Tropical Health Matters

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.

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.

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.

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.

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.

Today the issue of water is important for malaria mosquito propagation, both in irrigation and flooding. Artificial skin enables testing of mosquito biting. Fake medicines for malaria and other conditions threaten Africa’s health. Archived RDTs can aid surveillance. Finally there is concern for co-infection with both malaria and dengue leading to severe disease. Follow links below to read details.

Impact of sugarcane irrigation on malaria vector Anopheles mosquito fauna, abundance and seasonality in Arjo-Didessa, Ethiopia

Despite extensive irrigation development in Ethiopia, limited studies assessed the impact of irrigation on malaria vector mosquito composition, abundance and seasonality. This study aimed to evaluate the impact of sugarcane irrigation on species composition, abundance and seasonality of malaria vectors. Adult Anopheles mosquitoes were collected using CDC light traps from three irrigated and three non-irrigated clusters in and around Arjo-Didessa sugarcane irrigation scheme in southwestern Ethiopia.

Overall, 2108 female Anopheles mosquitoes comprising of six species were collected. The ongoing sugarcane irrigation activities in Arjo-Didessa created conditions suitable for malaria transmitting Anopheles species diversity and abundance. This could drive malaria transmission in Arjo-Didessa and its environs in both dry and wet seasons. Currently practiced malaria vector interventions need to be strengthened by including larval source management to reduce vector abundance in the irrigated areas.

Prevalence of and risk factors for severe malaria caused by Plasmodium and dengue virus co-infection

A systematic review and meta-analysis examined co-infection with both Plasmodium and dengue virus (DENV) infectious species could have serious and fatal outcomes if left undiagnosed and without timely treatment. The present study aimed to determine the pooled prevalence estimate of severe malaria among patients with co-infection, the risk of severe diseases due to co-infection, and to describe the complications of severe malaria and severe dengue among patients with co-infection. Relevant studies published between databases between 12 September 1970 and 22 May 2020 were identified and retrieved.

The present study found that there was a high prevalence of severe malaria among patients with Plasmodium and DENV co-infection. Physicians in endemic areas where these two diseases overlap should recognize that patients with this co-infection can develop either severe malaria or severe dengue with bleeding complications, but a greater risk of developing severe dengue than severe malaria was noted in patients with this co-infection.

South Sudan: Flooding deepens a humanitarian crisis in Pibor area

Today, however, the Pibor River has swelled to make parts of the town inaccessible and is threatening the clinic. Many neighborhoods cannot be reached by foot, and a local ferry is too expensive for many who live in the area. A mobile MSF team is providing medical care in hard-to-reach areas. “Our focus is now on malaria, measles and flooding,” said Josh Rosenstein, MSF deputy head of mission. “Today we are reaching out to the community through our daily mobile clinics, treating the most severe illnesses. We’re also implementing our flood contingency plan, which includes building additional flood defenses around the clinic to ensure we can continue to provide medical services, as the water level is rising at an alarming speed.”

Stratifying malaria receptivity in Bangladesh using archived rapid diagnostic tests

Surveillance of low-density infections and of exposure to vectors is crucial to understand where malaria elimination might be feasible, and where the risk of outbreaks is high. Archived rapid diagnostic tests (RDTs), used by national malaria control and elimination programs for clinical diagnosis, present a valuable, yet rarely used resource for in-depth studies on malaria epidemiology. 1022 RDTs from two sub-Districts in Bangladesh (Alikadam and Kamalganj) were screened by qPCR for low-density Plasmodium falciparum and Plasmodium vivax infections, and by ELISA for Anopheles salivary gland antibodies as a marker for exposure to vectors.

Concordance between RDT and qPCR was moderate. qPCR detected 31/1022 infections compared to 36/1022 diagnosed by RDT. Exposure to Anopheles was significantly higher in Kamalganj despite low transmission, which could be explained by low bed net use. Archived RDTs present a valuable source of antibodies for serological studies on exposure to vectors. In contrast, the benefit of screening archived RDTs to obtain a better estimate of clinical case numbers is moderate. Kamalganj could be prone to outbreaks.

