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Kołodziej D, Richert W, Świetlik D, Korzeniewski K. Asymptomatic Malaria Cases and Plasmodium Species among BaAka Pygmies in Central Africa. Pathogens 2024; 13:682. [PMID: 39204282 PMCID: PMC11357669 DOI: 10.3390/pathogens13080682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/09/2024] [Accepted: 08/10/2024] [Indexed: 09/03/2024] Open
Abstract
Malaria is a significant health problem in Africa, primarily due to the Plasmodium falciparum species, but this is not the only etiological factor responsible for malaria on the continent. The goal of the present research was to describe asymptomatic malaria cases and to identify Plasmodium species responsible for malaria in the BaAka Pygmies, inhabitants of the Central African Republic (CAR). Screening was realised in the period of August-September 2021 among 308 people, including 74 children and 234 adults reporting to a healthcare facility in Monasao (southwest CAR), an area inhabited by a semi-nomadic tribe of BaAka Pygmies. The study consisted of two phases. Phase I, which was conducted in Africa, consisted of performing malaria rapid diagnostic tests (mRDTs), taking haemoglobin measurements and collecting blood samples onto Whatman FTA cards for molecular diagnostics. Phase II, which was conducted in Poland, involved molecular tests (RT-PCR) to confirm or rule out malaria infections and to identify Plasmodium species responsible for the infections. mRDTs detected Plasmodium infections in 50.3% of children and 17.1% of adults participating in the study, whereas RT-PCR assays yielded positive results for 59.5% children and 28.6% adults. Molecular tests detected multiple Plasmodium falciparum infections but also three infections with P. malariae, three with P. ovale and one with P. vivax. The obtained results have confirmed numerous asymptomatic Plasmodium infections among the BaAka Pygmies. The rates of asymptomatic malaria cases in adults were twice as high as those in children, which may be indicative of the gradual acquisition of protective immunity with age. The study findings have also demonstrated that although most cases of malaria in Africa are caused by P. falciparum, three other species are also present in the region.
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Affiliation(s)
- Daria Kołodziej
- Department of Epidemiology and Tropical Medicine, Military Institute of Medicine—National Research Institute, 128 Szaserów St., 04-141 Warsaw, Poland; (D.K.); (W.R.)
| | - Wanesa Richert
- Department of Epidemiology and Tropical Medicine, Military Institute of Medicine—National Research Institute, 128 Szaserów St., 04-141 Warsaw, Poland; (D.K.); (W.R.)
| | - Dariusz Świetlik
- Department of Biostatistics and Neural Networks, Medical University of Gdańsk, 1 Dębinki St., 80-211 Gdańsk, Poland;
| | - Krzysztof Korzeniewski
- Department of Epidemiology and Tropical Medicine, Military Institute of Medicine—National Research Institute, 128 Szaserów St., 04-141 Warsaw, Poland; (D.K.); (W.R.)
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Cáceres Carrera L, Santamaría AM, Castillo AM, Romero L, Urriola E, Torres-Cosme R, Calzada JE. Detection through the use of RT-MqPCR of asymptomatic reservoirs of malaria in samples of patients from the indigenous Comarca of Guna Yala, Panama: Essential method to achieve the elimination of malaria. PLoS One 2024; 19:e0305558. [PMID: 39046959 PMCID: PMC11268588 DOI: 10.1371/journal.pone.0305558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 06/02/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Plasmodium vivax is the main causative agent of malaria in Panama. However, the prevalence of asymptomatic infections in the different endemic regions remains unknown. Understanding the epidemiological behavior of asymptomatic infections is essential for the elimination of malaria. This study aimed to determine the prevalence of asymptomatic malarial infections in one of the main endemic regions of Panama using multiplex real-time reverse transcription RT-MqPCR. METHODS A cross-sectional study was conducted in three communities in the Guna Yala Comarca. A total of 551 thick blood smears and their respective samples on filter paper were collected from volunteers of different ages and sexes from June 20 to 25, 2016. Infections by the Plasmodium spp. were diagnosed using microscopy and RT-MqPCR. All statistical analyses were performed using the R software. RESULTS The average prevalence of asymptomatic infections by P. vivax in the three communities detected by RT-MqPCR was 9.3%, with Ukupa having the highest prevalence (13.4%), followed by Aidirgandi (11.1%) and Irgandi (3.3%). A total of 74 samples were diagnosed as asymptomatic infections using RT-MqPCR. Light microscopy (LM) detected that 17.6% (13/74) of the asymptomatic samples and 82.4% (61/74) were diagnosed as false negatives. A 100% correlation was observed between samples diagnosed using LM and RT-MqPCR. A total of 52.7% (39/74) of the asymptomatic patients were female and 85.1% (63/74) were registered between the ages of 1 and 21 years. Factors associated with asymptomatic infection were community (aOR = 0.38 (95% CI 0.17-0.83), p < 0.001) and age aOR = 0.98 (95% CI 0.97-1.00), p < 0.05); F = 5.38; p < 0.05). CONCLUSIONS This study provides novel evidence of the considerable prevalence of asymptomatic P. vivax infections in the endemic region of Kuna Yala, representing a new challenge that requires immediate attention from the National Malaria Program. The results of this study provide essential information for the health authorities responsible for developing new policies. Furthermore, it will allow program administrators to reorient and design effective malaria control strategies that consider asymptomatic infections as a fundamental part of malaria control and move towards fulfilling their commitment to eliminate it.
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Affiliation(s)
- Lorenzo Cáceres Carrera
- Departmento de Entomología Médica del Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panamá, Panamá
| | - Ana María Santamaría
- Departmento de Parasitología del Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panamá, Panamá
| | - Anakena Margarita Castillo
- Departmento de Entomología Médica del Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panamá, Panamá
| | - Luis Romero
- Laboratorio Central de Referencia en Salud Pública del Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panamá, Panamá
| | - Eduardo Urriola
- Facultad de Ciencias Biomédicas, Universidad Latina de Panamá, Ciudad de Panamá, Panamá
| | - Rolando Torres-Cosme
- Departmento de Entomología Médica del Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panamá, Panamá
| | - José Eduardo Calzada
- Departmento de Parasitología del Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panamá, Panamá
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Zhang WX, Zhou Y, Tembo E, Du J, Zhang SS, Wei TT, Liu YQ, Wang C, Zulu R, Hamainza B, Cui F, Lu QB. Association between indoor residual spraying and the malaria burden in Zambia and factors associated with IRS refusals: a case-control study in Vubwi District. Parasit Vectors 2024; 17:274. [PMID: 38937791 PMCID: PMC11210042 DOI: 10.1186/s13071-024-06328-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/19/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Indoor residual spraying (IRS) has been implemented to prevent malaria in Zambia for several decades, but its effectiveness has not been evaluated long term and in Vubwi District yet. This study aimed to assess the association between IRS and the malaria burden in Zambia and Vubwi District and to explore the factors associated with refusing IRS. METHODS A retrospective study was used to analyze the association between IRS and malaria incidence in Zambia in 2001-2020 and in Vubwi District in 2014-2020 by Spearman correlation analysis. A case-control study was used to explore the factors associated with IRS refusals by households in Vubwi District in 2021. A logistic regression model was performed to identify factors associated with IRS refusals. RESULTS The malaria incidence reached its peak (391/1000) in 2001 and dropped to the lowest (154/1000) in 2019. The annual percentage change in 2001-2003, 2003-2008, 2008-2014, 2014-2018 and 2018-2020 was - 6.54%, - 13.24%, 5.04%, - 10.28% and 18.61%, respectively. A significantly negative correlation between the percentage of population protected by the IRS against the total population in Zambia (coverage) and the average malaria incidence in the whole population was observed in 2005-2020 (r = - 0.685, P = 0.003) and 2005-2019 (r = - 0.818, P < 0.001). Among 264 participants (59 in the refuser group and 205 in the acceptor group), participants with specific occupations (self-employed: OR 0.089, 95% CI 0.022-0.364; gold panning: OR 0.113, 95% CI 0.022-0.574; housewives: OR 0.129, 95% CI 0.026-0.628 and farmers: OR 0.135, 95% CI 0.030-0.608 compared to employees) and no malaria case among household members (OR 0.167; 95% CI 0.071-0.394) had a lower risk of refusing IRS implementation, while those with a secondary education level (OR 3.690, 95% CI 1.245-10.989) had a higher risk of refusing IRS implementation compared to those who had never been to school. CONCLUSIONS Increasing coverage with IRS was associated with decreasing incidence of malaria in Zambia, though this was not observed in Vubwi District, possibly because of the special geographical location of Vubwi District. Interpersonal communication and targeted health education should be implemented at full scale to ensure household awareness and gain community trust.
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Affiliation(s)
- Wan-Xue Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Yiguo Zhou
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing, China
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Elijah Tembo
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing, China
- Ministry of Health, Vubwi District, Lusaka, Zambia
| | - Juan Du
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Shan-Shan Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Ting-Ting Wei
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Ya-Qiong Liu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Chao Wang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Reuben Zulu
- National Malaria Elimination Centre, Lusaka, Zambia
| | | | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing, China.
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China.
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
| | - Qing-Bin Lu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing, China.
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China.
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
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Johnson AE, Upadhye A, Knight V, Gaskin EL, Turnbull LB, Ayuku D, Nyalumbe M, Abuonji E, John CC, McHenry MS, Tran TM, Ayodo G. Subclinical Inflammation in Asymptomatic Schoolchildren With Plasmodium falciparum Parasitemia Correlates With Impaired Cognition. J Pediatric Infect Dis Soc 2024; 13:288-296. [PMID: 38512283 DOI: 10.1093/jpids/piae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/19/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Subclinical inflammation and cognitive deficits have been separately associated with asymptomatic Plasmodium falciparum infections in schoolchildren. However, whether parasite-induced inflammation is associated with worse cognition has not been addressed. We conducted a cross-sectional pilot study to better assess the effect of asymptomatic P. falciparum parasitemia and inflammation on cognition in Kenyan schoolchildren. METHODS We enrolled 240 children aged 7-14 years residing in high malaria transmission in Western Kenya. Children performed five fluid cognition tests from a culturally adapted NIH toolbox and provided blood samples for blood smears and laboratory testing. Parasite densities and plasma concentrations of 14 cytokines were determined by quantitative PCR and multiplex immunoassay, respectively. Linear regression models were used to determine the effects of parasitemia and plasma cytokine concentrations on each of the cognitive scores as well as a composite cognitive score while controlling for age, gender, maternal education, and an interaction between age and P. falciparum infection status. RESULTS Plasma concentrations of TNF, IL-6, IL-8, and IL-10 negatively correlated with the composite score and at least one of the individual cognitive tests. Parasite density in parasitemic children negatively correlated with the composite score and measures of cognitive flexibility and attention. In the adjusted model, parasite density and TNF, but not P. falciparum infection status, independently predicted lower cognitive composite scores. By mediation analysis, TNF significantly mediated ~29% of the negative effect of parasitemia on cognition. CONCLUSIONS Among schoolchildren with PCR-confirmed asymptomatic P. falciparum infections, the negative effect of parasitemia on cognition could be mediated, in part, by subclinical inflammation. Additional studies are needed to validate our findings in settings of lower malaria transmission and address potential confounders that could affect both inflammation and cognitive performance.
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Affiliation(s)
- Alexander E Johnson
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Aditi Upadhye
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Veronicah Knight
- Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Erik L Gaskin
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lindsey B Turnbull
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David Ayuku
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Mental Health & Behavioral Sciences, Moi University School of Medicine, Eldoret, Kenya
| | - Mark Nyalumbe
- Department of Mental Health & Behavioral Sciences, Moi University School of Medicine, Eldoret, Kenya
| | - Emily Abuonji
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chandy C John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Megan S McHenry
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tuan M Tran
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - George Ayodo
- Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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Tusell M, Martí Coma-Cros E, Bhamani B, Mithi V, Serra-Casas E, Williams NA, Lindblade KA, Allen KC. Targeted Drug Administration to Reduce Malaria Transmission: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2024; 110:65-72. [PMID: 38266296 PMCID: PMC10993794 DOI: 10.4269/ajtmh.22-0754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 11/13/2023] [Indexed: 01/26/2024] Open
Abstract
In low- to very low-malaria transmission areas, most infections may be accrued within specific groups whose behaviors or occupations put them at increased risk of infection. If these infections comprise a large proportion of the reservoir of infection, targeting interventions to these groups could reduce transmission at the population level. We conducted a systematic review to assess the impact of providing antimalarials to groups of individuals at increased risk of malaria whose infections were considered to comprise a large proportion of the local reservoir of infections (targeted drug administration [TDA]). A literature search was conducted in March 2021 and updated in April 2022. Two reviewers screened titles, abstracts, and full-text records. The Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the certainty of the evidence (CoE) for each outcome. Out of 2,563 records, we identified five studies for inclusion: two cluster-randomized controlled trials (cRCTs) in Uganda and Kenya; one controlled before-after study in Ghana; and two uncontrolled before-after studies in Sri Lanka and Greece. Compared with no intervention, TDA resulted in little to no difference in the prevalence of infection at the population level (risk ratio [RR]: 0.85, 95% CI: 0.73-1.00; one cRCT, high CoE), although TDA likely resulted in a large reduction in prevalence among those targeted by the intervention (RR: 0.15, 95% CI: 0.06-0.38; two cRCTs, moderate CoE). Although TDA may reduce the burden of malaria among those receiving antimalarials, we found no evidence that it reduces transmission at the population level.
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Affiliation(s)
- Maria Tusell
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Elisabet Martí Coma-Cros
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Beena Bhamani
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Vita Mithi
- Armref Data for Action in Public Health Research Consultancy, Mzuzu, Malawi
- Society for Research on Nicotine and Tobacco – Genetics and Omics Network, Madison, Wisconsin
- Leaders of Africa Institute, Baltimore, Maryland
| | - Elisa Serra-Casas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Nana Aba Williams
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Kim A. Lindblade
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Koya C. Allen
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
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Jebiwott S, Gutapaka N, Sumari D, Loss G, Athuman T, Nyandele JP, Cummins H, Chemba M, Benjamin-Chung J, Gangar P, Wu X, Smith J, Chen I, Dorsey G, Fink G, Olotu A, Hsiang M. Child Health and Infection with Low Density (CHILD) malaria: a protocol for a randomised controlled trial to assess the long-term health and socioeconomic impacts of testing and treating low-density malaria infection among children in Tanzania. BMJ Open 2024; 14:e082227. [PMID: 38538037 PMCID: PMC10982758 DOI: 10.1136/bmjopen-2023-082227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/15/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION As malaria declines, low-density malaria infections (LMIs) represent an increasing proportion of infections and may have negative impacts on child health and cognition, necessitating development of targeted and effective solutions. This trial assesses the health, cognitive and socioeconomic impact of two strategies for detecting and treating LMI in a low transmission setting. METHODS AND ANALYSIS The study is a 3-arm open-label individually randomised controlled trial enrolling 600 children aged 6 months to 10 years in Bagamoyo district, Tanzania. Children are randomised to one of three arms: active case detection with molecular (ACDm) testing by high volume quantitative PCR (qPCR), passive case detection also with molecular testing (PCDm) and a control of standard PCD using rapid diagnostics tests (RDTs). Over the 2-year trial, ACDm participants receive malaria testing using RDT and qPCR three times annually, and malaria testing by RDT only when presenting with fever. PCDm and PCD participants receive malaria testing by RDT and qPCR or RDT only, respectively, when presenting with fever. RDT or qPCR positive participants with uncomplicated malaria are treated with artemether lumefantrine. The primary outcome is cumulative incidence of all-cause sick visits. Secondary outcomes include fever episodes, clinical failure after fever episodes, adverse events, malaria, non-malarial infection, antibiotic use, anaemia, growth faltering, cognition and attention, school outcomes, immune responses, and socioeconomic effects. Outcomes are assessed through monthly clinical assessments and testing, and baseline and endline neurodevelopmental testing. The trial is expected to provide key evidence and inform policy on health, cognitive and socioeconomic impact of interventions targeting LMI in children. ETHICS AND DISSEMINATION Study is approved by Tanzania NatHREC and institutional review boards at University of California San Francisco and Ifakara Health Institute. Findings will be reported on ClinicalTrials.gov, in peer-reviewed journals and through stakeholder meetings. TRIAL REGISTRATION NUMBER NCT05567016.
