Six-year trend analysis of malaria prevalence at University of Gondar Specialized Referral Hospital, Northwest Ethiopia, from 2014 to 2019

Factors associated with malaria in pregnancy among women attending ANC Clinic in Kwadaso Municipality, Ghana: a health facility based cross-sectional study

BACKGROUND

Globally, malaria remains a critical public health challenge, particularly in sub-Saharan Africa. Pregnant mothers are at a relatively higher risk of severe malaria than their non-pregnant counterparts due to natural immune suppression. In Ghana, the prevalence of malaria during pregnancy poses significant risks to maternal and fetal health. The primary aim of this study was to determine the factors associated with malaria in pregnancy among women attending ANC clinics in the Kwadaso Municipal, Ghana.

METHOD

This study employed a cross-sectional design to gather quantitative data from 405 pregnant women using a multistage sampling method. Data were collected through structured questionnaires administered. Descriptive and inferential statistics, including frequency tables, percentages, and regression analysis using Stata 17, were utilized for data analysis.

RESULTS

Out of the 405 participants, 201 (49.6%) tested positive for malaria, while the knowledge level of malaria among pregnant women was 16.5%. Bivariate logistic regression was conducted to determine the factors influencing malaria among pregnant women. The results showed that pregnant women aged 17 to 25 years are 5.41 times more likely to have high malaria prevalence compared to 40 to 51 age group (cOR = 5.41, 95% CI [2.20-6.83], p = 0.015). Pregnant women who do not use insecticide-treated bed nets regularly users are 10.3 times more likely to have high malaria compared to users (cOR = 10.3, 95% CI [4.05-11.02], p < 0.001). Multivarite logistic regression also showed that Women earning between 100 to 500 cedis are 7.0 times more likely to have malaria compared to those earning 3000 cedis or more (aOR = 7.0, 95% CI [3.23-8.74], p = 0.003). Women who do not regularly use insecticide-treated bed nets are 15.0 times more likely to experience high malaria prevalence compared to those who do use them (aOR = 15.0, 95% CI [7.03-16.09], p < 0.001), Lack of mosquito nets significantly increases the likelihood of 9.53 times high malaria prevalence (aOR = 9.53, 95% CI [4.07-10.95], p = 0.003). Pregnant women with Junior High School (JHS) education are 3.50 times more likely to have high malaria compared to those with no formal education (aOR = 3.50, 95% CI [1.32-4.78], p = 0.002).

CONCLUSION

This study highlights the significant burden of malaria among pregnant women in Kwadaso Municipal. Factors such as age, education levels, and socioeconomic status were identified as key determinants of malaria diagnosis. Additionally, environmental and preventive factors, including insufficient use of insecticide-treated bed nets and proximity to stagnant water, contributed to the likelihood of malaria. The study suggests that the Ghana Health Service and Ministry of Health should improve access to insecticide-treated bed nets, enhance malaria awareness, and integrate regular malaria screening into antenatal care.

Retrospective analysis of malaria prevalence over ten years (2015-2024) at Bichena Primary Hospital, Amhara Region, Ethiopia

BACKGROUND

Malaria remains a significant public health challenge in Ethiopia, hindering the country's productivity and development. While malaria incidence had decreased by 2018, and Ethiopia is working towards eliminating the disease by 2030, outbreaks still occur even in areas of low endemicity. Therefore the aim of this study was to assess the ten-year trend in malaria prevalence from 2015 to 2024 at Bichena Primary Hospital in the Amhara region of northwestern Ethiopia.

MATERIALS AND METHODS

A retrospective review of malaria blood film examination results was conducted using laboratory registration logbooks at Bichena Primary Hospital. Data collection was carried out from December 30, to January 14. The data were collected using a data collection sheet and entered into the Statistical Package for Social Sciences (SPSS) version for analysis. Bi-variable and multi-variable regression analyses and Pearson's chi-square test were used to examine associations and differences in malaria prevalence trends across factors such as sex, age, year, and season and Plasmodium species. Descriptive statistics were also used to summarize the sociodemographic characteristics of the study participants and the results were presented in graphs, tables and texts.