New tool mimics human skin to allow detailed study of mosquito biting

eLife: Researchers develop a human skin mimic to study mosquito biting in high resolution without using humans as ‘bait.’ The tool, which uses an artificial blood meal and a surface that mimics human skin, will provide detailed understanding of blood feeding without using human subjects as bait. It can also fit conveniently into a backpack, allowing the study of mosquitoes in laboratory and natural environments.

Blood feeding is essential for mosquitoes to reproduce, but it is during blood feeds on human hosts that they pass on pathogens such as malaria. It consists of a bite ‘substrate’ – a transparent, temperature-controlled surface that mimics body temperature to attract mosquitoes. An artificial meal is applied on top of this and covered with a commonly used membrane that mosquitoes can pierce. The meal resembles blood, allowing mosquitoes to engorge and increase their weight by two to threefold. This bite substrate is then placed in a transparent cage, and an external camera records the mosquitoes’ behaviour. The team tested biteOscope with four medically important species of mosquito.

Counterfeiting of Fake Drugs in Africa: current situation, causes and countermeasures

The more desirable a product is the higher the tendency to replicate it and meet that parcel of consumers that want to join the trend but cannot pay the price. Profit is one of the many reasons that make counterfeit an attractive business for many.  Africa, unfortunately but not surprisingly, is one of the most affected continents, comprehensible since its markets have become a huge target for second generation goods, with a major focus on pharmaceutical drugs.

The World Health Organization (hereinafter, WHO) stated that 42% of all fake medicine reported to them between the years of 2013 and 2017 was linked to the African continent and we expect that these numbers fall short of reality. Africa is seriously affected by it and one clear example is the anti-malarial medication. Anti-malarials and antibiotics are amongst the most commonly reported as fake or substandard medical products.

Today’s stories cover three continents including Surveillance for imported malaria in Sri Lanka, community perceptions in Colombia and Annual Fluctuations in Malaria Transmission Intensity in 5 sub-Saharan countries. In addition there is an overview of microscopy standards and an Integrated Macroeconomic Epidemiological Demographic Model to aid in planning malaria elimination. We also see how COVID-19 is disturbing Seasonal Malaria Chemoprevention activities in Burkina Faso. Read more by following the links in the sections below.

Will More of the Same Achieve Malaria Elimination?

… Results from an Integrated Macroeconomic Epidemiological Demographic Model. Historic levels of funding have reduced the global burden of malaria in recent years. Questions remain, however, as to whether scaling up interventions, in parallel with economic growth, has made malaria elimination more likely today than previously. The consequences of “trying but failing” to eliminate malaria are also uncertain. Reduced malaria exposure decreases the acquisition of semi-immunity during childhood, a necessary phase of the immunological transition that occurs on the pathway to malaria elimination. During this transitional period, the risk of malaria resurgence increases as proportionately more individuals across all age-groups are less able to manage infections by immune response alone. We developed a robust model that integrates the effects of malaria transmission, demography, and macroeconomics in the context of Plasmodium falciparum malaria within a hyperendemic environment.

The authors analyzed the potential for existing interventions, alongside economic development, to achieve malaria elimination. Simulation results indicate that a 2% increase in future economic growth will increase the US$5.1 billion cumulative economic burden of malaria in Ghana to US$7.2 billion, although increasing regional insecticide-treated net coverage rates by 25% will lower malaria reproduction numbers by just 9%, reduce population-wide morbidity by ?0.1%, and reduce prevalence from 54% to 46% by 2034. As scaling up current malaria control tools, combined with economic growth, will be insufficient to interrupt malaria transmission in Ghana, high levels of malaria control should be maintained and investment in research and development should be increased to maintain the gains of the past decade and to minimize the risk of resurgence, as transmission drops. © The American Society of Tropical Medicine and Hygiene [open-access]

Microscopy standards to harmonise methods for malaria clinical research studies

Research Malaria Microscopy Standards (ReMMS) applicable to malaria clinical research studies have been published in Malaria Journal. The paper describes the rationale for proposed standards to prepare, stain and examine blood films for malaria parasites. The standards complement the methods manual(link is external) previously published by the World Health Organization and UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR). The standards aim to promote consistency and comparability of data from microscopy performed for malaria research and hence to strengthen evidence for improvements in malaria prevention, diagnostics and treatment.

