Malaria Test Research Articles

Malaria care-seeking and treatment ideation among gold miners in Guyana

BackgroundAlthough miners are a priority population in malaria elimination in Guyana, scant literature exists on the drivers of malaria-related behaviour. This study explores the relationship between gold miners’ malaria-related ideation and the adoption of malaria care-seeking and treatment behaviours including prompt care-seeking, malaria testing, and self-medication.MethodsData are from a cross-sectional quantitative survey of 1685 adult miners between the ages of 18–59 years who live in mining camps in Regions 1, 7, and 8. The analysis focused on miners who reported an episode of fever in the past year (n = 745). Malaria care-seeking and treatment ideation was defined as a composite additive score consisting of the following variables: general malaria knowledge, perceived severity, perceived susceptibility, beliefs, perceived self-efficacy, perceived norms, interpersonal communication, and perceived response efficacy. Multivariable logistic regressions explored the relationship between ideation on care-seeking/treatment behaviours, controlling for confounding variables.ResultsMost miners with a recent episode of fever had perceived risk (92%), self-efficacy (67%), susceptibility (53%) and high malaria knowledge (53%). Overall, miners' care-seeking/treatment ideation score ranged from 0 to 8 with a mean of 4.1. Ideation scores were associated with higher odds of care-seeking for fever (aOR: 1.19; 95% CI 1.04–1.36), getting tested for malaria (aOR: 1.22; 95% CI 1.07–1.38) and lower odds of self-medication (aOR: 0.87; 95% CI 0.77–0.99).ConclusionsA national community case management initiative is using study findings as part of its scale-up, using volunteers to make testing and treatment services more accessible to miners. This is complemented by a multi-channel mass media campaign to improve miners’ ideation. Communication messages focus on increasing miners’ knowledge of malaria transmission and symptoms, encourage positive beliefs about malaria testing and volunteer testers, promote evidence about the effectiveness of testing, and reminders of how quick and easy it is to get a malaria test with the community case management initiative. Study findings also have implications for efforts to eliminate malaria across the Guiana Shield.

Prevalence of Plasmodium Species among Humans and Monkeys at Mole National Park in Northern Ghana

Malaria is one of the most severe public health problems in Ghana. In developing countries such as Ghana, with high of prevalence of malaria, the procedures for diagnoses and detection is limited in technological depth and for that reason most of these parasites; Plasmodium ovale, Plasmodium malariae, Plasmodium vivax and Plasmodium knowlesi are not routinely screened for; as such this study seeks to determine the prevalence of Plasmodium species among humans and monkeys at Mole National Park in Northern Ghana. A total sample size of 217 comprising 214 human subjects and 3 baboons were recruited in this study conducted at Mole National Park. Data including; age, marital status, gender, occupation, knowledge on malaria and educational background information were collected. Blood samples were taken from both humans and baboons for the malaria testing using RDT, Microscopy and PCR to detect Plasmodium falciparum, Plasmodium ovale, Plasmodium malariae, Plasmodium vivax and Plasmodium knowlesi. The mean age of the study participants was 24.2±15.2. All the 3 baboon subjects were negative on RDT but one (1) out of the three was positive on microscopy. That notwithstanding, the same microscopy positive baboon subject was Pan-Plasmodium positive on PCR but was negative for the tested Plasmodium falciparum, Plasmodium ovale and Plasmodium malariae. The study recorded prevalence of plasmodium species using RDT and microscopy respectively to be 22.9% and 18.2%. The prevalence of Plasmodium falciparum, Plasmodium ovale and Plasmodium malariae among the human participants from this study were 39.9%, 12.6% and 18.6% respectively. Mixed infections were identified in 7.5% of the human participants where 4.2% was Plasmodium falciparum/Plasmodium ovale, 2.8% was falciparum/malariae mixed infection and 0.5% malariae/ovale mixed infection. Sociodemographics, knowledge on malaria and interaction with monkeys of study participants did not show any significant association with malaria infection. Prevalence of malaria parasites was high among the participant, which poses threat to reduction of malaria in the country.

Characterising co-infections with Plasmodium spp., Mansonella perstans or Loa loa in asymptomatic children, adults and elderly people living on Bioko Island using nucleic acids extracted from malaria rapid diagnostic tests.

