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Idris ZM, Chan CW, Kongere J, Gitaka J, Logedi J, Omar A, Obonyo C, Machini BK, Isozumi R, Teramoto I, Kimura M, Kaneko A. High and Heterogeneous Prevalence of Asymptomatic and Sub-microscopic Malaria Infections on Islands in Lake Victoria, Kenya. Sci Rep 2016; 6:36958. [PMID: 27841361 PMCID: PMC5107902 DOI: 10.1038/srep36958] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/24/2016] [Indexed: 11/17/2022] Open
Abstract
Kenya is intensifying its national efforts in malaria control to achieve malaria elimination. Detailed characterization of malaria infection among populations living in the areas where the disease is endemic in Kenya is a crucial priority, especially for planning and evaluating future malaria elimination strategy. This study aimed to investigate the distribution and extent of malaria infection on islands in Lake Victoria of Kenya to aid in designing new interventions for malaria elimination. Five cross-sectional surveys were conducted between January 2012 and August 2014 on four islands (Mfangano, Takawiri, Kibuogi and Ngodhe) in Lake Victoria and a coastal mainland (Ungoye). Malaria prevalence varied significantly among settings: highest in Ungoye, followed by the large island of Mfangano and lowest in the three remaining small islands. Of the 3867 malaria infections detected by PCR, 91.8% were asymptomatic, 50.3% were sub-microscopic, of which 94% were also asymptomatic. We observed geographical differences and age dependency in both proportion of sub-microscopic infections and asymptomatic parasite carriage. Our findings highlighted the local heterogeneity in malaria prevalence on islands and a coastal area in Lake Victoria, and provided support for the inclusion of mass drug administration as a component of the intervention package to eliminate malaria on islands.
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Affiliation(s)
- Zulkarnain Md Idris
- Island Malaria Group, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, 17177, Sweden.,Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, 56000, Malaysia
| | - Chim W Chan
- Island Malaria Group, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, 17177, Sweden
| | - James Kongere
- Nagasaki University Nairobi Research Station, NUITM-KEMRI Project, Nairobi, 00202, Kenya
| | - Jesse Gitaka
- Department of Clinical Medicine, Mount Kenya University, Thika, 01000, Kenya
| | - John Logedi
- National Malaria Control Programme, Ministry of Public Health and Sanitation, Nairobi, 00100, Kenya
| | - Ahmeddin Omar
- National Malaria Control Programme, Ministry of Public Health and Sanitation, Nairobi, 00100, Kenya
| | - Charles Obonyo
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, 40100, Kenya
| | - Beatrice Kemunto Machini
- National Malaria Control Programme, Ministry of Public Health and Sanitation, Nairobi, 00100, Kenya
| | - Rie Isozumi
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, 558-8585, Japan
| | - Isao Teramoto
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, 558-8585, Japan
| | - Masatsugu Kimura
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, 558-8585, Japan
| | - Akira Kaneko
- Island Malaria Group, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, 17177, Sweden.,Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, 558-8585, Japan.,Institute of Tropical Medicine, Nagasaki University, Nagasaki, 852-8102, Japan
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Soti DO, Kinoti SN, Omar AH, Logedi J, Mwendwa TK, Hirji Z, Ferro S. Feasibility of an innovative electronic mobile system to assist health workers to collect accurate, complete and timely data in a malaria control programme in a remote setting in Kenya. Malar J 2015; 14:430. [PMID: 26530237 PMCID: PMC4632488 DOI: 10.1186/s12936-015-0965-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cornerstone of decision making aimed at improving health services is accurate and timely health information. The Ministry of Public Health and Sanitation in Kenya decided to pilot feasibility of Fionet, an innovation that integrates diagnostics, data capture and cloud services, in its malaria control programme to demonstrate usability and feasibility by primary level workers in a remote setting in Kenya. METHODS Eleven sites comprising one sub-district hospital, ten health centres and dispensaries were selected in three districts of Kisumu County to participate. Two health workers per site were selected, trained over a two-day period in the use of the Deki Reader™ to undertake rapid diagnostic testing (RDT) for malaria and data capture of patients' records. Health managers in the three districts were trained in the use of Fionet™ portal (web portal to cloud based information) to access the data uploaded by the Deki Readers. Field Support was provided by the Fio Corporation representative in Kenya. RESULTS A total of 5812 malaria RDTs were run and uploaded to the cloud database during this implementation research study. Uploaded data were automatically aggregated into predetermined reports for use by service managers and supervisors. The Deki Reader enhanced the performance of the health workers by not only guiding them through processing of a malaria RDT test, but also by doing the automated analysis of the RDT, capturing the image, determining whether the RDT was processed according to guidelines, and capturing full patient data for each patient encounter. Supervisors were able to perform remote Quality assurance/Quality control (QA/QC) activities almost in real time. CONCLUSION Quality, complete and timely data collection by health workers in a remote setting in Kenya is feasible. This paperless innovation brought unprecedented quality control and quality assurance in diagnosis, care and data capture, all in the hands of the health worker at point of care in an integrated way.
