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Newby G, Cotter C, Roh ME, Harvard K, Bennett A, Hwang J, Chitnis N, Fine S, Stresman G, Chen I, Gosling R, Hsiang MS. Testing and treatment for malaria elimination: a systematic review. Malar J 2023; 22:254. [PMID: 37661286 PMCID: PMC10476355 DOI: 10.1186/s12936-023-04670-8] [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: 05/09/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Global interest in malaria elimination has prompted research on active test and treat (TaT) strategies. METHODS A systematic review and meta-analysis were conducted to assess the effectiveness of TaT strategies to reduce malaria transmission. RESULTS A total of 72 empirical research and 24 modelling studies were identified, mainly focused on proactive mass TaT (MTaT) and reactive case detection (RACD) in higher and lower transmission settings, respectively. Ten intervention studies compared MTaT to no MTaT and the evidence for impact on malaria incidence was weak. No intervention studies compared RACD to no RACD. Compared to passive case detection (PCD) alone, PCD + RACD using standard diagnostics increased infection detection 52.7% and 11.3% in low and very low transmission settings, respectively. Using molecular methods increased this detection of infections by 1.4- and 1.1-fold, respectively. CONCLUSION Results suggest MTaT is not effective for reducing transmission. By increasing case detection, surveillance data provided by RACD may indirectly reduce transmission by informing coordinated responses of intervention targeting.
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Affiliation(s)
- Gretchen Newby
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
| | - Chris Cotter
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Michelle E Roh
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | - Kelly Harvard
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
| | - Adam Bennett
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
- PATH, Seattle, WA, USA
| | - Jimee Hwang
- Malaria Branch, Centers for Disease Control and Prevention, U.S. President's Malaria Initiative, Atlanta, GA, USA
| | - Nakul Chitnis
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Sydney Fine
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
| | - Gillian Stresman
- College of Public Health, University of South Florida, Tampa, FL, USA
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ingrid Chen
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | - Roly Gosling
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Michelle S Hsiang
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA.
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA.
- Department of Pediatrics, UCSF, San Francisco, CA, USA.
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Aidoo EK, Aboagye FT, Botchway FA, Osei-Adjei G, Appiah M, Duku-Takyi R, Sakyi SA, Amoah L, Badu K, Asmah RH, Lawson BW, Krogfelt KA. Reactive Case Detection Strategy for Malaria Control and Elimination: A 12 Year Systematic Review and Meta-Analysis from 25 Malaria-Endemic Countries. Trop Med Infect Dis 2023; 8:tropicalmed8030180. [PMID: 36977181 PMCID: PMC10058581 DOI: 10.3390/tropicalmed8030180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
Reactive case detection (RACD) is the screening of household members and neighbors of index cases reported in passive surveillance. This strategy seeks asymptomatic infections and provides treatment to break transmission without testing or treating the entire population. This review discusses and highlights RACD as a recommended strategy for the detection and elimination of asymptomatic malaria as it pertains in different countries. Relevant studies published between January 2010 and September 2022 were identified mainly through PubMed and Google Scholar. Search terms included "malaria and reactive case detection", "contact tracing", "focal screening", "case investigation", "focal screen and treat". MedCalc Software was used for data analysis, and the findings from the pooled studies were analyzed using a fixed-effect model. Summary outcomes were then presented using forest plots and tables. Fifty-four (54) studies were systematically reviewed. Of these studies, 7 met the eligibility criteria based on risk of malaria infection in individuals living with an index case < 5 years old, 13 met the eligibility criteria based on risk of malaria infection in an index case household member compared with a neighbor of an index case, and 29 met the eligibility criteria based on risk of malaria infection in individuals living with index cases, and were included in the meta-analysis. Individuals living in index case households with an average risk of 2.576 (2.540-2.612) were more at risk of malaria infection and showed pooled results of high variation heterogeneity chi-square = 235.600, (p < 0.0001) I2 = 98.88 [97.87-99.89]. The pooled results showed that neighbors of index cases were 0.352 [0.301-0.412] times more likely to have a malaria infection relative to index case household members, and this result was statistically significant (p < 0.001). The identification and treatment of infectious reservoirs is critical to successful malaria elimination. Evidence to support the clustering of infections in neighborhoods, which necessitates the inclusion of neighboring households as part of the RACD strategy, was presented in this review.
