Malaria Risk Areas Research Articles

A Retrospective Malaria Surveillance Data Analysis (2013-2017), Benishangul Gumuz Region, 2018

Routine Malaria surveillance data is useful for assessing incidence and trends over time and in stratification for targeting of malaria. The reporting completeness and potential bias of such data needs assessment. Approximately 52 million people (68%) live in malaria risk areas in Ethiopia, primarily at altitudes below 2,000 meters. Objective: The general objective of this analysis was to assess the trend and magnitude of Malaria surveillance data by time, place and laboratory result for the last five years in Benishangul Gumuz Region. Descriptive cross-sectional study was used to analyze Malaria surveillance data in terms of time, place and laboratory result. Data cleaning and analysis was made by using excel 2013 software. A total of 96757 expected health facilities were in the region from 2013-2017. A total of 86266 health facilities were reported in the last five years with an average completeness of 89.2%. In the last five years (2013-2017) total of 1186514 clinically and confirmed malaria cases were reported regionally with 2290606 total malaria suspected fever examined with ninety inpatient deaths. Among the total clinically and confirmed cases, 1172244 (98.8%) were outpatients, 14248 (1.2%) were inpatients and 1013046 (85.0%) cases were confirmed by laboratory. Out of the total confirmed malaria cases 811984 (80.2%) cases were due to P.falciparum malaria and 201030 (19.8%) cases were due to P.vivax malaria. There were no other species of malaria reported other than these two species. From the total expected health facilities; a total of 86266 health facilities were reported in the last five years with an average completeness of 89.2% which is above the WHO minimum requirement (80.0%). The malaria reports shows that significant improvement in cases of data quality and management from year to year and currently all zones, Woredas and health facilities including private and NGO facilities are included and reported weekly the malaria surveillance from the data report identified in this study. The average five year regional incidence of confirmed malaria (P. Falciparum and P. Vivax) was less than half the incidence of the clinical and confirmed malaria cases.

Spatial analysis and mapping of malaria risk areas using multi-criteria decision making in Didessa District, South West Ethiopia

Malaria has long been a cause of human suffering and mortality in Sub-Saharan Africa, particularly in Ethiopia. The objective of this study was to assess the spatial distribution of malaria risk us...

Assessment of malaria hazard, vulnerability, and risks in Dire Dawa City Administration of eastern Ethiopia using GIS and remote sensing

Malaria is a serious vector-borne disease affecting a greater proportion of the world’s population. Sub-Saharan Africa carries a disproportionately high share of the global malaria burden. Ethiopia is generally considered a low-to-moderate malaria transmission intensity country. However, the health sector in Ethiopia is greatly affected by climate change, which has profound consequences on the transmission cycles of vector-borne infectious diseases like malaria. The main objective of the study was to assess the spatial distribution of malaria hazard, vulnerability, and risk areas in Dire Dawa City Administration. GIS and remote-sensing in general and multi-criteria evaluation (MCE) in particular was used for assessing and mapping malaria hazard, risk, and vulnerable areas in Dire Dawa City Administration based on the data collected from various sources. The malaria hazard map of the study area labeled 0.6% of the region as low-hazard level, 79.7% moderate, 19.7% high, and 0.1% very low. Results of malaria vulnerability analysis reveal that about 23%, 73%, and 4% of the region was found to be vulnerable to malaria risk at very high, high, and low levels, respectively. The malaria risk map classifies 80% of the region as a moderate malaria-risk area and 20% as high malaria-risk area. This assessment advocates that the GIS and remote-sensing technology as tools can be used to provide timely information on malaria hazard, vulnerability, and risk areas for planning and taking measures at various levels ranging from early warning, monitoring, and control to prevention against malaria epidemics in a resource-efficient and cost-effective way.

Malaria standby emergency treatment (SBET) for travellers visiting malaria endemic areas: a systematic review and meta-analysis.

