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Manzoni G, Try R, Guintran JO, Christiansen-Jucht C, Jacoby E, Sovannaroth S, Zhang Z, Banouvong V, Shortus MS, Reyburn R, Chanthavisouk C, Linn NYY, Thapa B, Khine SK, Sudathip P, Gopinath D, Thieu NQ, Ngon MS, Cong DT, Hui L, Kelley J, Valecha NNK, Bustos MD, Rasmussen C, Tuseo L. Progress towards malaria elimination in the Greater Mekong Subregion: perspectives from the World Health Organization. Malar J 2024; 23:64. [PMID: 38429807 PMCID: PMC10908136 DOI: 10.1186/s12936-024-04851-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: 11/09/2023] [Accepted: 01/11/2024] [Indexed: 03/03/2024] Open
Abstract
Malaria remains a global health challenge, disproportionately affecting vulnerable communities. Despite substantial progress, the emergence of anti-malarial drug resistance poses a constant threat. The Greater Mekong Subregion (GMS), which includes Cambodia, China's Yunnan province, Lao People's Democratic Republic, Myanmar, Thailand, and Viet Nam has been the epicentre for the emergence of resistance to successive generations of anti-malarial therapies. From the perspective of the World Health Organization (WHO), this article considers the collaborative efforts in the GMS, to contain Plasmodium falciparum artemisinin partial resistance and multi-drug resistance and to advance malaria elimination. The emergence of artemisinin partial resistance in the GMS necessitated urgent action and regional collaboration resulting in the Strategy for Malaria Elimination in the Greater Mekong Subregion (2015-2030), advocating for accelerated malaria elimination interventions tailored to country needs, co-ordinated and supported by the WHO Mekong malaria elimination programme. The strategy has delivered substantial reductions in malaria across all GMS countries, with a 77% reduction in malaria cases and a 97% reduction in malaria deaths across the GMS between 2012 and 2022. Notably, China was certified malaria-free by WHO in 2021. Countries' ownership and accountability have been pivotal, with each GMS country outlining its priorities in strategic and annual work plans. The development of strong networks for anti-malarial drug resistance surveillance and epidemiological surveillance was essential. Harmonization of policies and guidelines enhanced collaboration, ensuring that activities were driven by evidence. Challenges persist, particularly in Myanmar, where security concerns have limited recent progress, though an intensification and acceleration plan aims to regain momentum. Barriers to implementation can slow progress and continuing innovation is needed. Accessing mobile and migrant populations is key to addressing remaining transmission foci, requiring effective cross-border collaboration. In conclusion, the GMS has made significant progress towards malaria elimination, particularly in the east where several countries are close to P. falciparum elimination. New and persisting challenges require sustained efforts and continued close collaboration. The GMS countries have repeatedly risen to every obstacle presented, and now is the time to re-double efforts and achieve the 2030 goal of malaria elimination for the region.
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Affiliation(s)
- Giulia Manzoni
- WHO Mekong Malaria Elimination Programme, Phnom Penh, Cambodia.
- Independent Consultant, Antananarivo, Madagascar.
