Malaria Prevention Research Articles

Socioeconomic determinants of malaria and hepatitis infections: insights from the Federal Medical Center, Makurdi, North Central, Nigeria.

Malaria and hepatitis are prevalent public health issues in Nigeria, significantly impacting health outcomes. Given the importance of the Federal Medical Center, Makurdi, as a key healthcare provider in the region, it is crucial to understand the prevalence and factors associated with these diseases within this setting. This study is designed to address this need, aiming to evaluate the prevalence and risk factors of malaria and hepatitis B and C among patients at the Federal Medical Center, Makurdi. A cross-sectional study design was employed, involving the meticulous analysis of patient records and diagnostic data from the Federal Medical Center, Makurdi. Data on malaria and hepatitis B and C prevalence were collected from laboratory reports and patient interviews. Socioeconomic information, including income, education level, and healthcare access, was also gathered. Statistical analyses were performed with utmost care to identify associations between disease prevalence and risk factors. The study examined 248 patients at the Federal Medical Centre, Makurdi, assessing malaria, Hepatitis B surface antigen (HBsAg), and Hepatitis C virus (HCV). Malaria prevalence was 52.4%, with higher rates in males (57.7%) than females (47.2%). HBsAg prevalence was 6.9%, and HCV was 4.8%, with no significant differences by sex or marital status. Income level impacted HCV rates, with middle-income individuals showing higher prevalence (21.4%). Malaria was most common in the 26-40 age group (35.4%). The findings underscore the need for targeted public health interventions. Enhanced access to preventive measures, such as insecticide-treated nets and safer blood transfusion practices, and educational disease prevention programs, are essential. Addressing socioeconomic disparities is crucial for effective disease control. To mitigate the burden of malaria and hepatitis B and C at the Federal Medical Center, Makurdi, a multifaceted approach is required. Improving preventive measures, healthcare access, and addressing socioeconomic determinants will reduce disease prevalence and improve patient outcomes.

Efficacy of attractive targeted sugar bait stations against malaria in Western Province Zambia: epidemiological findings from a two-arm cluster randomized phase III trial.

Attractive targeted sugar bait (ATSB) stations containing bait (to attract) and ingestion toxicant (to kill) sugar-foraging mosquitoes are hypothesized to reduce malaria transmission by shortening the lifespan of Anopheles vectors. A two-arm cluster-randomized controlled trial (cRCT) was conducted in Western Province Zambia. Seventy clusters of 250-350 households were assigned (1:1) by restricted randomization to an intervention arm (ATSB) or control arm (no ATSB) in the context of standard of care vector control (insecticide-treated nets and/or indoor residual spraying). Two ATSB stations (Westham Sarabi, 0.11% dinotefuran w/w) were maintained on exterior walls of eligible household structures for a 7-month deployment period (December-June) during the high malaria transmission season. The primary outcome was clinical malaria incidence among two consecutive seasonal cohorts of children aged 1-14years, followed-up monthly from January-June in 2022 and 2023. Secondary outcome was Plasmodium falciparum prevalence among individuals aged over six months. Analysis compared clinical malaria incidence and prevalence between arms among the intention-to-treat population. ATSB coverage, assessed by cross-sectional survey, was 98.3% in March-April 2022 and 89.5% in March-April 2023. 4494 children contributed any follow-up time to the cohort, with 2313 incident malaria cases in the intervention arm (1.28 per child per six-month transmission season), and 2449 in the control arm (1.38 per child-season). The incidence rate ratio between the two arms was 0.91 (95% CI 0.72-1.15, p = 0.42). 2536 individuals participated in cross-sectional surveys, with prevalence of P. falciparum 50.7% in the intervention arm and 53.5% in the control arm. The odds ratio between the two arms was 0.89 (95% CI 0.66-1.18, p = 0.42). Secondary covariable-adjusted and subgroup analyses did not substantially alter the findings. No serious adverse events associated with the intervention were reported. Two ATSB stations deployed per eligible structure for two consecutive transmission seasons did not result in a statistically significant reduction in clinical malaria incidence among children aged 1-14years or in P. falciparum prevalence in rural western Zambia. Further studies are needed to assess the efficacy of ATSB stations in different settings and with different deployment strategies. The trial is registered with Clinicaltrials.gov (NCT04800055).

Malaria in the Republic of Guinea 2022-2023: costs associated with the care pathway from the patient's perspective.

