Posts or Comments 28 January 2023

Monthly Archive for "September 2020"



COVID-19 &Health Systems &Health Workers &Household &ITNs &Mosquitoes &Urban Bill Brieger | 16 Sep 2020

Malaria News Today 2020-09-16

Today we learn about malaria-carrying A. stephensi invading African cities, how malaria outpaces COVID-19 in Central African Republic, and the need to examine malaria service delivery in the context of strong health services. Malaria Journal looks at ITN use in Uganda and malaria genetic variability even at the household level. Click on links to read full articles.

Spread of city-loving malaria mosquitoes could pose grave threat to Africa

An Asian malaria-carrying mosquito that has adapted to urban life has the potential to spread to dozens of cities across the African continent, a new modeling study suggests.
The mosquito species, Anopheles stephensi, poses a serious new threat for African cities, says Francesca Frentiu, a geneticist at the Queensland University of Technology who was not involved in the research. She praises the work as “an important effort, underpinned by robust methods.” A. stephensi hopped from Asia to the Arabian Peninsula between 2000 and 2010 and then made another jump to the Horn of Africa; scientists first discovered it in Djibouti in 2012, then later in Ethiopia and Sudan.

In times of COVID-19, malaria remains the number one killer of children in CAR

Since the beginning of the year, MSF teams have treated 39,631 malaria cases in Batangafo, compared to 23,642 in the same period last year. The hospital in Batangafo – a town of 31,000 people, including 22,000 displaced from elsewhere in the Central African Republic – is bustling with activity. While a particular focus has been placed on infection prevention and control measures to identify and isolate people with suspected cases of COVID-19, another deadly disease has a much heavier impact on the lives of people living here.

September is the rainy season, when malaria becomes more deadly than ever in the Central African Republic each year. It is the leading cause of death for children under five in the country. During periods when malaria transmission is high, eight out of ten paediatrics consultations in the hospital supported by Médecins Sans Frontières (MSF) in Batangafo are due to complications from malaria, including anaemia and dehydration.

Assessment of health service delivery parameters in Kano and Zamfara States, Nigeria

In 2013, the Nigeria Federal Ministry of Health established a Master Health Facility List (MHFL) as recommended by WHO. Since then, some health facilities (HFs) have ceased functioning and new facilities were established. We updated the MHFL and assessed service delivery parameters in the Malaria Frontline Project implementing areas in Kano and Zamfara States.

In 2016, the US Centers for Disease Control and Prevention (CDC), in collaboration with the Nigeria National Malaria Elimination Program (NMEP), established a 3-year intervention project, Malaria Frontline Project (MFP), with the objectives of strengthening the technical capacity of LGA-level health workers, improving malaria surveillance and facilitating evidence-based decision-making. The project was implemented in Kano and Zamfara States.

Some deficiencies in the list of facilities in DHIS2 and MHFL were uncovered making it difficult to submit and access malaria program data. Also, some facilities were still using the old version of register which did not collect all indicators required by DHIS2. In addition there were a small number of non-functional facilities. Finally the low number of facilities within the PHC category meeting the minimum HR requirement will hamper the countries effort to achieve its goal of universal health coverage. From the foregoing, the study identifies several areas to improve delivery of malaria services specifically and universal coverage in general.

Individual, community and region level predictors of insecticide-treated net use among women in Uganda: a multilevel analysis

ITN use attributable to regional and community level random effects was 39.1% and 45.2%, respectively. The study has illustrated that ITN policies and interventions in Uganda need to be sensitive to community and region level factors that affect usage. Also, strategies to enhance women’s knowledge on malaria prevention is indispensable in improving ITN use.

Genetic diversity and complexity of Plasmodium falciparum infections in the microenvironment among siblings of the same household in North-Central Nigeria

These findings showed that P. falciparum isolates exhibit remarkable degree of genetic diversity in the micro-environment of the household and are composed mainly of multiclonal infections, which is an indication of a high ongoing parasite transmission. This suggests that the micro-environment is an important area of focus for malaria control interventions and for evaluating intervention programmes.

Agriculture &Artesunate &Case Management &Children &Drug Development &Elimination &Funding &NTDs &Resistance Bill Brieger | 16 Sep 2020

Malaria News Today 2020-09-15

Malaria Journal released three articles ranging from the relation between malaria and agricultural irrigation, artemisinin resistance on the Myanmar-China border, and efforts at costing malaria elimination interventions. PLoS Medicine examined the quality of malaria clinical management in children. Finally, Frontiers in Cellular and Infection Microbiology reported on a new drug against malaria and toxoplasmosis. Click on links to read more details.

Minimal tillage and intermittent flooding farming systems show a potential reduction in the proliferation of Anopheles mosquito larvae in a rice field in Malanville, Northern Benin

Irrigation systems have been identified as one of the factors promoting malaria disease around agricultural farms in sub-Saharan Africa. However, if improved water management strategy is adopted during rice cultivation, it may help to reduce malaria cases among human population living around rice fields.

A clear reduction of larva density was observed with both intermittent flooding systems applied to minimal tillage (MT?+?IF?+?NL) and intermittent flooding applied to deep tillage (DT?+?IF?+?AL), showing that intermittent flooding could reduce the abundance of malaria vector in rice fields. Recommending intermittent flooding technology for rice cultivation may not only be useful for water management but could also be an intentional strategy to control mosquitoes vector-borne diseases around rice farms.

