Malaria News Today 2020-10-26: Haiti, India, Malaysia, Cape Verde

Recent news and abstracts explore malaria on three continents. Genetic aspects of malaria are studied in Haiti as well in Malaysia. Use of fish to control malaria carrying mosquitoes are successful in India. The movement toward malaria elimination is examined in Cape Verde. Finally, Non-invasive diagnostic tests are recognized/rewarded by NIH. Read more by following the links below.

NIH Awards Prize to Hemex Health’s Non-Invasive Sickle Cell, Malaria, Anemia Rapid Test (“SMART”) Diagnostic Technology

Researchers from Hemex Health, Medtronic plc, Case Western Reserve University, and the University of Nebraska Medical Center’s International Foundation Against Infectious Disease in Nigeria (IFAIN) were awarded 3rd place and $100,000 in the NIH Technology Accelerator Challenge.  Code named, SMART (Sickle, Malaria, Anemia, Rapid Test), the system includes non-invasive diagnostics for sickle cell, malaria, and anemia. The project seeks to build on Hemex Health’s Gazelle® platform, which currently includes minimally invasive tests (using a drop of blood) for malaria, the detection and quantification of hemoglobin variants, as well as for total hemoglobin for anemia determination.

The non-invasive test will screen for anemia, malaria, and sickle cell disease using an optical finger sensor similar to the way blood oxygen is measured. An advantage of combining the non-invasive and minimally invasive diagnostics is, when needed, more diagnostic information and confirmation is available on the same platform. The goal is a one-minute, $0.25 non-invasive malaria, sickle cell, and anemia test. “The world desperately needs easy-to-use diagnostic technologies with the flexibility needed to meet viruses and diseases in every corner of the planet,” said Ms. White.

Controlling Mosquitoes: Ramanathapuram district inches closer to malaria-free status

Steps taken by the Ramanathapuram district administration to control mosquito breeding for the last five years has enableed the district inch closer to being declared a ‘malaria-free district, with only one malarial fever case having been reported till September, this year. Last year, the district reported 43 cases.

One of the initiatives is to bring guppy fish from the Ayyankulam tank in Tiruvannamalai district and let them into all wells and tanks of the districts in 3:1 ratio (3 familes/one male). The fish thrives, eating the mosquito larvae and eggs and the incidence of malaria came down in the district.

Updates on malaria epidemiology and profile in Cabo Verde from 2010 to 2019: the goal of elimination

Located in West Africa, Cabo Verde is an archipelago consisting of nine inhabited islands. Malaria has been endemic since the settlement of the islands during the sixteenth century and is poised to achieve malaria elimination in January 2021. The aim of this research is to characterize the trends in malaria cases from 2010 to 2019 in Cabo Verde as the country transitions from endemic transmission to elimination and prevention of reintroduction phases. All confirmed malaria cases reported to the Ministry of Health between 2010 and 2019 were extracted from the passive malaria surveillance system.

A total of 814 incident malaria cases were reported in the country between 2010 and 2019, the majority of which were Plasmodium falciparum. Cabo Verde has made substantial gains in reducing malaria burden in the country over the past decade and are poised to achieve elimination in 2021. However, the high mobility between the islands and continental Africa, where malaria is still highly endemic, means there is a constant risk of malaria reintroduction. Characterization of imported cases provides useful insight for programme and enables better evidence-based decision-making to ensure malaria elimination can be sustained.

Genetic analysis reveals unique characteristics of Plasmodium falciparum parasite populations in Haiti

With increasing interest in eliminating malaria from the Caribbean region, Haiti is one of the two countries on the island of Hispaniola with continued malaria transmission. While the Haitian population remains at risk for malaria, there are a limited number of cases annually, making conventional epidemiological measures such as case incidence and prevalence of potentially limited value for fine-scale resolution of transmission patterns and trends. In this context, genetic signatures may be useful for the identification and characterization of the Plasmodium falciparum parasite population in order to identify foci of transmission, detect outbreaks, and track parasite movement to potentially inform malaria control and elimination strategies.

This study evaluated the genetic signals based on analysis of 21 single-nucleotide polymorphisms (SNPs) from 462 monogenomic (single-genome) P. falciparum DNA samples extracted from dried blood spots collected from malaria-positive patients reporting to health facilities in three southwestern Haitian departments (Nippes, Grand’Anse, and Sud) in 2016.

437 of the 462 samples shared high levels of genetic similarity–at least 20 of 21 SNPS–with at least one other sample in the dataset. These results revealed patterns of relatedness suggestive of the repeated recombination of a limited number of founding parasite types without significant outcrossing. These genetic signals offer clues to the underlying relatedness of parasite populations and may be useful for the identification of the foci of transmission and tracking of parasite movement in Haiti for malaria elimination.

Epidemiology of malaria among pregnant women during their first antenatal clinic visit in the middle belt of Ghana

A total of 1655 pregnant Ghanaian women aged 18 years and above with a gestational age of 13–22 weeks, who attended an antenatal care (ANC) clinic for the first time, were consented and enrolled into the study. A structured questionnaire was used to collect socio-demographic and obstetric data and information on use of malaria preventive measures. Venous blood (2 mL) was collected before sulfadoxine-pyrimethamine administration. Malaria parasitaemia and haemoglobin concentration were determined using microscopy and an automated haematology analyser, respectively.

One out of five pregnant women attending their first ANC clinic visit in an area of perennial malaria transmission in the middle belt of Ghana had Plasmodium falciparum infection. Age???25 years, multigravid, educated to high school level or above, and in household with higher socio-economic status were associated with a lower risk of malaria parasitaemia. Majority of the infections were below 1000 parasites/µL and with associated anaemia. There is a need to strengthen existing malaria prevention strategies to prevent unfavourable maternal and fetal birth outcomes in this population.

Genetic diversity of circumsporozoite protein in Plasmodium knowlesi isolates from Malaysian Borneo and Peninsular Malaysia

Understanding the genetic diversity of candidate genes for malaria vaccines such as circumsporozoite protein (csp) may enhance the development of vaccines for treating Plasmodium knowlesi. Hence, the aim of this study is to investigate the genetic diversity of non-repeat regions of csp in P. knowlesi from Malaysian Borneo and Peninsular Malaysia.
The phylogenetic analysis revealed indistinguishable clusters of P. knowlesi isolates across different geographic regions, including Malaysian Borneo and Peninsular Malaysia.

The csp non-repeat regions are relatively conserved and there is no distinct cluster of P. knowlesi isolates from Malaysian Borneo and Peninsular Malaysia. Distinctive variation data obtained in the C-terminal non-repeat region of csp could be beneficial for the design and development of vaccines to treat P. knowlesi.

