1
|
Arikawa S, Tchankoni MK, Gbeasor-Komlanvi FA, Atekpe SP, Atcha-Oubou T, Figueroa-Romero A, Fombah AE, Saute F, Samai M, Menendez C, Gonzalez R, Briand V, Ekouevi DK. Prevalence and risk factors associated with malaria infection in children under two years of age in southern Togo prior to perennial malaria chemoprevention implementation. Malar J 2023; 22:357. [PMID: 37990324 PMCID: PMC10664264 DOI: 10.1186/s12936-023-04793-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Malaria remains the leading cause of mortality and morbidity in young children in sub-Saharan Africa. To prevent malaria in children living in moderate-to-high malaria transmission areas, the World Health Organization has recommended perennial malaria chemoprevention (PMC). Prior to piloting PMC implementation in southern Togo, a household survey was conducted to estimate malaria infection prevalence in children under 2 years of age (U2). METHODS A cross-sectional community-based household survey was conducted in the Haho district in the Togo Plateaux region. A three-stage random sampling method was used to select study participants aged 10-23 months whose caretakers gave informed consent. The prevalence of Plasmodium infection, defined as a positive rapid diagnostic test (RDT), was estimated with 95% confidence interval (CI). Clinical malaria was defined as having a positive RDT plus fever (≥ 37.5 °C) or history of fever in the last 24 h. Mixed-effects logistic regression models were used to assess the child's, caretaker's, and household's factors associated with malaria infection. RESULTS A total of 685 children were included in the survey conducted January-February in 2022 (dry season). Median age was 17 months (interquartile range: 13-21). About 80% of the children slept under a bed net the night before the interview. Malaria infection prevalence was 32.1% (95% CI 27.7-37.0) with significant area variation (cluster range: 0.0-73.3). Prevalence of clinical malaria was 15.4% (95% CI 12.2-19.2). Children whose caretakers were animist (aOR: 1.71, 95% CI 1.19-2.46) and those living in mother-headed households (aOR: 2.39, 95% CI 1.43-3.99) were more likely to have a positive RDT. Living more than 5 km away from the nearest health facility (aOR: 1.60, 95% CI 1.04-2.44) and presence of two or more under-5-years children in the household (aOR: 1.44, 95% CI 1.01-2.07) were also associated with increased risk of infection. CONCLUSION One-third of the children U2 who participated in this survey had malaria infection, thus PMC could be a promising strategy to reduce malaria burden in young children in Plateaux region. Reinforcement of outreach services and targeting the poorest households should be prioritized to reduce the inequity in malaria prevention in children exposed to the infection.
Collapse
Affiliation(s)
- Shino Arikawa
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France.
| | - Martin Kouame Tchankoni
- Département de Santé Publique, Université de Lomé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Fifonsi A Gbeasor-Komlanvi
- Département de Santé Publique, Université de Lomé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Somiabalo P Atekpe
- Ministère de la Santé, de l'Hygiène Publique et de l'Accès Universel Aux Soins (MSHPAUS), District Sanitaire du Haho, Notsé, Togo
| | - Tinah Atcha-Oubou
- Ministère de la Santé, de l'Hygiène Publique et de l'Accès Universel aux Soins (MSHPAUS) Programme National de Lutte contre le Paludisme (PNLP), Lomé, Togo
| | - Antía Figueroa-Romero
- Barcelona Institute for Global Health, Hospital Clinic‑University of Barcelona, Barcelona, Spain
| | - Augustin E Fombah
- Barcelona Institute for Global Health, Hospital Clinic‑University of Barcelona, Barcelona, Spain
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Directorate of Research and Training, Ministry of Health, Freetown, Sierra Leone
| | - Clara Menendez
- Barcelona Institute for Global Health, Hospital Clinic‑University of Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
| | - Raquel Gonzalez
- Barcelona Institute for Global Health, Hospital Clinic‑University of Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
| | - Valérie Briand
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
- Epicentre, Paris, France
| | - Didier K Ekouevi
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
- Département de Santé Publique, Université de Lomé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| |
Collapse
|
2
|
Kabeya TK, Kasongo JCM, Matumba NB, Tshibangu DI, Garcia-Morzon LA, Burgueño E. Impact of mass distribution of long-lasting insecticide nets on the incidence of malaria in Lomami, Democratic Republic of Congo: a study based on electronic health record data (2018 - 2019). Pan Afr Med J 2023; 45:89. [PMID: 37663637 PMCID: PMC10474805 DOI: 10.11604/pamj.2023.45.89.33099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/16/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction holoendemic, malaria remains one of the major public health problems in Lomami Province in the Democratic Republic of Congo (DRC). To fight against it, a free mass distribution of long-lasting insecticide nets (LLINs) was organized in July 2019 throughout the province. The present study aimed to assess the incidence of malaria and its impact on anaemia of children from 0 to 59 months in this region before and after this intervention. Methods we had conducted a retrospective observational study from June to December 2018 and June to December 2019. The data were collected on District Health Information System version two (DHIS2) and analyzed with T-tests to compare the incidence rates before (second semester 2018) and after the distribution of LLINs (second semester 2019). Results the evolution of malaria cases immediately dropped after the distribution campaign. The incidence rates per 1,000 inhabitants in 2018 and 2019 were 106 and 107 respectively in the general population; 302 versus 305 in children aged 0 to 59 months and 219 versus 209 in pregnant women. The differences in incidence were not statistically significant with p values 0.497, 0.4602, and 0.3097 respectively. However, it was observed that the decrease in malaria cases led to a decrease in anaemia cases in general. Conclusion the LLIN distribution campaign did not decrease the incidence of malaria. The synergy of preventive interventions to reduce the incidence of malaria remains key.