Malaria prevention methods for travellers to low or moderate malaria risk areas vary and remain controversial. Standby emergency treatment (SBET) for malaria is one possible strategy increasingly recommended since 1988 with little evidence on its effectiveness or how it is truly being used. A systematic review and meta-analysis were performed based on a structured search in Embase, Medline, PubMed, Cochrane and Web of Science on 7 September 2018. The primary outcome was the overall prevalence of SBET use in travellers, and secondary outcomes were the proportion carrying SBET, the response to fever [use of SBET, health facility attendance and use of malaria rapid diagnostic test (mRDT)], adverse events to SBET and the proportion using SBET incorrectly (incorrect dosage/duration). The pooled SBET use prevalence was analysed using a random effects model. A descriptive summary was done to present secondary outcomes. The study protocol was registered with PROSPERO CRD42018103703. A total of 11 studies were eligible for inclusion among the 1027 titles identified by our search. The studies included 7/11 prospective cohort studies that recruited pre-travel clinic attendees in Europe and 4/11 cross-sectional studies, of which 3 recruited travellers at airports before their return home from Southeast Asia and Africa and 1 from an employee registry including long-term travellers. The overall pooled prevalence of SBET use among the 26403 travellers was 2.5% (95% confidence interval, 1.1-4.3%; range, 0.4-10.8%). There was significant variation in the proportion of travellers carrying SBET medication (40-100%), the proportion of travellers with appropriate response to fever (23-100%), adverse events (0-33%) and incorrect dosage/duration of SBET (0-100%). Adherence to the proposed recommendations for SBET use, notably the response to fever, was poor. If the use of SBET is to be pursued, modifications to the current SBET strategy should be considered, such as better selection of travellers at higher risk for malaria and the potential addition of mRDTs.

Use and retention of long-lasting insecticidal nets (LLINs) in a malaria risk area in the Brazilian Amazon: a 5-year follow-up intervention

BackgroundLong-lasting insecticidal nets (LLINs) are one of the main vector control strategies recommended by the World Health Organization for the control and elimination of malaria. This study aimed to evaluate the use and retention of LLINs during the 5 years of implementing an integrated control strategy in a malaria-endemic area in the Brazilian Amazon.MethodsThis intervention study was conducted in localities of the municipality of Barcelos, Amazonas, from 2008 to 2014. Four rural localities situated along the Padauiri River were the object of this study. Two localities (Bacabal-rio Aracá and the São Sebastião district) were used as controls. LLINs were distributed to all residents of the Padauiri River; assessments were made regarding their use and retention via a semistructured questionnaire, a household register, and direct observation during 5 years.ResultsOverall, 208 individuals participated in the study. In the baseline pilot study (2008), 9.9% of the subjects in the intervention group had slept with mosquito nets the previous night compared with 37.8% of the subjects in the control group. In 2010, this percentage was 43.2% in the intervention group and 50.9% in the control group. Therefore, 1 year after the implementation of the strategy, although there was an increase in the use of mosquito nets in both groups, this increase was significantly higher in the intervention group. This increase in LLINs use did not persist after 5 years of intervention. The households’ evaluation in 2014 showed that 80% of the houses in the intervention group owned at least one LLIN compared with 66% in the control group (p = 0.11); 76% of households in the intervention group owned sufficient LLINs for all family members compared with 50% in the control group (p = 0.007).ConclusionsHigh ownership and retention of the LLINs was observed in the intervention group. At 1 year after the distribution of these LLINs, there was a significant increase in their use that was not maintained over the long term. Control strategies must be permanent; however, exploring new strategies is necessary to ensure that the knowledge acquired further modifies the attitudes and behaviours.

Malaria elimination in Bhutan: asymptomatic malaria cases in the Bhutanese population living in malaria-risk areas and in migrant workers from India.

