World Malaria Day 2021: Commemorating 15 Years of Contribution by the United States President's Malaria Initiative

Effects of COVID-19 on malaria elimination initiatives in sub-Saharan Africa: a scoping review protocol

INTRODUCTION

The occurrence of the COVID-19 pandemic significantly impacted health systems, resulting in varied outcomes of different variables in terms of health. Due to the nature of the causative organism that is spread mainly in the air, the disease rapidly spread to numerous countries, leading to a series of mitigation measures being proposed and implemented, including but not limited to travel restrictions, decongesting and in some instances closure of workplaces and schools and banning of social gatherings. This could have negatively impacted implementing strategies meant to ensure the effective management of malaria, hoping to eliminate it in different countries in sub-Saharan Africa (SSA). This review seeks to explore the effect of the COVID-19 pandemic on malaria elimination initiatives in SSA.

METHODS AND ANALYSIS

An exploratory scoping review will be conducted on literature (searched using keywords and a search strategy) sources published in English on Web of Science, Cochrane Library, PUBMED, Dimensions, ProQuest, Scopus and African Journals Online. These would then be imported to Rayyan Software for screening for possible inclusion. The JBI Guidelines on Reviews, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist would guide the data collection, extraction and analysis from the accessed literature. Furthermore, charting, trends and developing themes would ensure the findings are presented comprehensively and yet understandable. The data collection and analysis process leading to the final submission of a review paper to a journal will be conducted from September 2023 to February 2024.

ETHICS AND DISSEMINATION

An application for ethical approval was lodged with the Health Sciences Research Ethics Committee at the University of the Free State in Bloemfontein, South Africa. This ethics committee granted ethics clearance (ethics number: UFS-HSD2022/1754). Results will be communicated through peer-reviewed publications, presentations, conferences, workshops and other means and forums to reach the critical stakeholders.

Impact of high human genetic diversity in Africa on immunogenicity and efficacy of RTS,S/AS01 vaccine

In modern medicine, vaccination is one of the most effective public health strategies to prevent infectious diseases. Indisputably, vaccines have saved millions of lives by reducing the burden of many serious infections such as polio, tuberculosis, measles, pneumonia, and tetanus. Despite the recent recommendation by the World Health Organization (WHO) to roll out RTS,S/AS01, this malaria vaccine still faces major challenges of variability in its efficacy partly due to high genetic variation in humans and malaria parasites. Immune responses to malaria vary between individuals and populations. Human genetic variation in immune system genes is the probable cause for this heterogeneity. In this review, we will focus on human genetic factors that determine variable responses to vaccination and how variation in immune system genes affect the immunogenicity and efficacy of the RTS,S/AS01 vaccine.

International modified Delphi study on malaria preventive behaviour: new themes, contexts and framework for future research on Plasmodium knowlesi malaria

INTRODUCTION

Plasmodium knowlesi malaria is a non-human simian malaria that threatens Southeast Asian rural communities. Studies indicate that non-compliant bednet usage, travelling into the forest and working as farmers and rubber tappers put communities at risk for infection. Despite guidelines, malaria incidence increases yearly and has become a public health concern. In addition to research gaps addressing factors that influence malaria prevention behaviour in these communities, there are no specific guidelines to facilitate strategies against the threat of P. knowlesi malaria.

METHOD

To examine potential factors that influence malaria-prevention behaviour in communities exposed to P. knowlesi malaria, 12 malaria experts participated in a modified Delphi study; every participant maintained their anonymity throughout the study. Three Delphi rounds were conducted via different online platforms between 15 November 2021 and 26 February 2022, and consensus was achieved when 70% of the participants agreed on a particular point with a 4-5 median. The results from the open-ended questions were then subjected to thematic analysis, and the dataset generated by this study was analysed using a deductive and inductive approach.