Access to safe, financial affordable health care is a key factor in reducing health disparities. The malaria is a major public health issue, with significant economic implications in Guinea where the free malaria care services were introduced in 2010. This paper analyzes the costs associated with the care pathway for malaria patients in the Republic of Guinea. An analysis of the costs associated with malaria disease was conducted using data from a cross-sectional survey on the determinants of malaria care pathway between December 2022 and March 2023. The data were collected in health facilities and at community health workers. According to the patient's perspective, Time-Driven Activity-Based Costing (TDABC) and micro-costing approaches were used to assess the costs associated with care-seeking, cases management, and income loss. A total of 3300 patients were recruited in 60 health facilities. The majority were in urban areas (64.8%). One third of the patients were children under five years old. Over half of the patients or caregivers were without formal education, and most households were headed by husbands (78.5%). The median monthly income of the head of households was $116.0. Furthermore, after diagnosis, 25.5% of cases were uncomplicated malaria, 19.2% were complicated, and 52.2% were malaria associated with other diseases. Globally 41% of cases were on their first care pathway. The costs of care-seeking varied according to type of malaria, from $3.5 and $13.5 respectively for uncomplicated and complicated cases. The median direct costs of case management at health facilities were $7.3 (IQR: $4.1,13.3) for uncomplicated and $30.5 (IQR: 15.7, 51.4) for complicated cases. The total costs associated with the global care pathway differed across types of malaria and age groups, with median costs estimated at $17.4 (IQR: 6.7, 34.8) for uncomplicated cases and $43.5 (IQR: $ 19.7, 74.0) for complicated malaria. A delay in appropriate care-seeking accounted for 19% of the costs incurred by malaria patients in Guinea (p < 0.001). Despite the introduction of free malaria prevention services, malaria patients or their caregivers continue to incur costs and loss of income. An approach to selective, free and affordable flat-rate costs could ensure the financial viability of health facilities and reduce out-of-pocket expenses. The next research will focus on the impact of free selective and flat-rate pricing on out-of-pocket expenses, and the analysis of the perception of the malaria care services by care providers and users.

Audience awareness of radio messages on adopting malaria preventive measures among rural dwellers in Oyo state, Nigeria

Purpose This study aims to examine the audience awareness of radio messages on malaria prevention and how these messages have influenced the adoption of malaria preventive measures among rural dwellers in Oyo State, Nigeria. Design/methodology/approach This research adopted a mixed-method approach, combining surveys and qualitative focus group discussions to gather data on respondents’ attitudes, knowledge and practices related to malaria prevention. The authors used Frequency distribution involving tables to present quantitative data, while we deployed thematic analysis to present qualitative data. Findings Results showed that most rural dwellers (86.5%) were exposed to malaria prevention radio messages. However, findings indicated that awareness alone did not influence the adoption of malaria preventive measures; instead, a positive attitude toward messages influenced the adoption of the malaria preventive measures. Practical implications Radio stations should tailor their messaging to address daily malaria difficulties while considering the target audience’s culture and belief systems. Also efforts should be directed at developing messages that promote awareness and build favorable attitudes toward preventative measures. Finally, radio stations, government agencies and health-care professionals must work together to guarantee that malaria prevention messages are effectively distributed. Originality/value The originality of this study comes from its unique ability to examine audience awareness of radio messages, mainly as it influences the adoption of malaria preventive measures.

Malaria Epidemiology in Rask City and Surrounding Areas (2020 - 2023), Southeast Iran

Background: Malaria, a disease caused by Plasmodium parasites and transmitted by Anopheles mosquitoes, remains a major global health challenge, causing widespread illness and mortality. Objectives: This study provides an in-depth analysis of malaria trends in Rask, Southeast Iran, from 2018 to 2023, assessing malaria prevalence, transmission factors, and impacts on the local population and healthcare system. Methods: Blood samples were collected from individuals suspected of having malaria at health centers in Rask. For each positive case, demographic information was recorded in a questionnaire. Data analysis was performed using SPSS 26, with t-tests applied to compare variables. Results: Findings indicate a peak in malaria cases in 2022, with an annual incidence rate of 2.49%. The most common species identified was Plasmodium vivax, affecting primarily males over the age of 12, with the highest number of cases reported in September. Conclusions: The results underscore the urgent need to enhance malaria prevention and control measures. The study emphasizes the value of targeted interventions, including improvements to prevention and treatment programs, reinforcement of healthcare systems, and advancement of health infrastructure. These strategies should consider climatic patterns and rainfall rates to effectively address malaria transmission dynamics.