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Affiliation(s)
- Sylvia Jebiwott
- Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Deborah Sumari
- Ifakara Health Institute, Bagamoyo, Tanzania, United Republic of
| | - Georg Loss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Thabit Athuman
- Ifakara Health Institute, Bagamoyo, Tanzania, United Republic of
| | | | - Hannah Cummins
- Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Mwajuma Chemba
- Ifakara Health Institute, Bagamoyo, Tanzania, United Republic of
| | - Jade Benjamin-Chung
- Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Pamela Gangar
- Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Xue Wu
- Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Jennifer Smith
- Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Ingrid Chen
- Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ally Olotu
- Ifakara Health Institute, Bagamoyo, Tanzania, United Republic of
| | - Michelle Hsiang
- Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
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Kabongo WNS, Mbonigaba J. Public health spending in Sub-Saharan Africa: exploring transmission mechanisms using the latent growth curve mediation model. HEALTH ECONOMICS REVIEW 2024; 14:14. [PMID: 38372932 PMCID: PMC10875913 DOI: 10.1186/s13561-023-00472-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/05/2023] [Indexed: 02/20/2024]
Abstract
In response to the imperatives of universal health coverage, structural factors that may hinder the effectiveness of increased spending in sub-Saharan Africa (SSA) need attention. This study assessed the mediating role of these factors in domestic general government health expenditure (DGGHE) effects to propose solutions for improving population health outcomes (PHO). The analysis used the Latent Growth Curve Mediation Model (LGCMM) approach within the structural equation model (SEM) framework for panel data from 42 SSA countries from 2015 to 2018. The findings were that malaria and female education formed a channel through which DGGHE imparted its effects on DALY in SSA, and these effects were achieved via the specific path from the DGGHE slope to the DALY slope, via malaria and female education slopes. However, the paper found no evidence of immunization coverage mediating the relationship between DGGHE and DALY in SSA. The paper concludes that structural factors affect the effectiveness of DGGHE on PHO, implying that governments should emphasize existing programs to fight against malaria and increase immunization coverage.
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Affiliation(s)
- Wa Ntita Serge Kabongo
- School of Accounting, Economics and Finance, University of KwaZulu Natal, University Road, Westville Campus, Durban, South Africa
| | - Josue Mbonigaba
- School of Accounting, Economics and Finance, University of KwaZulu Natal, University Road, Westville Campus, Durban, South Africa.
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Verguet S, Gautam P, Ali I, Husain A, Meyer S, Burbano C, Lloyd-Evans E, Coco M, Mphangwe M, Saka A, Zelalem M, Giyose BB, Li Z, Erzse A, Hofman K, Giner C, Avallone S, Kuusipalo H, Kristjansson E, Schultz L, Bundy DAP, Angrist N. Investing in school systems: conceptualising returns on investment across the health, education and social protection sectors. BMJ Glob Health 2023; 8:e012545. [PMID: 38114237 DOI: 10.1136/bmjgh-2023-012545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/04/2023] [Indexed: 12/21/2023] Open
Abstract
Public policies often aim to improve welfare, economic injustice and reduce inequality, particularly in the social protection, labour, health and education sectors. While these policies frequently operate in silos, the education sphere can operate as a cross-sectoral link. Schools represent a unique locus, with globally hundreds of millions of children attending class every day. A high-profile policy example is school feeding, with over 400 million students worldwide receiving meals in schools. The benefits of harmonising interventions across sectors with a common delivery platform include economies of scale. Moreover, economic evaluation frameworks commonly used to assess policies rarely account for impact across sectors besides their primary intent. For example, school meals are often evaluated for their impact on nutrition, but they also have educational benefits, including increasing attendance and learning and incorporating smallholder farmers into corporate value chains. To address these gaps, we propose the introduction of a comprehensive value-for-money framework for investments toward school systems that acknowledges the return to a common delivery platform-schools-and the multisectoral returns (eg, education, health and nutrition, labour, social protection) emerging from the rollout of school-based programmes. Directly building on benefit-cost analysis methods, this framework could help identify interventions that yield the highest gains in human capital per budget expenditure, with direct implications for finance ministries. Given the detrimental impact of COVID-19 on schoolchildren and human capital, it is urgent to build back stronger and more sustainable welfare systems.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Pratibha Gautam
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Iman Ali
- Tufts University, Medford, Massachusetts, USA
| | | | | | | | | | | | | | - Albert Saka
- Ministry of Education Science and Technology, Lilongwe, Malawi
| | - Meseret Zelalem
- Maternal, Child and Adolescent Health Lead Executive Officer, Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Boitshepo Bibi Giyose
- FAO/AUDA-NEPAD (African Union Development Agency - New Partnership for Africa's Development), Johannesburg, South Africa
| | - Zhihui Li
- Tsinghua Vanke School of Public Health, Beijing, China
| | - Agnes Erzse
- SAMRC Wits Centre for Health Economics and Decision Science PRICELESS SA, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC Wits Centre for Health Economics and Decision Science PRICELESS SA, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Céline Giner
- Organization for Economic Cooperation and Development, Paris, France
| | - Sylvie Avallone
- QualiSud, Univ Montpellier, Institut Agro, CIRAD, Avignon Université, Université de La Réunion, Montpellier, France
| | - Heli Kuusipalo
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Linda Schultz
- Research Consortium for the School Meals Coalition, London School of Hygiene and Tropical Medicine, London, UK
| | - Donald A P Bundy
- Research Consortium for the School Meals Coalition, London School of Hygiene and Tropical Medicine, London, UK
| | - Noam Angrist
- University of Oxford, Oxford, Oxfordshire, UK
- Youth Impact, Gaborone, Botswana
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Mwangi MN, Mzembe G, Ngwira CC, Vokhiwa M, Kapulula MD, Larson LM, Braat S, Harding R, McLean ARD, Hamadani JD, Biggs BA, Ataíde R, Phiri KS, Pasricha SR. Protocol for a randomised, multicentre, four-arm, double-blinded, placebo-controlled trial to assess the benefits and safety of iron supplementation with malaria chemoprevention to children in Malawi: IRMA trial. BMJ Open 2023; 13:e069011. [PMID: 37832986 PMCID: PMC10583080 DOI: 10.1136/bmjopen-2022-069011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Approximately 40% of children aged 6-59 months worldwide are anaemic. Iron-containing multiple micronutrient powders (MNPs) and iron supplements (syrup/drops) are used to combat anaemia in children in different parts of the world. However, evidence for functional benefits of iron supplementation in children is scarce, and potential risks remain poorly defined, particularly concerning diarrhoea and malaria. This trial aims to determine if: (1) the efficacy of iron supplements or MNPs (containing iron) given with malaria chemoprevention is superior to malaria chemoprevention alone, or (2) if the efficacy of malaria chemoprevention alone is superior to placebo on child cognitive development. METHODS AND ANALYSIS IRMA is a four-arm, parallel-group, double-blinded, placebo-controlled, triple-dummy, randomised trial in Southern Malawi. The study recruits 2168 infants aged 6 months, with an intervention period of 6 months and a post-intervention period of a further 6 months. Children are randomised into four arms: (1) No intervention (placebo); (2) malaria chemoprevention only; (3) MNPs and malaria chemoprevention; and (4) iron syrup and malaria chemoprevention. The primary outcome, cognitive development (Cognitive Composite Score (CogCS)), is measured at the end of the 6 months intervention. Secondary outcomes include CogCS at a further 6 months post-intervention, motor, language and behavioural development, physical growth and prevalence of anaemia and iron deficiency. Safety outcomes include incidence of malaria and other infections, and prevalence of malaria parasitaemia during and post-intervention period. ETHICS AND DISSEMINATION The trial is approved by the National Health Sciences Research Committee (#19/01/2213) (Malawi) and the Human Research Ethics Committee (WEHI: 19/012) (Australia). Written informed consent in the local language is obtained from each participant before conducting any study-related procedure. Results will be shared with the local community and internationally with academic and policy stakeholders. TRIAL REGISTRATION NUMBER ACTRN12620000386932.
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Affiliation(s)
- Martin N Mwangi
- Training and Research Unit of Excellence (TRUE), Blantyre, Malawi
- The Micronutrient Forum, Healthy Mothers Healthy Babies Consortium, Washington DC, Washington, USA
| | - Glory Mzembe
- Training and Research Unit of Excellence (TRUE), Blantyre, Malawi
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Maclean Vokhiwa
- Training and Research Unit of Excellence (TRUE), Blantyre, Malawi
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Leila M Larson
- Department of Health Promotion, Education, and Behaviour, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Sabine Braat
- Department of Infectious Diseases at the Peter Doherty Institute of Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, University of Melbourne School of Population and Global Health, Carlton, Victoria, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Rebecca Harding
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Alistair R D McLean
- Centre for Epidemiology and Biostatistics, University of Melbourne School of Population and Global Health, Carlton, Victoria, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Jena D Hamadani
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Beverley-Ann Biggs
- Department of Infectious Diseases at the Peter Doherty Institute of Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
- Diagnostic Haematology, The Royal Melbourne Hospital; and Clinical Haematology, Melbourne, Victoria, Australia
| | - Ricardo Ataíde
- Department of Infectious Diseases at the Peter Doherty Institute of Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Kamija S Phiri
- Training and Research Unit of Excellence (TRUE), Blantyre, Malawi
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Diagnostic Haematology, The Royal Melbourne Hospital; and Clinical Haematology, Melbourne, Victoria, Australia
- Department of Medical Biology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Makenga G, Baraka V, Francis F, Nakato S, Gesase S, Mtove G, Madebe R, Kyaruzi E, Minja DTR, Lusingu JPA, Geertruyden JPV. Effectiveness and safety of intermittent preventive treatment with dihydroartemisinin-piperaquine or artesunate-amodiaquine for reducing malaria and related morbidities in schoolchildren in Tanzania: a randomised controlled trial. Lancet Glob Health 2023; 11:e1277-e1289. [PMID: 37474234 DOI: 10.1016/s2214-109x(23)00204-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND In high transmission settings, most school-aged children harbour malaria parasites without showing symptoms, often leading to anaemia and possibly impaired psychomotor and cognitive abilities. We aimed to assess the effectiveness and safety of intermittent preventive treatment for malaria in school-aged children (IPTsc) living in highly endemic areas. METHODS We did an open-label randomised controlled trial in seven primary schools in northeastern Tanzania. Schoolchildren aged 5-15 years were individually randomly assigned (1:1:1) to receive dihydroartemisinin-piperaquine, artesunate-amodiaquine, or standard of care (control) using a balanced block design. Drugs were administered by schoolteachers, with supervision from study nurses, at months 0 (baseline), 4, and 8, and were given in line with manufacturer's recommendations with dose based on the child's bodyweight. The primary endpoints were change from baseline in mean haemoglobin concentration at months 12 and 20, and clinical incidence of malaria and prevalence of parasitaemia at months 12 and 20 in the intervention groups versus the control group. The outcome data were collected through longitudinal surveys conducted every 4 months. Data were analysed on the basis of intention to treat (including all randomised participants) and per protocol (comprising children who completed the full 3-day regimen of all three IPTsc treatment rounds as assigned). This study is registered with ClinicalTrials.gov (NCT03640403). FINDINGS Of the 1797 children scheduled for clinical screening, 1566 were enrolled and randomly allocated (526 to receive dihydroartemisinin-piperaquine, 527 to receive artesunate-amodiaquine, and 513 to receive standard of care). Due to COVID-19-related school closures, only two schools were visited at month 12 (135 children in the dihydroartemisinin-piperaquine group, 131 in the artesunate-amodiaquine group, and 118 in the control group). At month 12, compared with the control group, the change from baseline in mean haemoglobin concentration was increased by 0·5 g/dL (95% CI 0·2 to 0·8; p<0·0001) in the dihydroartemisinin-piperaquine group and 0·5 g/dL (0·2 to 0·7; p=0·0020) in the artesunate-amodiaquine group in the intention-to-treat analysis (with similar findings in the per protocol analysis). In the same period, in the intention-to-treat analysis, the prevalence of malaria parasitaemia increased from 28·5% (138 of 485 participants) to 33·6% (39 of 116) in the control group, but decreased from 28·0% (139 of 497) to 12·0% (15 of 125) in the dihydroartemisinin-piperaquine group (-21·6 percentage points [95% CI -31·9 to -11·3], p=0·0001 vs control at month 12) and from 24·7% (124 of 502) to 16·0% (20 of 125) in the artesunate-amodiaquine group (-17·6 percentage points [-28·4 to -6·9], p=0·0015). The decrease for artesunate-amodiaquine was larger in the per protocol analysis (-25·3 percentage points [-36·3 to -14·2], p<0·0001). The protective effect of IPTsc against malaria parasitaemia was 64% (95% CI 39 to 79; p<0·0001) for dihydroartemisinin-piperaquine and 52% (23 to 70; p=0·0015) for artesunate-amodiaquine in the intention-to-treat analysis, and was slightly higher on per protocol analysis. The protective effect against clinical malaria at month 12 was 20% (95% CI 9 to 29; p=0·0002) for dihydroartemisinin-piperaquine and 19% (8 to 28; p=0·0004) for artesunate-amodiaquine. No significant differences in any primary outcomes between the intervention and control groups were noted at month 20. Dihydroartemisinin-piperaquine and artesunate-amodiaquine were associated with a small number of mild adverse events, and there were no treatment-related serious adverse events or deaths. INTERPRETATION IPTsc with dihydroartemisinin-piperaquine or artesunate-amodiaquine is a safe and effective approach to reducing malaria parasitaemia, clinical malaria, and related morbidities, and is feasible to implement through programmes delivered by schoolteachers. FUNDING Flemish Interuniversity Council (VLIRUOS), EU EDCTP2 programme (MaReCa project), and Global Minds 2019. TRANSLATION For the Swahili translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Geofrey Makenga
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania; Global Health Institute, University of Antwerp, Antwerp, Belgium.
| | - Vito Baraka
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Filbert Francis
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Swabra Nakato
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Samwel Gesase
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - George Mtove
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Rashid Madebe
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Edna Kyaruzi
- Dar es Salaam University College of Education, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Daniel T R Minja
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - John P A Lusingu
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania; Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
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González-Sanz M, Berzosa P, Norman FF. Updates on Malaria Epidemiology and Prevention Strategies. Curr Infect Dis Rep 2023; 25:1-9. [PMID: 37361492 PMCID: PMC10248987 DOI: 10.1007/s11908-023-00805-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review The objective of this review was to provide an update on recent malaria epidemiology, both globally and in non-endemic areas, to identify the current distribution and repercussions of genetically diverse Plasmodium species and summarize recently implemented intervention and prevention tools. Recent Findings Notable changes in malaria epidemiology have occurred in recent years, with an increase in the number of total cases and deaths globally during 2020-2021, in part attributed to the COVID-19 pandemic. The emergence of artemisinin-resistant species in new areas and the expanding distribution of parasites harbouring deletions of the pfhrp2/3 genes have been concerning. New strategies to curb the burden of this infection, such as vaccination, have been implemented in certain endemic areas and their performance is currently being evaluated. Summary Inadequate control of malaria in endemic regions may have an effect on imported malaria and measures to prevent re-establishment of transmission in malaria-free areas are essential. Enhanced surveillance and investigation of Plasmodium spp. genetic variations will contribute to the successful diagnosis and treatment of malaria in future. Novel strategies for an integrated One Health approach to malaria control should also be strengthened.
