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Bhamani B, Martí Coma-Cros E, Tusell M, Mithi V, Serra-Casas E, Williams NA, Lindblade KA, Allen KC. Targeted Testing and Treatment To Reduce Human Malaria Transmission in High-Risk Populations: A Systematic Review. Am J Trop Med Hyg 2024; 110:54-64. [PMID: 38471159 PMCID: PMC10993793 DOI: 10.4269/ajtmh.23-0097] [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: 02/09/2023] [Accepted: 01/04/2024] [Indexed: 03/14/2024] Open
Abstract
As countries approach elimination of malaria, groups with increased exposure to malaria vectors or poor access to health services may serve as important human reservoirs of infection that help maintain transmission in the community. Parasitological testing and treatment targeted to these groups may reduce malaria transmission overall. This systematic review assessed the effectiveness of targeted testing and treatment (TTaT) to reduce malaria transmission, the contextual factors, and the results of modeling studies that estimated the intervention's potential impact. Bibliographic searches were conducted in March 2021 and updated in April 2022, and a total of 1,210 articles were identified. Three studies were included for outcome data: one factorial cluster randomized controlled trial (cRCT) in Kenya (5,233 participants), one cRCT in Ghana (3,046 participants), and one controlled before-and-after cohort study in schoolchildren in Malawi (786 participants). Nine reports were included for contextual factors, and two were included for mathematical modeling. Data on outcomes from the three studies suggested that at the community level, TTaT would result in little to no difference in the incidence of malaria infection (measured via active surveillance), adverse events, and severe AEs. In contrast, the effects of TTaT on prevalence (malaria parasitemia) among those targeted by the intervention were found to include a short-term impact on reducing transmission but little to no impact on transmission for extended periods. Future iterations of this review should ensure consideration for populations proven to host the vast majority of the reservoir of infection in lower-transmission settings to determine the effectiveness of the intervention.
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Affiliation(s)
- Beena Bhamani
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Elisabet Martí Coma-Cros
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Maria Tusell
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Vita Mithi
- Armref Data for Action in Public Health Research Consultancy, Mzuzu, Malawi
- Society for Research on Nicotine and Tobacco—Genetics and Omics Network, Madison, Wisconsin
- Leaders of Africa Institute, Baltimore, Maryland
| | - Elisa Serra-Casas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Nana Aba Williams
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Kim A. Lindblade
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Koya C. Allen
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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de Aguiar Barros J, Granja F, Pequeno P, Marchesini P, Ferreira da Cruz MDF. Gold miners augment malaria transmission in indigenous territories of Roraima state, Brazil. Malar J 2022; 21:358. [PMID: 36447220 PMCID: PMC9706895 DOI: 10.1186/s12936-022-04381-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Endemic malaria is present in all 15 municipalities of Roraima state, Brazilian Amazonia. Knowledge of epidemiological data of specific populations can guide health policies to formulate effective strategies for integrated control of health-disease care. This study aims to ascertain when, where and who fell ill with malaria in Roraima state from 2010 to 2020. METHODS This descriptive study was based on statistical secondary surveillance data through the analysis of relationships underlying numbers of cases, hospitalizations and deaths using the Malaria Epidemiological Surveillance Information System, Mortality Information System and Hospitalization Information System. RESULTS From 2010 to 2020, there were 138,504 autochthonous cases, 26,158 Venezuelan imported cases, 3765 hospitalizations, and 77 deaths from malaria reported in Roraima. Annual parasitic incidence and the number of hospitalizations showed impressive changes over the period, but without significantly correlating with number of deaths. The proportion of Plasmodium falciparum infections had significant shifts throughout this study. Malaria prevalence in indigenous and mining areas has been increasing since 2014. CONCLUSION The presence of miners in indigenous areas is a reality that has been contributing to the increase of malaria cases in Roraima. The need to implement health policies that also meet this contingent is reinforced.