BackgroundRegular and comprehensive epidemiological surveys of the filarial nematodes Mansonella perstans and Loa loa in children, adolescents and adults living across Bioko Island, Equatorial Guinea are lacking. We aimed to demonstrate that blood retained on malaria rapid diagnostic tests, commonly deployed for malaria surveys, could be used as a source of nucleic acids for molecular based detection of M. perstans and L. loa. We wanted to determine the positivity rate and distribution of filarial nematodes across different age groups and geographical areas as well as to understand level of co-infections with malaria in an asymptomatic population.MethodologyM. perstans, L. loa and Plasmodium spp. parasites were monitored by qPCR in a cross-sectional study using DNA extracted from a subset malaria rapid diagnostic tests (mRDTs) collected during the annual malaria indicator survey conducted on Bioko Island in 2018.Principal findingsWe identified DNA specific for the two filarial nematodes investigated among 8.2% (263) of the 3214 RDTs screened. Positivity rates of M. perstans and L. loa were 6.6% and 1.5%, respectively. M. perstans infection were more prominent in male (10.5%) compared to female (3.9%) survey participants. M. perstans parasite density and positivity rate was higher among older people and the population living in rural areas. The socio-economic status of participants strongly influenced the infection rate with people belonging to the lowest socio-economic quintile more than 3 and 5 times more likely to be L. loa and M. perstans infected, respectively. No increased risk of being co-infected with Plasmodium spp. parasites was observed among the different age groups.Conclusions/SignificanceWe found otherwise asymptomatic individuals were infected with M. perstans and L. loa. Our study demonstrates that employing mRDTs probed with blood for malaria testing represents a promising, future tool to preserve and ship NAs at room temperature to laboratories for molecular, high-throughput diagnosis and genotyping of blood-dwelling nematode filarial infections. Using this approach, asymptomatic populations can be reached and surveyed for infectious diseases beyond malaria.

On‐chip magnetophoretic capture in a model of malaria‐infected red blood cells

The search for new rapid diagnostic tests for malaria is a priority for developing an efficient strategy to fight this endemic disease, which affects more than 3 billion people worldwide. In this study, we characterize systematically an easy‐to‐operate lab‐on‐chip, designed for the magnetophoretic capture of malaria‐infected red blood cells (RBCs). The method relies on the positive magnetic susceptibility of infected RBCs with respect to blood plasma. A matrix of nickel posts fabricated in a silicon chip placed face down is aimed at attracting infected cells, while healthy cells sediment on a glass slide under the action of gravity. Using a model of infected RBCs, that is, erythrocytes with methemoglobin, we obtained a capture efficiency of about 70% after 10 min in static conditions. By proper agitation, the capture efficiency reached 85% after just 5 min. Sample preparation requires only a 1:10 volume dilution of whole blood, previously treated with heparin, in a phosphate‐buffered solution. Nonspecific attraction of untreated RBCs was not observed in the same time interval.

Adherence to malaria management guidelines by health care workers in the Busoga sub-region, eastern Uganda

BackgroundAppropriate malaria management is a key malaria control strategy. The objective of this study was to determine health care worker adherence levels to malaria case management guidelines in the Busoga sub-region, Uganda.MethodsHealth facility assessments, health care worker (HCW), and patient exit interview (PEI) surveys were conducted at government and private health facilities in the sub-region. All health centres (HC) IVs, IIIs, and a sample of HC IIs, representative of the tiered structure of outpatient service delivery at the district level were targeted. HCWs at these facilities were eligible for participation in the study. For PEIs, 210 patients of all ages presenting with a history of fever for outpatient care at selected facilities in each district were targeted. Patient outcome measures included testing rates, adherence to treatment, dispensing and counselling services as per national guidelines. The primary outcome was appropriate malaria case management, defined as the proportion of patients tested and only prescribed artemether-lumefantrine (AL) if positive. HCW readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and anti-malarials) to provide malaria case management were also assessed. Data were weighted to cater for the disproportionate representation of HC IIs in the study sample.ResultsA total of 3936 patients and 1718 HCW from 392 facilities were considered in the analysis. The median age of patients was 14 years; majority (63.4%) females. Most (70.1%) facilities were HCIIs and 72.7% were owned by the government. Malaria testing services were available at > 85% of facilities. AL was in stock at 300 (76.5%) facilities. Of those with a positive result, nearly all were prescribed an anti-malarial, with AL (95.1%) accounting for most prescriptions. Among those prescribed AL, 81.0% were given AL at the facility, lowest at HC IV (60.0%) and government owned (80.1%) facilities, corresponding to AL stock levels. Overall, 86.9% (95%CI 79.7, 90.7) of all enrolled patients received appropriate malaria case management. However, only 50.7% (21.2, 79.7) of patients seen at PFPs received appropriate malaria management.ConclusionAdherence levels to malaria case management guidelines were good, but with gaps noted mainly in the private sector. The supply chain for AL needs to be strengthened. Interventions to improve practise at PFP facilities should be intensified.

