Suspected Malaria Patients Research Articles

Prevalence of Plasmodium and Soil-Transmitted Helminth Coinfection and Associated Factors among Malaria-Suspected Patients Attending Shewa Robit Health Center, North-Central Ethiopia.

Plasmodium and soil-transmitted helminth (STH) coinfection is a major public health problem in developing countries. Its prevalence and associated factors are poorly addressed in the available research. Therefore, this study aimed to assess Plasmodium-STH coinfection prevalence and associated factors among malaria-suspected patients attending Shewa Robit Health Center, north-central Ethiopia. A cross-sectional study was conducted among 379 malaria-suspected patients attending Shewa Robit Health Center from April to May 2023. Stool and blood samples were collected from each participant. Plasmodium and STHs were detected from blood and stool samples by using blood film and the Kato-Katz method, respectively. Data were entered into Epi Info version 7 and analyzed by SPSS version 26. Descriptive statistics were used to compute Plasmodium-STH coinfection. Logistic regression was used to identify associated factors. Variables with a P-value <0.05 were considered statistically significant. Among the study participants, 27.9%, 20.3%, and 13.4% were positive for Plasmodium, STHs, and Plasmodium-STH coinfection, respectively. The prevalence of Plasmodium-Ascaris lumbricoides coinfection was high (7.6%). Unavailability of insecticide-treated bed nets (ITNs), improper use of ITNs, absence of indoor residual spraying, presence of stagnant water, and previous malaria infection were significantly associated (P <0.01) with Plasmodium infection. Being illiterate, using an unimproved latrine, having an untrimmed fingernail, and practicing open defecation were also significantly associated (P <0.03), with STH infection. Being male, illiterate, and living in rural areas were significantly associated (P <0.03) with Plasmodium-STH coinfection. The prevalence of Plasmodium-STH coinfection was high in malaria-endemic areas. Therefore, malaria-suspected cases should be checked for STH infection.

A digital microscope for the diagnosis of Plasmodium falciparum and Plasmodium vivax, including P. falciparum with hrp2/hrp3 deletion.

Sensitive and accurate malaria diagnosis is required for case management to accelerate control efforts. Diagnosis is particularly challenging where multiple Plasmodium species are endemic, and where P. falciparum hrp2/3 deletions are frequent. The Noul miLab is a fully automated portable digital microscope that prepares a blood film from a droplet of blood, followed by staining and detection of parasites by an algorithm. Infected red blood cells are displayed on the screen of the instrument. Time-to-result is approximately 20 minutes, with less than two minutes hands-on time. We evaluated the miLab among 659 suspected malaria patients in Gondar, Ethiopia, where P. falciparum and P. vivax are endemic, and the frequency of hrp2/3 deletions is high, and 991 patients in Ghana, where P. falciparum transmission is intense. Across both countries combined, the sensitivity of the miLab for P. falciparum was 94.3% at densities >200 parasites/μL by qPCR, and 83% at densities >20 parasites/μL. The miLab was more sensitive than local microscopy, and comparable to RDT. In Ethiopia, the miLab diagnosed 51/52 (98.1%) of P. falciparum infections with hrp2 deletion at densities >20 parasites/μL. Specificity of the miLab was 94.0%. For P. vivax diagnosis in Ethiopia, the sensitivity of the miLab was 97.0% at densities >200 parasites/μL (RDT: 76.8%, microscopy: 67.0%), 93.9% at densities >20 parasites/μL, and specificity was 97.6%. In Ethiopia, where P. falciparum and P. vivax were frequent, the miLab assigned the wrong species to 15/195 mono-infections at densities >20 parasites/μL by qPCR, and identified only 5/18 mixed-species infections correctly. In conclusion, the miLab was more sensitive than microscopy and thus is a valuable addition to the toolkit for malaria diagnosis, particularly for areas with high frequencies of hrp2/3 deletions.

Plasmodium falciparum pfhrp2 and pfhrp3 gene deletions among patients enrolled at 100 health facilities throughout Tanzania: February to July 2021