Geospatial Analysis of Malaria and Typhoid Prevalence Due to Waste Dumpsite Exposure in Kinshasa Districts with and without Waste Services: A Case Study of Bandalungwa and Bumbu, Democratic Republic of Congo

Municipal solid waste (MSW) management poses substantial challenges in rapidly urbanizing areas, with implications for both the environment and public health. This study focuses on the city of Kinshasa in the Democratic Republic of Congo, investigating whether the presence or absence of solid waste collection services results in varying health and economic impacts, and additionally, seeking to establish a correlation between residing in proximity to dumpsites and the prevalence of diseases like malaria and typhoid, thereby providing a comprehensive understanding of the health implications tied to waste exposure. Health data were collected through survey questionnaires, and the geospatial distribution of 19 dumpsites was analyzed using Google Earth Pro 7.3.1 for satellite imagery and GIS software 10.3.1 to map dumpsites and define 1 km buffer zones around the largest dumpsites for household sampling. Statistical analyses were conducted using R Version 4.2.3, employing Chi-square tests for disease prevalence and logistic regression to assess associations between waste management practices and health outcomes. A multivariate regression was used to evaluate correlations between discomfort symptoms (e.g., nasal and eye irritation) and waste activities. The geospatial analysis revealed significant variation in dumpsite size and location, with larger dumpsites near water bodies and flood-prone areas. The study contributes valuable insights into waste-related health risks, emphasizing the need for improved waste management policies in rapidly urbanizing areas like Kinshasa. The socio-demographic analysis reveals distinct traits within the surveyed populations of two communes, Bandalungwa (Bandal) and Bumbu. Bumbu, characterized by larger open dumpsites and limited waste collection services, exhibits a higher prevalence of certain diseases, particularly typhoid fever, and malaria. This discrepancy is statistically significant (p &lt; 2.2 × 10−16), suggesting a potential link between waste exposure and disease prevalence. In Bandal, self-waste collection is a high risk of exposure to typhoid (OR = 4.834 and p = 0.00001), but the implementation of a waste collection service shows protective effect (OR = 0.206 and p = 0.00001). The lack of waste collection services in Bumbu increases the risk of exposure, although not significantly (OR = 2.268 and p = 0.08). Key findings indicate that waste disposal methods significantly differ between Bandal and Bumbu. Bumbu’s reliance on burning and dumping creates environments conducive to disease vectors, contributing to elevated disease transmission risks. However, an in-depth correlation analysis reveals that specific waste management practices, such as burning, burying, and open dumping, do not exhibit statistically significant associations with disease prevalence, underlining the complexity of disease dynamics. This study contributes valuable insights into the importance for urban public health, particularly in rapidly urbanizing cities like Kinshasa, where inadequate waste management exacerbates health risks. By investigating the correlation between proximity to unregulated dumpsites and the prevalence of diseases such as malaria and typhoid fever, the research underscores the urgent need for targeted waste management policies. The stark health disparities between Bandal, with better waste services, and Bumbu, where services are lacking, highlight the protective effect of organized waste collection. These findings suggest that expanding public waste services and enforcing stricter regulations on waste disposal could reduce disease prevalence in vulnerable areas. Additionally, the study supports integrating waste management into urban planning as a critical public health measure. Its evidence-based approach offers valuable insights for policymakers in Kinshasa and other cities facing similar challenges, emphasizing the broader health implications of environmental governance in urban settings.

Examining malaria treatment and prevention spending efficiency in malaria-endemic countries, 2000–2020

BackgroundIn 2021, an estimated 750,000 people died from malaria. Despite this significant burden, globally, malaria incidence and mortality rates have substantially dropped over the last 30 years. However, growth in spending on malaria and improved outcomes have recently stagnated. This development has made it more important than ever to understand what constitutes efficient spending on malaria.MethodsData from various sources, including disaggregated data on malaria spending from the WHO Global Malaria Programme, National Health Accounts, and the Global Burden of Disease 2021 study was used in this study. The National Health Account report is produced at the end of a national accounting exercise that aims to map the flow of financial resources from all perspectives—incl. sources, agencies—in the health sector. Malaria spending estimates for all malaria-endemic countries from 2000 to 2020, with government and donor spending disaggregated into 11 key programme areas were generated in this study. Then, these spending estimates were combined with outcome data and estimated country efficiency using robust non-parametric stochastic frontier analysis and linear regression to examine the types of malaria spending associated with better malaria outcomes.ResultsAcross malaria-endemic countries, there is wide variation in malaria spending, with spending associated with the malaria burden within the country. Argentina, Paraguay, and Turkmenistan stood out as examples of low spending relative to their respective malaria incident per person at risk rates, while the Philippines, Guatemala, and Sri Lanka stood out as countries with case fatality ratios that were low relative to their malaria spending. Having a greater proportion of malaria spending sourced from donors or on prevention was associated with increases in incidence efficiency, while having a greater proportion of spending on anti-malarial medicines was associated with increases in case fatality efficiency.ConclusionsPrioritization of spending on prevention, anti-malarial medicines, and health systems strengthening can fight incident cases and fatalities simultaneously, especially in resource-scarce, malaria-endemic countries. Furthermore, improving the availability, frequency of collection, and quality of detailed disaggregated spending data is essential to support work that strengthens the evidence base on spending efficiency and work that improves understanding of how spending on malaria could be leveraged to bridge gaps in equity across population groups.