RESULTS

After a systematic, iterative process, knowledge and belief, social support, cognitive and environmental factors, past experience as a malaria patient, and the affordability and feasibility of a given intervention were critical contributors to malaria-prevention behaviour.

CONCLUSION

Future research on P. knowlesi malaria could adapt this study's findings for a more nuanced understanding of factors that influence malaria-prevention behaviour and improve P. knowlesi malaria programmes based on the expert consensus.

Barriers against and strategies for malaria control during the COVID-19 pandemic in low- and middle-income countries: a systematic review

BACKGROUND

The COVID-19 pandemic has disrupted malaria control activities globally. Notably, high levels of excess malaria morbidity and mortality in low- and middle-income countries (LMICs) were reported. Although it is crucial to systematically understand the main causes of the disruption to malaria control and synthesize strategies to prepare for future pandemics, such studies are scarce. Therefore, this study aims to better identify barriers against and strategies for malaria control.

METHODS

Following the PRISMA guidelines and through searches of electronic databases and Google Scholar, a systematic literature review was conducted to identify studies pertaining to malaria control published between January 2020 and December 2021. Only studies that discussed reported barriers and/or strategies related to malaria were included for the review. The Mixed Methods Quality Appraisal Tool (MMAT) and the Authority, Accuracy, Coverage, Objectivity, Date and Significance (AACODS) checklist were used for quality appraisal. Key information such as literature type, study design, setting and population, interventions, outcomes, barriers, and strategies were extracted. With an existing framework of four dimensions (accessibility, affordability, availability, and acceptability) further subdivided by the supply and demand sides, this study synthesized information on barriers and strategies related to malaria control and further categorized the strategies based on the time frame.

RESULTS

From the 30 selected studies, 27 barriers and 39 strategies were identified. The lockdown measures, which mainly threatened geographic accessibility and availability of malaria control services, were identified to be the main barrier hindering effective mobilization of community health workers and resources. Among the identified strategies, clear risk communication strategies would alleviate psychosocial barriers, which challenged acceptability. Some strategies that cross-cut points across all four dimensions would, require systems-level integration to enhance availability and affordability of malaria control. The strategies were distinguished between short-term, for instant response, and mid to long-term for future readiness.

CONCLUSIONS

The pandemic resulted in complex barriers to malaria control, particularly imposing a double burden on LMICs. Identifying strategies to overcome said barriers provides useful insights in the decision-making processes for the current and future pandemic. Cross-cutting strategies that integrate all dimensions need to be considered. Health system strengthening and resilience strategy appropriate for country-specific context is fundamental.

Building on Capacity Established through US Centers for Disease Control and Prevention Global Health Programs to Respond to COVID-19, Cameroon

The COVID-19 pandemic has highlighted the need for resilient health systems with the capacity to effectively detect and respond to disease outbreaks and ensure continuity of health service delivery. The pandemic has disproportionately affected resource-limited settings with inadequate health capacity, resulting in disruptions in health service delivery and worsened outcomes for key health indicators. As part of the US government's goal of ensuring health security, the US Centers for Disease Control and Prevention has used its scientific and technical expertise to build health capacity and address health threats globally. We describe how capacity developed through global health programs of the US Centers for Disease Control and Prevention in Cameroon was leveraged to respond to coronavirus disease and maintain health service delivery. The health system strengthening efforts in Cameroon can be applied in similar settings to ensure preparedness for future global public health threats and improve health outcomes.

Bayesian spatio-temporal modelling and mapping of malaria and anaemia among children between 0 and 59 months in Nigeria

BACKGROUND/M&M

A vital aspect of disease management and policy making lies in the understanding of the universal distribution of diseases. Nevertheless, due to differences all-over host groups and space-time outbreak activities, data are subject to intricacies. Herein, Bayesian spatio-temporal models were proposed to model and map malaria and anaemia risk ratio in space and time as well as to ascertain risk factors related to these diseases and the most endemic states in Nigeria. Parameter estimation was performed by employing the R-integrated nested Laplace approximation (INLA) package and Deviance Information Criteria were applied to select the best model.

