Defining symptoms of malaria in India in an era of asymptomatic infections

Malaria and missed school days: exploring school absenteeism patterns and local strategies in Odisha, India

Background

Malaria continues to pose a significant global health challenge, disproportionately affecting children. While its effects on physical health are well-documented, the impact on education, particularly school absenteeism, remains less understood. This study aimed to explore the influence of malaria on school absenteeism in Odisha, India.

Methods

A mixed-methods study was conducted in four southern districts of Odisha from September 2023 to February 2024. This involved a retrospective analysis of school attendance registers from five primary schools and qualitative interviews with 25 school teachers. Statistical analysis was performed using SATA 14.1. Mixed effects logistic regression analysis was used to determine the predictive factors of absenteeism with independent variables such as year, area of school and class. Qualitative data from interviews were transcribed and thematically analyzed.

Results

The study evaluated absenteeism among 832 children from Class 1 to Class 5 across four academic years (2016-2020), with schools averaging 185 working days annually. While absenteeism rates varied by school, the proportion of students with yearly absenteeism rates of ≥30% remained relatively stable, ranging from 6 to 12.1%. Average absenteeism ranged from 11.5 days in the academic year 2016-2017 to a peak of 22.6 days in 2018-2019. Logistic regression analysis revealed no significant association between malaria endemicity and absenteeism patterns. Schools employed several malaria prevention and case management strategies, including health education, long-lasting insecticidal nets (LLINs), vector control, screening, testing, and on-site treatment. However, resource constraints and cultural barriers continue to pose challenges.

Conclusion

Despite a decline in malaria cases in the study area, school absenteeism persists due to factors beyond malaria. Future interventions should address these broader socio-cultural and logistical issues to effectively manage absenteeism and improve educational outcomes in malaria-endemic regions.

Pooled prevalence of malaria and associated factors among vulnerable populations in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Malaria is a serious, fatal disease, and a high-risk determinant for human health globally. Children, pregnant women, and migrants are vulnerable groups for malaria infection in African regions. Recently, malaria is an endemic disease in Ethiopia.

OBJECTIVES

This study aimed to determine the pooled prevalence of malaria and its determinant factors among the most vulnerable populations in Ethiopia.

METHODS

Electronic databases, including PubMed, Google Scholar, Web of Science, Semantic Scholar, and Scopus were used for searching articles published since the 2020 Gregorian calendar and onwards. All peer-reviewed Ethiopian journals, health institutions, and Universities were considered for article searching. A PRISMA flow chart and Endnote software were used for article screening, and to remove duplications, respectively. The modified version of the Newcastle-Ottawa Scale was used for potential risk of bias assessments. The heterogeneity among the included studies was evaluated using the indicator of heterogeneity (I2). Egger's test and funnel plot were used to examine the possible publication bias. A random-effects analysis was used to assess the pooled prevalence of malaria, and its determinant factors with a 95% CI. The screening process, data extraction, and quality assessment were done independently, and any disagreements were resolved through discussions.

RESULTS

A total of twelve studies were included in this study. The pooled malaria prevalence was 11.10% (95% CI: 6.10, 16.11). Stagnant water (AOR: 4.19, 95% CI: 2.47, 7.11), no insecticide-treated net utilization (AOR: 3.15, 95% CI: 1.73, 5.73), and staying outdoors at night (AOR: 5.19, 95% CI: 2.08, 12.94) were the pooled estimated statistically risk factors for malaria prevalence. Whereas, insecticide-treated bed net utilization (AOR: 1.59, 95% CI: 0.23, 10.95) reduces the risk of malaria infection.

CONCLUSIONS

The pooled prevalence of malaria is high among vulnerable populations. Creating awareness regarding utilization of insecticide-treated bed nets, and draining stagnant water from the environment are possible interventions to reduce the prevalence of malaria.

Treatment-seeking and uptake of malaria prevention strategies among pregnant women and caregivers of children under-five years during COVID-19 pandemic in rural communities in South West Uganda: a qualitative study

Background

Despite efforts to avert the negative effects of malaria, there remain barriers to the uptake of prevention measures, and these have hindered its eradication. This study explored the factors that influence uptake of malaria prevention strategies among pregnant women and children under-five years and the impact of COVID-19 in a malaria endemic rural district in Uganda.

Methods

This was a qualitative case study that used focus group discussions, in-depth interviews, and key informant interviews involving pregnant women, caregivers of children under-five years, traditional birth attendants, village health teams, local leaders, and healthcare providers to explore malaria prevention uptake among pregnant women and children under-five years. The interviews were audio-recorded, transcribed and data were analyzed using thematic content approach.

