167 for Senegal. We found that Senegal’s National Malaria Program is decentralized with entomological monitoring in all districts, which is normal considering the intervention stage in the fight against malaria. In Burkina Faso, we found centralization of routine data. Conclusion: Our study synthesized the health policies applied in African countries which are at different stages of intervention in the fight against malaria and which have succeeded in maintaining low malaria prevalence (in Senegal) or in rapidly decreasing the prevalence of the disease (in Burkina Faso). Being close to elimination, Senegal required more active malaria surveillance than passive surveillance. Burkina Faso did not require a lot of active surveillance being not close to malaria elimination. These results encourage a review in the context of each African country.

Situational Analysis of Malaria Control Following the 2021 Distribution of Long Lasting Insecticide-Treated Bed Nets in the Tiko Health District, South West Region, Cameroon

Malaria is still a major public health concern in Cameroon as more than 20 million people are at risk of the disease. Despite the government’s effort to scale up the distribution of long lasting insecticide-treated bed nets (LLINs), full ownership and optimal use is still limited. In 2021, over a million LLINs were made available for distribution in the South West Region. However, the current situation of malaria has not yet been ascertained following the 2021 mass distribution campaign (MDC). Therefore, the aim of this study was to determine LLIN ownership, coverage, usage and the prevalence of malaria following the 2021 MDC in the Tiko Health District (THD), South West Region of Cameroon. A cross-sectional study was carried from May 1 to 27, 2022 in which a multi-stage sampling technique was used to enroll eligible participants. Data were collected from household heads using questionnaires and capillary blood samples collected from consented household members were used to test for malaria. Data were analyzed using SPSS version 25 at 0.05 significance level. From the 150 households surveyed, 96 (64.0%) owned a mosquito net before the recent MDC. There was an overall significant increase (p p = 0.644) in LLINs ownership between areas where door-to-door (79.5%) and fixed “Hit and Run” (75.8%) strategies were used in the distribution of LLINs in THD. The prevalence of malaria was 10.2%. The regular use of LLINs was significantly associated (p = 0.007) with low malaria prevalence. The 2021 MDC had an impact on malaria prevalence in those who properly used them.

Malaria in pregnancy control and pregnancy outcomes: a decade’s overview using Ghana’s DHIMS II data

BackgroundMalaria in pregnancy control interventions have been implemented through antenatal care services for more than 2 decades in Ghana. The uptake of these interventions has seen steady improvement over the years. This has occurred within the context of decreasing global trends of malaria infection confirmed by decreasing malaria in pregnancy prevalence in Ghana. However, not much is known about how these improvements in interventions uptake and reduction in malaria infection prevalence have impacted pregnancy outcomes in the country. This study aimed at describing trends of maternal anaemia and low birth weight prevalence and uptake of malaria in pregnancy control interventions over the last decade using data from Ghana’s District Health Information Management System (DHIMS II).MethodsData from Ghana’s DHIMS II on variables of interest covering the period 2012 to 2021 was analysed descriptively using Microsoft Excel 365. Results were computed as averages and percentages and presented in tables and graphs.ResultsThe prevalence of maternal anaemia at booking and at term and low birth weight increased marginally from 31.0%, 25.5% and 8.5% in 2012 to 36.6%, 31.9% and 9.5% in 2021 respectively. Severe anaemia prevalence at booking and at term remained under 2% over the study period. Women making at least 4 ANC visits, receiving at least 3 doses of intermittent preventive treatment of malaria and an insecticide-treated net increased from 77.0%, 41.4% and 4.1% in 2012 to 82%, 55.0% and 93.3% in 2021, respectively. Malaria test positivity rate reduced from 54.0% to 34.3% between 2014 and 2021 while women receiving iron and folate supplementation for 3 and 6 months rose from 43.0% and 25.5% to 89.7% and 61.8%, respectively between 2017 and 2021.ConclusionMaternal anaemia and low birth weight prevalence showed marginal upward trends over the last decade despite reduced malaria infection rate and improved uptake of malaria in pregnancy control interventions. There is room for improvement in current intervention implementation levels but the complex and multi-factorial aetiologies of maternal anaemia and low birth weight need urgent investigation and quantification to inform policy and practice.

