Malaria Mortality Research Articles

Evaluation of the protective efficacy of OlysetPlus ceiling nets for reduction of malaria incidence in children in Homa Bay County, Kenya: a cluster-randomised controlled study protocol

IntroductionMalaria is still a major health problem in sub-Saharan Africa, where 98% of global malaria mortality occurs. In addition, the spread of Plasmodium falciparum with partial artemisinin resistance in East...

The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapy

BackgroundHistorically, children who are HIV-exposed, uninfected (CHEU) have been found to have greater morbidity and mortality than children who are HIV-unexposed, uninfected (CHUU). To assess whether this difference persists in...

Genome-scale, functional screen of Plasmodium sexual replication.

Malaria mortality remains above 500 000 people annually, demonstrating the need for new and innovative control approaches. Using a genome-scale, functional screen of Plasmodium sexual replication, Sayers et al. identified over 300 genes essential for malaria transmission through the mosquito, providing many new candidates for drug and vaccine development.

The influence of caregiver’s malaria-related knowledge on the use of insecticide-treated net among children under-five: a cross-sectional study

BackgroundMalaria remains a critical public health challenge globally, particularly in sub-Saharan Africa where it significantly contributes to morbidity and mortality among children under-five. In Ghana, efforts to promote the use of insecticide-treated nets (ITNs) as a preventive measure have been substantial but utilization rates remain suboptimal. This study examines the influence of caregivers' malaria-related knowledge on ITN use among children under the age of five years in a rural district of Ghana.MethodsA community-based cross-sectional study was conducted in the Ahafo Ano South West District, Ghana, between June and October 2023. A total of 442 caregivers (mothers) of children under-five were selected using a two-stage sampling process. Data were collected through structured interviews and analysed using bivariate and multivariable logistic regression models to determine the association between caregivers’ malaria-related knowledge and ITN use among children.ResultsOut of 442 caregivers, 436 (98.6%) completed the survey. ITN use among children under-five the night before the survey was reported by 73.8% of caregivers. Overall, 36.8% of caregivers had good malaria-related knowledge, 41.2% had satisfactory knowledge, and 21.9% had poor knowledge. Multivariable analysis showed that caregivers with good malaria-related knowledge were 12 times more likely to use ITNs for their children (AOR = 12.06, 95% CI 2.30–53.20) compared to those with poor knowledge. Other significant predictors included education on ITN use, ITN ownership, child's age, and use of alternative malaria prevention methods.ConclusionThis study highlights the critical role of caregiver malaria-related knowledge in promoting ITN use among children under-five in rural Ghana. Caregivers with better knowledge were significantly more likely to use ITNs, emphasizing the need for targeted health education programs. Such interventions should enhance awareness of malaria risks and ITN benefits, empower caregivers to use ITNs effectively, and reduce barriers to ITN access. These findings provide valuable insights for policymakers aiming to improve ITN utilization and reduce malaria morbidity and mortality in vulnerable populations.

The mediating role of behavioural and socio-structural factors on the association between household wealth and childhood malaria in Ghana

BackgroundChildren under five continue to bear a disproportionate burden of malaria morbidity and mortality in endemic countries. While the link between socioeconomic position (SEP) and malaria is well established, the causal pathways remain poorly understood, hindering the design and implementation of more targeted structural interventions. This study examines the association between SEP and malaria among children in Ghana and explores the potential mediating role of behavioural and socio-structural factors.MethodsData from the Ghana Demographic and Health Survey (DHS) 2022 were analysed. As part of the survey, children were tested for malaria using a rapid diagnostic test (RDT), and SEP was measured using a household asset-based wealth index. Mediation analysis (MA) using a regression-based approach was performed to assess mediated effects between SEP and malaria in children under five in Ghana through housing quality, educational attainment (EA), long-lasting insecticidal net (LLIN) use, indoor residual spraying (IRS), and healthcare-seeking behaviour (HSB). Reported are the total natural indirect effects (TNIEs) and the proportion mediated (PM).ResultsOf the 3,884 children included in the survey, 19.4% (757) had malaria. Belonging to a household with high SEP was associated with a 43% lower risk of malaria (Prevalence Ratio, PR = 0.57; 95% Confidence Interval, CI 0.46–0.71). Regarding indirect (mediated) effects, maternal EA of secondary school or higher (OR = 0.68; 95% CI 0.60–0.77; PM = 17.5%), improved housing (OR = 0.80; 95% CI 0.68–0.91, PM = 9.2%), LLIN use (OR = 0.95; 95% CI 0.90–0.99, PM = 2.1%) partially mediated the association between SEP and malaria. The combined effect of all three mediators was higher than those in a single mediator or two sequential mediators (with EA as the initial mediator) (OR = 0.58; 95% CI 0.51–0.68, PM = 25.7%). No evidence of mediation was observed for HSB and IRS.ConclusionWe found evidence of mediation by EA, housing, LLIN use and IRS, suggesting that current biomedical and behavioural malaria control efforts could be complemented with structural interventions, such as improved housing and education. Future studies that test the effect of different or joint effects of multiple mediators based on prospective designs are recommended to strengthen the evidence.