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Affiliation(s)
- Ebenezer Krampah Aidoo
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Frank Twum Aboagye
- Biomedical and Public Health Research Unit, Council for Scientific and Industrial Research-Water Research Institute, Accra AH 38, Ghana
| | - Felix Abekah Botchway
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - George Osei-Adjei
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Michael Appiah
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Ruth Duku-Takyi
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, Kwame Nkrumah University of Science & Technology, University Post Office, Kumasi AK 039, Ghana
| | - Linda Amoah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra LG 581, Ghana
| | - Kingsley Badu
- Department of Theoretical & Applied Biology, Kwame Nkrumah University of Science & Technology, University Post Office, Kumasi AK 039, Ghana
| | - Richard Harry Asmah
- Department of Biomedical Sciences, School of Basic and Biomedical Science, University of Health & Allied Sciences, Ho PMB 31, Ghana
| | - Bernard Walter Lawson
- Department of Theoretical & Applied Biology, Kwame Nkrumah University of Science & Technology, University Post Office, Kumasi AK 039, Ghana
| | - Karen Angeliki Krogfelt
- Department of Science and Environment, Unit of Molecular and Medical Biology, The PandemiX Center, Roskilde University, 4000 Roskilde, Denmark
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, 2300 Copenhagen, Denmark
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Wesolowski A, Ippolito MM, Gebhardt ME, Ferriss E, Schue JL, Kobayashi T, Chaponda M, Kabuya JB, Muleba M, Mburu M, Matoba J, Musonda M, Katowa B, Lubinda M, Hamapumbu H, Simubali L, Mudenda T, Shields TM, Hackman A, Shiff C, Coetzee M, Koekemoer LL, Munyati S, Gwanzura L, Mutambu S, Stevenson JC, Thuma PE, Norris DE, Bailey JA, Juliano JJ, Chongwe G, Mulenga M, Simulundu E, Mharakurwa S, Agre P, Moss WJ. Policy Implications of the Southern and Central Africa International Center of Excellence for Malaria Research: Ten Years of Malaria Control Impact Assessments in Hypo-, Meso-, and Holoendemic Transmission Zones in Zambia and Zimbabwe. Am J Trop Med Hyg 2022; 107:68-74. [PMID: 36228913 PMCID: PMC9662215 DOI: 10.4269/ajtmh.21-1288] [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: 12/13/2021] [Accepted: 05/28/2022] [Indexed: 11/07/2022] Open
Abstract
The International Centers of Excellence for Malaria Research (ICEMR) were established by the National Institute of Allergy and Infectious Diseases more than a decade ago to provide multidisciplinary research support to malaria control programs worldwide, operating in endemic areas and contributing technology, expertise, and ultimately policy guidance for malaria control and elimination. The Southern and Central Africa ICEMR has conducted research across three main sites in Zambia and Zimbabwe that differ in ecology, entomology, transmission intensity, and control strategies. Scientific findings led to new policies and action by the national malaria control programs and their partners in the selection of methods, materials, timing, and locations of case management and vector control. Malaria risk maps and predictive models of case detection furnished by the ICEMR informed malaria elimination programming in southern Zambia, and time series analyses of entomological and parasitological data motivated several major changes to indoor residual spray campaigns in northern Zambia. Along the Zimbabwe-Mozambique border, temporal and geospatial data are currently informing investigations into a recent resurgence of malaria. Other ICEMR findings pertaining to parasite and mosquito genetics, human behavior, and clinical epidemiology have similarly yielded immediate and long-term policy implications at each of the sites, often with generalizable conclusions. The ICEMR programs thereby provide rigorous scientific investigations and analyses to national control and elimination programs, without which the impediments to malaria control and their potential solutions would remain understudied.
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Affiliation(s)
- Amy Wesolowski
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Matthew M. Ippolito
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary E. Gebhardt
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ellen Ferriss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jessica L. Schue
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tamaki Kobayashi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | | | - Andre Hackman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clive Shiff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maureen Coetzee
- Wits Research Institute for Malaria, Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Lizette L. Koekemoer
- Wits Research Institute for Malaria, Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Lovemore Gwanzura
- Biomedical Research and Training Institute, Harare, Zimbabwe
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | | | - Jennifer C. Stevenson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Macha Research Trust, Choma, Zambia
| | - Philip E. Thuma
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Macha Research Trust, Choma, Zambia
| | - Douglas E. Norris
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jonathan J. Juliano
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Modest Mulenga
- Directorate of Research and Postgraduate Studies, Lusaka Apex Medical University, Lusaka, Zambia
| | | | - Sungano Mharakurwa
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Africa University, Mutare, Zimbabwe
| | - Peter Agre
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William J. Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Ippolito MM, Gebhardt ME, Ferriss E, Schue JL, Kobayashi T, Chaponda M, Kabuya JB, Muleba M, Mburu M, Matoba J, Musonda M, Katowa B, Lubinda M, Hamapumbu H, Simubali L, Mudenda T, Wesolowski A, Shields TM, Hackman A, Shiff C, Coetzee M, Koekemoer LL, Munyati S, Gwanzura L, Mutambu S, Stevenson JC, Thuma PE, Norris DE, Bailey JA, Juliano JJ, Chongwe G, Mulenga M, Simulundu E, Mharakurwa S, Agre PC, Moss WJ. Scientific Findings of the Southern and Central Africa International Center of Excellence for Malaria Research: Ten Years of Malaria Control Impact Assessments in Hypo-, Meso-, and Holoendemic Transmission Zones in Zambia and Zimbabwe. Am J Trop Med Hyg 2022; 107:55-67. [PMID: 36228903 PMCID: PMC9662223 DOI: 10.4269/ajtmh.21-1287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/08/2022] [Indexed: 11/07/2022] Open
Abstract
For a decade, the Southern and Central Africa International Center of Excellence for Malaria Research has operated with local partners across study sites in Zambia and Zimbabwe that range from hypo- to holoendemic and vary ecologically and entomologically. The burden of malaria and the impact of control measures were assessed in longitudinal cohorts, cross-sectional surveys, passive and reactive case detection, and other observational designs that incorporated multidisciplinary scientific approaches: classical epidemiology, geospatial science, serosurveillance, parasite and mosquito genetics, and vector bionomics. Findings to date have helped elaborate the patterns and possible causes of sustained low-to-moderate transmission in southern Zambia and eastern Zimbabwe and recalcitrant high transmission and fatality in northern Zambia. Cryptic and novel mosquito vectors, asymptomatic parasite reservoirs in older children, residual parasitemia and gametocytemia after treatment, indoor residual spraying timed dyssynchronously to vector abundance, and stockouts of essential malaria commodities, all in the context of intractable rural poverty, appear to explain the persistent malaria burden despite current interventions. Ongoing studies of high-resolution transmission chains, parasite population structures, long-term malaria periodicity, and molecular entomology are further helping to lay new avenues for malaria control in southern and central Africa and similar settings.