Multilevel logistic regression modelling to quantify variation in malaria prevalence in Ethiopia.

Ethiopia has low malaria prevalence compared to most other malaria-endemic countries in Africa. However, malaria is still a major public health problem in the country. The binary logistic regression model has been widely used to analyse malaria indicator survey (MIS) data. However, most MIS have a hierarchical structure which may result in dependent data. Since this model assumes that conditional on the covariates the malaria statuses of individuals are independent, it ignores potential intra-cluster correlation among observations within a cluster and may generate biased analysis results and conclusions. Therefore, the aim of this study was to quantify the variation in the prevalence of malaria between sample enumeration areas (SEAs) or clusters, the effects of cluster characteristics on the prevalence of malaria using the intra-class correlation coefficient as well as to identify significant factors that affect the prevalence of malaria using the multilevel logistic regression modelling in three major regions of Ethiopia, namely Amhara, Oromia and Southern Nations, Nationalities and Peoples' (SNNP). Dataset for three regional states extracted from the 2011 Ethiopian National Malaria Indicator Surveys (EMIS) national representative samples was used in this study. It contains 9272 sample individuals selected from these regions. Various multilevel models with random sample SEA effects were applied taking into account the survey design weights. These weights are scaled to address unequal probabilities of selection within clusters. The spatial clustering of malaria prevalence was assessed applying Getis-Ord statistic to best linear unbiased prediction values of model random effects. About 53.82 and 28.72 per cents of the sampled households in the study regions had no mosquito net and sprayed at least once within the last 12 months, respectively. The results of this study indicate that age, gender, household had mosquito nets, the dwelling has windows, source of drinking water, the two SEA-level variables, i.e. region and median altitude, were significantly related to the prevalence of malaria. After adjusting for these seven variables, about 45% of the residual variation in the prevalence of malaria in the study regions was due to systematic differences between SEAs, while the remaining 55% was due to unmeasured differences between persons or households. The estimated MOR, i.e. the unexplained SEA heterogeneity, was 4.784. This result suggests that there is high variation between SEAs in the prevalence of malaria. In addition, the 80% interval odds ratios (IORs) related to SEA-level variables contain one suggesting that the SEA variability is large in comparison with the effect of each of the variable. The multilevel logistic regression with random effects model used in this paper identified five individual / household and two SEA-level risk factors of malaria infection. Therefore, the public health policy makers should pay attentions to those significant factors, such as improving the availability of pure drinking water. Further, the findings of spatial clustering provide information to health policymakers to plan geographically targeted interventions to control malaria transmission.

Prolonged fever and exaggerated hypercoagulopathy in malaria vivax relapse and COVID-19 co-infection: a case report

BackgroundCoronavirus disease 2019 (COVID-19) often causes atypical clinical manifestations similar to other infectious diseases. In malaria-endemic areas, the pandemic situation will very likely result in co-infection of COVID-19 and malaria, although reports to date are still few. Meanwhile, this disease will be challenging to diagnose in areas with low malaria prevalence because the symptoms closely resemble COVID-19.Case presentationA 23-year-old male patient presented to the hospital with fever, anosmia, headache, and nausea 1 week before. He was diagnosed with COVID-19 and treated for approximately 10 days, then discharged to continue self-quarantine at home. 2 weeks later, he returned to the hospital with a fever raised intermittently every 2 days and marked by a chilling-fever-sweating cycle. A laboratory test for malaria and a nasopharyngeal swab for SARS CoV-2 PCR were conducted, confirming both diagnoses. The laboratory examination showed markedly elevated D-dimer. He was treated with dihydroartemisinin-piperaquine (DHP) 4 tablets per day for 3 days and primaquine 2 tablets per day for 14 days according to Indonesian National Anti-malarial Treatment Guidelines. After 6 days of treatment, the patient had no complaints, and the results of laboratory tests had improved. This report describes the key points in considering the differential diagnosis and prompt treatment of malaria infection during the pandemic of COVID-19 in an endemic country to prevent the worse clinical outcomes. COVID-19 and malaria may also cause a hypercoagulable state, so a co-infection of those diseases may impact the prognosis of the disease.ConclusionThis case report shows that considering the possibility of a co-infection in a COVID-19 patient who presents with fever can prevent delayed treatment that can worsen the disease outcome. Paying more attention to a history of travel to malaria-endemic areas, a history of previous malaria infection, and exploring anamnesis regarding the fever patterns in patients are important points in making a differential diagnosis of malaria infection during the COVID-19 pandemic.