Plasmodium falciparum with the histidine rich protein 2 gene (pfhrp2) deleted from its genome can escape diagnosis by HRP2-based rapid diagnostic tests (HRP2-RDTs). The World Health Organization (WHO) recommends switching to a non-HRP2 RDT for P. falciparum clinical case diagnosis when pfhrp2 deletion prevalence causes ≥ 5% of RDTs to return false negative results. Tanzania is a country of heterogenous P. falciparum transmission, with some regions approaching elimination and others at varying levels of control. In concordance with the current recommended WHO pfhrp2 deletion surveillance strategy, 100 health facilities encompassing 10 regions of Tanzania enrolled malaria-suspected patients between February and July 2021. Of 7863 persons of all ages enrolled and providing RDT result and blood sample, 3777 (48.0%) were positive by the national RDT testing for Plasmodium lactate dehydrogenase (pLDH) and/or HRP2. A second RDT testing specifically for the P. falciparum LDH (Pf-pLDH) antigen found 95 persons (2.5% of all RDT positives) were positive, though negative by the national RDT for HRP2, and were selected for pfhrp2 and pfhrp3 (pfhrp2/3) genotyping. Multiplex antigen detection by laboratory bead assay found 135/7847 (1.7%) of all blood samples positive for Plasmodium antigens but very low or no HRP2, and these were selected for genotyping as well. Of the samples selected for genotyping based on RDT or laboratory multiplex result, 158 were P. falciparum DNA positive, and 140 had sufficient DNA to be genotyped for pfhrp2/3. Most of these (125/140) were found to be pfhrp2+/pfhrp3+, with smaller numbers deleted for only pfhrp2 (n = 9) or only pfhrp3 (n = 6). No dual pfhrp2/3 deleted parasites were observed. This survey found that parasites with these gene deletions are rare in Tanzania, and estimated that 0.24% (95% confidence interval: 0.08% to 0.39%) of false-negative HRP2-RDTs for symptomatic persons were due to pfhrp2 deletions in this 2021 Tanzania survey. These data provide evidence for HRP2-based diagnostics as currently accurate for P. falciparum diagnosis in Tanzania.

A Comprehensive Study on Prevalence, Species Distribution, and Influencing Factors of Malaria in Dir Lower, Pakistan

Background: Malaria remains a significant public health challenge in Pakistan, particularly in the Khyber Pakhtunkhwa province. Tehsil Samarbagh in the Dir Lower region exemplifies the areas heavily burdened by this parasitic disease. Understanding the prevalence and distribution of malaria and its causative Plasmodium species is crucial for developing targeted interventions. Objective: This study aimed to assess the prevalence of malaria, identify the distribution of Plasmodium species, and evaluate the factors influencing malaria infection in Tehsil Samarbagh, Dir Lower, Pakistan. Methods: A cross-sectional study was conducted from January to December 2023. Non-probability convenient sampling was employed to collect 1,925 blood samples from suspected malaria patients across various Union Councils in Tehsil Samarbagh. Malaria diagnosis was performed using thin and thick blood films stained with Giemsa, and species identification was achieved through microscopy. Data on demographic variables, clinical symptoms, and environmental conditions were also collected and analyzed using SPSS version 25. Results: The overall prevalence of malaria was found to be 15.01%. Plasmodium vivax was the predominant species, accounting for 71% of the positive cases, followed by Plasmodium falciparum at 21%, and mixed infections at 8%. Prevalence varied significantly across different Union Councils, with the highest rate observed in Samarbagh (18.96%). Males were more affected (17.66%) than females (11.44%). The age group most at risk was 31-40 years (19.69%). Seasonal variation was evident, with the highest prevalence in September (22.42%) correlating with peak temperatures and humidity levels. Conclusion: The study underscores the continued public health challenge posed by malaria in Tehsil Samarbagh, highlighting the dominance of Plasmodium vivax. Variations in prevalence by geographic area, gender, age, and season necessitate targeted public health interventions and enhanced diagnostic capabilities for malaria control and prevention.

Health facility-based prevalence of typhoid fever, typhus and malaria among individuals suspected of acute febrile illnesses in Southwest Region, Ethiopia.

Acute febrile illnesses such as typhoid fever, typhus, and malaria are still major causes of hospital admission in many parts of Ethiopia. However, there are substantial gaps in the monitoring systems, which result in a lack of knowledge about the geographic distribution and role of common pathogens, particularly in rural areas. Thus, this study was aimed at assessing the seroprevalence of typhoid fever, typhus, and malaria among suspected acute febrile patients at the MTU Teaching Hospital and Mizan-Aman Health Center, Southwest region of Ethiopia. A health facility-based cross-sectional study was carried out from July to October 2022. Blood samples were collected from a total of 384 individuals. Widal and Weilfelix direct card agglutination and tube agglutination test methods were used for the Salmonella enterica serotype Typhi (S. typhi) and Rickettsia infections. The diagnosis of malaria was made using thick and thin blood smears. Questionnaires given by interviewers were used to gather information on risk factors and other sociodemographic factors. The data was analyzed using STATA/SE 14.0. A total of 371 patients were tested for S. Typhi and Rickettsia infections using direct card agglutination and tube agglutination methods. Using the screening test, 20.5% (76/371) patients were reactive either for O or H antigens or both, of which 55.3% (42/76) were reactive by the titration test at the cutoff value ≥ 1:80. About 17.5% (65/371) were reactive to OX19 antigen by card agglutination test, and of which 58.5% (38/65) were reactive by the titration test at the cutoff value ≥ 1:80. The overall seroprevalence of S. Typhi and Rickettsia infections using combined direct card and tube agglutination techniques was 11.3% (42/371) and 10.2% (38/371), respectively. Out of 384 suspected malaria patients, 43 (11.2%) were found positive either for P. falciparum, 27 (7.03%), or P. vivax, 16 (4.2%). In this study, typhoid fever, typhus, and malaria were found among symptomatic acute febrile patients. To increase disease awareness, it is necessary to provide sustainable health education about risk factor behaviors, disease transmission, and prevention strategies. In addition, improving laboratory diagnosis services and early treatment may also lower the likelihood of potentially fatal consequences.