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Affiliation(s)
- Matthew M. Ippolito
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary E. Gebhardt
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ellen Ferriss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jessica L. Schue
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tamaki Kobayashi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | - Amy Wesolowski
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Andre Hackman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clive Shiff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maureen Coetzee
- Wits Research Institute for Malaria, Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Lizette L. Koekemoer
- Wits Research Institute for Malaria, Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Lovemore Gwanzura
- Biomedical Research and Training Institute, Harare, Zimbabwe
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | | | - Jennifer C. Stevenson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Macha Research Trust, Choma, Zambia
| | | | - Douglas E. Norris
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jonathan J. Juliano
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Modest Mulenga
- Directorate of Research and Postgraduate Studies, Lusaka Apex Medical University, Lusaka, Zambia
| | | | - Sungano Mharakurwa
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Africa University, Mutare, Zimbabwe
| | - Peter C. Agre
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William J. Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Mueller AK, Matoba J, Schue JL, Hamapumbu H, Kobayashi T, Stevenson JC, Thuma PE, Wesolowski A, Moss WJ, _ _. The Unmeasured Burden of Febrile, Respiratory, and Diarrheal Illnesses Identified Through Active Household Surveillance in a Low Malaria Transmission Setting in Southern Zambia. Am J Trop Med Hyg 2022; 106:1791-1799. [PMID: 35895429 PMCID: PMC9209922 DOI: 10.4269/ajtmh.21-1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/07/2022] [Indexed: 01/25/2023] Open
Abstract
Malaria incidence has declined in southern Zambia over recent decades, leading to efforts to achieve and sustain malaria elimination. Understanding the remaining disease burden is key to providing optimal health care. A longitudinal study conducted in a rural area of Choma District, Southern Province, Zambia, assessed the prevalence of and factors associated with symptoms of non-malarial illnesses and treatment-seeking behavior. We analyzed data collected monthly between October 2018 through September 2020 from 1,174 individuals from 189 households. No incident malaria cases were detected by rapid diagnostic tests among febrile participants. Mixed-effects logistic regression identified factors associated with cough, fever, diarrhea, and treatment-seeking. Incidence rates of cough (192 of 1,000 person-months), fever (87 of 1,000 person-months), and fever with cough (37 of 1,000 person-months) were highest among adults older than 65 years. Diarrhea incidence (37 of 1,000 person-months) was highest among children younger than 5 years. For every additional symptomatic household member, one's odds of experiencing symptoms increased: cough by 47% (95% CI, 40-55), fever by 31% (95% CI, 23-40), diarrhea by 31% (95% CI, 17-46), and fever with cough by 112% (95% CI, 90-137), consistent with household clustering of illnesses. However, between 35% and 75% of participants did not seek treatment for their symptoms. Treatment-seeking was most common for children 5 to 9 years old experiencing diarrhea (adjusted odds ratio, 3.61; 95% CI, 1.42-9.18). As malaria prevalence reduces, respiratory and diarrheal infections persist, particularly among young children but, notably, also among adults older than 65 years. Increasing awareness of the disease burden and treatment-seeking behavior are important for guiding resource re-allocation as malaria prevalence declines in this region.
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Affiliation(s)
- Alexandra K. Mueller
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland;,Address correspondence to Alexandra K. Mueller, Johns Hopkins School of Medicine, 5200 Eastern Ave., Baltimore, MD 21224. E-mail:
| | | | - Jessica L. Schue
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William J. Moss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;,W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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A Systematic Review and Meta-Analysis of Malaria Test Positivity Outcomes and Programme Interventions in Low Transmission Settings in Southern Africa, 2000-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116776. [PMID: 35682356 PMCID: PMC9180605 DOI: 10.3390/ijerph19116776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 02/01/2023]
Abstract
Malaria is one of the most significant causes of mortality and morbidity globally, especially in sub-Saharan Africa (SSA) countries. It harmfully disturbs the public’s health and the economic growth of many developing countries. Despite the massive effect of malaria transmission, the overall pooled proportion of malaria positivity rate in Southern Africa is still elusive. Therefore, the objective of this systematic review and meta-analysis is to pool estimates of the incidence of the malaria positivity rate, which is the first of its kind in South African countries. A literature search is performed to identify all published articles reporting the incidence of malaria positivity in Southern Africa. Out of the 3359 articles identified, 17 studies meet the inclusion for systematic review and meta-analysis. In addition, because substantial heterogeneity is expected due to the studies being extracted from the universal population, random-effects meta-analyses are carried out to pool the incidence of the malaria positivity rate from diverse diagnostic methods. The result reveals that between-study variability is high (τ2 = 0.003; heterogeneity I2 = 99.91% with heterogeneity chi-square χ2 = 18,143.95, degree of freedom = 16 and a p-value < 0.0001) with the overall random pooled incidence of 10% (95%CI: 8−13%, I2 = 99.91%) in the malaria positivity rate. According to the diagnostic method called pooled incidence estimate, the rapid diagnostic test (RDT) is the leading diagnostic method (17%, 95%CI: 11−24%, I2 = 99.95%), followed by RDT and qPCR and RDT and loop mediated isothermal amplification (LAMP), respectively, found to be (3%, 95%CI: 2−3%, I2 = 0%) and (2%, 95%CI: 1−3%, I2 = 97.94%).Findings of the present study suggest high malaria positive incidence in the region. This implies that malaria control and elimination programmes towards malaria elimination could be negatively impacted and cause delays in actualising malaria elimination set dates. Further studies consisting of larger samples and continuous evaluation of malaria control programmes are recommended.