No evidence of amplified Plasmodium falciparum plasmepsin II gene copy number in an area with artemisinin-resistant malaria along the China–Myanmar border

The emergence and spread of artemisinin resistance in Plasmodium falciparum poses a threat to malaria eradication, including China’s plan to eliminate malaria by 2020. Piperaquine (PPQ) resistance has emerged in Cambodia, compromising an important partner drug that is widely used in China in the form of dihydroartemisinin (DHA)-PPQ. Several mutations in a P. falciparum gene encoding a kelch protein on chromosome 13 (k13) are associated with artemisinin resistance and have arisen spread in the Great Mekong subregion, including the China–Myanmar border. Multiple copies of the plasmepsin II/III (pm2/3) genes, located on chromosome 14, have been shown to be associated with PPQ resistance.

DHA-PPQ for uncomplicated P. falciparum infection still showed efficacy in an area with artemisinin-resistant malaria along the China–Myanmar border. There was no evidence to show PPQ resistance by clinical study and molecular markers survey. Continued monitoring of the parasite population using molecular markers will be important to track emergence and spread of resistance in this region.

Costing malaria interventions from pilots to elimination programmes

Malaria programmes in countries with low transmission levels require evidence to optimize deployment of current and new tools to reach elimination with limited resources. Recent pilots of elimination strategies in Ethiopia, Senegal, and Zambia produced evidence of their epidemiological impacts and costs. There is a need to generalize these findings to different epidemiological and health systems contexts. Drawing on experience of implementing partners, operational documents and costing studies from these pilots, reference scenarios were defined for rapid reporting (RR), reactive case detection (RACD), mass drug administration (MDA), and in-door residual spraying (IRS). These generalized interventions from their trial implementation to one typical of programmatic delivery. In doing so, resource use due to interventions was isolated from research activities and was related to the pilot setting. Costing models developed around this reference implementation, standardized the scope of resources costed, the valuation of resource use, and the setting in which interventions were evaluated. Sensitivity analyses were used to inform generalizability of the estimates and model assumptions.

Populated with local prices and resource use from the pilots, the models yielded an average annual economic cost per capita of $0.18 for RR, $0.75 for RACD, $4.28 for MDA (two rounds), and $1.79 for IRS (one round, 50% households). Intervention design and resource use at service delivery were key drivers of variation in costs of RR, MDA, and RACD. Scale was the most important parameter for IRS. Overall price level was a minor contributor, except for MDA where drugs accounted for 70% of the cost. The analyses showed that at implementation scales comparable to health facility catchment area, systematic correlations between model inputs characterizing implementation and setting produce large gradients in costs. Prospective costing models are powerful tools to explore resource and cost implications of policy alternatives. By formalizing translation of operational data into an estimate of intervention cost, these models provide the methodological infrastructure to strengthen capacity gap for economic evaluation in endemic countries. The value of this approach for decision-making is enhanced when primary cost data collection is designed to enable analysis of the efficiency of operational inputs in relation to features of the trial or the setting, thus facilitating transferability.

Quality of clinical management of children diagnosed with malaria: A cross-sectional assessment in 9 sub-Saharan African countries between 2007–2018

Appropriate clinical management of malaria in children is critical for preventing progression to severe disease and for reducing the continued high burden of malaria mortality. This study aimed to assess the quality of care provided to children under 5 diagnosed with malaria across 9 sub-Saharan African countries. We used data from the Service Provision Assessment (SPA) survey. SPAs are nationally representative facility surveys capturing quality of sick-child care, facility readiness, and provider and patient characteristics across 9 countries, including Uganda (2007), Rwanda (2007), Namibia (2009), Kenya (2010), Malawi (2013), Senegal (2013–2017), Ethiopia (2014), Tanzania (2015), and Democratic Republic of the Congo (2018).

In this study, we found that a majority of children diagnosed with malaria across the 9 surveyed sub-Saharan African countries did not receive recommended care. Clinical management is positively correlated with the stocking of essential commodities and is somewhat improved in more recent years, but important quality gaps remain in the countries studied. Continued reductions in malaria mortality will require a bigger push toward quality improvements in clinical care. Despite increases in the distribution of malaria tests and effective antimalarial medications, significant gaps in the quality of care for pediatric malaria are present in these 9 countries. Further improvements in quality of malaria care may require a better understanding of remaining barriers and facilitators to appropriate management.

Novel drug could be a powerful weapon in the fight against malaria and toxoplasmosis

Princeton researchers are making key contributions toward developing a promising new treatment for the widespread and devastating diseases toxoplasmosis and malaria.
The Princeton scientists specialize in preparing the drug compound into a medicine that is both safe and effective for humans and able to reach its intended sites of action in the body in sufficient doses. An international team of scientists found the new drug—designated JAG21—to be highly effective against parasites in cell-based studies in the lab. After the discovery, team representatives contacted Princeton’s Robert Prud’homme for help in translating the JAG21 compound into a deliverable medication. Prud’homme is a co-author of a study, published in June 2020 in Frontiers in Cellular and Infection Microbiology, that describes the compound and its excellent preliminary results in mice.

Case Management &Children &CHW &Communication &COVID-19 &Education &Gender &ITNs &Politics Bill Brieger | 13 Sep 2020

Malaria News Today 2020-09-12/13 Weekend

Recent news over this weekend included efforts at school and peer education on bednets in Ethiopia, gender inequality effects of COVID-19 and pandemics, a reduction in severe malaria in Rwanda and increased use of home based case management, and the altering of scientific reports by political appointees. Links in these summaries take one to the full story.

Effectiveness of peer-learning assisted primary school students educating the rural community on insecticide-treated nets utilization in Jimma-zone Ethiopia

Abstract: Making insecticide-treated nets (ITNs) utilization a social norm would support the global goal of malaria eradication and Ethiopian national aim of its elimination by 2030. Jimma zone is one of the endemic settings in Ethiopia. This study aimed to report effects of malaria education, delivered by students, on community behaviours; particularly ITNs. The intervention engaged students from primary schools in participatory peer education within small groups, followed by exposing parents with malaria messages aimed at influencing perceptions and practices.