Malaria treatment for prevention: a modelling study of the impact of routine case management on malaria prevalence and burden

BackgroundTesting and treating symptomatic malaria cases is crucial for case management, but it may also prevent future illness by reducing mean infection duration. Measuring the impact of effective treatment on burden and transmission via field studies or routine surveillance systems is difficult and potentially unethical. This project uses mathematical modeling to explore how increasing treatment of symptomatic cases impacts malaria prevalence and incidence.MethodsLeveraging the OpenMalaria stochastic agent-based transmission model, we first simulated an array of transmission intensities with baseline effective treatment coverages of 28%, 44%, and 54% incorporated to reflect the 2023 coverage distribution across Africa, as estimated by the Malaria Atlas Project. We assessed the impact of increasing coverage to as high as 60%, the highest 2023 estimate on the continent. Subsequently, we performed simulations resembling the specific subnational endemicities of Kenya, Mozambique, and Benin, using the Malaria Atlas Project estimates of intervention coverages to reproduce historical subnational prevalence. We estimated the impact of increasing effective treatment coverage in these example settings in terms of prevalence reduction and clinical cases averted in children under 5 years old and the total population.ResultsThe most significant prevalence reduction – up to 50% – was observed in young children from lower transmission settings (prevalence below 0.2), alongside a 35% reduction in incidence, when increasing effective treatment from 28% to 60%. A nonlinear relationship between baseline transmission intensity and the impact of treatment was observed. Increasing effective treatment coverage to 60% reduced the risk in high-risk areas (prevalence in children under 5 years old > 0.3), affecting 39% of young children in Benin and 20% in Mozambique previously living in those areas. In Kenya where most of the population lives in areas with prevalence below 0.15, and case management is fairly high (53.9%), 0.39% of children were estimated to transition to lower-risk areas.ConclusionsImproving case management directly reduces the burden of illness, but these results suggest it also reduces transmission, especially for young children. With vector control interventions, enhancing case management can be an important tool for reducing transmission intensity over time.

Assessing the Efficacy of Gene-Drive Technology in Reducing Malaria Transmission in Sub-Saharan Africa: Current Progress and Future Prospects

Malaria continues to pose a significant public health challenge in Sub-Saharan Africa, necessitating innovative solutions to combat its transmission. This review examined the efficacy of gene-drive technology as a novel approach to reducing malaria transmission through genetic modifications of Anopheles mosquitoes. Utilizing a comprehensive literature review and analysis of experimental studies and pilot projects, we assessed the mechanisms of gene drives, including population suppression and replacement strategies. The findings indicated that gene-drive technology has the potential to significantly alter mosquito populations, thereby diminishing the burden of malaria. However, challenges such as ecological concerns, regulatory complexities, and public acceptance must be addressed for successful implementation. The integration of gene drives with existing malaria control measures, collaborative research efforts, and robust ethical governance is crucial for maximizing effectiveness and ensuring sustainable outcomes. Furthermore, monitoring and evaluation systems are essential for assessing the safety and efficacy of gene-drive initiatives. This review underscored the transformative potential of gene-drive technology in malaria prevention, advocating for continued dialogue among stakeholders to navigate the complexities associated with its application in Sub-Saharan Africa. Keywords: Gene-drive technology, Malaria transmission, Anopheles mosquitoes, Public health, Sub-Saharan Africa.

Prevalence and factors associated with cerebral malaria among children aged 6 to 59 months with severe malaria in Western Uganda: a hospital-based cross-sectional study

