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Pattanshetty S, Dsouza VS, Shekharappa A, Yagantigari M, Raj R, Inamdar A, Alsamara I, Rajvanshi H, Brand H. A Scoping Review on Malaria Prevention and Control Intervention in Fragile and Conflict-Affected States (FCAS): A Need for Renewed Focus to Enhance International Cooperation. J Epidemiol Glob Health 2024; 14:4-12. [PMID: 38224386 PMCID: PMC11043240 DOI: 10.1007/s44197-023-00180-7] [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: 08/21/2023] [Accepted: 12/11/2023] [Indexed: 01/16/2024] Open
Abstract
Malaria is a major public health problem in developing countries. The burden of malaria in fragile and conflict-affected states (FCAS) is increasing year by year. Moreover, the population living in FCAS is often the most vulnerable and at high risk of malaria due to factors, such as deteriorating healthcare system, mass relocations, and reduced resilience to shocks. Therefore, this scoping review aims to map the interventions that are conducted at the FCAS on malaria prevention among the general population. In addition, this review can help policy-makers and international health bodies, providing a comprehensive overview that can lead to more targeted, effective, and context-specific interventions. Databases, such as PubMed, EBSCO-CINAHL, Web of Science, ProQuest, and Cochrane Central Register of Controlled Trials, were searched using specified search terms. A total of 3601 studies were retrieved from the search. After screening, 62 studies were included in the synthesis that met the eligibility criteria. Narrative analysis of the findings was done. The results revealed that in fragile countries, interventions for children below 5 years of age included IPTi, TDA, and ACT. In conflicted countries, interventions for children below 5 years of age included TDA, LLINs, SMC, drug trials, and vaccination. Similar interventions were reported for other age groups and populations. Despite ongoing conflicts, malaria interventions have been maintained in these countries, but a persistent high burden of malaria remains. To achieve the goals of malaria elimination, the results of the review highlight the need for continued research and evaluation of malaria control interventions to assess their effectiveness and impact. Strengthening health systems, building partnerships, utilizing digital health technologies, and conducting context-specific research are recommended to improve healthcare access and reduce the burden of malaria in FCAS.
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Affiliation(s)
- Sanjay Pattanshetty
- Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Health Diplomacy, Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of International Health, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute-CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Viola Savy Dsouza
- Centre for Regulatory Science, Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Anupama Shekharappa
- Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Rohit Raj
- Department of Community Medicine, Manipal Tata Medical College, Manipal Academy of Higher Education, Jamshedpur, India
| | - Aniruddha Inamdar
- Centre for Health Diplomacy, Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Issam Alsamara
- Department of International Health, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute-CAPHRI, Maastricht University, Maastricht, The Netherlands
| | | | - Helmut Brand
- Department of International Health, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute-CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Elmardi KA, Adam I, Malik EM, Kafy HT, Abdin MS, Kleinschmidt I, Kremers S, Gubbels JS. Impact of malaria control interventions on malaria infection and anaemia in low malaria transmission settings: a cross-sectional population-based study in Sudan. BMC Infect Dis 2022; 22:927. [PMID: 36496398 PMCID: PMC9737986 DOI: 10.1186/s12879-022-07926-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The past two decades were associated with innovation and strengthening of malaria control interventions, which have been increasingly adopted at large scale. Impact evaluations of these interventions were mostly performed in moderate or high malaria transmission areas. This study aimed to evaluate the use and performance of malaria interventions in low transmission areas on malaria infections and anaemia. METHODS Data from the 2016 Sudan malaria indicator survey was used. Multi-level logistic regression analysis was used to assess the strength of association between real-life community-level utilization of malaria interventions [diagnosis, artemisinin-based combination therapies (ACTs) and long-lasting insecticidal nets (LLINs)] and the study outcomes: malaria infections and anaemia (both overall and moderate-to-severe anaemia). RESULTS The study analysis involved 26,469 individuals over 242 clusters. Malaria infection rate was 7.6%, overall anaemia prevalence was 47.5% and moderate-to-severe anaemia prevalence was 4.5%. The average community-level utilization was 31.5% for malaria diagnosis, 29.9% for ACTs and 35.7% for LLINs. The odds of malaria infection was