Price, quality, and market dynamics of malaria rapid diagnostic tests: analysis of Global Fund 2009\u20132018 data

BackgroundRapid diagnostic tests (RDTs) for malaria are a vital part of global malaria control. Over the past decade, RDT prices have declined, and quality has improved. However, the relationship between price and product quality and their larger implications on the market have yet to be characterized. This analysis used purchase data from the Global Fund together with product quality data from the World Health Organization (WHO) and Foundation for Innovative New Diagnostics (FIND) Malaria RDT Product Testing Programme to understand three unanswered questions: (1) Has the market share by quality of RDTs in the Global Fund’s procurement orders changed over time? (2) What is the relationship between unit price and RDT quality? (3) Has the market for RDTs financed by the Global Fund become more concentrated over time?MethodsData from 10,075 procurement transactions in the Global Fund’s database, which includes year, product, volume, and price, was merged with product quality data from all eight rounds of the WHO-FIND programme, which evaluated 227 unique RDT products. To describe trends in market share by quality level of RDT, descriptive statistics were used to analyse trends in market share from 2009 to 2018. A generalized linear regression model was then applied to characterize the relationship between price and panel detection score (PDS), adjusting for order volume, year purchased, product type, and manufacturer. Third, a Herfindahl–Hirschman Index (HHI) score was calculated to characterize the degree of market concentration.ResultsLower-quality RDTs have lost market share between 2009 and 2018, as have the highest-quality RDTs. No statistically significant relationship between price per test and PDS was found when adjusting for order volume, product type, and year of purchase. The HHI was 3,570, indicating a highly concentrated market.ConclusionsAdvancements in RDT affordability, quality, and access over the past decade risk stagnation if health of the RDT market as a whole is neglected. These results suggest that from 2009 to 2018, this market was highly concentrated and that quality was not a distinguishing feature between RDTs. This information adds to previous reports noting concerns about the long-term sustainability of this market. Further research is needed to understand the causes and implications of these trends.

Evaluating performance of multiplex real time PCR for the diagnosis of malaria at elimination targeted low transmission settings of Ethiopia

BackgroundMalaria incidence has declined in Ethiopia in the past 10 years. Current malaria diagnostic tests, including light microscopy and rapid antigen-detecting diagnostic tests (RDTs) cannot reliably detect low-density infections. Studies have shown that nucleic acid amplification tests are highly sensitive and specific in detecting malaria infection. This study took place with the aim of evaluating the performance of multiplex real time PCR for the diagnosis of malaria using patient samples collected from health facilities located at malaria elimination targeted low transmission settings in Ethiopia.MethodsA health facility-based, cross-sectional survey was conducted in selected malaria sentinel sites. Malaria-suspected febrile outpatients referred to laboratory for malaria testing between December 2019 and March 2020 was enrolled into this study. Sociodemographic information and capillary blood samples were collected from the study participants and tested at spot with RDTs. Additionally, five circles of dry blood spot (DBS) samples on Whatman filter paper and thick and thin smear were prepared for molecular testing and microscopic examination, respectively. Multiplex real time PCR assay was performed at Ethiopian Public Health Institute (EPHI) malaria laboratory. The performance of multiplex real time PCR assay, microscopy and RDT for the diagnosis of malaria was compared and evaluated against each other.ResultsOut of 271 blood samples, multiplex real time PCR identified 69 malaria cases as Plasmodium falciparum infection, 16 as Plasmodium vivax and 3 as mixed infections. Of the total samples, light microscopy detected 33 as P. falciparum, 18 as P. vivax, and RDT detected 43 as P. falciparum, 17 as P. vivax, and one mixed infection. Using light microscopy as reference test, the sensitivity and specificity of multiplex real time PCR were 100% (95% CI (93–100)) and 83.2% (95% CI (77.6–87.9)), respectively. Using multiplex real time PCR as a reference, light microscopy and RDT had sensitivity of 58% (95% CI 46.9–68.4) and 67% (95% CI 56.2–76.7); and 100% (95% CI 98–100) and 98.9% (95% CI 96–99.9), respectively. Substantial level of agreement was reported between microscopy and multiplex real time PCR results with kappa value of 0.65.ConclusionsMultiplex real-time PCR had an advanced performance in parasite detection and species identification on febrile patients’ samples than did microscopy and RDT in low malaria transmission settings. It is highly sensitive malaria diagnostic method that can be used in malaria elimination programme, particularly for community based epidemiological samples. Although microscopy and RDT had reduced performance when compared to multiplex real time PCR, still had an acceptable performance in diagnosis of malaria cases on patient samples at clinical facilities.