Collapse
Affiliation(s)
- Theddy Kazadi Kabeya
- School of Public Health, University of Mwene Ditu, Lomami, Democratic Republic of Congo
- Health Regional Division, Kabinda, Lomami, Democratic Republic of Congo
| | - Jean Claude Musasa Kasongo
- School of Public Health, University of Mwene Ditu, Lomami, Democratic Republic of Congo
- Mwene-Ditu Health Zone, Lomami, Democratic Republic of Congo
| | | | | | | | - Eduardo Burgueño
- Centre Médical Vésale, Ngaliema, Kinshasa, Democratic Republic of Congo
- School of Medicine, Official University of Mbujimayi, Kasai-Oriental, Democratic Republic of Congo
| |
Collapse
|
3
|
Anjorin S, Okolie E, Yaya S. Malaria profile and socioeconomic predictors among under-five children: an analysis of 11 sub-Saharan African countries. Malar J 2023; 22:55. [PMID: 36788541 DOI: 10.1186/s12936-023-04484-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND African region accounts for 95% of all malaria cases and 96% of malaria deaths with under-five children accounting for 80% of all deaths in the region. This study assessed the socioeconomic determinants of malaria prevalence and provide evidence on the socioeconomic profile of malaria infection among under-five children in 11 SSA countries. METHODS This study used data from the 2010 to 2020 Demographic and Health Survey (DHS). The survey used a two-stage stratified-cluster sampling design based on the sampling frame of the population and housing census of countries included. Statistical analyses relied on Pearson's χ2, using the CHAID decision-tree algorithm and logistic regression implemented in R V.4.6. RESULTS Of 8547 children considered, 24.2% (95% confidence interval CI 23.4-25.05%) had malaria infection. Also, the prevalence of malaria infection seems to increase with age. The following variables are statistically associated with the prevalence of malaria infection among under-five children: under-five child's age, maternal education, sex of household head, household wealth index, place of residence, and African region where mother-child pair lives. Children whose mothers have secondary education have about 56% lower risk (odds ratio = 0.44; 95% CI 0.40-0.48) of malaria infection and 73% lower (odds ratio = 0.37; 95% CI 0.32-0.43) among children living in the richest households, compared to children living in the poorest households. CONCLUSIONS The findings of this study provide unique insights on how socioeconomic and demographic variables, especially maternal education level significantly predicts under-five malaria prevalence across the SSA region. Therefore, ensuring that malaria interventions are underpinned by a multisectoral approach that comprehensively tackles the interplay of maternal education and other socioeconomic variables will be critical in attaining malaria prevention and control targets in SSA.
Collapse
|
4
|
Okitawutshu J, Signorell A, Kalenga JC, Mukomena E, Delvento G, Burri C, Mwaluke F, Buj V, Sangare M, Luketa S, Brunner N, Lee T, Hetzel M, Lengeler C, Tshefu A. Key factors predicting suspected severe malaria case management and health outcomes: an operational study in the Democratic Republic of the Congo. Malar J 2022; 21:274. [PMID: 36167567 PMCID: PMC9513903 DOI: 10.1186/s12936-022-04296-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background Evidence suggests that pre-referral Rectal Artesunate (RAS) can be a life-saving intervention for severe malaria in remote settings in Africa. Recognition of danger signs indicative of severe malaria is critical for prompt and appropriate case management. Methods This was an observational study conducted in three Health Zones of the Democratic Republic of the Congo to determine the distribution of dangers signs for severe malaria and assess their impact on RAS use, referral completion, injectable treatment and ACT provision, and health outcomes including death. An individual-level analysis was carried out, using multilevel-mixed effects logistic regression models. Severely ill febrile children < 5 years seeking care from community-based healthcare providers were recruited into a patient surveillance system based on the presence of key danger signs. Clinical and case management data were collected comprehensively over a 28 days period. Treatment seeking was elicited and health outcomes assessed during 28 days home visits. Results Overall, 66.4% of patients had iCCM general danger signs. Age of 2–5 years and iCCM general danger signs predicted RAS use (aOR = 2.77, 95% CI 2.04–3.77). RAS administration positively affected referral completion (aOR = 0.63, 95% CI 0.44–0.92). After RAS rollout, 161 children died (case fatality ratio: 7.1%, 95% CI 6.1–8.2). RAS improved the health status of the children on Day 28 (aOR = 0.64, 95% CI 0.45–0.92) and there was a non-significant trend that mortality was higher in children not receiving RAS (aOR = 1.50, 95% CI 0.86–2.60). Full severe malaria treatment at the RHF including injectable anti-malarial and a course of ACT was highly protective against death (aOR = 0.26, 95% CI 0.09–0.79). Conclusions The main findings point towards the fact that danger signs are reasonably well recognized by health provider at the primary care level, and that RAS could influence positively health outcomes of such severe disease episodes and death. Its effectiveness is hampered by the insufficient quality of care at RHF, especially the provision of a full course of ACT following parenteral treatment. These are simple but important findings that requires urgent action by the health system planners and implementers. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04296-2.