Over the intervention periods, the findings showed significant improvement in exposure to and content intensity of malaria messages delivered by students. Socio-demography, access, exposures to messages, and parental perception that students were good reminders predicted ITN utilization over the intervention periods with some changing patterns. Exposing the community to malaria education through students effectively supports behaviour change, particularly ITN usage, to be more positive towards desired malaria control practices. A school-based strategy is recommended to the national effort to combat malaria.

Melinda Gates calls on Leaders to Ensure that Women, Girls are Not Left Behind in the Global Response to COVID-19

Melinda Gates has launched a paper exploring how the COVID-19 pandemic has exploited pre-existing inequalities and drastically impacted women’s lives and livelihoods. In the paper, titled “The Pandemic’s Toll on Women and Girls,” Melinda makes the case that to recover fully from this pandemic, leaders must respond to the ways that it is affecting men and women differently. She puts forward a set of specific, practical policy recommendations that governments should consider in their pandemic response—to improve health systems for women and girls, design more inclusive economic policies, gather better data, and prioritize women’s leadership.Writing in the paper, Melinda describes how previous disease outbreaks, including AIDS and Ebola, tend to exploit existing forces of inequality, particularly around gender, systemic racism, and poverty.
Melinda concludes, “This is how we can emerge from the pandemic in all of its dimensions: by recognizing that women are not just victims of a broken world; they can be architects of a better one.

Severe malaria drops by 38% in Rwanda

In its annual Malaria and Neglected Tropical Diseases Report, the Ministry of Health says that the national malaria incidence reduced from 401 cases per 1,000-person in 2017-2018 fiscal year to 200 cases per 1,000-person in 2019-2020. According to the report, 4,358 cases of severe malaria (representing a 38 per cent reduction) were reported at the health facility level compared to 7,054 in 2018-2019. The decrease in malaria deaths is attributed to home based management interventions, the free treatment of malaria for Ubudehe Categories I and II and the quality of care at health facility level.

There has also been a steady increase of proportion of children under 5 and above plus adults who are seeking care from 13 per cent to 58 per cent in 2015-2016 and 2019-2020 respectively. “This indicates that interventions such home based treatment of children and adults that contributed to early diagnosis and treatment have been successful in decreasing the number of severe cases and consequently the number of malaria deaths,” the report indicates.

Political appointees sought to alter CDC scientific reports so they don’t contradict or undermine the president

Caputo (a US presidential appointee) and his communications staff have worked to delay CDC reports that contradict President Donald Trump’s rhetoric. One publication was held back for about a month, according to Politico, for recommending against the use of hydroxychloroquine, a malaria drug touted by the White House as a potential cure for COVID-19.

The reports, written by career scientists, are known as the Morbidity and Mortality Weekly Reports, and according to Politico, are used to “inform doctors, researchers, and the general public about how Covid-19 is spreading and who is at risk.” Jennifer Kates, of the Kaiser Family Foundation’s global health work, who has relied on past reports, told Political they are “the go-to place for the public health community to get information that’s scientifically vetted.” Alexander (a presidential appointee), in this missive, said any future reports related to the coronavirus “must be read by someone outside of CDC like myself.”

Climate &COVID-19 &Dengue &Diagnosis &Environment &Invest in Malaria Control &Mapping &mHealth &Migration &Mosquitoes &Nomadic People &Surveillance Bill Brieger | 11 Sep 2020

Malaria News Today 2020-09-11

Today’s news and abstracts look at a variety of issues ranging from overall malaria funding funding needs to the effect of climate change on different types of mosquitoes and the diseases they carry (e.g. malaria vs dengue). We also examine the need for surveillance among nomadic groups and the use of cell phones in a saliva based malaria testing system. Please click the links below to read more on each subject.

Rwanda: Government Needs U.S.$70 Million to Fill Malaria Financing Gap

By Nasra Bishumba: The Government needs $73 million to bridge the funding in the funds needed to fight malaria between 2020 and 2024, The New Times can reveal. The Rwanda National Strategic Plan 2020-2024 to fight malaria drawn up in June this year indicates that although the implementation requires Rwf295bn ($280 million), the government already has funding commitment to the tune of $206.8m (equivalent to 74 per cent).

According to the strategic plan, a copy of which The New Times has seen, this leaves a gap of $73m which it hopes to mobilize from different sources. With these funds, the government is seeking to protect at least 85 per cent of the population with preventive interventions and to work towards promptly testing and treating suspected malaria cases by 2024. To achieve this, the biggest chunk of the funds will be invested in malaria prevention to a tune of $186m, an equivalent of 66 per cent of the entire budget.

Climate Change May Shift Risks of Mosquito-borne Diseases

By Asher Jones: More dengue, less malaria. That may be the future in parts of Africa on a warming planet, depending on where you live. New research says it’s all about which mosquitoes will thrive. And the methods to control one don’t necessarily work on the other.

The mosquito that spreads malaria prefers relatively cool temperatures of 25 degrees Celsius (77 degrees Fahrenheit). The dengue mosquito does best at 29 degrees Celsius (84.2 degrees Fahrenheit). Because of this difference in optimal temperatures, “We would actually predict that climate change might have opposing effects [on disease transmission],” said Erin Mordecai, assistant professor of biology at Stanford University and lead author on the study. “Climate change might make it less suitable for malaria to be transmitted but more suitable for dengue to be transmitted.”

