Malaria Microscopy Research Articles

Profile of molecular markers of Sulfadoxine-Pyrimethamine-resistant Plasmodium falciparum in individuals living in southern area of Brazzaville, Republic of Congo

BackgroundAlthough the seasonal and perennial malaria chemopreventions are not implemented in the Republic of Congo, resistance to Sulfadoxine-pyrimethamine (SP) threatens the intermittent preventive treatment during pregnancy (IPTp-SP) and others treatments using the drug. The objective of this study was to determine the prevalence of molecular markers of P.falciparum resistance to SP in individuals with microscopic malaria infection in the south of Brazzaville. MethodsTwo parallel surveys (health facilities and community-based cross sectional studies) were carried out in urban and rural areas in southern Brazzaville. Between March and October 2021, blood samples were collected from 328 P. falciparum microscopic positive individuals (1- 83 years old, and sex ratio female/male of 1.1) to characterize dhfr and dhps genes involved in the P.falciparum resistance to SP. Restriction Fragment Length Polymorphism PCR was used for the detection of mutations within these parasite genes. ResultsHigh prevalence of mutations was reported within Pfdhfr gene: N51I; 328/328 (100%) ratio (prevalence) [95 CI uncertainty], C59R; 317/328 (96.6 %) [94.1-98.1%], S108N; 326/326 (100%), N164L; 3/326 (0.9%) [0.3-2.7%], and Pfdhps gene: A437G; 292/327 (89.3%) [85.5-92.2%], K540E; 140/327(42.8 %) [37.6-48.2%], A581G; 136/325 (41.8%) [36.6-42.3%]. The quintuple mutant (N51I+ C59R + S108N + A437G + K540E) and sextuple mutant haplotypes (N51I+ C59R + S108N + A437G + K540E + A581G) were reported for 11/144 (7.6%) [4.3-13.2%] and 5/144 (3.4% ) [1.5-7.9%]) of the participants respectively. The K540E and A437G mutants were more prevalent in the rural community; 81/139 (58.3%) [50.0-66.1%] and 135/139 (97.1%) [92.8-98.9%] respectively) than in the urban community; 21/50 (46.3%) [33.7-59.4%] and 47/54(87.0%) [75.6-93.6%] (p= 0.004 and p˂0.0001 respectively) ConclusionThese results indicate high prevalence of SP resistance mutations within the dhfr and dhps genes of P. falciparum isolates circulating in study sites, which may limit the efficacy of treatments using SP in these settings.

Association of first-line combination antiretroviral therapy with malaria among adult HIV-infected persons in Jos, Nigeria: a pilot cross sectional study

BackgroundMalaria and human immunodeficiency virus (HIV) infection coexist in significant numbers in some geographic areas including sub-Sahara Africa (SSA). HIV-infected patients are a World Health Organization (WHO) recognized high risk group for increased malaria morbidity. Majority of HIV-infected patients undertaking treatment in SSA are on WHO recognized first-line combination antiretroviral therapy (cART). Considering the immunity-enhancing capacity of antiretroviral therapies on people living with HIV, this study aimed to explore the association between first-line combination antiretroviral therapy (cART) with malaria parasitaemia and antigenaemia in adult HIV-infected persons and to determine the predictors of malaria antigenaemia in adult persons living with HIV.MethodsThe study was conducted at the AIDS Prevention Initiative in Nigeria (APIN) Centre, Jos University Teaching Hospital, Jos, Plateau State, from August 2018 to February 2019. Epi Info statistical tool was used to determine the sample size and power of the study. The study population consisted of three groups. The first group comprised first-line cART-experienced adult HIV-seropositive subjects, the second group comprised ARV-naïve HIV-seropositive adults and the third group comprised HIV-seronegative adults. For this pilot study, 60 persons were recruited into each group via convenience sampling. Malaria rapid diagnostic test (RDT) was performed according to manufacturer’s instruction for all the study participants using SD Bioline Malaria Ag P.f (HRP2/pLDH) (Standard Diagnostics, Hagal-Dong, Korea). All the study participants also had thick and thin blood film malaria microscopy. Data collected was processed and analyzed using the Stata statistical software version 15 (StataCorp, College Station, Texas). Chi square was used to test the association between malaria and first-line cART exposure. Univariate and multivariate analysis were also done to identify factors that were independently associated with malaria antigenaemia.ResultsA total of 180 persons participated in the study and involved 60 participants recruited in each of the three study groups. Overall, the predominant study participants were females (56.67%), traders (27.78%), secondary school leavers (43.33%) and urban dwellers (88.89%). Their mean age and standard deviation was 37.07 ± 11.53 years. Using malaria microscopy, the prevalence of malaria parasitaemia in ARV-naïve HIV-infected persons was 5% and 0% in the first-line cART-experienced HIV-infected persons as well as the HIV-negative persons. Malaria RDT result was positive in 7/60 (11.67%) of the first-line cART experienced HIV-infected participants, 6/60 (10%) of the ARV-naïve HIV-infected group and 1/60 (1.67%) of the HIV-negative group. Of the seven positive malaria RDT results in those on first-line cART, five persons were receiving zidovudine/lamivudine/nevirapine (AZT/3TC/NVP) while the remaining two were receiving tenofovir disoproxil fumarate/lamivudine/efavirenz (TDF/3TC/EFV), thus making an antigenaemia proportion of 16.67% and 6.67% respectively. Being an HIV-infected person on first-line cART (OR = 16.20, p = 0.04), having a headache (OR = 6.21, p = 0.03) and non-usage of window nets (OR = 3.74, p = 0.05) were found to be predictors of malaria antigenaemia.ConclusionMalaria parasite burden in HIV-infected persons on first-line cART is lower than that observed in ARV-naïve HIV-infected persons. Our study suggests that TDF/3TC/EFV may be associated with lower malaria antigenaemia when compared with AZT/3TC/NVP and can be considered an alternative first-line antiretroviral regimen in malaria-endemic regions.