Malaria News Today 2020-10-22

The search for adjunctive therapy to aid in recovery from cerebral malaria is explored in Malaria Journal. A faster acting crystalline form of an insecticide is studied. In Nigeria the National Malaria Elimination Program advocates for equal footing with COVID-19 action. Links to full stories and abstracts are found below.

Dimethyl fumarate reduces TNF and Plasmodium falciparum induced brain endothelium activation in vitro

Neida K. Mita-Mendoza, and colleagues studied Cerebral malaria (CM) which is associated with morbidity and mortality despite the use of potent anti-malarial agents. Brain endothelial cell activation and dysfunction from oxidative and inflammatory host responses and products released by Plasmodium falciparum-infected erythrocytes (IE), are likely the major contributors to the encephalopathy, seizures, and brain swelling that are associated with CM. The development of adjunctive therapy to reduce the pathological consequences of host response pathways could improve outcomes.

To accurately reflect clinically relevant parasite biology a unique panel of parasite isolates derived from patients with stringently defined CM was developed. The effect of TNF and these parasite lines on primary human brain microvascular endothelial cell (HBMVEC) activation in an in vitro co-culture model was tested. HBMVEC activation was measured by cellular release of IL6 and nuclear translocation of NF?B. The transcriptional and functional effects of dimethyl fumarate (DMF), an FDA approved drug which induces the NRF2 pathway, on host and parasite induced HBMVEC activation was characterized. In addition, the effect of DMF on parasite binding to TNF stimulated HBMVEC in a semi-static binding assay was examined.

The findings provide evidence that targeting the nuclear factor E2-related factor 2 ( NRF2) pathway in tumour necrosis factor (TNF) and parasite activated human brain microvascular endothelial cell (HBMVEC) mediates multiple protective pathways and may represent a novel adjunctive therapy to improve infection outcomes in CM.

Fast-acting insecticide polymorph could boost malaria-control efforts

Chemistry World reports on a faster-acting version of a common insecticide could boost malaria control efforts. The new crystalline form of deltamethrin is absorbed by mosquitoes 12 times faster than commercial forms and could help to limit malaria transmission despite growing rates of insecticide resistance.

Microcystals of contact insecticides like deltamethrin are crucial ingredients in indoor sprays and treated bed nets used to combat malaria-spreading mosquitoes. But many mosquito populations are developing resistance to these compounds, which is harming efforts to control the disease.

Treat Malaria as National Health Emergency, NEMP tells Federal Government

The Coordinator of National Malaria Elimination Programme (NEMP), has asked the federal government to tackle malaria as a national health emergency in the same manner COVID-19 pandemic is being handled. Against the background of increasing poverty in the country, Civil Society in Malaria Control, Immunisation and Nutrition (ACOMIN) has said there is a direct linkage between malaria scourge and the level of poverty in communities.

Speaking at a meeting with the civil society group involved in anti malaria advocacy, Coordinator of NEMP, said the current level of funding of the health sector by government is unacceptably low.

Malaria News Today 2020-10-21: perspectives on falciparum, transfusion issues, drug effectiveness

Ironically, blood transfusion helps with severe malaria, but can be dangerous in mild cases. And with severe malaria delay in treatment is a major risk. Malaria parasites can be surprisingly diverse, even in one home. Health system performance, drug quality and patient adherence are key factors in the effectiveness of anti-malarials. Read more on each article or abstract in the links provided.

The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria

Mousa A et al. conducted a systematic review and a pooled multicentre individual-patient meta-analysis in PLoS Medicine. Despite the reported association of delay in receiving treatment for uncomplicated malaria (UM) with an increased risk of developing severe malaria (SM), access to treatment remains low in most high-burden areas. Researchers performed a pooled individual-participant meta-analysis with the aim to ascertain the correlation between treatment delay and presenting with SM using Ovid MEDLINE and Embas.

Findings revealed significantly higher risk of severe disease in children and adults who had longer delays from symptom onset to treatment-seeking; this relationship was noted to be the strongest for progression to severe malarial anaemia. Per estimates, nearly half of the severe anaemia cases in both children and adults could be averted if they presented within the first 24 hours of symptom onset.

Malaria parasites in Nigeria are genetically diverse: a danger but also a useful tool

Segun Isaac Oyedeji notes that his team’s research has already confirmed that in malaria-endemic countries such as Nigeria, infected individuals carry P. falciparum parasites that are genetically complex or diverse. What we didn’t know was how diverse the parasites are in the micro environment, such as within households and among children of the same family.

Oyedeji thought that knowing the population structure within households could help us understand more about the pattern and development of the disease. It could also inform development of appropriate guidelines and control measures. He found that even in the micro environment, P. falciparum parasites exhibit high genetic diversity. This finding was similar to results from larger communities in malaria endemic regions and has the same important implications. The implication is that a one-size fits all intervention or approach against the parasites may not be effective. There were children living under the same roof and infected by parasites that were genetically different.

New evidence to guide the practice of blood transfusions in children with severe malaria

The Barcelona Institute for Global Health (ISGlobal) described a new study that shows that transfusions could help increase survival, even at higher haemoglobin levels than those currently recommended. The results show that blood transfusion increased the survival of patients with severe disease.

In cases with complications, such as impaired consciousness or elevated lactate in blood, transfusion improved survival even in children whose levels of haemoglobin were higher the recommended threshold of 60g /l. For example, among patients with impaired consciousness, the authors observed improved survival upon transfusion with haemoglobin levels as high as 105 g / l. However, in the case of mild cases, transfusion was associated with an increase in mortality.

Global estimation of anti-malarial drug effectiveness for the treatment of uncomplicated Plasmodium falciparum malaria 1991–2019

Giulia Rathmes and colleagues note that anti-malarial drugs play a critical role in reducing malaria morbidity and mortality, but their role is mediated by their effectiveness. Effectiveness is defined as the probability that an anti-malarial drug will successfully treat an individual infected with malaria parasites under routine health care delivery system. Anti-malarial drug effectiveness (AmE) is influenced by drug resistance, drug quality, health system quality, and patient adherence to drug use; its influence on malaria burden varies through space and time. This study used data from 232 efficacy trials.

The global effectiveness of artemisinin-based drugs was 67.4% (IQR: 33.3–75.8), 70.1% (43.6–76.0) and 71.8% (46.9–76.4) for the 1991–2000, 2006–2010, and 2016–2019 periods, respectively. The use of artemisinin-based combination therapy (ACT) with a competent partner drug and having multiple ACT as first-line treatment choice sustained high levels of effectiveness. High levels of access to healthcare, human resource capacity, education, and proximity to cities were associated with increased effectiveness. Effectiveness of non-artemisinin-based drugs was much lower than that of artemisinin-based.

