Malaria Test Research Articles

Agreement among rapid diagnostic tests, urine malaria tests, and microscopy in malaria diagnosis of adult patients in southwestern Nigeria.

ObjectiveWe determined the malaria prevalence and ascertained the degree of agreement among rapid diagnostic tests (RDTs), urine malaria tests, and microscopy in malaria diagnosis of adults in Nigeria.MethodsThis was a cross-sectional study among 384 consenting patients recruited at a tertiary health facility in southwestern Nigeria. We used standardized interviewer-administered questionnaires to collect patients’ sociodemographic information. Venous blood samples were collected and processed for malaria parasite detection using microscopy, RDTs, and urine malaria tests. The degree of agreement was determined using Cohen’s kappa statistic.ResultsThe malaria prevalence was 58.3% (95% confidence interval [CI]: 53.0–63.1), 20.6% (95% CI: 16.6–25.0), and 54.2% (95% CI: 49.0–59.2) for microscopy, RDTs, and urine malaria test, respectively. The percent agreement between microscopy and RDTs was 50.8%; the expected agreement was 45.1% and Cohen’s kappa was 0.104. The percent agreement between microscopy and urine malaria tests was 52.1%; the expected agreement was 50.7% and Cohen’s kappa was 0.03.ConclusionThe malaria prevalence was dependent on the method of diagnosis. This study revealed that RDTs are a promising diagnostic tool for malaria in resource-limited settings. However, urine malaria test kits require further improvement in sensitivity prior to field use in malaria-endemic settings.

Malaria Parasite Detection using Deep Learning

Abstract: Malaria is a serious disease. Nowadays, People need to go to laboratories or Laboratory technician comes to people`s house to do test for malaria. This process is time-consuming. This disease must be treated fast otherwise people will suffer through some serious complications such as liver failure, jaundice, and many more. For better treatment, reports have to be come out as quickly as possible. This paper makes accessible a review of work that has been done in space of reducing time for taking the test for malaria with help of Deep learning and Image processing.

Community-Based Malaria Testing Reduces Polypharmacy in a Population-Based Survey of Febrile Illness in Western Kenya.

Objective: The objective was to describe the relationship between the location of care, the malaria test result, and the type of medicine consumed for the fever, and to determine whether community-based access to malaria testing reduced polypharmacy. Methods: This is a secondary analysis of a cluster-randomized trial of an intervention designed to increase diagnostic testing and targeting of Artemesinin Combined Therapies (ACTs). Data collected at baseline, 12, and 18 months were analyzed to determine the impact of diagnostic testing on drug consumption patterns among febrile individuals. Results: Of the 5,756 participants analyzed, 60.1% were female, 42% were aged 5–17 years, and 58.1% sought care for fever in a retail outlet. Consumption of both ACT and antibiotics was 22.1% (n = 443/2008) at baseline. At endline, dual consumption had declined to 16.6%. There was reduced antibiotic consumption among those testing positive for malaria (39.5%–26.5%) and those testing negative (63.4%–55.1%), accompanied by a substantial decline in ACT use among malaria-negative participants. Conclusion: Diagnostic testing for malaria reduces dual consumption of ACTs and antibiotics, especially among those testing outside the formal healthcare sector.

Malaria and HIV Co-infection among COVID-19 Cohort in Selected Healthcare Facilities in Rivers State, Nigeria

Background: The COVID-19 pandemic began while improvement in malaria control and elimination had reached a peak. COVID-19 affected routine services particularly those for other killer infectious diseases including, HIV/AIDS and Malaria. This resulted in slowing progress in achieving control programs targets.
 Aim: The study was aimed at evaluating malaria and HIV coinfection among COVID-19 cohort in selected healthcare facilities in Rivers State of Nigeria.
 Methodology: The observational study showed a snapshot sampled only patients within the COVID-19 approved centers who consented to participate within the selected study area otherwise excluded. Simple random sampling technique was used to select 400 participants, giving subjects equal opportunity of participation. The majority of the data came from primary sources, but secondary sources were also used. Malaria testing was perform using microscopic method. Result outputs were presented on tables and charts.
 Results: The study showed high prevalence of malaria infection among COVID-19 patients -327 (81.8%) but low rate of HIV co-infection- 2 (0.5%).
 Conclusion: Much consideration should be channeled towards malaria endemicity and coinfection with COVID-19 unless it confers protective advantage as postulated by some studies however, a large scale and more in-depth study is suggested.

