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Huang S, Baker K, Ibinaiye T, Oresanya O, Nnaji C, Richardson S. Impact of seasonal malaria chemoprevention based on the number of medicines doses received on malaria burden among children aged 3-59 months in Nigeria: A propensity score-matched analysis. Trop Med Int Health 2024. [PMID: 38842452 DOI: 10.1111/tmi.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Seasonal malaria chemoprevention using sulfadoxine-pyrimethamine plus amodiaquine (sulfadoxine-pyrimethamine plus amodiaquine on Day 1 and amodiaquine on both Day 2 and Day 3) is delivered to children aged 3-59 months in areas of highly season malaria transmission. While the overall population-level impact of seasonal malaria chemoprevention on malaria control has been documented in various countries and time periods, there is no clear evidence regarding seasonal malaria chemoprevention impact based on the number of medicine doses children receive in one cycle in routine programmatic conditions. METHODS Data were extracted from Nigeria's routinely collected seasonal malaria chemoprevention end-of-round coverage surveys (2021, 2022). We matched seasonal malaria chemoprevention-targeted children who received specific numbers of seasonal malaria chemoprevention medicines with those who did not receive any doses of seasonal malaria chemoprevention medicines (non-sulfadoxine-pyrimethamine plus amodiaquine) using multiple sets of propensity score matches. We performed multilevel logistic regression for each matched group to evaluate the association between the number of doses of seasonal malaria chemoprevention medicines and monthly confirmed malaria cases (caregiver-reported malaria infection diagnosed by rapid diagnostic test at a health facility following the penultimate cycle of seasonal malaria chemoprevention). RESULTS Among 21,621 SMC-targeted children, 9.7% received non-sulfadoxine-pyrimethamine plus amodiaquine, 0.5% received only Day 1 sulfadoxine-pyrimethamine plus amodiaquine, 1.0% received Day 1 sulfadoxine-pyrimethamine plus amodiaquine and either Day 2 amodiaquine or Day 3 amodiaquine (sulfadoxine-pyrimethamine plus amodiaquine + amodiaquine), and 88.8% received Day 1 sulfadoxine-pyrimethamine plus amodiaquine and both Day 2 and Day 3 amodiaquine (sulfadoxine-pyrimethamine plus amodiaquine + amodiaquine + amodiaquine). Children receiving only Day 1 sulfadoxine-pyrimethamine plus amodiaquine did not have significant lower odds of rapid diagnostic tests-confirmed malaria than those receiving non-sulfadoxine-pyrimethamine plus amodiaquine (OR 0.77, 0.42-1.42). However, children receiving sulfadoxine-pyrimethamine plus amodiaquine + amodiaquine had significantly lower odds of rapid diagnostic tests-confirmed malaria than those receiving non-sulfadoxine-pyrimethamine plus amodiaquine (OR 0.42, 95% CI 0.28-0.63). Similarly, children receiving sulfadoxine-pyrimethamine plus amodiaquine + amodiaquine + amodiaquine also had significantly lower odds of rapid diagnostic test-confirmed malaria than those receiving non-sulfadoxine-pyrimethamine plus amodiaquine (OR 0.54, 95% CI 0.47-0.62). CONCLUSION Adherence to at least one daily dose of amodiaquine administration following receipt of Day 1 sulfadoxine-pyrimethamine plus amodiaquine by eligible children is crucial to ensure the effectiveness of seasonal malaria chemoprevention. This demonstrates the importance of enhancing caregiver awareness regarding the importance of amodiaquine and identifying barriers toward amodiaquine administration at the community level.
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Affiliation(s)
- Sikai Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kevin Baker
- Malaria Consortium UK, The Green House, London, UK
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | | | - Chuks Nnaji
- Malaria Consortium UK, The Green House, London, UK
| | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Soremekun S, Conteh B, Nyassi A, Soumare HM, Etoketim B, Ndiath MO, Bradley J, D'Alessandro U, Bousema T, Erhart A, Moreno M, Drakeley C. Household-level effects of seasonal malaria chemoprevention in the Gambia. COMMUNICATIONS MEDICINE 2024; 4:97. [PMID: 38778226 PMCID: PMC11111771 DOI: 10.1038/s43856-024-00503-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND In 2022 the WHO recommended the discretionary expansion of the eligible age range for seasonal malaria chemoprevention (SMC) to children older than 4 years. Older children are at lower risk of clinical disease and severe malaria so there has been uncertainty about the cost-benefit for national control programmes. However, emerging evidence from laboratory studies suggests protecting school-age children reduces the infectious reservoir for malaria and may significantly impact on transmission. This study aimed to assess whether these effects were detectable in the context of a routinely delivered SMC programme. METHODS In 2021 the Gambia extended the maximum eligible age for SMC from 4 to 9 years. We conducted a prospective population cohort study over the 2021 malaria transmission season covering 2210 inhabitants of 10 communities in the Upper River Region, and used a household-level mixed modelling approach to quantify impacts of SMC on malaria transmission. RESULTS We demonstrate that the hazard of clinical malaria in older participants aged 10+ years ineligible for SMC decreases by 20% for each additional SMC round per child 0-9 years in the same household. Older inhabitants also benefit from reduced risk of asymptomatic infections in high SMC coverage households. Spatial autoregression tests show impacts are highly localised, with no detectable spillover from nearby households. CONCLUSIONS Evidence for the transmission-reducing effects of extended-age SMC from routine programmes implemented at scale has been previously limited. Here we demonstrate benefits to the entire household, indicating such programmes may be more cost-effective than previously estimated.
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Affiliation(s)
- Seyi Soremekun
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.
| | - Bakary Conteh
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Abdoullah Nyassi
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Harouna M Soumare
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Blessed Etoketim
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Mamadou Ousmane Ndiath
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - John Bradley
- Medical Research Council International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annette Erhart
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Marta Moreno
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.
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Faye SLB, Lugand MM, Offianan AT, Dossou-Yovo A, Kouadio DKM, Pinto F. Field testing of user-friendly perennial malaria chemoprevention packaging in Benin, Côte d'Ivoire and Mozambique. Malar J 2024; 23:157. [PMID: 38773567 PMCID: PMC11106929 DOI: 10.1186/s12936-024-04977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/07/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Perennial malaria chemoprevention (PMC) aims to protect children at risk from severe malaria by the administration of anti-malarial drugs to children of defined ages throughout the year. Sulfadoxine-pyrimethamine (SP) has been widely used for chemoprevention in Africa and a child-friendly dispersible tablet formulation has recently become available. METHODS This qualitative non-interventional observational study was conducted in Benin, Côte d'Ivoire, and Mozambique between February and June 2022. Prototype blister packs, dispensing boxes and job aids designed to support dispersible SP deployment for PMC were evaluated using focus group discussions (FGD) and semi-structured in-depth individual interviews (IDI) with health authorities, health personnel, community health workers (CHWs) and caregivers. The aim was to evaluate knowledge and perceptions of malaria and chemoprevention, test understanding of the tools and identify gaps in understanding, satisfaction, user-friendliness and acceptability, and assess the potential role of CHWs in PMC implementation. Interviews were transcribed and imported to ATLAS.ti for encoding and categorization. Thematic content analysis used deductive and inductive coding with cross-referencing of findings between countries and participants to enrich data interpretation. Continuous comparison across the IDI and FGD permitted iterative, collaborative development of materials. RESULTS Overall, 106 participants completed IDIs and 70 contributed to FGDs. Malaria was widely recognised as the most common disease affecting children, and PMC was viewed as a positive intervention to support child health. The role of CHWs was perceived differently by the target groups, with caregivers appreciating their trusted status in the community, whereas health authorities preferred clinic-based deployment of PMC by health professionals. Empirical testing of the prototype blister packs, dispensing boxes and job aids highlighted the context-specific expectations of respondents, such as familiar situations and equipment, and identified areas of confusion or low acceptance. A key finding was the need for a clear product identity reflecting malaria. CONCLUSION Simple modifications profoundly affected the perception of PMC and influenced acceptability. Iterative quantitative investigation resulted in PMC-specific materials suited to the local context and socio-cultural norms of the target population with the aim of increasing access to chemoprevention in children most at risk of severe malaria.
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Affiliation(s)
- Sylvain Landry Birane Faye
- Laboratoire de Sociologie, Anthropologie, Psychologie (LASAP), Department of Sociology, Cheikh Anta DIOP University (UCAD), Dakar, Senegal
| | - Maud Majeres Lugand
- Medicines for Malaria Venture, 20 Route de Pré-Bois, PO Box 1826, 1215, Geneva 15, Switzerland.
| | - André Touré Offianan
- Department of Parasitology & Mycology, Institut Pasteur of Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Aurélie Dossou-Yovo
- Directorate of Health Training and Research, Ministry of Health, Cotonou, Benin
| | - Dieudonné Kouakou M'Bra Kouadio
- Département d'Anthropologie et de Sociologie/Centre de Recherche Pour le Développement, Université Alassane Ouattara, Bouaké, Côte d'Ivoire
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Moreno M, Barry A, Gmeiner M, Yaro JB, Sermé SS, Byrne I, Ramjith J, Ouedraogo A, Soulama I, Grignard L, Soremekun S, Koele S, Ter Heine R, Ouedraogo AZ, Sawadogo J, Sanogo E, Ouedraogo IN, Hien D, Sirima SB, Bradley J, Bousema T, Drakeley C, Tiono AB. Understanding and maximising the community impact of seasonal malaria chemoprevention in Burkina Faso (INDIE-SMC): study protocol for a cluster randomised evaluation trial. BMJ Open 2024; 14:e081682. [PMID: 38479748 PMCID: PMC10936478 DOI: 10.1136/bmjopen-2023-081682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
INTRODUCTION Seasonal malaria chemoprevention (SMC) involves repeated administrations of sulfadoxine-pyrimethamine plus amodiaquine to children below the age of 5 years during the peak transmission season in areas of seasonal malaria transmission. While highly impactful in reducing Plasmodium falciparum malaria burden in controlled research settings, the impact of SMC on infection prevalence is moderate in real-life settings. It remains unclear what drives this efficacy decay. Recently, the WHO widened the scope for SMC to target all vulnerable populations. The Ministry of Health (MoH) in Burkina Faso is considering extending SMC to children below 10 years old. We aim to assess the impact of SMC on clinical incidence and parasite prevalence and quantify the human infectious reservoir for malaria in this population. METHODS AND ANALYSIS We will perform a cluster randomised trial in Saponé Health District, Burkina Faso, with three study arms comprising 62 clusters of three compounds: arm 1 (control): SMC in under 5-year-old children, implemented by the MoH without directly observed treatment (DOT) for the full course of SMC; arm 2 (intervention): SMC in under 5-year-old children, with DOT for the full course of SMC; arm 3 (intervention): SMC in under 10-year-old children, with DOT for the full course of SMC. The primary endpoint is parasite prevalence at the end of the malaria transmission season. Secondary endpoints include the impact of SMC on clinical incidence. Factors affecting SMC uptake, treatment adherence, drug concentrations, parasite resistance markers and transmission of parasites will be determined. ETHICS AND DISSEMINATION The London School of Hygiene & Tropical Medicine's Ethics Committee (29193) and the Burkina Faso National Medical Ethics Committee (Deliberation No 2023-05-104) approved this study. The findings will be presented to the community; disease occurrence data and study outcomes will also be shared with the Burkina Faso MoH. Findings will be published irrespective of their results. TRIAL REGISTRATION NUMBER NCT05878366.