| | - Rady Try
- WHO Mekong Malaria Elimination Programme, Phnom Penh, Cambodia
| | - Jean Olivier Guintran
- World Health Organization Country Office, Phnom Penh, Cambodia
- Independent Consultant, Le Bar sur Loup, France
| | | | - Elodie Jacoby
- WHO Mekong Malaria Elimination Programme, Phnom Penh, Cambodia
- Independent Consultant, Ho Chi Minh, Viet Nam
| | - Siv Sovannaroth
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Zaixing Zhang
- World Health Organization Country Office, Phnom Penh, Cambodia
| | | | | | - Rita Reyburn
- World Health Organization Country Office, Vientiane, Lao PDR
| | | | - Nay Yi Yi Linn
- National Malaria Control Programme, Nay Pyi Taw, Myanmar
| | - Badri Thapa
- World Health Organization Country Office, Yangon, Myanmar
| | | | - Prayuth Sudathip
- Division of Vector Borne Diseases, Department of Disease Control, Bangkok, Thailand
| | - Deyer Gopinath
- World Health Organization Country Office, Bangkok, Thailand
| | - Nguyen Quang Thieu
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Viet Nam
| | | | | | - Liu Hui
- Yunnan Institute of Parasitic Diseases, Yunnan, China
| | - James Kelley
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | | | - Maria Dorina Bustos
- World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | | | - Luciano Tuseo
- WHO Mekong Malaria Elimination Programme, Phnom Penh, Cambodia
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
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Por I, Sovannaroth S, Moran A, Dysoley L, Nguon S, Bunthy O, Meas MS, Barat L, Slot R, Thangadurai S, Kapella BK, Hassan SED, Po L, An SS, Gimnig JE, McDowell M, Thigpen M, Armistead J, AlMossawi HJ, Kheang ST, Kak N. Cost-effectiveness of malaria elimination in Sampov Loun Operational District, Cambodia. MALARIAWORLD JOURNAL 2020; 11:2. [PMID: 34532221 PMCID: PMC8415074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Over the past decade, Cambodia has seen a significant decline in its malaria burden. The government has established the goal of eliminating malaria in the country by 2025. With PMI/USAID support, Cambodia is implementing a package of interventions as part of its efforts. This assessment aimed to describe the cost of malaria elimination activities in Sampov Loun Operational District (OD) between July 2015 and March 2018, to describe the cost per malaria case detected under PMI programming, and to estimate the incremental cost-effectiveness of the elimination programme per Plasmodium falciparum (Pf) or P. vivax (Pv)/Pf mixed case averted under the Cambodia Malaria Elimination Programme (CMEP) and the U.S. President's Malaria Initiative. Opportunity costs of government workers were also assessed to understand the theoretical cost of sustaining this programme through government efforts alone. MATERIALS AND METHODS We conducted an empirical micro-costing analysis based on elimination activities alone using CMEP internal project implementation data and corresponding epidemiologic data from July 2015 to March 2018 and empirical findings from implementation to date. We then constructed a cost model in Microsoft Excel using empirical data and used a cost-effectiveness decision tree to describe programme effectiveness in the first three years of implementation and to estimate efficacy for the subsequent year. RESULTS The total cost of malaria elimination activities in Sampov Loun OD from July 2015 to March 2018 was $883,096. The cost per case of malaria detected in 2017 was $1,304. Including opportunity costs for government staff from July 2015 to March 2018, the total cost was $926,000. Under continued CMEP implementation, the projected future total cost of the program would be about $110,000 per year, or $0.64 per Sampov Loun resident. The incremental cost-effectiveness of the elimination programme was $28 for every additional Pf or Pv/Pf mix malaria case averted, compared to the no-CMEP proxy. CONCLUSION CMEP activities are cost effective compared to the no-CMEP proxy, as shown through an incremental cost-effectiveness of $28 for every additional Pf or Pv/Pf mix malaria case averted. The total cost of the project is 0.93% of the total per capita spending on health in Cambodia and about 5% of all government health expenditure. Continuing investments in malaria will be needed at national level for stewardship and governance and at local level for ensuring programme readiness in case of malaria outbreaks.