ABSTRACTIn 2018, Bhutan reported 54 cases of malaria, of which six were indigenous, 14 introduced and 34 imported. Considering the continuous reduction in the number of indigenous cases, Bhutan plans to eliminate malaria by 2025 under the Bhutan Malaria Elimination Strategy. The study was conducted to assess the presence of asymptomatic plasmodial infection in both, Bhutanese population living in malaria-risk areas and in migrant workers to guide the elimination strategies. A cross-sectional study was conducted from April to May 2016 in 750 Bhutanese people and 473 migrant workers. Plasmodium falciparum and Plasmodium vivax infections were investigated by using a rapid diagnostic test (RDT) and the polymerase chain reaction (PCR). Prevalence of asymptomatic plasmodial infection based on PCR was 0.27% (95% CI: 0.05–1.07%) among Bhutanese people with a mean age of 43 years old. The proportions of males and females were 45% and 55%, respectively. Among migrant workers, the prevalence of asymptomatic plasmodial infection was 0.42% (95% CI: 0.07–1.69%) with a mean age of 30 years old. The majority of migrant workers were from the neighboring Indian State of West Bengal (57.51%), followed by Assam (12.26%). RDT in both study groups did not detect any plasmodial infection. The presence of a low prevalence of asymptomatic plasmodial infection indicates that the current elimination strategies and interventions are effective.

Downscaling incidence risk mapping for a Colombian malaria endemic region

To map at a fine spatial scale, the risk of malaria incidence for the important endemic region is Urabá-Bajo Cauca and Alto Sinú, NW Colombia, using a new modelling framework based on GIS and remotely sensed environmental data. The association between environmental and topographic variables obtained from remote sensors and the annual parasite incidence (API) for the years 2013-2015 was calculated using multiple regression analysis; subsequently, a model was constructed to estimate the API and to project it to the entire endemic region in order to design the risk map. The model was validated by relating the obtained API values with the presence of the three main Colombian malaria vectors, Anopheles darlingi, Anopheles albimanus and Anopheles nuneztovari. Temperature and Normalized Difference Water Index (NDWI) showed a significant correlation with the observed API. The risk map of malaria incidence showed that the zones at higher risk in the Urabá-Bajo Cauca and Alto Sinú region were located south-east of the region, while the northern area presented the lowest malaria risk. A method was generated to estimate the API for small urban centres, instead of the used reports at the municipality level. These results provide evidence of the utility of risk maps to identify environmentally vulnerable areas at a fine spatial resolution in the Urabá-Bajo Cauca and Alto Sinú region. This information contributes to the implementation of vector control interventions at the microgeographic scale at areas of high malaria risk.

English

Malaria is one of the most killer diseases in our planet earth. It is the primary cause of patient talks, admissions and demise every year in Ethiopia. It is important to reduce the transmission and effects of the problem identifying and mapping the malaria risk area using geospatial technologies. The general objective of the study is to analyze and map malaria prone areas using geospatial tools in Amibara and Gewanie Woredas of Afar Region. The specific objectives are to identify parameters that contribute to malaria hazard in the study area and to classify and map areas at risk of malaria. To achieve the stated objectives, the researchers employed spatial modeling technique particularly Weighted Overlay Analysis (WOA). Climatic data, topographical data and infrastructural data are the major data of the study. These data were processed and analyzed by ArcGIS, Erdas imagine, Idrisi, 3DEM terrain visualization and global mapper software. The result showed that the area is suitable moderately and marginally for malaria. From the total area of the study, 35 and 65% were moderately and marginally suitable for the occurrence of malaria respectively. Therefore, as malaria is one of the killer diseases the concerned bodies should use the technologies to prevent and control the transmission of malaria in the study area and there should be health package to prevent the diseases. Key words: Malaria mapping, geospatial tools.