Malaria prevalence and performance of diagnostic tests among patients hospitalized with acute undifferentiated fever in Zanzibar

BackgroundControl efforts in Zanzibar reduced the burden of malaria substantially from 2000 to 2015, but re-emergence of falciparum malaria has been observed lately. This study evaluated the prevalence of malaria and performance of routine diagnostic tests among hospitalized fever patients in a 1.5 years period in 2015 and 2016.MethodsFrom March 2015 to October 2016, paediatric and adult patients hospitalized with acute undifferentiated fever at Mnazi Mmoja Hospital, Zanzibar were included. The malaria prevalence, and performance of rapid diagnostic test (RDT) and microscopy, were assessed using polymerase chain reaction (PCR) as gold standard.ResultsThe malaria prevalence was 9% (63/731). Children under 5 years old had lower malaria prevalence (5%, 14/260) than older children (15%, 20/131, p = 0.001) and persons aged 16 to 30 years (13%, 15/119, p = 0.02), but not different from persons over 30 years old (6%, 14/217, p = 0.7). All cases had Plasmodium falciparum infection, except for one case of Plasmodium ovale. Ten malaria patients had no history of visiting mainland Tanzania. The RDT had a sensitivity of 64% (36/56) and a specificity of 98% (561/575), and microscopy had a sensitivity of 50% (18/36) and a specificity of 99% (251/254), compared to PCR. The malaria parasitaemia was lower in patients with false negative results on RDT (median 7 × 103 copies/µL, interquartile range [IQR] 2 × 103 – 8 × 104, p = 0.002) and microscopy (median 9 × 103 copies/µL, IQR 8 × 102 – 7 × 104, p = 0.006) compared to those with true positive RDT (median 2 × 105 copies/µL, IQR 3 × 104 – 5 × 105) and microscopy (median 2 × 105 copies/µL, IQR 6 × 104 – 5 × 105).ConclusionsThe study emphasizes that malaria was a frequent cause of febrile illness in hospitalized patients in Zanzibar in the years 2015-2016, particularly among school age children and young adults. We found evidence of autochthonous malaria transmission in Zanzibar. Compared to PCR, both RDT and microscopy had low sensitivity, and false negative results were associated with low parasitaemia. While low parasitaemia identified only by PCR in a semi-immune individual could be coincidental and without clinical relevance, clinicians should be aware of the risk of false negative results on routine tests.

Cross-sectional study of asymptomatic malaria and seroepidemiological surveillance of seven districts in Gia Lai province, Vietnam

