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The MalariaWorld Journal

Research: Performance and clinical usefulness of the Optimal-IT® test in the treatment of confirmed malaria cases in rural areas in Côte d’Ivoire

December 4, 2014 - 18:00 -- Bart G.J. Knols
Author(s): 
Yapo T. Aba, Emmanuel Bissagnené, Ouffoué Kra, Serge B. Assi, Raoul Moh, Pulchérie Goly, Nogbou Ello, Alain Kassi, Bessy R. Yao, Franklin Abouo, Eboi Ehui
Reference: 
MWJ2014, 5, 12

This study aimed at determining the performances of the Optimal-IT® test in the strategy for the exclusive treatment of uncomplicated malaria in rural areas in the forest region of San Pedro, Côte d’Ivoire. Patients exhibiting clinical signs of uncomplicated malaria who gave their consent benefited from thick blood film (TBF), blood smear (BS) and Optimal-IT® (pLDH-based) tests. Rapid diagnostic test (RDT) results were taken into consideration to decide on malaria treatment and then compared with TBF/BS results (reference) to assess the performances and clinical usefulness of the RDT. TBF/BS and Optimal-IT® were concordant in 92% of patients but discordant in 10 false negative (3%) and 19 false- positive patients (5%). The performances calculated were: sensitivity=95%, specificity=91%, positive predictive value=90%, negative predictive value=95%, positive likelihood ratio=10, negative likelihood ratio=0.06 and diagnostic odds ratio=166, indicating that Optimal-IT® is a powerful and credible diagnostic tool. The Optimal-IT® test, which is already used in the field, showed good performances to effectively detect patients with and without malaria. It is therefore adapted to the malaria treatment strategy limited to confirmed cases. 

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Research: HPLC separation and in vitro antimalarial studies of Artemisia annua plants from two different origins: Cameroon versus Luxembourg

November 16, 2014 - 12:30 -- Bart G.J. Knols
Author(s): 
Mutaz Akkawi, Suhair Jaber, Saleh Abu-Lafi, Mutaz Qutob, Qassem Abu-Rmeleh, Pierre Lutgen
Reference: 
MWJ2014, 5, 11

The search for new antimalarial drugs is urgently needed, especially drugs that can impede the heme detoxification pathway in the malaria parasite, a crucial requirement for parasite survival in host erythrocytes. Water infusions of Artemisia annua plants from two different origins, Cameroon and Luxembourg, were used in this study. Extracts from the leaves of the Cameroon plant showed a higher potential antimalarial activity, represented by a higher ability to inhibit β-haematin formation in vitro than A. annua extracts from Luxembourg. Although extracts of the plants of both origins showed comparable efficiencies at high concentrations, the absorbance value at 405 nm of a 10% dilution of the Cameroon plant extract was 0.075, whereas it was 1.515 for the Luxembourg plant extract. The absorbance is inversely proportional to the antimalarial activity. According to the Prep-HPLC chromatogram of the Cameroon crude sample, seven major compounds at 325 nm were found. However, only four much less pronounced compounds appeared in the Luxembourg crude sample under the same chromatographic conditions and concentration. These were preliminarily identified as polyphenolic compounds. A. annua infusions are widely used by people who cannot afford other treatments. Depending on the cultivation locality different chemical profiles exist. This results in differences in hemozoin formation and will therefore also lead to alterations in antimalarial activity.