Monitoring health systems readiness and inpatient malaria case-management at Kenyan county hospitals

BackgroundChange of severe malaria treatment policy from quinine to artesunate, a major malaria control advance in Africa, is compromised by scarce data to monitor policy translation into practice. In Kenya, hospital surveys were implemented to monitor health systems readiness and inpatient malaria case-management.MethodsAll 47 county referral hospitals were surveyed in February and October 2016. Data collection included hospital assessments, interviews with inpatient health workers and retrospective review of patients’ admission files. Analysis included 185 and 182 health workers, and 1162 and 1224 patients admitted with suspected malaria, respectively, in all 47 hospitals. Cluster-adjusted comparisons of the performance indicators with exploratory stratifications were performed.ResultsMalaria microscopy was universal during both surveys. Artesunate availability increased (63.8–85.1%), while retrospective stock-outs declined (46.8–19.2%). No significant changes were observed in the coverage of artesunate trained (42.2% vs 40.7%) and supervised health workers (8.7% vs 12.8%). The knowledge about treatment policy improved (73.5–85.7%; p = 0.002) while correct artesunate dosing knowledge increased for patients < 20 kg (42.7–64.6%; p < 0.001) and > 20 kg (70.3–80.8%; p = 0.052). Most patients were tested on admission (88.6% vs 92.1%; p = 0.080) while repeated malaria testing was low (5.2% vs 8.1%; p = 0.034). Artesunate treatment for confirmed severe malaria patients significantly increased (69.9–78.7%; p = 0.030). No changes were observed in artemether–lumefantrine treatment for non-severe test positive patients (8.0% vs 8.8%; p = 0.796). Among test negative patients, increased adherence to test results was observed for non-severe (68.6–78.0%; p = 0.063) but not for severe patients (59.1–62.1%; p = 0.673). Overall quality of malaria case-management improved (48.6–56.3%; p = 0.004), both for children (54.1–61.5%; p = 0.019) and adults (43.0–51.0%; p = 0.041), and in both high (51.1–58.1%; p = 0.024) and low malaria risk areas (47.5–56.0%; p = 0.029).ConclusionMost health systems and malaria case-management indicators improved during 2016. Gaps, often specific to different inpatient populations and risk areas, however remain and further programmatic interventions including close monitoring is needed to optimize policy translation.

Mapping and Modelling Malaria Risk Areas Using Climate, Socio-Demographic and Clinical Variables in Chimoio, Mozambique.

Background: Malaria continues to be a major public health concern in Africa. Approximately 3.2 billion people worldwide are still at risk of contracting malaria, and 80% of deaths caused by malaria are concentrated in only 15 countries, most of which are in Africa. These high-burden countries have achieved a lower than average reduction of malaria incidence and mortality, and Mozambique is among these countries. Malaria eradication is therefore one of Mozambique’s main priorities. Few studies on malaria have been carried out in Chimoio, and there is no malaria map risk of the area. This map is important to identify areas at risk for application of Public Precision Health approaches. By using GIS-based spatial modelling techniques, the research goal of this article was to map and model malaria risk areas using climate, socio-demographic and clinical variables in Chimoio, Mozambique. Methods: A 30 m × 30 m Landsat image, ArcGIS 10.2 and BioclimData were used. A conceptual model for spatial problems was used to create the final risk map. The risks factors used were: the mean temperature, precipitation, altitude, slope, distance to water bodies, distance to roads, NDVI, land use and land cover, malaria prevalence and population density. Layers were created in a raster dataset. For class value comparisons between layers, numeric values were assigned to classes within each map layer, giving them the same importance. The input dataset were ranked, with different weights according to their suitability. The reclassified outputs of the data were combined. Results: Chimoio presented 96% moderate risk and 4% high-risk areas. The map showed that the central and south-west “Residential areas”, namely, Centro Hipico, Trangapsso, Bairro 5 and 1° de Maio, had a high risk of malaria, while the rest of the residential areas had a moderate risk. Conclusions: The entire Chimoio population is at risk of contracting malaria, and the precise estimation of malaria risk, therefore, has important precision public health implications and for the planning of effective control measures, such as the proper time and place to spray to combat vectors, distribution of bed nets and other control measures.