Cryptic Zika virus infections unmasked from suspected malaria cases in Northeastern Nigeria

Introduction Although environmental and human behavioral factors in countries with Zika virus (ZIKV) outbreaks are also common in Nigeria, such an outbreak has not yet been reported probably due to misdiagnosis. The atypical symptoms of malaria and ZIKV infections at the initial phase could leverage their misdiagnosis. This study randomly recruited 496 malaria-suspected patients who visited selected health institutions in Adamawa, Bauchi, and Borno states for malaria tests. These patients’ sera were analyzed for ZIKV antibodies using ELISA and plaque reduction neutralization tests (PRNT) at 90% endpoint. About 13.8% of Zika virus-neutralizing antibodies (nAb) did not cross-react with dengue, yellow fever, and West Nile viruses suggesting possible monotypic infections. However, 86% of the sera with ZIKV nAb also neutralized other related viruses at varied degrees: dengue viruses (60.7%), West Nile viruses (23.2%), yellow fever virus (7.1%) and 39.3% were co-infections with chikungunya viruses. Notably, the cross-reactions could also reflect co-infections as these viruses are also endemic in the country. The serum dilution that neutralized 90–100% ZIKV infectivity ranged from 1:8 to 1:128. Also, our findings suggest distinct protection against the ZIKV between different collection sites studied. As indicated by nAb, acute ZIKV infection was detected in 1.7% of IgM-positive patients while past infections occurred in 8.5% of IgM-negatives in the three states. In Borno State, 9.4% of IgG neutralized ZIKV denoting past infections while 13.5% were non-neutralizing IgM and IgG indicating other related virus infections. The age, gender, and occupation of the patients and ZIKV nAb were not significantly different. ZIKV nAb from samples collected within 1–7 days after the onset of symptoms was not significantly different from those of 7–10 days. A wider interval with the same techniques in this study may probably give better diagnostic outcomes. ZIKV nAb was significantly distinct among recipients and non-recipients of antibiotic/antimalaria treatments before seeking malaria tests. The inhibiting effect of these drugs on ZIKV infection progression may probably contribute to the absence of neurological disorders associated with the virus despite being endemic in the environment for several decades. Also, protection against ZIKV as marked by the nAb was different among the vaccinated and unvaccinated YF vaccine recipients. Thus, the YF vaccine may be a good alternative to the Zika vaccine in resource-constrained countries. Conclusion The cryptic ZIKV infections underscore the need for differential diagnosis of malaria-suspected febrile patients for arboviruses, especially the Zika virus. The absence of systemic surveillance for the virus is worrisome because of its association with neurological disorders in newborns. Co-infections with other arboviruses may impact adversely on the management of these diseases individually.

Feasibility and Acceptability of a Strategy Deploying Multiple First-Line Artemisinin-Based Combination Therapies for Uncomplicated Malaria in the Health District of Kaya, Burkina Faso.

(1) Background: Effective malaria case management relies on World Health Organization (WHO) recommended artemisinin-based combination therapies (ACTs), but partial resistance to artemisinin has emerged and is spreading, threatening malaria control and elimination efforts. The strategy of deploying multiple first-line therapies (MFT) may help mitigate this threat and extend the therapeutic life of current ACTs. (2) Methods: A district-wide pilot quasi-experimental study was conducted, deploying three different ACTs at the public health facility (PHF) level for uncomplicated malaria treatment from December 2019 to December 2020 in the health district (HD) of Kaya, Burkina Faso. Mixed methods, including household and health facility-based quantitative and qualitative surveys, were used to evaluate the pilot programme. (3) Results: A total of 2008 suspected malaria patients were surveyed at PHFs, of which 79.1% were tested by rapid diagnostic test (RDT) with 65.5% positivity rate. In total, 86.1% of the confirmed cases received the appropriate ACT according to the MFT strategy. The adherence level did not differ by study segment (p = 0.19). Overall, the compliance level of health workers (HWs) with MFT strategy was 72.7% (95% CI: 69.7-75.5). The odds of using PHF as the first source of care increased after the intervention (aOR = 1.6; 95% CI, 1.3-1.9), and the reported adherence to the 3-day treatment regimen was 82.1%; (95% CI: 79.6-84.3). Qualitative results showed a high acceptance of the MFT strategy with positive opinions from all stakeholders. (4) Conclusions: Implementing an MFT strategy is operationally feasible and acceptable by stakeholders in the health systems in Burkina Faso. This study provides evidence to support the simultaneous use of multiple first-line artemisinin combination therapies in malaria-endemic countries such as Burkina Faso.