Collapse
Affiliation(s)
- Jean Okitawutshu
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland. .,University of Basel, Basel, Switzerland. .,Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.
| | - Aita Signorell
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Jean-Claude Kalenga
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Eric Mukomena
- School of Medicine, Department of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Giulia Delvento
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Christian Burri
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Fatou Mwaluke
- Clinton Health Access Initiative, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Nina Brunner
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Tristan Lee
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Manuel Hetzel
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| |
Collapse
|
5
|
Carrasco-Escobar G, Matta-Chuquisapon J, Manrique E, Ruiz-Cabrejos J, Barboza JL, Wong D, Henostroza G, Llanos-Cuentas A, Benmarhnia T. Quantifying the effect of human population mobility on malaria risk in the Peruvian Amazon. R Soc Open Sci 2022; 9:211611. [PMID: 35875474 PMCID: PMC9297009 DOI: 10.1098/rsos.211611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
The impact of human population movement (HPM) on the epidemiology of vector-borne diseases, such as malaria, has been described. However, there are limited data on the use of new technologies for the study of HPM in endemic areas with difficult access such as the Amazon. In this study conducted in rural Peruvian Amazon, we used self-reported travel surveys and GPS trackers coupled with a Bayesian spatial model to quantify the role of HPM on malaria risk. By using a densely sampled population cohort, this study highlighted the elevated malaria transmission in a riverine community of the Peruvian Amazon. We also found that the high connectivity between Amazon communities for reasons such as work, trading or family plausibly sustains such transmission levels. Finally, by using multiple human mobility metrics including GPS trackers, and adapted causal inference methods we identified for the first time the effect of human mobility patterns on malaria risk in rural Peruvian Amazon. This study provides evidence of the causal effect of HPM on malaria that may help to adapt current malaria control programmes in the Amazon.
Collapse
Affiliation(s)
- Gabriel Carrasco-Escobar
- Health Innovation Lab, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Jose Matta-Chuquisapon
- Health Innovation Lab, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Edgar Manrique
- Health Innovation Lab, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jorge Ruiz-Cabrejos
- Health Innovation Lab, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jose Luis Barboza
- Health Innovation Lab, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel Wong
- Health Innovation Lab, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Alejandro Llanos-Cuentas
- Instituto de Medicinal Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| |
Collapse
|
6
|
Nundu SS, Simpson SV, Arima H, Muyembe J, Mita T, Ahuka S, Yamamoto T. It Is Time to Strengthen the Malaria Control Policy of the Democratic Republic of Congo and Include Schools and School-Age Children in Malaria Control Measures. Pathogens 2022; 11:729. [PMID: 35889975 PMCID: PMC9315856 DOI: 10.3390/pathogens11070729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Despite a decade of sustained malaria control, malaria remains a serious public health problem in the Democratic Republic of Congo (DRC). Children under five years of age and school-age children aged 5–15 years remain at high risk of symptomatic and asymptomatic malaria infections. The World Health Organization’s malaria control, elimination, and eradication recommendations are still only partially implemented in DRC. For better malaria control and eventual elimination, the integration of all individuals into the national malaria control programme will strengthen malaria control and elimination strategies in the country. Thus, inclusion of schools and school-age children in DRC malaria control interventions is needed.
Collapse
|
7
|
Metelo-Matubi E, Zanga J, Binene G, Mvuama N, Ngamukie S, Nkey J, Schopp P, Bamba M, Irish S, Nguya-Kalemba-Maniania J, Fasine S, Nagahuedi J, Muyembe JJ, Mansiangi P. The effect of a mass distribution of insecticide-treated nets on insecticide resistance and entomological inoculation rates of Anopheles gambiae s.l. in Bandundu City, Democratic Repub`lic of Congo. Pan Afr Med J 2021; 40:118. [PMID: 34887992 PMCID: PMC8627145 DOI: 10.11604/pamj.2021.40.118.27365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/10/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction insecticide-treated nets (ITNs) remain the mainstay of malaria vector control in the Democratic Republic of Congo. However, insecticide resistance of malaria vectors threatens their effectiveness. Entomological inoculation rates and insecticide susceptibility in Anopheles gambiae s.l. were evaluated before and after mass distribution of ITNs in Bandundu City for possible occurrence of resistance. Methods a cross-sectional study was conducted from 15th July 2015 to 15th June 2016. Adult mosquitoes were collected using pyrethrum spray catches and human landing catches and identified to species level and tested for the presence of sporozoites. Bioassays were carried out before and after distribution of ITNs to assess the susceptibility of adult mosquitoes to insecticides. Synergist bioassays were also conducted and target site mutations assessed using Polymerase chain reaction (PCR). Results a total of 1754 female An. gambiae s.l. were collected before and after deployment of ITNs. Fewer mosquitoes were collected after the distribution of ITNs. However, there was no significant difference in sporozoite rates or the overall entomological inoculation rate before and after the distribution of ITNs. Test-mosquitoes were resistant to deltamethrin, permethrin, and Dichlorodiphenyltrichloroethane but susceptible to bendiocarb. Pre-exposure of mosquitoes to Piperonyl butoxide increased their mortality after exposure to permethrin and deltamethrin. The frequency of the Kinase insert domain receptor (kdr)-West gene increased from 92 to 99% before and after the distribution of nets, respectively. Conclusion seasonal impacts could be a limiting factor in the analysis of these data; however, the lack of decrease in transmission after the distribution of new nets could be explained by the high-level of resistance to pyrethroid.
