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Fauziah N, Rinawan FR, Nugraha NF, Faridah L, Jati KM, Dakosta A, Santika MK, Zakiyyudin MY, Muhsin A, Rizkillah KF, Nisa MN, Ristandi RB. Malaria elimination in West Java, Indonesia: A descriptive-and-qualitative study. J Vector Borne Dis 2024; 61:183-194. [PMID: 38922652 DOI: 10.4103/jvbd.jvbd_113_23] [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: 06/28/2023] [Accepted: 09/05/2023] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND OBJECTIVES Following World Health Organization (WHO) plans for thirty-five malaria-endemic countries, Indonesia will eliminate malaria by 2030. As one of the Indonesian provinces, West Java targeted subnational malaria elimination in 2022. This article aims to describe malaria surveillance data and elimination programs, including weaknesses in sustaining the program. METHODS This study used secondary data from malaria surveillance information system regencies/cities' case reports for 2019-2022 and achievement data of sub-national malaria elimination certification from each regency/city from 2014-2022. The data was confirmed from the evaluation study document, analysis of reported cases, and interviews. RESULTS Most cases were confirmed by microscopic examination (84.1% in 2021 and 94.4% in 2022) and rapid diagnostic tests (57% in 2019 and 58.1% in 2020). Malaria is more prevalent among men (93% in 2019, 95% in 2020, 96% in 2021, and 95.9% in 2022) and productive ages of 15-64 years (98.8% in 2019, 100% in 2020, 99.2% in 2021, and 98.8% in 2022), frequently occurs in the military (56.3% in 2019, 75.7% in 2020, 45.2% in 2021) and police (40.5% in 2022), often uses passive case detection for identifying cases (97.9% in 2019 and 2020, 95.2% in 2021, and 97.6% in 2022), and the majority undergo inpatient treatment (86.4% in 2019, 81.7% in 2021, and 82.6% in 2022). Most positive cases originated from imported cases, and last indigenous cases were still found in 2019. Plasmodium vivax dominated malaria cases and and relapses were high (55.0% in 2020, and 47.3% in 2022). INTERPRETATION CONCLUSION All regencies/cities have obtained sub-national malaria elimination certification in 2022. West Java has the potential to be verified for Java-Bali sub-national malaria elimination targeted in 2023, albeit cases of imported malaria still occur. It is imperative to address the issue of imported cases transitioning into locally transmitted cases (introduced) by effective coordination across all regencies/cities and inter-provincial efforts.
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Affiliation(s)
- Nisa Fauziah
- Division of Parasitology, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
- Laboratory of Parasitology, Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, West Java, Indonesia
| | - Fedri Ruluwedrata Rinawan
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
- Center for Health System Study and Health Workforce Education Innovation, Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
- Indonesian Society for Remote Sensing Branch West Java, Indoenesia
| | - Naufal Fakhri Nugraha
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, West Java, Indonesia
| | - Lia Faridah
- Division of Parasitology, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
- Laboratory of Parasitology, Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, West Java, Indonesia
| | - Karomahul Malaya Jati
- Undergraduate Medical Study Program, Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
| | - Angelina Dakosta
- Undergraduate Medical Study Program, Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
| | - Mahatyanta Kalya Santika
- Undergraduate Medical Study Program, Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
| | - Muhammad Yusuf Zakiyyudin
- Undergraduate Medical Study Program, Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
| | - Ahmad Muhsin
- Undergraduate Medical Study Program, Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
| | | | - Miftahul Nurun Nisa
- Health Polytechnic of Health Ministry Yogyakarta, Yogyakarta, Indonesia
- World Health Organization (WHO) Country Office of Indonesia, Jakarta, Indonesia
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Edwards HM, Sarwar R, Mahmud P, Emmanuel S, Maxwell K, Tibenderana JK. The private sector market for malaria rapid diagnostic tests in Nigeria: results of the 2018 market survey. Malar J 2022; 21:190. [PMID: 35710474 PMCID: PMC9205121 DOI: 10.1186/s12936-022-04209-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To avoid misuse of anti-malarials, correct diagnosis of fever prior to drug prescription is essential. Presumptive treatment in the private healthcare sector is a concern in Nigeria, where availability of affordable artemisinin-based combination therapy (ACT) is high following the implementation of subsidy schemes from 2010 to 2017. Similar subsidies have not, however, been implemented for malaria rapid diagnostic tests (RDTs). A market survey in 2018 predominantly designed to assess the ACT market in the private sector also collected data related