Results

Seventy-two participants were enrolled in the Focus Group Discussions, 12 in the in-depth interviews, and 2 as key informants. Pregnant women and caregivers of children under-five years were able to recognize causes of malaria, transmission, and symptoms. All participants viewed malaria prevention as a high priority, and the use of insecticide-treated mosquito bed nets (ITNs) was upheld. Participants' own experiences indicated adverse effects of malaria to both pregnant women and children under-five. Home medication and the use of local herbs were a common practice. Some participants didn’t use any of the malaria prevention methods due to deliberate refusal, perceived negative effects of the ITNs, and family disparity. The Corona Virus Disease-2019 (COVID-19) control measures did not abate the risk of malaria infection but these were deleterious to healthcare access and the focus of malaria prevention.

Conclusions

Although pregnant women and caregivers of children under-five years recognized symptoms of malaria infection, healthcare-seeking was not apt as some respondents used alternative approaches and delayed seeking formal healthcare. It is imperative to focus on the promotion of malaria prevention strategies and address drawbacks associated with misconceptions about these interventions, and promotion of health-seeking behaviors. As COVID-19 exacerbated the effect of malaria prevention uptake and healthcare seeking, it’s critical to recommit and integrate COVID-19 prevention measures in normative living and restrict future barriers to healthcare access.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12771-3.

Four decades of epidemiological data reveal trajectories towards malaria elimination in Kheda district (Gujarat), western part of India

BACKGROUND

Malaria is a main public health problem in India and was so particularly in the state of Gujarat in the western part of the country. This study assesses the effects of various interventions on malaria cases using data from the last 33 years (1987-2019).

METHODS

Here we have analysed 33 years of malaria epidemiological data from a malaria clinic in Kheda district in Gujarat. The data were digitised yearly and monthly, age-wise and gender-wise, and descriptive analysis was performed to assess the effects of several interventions on malaria burden.

RESULTS

During 1987-2019, our clinic diagnosed 5466 Plasmodium vivax and 4732 P. falciparum malaria cases. Overall, there was a declining trend in malaria cases except for the years 1991, 1994, 2004 and 2005. The year 2004 especially witnessed an epidemic in Kheda as well as throughout Gujarat. Malaria infections were most common (40%) among the 21-40 years age group. Fever was the most common symptom in all age groups.

INTERPRETATION

Introduction of revised drug policy and improved surveillance technique (rapid diagnosis kits) have strengthened the diagnosis and treatment of malaria in the district. Use of pyrethroid in indoor residual insecticide spray has also strengthened vector control. Among the various interventions used, long-lasting insecticide nets and introduction of artemisinin-based combination therapy have played significant roles in controlling malaria cases. A more drastic decline in P. falciparum cases versus P. vivax is evident, but the latter persists in high proportions and therefore new tools for malaria control will be needed for elimination.

Diagnostic performance of rapid diagnostic test, light microscopy and polymerase chain reaction during mass survey conducted in low and high malaria-endemic areas from two North-Eastern states of India

An early and accurate diagnosis followed by prompt treatment is pre-requisite for the management of any disease. Malaria diagnosis is routinely performed by microscopy and rapid diagnostic tests (RDTs) in the field settings; however, their performance may vary across regions, age and asymptomatic status. Owing to this, we assessed the diagnostic performance of conventional and advanced molecular tools for malaria detection in low and high malaria-endemic settings. We performed mass blood surveys in low and high endemic regions of two North-Eastern districts from the states of Assam and Meghalaya. A total of 3322 individuals were screened for malaria using RDT, microscopy and PCR and measures of diagnostic accuracy were estimated. Out of 3322 individuals, 649 (19.5%) were detected with malaria parasite. Asymptomatic were 86.4% (2872/3322), of which 19.4% (557/2872) had Plasmodium infection. The sensitivity and specificity of microscopy were 42.7% and 99.3%, and RDT showed 49.9% and 90.4%, respectively, considering PCR as standard. RDT (AUC: 0.65 vs 0.74; p = 0.001) and microscopy (AUC: 0.64 vs 0.76; p < 0.0001) performances were significantly lower in low compared to high endemic areas. True positive rate was lower in asymptomatics but true negative rate was found similar to symptomatic individuals. The conventional diagnostic tools (RDT and microscopy) had detected malaria in children with nearly twofold greater sensitivity than in the adults (p < 0.05). To conclude, asymptomatics, adults and low malaria-endemic regions require major attention due to mediocre performance of conventional diagnostic tools in malaria detection.