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Affiliation(s)
- Marta Moreno
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Aissata Barry
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | - Markus Gmeiner
- Department of Medical Microbiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | - Samuel S Sermé
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | - Isabel Byrne
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jordache Ramjith
- Department of Medical Microbiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | - Issiaka Soulama
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | - Lynn Grignard
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Seyi Soremekun
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon Koele
- Department of Medical Microbiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | | | - Jean Sawadogo
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | - Edith Sanogo
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | | | - Denise Hien
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | | | - John Bradley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Alfred B Tiono
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
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Bisanzio D, Keita MS, Camara A, Guilavogui T, Diallo T, Barry H, Preston A, Bangoura L, Mbounga E, Florey LS, Taton JL, Fofana A, Reithinger R. Malaria trends in districts that were targeted and not-targeted for seasonal malaria chemoprevention in children under 5 years of age in Guinea, 2014-2021. BMJ Glob Health 2024; 9:e013898. [PMID: 38413098 PMCID: PMC10900330 DOI: 10.1136/bmjgh-2023-013898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/26/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Seasonal malaria chemoprevention (SMC) is a main intervention to prevent and reduce childhood malaria. Since 2015, Guinea has implemented SMC targeting children aged 3-59 months (CU5) in districts with high and seasonal malaria transmission. OBJECTIVE We assessed the programmatic impact of SMC in Guinea's context of scaled up malaria intervention programming by comparing malaria-related outcomes in 14 districts that had or had not been targeted for SMC. METHODS Using routine health management information system data, we compared the district-level monthly test positivity rate (TPR) and monthly uncomplicated and severe malaria incidence for the whole population and disaggregated age groups (<5 years and ≥5 years of age). Changes in malaria indicators through time were analysed by calculating the district-level compound annual growth rate (CAGR) from 2014 to 2021; we used statistical analyses to describe trends in tested clinical cases, TPR, uncomplicated malaria incidence and severe malaria incidence. RESULTS The CAGR of TPR of all age groups was statistically lower in SMC (median=-7.8%) compared with non-SMC (median=-3.0%) districts. Similarly, the CAGR in uncomplicated malaria incidence was significantly lower in SMC (median=1.8%) compared with non-SMC (median=11.5%) districts. For both TPR and uncomplicated malaria incidence, the observed difference was also significant when age disaggregated. The CAGR of severe malaria incidence showed that all age groups experienced a decline in severe malaria in both SMC and non-SMC districts. However, this decline was significantly higher in SMC (median=-22.3%) than in non-SMC (median=-5.1%) districts for the entire population, as well as both CU5 and people over 5 years of age. CONCLUSION Even in an operational programming context, adding SMC to the malaria intervention package yields a positive epidemiological impact and results in a greater reduction in TPR, as well as the incidence of uncomplicated and severe malaria in CU5.
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Affiliation(s)
- Donal Bisanzio
- RTI International, Washington, District of Columbia, USA
| | | | - Alioune Camara
- Programme National de la Lutte contre le Paludisme, Ministère de la Santé et de l'Hygiène Publique, Conakry, Guinea
| | | | | | | | | | - Lamine Bangoura
- President's Malaria Initiative, US Agency for International Development, Conakry, Guinea
| | - Eliane Mbounga
- President's Malaria Initiative, US Agency for International Development, Conakry, Guinea
| | - Lia S Florey
- US Agency for International Development, Washington, District of Columbia, USA
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Khan J, Suau Sans M, Okot F, Rom Ayuiel A, Magoola J, Rassi C, Huang S, Mubiru D, Bonnington C, Baker K, Ahmed J, Nnaji C, Richardson S. A quasi-experimental study to estimate effectiveness of seasonal malaria chemoprevention in Aweil South County in Northern Bahr El Ghazal, South Sudan. Malar J 2024; 23:33. [PMID: 38267985 PMCID: PMC10810022 DOI: 10.1186/s12936-024-04853-x] [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: 06/12/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Seasonal malaria chemoprevention (SMC) is an effective intervention to prevent malaria in children in locations where the burden of malaria is high and transmission is seasonal. There is growing evidence suggesting that SMC with sulfadoxine-pyrimethamine and amodiaquine can retain its high level of effectiveness in East and Southern Africa despite resistance concerns. This study aims to generate evidence on the effectiveness of SMC when delivered under programmatic conditions in an area with an unknown anti-malarial drug resistance profile in the Northern Bahr el-Ghazal region of South Sudan. METHODS A non-randomized quasi experimental study was conducted to compare an intervention county with a control county. Five monthly SMC cycles were delivered between July and November 2022, targeting about 19,000 children 3-59 months old. Data were obtained from repeated cross-sectional household surveys of caregivers of children aged 3-59 months using cluster sampling. Wave 1 survey took place in both counties before SMC implementation; Waves 2 and 3 took place after the second and fourth monthly SMC cycles. Difference-in-differences analyses were performed by fitting logistic regression models with interactions between county and wave. RESULTS A total of 2760 children were sampled in the study across the three survey waves in both study counties. Children in the intervention arm had 70% lower odds of caregiver-reported fever relative to those in the control arm during the one-month period prior to Wave 2 (OR: 0.30, 95% CI 0.12-0.70, p = 0.003), and 37% lower odds in Wave 3 (OR: 0.63, 95% CI 0.22-1.59, p = 0.306) after controlling for baseline difference between counties in Wave 1. Odds of caregiver-reported RDT-confirmed malaria were 82% lower in the previous 1-month period prior to Wave 2 (OR: 0.18, 95% CI 0.07-0.49, p = 0.001) and Wave 3 (OR: 0.18, 95% CI 0.06-0.54, p = 0.003). CONCLUSION These results show high effectiveness of SMC using SPAQ in terms of reducing malaria disease during the high transmission season in children 3-59 month. Despite the promising results, additional evidence and insights from chemoprevention efficacy cohort studies, and analyses of relevant resistance markers, are required to assess the suitability of SMC for this specific context.
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Affiliation(s)
| | | | | | | | | | | | - Sikai Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | | | - Kevin Baker
- Malaria Consortium, London, UK
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | | | - Sol Richardson
- Malaria Consortium, London, UK
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Gatiba P, Laury J, Steinhardt L, Hwang J, Thwing JI, Zulliger R, Emerson C, Gutman JR. Contextual Factors to Improve Implementation of Malaria Chemoprevention in Children: A Systematic Review. Am J Trop Med Hyg 2024; 110:69-78. [PMID: 38081055 DOI: 10.4269/ajtmh.23-0478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/15/2023] [Indexed: 01/05/2024] Open
Abstract
Malaria remains a leading cause of childhood morbidity and mortality in sub-Saharan Africa, particularly among children under 5 years of age. To help address this challenge, the WHO recommends chemoprevention for certain populations. For children and infants, the WHO recommends seasonal malaria chemoprevention (SMC), perennial malaria chemoprevention (PMC; formerly intermittent preventive treatment in infants [IPTi]), and, more recently, intermittent preventive treatment in school children (IPTsc). This review describes the contextual factors, including feasibility, acceptability, health equity, financial considerations, and values and preferences, that impact implementation of these strategies. A systematic search was conducted on July 5, 2022, and repeated April 13, 2023, to identify relevant literature. Two reviewers independently screened titles for eligibility, extracted data from eligible articles, and identified and summarized themes. Of 6,295 unique titles identified, 65 were included. The most frequently evaluated strategy was SMC (n = 40), followed by IPTi (n = 18) and then IPTsc (n = 6). Overall, these strategies were highly acceptable, although with IPTsc, there were community concerns with providing drugs to girls of reproductive age and the use of nonmedical staff for drug distribution. For SMC, door-to-door delivery resulted in higher coverage, improved caregiver acceptance, and reduced cost. Lower adherence was noted when caregivers were charged with giving doses 2 and 3 unsupervised. For SMC and IPTi, travel distances and inclement weather limited accessibility. Sensitization and caregiver education efforts, retention of high-quality drug distributors, and improved transportation were key to improving coverage. Additional research is needed to understand the role of community values and preferences in chemoprevention implementation.
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Affiliation(s)
- Peris Gatiba
- Public Health Institute, Oakland, California
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica Laury
- Public Health Institute, Oakland, California
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jimee Hwang
- U.S. President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julie I Thwing
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rose Zulliger
- U.S. President's Malaria Initiative, United States Agency for International Development, Washington, District of Columbia
| | - Courtney Emerson
- U.S. President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julie R Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Thwing J, Williamson J, Cavros I, Gutman JR. Systematic Review and Meta-Analysis of Seasonal Malaria Chemoprevention. Am J Trop Med Hyg 2024; 110:20-31. [PMID: 38081050 PMCID: PMC10793029 DOI: 10.4269/ajtmh.23-0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/23/2023] [Indexed: 01/05/2024] Open
Abstract
Seasonal malaria chemoprevention (SMC) for children under 5 years of age for up to four monthly cycles during malaria transmission season was recommended by the WHO in 2012 and has been implemented in 13 countries in the Sahel, reaching more than 30 million children annually. Malaria control programs implementing SMC have asked the WHO to consider expanding the age range or number of monthly cycles. We conducted a systematic review and meta-analysis of SMC among children up to 15 years of age and up to six monthly cycles. Twelve randomized studies were included, with outcomes stratified by age (< 5/≥ 5 years), by three or four versus five or six cycles, and by drug where possible. Drug regimens included sulfadoxine-pyrimethamine + amodiaquine, amodiaquine-artesunate, and sulfadoxine-pyrimethamine + artesunate. Included studies were all conducted in Sahelian countries in which high-grade resistance to sulfadoxine-pyrimethamine was rare and in zones with parasite prevalence ranging from 1% to 79%. Seasonal malaria chemoprevention resulted in substantial reductions in uncomplicated malaria incidence measured during that transmission season (rate ratio: 0.27, 95% CI: 0.25-0.29 among children < 5 years; rate ratio: 0.27, 95% CI: 0.25-0.30 among children ≥ 5 years) and in the prevalence of malaria parasitemia measured within 4-6 weeks from the final SMC cycle (risk ratio: 0.38, 95% CI: 0.34-0.43 among children < 5 years; risk ratio: 0.23, 95% CI: 0.11-0.48 among children ≥ 5 years). In high-transmission zones, SMC resulted in a moderately reduced risk of any anemia (risk ratio: 0.77, 95% CI: 0.72-0.83 among children < 5 years; risk ratio: 0.70, 95% CI: 0.52-0.95 among children ≥ 5 years [one study]). Children < 10 years of age had a moderate reduction in severe malaria (risk ratio: 0.53, 95% CI: 0.37-0.76) but no evidence of a mortality reduction. The evidence suggests that in areas in which sulfadoxine-pyrimethamine and amodiaquine remained efficacious, SMC effectively reduced malaria disease burden among children both < 5 and ≥ 5 years old and that the number of cycles should be commensurate with the length of the transmission season, up to six cycles.