This study provides evidence that health system performance, drug quality and patient adherence influence the effectiveness of anti-malarials used in treating uncomplicated falciparum malaria. These results provide guidance to countries’ treatment practices and are critical inputs for malaria prevalence and incidence models used to estimate national level malaria burden.

Malaria News Today 2020-10-15

Recent publications in Malaria Journal, The Lancet and eLife tackle several challenges to saving lives and malaria elimination. Problems include low access to bednets for children in Ethiopia, high prevalence of asymptomatic malaria in Ghanaian adults, risk of co-infection with other infectious diseases, and gaps in current interventions to prevent malaria in pregnancy and children. On the hopeful side, new targets for drug therapy are being identified. Read more on each by following the links below.

Long-lasting insecticide-treated bed net ownership, utilization and associated factors among school-age children in Southern Ethiopia

Zerihun Zerdo and colleagues examined net use among children in malaria-prone areas of

Dara Mallo and Uba Debretsehay districts because malaria is one of the major causes of morbidity and mortality among school-age children (SAC) in sub-Saharan Africa. This study was part of a baseline assessment in a cluster-randomized controlled trial.

The ownership of at least one LLIN by households of school-aged children (SAC) was about 19.3% (95% CI 17.7–21.0%) but only 10.3% % (95% CI 7.7–13.7%) of these households had adequate access of bed nets to the household members. Ownership of bed net was lower than universal coverage of at least one bed net for two individuals. It is important to monitor replacement needs and educate mothers with low education level with their SAC on the benefit of consistent utilization of bed nets.

Prevalence of and risk factors for Plasmodium spp. co-infection with hepatitis B virus: a systematic review and meta-analysis

Kotepui and Kotepui observed that Plasmodium spp. and hepatitis B virus (HBV) are among the most common infectious diseases in underdeveloped countries. Therefore they examined co-infection in people living in endemic areas of both diseases. The PubMed, Web of Science, and Scopus databases were searched. Observational cross-sectional studies and retrospective studies assessing the prevalence of Plasmodium species and HBV co-infection were examined. and found 22 studies to include in a systematic review and meta-analysis. Overall, the pooled prevalence estimate of Plasmodium spp. and HBV co-infection was 6% (95% CI 4–7%, Cochran’s Q statistic?<?0.001, I2: 95.8%).

No difference in age or gender and risk of Plasmodium spp. and HBV co-infection group was found. The present study revealed the prevalence of Plasmodium spp. and HBV co-infection, which will help in understanding co-infection and designing treatment strategies. Future studies assessing the interaction between Plasmodium spp. and HBV are recommended.

High prevalence of asymptomatic malaria infections in adults, Ashanti Region, Ghana, 2018

Melina Heinemann and co-researchers noted that Ghana is among the high-burden countries for malaria infections and recently reported a notable increase in malaria cases. While asymptomatic parasitaemia is increasingly recognized as a hurdle for malaria elimination, studies on asymptomatic malaria are scarce, and usually focus on children and on non-falciparum species. Therefore asymptomatic adult residents from five villages in the Ashanti Region, Ghana, were screened for Plasmodium species by rapid diagnostic test (RDT) and polymerase chain reaction (PCR) during the rainy season. Samples tested positive were subtyped using species-specific real-time PCR.

Molecular prevalence of asymptomatic Plasmodium infection was 284/391 (73%); only 126 (32%) infections were detected by RDT. While 266 (68%) participants were infected with Plasmodium falciparum, 33 (8%) were infected with Plasmodium malariae and 34 (9%) with P. ovale. The sub-species P. ovale curtisi and P. ovale wallikeri were identified to similar proportions. Non-falciparum infections usually presented as mixed infections with P. falciparum.

Most adult residents in the Ghanaian forest zone are asymptomatic Plasmodium carriers. The high Plasmodium prevalence not detected by RDT in adults highlights that malaria eradication efforts must target all members of the population. Beneath Plasmodium falciparum, screening and treatment must also include infections with P. malariae, P. o. curtisi and P. o. wallikeri.

Scientists shed new light on mechanisms of malaria parasite motility

eLife reports a new insight on the molecular mechanisms that allow malaria parasites to move and spread disease within their hosts has just been published. The first X-ray structures of the molecular complex that allows malaria parasites to spread disease highlight a novel target for antimalarial treatments.

The movement and infectivity of the parasite Plasmodium falciparum, and ultimately its ability to spread malaria among humans, rely on a large molecular complex called the glideosome. The new findings provide a blueprint for the design of future antimalarial treatments that target both the glideosome motor and the elements that regulate it.

New Lancet Series: Malaria in early life

Malaria infections are harmful to both the pregnant mother and the developing fetus. Malaria is associated with a 3–4 times increased risk of miscarriage and a substantially increased risk of stillbirth, and it disproportionately affects children younger than 5 years. Falciparum malaria is responsible for more than 200 000 child deaths per year in Africa and vivax malaria causes excess mortality in children in Asia and Oceania. In a duet of papers, we review 1) the deleterious effects of malaria in pregnancy on the developing fetus and 2) the current strategies for prevention and treatment of malaria in children.

Paper 1 is “Deleterious effects of malaria in pregnancy on the developing fetus: a review on prevention and treatment with antimalarial drugs” by Makoto Saito, Valérie Briand, Aung Myat Min, and Rose McGready. The authors are concerned that one in ten maternal deaths in malaria endemic countries may result from Plasmodium falciparum infection, that malaria is associated with a 3–4 times increased risk of miscarriage and a substantially increased risk of stillbirth. While current treatment and prevention strategies reduce, but do not eliminate, malaria’s damaging effects on pregnancy outcomes. They conclude that there is a need for alternative strategies to prevent malaria in pregnancy.

Paper 2 is “Treatment and prevention of malaria in children” by Elizabeth A Ashley and Jeanne Rini Poespoprodjo. They examine the following interventions: Triple antimalarial combination therapies, the RTS,S/AS01 vaccine, seasonal malaria chemoprevention and preventing relapse in Plasmodium vivax infection with primaquine.

Malaria News Today 2020-10-08: the role of travel, asymptomatic disease and gut microbiome from AJTMH

The American Journal of Tropical Medicine and Hygiene has several new articles on malaria. Abstracts are shared. Two articles examine the role of travel in malaria transmission, both cross-border and rural-urban. Another considers the effect on pharmacokinetics of lumefantrine due to gut bacteria. In Uganda indoor spraying has reduced transmission, but asymptomatic cases remain among children. The challenges of asymptomatic malaria to elimination efforts is also examined in India. Links to the articles are found below.

