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The MalariaWorld Journal

Research: Plasmodium falciparum malaria in northern Côte d’Ivoire: prevalence in the general hospital of Tanda sanitary district

January 7, 2016 - 15:46 -- Bart G.J. Knols
Author(s): 
Thomas Y. Aba, Raoul Moh, Lassina Cissé, Gisele C. Yapo-Kouadio, Frederic N. Ello, Chrysostome Mossou, Zelica Diallo, Ouffoue Kra, Emmanuel Bissagnené
Reference: 
MWJ2016, 7, 1
 
Until about 2010, the majority of data collected on malaria in Côte d’Ivoire were based on presumptive cases, particularly in the northern part of the country, where parasitological research had rarely been carried out. The purpose of this study was to determine the actual malaria prevalence amongst presumptive cases admitted to one of the general hospitals in the Northern part of the country, where malaria diagnosis is suboptimal. A cross-sectional study was conducted in the general medicine, maternity and paediatric wards between January and August 2010. Patients of all ages, suspected of having malaria, were included after giving their informed oral consent. Several parameters were investigated: the presence of Plasmodium using thick blood film, HIV/ Plasmodium co-infection, signs of severity, aspects of malaria treatment and other associated factors. Of 379 patients included, with a median age of 4 yrs [range 1 month - 71 yrs], 9% were HIV-positive, 74% were ≤ 15 yrs of age, 60% were urbanised and 23% were using long-lasting insecticide-treated nets. Malaria prevalence was 67.5% and was significantly associated with the rainy season (p < 0.001), age ≤ 5 yrs (p = 0.004) and no cotrimoxazole chemoprophylaxis in HIV-infected patients (p = 0.04). Only P. falciparum was detected, with a mean density of 12,523 trophozoites/μl of blood, but with 12,610 trophozoites/μl of blood in HIV-positive patients and 7,055 trophozoites/μl of blood in HIV-negative patients (p < 0.001). Severe malaria accounted for 77% of cases. Prescribed antimalarial drugs were: IM artemether (56%), quinine (28%), artemether + lumefantrine (10%) and artesunate + amodiaquine (6%). Apyrexia and parasite clearance were observed at day 2-3 post treatment in 87% of patients. Adverse events were reported among 60 patients (17%). The outcome was marked by: a healing rate of 90%, a rate of 5% lost to follow-up and a 7% lethality for severe malaria, significantly associated with the age ≤ 5 yrs (p=0.02), hyperparasitaemia >20% (p=0.004), neurological disorders (p < 0.001) and respiratory distress (p=0.007). Malaria prevalence in the general hospital of Tanda remains high, with a predominance of severe malaria affecting children under the age of 5 yrs. 

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Research: Mosquito control via inbuilt net hoisting windows: the inverted S/O channel/grip device option

December 9, 2015 - 20:22 -- Bart G.J. Knols
Author(s): 
Francis S.O. Ugwu
Reference: 
MWJ2015, 6, 14
 
Effective control of in-house mosquitoes, due to entry prevention, takes advantage of the behavioural preferences of endophagy and endophily of mosquitoes. Insecticide-treated nets (ITN) adopt this, but is burdened with challenges, which result in dwindling adoption of the methodology in the tropics. An alternative is prevention of vector-human contact through house modifications, which adopts S/O channel/grip devices that form attachments to existing windows. Inverted S/O channel/grip frame (ISOWF) was therefore devised as an integrated window frame, which could be used for direct net attachment and housing shutters. The ISOWF is a lightweight material weighing 1/6 of the equivalent size of wood. Appropriate dies were employed to form channels from thin iron sheets in the preferred shape and size of a laterally inverted letter ‘S’ (ƨ). The upper half was minimised to form and facilitate the ‘O’ griping of nets, while the remaining half was bloated to house window shutters. Net hoisting or de-hoisting periods were determined by timing. A room screened with a net was attached to the device and situated next to a mosquito breeding room. This was used to evaluate the effectiveness of the method. The time taken to hoist the net was measured. The frame was constructed like a metal/ wooden frame, except that the anterior view had two steps. The average time taken to hoist or de-hoist a net across a 60 cm x 120 cm window, formed by the frame, was 5.96 and 1.68 minutes, respectively. The nets retained their integrity. Mixed mosquito populations numbering 1,341 in total could not gain access to a room with carbon dioxide attractant, and the ISOWF screen prevented passage.
 The ISOWF acts as a potential mosquito entry-prevention device, which further provides reinforcement to house screening. It forms an effective mosquito control device, which brands house screening as a sustainable environment for mosquito control, and subsequently, malaria control. This will also control the overall indoor densities of nuisance mosquitoes and other insect vectors.

