Malaria In Rural Areas Research Articles

The Role of Rural Health Centres in the Detection and Management of Malaria Outbreaks in a Low Transmission Setting of Choma District, Zambia

The Southern Province of Zambia has been afflicted with malaria for many years, but in recent times, with the success of the national malaria control programme, malaria transmission has declined significantly and is now at low ebb. This success has been attributed to the effective use of indoor residual spraying, proper use of insecticide-treated mosquito nets provided to the people, as well as the use of artemisinin combination therapies in all rural health centres (RHCs) to treat clinical malaria cases at health facilities as well as in the communities by trained community health workers (CHWs). Despite this success and in trying to understand the epidemiology and control of malaria in rural areas of sub-Saharan Africa, it has been clear that local elimination is most unlikely due many challenges such as lack of incentives for CHWs who are the first link of the community to the health care system, inability of the officially approved rapid diagnostic tests to detect low level parasitemia in asymptomatic individuals, and anti-malaria stock-outs in RHCs, especially during the rainy season when most areas are unreachable due to impassable roads. This paper discusses the role of RHCs in the detection and management of malaria outbreaks in low transmission settings and the challenges of achieving elimination in Choma District, Southern Province, Zambia. These challenges could adversely impact malaria elimination if they remain unanswered.

Intensive physiotherapy with subsequent community-based rehabilitation: two cases of cerebral malaria in rural areas of Malawi

[Purpose] This study aimed to elucidate the effect of intensive physiotherapy and community-based rehabilitation on motor function for patients with cerebral malaria in the rural areas of Malawi. [Participants and Methods] The participants were 10- and 9-year-old children with cerebral malaria. At ages 8 and 6 years, they contracted malaria, and their motor function decreased to Gross Motor Function Classification System level III. They underwent intensive physiotherapy for 2 weeks administered by their mothers and volunteers, who were taught rehabilitation exercises. The improvements in the participants’ motor functions were assessed after completion of therapy and 2 months later. [Results] In case 1, no improvement was observed in the 88-item Gross Motor Function Measure (GMFM-88) score after intensive physiotherapy. However, after 2 months of intensive physiotherapy, the total score improved by 6% from 61% to 67%, and the scores for the target areas improved from 12% to 20%. In case 2, the total GMFM-88 score improved from 66% to 68% during physiotherapy and further improved from 68% to 78% after 2 months. The score for the target areas improved from 25% to 26% and further improved from 26% to 49% after 2 months. [Conclusion] The participants in this study achieved improvements in GMFM-88 score after receiving intensive rehabilitation by community members. The effect was more pronounced after 2 months than immediately after intensive physiotherapy.

The Impact of Artesunate-Amodiaquine on Schistosoma mansoni Infection among Children Infected by Plasmodium in Rural Area of Lemfu, Kongo Central, Democratic Republic of the Congo.

Background Malaria and schistosomiasis remain life-threatening public health problems in sub-Saharan Africa. The infection pattern related to age indicates that preschool and school-age children are at the highest risk of malaria and schistosomiasis. Both parasitic infections, separately or combined, may have negative impacts on the haemoglobin concentration levels. The existing data revealed that artemisinin derivatives commonly used to cure malaria present also in antischistosomal activities. The current study investigated the impact of Artesunate-Amodiaquine (AS-AQ) on schistosomiasis when administered to treat malaria in rural area of Lemfu, DRC. Methodology A prospective longitudinal study including 171 coinfected children screened for anaemia, Schistosoma mansoni, and Plasmodium falciparum infections. The egg reduction rate and haemoglobin concentration were assessed four weeks after the treatment with AS-AQ, of all coinfected children of this series. Results One hundred and twenty-five (74.4%) out of 168 coinfected children treated and present during the assessment were found stool negative for S. mansoni eggs. Out of 43 (25.6%) children who remained positives, 37 (22%) showed a partial reduction of eggs amount, and no reduction was noted in 3.6% of coinfected. The mean of haemoglobin concentration and the prevalence of anaemia were, respectively, 10.74±1.5g/dl , 11.2±1.3g/dl, and 64.8%, 51.8%, respectively, before and after treatment, p<0.001. Conclusion The AS-AQ commonly used against Plasmodium allowed curing S. mansoni in coinfected children and increasing the Hb level. For the future, the randomized and multicentric clinical trials are needed for a better understanding of the effectiveness of AS-AQ against Schistosoma spp. The trial registration number was 3487183.