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Affiliation(s)
- Julie Thwing
- Malaria Branch, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Williamson
- Malaria Branch, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Irene Cavros
- U.S. President’s Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julie R. Gutman
- Malaria Branch, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Bottieau E, Mbow M, Brosius I, Roucher C, Gueye CT, Mbodj OT, Faye BT, De Hondt A, Smekens B, Arango D, Burm C, Tsoumanis A, Paredis L, Van Herrewege Y, Potters I, Richter J, Rosanas-Urgell A, Cissé B, Mboup S, Polman K. Antimalarial artesunate-mefloquine versus praziquantel in African children with schistosomiasis: an open-label, randomized controlled trial. Nat Med 2024; 30:130-137. [PMID: 38177851 PMCID: PMC10803269 DOI: 10.1038/s41591-023-02719-4] [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: 04/11/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024]
Abstract
Schistosomiasis treatment entirely relies on a single drug, praziquantel, prompting research into alternative therapeutics. Here we evaluated the efficacy and safety of the antimalarial combination artesunate-mefloquine for the treatment of schistosomiasis in a proof-of-concept, pragmatic, open-label, randomized controlled trial in primary schools of six villages endemic for schistosomiasis in northern Senegal. Children (6-14 years) were eligible if Schistosoma eggs were detected by microscopy in urine and/or stool. In total, 726 children were randomized 1:1 to praziquantel (standard care: 40 mg kg-1 single dose; n = 364) or to artesunate-mefloquine (antimalarial dosage: artesunate 4 mg kg-1 and mefloquine 8 mg kg-1 daily for three consecutive days; n = 362). Eight children not meeting the inclusion criteria were excluded from efficacy analysis. Median age of the remaining 718 participants was 9 years; 399 (55.6%) were male, and 319 (44.4%) female; 99.3% were infected with Schistosoma haematobium and 15.2% with S. mansoni. Primary outcomes were cure rate, assessed by microscopy, and frequency of drug-related adverse effects of artesunate-mefloquine versus praziquantel at 4 weeks after treatment. Cure rate was 59.6% (208/349) in the artesunate-mefloquine arm versus 62.1% (211/340) in the praziquantel arm. The difference of -2.5% (95% confidence interval (CI) -9.8 to 4.8) met the predefined criteria of noninferiority (margin set at 10%). All drug-related adverse events were mild or moderate, and reported in 28/361 children receiving artesunate-mefloquine (7.8%; 95% CI 5.4 to 11.0) versus 8/363 (2.2%; 95% CI 1.1 to 4.3) receiving praziquantel (P < 0.001). Artesunate-mefloquine at antimalarial dosage was moderately safe and noninferior to standard-care praziquantel for the treatment of schistosomiasis, predominantly due to S. haematobium. Multicentric trials in different populations and epidemiological settings are needed to confirm these findings. ClinicalTrials.gov identifier: NCT03893097 .
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Affiliation(s)
- Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Moustapha Mbow
- Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Dakar, Senegal
- Department of Immunology, Cheikh Anta Diop University, Dakar, Senegal
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Clémentine Roucher
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Cheikh Tidiane Gueye
- Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Dakar, Senegal
| | - Ousmane Thiam Mbodj
- Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Dakar, Senegal
| | - Babacar Thiendella Faye
- Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Dakar, Senegal
| | - Annelies De Hondt
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bart Smekens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Diana Arango
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christophe Burm
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Linda Paredis
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Yven Van Herrewege
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Idzi Potters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joachim Richter
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin, Berlin, Germany
| | - Anna Rosanas-Urgell
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Badara Cissé
- Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Dakar, Senegal
| | - Souleymane Mboup
- Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Dakar, Senegal
| | - Katja Polman
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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10
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Kajubi R, Ainsworth J, Baker K, Richardson S, Bonnington C, Rassi C, Achan J, Magumba G, Rubahika D, Nabakooza J, Tibenderana J, Nuwa A, Opigo J. A hybrid effectiveness-implementation study protocol to assess the effectiveness and chemoprevention efficacy of implementing seasonal malaria chemoprevention in five districts in Karamoja region, Uganda. Gates Open Res 2023; 7:14. [PMID: 38196920 PMCID: PMC10774186 DOI: 10.12688/gatesopenres.14287.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/11/2024] Open
Abstract
Background The World Health Organization (WHO) recommends seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine (SPAQ) for children aged 3 to 59 months, living in areas where malaria transmission is highly seasonal. However, due to widespread prevalence of resistance markers, SMC has not been implemented at scale in East and Southern Africa. An initial study in Uganda showed that SMC with SPAQ was feasible, acceptable, and protective against malaria in eligible children in Karamoja region. Nonetheless, exploration of alternative regimens is warranted since parasite resistance threats persist. Objective The study aims to test the effectiveness of SMC with Dihydroartemisinin-piperaquine (DP) or SPAQ (DP-SMC & SPAQ-SMC), chemoprevention efficacy as well as the safety and tolerability of DP compared to that of SPAQ among 3-59 months old children in Karamoja region, an area of Uganda where malaria transmission is highly seasonal. Methods A Type II hybrid effectiveness-implementation study design consisting of four components: 1) a cluster randomized controlled trial (cRCT) using passive surveillance to establish confirmed malaria cases in children using both SPAQ and DP; 2a) a prospective cohort study to determine the chemoprevention efficacy of SPAQ and DP (if SPAQ or DP clears sub-patent infection and provides 28 days of protection from new infection) and whether drug concentrations and/or resistance influence the ability to clear and prevent infection; 2b) a sub study examining pharmacokinetics of DP in children between 3 to <6 months; 3) a resistance markers study in children 3-59 months in the research districts plus the standard intervention districts to measure changes in resistance marker prevalence over time and finally; 4) a process evaluation. Discussion This study evaluates the effects of SPAQ-SMC versus DP-SMC on clinical malaria in vulnerable children in the context of high parasite SP resistance, whilst informing on the best implementation strategies. Conclusion This study will inform malaria policy in high-burden countries, specifically on utility of SMC outside the sahel, and contribute to progress in malaria control.
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Affiliation(s)
| | | | - Kevin Baker
- Technical, Malaria Consortium, London, UK
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | | | | | - Jane Achan
- Technical, Malaria Consortium, London, UK
| | | | - Denis Rubahika
- National Malaria Control Division, Ministry of Health of Uganda, Kampala, Uganda
| | - Jane Nabakooza
- National Malaria Control Division, Ministry of Health of Uganda, Kampala, Uganda
| | | | | | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health of Uganda, Kampala, Uganda
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11
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White NJ, Bonnington C, Nosten FH. A proposed method of grading malaria chemoprevention efficacy. Trans R Soc Trop Med Hyg 2023; 117:761-764. [PMID: 37427562 PMCID: PMC10629946 DOI: 10.1093/trstmh/trad042] [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: 05/22/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023] Open
Abstract
The efficacy and effectiveness of antimalarial drugs are threatened by increasing levels of resistance and therefore require continuous monitoring. Chemoprevention is increasingly deployed as a malaria control measure, but there are no generally accepted methods of assessment. We propose a simple method of grading the parasitological response to chemoprevention (focusing on seasonal malaria chemoprevention) that is based on pharmacometric assessment.
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Affiliation(s)
- N J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, OX3 7LJ, UK
| | - C Bonnington
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, OX3 7LJ, UK
- Malaria Consortium, London, UK
| | - F H Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, OX3 7LJ, UK
- Shoklo Malaria Research Unit, Mahidol‐Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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12
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Afolabi MO, Diaw A, Fall EHB, Sall FB, Diédhiou A, Seck A, Camara B, Niang D, Manga IA, Mbaye I, Sougou NM, Sow D, Greenwood B, Ndiaye JLA. Provider and User Acceptability of Integrated Treatment for the Control of Malaria and Helminths in Saraya, South-Eastern Senegal. Am J Trop Med Hyg 2023; 109:1047-1056. [PMID: 37722662 PMCID: PMC10622492 DOI: 10.4269/ajtmh.23-0113] [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: 02/19/2023] [Accepted: 07/07/2023] [Indexed: 09/20/2023] Open
Abstract
Integration of vertical programs for the control of malaria, schistosomiasis, and soil-transmitted helminthiasis has been recommended to achieve elimination of malaria and neglected tropical diseases (NTD) by 2030. This qualitative study was conducted within the context of a randomized controlled trial to explore the perceptions and views of parents/caregivers of at-risk children and healthcare providers to determine their acceptability of the integrated malaria-helminth treatment approach. Randomly selected parents/caregivers of children enrolled in the trial, healthcare providers, trial staff, malaria, and NTD program managers were interviewed using purpose-designed topic guides. Transcripts obtained from the interviews were coded and common themes identified using content analysis were triangulated. Fifty-seven study participants comprising 26 parents/caregivers, 10 study children aged ≥ 10 years, 15 trial staff, four healthcare providers, and two managers from the Senegal Ministry of Health were interviewed. Thirty-eight of the participants (66.7%) were males, and their ages ranged from 10 to 65 years. Overall, the integrated malaria-helminth treatment approach was considered acceptable, but the study participants expressed concerns about the taste, smell, and side effects associated with amodiaquine and praziquantel in the combination package. Reluctance to accept the medications was also observed among children aged 10 to 14 years due to peer influence and gender-sensitive cultural beliefs. Addressing concerns about the taste and smell of amodiaquine and praziquantel is needed to optimize the uptake of the integrated treatment program. Also, culturally appropriate strategies need to be put in place to cater for the inclusion of children aged 10 to 14 years in this approach.
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Affiliation(s)
- Muhammed O. Afolabi
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aminata Diaw
- Faculté de Medecine Pharmacie d’Odonto-Stomatologie, Université Cheikh Anta Diop, Dakar, Senegal
| | | | | | - Adams Diédhiou
- Faculté de Medecine Pharmacie d’Odonto-Stomatologie, Université Cheikh Anta Diop, Dakar, Senegal
| | - Amadou Seck
- Service de Parasitologie et Mycologie, Université de Thies, Thies, Senegal
| | - Baba Camara
- Hospital Administration, Saraya Health Centre, Saraya, Senegal
| | - Diatou Niang
- Hospital Administration, Saraya Health Centre, Saraya, Senegal
| | - Isaac A. Manga
- Faculté de Medecine Pharmacie d’Odonto-Stomatologie, Université Cheikh Anta Diop, Dakar, Senegal
| | - Ibrahima Mbaye
- Hospital Administration, Saraya Health Centre, Saraya, Senegal
| | - Ndèye Mareme Sougou
- Faculté de Medecine Pharmacie d’Odonto-Stomatologie, Université Cheikh Anta Diop, Dakar, Senegal
| | - Doudou Sow
- Service de Parasitologie et Mycologie, Université Gaston Berger de Saint-Louis, Saint-Louis, Senegal
| | - Brian Greenwood
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
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13
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Roh ME, Zongo I, Haro A, Huang L, Somé AF, Yerbanga RS, Conrad MD, Wallender E, Legac J, Aweeka F, Ouédraogo JB, Rosenthal PJ. Seasonal Malaria Chemoprevention Drug Levels and Drug Resistance Markers in Children With or Without Malaria in Burkina Faso: A Case-Control Study. J Infect Dis 2023; 228:926-935. [PMID: 37221018 PMCID: PMC10547452 DOI: 10.1093/infdis/jiad172] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/04/2023] [Accepted: 05/20/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Despite scale-up of seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine (SP-AQ) in children 3-59 months of age in Burkina Faso, malaria incidence remains high, raising concerns regarding SMC effectiveness and selection of drug resistance. Using a case-control design, we determined associations between SMC drug levels, drug resistance markers, and presentation with malaria. METHODS We enrolled 310 children presenting at health facilities in Bobo-Dioulasso. Cases were SMC-eligible children 6-59 months of age diagnosed with malaria. Two controls were enrolled per case: SMC-eligible children without malaria; and older (5-10 years old), SMC-ineligible children with malaria. We measured SP-AQ drug levels among SMC-eligible children and SP-AQ resistance markers among parasitemic children. Conditional logistic regression was used to compute odds ratios (ORs) comparing drug levels between cases and controls. RESULTS Compared to SMC-eligible controls, children with malaria were less likely to have any detectable SP or AQ (OR, 0.33 [95% confidence interval, .16-.67]; P = .002) and have lower drug levels (P < .05). Prevalences of mutations mediating high-level SP resistance were rare (0%-1%) and similar between cases and SMC-ineligible controls (P > .05). CONCLUSIONS Incident malaria among SMC-eligible children was likely due to suboptimal levels of SP-AQ, resulting from missed cycles rather than increased antimalarial resistance to SP-AQ.