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Affiliation(s)
- Jacqueline de Aguiar Barros
- Núcleo de Controle da Malária/Departamento de Vigilância Epidemiológica/Coordenação Geral de Vigilância em Saúde/SESAU-RR, Roraima, Brazil ,grid.440579.b0000 0000 9908 9447Centro de Estudos da Biodiversidade, Universidade Federal de Roraima (UFRR), Roraima, Brazil ,grid.418068.30000 0001 0723 0931Laboratório de Pesquisas em Malária/Malaria Research Laboratory, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil ,Programa de Pós-Graduação em Biodiversidade e Biotecnologia da Rede BIONORTE (PPG-BIONORTE), Roraima, Brazil
| | - Fabiana Granja
- grid.440579.b0000 0000 9908 9447Centro de Estudos da Biodiversidade, Universidade Federal de Roraima (UFRR), Roraima, Brazil ,grid.440579.b0000 0000 9908 9447Programa de Pós-Graduação em Recursos Naturais, Universidade Federal de Roraima (UFRR), Roraima, Brazil ,Programa de Pós-Graduação em Biodiversidade e Biotecnologia da Rede BIONORTE (PPG-BIONORTE), Roraima, Brazil
| | - Pedro Pequeno
- grid.440579.b0000 0000 9908 9447Programa de Pós-Graduação em Recursos Naturais, Universidade Federal de Roraima (UFRR), Roraima, Brazil
| | - Paola Marchesini
- grid.501318.eCoordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, MS, Brasília/DF, Brazil
| | - Maria de Fátima Ferreira da Cruz
- grid.418068.30000 0001 0723 0931Laboratório de Pesquisas em Malária/Malaria Research Laboratory, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil ,grid.418068.30000 0001 0723 0931Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal)/Reference Center for Malaria in the Extra-Amazonian Region of the Brazilian Ministry of Health, Fiocruz, Rio de Janeiro, Brazil
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Parent AA, Galindo MS, Lambert Y, Douine M. Combatting malaria disease among gold miners: a qualitative research within the Malakit project. Health Promot Int 2022; 37:6674364. [PMID: 36000529 DOI: 10.1093/heapro/daac058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Malaria is endemic in French Guiana, in particular, where illegal gold mining activities take place. Gold miners travel from Brazil to remote camps in the Guiana forest to carry out mining activities, exposing themselves to the presumed contamination area. This article presents the results of a qualitative case study of the Malakit project, an intervention where health facilitators offer appropriate training and distribution of self-diagnosis and self-treatment kits to manage an episode of malaria at resting sites on the French Guiana borders. The objectives were: (i) Determine the contextual elements influencing the use of Malakit; (ii) Understand the way gold miners perceive Malakit; (iii) Identify the elements that are favorable and unfavorable to the use of Malakit; (iv4) Identify what can be improved in the project. The data were collected using three methods: on-site observation, semi-structured individual interviews (n = 26), and group interviews (n = 2). The results indicate that Malakit responds to the need for treatment and facilitates access to care. Gold miners say they trust the facilitators and receive accurate explanations, the kit is easy to use and carry, and explanations given are sufficient. Nonetheless, the results lead us to believe that contextual elements influence exposure to numerous risk factors and that malaria among gold miners working illegally in French Guiana is a question of social inequalities in health. Thus, malaria intervention practices such as Malakit cannot be carried out without considering the complexity generated by social inequalities in health.
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Affiliation(s)
- André-Anne Parent
- CReSP and Interactions Research Centre, School of Social Work, Université de Montréal, Québec, Canada
| | | | - Yann Lambert
- Centre hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Maylis Douine
- Centre hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
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Olapeju B, Adams C, Wilson S, Simpson J, Hunter GC, Davis T, Mitchum L, Cox H, James K, Orkis J, Storey JD. Malaria care-seeking and treatment ideation among gold miners in Guyana. Malar J 2022; 21:29. [PMID: 35101036 PMCID: PMC8805325 DOI: 10.1186/s12936-022-04045-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/10/2022] [Indexed: 12/13/2022] Open
Abstract
Background Although miners are a priority population in malaria elimination in Guyana, scant literature exists on the drivers of malaria-related behaviour. This study explores the relationship between gold miners’ malaria-related ideation and the adoption of malaria care-seeking and treatment behaviours including prompt care-seeking, malaria testing, and self-medication. Methods Data are from a cross-sectional quantitative survey of 1685 adult miners between the ages of 18–59 years who live in mining camps in Regions 1, 7, and 8. The analysis focused on miners who reported an episode of fever in the past year (n = 745). Malaria care-seeking and treatment ideation was defined as a composite additive score consisting of the following variables: general malaria knowledge, perceived severity, perceived susceptibility, beliefs, perceived self-efficacy, perceived norms, interpersonal communication, and perceived response efficacy. Multivariable logistic regressions explored the relationship between ideation on care-seeking/treatment behaviours, controlling for confounding variables. Results Most miners with a recent episode of fever had perceived risk (92%), self-efficacy (67%), susceptibility (53%) and high malaria knowledge (53%). Overall, miners' care-seeking/treatment ideation score ranged from 0 to 8 with a mean of 4.1. Ideation scores were associated with higher odds of care-seeking for fever (aOR: 1.19; 95% CI 1.04–1.36), getting tested for malaria (aOR: 1.22; 95% CI 1.07–1.38) and lower odds of self-medication (aOR: 0.87; 95% CI 0.77–0.99). Conclusions A national community case management initiative is using study findings as part of its scale-up, using volunteers to make testing and treatment services more accessible to miners. This is complemented by a multi-channel mass media campaign to improve miners’ ideation. Communication messages focus on increasing miners’ knowledge of malaria transmission and symptoms, encourage positive beliefs about malaria testing and volunteer testers, promote evidence about the effectiveness of testing, and reminders of how quick and easy it is to get a malaria test with the community case management initiative. Study findings also have implications for efforts to eliminate malaria across the Guiana Shield.