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Carrel M, Kim S, Mwandagalirwa MK, Mvuama N, Bala JA, Nkalani M, Kihuma G, Atibu J, Diallo AO, Goel V, Thwai KL, Juliano JJ, Emch M, Tshefu A, Parr JB. Individual, household and neighborhood risk factors for malaria in the Democratic Republic of the Congo support new approaches to programmatic intervention. Health Place 2021; 70:102581. [PMID: 34020231 PMCID: PMC8328915 DOI: 10.1016/j.healthplace.2021.102581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Democratic Republic of the Congo (DRC) remains one of the countries most impacted by malaria despite decades of control efforts, including multiple mass insecticide treated net (ITN) distribution campaigns. The multi-scalar and complex nature of malaria necessitates an understanding of malaria risk factors over time and at multiple levels (e.g., individual, household, community). Surveillance of households in both rural and urban settings over time, coupled with detailed behavioral and geographic data, enables the detection of seasonal trends in malaria prevalence and malaria-associated behaviors as well as the assessment of how the local environments within and surrounding an individual's household impact malaria outcomes. METHODS Participants from seven sites in Kinshasa Province, DRC were followed for over two years. Demographic, behavioral, and spatial information was gathered from enrolled households. Malaria was assessed using both rapid diagnostic tests (RDT) and polymerase chain reaction (PCR) and seasonal trends were assessed. Hierarchical regression modeling tested associations between behavioral and environmental factors and positive RDT and PCR outcomes at individual, household and neighborhood scales. RESULTS Among 1591 enrolled participants, malaria prevalence did not consistently vary seasonally across the sites but did vary by age and ITN usage. Malaria was highest and ITN usage lowest in children ages 6-15 years across study visits and seasons. Having another member of the household test positive for malaria significantly increased the risk of an individual having malaria [RDT: OR = 4.158 (2.86-6.05); PCR: OR = 3.37 (2.41-4.71)], as did higher malaria prevalence in the 250 m neighborhood around the household [RDT: OR = 2.711 (1.42-5.17); PCR: OR = 4.056 (2.3-7.16)]. Presence of water within close proximity to the household was also associated with malaria outcomes. CONCLUSIONS Taken together, these findings suggest that targeting non-traditional age groups, children >5 years old and teenagers, and deploying household- and neighborhood-focused interventions may be effective strategies for improving malaria outcomes in high-burden countries like the DRC.
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Affiliation(s)
- Margaret Carrel
- Department of Geographical & Sustainability Sciences, 305 Jessup Hall, University of Iowa, Iowa City, IA, 52245, USA.
| | - Seungwon Kim
- Department of Geographical & Sustainability Sciences, 305 Jessup Hall, University of Iowa, Iowa City, IA, 52245, USA.
| | - Melchior Kashamuka Mwandagalirwa
- Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA; Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Nono Mvuama
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Joseph A Bala
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Marthe Nkalani
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Georges Kihuma
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Joseph Atibu
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Alpha Oumar Diallo
- Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Varun Goel
- Department of Geography, CB3220, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Kyaw L Thwai
- Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Jonathan J Juliano
- Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA; Division of Infectious Diseases, School of Medicine, CB#7030, 130 Mason Farm Road, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Michael Emch
- Department of Geography, CB3220, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Antoinette Tshefu
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Jonathan B Parr
- Division of Infectious Diseases, School of Medicine, CB#7030, 130 Mason Farm Road, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
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Moore C, Scherr T, Matoba J, Sing'anga C, Lubinda M, Thuma P, Wright D. mHAT app for automated malaria rapid test result analysis and aggregation: a pilot study. Malar J 2021; 20:237. [PMID: 34039358 PMCID: PMC8153521 DOI: 10.1186/s12936-021-03772-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/16/2021] [Indexed: 12/29/2022] Open
Abstract
Background There are a variety of approaches being used for malaria surveillance. While active and reactive case detection have been successful in localized areas of low transmission, concerns over scalability and sustainability keep the approaches from being widely accepted. Mobile health interventions are poised to address these shortcomings by automating and standardizing portions of the surveillance process. In this study, common challenges associated with current data aggregation methods have been quantified, and a web-based mobile phone application is presented to reduce the burden of reporting rapid diagnostic test (RDT) results in low-resource settings. Methods De-identified completed RDTs were collected at 14 rural health clinics as part of a malaria epidemiology study at Macha Research Trust, Macha, Zambia. Tests were imaged using the mHAT web application. Signal intensity was measured and a binary result was provided. App performance was validated by: (1) comparative limits of detection, investigated against currently used laboratory lateral flow assay readers; and, (2) receiver operating characteristic analysis comparing the application against visual inspection of RDTs by an expert. Secondary investigations included analysis of time-to-aggregation and data consistency within the existing surveillance structures established by Macha Research Trust. Results When compared to visual analysis, the mHAT app performed with 91.9% sensitivity (CI 78.7, 97.2) and specificity was 91.4% (CI 77.6, 97.0) regardless of device operating system. Additionally, an analysis of surveillance data from January 2017 through mid-February 2019 showed that while the majority of the data packets from satellite clinics contained correct data, 36% of data points required correction by verification teams. Between November 2018 and mid-February 2019, it was also found that 44.8% of data was received after the expected submission date, although most (65.1%) reports were received within 2 days. Conclusions Overall, the mHAT mobile app was observed to be sensitive and specific when compared to both currently available benchtop lateral flow readers and visual inspection. The additional benefit of automating and standardizing LFA data collection and aggregation poses a vital improvement for low-resource health facilities and could increase the accuracy and speed of data reporting in surveillance campaigns. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03772-5.
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Affiliation(s)
- Carson Moore
- Department of Chemistry, Vanderbilt University, 1234 Stevenson Center Lane, Nashville, TN, 37212, USA
| | - Thomas Scherr
- Department of Chemistry, Vanderbilt University, 1234 Stevenson Center Lane, Nashville, TN, 37212, USA.