Accuracy of diagnosis among clinical malaria patients: comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections

BackgroundThe World Health Organization recommends parasitological confirmation of all suspected malaria cases by microscopy or rapid diagnostic tests (RDTs) before treatment. These conventional tools are widely used for point-of-care diagnosis in spite of their poor sensitivity at low parasite density. Previous studies in Ghana have compared microscopy and RDT using standard 18S rRNA PCR as reference with varying outcomes. However, how these conventional tools compare with ultrasensitive varATS qPCR has not been studied. This study, therefore, sought to investigate the clinical performance of microscopy and RDT assuming highly sensitive varATS qPCR as gold standard.Methods1040 suspected malaria patients were recruited from two primary health care centers in the Ashanti Region of Ghana and tested for malaria by microscopy, RDT, and varATS qPCR. The sensitivity, specificity, and predictive values were assessed using varATS qPCR as gold standard.ResultsParasite prevalence was 17.5%, 24.5%, and 42.1% by microscopy, RDT, and varATS qPCR respectively. Using varATS qPCR as the standard, RDT was more sensitive (55.7% vs 39.3%), equally specific (98.2% vs 98.3%), and reported higher positive (95.7% vs 94.5%) and negative predictive values (75.3% vs 69.0%) than microscopy. Consequently, RDT recorded better diagnostic agreement (kappa = 0.571) with varATS qPCR than microscopy (kappa = 0.409) for clinical detection of malaria.ConclusionsRDT outperformed microscopy for the diagnosis of Plasmodium falciparum malaria in the study. However, both tests missed over 40% of infections that were detected by varATS qPCR. Novel tools are needed to ensure prompt diagnosis of all clinical malaria cases.

Comparison between the Diagnostic Performances of Rapid Diagnostic Test (RDT) using Advantage Malaria Card Pf/Pv Ag, Microscopy, and Polymerase Chain Reaction (PCR) in Malaria Suspected patients at the Merauke Regional General Hospital

Malaria prevalence in Indonesia is still high, especially in eastern Indonesia, namely Papua, reaching a peak of 16%, for example, in Merauke. The diagnosis of Malaria is conducted according to the gold standard, using the microscopy method. However, it is still limited, raising the need for a Rapid Diagnostic Test (RDT) examination. This study aims to evaluate the diagnostic performances of Immunochromatography (ICT) based RDT (using Advantage Malaria Card Pf/Pv Ag), compared to the diagnostic performances of microscopy and Polymerase Chain Reaction (PCR).This cross-sectional observational study took all fever patients of outpatient and inpatient care at the Merauke Regional General Hospital (hereinafter referred to as RSUD Merauke) from June to July 2019 as the samples. The sample population included all malaria patients with positive microscopy results, and the control population included all non-malarial fever patients at RSUD Merauke. Each specimen underwent microscopy (thick and thin preparations), RDT, and Real-Time (RT)-PCR tests using a Rotor Gene-Q (Qiagen) with abTESTM malaria 5qPCR III reagent. The diagnostic performances of RDT were analyzed by calculating its sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). The study was conducted on 105 samples, namely 55 malaria samples and 50 control samples, who underwent microscopy, RDT, and RT-PCR. RDT sensitivity to microscopy, P. vivax 100%, P. falciparum 89.5%; specificity of P. vivax 95.7%, P. falciparum 97.7%. RDT sensitivity to RT-PCR, P. vivax 53.5%, P. falciparum 48.6%; specificity of P. vivax 100%, P. falciparum 98.5%. The RDT p-value for microscopy and RT-PCR was p=0.000. RDT k-coefficient of microscopy, P. vivax 0.937, P. falciparum 0.871. RDT k-coefficient of PCR, P. vivax 0.427, P. falciparum 0.531. RDT is more sensitive to P. vivax than microscopy. RDT is more specific to P. vivax than RT-PCR. Further studies are suggested to discuss anti-malaria drug resistance and sequencing.

