Barriers to seeking health care among returning travellers with malaria: A systematic review

Delays in seeking healthcare and its determinants among malaria patients in Ethiopia: A systematic review and meta-analysis

METHODS

PubMed, Cochrane Library, Scopus, Web of Science, Google Scholar and Google were searched. Cross-sectional and case-control studies about delays in seeking healthcare for more than 24 hours were included. STATA 17 was used to analyze the data. Heterogeneity across studies was assessed via the I2 test. A funnel plot and Egger's test were used to assess publication bias. Subgroup analyses were performed by region and study setting. Sensitivity analysis was performed to determine the influence of individual studies.

RESULTS

A total of 18 articles with 7371 participants were included in this review. The pooled prevalence of delay in seeking healthcare was 67% (95% CI: 51%-84%). Age less than 15 years (OR: 2.27, 95% CI: 1.34-3.85), inability to read and write (OR: 3.36, 95% CI: 1.18-9.69), travel to health institutions on foot (OR: 2.77, 95% CI: 1.71-4.49), and by horse (OR: 2.76, 95% CI: 1.57-4.84), living far from a health institution (OR: 2.65, CI: 1.37-5.13), not having a family history of death (OR: 3.04, 95% CI: 2.14-4.33), and not being a member of community-based health insurance (OR: 7.14, 95% CI: 1.09-46.63) were significant determinants of delays in seeking healthcare.

CONCLUSION

The pooled prevalence of delays in seeking healthcare was high, and most of the determinants were modifiable. These findings underscore the need for targeted interventions to address these barriers and improve timely access to healthcare for affected populations.

The rising proportion of Plasmodium ovale spp. in imported malaria in Anhui Province, China: A retrospective propensity score-matched case-control study

No autochthonous malaria cases have been reported in Anhui Province, China, since 2014. However, imported malaria remains a significant public health concern. Moreover, the proportion of reported imported malaria cases attributed to Plasmodium ovale spp. (P. ovale spp.) has risen to unexpectedly high levels. The factors contributing to this increase and its potential impact on the healthcare system remain unknown. A retrospective case-control study utilizing surveillance data from 2012 to 2023 was conducted to explore these issues. By comparing individuals infected with P. ovale spp. to those with P. falciparum and employing propensity score matching, the research assessed epidemiological and clinical data. Results indicated that the proportion of cases from P. ovale spp. increased significantly (χ² = 9.388, P = 0.002), reaching 50.00 % in 2021. Differences between groups were noted in previous infection history (χ² = 8.358, P = 0.004), overseas stay duration (χ² = 7.856, P = 0.049), and onset timing (W = 2991.000, P < 0.001). P. ovale spp. cases had longer intervals from symptom onset to first medical visit and diagnosis than P. falciparum cases. Initial diagnosis and species identification were less accurate for P. ovale spp. (62.99 % and 30.52 %) compared to P. falciparum (74.03 % and 93.51 %). The increase in infections can be attributed to repeated exposure, which heightens the risk of contracting P. ovale spp. during extended stays in endemic regions, as well as to insufficient treatment of hepatic hypnozoites. It underscores the need for Anhui Province's healthcare facilities to enhance their diagnostic and treatment capacities for P. ovale spp., particularly through more sensitive detection techniques.

The Influence of Climate Change on Vector-Borne Diseases in a Wilderness Medicine Context

The imminent climate crisis has been labeled as the biggest health threat humanity must deal with. Vector-borne disease distribution and transmission as well as the population at risk are influenced to a great degree by environmental and climactic factors affecting both the vectors themselves and the causative pathogens. Paired with an increase in worldwide travel, urbanization, and globalization, along with population displacements and migration, elucidating the effects of anthropogenic climate change on these illnesses is therefore of the essence to stave off potential negative sequelae. Outcomes on different vector-borne diseases will be diverse, but for many of them, these developments will result in a distribution shift or expansion with the possibility of (re-)introduction of vector and pathogen species in previously nonendemic areas. The consequence will be a growing likelihood for novel human, vector, and pathogen interactions with an increased risk for infection, morbidity, and mortality. Wilderness medicine professionals commonly work in close relationship to the natural environment and therefore will experience these alterations most strongly in their practice. Hence, this article attempts to bring awareness to the subject at hand in a wilderness medicine context, with a focus on malaria, the most burdensome of arthropod-borne diseases. For prevention of the potentially dire consequences on human health induced by climate change, concerted and intensified efforts to reduce the burning of fossil fuels and thus greenhouse gas emissions will be imperative on a global scale.

Perceived causes and solutions for malaria prevalence among seasonal migrant workers in Northwest Ethiopia: a qualitative study

BACKGROUND

Seasonal migrant workers are at increased risk of malaria and can play a substantial role in transmitting the disease to receptive areas. Assessments conducted among these workers showed a high prevalence of malaria. This qualitative study aimed to explore the contributing factors and challenges to the high malaria prevalence among seasonal migrant workers in agricultural farm areas. The study also sought to identify potential solutions.