| | | | | | | | - Phil Thuma
- Macha Research Trust, Choma District, Zambia
| | - David Wright
- Department of Chemistry, Vanderbilt University, 1234 Stevenson Center Lane, Nashville, TN, 37212, USA
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9
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Malaria Rapid Diagnostic Tests: Literary Review and Recommendation for a Quality Assurance, Quality Control Algorithm. Diagnostics (Basel) 2021; 11:diagnostics11050768. [PMID: 33922917 PMCID: PMC8145891 DOI: 10.3390/diagnostics11050768] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 01/24/2023] Open
Abstract
Malaria rapid diagnostic tests (RDTs) have had an enormous global impact which contributed to the World Health Organization paradigm shift from empiric treatment to obtaining a parasitological diagnosis prior to treatment. Microscopy, the classic standard, requires significant expertise, equipment, electricity, and reagents. Alternatively, RDT’s lower complexity allows utilization in austere environments while achieving similar sensitivities and specificities. Worldwide, there are over 200 different RDT brands that utilize three antigens: Plasmodium histidine-rich protein 2 (PfHRP-2), Plasmodium lactate dehydrogenase (pLDH), and Plasmodium aldolase (pALDO). pfHRP-2 is produced exclusively by Plasmodium falciparum and is very Pf sensitive, but an alternative antigen or antigen combination is required for regions like Asia with significant Plasmodium vivax prevalence. RDT sensitivity also decreases with low parasitemia (<100 parasites/uL), genetic variability, and prozone effect. Thus, proper RDT selection and understanding of test limitations are essential. The Center for Disease Control recommends confirming RDT results by microscopy, but this is challenging, due to the utilization of clinical laboratory standards, like the College of American Pathologists (CAP) and the Clinical Lab Improvement Act (CLIA), and limited recourses. Our focus is to provide quality assurance and quality control strategies for resource-constrained environments and provide education on RDT limitations.
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10
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Hsiang MS, Ntshalintshali N, Kang Dufour MS, Dlamini N, Nhlabathi N, Vilakati S, Malambe C, Zulu Z, Maphalala G, Novotny J, Murphy M, Schwartz A, Sturrock H, Gosling R, Dorsey G, Kunene S, Greenhouse B. Active Case Finding for Malaria: A 3-Year National Evaluation of Optimal Approaches to Detect Infections and Hotspots Through Reactive Case Detection in the Low-transmission Setting of Eswatini. Clin Infect Dis 2021; 70:1316-1325. [PMID: 31095677 PMCID: PMC7318780 DOI: 10.1093/cid/ciz403] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 05/15/2019] [Indexed: 11/15/2022] Open
Abstract
Background Reactive case detection (RACD) is a widely practiced malaria elimination intervention whereby close contacts of index cases receive malaria testing to inform treatment and other interventions. However, the optimal diagnostic and operational approaches for this resource-intensive strategy are not clear. Methods We conducted a 3-year prospective national evaluation of RACD in Eswatini, a malaria elimination setting. Loop-mediated isothermal amplification (LAMP) was compared to traditional rapid diagnostic testing (RDT) for the improved detection of infections and for hotspots (RACD events yielding ≥1 additional infection). The potential for index case–, RACD-, and individual-level factors to improve efficiencies was also evaluated. Results Among 377 RACD events, 10 890 participants residing within 500 m of index cases were tested. Compared to RDT, LAMP provided a 3-fold and 2.3-fold higher yield to detect infections (1.7% vs 0.6%) and hotspots (29.7% vs 12.7%), respectively. Hotspot detection improved with ≥80% target population coverage and response times within 7 days. Proximity to the index case was associated with a dose-dependent increased infection risk (up to 4-fold). Individual-, index case–, and other RACD-level factors were considered but the simple approach of restricting RACD to a 200-m radius maximized yield and efficiency. Conclusions We present the first large-scale national evaluation of optimal RACD approaches from a malaria elimination setting. To inform delivery of antimalarial drugs or other interventions, RACD, when conducted, should utilize more sensitive diagnostics and clear context-specific operational parameters. Future studies of RACD’s impact on transmission may still be needed.
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Affiliation(s)
- Michelle S Hsiang
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas.,Malaria Elimination Initiative, Global Health Group.,Department of Pediatrics, University of California, San Francisco (UCSF)
| | | | | | | | | | | | | | | | | | - Joseph Novotny
- Clinton Health Access Initiative, Eswatini Office, Mbabane
| | - Maxwell Murphy
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, UCSF
| | - Alanna Schwartz
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, UCSF
| | | | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group
| | - Grant Dorsey
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, UCSF
| | | | - Bryan Greenhouse
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, UCSF
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11
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Kobayashi T, Kurani S, Hamapumbu H, Stevenson JC, Thuma PE, Moss WJ, For The Southern And Central Africa International Centers Of Excellence For Malaria Research. Prevalence of Glucose-6-Phosphate Dehydrogenase Deficiency and Gametocytemia in a Pre-Elimination, Low Malaria Transmission Setting in Southern Zambia. Am J Trop Med Hyg 2021; 104:1000-1002. [PMID: 33399042 DOI: 10.4269/ajtmh.20-1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/23/2020] [Indexed: 11/07/2022] Open
Abstract
The WHO recommends single low-dose (SLD) primaquine as a gametocytocide to reduce Plasmodium falciparum transmission in areas of low transmission. Despite this recommendation, uptake of SLD primaquine has been low because of concerns of glucose-6-phosphate dehydrogenase (G6PD) deficiency. Individuals with G6PD deficiency can experience hemolysis when exposed to primaquine. In Southern Province, Zambia, malaria transmission has declined significantly over the past decade. Single low-dose primaquine may be an effective tool, but there is limited information on G6PD deficiency. We screened 137 residents in Macha, Southern Province, Zambia, and the prevalence of G6PD (A-) was 15%. We also revisited data collected from 2008 to 2013 in the same area and found the highest gametocyte burden among those aged 5-15 years. The findings from this study suggest that SLD primaquine targeted to school-aged children may be an effective tool to help achieve malaria elimination in southern Zambia.