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Affiliation(s)
- Marta González-Sanz
- Infectious Diseases Department, National Referral Unit for Tropical Diseases, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Pedro Berzosa
- Malaria and Neglected Tropical Diseases Laboratory, National Centre for Tropical Medicine, Carlos III Health Institute, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Francesca F. Norman
- Infectious Diseases Department, National Referral Unit for Tropical Diseases, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid, Spain
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12
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Chin K, Joo H, Jiang H, Lin C, Savinova I, Joo S, Alli A, Sklar MC, Papa F, Simpson J, Baker AJ, Mazer CD, Darrah W, Hare GMT. Importance of assessing biomarkers and physiological parameters of anemia-induced tissue hypoxia in the perioperative period. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:186-197. [PMID: 36377057 PMCID: PMC10068554 DOI: 10.1016/j.bjane.2022.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Anemia is associated with increased risk of Acute Kidney Injury (AKI), stroke and mortality in perioperative patients. We sought to understand the mechanism(s) by assessing the integrative physiological responses to anemia (kidney, brain), the degrees of anemia-induced tissue hypoxia, and associated biomarkers and physiological parameters. Experimental measurements demonstrate a linear relationship between blood Oxygen Content (CaO2) and renal microvascular PO2 (y = 0.30x + 6.9, r2 = 0.75), demonstrating that renal hypoxia is proportional to the degree of anemia. This defines the kidney as a potential oxygen sensor during anemia. Further evidence of renal oxygen sensing is demonstrated by proportional increase in serum Erythropoietin (EPO) during anemia (y = 93.806*10-0.02, r2 = 0.82). This data implicates systemic EPO levels as a biomarker of anemia-induced renal tissue hypoxia. By contrast, cerebral Oxygen Delivery (DO2) is defended by a profound proportional increase in Cerebral Blood Flow (CBF), minimizing tissue hypoxia in the brain, until more severe levels of anemia occur. We hypothesize that the kidney experiences profound early anemia-induced tissue hypoxia which contributes to adaptive mechanisms to preserve cerebral perfusion. At severe levels of anemia, renal hypoxia intensifies, and cerebral hypoxia occurs, possibly contributing to the mechanism(s) of AKI and stroke when adaptive mechanisms to preserve organ perfusion are overwhelmed. Clinical methods to detect renal tissue hypoxia (an early warning signal) and cerebral hypoxia (a later consequence of severe anemia) may inform clinical practice and support the assessment of clinical biomarkers (i.e., EPO) and physiological parameters (i.e., urinary PO2) of anemia-induced tissue hypoxia. This information may direct targeted treatment strategies to prevent adverse outcomes associated with anemia.
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Affiliation(s)
- Kyle Chin
- University of Toronto, Temerty Faculty of Medicine, St. Michael's Hospital, Department of Anesthesia and Pain Medicine, Toronto, Canada; University of Toronto, Department of Physiology, Toronto, Canada
| | - Hannah Joo
- University of Toronto, Temerty Faculty of Medicine, St. Michael's Hospital, Department of Anesthesia and Pain Medicine, Toronto, Canada
| | - Helen Jiang
- University of Toronto, Temerty Faculty of Medicine, St. Michael's Hospital, Department of Anesthesia and Pain Medicine, Toronto, Canada
| | - Chloe Lin
- University of Toronto, Temerty Faculty of Medicine, St. Michael's Hospital, Department of Anesthesia and Pain Medicine, Toronto, Canada
| | - Iryna Savinova
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | - Sarah Joo
- University of Toronto, Temerty Faculty of Medicine, St. Michael's Hospital, Department of Anesthesia and Pain Medicine, Toronto, Canada
| | - Ahmad Alli
- University of Toronto, Temerty Faculty of Medicine, St. Michael's Hospital, Department of Anesthesia and Pain Medicine, Toronto, Canada
| | - Michael C Sklar
- St. Michael's Hospital, Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute, Toronto, Canada; University of Toronto, Temerty Faculty of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada; University of Toronto, St. Michael's Hospital, Department of Critical Care, Toronto, Canada
| | - Fabio Papa
- University of Toronto, Temerty Faculty of Medicine, St. Michael's Hospital, Department of Anesthesia and Pain Medicine, Toronto, Canada
| | - Jeremy Simpson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | - Andrew J Baker
- University of Toronto, Temerty Faculty of Medicine, St. Michael's Hospital, Department of Anesthesia and Pain Medicine, Toronto, Canada; St. Michael's Hospital, Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute, Toronto, Canada; University of Toronto, Temerty Faculty of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada; University of Toronto, St. Michael's Hospital, Department of Critical Care, Toronto, Canada
| | - C David Mazer
- University of Toronto, Temerty Faculty of Medicine, St. Michael's Hospital, Department of Anesthesia and Pain Medicine, Toronto, Canada; University of Toronto, Department of Physiology, Toronto, Canada; St. Michael's Hospital, Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute, Toronto, Canada; University of Toronto, Temerty Faculty of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada; University of Toronto, St. Michael's Hospital, Department of Critical Care, Toronto, Canada
| | - William Darrah
- University of Toronto, Temerty Faculty of Medicine, St. Michael's Hospital, Department of Anesthesia and Pain Medicine, Toronto, Canada
| | - Gregory M T Hare
- University of Toronto, Temerty Faculty of Medicine, St. Michael's Hospital, Department of Anesthesia and Pain Medicine, Toronto, Canada; University of Toronto, Department of Physiology, Toronto, Canada; St. Michael's Hospital, Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute, Toronto, Canada; St. Michael's Hospital Center of Excellence for Patient Blood Management, 30 Bond Street, Toronto, Canada.
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Implementation research of a cluster randomized trial evaluating the implementation and effectiveness of intermittent preventive treatment for malaria using dihydroartemisinin-piperaquine on reducing malaria burden in school-aged children in Tanzania: methodology, challenges, and mitigation. Malar J 2023; 22:7. [PMID: 36609279 PMCID: PMC9816525 DOI: 10.1186/s12936-022-04428-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/23/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND It has been more than 20 years since the malaria epidemiologic shift to school-aged children was noted. In the meantime, school-aged children (5-15 years) have become increasingly more vulnerable with asymptomatic malaria prevalence reaching up to 70%, making them reservoirs for subsequent transmission of malaria in the endemic communities. Intermittent Preventive Treatment of malaria in schoolchildren (IPTsc) has proven to be an effective tool to shrink this reservoir. As of 3rd June 2022, the World Health Organization recommends IPTsc in moderate and high endemic areas. Even so, for decision-makers, the adoption of scientific research recommendations has been stifled by real-world implementation challenges. This study presents methodology, challenges faced, and mitigations used in the evaluation of the implementation of IPTsc using dihydroartemisinin-piperaquine (DP) in three councils (Handeni District Council (DC), Handeni Town Council (TC) and Kilindi DC) of Tanga Region, Tanzania so as to understand the operational feasibility and effectiveness of IPTsc on malaria parasitaemia and clinical malaria incidence. METHODS The study deployed an effectiveness-implementation hybrid design to assess feasibility and effectiveness of IPTsc using DP, the interventional drug, against standard of care (control). Wards in the three study councils were the randomization unit (clusters). Each ward was randomized to implement IPTsc or not (control). In all wards in the IPTsc arm, DP was given to schoolchildren three times a year in four-month intervals. In each council, 24 randomly selected wards (12 per study arm, one school per ward) were chosen as representatives for intervention impact evaluation. Mixed design methods were used to assess the feasibility and acceptability of implementing IPTsc as part of a more comprehensive health package for schoolchildren. The study reimagined an existing school health programme for Neglected Tropical Diseases (NTD) control include IPTsc implementation. RESULTS The study shows IPTsc can feasibly be implemented by integrating it into existing school health and education systems, paving the way for sustainable programme adoption in a cost-effective manner. CONCLUSIONS Through this article other interested countries may realise a feasible plan for IPTsc implementation. Mitigation to any challenge can be customized based on local circumstances without jeopardising the gains expected from an IPTsc programme. Trial registration clinicaltrials.gov, NCT04245033. Registered 28 January 2020, https://clinicaltrials.gov/ct2/show/NCT04245033.
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Deressa A, Eyeberu A, Gamachu M, Debella A, Abamecha Ababulgu F. Perceived performances of peer learning and education approach on malaria prevention through primary schools communities in rural Ethiopia: Peer educators' perspectives. Front Public Health 2022; 10:861253. [PMID: 36457327 PMCID: PMC9706541 DOI: 10.3389/fpubh.2022.861253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Schools are viewed as natural hubs and an effective strategy for promoting community healthy practices such as malaria prevention and control. This study examined the perceived performance of the peer learning and education approach to malaria prevention in rural primary school communities in Ethiopia, which has thus far received little attention. Methods Post-intervention data were collected from 404 randomly selected peer educators between 2 April and June 2020 using a structured questionnaire. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 24.0. Multiple linear regression was used to identify independent predictors of perceived performance of school-based peer learning and educational approach. A statistically significant p-value of < 0.05 was considered statistically significant. Results Four hundred and one educators (99.2%) completed the interview. The mean score of perceived performance was 44.31 (SD = 6.13) which was above the expected mean level range of 11-55. Feasibility (β = 0.253, 95% CI = [0.313, 0.682]), and appropriateness (β = 0.163, 95% CI = [0.099, 0.442]) were significantly associated with perceived performance. Self-efficacy, malaria risk perception, eagerness to share and learn from each other's experiences, and preference for more than one subject were all significantly associated with perceived performance, with (β = 0.097, CI = [0.017, 0.242]), (β = 0.143, CI = [0.071, 0.233]), (β = 0.207, CI = [0.308, 0.826]) and (β = 0.075, CI = [0.084, 2.511]) at 95% CI, respectively. Conclusions The peer learning and education approach to malaria prevention and control in schools has a noticeably high level of perceived performance. Thus, it is recommended that when designing and implementing such programs through schools, personal and social (team) factors such as self-efficacy, risk perceptions, and peer education team spirit be considered.
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Affiliation(s)
- Alemayehu Deressa
- Department of Public Health and Policy, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mulugeta Gamachu
- Department of Public Health and Policy, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fira Abamecha Ababulgu
- Department of Health, Behavior, and Society, Faculty of Public Health Institute of Health, Jimma University, Jimma, Ethiopia
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Chinkhumba J, Kadzinje V, Jenda G, Kayange M, Mathanga DP. Impact of school-based malaria intervention on primary school teachers' time in Malawi: evidence from a time and motion study. Malar J 2022; 21:301. [PMID: 36289501 PMCID: PMC9607742 DOI: 10.1186/s12936-022-04324-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND School-based health (SBH) programmes that are contingent on primary school teachers are options to increase access to malaria treatment among learners. However, perceptions that provision of healthcare by teachers may be detrimental to teaching activities can undermine efforts to scale up school-based malaria control. The objective of this study was to assess the impact of school-based malaria diagnosis and treatment using the Learner Treatment Kit (LTK) on teachers' time. METHODS A time and motion study was conducted in 10 primary schools in rural Malawi. Teachers who had been trained to diagnose and treat uncomplicated malaria were continuously observed in real time during school sessions and the time they spent on all activities were recorded by independent observers before and after LTK implementation. A structured form, programmed digitally, was used for data collection. Paired sample t-tests were used to assess pre-post differences in average hours teachers spent on the following key activities: direct teaching; indirect teaching; administration; LTK and non-teaching tasks. Multivariable repeated measures mixed regression models were used to ascertain impact of LTK on average durations teachers spent on the key activities. RESULTS Seventy-four teachers, trained to use LTK, were observed. Their mean age and years of teaching experience were 34.7 and 8.7, respectively. Overall, 739.8 h of teacher observations took place. The average time teachers spent in school before relative to after LTK was 5.8 vs. 4.8 h, p = 0.01. The cumulative percentage of time teachers spent on core teaching activities (teaching and administration) was approximately 76% and did not change substantially before and after LTK. Some 24.3% of teachers' time is spent on non-teaching activities. On average, teachers spent 2.9% of their time providing LTK services daily. Per day, each teacher spent less time on administrative (0.74 vs. 1.07 h, p = 0.02) and non-teaching activities (0.96 vs. 1.41 h, p = 0.01) during LTK compared with the period before LTK. CONCLUSION School-based health (SBH) programmes are not detrimental to teaching activities. Teachers manage their time to ensure additional time required for SBH services is not at the expense of teaching duties. Programming and policy implications of tasking teachers with SBH does not have substantial opportunity costs. Teachers should continue delivering SBH programmes to promote learners' health.
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Affiliation(s)
- Jobiba Chinkhumba
- School of Public Health and Family Medicine, Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi ,Health Economics and Policy Unit, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Victor Kadzinje
- Save the Children International, Malawi Office, Lilongwe, Malawi
| | - Gomezgani Jenda
- Save the Children International, Malawi Office, Lilongwe, Malawi
| | - Michael Kayange
- grid.415722.70000 0004 0598 3405Ministry of Health, National Malaria Control Programme, Lilongwe, Malawi
| | - Don P. Mathanga
- School of Public Health and Family Medicine, Department of Community Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Cohee LM, Peterson I, Buchwald AG, Coalson JE, Valim C, Chilombe M, Ngwira A, Bauleni A, Schaffer-DeRoo S, Seydel KB, Wilson ML, Taylor TE, Mathanga DP, Laufer MK. School-Based Malaria Screening and Treatment Reduces Plasmodium falciparum Infection and Anemia Prevalence in Two Transmission Settings in Malawi. J Infect Dis 2022; 226:138-146. [PMID: 35290461 PMCID: PMC9373151 DOI: 10.1093/infdis/jiac097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In areas highly endemic for malaria, Plasmodium falciparum infection prevalence peaks in school-age children, adversely affecting health and education. School-based intermittent preventive treatment reduces this burden but concerns about cost and widespread use of antimalarial drugs limit enthusiasm for this approach. School-based screening and treatment is an attractive alternative. In a prospective cohort study, we evaluated the impact of school-based screening and treatment on the prevalence of P. falciparum infection and anemia in 2 transmission settings. METHODS We screened 704 students in 4 Malawian primary schools for P. falciparum infection using rapid diagnostic tests (RDTs), and treated students who tested positive with artemether-lumefantrine. We determined P. falciparum infection by microscopy and quantitative polymerase chain reaction (qPCR), and hemoglobin concentrations over 6 weeks in all students. RESULTS Prevalence of infection by RDT screening was 37% (9%-64% among schools). An additional 9% of students had infections detected by qPCR. Following the intervention, significant reductions in infections were detected by microscopy (adjusted relative reduction [aRR], 48.8%; P < .0001) and qPCR (aRR, 24.5%; P < .0001), and in anemia prevalence (aRR, 30.8%; P = .003). Intervention impact was reduced by infections not detected by RDT and new infections following treatment. CONCLUSIONS School-based screening and treatment reduced P. falciparum infection and anemia. This approach could be enhanced by repeating screening, using more-sensitive screening tests, and providing longer-acting drugs. CLINICAL TRIALS REGISTRATION NCT04858087.
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Affiliation(s)
- Lauren M Cohee
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ingrid Peterson
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrea G Buchwald
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jenna E Coalson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Clarissa Valim
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Moses Chilombe
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Andrew Ngwira
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Andy Bauleni
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Karl B Seydel
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Mark L Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Terrie E Taylor
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Don P Mathanga
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Miriam K Laufer
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Nundu SS, Simpson SV, Arima H, Muyembe JJ, Mita T, Ahuka S, Yamamoto T. It Is Time to Strengthen the Malaria Control Policy of the Democratic Republic of Congo and Include Schools and School-Age Children in Malaria Control Measures. Pathogens 2022; 11:729. [PMID: 35889975 PMCID: PMC9315856 DOI: 10.3390/pathogens11070729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Despite a decade of sustained malaria control, malaria remains a serious public health problem in the Democratic Republic of Congo (DRC). Children under five years of age and school-age children aged 5-15 years remain at high risk of symptomatic and asymptomatic malaria infections. The World Health Organization's malaria control, elimination, and eradication recommendations are still only partially implemented in DRC. For better malaria control and eventual elimination, the integration of all individuals into the national malaria control programme will strengthen malaria control and elimination strategies in the country. Thus, inclusion of schools and school-age children in DRC malaria control interventions is needed.
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Affiliation(s)
- Sabin S. Nundu
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; (J.-J.M.); (S.A.)
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8523, Japan; (S.V.S.); (T.Y.)
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan;
| | - Shirley V. Simpson
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8523, Japan; (S.V.S.); (T.Y.)
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan;
| | - Hiroaki Arima
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan;
| | - Jean-Jacques Muyembe
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; (J.-J.M.); (S.A.)
| | - Toshihiro Mita
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan;
| | - Steve Ahuka
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; (J.-J.M.); (S.A.)
| | - Taro Yamamoto
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8523, Japan; (S.V.S.); (T.Y.)