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Yan SD, Simpson J, Mitchum L, Orkis J, Davis T, Wilson S, Trotman N, Imhoff H, Cox H, Hunter G, Olapeju B, Adams C, Storey JD. Human-centered design process and solutions to promote malaria testing and treatment seeking behavior in Guyana hinterlands. BMC Public Health 2021; 21:2287. [PMID: 34911505 PMCID: PMC8672563 DOI: 10.1186/s12889-021-12297-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Malaria is a persistent public health challenge among miners and other hard-to-reach populations in Guyana’s hinterland, specifically in Regions 1, 7, 8, and 9. Despite an overall decrease in malaria prevalence throughout Guyana, it remains common among mining populations whose work conditions both contribute toward malaria transmission and make it difficult to seek timely, Ministry of Health (MoH) approved malaria testing and treatment services. In an effort to develop innovative approaches to address this public health challenge, an interdisciplinary team of public health professionals, designers, and mining organizations collaborated using a human-centered design (HCD) process facilitated by the USAID-funded Breakthrough ACTION Guyana project in partnership with the MoH. Methods This paper describes two phases: [1] Define and [2] Design & Test. In the Define phase, following a literature review, we conducted 108 qualitative interviews with miners, camp managers, trained malaria testers, health workers, and other key stakeholders to understand experiences and challenges when seeking malaria testing and treatment services. These interviews were synthesized into 11 insights on issues such as risk perception, malaria knowledge, preventive behaviors, traditional and self-treatment, adherence to the correct treatment, testing, and coordination and communication gaps. From these insights, during the Design & Test phase, we developed 33 “How might we…?” questions which led to 792 ideas, of which eight emergent concepts were prototyped and refined in the field with 145 miners, camp managers, and stakeholders. Results The five final prototypes included: “Little Mosquito, Big Problem” social behavior change campaign; rapid counseling cards; branded malaria testing and treatment services; innovations in treatment adherence; and a participants, content, and logistics approach. Conclusion When applying HCD to public health issues, there are both opportunities and challenges to reconcile gaps that may exist between the two disciplines. However, HCD provides additional tools and mindsets to generatively work with migrant and mobile mining communities to encourage malaria testing and treatment services.
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Affiliation(s)
- Shirley D Yan
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite, Baltimore, MD, 310, USA.,Noora Health, San Francisco, California, USA
| | - Joann Simpson
- Breakthrough ACTION Guyana, XX Barrack St., Georgetown, Guyana.
| | - Lyndsey Mitchum
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite, Baltimore, MD, 310, USA
| | - Jennifer Orkis
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite, Baltimore, MD, 310, USA
| | - TrishAnn Davis
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite, Baltimore, MD, 310, USA
| | - Sean Wilson
- Breakthrough ACTION Guyana, XX Barrack St., Georgetown, Guyana
| | - Neil Trotman
- Vector Control Services, Ministry of Health, Middle Street, Georgetown, Guyana
| | - Helen Imhoff
- Vector Control Services, Ministry of Health, Middle Street, Georgetown, Guyana
| | - Horace Cox
- Vector Control Services, Ministry of Health, Middle Street, Georgetown, Guyana
| | | | - Bolanle Olapeju
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite, Baltimore, MD, 310, USA
| | - Camille Adams
- Breakthrough ACTION Guyana, XX Barrack St., Georgetown, Guyana
| | - J Douglas Storey
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite, Baltimore, MD, 310, USA
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Thinking clearly about social aspects of infectious disease transmission. Nature 2021; 595:205-213. [PMID: 34194045 DOI: 10.1038/s41586-021-03694-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023]
Abstract
Social and cultural forces shape almost every aspect of infectious disease transmission in human populations, as well as our ability to measure, understand, and respond to epidemics. For directly transmitted infections, pathogen transmission relies on human-to-human contact, with kinship, household, and societal structures shaping contact patterns that in turn determine epidemic dynamics. Social, economic, and cultural forces also shape patterns of exposure, health-seeking behaviour, infection outcomes, the likelihood of diagnosis and reporting of cases, and the uptake of interventions. Although these social aspects of epidemiology are hard to quantify and have limited the generalizability of modelling frameworks in a policy context, new sources of data on relevant aspects of human behaviour are increasingly available. Researchers have begun to embrace data from mobile devices and other technologies as useful proxies for behavioural drivers of disease transmission, but there is much work to be done to measure and validate these approaches, particularly for policy-making. Here we discuss how integrating local knowledge in the design of model frameworks and the interpretation of new data streams offers the possibility of policy-relevant models for public health decision-making as well as the development of robust, generalizable theories about human behaviour in relation to infectious diseases.