BackgroundMalaria elimination by 2030 is an aim of many countries in the Greater Mekong Sub-region, including Vietnam. However, to achieve this goal and accelerate towards malaria elimination, countries need to determine the extent and prevalence of asymptomatic malaria as a potential reservoir for malaria transmission and the intensity of malaria transmission. The purpose of this study was to determine the prevalence of asymptomatic malaria and seropositivity rate in several districts of Gia Lai province in the Central Highlands of Vietnam.MethodsA cross-sectional survey of asymptomatic malaria and serological testing was conducted in 3283 people living at 14 communes across seven districts in Gia Lai province in December 2016 to January 2017. Finger prick capillary blood samples were tested for malaria using rapid diagnostic testing and polymerase chain reaction (PCR), as well as detecting antibodies against 3 Plasmodium falciparum and 4 Plasmodium vivax antigens by indirect enzyme-linked immunosorbent assay (ELISA). Age-seroprevalence curves were fitted using reverse catalytic models with maximum likelihood.ResultsThe study population was predominantly male (65.9%, 2165/3283), adults (88.7%, 2911/3283) and of a minority ethnicity (72.2%, 2371/3283), with most participants being farmers and outdoor government workers (90.2%, 2960/3283). Using a small volume of blood (≈ 10 µL) the PCR assay revealed that 1.74% (57/3283) of the participants had asymptomatic malaria (P. falciparum 1.07%, P. vivax 0.40%, Plasmodium malariae 0.15% and mixed infections 0.12%). In contrast, the annual malaria prevalence rates for clinical malaria in the communities where the participants lived were 0.12% (108/90,395) in 2016 and 0.22% (201/93,184) in 2017. Seropositivity for at least one P. falciparum or one P. vivax antigen was 38.5% (1257/3262) and 31.1% (1022/3282), respectively. Age-dependent trends in the proportion of seropositive individuals in five of the districts discriminated the three districts with sustained low malaria prevalence from the two districts with higher transmission.ConclusionsAsymptomatic Plasmodium carriers were found to be substantially more prevalent than clinical cases in seven districts of Gia Lai province, and a third of the population had serological evidence of previous malaria exposure. The findings add knowledge on the extent of asymptomatic malaria and transmission for developing malaria elimination strategies for Vietnam.

Treatment Outcome of Severe Malaria and Associated Factors among Adults Admitted in Arba Minch General Hospital, Southern Nation Nationality and People's Region, Ethiopia.

Introduction Malaria is a protozoan disease transmitted by the bite of infected female Anopheles mosquitoes. Progression to severe and fatal disease is largely but not entirely confined to Plasmodium falciparum infections. Malaria is a major public health problem in Ethiopia despite relatively low malaria prevalence compared to most other malaria-endemic countries in Africa. In Ethiopia, a nationwide report during 2015 showed that the total number of deaths associated with malaria was 1561. Methods A retrospective cross-sectional study was conducted in Arba Minch General Hospital on February 2019. Data were collected from a patient record who was admitted with severe malaria in the past four years from Sept. 2015 to Aug. 2018. Results This study included a total of 387 patients with severe malaria. The mortality rate associated with severe malaria in the year between 2015 and 2018 at Arba Minch General Hospital was 5.7%. Comorbidity, impaired consciousness, and acidosis were significantly associated with mortality, at significant level of P < 0.05. Conclusions Comorbidity, impaired consciousness, and acidosis were found to be poor prognostic indicators for patients with severe malaria.

Detection of IgM and IgG Dengue antibodies in febrile patients suspected of malaria attending health center in Jos, Nigeria

Background: Despite the public health importance of dengue infections, it is less investigated by clinicians and rarely considered in the differential diagnosis of febrile illnesses in Nigeria. The objective was to detect the presence of Dengue IgG/IgM antibodies and Plasmodium species in the blood of febrile patients. Methods: This is a cross sectional study conducted among ninety-four (94) consenting febrile patients suspected of malaria in Jos. Duo detection of dengue antibodies (IgG/IgM) were determined by ELISA technique. Total DNA was extracted from patient serum and quantified to determine concentration and quality of the extraction process. Malaria was detected by Real Time Polymerase Chain Reaction. Results: Dengue antibodies were detected in 55.3% (52/94) of the febrile patients. The mean age was 29.9±1.2. Highest dengue prevalence of 75% (39/52), 50% (26/52) and 59.6% (31/52) were recorded among females, students and non-users of mosquito nets, respectively. In all. 11.7% (11/94) of the samples tested positive for malaria. Age group 11-20 years recorded the highest prevalence of malaria, 63.6% (7/11). Dengue and Malaria co-infection was documented in 5.3% (5/94). There was a significant difference in the prevalence of dengue and malaria among febrile subjects. Conclusion: No association of dengue infection with gender and use of Insecticide Treated Nets was found. The lower malaria prevalence compared to dengue suggests that febrile illness in this population is shown to be associated more with dengue infection. We recommend a continuous surveillance of dengue infection in this population and consideration of dengue in the differential diagnosis of febrile illnesses.