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

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

A quantitative and systematic analysis of Anopheles stephensi bionomics and control approaches

Anopheles stephensi is a mosquito endemic to South Asia and the Arabian Peninsula that has recently been detected in eight African countries, posing a significant threat to global malaria control efforts. A challenge with An. stephensi is that it requires unique surveillance and control tools when compared to other malaria vectors. Through a systematic literature review, we investigated the efficacy of trapping methods and controls for An. stephensi mosquitoes, with a focus on studies of its behavior and biology. Data from 83 articles (native range: Afghanistan, India, Iran, Iraq, Pakistan, and Qatar; invasive range: Djibouti, Ethiopia, Sri Lanka, Saudi Arabia, and Sudan) met our study inclusion criteria. Data from these studies revealed that using host-seeking animal baited traps increased the number of mosquitoes collected per trap per day in the native range when compared to host-seeking human baited traps. However, these differences were not present in data collection rate assessments from the invasive range. We also found that An. stephensi equally used a large variety of breeding habitats in the native range, but that it tended to prefer water reservoirs and wastewater in the invasive range. Finally, we found that temephos, fenthion, Bacillus thuringiensis israelensis, and Beauveri bassiana were more effective at reducing larvae in their native range compared to the approaches found in our systematic literature search, but the relative effectiveness of these approaches in the invasive range was less clear. Understanding proven historical surveillance and control approaches is essential to the advancement of invasive An. stephensi mitigation efforts, but continued investigations in the invasive range are critical to reducing the impacts of malaria morbidity and mortality.

Expanded roles of community health workers beyond malaria in the Asia-Pacific: A systematic review.

In the Greater Mekong Subregion (GMS), community health workers (CHWs) are a key component of malaria elimination strategies. As malaria declines, support for, and uptake of, malaria services may also subsequently decrease. Expanding their roles beyond malaria has been proposed to sustain the services. A systematic review was conducted to identify and characterize programmes with CHWs providing services in addition to those for malaria in the Asia Pacific. This review describes the expanded roles, identifies evidence of impact or success of the programmes, and explores strategies to ensure sustainability and factors for effective implementation to inform the design of malaria CHW programmes. Searches were conducted in 6 databases, for grey literature, and in bibliographies of retrieved articles. Data were extracted from 38 published articles, 12 programme reports, and 4 programme briefs and analysed using thematic coding and descriptive analysis. Twenty-nine programmes were identified with CHWs performing both malaria and non-malaria roles in the Asia Pacific. There was evidence of impact on malaria incidence in 4 of these, none on malaria mortality, and 4 on other diseases. Monitoring and evaluation mechanisms, multi-sectoral stakeholder collaborations, and adequate training and consistent supervision of CHWs were key to effective programme implementation. Integration of programmes into broader health services, ongoing political and funding support, and engagement with local communities were found to contribute to sustaining provision of health services by CHWs. Expanding CHW roles depends on programme management and strengthening linkages with local health systems. To sustain malaria CHW services, countries need adequate policies and financing, and sufficiently strong health systems to deliver basic health services that are adapted to the health needs of the community which means transitioning away from vertical disease programs. Further research should explore programmes that have not been captured in this review and address gaps in measuring malaria outcomes.

CAM: a novel aid system to analyse the coloration quality of thick blood smears using image processing and machine learning techniques.