Comparative Evaluation of the Diagnostic Performance Characteristics of a One-Step Urine Malaria Test (UMT) against Rapid Diagnostic Tests (RDT) in Febrile Patients from Fako Division, Cameroon

Background: Presently, all malaria diagnostic methods like: microscopy and Rapid Diagnostic Tests are invasive as they depend on blood samples for malaria diagnosis. Hence this study was aimed at comparing the diagnostic performance characteristics of the novel UMT to the currently used Blood RDT, and to find out the efficacy of this UMT in detecting low parasitemia in the study population. Methodology: A cross sectional study involving 200 febrile participants, with no signs and symptoms of rheumatoid arthritis, kidney diseases, no history of hematuria, >15/µl leucocytes and urobilinogens of >1 mg/dl in their urine, were recruited from the month of April to August 2017 in the Limbe and Buea Regional Hospitals. The main samples requested for analyses were urine and blood. Results: Using the blood smear microscopy as standard, out of the 200 participants, 93 (46.5%) were positive for P. malaria. UMT had a sensitivity and specificity of 82.41% and 83.48 while that of RDT was 84.09% and 83.03 respectively falciparum (CI: 72.80 to 92.05%, Kappa 0.665, p =0.001). The UMT had a lowest limit of detection of 140 parasites/μl which was similar to RDT. The PPV and NPV of UMT and RDT were (81.74% and 85.98%) and (80.04% and 87.28%), respectively. There was a close agreement between the RDT and UMT when compared to microscopy (83.5% and 83.0% respectively). Conclusion: The UMT kit that was evaluated in comparison to the blood based RDT, showed a lot of similarities using the blood smear microscopy as gold standard. Hence, it can be used in our setting for the prompt and accurate diagnosis of malaria in febrile patients.

Blood Group ABO, Placental Malaria Parasitization and Pregnancy Outcome in Munuki Primary health Centre in South Sudan

Several studies in Malaria endemic areas have reported conflicting observations on Blood Group ABO association with placental Malaria and pregnancy outcome. The purpose of this study is to determine the association between Placental Malaria and Blood Group O in the Munuki Primary Health Care Centre in South Sudan. Material and Methods: This was a prospective study. Each pregnant lady was enrolled after signing of informed consent and meeting study entry criteria. In all 589 pregnant women were evaluated. For each done were; ABO phenotype ones, at the enrolment and testing for malaria in and twice in the cause of pregnancy. Peripheral blood malaria parasites testing were by using RDT test to describe the type of plasmodium species. Results: The 589 enrolled were as follows; 154 (32.6%), 124 (26.3%) and 182 (38.6%) primigravidae, secundigravidae and multigravidae, respectively. The ABO distribution was; 124 (A), 59 (B), 14 (AB) and 257 (O). Negative peripheral Malaria parasites for pregnant women at ANC have higher positive Peripheral Malaria at DR with OR 2.93 CI (1.78__4.88) and ANC positive Malaria cases had higher chances of become positive during delivery OR 0.43 CI (0.30___0.62). Blood group O and peripheral malaria at DR with OR 1.17 CI (0.92___1.48) and Other Blood group at DR with OR 0.84 CI (0.67___1.06). Blood group O participants had higher P. Falciparum 60 /106 accounts for 56.6%. These results revealed significance interaction effect of Placental Malaria Parasites in Blood group O in Munuki Primary Health Center in Juba-South Sudan. This study recommends usage of protective measures against malaria during pregnancy.