Collapse
Affiliation(s)
- Emery Metelo-Matubi
- Faculté de Médecine, Université de Bandundu, B.P 548 Bandundu-ville, Bandundu, République Démocratique de Congo.,Institut National de Recherche Biomédicale, B.P 1197 KIN 1, Kinshasa, République Démocratique de Congo.,Faculté des Sciences, Département de Biologie, Unité de Recherche Entomologique, B.P 190 KIN XI, Université de Kinshasa, Kinshasa, République Démocratique de Congo
| | - Josué Zanga
- Faculté de Médecine, Ecole de Santé Publique, Département de Santé Environnementale, B.P 834 KIN XI, Université de Kinshasa, Kinshasa, République Démocratique de Congo
| | - Guillaume Binene
- Institut National de Recherche Biomédicale, B.P 1197 KIN 1, Kinshasa, République Démocratique de Congo
| | - Nono Mvuama
- Faculté de Médecine, Ecole de Santé Publique, Département de Santé Environnementale, B.P 834 KIN XI, Université de Kinshasa, Kinshasa, République Démocratique de Congo
| | - Solange Ngamukie
- Faculté de Médecine, Ecole de Santé Publique, Département de Santé Environnementale, B.P 834 KIN XI, Université de Kinshasa, Kinshasa, République Démocratique de Congo
| | - Jadis Nkey
- Faculté de Médecine, Université de Bandundu, B.P 548 Bandundu-ville, Bandundu, République Démocratique de Congo
| | - Pauline Schopp
- United States President´s Malaria Initiative and Entomology Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Maxwell Bamba
- Faculté de Médecine, Ecole de Santé Publique, Département de Santé Environnementale, B.P 834 KIN XI, Université de Kinshasa, Kinshasa, République Démocratique de Congo
| | - Seth Irish
- United States President´s Malaria Initiative and Entomology Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | | | - Sylvie Fasine
- Institut National de Recherche Biomédicale, B.P 1197 KIN 1, Kinshasa, République Démocratique de Congo
| | - Jonas Nagahuedi
- Faculté des Sciences, Département de Biologie, Unité de Recherche Entomologique, B.P 190 KIN XI, Université de Kinshasa, Kinshasa, République Démocratique de Congo
| | - Jean-Jacques Muyembe
- Institut National de Recherche Biomédicale, B.P 1197 KIN 1, Kinshasa, République Démocratique de Congo
| | - Paul Mansiangi
- Faculté de Médecine, Ecole de Santé Publique, Département de Santé Environnementale, B.P 834 KIN XI, Université de Kinshasa, Kinshasa, République Démocratique de Congo
| |
Collapse
|
8
|
Deutsch-Feldman M, Brazeau NF, Parr JB, Thwai KL, Muwonga J, Kashamuka M, Tshefu Kitoto A, Aydemir O, Bailey JA, Edwards JK, Verity R, Emch M, Gower EW, Juliano JJ, Meshnick SR. Spatial and epidemiological drivers of Plasmodium falciparum malaria among adults in the Democratic Republic of the Congo. BMJ Glob Health 2021; 5:bmjgh-2020-002316. [PMID: 32601091 PMCID: PMC7326263 DOI: 10.1136/bmjgh-2020-002316] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background Adults are frequently infected with malaria and may serve as a reservoir for further transmission, yet we know relatively little about risk factors for adult infections. In this study, we assessed malaria risk factors among adults using samples from the nationally representative, cross-sectional 2013–2014 Demographic and Health Survey (DHS) conducted in the Democratic Republic of the Congo (DRC). We further explored differences in risk factors by urbanicity. Methods Plasmodium falciparum infection was determined by PCR. Covariates were drawn from the DHS to model individual, community and environmental-level risk factors for infection. Additionally, we used deep sequencing data to estimate the community-level proportions of drug-resistant infections and included these estimates as potential risk factors. All identified factors were assessed for differences in associations by urbanicity. Results A total of 16 126 adults were included. Overall prevalence of malaria was 30.3% (SE=1.1) by PCR; province-level prevalence ranged from 6.7% to 58.3%. Only 17% of individuals lived in households with at least one bed-net for every two people, as recommended by the WHO. Protective factors included increasing within-household bed-net coverage (Prevalence Ratio=0.85, 95% CI=0.76–0.95) and modern housing (PR=0.58, 95% CI=0.49–0.69). Community-level protective factors included increased median wealth (PR=0.87, 95% CI=0.83–0.92). Education, wealth, and modern housing showed protective associations in cities but not in rural areas. Conclusions The DRC continues to suffer from a high burden of malaria; interventions that target high-risk groups and sustained investment in malaria control are sorely needed. Areas of high prevalence should be prioritised for interventions to target the largest reservoirs for further transmission.