Asymptomatic Plasmodium falciparum and HBV coinfections among inmates at Owo Correctional Facility, Nigeria

BackgroundMalaria and hepatitis B are significant public health infections in Nigeria. Coinfection with both pathogens is common where both diseases are endemic. Epidemiological surveys are essential for determining the burden of diseases and possible coinfection with multiple pathogens in vulnerable populations. There has been a lack of reports on HBV/malaria coinfection, particularly among marginalized groups in Ondo State. Thus, we used malaria microscopy and the HBsAg serological test to examine the prevalence of asymptomatic malaria parasitemia and HBV infections respectively among inmates at the Nigerian Correctional Center in Owo, Ondo State, Nigeria.ResultsOut of the 126 prisoners and staff members who were evaluated, 20.6% and 7.9% tested positive for malaria and HBV infections, respectively. It was discovered that 1.6% of the individuals were coinfected with malaria and HBV. Plasmodium falciparum was the only malaria species recovered in malaria-infected individuals. Except for HBV, where gender was found to differ considerably with the proportion of HBV infection, variations in single infections with either pathogen did not vary with demographic characteristics.ConclusionWe suggest that the prison system should be considered in healthcare programs to improve the health of inmates.

Performance evaluation of a combination Plasmodium dual-antigen CRP rapid diagnostic test in Lambaréné, Gabon.

The consequent use of malaria rapid diagnostic tests (RDTs) preceding a treatment decision has improved the global management of malaria. A combination RDT, including an inflammation marker to potentially guide antibiotic prescription, could improve the management of acute febrile illness (AFI). We performed a prospective, cross-sectional study in Gabon evaluating the STANDARD Malaria/CRP DUO (S-DUO) RDT. Participants aged 2 to 17 years with fever at presentation and/or a history of fever < 7 days were enrolled. Expert microscopy, SD Bioline Malaria Ag P.f/Pan test for malaria detection, and NycoCard CRP device for CRP were used as comparators. AFI cases were classified on a spectrum encompassing bacterial vs. non-bacterial infection. 415 participants with AFI were enrolled. S-DUO RDT sensitivity and specificity for malaria detection vs. microscopy were 99·1% (95·2-100%) and 72·7% (64·3-80·1%); and for CRP detection (20mg/L and above) 86·9% (80-92%) and 87% (79·2-92·7%), respectively. The difference in CRP levels between bacterial infection (mean = 41·2mg/L) and other causes of fever, measured from our study population using the Nycocard device, was statistically significant (p < 0·01); CRP precision-recall AUC to distinguish bacterial infection class vs. non-bacterial classifications was 0·79. S-DUO RDT is suitable for malaria detection in moderate-to-high malaria transmission settings such as in Lambaréné; however, a CRP band detection limit > 40mg/L is more adequate for indication of antibiotic prescription for AFI cases in Gabon.

Quality Control of Microscopic Diagnosis of Malaria in Healthcare Facilities and Submicroscopic Infections in Mossendjo, the Department of Niari, the Republic of the Congo.

The control and management of malaria are linked to the quality of diagnosis. We sought to estimate the performance of routine microscopy for malaria diagnosis and assess the prevalence of submicroscopic Plasmodium (P.) falciparum infection among febrile patients in two healthcare facilities in Mossendjo, the Republic of the Congo. A cross-sectional study was conducted between January and December 2022. A total of 650 and 234 patients with signs of uncomplicated malaria were enrolled at the Centre de Sante Intégré (CSIMSJ) and Hôpital de Base (HBMSJ), respectively. Two thick blood smears were performed for each patient, one analyzed by routine microscopists and the other by an expert. The msp-1 and msp-2 genes were genotyped to detect submicroscopic P. falciparum infection. At the CSIMSJ, the sensitivity was 49.5% and the specificity was 88.6%. The positive and negative predictive values were 77.7% and 68.7%, respectively. At the HBMSJ, the sensitivity was 32.9% and the specificity was 79.4%. The positive and negative predictive values were 44.8% and 69.5%, respectively. P. falciparum was the only species detected by routine microscopists, while experts identified some cases with P. malariae and P. ovale. The proportion of submicroscopic infections was 35.75%. Children under 5 years old had higher rates of parasitemia. However, submicroscopic infections were more pronounced in the adult group. The performance of routine malaria microscopists at Mossendjo was inaccurate at both sites. With the large proportion of submicroscopic infection, malaria management at Mossendjo requires the improvement of microscopists' skills and the concomitant use of RDTs.