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan;
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18
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Bylicka-Szczepanowska E, Korzeniewski K. Asymptomatic Malaria Infections in the Time of COVID-19 Pandemic: Experience from the Central African Republic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063544. [PMID: 35329229 PMCID: PMC8951439 DOI: 10.3390/ijerph19063544] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
According to the latest World Health Organization malaria report, 95% of 241 million global malaria cases and 96% of 627,000 malaria deaths that were recorded in 2020 occurred in Africa. Compared to 2019, 14 million more cases and 69,000 more malaria deaths were recorded, mainly because of disruptions to medical services during the COVID-19 pandemic. The aim of this study was to assess the prevalence of asymptomatic malaria cases in children and adults living in the Dzanga Sangha region in the Central African Republic (CAR) during the COVID-19 pandemic. Rapid immunochromatographic assays for the qualitative detection of Plasmodium species (P. falciparum, P. vivax, P. ovale/P. malariae) circulating in whole blood samples were used. A screening was performed in the group of 515 patients, 162 seemingly healthy children (aged 1–15) and 353 adults, all inhabiting the villages in the Dzanga Sangha region (southwest CAR) between August and September 2021. As much as 51.2% of asymptomatic children and 12.2% of adults had a positive result in malaria rapid diagnostic tests (mRDTs). Our findings demonstrated a very high prevalence of asymptomatic malaria infections in the child population. Limited access to diagnostics, treatment and prevention of malaria during the global COVID-19 pandemic and less medical assistance from developed countries may be one of the factors contributing to the increase in the prevalence of disease in Africa.
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Affiliation(s)
| | - Krzysztof Korzeniewski
- Department of Epidemiology and Tropical Medicine, Military Institute of Medicine, 04-141 Warsaw, Poland
- Department of Tropical Medicine and Epidemiology, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland
- Correspondence:
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Yaro JB, Tiono AB, Ouedraogo A, Lambert B, Ouedraogo ZA, Diarra A, Traore A, Lankouande M, Soulama I, Sanou A, Worrall E, Agboraw E, Sagnon N, Ranson H, Churcher TS, Lindsay SW, Wilson AL. Risk of Plasmodium falciparum infection in south-west Burkina Faso: potential impact of expanding eligibility for seasonal malaria chemoprevention. Sci Rep 2022; 12:1402. [PMID: 35082312 PMCID: PMC8791962 DOI: 10.1038/s41598-022-05056-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022] Open
Abstract
Burkina Faso has one of the highest malaria burdens in sub-Saharan Africa despite the mass deployment of insecticide-treated nets (ITNs) and use of seasonal malaria chemoprevention (SMC) in children aged up to 5 years. Identification of risk factors for Plasmodium falciparum infection in rural Burkina Faso could help to identify and target malaria control measures. A cross-sectional survey of 1,199 children and adults was conducted during the peak malaria transmission season in the Cascades Region of south-west Burkina Faso in 2017. Logistic regression was used to identify risk factors for microscopically confirmed P. falciparum infection. A malaria transmission dynamic model was used to determine the impact on malaria cases averted of administering SMC to children aged 5-15 year old. P. falciparum prevalence was 32.8% in the study population. Children aged 5 to < 10 years old were at 3.74 times the odds (95% CI = 2.68-5.22, P < 0.001) and children aged 10 to 15 years old at 3.14 times the odds (95% CI = 1.20-8.21, P = 0.02) of P. falciparum infection compared to children aged less than 5 years old. Administration of SMC to children aged up to 10 years is predicted to avert an additional 57 malaria cases per 1000 population per year (9.4% reduction) and administration to children aged up to 15 years would avert an additional 89 malaria cases per 1000 population per year (14.6% reduction) in the Cascades Region, assuming current coverage of pyrethroid-piperonyl butoxide ITNs. Malaria infections were high in all age strata, although highest in children aged 5 to 15 years, despite roll out of core malaria control interventions. Given the burden of infection in school-age children, extension of the eligibility criteria for SMC could help reduce the burden of malaria in Burkina Faso and other countries in the region.
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Affiliation(s)
- Jean Baptiste Yaro
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
- Department of Biosciences, Durham University, Durham, UK
| | - Alfred B Tiono
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Alphonse Ouedraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Ben Lambert
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Z Amidou Ouedraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Adama Traore
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Malik Lankouande
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Issiaka Soulama
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Antoine Sanou
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
- Institute of Biodiversity, Animal Health & Comparative Medicine, Glasgow University, Glasgow, UK
| | - Eve Worrall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Efundem Agboraw
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - N'Fale Sagnon
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Hilary Ranson
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Thomas S Churcher
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | | | - Anne L Wilson
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK.
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Cirera L, Castelló JV, Brew J, Saúte F, Sicuri E. The impact of a malaria elimination initiative on school outcomes: Evidence from Southern Mozambique. ECONOMICS AND HUMAN BIOLOGY 2022; 44:101100. [PMID: 34922211 DOI: 10.1016/j.ehb.2021.101100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/08/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Despite the significant improvements achieved over the last ten years, primary education attainment in Mozambique is still low. Potential reasons acting from the demand perspective include ill health, among other factors. In Mozambique, ill health is still largely linked to malaria, which is a leading cause of outpatient contacts, hospital admissions and death, particularly among under-five and school-aged children. Despite this, in Mozambique and more generally, in malaria endemic countries, the identification and measurement of how improved malaria indicators may contribute to better school outcomes remains largely unknown. In particular, there is a low understanding of the extent to which better health translates immediately into school indicators, such as absenteeism and grades. In this study, we exploit the first year of a malaria elimination initiative implemented in Magude district (Southern Mozambique) that started in 2015, as a quasi-experiment to estimate the impact of malaria on selected primary school outcomes. While malaria was not eliminated, its incidence drastically dropped. We use as control a neighbouring district (Manhiça) with similar socio-economic and epidemiological characteristics. By employing a difference-in-differences (DiD) approach, we examine whether the positive health shock translated into improved school outcomes. Using information from school registers, we generated a dataset on school attendance and grades for 9,848 primary-school students from 9 schools (4 in the treated district and 5 in the control district). In our main specification, a repeated cross-section analysis, we find that the elimination initiative led to a 28% decrease in school absenteeism and a 2% increase in students' grades. Our results are robust across different specifications, including a panel DiD individual fixed effects estimate on a sub-sample of students. These findings provide evidence on the negative impact of malaria on primary education attainment and suggest remarkable economic benefits consequent to its elimination.
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Affiliation(s)
- Laia Cirera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Judit Vall Castelló
- Department of Economics & Institut D'economia De Barcelona (IEB), Universitat de Barcelona, Spain; Centre for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain
| | - Joe Brew
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Vrije Universiteit, Amsterdam, The Netherlands
| | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Elisa Sicuri
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; LSE Health, Department of Health Policy, London School of Economics and Political Science, London, UK.
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21
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Nundu SS, Culleton R, Simpson SV, Arima H, Muyembe JJ, Mita T, Ahuka S, Yamamoto T. Malaria parasite species composition of Plasmodium infections among asymptomatic and symptomatic school-age children in rural and urban areas of Kinshasa, Democratic Republic of Congo. Malar J 2021; 20:389. [PMID: 34600558 PMCID: PMC8487491 DOI: 10.1186/s12936-021-03919-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Malaria remains a major public health concern in the Democratic Republic of Congo (DRC), and school-age children are relatively neglected in malaria prevalence surveys and may constitute a significant reservoir of transmission. This study aimed to understand the burden of malaria infections in school-age children in Kinshasa/DRC. METHODS A total of 634 (427 asymptomatic and 207 symptomatic) blood samples collected from school-age children aged 6 to 14 years were analysed by microscopy, RDT and Nested-PCR. RESULTS The overall prevalence of Plasmodium spp. by microscopy, RDT and PCR was 33%, 42% and 62% among asymptomatic children and 59%, 64% and 95% in symptomatic children, respectively. The prevalence of Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale spp. by PCR was 58%, 20% and 11% among asymptomatic and 93%, 13% and 16% in symptomatic children, respectively. Among P. ovale spp., P. ovale curtisi, P. ovale wallikeri and mixed P. ovale curtisi + P. ovale wallikeri accounted for 75%, 24% and 1% of infections, respectively. All Plasmodium species infections were significantly more prevalent in the rural area compared to the urban area in asymptomatic infections (p < 0.001). Living in a rural as opposed to an urban area was associated with a five-fold greater risk of asymptomatic malaria parasite carriage (p < 0.001). Amongst asymptomatic malaria parasite carriers, 43% and 16% of children harboured mixed Plasmodium with P. falciparum infections in the rural and the urban areas, respectively, whereas in symptomatic malaria infections, it was 22% and 26%, respectively. Few children carried single infections of P. malariae (2.2%) and P. ovale spp. (1.9%). CONCLUSION School-age children are at significant risk from both asymptomatic and symptomatic malaria infections. Continuous systematic screening and treatment of school-age children in high-transmission settings is needed.
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Affiliation(s)
- Sabin S Nundu
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Nagasaki University, Nagasaki, Japan
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Richard Culleton
- Division of Molecular Parasitology, Proteo-Science Center, Ehime University, Ehime, Japan.
| | - Shirley V Simpson
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Nagasaki University, Nagasaki, Japan
| | - Hiroaki Arima
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Jean-Jacques Muyembe
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Toshihiro Mita
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Steve Ahuka
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Taro Yamamoto
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Nagasaki University, Nagasaki, Japan
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Awosolu OB, Yahaya ZS, Farah Haziqah MT. Prevalence, Parasite Density and Determinants of Falciparum Malaria Among Febrile Children in Some Peri-Urban Communities in Southwestern Nigeria: A Cross-Sectional Study. Infect Drug Resist 2021; 14:3219-3232. [PMID: 34434052 PMCID: PMC8380643 DOI: 10.2147/idr.s312519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Malaria remains a serious public health problem worldwide, particularly in tropical and subtropical regions, including Nigeria. This study investigates the prevalence, parasite density and determinants of malaria among symptomatic children in some peri-urban communities in southwestern Nigeria. Methods This was a randomized cross-sectional and hospital-based study. The standard method of microscopy was employed. Thick and thin films were prepared and viewed under a light microscope to identify and quantify malaria parasites. A well-structured and pre-tested questionnaire was used to obtain the subject’s information on the demographic, socio-economic and environmental variables. Results A total of 380 (71.7%) participants were infected with Plasmodium falciparum with a mean parasite density of 1857.11 parasite/µL of blood. Malaria prevalence and mean parasite density were significantly higher among male compared to their female counterparts [80.3% vs 61.4% and 2026.46 vs 1619.63 parasite/µL of blood]. Similarly, age group ≤5 years had the highest malaria prevalence (92.2%) and mean parasite density (2031.66 parasite/µL of blood) than other age groups (AOR 2.281, 95% CI: 1.187–4.384, P < 0.05). The multivariate logistic analysis showed that malaria disease is significantly associated with having mother with no formal education (AOR 12.235, 95% CI: 3.253–46.021, P < 0.05), having well and river as a major source of household water supply (AOR 13.810, 95% CI: 3.012–63.314, P < 0.05 vs AOR 5.639, 95% CI: 1.455–21.853, P < 0.05) and presence of stagnant water around home (AOR 5.22, 95% CI: 2.921–9.332, P < 0.05). Furthermore, protective factors observed include ownership of mosquito bed net (AOR 0.474, 95% CI: 0.223–1.008, P < 0.05) and distance of home to hospital (AOR 0.279, 95% CI: 0.158–0.493, P < 0.05). Conclusion Malaria remains a serious public health problem in the study area. Adopting integrated malaria control measures including educating parents on malaria prevention and control strategies, distributing mosquito bed nets, and establishing larvae source management program is highly imperative.
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Affiliation(s)
- Oluwaseun Bunmi Awosolu
- School of Biological Sciences, Universiti Sains Malaysia, Penang, 11800 USM, Malaysia.,Department of Biology, Federal University of Technology, Akure, Nigeria
| | - Zary Shariman Yahaya
- School of Biological Sciences, Universiti Sains Malaysia, Penang, 11800 USM, Malaysia
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Prusty D, Gupta N, Upadhyay A, Dar A, Naik B, Kumar N, Prajapati VK. Asymptomatic malaria infection prevailing risks for human health and malaria elimination. INFECTION GENETICS AND EVOLUTION 2021; 93:104987. [PMID: 34216796 DOI: 10.1016/j.meegid.2021.104987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 01/09/2023]
Abstract
There has been a consistent rise in malaria cases in the last few years. The existing malaria control measures are challenged by insecticide resistance in the mosquito vector, drug résistance in parasite populations, and asymptomatic malaria (ASM) in healthy individuals. The absence of apparent malaria symptoms and the presence of low parasitemia makes ASM a hidden reservoir for malaria transmission and an impediment in malaria elimination efforts. This review focuses on ASM in malaria-endemic countries and the past and present research trends from those geographical locations. The harmful impacts of asymptomatic malaria on human health and its contribution to disease transmission are highlighted. We discuss certain crucial genetic changes in the parasite and host immune response necessary for maintaining low parasitemia leading to long-term parasite survival in the host. Since the chronic health effects and the potential roles for disease transmission of ASM remain mostly unknown to significant populations, we offer proposals for developing general awareness. We also suggest advanced technology-based diagnostic methods, and treatment strategies to eliminate ASM.
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Affiliation(s)
- Dhaneswar Prusty
- Department of Biochemistry, School of Life Sciences, Central University of Rajasthan, Bandarsindri, Kishangarh, Ajmer, 305817, Rajasthan, India.
| | - Nidhi Gupta
- Department of Biochemistry, School of Life Sciences, Central University of Rajasthan, Bandarsindri, Kishangarh, Ajmer, 305817, Rajasthan, India
| | - Arun Upadhyay
- Department of Biochemistry, School of Life Sciences, Central University of Rajasthan, Bandarsindri, Kishangarh, Ajmer, 305817, Rajasthan, India
| | - Ashraf Dar
- Department of Biochemistry, University of Kashmir, Hazaratbal, Srinagar 190006, Jammu and Kashmir, India
| | - Biswajit Naik
- Department of Biochemistry, School of Life Sciences, Central University of Rajasthan, Bandarsindri, Kishangarh, Ajmer, 305817, Rajasthan, India
| | - Navin Kumar
- School of Biotechnology, Gautam Buddha University, Greater Noida, 201308, UP, India
| | - Vijay Kumar Prajapati
- Department of Biochemistry, School of Life Sciences, Central University of Rajasthan, Bandarsindri, Kishangarh, Ajmer, 305817, Rajasthan, India
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Kamaliddin C, Sutherland CJ, Houze S, Cottrell G, Briand V, Mogollon DC, Pillai DR. The role of ultra-sensitive molecular methods for detecting malaria - the broader perspective. Clin Infect Dis 2021; 73:e1387-e1390. [PMID: 33693719 DOI: 10.1093/cid/ciab221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
Ultra-sensitive molecular diagnostics are lowering the limit of detection for malaria parasites in the blood and providing insights not captured by conventional tool such as microscopy and rapid antigen tests. Low-level malaria infections identified by molecular tools may influence clinical outcomes, transmission events, and elimination efforts. While many ultra-sensitive molecular methods require well-equipped laboratories, technologies such as loop-mediated isothermal amplification (LAMP) or recombinase polymerase amplification (RPA) provide more portable and analytically sensitive solutions. These tools may benefit asymptomatic patient screening, antenatal care, and elimination campaigns. We review the recent evidence, offer our perspective on the impact of these new tests and identify future research priorities.