RESULTS

Out of the 24,107 malaria blood films examined, 4,322 (17.9%, 95% CI: 17.4%-18.4%) tested positive for Plasmodium infections. Of the confirmed cases, 58.7% were P. vivax, 28.6% were P. falciparum, and 12.2% were mixed infections. P. vivax was the predominant species throughout the study period (2015-2024), except for the years 2016 and 2018, when P. falciparum was more prevalent. Subsequently, an increase in malaria cases was reported, with the highest proportion recorded in 2024 (26.8%) and the lowest in 2018 (4%). The likelihood of malaria prevalence was 1.28 times higher in males than in females. Additionally, the chance of malaria prevalence was 1.27 times higher in the 15-24 age group compared to other age groups. The study revealed a significant rise in malaria prevalence, highlighting that malaria remains a major public health issue in the study area. There were also pronounced seasonal variations in malaria cases each year, with males and younger adults being more affected than females, older age groups, and children under five.

CONCLUSIONS AND RECOMMENDATIONS

Malaria prevention and control efforts need to be strengthened, focusing on regional differences. Ongoing research on diagnostic challenges, parasite elimination, and mosquito infectivity after malaria treatment is essential.

Gender characteristics, social determinants, and seasonal patterns of malaria incidence, relapse, and mortality in Sistan and Baluchistan province and other province of Iran: A systematic review and meta-analysis

INTRODUCTION

Malaria is a climate-dependent disease influenced by gender, social determination, seasonal patterns, and relapse incidence This study reviews these characteristics of malaria in the Sistan and Baluchistan (S&B) province and another province of Iran.

METHODS

This systematic review and meta-analysis was conducted through systematic and manual searches in electronic databases such as PubMed, Web of Science, Scopus, Science Direct, Google Scholar, and the Scientific Information Database. Studies from the S&B province, published from 1990 to 2024, written in Farsi and English, and reporting incidence, relapse, or death were included in this study. The quality of the studies was evaluated using the Newcastle-Ottawa Scale.

RESULTS

Out of 1941 studies initially identified, 43 were included in the systematic review, with 12 studies on relapse and 43 on incidence included in the meta-analysis. The combined results of the 43 primary studies using the random effect model showed that the frequency of malaria among infected women is 32% in S&B, 22% in other parts of Iran and 24% in the whole of Iran. This is 68%, 77% and 75% in men respectively. Among the primary studies, 8 deaths were reported in two studies, all of which were men. The incidence rate of malaria relapse varied from 0.30% to 46%. Based on the random effect model, the malaria relapse rate in Iran was estimated at 9%. The highest incidence of malaria in Iran was between spring and summer, and the lowest incidence was winter and spring. Most studies showed a downward trend in malaria incidence of malaria between 1986 to 2019. In term of socio-demographic status, malaria was more common in rural areas (82%). Although 28% were employed, and in term of age, young and old individuals (15 to 50 years) had the highest rate of infection.

CONCLUSION

This systematic review and meta-analysis revealed a lower incidence of malaria in women compared to men. The findings highlight the need for health care and the importance of targeted malaria control interventions, especially for men, rural areas, hot weather conditions, and young to middle-aged age groups, particularly in the S&B province.

A retrospective analysis of the malaria trend in Yemen over the sixteen-years, from 2006 to 2021

BACKGROUND

Malaria is one of the important diseases that threatens the global health system, especially in developing countries, including Yemen. Based on surveillance data, this analysis aimed to assess the trend of malaria in Yemen over the last sixteen years from 2006 to 2021.

METHODS

A retrospective analysis was conducted on secondary malaria data from the database from the Ministry of Public Health and Population in Yemen.