Awareness on causes and transmission of malaria in rural Kolar of Southern India: a comparative study

Background: Malaria is a major public health problem in several parts of country. Malaria beliefs and practices are often related to culture, and can influence the effectiveness of control strategies. This study was undertaken to assess the awareness of malaria in rural areas of Kolar with varying endemicity.Methods: A cross sectional community based study was conducted. A sample of 207 Household respondents across the Kolar rural area were randomly selected and interviewed to collect information on awareness regarding Malaria. Two villages each were randomly selected from the two PHC areas in Mulbagal Taluk, Kolar District. PHC areas was taken based on annual parasite incidence more than 2 and less than 1 consistently in the past five years by using pre-tested structured proforma. Data analyzed by using epi info 2.5 version software.Results: It was observed that appropriate knowledge regarding malaria transmission from person to person is more in Devarayasamudra Primary Health Center area (69.2%) where API&gt;2 compared to Nangli Primary Health Center area (26.2%) where API&lt;1 and the knowledge regarding causes of malaria is also more in Devarayasamudra PHC area compared to Nangli area. Majority (87%) of the respondents got information about malaria from the health workers at Devarayasamudra PHC area.Conclusions: The Community knowledge on malaria, its transmission and its prevalence and control clearly depends on the endemicity of malaria. The communities studied under Devarayasamudra PHC area which is problematic for malaria had a better knowledge on malaria transmission and its prevention.

Burden of Malaria in Rural area Jhansi- A clinico-epidemiological study.

Introduction: Malaria is a protozoan disease transmitted by the bite of infected Anopheles mosquitoes.WHO estimates that there were 216 million cases of malaria in 2016 resulting in 445,000 deaths. According to world malaria report 2012, India alone has an estimated 24 million cases per year. It is preventable and curable. Aims and objectives: To assess the burden of malaria in a rural area, and evaluate the clinico-epidemiological factors among malaria positive cases. Material and Methods: The study was conducted among 300 adult patients of malaria (Pf, Pv, Pf+ Pv) in the rural field practice area, by the Department of Community Medicine at MLB Medical College from March 2017 to October 2017. All the patients presenting fever with the suspicion of malaria were examined. Only peripheral smear / quantitative buffy coat positive patient was included. Results: Out of total 300 patients of malaria 147 (49%) patients were of P. falciparum , 110 (36.67%) were of P. vivax and 43(14.33%) were of mixed infection. There was no predilection observed in this study towards any sex. Fever was the most common manifestation followed by Chills and rigors. While altered sensorium was seen in 71 (23.67%). Conclusion: Use of multipronged strategies to combat the disease transmission and control with an integration of multi-sectoral collaboration is needed in a rural area.

Introducing the concept of a new pre-referral treatment for severely ill febrile children at community level: a sociological approach in Guinea-Bissau

BackgroundInnovative strategies are needed to tackle childhood mortality in the rural tropics. Artesunate suppositories were developed to bring emergency treatment closer to severely ill children with malaria in rural areas where injectable treatment is not possible for several hours. Adding an antibacterial rectal drug would extend this strategy to treat non-malarial febrile illness as well. The objective of these studies was to assess acceptability of such a new pre-referral strategy by healthcare providers and likely uptake by the population.MethodsTwo qualitative studies were conducted between May and July 2009. Study 1 investigated the acceptability of introducing a combined antimalarial-antibacterial suppository by interviewing 27 representatives of the three administrative levels (central government, regional, local) of the health sector; Study 2 investigated treatment-seeking behaviour and acceptability of this intervention at community level by interviewing 74 mothers in 2 villages.Results and ConclusionsUp to 92% of health representatives were in favour of introducing a new pre-referral strategy to tackle both malaria and non-malaria related severe illnesses in Guinea-Bissau, provided it was endorsed by international health authorities. The main obstacles to implementation were the very limited human and financial resources. In the two villages surveyed, 44% of the mothers associated severe illness with fever only, or fever plus one additional symptom. Mothers’ judgement of severity and ensuing decisions were not specific for serious illness, indicating that initial training to recognize signs of severe disease and treatment availability for non-severe, fever-associated symptoms will be required to prevent overuse of a new intervention designed as a pre-referral treatment for severely ill children. Level C health centres were the first resort in both villages (50% and 87% of respondents respectively). This information is encouraging for the implementation of a pre-referral treatment.