IntroductionCerebral malaria, caused by Plasmodium falciparum, represents the most severe neurologic complication of malaria. Its association with high morbidity and mortality rates, especially among young children, underscores its clinical significance. In sub-Saharan Africa, including Uganda, cerebral malaria remains a major health challenge, contributing significantly to the high child mortality rate. Despite advances in malaria control, the burden of cerebral malaria among children under five is substantial, reflecting the need for targeted interventions and improved management strategies. This study aimed to determine the prevalence of cerebral malaria and identify associated factors among children admitted with severe malaria at a tertiary hospital in western Uganda.MethodsThis was a cross-sectional, descriptive, and analytical study involving children aged 6 to 59 months admitted with severe malaria. The study was conducted from January to March 2023 at Fort Portal Regional Referral Hospital. Severe and cerebral malaria were defined as per the WHO criteria. Sociodemographic, clinical, and laboratory data were collected and analyzed using IBM SPSS version 27. Logistic regression analysis was used to evaluate the factors associated with cerebral malaria. A p-value < 0.05 indicated statistical significance.ResultsA total of 250 children were recruited (mean age 33.1 ± 17.3 months). The prevalence of cerebral malaria was 12.8% (95% CI: 8.9–17.6). Cerebral malaria was independently associated with male sex (aOR: 3.05, 95% CI: 1.20–7.77, p = 0.02), abnormal bleeding (aOR: 13.22, 95% CI: 11.54–15.16, p = 0.001), history of convulsions (aOR 12.20, 95% CI: 10.7–21.69, p = 0.010), acute kidney injury (aOR: 4.50, 95% CI: 1.30–15.53, p = 0.02), and hyponatremia (aOR: 3.47, 95% CI: 1.34–8.96, p = 0.010).Conclusions and recommendationsThe prevalence of cerebral malaria was high among children with severe malaria. Factors associated with cerebral malaria included male gender, history of convulsions, abnormal bleeding, acute kidney injury, and hyponatremia. Targeted interventions and early management are essential to improve clinical outcomes.

Perspectives of postpartum women on intermittent presumptive treatment in Uganda: implications for malaria prevention: a qualitative study

BackgroundMalaria during pregnancy leads to many deaths in Africa. COVID-19 contributed to more malaria cases due to interruptions in prevention efforts. Intermittent presumptive treatment (IPTP) is an effective malaria prevention strategy for pregnant women, but adoption barriers still exist. The study aim was to explore barriers to the adoption of IPTP at Kawempe National Referral Hospital (KNRH) Uganda.MethodsIn a qualitative study design, data was collected using focus group discussions. A total of 37 postpartum mothers were interviewed in six focus group discussions. The interviews were conducted using a structured guide to explore barriers to IPTP implementation at KNRH. The data was transcribed, coded, and analysed using NVivo 10.ResultsThe study found that mothers lacked adequate knowledge about IPTP, faced socioeconomic and cultural constraints, fear of side effects, a high pill burden, and experience of health system challenges as major themes of barriers to optimal IPTP use.Conclusions and recommendationsChallenges in the service delivery and inadequate information in regard to importance and expected side effects were identified by the users as the major barriers to IPTP delivery in public health care setting. Improving delivery of focused health education talks and health work attitude and delivery chain for IPTP in the health facilities are recommended to increase its uptake.

Implementation of a Mobile Health Approach to a Long-Lasting Insecticidal Net Uptake Intervention for Malaria Prevention Among Pregnant Women in Tanzania: Process Evaluation of the Hati Salama (HASA) Randomized Controlled Trial Study.

Malaria infection is associated with many adverse outcomes for pregnant women and neonates, yet pregnant women in East and Southern Africa remain frequently exposed to malaria. Long-lasting insecticidal nets (LLINs) can help prevent malarial infections and the associated adverse events. The Hati Salama (HASA) study was a cluster-randomized controlled trial implemented in 100 antenatal health facilities in urban and rural settings of Tanzania that provided pregnant women in both intervention and control groups with e-vouchers to redeem for LLINs for malaria prevention. The intervention group received behavior change communication mobile messages across a 14-day period while the e-voucher was active, and no significant difference between the rates of e-voucher redemption was found across the two groups. This study was a process evaluation of the HASA randomized controlled trial to determine barriers and facilitators to e-voucher reception and LLIN acquisition for pregnant women enrolled in the trial, as well as challenges and lessons learned by nurses who worked at the antenatal health facilities supporting the trial. Following the e-voucher's expiration at 14 days, voluntary phone follow-up surveys were conducted for nurses who supported the trial, as well as participants in both intervention and control groups of the trial who did not redeem their e-vouchers. Survey questions asked nurses about workflow, training sessions, network connectivity, proxy phone use, and more. Surveys asked participants about reasons for not redeeming e-vouchers. Both surveys provided lists of preset answers to questions, as well as the option to provide open-ended responses. Nurses and trial participants were contacted between January and June 2016 on up to three occasions. While nurses who supported the HASA trial seemed to recognize the value of the program in their communities, some barriers identified by nurses included network connectivity, workload increase, inadequate training and on-the-ground support, and difficulty following the workflow. Several barriers identified by trial participants included personal obligations preventing them from redeeming the e-voucher on time, network connectivity issues, losing the e-voucher number, no stock of LLINs at retailers when attended, inadequate explanation of where or how to redeem the e-voucher, or not receiving an SMS text message with the e-voucher number promptly or at all. Large-scale e-voucher platforms for health-related commodity interventions, such as LLIN distribution in sub-Saharan Africa, are feasible, but challenges, including network connectivity, must be addressed. Nurses identified issues to be considered in a future scale-up, such that the number of nurses trained should be increased and the e-voucher issuance workflow should be simplified. To address some of the key barriers impacting e-voucher redemption for trial participants, the network of retailers could be expanded and the e-voucher expiration period should be extended. ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624.