Evidence of Microbiome–Drug Interaction between the Antimalarial Lumefantrine and Gut Microbiota in Mice

The antimalarial drug lumefantrine exhibits erratic pharmacokinetics. Intersubject variability might be attributed, in part, to differences in gut microbiome–mediated drug metabolism. We assessed lumefantrine disposition in healthy mice stratified by enterotype to explore associations between the gut microbiota and lumefantrine pharmacokinetics. Gut microbiota enterotypes were classified according to abundance and diversity indices from 16S rRNA sequencing. Pharmacokinetic parameters were computed using noncompartmental analysis. Two distinct enterotypes were identified.

Maximal concentration (C max) and total drug exposure measured as the area under the drug concentration–time curve (AUC0–24) differed significantly between the groups. The mean and standard deviation of C max were 660 ± 220 ng/mL versus 390 ± 59 ng/mL (P = 0.02), and AUC0–24 was 9,600 ± 2,800 versus 5,800 ± 810 ng × h/mL (P = 0.01). In healthy mice intragastrically dosed with the antimalarial drug lumefantrine in combination with artemether, lumefantrine exposure was associated with gut bacterial community structure. Studies of xenobiotic–microbiota interactions can inform drug posology and elucidate mechanisms of drug disposition.

Malaria Transmission, Infection, and Disease following Sustained Indoor Residual Spraying of Insecticide in Tororo, Uganda

Tororo, a district in Uganda with historically high malaria transmission intensity, has recently scaled up control interventions, including universal long-lasting insecticidal net distribution in 2013 and 2017, and sustained indoor residual spraying (IRS) of insecticide since December 2014. We describe the burden of malaria in Tororo 5 years following the initiation of IRS. We followed a cohort of 531 participants from 80 randomly selected households in Nagongera subcounty, Tororo district, from October 2017 to October 2019. Mosquitoes were collected every 2 weeks using CDC light traps in all rooms where participants slept, symptomatic malaria was identified by passive surveillance, and microscopic and submicroscopic parasitemia were measured every 4 weeks using active surveillance. Over the 2 years of follow-up, 15,780 female anopheline mosquitos were collected, the majority (98.0%) of which were Anopheles arabiensis.

The daily human biting rate was 2.07, and the annual entomological inoculation rate was 0.43 infective bites/person/year. Only 38 episodes of malaria were diagnosed (incidence 0.04 episodes/person/year), and there were no cases of severe malaria or malarial deaths. The prevalence of microscopic parasitemia was 1.9%, and the combined prevalence of microscopic and submicroscopic parasitemia was 10.4%, each highest in children aged 5–15 years (3.3% and 14.0%, respectively). After 5 years of intensive vector control measures in Tororo, the burden of malaria was reduced to very low transmission levels. However, a significant proportion of the population remained parasitemic, primarily school-aged children with submicroscopic parasitemia, providing a potential reservoir for malaria transmission.

Malaria Diagnosed in an Urban Setting Strongly Associated with Recent Overnight Travel: A Case–Control Study from Kampala, Uganda

Malaria is frequently diagnosed in urban Kampala, despite low transmission intensity. To evaluate the association between recent travel out of Kampala and malaria, we conducted a matched case–control study. Cases were febrile outpatients with a positive malaria test; controls were febrile outpatients with a negative test. For every two cases, five controls were selected, matching on age. Data were collected on recent overnight travel out of Kampala (past 60 days), destination and duration of travel, and behavioral factors, including sleeping under an insecticide-treated net (ITN) during travel. From July to August 2019, 162 cases and 405 controls were enrolled. The locations of residence of cases and controls were similar. More controls were female (62.7% versus 46.3%, P < 0.001). Overall, 158 (27.9%) participants reported recent overnight travel.

Travelers were far more likely to be diagnosed with malaria than those who did not travel (80.4% versus 8.6%, OR 58.9, 95% CI: 23.1–150.1, P < 0.001). Among travelers, traveling to a district not receiving indoor residual spraying of insecticide (OR 35.0, 95% CI: 4.80–254.9, P < 0.001), no ITN use (OR 30.1, 95% CI: 6.37–142.7, P < 0.001), engaging in outdoor activities (OR 22.0, 95% CI: 3.42–141.8, P = 0.001), and age < 16 years (OR 8.36, 95% CI: 2.22–56.2, P = 0.03) were associated with increased odds of malaria. Kampala residents who traveled overnight out of the city were at substantially higher risk of malaria than those who did not travel. For these travelers, personal protection measures, including sleeping under an ITN when traveling, should be advocated.

Prevalence of Asymptomatic Malaria Parasitemia in Odisha, India: A Challenge to Malaria Elimination

The prevalence of malaria in India is decreasing, but it remains a major concern for public health administration. The role of submicroscopic malaria and asymptomatic malaria parasitemia and their persistence is being explored. A cross-sectional survey was conducted in the Kandhamal district of Odisha (India) during May–June 2017. Blood samples were collected from 1897 individuals for screening of asymptomatic parasitemia. Samples were screened using rapid diagnostic tests (RDTs) and examined microscopically for Plasmodium species. Approximately 30% of randomly selected samples (n = 586) were analyzed using real-time PCR (qPCR), and the genetic diversity of Plasmodium falciparum was analyzed.

The prevalence of Plasmodium species among asymptomatic individuals detected using qPCR was 18%, which was significantly higher than that detected by microscopy examination (5.5%) or RDT (7.3%). Of these, 37% had submicroscopic malaria. The species-specific prevalence among asymptomatic malaria-positive cases for P. falciparum, Plasmodium vivax, and mixed infection (P. falciparum and P. vivax) by qPCR was 57%, 29%, and 14%, respectively. The multiplicity of infection was 1.6 and 1.2 for the merozoite surface protein-1 gene (msp1) and (msp2), respectively. Expected heterozygosity was 0.64 and 0.47 for msp1 and msp2, respectively. A significant proportion of the study population, 105/586 (18%), was found to be a reservoir for malaria infection, and identification of this group will help in the development of elimination strategies.

Travel Is a Key Risk Factor for Malaria Transmission in Pre-Elimination Settings in Sub-Saharan Africa: A Review of the Literature and Meta-Analysis

By sustaining transmission or causing malaria outbreaks, imported malaria undermines malaria elimination efforts. Few studies have examined the impact of travel on malaria epidemiology. We conducted a literature review and meta-analysis of studies investigating travel as a risk factor for malaria infection in sub-Saharan Africa using PubMed. We identified 22 studies and calculated a random-effects meta-analysis pooled odds ratio (OR) of 3.77 (95% CI: 2.49–5.70), indicating that travel is a significant risk factor for malaria infection.