to RDTs, results of which are presented herein. METHODS A 2018 market survey consisted of (i) an outlet survey targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across different regions of Nigeria to assess supply-side market factors related to availability of RDTs (defined as having stock available for purchase at the time of the survey) and (ii) a household survey to determine demand-side factors related to knowledge of RDTs, healthcare-seeking practices and affordability. RESULTS Availability of RDTs at the time of the survey was low in both outlet types and significantly lower in PPMVs (22.1%, 95% CI) among pharmacies versus (13.6%, 95% CI) among PPMVs (p < 0.01). Reasons for not restocking RDTs included low demand and no supply. The majority of households diagnose malaria based on experience, while one-third would visit a PPMV or pharmacy. Half of households had heard of RDTs (48.4%) and 38.6% thought they were affordable. CONCLUSIONS Low availability of RDTs among PPMVs and pharmacies may be attributed to lack of demand, supply-side issues and cost. Increasing household knowledge of RDTs may aid increasing demand, while subsidized RDTs may address supply and price issues. Addressing the deficit in RDT provision is important for targeting of ACT medicines.
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Affiliation(s)
- Hannah M Edwards
- Malaria Consortium Headquarters, 244-254 Cambridge Heath Rd, London, E2 9DA, UK.
| | - Rubaiyath Sarwar
- Innovision Consulting Private Limited, Level 3 & 4 House 26 Road 6 Baridhara J Block Pragati Sarani, Dhaka, 1212, Bangladesh
| | - Parvez Mahmud
- Innovision Consulting Private Limited, Level 3 & 4 House 26 Road 6 Baridhara J Block Pragati Sarani, Dhaka, 1212, Bangladesh
| | - Shekarau Emmanuel
- Case Management Branch, National Malaria Elimination Programme, First Floor, Abia House, Central Business District, Abuja, Nigeria
| | - Kolawole Maxwell
- Malaria Consortium Nigeria, 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja, FCT, Nigeria
| | - James K Tibenderana
- Malaria Consortium Headquarters, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
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Edwards HM, Sarwar R, Mahmud P, Emmanuel S, Maxwell K, Tibenderana JK. The impact of the private sector co-payment mechanism (PSCM) on the private market for ACT in Nigeria: results of the 2018 cross-sectional outlet and household market surveys. Malar J 2022; 21:42. [PMID: 35151332 PMCID: PMC8841089 DOI: 10.1186/s12936-021-04039-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022] Open
Abstract
Background The private sector plays a large role in malaria treatment provision in Nigeria. To improve access to, and affordability of, quality-assured artemisinin-based combination therapy (QA-ACT) within this sector, the Affordable Medicines Facility-Malaria began operations in 2010 and transitioned to a private sector co-payment mechanism (PSCM) until 2017. To assess the impact of the scheme on the ACT market, cross-sectional household and outlet surveys were conducted in 2018 to coincide with the final stockages of ACT medicines procured under the PSCM. Methods An outlet survey was conducted targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across different regions of Nigeria to assess supply-side market factors related to availability and cost of anti-malarials, including artemisinin-based combinations subsidised under the PSCM (called green leaf ACT on account of their green leaf logo) and those not subsidised (non-green leaf ACT). A concurrent household survey was conducted to determine demand-side factors related to treatment-seeking practices, ACT brand preference and purchase decision. Data were compared with previous ACTWatch surveys to consider change over time. Results Availability of artemisinin-based combinations increased significantly over the PSCM period and was almost universal by the time of the 2018 market survey. This increase was seen particularly among PPMVs. While the cost of green leaf ACT remained relatively stable over time, the cost of non-green leaf ACT reduced significantly so that by 2018 they had equivalent affordability. Unsubsidised brands were also available in different formulations and dosages, with double-strength artemisinin-based combination reported as the most frequently purchased dosage type, and child artemisinin-based combinations popular in suspension and dispersible forms (forms not subsidised by the PSCM). Conclusions The PSCM had a clear impact on increasing not only the reach of subsidized QA brands, but also of non-subsidised brands. Increased market competition led to innovation from unsubsidised brands and large reductions in costs to make them competitive with subsidised brands. Concerns are drawn from the large market share that non-QA brands have managed to gain as well as the continued market share of oral artemisinin monotherapies. Continued monitoring of the market is recommended, along with improved local capacity for QA-certification and monitoring. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-04039-9.