Knowledge and practices among healthcare workers regarding dengue in Togo.

In Togo where malaria is endemic, because main signs of malaria and dengue are similar, the use of malarial drugs first could contribute to a delay in the diagnosis of dengue and the dissemination of the disease. Thus, it is important that healthcare workers (HCW) have a good knowledge of these diseases.To assess the knowledge, and practices regarding dengue infection among HCW in Togo.A cross-sectional study was carried out from November 2020 to March 2021 among HCW in Togo. A pre-tested digital questionnaire was used for data collection. Based on clinical signs of dengue, preventive measures, infection type and disease type, a knowledge score was constructed with eight questions.A total of 334 HCW with median age 32 years, IQR:(28-38) responded to the survey and the sex ratio male/female was 5.9. The majority (94.0%) of HCW have heard about dengue through training (73.3%), internet (38.0%) and media (33.2%). Compared with lower executive HCW, senior manager were more knowledgeable about the causative agent, the symptoms and preventive methods of dengue infection (p<0.001). Globally, good knowledge (score ≥6) about dengue was found for 47.1% of HCW. More than 9 out of 10 HCW (91.3%) reported the lack of dengue diagnostic tools.Providing health structures with dengue diagnostic tools and training health personnel in their use in any febrile patient with a negative or positive malaria test would help prevent dengue epidemic.

Knowledge, attitudes and practices towards malaria diagnostics among healthcare providers and healthcare-seekers in Kondoa district, Tanzania: a multi-methodological situation analysis

BackgroundDespite the large-scale rollout of malaria rapid diagnostic tests (RDTs) in Tanzania, many healthcare providers (HCPs) continue using blood film microscopy (BFM) and clinical examination to diagnose malaria, which can increase the risk of mal-diagnosis and over-prescribing of anti-malarials. Patients disregarding negative test results and self-treating exacerbate the problem. This study explored the knowledge, attitudes and practices of HCPs and healthcare-seekers regarding RDTs in comparison to BFM testing.MethodsA situational analysis was, therefore, conducted in Kondoa District, Dodoma Region, Tanzania. A multi-methodological approach was adopted including (i) a health facility inventory and screening of logbooks from May 2013 to April 2014 with 77,126 patient entries from 33 health facilities; (ii) a survey of 40 HCPs offering malaria services; and iii) a survey of 309 randomly selected household members from the facilities’ catchment area. Surveys took place in April and May 2014.ResultsHealth facility records revealed that out of 77,126 patient entries, 22% (n = 17,235) obtained a malaria diagnosis. Of those, 45% were made with BFM, 33% with RDT and 22% with clinical diagnosis. A higher rate of positive diagnoses was observed with BFM compared with RDT (71% vs 14%). In the HCP survey, 48% preferred using BFM for malaria testing, while 52% preferred RDT. Faced with a negative RDT result for a patient presenting with symptoms typical for malaria, 25% of HCPs stated they would confirm the result with a microscopy test, 70% would advise or perform a clinical diagnosis and 18% would prescribe anti-malarials. Interviews with household members revealed a preference for microscopy testing (58%) over RDT (23%), if presented with malaria symptoms. For participants familiar with both tests, a second opinion was desired in 45% after a negative microscopy result and in 90% after an RDT.ConclusionsNon-adherence to negative diagnostics by HCPs and patients continues to be a concern. Frequent training and supportive supervision for HCPs diagnosing and treating malaria and non-malaria febrile illnesses is essential to offer quality services that can instil confidence in HCPs and patients alike. The introduction of new diagnostic devices should be paired with context-specific behaviour change interventions targeting healthcare-seekers and healthcare providers.