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Affiliation(s)
- Ir Por
- National Institute of Public Health, Phnom Penh, Cambodia
| | | | | | - Lek Dysoley
- National Malaria Control Program, Phnom Penh, Cambodia
| | - Sokomar Nguon
- PMI/USAID Cambodia Malaria Elimination Project, Phnom Penh, Cambodia
| | - Om Bunthy
- Sampov Loun Operational District, Battambang Province, Cambodia
| | - May Sak Meas
- Sampov Loun Operational District, Battambang Province, Cambodia
| | - Lawrence Barat
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | - Rida Slot
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | | | - Bryan K. Kapella
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | - Saad El-Din Hassan
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | - Ly Po
- National Malaria Control Program, Phnom Penh, Cambodia
| | - Sen Sam An
- PMI/USAID Cambodia Malaria Elimination Project, Phnom Penh, Cambodia
| | - John E. Gimnig
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | - Mary McDowell
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | - Michael Thigpen
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | - Jennifer Armistead
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | | | - Soy Ty Kheang
- National Institute of Public Health, Phnom Penh, Cambodia;,PMI/USAID Cambodia Malaria Elimination Project, Phnom Penh, Cambodia
| | - Neeraj Kak
- University Research Co., LLC (URC), Chevy Chase, MD, USA;,*
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Wojnarski B, Lon C, Sea D, Sok S, Sriwichai S, Chann S, Hom S, Boonchan T, Ly S, Sok C, Nou S, Oung P, Kong N, Pheap V, Thay K, Dao V, Kuntawunginn W, Feldman M, Gosi P, Buathong N, Ittiverakul M, Uthaimongkol N, Huy R, Spring M, Lek D, Smith P, Fukuda MM, Wojnarski M. Evaluation of the CareStart™ glucose-6-phosphate dehydrogenase (G6PD) rapid diagnostic test in the field settings and assessment of perceived risk from primaquine at the community level in Cambodia. PLoS One 2020; 15:e0228207. [PMID: 32004348 PMCID: PMC6994100 DOI: 10.1371/journal.pone.0228207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 01/10/2020] [Indexed: 11/19/2022] Open
Abstract
Background Primaquine is an approved radical cure treatment for Plasmodium vivax malaria but treatment can result in life-threatening hemolysis if given to a glucose-6-phosphate dehydrogenase deficient (G6PDd) patient. There is a need for reliable point-of-care G6PD diagnostic tests. Objectives To evaluate the performance of the CareStart™ rapid diagnostic test (RDT) in the hands of healthcare workers (HCWs) and village malaria workers (VMWs) in field settings, and to better understand user perceptions about the risks and benefits of PQ treatment guided by RDT results. Methods This study enrolled 105 HCWs and VMWs, herein referred to as trainees, who tested 1,543 healthy adult male volunteers from 84 villages in Cambodia. The trainees were instructed on G6PD screening, primaquine case management, and completed pre and post-training questionnaires. Each trainee tested up to 16 volunteers in the field under observation by the study staff. Results Out of 1,542 evaluable G6PD volunteers, 251 (16.28%) had quantitative enzymatic activity less than 30% of an adjusted male median (8.30 U/g Hb). There was no significant difference in test sensitivity in detecting G6PDd between trainees (97.21%), expert study staff in the field (98.01%), and in a laboratory setting (95.62%) (p = 0.229); however, test specificity was different for trainees (96.62%), expert study staff in the field (98.14%), and experts in the laboratory (98.99%) (p < 0.001). Negative predictive values were not statistically different for trainees, expert staff, and laboratory testing: 99.44%, 99.61%, and 99.15%, respectively. Knowledge scores increased significantly post-training, with 98.7% willing to prescribe primaquine for P.vivax malaria, an improvement from 40.6% pre-training (p < 0.001). Conclusion This study demonstrated ability of medical staff with different background to accurately use CareStart™ RDT to identify G6PDd in male patients, which may enable safer prescribing of primaquine; however, pharmacovigilance is required to address possible G6PDd misclassifications.