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Affiliation(s)
- Claire Kamaliddin
- Department of Microbiology, Immunology, and Infectious Disease, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Colin J Sutherland
- Department of Infection Biology, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - Sandrine Houze
- UMR261 - MERIT, IRD, Faculté de Pharmacie, Université de Paris, Paris, Île-de-France.,Centre National de Référence pour le Paludisme, Bichat-Claude Bernard Hospital, Paris, France
| | - Gilles Cottrell
- UMR261 - MERIT, IRD, Faculté de Pharmacie, Université de Paris, Paris, Île-de-France
| | - Valerie Briand
- Institut de Recherche pour le Développement (IRD), Inserm, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Daniel Castaneda Mogollon
- Department of Microbiology, Immunology, and Infectious Disease, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Dylan R Pillai
- Department of Microbiology, Immunology, and Infectious Disease, Cumming School of Medicine, University of Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, AB, Canada.,Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, AB, Canada
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Korzeniewski K, Bylicka-Szczepanowska E, Lass A. Prevalence of Asymptomatic Malaria Infections in Seemingly Healthy Children, the Rural Dzanga Sangha Region, Central African Republic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:814. [PMID: 33477889 PMCID: PMC7833374 DOI: 10.3390/ijerph18020814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/24/2023]
Abstract
According to the World Health Organization 94% of global malaria cases and 94% of global malaria deaths have been reported from Africa. Unfortunately, it is difficult to determine the exact prevalence of disease in some African countries due to a large number of asymptomatic cases. The aim of this study was to assess the prevalence of malaria infections in seemingly healthy children living in the Central African Republic (CAR). CareStartTM Malaria HRP2 rapid diagnostic test (RDT) targeting Plasmodium falciparum was used to test a group of 500 asymptomatic children aged 1-15 years old (330 settled Bantu and 170 semi-nomadic BaAka Pygmies) inhabiting the villages in the Dzanga Sangha region (south-west CAR) in March 2020. In total, 32.4% of asymptomatic Bantu and 40.6% of asymptomatic Pygmy children had a positive result of malaria RDT. Our findings allowed us to demonstrate the high prevalence of asymptomatic malaria infections in south-west CAR. RDTs seem to be a useful tool for the detection of Plasmodium falciparum in areas with limited possibilities of using other diagnostic methods, such as light microscopy and molecular biology.
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Affiliation(s)
- Krzysztof Korzeniewski
- Department of Epidemiology and Tropical Medicine, Military Institute of Medicine, 128 Szaserów St., 04-141 Warsaw, Poland
- Department of Occupational, Metabolic and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 9B Powstania Styczniowego St., 81-519 Gdynia, Poland
| | - Emilia Bylicka-Szczepanowska
- 4th Department of Infectious Diseases, Provincial Hospital for Infectious Diseases, 37 Wolska St., 01-201 Warsaw, Poland;
| | - Anna Lass
- Department of Tropical Parasitology, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 9B Powstania Styczniowego St., 81-519 Gdynia, Poland;
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Cohee LM, Opondo C, Clarke SE, Halliday KE, Cano J, Shipper AG, Barger-Kamate B, Djimde A, Diarra S, Dokras A, Kamya MR, Lutumba P, Ly AB, Nankabirwa JI, Njagi JK, Maiga H, Maiteki-Sebuguzi C, Matangila J, Okello G, Rohner F, Roschnik N, Rouhani S, Sissoko MS, Staedke SG, Thera MA, Turner EL, Van Geertruyden JP, Zimmerman MB, Jukes MCH, Brooker SJ, Allen E, Laufer MK, Chico RM. Preventive malaria treatment among school-aged children in sub-Saharan Africa: a systematic review and meta-analyses. Lancet Glob Health 2020; 8:e1499-e1511. [PMID: 33222799 PMCID: PMC7721819 DOI: 10.1016/s2214-109x(20)30325-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 05/09/2020] [Accepted: 07/02/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The burden of malaria infection in sub-Saharan Africa among school-aged children aged 5-15 years is underappreciated and represents an important source of human-to-mosquito transmission of Plasmodium falciparum. Additional interventions are needed to control and eliminate malaria. We aimed to assess whether preventive treatment of malaria might be an effective means of reducing P falciparum infection and anaemia in school-aged children and lowering parasite transmission. METHODS In this systematic review and two meta-analyses, we searched the online databases PubMed, Embase, Cochrane CENTRAL, and Clinicaltrials.gov for intervention studies published between Jan 1, 1990, and Dec 14, 2018. We included randomised studies that assessed the effect of antimalarial treatment among asymptomatic school-aged children aged 5-15 years in sub-Saharan Africa on prevalence of P falciparum infection and anaemia, clinical malaria, and cognitive function. We first extracted data for a study-level meta-analysis, then contacted research groups to request data for an individual participant data meta-analysis. Outcomes of interest included prevalence of P falciparum infection detected by microscopy, anaemia (study defined values or haemoglobin less than age-adjusted and sex-adjusted values), clinical malaria (infection and symptoms on the basis of study-specific definitions) during follow-up, and code transmission test scores. We assessed effects by treatment type and duration of time protected, and explored effect modification by transmission setting. For study-level meta-analysis, we calculated risk ratios for binary outcomes and standardised mean differences for continuous outcomes and pooled outcomes using fixed-effect and random-effects models. We used a hierarchical generalised linear model for meta-analysis of individual participant data. This study is registered with PROSPERO, CRD42016030197. FINDINGS Of 628 studies identified, 13 were eligible for the study-level meta-analysis (n=16 309). Researchers from 11 studies contributed data on at least one outcome (n=15 658) for an individual participant data meta-analysis. Interventions and study designs were highly heterogeneous; overall risk of bias was low. In the study-level meta-analysis, treatment was associated with reductions in P falciparum prevalence (risk ratio [RR] 0·27, 95% CI 0·17-0·44), anaemia (0·77, 0·65-0·91), and clinical malaria (0·40, 0·28-0·56); results for cognitive outcomes are not presented because data were only available for three trials. In our individual participant data meta-analysis, we found treatment significantly decreased P falciparum prevalence (adjusted RR [ARR] 0·46, 95% CI 0·40-0·53; p<0·0001; 15 648 individuals; 11 studies), anaemia (ARR 0·85, 0·77-0·92; p<0·0001; 15 026 individuals; 11 studies), and subsequent clinical malaria (ARR 0·50, 0·39-0·60; p<0·0001; 1815 individuals; four studies) across transmission settings. We detected a marginal effect on cognitive function in children older than 10 years (adjusted mean difference in standardised test scores 0·36, 0·01-0·71; p=0·044; 3962 individuals; five studies) although we found no significant effect when combined across all ages. INTERPRETATION Preventive treatment of malaria among school-aged children significantly decreases P falciparum prevalence, anaemia, and risk of subsequent clinical malaria across transmission settings. Policy makers and programme managers should consider preventive treatment of malaria to protect this age group and advance the goal of malaria elimination, while weighing these benefits against potential risks of chemoprevention. FUNDING US National Institutes of Health and Burroughs Wellcome Fund/ASTMH Fellowship.
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Affiliation(s)
- Lauren M Cohee
- Center for Vaccine Development and Global Health, University of Maryland, Baltimore, MA, USA
| | - Charles Opondo
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Siân E Clarke
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Katherine E Halliday
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jorge Cano
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrea G Shipper
- University of Maryland School of Medicine, and Health Sciences and Human Services Library, University of Maryland, Baltimore, MA, USA
| | | | - Abdoulaye Djimde
- Faculty of Medicine, Pharmacy, and Odnonto-Stomatology, Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Mali
| | | | - Aditi Dokras
- Department of Pediatrics, University of Maryland, Baltimore, MA, USA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Pascal Lutumba
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Joaniter I Nankabirwa
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda
| | - J Kiambo Njagi
- National Malaria Control Programme, Ministry of Health, Nairobi, Kenya
| | - Hamma Maiga
- Faculty of Medicine, Pharmacy, and Odnonto-Stomatology, Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Mali
| | | | - Junior Matangila
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - George Okello
- Health Systems and Social Science Research Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Saba Rouhani
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Save the Children, Bamako, Mali
| | - Mahamadou S Sissoko
- Faculty of Medicine, Pharmacy, and Odnonto-Stomatology, Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Sarah G Staedke
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Mahamadou A Thera
- Faculty of Medicine, Pharmacy, and Odnonto-Stomatology, Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Elizabeth L Turner
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Michael B Zimmerman
- Institute of Food, Nutrition, and Health, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | | | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Miriam K Laufer
- Center for Vaccine Development and Global Health, University of Maryland, Baltimore, MA, USA
| | - R Matthew Chico
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Ssemata AS, Opoka RO, Ssenkusu JM, Nakasujja N, John CC, Bangirana P. Socio-emotional and adaptive behaviour in children treated for severe anaemia at Lira Regional Referral Hospital, Uganda: a prospective cohort study. Child Adolesc Psychiatry Ment Health 2020; 14:45. [PMID: 33292468 PMCID: PMC7694894 DOI: 10.1186/s13034-020-00352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/21/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Severe anaemia is a global public health challenge commonly associated with morbidity and mortality among children < 5 years of age in Sub-Saharan Africa. However, less is known about the behavioural performance of children < 5 years surviving severe anaemia in low resource settings. We investigated social-emotional and adaptive behaviour in children < 5 years diagnosed with severe anaemia in Northern Uganda. METHODS We conducted a hospital based prospective cohort study among children 6-42 months who were treated for severe anaemia (n = 171) at Lira Regional Referral Hospital, Uganda. Socio-emotional and adaptive behaviour were assessed 14 days post discharge using the Bayley Scales of Infant and Toddler Development, 3rd edition. Age-adjusted z-scores for each domain were calculated using scores from healthy community children (n = 88) from the same environment for each age category. Multiple linear regression was used to compare z-scores in the social-emotional and adaptive behaviour scales between the two groups after adjusting for weight-for-age z-score, social economic status, mother's education, father's education and father's employment on all the scales. RESULTS Compared with healthy community controls, children with severe anaemia had poorer [adjusted mean scores (standard error)], socio-emotional [- 0.29, (0.05) vs. 0.01, (0.08), P = 0.002]; but not overall/ composite adaptive behaviour [- 0.10, (0.05) vs. - 0.01, (0.07), P = 0.343]. Within the adaptive behaviour subscales, children with SA displayed significantly poorer scores on the community use [adjusted mean score (standard error)], [- 0.63, (0.10) vs. - 0.01, (0.13), P < 0.001]; and leisure [- 0.35, (0.07) vs. - 0.02, (0.07), P = 0.036] skills. CONCLUSION This study suggests that severe anaemia in children < 5 years is associated with poor social-emotional scores in the short-term post clinical recovery in Northern Uganda. We recommend long-term follow-up to determine the course of these problems and appropriate interventions to reduce the behavioural burden among children < 5 years surviving severe anaemia in Uganda.
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Affiliation(s)
- Andrew Sentoogo Ssemata
- Department of Psychiatry, Makerere University, College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Robert Opika Opoka
- Department of Paediatrics and Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
| | - John Mbaziira Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University, College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Chandy C John
- Ryan White Center for Pediatric Infectious Disease & Global Health, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Paul Bangirana
- Department of Psychiatry, Makerere University, College of Health Sciences, P.O. Box 7072, Kampala, Uganda
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Cohee LM, Halliday KE, Gelli A, Mwenyango I, Lavadenz F, Burbano C, Drake L, Bundy DAP. The Role of Health in Education and Human Capital: Why an Integrated Approach to School Health Could Make a Difference in the Futures of Schoolchildren in Low-Income Countries. Am J Trop Med Hyg 2020; 104:424-428. [PMID: 33241787 DOI: 10.4269/ajtmh.20-0779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
Healthy students learn better, yet most current investments in schoolchildren focus on education and learning while largely neglecting the health of the learner. Some school-based interventions, such as school feeding and deworming, are already successfully targeted at this age-group, but the efficiency and cost-effectiveness of such programs could be greatly enhanced by better integrated delivery alongside other priority health interventions. A symposium at the society's 68th annual meeting launched a process to explore how integrated delivery of school-based interventions can address prevalent health conditions in school-age children.
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Affiliation(s)
- Lauren M Cohee
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Katherine E Halliday
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aulo Gelli
- International Food Policy Research Institute, Washington, District of Columbia
| | | | | | | | - Lesley Drake
- Partnership for Childhood Development, Imperial College London, United Kingdom
| | - Donald A P Bundy
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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McCann RS, Cohee LM, Goupeyou-Youmsi J, Laufer MK. Maximizing Impact: Can Interventions to Prevent Clinical Malaria Reduce Parasite Transmission? Trends Parasitol 2020; 36:906-913. [PMID: 32917511 PMCID: PMC7581555 DOI: 10.1016/j.pt.2020.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/19/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
Malaria interventions may reduce the burden of clinical malaria disease, the transmission of malaria parasites, or both. As malaria interventions are developed and evaluated, including those interventions primarily targeted at reducing disease, they may also impact parasite transmission. Achieving global malaria eradication will require optimizing the transmission-reducing potential of all available interventions. Herein, we discuss the relationship between malaria parasite transmission and disease, including mechanisms by which disease-targeting interventions might also impact parasite transmission. We then focus on three malaria interventions with strong evidence for reducing the burden of clinical malaria disease and examine their potential for also reducing malaria parasite transmission.
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Affiliation(s)
- Robert S McCann
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Lauren M Cohee
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jessy Goupeyou-Youmsi
- MAC Communicable Diseases Action Centre, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Miriam K Laufer
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Makenga G, Menon S, Baraka V, Minja DT, Nakato S, Delgado-Ratto C, Francis F, Lusingu JP, Van Geertruyden JP. Prevalence of malaria parasitaemia in school-aged children and pregnant women in endemic settings of sub-Saharan Africa: A systematic review and meta-analysis. Parasite Epidemiol Control 2020; 11:e00188. [PMID: 33145445 PMCID: PMC7591779 DOI: 10.1016/j.parepi.2020.e00188] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 12/05/2022] Open
Abstract
Despite increased malaria control efforts, school-aged children (5–14 years) have higher a malaria prevalence compared to children under-five. In high-transmission settings, up to 70% of school-aged children harbour malaria parasitaemia and therefore contribute significantly to the reservoir for transmission. A systematic review was performed to explore the correlation between the malaria parasite carriage in pregnant women and school-aged children living in similar endemic settings of sub Saharan Africa to inform strategies to improve targeted malaria control. In order to obtain data on malaria prevalence in pregnant women and school-aged children living in the same endemic setting, we searched the Malaria in Pregnancy Library, PubMed, Cochrane library and Web of Science in December 2018. We fit a fixed effect model to obtain a pooled risk ratio (PRR) of malaria in school-aged children versus pregnant women and used Poisson regression to estimate risk ratios in school-aged children for every increase in prevalence in pregnant women. We used data from six (out of 1096) sources that included 10 data points. There was a strong linear relation between the prevalence of malaria infection in pregnant women and school-aged children (r = 0·93, p < 0·0001). School-aged children were nearly twice at risk to carry parasites compared to pregnant women (RR = 1.95, 95% CI: 1·69–2.25, p < 0.01). Poisson regression showed that a 1% increase in prevalence of malaria infection in pregnant women was significantly associated with increase in risk in school-aged children by 4%. Malaria infection prevalence in school-aged children is strongly correlated with the prevalence in pregnant women living in the same community, and may be considered as alternative indicators to track temporal and spatial trends in malaria transmission intensity. Chemoprevention strategies targeting school-aged children should be explored to reduce malaria burden and transmission in school-aged children and its potential impact on communities.