significantly reduced by 14% for each 10% increase in the utilization of malaria diagnosis (adjusted odds ratio (aOR) per 10% utilization 0.86, 95% CI 0.78-0.95, p = 0.004). However, the odds of infection was positively associated with the utilization of LLINs at community-level (aOR per 10% utilization 1.20, 95% CI 1.11-1.29, p < 0.001). No association between malaria infection and utilization of ACTs was identified (aOR per 10% utilization 0.97, 95% CI 0.91-1.04, p = 0.413). None of the interventions was associated with overall anaemia nor moderate-to-severe anaemia. CONCLUSION There was strong evidence that utilization of malaria diagnosis at the community level was highly protective against malaria infection. No protective effect was seen for community utilization of ACTs or LLINs. No association was established between any of the interventions and overall anaemia or moderate-to-severe anaemia. This lack of effectiveness could be due to the low utilization of interventions or the low level of malaria transmission in the study area. Identification and response to barriers of access and low utilization of malaria interventions are crucial. It is crucial to ensure that every suspected malaria case is tested in a timely way, notably in low transmission settings.
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Affiliation(s)
- Khalid Abdelmutalab Elmardi
- grid.414827.cHealth Information, Monitoring and Evaluation and Evidence Department, Federal Ministry of Health, Khartoum, Sudan ,grid.5012.60000 0001 0481 6099Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Ishag Adam
- grid.412602.30000 0000 9421 8094Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Elfatih Mohamed Malik
- grid.9763.b0000 0001 0674 6207Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Hmooda Toto Kafy
- grid.414827.cDirectorate General of Primary Health Care, Federal Ministry of Health, Khartoum, Sudan
| | - Mogahid Sheikheldien Abdin
- grid.414827.cHealth Information, Monitoring and Evaluation and Evidence Department, Federal Ministry of Health, Khartoum, Sudan
| | - Immo Kleinschmidt
- grid.8991.90000 0004 0425 469XMRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK ,grid.11951.3d0000 0004 1937 1135Faculty of Health Sciences, School of Pathology, Wits Research Institute for Malaria, University of the Witwatersrand, Johannesburg, South Africa ,Southern African Development Community Malaria Elimination Eight Secretariat, Windhoek, Namibia
| | - Stef Kremers
- grid.5012.60000 0001 0481 6099Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Jessica Sophia Gubbels
- grid.5012.60000 0001 0481 6099Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
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Muhumuza E, Namuhani N, Balugaba BE, Namata J, Ekirapa Kiracho E. Factors associated with use of malaria control interventions by pregnant women in Buwunga subcounty, Bugiri District. Malar J 2016; 15:342. [PMID: 27377627 PMCID: PMC4932743 DOI: 10.1186/s12936-016-1407-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 03/21/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Uganda, the Government has promoted the use of intermittent preventive treatment of malaria in pregnancy (IPTp) and insecticide-treated bed nets (ITNs) as malaria control strategies for pregnant women. However, their utilization among pregnant women is low. This study aimed at assessing factors associated with use of IPTp for malaria and ITNs by pregnant women in Buwunga sub-county, Bugiri District. METHODS This was a cross-sectional study, conducted in Buwunga sub-county, Bugiri District, employing quantitative data collection tools. A total of 350 household members were randomly selected to participate in the study. Data were entered and analysed using Epi info version 3.5.1; bivariable and multivariable analysis was done to assess the factors associated with use of IPTp and ITNs among pregnant women. RESULTS The level of uptake of IPTp1 (at least one dose) was 63.7 % while IPTp2 (at least two doses) was 42.0 %. More than half (58.6 %) of the mothers had slept under an ITN the night before the survey. Slightly more than half (51.9 %) of the mothers mentioned stock outs as the major reason for not accessing IPTp and ITNs. The main factors that were statistically significant for IPTp2 uptake were the knowledge of mothers on IPTp2 (AOR 2.48 95 % CI 1.53-4.02) and providing women with free clean water at the antenatal care (ANC) clinic (AOR 3.63 95 % CI 2.06-6.39). Factors that were significant for ITN utilization included education level of mothers (AOR 2.03 95 % CI 1.09-3.78), ease of access (AOR 2.74 95 % CI 1.65-4.52), and parity (AOR 1.71 95 % CI 1.01-1.29). CONCLUSION The level of uptake of the two recommended doses of sulfadoxine-pyrimethamine (SP) tablets for malaria prevention (IPTp2) was low, slightly more than half of the mothers slept under an ITN the night before the survey. Appropriate measures to increase the level of uptake of IPTp2 and coverage of ITNs among pregnant women should be implemented, and these include providing health education about IPTp and ITNs, and ensuring that mothers are provided with free safe clean water at ANC clinic.