Odds ratios were particularly high in urban locations when travel was to rural areas, to more endemic/high transmission areas, and in young children. Although there was substantial heterogeneity in the magnitude of association across the studies, the pooled estimate and directional consistency support travel as an important risk factor for malaria infection.

Malaria News Today 2020-10-06: malaria in pregnancy, parasites surviving fever and private sector support

Today’s news featured a media briefing by the RBM Partnership and AMMREN on the challenges of protecting pregnant women from malaria. Additional news expands on these challenges. Research looks at how malaria parasites withstand the heat of a patient’s fever. Finally examples are presented of collaboration between international organizations and the private sector for malaria and disease control. Follow the links to gain more information.

Speed Up IPTp Scale-Up: a media briefing on maternal health

A panel discussion and media briefing on new approaches and lessons learned formed part of an online global call to end malaria in pregnancy with intermittent preventive treatment. The briefing on Tuesday, 6 October 2020, was sponsored by the Roll Back Malaria Partnership and AMMREN. The RBM website features background on the call to action.

The panel discussion included Dr. Aminata Cisse ep. Traore, Sous Directrice de la Santé de la Reproduction/Direction Générale de la Santé et de l’Hygiène Publique, Ministére de la Santé et de l’Hygiène Publique, Mali; Dr. Anshu Banerjee, Director Department of Maternal, Newborn, Child, Adolescent Health & Ageing, World Health Organization (WHO), and Dr. Pedro Alonso, Director Global Malaria Programme, WHO. The discussion was moderated by Mildred Komey, Malaria in Pregnancy Focal Person, National Malaria Control Program, Ghans Health Service.

The discussion covered the importance of launching this call now, what we’ve learned over the last few years, and examples of innovative strategies from Mali. There was a Q&A session with journalists after the presentations.

The presentation by Dr Alonso showed the progress in achieving IPTp coverage goals. He also pointed out the social and economic factors that affect access and equity to intermittent preventive treatment of malaria in pregnancy and protection of maternal health (see slides).

Experts say Africa must scale-up malaria protection for pregnant women

In support of the RBM/AMMREN briefing described above, Sola Ogundipe reports that amidst the COVID-19 pandemic in sub-Saharan Africa, malaria – one of the world’s oldest diseases – is impacting disproportionately on pregnant women and children aged under five.

For a pregnant woman, her fetus, and the newborn child malaria infection carries substantial risks. Calling for a speedy scale-up to boost protection against malaria for pregnant women in Africa, the Roll Back Malaria, RBM Partnership to End Malaria Working Group is issuing an urgent appeal to leaders and health policymakers to increase access to Intermittent Preventive Treatment during pregnancy, IPTp, among eligible pregnant women in sub-Saharan Africa.

Along with stakeholders, the RBM Partnership is pushing for scale-up coverage of three doses of IPTp to reach all eligible women in sub-Saharan Africa by 2025. In 2019, according to the RBM Partnership, an estimated 11 million pregnant women in sub-Saharan Africa, or 29 percent of all pregnancies were infected with malaria.

How malaria parasites withstand a fever’s heat

The parasites that cause 200 million cases of malaria each year can withstand feverish temperatures that make their human hosts miserable. Now, a team is beginning to understand how they do it. The researchers have identified a lipid-protein combo that springs into action to gird the parasite’s innards against heat shock.

Understanding how malaria protects its cells against heat and other onslaughts could lead to new ways to fight tough-to-kill strains, researchers say. Findings could lead to ways to maximize our existing antimalarial arsenal.

Global Fund and Chevron – United Against HIV, TB and Malaria

The Global Fund and Chevron Corporation have celebrated a 12-year partnership that served as an example of the private sector’s contribution to the fight against infectious diseases and to building resilient health systems. Chevron, a Global Fund partner since January 2008, has supported Global Fund programs against HIX4 tuberculosis and malaria for a total investment of US$60 million in Angola, Indonesia, Nigeria, the Philippines, South Africa, Thailand and Vietnam.

Chevron’s partnership has contributed to helping more than a million people living with HIV access lifesaving antiretroviral therapy; supported efforts to distribute over one million long-lasting insecticide-treated mosquito nets to families to prevent malaria; helped detect thousands of TB cases; promoted education programs for the young, and helped build stronger health systems.

In Nigeria, Chevron’s $5 million investment from October 2017 to December 201 9 supported the national HIV and TB programs, reaching key and vulnerable populations, as well as interventions aimed at strengthening the health system. Sustainable and resilient systems for health are indispensable in the fight against the epidemics of HIV TB and malaria, as well as the first line of defense against new diseases like COVID-19. “With rising cases of COVID-1 9, the stakes are very high. Deaths from HIV, TB and malaria are likely to increase. Investments by partners like Chevron are fundamental.

Malaria News Today 2020-10-05: Concerns from Mali, Comoros, Ecuador, Southeast Asia and More

News and abstracts provide more on the surge of malaria in Mali. COVID-19 complicates malaria elimination in Southeast Asia. Peace Corps health care for volunteers in Comoros is questioned. Malaria risk in Ecuador is investigated. Risk maps are used/not used in three Sub-Saharan countries. The potential of microbiological control is considered. More information on each topic is available in the links provided.

Health workers raise alarm over surge in malaria cases, deaths in Mali

More details emerge on malaria in northern Mali. Medical workers in Mali raised an alarm over a surge in malaria cases which has seen at least 23 people killed by the disease in just the past one week. About 13,000 malaria cases were reported in the north by medical workers between September 21 and 27, representing an 88 percent increase in cases from the previous week. 59 people have died of malaria in the nation’s northern region since the beginning of the year, according to the ministry, which confirmed the deaths of the 23 people over the aforementioned September period.

Will COVID-19 hamper ASEAN’s fight to eliminate malaria?

Although progress elsewhere in the world has been slow, in the Asia-Pacific, deaths due to the mosquito-borne disease have dropped by 70% and cases have dropped by 22%. Within ASEAN, those figures—according to the Asia Pacific Leaders Malaria Alliance (APLMA)—are 92% and 67% respectively. The battle to eliminate malaria is continually evolving with different species of disease-carrying mosquitoes and parasites presenting new challenges. In 2008, a new strain of malaria that proved resistant to the anti-malarial drug artemisinin, nicknamed “super malaria”, emerged in Cambodia. It spread through the Greater Mekong region into Laos, Thailand and Vietnam and by 2017, it had developed resistance to another drug, piperaquine.