A framework for evaluating health system surveillance sensitivity to support public health decision-making for malaria elimination: a case study from Indonesia

BackgroundThe effectiveness of a surveillance system to detect infections in the population is paramount when confirming elimination. Estimating the sensitivity of a surveillance system requires identifying key steps in the care-seeking cascade, from initial infection to confirmed diagnosis, and quantifying the probability of appropriate action at each stage. Using malaria as an example, a framework was developed to estimate the sensitivity of key components of the malaria surveillance cascade.MethodsParameters to quantify the sensitivity of the surveillance system were derived from monthly malaria case data over a period of 36 months and semi-quantitative surveys in 46 health facilities on Java Island, Indonesia. Parameters were informed by the collected empirical data and estimated by modelling the flow of an infected individual through the system using a Bayesian framework. A model-driven health system survey was designed to collect empirical data to inform parameter estimates in the surveillance cascade.ResultsHeterogeneity across health facilities was observed in the estimated probability of care-seeking (range = 0.01–0.21, mean ± sd = 0.09 ± 0.05) and testing for malaria (range = 0.00–1.00, mean ± sd = 0.16 ± 0.29). Care-seeking was higher at facilities regularly providing antimalarial drugs (Odds Ratio [OR] = 2.98, 95% Credible Intervals [CI]: 1.54–3.16). Predictably, the availability of functioning microscopy equipment was associated with increased odds of being tested for malaria (OR = 7.33, 95% CI = 20.61).ConclusionsThe methods for estimating facility-level malaria surveillance sensitivity presented here can help provide a benchmark for what constitutes a strong system. The proposed approach also enables programs to identify components of the health system that can be improved to strengthen surveillance and support public-health decision-making.

Prevalence of Malaria and Covid-19 in Febrile Patients in Lomé, Togo in 2020.

PurposeThe objective of this study was to estimate the prevalence of malaria and Covid-19 by PCR and serological tests in febrile patients in Lomé.MethodsA cross-sectional study was conducted from September 1 to October 31, 2020 in febrile patients ≥ 10 years in three health facilities in Lomé. Finger stick blood was collected to detect Plasmodium spp. using thin/thick smear and venous blood on EDTA tubes to test for malaria Histidin-Rich-Protein-2 antigen using rapid diagnostic tests (RDT) and SARS-CoV-2 antibodies specific immunoglobulin (Ig) M and G. Detection of SARS-CoV-2 in nasopharyngeal samples was performed by rRT-PCR using GeneXpert.ResultsA total of 243 participants (61.7% of female) with median age 28 years (IQR 18–41) were included in the study. Prevalence of malaria was 25.1%, 95% CI [19.8–31.0] and 30.4%, 95% CI [24.7–36.7] for thin/thick smear and rapid malaria test, respectively. Eighteen patients (7.4%, 95% CI [4.4–11.5]) were positive for SARS-CoV-2 and forty-two (17.3%, 95% CI [12.8–22.6]) were positive for IgM and/or IgG against SARS-CoV-2. SARS-CoV-2 IgM seroprevalence was significantly higher in malaria RDT positive participants (33.8% vs. 10.1%, p < 0.001).ConclusionThis study confirms a possible cross-reactivity between Covid-19 and malaria in case of single use of rapid tests, suggesting a possible past contamination. In case of clinical signs related to Covid-19 in malaria-endemic areas, PCR screening should be requested in order to identify and isolate patients.