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Affiliation(s)
- Michelle E Roh
- Institute for Global Health Sciences, Malaria Elimination Initiative, University of California, San Francisco
| | - Issaka Zongo
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Alassane Haro
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Liusheng Huang
- Department of Clinical Pharmacy, University of California, San Francisco
| | | | | | | | - Erika Wallender
- Department of Clinical Pharmacy, University of California, San Francisco
| | - Jennifer Legac
- Department of Medicine, University of California, San Francisco
| | - Francesca Aweeka
- Department of Clinical Pharmacy, University of California, San Francisco
| | - Jean-Bosco Ouédraogo
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
- Institut des Sciences et Techniques, Bobo-Dioulasso, Burkina Faso
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14
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Dao F, Dembele L, Diarra B, Sogore F, Marin-Menendez A, Goita S, Haidara AS, Barre YN, Sangare CPO, Kone A, Ouologuem DT, Dara A, Tekete MM, Talman AM, Djimde AA. The Prevalence of Human Plasmodium Species during Peak Transmission Seasons from 2016 to 2021 in the Rural Commune of Ntjiba, Mali. Trop Med Infect Dis 2023; 8:438. [PMID: 37755899 PMCID: PMC10535850 DOI: 10.3390/tropicalmed8090438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
Up-to-date knowledge of key epidemiological aspects of each Plasmodium species is necessary for making informed decisions on targeted interventions and control strategies to eliminate each of them. This study aims to describe the epidemiology of plasmodial species in Mali, where malaria is hyperendemic and seasonal. Data reports collected during high-transmission season over six consecutive years were analyzed to summarize malaria epidemiology. Malaria species and density were from blood smear microscopy. Data from 6870 symptomatic and 1740 asymptomatic participants were analyzed. The median age of participants was 12 years, and the sex ratio (male/female) was 0.81. Malaria prevalence from all Plasmodium species was 65.20% (95% CI: 60.10-69.89%) and 22.41% (CI: 16.60-28.79%) for passive and active screening, respectively. P. falciparum was the most prevalent species encountered in active and passive screening (59.33%, 19.31%). This prevalence was followed by P. malariae (1.50%, 1.15%) and P. ovale (0.32%, 0.06%). Regarding frequency, P. falciparum was more frequent in symptomatic individuals (96.77% vs. 93.24%, p = 0.014). In contrast, P. malariae was more frequent in asymptomatic individuals (5.64% vs. 2.45%, p < 0.001). P. ovale remained the least frequent species (less than 1%), and no P. vivax was detected. The most frequent coinfections were P. falciparum and P. malariae (0.56%). Children aged 5-9 presented the highest frequency of P. falciparum infections (41.91%). Non-falciparum species were primarily detected in adolescents (10-14 years) with frequencies above 50%. Only P. falciparum infections had parasitemias greater than 100,000 parasites per µL of blood. P. falciparum gametocytes were found with variable prevalence across age groups. Our data highlight that P. falciparum represented the first burden, but other non-falciparum species were also important. Increasing attention to P. malariae and P. ovale is essential if malaria elimination is to be achieved.
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Affiliation(s)
- Francois Dao
- Malaria Research and Training Center, Faculty of Pharmacy, Faculty of Medicine and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako 1805, Mali; (F.D.); (B.D.); (F.S.); (S.G.); (A.S.H.); (Y.N.B.); (C.P.O.S.); (A.K.); (D.T.O.); (A.D.); (M.M.T.)
- MIVEGEC, Université de Montpellier, CNRS, IRD, 34095 Montpellier, France; (A.M.-M.); (A.M.T.)
| | - Laurent Dembele
- Malaria Research and Training Center, Faculty of Pharmacy, Faculty of Medicine and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako 1805, Mali; (F.D.); (B.D.); (F.S.); (S.G.); (A.S.H.); (Y.N.B.); (C.P.O.S.); (A.K.); (D.T.O.); (A.D.); (M.M.T.)
| | - Bakoroba Diarra
- Malaria Research and Training Center, Faculty of Pharmacy, Faculty of Medicine and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako 1805, Mali; (F.D.); (B.D.); (F.S.); (S.G.); (A.S.H.); (Y.N.B.); (C.P.O.S.); (A.K.); (D.T.O.); (A.D.); (M.M.T.)
| | - Fanta Sogore
- Malaria Research and Training Center, Faculty of Pharmacy, Faculty of Medicine and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako 1805, Mali; (F.D.); (B.D.); (F.S.); (S.G.); (A.S.H.); (Y.N.B.); (C.P.O.S.); (A.K.); (D.T.O.); (A.D.); (M.M.T.)
| | | | - Siaka Goita
- Malaria Research and Training Center, Faculty of Pharmacy, Faculty of Medicine and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako 1805, Mali; (F.D.); (B.D.); (F.S.); (S.G.); (A.S.H.); (Y.N.B.); (C.P.O.S.); (A.K.); (D.T.O.); (A.D.); (M.M.T.)
| | - Aboubacrin S. Haidara
- Malaria Research and Training Center, Faculty of Pharmacy, Faculty of Medicine and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako 1805, Mali; (F.D.); (B.D.); (F.S.); (S.G.); (A.S.H.); (Y.N.B.); (C.P.O.S.); (A.K.); (D.T.O.); (A.D.); (M.M.T.)
| | - Yacouba N. Barre
- Malaria Research and Training Center, Faculty of Pharmacy, Faculty of Medicine and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako 1805, Mali; (F.D.); (B.D.); (F.S.); (S.G.); (A.S.H.); (Y.N.B.); (C.P.O.S.); (A.K.); (D.T.O.); (A.D.); (M.M.T.)
| | - Cheick P. O. Sangare
- Malaria Research and Training Center, Faculty of Pharmacy, Faculty of Medicine and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako 1805, Mali; (F.D.); (B.D.); (F.S.); (S.G.); (A.S.H.); (Y.N.B.); (C.P.O.S.); (A.K.); (D.T.O.); (A.D.); (M.M.T.)
| | - Aminatou Kone
- Malaria Research and Training Center, Faculty of Pharmacy, Faculty of Medicine and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako 1805, Mali; (F.D.); (B.D.); (F.S.); (S.G.); (A.S.H.); (Y.N.B.); (C.P.O.S.); (A.K.); (D.T.O.); (A.D.); (M.M.T.)
| | - Dinkorma T. Ouologuem
- Malaria Research and Training Center, Faculty of Pharmacy, Faculty of Medicine and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako 1805, Mali; (F.D.); (B.D.); (F.S.); (S.G.); (A.S.H.); (Y.N.B.); (C.P.O.S.); (A.K.); (D.T.O.); (A.D.); (M.M.T.)
| | - Antoine Dara
- Malaria Research and Training Center, Faculty of Pharmacy, Faculty of Medicine and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako 1805, Mali; (F.D.); (B.D.); (F.S.); (S.G.); (A.S.H.); (Y.N.B.); (C.P.O.S.); (A.K.); (D.T.O.); (A.D.); (M.M.T.)
| | - Mamadou M. Tekete
- Malaria Research and Training Center, Faculty of Pharmacy, Faculty of Medicine and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako 1805, Mali; (F.D.); (B.D.); (F.S.); (S.G.); (A.S.H.); (Y.N.B.); (C.P.O.S.); (A.K.); (D.T.O.); (A.D.); (M.M.T.)
| | - Arthur M. Talman
- MIVEGEC, Université de Montpellier, CNRS, IRD, 34095 Montpellier, France; (A.M.-M.); (A.M.T.)
| | - Abdoulaye A. Djimde
- Malaria Research and Training Center, Faculty of Pharmacy, Faculty of Medicine and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako 1805, Mali; (F.D.); (B.D.); (F.S.); (S.G.); (A.S.H.); (Y.N.B.); (C.P.O.S.); (A.K.); (D.T.O.); (A.D.); (M.M.T.)
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Ujuju CN, Mokuolu OA, Nwafor-Okoli C, Nnamani KO. Unravelling factors associated with malaria parasitaemia among children 6-24 months to inform malaria interventions in Nigeria: evidence from 2021 Malaria Indicator Survey. Malar J 2023; 22:247. [PMID: 37641100 PMCID: PMC10464367 DOI: 10.1186/s12936-023-04683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND As an additional two million malaria cases were reported in 2021 compared to the previous year, concerted efforts toward achieving a steady decline in malaria cases are needed to achieve malaria elimination goals. This work aimed at determining the factors associated with malaria parasitaemia among children 6-24 months for better targeting of malaria interventions. METHODS A cross-sectional study analysed 2021 Nigeria Malaria Indicator Survey dataset. Data from 3058 children 6-24 months were analyzed. The outcome variable was children 6-24 months whose parasitaemia was determined using a rapid diagnostic test (RDT). Independent variables include child age in months, mothers' age, mothers' education, region, place of residence, household ownership and child use of insecticide-treated net (ITN), exposure to malaria messages and knowledge of ways to prevent malaria. Logistic regression analysis was conducted to examine possible factors associated with malaria parasitaemia in children 6-24 months. RESULTS Findings revealed that 28.7% of the 3058 children aged 6-24 months tested positive for malaria by RDT. About 63% of children 12-17 months (aOR = 1.63, 95% CI 1.31-2.03) and 91% of children 18 to 24 months (aOR = 1.91, 95% CI 1.51-2.42) were more likely to have a positive malaria test result. Positive malaria test result was also more likely in rural areas (aOR = 1.79, 95% CI 2.02-24.46), northeast (aOR = 1.54, 95% CI 1.02-2.31) and northwest (aOR = 1.63, 95% CI 1.10-2.40) region. In addition, about 39% of children who slept under ITN had a positive malaria test result (aOR = 1.39 95% CI 1.01-1.90). While children of mothers with secondary (aOR = 0.40, 95% CI 0.29-0.56) and higher (aOR = 0.26, 95% CI 0.16-0.43) levels of education and mothers who were aware of ways of avoiding malaria (aOR = 0.69, 95% CI 0.53-0.90) were less likely to have a malaria positive test result. CONCLUSION As older children 12 to 24 months, children residing in the rural, northeast, and northwest region are more likely to have malaria, additional intervention should target them in an effort to end malaria.