Platelet Parameters and Their Correlation with Parasitemia Levels Among Malaria Infected Adult Patients at Jinella Health Center, Harar, Eastern Ethiopia: Comparative Cross-Sectional Study.

Malaria is a major public health problem with the highest morbidity and mortality in developing countries. Hematological changes play a great role in malaria pathogenesis through platelets and platelet parameters. However, the changes in platelet parameters are not clearly described in Ethiopia. Therefore, this study aimed to compare platelet parameters and their correlation with parasitemia among malaria-infected adult patients and healthy adults. An institutional-based comparative cross-sectional study was conducted involving 186 (93 malaria-infected patients and 93 healthy adults) study participants using a convenient sampling technique at Jinella health center, Harar, Eastern Ethiopia, from July 10-August 10, 2022. Five milliliters of venous blood were collected from each study participant, and platelet parameters were analyzed using a Unicel (DxH 800) automated hematologic analyzer. A drop of blood was taken from malaria-suspected patients for blood film preparation. Results between two groups were compared using the Mann-Whitney U-test. Spearman's rank correlation coefficient was used to evaluate the relationships between two continuous variables. A P-value of< 0.05 was considered statistically significant. Platelet, plateletcrit, and mean platelet volume of malaria-infected patients were significantly lower as compared with healthy adults (103 x103cells/μL vs 268 x103cells/μL, 0.13 fl vs 0.23 fl, and 9.6 fl vs 15.3 fl), respectively). Conversely, platelet distribution width and platelet large cell ratio were higher in malaria-infected patients than healthy adults (19.2% vs 15.3% and 0.35% vs 0.29%), respectively). Parasitemia levels had a moderately inverse correlation with platelet count (r= -0.419) and a weakly positive correlation with mean platelet volume (r=0.278). The platelet, plateletcrit, and mean platelet volume of malaria-infected patients were significantly lower as compared with healthy adults. Malaria parasitemia had a moderate inverse correlation with platelet count and a weak positive correlation with mean platelet volume. Thrombocytopenia and alteration of platelet parameters should be considered in malaria patients.

Prevalence of glucose-6-phosphate dehydrogenase deficiency (G6PDd) and clinical implication for safe use of primaquine in malaria-endemic areas of Hainan Province, China.

Primaquine, the only licensed antimalarial drug for eradication of Plasmodium vivax and Plasmodium ovale malaria, may cause acute hemolytic anemia in individuals with glucose-6-phosphate dehydrogenase deficiency (G6PDd) during treatment. The different prevalence and distribution patterns of G6PDd in Hainan, the ancient malaria-endemic area, are unclear. This study included 5,622 suspected malaria patients between 2009 and 2011 in 11 counties of Hainan. Glucose-6-phosphate dehydrogenase deficiency prevalence was determined using the fluorescent spot test (FST) and malaria patients was confirmed by a positive light microscopy. The G6PDd prevalence for different ethnic groups, genders, and counties were calculated and compared using χ2-test. Spatial cluster and Spearman rank correlation of G6PDd prevalence and malaria incidence were analyzed. The overall G6PDd prevalence of study population was 7.45%. The G6PDd prevalence of males, Li ethnic minority, and malaria patients was significantly higher than that of females, Han ethnic majority, and non-malarial patients (p < 0.01), respectively. The spatial cluster of G6PDd and malaria located in south-western and central-southern Hainan, respectively, with no significant correlation. The study provides essential information on G6PDd prevalence in ancient malaria-endemic areas of Hainan Province. We also highlight the need for a better understanding of the mechanisms underlying the relationship between G6PDd prevalence and malaria incidence. These findings provide a reference for the safety of the primaquine-based intervention, even after malaria elimination.

Plasmodium falciparum pfhrp2 and pfhrp3 Gene Deletions and Relatedness to Other Global Isolates, Djibouti, 2019-2020.

Deletions of pfhrp2 and paralogue pfhrp3 (pfhrp2/3) genes threaten Plasmodium falciparum diagnosis by rapid diagnostic test. We examined 1,002 samples from suspected malaria patients in Djibouti City, Djibouti, to investigate pfhrp2/3 deletions. We performed assays for Plasmodium antigen carriage, pfhrp2/3 genotyping, and sequencing for 7 neutral microsatellites to assess relatedness. By PCR assay, 311 (31.0%) samples tested positive for P. falciparum infection, and 296 (95.2%) were successfully genotyped; 37 (12.5%) samples were pfhrp2+/pfhrp3+, 51 (17.2%) were pfhrp2+/pfhrp3–, 5 (1.7%) were pfhrp2–/pfhrp3+, and 203 (68.6%) were pfhrp2–/pfhrp3–. Histidine-rich protein 2/3 antigen concentrations were reduced with corresponding gene deletions. Djibouti P. falciparum is closely related to Ethiopia and Eritrea parasites (pairwise GST 0.68 [Ethiopia] and 0.77 [Eritrea]). P. falciparum with deletions in pfhrp2/3 genes were highly prevalent in Djibouti City in 2019–2020; they appear to have arisen de novo within the Horn of Africa and have not been imported.