Battling malaria's morbidity and mortality rates demands innovative methods related to malaria diagnosis. Thick blood smears (TBS) are the gold standard for diagnosing malaria, but their coloration quality is dependent on supplies and adherence to standard protocols. Machine learning has been proposed to automate diagnosis, but the impact of smear coloration on parasite detection has not yet been fully explored. To develop Coloration Analysis in Malaria (CAM), an image database containing 600 images was created. The database was randomly divided into training (70%), validation (15%), and test (15%) sets. Nineteen feature vectors were studied based on variances, correlation coefficients, and histograms (specific variables from histograms, full histograms, and principal components from the histograms). The Machine Learning Matlab Toolbox was used to select the best candidate feature vectors and machine learning classifiers. The candidate classifiers were then tuned for validation and tested to ultimately select the best one. This work introduces CAM, a machine learning system designed for automatic TBS image quality analysis. The results demonstrated that the cubic SVM classifier outperformed others in classifying coloration quality in TBS, achieving a true negative rate of 95% and a true positive rate of 97%. An image-based approach was developed to automatically evaluate the coloration quality of TBS. This finding highlights the potential of image-based analysis to assess TBS coloration quality. CAM is intended to function as a supportive tool for analyzing the coloration quality of thick blood smears.

Global Fight against Malaria: Goals and Achievements 1900–2022

This article examines the historical and ongoing efforts to fight malaria, a parasitic disease caused by Plasmodium species and transmitted by Anopheles mosquitoes. Despite over a century of control efforts, malaria remains a major global health issue. In 2022, there were an estimated 249 million cases across 85 countries, leading to approximately 600,000 deaths. In the recently published Global Technical Strategy for Malaria 2016–2030, the World Health Organization (WHO) has prioritized malaria eradication. The main goals are to reduce malaria incidence and mortality by 90% by 2030 compared to 2015 levels. However, as of 2022, progress has been limited, with only a 2% reduction in incidence and a 6% reduction in mortality. This review traces the historical context of malaria, highlighting its ancient origins and the pivotal scientific discoveries in the late 19th century that paved the way for modern control measures. The Global Malaria Eradication Programme launched by the WHO in 1955 initially showed promise, largely due to the insecticide DDT, but ultimately failed to achieve its goals mainly due to logistical problems, vector resistance to DDT, and inadequate funding. Despite significant advances in the early 21st century, including the Roll Back Malaria initiative and increased international funding, malaria eradication remains a distant goal. Persistent challenges, such as weak healthcare systems, parasite and vector resistance to drugs and insecticides, and inadequate funding, continue to hamper global efforts. Therefore, this article underscores the need for a deeper understanding of malaria’s history and recent evolution to inform future strategies for eradication.

Prevalence and Mortality of Malaria among Children under Five in Sub-Saharan Africa: A Review

Malaria had been a significant public health challenge in sub-Saharan Africa, particularly affecting children under five years of age, who accounted for over two-thirds of all malaria-related deaths globally. This review examined the prevalence and mortality rates of malaria among this vulnerable population, highlighting key determinants such as socioeconomic status, maternal education, environmental conditions, and access to healthcare. Recent data indicated that approximately 24.2% of children under five in the region are affected by malaria, with socioeconomic disparities exacerbating the risk. The review also discussed the effectiveness of various preventive interventions, including insecticide-treated nets (ITNs), indoor residual spraying (IRS), and seasonal malaria chemoprevention (SMC), emphasizing the need for multifaceted approaches that address both biological and social determinants of health. A comprehensive literature review was conducted to synthesize current research findings and provide insights into the challenges and opportunities for reducing malaria incidence and mortality in this demographic. Ultimately, addressing the complex interplay of risk factors is essential for developing targeted strategies to mitigate the impact of malaria on young children in sub-Saharan Africa. Keywords: Malaria, Children under five, Prevalence, Mortality, Sub-Saharan Africa.