Africa’s Nomadic Pastoralists and Their Animals Are an Invisible Frontier in Pandemic Surveillance

@ASTMH The effects of COVID-19 have gone undocumented in nomadic pastoralist communities across Africa, which are largely invisible to health surveillance systems despite the fact that they are of key significance in the setting of emerging infectious disease. We expose these landscapes as a “blind spot” in global health surveillance, elaborate on the ways in which current health surveillance infrastructure is ill-equipped to capture pastoralist populations and the animals with which they coexist, and highlight the consequential risks of inadequate surveillance among pastoralists and their livestock to global health. As a platform for further dialogue, we present concrete solutions to address this gap.

Mobile phone-based saliva test wins NIH prize

Cornell researchers’ concept for a quick, non-invasive, mobile phone-based system to detect infectious diseases, inflammation and nutritional deficiencies in saliva was awarded a $100,000 National Institutes of Health Technology Accelerator Challenge prize. The NIH’s prize challenge encourages the development of new, non-invasive diagnostic technologies important for global health. For the group’s saliva-based test, a small 3D-printed adapter is clipped to a mobile phone and synced with a mobile app. The app uses the phone’s camera to image test strips to detect malaria, iron deficiency and inflammation, with results in under 15 minutes.

The proposal builds on the FeverPhone and NutriPhone platforms developed by the team at Cornell’s Institute for Nutritional Sciences, Global Health and Technology (INSiGHT). The technologies, funded by the NIH and the National Science Foundation, evaluate infections and nutritional status using blood. According to Mehta, technologies using salivary biomarkers could revolutionize how conditions such as malaria and iron deficiency are identified and addressed, especially in settings where access to primary health care and traditional, laboratory-based tests is limited.

Monsoon infections: How to tell the difference between dengue and malaria? Watch out for these symptoms

While both diseases are mosquito-borne and cause similar symptoms such as fever, joint/muscle pain, headaches, and fatigue, some differences between their symptoms can help you identify the specific infections. Unique symptoms of Malaria: Stomach problems such as vomiting, Diarrhoea, Dry cough, Shivering, Spleen enlargement Unique symptoms of Dengue: Pain behind the eyes, Swollen glands, Rashes

Diagnosis &Elimination &Environment &Health Information &Health Systems &History &Invest in Malaria Control &Microscopy &Surveillance &Trachoma Bill Brieger | 10 Sep 2020

Malaria News Today 2020-09-10

These malaria and related news and abstracts stress the importance of sentinel surveillance systems, strong political and systems commitment to disease elimination, malachite green loop-mediated isothermal amplification for better malaria detection, and the threat of neglected fungal infections. An article from The Lancet shows that it is not just money that is needed to eliminate malaria, but better management and systems. Finally a bit of history from 18th Century North Carolina is shared. Click the links in each section to learn more about each topic.

Implementation of a malaria sentinel surveillance system in Togo: a pilot study

Since July 2017, 16 health facilities called sentinel sites, 4 hospitals and 12 peripheral care units located in 2 epidemiologically different health regions of Togo, have provided weekly data on malaria morbidity and mortality for the following 3 target groups:?<?5-years-old children,???5-years-old children and adults, and pregnant women. Data from week 29 in 2017 to week 13 in 2019 were analysed.

Each sentinel site provided complete data and the median time to data entry was 4 days. The number of confirmed malaria cases increased during the rainy seasons both in children under 5 years old and in children over 5 years old and adults. Malaria-related deaths occurred mainly in children under 5 years old and increased during the rainy seasons. The mean percentage of tested cases for malaria among suspected malaria cases was 99.0%. The mean percentage of uncomplicated malaria cases handled in accordance with national guidelines was 99.4%. The mean percentage of severe malaria cases detected in peripheral care units that were referred to a hospital was 100.0%. Rapid diagnostic tests and artemisinin-based combination therapies were out of stock several times, mainly at the beginning and end of the year. No hospital was out of stock of injectable artesunate or injectable artemether.

These indicators showed good management of malaria cases in the sentinel sites. Real-time availability of data requires a good follow-up of data entry on the online platform. The management of input stocks and the promptness of data need to be improved to meet the objectives of this malaria sentinel surveillance system.

Evaluation of the colorimetric malachite green loop-mediated isothermal amplification (MG-LAMP) assay …

… for the detection of malaria species at two different health facilities in a malaria endemic area of western Kenya. Prompt diagnosis and effective malaria treatment is a key strategy in malaria control. However, the recommended diagnostic methods, microscopy and rapid diagnostic tests (RDTs), are not supported by robust quality assurance systems in endemic areas. This study compared the performance of routine RDTs and smear microscopy with a simple molecular-based colorimetric loop-mediated isothermal amplification (LAMP) at two different levels of the health care system in a malaria-endemic area of western Kenya.

Patients presenting with clinical symptoms of malaria at Rota Dispensary (level 2) and Siaya County Referral Hospital (level 4) were enrolled into the study after obtaining written informed consent. Capillary blood was collected to test for malaria by RDT and microscopy at the dispensary and county hospital, and for preparation of blood smears and dried blood spots (DBS) for expert microscopy and real-time polymerase chain reaction (RT-PCR).

Results of the routine diagnostic tests were compared with those of malachite green loop-mediated isothermal amplification (MG-LAMP) performed at the two facilities.
A total of 264 participants were enrolled into the study. At the dispensary level, the positivity rate by RDT, expert microscopy, MG-LAMP and RT-PCR was 37%, 30%, 44% and 42%, respectively, and 42%, 43%, 57% and 43% at the county hospital. Using RT-PCR as the reference test, the sensitivity of RDT and MG-LAMP was 78.1% (CI 67.5–86.4) and 82.9% (CI 73.0–90.3) at Rota dispensary.

At Siaya hospital the sensitivity of routine microscopy and MG-LAMP was 83.3% (CI 65.3–94.4) and 93.3% (CI 77.9–99.2), respectively. Compared to MG-LAMP, there were 14 false positives and 29 false negatives by RDT at Rota dispensary and 3 false positives and 13 false negatives by routine microscopy at Siaya Hospital. MG-LAMP is more sensitive than RDTs and microscopy in the detection of malaria parasites at public health facilities and might be a useful quality control tool in resource-limited settings.