METHODS

A descriptive phenomenological approach was employed to investigate the perceived causes, challenges, and solutions related to malaria prevalence among seasonal migrant workers in the development corridors of southwest Ethiopia. This approach emphasizes describing experiences as they are, without researcher interpretation. Data were gathered from 24 individuals purposefully selected for their close involvement with seasonal migrant workers and their experience with malaria issues in agricultural farm areas. Open-ended questions were used, and interviews were conducted in safe, quiet settings. Data management was performed using Open Code software version 4.03, and thematic analysis was applied to the contents.

RESULTS

The study findings identified origin from highland areas, low health-seeking behaviour, working at night, and lack of use of long-lasting insecticidal nets (LLINs) as the perceived causes of high malaria prevalence among seasonal migrant workers by the study participants. Limited collaboration among stakeholders, a lack of migrant-friendly malaria prevention strategies, and inconsistent support for medical supplies were challenges highlighted by the key informants. Therefore, seasonal migrant workers were faced with high risk of malaria due to factors such as lack of immunity, delayed treatment, exposure to mosquitoes, and limited prevention efforts. Addressing these challenges is crucial for reducing malaria prevalence among this vulnerable population.

CONCLUSION

The study findings highlighted the need for targeted interventions to address the specific factors contributing to high malaria prevalence among seasonal migrant workers and to overcome the challenges in implementing effective malaria prevention strategies in this vulnerable population. Further study should be conducted to include the views and positions of seasonal migrant workers, owners of the farm areas, host communities, and political leaders.

Epidemiological feature of imported malaria in Taiwan during the 2014-to-2020 period

Although the World Health Organization (WHO) certified Taiwan as being malaria-free in 1965, there are reports of a few imported cases each year by travelers who visit malaria-endemic areas. This study examined the epidemiology of imported malaria cases in Taiwan from 2014 to 2020, utilizing national surveillance data from the Taiwan Centers for Disease Control. Malaria cases were confirmed through the application of standard laboratory methods. Passenger data came from the Tourism Bureau, Ministry of Transportation and Communication, Taiwan (TBMTC). All data were analyzed using SPSS version 21. The analysis included a dataset comprising 64 cases of imported malaria. Of the total cases, 77.8% were acquired from Africa, and 17.5% from Asia. Plasmodium falciparum was responsible for more than half (57.1%) of the cases, Plasmodium vivax malaria for 25.4% of cases, Plasmodium malariae malaria for 6.3%, Plasmodium ovale malaria for 4.8%, and unspecified pathogen malaria for 6.3% of the cases. Majority of the patients were male (75%) and were predominantly aged 20 to 59 years (70.3%). Most cases of imported malaria occurred during the fall season, and 51.6% of cases occurred in 8 cities during the period of 2014 to 2020. No evidence exists to indicate that indigenous malaria transmission occurs in Taiwan. Anopheles minimus was found in 4 cities (counties), namely Tainan City and Pingtung County in Southern Taiwan; Hualien County and Taitung County in Eastern Taiwan. The findings of this study highlight the necessity for robust surveillance systems, effective vector control measures, and targeted interventions for travelers and immigrants to prevent malaria outbreaks and maintain Taiwan's malaria-free status.

Establishing and applying an adaptive framework for imported malaria: a field practice in Anhui Province, China from 2012 to 2022

BACKGROUND

Anhui Province is currently facing an increase in imported malaria cases as a result of globalization and international travel. In response, Anhui Province has implemented a comprehensive adaptive framework to effectively address this threat.

METHODS

This study collected surveillance data from 2012 to 2022 in Anhui Province. Descriptive statistics were used to analyze the epidemiological characteristics of imported malaria cases. Additionally, multivariate logistic regression was employed to identify factors associated with severe malaria. Documents were reviewed to document the evolution of the adaptive framework designed to combat imported malaria. The effectiveness of the adaptive framework was evaluated based on the rates of timely medical visits, timely diagnosis, and species identification.

RESULTS

During the study period, a total of 1008 imported malaria cases were reported across 77 out of 105 counties in Anhui Province, representing a coverage of 73.33%. It was found that 10.52% of imported cases went undiagnosed for more than seven days after onset. The multivariate analysis revealed several potential risk factors for severe malaria, including increasing age (OR = 1.049, 95%CI:1.015-1.083), occupation (waitperson vs. worker, OR = 2.698, 95%CI:1.054-6.906), a longer time interval between onset and the initial medical visit (OR = 1.061, 95%CI:1.011-1.114), and misdiagnosis during the first medical visit (OR = 5.167, 95%CI:2.535-10.533). Following the implementation of the adaptive framework, the rates of timely medical visits, timely diagnosis, and species identification reached 100.00%, 78.57%, and 100.00%, respectively.

CONCLUSIONS

Anhui Province has successfully developed and implemented an adaptive framework for addressing imported malaria, focusing on robust surveillance, prompt diagnosis, and standardized treatment. The experiences gained from this initiative can serve as a valuable reference for other non-endemic areas.