Advances in Artemisinin Resistance: Mechanisms, Detection, and Novel Therapeutic Approaches

Artemisinin-based combination therapies (ACTs) have been instrumental in reducing global malaria mortality over the past two decades. However, the rise of artemisinin resistance, particularly in Southeast Asia and parts of Africa, threatened these gains. Artemisinin resistance was characterized by delayed parasite clearance and is primarily driven by mutations in the kelch13 (K13) gene, which reduce the drug’s efficacy. This review explored the mechanisms behind artemisinin resistance, including genetic mutations, parasite stress responses, and reduced ring-stage sensitivity. Detection strategies, such as the use of molecular markers like K13 mutations and in vitro phenotypic assays, were discussed in detail. To combat resistance, novel therapeutic approaches were emerging, including the optimization of ACTs, the use of triple-drug regimens, host-directed therapies, and gene-editing technologies. The article highlighted the need for new antimalarial drugs, improved diagnostic tools, and global collaboration to address this growing challenge. We conducted the review by analyzing recent literature and summarizing advances in both resistance mechanisms and therapeutic strategies. Finally, future directions were outlined, emphasizing the importance of research, regulatory frameworks, and investment to mitigate the spread of resistance and ensure effective malaria control. Keywords: Artemisinin resistance, K13 mutations, malaria treatment, combination therapies, gene editing, host-directed therapies.

Long-lasting insecticidal nets use and the prevalence of Plasmodium falciparum infection among pregnant women attending antenatal care at the Bonassama District Hospital, Littoral Region of Cameroon: a cross-sectional study

BackgroundMalaria during pregnancy continues to be a significant cause of morbidity and mortality for both infants and mothers, particularly in sub-Saharan African (SSA) countries, despite increased efforts to control it. The utilization of long-lasting insecticide-treated nets (LLINs) during pregnancy is a well-established strategy to reduce the prevalence of malaria. Nonetheless, inadequate adherence remains a persistent challenge in certain regions with high malaria endemicity. This research aimed to assess the effectiveness of long-lasting insecticidal nets in preventing asymptomatic malaria infections among pregnant women attending antenatal care at the Bonassama District Hospital in the Littoral Region of Cameroon.MethodsA hospital-based cross-sectional study was conducted from March to June 2022. Data on sociodemographic characteristics and LLIN usage were collected through a structured questionnaire, while asymptomatic malaria infections were identified using a PfHRP2/pLDH malaria qualitative rapid diagnostic kit. The relationship between categorical variables was analyzed using the chi-square test and logistic regression at a significance level of 5%.ResultsOut of the 411 pregnant women included in the study, 35.4% were diagnosed with malaria. The LLIN utilization rate was 65.1%. The risk of malaria infection was 2.7 times higher (AOR = 2.75, 95% CI = 1.83–4.14, p < 0.001) among women who did not consistently use LLINs compared to those who did. Pregnant women in their first trimester (AOR = 3.40, 95% CI = 1.24–4.64, p = 0.010) and second trimester (AOR = 1.90, 95%CI = 0.99–3.62, p = 0.055) were more likely to sleep under net when compared to those in the third trimester. Younger women 20–29 years (71.4%), those in the first trimester (69.6%) and those who had the nets before pregnancy (68.9%) were amongst those who frequently used use the nets. Among the reasons reported for not frequently using LLINs were heat (55.2%), suffocation (13.6%) and the smell of nets (8.4%).ConclusionThe use of LLIN was moderately high among the participants in this study, though still below national target. Age group, religion and gestation period were the major factors determining the use of LLINs. Considering the proven effectiveness of LLINs in reducing malaria morbidity and mortality, it is imperative for the National Malaria Control Programme (NMCP) to remain focused in promoting both LLIN ownership and utilization to achieve the national target of 100% and 80%, respectively.

Patient socio-demographics and clinical factors associated with malaria mortality: a case control study in the northern region of Ghana