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Research: Modelling the impact of declining insecticide resistance with mosquito age on malaria transmission

November 14, 2015 - 16:33 -- Bart G.J. Knols
Author(s): 
Adam Saddler, Jacob C Koella
Reference: 
MWJ2015, 6, 13
 
The evolution of insecticide resistance can lead to an increase in the entomological indicators of malaria transmission, such as mosquito survival and blood feeding rates, thus threatening efforts to control malaria. Yet, there is little evidence from the field that malaria control programmes are failing due to insecticide resistance. One explanation for this apparent contradiction is the growing evidence that insecticide resistance declines with mosquito age. Once a mosquito is first infected by Plasmodium parasites, it will not be able to transmit those parasites until they have undergone development, which lasts around 10 days. Thus, although the evolution of resistance in a population will enhance the survival of young mosquitoes, the insecticide may still kill old, and thus potentially infectious, mosquitoes, and thereby maintaining its efficacy in controlling malaria. The current evidence for age-related insecticide resistance is reviewed. A mathematical model is then described that predicts how the decline of resistance with the age of a mosquito will affect the intensity of transmission of malaria. The model combines the behavioural response of the mosquitoes to insecticides with an epidemiological model of malaria. It was found that phenotypic resistance decreases between 1.37% to 9.71% per day, independent of the mosquito species or strain. The models suggest that a decline in resistance within this range strongly diminishes the predicted impact of insecticide resistance on the effectiveness of malaria transmission-controlling interventions.
 Our model can be used to assess the threat of insecticide-resistance for the control of malaria. The model confirms observations from the field suggesting that, even where genetically insecticide-resistant mosquitoes dominate populations, insecticides can substantially reduce the transmission of malaria.

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Research: Diversity, resistance and vector competence of endophilic anophelines from southern Ghana

October 31, 2015 - 19:19 -- Bart G.J. Knols
Author(s): 
Michael Osae, Alessi Kwawukume, Michael Wilson, David Wilson, Lizette L. Koekemoer
Reference: 
MWJ2015, 6, 12
 
As part of efforts to monitor the impact of vector control strategies so that they can be improved and more targeted, we collected baseline data on aspects of the bionomics of endophilic anophelines in southern Ghana. Indoor resting anophelines were collected using mouth aspirators and pyrethroid spray catch. Anopheles females were identified to species level using morphological characteristics and sibling species were distinguished by PCR. The presence of the L1014F mutation, conferring resistance to insecticides, was determined in An. gambiae s.s. and An. coluzzii samples using TaqMan real-time PCR. Host blood meal sources were determined by PCR, and the presence of Plasmodium falciparum circumsporozoite proteins determined by ELISA. A total of 892 female Anopheles (31% An. gambiae, 41% An. coluzzii and 28% An. funestus) were collected from six villages. The L1014F mutation was almost fixed in all populations studied (allele frequencies: 0.87-1.00). Both An. gambiae s.l. and An. funestus fed mainly on humans, with a human blood index of 1, although some animal feeding was recorded in An. gambiae. P. falciparum was detected in all ecological zones and in all three major vector species, being 4.9% in An. funestus, 3.8% in An. gambiae s.s. and 1.1% in An. coluzzii. These findings suggest that the three major vectors of malaria are present in all ecological zones of southern Ghana and contribute to disease transmission. The near fixation of the L1014F mutation in southern Ghana poses a great threat to vector control, thus highlighting the urgent need to implement measures to maintain the efficacy of current control tools and to develop novel control strategies.