RESULTS

In malaria, model 7 which basically suggests that previous trend of an event cannot account for future trend i.e., Interaction with one random time effect (random walk) has the least deviance. On the other hand, model 6 assumes that previous event can be used to predict future event i.e., (Interaction with one random time effect (ar1)) gave the least deviance in anaemia.

DISCUSSION

For malaria and anaemia, models 7 and 6 were selected to model and map these diseases in Nigeria, because these models have the capacity to receive strength from adjacent states, in a manner that neighbouring states have the same risk. Changes in risk and clustering with a high record of these diseases among states in Nigeria was observed. However, despite these changes, the total risk of malaria and anaemia for 2010 and 2015 was unaffected.

CONCLUSION

Notwithstanding the methods applied, this study will be valuable to the advancement of a spatio-temporal approach for analyzing malaria and anaemia risk in Nigeria.

Malaria Parasite Classification Framework using a Novel Channel Squeezed and Boosted CNN

Malaria is a life-threatening infection that infects the red blood cells (RBCs) that gradually grows throughout the body. The plasmodium parasite is caused by a female anopheles mosquito bite and severely affects numerous individuals within the world every year. Therefore, early detection tests are required to predict infected parasitic cells. The proposed technique exploits deep convolutional neural network (CNN) learning capability to detect the thin-blood smear parasitic patients from healthy individuals. In this regard, the detection is accomplished using a novel STM-SB-RENet block-based CNN that employs the idea of split-transform-merge (STM) and channel Squeezing-Boosting (SB) in a modified fashion. In this connection, a new convolutional block-based STM is developed, which systematically implements region and edge operations to explore the parasitic malaria pattern related to region-homogeneity, structural obstruction, and boundary-defining features. Moreover, the diverse boosted feature maps are achieved by incorporating the new channel SB and Transfer Learning (TL) idea in each STM block at abstract, intermediate, and target levels to capture minor contrast and texture variation between parasitic and normal artifacts. The malaria input images to the proposed models are initially transformed using discrete wavelet transform to generate enhanced and reduced feature space. The proposed architectures are validated using hold-out cross-validation on the National Institute of Health Malaria dataset. The proposed methods outperform the train from scratch, and TL-based fine-tuned existing techniques. The considerable performance (accuracy: 97.98%, sensitivity: 0.988, F-score: 0.980, and AUC: 0.996) of STM-SB-RENet suggests that it can be utilized to screen parasitic malaria patients.

End Malaria Faster: Taking Lifesaving Tools Beyond “Access” to “Reach” All People in Need

To “reach the unreached” with preventive and curative malaria services, we must know which individuals and communities remain unreached and then bring tailored services from the clinic to the community and home.

Management of febrile illness in rural Guinea over a seven-year period: A retrospective study

INTRODUCTION

Febrile illnesses constitute a major clinical challenge in tropical settings. We aimed to assess the frequency, presentation and management of febrile illness at two health facilities in Forécariah, Guinea, with a focus on appropriateness of antibiotic prescription.

MATERIALS AND METHODS

This was a retrospective study conducted in patient files in a health center and a district hospital. Proportions of antibiotic prescription were determined by age group and syndromes as well as appropriateness of antibiotic prescription using the WHO model list (2019).

RESULTS

From 2014 to 2020, 23,583 of 62,185 (38.0%) visits were related to febrile illness. Most patients with fever were female (56.1%) and evaluated at the health center (81.0%). Gastrointestinal (40.6%) and respiratory syndromes (36.8%), and undifferentiated fever (30.0%) were the most common presentations. Malaria was confirmed in 61.3% of the cohort. Overall, the rate of antibiotic prescription was high (14,834/23,583, 62.9%), mostly among patients aged <5 years (5,285/7,566, 69.9%), those with respiratory (7,577/8,684, 87.3%) and gastrointestinal (6,324/9,585, 66.0%) syndromes. Moreover, 7,432/14,465 (51.4%) patients with malaria were also prescribed an antibiotic. Penicillin (42.0%), cotrimoxazole (26.3%) and quinolones (18.7%) were the most frequently prescribed antibiotics. Overall, appropriateness of antibiotic prescription was low (38.3%), and even more so in patients with respiratory (29.1%) and gastrointestinal (25.8%) syndromes.