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Affiliation(s)
- Elizabeth Muhumuza
- School of Public Health, College of Health sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Noel Namuhani
- School of Public Health, College of Health sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Bonny Enock Balugaba
- School of Public Health, College of Health sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Jessica Namata
- School of Public Health, College of Health sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Elizabeth Ekirapa Kiracho
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
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Sisya TJ, Kamn'gona RM, Vareta JA, Fulakeza JM, Mukaka MFJ, Seydel KB, Laufer MK, Taylor TE, Nkhoma SC. Subtle changes in Plasmodium falciparum infection complexity following enhanced intervention in Malawi. Acta Trop 2015; 142:108-14. [PMID: 25460345 PMCID: PMC4296692 DOI: 10.1016/j.actatropica.2014.11.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/25/2014] [Accepted: 11/17/2014] [Indexed: 11/29/2022]
Abstract
We examined impact of intense malaria control on parasite genetic structure in Malawi. Malaria infections sampled before and after intense control were genotyped at 24 SNPs. Despite intense control efforts, parasite genetic diversity was unchanged over time. Only the mean number of heterozygous SNPs within infections showed change over time. Findings suggest minimal or no change in malaria transmission despite intense control.
With support from the Global Fund, the United States President's Malaria Initiative (PMI) and other cooperating partners, Malawi is implementing a comprehensive malaria control programme involving indoor residual spraying in targeted districts, universal coverage with insecticide-treated bed nets, use of rapid diagnostic tests to confirm the clinical diagnosis of malaria and use of the highly effective artemisinin-based combination therapy, artemether-lumefantrine (AL), as the first-line treatment for malaria. We genotyped 24 genome-wide single nucleotide polymorphisms (SNPs) in Plasmodium falciparum infections (n = 316) sampled from a single location in Malawi before (2006 and 2007) and after enhanced intervention (2008 and 2012). The SNP data generated were used to examine temporal changes in the proportion of multiple-genotype infections (MIs), mean number of heterozygous SNPs within MIs, parasite genetic diversity (expected heterozygosity and genotypic richness), multilocus linkage disequilibrium and effective population size (Ne). While the proportion of MIs, expected heterozygosity, genotypic richness, multilocus linkage disequilibrium and Ne were unchanged over time, the mean number (±standard deviation) of heterozygous SNPs within MIs decreased significantly (p = 0.01) from 9(±1) in 2006 to 7(±1) in 2012. These findings indicate that the genetic diversity of P. falciparum malaria parasites in this area remains high, suggesting that only subtle gains, if any, have been made in reducing malaria transmission. Continued surveillance is required to evaluate the impact of malaria control interventions in this area and the rest of Malawi, and to better target control interventions.
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Affiliation(s)
- Tamika J Sisya
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Raphael M Kamn'gona
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Jimmy A Vareta
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Joseph M Fulakeza
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi; Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Mavuto F J Mukaka
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Karl B Seydel
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi; Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Miriam K Laufer
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi; Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Terrie E Taylor
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi; Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Standwell C Nkhoma
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi; Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA Liverpool, UK.
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