Terminating Trachoma. How Myanmar eliminated blinding trachoma.

Download the book  from WHO New Delhi: World Health Organization, Regional Office for South-East Asia; 2020. Licence: CC BY-NC-SA 3.0 IGO.  Myanmar’s three-phase approach to eliminating trachoma has been a great success, which will certainly continue. The country’s visionary National Eye Health Plan 2017-2021, which is closely aligned with international policies for prevention of blindness, gives confidence that Myanmar will maintain its elimination status. This book chronicles how a combination of good leadership, effective partnerships, health-care facilities and hardworking health-care personnel helped Myanmar eliminate trachoma as a public health problem.

Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health, SDG Progress

Although the progress towards Sustainable Development Goal (SDG) 3, which aims to “ensure healthy lives and promote well-being for all at all ages”, has been assessed in various works, there is less research focusing on tracking spending towards this goal. In this study, spending estimates were used to determine progress in financing the priority areas of SDG3, examine the correlation between outcomes and financing, and identify where resource gains are most required to attain the SDG3 indicators for which data are available.

From 1995 to 2017, domestic health spending was determined, disaggregated by source (government, out-of-pocket, and prepaid private) for 195 countries and territories. Outcomes suggest a global rise in total health spending since the state of the SDGs in 2015, reaching $7·9 trillion (7·8–8·0) in 2017, and is estimated to rise to $11·0 trillion (10·7–11·2) by 2030, although with substantial disparity across countries. Per estimates, low-income and middle-income countries, in 2017, had an estimated spending of $20·2 billion on HIV/AIDS, $10·9 billion on tuberculosis, and $5·1 billion on malaria in endemic countries.

Although there is an increase in both domestic government and DAH spending, across these three diseases, variation in the accompanied changes in outcomes was observed. Malaria was noted to have the most consistent reductions in outcomes across countries as spending has raised. Findings thereby suggest mixed progress towards meeting the SDG3 targets; the progress varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that outcomes do not always improve with increases in spending.

Although more resources may be required by the countries to achieve SDG3, there will also be a necessity for addressing other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages.

Ignored fungal infections kill more people annually than HIV and malaria combined

Carolina Pohl-Albertyn says that, “You may also know that there are other infections causing great concern, such as HIV (690 000 deaths/year), tuberculosis (1.5-million deaths/year), and malaria (405,000 deaths/year). But what would be your reaction if you knew that fungal infections (ranging from skin and mucosal infections (e.g. vaginal or oral thrush) to deadly systemic and organ infections (e.g. candidiasis, cryptococcal meningitis, and bronchopulmonary aspergillosis]) affect more than one-billion people each year, of which more than 150-million cases are severe and life-threatening and cause 1.7 million deaths per year?”

Malaria was once scourge in Chowan County, North Carolina

Nicole Bowman-Layton (Editor) provides some history of malaria. It’s fascinating to think that less than 100 years ago this disease was still a major scourge in Chowan County. I’ve wanted to write about this topic for a long time since the coronavirus popped up but was a bit concerned about writing about a somewhat depressing topic.

According to NCPedia malaria came to North Carolina in the 1500s from some of the first European explorers who were bitten by our friendly Anopheles mosquitoes and then transmitted to the native population. And as we well know, we live in a very damp environment surrounded by sitting water which certainly increases the harvest of mosquitos. Some of the most prominent Revolutionary Edentonians suffered from the “Ague” during their lives. Declaration signer Joseph Hewes suffered from “intermittent fever and ague” throughout his life which were certainly symptoms of malaria.

The German traveler Dr. Johan Schoepf wrote in his book Travels in the Confederation, 1783-1784, of “…the sickliness of the inhabitants, especially prevalent in the low, overflowed, and swampy parts of this country, and giving the people a pale, decayed, and prematurely old look. This is the case not only about Edenton, but along the entire low-lying coast, which this fall, from Virginia to South Carolina, was visited with numerous fevers.

Community &COVID-19 &Infection Prevention &Innovation &Zoonoses Bill Brieger | 10 Sep 2020

Innovate4AMR emphasizes social innovations in resource-limited settings

From Innovate4AMR Team: We are reaching out about Innovate4Health, a global design sprint for student teams to design innovative solutions to address emerging infectious diseases.
This collaborative design sprint grows out of our past two years’ worth of work organizing Innovate4AMR. With COVID-19, we have broadened the scope from drug-resistant infections to tackling urgent challenges and health inequities of emerging infectious diseases. Organized by the ReAct—Action on Antibiotic Resistance, the International Federation of Medical Students’ Associations (IFMSA), and the IDEA (Innovation + Design Enabling Access) Initiative at the Johns Hopkins Bloomberg School of Public Health, Innovate4Health offers student teams the opportunity to join the front lines of the fight against antimicrobial resistance and COVID-19.
This year, student teams are encouraged to innovate around one of three pillars: 1) Ensuring effective prevention and treatment of emerging infectious diseases in the hospital setting; 2) Preventing zoonotic disease transmission in food systems; and 3) Making community health systems more resilient to emerging infectious diseases. We hope that you might pass this along to faculty colleagues at universities and share this opportunity with potentially interested students.
Taking a systems approach, Innovate4Health emphasizes social innovations that consider the needs of resource-limited settings. We are looking for student teams (2-4 students per team) with ideas for innovative solutions. Through the design sprint, teams will work through ideation, implementation, and advocacy strategies to support the adoption of these approaches. The selected teams will work with a team of experts to co-construct their solutions through both recorded and live learning sessions. We invite applications from teams that would be excited to collaborate with other highly talented student teams.
The design sprint will extend over three to four months. We will explore the local context of resource-limited settings through guided tours through virtual healthscapes, from a wet market to a secondary hospital.
Students do not need any previous experience on antimicrobial resistance (AMR) or other emerging infectious diseases. In the competitive application process, we are looking for student teams providing a vision for what they might want to innovate, including the specific problem and context, as well as sharing how they might be positioned to help implement such a project.
At the application stage, however, we do not expect fully developed projects. The design sprint process is intended to help teams develop further their ideas from the application stage. Innocate4AMR have outlined additional information on Innovate4Health on our website. There, you will also find more background information on Innovate4Health, as well as the design sprint timeline, Terms and Conditions, and submission guidelines. Last year, 163 student teams answered our call for Innovate4AMR applications, and ten finalist teams were selected.
The deadline for team applications is Sunday, October 18, 2020. Those selected to participate in the design sprint will go through developing stages of idea refinement, implementation planning, and advocacy planning, after which the best teams will have the opportunity to present to an international panel. We will be releasing additional resources to support teams in developing applications, and interested students can sign up for updates here.
Innovate4AMR would appreciate your help in spreading the word about Innovate4Health. If you or your students have further questions, please write our team at innovate4amr@gmail.com.
 