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Affiliation(s)
- Chinazo N Ujuju
- Research Department, Data for Decisions Nigeria Ltd, Abuja, Nigeria.
| | - Olugbenga A Mokuolu
- Centre for Malaria and Other Tropical Diseases Care, University of Ilorin Teaching Hospital, Ilorin, Nigeria
- Department of Paediatrics, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | | | - Kenechi O Nnamani
- Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
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Challenger JD, van Beek SW, ter Heine R, van der Boor SC, Charles GD, Smit MJ, Ockenhouse C, Aponte JJ, McCall MBB, Jore MM, Churcher TS, Bousema T. Modeling the Impact of a Highly Potent Plasmodium falciparum Transmission-Blocking Monoclonal Antibody in Areas of Seasonal Malaria Transmission. J Infect Dis 2023; 228:212-223. [PMID: 37042518 PMCID: PMC10345482 DOI: 10.1093/infdis/jiad101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/06/2023] [Accepted: 04/11/2023] [Indexed: 04/13/2023] Open
Abstract
Transmission-blocking interventions can play an important role in combating malaria worldwide. Recently, a highly potent Plasmodium falciparum transmission-blocking monoclonal antibody (TB31F) was demonstrated to be safe and efficacious in malaria-naive volunteers. Here we predict the potential public health impact of large-scale implementation of TB31F alongside existing interventions. We developed a pharmaco-epidemiological model, tailored to 2 settings of differing transmission intensity with already established insecticide-treated nets and seasonal malaria chemoprevention interventions. Community-wide annual administration (at 80% coverage) of TB31F over a 3-year period was predicted to reduce clinical incidence by 54% (381 cases averted per 1000 people per year) in a high-transmission seasonal setting, and 74% (157 cases averted per 1000 people per year) in a low-transmission seasonal setting. Targeting school-aged children gave the largest reduction in terms of cases averted per dose. An annual administration of the transmission-blocking monoclonal antibody TB31F may be an effective intervention against malaria in seasonal malaria settings.
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Affiliation(s)
- Joseph D Challenger
- Medical Research Council Centre for Global Infections Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | | | - Rob ter Heine
- Department of Pharmacy, Radboud Institute for Health Sciences
| | - Saskia C van der Boor
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Giovanni D Charles
- Medical Research Council Centre for Global Infections Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Merel J Smit
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris Ockenhouse
- PATH Center for Vaccine Innovation and Access, Washington, District of Columbia, USA
| | - John J Aponte
- PATH Center for Vaccine Innovation and Access, Geneva, Switzerland
| | - Matthew B B McCall
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matthijs M Jore
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas S Churcher
- Medical Research Council Centre for Global Infections Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
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17
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Xu M, Hu YX, Lu SN, Idris MA, Zhou SD, Yang J, Feng XN, Huang YM, Xu X, Chen Y, Wang DQ. Seasonal malaria chemoprevention in Africa and China's upgraded role as a contributor: a scoping review. Infect Dis Poverty 2023; 12:63. [PMID: 37403183 DOI: 10.1186/s40249-023-01115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Children under five are the vulnerable population most at risk of being infected with Plasmodium parasites, especially in the Sahel region. Seasonal malaria chemoprevention (SMC) recommended by World Health Organization (WHO), has proven to be a highly effective intervention to prevent malaria. Given more deaths reported during the COVID-19 pandemic than in previous years due to the disruptions to essential medical services, it is, therefore, necessary to seek a more coordinated and integrated approach to increasing the pace, coverage and resilience of SMC. Towards this end, fully leverage the resources of major players in the global fight against malaria, such as China could accelerate the SMC process in Africa. METHODS We searched PubMed, MEDLINE, Web of Science, and Embase for research articles and the Institutional Repository for Information Sharing of WHO for reports on SMC. We used gap analysis to investigate the challenges and gaps of SMC since COVID-19. Through the above methods to explore China's prospective contribution to SMC. RESULTS A total of 68 research articles and reports were found. Through gap analysis, we found that despite the delays in the SMC campaign, 11.8 million children received SMC in 2020. However, there remained some challenges: (1) a shortage of fully covered monthly courses; (2) lack of adherence to the second and third doses of amodiaquine; (3) four courses of SMC are not sufficient to cover the entire malaria transmission season in areas where the peak transmission lasts longer; (4) additional interventions are needed to consolidate SMC efforts. China was certified malaria-free by WHO in 2021, and its experience and expertise in malaria elimination can be shared with high-burden countries. With the potential to join the multilateral cooperation in SMC, including the supply of quality-assured health commodities, know-how transfer and experience sharing, China is expected to contribute to the ongoing scale-up of SMC. CONCLUSIONS A combination of necessary preventive and curative activities may prove beneficial both for targeted populations and for health system strengthening in the long run. More actions are entailed to promote the partnership and China can be one of the main contributors with various roles.
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Affiliation(s)
- Ming Xu
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yun-Xuan Hu
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Shen-Ning Lu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, China
| | | | - Shu-Duo Zhou
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Jian Yang
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Xiang-Ning Feng
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yang-Mu Huang
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Xian Xu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Ying Chen
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China.
- Institute for Global Health and Development, Peking University, Beijing, China.
| | - Duo-Quan Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, China.
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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18
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Natama HM, Traoré TE, Rouamba T, Somé MA, Zango SH, Rovira-Vallbona E, Sorgho H, Guetens P, Coulibaly-Traoré M, Valéa I, Tinto H, Rosanas-Urgell A. Performance of PfHRP2-RDT for malaria diagnosis during the first year of life in a high malaria transmission area in Burkina Faso. J Parasit Dis 2023; 47:280-289. [PMID: 37193494 PMCID: PMC10182193 DOI: 10.1007/s12639-023-01566-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/07/2023] [Indexed: 01/20/2023] Open
Abstract
In this study, we evaluated the performance of a P. falciparum Histidine Rich Protein 2 (PfHRP2)-based rapid diagnostic test (RDT) used for malaria case detection (SD-Bioline malaria RDT P.f®) along with light microscopy (LM) against qPCR among children during the first year of life in a high and seasonal malaria transmission area in Burkina Faso. A total of 723 suspected malaria cases (including multiple episodes) that occurred among 414 children participating in a birth-cohort study were included in the present analysis. Factors including age at the time of malaria screening, transmission season and parasite densities were investigated for their potential influence in the performance of the RDT. Clinical malaria cases as detected by RDT, LM and qPCR were 63.8%, 41.5% and 49.8%, respectively. Compared with qPCR, RDT had a false-positive results rate of 26.7%, resulting in an overall accuracy of 79.9% with a sensitivity of 93%, a specificity of 66.1%, a Positive Predictive Value of 73.3% and a Negative Predictive Value of 91.6%. Its specificity differed significantly between high and low transmission seasons (53.7% vs 79.8%; P < 0.001) and decreased with increasing age (80.6-62%; P for trend = 0.024). The overall accuracy of LM was 91.1% and its performance was not significantly influenced by transmission season or age. These findings highlight the need to adapt malaria diagnostic tools recommendations to face the challenge of adequate malaria detection in this population group living in high burden and seasonal malaria transmission settings.
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Affiliation(s)
- Hamtandi Magloire Natama
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Tiampan Edwig Traoré
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - M. Athanase Somé
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Serge Henri Zango
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Eduard Rovira-Vallbona
- Universitat de Barcelona, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Hermann Sorgho
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Pieter Guetens
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Maminata Coulibaly-Traoré
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Innocent Valéa
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Halidou Tinto
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Anna Rosanas-Urgell
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Manga IA, Tairou F, Seck A, Kouevidjin E, Sylla K, Sow D, Gueye AB, Ba M, Ndiaye M, Tine RCK, Gaye O, Faye B, Ndiaye JLA. Effectiveness of seasonal malaria chemoprevention administered in a mass campaign in the Kedougou region of Senegal in 2016: a case-control study. Wellcome Open Res 2023; 7:216. [PMID: 37153452 PMCID: PMC10154913 DOI: 10.12688/wellcomeopenres.18057.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 05/11/2023] Open
Abstract
Background: Seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) is a malaria prevention strategy recommended since 2012 by the World Health Organization (WHO) for children under 5 years. In Senegal, the scaling up of SMC started in 2013 in the south-eastern regions of the country with an extension of the target to 10 years old children. The scaling up of SMC requires regular evaluation of the strategy as recommended by the WHO. This study was conducted to evaluate the effectiveness of SMC. Methods: A case-control study was conducted in some villages of the health districts of Saraya and Kedougou in the Kedougou region from July to December 2016. A case was a sick child, aged 3 months to 10 years, seen in consultation and with a positive malaria rapid diagnostic test (RDT). The control was a child of the same age group with a negative RDT and living in the same compound as the case or in a neighbouring compound. Each case was matched with two controls. Exposure to SMC was assessed by interviewing the mothers/caretakers and by checking the SMC administration card. Results: Overall, 492 children, including 164 cases and 328 controls, were recruited in our study. Their mean ages were 5.32 (+/- 2.15) and 4.44 (+/-2.25) years for cases and controls, respectively. The number of boys was higher in both cases (55.49%; CI 95%=47.54-63.24%) and controls (51,22%; CI 95%=45.83-56.58%). Net ownership was 85.80% among cases and 90.85% among controls (p=0,053). The proportion of controls who received SMC was higher than that of cases (98.17% vs 85.98% and p=1.10 -7). The protective effectiveness of SMC was 89% (OR= 0.12 (CI 95%=0.04-0.28)). Conclusions: SMC is an effective strategy in the control of malaria in children. Case-control studies are a good approach for monitoring the efficacy of drugs administered during SMC.