Descriptive Analysis of Malaria Surveillance System Data, Yemen, 2011-2015

Background: Malaria remains one of the most serious health problems in Yemen where 68% of population is living in malaria risk areas. An Integrated Malaria Surveillance System (IMSS) was introduced in 2009 to improve reporting. Objective: To describe the epidemiology of malaria and identify groups at risk. Methods: Data for 2011-2015 was obtained from the National Malaria Control Program (NMCP). According to the NMCP Guidelines, confirmed malaria case is defined as a case that is positive by microscopy or rapid test. We calculated incidence rate (IR) by age group, sex, type of plasmodium, seasonality and population at risk using projections from the 2014 Central Statistical Organization data. Results: Although the overall malaria IR dropped from 11/1000 in 2011 to 5 in 2015, the IR among < 5 children increased from 8 to 15/1000 and the percentage of confirmed cases increased from 0.64% to 0.83%. Among pregnant women, the IR increased from 4/1000 in 2011 to 6 in 2014 but decreased to 2 in 2015. Two thirds of malaria cases were reported among males and from the coastal governorates. Plasmodium Falciparum accounted for 99% of cases. Conclusions: Despite IR dropped from 2011 to 2015, such drop might not reflect improvement in control and prevention measures, but could reflects underreporting due to political instability, war situation and poor access to health facilities. Proper targeting especially of coastal areas by insecticide treated bed nets and indoor residual spraying is necessary. Strengthening of surveillance system for high-risk groups i.e. <5 children and pregnant women is recommended. A qualitative research should investigate reasons behind the predominance of malaria among males. Further IMSS evaluation is recommended. [iproc 2018;4(1):e10637]

Long-Lasting Insecticide Net Ownership, Access and Use in Southwest Ethiopia: A Community-Based Cross-Sectional Study.

Introduction: A large proportion of the Ethiopian population (approximately 68%) lives in malaria risk areas. Millions of long-lasting insecticide treated nets (LLINs) have been distributed as part of the malaria prevention and control strategy in the country. This study assessed the ownership, access and use of LLNs in the malaria endemic southwest Ethiopia. Methods: A community-based cross-sectional study was conducted in southwest Ethiopia during October–November 2015, including 836 households from sixteen villages around Gilgel-Gibe dam area. Indicators of ownership, access and use of LLINs were derived following the Roll Back Malaria (RBM) guidelines. Factors associated with failure for both LLIN access and use were analysed at household level using a multivariate logistic regression model. Results: The proportion of households with at least one LLIN was 82.7% (95% CI: 80.0, 85.1). However, only 68.9% (95% CI: 65.6, 71.9) had enough LLINs to cover all family members (with ≥one LLIN for every two persons). While 75.3% (95% CI: 68.4, 83.0) of the population was estimated to have accessed to LLINs, only 63.8% (95% CI: 62.3, 65.2) reported to have used a LLIN the previous night. The intra-household gap (i.e., households owning at least one LLIN, but unable to cover all family members) and the behavioral gap (i.e., household members who did not sleep under a LLIN despite having access to one) were 16.8% and 10.5%, respectively. Age, marital status and education of household heads, as well as household size and cooking using firewood were associated with the access to enough LLINs within households. Decreased access to LLINs at households was the main determinant for not achieving ≥80% household members sleeping under a LLIN the previous night. Other associated factors were household size and education level of household head. Conclusions: LLIN coverage levels in study villages remain below national targets of 100% for ownership and 80% for use. The access to enough LLINs within the households is the main restriction of LLIN use in the study area.

Metode Skoring dan Metode Fuzzy dalam Penentuan Zona Resiko Malaria di Pulau Flores

The purpose of this study is to compare the results of malaria risk zone mapping using scoring method and fuzzy method against the actual data (API 2014). Variables used in determining malaria risk area are temperature, densiy of vegetation and land cover. Satellite image manipulation is performed using remote sensing technology. As a result, the average of every pixel in the district area for temperature, density of vegetation, and land cover is obtained. The result is then processed using the scoring model and fuzzy model. Accuracy tests have been conducted for 91 districts where the fuzzy model has an accuracy rate of 61.54% while the scoring model produce an accuracy of 18.68%. The test result shows that the fuzzy model tends to produce a higher grade than the actual grade. Fuzzy model produces class “High” but actually “Low” (17.85%), fuzzy model produces class “Medium” but actually “Low” (2.20%), or fuzzy models produces class “High” but actually “Medium” (14.29%). This could be caused by a form of intervention for mosquito nest eradication conducted in some districts, that is quite effective. Besides, some districts are not participating actively in detecting the number of malaria cases, hence, the actual data provided by Puskesmas tends to be lower.