BackgroundGhana is a malaria-endemic country with the entire population at risk. The Northern region of the country recorded the highest malaria case fatality rate (CFR) for two consecutive years: 1.11% in 2013 and 1.07% in 2014. Even though the National Malaria Elimination Programme (NMEP) has achieved a reduction in malaria mortality, the existence of high case fatality in the Northern region was alarming. This study, therefore, aimed to determine the factors associated with malaria mortality in the northern region of Ghana to institute control measures.MethodsAn unmatched case control study was conducted from July 2015 to August 2015. The study population consisted of patients admitted to health facilities for severe malaria in the Northern region of Ghana. A case was defined as a patient diagnosed with severe malaria at an eligible health facility who died as a result of malaria. A control was a patient diagnosed with severe malaria admitted to an eligible health facility who did not die. Health facilities that recorded CFRs of 1.0% and above were randomly sampled for this study, after which, 10 cases and 20 controls were recruited from each health facility. Information on cases and controls was then abstracted from hospital records using an electronically deployed abstraction tool. Continuous variables were expressed as means and medians, and categorical variables as frequencies and proportions. Multivariable logistic regression was used to assess the strength of the association between malaria mortality and factors predictive of malaria mortality. A p-value of < 0.05 was considered statistically significant.ResultsIn all, a total of 95 cases and 190 controls participated in this study. The median ages of cases and controls were 4.1 years (IQR = 21.6) and 5.7 years (IQR = 18.2), respectively. Fifty-four (56.8%) cases were females, while 93 (49.0%) of the controls were females. Factors associated with malaria mortality included: duration of hospital stay less than 24 h [aOR: 12.0, 95% CI (5.9–24.6)], severe pallor [aOR: 2.3, 95% CI (1.1–4.6)], children under 5 years [aOR: 2.8, 95% CI (1.4–5.6)], oral Artesunate/Amodiaquine administration [aOR: 0.4, 95% CI (0.2–0.9)] and sepsis as an additional diagnosis [aOR: 4.1, 95% CI (1.8–9.5)].ConclusionPredictors of malaria mortality in the Northern region include children under 5 years, severe pallor, sepsis as an additional diagnosis, and use of oral anti-malarial. Patients with severe pallor and sepsis as co-morbidities should receive proactive management. The NMEP and its partners should implement measures to strengthen the referral system, anaemia prevention and management, and retrain health workers on malaria case management. Malaria control interventions targeted at under five children in the region should be reviewed and enhanced.

Absence of developmental and reproductive toxicity in rats, rabbits, and zebrafish embryos exposed to antimalarial drug cabamiquine.

When developing new antimalarial drugs, considering their potential use during pregnancy as preventive or curative therapy is crucial. This prevents the parasite from affecting embryonic development and reduces maternal and fetal death risks. Consequently, understanding the exposure and safety of antimalarial drugs during pregnancy is crucial, with well-designed animal studies playing a key role in this assessment. As part of the drug development program for cabamiquine, a series of developmental and reproductive toxicity studies were conducted in rats and rabbits. Additionally, the zebrafish embryo model was used to further improve embryo exposure, minimize confounding factors related to maternal toxicity, and assess developmental risks of cabamiquine. In these studies, although maternal toxicity was observed, there were no cabamiquine-related adverse effects on fertility, embryonic, or fetal development at maternal exposures representing significant multiples (up to five and 10 times higher in rabbit and rats, respectively) than the exposure at the anticipated efficacious human dose. Similarly, no adverse effects were observed on ZF embryonic development, even though cabamiquine concentrations in the embryos were 10-fold higher than nominal concentrations. The results obtained in a full set of reproductive toxicity studies did not provide evidence of detrimental effects on the conceptuses and progeny at maternally nontoxic doses and exposures, still representing a multiple of the anticipated systemic exposures in women of childbearing potential (WOCBP). Cabamiquine can therefore be considered a suitable therapeutic option for WOCBP and pregnant women living in malaria-endemic regions by significantly reducing maternal and infant malaria death rates.

Dual nature of type I interferon responses and feedback regulations by SOCS1 dictate malaria mortality

IntroductionType I interferon (IFN-I, IFN-α/β), precisely controlled by multiple regulators, including suppressor of cytokine signaling 1 (SOCS1), is critical for host defense against pathogens. However, the impact of IFN-α/β on malaria parasite infections, beneficial or detrimental, remains controversial. ObjectivesThe contradictory results are suspected to arise from differences in parasite species and host genetic backgrounds. To date, no prior study has employed a comparative approach utilizing two parasite models to investigate the underlying mechanisms of IFN-I response. Moreover, whether and how SOCS1 involves in the distinct IFN-α/β dynamics is still unclear. MethodsHere we perform single-cell RNA sequencing analyses (scRNA-seq) to dissect the dynamics of IFN-α/β responses against P. yoelii 17XL (17XL) and P. berghei ANKA (PbANKA) infections; conduct flow cytometry analysis and functional depletion to identify key cellular players induced by IFN-I; and establish mathematical models to explore the mechanisms underlying the differential IFN-I dynamics regulated by SOCS1. Results17XL stimulates an early protective but insufficient toll-like receptor 7 (TLR7)-interferon regulatory factor 7 (IRF7)-dependent IFN-α/β response, resulting in CD11ahiCD49dhiCD4+ T cell activation to enhance anti-malarial immunity. On the contrary, a late IFN-α/β induction through toll-like receptor 9 (TLR9)-IRF7/ stimulator of interferon genes (STING)- interferon regulatory factor 3 (IRF3) dependent pathways expands programmed cell death protein 1 (PD-1)+CD8+ T cells and impairs host immunity during PbANKA infection. Furthermore, functional assay and mathematical modeling show that SOCS1 significantly suppresses IFN-α/β production via negative feedback and incoherent feed-forward loops (I1-FFL). Additionally, differential activation patterns of various transcriptional factors (TFs) synergistically regulate the distinct IFN-I responses. ConclusionThis study reveals the dual functions of IFN-I in anti-malarial immunity: Early IFN-α/β enhances immune responses against Plasmodium infection by promoting CD11ahiCD49dhiCD4+ T cell, while late IFN-α/β suppresses these response by expanding PD-1+CD8+ T cells. Moreover, both the SOCS1-related network motifs and TFs activation patterns contribute to determine distinct dynamics of IFN-I responses. Hence, our findings suggest therapies targeting SOCS1- or TFs-regulated IFN-I dynamics could be an efficacious approach for preventing malaria and enhancing vaccine efficacy.