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Affiliation(s)
- Isaac Akhenaton Manga
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Fassiatou Tairou
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Amadou Seck
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Ekoue Kouevidjin
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Khadime Sylla
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Doudou Sow
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Alioune Babara Gueye
- Ministry of Health and Social Action, National Malaria Control Program, Dakar, Senegal
| | - Mady Ba
- Ministry of Health and Social Action, National Malaria Control Program, Dakar, Senegal
| | - Magatte Ndiaye
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Roger Clément Kouly Tine
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Omar Gaye
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Babacar Faye
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Jean Louis Abdourahim Ndiaye
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
- Service of Parasitology Mycology/Departement of medical biology, UFR Santé/University Iba Der Thiam, Thies, Senegal
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20
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Nuwa A, Baker K, Bonnington C, Odongo M, Kyagulanyi T, Bwanika JB, Richardson S, Nabakooza J, Achan J, Kajubi R, Odong DS, Nakirunda M, Magumba G, Beinomugisha G, Marasciulo-Rice M, Abio H, Rassi C, Rutazaana D, Rubahika D, Tibenderana J, Opigo J. A non-randomized controlled trial to assess the protective effect of SMC in the context of high parasite resistance in Uganda. Malar J 2023; 22:63. [PMID: 36814301 PMCID: PMC9945593 DOI: 10.1186/s12936-023-04488-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/11/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Until recently, due to widespread prevalence of molecular markers associated with sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) resistance in east and southern Africa, seasonal malaria chemoprevention (SMC) has not been used at scale in this region. This study assessed the protective effectiveness of monthly administration of SP + AQ (SPAQ) to children aged 3-59 months in Karamoja sub-region, Uganda, where parasite resistance is assumed to be high and malaria transmission is seasonal. METHODS A two-arm quasi-experimental, open-label prospective non-randomized control trial (nRCT) was conducted in three districts. In two intervention districts, 85,000 children aged 3-59 months were targeted to receive monthly courses of SMC using SPAQ during the peak transmission season (May to September) 2021. A third district served as a control, where SMC was not implemented. Communities with comparable malaria attack rates were selected from the three districts, and households with at least one SMC-eligible child were purposively selected. A total cohort of 600 children (200 children per district) were selected and followed using passive surveillance for breakthrough confirmed malaria episodes during the five-month peak transmission season. Malaria incidence rate per person-months and number of malaria episodes among children in the two arms were compared. Kaplan-Meier failure estimates were used to compare the probability of a positive malaria test. Other factors that may influence malaria transmission and infection among children in the two arms were also assessed using multivariable cox proportional hazards regression model. RESULTS The malaria incidence rate was 3.0 and 38.8 per 100 person-months in the intervention and control groups, respectively. In the intervention areas 90.0% (361/400) of children did not experience any malaria episodes during the study period, compared to 15% (29/200) in the control area. The incidence rate ratio was 0.078 (95% CI 0.063-0.096), which corresponds to a protective effectiveness of 92% (95% CI 90.0-94.0) among children in the intervention area. CONCLUSION SMC using SPAQ provided high protective effect against malaria during the peak transmission season in children aged 3-59 months in the Karamoja sub-region of Uganda.
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Affiliation(s)
| | - Kevin Baker
- grid.475304.10000 0004 6479 3388Malaria Consortium, London, UK ,grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Musa Odongo
- grid.452563.3Malaria Consortium Uganda, Kampala, Uganda
| | | | | | - Sol Richardson
- grid.475304.10000 0004 6479 3388Malaria Consortium, London, UK ,grid.12527.330000 0001 0662 3178Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Jane Nabakooza
- grid.415705.2National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Jane Achan
- grid.475304.10000 0004 6479 3388Malaria Consortium, London, UK
| | | | | | | | | | | | | | - Hilda Abio
- grid.452563.3Malaria Consortium Uganda, Kampala, Uganda
| | - Christian Rassi
- grid.475304.10000 0004 6479 3388Malaria Consortium, London, UK
| | - Damian Rutazaana
- grid.415705.2National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Denis Rubahika
- grid.415705.2National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | | | - Jimmy Opigo
- grid.415705.2National Malaria Control Division, Ministry of Health, Kampala, Uganda
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21
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Konate D, Diawara SI, Sogoba N, Shaffer J, Keita B, Cisse A, Sanogo I, Dicko I, Guindo MDA, Balam S, Traore A, Kante S, Dembele A, Kasse F, Denou L, Diakite SA, Traore K, M'Baye Thiam S, Sanogo V, Toure M, Diarra A, Agak GW, Doumbia S, Diakite M. Effect of a fifth round of seasonal malaria chemoprevention in children aged 5-14 years in Dangassa, an area of long transmission in Mali. Parasite Epidemiol Control 2023; 20:e00283. [PMID: 36704118 PMCID: PMC9871299 DOI: 10.1016/j.parepi.2022.e00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/06/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023] Open
Abstract
Despite a significant reduction in the burden of malaria in children under five years-old, the efficient implementation of seasonal malaria chemoprevention (SMC) at large scale remains a major concern in areas with long malaria transmission. Low coverage rate in the unattainable areas during the rainy season, a shift in the risk of malaria to older children and the rebound in malaria incidence after stopping drug administration are mainly reported in these areas. These gaps represent a major challenge in the efficient implementation of SMC measures. An open randomized study was conducted to assess the effect of a fifth additional round to current regime of SMC in older children living in Dangassa, a rural malaria endemic area. Poisson regression Model was used to estimate the reduction in malaria incidence in the intervention group compared to the control group including age groups (5-9 and 10-14 years) and the use of long-lasting insecticidal nets (LLINs; Yes or No) with a threshold at 5%. Overall, a downward trend in participation rate was observed from August (94.3%) to November (87.2%). In November (round 4), the risk of malaria incidence was similar in both groups (IRR = 0.66, 95%CI [0.35-1.22]). In December (round 5), a decrease of 51% in malaria incidence was observed in intervention group compared to control group adjusted for age groups and the use of LLINs (IRR = 0.49, 95%CI [0.26-0.94]), of which 17% of reduction is attributable to the 5th round in the intervention group. An additional fifth round of SMC resulted in a significant reduction of malaria incidence in the intervention group. The number of SMC rounds could be adapted to the local condition of malaria transmission.
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Affiliation(s)
- Drissa Konate
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
- Corresponding author.
| | - Sory I. Diawara
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Nafomon Sogoba
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Jeff Shaffer
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Bourama Keita
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Abdourhamane Cisse
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Ibrahim Sanogo
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ilo Dicko
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Merepen dite Agnes Guindo
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Saidou Balam
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Abdouramane Traore
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Salimata Kante
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Assitan Dembele
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Fatoumata Kasse
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Larissa Denou
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Seidina A.S. Diakite
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Karim Traore
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Sidibe M'Baye Thiam
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Vincent Sanogo
- National Malaria Control Program, Ministry of Health, Bamako, Mali
| | - Mahamoudou Toure
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ayouba Diarra
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - George W. Agak
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Seydou Doumbia
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mahamadou Diakite
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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22
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Kajubi R, Ainsworth J, Baker K, Richardson S, Bonnington C, Rassi C, Achan J, Magumba G, Rubahika D, Nabakooza J, Tibenderana J, Nuwa A, Opigo J. A hybrid effectiveness-implementation study protocol to assess the effectiveness and chemoprevention efficacy of implementing seasonal malaria chemoprevention in five districts in Karamoja region, Uganda. Gates Open Res 2023. [DOI: 10.12688/gatesopenres.14287.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background: The World Health Organization (WHO) recommends seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine for children aged 3 to 59 months, living in areas where malaria transmission is highly seasonal. However, due to widespread prevalence of resistance markers, SMC has not been implemented at scale in East and Southern Africa. An initial study in Uganda showed that SMC with SPAQ was feasible, acceptable, and protective against malaria in eligible children in Karamoja region. Nonetheless, exploration of alternative regimens is warranted since parasite resistance threats persist. Objective: The study aims to test the effectiveness of SMC with DP or SPAQ (DP-SMC & SPAQ-SMC), chemoprevention efficacy as well as the safety and tolerability of DP compared to that of SPAQ among 3-59 months old children in Karamoja region, an area of Uganda where malaria transmission is highly seasonal. Methods: A Type II hybrid effectiveness-implementation study design consisting of four components: 1) a cluster randomized controlled trial (cRCT) using passive surveillance to establish confirmed malaria cases in children using both SPAQ and DP; 2a) a prospective cohort study to determine the chemoprevention efficacy of SPAQ and DP (if SPAQ or DP clears sub-patent infection and provides 28 days of protection from new infection) and whether drug concentrations and/or resistance influence the ability to clear and prevent infection; 2b) a sub study examining pharmacokinetics of DP in children between 3 to <6 months; 3) a resistance markers study in children 3–59 months in the research districts plus the standard intervention districts to measure changes in resistance marker prevalence over time and finally; 4) a process evaluation. Discussion: This study evaluates the effects of a clinical intervention on relevant outcomes whilst collecting information on implementation. Conclusion: This study will inform malaria policy in high-burden countries and contribute to progress in malaria control.
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Oduma CO, Ombok M, Zhao X, Huwe T, Ondigo BN, Kazura JW, Grieco J, Achee N, Liu F, Ochomo E, Koepfli C. Altitude, not potential larval habitat availability, explains pronounced variation in Plasmodium falciparum infection prevalence in the western Kenya highlands. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001505. [PMID: 37068071 PMCID: PMC10109483 DOI: 10.1371/journal.pgph.0001505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/03/2023] [Indexed: 04/18/2023]
Abstract
Progress in malaria control has stalled over the recent years. Knowledge on main drivers of transmission explaining small-scale variation in prevalence can inform targeted control measures. We collected finger-prick blood samples from 3061 individuals irrespective of clinical symptoms in 20 clusters in Busia in western Kenya and screened for Plasmodium falciparum parasites using qPCR and microscopy. Clusters spanned an altitude range of 207 meters (1077-1284 m). We mapped potential mosquito larval habitats and determined their number within 250 m of a household and distances to households using ArcMap. Across all clusters, P. falciparum parasites were detected in 49.8% (1524/3061) of individuals by qPCR and 19.5% (596/3061) by microscopy. Across the clusters, prevalence ranged from 26% to 70% by qPCR. Three to 34 larval habitats per cluster and 0-17 habitats within a 250m radius around households were observed. Using a generalized linear mixed effect model (GLMM), a 5% decrease in the odds of getting infected per each 10m increase in altitude was observed, while the number of larval habitats and their proximity to households were not statistically significant predictors for prevalence. Kitchen located indoors, open eaves, a lower level of education of the household head, older age, and being male were significantly associated with higher prevalence. Pronounced variation in prevalence at small scales was observed and needs to be taken into account for malaria surveillance and control. Potential larval habitat frequency had no direct impact on prevalence.
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Affiliation(s)
- Colins O Oduma
- Department of Biochemistry and Molecular Biology, Egerton University, Nakuru, Kenya
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Maurice Ombok
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Xingyuan Zhao
- Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, IN, United States of America
| | - Tiffany Huwe
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States of America
| | - Bartholomew N Ondigo
- Department of Biochemistry and Molecular Biology, Egerton University, Nakuru, Kenya
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - James W Kazura
- Case Western Reserve University, Center for Global Health and Diseases, Cleveland, OH, United States of America
| | - John Grieco
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States of America
| | - Nicole Achee
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States of America
| | - Fang Liu
- Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, IN, United States of America
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States of America
| | - Eric Ochomo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Cristian Koepfli
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States of America
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Koko DC, Maazou A, Jackou H, Eddis C. Analysis of attitudes and practices influencing adherence to seasonal malaria chemoprevention in children under 5 years of age in the Dosso Region of Niger. Malar J 2022; 21:375. [PMID: 36474264 PMCID: PMC9727940 DOI: 10.1186/s12936-022-04407-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Seasonal malaria chemoprevention (SMC) consists of the intermittent administration of a 3 day course of anti-malarial medications during the months of highest malaria risk in the Sahel region, where malaria transmission is highly seasonal. SMC is an effective intervention to reduce episodes of uncomplicated and severe malaria in children. However, morbidity cannot be lowered without adherence to medications. The objective of this study was to examine SMC medication adherence and to identify the attitudes and practices of caregivers during the 2020 SMC campaign in the Dosso region. METHODS This study was conducted based on data from independent monitoring using random cluster sampling. Adherence levels and the attitudes and practices of caregivers were evaluated using data from caregivers' self-reports and analysed according to Bernard Vrijens' taxonomy. RESULTS At the initiation of treatment phase, 99% of children (N = 2296) received their first administration of medication, with 90% of caregivers (N = 1436) knowing that the medications help prevent malaria. However, only 56% of caregivers (N = 1856) reported that treatment initiation took place under direct observation by the distributor. At the implementation of treatment phase, 90% of children (N = 2132) took their medication on the second day and 84% (N = 1068) took it the third day. "Forgetting," "not having time," and "the mother's absence" were the main reasons caregivers gave to explain discontinuation of the 3 day course of medication. CONCLUSION This simple, low-cost survey demonstrated that coverage of SMC and adherence by caregivers to completing the full 3 day medication course was high. The survey also showed that knowledge, attitudes, and practices of some caregivers regarding adherence to medications during the SMC campaign could be improved. Expanding distributors' training, developing and providing them with tools for interpersonal communication, and strengthening supervision could lead to even higher adherence.