Insecticide-treated bednets and chemoprophylaxis reduce malaria mortality and parasite prevalence.

This commentary discusses an influential study from 1993 that demonstrated, among West African children, an overall mortality benefit of insecticide-impregnated bednets, and the reduction of malaria prevalence by chemoprophylaxis. Led by Brian Greenwood and colleagues in The Gambia, the trial also showed these tools to be affordable and practicable. In the years since, >2 billion bednets have been provided to high-risk populations and have contributed greatly to reductions in malaria-attributable mortality. Seasonal malaria chemoprevention now protects 50 million African children annually. Few interventions in tropical medicine have achieved such an impact.

Upregulation of Interferon Gamma Gene Expression among Asymptomatic Malaria Adults in Bayelsa State, Nigeria

Despite concerted efforts, malaria remains a global public health problem. Treatment for asymptomatic malaria will reduce the health care burden of malaria. However evidence-based data for the presence of systemic pathology in asymptomatic malaria, which might inform treatment remains limited. The present study investigated the current prevalence of asymptomatic malaria in Bayelsa State, Nigeria and differences in interferon gamma (IFNγ) mRNA expression between asymptomatic malaria individuals (AMIs) and uninfected individuals (UIs), in relation to ABO blood groups and hemoglobin genotype (Hb) variants. A cross-sectional design was employed to randomly select 146 non-febrile participants from Sagbama LGA, Bayelsa State. Plasmodium falciparum infection was determined using high-resolution melting analysis and participants were grouped into UIs and AMIs. Hb, blood groups, and IFNγ mRNA expression were determined using electrophoresis, agglutination, and real-time PCR method respectively. Logistic regression and t-test were used to determine significant differences between groups at P < 0.05. The current prevalence of asymptomatic malaria in Bayelsa State was found to be 89.73%. Age and sex were associated with asymptomatic malaria (P < 0.05). Plasmodium falciparum DNA melt curves for AMIs aligned at 83.89±0.34°C, while the amplification cycle thresholds were below 30 cycles. Compared with UIs, the gene expression of IFNγ mRNA was significantly (P < 0.001) higher among AMIs. Also, among AMIs those with A, B, and AB blood groups expressed significantly higher levels of IFNγ mRNA compared with blood groups O AMIs. Furthermore, AMIs with HbAA expressed significantly higher levels of IFNγ mRNA compared with HbAS AMIs. The novelty of the present study is the demonstration of the existence of systemic pathology in asymptomatic malaria and the demonstration that the intensity of systemic pathology is dependent on blood types and haemoglobin genotype variants. Findings of the present study have implications for policy creation towards asymptomatic malaria treatment.

Field-evolved resistance to neonicotinoids in the mosquito, Anopheles gambiae, is associated with mutations of nicotinic acetylcholine receptor subunits combined with cytochrome P450-mediated detoxification

New insecticides prequalified for malaria control interventions include modulators of nicotinic acetylcholine receptors that act selectively on different subunits leading to variable sensitivity among arthropods. This study aimed to investigate the molecular mechanisms underlying contrasting susceptibility to neonicotinoids observed in wild populations of two mosquito sibling species. Bioassays and a synergist test with piperonyl butoxide revealed that the sister taxa, Anopheles gambiae and An. coluzzii, from Yaounde, Cameroon, both have the potential to develop resistance to acetamiprid through cytochrome P450-mediated detoxification. However, contrary to An. coluzzii, An. gambiae populations are evolving cross-resistance to several active ingredients facilitated by mutations of nicotinic acetylcholine receptors (nAChRs). We sequenced coding regions on the β1 and α6 nAChR subunits where variants associated with resistance to neonicotinoids or to spinosyns have been found in agricultural pests and detected no mutation in An. coluzzii. By contrast, six nucleotide substitutions including an amino acid change in one of the loops that modulate ligand binding and affect sensitivity were present in the resistant species, An. gambiae. Allele frequency distributions were consistent with the spread of beneficial mutations that likely reduce the affinity of An. gambiae nAChRs for synthetic modulators. Our findings provide critical information for the application and resistance management of nAChR modulators in malaria prevention.