RESULTS

Of the 15,153,763 suspected cases, approximately 3,651,508 malaria cases were confirmed by both laboratory and clinical diagnoses. Plasmodium falciparum, P. vivax, mixed infections, P. malariae, and P. ovale were recorded at 1,118,117 (98.72%), 123,28 (1.10%), 1838 (0.16%), 155 (0.01%), and 30 (0.01%), respectively. Approximately 77.2% of all malaria cases were recorded in six governorates. Al Hudaydah recorded the highest number of malaria cases (1,231,294), followed by Hajjah (623,937), Taiz (450,051), Dhamar (167,399), Sa'adah (157,881), and Al-Mahweet (154,763). The overall incidence rate of malaria cases and P. falciparum, respectively, was 8.9 and 2.66 per 1,000 people. The highest mean incidence rate of malaria was recorded in Al Hudaydah, Hajjah, Al-Mahweet, Sa'adah, and Abyan, respectively, at 29.71, 19.49, 14.98, 10.62, and 10.14 per 1,000 people. Yemen reported 704 (0.02%) malaria death cases with an overall rate of case fatality of 0.03% and a mortality rate of 0.18 per 100,000 populations. The trend of case fatality decreased from 0.029% in 2006 to 0.015% in 2020, while the mortality rate per 100,000 individuals decreased from 0.3 in 2006 to 0.08 in 2021.

CONCLUSION

It currently suggests a continuous increase in the malaria burden without specifying trends or fluctuations and is becoming a public health threat and causing widespread concern. Therefore, the treatment and prevention of malaria infection are crucial for reducing mortality and complications by increasing the use of vector control tools and promoting early diagnosis and treatment.

Factors associated with malaria in pregnancy among women attending ANC clinics in selected districts of the Ashanti Region, Ghana

BACKGROUND

Malaria is a disease deeply rooted in poverty. Malaria in pregnant women leads to severe complications, including low birth weight and neonatal mortality, which can adversely affect both mother and child. This study aimed to identify the factors associated with malaria in pregnancy among women attending antenatal care (ANC) clinics in three districts of the Ashanti Region, Ghana.

METHODS

A cross-sectional study was conducted among 1215 pregnant women selected through multi-stage sampling. Data were collected using structured questionnaires and analysed using descriptive and inferential statistics, including regression analysis.

RESULTS

The self-reported prevalence of at least one episode of malaria was 76.7% (95% CI [74.1-79.3%]). Age, education, marital status, income, and religion were significantly associated with the prevalence of malaria among pregnant women, with a p-value < 0.001. Pregnant women aged 17-25 years were 10.26 times more likely to have malaria compared to other age groups (aOR = 10.26, 95% CI [4.52-11.05], p = 0.000). Women with no formal education had higher odds of malaria, being 15.10 times more likely to have malaria compared to those with tertiary education (aOR = 15.10, 95% CI [7.32-16.78], p = 0.002). Women not using insecticide-treated bed nets (ITNs) were 20 times more likely to have malaria compared to those who used ITNs (aOR = 20.0, 95% CI [7.04-21.03], p = 0.000).

CONCLUSION

Age, education, marital status, income, religion and insecticide-treated bed net (ITN) use significantly influence malaria prevalence in pregnancy. To achieve SDG 3 (Good Health and Well-being), particularly Target 3.1 (reducing maternal mortality) and Target 3.3 (ending malaria), the Ghana Health Service and Ministry of Health should prioritize expanding ITN distribution, educational campaigns, and targeted support for vulnerable groups to reduce malaria prevalence during pregnancy and improve maternal health outcomes.

Sex differences in CD8+ T cell responses during adaptive immunity

Biological sex is an important variable that influences the immune system's susceptibility to infectious and non-infectious diseases and their outcomes. Sex dimorphic features in innate and adaptive immune cells and their activities may help to explain sex differences in immune responses. T lymphocytes in the adaptive immune system are essential to providing protection against infectious and chronic inflammatory diseases. In this review, T cell responses are discussed with focus on the current knowledge of biological sex differences in CD8+ T cell mediated adaptive immune responses in infectious and chronic inflammatory diseases. Future directions aimed at investigating the molecular and cellular mechanisms underlying sex differences in diverse T cell responses will continue to underscore the significance of understanding sex differences in protective immunity at the cellular level, to induce appropriate T cell-based immune responses in infection, autoimmunity, and cancer. This article is categorized under: Immune System Diseases > Molecular and Cellular Physiology Infectious Diseases > Molecular and Cellular Physiology.