Evaluation of Malaria Parasitaemia and Assessing the Knowledge, Attitude and Practice of Pregnant Women Attending Health Facilities in Owerri Metropolis towards Malaria Prevention and Control

There are a few investigations on malaria in pregnancy; however, examinations zeroing in on the discernment and current acts of malaria counteraction and treatment among pregnant women are scanty. This examination was pointed toward evaluating the information, recognitions about malaria anticipation with accentuation on information about placental malaria too consistence to utilization of LLIN and IPTP among pregnant women in Owerri, South Eastern Nigeria. A cross-sectional descriptive study was conducted at an emergency department, Federal Medical Centre, Owerri using a pretested questionnaire from 200 randomly selected consenting pregnant women. Acknowledgment of malaria manifestations during pregnancy, information about IPTP and placenta malaria were things used to survey the degree of information about malaria in pregnancy. Their blood tests were additionally diagnosed for malaria parasitaemia. Malaria prevalence in the examination populace by microscopy was 13.5%. Additionally 62% of the respondents were learned about the conceivable impeding impacts of the existences of malaria during pregnancy. About 79.5% of the respondent decidedly related mosquitoes to malaria contamination while 31% and 14% related reason for malaria disease to messy encompassing and stale water individually. Malaria Prevention Mentality and Practice in this examination was acceptable (60%) while 18.5% had reasonable practice. All the more so and 15.5% of the respondents had been associated with helpless practice. About 34% of the pregnant ladies rested under a mosquito net frequently study watched factual criticalness between age, occupation and malaria counteraction rehearses (p = 0.014, 0.0089). There was likewise measurably huge relationship between respondent’s training and respondent mentality (p = 0.0034). Information with respect to the utilization of Sulphodaxine primethamine (SP) as medication of decision during pregnancy was restricted (12.0%) as utilization of chloroquine was positioned most elevated (48%). The study showed low peripheral malaria prevalence and furthermore exhibited that pregnant women’s knowledge, mentality and practice towards malaria avoidance was impressively all things considered. Be that as it may, there was helpless information about discontinuous preventive treatment of malaria (IPTP) or suggested antimalarial during pregnancy.

Prevalence, intensity and some vector dynamics of malaria in Ogbaru local government area of Anambara State, Nigeria

A study on the prevalence, intensity and some vector dynamics of malaria was carried out in Ogbaru Local Government Area of Anambra State using standard parasitological and entomological techniques for rapid assessment of malaria infection, level of parasitaemia and morphological features of mosquitoes. The results showed an overall malaria RDT prevalence of 20% and community based prevalence of 13 (16.0%) and 22(24%) for Odekpe and Ogbakuba respectively. In Odekpe, the age range (1-7 years) had the highest prevalence while in Ogbakuba the highest prevalence was the age range 7-14 years. Overall, males had lower malaria prevalence (14.0%) than females (21.0%). The intensity of malaria infection from each of the communities revealed that both high (&gt;2000 - 250000parasites/µl) and medium (&gt;500-2000 parasites/µl) parasitaemia was more in Ogbakuba community. Two hundred and thirty (230) mosquitoes were collected. One hundred and four (45%) of the total mosquito population in the study were found to be unfed with blood meal, whereas 86(37%) and 40(17%) were freshly and previously fed respectively. One hundred and forty two (61.7%) of the mosquitoes appeared gravid against 88(38%) that were non-gravid. The mosquitoes encountered were Anopheles gambiae 76(33.04%), Anopheles funestus 86(37.39%), and Culex specie 68(29.56%). Malaria transmission and possibility of an ongoing transmission of other mosquito-borne diseases among residents in the study area should necessitate design for further studies that would explore the interactions of mosquito species and the diseases they transmit in co- endemic communities as well as effective methods for their control.