Epidemiological profile of severe malaria and sickle cell disease in children at the mother and child university hospital center Jeanne Ebori foundation of libreville from 2020 to 2021

Background: Hemoglobinopathies represent the most common genetic diseases worldwide. In Gabon, the clinico-biological profile of patients with homozygous hemoglobin S or those with AS sickle cell traits, faced with this prevalence of serious malaria, remains unknown today. The objective was to evaluate the complications of severe malaria in SS homozygous sickle cell patients and those carrying AS sickle cell traits. Methods: This is an observational, retrospective study, with descriptive and analytical aims which took place from January 2020 to October 2021. The parameters studied were socio-demographic, clinical and paraclinical data, the diagnosis chosen, therapeutic data and evolution. Results: severe neurological form of malaria was the most common criterion with a frequency of 41.7%, followed by parasitic forms 35.8% and anemic forms 21.8%. Among AS heterozygotes, the most widespread severe form was the neurological form with a frequency of 63.2%, the anemic form 26.3% and parasitic at 10.5%. In homozygous SS subjects, the most widespread severe form was the anemic form with a frequency of 68.1% followed by neurological forms 27.7% and parasitic forms 4.2%. Abdominal pain, prostration, respiratory distress were the main signs in SS homozygotes. In heterozygotes, prostration, convulsion and clinical jaundice were the main signs. A total of 99.8% of our patients were cured. Conclusions: All the electrophoretic profiles identified were subject to this infection which mainly affects heterozygous AS subjects and subjects with the AA electrophoretic profile in its severe neurological form and homozygous SS subjects in its anemic form.

The effect of intermittent preventive treatment for malaria with dihydroartemisinin–piperaquine on vaccine-specific responses among schoolchildren in rural Uganda (POPVAC B): a double-blind, randomised controlled trial

Several important vaccines differ in immunogenicity and efficacy between populations. We hypothesised that malaria suppresses responses to unrelated vaccines and that this effect can be reversed-at least partially-by monthly malaria intermittent preventive treatment (IPT) in high-transmission settings. We conducted an individually randomised, double-blind, placebo-controlled trial of the effect of malaria IPT with dihydroartemisinin-piperaquine on vaccine responses among schoolchildren aged 9-17 years in Jinja district, Uganda. Participants were recruited from two schools and did not have exposure to vaccines of interest after the age of 5 years, with the exception of human papillomavirus (HPV). Computer-generated 1:1 randomisation was implemented in REDCap. 3-day courses of dihydroartemisinin-piperaquine (dosage by weight) or placebo were administered monthly, including twice before the first vaccination. Trial participants were vaccinated with the live parenteral BCG vaccine (Serum Institute of India, Pune, India) at week 0; yellow fever vaccine (YF-17D; Sanofi Pasteur, Lyon, France); live oral typhoid vaccine (Ty21a; PaxVax, London, UK), and quadrivalent virus-like particle HPV vaccine (Merck, Rahway, NJ, USA) at week 4; and toxoid vaccines (tetanus-diphtheria; Serum Institute of India) and an HPV booster at week 28. An additional HPV vaccination at week 8 was provided to female participants older than 14 years who had not previously been vaccinated, and a tetanus-diphtheria booster was given after completion of the trial at week 52. Primary outcomes were vaccine responses at week 8 and, for tetanus-diphtheria, at week 52, and analysis was done in the intention-to-treat population. Malaria parasite prevalence at enrolment and during follow-up was determined retrospectively by PCR. The safety population comprised all randomly allocated participants. The trial was registered at the ISRCTN Registry (ISRCTN62041885) and is complete. Between May 25 and July 14, 2021, we assessed 388 potential participants for eligibility. We enrolled and randomly allocated 341 participants to the two groups (170 [50%] to dihydroartemisinin-piperaquine and 171 [50%] to placebo); 192 (56%) were female and 149 (44%) participants were male. 145 (85%) participants in the dihydroartemisinin-piperaquine group and 140 participants (82%) in the placebo group were followed up until the week 52 endpoint. At enrolment, 109 (64%) of all participants in the dihydroartemisinin-piperaquine group and 99 (58%) of 170 participants in the placebo group had malaria; this reduced to 6% or lower at all follow-up visits in the dihydroartemisinin-piperaquine group. There was no effect of dihydroartemisinin-piperaquine versus placebo on primary outcomes: BCG-specific IFNγ ELISpot response had a geometric mean ratio (GMR) of 1·09 (95% CI 0·93-1·29), p=0·28; yellow fever neutralising antibody was 1·19 (0·91-1·54), p=0·20 for plaque reduction neutralising reference tests (PRNT50) titres (the reciprocal of the last plasma dilution that reduced by 50%) and 1·24 (0·97-1·58), p=0·09 for PRNT90 titres (reciprocal of the last plasma dilution that reduced by 90%); and IgG to Salmonella enterica serovar Typhi O-lipopolysaccharide was 1·09 (0·81-1·46), p=0·58, HPV-16 was 0·72 (0·44-1·77), p=0·19, HPV-18 was 0·71 (0·47-1·09), p=0·11; tetanus toxoid was 1·22 (0·91-1·62), p=0·18, and diphtheria toxoid was 0·97 (0·83-1·13), p=0·72. There was some evidence that dihydroartemisinin-piperaquine reduced waning of the yellow fever response. IPT for malaria with dihydroartemisinin-piperaquine did not improve peak vaccine responses, despite reducing malaria prevalence. Possible longer-term effects on response waning should be further explored. UK Medical Research Council. For the Luganda translation of the abstract see Supplementary Materials section.