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Malaria Rapid Diagnostic Tests: Literary Review and Recommendation for a Quality Assurance, Quality Control Algorithm. Diagnostics (Basel) 2021; 11:diagnostics11050768. [PMID: 33922917 PMCID: PMC8145891 DOI: 10.3390/diagnostics11050768] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 01/24/2023] Open
Abstract
Malaria rapid diagnostic tests (RDTs) have had an enormous global impact which contributed to the World Health Organization paradigm shift from empiric treatment to obtaining a parasitological diagnosis prior to treatment. Microscopy, the classic standard, requires significant expertise, equipment, electricity, and reagents. Alternatively, RDT’s lower complexity allows utilization in austere environments while achieving similar sensitivities and specificities. Worldwide, there are over 200 different RDT brands that utilize three antigens: Plasmodium histidine-rich protein 2 (PfHRP-2), Plasmodium lactate dehydrogenase (pLDH), and Plasmodium aldolase (pALDO). pfHRP-2 is produced exclusively by Plasmodium falciparum and is very Pf sensitive, but an alternative antigen or antigen combination is required for regions like Asia with significant Plasmodium vivax prevalence. RDT sensitivity also decreases with low parasitemia (<100 parasites/uL), genetic variability, and prozone effect. Thus, proper RDT selection and understanding of test limitations are essential. The Center for Disease Control recommends confirming RDT results by microscopy, but this is challenging, due to the utilization of clinical laboratory standards, like the College of American Pathologists (CAP) and the Clinical Lab Improvement Act (CLIA), and limited recourses. Our focus is to provide quality assurance and quality control strategies for resource-constrained environments and provide education on RDT limitations.
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High burden of co-morbidity and mortality among severely malnourished children admitted to outpatient therapeutic programme facilities in the conflict setting of Borno, Nigeria: a retrospective review. Public Health Nutr 2019; 22:1786-1793. [PMID: 30741140 DOI: 10.1017/s1368980018003968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To present evidence on the burden and outcomes of co-morbidities among severely malnourished (SAM) children admitted to outpatient therapeutic programme (OTP) facilities in the conflict setting of Borno, Nigeria. DESIGN Retrospective medical chart review. SETTING Facility-based study.ParticipantsChildren aged 6-59 months with SAM enrolled in OTP between June and November 2016 whose medical records were analysed. Only pneumonia and diarrhoea were examined due to data limitations. Stata software was used for descriptive, multivariate and survival analyses. RESULTS Records of 396 children with median age of 15 months were identified and analysed from the date of enrolment to exit from OTP. Mean length of stay in OTP was 61d, with co-infected SAM children having shorter stay (P=0·006). Of the total, 148 (37·4 %) had at least one co-morbidity (pneumonia or diarrhoea), of which thirty-nine (26·4 %) had both. Cumulative rate of mortality during follow-up time was 9·5 (95 % CI 6·0, 15·1) per 10 000 child-days; SAM children with co-morbidities were ten times more likely to die than those without (hazard ratio=10·2; 95 % CI 3·4, 31·0). In multivariable analysis, co-morbidity (P=0·01), oedema (P=0·003), dehydration (P=0·02) and weight on admission (P=0·01) were associated with mortality. Both recovery and defaulter rates (57·8 and 36·1 %, respectively) did not meet SPHERE standards. CONCLUSIONS Children with SAM and co-morbidities are less likely to survive, presenting a significant barrier in improving child survival. The findings call for integrated OTP models that incorporate clinical algorithms and ensure prompt referral for SAM children with co-morbidity.