Malaria and Typhoid Co-Infection among Children under 5 Years of Age at Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Anambra State, Nigeria

This study sheds light on the prevalence of malaria and typhoid in children below the age of five in a hospital in Nigeria. This study aimed to determine the presence of malaria, typhoid and malaria-typhoid co-infection in children less than five years of age. In this community-based descriptive, quantitative and cross-sectional hospital-based survey, the blood samples of 125 children between 0 to less than 5 years (68 males and 57 females) were examined for the presence of malaria parasites and typhoid infection. Blood samples were collected using venepuncture. The malaria parasitaemia was detected using malaria microscopy on a thick blood film. Typhoid fever infection was detected using the Widal Agglutination Test. The chi-square test was used to compare the prevalence of malaria, typhoid fever and malaria/typhoid co-infections between male and female infected and uninfected participants and between children below 1 year and those 1 year and above. P-values less than 0.05 were considered significant. A prevalence of 47.2%, 32% and 16% were recorded for malaria, typhoid and malaria/typhoid co-infection respectively. A mean malaria parasite intensity of 56.8475 (±3.30177) was recorded. There was no significant difference between the prevalence of malaria, typhoid and malaria/typhoid co-infection between the genders and age groups. Also, there was no significant difference between the mean PCV of the infected (33.1610 (±0.80748) and uninfected (34.6667 (0.48441) (P&gt; 0.05). These results underscore the importance of continued efforts to combat these diseases and improve the health and well-being of children in the region.

Health workers’ adherence to malaria case management protocols in Northern Sudan: a qualitative study

BackgroundNonadherence to national standards for malaria diagnosis and treatment has been reported in Sudan. In this study, qualitative research examined the clinical domains of nonadherence, factors influencing nonadherent practices and health workers’ views on how to improve adherence.MethodsIn September 2023, five Focus Group Discussions (FGDs) were undertaken with 104 health workers from 42 health facilities in Sudan’s Northern State. The participants included medical assistants, doctors, nurses, laboratory personnel, pharmacists and public health officers. The FGDs followed a semi-structured guide reflecting the national malaria case management protocol. Qualitative thematic analysis was performed.ResultsNonadherent practices included disregarding parasitological test results, suboptimal paediatric artemether–lumefantrine (AL) dosing, lack of counselling, use of prohibited artemether injections for uncomplicated and severe malaria, artesunate dose approximations and suboptimal preparations, lack of AL follow on treatment for severe malaria; and rare use of primaquine for radical Plasmodium vivax treatment and dihydroartemisinin-piperaquine as the second-line treatment for uncomplicated malaria. Factors influencing nonadherence included stock-outs of anti-malarials and RDTs; staff shortages; lack of training, job aids and supervision; malpractice by specialists; distrust of malaria microscopy and RDTs; and patient pressure for diagnosis and treatment. Health workers recommended strengthening the supply chain; hiring personnel; providing in-service protocol training including specialists; establishing external quality assurance for malaria diagnosis; and providing onsite supportive supervision and public health campaigns.ConclusionsThis study revealed a broad spectrum of behavioural and systemic challenges in malaria management among frontline health workers in Northern Sudan, including nonadherence to protocols due to resource shortages, training gaps, a lack of supportive supervision and patient pressure. These insights, including health workers’ views about improvements, will inform evidence-based interventions by Sudan’s National Malaria Control Programme to improve health systems readiness and the quality of malaria case management.

Sub-microscopic Plasmodium falciparum infections and multiple drug resistant single nucleotide polymorphic alleles in pregnant women from southwestern Nigeria