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Research: Enabling factors facilitating the use of neem-based remedies for the management of malaria in the Lower Shire District of Chikwawa, Malawi

October 2, 2014 - 16:18 -- Bart G.J. Knols
Author(s): 
Edson Dembo, Fraction Dzinjalamala, Annette Habluetzel
Reference: 
MWJ2014, 5, 10

This study aimed to determine factors that facilitate the use of herbal remedies within communities in the management of malaria in the presence of free health care services,with the intention of assessing the feasibility of developing improved herbal products as anti-malarial prophylaxis. Data on factors driving the use of neem-based preparations commonly used in the management of malaria were collected through qualitative interviews and focus group discussions. Neem and moringa were identified as the principal plants used for the management of malaria. Factors favouring the communal use of neem-based remedies included the habit of resorting to herbal remedies as first aid treatment, lack of drugs and proper medical care in modern health facilities, and the need for preventive anti-malarial remedies during the high-transmission season. The perceived effectiveness of neem-based herbal remedies was based on their fast action against the symptoms of malaria, thereby providing immediate relief to the patient, which might explain their wide-scale use for malaria treatment. Local communities prefer to use neem and/or moringa remedies for their primary healthcare needs in the management of malaria because of their ease of access, preparation and administration without frequent adverse events, as opposed to ACTs. These remedies are already being used as prophylaxis in unimproved/non-standardised formulation. This suggests that standardised herbal preparations would be culturally acceptable at community level. Evidence-based research is required to validate parasitological and clinical efficacy and determine safety of these anti-malarial herbs.

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Research: The current status of infrastructure for monitoring the efficacy of antimalarial therapeutics in Zambia

September 23, 2014 - 13:54 -- Bart G.J. Knols
Author(s): 
Ellah Zingani, Satoshi Inoue, Lungwani Tyson M. Muungo
Reference: 
MWJ2014, 5, 9
 
The purpose of this study was to evaluate the current status of malaria diagnosis and treatment, and to monitor the therapeutic efficacy of antimalarial drugs. A descriptive cross-sectional survey was conducted from 2011 to 2013 at 10 district hospitals in Zambia designated as malaria sentinel sites as well as at the National Malaria Control Centre. Although basic infrastructure necessary for monitoring antimalarial drug resistance (such as laboratory, dispensary, admission ward, database unit, administration offices, bed space, examination and emergency rooms) was present at all sites, there was a shortage of licensed healthcare personnel. At some sites, antimalarial drugs were prescribed for malaria-like symptoms without diagnostic confirmation by blood smear. There was no regular monitoring of antimalarial drug resistance: only one trial was conducted among all sites in the previous 24 months. A lack of antimalarial drug resistance monitoring might be associated with personnel and funding shortages. Additional financial support would be necessary to avoid the development and spread of drug-resistant malaria in Zambia.

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Research: Economic aspects of suppressing malaria in Africa

September 22, 2014 - 13:59 -- Bart G.J. Knols
Author(s): 
William R. Jobin
Reference: 
MWJ2014, 5, 8
 
The purpose of this study was to determine whether investments in suppressing malaria might produce significant benefits for African nations. Two epidemiologic analyses wereused in parallel to evaluate data from Africa: a before-after comparison of countries treated under the US President’s Malaria Initiative for Africa (PMI), and a simultaneous comparison of treated-untreated countries. From 2007 to 2012, relative increases in population and gross domestic product (GDP) were greater in 14 countries treated as part of PMI than in 9 similar, but untreated countries. In the treated countries the relative increase in the GDP of 0.61 before malaria suppression rose to 0.64 afterwards; whereas in the untreated countries it fell from 0.67 to 0.56. The increase in GDP in the 14 treated countries that was attributable to malaria suppression over the 5-year interval was about $4.77 billion. During that period, the mean cost of suppressing malaria had been about $1.43 billion, indicating a return on the investment of 3.4 to 1. However, the costs began rising steeply in 2012. Malaria suppression might be worthwhile for African countries to undertake themselves, as long as the biocides and drugs in current use remain effective.