Prevalence, Testing and Treatment Patterns of Malaria; A Hospital Based Five-Year Analyses by Age in Kwaebibirem, Eastern Ghana

Objective: Malaria, caused by single-celled microorganisms of the plasmodium group, is a mosquitoborne infectious disease that affects humans and other animals. Objectives prioritizing control and elimination led to the T3 policy (i.e., ‘Test, Treat and Track’) encouraging scale up of diagnostic testing, treatment and surveillance. This study analyses the prevalence of malaria infection andassesses health institutional compliance with policy directives for testing before treatment of all clinically suspected malaria cases.Methodology: A 5-year record review of malaria morbidity, 2014-2018, was completed with the DHIMS-2 web-based database using a cross sectional study design.Results: Despite a downward trend that decreased with increasing age through adolescence, higher proportions of hospital clients aged ≤ 28 days to 17 years were subjected to confirmatory malaria tests. This remained comparatively low among adults. The highest yield of positive malaria tests was observed among patients aged 1 month to 17 years. Malaria’s morbidity burden remained highest among hospital clients aged 1 month to 15 years of age while the highest proportion of hospital clients treated without priorconfirmatory tests was observed among the ages of 18 to 70 years and above. Proportion of patients treated for malaria without prior confirmatory tests therefore increased with increasing patient age.Conclusion: Isolated cases of presumptively treated malaria suggest that universal compliance with the first T of the T3 policy is yet unattained, potentially invalidating quality of the other Ts.Recommendations: Correlates for presumptive treatment should be investigated to facilitate acceleration towards attainment of universal compliance with the T3 policy.

The Demographical Prevalence of Malaria in Pregnant Women in Oshimili South Local Government Area of Delta State, Nigeria

This study evaluated the prevalence of malaria in pregnant women attending antenatal clinics in Delta state. Thick-film microscopy was used to detect parasitaemia while polymerase chain reaction (PCR) was employed to confirm positivity. Statistical method used were Chi square, Paired Sample T test and Pearson Correlation test at 5% level using SPSS version 23.0. Out of three hundred and fifty (350) HIV-negative and asymptomatic pregnant women examined at first antenatal registration, one hundred and twenty-two (122) were found positive for malaria parasite. The percentage prevalence of malaria positive cases recorded using microscopy was 34.86% (122/350) while PCR confirmed the positivity of 84% (21/25) for both positive and negative samples derived from microscopy. Prevalence of malaria in relation to age, gravidity, and educational qualification were statistically significant while prevalence in relation to occupation, the hospital they attended were not statistically significant. Participants within the age group of 15-19(66.6%), primigravidae (42.6%), primary education (100%) and traders/businessmen had the highest prevalence of malaria. It is therefore recommended that malaria test should be one of the routine tests compulsorily done on pregnant women to avoid complications and public awareness campaign programs on preventive measures against malaria should be regularly conducted to make the journey to eradication of malaria from Nigeria an easier one.

Accelerating malaria elimination in Cambodia: an intensified approach for targeting at-risk populations

BackgroundMalaria in Cambodia has decreased by 90.8% between 2010 and 2020, driven by the commitment of the National Center for Parasitology, Entomology and Malaria (CNM) and the achievements of the roll-out of a village malaria worker programme. However, in the first seven months of 2018, CNM identified a 207% increase (11,969 to 36,778) in confirmed malaria cases compared to the same months in the previous year. To address this increase, CNM developed the “Intensification Plan” (IP), implemented between October 2018 and December 2020.MethodsThe structure of the IP was summarized, including the selection of sites, the interventions implemented in the selected health facility catchment areas (HFCAs) and the monitoring and evaluation process. Data on IP interventions were collected by CNM and civil society organisations. Data on malaria cases and tests from all HFCAs in Cambodia from January 2018 to December 2020 were sourced from the Cambodia Malaria Information System (MIS) and WHO Malaria Elimination Database. Malaria data from IP HFCAs and non-IP HFCAs was analysed and compared to present the changes in malaria testing and confirmed cases before and during implementation of the IP.ResultsBetween October 2018 and December 2020, through the IP 16,902 forest packs and 293,090 long-lasting insecticide treated nets were distributed. In the 45 HFCAs included in the IP, 431,143 malaria tests were performed and 29,819 malaria cases were diagnosed, 5364 (18%) of which were Plasmodium falciparum/mixed cases. During the intervention period, over all HFCAs included in IP, P. falciparum/mixed cases declined from 1029 to 39, a 96.2% decrease, and from 25.4 P. falciparum/mixed cases per HFCA to 0.9. HFCAs not included in IP declined from 468 to 43 cases, a 90.8% decrease, showing that routine malaria activities in Cambodia were also playing an important contribution to malaria control.ConclusionsOver the course of IP implementation there was a substantial increase in malaria testing and both overall malaria cases and P. falciparum/mixed cases decreased month on month. The initiative yields lessons learned for Cambodia to reach the final stage of elimination as well as for other countries aiming to accelerate their malaria control programmes.

