Dynamics of the Composition of Plasmodium Species Contained within Asymptomatic Malaria Infections in the Central Region of Ghana

Background

Monitoring changes in the composition of the Plasmodium species circulating within the population over a period can inform appropriate treatment recommendations. This study monitored variations in the prevalence of four common human Plasmodium species carried by children with asymptomatic malaria infections over a two-year period.

Methods

Two cross-sectional studies were conducted in November 2017 and December 2019. A total of 210 children aged between 4 and 13 years were recruited in 2017, and 164 similarly aged children were recruited in 2019. Approximately 150 μl of finger-pricked blood was used to prepare thick and thin blood smears as well as spot Whatman® #3 filter paper. Genomic DNA was extracted from the dried blood spots and used in PCR to amplify the 18S rRNA gene from four different human Plasmodium parasites.

Results

Parasite prevalence by microscopy and the prevalence of P. falciparum detected by PCR was relatively similar at the two time points (Pearson chi-square = 0.405, p=0.525, and Pearson chi-square = 0.452, p=0.501, respectively). However, the prevalence of PCR detectable P. malariae increased by 8.5-fold, whilst P. ovale increased from 0 to 9% in the children sampled in 2019 relative to the children sampled in 2017. The only parasite species identified by microscopy in this study was P. falciparum, and no P. vivax was identified by either microscopy or PCR in the study population during the study period.

Conclusion

There is the need to implement molecular diagnostic tools for malaria parasite surveillance in Ghana. This will enable the identification and treatment of all circulating malaria parasites including P. malariae and P. ovale, whose population is expanding in parts of Ghana including Simiw.

Availability and choice of antimalarials at medicine outlets in Ghana: the question of access to effective medicines for malaria control

Although national and international efforts to combat malaria have intensified over the years, problems with availability, distribution, and choice of antimalarials at medicine outlets in Africa continue to exist. This article presents the results of an indicator-based assessment of availability and choice of antimalarials at 130 licensed medicine outlets in Ghana. We also discuss how the choice of an antimalarial to dispense conforms to recommendations of the national policy for malaria therapy. Data were obtained through face-to-face interviews, by reviewing facility records, and by observing the practices of dispensing staff in the medicine outlets. Antimalarials recommended in the policy were not readily available in the most accessible medicine outlets. Few outlets adhered to the policy when choosing antimalarials. Interventions targeting medicine outlets should be initiated to improve availability and access to effective medicines in order to support the national program for malaria control.

Feasibility and acceptability of the use of artemether-lumefantrine in the home management of uncomplicated malaria in children 6-59 months old in Ghana

OBJECTIVE

We assessed the feasibility and acceptability of and the willingness to use artemether-lumefantrine (Coartem) during early, appropriate treatment of malaria/fever in children aged 6-59 months at the community and household level in a rural malaria-endemic area in Ghana.

METHOD

In this descriptive study with a pre- post-evaluation of an intervention, community perceptions of fever, health-seeking behaviour and current treatment practices for children aged 6-59 months were ascertained through qualitative research and surveys. The children were counted in a household census and given identification cards. Community-based agents (who were supervised monthly) dispensed a 6-dose-treatment formulation of Coartem over a 4 months period and counseled caregivers on case management and referral. Caregivers who consulted were followed up after 4 days to determine adherence to the treatment regimen. Blister packs of the drugs were inspected where available. The performance of the agents in terms of counselling, advising on referral and reporting was evaluated. Community satisfaction was also assessed qualitatively through focus group discussions and interviews.

RESULTS

Three hundred and sixty-three children sought care during the intervention period. All 235 children aged 6-35 months were correctly provided the one tablet per dose per treatment package compared with 119 of 125 children 36-59 months (95.2%). Only 5 of 17 children were referred appropriately. All 334 caregivers followed the correct drug administration schedule, i.e. twice a day for 3 days. Validation of drugs received indicates that all 204 children aged 6-35 months and 103/118 (87.3%) children aged 36-59 months received the correct drug dose. Adherence of agents and caregivers to the treatment was 308/334 (92.5%). Delay in seeking care was reduced from 3 to 2 days. No serious adverse drug reactions were reported. Community members were enthusiastic about the performance of the agents.

CONCLUSION

A Home Management of Malaria (HMM) strategy with Coartem using trained community-based agents supervised monthly is feasible, acceptable, and can achieve high levels of compliance within Dangme, West District of Ghana. However, if the intervention is to be sustainable, the agents need to be paid.

Socio-cultural determinants of treatment delay for childhood malaria in southern Ghana

We studied socio-cultural determinants of timely appropriate treatment seeking for children under 5 years suspected of having a perceived malaria-related illness. Caretakers of children with suspected malaria were interviewed about illness-related experiences, meanings and behaviour in two endemic villages in southern Ghana. Only 11% of children suspected of having a perceived malaria-related illness received timely appropriate treatment consistent with the Abuja target of treating malaria within 24 h of illness onset; 33% of children received appropriate treatment within 48 h. Reported perceived causes of phlegm predicted timely, appropriate treatment within 24 h of illness onset (P = 0.04) in a multivariate logistic regression model; playing on the ground (P < 0.01) predicted such treatment within 48 h. Two categories of distress, paleness or shortage of blood (P = 0.05) and sweating profusely (P = 0.03), also predicted timely, appropriate treatment within 24 h in a multivariate logistic regression model. Knowing that mosquitoes transmit malaria was not associated with timely, appropriate help seeking for the children, even though such knowledge may promote personal protective measures, especially use of bednets. Patterns of distress and PC were related to timely, appropriate help seeking, but not as expected. Effects on health seeking of illness-related experience and meaning are complex, and explaining their role may strengthen interventions for childhood malaria.

How local community knowledge about malaria affects insecticide-treated net use in northern Ghana

Large-scale trials of insecticide-treated nets (ITNs) throughout Sub-Saharan Africa demonstrated that they reduce child mortality in malaria endemic communities. These encouraging results have generated interest in ITNs as a viable malaria control strategy in many malaria endemic countries. However, regular use of ITNs under routine or non-project conditions has been beset with several problems. This paper explores how local community knowledge about malaria acts as a barrier to the use of ITNs in three settings. We employed structured formal observation and a range of interviewing techniques which included informal interviews, focus group discussions, semi-structured in-depth interviews, and structured survey interviewing. People recognize the term 'malaria' but have limited biomedical knowledge of the disease, including its aetiology, the role of the vector, and host response. Convulsions and anaemia are rarely linked to malaria. The people acknowledged a role for ITNs in nuisance reduction, but not for malaria prevention.

How do patients use antimalarial drugs? A review of the evidence

Patient adherence is a major determinant of the therapeutic response to antimalarial drugs, as most treatments are taken at home without medical supervision. With the introduction of new, effective, but more expensive antimalarials, there is concern that the high levels of efficacy observed in clinical trials may not be translated into effectiveness in the normal context of use. We reviewed available published evidence on adherence to antimalarial drugs and community drug usage; 24 studies were identified of which nine were 'intervention' studies, seven were classified as 'outcome studies', and the remainder were purely descriptive studies of antimalarial adherence. Definitions, methods, and results varied widely. Adherence was generally better when treatments were effective, and was improved by interventions focusing on provider knowledge and behaviour, packaging, and provision of correct dosages. There is insufficient information on this important subject, and current data certainly do not justify extrapolation from results with ineffective drugs to new effective treatments. Research in this area would benefit from of standardization of methodologies and the application of pharmacokinetic modelling.