Collapse
Affiliation(s)
- Molly Deutsch-Feldman
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nicholas F Brazeau
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan B Parr
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kyaw L Thwai
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeremie Muwonga
- National AIDS Control Program, Kinshasa, Congo (the Democratic Republic)
| | - Melchior Kashamuka
- School of Public Health, University of Kinshasa Faculty of Medicine, Kinshasa, Congo (the Democratic Republic)
| | - Antoinette Tshefu Kitoto
- School of Public Health, University of Kinshasa Faculty of Medicine, Kinshasa, Congo (the Democratic Republic)
| | - Ozkan Aydemir
- Department of Pathology and Laboratory Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffrey A Bailey
- Department of Pathology and Laboratory Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert Verity
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Michael Emch
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily W Gower
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan J Juliano
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Genetics and Molecular Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steven R Meshnick
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
9
|
Emina JBO, Doctor HV, Yé Y. Profiling malaria infection among under-five children in the Democratic Republic of Congo. PLoS One 2021; 16:e0250550. [PMID: 33956848 DOI: 10.1371/journal.pone.0250550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/12/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction In 2018, Malaria accounted for 38% of the overall morbidity and 36% of the overall mortality in the Democratic Republic of Congo (DRC). This study aimed to identify malaria socioeconomic predictors among children aged 6–59 months in DRC and to describe a socioeconomic profile of the most-at-risk children aged 6–59 months for malaria infection. Materials and methods This study used data from the 2013 DRC Demographic and Health Survey. The sample included 8,547 children aged 6–59 months who were tested for malaria by microscopy. Malaria infection status, the dependent variable, is a dummy variable characterized as a positive or negative test. The independent variables were child’s sex, age, and living arrangement; mother’s education; household’s socioeconomic variables; province of residence; and type of place of residence. Statistical analyses used the chi-square automatic interaction detector (CHAID) model and logistic regression. Results Of the 8,547 children included in the sample, 25% had malaria infection. Four variables—child’s age, mother’s education, province, and wealth index—were statistically associated with the prevalence of malaria infection in bivariate analysis and multivariate analysis (CHAID and logistic regression). The prevalence of malaria infection increases with child’s age and decreases significantly with mother’s education and the household wealth index. These findings suggest that the prevalence of malaria infection is driven by interactions among environmental factors, socioeconomic characteristics, and probably differences in the implementation of malaria programs across the country. The effect of mother’s education on malaria infection was only significant among under-five children living in Ituri, Kasaï-Central, Haut-Uele, Lomami, Nord-Ubangi, and Maniema provinces, and the effect of wealth index was significant in Mai-Ndombe, Tshopo, and Haut-Katanga provinces. Conclusion Findings from this study could be used for targeting malaria interventions in DRC. Although malaria infection is common across the country, the prevalence of children at high risk for malaria infection varies by province and other background characteristics, including age, mother’s education, wealth index, and place of residence. In light of these findings, designing provincial and multisectoral interventions could be an effective strategy to achieve zero malaria infection in DRC.
Collapse
|
10
|
Lufungulo Bahati Y, Delanghe J, Bisimwa Balaluka G, Sadiki Kishabongo A, Philippé J. Asymptomatic Submicroscopic Plasmodium Infection Is Highly Prevalent and Is Associated with Anemia in Children Younger than 5 Years in South Kivu/Democratic Republic of Congo. Am J Trop Med Hyg 2020; 102:1048-1055. [PMID: 32124722 DOI: 10.4269/ajtmh.19-0878] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
One of the most important problems in controlling malaria is the limited access to effective and accurate diagnosis of malaria parasitemia. In the Democratic Republic of Congo (DRC), malaria is one of the leading causes of morbidity and mortality. The purpose of this study was to assess the prevalence of anemia and the relationship with asymptomatic submicroscopic Plasmodium infection. A cross-sectional study was carried out among 1,088 apparently healthy children aged between 6 and 59 months selected at random in the health zone of Miti Murhesa in South Kivu/DRC. Capillary blood was obtained for hemoglobin (Hb) concentration measurement by Hemocue® Hb 301. Malaria detection was performed by microscopy and the loop-mediated isothermal amplification (LAMP) assay. Anemia was defined as Hb < 11g/dL. We applied the chi-square test for comparisons, and multiple logistic regression was used to identify the risk factors for anemia and submicroscopic Plasmodium infection. The prevalence of anemia was 39.6%, and the prevalence of parasitemia was 15.9% and 34.0% using microscopy and LAMP test, respectively. Submicroscopic Plasmodium infection was found in 22.3% of the children. The independent risk factors for anemia are Plasmodium infection, children younger than 24 months, low middle-upper arm circumference, and history of illness two weeks before. Otherwise, children with submicroscopic malaria infection have a significantly increased risk for anemia, with a need of transfusion. The prevalence of malaria infection was underestimated, when microscopy was used to diagnose malaria. Children with low parasitemia detected by LAMP but not by microscopy showed a significantly increased prevalence of anemia.