Active case detection and treatment of malaria in pregnancy using LAMP technology (LAMPREG): a pragmatic randomised diagnostic outcomes trial—study protocol

IntroductionMalaria is one of the major public health problems in sub-Saharan Africa. It contributes significantly to maternal and fetal morbidity and mortality in affected countries. This study aims to evaluate...

Prevalence and speciation of malaria parasites among patients attending Ahoada and Amassoma Communities’ general hospitals in Rivers and Bayelsa State, Nigeria

Malaria is one of the deadly diseases recognized globally in children and adults especially in Nigeria and some African countries. This study was designed to determine Prevalence and Speciation of malaria parasites from patients attending Ahoada and Amassoma Communities’ General Hospitals in Rivers and Bayelsa States respectively. A total of two hundred (200) venous blood collected from Amassoma [101(40 males, 61 Female) and Ahoada [99; 46male, 53 females) into sterile Ethylene Diamine Tetra Acetic Acid (EDTA) bottles from patients attending the above mentioned General Hospitals were immediately transferred to Medical Microbiology Laboratory, Department of Medical Laboratory Science for analysis using Microscopy by staining, Rapid Diagnostic Tests kits (SD Bioline kits; Pf/pan and Pf specific kit) and molecular analysis by Polymerase Chain Reaction (PCR) technique. Twenty (20) positive samples were subjected to Polymerase Chain Reaction Technique for Speciation. Findings showed 141(70.5%) subjects positive to malaria parasites comprised of Children 25(12.5%) between age of 6 and 17 years, adult female 63(31.5%) and male 53(26.5%) between the age of 18 and 90. Also noted were subjects with age ranges of 6-10, 21-25, 51-55 and 86-90 years had the highest percentage prevalence of 100%, followed by 41-45 years with a prevalence rate of 83.3% and the least prevalence was 33.3% from 56-60 years. Observations showed that out of 20 positive samples subjected to molecular diagnosis for Speciation, 17(85%) were Plasmodium falciparum, thus revealing their predominance of 90%. In conclusion, Plasmodium falciparum was the predominant parasite among Plasmodia species responsible for malaria infection in both Rivers and Bayelsa States. Female and children are vulnerable to malaria infection as revealed in this study. Therefore, the government is encouraged to take women and children’s health into consideration by conducting malaria test for them weekly to enable prompt treatment where applicable.