Anemia &Dracunculiasis Guinea Worm &Elimination &Leishmaniasis &MDA &Schistosomiasis Bill Brieger | 09 Sep 2020

NTD News Today 2020-09-09 from ASTMH

The current table of contents from the American Journal of Tropical Medicine and Hygiene features several important articles on neglected tropical diseases and malaria. Below are abstracts of several with links to the journal.

Agent-Based Simulation for Seasonal Guinea Worm Disease in Chad Dogs

The campaign to eradicate dracunculiasis (Guinea worm [GW] disease) and its causative pathogen Dracunculus medinensis (GW) in Chad is challenged by infections in domestic dogs, which far outnumber the dwindling number of human infections. We present an agent-based simulation that models transmission of GW between a shared water source and a large population of dogs. The simulation incorporates various potential factors driving the infections including external factors and two currently used interventions, namely, tethering and larvicide water treatments.

By defining and estimating infectivity parameters and seasonality factors, we test the simulation model on scenarios where seasonal patterns of dog infections could be driven by the parasite’s life cycle alone or with environmental factors (e.g., temperature and rainfall) that could also affect human or dog behaviors (e.g., fishing versus farming seasons).

We show that the best-fitting model includes external factors in addition to the pathogen’s life cycle. From the simulation, we estimate that the basic reproductive number, R 0, is approximately 2.0; our results also show that an infected dog can transmit the infection to 3.6 other dogs, on average, during the month of peak infectivity (April). The simulation results shed light on the transmission dynamics of GWs to dogs and lay the groundwork for reducing the number of infections and eventually interrupting transmission of GW.

Village Response to Mass Drug Administration for Schistosomiasis in Mwanza Region, Northwestern Tanzania

Are We Missing Socioeconomic, Cultural, and Political Dimensions?

Praziquantel (PZQ)-based mass drug administration (MDA) is the main approach for controlling schistosomiasis in endemic areas. Interventions such as provision and use of clean and safe water, minimizing contacts with infested water, disposal of human waste in latrines, and snail control provide additional key interventions to break the transmission cycle and could complement and perhaps sustain the benefits of MDA. However, all interventions deployed need to be accepted by the targeted communities. A qualitative study was conducted to examine factors that might differentiate villages which did not show a substantial decrease in Schistosoma mansoni prevalence despite repeated, high treatment coverage referred to as “persistent hotspot villages” from villages which showed a substantial decrease in prevalence referred to as “responding (RES) villages.” A convenient sample of adults was drawn from eight villages. Thirty-nine key informants were interviewed and 16 focus groups were held with a total of 123 participants. Data were analyzed manually using a thematic content approach. In both hotspot and RES villages, schistosomiasis was not considered to be a priority health problem because of its chronic nature, lack of knowledge and awareness, and poverty among study communities.

Hotspot villages exhibited poor leadership style, lack of or insufficient social engagement, little or lack of genuine community participation, little motivation, and commitment to schistosomiasis control compared with RES villages where there were commitment and motivation to fight schistosomiasis. We support the view of scholars who advocate for the adoption of a biosocial approach for effective and sustainable PZQ-based MDA for schistosomiasis control.

Assessment of Incubation Period of Cutaneous Leishmaniasis due to Leishmania major in Tunisia

The period between the infective sandfly bites and appearance of cutaneous leishmaniasis (CL) lesions is still hypothetical and little studied. This work aimed at assessing the incubation time of zoonotic CL (ZCL) due to Leishmania major using a standardized methodology. The retrospective analysis used the epidemiological, clinical, and biological information available in the database recording all the CL cases diagnosed at the Parasitology Department of the Pasteur Institute of Tunis during 2015–2019. It allowed for the selection of 92 privileged observations 1) of confirmed CL cases with presentation suggestive of ZCL form 2) living in northern regions free of ZCL 3) with a single infective trip of less than a week to ZCL foci during transmission season and 4) with accurate dates of travel and onset of lesions. Incubation length computed in this population ranged from 1 to 21 weeks, with a median of 5 weeks (interquartile range: 3–8.5 weeks).

Schistosoma mansoni Vector Snails in Antigua and Montserrat

Snail-Related Considerations Pertinent to a Declaration of Elimination of Human Schistosomiasis.