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Affiliation(s)
- Geofrey Makenga
- National Institute for Medical Research, Tanga Centre, P. O. Box 5004, Tanga, Tanzania
- Global Health Institute, University of Antwerp, Antwerp, Belgium
- Corresponding author at.: National Institute for Medical Research, Tanga Centre, P. O. Box 5004, Tanga, Tanzania.
| | - Sonia Menon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Vito Baraka
- National Institute for Medical Research, Tanga Centre, P. O. Box 5004, Tanga, Tanzania
| | - Daniel T.R. Minja
- National Institute for Medical Research, Tanga Centre, P. O. Box 5004, Tanga, Tanzania
| | - Swabra Nakato
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | | | - Filbert Francis
- National Institute for Medical Research, Tanga Centre, P. O. Box 5004, Tanga, Tanzania
| | - John P.A. Lusingu
- National Institute for Medical Research, Tanga Centre, P. O. Box 5004, Tanga, Tanzania
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Impact of Three-Year Intermittent Preventive Treatment Using Artemisinin-Based Combination Therapies on Malaria Morbidity in Malian Schoolchildren. Trop Med Infect Dis 2020; 5:tropicalmed5030148. [PMID: 32957604 PMCID: PMC7560034 DOI: 10.3390/tropicalmed5030148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022] Open
Abstract
Previous studies have shown that a single season of intermittent preventive treatment in schoolchildren (IPTsc) targeting the transmission season has reduced the rates of clinical malaria, all-cause clinic visits, asymptomatic parasitemia, and anemia. Efficacy over the course of multiple years of IPTsc has been scantly investigated. Methods: An open, randomized-controlled trial among schoolchildren aged 6–13 years was conducted from September 2007 to January 2010 in Kolle, Mali. Students were included in three arms: sulphadoxine-pyrimethamine+artesunate (SP+AS), amodiaquine+artesunate (AQ+AS), and control (C). All students received two full doses, given 2 months apart, and were compared with respect to the incidence of clinical malaria, all-cause clinic visits, asymptomatic parasitemia, and anemia. Results: A total of 296 students were randomized. All-cause clinic visits were in the SP+AS versus control (29 (20.1%) vs. 68 (47.2%); 20 (21.7%) vs. 41 (44.6%); and 14 (21.2%) vs. 30 (44.6%); p < 0.02) in 2007, 2008, and 2009, respectively. The prevalence of asymptomatic parasitemia was lower in the SP+AS compared to control (38 (7.5%) vs. 143 (28.7%); and 47 (12.7%) vs. 75 (21.2%); p < 0.002) in 2007 and 2008, respectively. Hemoglobin concentration was significantly higher in children receiving SP+AS (11.96, 12.06, and 12.62 g/dL) than in control children (11.60, 11.64, and 12.15 g/dL; p < 0.001) in 2007, 2008, and 2009, respectively. No impact on clinical malaria was observed. Conclusion: IPTsc with SP+AS reduced the rates of all-cause clinic visits and anemia during a three-year implementation.
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Effectiveness of peer-learning assisted primary school students educating the rural community on insecticide-treated nets utilization in Jimma-zone Ethiopia. Malar J 2020; 19:331. [PMID: 32917225 PMCID: PMC7488415 DOI: 10.1186/s12936-020-03401-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022] Open
Abstract
Background Making insecticide-treated nets (ITNs) utilization a social norm would support the global goal of malaria eradication and Ethiopian national aim of its elimination by 2030. Jimma zone is one of the endemic settings in Ethiopia. This study aimed to report effects of malaria education, delivered by students, on community behaviours; particularly ITNs. Methods In pre-posttest, cross-sectional household surveys conducted in rural villages of 5 districts in Jimma Zone, Ethiopia, 762 households were sampled. The intervention engaged students from primary schools in participatory peer education within small groups, followed by exposing parents with malaria messages aimed at influencing perceptions and practices. The data were analysed using SPSS version 20.0. Proportions/means differences were computed to compare changes in exposure, knowledge, perceptions, and practices using 95% CI at p < 0.05. Regression analyses were conducted to assess exposures to school-based education, content intensity, perception, and access related predictors of ITN utilization over the intervention periods. Results Over the intervention periods, the findings showed significant improvement in exposure to and content intensity of malaria messages delivered by students, effect size (ES) = 44.5% and 19.3%, p < 0.001, respectively. ITN utilization (ES = 25.8%), and the reported behaviour of giving ITN priority to children under 5 years old and pregnant women increased by ES = 16.3% and 24.8%, respectively. The exposure status or content intensity of malaria education, in turn, significantly improved comprehensive knowledge about malaria (β = +1.82), misconceptions about causes (β = − 11.46), awareness of caring for ITN (β = +24.79), identifying ITN as effective preventive methods (OR = 1.93), attitude towards ITN (β = +0.20), perceived efficacy of ITN (OR = 1.04), acceptance of ITN as a means to control the danger of malaria (β = +8.08%), and ITN utilization (OR = 1.85). Nonetheless, perceived threat (β = − 0.19) significantly negatively correlated with exposure to students’ messages. Socio-demography, access, exposures to messages, and parental perception that students were good reminders predicted ITN utilization over the intervention periods with some changing patterns. Conclusions Exposing the community to malaria education through students effectively supports behaviour change, particularly ITN usage, to be more positive towards desired malaria control practices. A school-based strategy is recommended to the national effort to combat malaria.
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Girma S, Cheaveau J, Mohon AN, Marasinghe D, Legese R, Balasingam N, Abera A, Feleke SM, Golassa L, Pillai DR. Prevalence and Epidemiological Characteristics of Asymptomatic Malaria Based on Ultrasensitive Diagnostics: A Cross-sectional Study. Clin Infect Dis 2020; 69:1003-1010. [PMID: 30475992 DOI: 10.1093/cid/ciy1005] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/22/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND As the global public-health objectives for malaria evolve from malaria control towards malaria elimination, there is increasing interest in the significance of asymptomatic infections and the optimal diagnostic test to identify them. METHOD We conducted a cross-sectional study of asymptomatic individuals (N = 562) to determine the epidemiological characteristics associated with asymptomatic malaria. Participants were tested by rapid diagnostic tests (CareStart, Standard Diagnostics [SD] Bioline, and Alere ultrasensitive RDT [uRDT]), loop-mediated isothermal amplification (LAMP), and quantitative reverse transcription polymerase chain reaction (qRT-PCR) to determine malaria positivity. Hemoglobin values were recorded, and anemia was defined as a binary variable, according to World Health Organization guidelines. RESULTS Compared to reference qRT-PCR, LAMP had the highest sensitivity (92.6%, 95% confidence interval [CI] 86.4-96.5), followed by uRDT Alere Malaria (33.9%, 95% CI 25.5-43.1), CareStart Malaria (14.1%, 95% CI 8.4-21.5), microscopy (5.0%, 95% CI 1.8-10.5), and SD Bioline (5.0%, 95% CI 1.8-10.5). For Plasmodium falciparum specimens only, the sensitivity for uRDT Alere Malaria was 50.0% (95% CI 38.8-61.3) and SD Bioline was 7.3% (95% CI 2.7-15.3). Based on multivariate regression analysis with qRT-PCR as the gold standard, for every 3.2% increase in the prevalence of asymptomatic malaria, hemoglobin decreased by 1 gram per deciliter (prevalence ratio 0.968, 95% CI 0.940-0.997; P = .032). Deletions (4.8%) in hrp2 were noted. CONCLUSIONS While uRDT Alere Malaria has superior sensitivity to rapid diagnostic tests and microscopy in detecting asymptomatic malaria, LAMP is superior still. Ultrasensitive diagnostics provide the accurate prevalence estimates of asymptomatic malaria required for elimination.
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Affiliation(s)
- Seble Girma
- Ethiopian Public Health Institute, Addis Ababa University, Ethiopia.,Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
| | - James Cheaveau
- Clinical Section of Microbiology, Calgary Laboratory Services, Alberta.,Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Alberta
| | - Abu Naser Mohon
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Alberta
| | - Dewdunee Marasinghe
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec
| | - Ruth Legese
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Alberta
| | - Nirujah Balasingam
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Alberta
| | - Adugna Abera
- Ethiopian Public Health Institute, Addis Ababa University, Ethiopia
| | - Sindew M Feleke
- Ethiopian Public Health Institute, Addis Ababa University, Ethiopia
| | - Lemu Golassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
| | - Dylan R Pillai
- Clinical Section of Microbiology, Calgary Laboratory Services, Alberta.,Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Alberta.,Department of Pathology and Laboratory Medicine, Alberta, Canada.,Department of Medicine, University of Calgary, Alberta, Canada
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Kebede Y, Abebe L, Alemayehu G, Sudhakar M, Birhanu Z. School-based social and behavior change communication (SBCC) advances community exposure to malaria messages, acceptance, and preventive practices in Ethiopia: A pre-posttest study. PLoS One 2020; 15:e0235189. [PMID: 32584891 PMCID: PMC7316301 DOI: 10.1371/journal.pone.0235189] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 06/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background Ethiopia has shown incredible success in malaria morbidity, mortality, and control. Community empowerment is a milestone to meet the ambitious plans of eliminating malaria by 2030. Objectives This study aimed to evaluate school-based malaria social behavior change communication (SBCC) in terms of community message exposure, acceptance, knowledge, and practices. Methods A community-based pre-posttest study was conducted in five districts of the Jimma Zone, Ethiopia. 762 and 759 households were sampled for baseline and end-line, respectively. The intervention engaged students from primary schools on participatory peer education within small groups, followed by exposing parents with malaria messages aimed to influencing ideation and preventive practices. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. Proportion/mean differences were computed to compare both surveys on exposure, knowledge, perceptions, and practices at p <0.05. Finally, a regression analysis was conducted between key changes and school-based exposure. Results The study revealed a sharp increase in exposure to malaria messages with effect size (ES) of 65.7%, p <0.001. School specific exposure has grown to 57.8% (ES = 44.5%). Comprehensive knowledge about malaria increased to 39.1% (ES = 14.8%). Identifying mosquito bites as a cause of malaria was increased by ES = 20.8%. A slight reduction in risk perception (ES = 3.3%) and attitude (ES = 3.8%) and a higher rise in self-efficacy (ES = 8.5%) were observed. Community message acceptance in favor of malaria danger control was significantly improved by 10% i.e. an increase in rational decision making to uptake preventive practices. Consistently, insecticide-treated nets (ITNs) usage was improved to 63.0% (ES = 25.8%). Giving priority to use ITNs for under five years old children and pregnant women grew by 16.3% and 24.8%, respectively. Significant improvements were observed in treatment-seeking for fever (ES = 16.3%) and early treatment-seeking (ES = 15.5%). Not painting or plastering walls 6 months within spraying changed by ES = 61%. No significant change was observed in drug adherence. The school-based content intensity of exposure had effects on comprehensive knowledge, message acceptance, and ITN utilization. Conclusions Engaging school-aged children effectively advances community exposure, perception, and behaviors. We recommend the inclusion of school-based SBCC in the national malaria control programs.
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Affiliation(s)
- Yohannes Kebede
- Department of Health, Behavior, and Society, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Lakew Abebe
- Department of Health, Behavior, and Society, Jimma University, Jimma, Ethiopia
| | - Guda Alemayehu
- President’s Malaria Initiative, United States Agency for International Development, Addis Ababa, Ethiopia
| | - Morankar Sudhakar
- Department of Health, Behavior, and Society, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behavior, and Society, Jimma University, Jimma, Ethiopia
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Jeon SG, Yoo A, Chun DW, Hong SB, Chung H, Kim JI, Moon M. The Critical Role of Nurr1 as a Mediator and Therapeutic Target in Alzheimer's Disease-related Pathogenesis. Aging Dis 2020; 11:705-724. [PMID: 32489714 PMCID: PMC7220289 DOI: 10.14336/ad.2019.0718] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/18/2019] [Indexed: 01/16/2023] Open
Abstract
Several studies have revealed that the transcription factor nuclear receptor related 1 (Nurr1) plays several roles not only in the regulation of gene expression related to dopamine synthesis, but also in alternative splicing, and miRNA targeting. Moreover, it regulates cognitive functions and protects against inflammation-induced neuronal death. In particular, the role of Nurr1 in the pathogenesis of Parkinson's disease (PD) has been well investigated; for example, it has been shown that it restores behavioral and histological impairments in PD models. Although many studies have evaluated the connection between Nurr1 and PD pathogenesis, the role of Nurr1 in Alzheimer's disease (AD) remain to be studied. There have been several studies describing Nurr1 protein expression in the AD brain. However, only a few studies have examined the role of Nurr1 in the context of AD. Therefore, in this review, we highlight the overall effects of Nurr1 under the neuropathologic conditions related to AD. Furthermore, we suggest the possibility of using Nurr1 as a therapeutic target for AD or other neurodegenerative disorders.
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Affiliation(s)
- Seong Gak Jeon
- Department of Biochemistry, College of Medicine, Konyang University, Daejeon, 35365, Republic of Korea
| | - Anji Yoo
- Department of Biochemistry, College of Medicine, Konyang University, Daejeon, 35365, Republic of Korea
| | - Dong Wook Chun
- Department of Biochemistry, College of Medicine, Konyang University, Daejeon, 35365, Republic of Korea
| | - Sang Bum Hong
- Department of Biochemistry, College of Medicine, Konyang University, Daejeon, 35365, Republic of Korea
| | - Hyunju Chung
- Department of Core Research Laboratory, Clinical Research Institute, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Jin-il Kim
- Department of Nursing, College of Nursing, Jeju National University, Jeju-si 63243, Republic of Korea
| | - Minho Moon
- Department of Biochemistry, College of Medicine, Konyang University, Daejeon, 35365, Republic of Korea
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Makenga G, Baraka V, Francis F, Nakato S, Gesase S, Mtove G, Madebe R, Kyaruzi E, Minja DT, Lusingu JP, Van geertruyden JP. Effectiveness and safety of intermittent preventive treatment for malaria using either dihydroartemisinin-piperaquine or artesunate-amodiaquine in reducing malaria related morbidities and improving cognitive ability in school-aged children in Tanzania: A study protocol for a controlled randomised trial. Contemp Clin Trials Commun 2020; 17:100546. [PMID: 32382685 PMCID: PMC7201189 DOI: 10.1016/j.conctc.2020.100546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In high transmission settings, up to 70% of school-aged children harbour malaria parasites without showing any clinical symptoms. Thus, epidemiologically, school aged children act as a substantial reservoir for malaria transmission. Asymptomatic Plasmodium infections induce inflammation leading to iron deficiency anaemia. Consequently, anaemia retards child growth, predisposes children to other diseases and reduces cognitive potential that could lead to poor academic performance. School aged children become increasingly more vulnerable as compared to those aged less than five years due to delayed acquisition of protective immunity. None of the existing Intermittent Preventive Treatment (IPT) strategies is targeting school-aged children. Here, we describe the study protocol of a clinical trial conducted in north-eastern Tanzania to expand the IPT by assessing the effectiveness and safety of two antimalarial drugs, Dihydroartemisinin-Piperaquine (DP) and Artesunate-Amodiaquine (ASAQ) in preventing malaria related morbidities in school-aged children (IPTsc) living in a high endemic area. METHODS/DESIGN The trial is a phase IIIb, individual randomized, open label, controlled trial enrolling school children aged 5-15 years, who receive either DP or ASAQ or control (no drug), using a "balanced block design" with the "standard of care" arm as reference. The interventional treatments are given three times a year for the first year. A second non-interventional year will assess possible rebound effects. Sample size was estimated to 1602 school children (534 per group) from selected primary schools in an area with high malaria endemicity. Thick and thin blood smears (to measure malaria parasitaemia using microscope) were obtained prior to treatment at baseline, and will be obtained again at month 12 and 20 from all participants. Haemoglobin concentration using a haemoglobinometer (HemoCue AB, Sweden) will be measured four monthly. Finger-prick blood (dried bloodspot-DBS) prepared on Whatman 3 M filter paper, will be used for sub-microscopic malaria parasite detection usingPCR, detect markers of drug resistance (using next generation sequencing (NGS) technology), and malaria serological assays (using enzyme-linked immunosorbent assay, ELISA). To determine the benefit of IPTsc on cognitive and psychomotor ability test of everyday attention for children (TEA-Ch) and a '20 m Shuttle run' respectively, will be conducted at baseline, month 12 and 20. The primary endpoints are change in mean haemoglobin from baseline concentration and reduction in clinical malaria incidence at month 12 and 20 of follow up. Mixed design methods are used to assess the acceptability, cost-effectiveness and feasibility of IPTsc as part of a more comprehensive school children health package. Statistical analysis will be in the form of multilevel modelling, owing to repeated measurements and clustering effect of participants. DISCUSSION Malaria intervention using IPTsc strategy may be integrated in the existing national school health programme. However, there is limited systematic evidence to assess the effectiveness and operational feasibility of this approach. School-aged children are easily accessible in most endemic malaria settings. The evidence from this study will guide the implementation of the strategy to provide complementary approach to reduce malaria related morbidity, anaemia and contribute to the overall burden reduction. TRIAL REGISTRATION Clinicaltrials.gov: NCT03640403, registered on Aug 21, 2018, prospectively registered.Url https://www.clinicaltrials.gov/ct2/show/NCT03640403?term=NCT03640403&rank=1.