Accuracy of Rapid Diagnostic Test for Malaria Compared to Microscopy

Objective: To determine the diagnostic accuracy of the Rapid Diagnostic Test in the detection of malaria by taking routine microscopy as a gold standard.&#x0D; Study design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Haematology, Pakistan Naval Ship Rahat Hospital, Karachi Pakistan, from Aug 2018 to Jan 2019.&#x0D; Methodology: Patients diagnosed as a case with malaria were included. Malaria was confirmed by using a Rapid detection test and microscopy. Mean and standard deviations were calculated for the quantitative variables like age. Frequencies and percentages were calculated for the qualitative variables like gender. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated.&#x0D; Results: Out of 175 patients in the study, the mean age was 39.30 ± 11.29 years. 85 (48.6%) were male, and 90 (51.4%) were female. Out of 175 patients, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the rapid diagnostic test for malaria, keeping microscopy as the gold standard was found to be 87.2%, 74.15%, 67.34%, 85.71% and 80.57% respectively.&#x0D; Conclusion: Rapid immune-capture tests can have excellent applicability in malaria diagnosis. Field workers can reliably read such tests without any supervision. It appears to satisfy the desired criteria of being rapid, easy to perform, interpret and reasonably accurate.

Evaluation of two commercial kits and two laboratory-developed qPCR assays compared to LAMP for molecular diagnosis of malaria

BackgroundMalaria is an infectious disease considered as one of the biggest causes of mortality in endemic areas. This life-threatening disease needs to be quickly diagnosed and treated. The standard diagnostic tools recommended by the World Health Organization are thick blood smears microscopy and immuno-chromatographic rapid diagnostic tests. However, these methods lack sensitivity especially in cases of low parasitaemia and non-falciparum infections. Therefore, the need for more accurate and reliable diagnostic tools, such as real-time polymerase chain reaction based methods which have proven greater sensitivity particularly in the screening of malaria, is prominent. This study was conducted at the French National Malaria Reference Centre to assess sensitivity and specificity of two commercial malaria qPCR kits and two in-house developed qPCRs compared to LAMP.Methods183 blood samples received for expertise at the FNMRC were included in this study and were subjected to four different qPCR methods: the Biosynex Ampliquick® Malaria test, the BioEvolution Plasmodium Typage test, the in-house HRM and the in-house TaqMan qPCRs. The specificity and sensitivity of each method and their confidence intervals were determined with the LAMP-based assay Alethia® Malaria as the reference for malaria diagnosis. The accuracy of species diagnosis of the Ampliquick® Malaria test and the two in-house qPCRs was also evaluated using the BioEvolution Plasmodium Typage test as the reference method for species identification.ResultsThe main results showed that when compared to LAMP, a test with excellent diagnostic performances, the two in-house developed qPCRs were the most sensitive (sensitivity at 100% for the in-house TaqMan qPCR and 98.1% for the in-house HRM qPCR), followed by the two commercial kits: the Biosynex Ampliquick® Malaria test (sensitivity at 97.2%) and the BioEvolution Plasmodium Typage (sensitivity at 95.4%). Additionally, with the in-house qPCRs we were able to confirm a Plasmodium falciparum infection in microscopically negative samples that were not detected by commercial qPCR kits. This demonstrates that the var genes of P. falciparum used in these in-house qPCRs are more reliable targets than the 18S sRNA commonly used in most of the developed qPCR methods for malaria diagnosis.ConclusionOverall, these results accentuate the role molecular methods could play in the screening of malaria. This may represent a helpful tool for other laboratories looking to implement molecular diagnosis methods in their routine analysis, which could be essential for the detection and treatment of malaria carriers and even for the eradication of this disease.