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Olapeju B, Adams C, Hunter G, Wilson S, Simpson J, Mitchum L, Davis T, Orkis J, Cox H, Trotman N, Imhoff H, Storey D. Malaria prevention and care seeking among gold miners in Guyana. PLoS One 2020; 15:e0244454. [PMID: 33373407 PMCID: PMC7771697 DOI: 10.1371/journal.pone.0244454] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/09/2020] [Indexed: 11/19/2022] Open
Abstract
Despite being a priority population in malaria elimination, there is scant literature on malaria-related behavior among gold miners. This study explores the prevalence and factors influencing malaria prevention, care seeking and treatment behaviors in Guyana gold mining camps. A cross sectional survey was conducted among adult gold miners living in mining camps in the hinterland Regions 1 (Barima-Waini), 7 (Cuyuni-Mazaruni), and 8 (Potaro-Siparuni). Multivariable logistic regressions explored factors associated with miners’ self-report of mosquito net use, prompt care-seeking; self-medication; and testing for malaria. A third of miners used a mosquito net the night preceding the survey and net use was higher among those who believed that net use was the norm in their camp (aOR: 3.11; 95% CI:1.65, 5.88). Less than half (45%) of miners had a fever in the past 12 months, among whom 36% sought care promptly, 48% tested positive for malaria while 54% self-medicated before seeking care. Prompt care-seeking was higher among miners with high malaria knowledge (aOR: 1.44; 95% CI: 1.01, 2.05). Similarly, testing rates increased with secondary education (aOR: 1.71; 95% CI: (1.16, 2.51), high malaria knowledge (aOR: 1.45; 95% CI: 1.02, 2.05), positive beliefs regarding malaria transmission, threat, self-diagnosis, testing and treatment, and, trust in government services (aOR: 1.59; 95% CI (1.12, 2.27) and experience of a prior malaria episode (aOR: 2.62; 95% CI: 1.71, 4.00). Self-medication was lower among male miners (aOR: 0. 52; 95% CI: 0.32, 0.86). Malaria prevention and care seeking behaviors among miners are somewhat low and influenced by mosquito net usage, perceived norms, malaria knowledge and prior episode of confirmed malaria. Study findings have implications for malaria interventions in the hinterland regions of Guyana such as the mass and continuous distribution of insecticide treated nets as well as community case management initiatives using trained malaria testing and treatment volunteers to curb malaria transmission among remote gold mining populations. These include efforts to identify and address gaps in distributing mosquito nets to miners and address miners’ barriers to prompt care seeking, malaria testing and treatment adherence. Targeted social and behavior change messaging is needed on net acquisition, use and care, prompt care-seeking, malaria testing and treatment adherence. Additional efforts to ensure the overall sustainability of the community case management initiative include increased publicity of the community case management initiative among miners, use of incentives to promote retention rates among the community case management volunteer testers and public private partnerships between the Guyana Ministry of Health and relevant mining organizations.
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Affiliation(s)
- Bolanle Olapeju
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America
- * E-mail:
| | - Camille Adams
- Breakthrough ACTION Guyana, Georgetown, Demerara-Mahaica, Guyana
| | - Gabrielle Hunter
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America
| | - Sean Wilson
- Breakthrough ACTION Guyana, Georgetown, Demerara-Mahaica, Guyana
| | - Joann Simpson
- Breakthrough ACTION Guyana, Georgetown, Demerara-Mahaica, Guyana
| | - Lyndsey Mitchum
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America
| | - TrishAnn Davis
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America
| | - Jennifer Orkis
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America
| | - Horace Cox
- National Malaria Program, Ministry of Health, Georgetown, Demerara-Mahaica, Guyana
| | - Neil Trotman
- National Malaria Program, Ministry of Health, Georgetown, Demerara-Mahaica, Guyana
| | - Helen Imhoff
- National Malaria Program, Ministry of Health, Georgetown, Demerara-Mahaica, Guyana
| | - Douglas Storey
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America
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