Performance and clinical usefulness of the Optimal-IT® test in the treatment of confirmed malaria cases in rural areas in Côte d'Ivoire.

In Africa, malaria care is mostly based on clinical presumption and the general application of antimalarial treatment to all febrile episodes over several years. Treatment limited to confirmed cases might curb the practice of equating fever with malaria, antimalarial drug abuse and the extension of Plasmodium resistance, provided that powerful and reliable rapid diagnostic tests are used. This study aimed at determining the performances of the Optimal-IT® test in the strategy for the exclusive treatment of uncomplicated malaria in rural areas. A prospective study conducted in the forest region of San Pedro, Côte d'Ivoire, included patients exhibiting clinical signs of uncomplicated malaria who gave their consent and benefited from thick blood film (TBF), blood smear (BS) and Optimal-IT® (pLDH-based) test. Rapid diagnostic test (RDT) results were taken into consideration to decide on malaria treatment and then compared with TBF/BS results (reference) to assess the performances and clinical usefulness of the RDT. The mean age of the 384 patients included (209 men, 175 women) was 28 years and the mean temperature was 38.1°C. TBF/BS and Optimal-IT® were concordant in 92% of patients but discordant in 10 false negative (3%) and 19 false-positive patients (5%). The average parasite density of P. falciparum was 25,600 trophozoites/μl. The performances calculated were: sensitivity=95%, specificity=91%, positive predictive value=90%, negative predictive value=95%, positive likelihood ratio=10, negative likelihood ratio=0.06 and diagnostic odds ratio=166, indicating that Optimal-IT® is a powerful and credible diagnostic tool. The 193 RDT-positive patients treated were healed, despite three recurrence cases at day (D) D17, D25 and D27, respectively. RDT-negative patients received various treatments (antibiotics, paracetamol), but two patients among them presented with a bout of malaria on D7. None of the previously untreated patients returned with severe malaria. The Optimal-IT® test, which is already used in the field, showed good performances to effectively detect patients with and without malaria. It is therefore adapted to the malaria treatment strategy limited to confirmed cases.

Endemicity of malaria in rural areas: A prospective longitudinal study in India

The aim of the study is to assess the magnitude of the problem and certain epidemiological factors associated with malaria and examine the changing pattern of malaria through its parameters of measurement during 2009-2011. The study was carried out at the Rural Health Training Center (RHTC), under the J. N. Medical College, Aligarh Mus-lim University, Aligarh, (India) for three years from 1st January 2009 to 31st December 2011. Teams of doctors and paramedical staff regularly visited the villages. If any person was found to be suffering from fever, his/her blood was examined for the malaria parasite. Patients were given presumptive treatment and radical treatment if slides were positive. The findings of the study demonstrated that the number of malaria cases increased during the study period, but in the year 2010, a sudden upsurge was noticed. Out of 5594 patients, most of the patients seen were in the age group of 11-20 years (34.3%). P. vivax (96.2%) was the most common malaria infection in these areas. An increasing trend of malaria was seen from July to October. Most of the parameters of malaria measurement in-creased many folds in 2010 and showed a declining trend in 2011. The overall findings of the study indicated the high endemicity of malaria in the study area and demonstrated a changing pattern of malaria in the registered vil-lages as most of the parameters of malaria measurement increased. An integrated approach is needed which in-cludes mass survey or active surveillance, and appropriate drug therapy to tackle this public health problem. DOI: http://dx.doi.org/10.3329/seajph.v2i2.15940 South East Asia J Public Health | Jul-Dec 2012 | Vol 2 Issue 2 | 28-33