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Affiliation(s)
- Geofrey Makenga
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Vito Baraka
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Filbert Francis
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Swabra Nakato
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Samwel Gesase
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - George Mtove
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Rashid Madebe
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Edna Kyaruzi
- College of Education (DUCE), University of Dar Es Salaam, Dar Es Salaam, Tanzania
| | - Daniel T.R. Minja
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - John P.A. Lusingu
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
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Clark H, Coll-Seck AM, Banerjee A, Peterson S, Dalglish SL, Ameratunga S, Balabanova D, Bhan MK, Bhutta ZA, Borrazzo J, Claeson M, Doherty T, El-Jardali F, George AS, Gichaga A, Gram L, Hipgrave DB, Kwamie A, Meng Q, Mercer R, Narain S, Nsungwa-Sabiiti J, Olumide AO, Osrin D, Powell-Jackson T, Rasanathan K, Rasul I, Reid P, Requejo J, Rohde SS, Rollins N, Romedenne M, Singh Sachdev H, Saleh R, Shawar YR, Shiffman J, Simon J, Sly PD, Stenberg K, Tomlinson M, Ved RR, Costello A. A future for the world's children? A WHO-UNICEF-Lancet Commission. Lancet 2020; 395:605-658. [PMID: 32085821 DOI: 10.1016/s0140-6736(19)32540-1] [Citation(s) in RCA: 405] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/10/2019] [Accepted: 09/19/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Helen Clark
- The Helen Clark Foundation, Auckland, New Zealand; Partnership for Maternal Newborn & Child Health, Geneva, Switzerland
| | | | - Anshu Banerjee
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | - Stefan Peterson
- UNICEF Headquarters, Programme Division, Health Section, New York, USA
| | - Sarah L Dalglish
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, OT, Canada; Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - John Borrazzo
- Global Financing Facility, World Bank, Washington, DC, USA
| | - Mariam Claeson
- Global Financing Facility, World Bank, Washington, DC, USA
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Fadi El-Jardali
- Department of Health Management and Policy, Beirut, Lebanon; Knowledge to Policy Center American University of Beirut, Beirut, Lebanon
| | - Asha S George
- School of Public Health, University of Western Cape, Bellville, South Africa
| | | | - Lu Gram
- Institute for Global Health, London, UK
| | - David B Hipgrave
- UNICEF Headquarters, Programme Division, Health Section, New York, USA
| | - Aku Kwamie
- Health Policy and Systems Research Consultant, Accra, Ghana
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Raúl Mercer
- Program of Social Sciences and Health, Latin American School of Social Sciences, Buenos Aires, Argentina
| | - Sunita Narain
- Centre for Science and Environment, New Delhi, India
| | | | | | | | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Papaarangi Reid
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, Data and Analytics Section, New York, USA
| | - Sarah S Rohde
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Nigel Rollins
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | | | - Harshpal Singh Sachdev
- Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Rana Saleh
- Knowledge to Policy Center American University of Beirut, Beirut, Lebanon
| | - Yusra R Shawar
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jeremy Shiffman
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jonathon Simon
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | - Peter D Sly
- Children's Health and Environment Program, The University of Queensland, Brisbane, QLD, Australia
| | - Karin Stenberg
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Rajani R Ved
- National Health Systems Resource Centre, New Delhi, India
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Halliday KE, Witek-McManus SS, Opondo C, Mtali A, Allen E, Bauleni A, Ndau S, Phondiwa E, Ali D, Kachigunda V, Sande JH, Jawati M, Verney A, Chimuna T, Melody D, Moestue H, Roschnik N, Brooker SJ, Mathanga DP. Impact of school-based malaria case management on school attendance, health and education outcomes: a cluster randomised trial in southern Malawi. BMJ Glob Health 2020; 5:e001666. [PMID: 32133163 PMCID: PMC7042571 DOI: 10.1136/bmjgh-2019-001666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Evidence indicates children who suffer from ill-health are less likely to attend or complete schooling. Malaria is an important cause of morbidity and mortality in school-age children. However, they are less likely to receive malaria treatment at health facilities and evidence for how to improve schoolchildren's access to care is limited. This study aimed to evaluate the impact of a programme of school-based malaria case management on schoolchildren's attendance, health and education. Methods A cluster randomised controlled trial was conducted in 58 primary schools in Zomba District, Malawi, 2011-2015. The intervention, implemented in 29 randomly selected schools, provided malaria rapid diagnostic tests and artemisinin-based combination therapy to diagnose and treat uncomplicated malaria as part of basic first aid kits known as 'Learner Treatment Kits' (LTK). The primary outcome was school attendance, assessed through teacher-recorded daily attendance registers and independent periodic attendance spot checks. Secondary outcomes included prevalence of Plasmodium spp infection, anaemia, educational performance, self-reported child well-being and health-seeking behaviour. A total of 9571 children from standards 1-7 were randomly selected for assessment of school attendance, with subsamples assessed for the secondary outcomes. Results Between November 2013 and March 2015, 97 trained teachers in 29 schools provided 32 685 unique consultations. Female schoolchildren were significantly more likely than male to seek a consultation (unadjusted OR=1.78 (95% CI 1.58 to 2.00). No significant intervention effect was observed on the proportion of child-days recorded as absent in teacher registers (n=9017 OR=0.90 (95% CI 0.77 to 1.05), p=0.173) or of children absent during random school visits-spot checks (n=5791 OR=1.09 (95% CI 0.87 to 1.36), p=0.474). There was no significant impact on child-reported well-being, prevalence of Plasmodium spp, anaemia or education scores. Conclusion Despite high community demand, the LTK programme did not reduce schoolchildren's absenteeism or improve health or education outcomes in this study setting. Trial registration number ClinicalTrials.gov NCT02213211.
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Affiliation(s)
- Katherine E Halliday
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Stefan S Witek-McManus
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | | | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Andrew Bauleni
- Malaria Alert Centre, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Saidi Ndau
- Zomba District Health Office, Ministry of Health, Zomba, Malawi
| | - Emmanuel Phondiwa
- District Education Office, Ministry of Education, Science and Technology, Zomba, Malawi
| | - Doreen Ali
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Virginia Kachigunda
- Department of School Health, Nutrition, HIV & AIDS, Ministry of Education, Science and Technology, Lilongwe, Malawi
| | - John H Sande
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | | | | | | | - David Melody
- Save the Children International, Lilongwe, Malawi
| | | | | | - Simon J Brooker
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Don P Mathanga
- Malaria Alert Centre, College of Medicine, University of Malawi, Blantyre, Malawi
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Cheaveau J, Mogollon DC, Mohon MAN, Golassa L, Yewhalaw D, Pillai DR. Asymptomatic malaria in the clinical and public health context. Expert Rev Anti Infect Ther 2019; 17:997-1010. [PMID: 31718324 DOI: 10.1080/14787210.2019.1693259] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction: Historically, the global community has focused on the control of symptomatic malaria. However, interest in asymptomatic malaria has been growing, particularly in the context of malaria elimination.Areas covered: We undertook a comprehensive PubMed literature review on asymptomatic malaria as it relates to detection and elimination with emphasis between 2014 and 2019. Diagnostic tools with a low limit of detection (LOD) have allowed us to develop a more detailed understanding of asymptomatic malaria and its impact. These highly sensitive diagnostics have demonstrated that the prevalence of asymptomatic malaria is greater than previously thought. In addition, it is now possible to detect the malaria reservoir in the community, something that was previously not feasible. Asymptomatic malaria has previously not been treated, but research has begun to examine whether treating individuals with asymptomatic malaria may lead to health benefits. Finally, we have begun to understand the importance of asymptomatic malaria in ongoing transmission.Expert opinion: Therefore, with malaria elimination back on the agenda, asymptomatic malaria can no longer be ignored, especially in light of new ultra-sensitive diagnostic tools.
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Affiliation(s)
- James Cheaveau
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Canada, AB, Canada
| | - Daniel Castaneda Mogollon
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Canada, AB, Canada
| | - Md Abu Naser Mohon
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Canada, AB, Canada
| | - Lemu Golassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Delenasaw Yewhalaw
- Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Dylan R Pillai
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Canada, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
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Rehman AM, Maiteki-Sebuguzi C, Gonahasa S, Okiring J, Kigozi SP, Chandler CIR, Drakeley C, Dorsey G, Kamya MR, Staedke SG. Intermittent preventive treatment of malaria delivered to primary schoolchildren provided effective individual protection in Jinja, Uganda: secondary outcomes of a cluster-randomized trial (START-IPT). Malar J 2019; 18:318. [PMID: 31533845 PMCID: PMC6751800 DOI: 10.1186/s12936-019-2954-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intermittent preventive treatment (IPT) of malaria is recommended as policy for certain high-risk populations, but not currently for schoolchildren. A cluster-randomized trial was conducted to evaluate the effect of IPT with dihydroartemisinin-piperaquine (DP) on primary schoolchildren in Jinja, Uganda. Results of the impact of IPT of schoolchildren on community-level transmission have been reported previously. Here, secondary outcomes from a school-based survey are presented. METHODS Eighty-four clusters (one primary school plus 100 households) were randomized to intervention and control (1:1 ratio). Participants from intervention schools received monthly IPT with DP for up to 6 rounds (June-December 2014). At endline (November-December 2014), randomly selected children from all 84 schools were surveyed (13 per school) and thick blood smears were done. Those with fever or history of fever were tested with rapid diagnostic tests (RDTs) for malaria. Haemoglobin was measured in every fifth participant. Outcome measures included prevalence of asexual parasites and gametocytes (by microscopy), and prevalence of anaemia. Prevalence outcomes were analysed using generalized linear Poisson models with log link function, incorporating a cluster-level random intercept and quantified using prevalence risk ratios. RESULTS Among 23,280 students listed on the 42 intervention school registers, 10,079 (43.3%) aged 5-20 years were enrolled into the IPT intervention and received at least one dose of DP; of these, 9286 (92.1%) received at least one full (3-day) course. In total, 1092 children were enrolled into the final school survey (546 per arm) and had a thick blood smear done; of these, 255 had haemoglobin measured (129 intervention, 126 control). Children in the intervention arm were less likely to have asexual parasites (9.2% intervention vs 44.1% control, adjusted risk ratio [aRR] 0.22 [95% CI 0.16-0.30] p < 0.001), gametocytes (3.1% intervention vs 9.5% control, aRR 0.34 [95% CI 0.20-0.56] p < 0.001), fever (20.2% intervention vs 56.2% control, aRR 0.35 [95% CI 0.25-0.50] p < 0.001), or symptomatic malaria (5.1% intervention vs 35.7% control, aRR 0.14 [95% CI 0.08-0.26] p < 0.001). Prevalence of anaemia and mean haemoglobin were similar in both study arms. CONCLUSIONS School-aged children are a major reservoir of malaria parasites. Delivering IPT to schoolchildren would benefit individual children and may reduce transmission. School-based IPT could help to intensify malaria control toward elimination, and should be considered for policies and programmes. Trial registration Clinicaltrials.gov (NCT02009215), Registered 11 December 2013. https://clinicaltrials.gov/ct2/show/NCT02009215.
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Affiliation(s)
- Andrea M Rehman
- Department of Infectious Disease Epidemiology, LSHTM, London, UK
| | | | - Samuel Gonahasa
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Simon P Kigozi
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Clare I R Chandler
- Department of Global Health & Development, Department of Clinical Research, LSHTM, London, UK
| | | | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, USA
| | - Moses R Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sarah G Staedke
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda.
- Department of Clinical Research, London School of Hygiene & Tropical Medicine (LSHTM), London, UK.
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Geng J, Malla P, Zhang J, Xu S, Li C, Zhao Y, Wang Q, Kyaw MP, Cao Y, Yang Z, Cui L. Increasing trends of malaria in a border area of the Greater Mekong Subregion. Malar J 2019; 18:309. [PMID: 31514740 PMCID: PMC6739967 DOI: 10.1186/s12936-019-2924-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/17/2019] [Indexed: 11/27/2022] Open
Abstract
Background Intensive malaria transmission along international borders is a significant impediment to malaria elimination in the Greater Mekong Subregion (GMS) of Southeast Asia. Passive case detection (PCD) was used to study the dynamics and trends of malaria transmission at the China–Myanmar border to provide epidemiologic information for improved malaria control. Methods PCD was conducted in one hospital and 12 clinics near the Laiza town in northeast Myanmar from 2011 to 2016. Clinical malaria was diagnosed by microscopy and demographic information was captured using a structured questionnaire at the time of the patient’s presentation for care. Results Over the study period, 6175 (19.7%) malaria cases were confirmed by microscopy from 31,326 suspected cases. The four human malaria parasite species were all identified, with Plasmodium vivax and Plasmodium falciparum accounting for 5607 (90.8%) and 481 (7.8%) of the confirmed cases, respectively. In contrast to the steady decline of malaria in the general GMS, the study site had an upward trend of malaria incidence with vivax malaria outbreaks in 2013 and 2016. Adult males, children under the age of 15, and those with occupations such as farming, being a soldier or student, had significantly higher risks of clinical malaria compared to having fevers from other aetiologies. A self-reported history of clinical malaria was also associated with a higher risk of confirmed malaria. Conclusions The China–Myanmar border area has experienced an overall upward trend of malaria incidence in recent years with P. vivax becoming the predominant species. Evidence-based control strategies need to focus on high-risk populations.
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Affiliation(s)
- Jinting Geng
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Pallavi Malla
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA
| | - Jiaqi Zhang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Shiling Xu
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Cuiying Li
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Yan Zhao
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Qinghui Wang
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | | | - Yaming Cao
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China.
| | - Liwang Cui
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA.
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Kao J, Mutuku F, Martin S, Lee J, Mwandi J, Mukoko D, Malhotra I, King CH, LaBeaud AD. Early Childhood Anemia in a Birth Cohort in Coastal Kenya: Links to Infection and Nutrition. Am J Trop Med Hyg 2019; 101:242-252. [PMID: 31074407 PMCID: PMC6609201 DOI: 10.4269/ajtmh.17-0688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/11/2019] [Indexed: 11/07/2022] Open
Abstract
Anemia is known to impact a child's growth and development, but not all anemias are caused by iron deficiency, and the CDC and WHO have emphasized investigating other contributors to anemia. This cross-sectional sub-study of a 2012-2016 maternal-child cohort in coastal Kenya evaluated 244 children and found 185 (76%) to have been anemic on at least one time point since birth. At the time of assessment in 2016, evaluation included a complete blood count, nutritional assessment, and testing for parasitic infections, focusing on the primary outcome of anemia, defined as hemoglobin (Hb) < 11 g/dL. The average age at assessment was 20.5 ± 7 months. Ninety-five percent had a lifetime average Hb in the anemic range. Adjusting for age and gender, prior or current malaria infection (prior: Hb β = -0.99, 95% CI: -1.49 to -0.49, P = 0.01), or having any current infection with hookworm, Trichuris, Strongyloides, Ascaris, and/or malaria (β = -0.84, 95% CI: -1.36 to -0.33, P = 0.01) was associated with decreased current Hb. Nutritional evaluation revealed that children with a declining Hb ate fewer vitamin-A-rich vegetables per week (P = 0.01) or eggs (P = 0.01), drank more milk (P = 0.07), and ate more bread (P = 0.01), and were more likely to live in a household that experienced food shortage (P = 0.05). The high prevalence of anemia, polyparasitism, and dietary insufficiency among children in rural coastal Kenya suggests that remedial interventions will need to address both diet and parasitic infections to effectively combat this significant health threat.