CONCLUSIONS

Febrile illness is a major cause of consultation in rural Guinea. Rate of antibiotic prescription was high, even in confirmed malaria and was often considered inappropriate. There is a pressing need to investigate the etiological spectrum and improve the diagnostic approach of febrile illness in Guinea.

Analysing malaria events from 1840 to 2020: the narrative told through postage stamps

The role played by postage stamps in the history of malaria control and eradication has largely gone unrecognized. Scientific investigators of malaria, especially Nobel laureates, were commemorated with special issues, but the work of the World Health Organization (WHO), which promoted an ambitious and global philatelic initiative in 1962 to support global eradication, is generally overlooked. This review examines the philatelic programme that helped to generate international commitment to the goal of malaria eradication in 1962 and established philatelic malaria icons that had worldwide recognition. Malaria-related postage stamps have continued to be issued since then, but the initial failure of malaria eradication and the changing goals of each new malaria programme, inevitably diluted their role. After the first Global Malaria Eradication Campaign was discontinued in 1969, few Nations released philatelic issues. Since the Spirit of Dakar Call for Action in 1996 a resurgence of postage stamp releases has occurred, largely tracking global malaria control initiatives introduced between 1996 and 2020. These releases were not co-ordinated by the WHO as before, were more commercialized and targeted stamp collectors, especially with attractive miniature sheets, often produced by photomontage. Having a different purpose, they demonstrated a much wider diversity in symbolism than the earlier stylized issues and at times, have been scientifically inaccurate. Nonetheless postage stamps greatly helped to communicate the importance of malaria control programmes to a wide audience and to some extent, have supported preventive health messages.

Public health-relevant consequences of the COVID-19 pandemic on malaria in sub-Saharan Africa: a scoping review

BACKGROUND

The COVID-19 pandemic has resulted in unprecedented challenges to health systems worldwide, including the control of non-COVID-19 diseases. Malaria cases and deaths may increase due to the direct and indirect effects of the pandemic in malaria-endemic countries, particularly in sub-Saharan Africa (SSA). This scoping review aims to summarize information on public health-relevant effects of the COVID-19 pandemic on the malaria situation in SSA.

METHODS

Review of publications and manuscripts on preprint servers, in peer-reviewed journals and in grey literature documents from 1 December, 2019 to 9 June, 2021. A structured search was conducted on different databases using predefined eligibility criteria for the selection of articles.

RESULTS

A total of 51 papers have been included in the analysis. Modelling papers have predicted a significant increase in malaria cases and malaria deaths in SSA due to the effects of the COVID-19 pandemic. Many papers provided potential explanations for expected COVID-19 effects on the malaria burden; these ranged from relevant diagnostical and clinical aspects to reduced access to health care services, impaired availability of curative and preventive commodities and medications, and effects on malaria prevention campaigns. Compared to previous years, fewer country reports provided data on the actual number of malaria cases and deaths in 2020, with mixed results. While highly endemic countries reported evidence of decreased malaria cases in health facilities, low endemic countries reported overall higher numbers of malaria cases and deaths in 2020.

CONCLUSIONS

The findings from this review provide evidence for a significant but diverse impact of the COVID-19 pandemic on malaria in SSA. There is the need to further investigate the public health consequences of the COVID-19 pandemic on the malaria burden. Protocol registered on Open Science Framework: https://doi.org/10.17605/OSF.IO/STQ9D.