“Testing for malaria does not cure any pain” A qualitative study exploring low use of malaria rapid diagnostic tests at drug shops in rural Uganda

“Testing for malaria does not cure any pain” A qualitative study exploring low use of malaria rapid diagnostic tests at drug shops in rural Uganda

Double Jeopardy in Malaria Infected Children with Common Haemoglobinopathies: A Cross-sectional Study in Malaria Mesoendemic Districts of Ghana

Introduction: Malaria and conditions associated with common haemoglobinopathies constitute a health threat to young children in sub-Saharan Africa. Malaria is known to exert some influence on common haemoglobin variants while haemoglobinopathies also exacerbate malarial infection especially in children as a result of anaemia and other conditions. Aim: To assess the views of parents/guardians on malaria and haemoglobinopathies and to determine the extent to which common haemoglobin variants influence malaria parasitaemia among children in the acute stage of the infection. Materials and Methods: This cross-sectional study was conducted in seven districts in the forest zone of Ghana between June 2018 and July 2018 and involved 342 malariaparasitaemic subjects aged 5 years and below. Questionnaires were administered to elicit responses on malaria prevention and sickle cell knowledge from the parents/guardians/caretakers accompanying the children to seek healthcare. Followup responses on medication and treatment outcome were collected during and after treatment. Venous blood samples were collected for malaria test, sickle cell investigations and identification of common haemoglobinopathies. After treatment, malaria tests were conducted using microscopy. The Chi-square model was used to compare categorical data between groups, and the independent t-test used to compare means between groups. Results: A total of 220 respondents (64.3%) identified fever as the most classical symptom of malaria, whilst 167 (48.8%) consistently used Insecticide Treated Nets (ITNs). More so, 146 respondents (42.7%) strongly agreed that Sickle Cell Disease (SCD) is a curse, and 182 respondents (53.2%) strongly agreed that SCD is inherited with 225 (65.8%) strongly agreeing that SCD children die before their teen ages. Common haemoglobin variants identified were HbAC 17 (5%), HbAF 7 (2%), HbAS 86 (25.1%), HbSC 4 (1.2%) and HbSS 9 (2.6%). One month posttreatment, 10 (58.8%) of HbAC subjects, all 9 (100%) of HbSS and all 4 (100%) of HbSC subjects were still parasitaemic but with significantly low mean parasite density (495±1744). Conclusion: Knowledge on malaria among the parents/guardians/ caretakers was satisfactory, but usage of bed nets was poor, warranting the need for targeted health education of the rural folk. Though parasite densities had significant reductions, all subjects with HbSC and HbSS phenotypes remained parasitaemic after 4 weeks of treatment, suggesting a double jeopardy for individuals with SCD. Routine newborn screening in all healthcare facilities in Ghana could be a proactive step in malaria case management.

Care of the Immigrant Child.

Care of the Immigrant Child.

POSC98 A Model to Evaluate the Cost-Effectiveness of a Highly-Sensitive Rapid Diagnostic Test for Malaria in a Community Setting in Uganda

Malaria remains a major cause of morbidity in Uganda, despite the presence of effective and low-cost interventions such as artemisinin-based combination therapy (ACT) and sulfadoxine/pyrimethamine (SP). This is largely attributed to the prevalence of asymptomatic low-density infections that often go undetected and hence untreated. A new generation of highly-sensitive rapid diagnostic tests (HS-RDTs) has been shown to detect asymptomatic low-density infections, offering a potential tool to help move Uganda towards Malaria elimination. A pragmatic literature review informed the conceptualisation and structuring of a cost-effectiveness model to evaluate use of the HS-RDT compared with conventional diagnostic tests (c-RDT) in three patient cohorts – febrile patients presenting at community health facilities, pregnant women attending ante-natal clinics, and asymptomatic household members of febrile children aged <5. A decision tree model will be used for the analysis to compare clinical (DALY) and cost outcomes, with patients entering the model at diagnosis stage. Clinical inputs, direct and indirect costs (including testing, treatment, disease management and mortality) are sourced from local publications. Prevalence, rapid diagnostic test (RDT) sensitivity and false positive rates will be based on data from a community based observational study in Mpigi District, Uganda. Results from the observational study and model outputs, will be used to test the hypothesis that the higher detection rate using HS-RDT translates into a larger number of asymptomatic malaria cases detected in all three patient cohorts, leading to clinical and cost benefits. Targeting and treating asymptomatic infections is also anticipated to help reduce the asymptomatic Malaria reservoir, thereby contributing towards the goal of Malaria elimination. One way sensitivity analysis will be conducted to test model sensitivity to key inputs. A limitation of this approach is that the model is not a dynamic transmission model and does not therefore model long-term consequences and seasonal effects.