Increased malaria parasitaemia among adults living with HIV who have discontinued cotrimoxazole prophylaxis in Kitgum district, Uganda.

BackgroundAlthough WHO recommends cotrimoxazole (CTX) discontinuation among HIV patients who have undergone immune recovery and are living in areas of low prevalence of malaria, some countries including Uganda recommend CTX discontinuation despite having a high malaria burden. We estimated the prevalence and factors associated with malaria parasitaemia among adults living with HIV attending hospital outpatient clinic before and after discontinuation of CTX prophylaxis.MethodsBetween March and April 2019, 599 participants aged 18 years and above, and attending Kitgum hospital HIV clinic in Uganda were enrolled in a cross study. A standardized questionnaire was administered and physical examination conducted. A finger-prick blood sample was collected for identification of malaria parasites by microscopy. The prevalence of parasitaemia was estimated and compared among participants on and those who had discontinued CTX prophylaxis, and factors associated with malaria parasitaemia assessed.ResultsOf the enrolled participants, 27 (4.5%) had malaria parasites and 452 (75.5%) had stopped CTX prophylaxis. Prevalence of malaria parasitaemia was significantly higher in participants who had stopped CTX prophylaxis (5.5% versus 1.4% p = 0.03) and increased with increasing duration since the discontinuation of prophylaxis. Compared to participants taking CTX, those who discontinued prophylaxis for 3–5 months and >5 months were more likely to have malaria parasites (adjusted prevalence ratio (aPR) = 1.64, 95% CI 0.37–7.29, p = 0.51, and aPR = 6.06, 95% CI 1.34–27.3, P = 0.02). Low CD4 count (< 250cells/mm3) was also associated with increased risk of having parasites (aPR = 4.31, 95% CI 2.13–8.73, p <0.001).ConclusionPeople from malaria endemic settings living with HIV have a higher prevalence of malaria parasitaemia following discontinuation of CTX compared to those still on prophylaxis. The risk increased with increasing duration since discontinuation of the prophylaxis. HIV patients should not discontinue CTX prophylaxis in areas of Uganda where the burden of malaria remains high. Other proven malaria control interventions may also be encouraged in HIV patients following discontinuation of CTX prophylaxis.

The impact of HIV-associated immunosuppression on the Plasmodium falciparum chloroquine resistance transporter gene (PfCRT) of HIV patients in Akure, Nigeria

BackgroundThe study evaluated the prevalence of malaria and Plasmodium falciparum chloroquine resistance transporter gene (PfCRT) in HIV patients attending Specialist Hospital, Akure. This study was carried out between April and June 2019. Three hundred and seventeen (317) patients attending the antiretroviral clinic (ART) were involved, out of which 89 (28.08%) were males and 228 (71.92%) were females. HIV test was done using the Unigold® HIV test kit, malaria test was done using thick and thin blood smear, CD4 test was done using the Partec® CD4 counter and PCR was used to detect the presence of plasmodium falciparum mutant gene. The data obtained from this analysis was subjected to Pearson’s Chi-square test.ResultsThe overall result showed low prevalence of malaria (23.03%) in the sampled patients. Highest malaria prevalence (31.0%) was recorded in HIV patients with CD4 count between 200–500 cells/μl of blood, with the males recording 24.7% malaria prevalence. The age group 20–29 years recorded the highest prevalence of 27.3%. A higher prevalence 91.1% of PfCRT gene in HIV-positive and (40.0%) in HIV-negative patients was recorded with 100% prevalence in patients with CD4 count ≤ 200. This shows that the low prevalence of malaria recorded in this study could be credited to good health-seeking attitude of HIV patients and the upscale of HIV care and treatment centres.ConclusionThe high prevalence of PfCRT gene shows that treatment of malaria with chloroquine is still being practised despite the availability of artemisinin-based combination therapy (ACTs) as the recommended regimen for malaria treatment.