ObjectivesThe study evaluated sub-microscopic malaria infections in pregnancy using two malaria Rapid Diagnostic Tests (mRDTs), microscopy and RT-PCR and characterized Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and Plasmodium falciparum dihydropteroate synthase (Pfdhps) drug resistant markers in positive samples.MethodsThis was a cross sectional survey of 121 pregnant women. Participants were finger pricked, blood drops were collected for rapid diagnosis with P. falciparum histidine-rich protein 11 rapid diagnostic test kit and the ultra-sensitive Alere Pf malaria RDT, Blood smears for microscopy and dried blood spots on Whatman filter paper for molecular analysis were made. Real time PCR targeting the var acidic terminal sequence (varATS) gene of P. falciparum was carried out on a CFX 96 real time system thermocycler (BioRad) in discriminating malaria infections. For each run, laboratory strain of P. falciparum 3D7 and nuclease free water were used as positive and negative controls respectively. Additionally, High resolution melt analyses was employed for genotyping of the different drug resistance markers.ResultsOut of one hundred and twenty-one pregnant women sampled, the SD Bioline™ Malaria Ag P.f HRP2-based malaria rapid diagnostic test (mRDT) detected eight (0.06%) cases, the ultra-sensitive Alere™ malaria Ag P.f rapid diagnostic test mRDT had similar outcome in the same samples as detected by the HRP2-based mRDT. Microscopy and RT-PCR confirmed four out of the eight infections detected by both rapid diagnostic tests as true positive and RT-PCR further detected three false negative samples by the two mRDTs providing a sub-microscopic malaria prevalence of 3.3%. Single nucleotide polymorphism in Pfdhps gene associated with sulphadoxine resistance revealed the presence of S613 mutant genotypes in three of the seven positive isolates and isolates with mixed wild/mutant genotype at codon A613S. Furthermore, four mixed genotypes at the A581G codon were also recorded while the other Pfdhps codons (A436G, A437G and K540E) showed the presence of wild type alleles. In the Pfdhfr gene, there were mutations in 28.6%, 28.6%, and 85.7% at the I51, R59 and N108 codons respectively. Mixed wild and mutant type genotypes were also observed in 28.6% each of the N51I, and C59R codons. For the Pfcrt, two haplotypes CVMNK and CVIET were observed. The SVMNT was altogether absent. Triple mutant CVIET 1(14.3%) and triple mutant + wild genotype CVIET + CVMNK 1(14.3%) were observed. The Pfmdr1 haplotypes were single mutants YYND 1(14.3%); NFND 1(14.3%) and double mutants YFND 4(57.1%); YYDD 1(14.3%).

Prevalence, Associated Factors and Treatment Outcomes of Laboratory-confirmed Pregnancy Malaria at Antenatal Care in Three Healthcare Facilities of Douala, Cameroon

Pregnancy malaria is a life-threatening condition to the mother, the fetus and the newborn. Since the implementation of the World Health Organization’s recommendations of specific malaria control strategies to pregnant women in malaria endemic countries, evaluation studies are needed to assess the prevalence of malaria in pregnancy. This cross-sectional prospective study was therefore set to determine the prevalence and associated factors as well as the treatment outcomes of Plasmodium infection among pregnant women attending antenatal care in three hospitals of Douala in Cameroon.&#x0D; Each volunteered pregnant woman received for antenatal care was questioned according to the study questionnaire to collect sociodemographic data, use of malaria prevention tools and pregnancy history. Then a laboratory test was carried for Plasmodium detection in the peripheral blood using microscopy and a HRP2-based rapid diagnostic test. Plasmodium carrying pregnant women were treated according to the national malaria program scheme followed by post-treatment follow-up. Data were processed and analyzed using SPSS.20 software. Association of Plasmodium infection with risk factors was analyzed as univariate using Pearson Chi-square and Fisher Exact tests considering a P-value &lt; 0.05 as statistically significant.&#x0D; A total of 487 pregnant women aged between 18 years and 42 years were included in the study. The prevalence of Plasmodium infection was 3.5% and 4.3% by malaria rapid diagnostic test and microscopy respectively. Only Plasmodium falciparum asexual stage was detected. Parasite loads were low. Factors associated with Plasmodium falciparum higher prevalence were being less than 21 years old (0.02), not sleeping under mosquitoe net daily (p=0.04) and having fever during the pregnancy (p=0.04). Parenteral treatment with either artesunate, artemether or quinine sulfate showed good efficacy.&#x0D; Conclusion: Pregnant women attending the antenatal cares harbored low Plasmodium infection prevalence and loads. Being of young age, not sleeping under mosquitoe bednet daily and having fever during the pregnancy were predictive Plasmodium falciparum. Plasmodium infected pregnant women were successfully treated with antimalarial medications recommended by the national Ministry of Public Health. The authors recommend increasing efforts by health authorities to strengthen malaria prevention in pregnant women through more adherence to sleeping under ITNs daily and taking IPT-sp as well as systematic detection of Plasmodium infection at each antenatal visit.

Evaluating Malaria Rapid Diagnostic Tests and Microscopy for Detecting Plasmodium Infection and Status of Plasmodium falciparum Histidine-Rich Protein 2/3 Gene Deletions in Southeastern Nigeria.