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Research: Malaria epidemic outbreaks in the Democratic Republic of Congo, part I: cross-sectional survey in Mweka District

September 10, 2015 - 13:00 -- Bart G.J. Knols
Author(s): 
Célestin N. Nsibu, Dieudonné N. Mumba, Gauthier K. Mesia, Thierry L. Bobanga, Célestin de P. Manianga, Clarisse M. Mbo, Samuel M. Mampunza, Gaston L. Tona
Reference: 
MWJ2015, 6, 11
 
A series of fever outbreaks has previously been reported in the DR Congo. The occurrence of similar outbreaks in Mweka district presented the opportunity to investigate these occurrences.
 Health facilities and communities were visited. Blood samples for malaria, salmonellosis, Chikungunya, dengue and filovirus testing were obtained both in health facilities and the communities. Capture of mosquitoes and larvae in breeding sites was done and used bednets were collected. An increase in the number of malaria cases beyond the expected number for the study period was observed in the two health districts located in the savannah zone (p<0.05) and in one health centre among sixteen located in the forest zone (p<0.05). In the health facilities and households visited (653 people), 141 persons had fever of which 82.2% was attributed to Plasmodium falciparum malaria. An incidence of 5.87% was recorded in the first half of 2013. Hundred and sixty patients (6.9%) died among 2,304 admitted for severe malaria in the three referral hospitals, 118 of them were children of under five years old. PCR testing of the blood samples obtained during home visits revealed malaria parasites in 63 (73.3%) of the 86 analysed samples. The test was negative for other parasites and bacteria and one dengue virus case was detected. Anopheles gambiae from Mweka were found to be resistant to permethrin using the WHO susceptibility test, with a knock down rate of ≤ 50% and mortality of ≤ 30%. These investigations confirmed epidemic outbreaks in Mweka District caused by malaria with a high mortality rate in children below five years of age.

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4.333335
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Research: Knowledge and practice on malaria diagnosis and treatment among healthcare providers working in private health facilities in Ethiopia: A cross-sectional facility-based survey

July 31, 2015 - 08:45 -- Bart G.J. Knols
Author(s): 
Mesele Damte Argaw
Reference: 
MWJ2015, 6, 10
 
The knowledge and practice of malaria diagnosis and treatment among healthcare providers (HCPs) working in Private Health Facilities (PHFs) in Ethiopia was assessed. A facility-based cross-sectional study was conducted from April to June 2012. Quantitative and qualitative data were collected and 264 HCPs from 264 PHFs in malaria-endemic towns were enrolled. The majority (84.5%) of the HCPs were males, 106 (40%) were nurses and 135 (51.0%) had practiced for more than seven years. The knowledge of HCPs about the malaria programme was scored (from 1-5), and the mean was 2.52 (95% CI: 2.32-2.72), with 40.5% of the HCPs scoring above the mean. The majority knew the recommended treatment following confirmed diagnosis (91.3% for Plasmodium vivax, 88.6% for P. falciparum). 73.1% of suspected cases were investigated for parasitological diagnosis. The malaria slide positivity rate was 37.6%; however, only 60.0% of the confirmed cases were treated for malaria. Presumptive malaria treatment was offered to about 40% of patients. The adherence rate of HCPs towards prescribing the recommended first line drugs was 44.2% for chloroquine, 47.9% for ACTs and 77.9% for quinine. The study revealed that in Ethiopia HCPs in private practices have major gaps in knowledge and practice related to malaria case management. Therefore, provision of malaria diagnosis and case management training, supportive supervision and job aids is recommended for private healthcare providers, especially for nurses and for younger healthcare professionals.