Malaria in Sundargarh district, Odisha, India: Epidemiological and behavioral aspects from surveys

To characterize malaria and assist in prevention efforts, we conducted a series of epidemiological studies in Sundargarh district, India, as part of an NIH-funded International Center of Excellence for Malaria Research. In a published survey around Rourkela in 2013-2014 (N = 1307), malaria prevalence was found to be 8.3%. Using these data, villages were divided into low (<2%), medium (2-10%) and high (>10%) malaria prevalence, and risk factors assessed by type of village. In the six low malaria villages, four persons were positive by PCR; in the four medium malaria villages, prevalence was 7% (35 infections, 7 P. vivax); and in the three high malaria villages, prevalence was 21% (62 infections, 10 P. vivax and 5 mixed with P. vivax and P. falciparum). A total of 30.6% infections were submicroscopic and 40.6% were asymptomatic. Our analyses showed that the rainy season and male gender were risk factors for malaria; in high malaria villages, young age was an additional risk factor, and indoor and outdoor spraying was protective compared to no spraying. We undertook a subsequent behavioral survey in four of the medium and high malaria villages in 2017 to investigate the behavioral aspects of malaria risk. Among 500 participants in 237 households, adult men (15+ years) were more likely to be outside in the evening (34.5% vs. 7.9% among adult women 15+ years and 0.7% among children, p < 0.001), or to sleep outside (7.5% vs. 0.5% and 0%, respectively, p < 0.001). Although women were more likely to get up before 6 a.m. (86.6%, vs. 70.5% among men, 50.7% among children, p < 0.001), men were more likely to be outside in the early morning (77.6% among men, 11.2% among women, and 11.1% among children, p < 0.001). More children used insecticide treated nets the previous night (73.4%) than men (45.6%) or women (39.6%), and repellents were used by 29.5% of 234 households (insecticide creams were not used at all). Malaria control and elimination in India will need local approaches, and the promotion of repellent cream use by at-risk groups could be further explored in addition to mass-screen or treat programs in high-risk villages.

Etiologic Agents of Fever of Unknown Origin Among Patients Attending Mnazi Mmoja Hospital, Zanzibar.

Fever of unknown origin (FUO) remains an important public health problem. With malaria transmission declining in some parts of Africa, the evidence suggests other infectious agents now account for most FUO. The purpose of this study was to identify the etiologic agents of FUO in a cross-section of patients at the Mnazi Mmoja hospital in Zanzibar, Tanzania. A multiplex TaqMan gene expression Array Card (TAC) and plates were used for detection and classification of different pathogens in blood samples obtained from patients with FUO. Logistic regression analyses was performed using pathogens detected and sociodemographic characteristics as outcome and exposure variables respectively. Odd ratios and 95% confidence interval were calculated and statistical significance was set at P < .05. Thirty-three different pathogens were detected in 27 patient blood samples. The following pathogens were detected in decreasing order of prevalence; Dengue virus, Plasmodium species, Rickettsia, Brucella species, Salmonella typhi, and less than 1% for each of Bartonella, Coxiella burnetii, Salmonella species, and Leptospira. Co-infections of Plasmodium with Dengue and S. typhi were also detected, including one case with three different pathogens-Plasmodium, Rickettsia and Brucella. There was no association between the etiologic agents of FUO and demographic or clinical characteristics. Zoonotic and arboviral etiological agents of fever of unknown origin are present among patients at the Mnazi Mmoja hospital in Zanzibar, Tanzania. There is a need to develop a baseline of standardized diagnostic approaches particularly within the hospital setting. In areas with low malaria prevalence like Zanzibar, Dengue, Rickettsia, Coxiella burnetii, Brucellosis should be considered by clinicians in the differential diagnoses of FUO.