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Affiliation(s)
- Bertha Wojnarski
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- The George Washington University, School of Nursing, Washington, DC, United States of America
| | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Darapiseth Sea
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Somethy Sok
- Ministry of National Defense, Department of Health, Phnom Penh, Cambodia
| | | | | | - Sohei Hom
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - Sokna Ly
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Chandara Sok
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Samon Nou
- Chenda Polyclinic (CPC), Phnom Penh, Cambodia
| | - Pheaktra Oung
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Nareth Kong
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Vannak Pheap
- Ministry of National Defense, Department of Health, Phnom Penh, Cambodia
| | - Khengheang Thay
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Vy Dao
- Ministry of National Defense, Department of Health, Phnom Penh, Cambodia
| | | | - Mitra Feldman
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Panita Gosi
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Nillawan Buathong
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mali Ittiverakul
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Michele Spring
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Dysoley Lek
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Philip Smith
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mark M. Fukuda
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mariusz Wojnarski
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- * E-mail:
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Dable MT, Tano KD, Ouattara M, Silue KD, Menan EIH, Yavo W. Ex vivo efficacy of selective chalcone derivatives on reference strains and field isolates of Plasmodium falciparum. Pathog Glob Health 2020; 113:359-363. [PMID: 31910738 DOI: 10.1080/20477724.2019.1710065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The extension of Plasmodium falciparum resistance to existing antimalarial drugs is worrying. Faced with this problem, the search for new and effective molecules is necessary. In this context, six chalcone derivatives (B1, B11, B14, B17, SCA02 and SCA03) were tested on field isolates and then reference strains to evaluate their antiplasmodial activity by using the Rieckmann semi-microtest, recommended by WHO, for in vitro and ex vivo activity tests. Compounds B14 and B17 exhibited promising antiplasmodial activities (IC50s: 14.41-16.40 μM) regardless of the type of isolate. Compounds B1, B11, SCA02 and SCA03 showed a moderate inhibition of field isolates (IC50S: 25.63-48.29 μM) and very good activity against reference strains (IC50s: 3.82-10.03 μM). Therefore, more structural modulations should improve their efficiency and make these molecules very good candidates for future effective antimalarial drugs.
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Affiliation(s)
- Marius Trésor Dable
- Malaria Research and Control Centre, National Institute of Public Health, Abidjan, Côte d'Ivoire
| | - Konan Dominique Tano
- Malaria Research and Control Centre, National Institute of Public Health, Abidjan, Côte d'Ivoire
| | - Mahama Ouattara
- Department of Therapeutic Chemistry and Organic Chemistry, Faculty of Pharmacy and Biological Sciences Félix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
| | | | - Eby I Hervé Menan
- Centre for Diagnosis and Research on AIDS and other infectious diseases, Abidjan, Côte d'Ivoire
| | - William Yavo
- Malaria Research and Control Centre, National Institute of Public Health, Abidjan, Côte d'Ivoire.,Department of Parasitology-Mycology, Faculty of Pharmacy and Biological Sciences, Félix Houphouët Boigny University, Abidjan, Côte d'Ivoire
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5
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Boudarene L, James R, Coker R, Khan MS. Are scientific research outputs aligned with national policy makers' priorities? A case study of tuberculosis in Cambodia. Health Policy Plan 2018; 32:i3-i11. [PMID: 29028223 DOI: 10.1093/heapol/czx041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 11/13/2022] Open
Abstract
With funding for tuberculosis (TB) research decreasing, and the high global disease burden persisting, there are calls for increased investment in TB research. However, justification of such investments is questionable, when translation of research outputs into policy and health care improvements remains a challenge for TB and other diseases. Using TB in Cambodia as a case study, we investigate how evidence needs of national policy makers are addressed by topics covered in research publications. We first conducted a systematic review to compile all studies on TB in Cambodia published since 2000. We then identified priority areas in which evidence for policy and programme planning are required from the perspective of key national TB control stakeholders. Finally, results from the literature review were analysed in relation to the priority research areas for national policy makers to assess overlap and highlight gaps in evidence. Priority research areas were: TB-HIV co-infection; childhood TB; multidrug resistant TB (MDR-TB); and universal and equitable access to quality diagnosis and treatment. On screening 1687 unique papers retrieved from our literature search, 253 were eligible publications focusing on TB in Cambodia. Of these, only 73 (29%) addressed one of the four priority research areas. Overall, 30 (11%), five (2%), seven (2%) and 37 (14%) studies reported findings relevant to TB-HIV, childhood TB, MDR-TB and access to quality diagnosis and treatment respectively. Our analysis shows that a small proportion of the research outputs in Cambodia address priority areas for informing policy and programme planning. This case study illustrates that there is substantial room for improvement in alignment between research outputs and evidence gaps that national policy makers would like to see addressed; better coordination between researchers, funders and policy makers' on identifying priority research topics may increase the relevance of research findings to health policies and programmes.