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Research: How well do malaria tests correlate with disease severity? Comparison of parasite density in children with mild and severe malaria

June 26, 2014 - 14:42 -- Bart G.J. Knols
Author(s): 
Sarah N. Kituyi, Nancy Nyakoe, Joseph N. Ngeranwa, Steven Runo, John N. Waitumbi
Reference: 
MWJ 2014, 5, 7
 
This study determined how well parasite density estimates by microscopy, qPCR and PfHRP-2 correlate to malaria severity. Patients aged ≤ 5 yrs with severe (n = 60, Hb ≤ 6 g/dl) and mild (n = 60, Hb > 6 g/dl) malaria were enrolled to take part in a case control study at Kisumu District Hospital, Western Kenya. Parasite load was determined by microscopy, qPCR targeting the 18s rRNA gene and PfHRP-2 antigen ELISA. The median parasite load and the 25th and the 75th percentile by microscopy in children with severe malaria (SM) was 49,958 parasites/μl (12,013-128,695) compared to 24,233 (6,122-103,886) in the group with mild malaria (MM), P = 0.10. By qPCR, the translated median parasite density was 31,550 parasites/μl (4,106-196,640) in the SM group compared to 24,365 parasites/μl (5,512-93,401) in the MM group (P = 0.73). According to PfHRP-2, the translated median parasite load in children with SM was 628,775 parasites/μl (332,222-1.165x106) compared to 150,453 (94,292-399,100) in children with MM (P < 0.0001). Unlike microscopy and qPCR, the parasite load detected by PfHRP-2 correlates with disease severity. Because of its unique attributes, PfHRP-2 is able to account for trophozoites and schizonts that are sequestered away from peripheral circulation. Because it persists in circulation, it also serves as an indicator of the magnitude of current and recent infections.

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Research: Misdiagnosis of malaria using wrong buffer substitutes for rapid diagnostic tests in poor resource setting in Enugu, southeast Nigeria

May 12, 2014 - 12:31 -- Bart G.J. Knols
Author(s): 
Johnbull S. Ogboi, Polycarp U. Agu, Adeniyi F. Fagbamigbe, Onyemocho Audu, Augustine Akubue, Ifeyinwa Obianwu
Reference: 
MWJ 2014, 5, 6
 
This study explored the phenomenon of using the wrong buffer vial (often a kit from another brand or buffer from HIV rapid test kits), dextrose, saline or distilled water among health care providers who used RDTs for malaria diagnosis in resource poor settings in Enugu South East, Nigeria. Of the 80 study participants that completed their questionnaires, 56.3% reported that malaria diagnosis was positive using non-buffer RDTs detection while others reported negative results. Among the various professionals who used RDTs, 76.2% reported to have run out of RDT buffer stock at least once. Of the study participants that ran out of RDT buffer solution, 73% declared to have used non-RDT alternatives (physiological saline, 0.9% NaCl), distilled water, HIV buffer or ordinary water). Only 30% had received formal training on the proper usage and application of RDTs while 70% had never received any formal training on RDTs but learnt the technique of using RDT on the job. This study demonstrated that at least three quarters of health care workers in a resource poor setting had run out of buffer when using malaria RDTs and that the majority of them had used buffer substitutes, which are known to generate inaccurate tests results. This has the consequence of misdiagnosis, thus potentially damaging the credibility of malaria control.

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Research: High acceptance of artemisinin-based combination therapy for the home management of malaria in rural communities in southwest Nigeria

April 22, 2014 - 19:27 -- Bart G.J. Knols
Author(s): 
Catherine Olufunke Falade, Ikeoluwapo Oyeneye Ajayi, Oyindamola Bidemi Yusuf, Franco Pagnoni
Reference: 
MWJ 2014, 5, 5

In rural southwest Nigeria we set out to evaluate the feasibility and acceptability of using artemether-lumefantrine (AL) at the community level to treat acute uncomplicated malaria.Following advocacy and community mobilisation, 60 community medicine distributors (CMDs) were trained to recognise the signs and symptoms of childhood malaria and to treat febrile children aged 6–59 months with AL, after ruling out certain danger signs. Based on CMDs’ records, 97.6% (1019/1044) of the children treated with AL received the correct dose. Over half (52.3%) of the children (288/551) whose caregivers participated in the 2-week fever recall survey reportedly received AL from a CMD. Of the children treated with AL, 80.2% (231/288) received prompt treatment at the correct dose and for the correct length of time. Ninety-eight percent of the caregivers perceived AL to be effective and none reported severe adverse events. The use of AL at the community level is feasible and acceptable in the home management of malaria in rural southwest Nigeria. Challenges that must be addressed include avoiding stock outs, ensuring adequate number of CMDs and providing incentives to ensure their availability.