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Affiliation(s)
- Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shaheen Kurani
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Jennifer C Stevenson
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Macha Research Trust, Choma, Zambia
| | - Philip E Thuma
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Macha Research Trust, Choma, Zambia
| | - William J Moss
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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12
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Searle KM, Katowa B, Musonda M, Pringle JC, Hamapumbu H, Matoba J, Lubinda M, Shields T, Kobayashi T, Stevenson JC, Norris DE, Thuma PE, Wesolowski A, Moss WJ, For The Southern And Central Africa International Center Of Excellence For Malaria Research. Sustained Malaria Transmission despite Reactive Screen-and-Treat in a Low-Transmission Area of Southern Zambia. Am J Trop Med Hyg 2020; 104:671-679. [PMID: 33236715 PMCID: PMC7866307 DOI: 10.4269/ajtmh.20-0947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/28/2020] [Indexed: 12/30/2022] Open
Abstract
Malaria elimination strategies are designed to more effectively identify and treat infected individuals to interrupt transmission. One strategy, reactive screen-and-treat, starts with passive detection of symptomatic cases at health facilities. Individuals residing within the index case and neighboring households are screened with a malaria rapid diagnostic test (RDT) and treated if positive. However, it is unclear to what extent this strategy is effective in reducing transmission. Reactive screen-and-treat was implemented in Choma district, Southern Province, Zambia, in 2013, in which residents of the index case and neighboring households within 140 m were screened with an RDT. From March 2016 to July 2018, the screening radius was extended to 250-m, and additional follow-up visits at 30 and 90 days were added to evaluate the strategy. Plasmodium falciparum parasite prevalence was measured using an RDT and by quantitative PCR (qPCR). A 24-single nucleotide polymorphism molecular bar-code assay was used to genotype parasites. Eighty-four index case households with 676 residents were enrolled between March 2016 and March 2018. Within each season, parasite prevalence declined significantly in index households at the 30-day visit and remained low at the 90-day visit. However, parasite prevalence was not reduced to zero. Infections identified by qPCR persisted between study visits and were not identified by RDT. Parasites identified within the same household were most genetically related; however, overall parasite relatedness was low and similar across time and space. Thus, despite implementation of a reactive screen-and-treat program, parasitemia was not eliminated, and persisted in targeted households for at least 3 months.
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Affiliation(s)
- Kelly M Searle
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | | | | | - Julia C Pringle
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | - Timothy Shields
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer C Stevenson
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Macha Research Trust, Macha, Zambia
| | - Douglas E Norris
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Philip E Thuma
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Macha Research Trust, Macha, Zambia
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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13
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Mlacha YP, Wang D, Chaki PP, Gavana T, Zhou Z, Michael MG, Khatib R, Chila G, Msuya HM, Chaki E, Makungu C, Lin K, Tambo E, Rumisha SF, Mkude S, Mahende MK, Chacky F, Vounatsou P, Tanner M, Masanja H, Aregawi M, Hertzmark E, Xiao N, Abdulla S, Zhou XN. Effectiveness of the innovative 1,7-malaria reactive community-based testing and response (1, 7-mRCTR) approach on malaria burden reduction in Southeastern Tanzania. Malar J 2020; 19:292. [PMID: 32799857 PMCID: PMC7429894 DOI: 10.1186/s12936-020-03363-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In 2015, a China-UK-Tanzania tripartite pilot project was implemented in southeastern Tanzania to explore a new model for reducing malaria burden and possibly scaling-out the approach into other malaria-endemic countries. The 1,7-malaria Reactive Community-based Testing and Response (1,7-mRCTR) which is a locally-tailored approach for reporting febrile malaria cases in endemic villages was developed to stop transmission and Plasmodium life-cycle. The (1,7-mRCTR) utilizes existing health facility data and locally trained community health workers to conduct community-level testing and treatment. METHODS The pilot project was implemented from September 2015 to June 2018 in Rufiji District, southern Tanzania. The study took place in four wards, two with low incidence and two with a higher incidence. One ward of each type was selected for each of the control and intervention arms. The control wards implemented the existing Ministry of Health programmes. The 1,7-mRCTR activities implemented in the intervention arm included community testing and treatment of malaria infection. Malaria case-to-suspect ratios at health facilities (HF) were aggregated by villages, weekly to identify the village with the highest ratio. Community-based mobile test stations (cMTS) were used for conducting mass testing and treatment. Baseline (pre) and endline (post) household surveys were done in the control and intervention wards to assess the change in malaria prevalence measured by the interaction term of 'time' (post vs pre) and arm in a logistic model. A secondary analysis also studied the malaria incidence reported at the HFs during the intervention. RESULTS Overall the 85 rounds of 1,7-mRCTR conducted in the intervention wards significantly reduced the odds of malaria infection by 66% (adjusted OR 0.34, 95% CI 0.26,0.44, p < 0001) beyond the effect of the standard programmes. Malaria prevalence in the intervention wards declined by 81% (from 26% (95% CI 23.7, 7.8), at baseline to 4.9% (95% CI 4.0, 5.9) at endline). In villages receiving the 1,7-mRCTR, the short-term case ratio decreased by over 15.7% (95% CI - 33, 6) compared to baseline. CONCLUSION The 1,7-mRCTR approach significantly reduced the malaria burden in the areas of high transmission in rural southern Tanzania. This locally tailored approach could accelerate malaria control and elimination efforts. The results provide the impetus for further evaluation of the effectiveness and scaling up of this approach in other high malaria burden countries in Africa, including Tanzania.
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Affiliation(s)
- Yeromin P Mlacha
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Duoquan Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Prosper P Chaki
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania.