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Affiliation(s)
- Lydia Boudarene
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore 117549, Singapore.,University of Health Science, 73 Preah Monivong Blvd (93), Phnom Penh, Cambodia
| | - Richard James
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore 117549, Singapore.,University of Health Science, 73 Preah Monivong Blvd (93), Phnom Penh, Cambodia
| | - Richard Coker
- Communicable Diseases Research and Policy Group, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK.,Mahidol University, 420/1 Ratchawithi RD, Ratchathewi District, Bangkok, Thailand
| | - Mishal S Khan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore 117549, Singapore.,Communicable Diseases Research and Policy Group, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
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6
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Onyiah P, Adamu AMY, Afolabi RF, Ajumobi O, Ughasoro MD, Odeyinka O, Nguku P, Ajayi IO. Bottlenecks, concerns and needs in malaria operational research: the perspectives of key stakeholders in Nigeria. BMC Res Notes 2018; 11:272. [PMID: 29728139 PMCID: PMC5935974 DOI: 10.1186/s13104-018-3379-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 04/30/2018] [Indexed: 01/10/2023] Open
Abstract
Objective We conducted a study to determine stakeholders’ perspective of the bottlenecks, concerns and needs to malaria operational research (MOR) agenda setting in Nigeria. Results Eighty-five (37.9%) stakeholders identified lack of positive behavioural change as the major bottleneck to MOR across the malaria thematic areas comprising of malaria prevention 58.8% (50), case management 34.8% (39), advocacy communication and social mobilisation 4.7% (4) while procurement and supply chain management (PSM) and programme management experts had the least response of 1.2% (1) each. Other bottlenecks were inadequate capacity to implement (13.8%, n = 31), inadequate funds (11.6%, n = 26), poor supply management (9.4%, n = 21), administrative bureaucracy (5.8%, n = 13), inadequacy of experts (1.3%, n = 3) and poor policy implementation (4.9%, n = 11). Of the 31 stakeholders who opined lack of capacity to execute malaria operational research; 17 (54.8%), 10 (32.3%), 3 (9.7%) and 1 (3.2%) were experts in case management, malaria prevention, surveillance, monitoring and evaluation and PSM respectively. Improvement in community enlightenment and awareness strategies; and active involvement of health care workers public and private sectors were identified solutions to lack of positive behavioural change. Electronic supplementary material The online version of this article (10.1186/s13104-018-3379-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pamela Onyiah
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Al-Mukhtar Y Adamu
- Department of Medical Microbiology and Parasitology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Rotimi F Afolabi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Queen Elizabeth Road, UCH Campus, Ibadan, 23402, Oyo State, Nigeria.