Alertness regarding malaria in rural community of Vadodara

Background: Malaria remains a major cause of morbidity and mortality in tropical and subtropical regions of the world, despite decades of malaria control efforts. Aims & Objective: This study looked into the local community understanding of malaria treatment-seeking patterns, preventive measures and practices in rural area of Vadodara. Material and Methods: A descriptive cross-sectional survey was carried out in rural area of Vadodara. A structured questionnaire was administered to 168 randomly selected households. Only one adult person was interviewed per household. The interviewees were the heads of households and in the absence of the heads of households responsible adults above 18 years were interviewed. Results: A substantial number of research participants showed reasonable information of malaria, including correct association between malaria and mosquito bites, its potential fatal consequences and proper treatment practices. 84.1% (n = 168) of the respondents considered that they consult treatment within 24 hours of onset of malaria symptoms, with health facilities as their first treatment option. Conclusion: Despite fair knowledge of malaria in rural area of Vadodara, there is a need for improving the availability of information through the preferred community channels as well as professional health routes.

Access to subsidized artemether-lumefantrine from the private sector among febrile children in rural setting in Kilosa, Tanzania.

The World Health Organization aims at universal access to effective antimalarial treatment by the year 2015. Consequently, an enormous financial resource has been invested on Artemisinin Combination Therapy (ACT) subsidy. In Tanzania, strategies to increase access of artemether-lumufantrine (ALu) rural areas, where the burden is highest, includes subsidy to the Faith-based Organisations (FBO) facilities and accredited drug dispensing outlets (ADDOs). This study was done to assess the extent to which children suffering from malaria access ALu from the private sector in rural areas. A total of 1,235 under fives randomly selected from 12 rural villages were followed up at home on weekly basis for six months in Kilosa district in 2008. Using a structured questionnaire, caretakers were interviewed about the child's history of fever in the past 7 days; type of treatment given and the source. Baseline data were obtained on demographic characteristics, caretakers' knowledge about malaria and social economic indicators of the household. Of the 1,235 children followed-up, 740 care-seeking visits were recorded, of which, 264 (35.7%) were made at government health facilities and nearly a quarter (24.1%; 178/740) at ordinary shops that sell general merchandize including rice and sugar. Only 22% of the caretakers sought care from FBO and ADDOs. While 686 (86.6%) of the episodes were treated with antimalarials, only 319 (43%) received ALu, the recommended antimalarial. Majority (83%) of the visits made at government facilities were prescribed with ALu compared to less than half who went to FBO facilities (40.0%) and ADDOs (25.0%). In conclusion, this study has shown that less than a quarter of fever episodes suspected to be malaria in rural areas were made at FBO facilities and ADDOs, of which, less than half were treated with ALu. This shows that ALu subsidy to formal private sector does not adequately reach children in rural areas, where the malaria burden is highest. This cast some doubts if the target of universal access to effective antimalarial, by 2015, will be reached. There is need to consider enlisting the services of community health workers in the efforts to improve access to ALu in rural areas. Further research is needed to explore providers' / dispensers' preference for non-recommended antimalarials in the private sector and caretakers' preference for ordinary shops.

Sociocultural etiology to guide community control of malaria in Côte d’Ivoire

In the rural communities of Côte d'Ivoire, malaria control is guided by the sociocultural etiology or perception of this disease, as we can see by studies conducted in the Baoulé and Gouro communities. These studies show that these communities establish a link between the sun, excessive oil consumption, agricultural activities, disease, and lack of hygiene. Mosquitoes, however, are not identified as the cause of malaria but rather as an insect noxious by their noise and painful bites. These populations use both traditional and modern means to move mosquitoes away from their homes. Analysis of this social reality shows that the battle against malaria in rural areas is not simply a problem of health education. It is thus important in developing malaria control programmes to adopt a strategy that links community participation and health education.