PREVALENCE OF MALARIA PARASITES AMONG PREGNANT WOMEN ATTENDING GENERAL HOSPITAL GARAKU, KOKONA LOCAL GOVERNMENT, NASARAWA STATE

Malaria remains a significant health concern, particularly among pregnant women in various regions of Nigeria, including the Kokona metropolis. This study aimed to determine the prevalence of malaria among pregnant women in Garaku, Kokona LGA, Nasarawa State, and to assess the diagnostic accuracy of Microscopy versus Rapid Diagnostic Test (RDT). Blood samples were collected from 150 pregnant women in the Kokona Local Government Area and analyzed using both Microscopy and RDT. Data were analyzed using SPSS software version 23.0, with statistical significance set at P &lt; 0.05. The overall prevalence of malaria was found to be 31.33%, with the highest prevalence observed among women in their first trimester (36.71%). Microscopy demonstrated a higher positivity rate compared to RDT. Additionally, women aged 31-40 years exhibited the highest susceptibility, with a prevalence of 42.11%. However, no significant difference was noted in malaria prevalence based on the usage of mosquito nets or parity status. The study underscores the high prevalence of malaria among pregnant women in the region, emphasizing the need for enhanced intervention strategies. Microscopy remains a more reliable diagnostic tool than RDT. Early antenatal booking and regular preventive measures are crucial to mitigating the adverse effects of malaria during pregnancy. Furthermore, environmental sanitation efforts should be intensified to reduce mosquito breeding and subsequent malaria transmission.

Exploring Information Sources on Malaria Prevention and Their Impact on Knowledge Among Pregnant Women in Urban Ghana

Exploring Information Sources on Malaria Prevention and Their Impact on Knowledge Among Pregnant Women in Urban Ghana

RTS, S malaria vaccination among children aged 24–59 months in the Sunyani Municipality, Ghana; 2023

BackgroundFollowing the successful pilot of RTS,S malaria vaccine, it has been recommended by the WHO for prevention of Plasmodium falciparum malaria in children living in endemic areas. Despite the proven benefits of the malaria vaccine, uptake especially of the fourth dose, remains relatively low. We assessed complete uptake of RTS,S malaria vaccine among children 24–59 months and associated factors in the Sunyani Municipality of Ghana. MethodsA cross-sectional study was conducted among 361 caregivers of children aged 24–59 months in the Sunyani Municipality, who had received at least one dose of RTS,S malaria vaccine. Structured questionnaires were administered to caregivers and relevant vaccination information was extracted from the maternal and child health record books. Binary logistic regression analysis was used to determine factors associated with complete uptake of the vaccine at 95 % confidence interval (CI). ResultsApproximately 45 % (164/361) of the children had completed the RTS,S malaria vaccination schedule. Children aged 48–59 months (AOR:0.26, 95 %CI:0.09–0.76), those with caregivers who believed that children were being used for experiment (AOR:0.29, 95 %CI:0.16–0.54) or doubted the safety of the vaccine (AOR:0.27, 95 %CI:0.14–0.52) were less likely to complete the four doses. On the other hand, children of caregivers who reported vaccine shortages and travelled long distances to access immunization services (AOR:3.15, 95 %CI:1.17–8.47), and those with adequate knowledge on the malaria vaccine (AOR:1.89, 95 %CI:1.08–3.29) were more likely to complete the vaccination schedule. ConclusionLess than half of the children who started RTS,S malaria vaccination completed the full schedule. Age of child, caregiver knowledge and perception of the malaria vaccine, and access to immunization service were associated with complete uptake of the RTS,S malaria vaccine. Strengthening caregiver education and access to immunization services could improve uptake of the subsequent doses and coverage of the fourth dose.