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Research: A formative study of disposal and re-use of old mosquito nets by communities in Malindi, Kenya

June 29, 2015 - 12:58 -- Bart G.J. Knols
Author(s): 
Lydiah W. Kibe, Anne W. Kamau, John K. Gachigi, Annette Habluetzel, Charles M. Mbogo
Reference: 
MWJ2015, 6, 9
 
About 30 million insecticide treated bednets have been distributed in Kenya since 2001 and ownership is approaching full coverage. As a consequence of this achievement, Kenya is faced with the challenge of disposing old nets that are no longer in use. The study aimed at investigating ways of disposal and re-use of old and torn nets by end users. A formative study was conducted in the former Malindi District in Coastal Kenya. A total of 6 Focus Group Discussions, 10 Key Informant Interviews and 9 transect walks/drives were undertaken. There were variations in disposal and re-use of old nets between urban and rural or peri-urban residents. In all settings, people adopted innovative and beneficial ways of re-using old, expired nets, and those that were damaged beyond repair. Common causes of damage were fire, children, domestic animals sharing the sleeping room and friction from the bed poles while hanging or tacking it in under a sleeping mat. Re-use was most prominent in farming activities (78%) and less to for use in mosquito control, like window screening (15%). The remaining 8% was related to making ropes, swings, footballs, goal posts and fishing nets. Advantageous texture and nature of the netting material, perceived economic benefit and lack of guidelines for disposal were the main reasons cited by residents for re-using old nets. It is important that re-use and disposal of old nets is distinguished from misuse of newly distributed nets. Alternative uses of old nets as opposed to misuse of new nets was found to be common in our study.

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Research: Risk factors associated with occurrence of placental malaria in a population of parturients in Abeokuta, Ogun State, Nigeria

June 22, 2015 - 07:45 -- Bart G.J. Knols
Author(s): 
Ayodele S. Babalola, Oluwafunmilayo A. Idowu, Sammy O. Sam-Wobo, Eniola Fabusoro
Reference: 
MWJ2015, 6, 8
 
Placental malaria has long been acknowledged as a complication of malaria in pregnancy, and has been associated with poor pregnancy outcome in malaria-endemic areas. This study was conducted to determine the risk factors associated with occurrence of placental malaria in a population of parturients in Abeokuta Ogun State, Nigeria. Maternal and placenta blood samples were collected from 211 parturients. Blood films were prepared, stained with 10% Giemsa and microscopically analysed for the presence of parasites. Demographic characteristics were recorded in case record forms. Chi-square tests and a regression model were computed to analyse risks, using SPSS version 16.0. Overall, 40.8% (86 of 211) of the parturients had malaria at the time of delivery, with 19.0% (40 of 211) having placental malaria. We identified being within the age range of 18-22 years [OR = 4.4, 95% CL = 1.1-17.4, P = 0.046], being primigravid [OR = 2.1, 95% CL = 0.9-5.1, P = 0.028] and living in a congested apartment [OR = 1.6, 95% CL = 0.4-6.0, P = 0.029] as significant risk factors for placental malaria. Non-usage of intermittent preventive treatment (IPT) [OR = 2.6, 95% CL = 1.2-5.4, P = 0.018], long-lasting insecticidal nets (LLINs) [OR = 2.7, 95% CL = 1.3-5.5, P = 0.005] were also risk factors for placental malaria. In Abeokuta, the proper use of LLIN and IPT for pregnant women is essential to curb the scourge of malaria, associated risks and poor pregnancy outcomes.