Community Case Management of Fever Due to Malaria and Pneumonia in Children Under Five in Zambia: A Cluster Randomized Controlled Trial

Pneumonia and malaria, two of the leading causes of morbidity and mortality among children under five in Zambia, often have overlapping clinical manifestations. Zambia is piloting the use of artemether-lumefantrine (AL) by community health workers (CHWs) to treat uncomplicated malaria. Valid concerns about potential overuse of AL could be addressed by the use of malaria rapid diagnostics employed at the community level. Currently, CHWs in Zambia evaluate and treat children with suspected malaria in rural areas, but they refer children with suspected pneumonia to the nearest health facility. This study was designed to assess the effectiveness and feasibility of using CHWs to manage nonsevere pneumonia and uncomplicated malaria with the aid of rapid diagnostic tests (RDTs). Community health posts staffed by CHWs were matched and randomly allocated to intervention and control arms. Children between the ages of 6 months and 5 years were managed according to the study protocol, as follows. Intervention CHWs performed RDTs, treated test-positive children with AL, and treated those with nonsevere pneumonia (increased respiratory rate) with amoxicillin. Control CHWs did not perform RDTs, treated all febrile children with AL, and referred those with signs of pneumonia to the health facility, as per Ministry of Health policy. The primary outcomes were the use of AL in children with fever and early and appropriate treatment with antibiotics for nonsevere pneumonia. A total of 3,125 children with fever and/or difficult/fast breathing were managed over a 12-month period. In the intervention arm, 27.5% (265/963) of children with fever received AL compared to 99.1% (2066/2084) of control children (risk ratio 0.23, 95% confidence interval 0.14-0.38). For children classified with nonsevere pneumonia, 68.2% (247/362) in the intervention arm and 13.3% (22/203) in the control arm received early and appropriate treatment (risk ratio 5.32, 95% confidence interval 2.19-8.94). There were two deaths in the intervention and one in the control arm. The potential for CHWs to use RDTs, AL, and amoxicillin to manage both malaria and pneumonia at the community level is promising and might reduce overuse of AL, as well as provide early and appropriate treatment to children with nonsevere pneumonia. ClinicalTrials.govNCT00513500

Concurrent Helminthic Infection Protects Schoolchildren with Plasmodium vivax from Anemia

Background Plasmodium vivax is responsible for a significant portion of malaria cases worldwide, especially in Asia and Latin America, where geo-helminthiasis have a high prevalence. Impact of the interaction between vivax malaria and intestinal helminthes has been poorly explored. The objective of this study was to evaluate the influence of intestinal helminthiasis on the concentration of hemoglobin in children with Plasmodium vivax malaria in rural areas in the municipality of Careiro, in the Western Brazilian Amazon.Methodology/Principal FindingsA cohort study was conducted from April to November 2008, enrolling children from 5 to 14 years old in two rural areas endemic for malaria. A cross-sectional evaluation was performed in April to actively detect cases of malaria and document baseline hemoglobin and nutritional status. Children were followed-up for six months through passive case detection of malaria based on light microscopy. Throughout the follow-up interval, hemoglobin value and stool examination (three samples on alternate days) were performed on children who developed P. vivax malaria. For 54 schoolchildren with a single infection by P. vivax, hemoglobin during the malaria episode was similar to the baseline hemoglobin for children co-infected with Ascaris lumbricoides (n = 18), hookworm (n = 11) and Trichuris trichiura (n = 9). In children without intestinal helminthes, a significant decrease in the hemoglobin during the malarial attack was seen as compared to the baseline concentration. In the survival analysis, no difference was seen in the time (in days) from the baseline cross-sectional to the first malarial infection, between parasitized and non-parasitized children.Conclusion/SignificanceFor the first time, a cohort study showed that intestinal helminthes protect against hemoglobin decrease during an acute malarial attack by P. vivax.

Fièvre recurrente à tiques : un diagnostic non rare au décours d’un séjour touristique au Sénégal

In Senegal, tick-borne relapsing fever caused by the spirochetes Borrelia crucidurae is the most common cause of fever after malaria in rural areas. However, this is only rarely diagnosed in France, probably because: i) the diagnosis relies on investigations that are not routinely done; ii) even undiagnosed, borreliosis may be cured with empirical antibiotic treatment. We report four observations of tick-borne relapsing fever in patients returning from Senegal: In two patients, the diagnosis relied on the observation of spirochetes in blood smears; in the other two, the diagnosis relied on typical clinico-biological signs, borreliosis serology and exposure. These four cases diagnosed over a four year period in one institution suggest that relapsing fever is not rare in patients returning from West Africa. Patients who return form Senegal with unexplained fever should be investigated with careful examination of blood smears and PCR on blood samples.