| | - Tegemeo Gavana
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Zhengbin Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Mihayo G Michael
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Rashid Khatib
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Godlove Chila
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Hajirani M Msuya
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Exavery Chaki
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Christina Makungu
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Kangming Lin
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Ernest Tambo
- Higher Institute of Health Sciences, Université des Montagnes, Bangangté, BP 208, Cameroon
| | - Susan F Rumisha
- National Institute for Medical Research (NIMR), P.O. Box 9653, Dar es Salaam, Tanzania
| | - Sigsbert Mkude
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Muhidin K Mahende
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Frank Chacky
- National Malaria Control, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Honorati Masanja
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Maru Aregawi
- The Global Malaria Programme (GMP), World Health Organization, Geneva, Switzerland
| | - Ellen Hertzmark
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ning Xiao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Salim Abdulla
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Road, Shanghai, 200025, People's Republic of China
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14
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Bhondoekhan FRP, Searle KM, Hamapumbu H, Lubinda M, Matoba J, Musonda M, Katowa B, Shields TM, Kobayashi T, Norris DE, Curriero FC, Stevenson JC, Thuma PE, Moss WJ. Improving the efficiency of reactive case detection for malaria elimination in southern Zambia: a cross-sectional study. Malar J 2020; 19:175. [PMID: 32381005 PMCID: PMC7206707 DOI: 10.1186/s12936-020-03245-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/23/2020] [Indexed: 01/20/2023] Open
Abstract
Background Reactive case detection (RCD) seeks to enhance malaria surveillance and control by identifying and treating parasitaemic individuals residing near index cases. In Zambia, this strategy starts with passive detection of symptomatic incident malaria cases at local health facilities or by community health workers, with subsequent home visits to screen-and-treat residents in the index case and neighbouring (secondary) households within a 140-m radius using rapid diagnostic tests (RDTs). However, a small circular radius may not be the most efficient strategy to identify parasitaemic individuals in low-endemic areas with hotspots of malaria transmission. To evaluate if RCD efficiency could be improved by increasing the probability of identifying parasitaemic residents, environmental risk factors and a larger screening radius (250 m) were assessed in a region of low malaria endemicity. Methods Between January 12, 2015 and July 26, 2017, 4170 individuals residing in 158 index and 531 secondary households were enrolled and completed a baseline questionnaire in the catchment area of Macha Hospital in Choma District, Southern Province, Zambia. Plasmodium falciparum prevalence was measured using PfHRP2 RDTs and quantitative PCR (qPCR). A Quickbird™ high-resolution satellite image of the catchment area was used to create environmental risk factors in ArcGIS, and generalized estimating equations were used to evaluate associations between risk factors and secondary households with parasitaemic individuals. Results The parasite prevalence in secondary (non-index case) households was 0.7% by RDT and 1.8% by qPCR. Overall, 8.5% (n = 45) of secondary households had at least one resident with parasitaemia by qPCR or RDT. The risk of a secondary household having a parasitaemic resident was significantly increased in proximity to higher order streams and marginally with increasing distance from index households. The adjusted OR for proximity to third- and fifth-order streams were 2.97 (95% CI 1.04–8.42) and 2.30 (95% CI 1.04–5.09), respectively, and that for distance to index households for each 50 m was 1.24 (95% CI 0.98–1.58). Conclusion Applying proximity to streams as a screening tool, 16% (n = 3) more malaria-positive secondary households were identified compared to using a 140-m circular screening radius. This analysis highlights the potential use of environmental risk factors as a screening strategy to increase RCD efficiency.
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Affiliation(s)
- Fiona R P Bhondoekhan
- MACS/WIHS Combined Cohort Study, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Kelly M Searle
- MACS/WIHS Combined Cohort Study, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA
| | | | | | | | | | - Ben Katowa
- Macha Research Trust, Choma District, Zambia
| | - Timothy M Shields
- MACS/WIHS Combined Cohort Study, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Tamaki Kobayashi
- MACS/WIHS Combined Cohort Study, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Douglas E Norris
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Frank C Curriero
- MACS/WIHS Combined Cohort Study, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer C Stevenson
- Macha Research Trust, Choma District, Zambia.,Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Philip E Thuma
- Macha Research Trust, Choma District, Zambia.,Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William J Moss
- MACS/WIHS Combined Cohort Study, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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15
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Taylor SM, Sumner KM, Freedman B, Mangeni JN, Obala AA, Prudhomme O'Meara W. Direct Estimation of Sensitivity of Plasmodium falciparum Rapid Diagnostic Test for Active Case Detection in a High-Transmission Community Setting. Am J Trop Med Hyg 2020; 101:1416-1423. [PMID: 31674301 DOI: 10.4269/ajtmh.19-0558] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Community-based active case detection of malaria parasites with conventional rapid diagnostic tests (cRDTs) is a strategy used most commonly in low-transmission settings. We estimated the sensitivity of this approach in a high-transmission setting in Western Kenya. We tested 3,547 members of 912 households identified in 2013-2014 by index children with (case) and without (control) cRDT-positive malaria. All were tested for Plasmodium falciparum with both a cRDT targeting histidine-rich protein 2 and with an ultrasensitive real-time polymerase chain reaction (PCR). We computed cRDT sensitivity against PCR as the referent, compared prevalence between participant types, and estimated cRDT detectability as a function of PCR-estimated parasite density. Parasite prevalence was 22.9% by cRDTs and 61.5% by PCR. Compared with children aged < 5 years or adults aged > 15 years, geometric mean parasite densities (95% CI) were highest in school-age children aged 5-15 years (8.4 p/uL; 6.6-10.6). The overall sensitivity of cRDT was 36%; among asymptomatic household members, cRDT sensitivity was 25.5% and lowest in adults aged > 15 years (15.8%). When modeled as a function of parasite density, relative to school-age children, the probability of cRDT positivity was reduced in both children aged < 5 years (odds ratio [OR] 0.48; 95% CI: 0.34-0.69) and in adults aged > 15 years (OR: 0.35; 95% CI: 0.27-0.47). An HRP2-detecting cRDT had poor sensitivity for active P. falciparum case detection in asymptomatic community members, and sensitivity was lowest in highly prevalent low-density infections and in adults. Future studies can model the incremental effects of high-sensitivity rapid diagnostic tests and the impacts on transmission.