Delays in malaria diagnosis increase treatment failures and deaths. In endemic regions, standard diagnostic methods are microscopy and malaria rapid diagnostic tests (mRDTs) detecting Plasmodium falciparum histidine-rich protein 2/3 (PFHRP2/PFHRP3), but gene deletions can allow certain parasites to remain undetected. We enlisted a cohort comprising 207 symptomatic individuals, encompassing both children and adults, at a hospital in Nnewi, Nigeria. The prevalence of parasites was determined using a highly sensitive, species-specific quantitative polymerase chain reaction (SS-qPCR). Within a subset of 132 participants, we assessed the sensitivity and specificity of microscopy and HRP2-mRDTs in comparison to SS-qPCR for the detection of P. falciparum. We also investigated the prevalence of pfhrp2/pfhrp3 gene deletions. Greater sensitivity was achieved with mRDTs (95%) compared with microscopy (77%). Also, mRDTs exhibited greater specificity (68%) than microscopy (44%). The positive predictive value of mRDTs (89%) surpassed that of microscopy (80%), suggesting a greater probability of accurately indicating the presence of infection. The negative predictive value of mRDTs (82%) was far greater than microscopy (39%). Of the 165 P. falciparum-positive samples screened for pfhrp2/pfhrp3 gene deletions, one gene deletion was detected in one sample. Regarding infection prevalence, 84% were positive for Plasmodium spp. (by reverse transcription [RT]-qPCR), with P. falciparum responsible for the majority (97%) of positive cases. Thus, exclusive reliance on microscopy in endemic areas may impede control efforts resulting from false negatives, underscoring the necessity for enhanced training and advocating for high-throughput molecular testing such as RT-qPCR or qPCR at referral centers to address limitations.

Malaria Diagnosis at the Pediatric Emergency Unit of a Teaching Hospital in Makurdi, North Central Nigeria.

Globally, there were 241 million cases of malaria in 2020, with an estimated 627,000 deaths with Nigeria accounting for 27% of the global malaria cases. In sub-Saharan Africa, testing is low with only 28% of children with a fever receiving medical advice or a rapid diagnostic test in 2021. In Nigeria, there are documented reports of over-diagnosis and over-treatment of malaria in children. Therefore, this study examined the diagnosis of malaria at the Benue State University Teaching Hospital, Makurdi. A 5-year (2018-2022) retrospective study was carried out at the Emergency Pediatric Unit (EPU). Records of all children presenting to the EPU with an assessment of malaria were retrieved and reviewed. Data was analyzed using SPSS 23. Out of 206 children reviewed, 128 (62.1%) were tested using either malaria RDT or microscopy while 78(37.9%) were not tested. Out of the number tested, 59(46.1%) were negative while 69(53.9%) tested positive, of which 14(20.3%) had uncomplicated malaria while 55(79.7%) had severe malaria. However, while 97.1% (n=67) of the positive cases were treated with IV artesunate, 69.5% (n=41) of those who tested negative and 88.5% (69) of those who were not tested also received IV artesunate. Moreover, while 85.5% (n=59) of those who tested positive received oral artemisinin-based combination therapy (ACT), 72.9% (n=43) of those who tested negative and 67.9% (53) of those who were not tested also received oral ACT. There was over-diagnosis of malaria, and subsequently, over-treatment. Hence continued emphasis on parasitological confirmation of malaria before treatment is recommended.

Malaria elimination and the need for intensive inter-country cooperation: a critical evaluation of regional technical co-operation in Southern Africa

BackgroundMalaria elimination requires closely co-ordinated action between neighbouring countries. In Southern Africa several countries have reduced malaria to low levels, but the goal of elimination has eluded them thus far. The Southern Africa Development Community (SADC) Malaria Elimination Eight (E8) initiative was established in 2009 between Angola, Botswana, Eswatini, Mozambique, Namibia, South Africa, Zambia, and Zimbabwe to coordinate malaria interventions aiming to eliminate malaria by 2030. Cross-border coordination is important in malaria elimination settings as it strengthens surveillance, joint planning and implementation, knowledge exchange and optimal use of resources. This paper describes how this collaboration is realized in practice, its achievements and challenges, and its significance for malaria elimination prospects.MethodsThe ministers of health of the E8 countries oversee an intergovernmental technical committee supported by specialist working groups consisting of technical personnel from member countries and partner institutions. These technical working groups are responsible for malaria elimination initiatives in key focus areas such as surveillance, vector control, diagnosis, case management, behaviour change and applied research. The technical working groups have initiated and guided several collaborative projects which lay essential groundwork for malaria elimination.ResultsThe E8 collaboration has yielded achievements in the following key areas. (1) Establishment and evaluation of malaria border health posts to improve malaria services in border areas and reduce malaria among resident and, mobile and migrant populations. (2) The development of a regional malaria microscopy slide bank providing materials for diagnostic training and proficiency testing. (3) A facility for regional external competency assessment and training of malaria microscopy trainers in collaboration with the World Health Organization. (4) Entomology fellowships that improved capacity in entomological surveillance; an indoor residual spraying (IRS) training of trainers’ scheme to enhance the quality of this core intervention in the region. (5) Capacity development for regional malaria parasite genomic surveillance. (6) A mechanism for early detection of malaria outbreak through near real time reporting and a quarterly bulletins of malaria incidence in border districts.ConclusionsThe E8 technical working groups system embodies inter-country collaboration of malaria control and elimination activities. It facilitates sustained interaction between countries through a regional approach. The groundwork for elimination has been laid, but the challenge will be to maintain funding for collaboration at this level whilst reducing reliance on international donors and to build capacities necessary to prepare for malaria elimination.