Collapse
Affiliation(s)
- Yvette Lufungulo Bahati
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.,Department of Pediatrics, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Joris Delanghe
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | | | | | - Jan Philippé
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
11
|
Kigozi SP, Kigozi RN, Epstein A, Mpimbaza A, Sserwanga A, Yeka A, Nankabirwa JI, Halliday K, Pullan RL, Rutazaana D, Sebuguzi CM, Opigo J, Kamya MR, Staedke SG, Dorsey G, Greenhouse B, Rodriguez-Barraquer I. Rapid shifts in the age-specific burden of malaria following successful control interventions in four regions of Uganda. Malar J 2020; 19:128. [PMID: 32228584 PMCID: PMC7106889 DOI: 10.1186/s12936-020-03196-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/20/2020] [Indexed: 12/17/2022] Open
Abstract
Background Malaria control using long-lasting insecticidal nets (LLINs) and indoor residual spraying of insecticide (IRS) has been associated with reduced transmission throughout Africa. However, the impact of transmission reduction on the age distribution of malaria cases remains unclear. Methods Over a 10-year period (January 2009 to July 2018), outpatient surveillance data from four health facilities in Uganda were used to estimate the impact of control interventions on temporal changes in the age distribution of malaria cases using multinomial regression. Interventions included mass distribution of LLINs at all sites and IRS at two sites. Results Overall, 896,550 patient visits were included in the study; 211,632 aged < 5 years, 171,166 aged 5–15 years and 513,752 > 15 years. Over time, the age distribution of patients not suspected of malaria and those malaria negative either declined or remained the same across all sites. In contrast, the age distribution of suspected and confirmed malaria cases increased across all four sites. In the two LLINs-only sites, the proportion of malaria cases in < 5 years decreased from 31 to 16% and 35 to 25%, respectively. In the two sites receiving LLINs plus IRS, these proportions decreased from 58 to 30% and 64 to 47%, respectively. Similarly, in the LLINs-only sites, the proportion of malaria cases > 15 years increased from 40 to 61% and 29 to 39%, respectively. In the sites receiving LLINs plus IRS, these proportions increased from 19 to 44% and 18 to 31%, respectively. Conclusions These findings demonstrate a shift in the burden of malaria from younger to older individuals following implementation of successful control interventions, which has important implications for malaria prevention, surveillance, case management and control strategies.
Collapse
Affiliation(s)
- Simon P Kigozi
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda.
| | - Ruth N Kigozi
- USAID's Malaria Action Program for Districts, PO Box 8045, Kampala, Uganda
| | - Adrienne Epstein
- Department of Epidemiology & Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Arthur Mpimbaza
- Child Health and Development Centre, Makerere University College of Health Sciences, Mulago Hospital Complex, PO Box 7072, Kampala, Uganda
| | - Asadu Sserwanga
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Adoke Yeka
- School of Public Health, Makerere University College of Health Sciences, Mulago Hospital Complex, PO Box 7072, Kampala, Uganda
| | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda.,School of Medicine, Makerere University College of Health Sciences, Mulago Hospital Complex, PO Box 7072, Kampala, Uganda
| | - Katherine Halliday
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Rachel L Pullan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Damian Rutazaana
- National Malaria Control Division, Uganda Ministry of Health, Kampala, Uganda
| | - Catherine M Sebuguzi
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda.,National Malaria Control Division, Uganda Ministry of Health, Kampala, Uganda
| | - Jimmy Opigo
- National Malaria Control Division, Uganda Ministry of Health, Kampala, Uganda
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda.,School of Medicine, Makerere University College of Health Sciences, Mulago Hospital Complex, PO Box 7072, Kampala, Uganda
| | - Sarah G Staedke
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Grant Dorsey
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda.,Department of Medicine, University of California, San Francisco, 1001 Potrero Ave, SFGH Building 30, San Francisco, CA, 94110, USA
| | - Bryan Greenhouse
- Division of HIV, ID, and Global Medicine, University of California, San Francisco, 1001 Potrero Ave, SFGH, Building 3, San Francisco, CA, 94110, USA.,Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Isabel Rodriguez-Barraquer
- Division of HIV, ID, and Global Medicine, University of California, San Francisco, 1001 Potrero Ave, SFGH, Building 3, San Francisco, CA, 94110, USA
| |
Collapse
|
12
|
Boyce MR, Katz R, Standley CJ. Risk Factors for Infectious Diseases in Urban Environments of Sub-Saharan Africa: A Systematic Review and Critical Appraisal of Evidence. Trop Med Infect Dis 2019; 4:E123. [PMID: 31569517 DOI: 10.3390/tropicalmed4040123] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/04/2019] [Accepted: 09/20/2019] [Indexed: 12/19/2022] Open
Abstract
Our world is rapidly urbanizing. According to the United Nations, between 1990 and 2015, the percent of the world’s population living in urban areas grew from 43% to 54%. Estimates suggest that this trend will continue and that over 68% of the world’s population will call cities home by 2050, with the majority of urbanization occurring in African countries. This urbanization is already having a profound effect on global health and could significantly impact the epidemiology of infectious diseases. A better understanding of infectious disease risk factors specific to urban settings is needed to plan for and mitigate against future urban outbreaks. We conducted a systematic literature review of the Web of Science and PubMed databases to assess the risk factors for infectious diseases in the urban environments of sub-Saharan Africa. A search combining keywords associated with cities, migration, African countries, infectious disease, and risk were used to identify relevant studies. Original research and meta-analyses published between 2004 and 2019 investigating geographical and behavioral risk factors, changing disease distributions, or control programs were included in the study. The search yielded 3610 papers, and 106 met the criteria for inclusion in the analysis. Papers were categorized according to risk factors, geographic area, and study type. The papers covered 31 countries in sub-Saharan Africa with East Africa being the most represented sub-region. Malaria and HIV were the most frequent disease focuses of the studies. The results of this work can inform public health policy as it relates to capacity building and health systems strengthening in rapidly urbanizing areas, as well as highlight knowledge gaps that warrant additional research.