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

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

Solving the enigma of acute febrile illness

The diagnosis of patients presenting with acute febrile illness is one of the most challenging in clinical medicine. For many years in Africa and other tropical regions, fever has been presumptively treated as malaria. 1 Macarayan E Papanicolas I Jha A The quality of malaria care in 25 low-income and middle-income countries. BMJ Glob Health. 2020; 5e002023 Crossref PubMed Scopus (8) Google Scholar The development and widespread use of malaria rapid tests markedly improved the specificity of the diagnosis of fever caused by malarial parasites but led to unacceptable levels of presumptive use of antibiotics for patients with negative malaria rapid test results. 2 Hopkins H Bruxvoort KJ Cairns ME et al. Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings. BMJ. 2017; 356j1054 PubMed Google Scholar , 3 D'Acremont V Kilowoko M Kyungu E et al. Beyond malaria—causes of fever in outpatient Tanzanian children. N Engl J Med. 2014; 370: 809-817 Crossref PubMed Scopus (288) Google Scholar , 4 WHOIntegrated management of childhood illness. https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/child-health/integrated-management-of-childhood-illnessDate accessed: May 1, 2022 Google Scholar This unintended consequence is serious as it contributes to antimicrobial resistance and affects our ability to conserve antibiotics for future generations. 5 Murray CJL Ikuta KS Sharara F et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022; 399: 629-655 Summary Full Text Full Text PDF PubMed Scopus (651) Google Scholar In their Article in The Lancet Infectious Diseases, Yukari C Manabe and colleagues showed that highly accurate multiplex molecular tests for determining some of the causes of fever are now available outside of laboratory settings with only 2–3 min of hands-on time and providing results within 1 h. 6 Manabe YC Betz J Jackson O Clinical evaluation of the BioFire Global Fever Panel for the identification of malaria, leptospirosis, chikungunya, and dengue from whole blood: a prospective, multicentre, cross-sectional diagnostic accuracy study. Lancet Infect Dis. 2022; (published online June 15.)https://doi.org/10.1016/S1473-3099(22)00290-0 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar These multiplex molecular tests that can be performed at the point of need represent another major advance towards solving the enigma of differential diagnosis of acute febrile illness, and have added utility as a public health tool for surveillance and outbreak investigations. Clinical evaluation of the BioFire Global Fever Panel for the identification of malaria, leptospirosis, chikungunya, and dengue from whole blood: a prospective, multicentre, cross-sectional diagnostic accuracy studyThis 1 h sample-to-answer, molecular device can detect common causative agents of acute febrile illness with excellent positive percent agreement and negative percent agreement directly in whole blood. The targets of the assay are prevalent in tropical and subtropical regions globally, and the assay could help to provide both public health surveillance and individual diagnoses. Full-Text PDF

High asymptomatic malaria among seasonal migrant workers departing to home from malaria endemic areas in northwest Ethiopia

BackgroundIn Ethiopia, thousands of seasonal migrant workers travel from non-malaria or mild malaria transmission areas to malaria-endemic areas for seasonal farm activities. Most of these migrants stay in the farm areas for land preparation, plowing, planting, weeding, and harvesting for a specific period and return to their living areas. However, there is limited evidence of how seasonal migrant workers contribute to the transmission of malaria to new or less malaria transmission areas.MethodsA cross-sectional study was conducted at the departure phase of seasonal migrant workers in the Metema district from September 2018 to October 2019. A total of 1208 seasonal migrant workers were interviewed during their departure from farm sites to their homes. The face-to-face interviews were performed using a pretested structured questionnaire. Moreover, blood samples were collected from each study participant for microscopic malaria parasite examination. The data were fitted with the logistic regression model to estimate the predictors of malaria transmission.ResultsAt departure to home, the prevalence of malaria among seasonal migrant workers was 17.5% (15.6–19.45%). Approximately 71.80% (177/212) of the cases were Plasmodium falciparum, and 28.20% (35/212) were Plasmodium vivax. Most seasonal migrant workers 934 (77.4%) were from rural residences and highlanders 660 (55%). Most 661 (55.4%) of the migrants visited two and more farm sites during their stay at development corridors for harvesting activities. Approximately 116 (54.7%) asymptomatic malaria cases returned to the Dembia 46 (21.7%), Chilaga 46 (19.8%) and Metema 28 (13.2%) districts.ConclusionIn this study, asymptomatic malaria remains high among seasonal migrant workers departing to home from malaria endemic areas. This may fuel a resurgence of malaria transmission in the high lands and cause challenges to the country's malaria prevention and elimination efforts. Hence, tailored interventions for seasonal migrant workers could be in place to enhance malaria control and elimination in Ethiopia, such as asymptomatic malaria test and treat positive cases at departure and transit, and integration between malaria officers at their origin and departure for further follow-up to decrease any risk of spread at the origin.