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4.5
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Research: Qualitative Assessment of rural health workers’ management of malaria in sick children

June 18, 2015 - 09:39 -- Bart G.J. Knols
Author(s): 
Ayodele S. Jegede, Ikeoluwapo O. Ajayi, Frederick O. Oshiname, Catherine O. Falade, Daniel Chandramohan, Hamade Prudence, Jayne Webster, Ebenezer Baba
Reference: 
MWJ2015, 6, 7
 
Febrile illnesses are common causes of morbidity and mortality among under-five children in sub-Saharan Africa. The recommended strategy for effective case management of uncomplicated malaria is parasitological confirmation prior to use of artemisinin-based combination therapy (ACT). There is a lack of qualitative information explaining factors, which influence malaria case management practices among health workers. This study explores the perceptions of health managers and health care providers on the case management of uncomplicated malaria among under-fives in selected primary health care (PHC) facilities of two Local Government Areas (LGAs), Katcha and Gbako, as part of baselines for capacity-building interventions planned in Niger State, Nigeria. Interviewees included state- and LGA-level health programme managers, and frontline health workers purposively selected to cover a range of cadres involved in case management of sick children. Issues explored were history taking, diagnosis, appropriate diagnosis of malaria, prescription for malaria, referrals and adherence to referral. Data coding was carried out with Nvivo qualitative software (version 8) and content analysed. History taking was often not carried out appropriately by the health workers. Treatment of malaria was not based on parasite-based diagnosis. Most of the health workers reported that they prescribed ACTs for treating presumed uncomplicated malaria. Care givers’ preferences, poor transportation systems and lack of financial resources led to poor adherence to referral advice. Absence of health workers from their duty post hindered effective service delivery. Prescription of ACTs as a first line of treatment for uncomplicated malaria without a parasite-based diagnosis was the standard case management practice. Parasite-based diagnosis for malaria will invariably lead to better treatment for non-malaria fever cases among the studied age group. Continuous capacity building aimed at improving adherence to current recommendations on parasite- based diagnosis and good clinical practice would be required to support the paradigm shift to parasite-based diagnosis of malaria.

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Research: Assessment of competence of participants before and after 7-day intensive malaria microscopy training courses in Nigeria

June 9, 2015 - 11:36 -- Bart G.J. Knols
Author(s): 
Yetunde A. Olukosi, Chimere O. Agomo, Oluwagbemiga O. Aina, Samuel K. Akindele, Hilary I. Okoh, Margaret O. Akinyele, Olusola Ajibaye, Bassey A. Orok, Bamidele A. Iwalokun, Veronica Enya, Uche T. Igbasi, Samson Awolola
Reference: 
MWJ2015, 6, 6
 
Accuracy of malaria diagnosis by microscopy has been a challenge in Nigeria due to poor competence of microscopists and inability to report on malaria species other than Plasmodium falciparum. Short courses were conducted to improve the skills of laboratory personnel to perform malaria microscopy in public health facilities. Seven-day malaria microscopy courses were conducted annually between 2011 and 2013.The training courses contained theoretical and practical sessions. Impact of the training was evaluated by practical and theoretical pre- and post-training assessments on malaria slide reading, parasite enumeration and basic malariology. The 102 participants who completed the training consisted of medical laboratory scientists (62; 60.8%), medical laboratory technicians (24; 23.5%) and other healthcare workers (16; 15.7%). The knowledge of basic malariology (theory) at pre- and post-tests were 34% (95% CI 31.7-36.3%) and 74.9% (95% CI 71.8-78.0%), respectively (P<0.001). The mean slide reading detection, species and counting agreements in pre-training assessment were 48.9%, 27.9% and 0%, respectively, and in post-training 56.8%, 39.2% and 25%, respectively. The mean species agreements in picture test pre- and post-training were 21.9% and 55.1%, respectively. There were significant differences (P<0.05) in the median pre-test scores in picture tests and basic malariology of the three categories of participants but not in malaria slide reading and parasite counting tests. However, post-training, a significant difference in test scores of the three categories of participants was recorded only for basic malariology (P=0.0003). The 7-day malaria microscopy courses significantly increased the knowledge and microscopy skills of the trainees and were sufficient to bridge the significant difference in baseline microscopy skills of the different categories of trainees that participated in the training courses.

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