| | - Olufemi Ajumobi
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,African Field Epidemiology Network, Abuja, Nigeria
| | - Maduka D Ughasoro
- Department of Paediatrics, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Oluwaseun Odeyinka
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Queen Elizabeth Road, UCH Campus, Ibadan, 23402, Oyo State, Nigeria
| | - Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,African Field Epidemiology Network, Abuja, Nigeria
| | - IkeOluwapo O Ajayi
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Queen Elizabeth Road, UCH Campus, Ibadan, 23402, Oyo State, Nigeria
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7
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Ly P, Thwing J, McGinn C, Quintero CE, Top-Samphor N, Habib N, Richards JS, Canavati SE, Vinjamuri SB, Nguon C. The use of respondent-driven sampling to assess malaria knowledge, treatment-seeking behaviours and preventive practices among mobile and migrant populations in a setting of artemisinin resistance in Western Cambodia. Malar J 2017; 16:378. [PMID: 28927405 PMCID: PMC5606124 DOI: 10.1186/s12936-017-2003-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 08/30/2017] [Indexed: 12/31/2022] Open
Abstract
Background Multi-drug-resistant Plasmodium falciparum threatens malaria elimination efforts in Cambodia and the Greater Mekong Subregion (GMS). Malaria burden in the GMS is higher among certain high-risk demographic groups in Cambodia, especially among migrant and mobile populations (MMPs). This respondent driven sampling (RDS) study was conducted in order to determine malaria knowledge, treatment-seeking behaviours and preventive practices among two MMP groups in Western Cambodia. Methods An RDS survey of MMPs was implemented in four purposively-selected communes along the Thai–Cambodia border; two in Veal Veang District and two in Pailin Province, chosen due to their sizeable MMP groups, their convenience of access, and their proximity to Thailand, which allowed for comparison with RDS studies in Thailand. Results There were 764 participants in Pailin Province and 737 in Veal Veang District. Health messages received in Veal Veang were most likely to come from billboards (76.5%) and family and friends (57.7%), while in Pailin they were most likely to come from sources like radio (57.1%) and television (31.3%). Knowledge of malaria transmission by mosquito and prevention by bed net was above 94% in both locations, but some misinformation regarding means of transmission and prevention methods existed, predominantly in Veal Veang. Ownership of treated bed nets was lower in Pailin than in Veal Veang (25.3% vs 53.2%), while reported use the night before the survey was higher in Pailin than in Veal Veang (57.1% vs 31.6%). Use of private sector health and pharmaceutical services was common, but 81.1% of patients treated for malaria in Pailin and 86.6% in Veal Veang had received a diagnostic test. Only 29.6% of patients treated in Pailin and 19.6% of those treated in Veal Veng reported receiving the indicated first-line treatment. Discussion Barriers in access to malaria prevention and case management were common among MMPs, with marked variation by site. Resolving both nation-wide and MMP-specific challenges will require targeted interventions that take into account this heterogeneity.
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Affiliation(s)
- Po Ly
- National Centre For Parasitology, Entomology and Malaria Control, Ministry of Health, Corner Street 92, Rapaing Svay Village, Sankat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia
| | - Julie Thwing
- Malaria Branch, Division of Parasitic Disease and Malaria, Centres for Disease Control and Prevention, Atlanta, USA
| | - Colleen McGinn
- WHO Representative Office in Cambodia, # 61-64 Norodam Preah Blvd., Penh, Phnom Penh, Cambodia
| | - Cesia E Quintero
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
| | - Narann Top-Samphor
- WHO Representative Office in Cambodia, # 61-64 Norodam Preah Blvd., Penh, Phnom Penh, Cambodia
| | - Najibullah Habib
- WHO Representative Office in Cambodia, # 61-64 Norodam Preah Blvd., Penh, Phnom Penh, Cambodia
| | - Jack S Richards
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
| | - Sara E Canavati
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia. .,Vysnova Partners Inc., Washington, DC, USA.