Analysis and validation of silica-immobilised BST polymerase in loop-mediated isothermal amplification (LAMP) for malaria diagnosis

Bacillus stearothermophilus large fragment (BSTLF) DNA polymerase is reported, isolated on silica via a fused R5 silica-affinity peptide and used in nucleic acid diagnostics. mCherry (mCh), included in the fusion construct, was shown as an efficient fluorescent label to follow the workflow from gene to diagnostic. The R5 immobilisation on silica from cell lysate was consistent with cooperative R5-specific binding of R52-mCh-FL-BSTLF or R52-mCh-H10-BSTLF fusion proteins followed by non-specific protein binding (including E. coli native proteins). Higher R5-binding could be achieved in the presence of phosphate, but phosphate residue reduced loop-mediated isothermal amplification (LAMP) performance, possibly blocking sites on the BSTLF for binding of β- and γ-phosphates of the dNTPs. Quantitative assessment showed that cations (Mg2+ and Mn2+) that complex the PPi product optimised enzyme activity. In malaria testing, the limit of detection depended on Plasmodium species and primer set. For example, 1000 copies of P. knowlesi 18S rRNA could be detected with the P.KNO-LAU primer set with Si-R52-mCh-FL-BSTLF , but 10 copies of P. ovale 18S rRNA could be detected with the P.OVA-HAN primer set using the same enzyme. The Si-immobilised BSTLF outperformed the commercial enzyme for four of the nine Plasmodium LAMP primer sets tested. Si-R52-mCh-FL-BSTLF production was transferred from Cambridge to Accra and set up de novo for a trial with clinical samples. Different detection limits were found, targeting the mitochondrial DNA or the 18S rRNA gene for P. falciparum. The results are discussed in comparison with qPCR and sampling protocol and show that the Si-BSTLF polymerase can be optimised to meet the WHO recommended guidelines.Graphical abstract

Adherence to national malaria clinical management and testing guidelines in selected private clinics of Gambela Town, Gambela Region, Ethiopia: a mixed method study

BackgroundThe World Health Organization World Malaria Report of 2019 indicated an estimated 228 million cases of malaria occurred worldwide in 2018. More than 75% of the total area of Ethiopia is malarious, making malaria a leading public health problem in Ethiopia. Adherence to clinical guidelines improves the quality of care received by patients, thus improving patient outcomes. This study investigates healthcare workers’ adherence to malaria testing and treatment guidelines in selected private clinics of Gambela Town, Ethiopia.MethodsA mixed study design involving a retrospective review of 425 patient files and 20 healthcare worker interviews in private clinics was implemented. Data were collected using pre-tested data collection forms. The collected data were then cleaned and entered into statistical software for analysis, with a level of significance set at < 0.05. A qualitative analysis was also conducted using healthcare worker interviews to identify the existing barriers to guideline adherence.ResultsAmong the 430 cases of suspected malaria, only 65% were tested for malaria. Of those tested, 75% tested positive and 25% tested negative. The most common co-morbidity in patients treated for malaria was anaemia (30%), followed by gastroenteritis (10%). Patients with co-morbidities were more likely to receive appropriate treatment (p = 0.03) compared to those without co-morbidities. All healthcare workers interviewed were aware of the existence of the malaria treatment guidelines. However, many were not aware of the contents of the guidelines and only 40% had been trained to understand the guidelines. Overall, 85% of the workers claimed to adhere to guidelines, with 15% claiming non-adherence.ConclusionThe gap between knowledge of the malaria treatment guidelines and their application by healthcare workers remains wide. The level of knowledge of these guidelines was also low. Continuous training, follow-up, supportive supervision, and improved adherence to the malaria guidelines are therefore recommended.