Evaluation of Malaria Microscopy Diagnostic Performance at 40 Public Health Facilities in Abidjan, Côte d'Ivoire in 2020.

Microscopic diagnosis of Giemsa-stained thick and thin blood films remained the gold standard laboratory method for the diagnosis of malaria. In this context, we felt it was important to conduct this evaluation with 40 public medical biology laboratories (MBLs) in the Abidjan 1 health region that perform blood parasitology tests to improve their implementation process. This descriptive and analytical study took place in July 2020 and involved participating laboratories (PLs) from the public sector in Abidjan. A set of 3 blood smear slides of variable parasite densities (PDs) with assigned values (AVs) of parasite densities and assigned Plasmodium species was used. The criterion for establishing the parasite density compliance interval was assigned values of ± 25%, and the performance rates were compared to the 80% recommended by the WHO for the African region. Nearly a quarter (11/40) of the participating laboratories had a compliance rate greater than 80%, including 10 with a performance of 100% for the ability to identify parasites. Regarding identifying plasmodial species, a concordance rate of 100% was obtained for slide 1 for Plasmodium falciparum, while this rate was 20% for slide 2 for Plasmodium ovale. For parasite densities < 200/µl, 87.5% of the participating laboratories (PLs) had a performance rate lower than 80%, while 95% of these PLs had a performance rate higher than 80% for parasitaemia > 2000/µl. There is a need to strengthen adapted to low parasitaemia, to improve the biological confirmation of malaria in Côte d'Ivoire.

Demographic and socio-economic factors affecting bed net ownership, usage, and malaria transmission among adult patients seeking healthcare in two Ghanaian urban cities

BackgroundThe most cost-effective malaria prevention and control strategy is the use of a bed net. However, several factors affect the ownership and usage of bed nets among the adult population. Hence, this study aimed to examine socio-demographic factors affecting bed net ownership, usage and malaria transmission among adult patients seeking healthcare in two Ghanaian urban cities.MethodsThis hospital-based cross-sectional study was conducted, between January and September 2021, at Bremang Seventh-Day Adventist Hospital, Suame Municipal, Ashanti Region and Sunyani Municipal Hospital, Sunyani, Bono Region, Ghana. Structured questionnaires were administered to a total of 550 participants to ascertain their ownership and usage of the bed nets. Afterwards, finger prick blood samples were collected for malaria microscopy. Crude and adjusted prevalence ratios (PR) and their respective 95% CIs were calculated, using Poisson regression with robust standard errors, to show associated variables in bivariate and multivariate analyses respectively. R software (version 4.1.1) was used to perform all statistical analyses.ResultsAbout 53.3% (n = 293) of participants owned at least one-bed net but only 21.5% (n = 118) slept under it the previous night. Those married were 2.0 (95% CI: 1.6 – 2.5) and 2.4 (95% CI: 1.6 – 3.5) times more likely to own and use a bed net respectively than those who never married. Also, pregnant women were 1.3 (95% CI: 1.1 – 1.6) and 1.8 (95% CI: 1.3 – 2.5) times more likely to own and use a bed net respectively than non-pregnant. Even though income levels were not associated with bed net ownership and usage, students were 0.4 (95% CI: 0.2 – 0.6) and 0.2 (95% CI: 0.1 – 0.5) times less likely to own and use bed net respectively compared to formally employed persons. The overall malaria prevalence rate was 7.8%. Malaria-negative patients were 1.6 (95% CI: 1.2 – 2.0) and 2.4 (95% CI: 1.4 – 4.1) times more likely to own and use bed nets respectively than malaria positive. Patients with tertiary education recorded the lowest malaria prevalence (3.5%, n = 4). None of those with a monthly income > $300 recorded a case of malaria. On the contrary, majority 83%, n/N = 25/30) of the malaria-positive patients earned ≤ $150.ConclusionThe National Malaria Control Program should conduct comprehensive mapping of all urban population segments before launching mass bed net distribution campaigns, taking into account demographic and socioeconomic factors to enhance bed net utilization and reduce malaria prevalence.

Microscopic parasite malaria classification using best feature selection based on generalized normal distribution optimization.

Malaria disease can indeed be fatal if not identified and treated promptly. Due to advancements in the malaria diagnostic process, microscopy techniques are employed for blood cell analysis. Unfortunately, the diagnostic process of malaria via microscopy depends on microscopic skills. To overcome such issues, machine/deep learning algorithms can be proposed for more accurate and efficient detection of malaria. Therefore, a method is proposed for classifying malaria parasites that consist of three phases. The bilateral filter is applied to enhance image quality. After that shape-based and deep features are extracted. In shape-based pyramid histograms of oriented gradients (PHOG) features are derived with the dimension of N × 300. Deep features are derived from the residual network (ResNet)-50, and ResNet-18 at fully connected layers having the dimension of N × 1,000 respectively. The features obtained are fused serially, resulting in a dimensionality of N × 2,300. From this set, N × 498 features are chosen using the generalized normal distribution optimization (GNDO) method. The proposed method is accessed on a microscopic malarial parasite imaging dataset providing 99% classification accuracy which is better than as compared to recently published work.