Effectiveness of housing design features in malaria prevention: architects’ perspective

Introduction: This research aimed to assess housing design consideration features and architects’ perceptions of their effectiveness in malaria prevention. Previous studies have highlighted various architectural design elements that can reduce mosquito entry into homes, thus contributing to malaria prevention. This study aims to build on these insights by evaluating specific design features and gathering professional opinions on their effectiveness.Methods: The methodological approach adopted was quantitative, with data collected using a structured questionnaire containing closed-ended questions and a checklist. The observation checklist was used to ascertain mosquito entry reduction features incorporated in 208 systematically selected houses in Garneton East, Kitwe, Zambia. Additionally, a structured questionnaire containing fourteen key design features identified from the literature was administered to 76 architects purposively sampled to establish their perceptions of the effectiveness of these design factors in malaria prevention. Data collected was analyzed using descriptive statistics and exploratory factor analysis.Results: The findings revealed that most houses needed to incorporate design features to reduce mosquito entry. The common features incorporated were ceilings (86.80%), screened air ventilation (59.80%), and window screens (54.40%). The use of window and door screens, as well as mosquito-repellent paint, were perceived as the most effective measures by the architects.Discussion: The results suggest a keen awareness among architects regarding the efficacy of certain design features in malaria prevention. Despite this awareness, the implementation of these features in actual housing designs needs to be improved. This indicates a need for greater effort and adaptation in building regulations to promote the use of mosquito entry reduction features. Enhancing housing designs with these features can significantly reduce malaria morbidity and mortality. Therefore, it is recommended that building regulations be updated to support and encourage the incorporation of mosquito entry reduction features in housing designs.

Examining geographical inequalities for malaria outcomes and spending on malaria in 40 malaria-endemic countries, 2010–2020

BackgroundWhile substantial gains have been made in the fight against malaria over the past 20 years, malaria morbidity and mortality are marked by inequality. The equitable elimination of malaria within countries will be determined in part by greater spending on malaria interventions, and how those investments are allocated. This study aims to identify potential drivers of malaria outcome inequality and to demonstrate how spending through different mechanisms might lead to greater health equity.MethodsUsing the Gini index, subnational estimates of malaria incidence and mortality rates from 2010 to 2020 were used to quantify the degree of inequality in malaria burden within countries with incidence rates above 5000 cases per 100,000 people in 2020. Estimates of Gini indices represent within-country distributions of disease burden, with high values corresponding to inequitable distributions of malaria burden within a country. Time series analyses were used to quantify associations of malaria inequality with malaria spending, controlling for country socioeconomic and population characteristics.ResultsBetween 2010 and 2020, varying levels of inequality in malaria burden within malaria-endemic countries was found. In 2020, values of the Gini index ranged from 0.06 to 0.73 for incidence, 0.07 to 0.73 for mortality, and 0.00 to 0.36 for case fatality. Greater total malaria spending, spending on health systems strengthening for malaria, healthcare access and quality, and national malaria incidence were associated with reductions in malaria outcomes inequality within countries. In addition, government expenditure on malaria, aggregated government and donor spending on treatment, and maternal educational attainment were also associated with changes in malaria outcome inequality among countries with the greatest malaria burden.ConclusionsThe findings from this study suggest that prioritizing health systems strengthening in malaria spending and malaria spending in general especially from governments will help to reduce inequality of the malaria burden within countries. Given heterogeneity in outcomes in countries currently fighting to control malaria, and the challenges in increasing both domestic and international funding allocated to control and eliminate malaria, the efficient targeting of limited resources is critical to attain global malaria eradication goals.