Knowledge of malaria amongst caregivers of young children in rural and urban communities in Southwest Nigeria

Purpose: To compare the awareness and treatment knowledge of malaria amongst caregivers of young children in urban and rural areas of Ado-Odo/Ota Local Government Area in Ogun State. Method: Structured questionnaires were administered to caregivers of children under the age of five years in 1472 households using a multistage random sampling technique. Results: Many respondents (65%) attributed the cause of malaria to mosquito bite. The knowledge of malaria treatment (particularly the knowledge of pediatric doses) was generally poor. Caregivers in urban areas had better understanding of the dosage regimen for both adult and pediatric doses (p<0.05) than those in rural areas (p <0.05). However, caregivers in urban areas also sought more frequently for treatment of their children that are febrile than those living in rural areas. The latter visited the patent medicine vendors more frequently than the former (p<0.05). Conclusion: The caregivers of children in the communities studied have poor knowledge of malaria. Those in urban areas have better health-seeking behaviour than those in rural areas. There is therefore need for urgent interventions to promote appropriate treatments of malaria in rural areas.

Feasibility of a community health worker strategy for providing near and appropriate treatment of malaria in southeast Nigeria: An analysis of activities, costs and outcomes

Rationale Community health workers (CHWs) could be used to bring appropriate and timely treatment of malaria closer to home and there is the need to increase the body of knowledge about the feasibility of implementing the strategy. Objective To determine the processes, costs and outcomes of design and implementation of a strategy based on use of CHWs for near and appropriate treatment of malaria. Methods The CHW strategy was implemented in two villages (Adu and Ahani) in Enugu state, southeast Nigeria. Adu and Ahani have a population of approximately 3500 and 5000 residents, respectively. The study was conducted in four phases: (1) baseline survey; (2) design; (3) implementation, supervision and monitoring; and (4) evaluation. Interactive meeting with all the stakeholders were used to fine-tune the design of the CHW strategy. Community members that were selected by the project team with the help of community leaders were trained to become CHWs and their remuneration was through commissions on their drug sales. Community and provider's financial and non-financial costs of the startegy were computed. Results Non-financial costs were the highest contributor to consumer costs, while financial costs constituted more than 90% of provider costs. The total consumer cost in Ahani was US$ 2548, while the consumer cost in Adu was US$ 1585. The total provider cost in Ahani was US$ 4515, while in Adu it was US$ 4302. The unit cost cost per villager was US$ 1.40 in Ahani and US$ 1.70 in Adu, while the unit financial consumer cost per treated patient was $0.05 in both villages, respectively. The CHWs were acceptable to the people and had an increased market share out of existing malaria treatment provision strategies. Conclusion The cost of starting up the CHW strategy is low and should be affordable to malaria control programs and communities. The CHW strategy is also economically viable and a potential cost-effective source for providing timely, and appropriate treatment of malaria in rural areas. It should be fine-tuned and added to malaria control armamenterium in Nigeria and other parts of sub-Saharan Africa.

Rapid urban malaria appraisal (RUMA) I: epidemiology of urban malaria in Ouagadougou.

BackgroundRapid urbanization in sub-Saharan Africa has a major impact on malaria epidemiology. While much is known about malaria in rural areas in Burkina Faso, the urban situation is less well understood.MethodsAn assessment of urban malaria was carried out in Ouagadougou in November -December, 2002 during which a rapid urban malaria appraisal (RUMA) was applied.ResultsThe school parasitaemia prevalence was relatively high (48.3%) at the cold and dry season 2002. Routine malaria statistics indicated that seasonality of malaria transmission was marked. In the health facilities, the number of clinical cases diminished quickly at the start of the cold and dry season and the prevalence of parasitaemia detected in febrile and non-febrile cases was 21.1% and 22.0%, respectively. The health facilities were likely to overestimate the malaria incidence and the age-specific fractions of malaria-attributable fevers were low (0–0.13). Peak prevalence tended to occur in older children (aged 6–15 years). Mapping of Anopheles sp. breeding sites indicated a gradient of endemicity between the urban centre and the periphery of Ouagadougou. A remarkable link was found between urban agriculture activities, seasonal availability of water supply and the occurrence of malaria infections in this semi-arid area. The study also demonstrated that the usage of insecticide-treated nets and the education level of family caretakers played a key role in reducing malaria infection rates.ConclusionThese findings show that determining local endemicity and the rate of clinical malaria cases are urgently required in order to target control activities and avoid over-treatment with antimalarials. The case management needs to be tailored to the level of the prevailing endemicity.