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Affiliation(s)
| | - Aminata Maazou
- U.S. PMI Impact Malaria Project, Population Services International, Niamey, Niger
| | - Hadiza Jackou
- Programme National de Lutte Contre le Paludisme, Niamey, Niger
| | - Charlotte Eddis
- grid.507606.2U.S. PMI Impact Malaria Project, Population Service International, Washington, DC USA
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Cairns M, Barry A, Zongo I, Sagara I, Yerbanga SR, Diarra M, Zoungrana C, Issiaka D, Sienou AA, Tapily A, Sanogo K, Kaya M, Traore S, Diarra K, Yalcouye H, Sidibe Y, Haro A, Thera I, Snell P, Grant J, Tinto H, Milligan P, Chandramohan D, Greenwood B, Dicko A, Ouedraogo JB. The duration of protection against clinical malaria provided by the combination of seasonal RTS,S/AS01 E vaccination and seasonal malaria chemoprevention versus either intervention given alone. BMC Med 2022; 20:352. [PMID: 36203149 PMCID: PMC9540742 DOI: 10.1186/s12916-022-02536-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A recent trial of 5920 children in Burkina Faso and Mali showed that the combination of seasonal vaccination with the RTS,S/AS01E malaria vaccine (primary series and two seasonal boosters) and seasonal malaria chemoprevention (four monthly cycles per year) was markedly more effective than either intervention given alone in preventing clinical malaria, severe malaria, and deaths from malaria. METHODS In order to help optimise the timing of these two interventions, trial data were reanalysed to estimate the duration of protection against clinical malaria provided by RTS,S/AS01E when deployed seasonally, by comparing the group who received the combination of SMC and RTS,S/AS01E with the group who received SMC alone. The duration of protection from SMC was also estimated comparing the combined intervention group with the group who received RTS,S/AS01E alone. Three methods were used: Piecewise Cox regression, Flexible parametric survival models and Smoothed Schoenfeld residuals from Cox models, stratifying on the study area and using robust standard errors to control for within-child clustering of multiple episodes. RESULTS The overall protective efficacy from RTS,S/AS01E over 6 months was at least 60% following the primary series and the two seasonal booster doses and remained at a high level over the full malaria transmission season. Beyond 6 months, protective efficacy appeared to wane more rapidly, but the uncertainty around the estimates increases due to the lower number of cases during this period (coinciding with the onset of the dry season). Protection from SMC exceeded 90% in the first 2-3 weeks post-administration after several cycles, but was not 100%, even immediately post-administration. Efficacy begins to decline from approximately day 21 and then declines more sharply after day 28, indicating the importance of preserving the delivery interval for SMC cycles at a maximum of four weeks. CONCLUSIONS The efficacy of both interventions was highest immediately post-administration. Understanding differences between these interventions in their peak efficacy and how rapidly efficacy declines over time will help to optimise the scheduling of SMC, malaria vaccination and the combination in areas of seasonal transmission with differing epidemiology, and using different vaccine delivery systems. TRIAL REGISTRATION The RTS,S-SMC trial in which these data were collected was registered at clinicaltrials.gov: NCT03143218.
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Affiliation(s)
- Matthew Cairns
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Amadou Barry
- Malaria Research and Training Centre, Bamako, Mali
| | - Issaka Zongo
- Institut de Recherche en Sciences de la Santé, Bobo Dioulasso, Burkina Faso
| | | | - Serge R Yerbanga
- Institut de Recherche en Sciences de la Santé, Bobo Dioulasso, Burkina Faso
| | | | - Charles Zoungrana
- Institut de Recherche en Sciences de la Santé, Bobo Dioulasso, Burkina Faso
| | | | - Abdoul Aziz Sienou
- Institut de Recherche en Sciences de la Santé, Bobo Dioulasso, Burkina Faso
| | | | | | | | | | | | | | | | - Alassane Haro
- Institut de Recherche en Sciences de la Santé, Bobo Dioulasso, Burkina Faso
| | | | - Paul Snell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Grant
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé, Bobo Dioulasso, Burkina Faso
| | - Paul Milligan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniel Chandramohan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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26
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Avoiding another lost decade in reducing malaria burden in African infants and young children. Lancet Glob Health 2022; 10:e1385-e1386. [DOI: 10.1016/s2214-109x(22)00334-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/18/2022] [Indexed: 11/21/2022]
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Manga IA, Tairou F, Seck A, Kouevidjin E, Sylla K, Sow D, Gueye AB, Ba M, Ndiaye M, Tine RCK, Gaye O, Faye B, Ndiaye JLA. Effectiveness of seasonal malaria chemoprevention administered in a mass campaign in the Kedougou region of Senegal in 2016: a case-control study. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18057.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) is a malaria prevention strategy recommended since 2012 by the World Health Organization (WHO) for children under 5 years. In Senegal, the scaling up of SMC started in 2013 in the south-eastern regions of the country with an extension of the target to 10 years old children. The scaling up of SMC requires regular evaluation of the strategy as recommended by the WHO. This study was conducted to evaluate the effectiveness of SMC. Methods: A case-control study was conducted in some villages of the health districts of Saraya and Kedougou in the Kedougou region from July to December 2016. A case was a sick child, aged 3 months to 10 years, seen in consultation and with a positive malaria rapid diagnostic test (RDT). The control was a child of the same age group with a negative RDT and living in the same compound as the case or in a neighbouring compound. Each case was matched with two controls. Exposure to SMC was assessed by interviewing the mothers/caretakers and by checking the SMC administration card. Results: Overall, 492 children, including 164 cases and 328 controls, were recruited in our study. Their mean ages were 5.32 (+/- 2.15) and 4.44 (+/-2.25) years for cases and controls, respectively. The number of boys was higher in both cases (55.49%; CI 95%=47.54-63.24%) and controls (51,22%; CI 95%=45.83-56.58%). Net ownership was 85.80% among cases and 90.85% among controls (p=0,053). The proportion of controls who received SMC was higher than that of cases (98.17% vs 85.98% and p=1.10-7). The protective effectiveness of SMC was 89% (OR= 0.12 (CI 95%=0.04-0.28)). Conclusions: SMC is an effective strategy in the control of malaria in children. Case-control studies are a good approach for monitoring the efficacy of drugs administered during SMC.
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Factors Influencing Second and Third Dose Observance during Seasonal Malaria Chemoprevention (SMC): A Quantitative Study in Burkina Faso, Mali and Niger. Trop Med Infect Dis 2022; 7:tropicalmed7090214. [PMID: 36136625 PMCID: PMC9503675 DOI: 10.3390/tropicalmed7090214] [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: 06/21/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
This study aims to evaluate the factors influencing the adherence to the 2nd and 3rd doses of Amodiaquine (AQ) during seasonal malaria chemoprevention (SMC) in Burkina Faso, Mali, and Niger. Overall, 3132 people were interviewed during surveys between 2019 and 2020 in 15 health districts. In Burkina Faso, Mali, and Niger, the proportions of non-adherence were 4.15%, 5.60%, and 13.30%, respectively, for the 2nd dose and 3.98%, 5.60% and 14.39% for the 3rd dose. The main cause of non-adherence to the 2nd and 3rd doses was other illnesses in 28.5% and 29.78%, respectively, in Burkina Faso, 5.35% and 5.35% in Mali and 1.6% and 0.75% in Niger. It was followed by vomiting in 12.24% and 10.63% for Burkina and 2.45% and 3.78% in Niger. The last cause was refusal in 6.12% and 4.25% in Burkina, 33.9% and 15.25% in Mali and 0.8% and 1.51% in Niger. Non-adherence of doses related to parents was primarily due to their absence in 28.5% and 27.65% in Burkina, 16.07% and 16.07% in Mali and 7.37% and 6.06% in Niger. Traveling was the second cause related to parents in 12.24% and 12.76% in Burkina, 19.64% and 19.64% in Mali and 0.81% and 0.75% in Niger. Non-adherence related to community distributors was mainly due to missing the doses in 4.08% and 4.25% in Burkina, 23.21% and 23.21% in Mali, 77.04% and 76.51% in Niger. Our study reported very small proportions of non-adherence to 2nd and 3rd doses of SMC and identified the main causes of non-adherence. These findings will provide helpful information for policymakers and public health authorities to improve adherence to SMC
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29
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Manga IA, Tairou F, Seck A, Kouevidjin E, Sylla K, Sow D, Gueye AB, Ba M, Ndiaye M, Tine RCK, Gaye O, Faye B, Ndiaye JLA. Effectiveness of seasonal malaria chemoprevention administered in a mass campaign in the Kedougou region of Senegal in 2016: a case-control study. Wellcome Open Res 2022; 7:216. [PMID: 37153452 PMCID: PMC10154913 DOI: 10.12688/wellcomeopenres.18057.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) is a malaria prevention strategy recommended since 2012 by the World Health Organization (WHO) for children under 5 years. In Senegal, the scaling up of SMC started in 2013 in the south-eastern regions of the country with an extension of the target to 10 years old children. The scaling up of SMC requires regular evaluation of the strategy as recommended by the WHO. This study was conducted to evaluate the effectiveness of SMC. Methods: A case-control study was conducted in some villages of the health districts of Saraya and Kedougou in the Kedougou region from July to December 2016. A case was a sick child, aged 3 months to 10 years, seen in consultation and with a positive malaria rapid diagnostic test (RDT). The control was a child of the same age group with a negative RDT and living in the same compound as the case or in a neighbouring compound. Each case was matched with two controls. Exposure to SMC was assessed by interviewing the mothers/caretakers and by checking the SMC administration card. Results: Overall, 492 children, including 164 cases and 328 controls, were recruited in our study. Their mean ages were 5.32 (+/- 2.15) and 4.44 (+/-2.25) years for cases and controls, respectively. The number of boys was higher in both cases (55.49%; CI 95%=47.54-63.24%) and controls (51,22%; CI 95%=45.83-56.58%). Net ownership was 85.80% among cases and 90.85% among controls (p=0,053). The proportion of controls who received SMC was higher than that of cases (98.17% vs 85.98% and p=1.10 -7). The protective effectiveness of SMC was 89% (OR= 0.12 (CI 95%=0.04-0.28)). Conclusions: SMC is an effective strategy in the control of malaria in children. Case-control studies are a good approach for monitoring the efficacy of drugs administered during SMC.