Investigations leading to a WHO-validated declaration of elimination of schistosomiasis transmission are contemplated for several countries, including Caribbean island nations. With assistance from the Pan American Health Organization, we undertook freshwater snail surveys in two such nations, Antigua and Barbuda, and Montserrat in September and October 2017. Historically, the transmission of Schistosoma mansoni supported by the Neotropical vector snail Biomphalaria glabrata occurred in both countries. Transmission on the islands is thought to have been interrupted by the treatment of infected people, improved sanitation, introduction of competitor snails, and on Montserrat with the eruption of the Soufrière volcano which decimated known B. glabrata habitats. Guided by the available literature and local expertise, we found Biomphalaria snails in seven of 15 and one of 14 localities on Antigua and Montserrat, respectively, most of which were identified anatomically and molecularly as Biomphalaria kuhniana.

Two localities on Antigua harbored B. glabrata, but no schistosome infections in snails were found. For snail-related aspects of validation of elimination, there are needs to undertake basic local training in medical malacology, be guided by historical literature and recent human schistosomiasis surveys, improve and validate sampling protocols for aquatic habitats, enlist local expertise to efficiently find potential transmission sites, use both anatomical and molecular identifications of schistosomes or putative vector snail species found, if possible determine the susceptibility of recovered Biomphalaria spp. to S. mansoni, publish survey results, and provide museum vouchers of collected snails and parasites as part of the historical record.

Decreased Mortality of falciparum Malaria in Anemic Prisoners of War?

Modern clinical trials have suggested that anemia protects against malaria mortality. Military records of the Second World War in Asia were examined to see if there was support for this hypothesis. When relatively well-nourished Imperial Japanese Navy sailors captured on Nauru (n = 799) were imprisoned on the Fauro Islands, 26% died from falciparum malaria. Similarly treated but very malnourished colocated Imperial Army soldiers experienced low stable malaria mortality. One-fifth of previously healthy Australian Army soldiers (n = 252) retreating from New Britain died largely because of malaria in April 1942. Malnourished prisoners of war, who were as a group very anemic, both Australian Army soldiers in Thailand and Japanese Army soldiers in Papua New Guinea, had high malaria rates but very low (< 3%) mortality rates. Malaria immunity does not adequately explain this dichotomy, suggesting that severe nutritional deprivation may be protective against malaria mortality possibly because of iron-deficiency anemia.

COVID-19 &Diagnosis &Ebola &Malaria in Pregnancy &MDA &NTDs &Trachoma &Zoonoses Bill Brieger | 08 Sep 2020

Malaria News Today 2020-09-08

Today we share news and abstracts concerning detecting malaria in pregnancy, news about the opening remarks from the WHO Director General at a special malaria and COVID-19 webinar, resumption of NTD activities after COVID-19 restrictions reduced, and mapping of Ebola carrying bats whose territory overlaps malaria in Africa. Click on the links to read more.

Prevalence and clinical impact of malaria infections detected with a highly sensitive HRP2 rapid diagnostic test in Beninese pregnant women

While sub-microscopic malarial infections are frequent and potentially deleterious during pregnancy, routine molecular detection is still not feasible. This study aimed to assess the performance of a Histidine Rich Protein 2 (HRP2)-based ultrasensitive rapid diagnostic test (uRDT, Alere Malaria Ag Pf) for the detection of infections of low parasite density in pregnant women.

This study demonstrates the higher performance of uRDT, as compared to cRDTs, to detect low parasite density P. falciparum infections during pregnancy, particularly in the 1st trimester. uRDT allowed the detection of infections associated with maternal anaemia.

The distribution range of Ebola virus carriers in Africa may be larger than previously assumed

Since Ebola overlaps both symptomatically and geographically with malaria in Africa, it is “Worrying that science has hitherto underestimated the range of Ebola-transmitting bat and fruit bat species. In this case, the models would provide a more realistic picture,” explains Dr. Lisa Koch

Based on ecological niche modeling, his team was able to show that the respective bat and fruit bat species are able to thrive in West and East Africa, including large parts of Central Africa. A wide belt of potential habitats extends from Guinea, Sierra Leone, and Liberia in the west across the Central African Republic, the Republic of the Congo and the Democratic Republic of the Congo to Sudan and Uganda in the East. A few of the studied bats and fruit bats may even occur in the eastern part of South Africa.

WHO Director-General’s Opening Remarks At the Webinar – Responding to the Double Challenge of Malaria and Covid-19

The WHO Director General is encouraged by efforts to maintain malaria services despite the COVID-19 outbreak, but says, “I would like to recognize and applaud all these efforts, and to thank all of you who have worked so hard to preserve and maintain those services to the greatest degree possible. However, despite these actions, it breaks my heart to report that we still expect to see an increase in cases and deaths from malaria.

“In a recent WHO survey of 105 countries, 46% of countries reported disruptions in malaria diagnosis and treatment. These disruptions threaten to set us back even further in realizing our shared vision for a malaria-free world.”

NTD Disease treatments restart in Africa as COVID-19 restrictions ease

It is not just malaria services that have been disrupted by COVID-19 responses. Treatment programmes that will reach millions of Africans at risk from debilitating neglected tropical diseases (NTDs) have restarted in a significant step towards COVID-19 recovery. Around one million people in Jigawa state, Nigeria have received antibiotics to treat the blinding eye disease trachoma and stop it from spreading.

Nigeria is the first country that Sightsavers and partners has supported to resume work on NTDs, which can have a devastating impact on some of the poorest communities in the world, with other African countries due to follow soon. In April, the threat of COVID-19 led the World Health Organization to recommend suspending mass treatment campaigns, which treat and prevent these diseases, but it has since provided guidance on restarting activities safely.

Capacity Building &Conflict &Health Systems &Integration Bill Brieger | 07 Sep 2020

Malaria News Today 2020-09-07

Today’s updates are brief and look at Vietnam in Southeast Asia and South Sudan in Africa. Both are concerned with health systems issues. Please click on links to read more details.