Collapse
|
13
|
Essendi WM, Vardo-Zalik AM, Lo E, Machani MG, Zhou G, Githeko AK, Yan G, Afrane YA. Epidemiological risk factors for clinical malaria infection in the highlands of Western Kenya. Malar J 2019; 18:211. [PMID: 31234879 PMCID: PMC6591804 DOI: 10.1186/s12936-019-2845-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 06/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background Understanding the complex heterogeneity of risk factors that can contribute to an increased risk of malaria at the individual and household level will enable more effective use of control measures. The objective of this study was to understand individual and household factors that influence clinical malaria infection among individuals in the highlands of Western Kenya. Methods This was a matched case–control study undertaken in the Western Kenya highlands. Clinical malaria cases were recruited from health facilities and matched to asymptomatic individuals from the community who served as controls. Each participant was screened for malaria using microscopy. Follow-up surveys were conducted with individual households to collect socio-economic data. The houses were also checked using pyrethrum spray catches to collect mosquitoes. Results A total of 302 malaria cases were matched to 604 controls during the surveillance period. Mosquito densities were similar in the houses of both groups. A greater percentage of people in the control group (64.6%) used insecticide-treated bed nets (ITNs) compared to the families of malaria cases (48.3%). Use of ITNs was associated with lower level of clinical malaria episodes (odds ratio 0.51; 95% CI 0.39–0.68; P < 0.0001). Low income was the most important factor associated with higher malaria infections (adj. OR 4.70). Use of malaria prophylaxis was the most important factor associated with less malaria infections (adj OR 0.36). Mother’s (not fathers) employment status (adj OR 0.48) and education level (adj OR 0.54) was important malaria risk factor. Houses with open eaves was an important malaria risk factor (adj OR 1.72). Conclusion The identification of risk factors for clinical malaria infection provides information on the local malaria epidemiology and has the potential to lead to a more effective and targeted use of malaria control measures. These risk factors could be used to assess why some individuals acquire clinical malaria whilst others do not and to inform how intervention could be scaled at the local level.
Collapse
Affiliation(s)
| | - Anne M Vardo-Zalik
- The Pennsylvania State University, 1031 Edgecomb Avenue, York, PA, 1740, USA
| | - Eugenia Lo
- Department of Biological Sciences, University of North Carolina at Charlotte, Woodward Hall 380C, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Maxwell G Machani
- Climate and Human Health Research Unit, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Guofa Zhou
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA, 92697, USA
| | - Andrew K Githeko
- Climate and Human Health Research Unit, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Guiyun Yan
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA, 92697, USA
| | - Yaw A Afrane
- Department of Medical Microbiology, College of Health Sciences, University of Ghana, Accra, Ghana.
| |
Collapse
|
14
|
Millar J, Psychas P, Abuaku B, Ahorlu C, Amratia P, Koram K, Oppong S, Valle D. Detecting local risk factors for residual malaria in northern Ghana using Bayesian model averaging. Malar J 2018; 17:343. [PMID: 30268127 DOI: 10.1186/s12936-018-2491-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is a need for comprehensive evaluations of the underlying local factors that contribute to residual malaria in sub-Saharan Africa. However, it is difficult to compare the wide array of demographic, socio-economic, and environmental variables associated with malaria transmission using standard statistical approaches while accounting for seasonal differences and nonlinear relationships. This article uses a Bayesian model averaging (BMA) approach for identifying and comparing potential risk and protective factors associated with residual malaria. Results The relative influence of a comprehensive set of demographic, socio-economic, environmental, and malaria intervention variables on malaria prevalence were modelled using BMA for variable selection. Data were collected in Bunkpurugu-Yunyoo, a rural district in northeast Ghana that experiences holoendemic seasonal malaria transmission, over six biannual surveys from 2010 to 2013. A total of 10,022 children between the ages 6 to 59 months were used in the analysis. Multiple models were developed to identify important risk and protective factors, accounting for seasonal patterns and nonlinear relationships. These models revealed pronounced nonlinear associations between malaria risk and distance from the nearest urban centre and health facility. Furthermore, the association between malaria risk and age and some ethnic groups was significantly different in the rainy and dry seasons. BMA outperformed other commonly used regression approaches in out-of-sample predictive ability using a season-to-season validation approach. Conclusions This modelling framework offers an alternative approach to disease risk factor analysis that generates interpretable models, can reveal complex, nonlinear relationships, incorporates uncertainty in model selection, and produces accurate predictions. Certain modelling applications, such as designing targeted local interventions, require more sophisticated statistical methods which are capable of handling a wide range of relevant data while maintaining interpretability and predictive performance, and directly characterize uncertainty. To this end, BMA represents a valuable tool for constructing more informative models for understanding risk factors for malaria, as well as other vector-borne and environmentally mediated diseases. Electronic supplementary material The online version of this article (10.1186/s12936-018-2491-2) contains supplementary material, which is available to authorized users.