Malaria Prevalence and Risk Factors in Outpatients at Teda Health Center, Northwest Ethiopia: A Cross-Sectional Study

Background

Despite extensive efforts and achievements made in prevention and control, malaria is still a public health problem in Ethiopia. Currently, the case number has been climbing, even changing the epidemiology to the previously low-burden reporting locations. Therefore, our study is aimed at assessing malaria prevalence and associated risk factors in outpatients, Northwest Ethiopia.

Methods

A facility-based cross-sectional study was conducted among 318 malaria-suspected outpatients from October 22 to December 15, 2022, at Teda Health Center, Northwest Ethiopia. Sociodemographic characteristics and malaria risk factors were assessed by a face-to-face interview using a pretested questionnaire. Plasmodium parasites were detected by using microscopy on a blood film stained with 10% and 3% Giemsa stain. The data were analyzed using Statistical Package for Social Sciences software version 25, and statistical significance was reported at a p value < 0.05.

Results

Of the 318 study participants, 124 (39.0%; 95%CI = 33.6% - 44.6%) tested positive for Plasmodium infection. Plasmodium vivax, P. falciparum, and mixed infections were identified in 71 (57.3%), 47 (37.9%), and 6 (4.8%), respectively, among positive study participants. Individuals above the age of 15 (AOR = 2.704, 95% CI 1.370-5.336) were more likely to be infected with Plasmodium than under-five-year-old individuals. Rural residents (AOR = 2.56, 95% CI 1.281-5.098), those who sleep or work outside at night (AOR = 1.99, 95% CI 1.020-3.875), and individuals who did not use long-lasting insecticide-treated net (AOR = 3.26, 95% CI 1.633-6.499) and had a family member with a history of malaria (AOR = 2.902, 95%CI = 1.671 - 5.041) had higher odds of acquiring Plasmodium infection than their counterparts.

Conclusion

In our study area, malaria was a major health problem, with P. vivax being the dominant species. Multiple environmental and behavioural factors were associated with the infection acquisition. Therefore, urgent holistic intervention is required.

Prevalence of Malaria and Associated Factors during the Minor Malaria Season among Febrile Under-Five Children Attending Mohammed Akile Memorial General Hospital

Malaria is one of the major public health problems in sub-Saharan Africa, including Ethiopia. Children under the age of five are immunologically naive to plasmodium parasites, making them the most vulnerable group to clinical manifestations of malaria infection. Despite the severity of the disease in children under five years of age, most studies on malaria focus on the adult population. In the present study, a cross-sectional study design based on health facilities was used during the minor malaria season from February 18 to May 28, 2023, at Mohammed Akile Memorial General Hospital, in Afar Regional State, district of Amibara located in the town of Berta. The finding revealed that 19.8% prevalence among symptomatic children with 61.04% and 38.96% of P. falciparum and P. vivax, respectively. In the present study area, malaria infection in children under five years of age is significantly associated with the presence of stagnant water in the residential area, inappropriate or no use of insecticide-treated net, and indoor residual spraying (IRS). The prevalence of malaria among symptomatic children under five years of age is higher compared to the national prevalence of malaria among the general population. Therefore, community mobilization through health promotion, aiming to interrupt the transmission of malaria at the community level, is paramount.

Spatiotemporal distribution and bionomics of Anopheles stephensi in different eco-epidemiological settings in Ethiopia

BACKGROUND

Malaria is a major public health concern in Ethiopia, and its incidence could worsen with the spread of the invasive mosquito species Anopheles stephensi in the country. This study aimed to provide updates on the distribution of An. stephensi and likely household exposure in Ethiopia.