Malaria investigation and treatment of children admitted to county hospitals in western Kenya.

BackgroundUp to 90 % of the global burden of malaria morbidity and mortality occurs in sub-Saharan Africa and children under-five bear a disproportionately high malaria burden. Effective inpatient case management can reduce severe malaria mortality and morbidity, but there are few reports of how successfully international and national recommendations are adopted in management of inpatient childhood malaria.MethodsA descriptive cross-sectional study of inpatient malaria case management practices was conducted using data collected over 24 months in five hospitals from high malaria risk areas participating in the Clinical Information Network (CIN) in Kenya. This study describes documented clinical features, laboratory investigations and treatment of malaria in children (2–59 months) and adherence to national guidelines.ResultsA total of 13,014 children had a malaria diagnosis on admission to the five hospitals between March, 2014 and February, 2016. Their median age was 24 months (IQR 12–36 months). The proportion with a diagnostic test for malaria requested was 11,981 (92.1 %). Of 10,388 patients with malaria test results documented, 8050 (77.5 %) were positive and anti-malarials were prescribed in 6745 (83.8 %). Malaria treatment was prescribed in 1613/2338 (69.0 %) children with a negative malaria result out of which only 52 (3.2 %) had a repeat malaria test done as recommended in national guidelines. Documentation of clinical features was good across all hospitals, but quinine remained the most prescribed malaria drug (47.2 % of positive cases) although a transition to artesunate (46.1 %) was observed. Although documented clinical features suggested approximately half of positive malaria patients were not severe cases artemether-lumefantrine was prescribed on admission in only 3.7 % cases.ConclusionsDespite improvements in inpatient malaria care, high rates of presumptive treatment for test negative children and likely over-use of injectable anti-malarial drugs were observed. Three years after national policy change, there is a gradual transition to artesunate. Continued efforts to support improved routine inpatient malaria care through dissemination and implementation of guidelines, and access to recommended drugs are needed together with improved capacity of hospitals to investigate other causes of severe illness in children. Efforts to improve clinical information could help track progress.

GIS malaria risk assessment of Akure North and South Local Government Areas, Ondo State, Nigeria

Malaria, a mosquito-borne, protozoan disease, is an important health problem of developing countries, especially Africa. The study was designed to map malaria risk areas within Akure North and South Local Government Areas of Ondo State. Health-based survey, larval survey, socio-economic survey, and Geographic Information System (GIS) were used in achieving the objectives of the study. Larvae of mosquitoes were collected from breeding sites across the study areas; information on reported malaria cases from year 2010 to 2013 were retrieved from primary health centres, while socio-economic data of the population were generated using questionnaires. Maps of dumpsites, rivers, primary health centres and land use/land cover of the areas were generated using a combination of field and satellite data in a GIS environment. Pearson’s chi-square was used to correlate variables. The results showed that the presence of anopheline larvae (18%) in the study areas and the socio-economic characteristics of the population were contributory factors to malaria infection. Environmental conditions of respondents were significant (p&lt;0.05) when correlated with prevalence of malaria (62.4%). High prevalence of malaria and the presence of anopheline mosquitoes indicated that the entire study area is a malaria endemic zone as represented in the generated risk map. Therefore, it can be concluded that a change in environmental conditions and lifestyle choices can reduce the malaria endemicity. Areas with high altitude, presence of larvae, water bodies, dumpsites and other factors present higher risk of malaria and vice versa. The introduction of environmental sanitation could ensure that mosquito breeding grounds are eliminated through filling up of depressions, disposing shells, discarding cans and earthen vessels appropriately.Keywords: GIS, malaria, risk map, mosquito, primary health centre