| | - Seshu Babu Vinjamuri
- National Centre For Parasitology, Entomology and Malaria Control, Ministry of Health, Corner Street 92, Rapaing Svay Village, Sankat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia
| | - Chea Nguon
- National Centre For Parasitology, Entomology and Malaria Control, Ministry of Health, Corner Street 92, Rapaing Svay Village, Sankat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia
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8
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Canavati SE, Quintero CE, Haller B, Lek D, Yok S, Richards JS, Whittaker MA. Maximizing research study effectiveness in malaria elimination settings: a mixed methods study to capture the experiences of field-based staff. Malar J 2017; 16:362. [PMID: 28893264 PMCID: PMC5594431 DOI: 10.1186/s12936-017-2016-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 09/06/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In a drug-resistant, malaria elimination setting like Western Cambodia, field research is essential for the development of novel anti-malarial regimens and the public health solutions necessary to monitor the spread of resistance and eliminate infection. Such field studies often face a variety of similar implementation challenges, but these are rarely captured in a systematic way or used to optimize future study designs that might overcome similar challenges. Field-based research staff often have extensive experience and can provide valuable insight regarding these issues, but their perspectives and experiences are rarely documented and seldom integrated into future research protocols. This mixed-methods analysis sought to gain an understanding of the daily challenges encountered by research field staff in the artemisinin-resistant, malaria elimination setting of Western Cambodia. In doing so, this study seeks to understand how the experiences and opinions of field staff can be captured, and used to inform future study designs. METHODS Twenty-two reports from six field-based malaria studies conducted in Western Cambodia were reviewed using content analysis to identify challenges to conducting the research. Informal Interviews, Focus Group Discussions and In-depth Interviews were also conducted among field research staff. Thematic analysis of the data was undertaken using Nvivo 9® software. Triangulation and critical case analysis was also used. RESULTS There was a lack of formalized avenues through which field workers could report challenges experienced when conducting the malaria studies. Field research staff faced significant logistical barriers to participant recruitment and data collection, including a lack of available transportation to cover long distances, and the fact that mobile and migrant populations (MMPs) are usually excluded from studies because of challenges in follow-up. Cultural barriers to communication also hindered participant recruitment and created unexpected delays. Field staff often paid a physical, emotional and financial cost, going beyond their duty in order to keep the study running. CONCLUSIONS Formal monthly reports filled out by field study staff could be a key tool for capturing field study staff experiences effectively, but require specific report fields to encourage staff to outline their challenges and to propose potential solutions. Forging strong bonds with communities and their leaders may improve communication, and decrease barriers to participant recruitment. Study designs that make it feasible for MMPs to participate should be pursued; in addition to increasing the potential participant pool, this will ensure that the most malaria-endemic demographic is taken into account in research studies. Overlaps between clinical care and research create ethical dilemmas for study staff, a fact that warrants careful consideration. Lessons learned from study field staff should be used to create a set of locally-relevant recommendations to inform future study designs.
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Affiliation(s)
- Sara E. Canavati
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
- Vysnova Partners Inc., Washington, DC USA
| | - Cesia E. Quintero
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
| | | | - Dysoley Lek
- The National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Sovann Yok
- Provincial Health Department, Pailin City, Pailin Province Cambodia
| | - Jack S. Richards
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
- Department of Medicine, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
- Department of Infectious Diseases, Monash University, Melbourne, Australia
| | - Maxine Anne Whittaker
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
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Khan M, James R, Sundaram N, Wu S, Eang MT, Vonthanak S, Coker R. Less research on tuberculosis than HIV and malaria when research agendas are poorly coordinated: a systematic review of research outputs from Cambodia. Int J Infect Dis 2016; 56:25-29. [PMID: 27979784 DOI: 10.1016/j.ijid.2016.11.417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/19/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Coordination of health interventions and research is often weak during periods of political transition and unprecedented aid inflows, which Cambodia has recently experienced. Although HIV, tuberculosis (TB), and malaria have been a focus of international funding, TB has received much less. This study compares the numbers and methodologies of studies conducted on TB, malaria, and HIV in Cambodia, identifying evidence gaps and future research needs. METHODS Three electronic databases and the grey literature were searched for studies on HIV, TB, and malaria published between January 2000 and October 2015. Information about the disease focus and methodology was extracted from the studies included. RESULTS A total of 2581 unique studies were screened and 712 were included in the analysis. The results of this review demonstrated that despite increasing numbers of publications, there have been fewer studies on TB (16%) than HIV (43%) and malaria (41%). Observational epidemiological studies outnumbered other methodologies (44%) for all three diseases. CONCLUSIONS Despite substantial investments, important research areas appear to have been neglected in Cambodia; specifically, studies on TB and studies involving economic, qualitative, interventional, and genomics methods. The inter-disease disparity in published research in Cambodia identified, considered alongside disease burden, suggests that an increase in TB research may be needed to inform control strategies.