Comparative evaluation of BinaxNOW™ Malaria rapid diagnostic test, microscopy and polymerase chain reaction for Plasmodium falciparum detection among individuals suspected with malaria in Lagos, southwest Nigeria

Malaria is a major public health problem in the tropics, especially in resource-limited settings where presumptive malaria treatment is well practised. Prompt malaria diagnosis is essential in ensuring definitive antimalarial therapy. Malaria rapid diagnostic tests (mRDTs) are a suitable option in resource-limited settings. The study evaluated and compared the diagnostic performance of BinaxNOW™ mRDT, microscopy and quantitative polymerase chain reaction (qPCR) in suspected malaria cases in Lagos, south-western Nigeria. The cross-sectional study was conducted in four Primary Health Centres and Ikorodu General Hospital in Lagos. A total of 146 suspected malaria patients aged 2 to 67years were screened between August 2013 and November 2013. Venous blood samples were collected after informed consent was obtained from participants or guardians for mRDT, thick blood film for microscopy and dried blood spots on filter paper for PCR assays. Sociodemographic information of each patient was collected with a structured case report form. The sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, and kappa’s level of agreement were analysed. The level of statistical significance was set at ρ ≤ 0.05. Falciparum malaria positive rate and prevalence were temperature (56.8%) and age-dependent (42.5%). The sensitivity and specificity of mRDT and microscopy were 94.7%, 91.7% and 85.4%, 96.5% respectively. While the positive predictive value (PPV) and negative predictive (NPV) were 79.9%, 94.2% and 96.4%, 95.0%. The diagnostic accuracy and kappa’s level of agreement for mRDT and microscopy were 89.0%, 94.5% and 0.78 and 0.89, respectively. The performance of BinaxNOW™ malaria RDT was comparable with microscopy and can be used to guide malaria treatment in resource-limited settings to enhance parasite-based treatment of all suspected malaria cases when microscopy is unavailable.

Prevalence of G6PD deficiency and distribution of its genetic variants among malaria-suspected patients visiting Metehara health centre, Eastern Ethiopia

BackgroundGlucose-6-phosphate dehydrogenase (G6PD) is cytosolic enzyme, which has a vital role for the integrity and functioning of red blood cells. Lower activity of this enzyme leads to the occurrence of acute haemolytic anaemia after exposure to oxidative stressors like primaquine. Primaquine is an important drug for the radical cure of Plasmodium vivax and blocking transmission of Plasmodium falciparum, and thereby enhancing malaria elimination. However, there is a need to identify G6PD deficient individuals and administer the drug with caution due to its haemolytic side effects. The main objective of this study is to determine the prevalence of G6PD deficiency among malaria-suspected individuals.MethodsA facility-based cross-sectional study was conducted from September 2020 to September 2021 in Metehara Health Centre, Eastern Ethiopia. A structured questionnaire was used to collect the socio-demographic and clinical information of the study participants. Capillary and venous blood samples were collected based on standard procedures for onsite screening, dried blood spot preparation, and malaria microscopy. The G6PD enzyme activity was measured by careSTART™ G6PD biosensor analyzer. Data was entered and analysed by SPSS.ResultsA total of 498 study participants were included in the study, of which 62% (309) were males. The overall prevalence of G6PD deficiency based on the biosensor screening was 3.6% (18/498), of which 2.9% and 4.8% were males and females, respectively. Eleven of the G6PD deficient samples had mutations confirmed by G6PD gene sequencing analysis. Mutations were detected in G267 + 119C/T, A376T, and ChrX:154535443. A significant association was found in sex and history of previous malaria infection with G6PD deficiency.ConclusionsThe study showed that the G6PD deficient phenotype exists in Metehara even if the prevalence is not very high. G267 + 119C/T mutation is the predominant G6PD variant in this area. Therefore, malaria patient treatment using primaquine should be monitored closely for any adverse effects.

Prevalence of Malaria and Associated Factors among Malaria-Suspected Patients Attending Hamusit Health Center, Northwest Ethiopia: A Cross-Sectional Study.