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Welle SC, Ajumobi O, Dairo M, Balogun M, Adewuyi P, Adedokun B, Nguku P, Gidado S, Ajayi I. Preference for Artemisinin-based combination therapy among healthcare providers, Lokoja, North-Central Nigeria. Glob Health Res Policy 2019; 4:1. [PMID: 30680328 PMCID: PMC6339351 DOI: 10.1186/s41256-018-0092-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022] Open
Abstract
Background In Nigeria, Artemisinin-based Combination Therapy (ACT) is the recommended first line antimalarial medicine for uncomplicated malaria. However, health care providers still continue the use of less efficacious medicines such as Sulphadoxine-pyrimethamine and chloroquine. We therefore determined preference for ACT (PFA) and factors associated with PFA among healthcare providers (HCP) in Lokoja, North-Central Nigeria as well as assessed healthcare providers' knowledge of malaria case management. Methods We conducted a cross-sectional study among physicians, nurses, pharmacists, community health officers (CHOs), community health extension workers (CHEWs) and, patent and proprietary medicine vendors (PPMVs). Interviewer-administered questionnaires were administered to collect data on respondents' characteristics, previously received malaria case management training and knowledge of malaria treatment. Knowledge scores ≥3 were categorised as good, maximum obtainable being 5. Results Of the 404 respondents, 214 (53.0%) were males. Overall, 219 (54.2%) respondents who received malaria case management training included PPMVs: 79 (65.8%), CHEWs: 25 (64.1%), CHOs: 5 (55.6%), nurses: 72 (48.7%), physicians: 35 (47.3%) and pharmacists: 3 (23.1%). Overall, 202 (50.0%) providers including physicians: 69 (93.2%), CHO: 8 (88.9%), CHEWs: 33 (84.6%), pharmacists: 8 (61.5%), nurses: 64 (43.2%) and PPMVs: 20 (16.5%), had good knowledge of malaria treatment guidelines. Overall, preference for ACT among healthcare providers was 39.6%. Physicians: 50 (67.6%), pharmacists: 7 (59.3%) CHOs: 5 (55.6%), CHEWS: 16 (41.0%), nurses: 56 (37.8%) and PPMV: 24 (19.8%) had PFA. Receiving malaria case management training (adjusted odds ratio [aOR]) = 2.3; CI = 1.4 - 3.7) and having good knowledge of malaria treatment (aOR = 4.0; CI = 2.4 - 6.7) were associated with PFA. Conclusions Overall preference for ACT use was low among health care providers in this study. Preference for ACTs and proportion of health workers with good knowledge of malaria case management were even lower among PPMVs who had highest proportion of those who received malaria case management training. We recommend evaluation of current training quality, enhanced targeted training, follow-up supportive supervision of PPMVs and behavior change communication on ACT use.
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Affiliation(s)
- Sylvanus C Welle
- 1Division of Health Promotion, Department of Family Health, Federal Ministry of Health, Abuja, Nigeria.,Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Olufemi Ajumobi
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,3African Field Epidemiology Network, Nigeria Country Office, Abuja, Nigeria
| | - Magbagbeola Dairo
- 4Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Muhammad Balogun
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,3African Field Epidemiology Network, Nigeria Country Office, Abuja, Nigeria
| | - Peter Adewuyi
- Liberia Field Epidemiology Training Programme, Monrovia, Liberia
| | - Babatunde Adedokun
- 4Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,3African Field Epidemiology Network, Nigeria Country Office, Abuja, Nigeria
| | - Saheed Gidado
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,3African Field Epidemiology Network, Nigeria Country Office, Abuja, Nigeria
| | - IkeOluwapo Ajayi
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,4Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
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