Unravelling the quality of malaria microscopy across Kinshasa, DR Congo.

In the current study we assessed clinical laboratories' staff ability across the city of Kinshasa with particular focus on their practices and performance regarding malaria microscopy. This was a non-random cross-sectional study included clinical laboratories in Kinshasa and focused on cross-checking of blood slides, a questionnaire and checklist according to standardised analytic malaria microscopy procedures. Regarding the cross-checking of slides, participant responses were considered 'corrects' in cases of complete congruence with the reference; 'acceptable' for malaria-positive slides but no identification of Plasmodium species, stage of development, parasite density and/or reported as P. falciparum instead of 'P. non falciparum'; and 'incorrect' if 'false positive' and 'false negative' cases. Eighty-eight among the 90 targeted clinical laboratories (participation 97.8%) took part in the investigation from February to July 2019. The ability assessment revealed that individuals qualified to perform thick blood films (TBF) according to the national malaria control program (NMCP) procedures ranged from 48.6% to 100.0%. Overall cross-checking performance of 167 eligible routine slides was relatively low: 37.7%; 25.8% and 36.5% of correct, acceptable and incorrect responses, respectively. The first routine slide was correctly and acceptably scored respectively by 35.3% and 28.2% of participating laboratories (n = 85); and the second, by 40.2% and 23.2% respectively (n = 82). The sensitivity and specificity were found to be 79.4% and 53.8%, respectively. However, the relative high scores reported in relation with the ability needed to perform TBF based on NMCP standards contrasted with the poor performance from cross-checking slides. Consecutively, only one-third of the 88 participating laboratories reached a score > 60% in agreement with NMCP procedures and had acceptable responses to cross-checked slides. The study was conducted as part of the activities relating to "Ensuring early diagnosis and prompt malaria treatment" component of the national malaria control strategy with NMCP support. More laboratories must implement clear and standardised malaria microscopy procedures, and need to include more rigorous quality control.

Evaluation of Malaria Microscopy Diagnostic Performance at the Public Health Center on the Border of Indonesia Timor-Leste.

Accurate diagnosis is a key strategy for controlling and preventing malaria. Regular evaluation of the performance of malaria microscopy diagnosis is essential to ensure its high quality. This study aims to assess the accuracy of malaria microscopy at selected public health facilities on the border of Indonesia and Timor-Leste. The design of this research is observational with a cross-sectional approach, conducted at five public health centers located on the Indonesia Timor-Leste border from July to September 2022. Stained slides were collected from patients with a fever (≥37°C). These stained slides were then examined for malaria diagnosis. The results revealed that all five public health centers showed perfect or nearly perfect agreement with the reference microscopist regarding malaria detection by microscopy (κ =0.9-1). To maintain the high quality of malaria microscopy diagnosis, it is imperative to conduct regular training, monitoring, and evaluation.

Exploring the relationship between Plasmodium falciparum genetic diversity and antimalarial drugs resistance markers in a malaria-endemic region of Burkina Faso.

the diversity of Plasmodium falciparum genotypes affects the dynamics of malaria transmission and is thought to be one of the factors hampering malaria control efforts. This study aimed to investigate the relationship between Plasmodium falciparum genetic diversity and chloroquine and sulfadoxine-pyrimethamine resistance markers in malaria endemic areas of Burkina Faso. in a cross-sectional study, populations residing in Nouna health district were randomly recruited. Blood samples were used for microscopic malaria diagnosis, and genetic polymorphism alleles of msp1 and msp2 genotyping by nested PCR. Restricted fragment length polymorphism analysis was used to identify antimalarial resistance markers. Logistic regression analysis explored the association between msp1/msp2 alleles and antimalarial drug resistance markers. ANOVA was used to explore the association between the mean complexity of infection (mCOI) and prevalence of resistance markers. the overall prevalence of Plasmodium falciparum infection was 27.1%. The proportions of K1, MAD20, RO33, FC27, 3D7 individuals with mutations in the pfcrt76T gene were 4.3%, 6.9%, 7.0%, 6.8% and 7.1% respectively. Those with mutations in pfmdr1 were 2.7%, 2%, 2.3%, 6.8% and 7.1%. No significant associations were detected between msp1/msp2 alleles and chloroquine or sulfadoxine-pyrimethamine resistance markers. However, the mean complexity of infection (mCOI) was significantly higher in individuals with the pfcrt76T mutation. overall, this study showed that the genetic diversity of Plasmodium falciparum does not significantly affect the presence of antimalarial drug resistance genes. The competition between different strains (polyclonality) of the parasite within the host was probably unfavorable for mutant strains.