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Affiliation(s)
- Mishal Khan
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Richard James
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Neisha Sundaram
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mao Tang Eang
- National Centre for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Saphonn Vonthanak
- University of Health Science, Phnom Penh, Cambodia; National Centre for HIV/AIDS, Dermatology and STDs (NCHADS), Phnom Penh, Cambodia
| | - Richard Coker
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK; Mahidol University, Ratchathewi District, Bangkok, Thailand
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Sweileh WM, Sawalha AF, Al-Jabi SW, Zyoud SH, Shraim NY, Abu-Taha AS. A bibliometric analysis of literature on malaria vector resistance: (1996 - 2015). Global Health 2016; 12:76. [PMID: 27884199 PMCID: PMC5123357 DOI: 10.1186/s12992-016-0214-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/08/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Emergence of insecticide resistance in malaria vectors is a real threat to future goals of elimination and control of malaria. Therefore, the objective of this study was to assess research trend on insecticide resistance of Anopheles mosquito. In specific, number of publications, countries, institutions, and authors' research profile, citation analysis, international collaborations, and impact of journals publishing documents on insecticide resistance will be presented. It was conducted via Scopus search engine which was used to retrieve relevant data. Keywords used were based on literature available on this topic. The duration of study was set from 1996-2015. RESULTS A total of 616 documents, mainly as original research articles (n = 569; 92.37%) were retrieved. The average number of citations per article was 26.36. Poisson log-linear regression analysis indicated that there was a 6.00% increase in the number of publications for each extra article on pyrethroid resistance. A total of 82 different countries and 1922 authors participated in publishing retrieved articles. The United Kingdom (UK) ranked first in number of publications followed by the United States of America (USA) and France. The top ten productive countries included seven African countries. The UK had collaborations mostly with Benin (relative link strength = 46). A total of 1817 institution/ organizations participated in the publication of retrieved articles. The most active institution/ organization was Liverpool School of Tropical Medicine. Retrieved articles were published in 134 different scientific peer reviewed journals. The journal that published most on this topic was Malaria Journal (n = 101; 16.4%). Four of the top active authors were from South Africa and two were from the UK. Three of the top ten cited articles were published in Insect Molecular Biology journal. Six articles were about pyrethroid resistance and at least two were about DDT resistance. CONCLUSION Publications on insecticide resistance in malaria vector has gained momentum in the past decade. International collaborations enhanced the knowledge about the situation of vector resistance in countries with endemic malaria. Molecular biology of insecticide resistance is the key issue in understanding and overcoming this emerging problems.
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Affiliation(s)
- Waleed M. Sweileh
- Department of Physiology, Pharmacology, Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ansam F. Sawalha
- Department of Physiology, Pharmacology, Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Samah W. Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Naser Y. Shraim
- Department of Pharmaceutical Chemistry and Technology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Adham S. Abu-Taha
- Department of Physiology, Pharmacology, Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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Abstract
Parasites of the genus Plasmodium have a complex life cycle. They alternate between their final mosquito host and their intermediate hosts. The parasite can be either extra- or intracellular, depending on the stage of development. By modifying their shape, motility, and metabolic requirements, the parasite adapts to the different environments in their different hosts. The parasite has evolved to escape the multiple immune mechanisms in the host that try to block parasite development at the different stages of their development. In this article, we describe the mechanisms reported thus far that allow the Plasmodium parasite to evade innate and adaptive immune responses.
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Affiliation(s)
- Laurent Rénia
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Yun Shan Goh
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore
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