Background Malaria is one of the major public health problems in developing countries like Ethiopia. Despite efforts to reduce the mortality and morbidity, the disease is still a prominent health problem in Ethiopia. This study, therefore, was undertaken to assess the prevalence of malaria and associated factors among symptomatic patients in Northwest Ethiopia. Methods A facility based cross-sectional study was conducted from February to March 2020 among 210 febrile patients attending Hamusit Health Center, Northwest Ethiopia. A structured questionnaire was used to collect data on sociodemographic characteristics and factors perceived to be associated with Plasmodium infection. Questionnaire data was collected through face to face interview. Thin and thick blood films were prepared from capillary blood buffy coat samples. Data were analyzed using Statistical Package for Social Sciences Software version 20. Results Out of 210 malaria-suspected participants, 61 (29.0%) were confirmed to be infected by Plasmodium species. Plasmodium falciparum and P. vivax monoinfections were detected in 41 (19.5%) and 10 (4.8%) participants, respectively. Mixed infection was detected in 10 (4.8%) participants. Female participants (AOR = 2.261; 95% CI: 1.118-4.571; P = 0.023) and those having family members with history of malaria (AOR =2.261; 95% CI: 1.264-5.340; P = 0.009) had higher odds of acquiring Plasmodium infection as compared to their counterparts. Using insecticide-treated bed net and draining stagnant water were the most commonly mentioned malaria prevention measures reported by 71.9% and 8.1% of the respondents, respectively. Conclusion Malaria contributes significantly for febrile illnesses in the study area. Therefore, community mobilization should be strengthen in order to improve implementation of malaria control activities and, hence, reducing the prevalence.

Five-Year Trend of Malaria Prevalence in Mojo Town, Central Ethiopia: Shifting Burden of the Disease and Its Implication for Malaria Elimination: A Retrospective Study.

IntroductionMalaria continues to strike hardest against the health and economic development in Ethiopia. The peak of malaria incidence follows the main rainfall season in each year; however, its transmission tends to be highly heterogeneous within or between years and from area to area. Thus, this study was aimed to determine the trend prevalence of malaria in Mojo town, central Ethiopia.MethodsA retrospective study was conducted in Mojo town, East Shoa zone, Ethiopia from February to March 2021. Malaria cases and related data documented between 2016 and 2020 were carefully reviewed from laboratory registration logbooks. The collected data were analyzed using descriptive statistics.ResultsA total of 19,106 blood films were examined from malaria-suspected patients. The overall microscopically confirmed prevalence of malaria was 4.2% (793/19,106). Plasmodium vivax was the predominant species accounting for 76.2% (604/793) of positive samples. Malaria cases declined from 259 in 2016 to 77 in 2020. The proportion of malaria was higher among males (64.8%, 514/793) than females (35.2%, 279/793) (P < 0.0001). Higher malaria cases were observed from the age group 15–24 years followed by the age group of 25–34 (P < 0.0001). The number of malaria cases was at a high level from September to November and lowest from December to February.ConclusionDespite a declining trend of malaria prevalence, it remains a public health burden in the area. P. vivax, the predominant species, should get attention during prevention and control strategies for the successful progress of the malaria elimination program.

Nationwide molecular surveillance of three\xa0Plasmodium\xa0species harboured by symptomatic malaria patients living in Ghana

BackgroundClinical presentations of malaria in Ghana are primarily caused by infections containing microscopic densities of Plasmodium falciparum, with a minor contribution from Plasmodium malariae and Plasmodium ovale. However, infections containing submicroscopic parasite densities can result in clinical disease. In this study, we used PCR to determine the prevalence of three human malaria parasite species harboured by suspected malaria patients attending healthcare facilities across the country.MethodsArchived dried blood spots on filter paper that had been prepared from whole blood collected from 5260 patients with suspected malaria attending healthcare facilities across the country in 2018 were used as experimental material. Plasmodium species-specific PCR was performed on DNA extracted from the dried blood spots. Demographic data and microscopy data for the subset of samples tested were available from the original study on these specimens.ResultsThe overall frequency of P. falciparum, P. malariae and P. ovale detected by PCR was 74.9, 1.4 and 0.9%, respectively. Of the suspected symptomatic P. falciparum malaria cases, 33.5% contained submicroscopic densities of parasites. For all regions, molecular diagnosis of P. falciparum, P. malariae and P. ovale was significantly higher than diagnosis using microscopy: up to 98.7% (75/76) of P. malariae and 97.8% (45/46) of P. ovale infections detected by PCR were missed by microscopy.ConclusionPlasmodium malariae and P. ovale contributed to clinical malaria infections, with children aged between 5 and 15 years harbouring a higher frequency of P. falciparum and P. ovale, whilst P. malariae was more predominant in individuals aged between 10 and 20 years. More sensitive point-of-care tools are needed to detect the presence of low-density (submicroscopic) Plasmodium infections, which may be responsible for symptomatic infections.Graphical

Validation of a Mobile Health Technology Platform (FeverTracker) for Malaria Surveillance in India: Development and Usability Study.