Diagnostic accuracy of fluorescence flow-cytometry technology using Sysmex XN-31 for imported malaria in a non-endemic setting.

Malaria diagnosis based on microscopy is impaired by the gradual disappearance of experienced microscopists in non-endemic areas. Aside from the conventional diagnostic methods, fluorescence flow cytometry technology using Sysmex XN-31, an automated haematology analyser, has been registered to support malaria diagnosis. The aim of this prospective, monocentric, non-interventional study was to evaluate the diagnostic accuracy of the XN-31 for the initial diagnosis or follow-up of imported malaria cases compared to the reference malaria tests including microscopy, loop mediated isothermal amplification, and rapid diagnostic tests. Over a one-year period, 357 blood samples were analysed, including 248 negative and 109 positive malaria samples. Compared to microscopy, XN-31 showed sensitivity of 100% (95% CI: 97.13–100) and specificity of 98.39% (95% CI: 95.56–100) for the initial diagnosis of imported malaria cases. Moreover, it provided accurate species identification asfalciparumor non-falciparumand parasitaemia determination in a very short time compared to other methods. We also demonstrated that XN-31 was a reliable method for patient follow-up on days 3, 7, and 28. Malaria diagnosis can be improved in non-endemic areas by the use of dedicated haematology analysers coupled with standard microscopy or other methods in development, such as artificial intelligence for blood slide reading. Given that XN-31 provided an accurate diagnosis in 1 min, it may reduce the time interval before treatment and thus improve the outcome of patient who have malaria.

Quality Assurance Assessment for Malaria Rapid Diagnostic Test in Ngoma District, Eastern Province of Rwanda: A Cross-sectional Prospective Study

Currently, malaria rapid diagnostic tests (mRDTs) are increasingly used for the diagnosis of malaria, particularly in communities where microscopy-based diagnosis is not practical. However, the diagnostic accuracy of mRDTs performed by community health workers (CHWs) remains unknown. This study was conducted to determine the accuracy of mRDT results performed by CHWs in Ngoma district, eastern province of Rwanda. This was a cross sectional prospective study. A total of 420 blood samples of patients self-reported to CHWs for malaria diagnosis were collected and analyzed by CHWs using mRDT, and quality control tests were performed by using microscopy as a reference test. The study was conducted from 22 April to 08 July 2021. Among the 420 patients, 234 (55.71%) were females, and 186 (44.29%) were males. Malaria test positivity was 2.62% by using mRDT and 1.67% by using microscopic tests. The sensitivity and specificity of mRDT were 85.71% and 98.78%, respectively. The negative predictive value, positive predictive value and accuracy of mRDTs were 99.75%, 54.54% and 98.57%, respectively. The sensitivity of mRDT was below the WHO recommended sensitivity (>95%), although the specificity (98.78%) was within the WHO recommended specificity (>=90). There was substantial agreement between the mRDT and malaria microscopic test results, k=0.642. mRDTs continue to be an appropriate choice for malaria diagnosis in the absence of microscopy.

Provider Adherence to Malaria Test, Treat and Track Policy in the Binduri District of the Upper East Region of Ghana

Provider Adherence to Malaria Test, Treat and Track Policy in the Binduri District of the Upper East Region of Ghana

Report of the Korean Association of External Quality Assessment Service on Peripheral Blood Smear Testing for Malaria in 2020

Report of the Korean Association of External Quality Assessment Service on Peripheral Blood Smear Testing for Malaria in 2020

Malaria Prevalence and Treatment Seeking Behaviour of Campus Students in Mkpat Enin, Akwa Ibom State, Nigeria