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Affiliation(s)
- Isaac Akhenaton Manga
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Fassiatou Tairou
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Amadou Seck
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Ekoue Kouevidjin
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Khadime Sylla
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Doudou Sow
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Alioune Babara Gueye
- Ministry of Health and Social Action, National Malaria Control Program, Dakar, Senegal
| | - Mady Ba
- Ministry of Health and Social Action, National Malaria Control Program, Dakar, Senegal
| | - Magatte Ndiaye
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Roger Clément Kouly Tine
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Omar Gaye
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Babacar Faye
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
| | - Jean Louis Abdourahim Ndiaye
- Department of Parasitology-Mycology/Faculty of medicine, pharmacy and odontology, University of Cheikh Anta Diop, Dakar, Senegal
- Service of Parasitology Mycology/Departement of medical biology, UFR Santé/University Iba Der Thiam, Thies, Senegal
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Cissoko M, Sagara I, Landier J, Guindo A, Sanogo V, Coulibaly OY, Dembélé P, Dieng S, Bationo CS, Diarra I, Magassa MH, Berthé I, Katilé A, Traoré D, Dessay N, Gaudart J. Sub-national tailoring of seasonal malaria chemoprevention in Mali based on malaria surveillance and rainfall data. Parasit Vectors 2022; 15:278. [PMID: 35927679 PMCID: PMC9351140 DOI: 10.1186/s13071-022-05379-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background In malaria endemic countries, seasonal malaria chemoprevention (SMC) interventions are performed during the high malaria transmission in accordance with epidemiological surveillance data. In this study we propose a predictive approach for tailoring the timing and number of cycles of SMC in all health districts of Mali based on sub-national epidemiological surveillance and rainfall data. Our primary objective was to select the best of two approaches for predicting the onset of the high transmission season at the operational scale. Our secondary objective was to evaluate the number of malaria cases, hospitalisations and deaths in children under 5 years of age that would be prevented annually and the additional cost that would be incurred using the best approach. Methods For each of the 75 health districts of Mali over the study period (2014–2019), we determined (1) the onset of the rainy season period based on weekly rainfall data; (ii) the onset and duration of the high transmission season using change point analysis of weekly incidence data; and (iii) the lag between the onset of the rainy season and the onset of the high transmission. Two approaches for predicting the onset of the high transmission season in 2019 were evaluated. Results In the study period (2014–2019), the onset of the rainy season ranged from week (W) 17 (W17; April) to W34 (August). The onset of the high transmission season ranged from W25 (June) to W40 (September). The lag between these two events ranged from 5 to 12 weeks. The duration of the high transmission season ranged from 3 to 6 months. The best of the two approaches predicted the onset of the high transmission season in 2019 to be in June in two districts, in July in 46 districts, in August in 21 districts and in September in six districts. Using our proposed approach would prevent 43,819 cases, 1943 hospitalisations and 70 deaths in children under 5 years of age annually for a minimal additional cost. Our analysis shows that the number of cycles of SMC should be changed in 36 health districts. Conclusion Adapting the timing of SMC interventions using our proposed approach could improve the prevention of malaria cases and decrease hospitalisations and deaths. Future studies should be conducted to validate this approach. Graphical Abstract ![]()
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Affiliation(s)
- Mady Cissoko
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali. .,INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France. .,Direction Régionale de la Santé de Tombouctou, 59, Tombouctou, Mali.
| | - Issaka Sagara
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali.,INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | - Jordi Landier
- INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | - Abdoulaye Guindo
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali.,INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | - Vincent Sanogo
- Programme National de Lutte contre le Paludisme (PNLP Mali), 233, Bamako, Mali
| | - Oumou Yacouba Coulibaly
- Direction Générale de la Santé et Hygiène Publique, Sous-Direction Lutte Contre la Maladie (DGSHP-SDLM), 233, Bamako, Mali
| | - Pascal Dembélé
- Programme National de Lutte contre le Paludisme (PNLP Mali), 233, Bamako, Mali
| | - Sokhna Dieng
- INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | | | - Issa Diarra
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali
| | - Mahamadou H Magassa
- Programme National de Lutte contre le Paludisme (PNLP Mali), 233, Bamako, Mali
| | - Ibrahima Berthé
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali
| | - Abdoulaye Katilé
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali.,INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | - Diahara Traoré
- Programme National de Lutte contre le Paludisme (PNLP Mali), 233, Bamako, Mali
| | - Nadine Dessay
- ESPACE-DEV, UMR228, IRD/UM/UR/UG/UA, Institut de Recherche Pour le Développement (IRD) France, 34093, Montpellier, France
| | - Jean Gaudart
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali.,APHM, INSERM, SESSTIM, ISSPAM, Hop Timone, BioSTIC, Biostatistic & ICT, Aix-Marseille University, 13005, Marseille, France
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31
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Balla K, Malm K, Njie O, Hounto Ogouyemi A, Uhomoibhi P, Poku-Awuku A, Tchouatieu AM, Aikpon R, Bah A, Kolley O, Ogbulafor N, Oppong S, Adomako K, Houndjo W, Jah H, Banerji J, Nikau J, Affoukou C, Egwu E, Houtohossou C, Van Hulle S. Introducing field digital data collection systems into seasonal malaria chemoprevention campaigns: opportunities for robust evidence development and national e-health strategies. BMJ Glob Health 2022; 7:bmjgh-2021-007899. [PMID: 35296463 PMCID: PMC8928254 DOI: 10.1136/bmjgh-2021-007899] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/01/2022] [Indexed: 11/28/2022] Open
Abstract
Seasonal malaria chemoprevention (SMC) is a World Health Organization-recommended intervention to protect children under the age of 5 in Africa’s Sahel region. While SMC remains highly effective in decreasing malaria cases, implementing countries face several challenges regarding collecting quality data; monitoring coverage and compliance and overcoming delays in campaigns due to late payment to field distributors. To address these challenges, the National Malaria Control Programmes of Benin, The Gambia, Ghana and Nigeria introduced digital data collection (DDC) tools to support their SMC campaigns. To facilitate cross-country learning, this paper investigates the impact of using DDCs in SMC campaigns by comparing country responses. Country experience suggests that in comparison to paper-based data collection systems, using DDC tools help to overcome data quality and operational challenges; cloud-based features also made data more accessible. Thus, scaling up DDC tools and linking them with routine national health management systems could help generate robust evidence for malaria policy development and programming. Of note, evidence from Benin showed that using digital tools reduced the time to pay staff and volunteers by 5 weeks. In Benin’s experience, DDC also offered cost benefits (1.5 times cheaper) versus the use of paper-based tools. The authors note that no application offers greater benefits than the other—countries will select a technology that best suits their needs. Several applications are currently being used and newer ones are also being developed. Another option is to develop in-house applications that can be adjusted to local health programmes. Cost-effectiveness studies to inform on whether DDCs offer cost advantages would be beneficial. More studies on DDC are needed from SMC-implementing countries to identify additional benefits and drawbacks of digital applications. These will similarly help national malaria policy and programming efforts.
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Affiliation(s)
- Kanda Balla
- National Malaria Control Programme of the Gambia, Ministry of Health, Banjul, Gambia
| | - Kezia Malm
- National Malaria Control Programme, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Ousman Njie
- Malaria Programming, Catholic Relief Services, Banjul, Gambia
| | | | | | - Abena Poku-Awuku
- Access and Product Management Department, Medicines for Malaria Venture, Geneva, Switzerland
| | | | - Rock Aikpon
- National Malaria Control Programme, Ghana Health Service, Accra, Ghana
| | - Alieu Bah
- Malaria Programming, Catholic Relief Services, Banjul, Gambia
| | - Olimatou Kolley
- National Malaria Control Programme of the Gambia, Ministry of Health, Banjul, Gambia
| | - Nnenna Ogbulafor
- Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | | | | | - William Houndjo
- National Malaria Control Programme of Benin, Ministry of Health Benin, Coutonou, Benin
| | - Huja Jah
- Programming, Catholic Relief Services, Baltimore, Maryland, USA
| | - Jaya Banerji
- Medicines for Malaria Venture, Geneva, Switzerland
| | - Jamilu Nikau
- National Malaria Elimination Programme, Federal Ministry of Health, Lagos, Nigeria
| | - Cyriaque Affoukou
- National Malaria Control Programme of Benin, Ministry of Health Benin, Coutonou, Benin
| | - Elijah Egwu
- Malaria Programming, Catholic Relief Services, Coutonou, Benin
| | - Camille Houtohossou
- National Malaria Control Programme of Benin, Ministry of Health Benin, Coutonou, Benin
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Uhomoibhi P, Malm KL, Cisse I, Dzibo H, Poku-Awuku A, Tchouatieu AM, Olumese PE, Van Hulle S, Florey L, Filler S, Banerji J. Redoubling efforts to sustain seasonal malaria chemoprevention. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:142-144. [PMID: 35074135 DOI: 10.1016/s2352-4642(22)00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Affiliation(s)
| | | | - Idrissa Cisse
- National Malaria Control Program of Mali, Bamako, Mali
| | | | - Abena Poku-Awuku
- Advocacy Department, Medicines for Malaria Venture, Geneva 1215, Switzerland.
| | - André-Marie Tchouatieu
- Access and Product Development Department, Medicines for Malaria Venture, Geneva 1215, Switzerland
| | - Peter Ehizibue Olumese
- Country and Regional Support Partner Committee, RBM Partnership to End Malaria, Geneva, Switzerland
| | | | - Lia Florey
- US President's Malaria Initiative, Washington, DC, USA
| | - Scott Filler
- Technical Advice and Partnerships Unit, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Jaya Banerji
- Communications Department, Medicines for Malaria Venture, Geneva 1215, Switzerland
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There Is No Last Name For This Author P, Kaur H, Persoons L, Andrei G, Singh K. Quinoline-dihydropyrimidin-2(1H)-one hybrids: Synthesis, biological activity and mechanistic studies. ChemMedChem 2022; 17:e202200031. [PMID: 35174629 DOI: 10.1002/cmdc.202200031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/16/2022] [Indexed: 11/10/2022]
Abstract
A novel class of quinoline-dihydropyrimidin-2(1H)-one (DHPM) hybrids was synthesized and in vitro antiplasmodial activity was evaluated against chloroquine sensitive (D10) and chloroquine resistant (Dd2) strains of Plasmodium falciparum, the human malaria parasite. The antiplasmodial activity was compared to previously reported DHPM based molecular hybrids. Dual mode of antiplasmodial action of the most active member has been evaluated through heme binding study and in silico docking in the active site of dihydrofolate enzymes (wild-type as well as mutant). Favourable pharmacokinetic parameters were predicted in the ADMET evaluation. The new hybrids were also tested against a number of DNA and RNA viruses. No antiviral activity was found, except for one hybrid that showed mild inhibitory activity against two strains of cytomegalovirus (AD-169 and Davis), The most active hybrid was found to be a selective inhibitor of the growth of P. falciparum as well as a modest inhibitor of varicella zoster virus in HEL cells. Cytotoxicity of all hybrids was assessed in HEL, HeLa, Vero, MDCK, and CRFK cell cultures.
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Affiliation(s)
| | | | - Leentje Persoons
- KU Leuven: Katholieke Universiteit Leuven, Microbiology, BELGIUM
| | - Graciela Andrei
- KU Leuven: Katholieke Universiteit Leuven, Microbiology, BELGIUM
| | - Kamaljit Singh
- Guru Nanak Dev University, Chemistry, GT Road, 143005, Amritsar, INDIA
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