Application of geographical information system and remote sensing in malaria research and control in South Africa: a review

This paper presents a review of numerous items of published literature on the use of spatial technology for malaria epidemiology in South Africa between 1930 and 2013. In particular, focus is on the use of statistical and mathematical models as well as geographic information science (GIS) and remote sensing (RS) technology for malaria research. First, the review takes cognisance of the use of predictive models to determine the association between climatic factors and malaria epidemics only in KwaZulu-Natal province. Similar studies in other endemic regions such as Limpopo and Mpumalanga provinces have not been reported in the literature. While the integration of GIS with remote sensing has the potential of identifying, characterising, and monitoring breeding habitats and mapping malaria risk areas in South Africa, studies on the application of spatial technology in malaria research and control in South Africa are inexhaustive and have not been reported in the literature. As a result, a critical robust mal...

Spatial and temporal epidemiology of malaria in extra-Amazonian regions of Brazil.

BackgroundMosquitoes, Plasmodium parasites, and humans live in sympatry in some extra-Amazonian regions of Brazil. Recent migrations of people from Amazonia and other countries to extra-Amazonian regions have led to many malaria outbreaks. Lack of relevant expertise among health professionals in non-endemic areas can lead to a neglect of the disease, which can be dangerous given its high fatality rate. Therefore, understanding the spatial and temporal epidemiology of malaria is essential for developing strategies for disease control and elimination. This study aimed to characterize imported (IMP) and autochthonous/introduced (AU/IN) cases in the extra-Amazonian regions and identify risk areas and groups.MethodsEpidemiological data collected between 2007 and 2014 were obtained from the Notifiable Diseases Information System of the Ministry of Health (SINAN) and from the Department of the Unified Health System (DATASUS). High malaria risk areas were determined using the Local Indicator of Spatial Association. IMP and AU/IN malaria incidence rates were corrected by Local Empirical Bayesian rates.ResultsA total of 6092 malaria cases (IMP: 5416, 88.9 %; AU/IN: 676, 11.1 %) was recorded in the extra-Amazonian regions in 2007–2014. The highest numbers of IMP and AU/IN cases were registered in 2007 (n = 862) and 2010 (n = 149), respectively. IMP cases were more frequent than AU/IN cases in all states except for Espírito Santo. Piauí, Espírito Santo, and Paraná states had high incidences of AU/IN malaria. The majority of infections were by Plasmodium falciparum in northeast and southeast regions, while Plasmodium vivax was the predominant species in the south and mid-west showed cases of dual infection. AU/IN malaria cases were concentrated in the coastal region of Brazil, which contains the Atlantic Forest and hosts the Anopheles transmitters. Several malaria clusters were also associated with the Brazilian Pantanal biome and regions bordering the Amazonian biome.ConclusionMalaria is widespread outside the Amazonian region of Brazil, including in more urbanized and industrialized states. This fact is concerning because these highly populated areas retain favourable conditions for spreading of the parasites and vectors. Control measures for both IMP and AU/IN malaria are essential in these high-risk areas.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0934-6) contains supplementary material, which is available to authorized users.

Quality of malaria diagnosis and molecular confirmation of Plasmodium ovale curtisi in a rural area of the southeastern region of Ethiopia.