METHODS

Entomological surveillance was performed in 26 urban settings in Ethiopia from 2021 to 2023. A kilometer-by-kilometer quadrant was established per town, and approximately 20 structures per quadrant were surveyed every 3 months. Additional extensive sampling was conducted in 50 randomly selected structures in four urban centers in 2022 and 2023 to assess households' exposure to An. stephensi. Prokopack aspirators and CDC light traps were used to collect adult mosquitoes, and standard dippers were used to collect immature stages. The collected mosquitoes were identified to species level by morphological keys and molecular methods. PCR assays were used to assess Plasmodium infection and mosquito blood meal source.

RESULTS

Catches of adult An. stephensi were generally low (mean: 0.15 per trap), with eight positive sites among the 26 surveyed. This mosquito species was reported for the first time in Assosa, western Ethiopia. Anopheles stephensi was the predominant species in four of the eight positive sites, accounting for 75-100% relative abundance of the adult Anopheles catches. Household-level exposure, defined as the percentage of households with a peridomestic presence of An. stephensi, ranged from 18% in Metehara to 30% in Danan. Anopheles arabiensis was the predominant species in 20 of the 26 sites, accounting for 42.9-100% of the Anopheles catches. Bovine blood index, ovine blood index and human blood index values were 69.2%, 32.3% and 24.6%, respectively, for An. stephensi, and 65.4%, 46.7% and 35.8%, respectively, for An. arabiensis. None of the 197 An. stephensi mosquitoes assayed tested positive for Plasmodium sporozoite, while of the 1434 An. arabiensis mosquitoes assayed, 62 were positive for Plasmodium (10 for P. falciparum and 52 for P. vivax).

CONCLUSIONS

This study shows that the geographical range of An. stephensi has expanded to western Ethiopia. Strongly zoophagic behavior coupled with low adult catches might explain the absence of Plasmodium infection. The level of household exposure to An. stephensi in this study varied across positive sites. Further research is needed to better understand the bionomics and contribution of An. stephensi to malaria transmission.

Plasmodium falciparum transmission in the highlands of Ethiopia is driven by closely related and clonal parasites

Malaria cases are frequently recorded in the Ethiopian highlands even at altitudes above 2000 m. The epidemiology of malaria in the Ethiopian highlands, and, in particular, the role of importation by human migration from the highly endemic lowlands is not well understood. We sequenced 187 Plasmodium falciparum samples from two sites in the Ethiopian highlands, Gondar (n = 159) and Ziway (n = 28), using a multiplexed droplet digital PCR (ddPCR)-based amplicon sequencing method targeting 35 microhaplotypes and drug resistance loci. Here, we characterize the parasite population structure and genetic relatedness. We identify moderate parasite diversity (mean HE : 0.54) and low infection complexity (74.9% monoclonal). A significant percentage of infections share microhaplotypes, even across transmission seasons and sites, indicating persistent local transmission. We identify multiple clusters of clonal or near-clonal infections, highlighting high genetic relatedness. Only 6.3% of individuals diagnosed with P. falciparum reported recent travel. Yet, in clonal or near-clonal clusters, infections of travellers were frequently observed first in time, suggesting that parasites may have been imported and then transmitted locally. 31.1% of infections are pfhrp2-deleted and 84.4% pfhrp3-deleted, and 28.7% have pfhrp2/3 double deletions. Parasites with pfhrp2/3 deletions and wild-type parasites are genetically distinct. Mutations associated with resistance to sulphadoxine-pyrimethamine or suggested to reduce sensitivity to lumefantrine are observed at near-fixation. In conclusion, genomic data corroborate local transmission and the importance of intensified control in the Ethiopian highlands.