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Research: Suppression of malaria transmission and increases in economic productivity in African countries from 2007 to 2011

March 4, 2014 - 16:34 -- Bart G.J. Knols
Author(s): 
William R. Jobin
Reference: 
MWJ 2014, 5, 4
 
 
To test the assumption that reductions in malaria in Africa will increase economic productivity, a correlation-regression analysis was conducted to
evaluate the impact ofexpenditures by the US President’s Malaria Initiative for Africa (PMI), and increases in the economic productivity of countries included in the PMI. For the 12 most representative countries the per capita expenditures for malaria suppression in the 2011 budget of the PMI were compared with observed increases in per capita economic productivity. The measure of economic productivity used was the per capita Gross Domestic Product (GDP) for the period 2007 to 2011. With a mean annual expenditure for suppressing malaria slightly above 1 US dollar per capita (range 0.44-3.40), there was a positive but weak correlation of higher expenditures with increased economic productivity. The correlation coefficient r was 0.5. The increase in per capita GDP in these countries over the 4-year period varied between 60 and 200 USD. The slope of the regression line and thus the ratio of benefits to cost from this programme varied slightly between ecologic zones, but the mean was 6.75 to 1. This meant that there was an increase in per capita GDP of $6.75 for every $1 invested per capita in suppressing malaria. The high benefits to cost ratio from the PMI makes suppression of malaria by methods used by the initiative potentially an attractive investment, at least for the near future while the biocides and drugs deployed are still effective.

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Research: Persistence of markers of chloroquine resistance among P. falciparum isolates recovered from two Nigerian communities

February 26, 2014 - 09:30 -- Bart G.J. Knols
Author(s): 
Yetunde A. Olukosi, Muyiwa K. Oyebola, Olusola Ajibaye, Bassey A. Orok, Olugbenga O. Aina, Chimere O. Agomo, Bamidele A. Iwalokun, Samuel K. Akindele, Veronica N.V. Enya, Hilary I. Okoh
Reference: 
MWJ 2014, 5, 3
 
We investigated the prevalence of the major markers of chloroquine resistance years after the withdrawal of the drug in Nigeria.
 Finger prick blood samples were collected from participants presenting with symptoms of malaria in Lagos, Nigeria. Thick and thin blood smears were prepared for microscopy and dry blood spots made from malaria-positive participants for parasite DNA extraction. The detection of mutations in the Plasmodium falciparum chloroquine resistance transporter (pfcrt) and P. falciparum multidrug resistance (pfmdr1) genes was performed by nested polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Of the 1527 blood samples that were confirmed by PCR to be P. falciparum positive, 412 and 344 were typed for the molecular detection of pfcrt and pfmdr1 gene mutations, respectively. The mutant alleles of pfcrt were present among 290 (70%) parasite carriers while the pfmdr1 mutant allele was found in 117 (34%) of the total population. There were higher distributions of the mutant alleles for the two loci in Ijede than in Lekki. The observed frequencies of pfcrt mutant alleles in the two parasite populations were in agreement with the expected frequencies predicted by Hardy-Weinberg. In comparing data with studies conducted between 2000 and 2002 in Ijede, we observed an increase in the prevalence of mutant type pfcrt against a marginal decline in the pfmdr1 mutant type. The high frequencies of pfcrt mutation are suggestive of a persistent drug pressure and continuing inefficacy of chloroquine as an antimalarial drug.

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