Malaria Week 2020 – Why Integration Could Be the Key to Elimination

Hosted by the Government of Vietnam, Malaria Week 2020 (7-11 September) brings together government officials and diverse partners to drive forward the elimination of malaria from Asia Pacific by 2030. This year’s theme centres on the three I’s – Inclusion. Integration. Innovation – and captures the ambition to unite the region and harness innovation as efforts intensify to eradicate malaria globally and in Asia Pacific. Key topics in the series this week include surveillance systems, sustaining health financing, and innovation within the malaria landscape.

Given the backdrop of COVID-19 to this year’s event, discussions will have a focus on sustaining health financing and in particular malaria interventions during a pandemic, the critical role of community-based approaches in health systems strengthening and the need for strong surveillance and timely reporting, in addition to the role of innovation and private provider engagement in accelerating malaria elimination and strengthening health security.

Healthcare in South Sudan: A Fractured System

A limited access to healthcare facilities, medical supplies in South Sudan results in high number of preventable deaths. high rates of tuberculosis, HIV/AIDS, malaria, and diarrheal diseases in country.

The South Sudanese population has very limited access to healthcare facilities, with only 44% of the population living within a one-hour walk of a medical center. This adds an extra burden on those in need of medical attention as the majority of the population has to walk for an extended time to reach a medical center. During a time of civil unrest, traveling for an extended period comes with increased exposure to the risk of ambushes and looting.

Climate &coinfection &coronavirus &Dengue &Health Information Bill Brieger | 06 Sep 2020

Malaria News Weekend 2020-09-05/6

We are sharing more updates from newsletters and journal abstracts found online. Issues include mapping malaria in connection with climate change, COVID-19 possibly inhibiting reporting o malaria cases, co-infection with coronavirus and malaria or dengue, Plasmodium knowlesi in northern India, and the effect of sanitation campaigns on infectious diseases. Click on links to read details.

Malaria kills 400,000 people a year, A new map shows where climate change will make it worse

A new study examines the impact of climate change on malaria in Africa. The maps reveal which areas will become more – or less – climatically suitable. Of an estimated 228 million cases of malaria worldwide each year, around 93% are in Africa. This proportion is more or less the same for the 405,000 malaria deaths globally.

That’s why there are huge efforts underway to provide detailed maps of current malaria cases in Africa, and to predict which areas will become more susceptible in future, since such maps are vital to control and treat transmission. Mosquito populations can respond quickly to climate change, so it is also important to understand what global warming means for malaria risk across the continent.

If it is too warm or too cold, then either the malaria parasite or the mosquito that transmits the parasite between humans will not survive. This suitable temperature range is relatively well established by field and laboratory studies and forms the basis for current projections of the impact of climate change on malaria. Yet, surface water is equally crucial as it provides habitat for the mosquitoes to lay their eggs. See original article in Nature Communications.

Malaria Situation in the Peruvian Amazon during the COVID-19 Pandemic

Malaria Situation in the Peruvian Amazon during the COVID-19 Pandemic. This article was originally published in Am J Trop Med Hyg. (2020 Sep 3. doi: 10.4269/ajtmh.20-0889). Online ahead of print. The Peruvian Ministry of Health reports a near absence of malaria cases in the Amazon region during the COVID-19 pandemic.

However, the rapid increase in SARS-CoV-2 infections has overwhelmed the Peruvian health system, leading to national panic and closure of public medical facilities, casting doubt on how accurately malaria cases’ numbers reflect reality. In the Amazon region of Loreto, where malaria cases are concentrated, COVID-19 has led to near-complete closure of the primary healthcare system, and diagnosis and treatment of acute febrile illnesses, including malaria, has plummeted. Here, we describe the potential association of COVID-19 with a markedly reduced number of reported malaria cases due to the reduced control activities carried out by the Peruvian Malaria Zero Program, which could lead to malaria resurgence and an excess of morbidity and mortality.

Dengue, malaria a new threat for Covid patients

Doctors in at least two Delhi hospitals have reported patients with twin infections of Covid-19 and dengue or malaria, a trend that could become worrying since the double disease may be deadlier, and the region is entering its most critical season for mosquito-transmitted diseases. The anecdotal reports tie in with latest findings that suggest a high prevalence of co-infections of diseases such as malaria, dengue and leptospirosis, which together have several symptoms that overlap with a symptomatic Covid-19 illness. Andhra villages see big drop in dengue, malaria, typhoid cases after pilot sanitation drive. Andhra govt data shows cases of seasonal diseases like dengue, typhoid, acute diarrhoea & malaria fell 97.4%, 96%, 81.7% and 50.4%, respectively, after the sanitation drive.

Now, months after the launch of the drive called ‘Manam Mana Parishubhratha’ (Our Cleanliness and Us), these villages have recorded a massive drop in the numbers of patients reporting with seasonal diseases like dengue, typhoid, malaria and acute diarrhoea. a 50.4% decrease in malaria cases (601), said the data.

AIIMS study finds zoonotic malarial parasite in acute febrile illnesses patients.

A zoonotic disease is a disease that can be spread/jump from animals to humans and vice versa. AIIMS researchers have sounded a note of caution after finding the presence of monkey malarial parasite ‘Plasmodium knowlesi’ in the north Indian population while doing a study on patients with acute febrile illnesses (AFI) and pathogens causing them.

The presence of the zoonotically transmitted malaria parasite was found during the study of acute febrile illnesses and causative pathogens in certain patients admitted in AIIMS from July 2017 to September 2018. The All Indian Institute of Medical Sciences (AIIMS) researchers from the Department of Biochemistry, along with clinicians from the Department of Medicine, were involved in the study on the pathogens causing severe fever.

 

 

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