Analysing the six-year malaria trends at Metehara Health Centre in Central Ethiopia: the impact of resurgence on the 2030 elimination goals

BACKGROUND

Despite Ethiopia's concerted efforts to eliminate malaria by 2030, the disease continues to pose a significant public health and socioeconomic challenge in the country. The year 2021 witnessed 2.78 million malaria cases and 8041 associated deaths, emphasizing the persistent threat. Monitoring the prevalence trend of malaria is crucial for devising effective control and elimination strategies. This study aims to assess the trend of malaria prevalence at the Metehara Health Centre in the East Shoa Zone, Ethiopia.

METHODS

A retrospective study, spanning from February to September 2023, utilized malaria registration laboratory logbooks at Metehara Health Centre to evaluate the prevalence of malaria from 2017/18 to 2022/23. Malaria and related data were collected using a pre-designed data collection sheet. Descriptive statistics were employed for data summarization, presented through graphs and tables.

RESULTS

Out of 59,250 examined blood films, 17.4% confirmed the presence of Plasmodium infections. Among the confirmed cases, 74.3%, 23.8%, and 1.84% were attributed to Plasmodium falciparum, Plasmodium vivax, and mixed infections, respectively. The trend of malaria exhibited a steady decline from 2017/18 to 2021/22, reaching 9.8% prevalence. However, an abrupt increase to 26.5% was observed in 2022/23. Males accounted for a higher proportion (66%) of cases compared to females (34%). The age group 15-24 years experienced the highest malaria incidence at 42%. Notably, malaria cases peaked during autumn (September to November) at 43% and reached the lowest percentage during spring (March to May) at 13%.

CONCLUSION

Malaria persists as a significant health challenge in and around Metehara, central Ethiopia, predominantly driven by Plasmodium falciparum. The five-year declining trend was interrupted by a notable upsurge in 2022/23, indicating a resurgence of malaria in the study area. It is imperative to adopt a reverse strategy to sustain the progress achieved by the national malaria control plan.

Molecular investigation of malaria-infected patients in Djibouti city (2018-2021)

BACKGROUND

The Republic of Djibouti is a malaria endemic country that was in pre-elimination phase in 2006-2012. From 2013, however, malaria has re-emerged in the country, and its prevalence has been increasing every year. Given the co-circulation of several infectious agents in the country, the assessment of malaria infection based on microscopy or histidine-rich protein 2 (HRP2)-based rapid diagnostic tests (RDT) has shown its limitations. This study, therefore, aimed to assess the prevalence of malaria among febrile patients in Djibouti city using more robust molecular tools.

METHODS

All suspected malaria cases reported to be microscopy-positive were randomly sampled (n = 1113) and included in four health structures in Djibouti city over a 4-year period (2018-2021), mainly during the malaria transmission season (January-May). Socio-demographic information was collected, and RDT was performed in most of the included patients. The diagnosis was confirmed by species-specific nested polymerase chain reaction (PCR). Data were analysed using Fisher's exact test and kappa statistics.

RESULTS

In total, 1113 patients with suspected malaria and available blood samples were included. PCR confirmed that 788/1113 (70.8%) were positive for malaria. Among PCR-positive samples, 656 (83.2%) were due to Plasmodium falciparum, 88 (11.2%) Plasmodium vivax, and 44 (5.6%) P. falciparum/P. vivax mixed infections. In 2020, P. falciparum infections were confirmed by PCR in 50% (144/288) of negative RDTs. After the change of RDT in 2021, this percentage decreased to 17%. False negative RDT results were found more frequently (P < 0.05) in four districts of Djibouti city (Balbala, Quartier 7, Quartier 6, and Arhiba). Malaria occurred less frequently in regular bed net users than in non-users (odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.42-0.92).

CONCLUSIONS

The present study confirmed the high prevalence of falciparum malaria and, to a lesser extent, vivax malaria. Nevertheless, 29% of suspected malaria cases were misdiagnosed by microscopy and/or RDT. There is a need to strengthen the capacity for diagnosis by microscopy and to evaluate the possible role of P. falciparum hrp2 gene deletion, which leads to false negative cases of P. falciparum.