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Affiliation(s)
- Steve M Taylor
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina.,Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.,Duke Global Health Institute, Durham, North Carolina
| | - Kelsey M Sumner
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.,Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Betsy Freedman
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | | | - Andrew A Obala
- College of Health Sciences, Moi University, Eldoret, Kenya
| | - Wendy Prudhomme O'Meara
- College of Health Sciences, Moi University, Eldoret, Kenya.,Duke Global Health Institute, Durham, North Carolina.,Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
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16
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Pringle JC, Tessema S, Wesolowski A, Chen A, Murphy M, Carpi G, Shields TM, Hamapumbu H, Searle KM, Kobayashi T, Katowa B, Musonda M, Stevenson JC, Thuma PE, Greenhouse B, Moss WJ, Norris DE. Genetic Evidence of Focal Plasmodium falciparum Transmission in a Pre-elimination Setting in Southern Province, Zambia. J Infect Dis 2020; 219:1254-1263. [PMID: 30445612 DOI: 10.1093/infdis/jiy640] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/09/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Southern Province, Zambia has experienced a dramatic decline in Plasmodium falciparum malaria transmission in the past decade and is targeted for elimination. Zambia's National Malaria Elimination Program recommends reactive case detection (RCD) within 140 m of index households to enhance surveillance and eliminate remaining transmission foci. METHODS To evaluate whether RCD captures local transmission, we genotyped 26 microsatellites from 106 samples collected from index (n = 27) and secondary (n = 79) cases detected through RCD in the Macha Hospital catchment area between January 2015 and April 2016. RESULTS Participants from the same RCD event harbored more genetically related parasites than those from different RCD events, suggesting that RCD captures, at least in part, infections related through local transmission. Related parasites clustered in space and time, up to at least 250 m from index households. Spatial analysis identified a putative focal transmission hotspot. CONCLUSIONS The current RCD strategy detects focal transmission events, although programmatic guidelines to screen within 140 m of index households may fail to capture all secondary cases. This study highlights the utility of parasite genetic data in assessing programmatic interventions, and similar approaches may be useful to malaria elimination programs seeking to tailor intervention strategies to the underlying transmission epidemiology.
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Affiliation(s)
- Julia C Pringle
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anna Chen
- Department of Medicine, University of California, San Francisco
| | - Maxwell Murphy
- Department of Medicine, University of California, San Francisco.,Division of Biostatistics, University of California, Berkeley
| | - Giovanna Carpi
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Biological Sciences, Purdue University, West Lafayette, Indiana
| | - Timothy M Shields
- Department of Epidemiology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Kelly M Searle
- Department of Epidemiology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Jennifer C Stevenson
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Macha Research Trust, Choma, Zambia
| | | | - Bryan Greenhouse
- Department of Medicine, University of California, San Francisco.,Chan Zuckerberg Biohub, San Francisco, California
| | - William J Moss
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Douglas E Norris
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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17
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Kobayashi T, Jain A, Liang L, Obiero JM, Hamapumbu H, Stevenson JC, Thuma PE, Lupiya J, Chaponda M, Mulenga M, Mamini E, Mharakurwa S, Gwanzura L, Munyati S, Mutambu S, Felgner P, Davies DH, Moss WJ. Distinct Antibody Signatures Associated with Different Malaria Transmission Intensities in Zambia and Zimbabwe. mSphere 2019; 4:e00061-19. [PMID: 30918058 PMCID: PMC6437277 DOI: 10.1128/mspheredirect.00061-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 12/30/2022] Open
Abstract
Antibodies to Plasmodium falciparum are specific biomarkers that can be used to monitor parasite exposure over broader time frames than microscopy, rapid diagnostic tests, or molecular assays. Consequently, seroprevalence surveys can assist with monitoring the impact of malaria control interventions, particularly in the final stages of elimination, when parasite incidence is low. The protein array format to measure antibodies to diverse P. falciparum antigens requires only small sample volumes and is high throughput, permitting the monitoring of malaria transmission on large spatial and temporal scales. We expanded the use of a protein microarray to assess malaria transmission in settings beyond those with a low malaria incidence. Antibody responses in children and adults were profiled, using a P. falciparum protein microarray, through community-based surveys in three areas in Zambia and Zimbabwe at different stages of malaria control and elimination. These three epidemiological settings had distinct serological profiles reflective of their malaria transmission histories. While there was little correlation between transmission intensity and antibody signals (magnitude or breadth) in adults, there was a clear correlation in children younger than 5 years of age. Antibodies in adults appeared to be durable even in the absence of significant recent transmission, whereas antibodies in children provided a more accurate picture of recent levels of transmission intensity. Seroprevalence studies in children could provide a valuable marker of progress toward malaria elimination.IMPORTANCE As malaria approaches elimination in many areas of the world, monitoring the effect of control measures becomes more important but challenging. Low-level infections may go undetected by conventional tests that depend on parasitemia, particularly in immune individuals, who typically show no symptoms of malaria. In contrast, antibodies persist after parasitemia and may provide a more accurate picture of recent exposure. Only a few parasite antigens-mainly vaccine candidates-have been evaluated in seroepidemiological studies. We examined antibody responses to 500 different malaria proteins in blood samples collected through community-based surveillance from areas with low, medium, and high malaria transmission intensities. The breadth of the antibody responses in adults was broad in all three settings and was a poor correlate of recent exposure. In contrast, children represented a better sentinel population for monitoring recent malaria transmission. These data will help inform the use of multiplex serology for malaria surveillance.
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Affiliation(s)
- Tamaki Kobayashi
- Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aarti Jain
- Vaccine Research & Development Center, Department of Physiology & Biophysics, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Li Liang
- Vaccine Research & Development Center, Department of Physiology & Biophysics, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Joshua M Obiero
- Vaccine Research & Development Center, Department of Physiology & Biophysics, School of Medicine, University of California, Irvine, Irvine, California, USA
| | | | - Jennifer C Stevenson
- Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Macha Research Trust, Choma, Zambia
| | - Philip E Thuma
- Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Macha Research Trust, Choma, Zambia
| | - James Lupiya
- Tropical Diseases Research Centre, Ndola, Zambia
| | | | | | - Edmore Mamini
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | | | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Susan Mutambu
- National Institute of Health Research, Harare, Zimbabwe
| | - Philip Felgner
- Vaccine Research & Development Center, Department of Physiology & Biophysics, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - D Huw Davies
- Vaccine Research & Development Center, Department of Physiology & Biophysics, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - William J Moss
- Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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