Background: Malaria is still thriving despite efforts to eradicate the disease. This study aimed to determine the prevalence of malaria and treatment-seeking behaviour among university students in Ikot Akpaden campus of Akwa Ibom State University Methods: A cross-sectional study on 700 undergraduate students randomly selected was carried out between July to December 2017 in Akwa Ibom State University. Structured questionnaires were administered to collect data. Microscopy and Rapid Diagnostic Tests (RDT) were done to determine parasitaemia for students who voluntarily consented to be tested. Chi-square test at P&lt; 0.05 was used to evaluate the prevalence of malaria and the differences in the student’s attitude on malaria treatment and prevention practices. Results: Of the 500 students who filled the questionnaire, 100 students consented to undergo the test, 56 (56%) were males, while 44 (44%) were females. Only15 students (17.86%) were positive for both microscopy and RDT. Malaria prevalence by microscopy (84%) was significantly higher than RDT (27%). Fever and head-ache were the most common symptoms recorded. RDT had a sensitivity of 17.86%, a specificity of 25%, a positive predictive value of 55.56%, and a negative predictive value of 5.48%. Conclusion: This study revealed a higher prevalence of malaria by microscopy than RDT among the students, indicating that the use of RDTs is limited. RDTS may have more usefulness in remote areas, but microscopy remains the reference technique. Overall, 96.2% knew about malaria while 85.3% knew mosquito bites cause malaria. The majority, 69.2%, of participants go for malaria test as the first action when malaria is suspected, 83% use antimalarial combination therapy medication, and 62.6% sought treatment of malaria immediately.

Low Malaria Transmission in Rosso, an Irrigated Rice-Growing Area in Mauritania

The construction of dams along the Senegal River resulted in an increase in irrigated land areas and changes in the epidemiology and transmission of water-related diseases. The objective of this study was to update epidemiological data on malaria in Rosso, one of the major Mauritanian cities along the Senegal River. Febrile patients (n = 318) were screened for malaria using a rapid diagnostic test (RDT) for malaria and microscopic examination of blood smears. Diagnosis was later confirmed by polymerase chain reaction (PCR). The mean age of 318 febrile patients was 25.1 (range 1–80 years). Only 7 (2.2%) and 2 (0.6%) had a positive RDT and thick smear, respectively. PCR confirmed the diagnosis in two Plasmodium vivax-infected patients. Most participants (198/318, 62.3%) had no recent travel history outside Rosso. The majority of the febrile patients (90%, 284/311) owned at least one insecticide-treated net (ITN). The frequency of the use of ITNs was not significantly associated with season (rainy vs. dry seasons; p = 0.9) or with the number of ITNs per household (rs = 0.07; n = 285; p = 0.19). Of 285 individuals with ITNs, only two (0.7%) with no travel history were PCR-positive for malaria. Despite the presence of mosquito breeding sites related to rice irrigation, malaria transmission in Rosso remained very low, possibly due to the high coverage and frequent use of bed nets. Regular entomological surveillance for possible changes in the prevalence of Anopheles mosquito species and their behavioural aspects should be implemented.

Human-centered design process and solutions to promote malaria testing and treatment seeking behavior in Guyana hinterlands

BackgroundMalaria is a persistent public health challenge among miners and other hard-to-reach populations in Guyana’s hinterland, specifically in Regions 1, 7, 8, and 9. Despite an overall decrease in malaria prevalence throughout Guyana, it remains common among mining populations whose work conditions both contribute toward malaria transmission and make it difficult to seek timely, Ministry of Health (MoH) approved malaria testing and treatment services. In an effort to develop innovative approaches to address this public health challenge, an interdisciplinary team of public health professionals, designers, and mining organizations collaborated using a human-centered design (HCD) process facilitated by the USAID-funded Breakthrough ACTION Guyana project in partnership with the MoH.MethodsThis paper describes two phases: [1] Define and [2] Design & Test. In the Define phase, following a literature review, we conducted 108 qualitative interviews with miners, camp managers, trained malaria testers, health workers, and other key stakeholders to understand experiences and challenges when seeking malaria testing and treatment services. These interviews were synthesized into 11 insights on issues such as risk perception, malaria knowledge, preventive behaviors, traditional and self-treatment, adherence to the correct treatment, testing, and coordination and communication gaps. From these insights, during the Design & Test phase, we developed 33 “How might we…?” questions which led to 792 ideas, of which eight emergent concepts were prototyped and refined in the field with 145 miners, camp managers, and stakeholders.ResultsThe five final prototypes included: “Little Mosquito, Big Problem” social behavior change campaign; rapid counseling cards; branded malaria testing and treatment services; innovations in treatment adherence; and a participants, content, and logistics approach.ConclusionWhen applying HCD to public health issues, there are both opportunities and challenges to reconcile gaps that may exist between the two disciplines. However, HCD provides additional tools and mindsets to generatively work with migrant and mobile mining communities to encourage malaria testing and treatment services.