In response, scientists and researchers focused their resources on areas where the new strain was present and were making headway towards eliminating it. COVID-19 could threaten that progress. “We have enough evidence from the Ebola epidemic to suggest how progress on malaria elimination could be derailed and we are seeing some clear warnings now,” APLMA/APMEN commented. Historically, malaria cases have risen in countries where healthcare is interrupted due to conflict, disaster and war.

Peace Corps faces questions over death of volunteer from Inverness

By Sheryl Gay Stolberg of the New York Times reported that the Peace Corps, which suspended all operations for the first time in its history as the novel coronavirus raced around the globe, is facing renewed questions about the quality of its medical care — in particular, after the death of a 24-year-old volunteer from undiagnosed malaria — as it prepares to send volunteers back into the field.

An investigation by the Peace Corps inspector general documented a string of problems with Heiderman’s care. Her doctor had “limited training in tropical medicine,” the investigation found, and failed to test for malaria, which would have revealed that Heiderman had been infected by the deadliest malaria parasite. The Peace Corps was also using outdated 2006 guidelines for malaria, which did not reflect the current standard of care.

Anopheline and human drivers of malaria risk in northern coastal Ecuador

Understanding local anopheline vector species and their bionomic traits, as well as related human factors, can help combat gaps in protection. In San José de Chamanga, Esmeraldas, at the Ecuadorian Pacific coast, anopheline mosquitoes were sampled by both human landing collections (HLCs) and indoor-resting aspirations (IAs) and identified using both morphological and molecular methods.

Among 222 anopheline specimens captured, based on molecular analysis. The exophagic feeding of anopheline vectors in San Jose de Chamanga, when analysed in conjunction with human behaviour, indicates a clear gap in protection even with high LLIN coverage. The lack of indoor-resting anophelines suggests that indoor residual spraying (IRS) may have limited effect. The presence of asymptomatic infections implies the presence of a human reservoir that may maintain transmission.

How useful are malaria risk maps at the country level?

This study examined the perceptions of decision-makers in Kenya, Malawi and the Democratic Republic of Congo. Declining malaria prevalence and pressure on external funding have increased the need for efficiency in malaria control in sub-Saharan Africa (SSA). Modelled Plasmodium falciparum parasite rate (PfPR) maps are increasingly becoming available and provide information on the epidemiological situation of countries. However, how these maps are understood or used for national malaria planning is rarely explored. In this study, the practices and perceptions of national decision-makers on the utility of malaria risk maps, showing prevalence of parasitaemia or incidence of illness, was investigated.

Three different types of maps were used to show malaria epidemiological strata: malaria prevalence using a PfPR modelled map (Kenya); malaria incidence using routine health system data (Malawi); and malaria prevalence using data from the most recent Demographic and Health Survey (DRC). In Kenya the map was used to target preventative interventions, including long-lasting insecticide-treated nets (LLINs) and intermittent preventive treatment in pregnancy (IPTp), whilst in Malawi and DRC the maps were used to target in-door residual spraying (IRS) and LLINs distributions in schools. Maps were also used for operational planning, supply quantification, financial justification and advocacy. Findings from the interviews suggested that decision-makers lacked trust in the modelled PfPR maps when based on only a few empirical data points (Malawi and DRC). Despite the availability of national level modelled PfPR maps in all three countries, they were only used in one country.

Infection of highly insecticide-resistant malaria vector Anopheles coluzzii with entomopathogenic bacteria

This study found that Chromobacterium violaceum reduces its survival, blood feeding propensity and fecundity of mosquitoes in Burkina Faso. The study was motivated by the concern that malaria eradication will not be achieved without the introduction of novel control tools. Microbiological control might be able to make a greater contribution to vector control in the future. The interactions between bacteria and mosquito make mosquito microbiota really promising from a disease control perspective.
Methods

To assess entomopathogenic effects of C. violaceum infection on mosquitoes, three different types of bioassays were performed in laboratory. These bioassays aimed to evaluate the impact of C. violaceum infection on mosquito survival, blood feeding and fecundity, respectively. During bioassays mosquitoes were infected through the well-established system of cotton ball soaked with 6% glucose containing C. violaceum.

The data showed important properties of Burkina Faso C. violaceum strains, which are highly virulent against insecticide-resistant An. coluzzii, and reduce both mosquito blood feeding and fecundity propensities. However, additional studies as the sequencing of C. violaceum genome and the potential toxins secreted will provide useful information render it a potential candidate for the biological control strategies of malaria and other disease vectors.

 

Malaria News Today 2020-10-02/03

Recent news and abstracts include mosquito control using solar disruption of of larval habitats and plants that repel the insects around homes. The challenges of malaria related anemia in pregnancy is discussed. Malaria cases increase in Mali and Mozambique, but in the latter, deaths actually decrease. Malaria parasites have ways of making people more attractive to mosquito bites. Finally covid-19 has not disrupted malaria work as much as anticipated. Read more at the links in the sections below.

Improved Mosquito Control with Solar Power Machine that Causes Ripple Effect

Kristina Panos writes that mosquito haters of the world, rejoice! A few years ago we told you about the first version of this solar-powered mosquito repellent that works by disturbing the surface of standing water. Since then, the project has received worldwide attention, and [Pranav] is back with Solar Scare Mosquito version 2.0 in time for the the 2020 Hackaday Prize.

The idea’s still the same as before: let mosquitoes lay their eggs in the standing waters of tanks and swamps, then disturb the water with vibrations so the larvae on the surface can’t breathe. As smart as this simple idea is, version 2.0 is even smarter. It has a microphone that listens to the wing-beat frequencies of mosquitoes that like to hang around places like that. Inside there’s an Arduino MKR GSM to run the ripple-generating air pump, detect water from the sensor, and gather data from the microphone.

With a network of these devices all reporting data, [Pranav] envisions an early warning system for mosquito-borne epidemics that works by alerting the locals through their phones. Solar Scare Mosquito has come a long way since 2014.

Malaria cases spike in northern Mali

Malaria cases in northern Mali have spiked, according to medical workers, claiming 23 lives in the often lawless desert region last week alone. Mali’s ministry of health said this week that 59 people have died of malaria in the north since the start of the year, almost double the number of deaths over the same period last year.

Already struggling to curb coronavirus, the poor Sahel country is also fighting a brutal jihadist insurgency active in the north and centre of the country.

A powerful attractant: Malaria parasites lure blood-sucking mosquitoes

The malaria parasite’s gametocyte-stage has been demonstrated in the field to heavily manipulate the blood-seeking behaviour of vector mosquitoes through increasing the appeal of biting an infected host.

Plasmodium parasites, the causative agents of Malaria in humans and animals, are well known for manipulating both their human and mosquito hosts as a way of maximising the probability of interactions between them, thereby increasing the chance malaria parasites are transmitted from host to host. One way in which these devious parasites have been shown to increase the probability of host interaction is during their transmissible (gametocyte) stage.