Collapse
|
15
|
Dinko B, Amakpa E, Kweku M, Amoah P, Tampuori J, Adjuik M, Awandare GA, Deitsch KW. Plasmodium falciparum malaria cases detected for prompt treatment by rapid diagnostic tests in the Ho Teaching Hospital of the Volta Region of Ghana. Parasite Epidemiol Control 2018; 3:e00072. [PMID: 29988323 PMCID: PMC6020104 DOI: 10.1016/j.parepi.2018.e00072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 01/10/2023] Open
Abstract
Background Prompt diagnosis and effective treatment of malaria cases with efficacious drugs is an important strategy in the management and control of malaria in endemic populations. As part of a study investigating the factors modulating the development of Plasmodium falciparum gametocytes in the human host, we assessed the rate of RDT positivity of patients in different departments of the Ho Teaching Hospital and the relation with age and anaemia. Materials and methods Eight-hundred and ten individuals attending clinic at various departments within the Ho Teaching Hospital were screened for malaria antigenaemia using RDT as a point-of-entry investigation. RDT positive individuals were immediately treated for malaria whereas RDT negative individuals were treated for other ailments. Haematological analyses were performed for 69 of these patients and the relationship between RDT results and haemoglobin levels were investigated. Results The overall RDT positivity rate was 19.8% (160/810) of all individuals screened. There was no significant difference in the haemoglobin levels of RDT-positive and RDT-negative individuals (p value = 0.272). The highest number of attendees screened was children in the paediatric outpatient department and paediatric ward, 62% (507/810), with RDT positivity rate of 17% (91/507). We found the highest RDT positivity rate of 51% (19/37) in the male medical ward. Conclusions This study shows that RDT is a useful tool in promoting prompt diagnosis and management of malaria and though children form a majority of hospital attendees and malaria infections, the frequency of malaria detection may be higher in adults as compared to children.
Collapse
Affiliation(s)
- Bismarck Dinko
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Eric Amakpa
- Department of Obstetrics and Gyaenocology, Ho Teaching Hospital, Ho, Volta Regiona, Ghana
| | - Margaret Kweku
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Paul Amoah
- Diagnostic Laboratory, Ho Teaching Hospital, Ho, Volta Regiona, Ghana
| | - John Tampuori
- Department of Urology, Ho Teaching Hospital, Ho, Volta Regiona, Ghana
| | - Martin Adjuik
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Gordon A Awandare
- Department of Biochemistry, Cell and Molecular Biology and West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon-Accra, Ghana
| | - Kirk W Deitsch
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, USA
| |
Collapse
|
16
|
Ntuku HM, Ruckstuhl L, Julo-Réminiac JE, Umesumbu SE, Bokota A, Tshefu AK, Lengeler C. Long-lasting insecticidal net (LLIN) ownership, use and cost of implementation after a mass distribution campaign in Kasaï Occidental Province, Democratic Republic of Congo. Malar J 2017; 16:22. [PMID: 28068989 PMCID: PMC5223346 DOI: 10.1186/s12936-016-1671-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Long-lasting insecticidal nets (LLIN) are a highly effective means for preventing malaria infection and reducing associated morbidity and mortality. Mass free distribution campaigns have been shown to rapidly increase LLIN ownership and use. Around 3.5 million LLINs were distributed free of charge in the Kasaï Occidental Province in the Democratic Republic of Congo (DRC) in September–October 2014, using two different approaches, a fixed delivery strategy and a door-to-door strategy including hang-up activities. Methods Repeated community-based cross-sectional surveys were conducted 2 months before and six months after the mass distribution. Descriptive statistics were used to measure changes in key malaria household indicators. LLIN ownership and use were compared between delivery strategies. Univariate and multivariate logistic regression analyses were used to identify factors associated with LLIN use before and after the mass distribution. A comparative financial cost analysis between the fixed delivery and door-to-door distribution strategies was carried out from the provider’s perspective. Results Household ownership of at least one LLIN increased from 39.4% pre-campaign to 91.4% post-campaign and LLIN universal coverage, measured as the proportion of households with at least one LLIN for every two people increased from 4.1 to 41.1%. Population access to LLIN within the household increased from 22.2 to 80.7%, while overall LLIN use increased from 18.0 to 68.3%. Higher LLIN ownership was achieved with the fixed delivery strategy compared with the door-to-door (92.5% [95% CI 90.2–94.4%] versus 85.2% [95% CI 78.5–90.0%]), while distribution strategy did not have a significant impact on LLIN use (69.6% [95% CI 63.1–75.5%] versus 65.7% [95% CI 52.7–76.7%]). Malaria prevalence among children aged 6–59 months was 44.8% post-campaign. Living in a household with sufficient numbers of LLIN to cover all members was the strongest determinant of LLIN use. The total financial cost per LLIN distributed was 6.58 USD for the fixed distribution strategy and 6.61 USD for the door-to-door strategy. Conclusions The mass distribution campaign was effective for rapidly increasing LLIN ownership and use. These gains need to be sustained for long-term reduction in malaria burden. The fixed delivery strategy achieved a higher LLIN coverage at lower delivery cost compared with the door-to-door strategy and seems to be a better distribution strategy in the context of the present study setting.
Collapse
Affiliation(s)
- Henry Maggi Ntuku
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Laura Ruckstuhl
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Solange E Umesumbu
- National Malaria Control Programme, Kinshasa, Democratic Republic of Congo
| | - Alain Bokota
- National Malaria Control Programme, Kinshasa, Democratic Republic of Congo
| | | | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| |
Collapse
|