Proactive home-based malaria management in rural communities of Bassar Health District in northern Togo from 2014 to 2017: PECADOM + , a pilot experiment

BackgroundTogo's National Malaria Control Programme has initiated an active home-based malaria management model for all age groups in rural areas of Bassar Health District. This report describes the model, reports its main results, and determines the factors associated with positive rapid diagnostic test results.MethodsFrom 2014 to 2017, in three peripheral care units of Bassar Health District (Binaparba, Nangbani, and Baghan), community health workers visited residents' homes weekly to identify patients with malaria symptoms, perform rapid diagnostic tests in symptomatic patients, and give medication to positive cases. Univariate and multivariate logistic regression models were used to determine the factors associated with positive tests.ResultsThe study covered 11,337 people (817 in 2014, 1804 in 2015, 2638 in 2016, and 6078 in 2017). The overall mean age was 18 years (95% CI 5–29; min–max: 0–112 years). The median age was 10 years (SD: 16.9). The proportions of people tested positive were 75.3% in Binaparba, 77.4% in Nangbani, and 56.6% in Baghan. The 5–10 age group was the most affected category (24.2% positive tests). Positive tests were more frequent during the rainy than during the dry season (62 vs. 38%) and the probability of positive test was 1.76 times higher during the rainy than during the dry season (adjusted OR = 1.74; 95% CI 1.60–1.90). A fever (37.5 °C or higher) increased significantly the probability of positive test (adjusted OR = 2.19; 95% CI 1.89–2.54). The risk of positive test was 1.89 times higher in passive than in active malaria detection (adjusted OR = 1.89; 95% CI 1.73–2.0).ConclusionsThis novel experimental community and home-based malaria management in Togo suggested that active detection of malaria cases is feasible within 24 h, which allows rapid treatments before progression to often-fatal complications. This PECADOM + program will help Togo's National Malaria Control Programme reduce malaria morbidity and mortality in remote and hard-to-reach communities.

Space–time clusters and co-occurrence of Plasmodium vivax and Plasmodium falciparum malaria in West Bengal, India

BackgroundMalaria, a prominent vector borne disease causing over a million annual cases worldwide, predominantly affects vulnerable populations in the least developed regions. Despite their preventable and treatable nature, malaria remains a global public health concern. In the last decade, India has faced a significant decline in malaria morbidity and mortality. As India pledged to eliminate malaria by 2030, this study examined a decade of surveillance data to uncover space–time clustering and seasonal trends of Plasmodium vivax and Plasmodium falciparum malaria cases in West Bengal.MethodsSeasonal and trend decomposition using Loess (STL) was applied to detect seasonal trend and anomaly of the time series. Univariate and multivariate space–time cluster analysis of both malaria cases were performed at block level using Kulldorff’s space–time scan statistics from April 2011 to March 2021 to detect statistically significant space–time clusters.ResultsFrom the time series decomposition, a clear seasonal pattern is visible for both malaria cases. Statistical analysis indicated considerable high-risk P. vivax clusters, particularly in the northern, central, and lower Gangetic areas. Whereas, P. falciparum was concentrated in the western region with a significant recent transmission towards the lower Gangetic plain. From the multivariate space–time scan statistics, the co-occurrence of both cases were detected with four significant clusters, which signifies the regions experiencing a greater burden of malaria cases.ConclusionsSeasonal trends from the time series decomposition analysis show a gradual decline for both P. vivax and P. falciparum cases in West Bengal. The space–time scan statistics identified high-risk blocks for P. vivax and P. falciparum malaria and its co-occurrence. Both malaria types exhibit significant spatiotemporal variations over the study area. Identifying emerging high-risk areas of P. falciparum malaria over the Gangetic belt indicates the need for more research for its spatial shifting. Addressing the drivers of malaria transmission in these diverse clusters demands regional cooperation and strategic strategies, crucial steps towards overcoming the final obstacles in malaria eradication.