Prevalence of malaria infection and factors associated among HIV-infected adult patients attending HIV care and treatment clinic at Kitete regional referral hospital in Tabora region, Tanzania: a cross-sectional study

BackgroundHIV and malaria are serious public health concerns, particularly in Tanzania. HIV-infected individuals are more likely to get malaria and its complications. However, data on the interaction of the two diseases in Tanzania are limited. This cross-sectional study aimed to determine the prevalence of malaria infection and associated factors among HIV-infected adults attending HIV care and treatment clinic at Kitete regional referral hospital in Tabora region, Tanzania.MethodologyThe cross-sectional study was carried out between March and May 2022 at Kitete regional referral hospital in Tanzania. A total of 246 HIV-infected adults were selected by systematic random sampling. Malaria was diagnosed using both malaria rapid diagnostic test (mRDT) and malaria microscopy. Social demographic data were collected using a structured questionnaire, while clinical history and laboratory parameters were extracted from patients’ files. Data were analyzed using STATA version 15.1, and a p value < 0.05 was considered statistically significant. The study included consenting HIV+ adults and excluded pregnant women and recent antimalarial users.ResultsTwenty-six out of 242 participants 10.7% (95% CI 6.9–15.6%) tested positive for malaria using mRDT, while 20 out of 242 participants 8.3% (95% CI 4.9–13.1%) tested positive for malaria using blood smear for malaria microscopy. Independent factors associated with malaria infection were living in rural areas (aOR = 2.81, 95% CI = 1.06–7.45, p = 0.038), poor adherence to anti-retroviral therapy (aOR = 3.66, 95% CI = 1.04–12.7, p = 0.043), HIV viral load of ≥ 1000 copies/mL (aOR = 3.2, 95% CI = 1.00–10.5, p = 0.02, CD4 count ≤ 350 cells/µL (aOR = 2.8, 95% CI = 1.10–7.30, p = 0.03), while using mosquito nets (aOR = 0.27, 95% CI = 0.08–0.90, p = 0.033) and receiving health education (aOR = 0.26, 95% CI = 0.09–0.71, p = 0.009) were protective factors.ConclusionsThe study reveals a concerning prevalence of malaria infection among adult HIV patients at Kitete regional referral hospital. Risk factors identified include a high HIV viral load, low CD4 count, lack of health education, rural residence, and non-use of mosquito nets. The results emphasize the necessity for focused health education, enhanced access to preventive measures, and consistent adherence to ART to reduce the risk of malaria in this vulnerable population.

Feasibility and safety of integrating mass drug administration for helminth control with seasonal malaria chemoprevention among Senegalese children: a randomized controlled, observer-blind trial

BackgroundThe overlap in the epidemiology of malaria and helminths has been identified as a potential area to exploit for the development of an integrated control strategy that may help to achieve elimination of malaria and helminths. A randomized, controlled, observer-blind trial was conducted to assess the feasibility and safety of combining mass drug administration (MDA) for schistosomiasis and soil transmitted helminths (STH) with seasonal malaria chemoprevention (SMC) among children living in Senegal.MethodsFemale and male children aged 1–14 years were randomized 1:1:1, to receive Vitamin A and Zinc on Day 0, followed by SMC drugs (sulfadoxine-pyrimethamine and amodiaquine) on Days 1–3 (control group); or praziquantel and Vitamin A on Day 0, followed by SMC drugs on Days 1–3 (treatment group 1); or albendazole and praziquantel on Day 0, followed by SMC drugs on Days 1–3 (treatment group 2). Safety assessment was performed by collecting adverse events from all children for six subsequent days following administration of the study drugs. Pre- and post-intervention, blood samples were collected for determination of haemoglobin concentration, malaria microscopy, and PCR assays. Stool samples were analyzed using Kato-Katz, Merthiolate-iodine-formalin and PCR methods. Urine filtration, PCR and circulating cathodic antigen tests were also performed.ResultsFrom 9 to 22 June 2022, 627 children aged 1–14 years were randomized into the three groups described above. Mild, transient vomiting was observed in 12.6% (26/206) of children in treatment group 2, in 10.6% (22/207) in group 1, and in 4.2% (9/214) in the control group (p = 0.005). Pre-intervention, the geometric mean value of Plasmodium falciparum parasite density was highest among children who received albendazole, praziquantel with SMC drugs. Post-intervention, the parasite density was highest among children who received SMC drugs only. Children who received praziquantel and SMC drugs had a lower risk of developing severe anaemia than their counterparts who received SMC drugs alone (OR = 0.81, 95% CI 0.13–5.00, p = 0.63).ConclusionsIntegration of MDA for helminths with SMC drugs was safe and feasible among Senegalese children. These findings support further evaluation of the integrated control model.Trial registration: The study is registered at Clinical Trial.gov NCT05354258.