DESCRIPTIVE STUDY ON THE EFFICACY AND SAFETY OF ARTESUNATE SUPPOSITORY IN COMBINATION WITH OTHER ANTIMALARIALS IN THE TREATMENT OF SEVERE MALARIA IN SUDAN

Documentation on the efficacy of artesunate in Africa is limited, and no experience of artesunate use in Sudan is documented. Severe malaria in rural areas of Sudan, where facilities for the safe and effective use of parenteral quinine are lacking, is a frequent problem. Early treatment with artesunate suppositories would provide a simple method for use by unskilled staff and would be an alternative approach to treat malaria in settings with poor resources. We describe a hospital-based study of rectal artesunate in 100 adult patients with severe falciparum malaria with a dose derived from pharmacokinetic data (200 mg every 8 hours) over 3 days, which halted progression of severe disease and had a low fatality rate. The dosage schedule led to a rapid clinical response and reduced parasite clearance and fever subsidence times of (31.5 +/- 10.1 hours) and (31.4 +/- 11.1 hours). The sequential treatment of rectal artesunate with either doxycycline or pyrimethamine/sulfadoxine or mefloquine resulted in similar clinical cure rates of around 100%, and the combination of artesunate with either doxycycline or pyrimethamine/sulfadoxine was equally effective as mefloquine in preventing recrudescence. There were no significant adverse effects or signs of toxicity related to the treatment observed during the 28-day follow-up. The combination regimens could be used in areas where there is limited access to parenteral therapy for malaria.

Investigation of the efficacy of two rapid assessment techniques (Optimal 1 and SD-Bioline) for the diagnosis of malaria in rural areas of Nigeria

We had previously studied the efficacy of three new techniques-Para Sight F, (PSF), Immunochromatographic Test (ICT) and Quantitative Buffy Coat (QBC) – as possible replacements for the time-consuming microscopy in the diagnosis of malaria. Two more rapid assessment techniques (the Optimal 1 and SD-BIOLINE) were recently introduced into Nigeria and claimed to exhibit high sensitivity and specificity. Optimal 1 was particularly claimed to distinguish between P falciparum, P. malariae, P ovale and P. vivax. We have in this work evaluated the efficacy of both the Optimal 1 and SD-Bioline in 240 patients from Ibafo and Magboro Communities in Obafemi-Owode LGA of Ogun State, Nigeria. Results showed that with regard to the detection of P. falciparum, Optimal 1 gave a sensitivity, specificity, positive and negative predictive values of 63.95%, 92.20%, 82.1% and 82.1% respectively, while the SD-Bioline gave 54.84%, 42.9%, 68.0% and 68.0% respectively. In retrospect, the sensitivities shown by 3 other techniques (ICT, PSF and QBC) investigated by us were 88.63, 89.95 and 87.6% respectively. Their specificities on the other hand were 94.60, 91.17, 94.70% respectively. The main advantage of the rapid Optimal 1 technique is that it was able to detect P. malariae which microscopy also detected in three patients. The SD-BIOLINE gave the worst comparative result and could not be recommended for use in Nigeria. This work in conclusion has shown that Optimal 1 could be useful in the rapid diagnosis of the various species of Plasmodium in Nigeria provided the patients could afford the test. (Af. J. of Clinical and Experimental Microbiology: 2003 4(1): 6-13)

Artesunate suppositories: an effective treatment for severe falciparum malaria in rural areas

Artesunate suppositories: an effective treatment for severe falciparum malaria in rural areas