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Affiliation(s)
- Julia Kao
- Stanford University School of Medicine, Stanford, California
| | | | - Shanique Martin
- Stanford University School of Medicine, Stanford, California
| | - Justin Lee
- Stanford University School of Medicine, Stanford, California
| | - Jackson Mwandi
- Vector Borne Disease Control Unit, Msambweni Field Laboratory, Kwale County, Kenya
| | - Dunstan Mukoko
- Vector-Borne Diseases Control Unit, Ministry of Health, Nairobi, Kenya
| | - Indu Malhotra
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
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Cohee LM, Chilombe M, Ngwira A, Jemu SK, Mathanga DP, Laufer MK. Pilot Study of the Addition of Mass Treatment for Malaria to Existing School-Based Programs to Treat Neglected Tropical Diseases. Am J Trop Med Hyg 2018; 98:95-99. [PMID: 29141763 PMCID: PMC5928736 DOI: 10.4269/ajtmh.17-0590] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Malaria and neglected tropical diseases (NTDs), including schistosomiasis and soil transmitted helminths, threaten the health of school aged in sub-Saharan Africa. Established school-based mass drug administration (MDA) programs are used to control NTDs. Recent clinical trials have shown benefit of mass treatment of malaria in schools. The potential of adding malaria treatment to existing NTD programs has not been thoroughly evaluated. We offered malaria treatment with artemether-lumefantrine during routine NTD MDA and developed peer education programs in two primary schools in southern Malawi. We assessed participation, safety, and tolerability of coadministration of artemether-lumefantrine with praziquantel and albendazole. Results were compared with two schools conducting standard NTD MDA with additional monitoring by study staff. A total of 3,387 students (68%) received the standard NTD MDA. Among parents who came to schools on the day of the MDA, malaria treatment was well accepted; 87% of students who received the standard NTD MDA in intervention schools also consented for treatment with artemether-lumefantrine. The most frequent treatment emergent adverse events (AEs) were headache and vomiting. However, AEs were rare and were not more frequent in students who received artemether-lumefantrine in addition to praziquantel and albendazole. In this study, we found that the addition of malaria treatment to NTD MDA is well-received and safe. Such integrated programs may leverage existing infrastructures to reduce intervention costs and could become the framework for further integrated school-based health programs.
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Affiliation(s)
- Lauren M Cohee
- Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Moses Chilombe
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Andrew Ngwira
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Don P Mathanga
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Miriam K Laufer
- Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland
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Mooney JP, Barry A, Gonçalves BP, Tiono AB, Awandu SS, Grignard L, Drakeley CJ, Bottomley C, Bousema T, Riley EM. Haemolysis and haem oxygenase-1 induction during persistent "asymptomatic" malaria infection in Burkinabé children. Malar J 2018; 17:253. [PMID: 29980206 PMCID: PMC6035425 DOI: 10.1186/s12936-018-2402-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/03/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The haemolysis associated with clinical episodes of malaria results in the liberation of haem, which activates the enzyme haem oxygenase-1 (HO-1). HO-1 has been shown to reduce neutrophil function and increase susceptibility to invasive bacterial disease. However, the majority of community-associated malaria infections are subclinical, often termed "asymptomatic" and the consequences of low-grade haemolysis during subclinical malaria infection are unknown. STUDY DESIGN AND RESULTS As part of an ongoing study of subclinical malaria in Burkina Faso, 23 children with subclinical Plasmodium falciparum infections (determined by qPCR) were compared with 21 village-matched uninfected control children. Infected children showed evidence of persistent haemolysis over 35 days, with raised plasma haem and HO-1 concentrations. Concentrations of IL-10, which can also directly activate HO-1, were also higher in infected children compared to uninfected children. Regression analysis revealed that HO-1 was associated with haemolysis, but not with parasite density, anaemia or IL-10 concentration. CONCLUSIONS This study reveals that subclinical P. falciparum malaria infection is associated with sustained haemolysis and the induction of HO-1. Given the association between HO-1, neutrophil dysfunction and increased risk of Salmonella bacteraemia, prolonged HO-1 induction may explain epidemiological associations and geographic overlap between malaria and invasive bacterial disease. Further studies are needed to understand the consequences of persistent subclinical malaria infection, low-grade haemolysis and raised HO-1 on immune cell function and risk of comorbidities.
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Affiliation(s)
- Jason P Mooney
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK. .,The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, UK.
| | - Aissata Barry
- Centre National de Recherche et de Formation sur le Paludisme, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Bronner P Gonçalves
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | - Alfred B Tiono
- Centre National de Recherche et de Formation sur le Paludisme, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Shehu S Awandu
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lynn Grignard
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris J Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Teun Bousema
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eleanor M Riley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK.,The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, UK
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Klejnstrup NR, Buhl-Wiggers J, Jones S, Rand J. Early life malaria exposure and academic performance. PLoS One 2018; 13:e0199542. [PMID: 29933388 PMCID: PMC6014671 DOI: 10.1371/journal.pone.0199542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 06/08/2018] [Indexed: 11/19/2022] Open
Abstract
Malaria is a major cause of morbidity and mortality in sub-Saharan Africa. It is also a dynamic contributor to poverty through its effects on children's cognitive development. This paper examines the degree to which malaria in early childhood impacts on educational achievement in later childhood. The substantial decline in malaria in the region over recent years allows an assessment of its impact to be made. Focusing on Tanzania, we combine data from the Malaria Atlas Project and the 2010-2014 Uwezo household surveys (N = 246,325). We relate the district-level risk of malaria in a child's year of birth to his/her performance in tests of acquired cognitive skills (literacy and numeracy). For causal identification, we rely on differences across districts in the pace of decline in malaria prevalence occurring over the last 15 years. We control for time-invariant district level, age, birth cohort and survey year effects, as well as district-level trends and individual and household-specific factors. In addition, we use sibling variation in birth-year exposure to malaria to strengthen our identification. A ten percentage-point decrease in malaria prevalence in birth year is associated with a 0.06 standard deviation (p = 0.000) increase in English literacy achievement. This estimate is comparable in magnitude to education intervention programs with very large effects. Our results are robust to a large number of sensitivity analyses. We find no statistically significant effects of birth-year malaria exposure on attainments in numeracy and Kiswahili, and we argue that this is probably attributable to strong ceiling effects in these test scores. We conclude that in Tanzania malaria is an important factor in geographical variation in English literacy. This indicates that malaria is a significant public health challenge to educational achievement in this country, and probably in other regions with malaria.
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Affiliation(s)
- Ninja Ritter Klejnstrup
- Department of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | | | - Sam Jones
- Department of Economics, University of Copenhagen, Copenhagen, Denmark
| | - John Rand
- Department of Economics, University of Copenhagen, Copenhagen, Denmark
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46
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Cohee L, Laufer M. Tackling malaria transmission in sub-Saharan Africa. Lancet Glob Health 2018; 6:e598-e599. [PMID: 29661636 PMCID: PMC6375073 DOI: 10.1016/s2214-109x(18)30197-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/20/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Lauren Cohee
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Division of Malaria, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Miriam Laufer
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Division of Malaria, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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47
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Staedke SG, Maiteki-Sebuguzi C, Rehman AM, Kigozi SP, Gonahasa S, Okiring J, Lindsay SW, Kamya MR, Chandler CIR, Dorsey G, Drakeley C. Assessment of community-level effects of intermittent preventive treatment for malaria in schoolchildren in Jinja, Uganda (START-IPT trial): a cluster-randomised trial. LANCET GLOBAL HEALTH 2018; 6:e668-e679. [PMID: 29661635 PMCID: PMC5952991 DOI: 10.1016/s2214-109x(18)30126-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/16/2018] [Accepted: 03/01/2018] [Indexed: 12/16/2022]
Abstract
Background Intermittent preventive treatment (IPT) is a well established malaria control intervention. Evidence that delivering IPT to schoolchildren could provide community-level benefits is limited. We did a cluster-randomised controlled trial to assess the effect of IPT of primary schoolchildren with dihydroartemisinin-piperaquine (DP) on indicators of malaria transmission in the community, in Jinja, Uganda. Methods We included 84 clusters, each comprising one primary school and the 100 closest available households. The clusters were randomly assigned 1:1 to receive IPT with DP or standard care (control) by restricted randomisation to ensure balance by geography and school type. Children in intervention schools received IPT monthly for up to six rounds (June to December, 2014). We did cross-sectional community surveys in randomly selected households at baseline and in January to April, 2015, during which we measured participants' temperatures and obtained finger-prick blood smears for measurement of parasite prevalence by microscopy. We also did entomological surveys 1 night per month in households from 20 randomly selected IPT and 20 control clusters. The primary trial outcome was parasite prevalence in the final community survey. The primary entomological survey outcome was the annual entomological inoculation rate (aEIR) from July, 2014, to April, 2015. This trial is registered at ClinicalTrials.gov, number NCT02009215. Findings Among 23 280 students registered in the 42 intervention schools, 10 079 (43%) aged 5–20 years were enrolled and received at least one dose of DP. 9286 (92%) of 10 079 received at least one full course of DP (three doses). Community-level parasite prevalence was lower in the intervention clusters than in the control clusters (19% vs 23%, adjusted risk ratio 0·85, 95% CI 0·73–1·00, p=0·05). The aEIR was lower in the intervention group than in the control group, but not significantly so (10·1 vs 15·2 infective bites per person, adjusted incidence rate ratio 0·80, 95% CI 0·36–1·80, p=0·59). Interpretation IPT of schoolchildren with DP might have a positive effect on community-level malaria indicators and be operationally feasible. Studies with greater IPT coverage are needed. Funding UK Medical Research Council, UK Department for International Development, and Wellcome Trust.
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Affiliation(s)
- Sarah G Staedke
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Andrea M Rehman
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Simon P Kigozi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Moses R Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Clare I R Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Chris Drakeley
- Department of Infection and Immunity, London School of Hygiene and Tropical Medicine, London, UK
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Thera MA, Kone AK, Tangara B, Diarra E, Niare S, Dembele A, Sissoko MS, Doumbo OK. School-aged children based seasonal malaria chemoprevention using artesunate-amodiaquine in Mali. Parasite Epidemiol Control 2018; 3:96-105. [PMID: 29988270 PMCID: PMC6011810 DOI: 10.1016/j.parepi.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/02/2018] [Accepted: 02/03/2018] [Indexed: 11/01/2022] Open
Abstract
Introduction Malaria is still a public health problem in Africa. Seasonal Malaria Chemoprevention (SMC) is an efficient control strategy recommended by WHO that targets children under five year old living in areas of seasonal malaria transmission. SMC uses the combination amodiaquine (AQ) - sulfadoxine-pyrimethamine (SP). However SP selects rapidly drug resistant parasites. And malaria burden may increase in older children where SMC is implemented. We initiated a pilot study to assess an alternative approach to SMC in older children in Mali. Methods A randomized open-label clinical trial was conducted to test the efficacy and safety of SMC using artesunate - amodiaquine in school aged children in Mali. Two hundred pupils aged 6-15 years old were enrolled and randomized into two arms of 100 each, to receive either artesunate-amodiaquine (ASAQ) monthly or no intervention. Both arms were followed and clinical malaria were diagnosed and treated with arthemeter-lumefanthrine as recommended by Mali National Malaria Control Program. ASAQ was administered 3 days under study team direct observation and during 4 consecutive months starting in October 2013. Follow up was continued until April 2014. Results Overall, 20 cases of uncomplicated clinical malaria were encountered in the Control arm and three cases in the ASAQ arm, showing a protective efficacy of 85% 95% CI [80.1-89.9] against clinical malaria. Protective efficacy against malaria infection was 69.6% 95% CI [58.6-21.4]. No effect on anemia was observed. ASAQ was well tolerated. Most common solicited adverse events were abdominal pain and headaches of mild intensity in respectively 64% and 44% of children that swallowed ASAQ. Conclusion ASAQ is effective and well tolerated as SMC targeting older children in a peri urban setting in Mali. Its administration at schools is a feasible and accepted strategy to deliver the intervention.
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Affiliation(s)
- Mahamadou A Thera
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Abdoulaye K Kone
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Bourama Tangara
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Elizabeth Diarra
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Sirama Niare
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Abdramane Dembele
- Service of Psychiatry, University and Hospital Center of Point G, Bamako, Mali
| | - Mahamadou S Sissoko
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Ogobara K Doumbo
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
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Kabajulizi J, Keogh-Brown MR, Smith RD. The welfare implications of public healthcare financing: a macro-micro simulation analysis of Uganda. Health Policy Plan 2017; 32:1437-1448. [PMID: 29092033 DOI: 10.1093/heapol/czx125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 11/12/2022] Open
Abstract
Studies on global health and development suggest that there is a strong correlation between the burden of disease and a country's level of income. Poorer countries tend to suffer more deaths from preventable causes such as communicable, maternal, perinatal and nutritional conditions, compared with high-income countries. In low-income countries, the government health expenditure share in the general government budget is low and out-of-pocket payments for healthcare relatively high. They also rely heavily on external resources for health funding, yet sustainability of external resource flows is not guaranteed. This article explores increasing public healthcare funding from domestic resources mobilization, and evaluates the impact of measures to achieve this on sectoral growth and poverty reduction rates in Uganda using a dynamic computable general equilibrium model. This article shows that increasing the government health budget share, facilitates expanded healthcare services, improved population health, higher sectoral growth and reduced poverty. The agricultural sector is predicted to post the highest growth when compared with services and industry sectors under both domestic taxation and aid funding scenarios, while national poverty is predicted to decline from 31 to 12% of the population by 2020. This article demonstrates that the most effective measure is to frontload investment in healthcare and generate additional domestic funding for health from a household tax earmarked for health.
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Affiliation(s)
- Judith Kabajulizi
- Economics, School of Economics, Finance and Accounting, Faculty of Business and Law, Coventry University, Priory Street, Coventry, CV1 5FB, UK
| | - Marcus R Keogh-Brown
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Richard D Smith
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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50
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Clarke SE, Rouhani S, Diarra S, Saye R, Bamadio M, Jones R, Traore D, Traore K, Jukes MC, Thuilliez J, Brooker S, Roschnik N, Sacko M. Impact of a malaria intervention package in schools on Plasmodium infection, anaemia and cognitive function in schoolchildren in Mali: a pragmatic cluster-randomised trial. BMJ Glob Health 2017; 2:e000182. [PMID: 29081992 PMCID: PMC5656118 DOI: 10.1136/bmjgh-2016-000182] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 03/24/2017] [Accepted: 03/31/2017] [Indexed: 11/23/2022] Open
Abstract
Background School-aged children are rarely targeted by malaria control programmes, yet the prevalence of Plasmodium infection in primary school children often exceeds that seen in younger children and could affect haemoglobin concentration and school performance. Methods A cluster-randomised trial was carried out in 80 primary schools in southern Mali to evaluate the impact of a school-based malaria intervention package. Intervention schools received two interventions sequentially: (1) teacher-led participatory malaria prevention education, combined with distribution of long-lasting insecticidal nets (LLINs), followed 7 months later at the end of the transmission season by (2) mass delivery of artesunate and sulfadoxine-pyrimethamine administered by teachers, termed intermittent parasite clearance in schools (IPCs). Control schools received LLINs as part of the national universal net distribution programme. The impact of the interventions on malaria and anaemia was evaluated over 20 months using cross-sectional surveys in a random subset of 38 schools(all classes), with a range of cognitive measures (sustained attention, visual search, numeracy, vocabulary and writing) assessed in a longitudinal cohort of children aged 9–12 years in all 80 schools. Results Delivery of a single round of IPCs was associated with dramatic reductions in malaria parasitaemia (OR 0.005, 95% CI 0.002 to 0.011, p<0.001) and gametocyte carriage (OR 0.02, 95% CI 0.00 to 0.17, p<0.001) in intervention compared with control schools. This effect was sustained for 6 months until the beginning of the next transmission season. IPCs was also associated with a significant decrease in anaemia (OR 0.56, 95% CI 0.40 to 0.78, p=0.001), and increase in sustained attention (difference +0.23, 95% CI 0.10 to 0.36, p<0.001). There was no evidence of impact on other cognitive measures. Conclusion The combination of malaria prevention education, LLINs and IPCs can reduce anaemia and improve sustained attention of school children in areas of highly seasonal transmission. These findings highlight the impact of asymptomatic malaria infection on cognitive performance in schoolchildren and the benefit of IPCs in reducing this burden. Additionally, malaria control in schools can help diminish the infectious reservoir that sustains Plasmodium transmission.
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Affiliation(s)
- Siân E Clarke
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Saba Rouhani
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Save the Children, Bamako, Mali
| | | | - Renion Saye
- Ministry of Health, Institut National de Recherche en Santé Publique, Bamako, Mali
| | | | - Rebecca Jones
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Diahara Traore
- Ministry of Health, Programme National de Lutte contre le Paludisme, Bamako, Mali
| | - Klenon Traore
- Ministry of Health, Programme National de Lutte contre le Paludisme, Bamako, Mali
| | | | - Josselin Thuilliez
- CNRS (Centre National de la Recherche Scientifique) - Centre d'Économie de la Sorbonne, Paris, France
| | - Simon Brooker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Moussa Sacko
- Ministry of Health, Institut National de Recherche en Santé Publique, Bamako, Mali
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