This is achieved by inducing host red blood cells to produce volatile compounds that attract malarial vector species, such as mosquitos in the Anopheles family. The increase in production of volatile compounds, such as certain aldehydes and terpenes, by host red blood cells was shown back in 2017 to be specifically induced by a gametocyte-produced molecule called (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate, also known as HMBPP.

Malaria campaigns fight off Covid disruptions to deliver programmes

Almost all planned work against the disease has gone ahead this year, delivering nets, drugs and the world’s first malaria vaccine. More than 90% of anti-malaria campaigns planned this year across four continents are on track, despite disruptions caused by the coronavirus pandemic, according to new research.

The delivery of insecticide-treated nets and provision of antimalarial medicines in the majority of malaria-affected countries across Africa, Asia and the Americas were still going ahead, a high-level meeting organised by the RBM Partnership to End Malaria heard on Thursday.

Malaria associated with increased prevalence of anemia during pregnancy

Ken Downey Jr. and colleagues conducted a study in seven sub-Saharan African countries demonstrated an association between malaria and an increased prevalence of anemia among pregnant women, according to findings published in BMC Pregnancy and Childbirth.

“Pregnant women in sub-Saharan Africa suffer a double burden of malaria and HIV infections, and these infections interact with each other to cause anemia,” Ssentongo told Healio. “If not treated, the risk of the mother and the unborn baby dying is high. Multipronged strategies to prevent and treat malaria in HIV pregnant women are critical to ensure the survival of the mothers and their unborn babies.”Paddy Ssentongo, MD, MPH, a research assistant professor at Penn State University,

Mozambique: Malaria Cases Increase, Malaria Death Toll Declines

From January to August, 442 people in Mozambique are known to have died from malaria, according to Health Minister Armindo Tiago. Speaking at the launch of a National Home Spraying Campaign, Tiago said the malaria death toll, in the first eight months of the year, was significantly lower than that recorded in the same period in 2019, when 562 people died of the disease.

But although fewer people are dying of malaria, the number of malaria cases has actually increased – from 7.86 million cases in January-August 2019 to 8.36 million in the same months this year. The number of cases rose by 6.4 per cent, but the number of deaths fell by 21.4 per cent. Thus there is the drive to persuade families to change their behaviour.

The Plants That Keep Mosquitoes Away

Protect outdoor areas from mosquitoes and bugs to enjoy evenings outside. Including the following plants in a home garden can provide homeowners with some important weapons in the war against mosquitoes.

1. Citronella Plants: You may already be familiar with citronella plants, as they are known for emitting a strong smell that mosquitoes find objectionable. This group of plants contain citronellal, the active ingredient commonly found in mosquito repellents like citronella patio candles or sprays.

2. The Mint Family: Some members of the mint family have the power to repel mosquitoes, or at least take the sting out of their bites. Check Lemon Balm, Peppermint, Basil, Lavender, Sage, and Catnip.

3. Flowers: Believe it or not, ornamental plants can actually do double duty and function as mosquito repellents. Even better, these plants love sun and are drought resistant. Marigolds, and their relative, tarragoncontain pyrethrum, an ingredient found in many insect repellents. Verbena is a lemon-scented, easy-to-grow perennial. Citrosum is also named “the mosquito plant,” and is one of the best plants in the game for repelling mosquitoes.

Malaria News Today 2020-10-01

News focuses on getting a handle on urban malaria in Uganda and Tanzania. Listen to a program on the disease burden of malaria in Africa.  Chad reports a high test positivity rate. Algeria is re-experiencing malaria after it was officially eliminated. Links for more details are found in each section.

Modelling and mapping the intra-urban spatial distribution of Plasmodium falciparum parasite rate using very-high-resolution satellite derived indicators

Stefanos Georganos, Oscar Brousse, Moritz Lennert, and others in International Journal of Health Geographics report on the rapid and often uncontrolled rural–urban migration in Sub-Saharan Africa is transforming urban landscapes expected to provide shelter for more than 50% of Africa’s population by 2030. Case studies include two Sub-Saharan African cities, Kampala and Dar es Salaam.

Openly accessible land-cover, land-use, population and OpenStreetMap data were employed to spatially model Plasmodium falciparum parasite rate standardized to the age group 2–10 years (PfPR2–10) in the two cities through the use of a Random Forest (RF) regressor. The RF models integrated physical and socio-economic information to predict PfPR2–10 across the urban landscape. Intra-urban population distribution maps were used to adjust the estimates according to the underlying population.

The results suggest that the spatial distribution of PfPR2–10 in both cities is diverse and highly variable across the urban fabric. Dense informal settlements exhibit a positive relationship with PfPR2–10 and hotspots of malaria prevalence were found near suitable vector breeding sites such as wetlands, marshes and riparian vegetation. In both cities, there is a clear separation of higher risk in informal settlements and lower risk in the more affluent neighborhoods. Additionally, areas associated with urban agriculture exhibit higher malaria prevalence values. This study demonstrates the importance of remote sensing as an epidemiological tool for mapping urban malaria variations at large spatial extents, and for promoting evidence-based policy making and control efforts.

Malaria: Africa’s nagging health burden

Listen to Episode Nine of Africa Science Focus is on malaria, which is one of the biggest killers on the continent. “Malaria is so common you can get it anywhere, anyhow, any time,” Jessica, a malaria sufferer in Liberia, tells the programme. This is because Africa’s mosquitoes are “supremely efficient vectors of malaria disease”, says the World Health Organization’s David Schellenberg.

Malaria: More than 500K cases reported in Chad, Deadliest disease in country

According to data from the National Committee for Epidemic Control (CTNLE), out of the 943,040 malaria tests conducted between 1 January and 13 September 2020, a total of 571,258 cases were confirmed (60.5 percent), with 1,280 deaths across the country. In addition close to 1,140,000 suspected cases based on clinical symptoms but who have not been tested. Among these suspected cases, 1,368 people have died. The most affected provinces are, among others, Logone oriental (with a total of 80,930 cases), Mandoul (82 258 cases), Moyen-Chari (60 207 cases), Tandjle (55 777 cases) and N’Djamena (53 976 cases).

Officials say the situation is slightly better than last year around the same period when 689,563 cases were confirmed and 1,323 died – a difference of 118,305 cases and 43 deaths. However, the situation has worsened compared to 2017 and 2018 when the number of confirmed cases were 524,148 and 534,781 (with 957 and 922 deaths) respectively.