BackgroundApproximately 50 million people (60 %) live in malaria risk areas in Ethiopia, at altitudes below 2000 m. According to official data, 60–70 % of malaria cases are due to Plasmodium falciparum, and 40–30 % by Plasmodium vivax. The species Plasmodium ovale was detected in 2013 in the northwest of the country, being the first report of the presence of this species in Ethiopia since the 60 s. The aim of this study was to assess the diagnosis by microscopy and PCR, and demonstrate the presence of other Plasmodium species in the country.MethodsThe survey was conducted in Bulbula, situated in the Rift Valley (West Arsi Province, Oromia Region). From December 2010 to October 2011, 3060 samples were collected from patients with symptoms of malaria; the diagnosis of malaria was done by microscopy and confirmation by PCR.Results736 samples were positive for malaria by microscopy. After removing the 260 samples (109 positives and 151 negatives) for which it was not possible to do PCR, there were a total of 2800 samples, 1209 are used for its confirmation by PCR and quality control (627 are positives and 582 negatives by microscopy). From the 627 positive samples, 604 were confirmed as positive by PCR, 23 false positives were detected, and the group of 582 negative samples, 184 were positive by PCR (false negatives), which added to the previous positive samples is a total of 788, positive samples for some species of Plasmodium sp. 13.3 % more positives were detected with the PCR than the microscopy. Importantly, 23 samples were detected by PCR as P. ovale, after the sequencing of these samples was determined as P. ovale curtisi.ConclusionsThe PCR detected more positive samples than the microscopy; in addition, P. ovale and P. ovale/P. vivax were detected that had not been detected by microscopy, which can affect in the infection control.

Modelling the Spatial Distribution of the Anopheles Mosquito for Malaria Risk Zoning Using Remote Sensing and GIS

Remote Sensing and Geographic Information System was used to develop a spatial risk malaria distribution model based on environmental suitability for survival of the Anopheles gambie sp. Complex (A. arabiensis and A. gambae), the vector known to transmit malaria in Zimbabwe (Masendu, 1996). Employing geostatistical techniques, spatial analysis of environmental factors that contribute to the spread of the malaria vector was conducted to develop a malaria risk model that could be used in effective malaria control planning in Zimbabwe. The study was conducted in the Piriwiri, Umfuli and Magondi communal lands of Zimbabwe. A model was developed that defined malaria hot spots in the communal lands where attention must be given in developing plans and strategies for malaria control. Environmental data collected from satellite images and validated by fieldwork were used in the study. Based on expert knowledge, specific environmental factors favourable for Anopheles malaria vector were identified. This information was then used to predict the suitability of the area for the Anopheles mosquito using Indicator Kriging Algorithm (Isaacs et al., 1989). This method calculated the probability of exceeding an environmental indicator threshold (this allowed the prediction that a particular area (location) in the communal lands is suitable for the survival and spread of the Anopheles) and integrated them into a potential vector distribution model for the area. This model was used to determine areas that are potentially risky for malaria. Again the spatial distribution of malaria was calculated, based on clinical malaria data and accessibility to the clinics, and compared with the potential vector distribution zones to determine areas with high malaria risk. Except a few areas in Umfuli that were highly favourable for the Anopheles mosquito, most of the communal lands were not suitable for anopheles to survive indicating that malaria incidences are generally associated with highly favourable areas for the vector. Combining GIS and remote sensing applications with geostatistical analysis is a promising approach to define malaria risk areas in Zimbabwe. However, further quantitative research is necessary to validate the relationships within the malaria transmission system, especially on the vector and the human environment aspects.

Factors influencing the usage of different types of malaria prevention methods during pregnancy in Kenya.

In sub-Saharan Africa, malaria is a leading cause of morbidity and mortality, which, during pregnancy, is associated with adverse health outcomes for both mother and foetus. Utilization of Insecticide Treated Nets (ITNs) and Intermittent Preventive Therapy (IPTp) is advocated to prevent malaria during pregnancy. To examine factors which influence the use of different types of malaria prevention methods among pregnant women in Kenya. This study used 2008-09 Kenya Demographic and Health survey. Pregnant women aged 15-49 years were included (622 women). Distribution of the study population was assessed in frequency tables. Bivariate and multivariate logistic regression analysis was employed. Fifty-two percent of women used ITNs and 38.5% reported uptake of IPTp. In multivariate analysis age, malaria risk areas, religion, education and income influenced ITN usage, whereas only age, malaria risk areas and marital status were found to influence IPTP uptake. ITN use and IPTp uptake were well below the 80% Kenya Malaria Strategy 2006 target. In an effort to increase uptake it is vital for future research to understand reasons for low usage and uptake of malaria prevention programmes so as to enable policy-makers to make informed decisions.