BackgroundA surveillance system is the foundation for disease prevention and control. Malaria surveillance is crucial for tracking regional and temporal patterns in disease incidence, assisting in recorded details, timely reporting, and frequency of analysis.ObjectiveIn this study, we aim to develop an integrated surveillance graphical app called FeverTracker, which has been designed to assist the community and health care workers in digital surveillance and thereby contribute toward malaria control and elimination.MethodsFeverTracker uses a geographic information system and is linked to a web app with automated data digitization, SMS text messaging, and advisory instructions, thereby allowing immediate notification of individual cases to district and state health authorities in real time.ResultsThe use of FeverTracker for malaria surveillance is evident, given the archaic paper-based surveillance tools used currently. The use of the app in 19 tribal villages of the Dhalai district in Tripura, India, assisted in the surveillance of 1880 suspected malaria patients and confirmed malaria infection in 93.4% (114/122; Plasmodium falciparum), 4.9% (6/122; P vivax), and 1.6% (2/122; P falciparum/P vivax mixed infection) of cases. Digital tools such as FeverTracker will be critical in integrating disease surveillance, and they offer instant data digitization for downstream processing.ConclusionsThe use of this technology in health care and research will strengthen the ongoing efforts to eliminate malaria. Moreover, FeverTracker provides a modifiable template for deployment in other disease systems.

Comparative Performance Evaluation of Symptomology, Point-of-Care Test and Microscopy in the Diagnosis of Malaria on Suspected Malaria Cases in Katsina, Nigeria

Malaria is the most dominant cause of human morbidity and mortality with huge medical, psychological and economic impact in Nigeria. Prompt and accurate diagnosis is one of the key components in the control of malaria disease. In Katsina State, clinical (symptomatic) diagnosis and Pf HRP-2 RDT are the two main methods routinely used for the diagnosis of malaria. Only tertiary, secondary and few primary hospitals employ microscopy in malaria diagnosis. This study was done to assess the performance of the clinical diagnosis, SD-BioLine (PfHRP-2) rapid diagnostic tests (RDTs) and Microscopy in the diagnosis of Malaria disease in Katsina State. In this cross-sectional study, involving three hospitals, blood samples of 400 clinically suspected malaria patients were tested for malaria using microscopy with Giemsa-stained films and Rapid Diagnostic Test (RDT), using SD Bioline Pf HRP-2 kit. Malaria prevalence using microscopy was 29.8% (119/400). Pf HRP-2 RDT recorded lower sensitivity with a parasite prevalence of 23.8% (95/400). PfHRP-2 RDT was able to identify only patients infected with P. falciparum in comparison to microscopy that detected a prevalence of 6% of malaria infections other than P. falciparum. The research indicated that clinical diagnosis in Katsina state is not very effective in malaria treatment. PfHRP-2 RDT is not an ideal test kit, as there exist, other Plasmodium species, in Katsina State that can equally cause malaria infection.

Assessing the Performance of CareStart™ Malaria Rapid Diagnostic Tests in Northwest Ethiopia: A Cross-Sectional Study.

Background While rapid diagnostic tests are an alternative diagnostic tests for microscopy in the diagnosis of malaria in rural settings, their performance has been inconsistent. Performance of rapid diagnostic tests might be affected by manufacturing process, transportation and storage, parasitemia level, and skill of personnel who perform the tests. Therefore, periodic evaluation of the local field performance of rapid diagnostic tests is mandatory in order to make early corrections in case of decreased performance. Methods A facility-based cross-sectional study was conducted from January to May 2020 among 257 malaria-suspected patients attending selected health centers in Bahir Dar Zuria district. Capillary blood was collected from each participant and tested for Plasmodium infection by CareStart™ rapid diagnostic test kit and thin and thick blood film microscopy. Data were analyzed using statistical software for social sciences version 20 and MedCalc software version 19.3. Sensitivity, specificity, positive and negative predictive values, and kappa value were calculated to evaluate the performance of rapid diagnostic tests against microscopy. Results Among 257 study participants, 47 (18.3%) were tested positive for Plasmodium infection by at least one of the diagnostic methods. Rapid diagnostic tests revealed 3 false positive and 3 false negative results. The sensitivity and specificity of CareStart Malaria Pf/Pv Combo test were 93.2% and 98.6%, respectively (kappa = 0.918). Conclusion CareStart™ rapid diagnostic test has comparable performance with microscopy for malaria diagnosis. We recommend continued use of CareStart Malaria Pf/Pv Combo test at health posts in Ethiopia where microscopy is not available.