Algeria faces new malaria cases one year after victory over deadly disease

Algeria Tuesday registered over 1,000 cases of malaria, one year after the World Health Organization (WHO) declared the country malaria-free. The cases, according to the health ministry, are imported cases and have been spotted in five governorates namely Tamanrasset (918), Adrar (96), Illizi (89), Ouargla (5) and Ghardaïa (2).

The ministry noted that every year, in September after first rains, the country often registers imported malaria cases, hailing from Sahel neighboring countries or Algerians who sojourned in those countries. The WHO in May 2019, declared Algeria malaria-free. The certification is awarded to countries after three straight years of zero home-born cases of malaria.

Malaria News Today 2020-09-30: Diagnostics, Mosquito Genes and Neutrophils

Mosquito populations vary across nations and can be spurred by change in land use and deforestation as seen in Madagascar. Urine and saliva have potential in diagnostics but have lower sensitivity than blood tests. Not all insects have similar genes, and mosquitoes evolved a different gene to handle body segmentation. The DHS Program has released recent Malaria Indicator Surveys for Ghana and Uganda, but indicators are below targets. The emerging roles for neutrophils in malaria will be discussed at a webinar. Finally cost-effectiveness issues around RDTs is noted. More information can be obtained via the hyperlinks.

Variation in Anopheles distribution and predictors of malaria infection risk across regions of Madagascar

Deforestation and land use change is widespread in Madagascar, altering local ecosystems and creating opportunities for disease vectors, such as the Anopheles mosquito, to proliferate and more easily reach vulnerable, rural populations. Knowledge of risk factors associated with malaria infections is growing globally, but these associations remain understudied across Madagascar’s diverse ecosystems experiencing rapid environmental change. This study aims to uncover socioeconomic, demographic, and ecological risk factors for malaria infection across regions through analysis of a large, cross-sectional dataset.

The presence of aquatic agriculture (both within and surrounding communities) is the strongest predictive factor of habitats containing Anopheles larvae across all regions. Ecological and socioeconomic risk factors for malaria infection vary dramatically across study regions and range in their complexity. Risk factors for malaria transmission differ dramatically across regions of Madagascar. These results may help stratifying current malaria control efforts in Madagascar beyond the scope of existing interventions.

Evaluating the potential of using urine and saliva specimens for malaria diagnosis in suspected patients in Ghana

This study aimed at detecting PfHRP2 and pLDH malaria antigens in urine and salivary specimens of suspected malaria patients using RDT kits, and identifying factors influencing the detection of these antigens. Malaria rapid test kit (SD Bioline RDT kit) was used to detect malaria antigens, PfHRP2 and pLDH, in blood, urine and saliva samples received from patients suspected of malaria. Subsequently, malaria parasitaemia was determined.

A total of 706 suspected malaria patients provided all three specimens. Prevalence of malaria by microscopy and RDT was 44.2% and 53.9%, respectively. Compared to blood, the sensitivities of urine and saliva were 35.2% and 57.0% respectively. Haemoglobin concentration?<?9.9 g/dL, body temperature?>?38.7 °C and occult blood influenced the detection of malaria antigens in both urine and saliva. Furthermore, the antigens were not detected in urine and saliva when parasitaemia was?<?60,000 parasites/µL and?<?40,000 parasites/µL, respectively.

Saliva, with or without blood contamination, was found to be more efficient that urine samples. Therefore these non-blood specimens have the potential to be used as non-invasive samples for malaria diagnosis. However, this approach is useful in severe to moderate anaemia, hyperthermia, parasitaemia?>?60,000 parasites/µL and samples contaminated with blood.

Mosquitos lost an essential gene for body segmentation with no ill effects

University of Maryland entomologists discovered that a gene critical for survival in other insects is missing in mosquitoes—the gene responsible for properly arranging the insects’ segmented bodies. The researchers also found that a related gene evolved to take over the missing gene’s job. Although laboratory studies have shown that similar genes can be engineered to substitute for one another, this is the first time that scientists identified a gene that naturally evolved to perform the same critical function as a related gene long after the two genes diverged down different evolutionary paths.

The work emphasizes the importance of caution in genetic studies that use model animals to make conclusions across different species. It also points to a new potential avenue for research into highly targeted mosquito control strategies. The research study was published in the September 30, 2020, issue of the journal Communications Biology. “Every single arthropod has a segmented body plan. And you would think it develops the same way in all of them. But what we found is that it doesn’t,” said Alys Jarvela. “That means different genes probably regulate male fertility in mosquitoes, and they might be unique to the mosquito, which could potentially provide a powerful avenue for controlling mosquitoes without harming other insects such as butterflies and bees,” Jarvela said.

Two New Malaria Indicator Surveys Available

Ghana 2019 MIS/DHS Infographic. Malaria prevalence going down from 27% in 2014 to 14% in 2019. Still below target in terms of ITN coverage of and in households.

Uganda 2018-19 MIS/DHS Infographic.  Wide regional variation in malaria prevalence from 1-5% in the southwest to 34% in the northeast. ITN use by children and pregnant women below 2/3rds, while only 2/5 pregnant women got 3 doses of IPT.

Emerging Roles for Neutrophils in Malaria

Aubrey Cunnington and an interdisciplinary translational research group studying host-pathogen interactions in severe infections, focussing on malaria in particular. See for example,  “A More Granular View of Neutrophils in Malaria

Neutrophils are abundant innate immune cells with crucial roles in immunity and vascular inflammation. Recent evidence indicates that neutrophils have a dual role in malaria, contributing to both pathogenesis and control of Plasmodium. We discuss emerging mechanisms behind these opposing functions and identify key outstanding questions.

Cost-effectiveness analysis of malaria rapid diagnostic test in the elimination setting

As more and more countries approaching the goal of malaria elimination, malaria rapid diagnostic tests (RDT) was recomended to be a diagnostic strategy to achieve and maintain the statute of malaria free, as it’s less requirements on equipment and expertise than microscopic examination. But there are very few economic evaluations to confirm whether RDT was cost-effective in the setting of malaria elimination. This research aimed to offer evidence for helping decision making on malaria diagnosis strategy.

The results showed that RDT strategy was the most effective (245 cases) but also the most costly (United States Dollar [USD] 4.47 million) compared to using microscopy alone (238 cases, USD 3.63 million), and RDT followed by microscopy (221 cases, USD 2.75 million). There was no strategy dominated. One-way sensitivity analysis reflected that the result was sensitive to the change in labor cost and two-way sensitivity analysis indicated that the result was not sensitive to the proportion of falciparum malaria. The result of Monte Carlo simulation showed that RDT strategy had higher effects and higher cost than other strategies with a high probability. Compared to microscopy and RDT followed by microscopy, RDT strategy had higher effects and higher cost in the setting of malaria elimination.