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Affiliation(s)
- David O Soti
- Division of Health Informatics and Monitoring and Evaluation, Ministry of Health, PO Box 30016-00100, Nairobi, Kenya.
| | | | - Ahmeddin H Omar
- Division of Health Informatics and Monitoring and Evaluation, Ministry of Health, PO Box 30016-00100, Nairobi, Kenya.
| | - John Logedi
- Division of Health Informatics and Monitoring and Evaluation, Ministry of Health, PO Box 30016-00100, Nairobi, Kenya.
| | - Teresa K Mwendwa
- Department of Physiology, University of Nairobi, P O Box 52379-00200, Nairobi, Kenya.
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Isozumi R, Uemura H, Kimata I, Ichinose Y, Logedi J, Omar AH, Kaneko A. Novel mutations in K13 propeller gene of artemisinin-resistant Plasmodium falciparum. Emerg Infect Dis 2015; 21:490-2. [PMID: 25695257 PMCID: PMC4344268 DOI: 10.3201/eid2103.140898] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We looked for mutations in the Plasmodium falciparum K13 propeller gene of an artemisinin-resistant parasite on islands in Lake Victoria, Kenya, where transmission in 2012–2013 was high. The 4 new types of nonsynonymous, and 5 of synonymous, mutations we detected among 539 samples analyzed provide clues to understanding artemisinin-resistant parasites.
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Menya D, Logedi J, Manji I, Armstrong J, Neelon B, O'Meara WP. An innovative pay-for-performance (P4P) strategy for improving malaria management in rural Kenya: protocol for a cluster randomized controlled trial. Implement Sci 2013; 8:48. [PMID: 23656836 PMCID: PMC3664216 DOI: 10.1186/1748-5908-8-48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/11/2013] [Indexed: 11/25/2022] Open
Abstract
Background In high-resource settings, ‘pay-for-performance’ (P4P) programs have generated interest as a potential mechanism to improve health service delivery and accountability. However, there has been little or no experimental evidence to guide the development or assess the effectiveness of P4P incentive programs in developing countries. In the developing world, P4P programs are likely to rely, at least initially, on external funding from donors. Under these circumstances, the sustainability of such programs is in doubt and needs assessment. Methods/design We describe a cluster-randomized controlled trial underway in 18 health centers in western Kenya that is testing an innovative incentive strategy to improve management of an epidemiologically and economically important problem—diagnosis and treatment of malaria. The incentive scheme in this trial promotes adherence to Ministry of Health guidelines for laboratory confirmation of malaria before treatment, a priority area for the Ministry of Health. There are three important innovations that are unique to this study among those from other resource-constrained settings: the behavior being incentivized is quality of care rather than volume of service delivery; the incentives are applied at the facility-level rather than the individual level, thus benefiting facility infrastructure and performance overall; and the incentives are designed to be budget-neutral if effective. Discussion Linking appropriate case management for malaria to financial incentives has the potential to improve patient care and reduce wastage of expensive antimalarials. In our study facilities, on average only 25% of reported malaria cases were confirmed by laboratory diagnosis prior to the intervention, and the total treatment courses of antimalarials dispensed did not correspond to the number of cases reported. This study will demonstrate whether facility rather than individual incentives are compelling enough to improve case management, and whether these incentives lead to offsetting cost-savings as a result of reduced drug consumption. Trial registration ClinicalTrials.gov Registration Number NCT01809873
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Affiliation(s)
- Diana Menya
- Department of Epidemiology and Nutrition, Moi University School of Public Health, College of Health Sciences, Nandi Road, Eldoret, Kenya
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Talisuna AO, Karema C, Ogutu B, Juma E, Logedi J, Nyandigisi A, Mulenga M, Mbacham WF, Roper C, Guerin PJ, D'Alessandro U, Snow RW. Mitigating the threat of artemisinin resistance in Africa: improvement of drug-resistance surveillance and response systems. Lancet Infect Dis 2013; 12:888-96. [PMID: 23099083 DOI: 10.1016/s1473-3099(12)70241-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Artemisinin-resistant Plasmodium falciparum malaria has emerged in western Cambodia and has been detected in western Thailand. The situation is ominously reminiscent of the emergence of resistance to chloroquine and to sulfadoxine-pyrimethamine several decades ago. Artemisinin resistance is a major threat to global public health, with the most severe potential effects in sub-Saharan Africa, where the disease burden is highest and systems for monitoring and containment of resistance are inadequate. The mechanisms that underlie artemisinin resistance are not fully understood. The main phenotypic trait associated with resistance is a substantial delay in parasite clearance, so far reported in southeast Asia but not in Africa. One of the pillars of the WHO global plan for artemisinin resistance containment is to increase monitoring and surveillance. In this Personal View, we propose strategies that should be adopted by malaria-endemic countries in Africa: resource mobilisation to reactivate regional surveillance networks, establishment of baseline parasite clearance profiles to serve as benchmarks to track emerging artemisinin resistance, improved data sharing to allow pooled analyses to identify rare events, modelling of risk factors for drug resistance, and development and validation of new approaches to monitor resistance.
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Affiliation(s)
- Ambrose O Talisuna
- Malaria Public Health and Epidemiology Group, University of Oxford and KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
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