Microscopy is important in both malaria diagnosis and research. It is used to differentiate between Plasmodium species and stages and to estimate parasite density in the blood – an important determinant of the severity of disease. It is also used to monitor the effectiveness of drugs based on the rate at which parasites recrudesce or are cleared from the blood.

While rapid diagnostic tests have replaced microscopy in some contexts, microscopy remains an essential tool to support clinical diagnosis and research. The standardisation of methods allows direct comparisons from studies conducted across different points in time and location. This facilitates individual participant data meta-analyses, recognised as the gold standard approach to generate evidence for improvements in interventions and hence patient outcomes.

Estimating Annual Fluctuations in Malaria Transmission Intensity and in the Use of Malaria Control Interventions in Five Sub-Saharan African Countries

RTS,S/AS01E malaria vaccine safety, effectiveness, and impact will be assessed in pre- and post-vaccine introduction studies, comparing the occurrence of malaria cases and adverse events in vaccinated versus unvaccinated children. Because those comparisons may be confounded by potential year-to-year fluctuations in malaria transmission intensity and malaria control intervention usage, the latter should be carefully monitored to adequately adjust the analyses. This observational cross-sectional study is assessing Plasmodium falciparum parasite prevalence (PfPR) and malaria control intervention usage over nine annual surveys performed at peak parasite transmission. Plasmodium falciparum parasite prevalence was measured by microscopy and nucleic acid amplification test (quantitative PCR) in parallel in all participants, and defined as the proportion of infected participants among participants tested. Results of surveys 1 (S1) and 2 (S2), conducted in five sub-Saharan African countries, including some participating in the Malaria Vaccine Implementation Programme (MVIP), are reported herein; 4,208 and 4,199 children were, respectively, included in the analyses.

Plasmodium falciparum parasite prevalence estimated using microscopy varied between study sites in both surveys, with the lowest prevalence in Senegalese sites and the highest in Burkina Faso. In sites located in the MVIP areas (Kintampo and Kombewa), PfPR in children aged 6 months to 4 years ranged from 24.8% to 27.3%, depending on the study site and the survey. Overall, 89.5% and 86.4% of children used a bednet in S1 and S2, of whom 68.7% and 77.9% used impregnated bednets. No major difference was observed between the two surveys in terms of PfPR or use of malaria control interventions. © The American Society of Tropical Medicine and Hygiene [open-access]

Community perception of malaria in a vulnerable municipality in the Colombian Pacific

Malaria primarily affects populations living in poor socioeconomic conditions, with limited access to basic services, deteriorating environmental conditions, and barriers to accessing health services. Control programmes are designed without participation from the communities involved, ignoring local knowledge and sociopolitical and cultural dynamics surrounding their main health problems, which implies imposing decontextualized control measures that reduce coverage and the impact of interventions. The objective of this study was to determine the community perception of malaria in the municipality of Olaya Herrera in the Colombian Pacific.

A 41-question survey on knowledge, attitudes, and practices (KAP) related to malaria, the perception of actions by the Department of Health, and access to the health services network was conducted. In spite of the knowledge about malaria and the efforts of the Department of Health to prevent it, the community actions do not seem to be consistent with this knowledge, as the number of cases of malaria is still high in the area.

Use of a Plasmodium vivax genetic barcode for genomic surveillance and parasite tracking in Sri Lanka

Sri Lanka was certified as a malaria-free nation in 2016; however, imported malaria cases continue to be reported. Evidence-based information on the genetic structure/diversity of the parasite populations is useful to understand the population history, assess the trends in transmission patterns, as well as to predict threatening phenotypes that may be introduced and spread in parasite populations disrupting elimination programmes. This study used a previously developed Plasmodium vivax single nucleotide polymorphism (SNP) barcode to evaluate the population dynamics of P. vivax parasite isolates from Sri Lanka and to assess the ability of the SNP barcode for tracking the parasites to its origin.

A total of 51 P. vivax samples collected during 2005–2011, mainly from three provinces of the country, were genotyped for 40 previously identified P. vivax SNPs using a high-resolution melting (HRM), single-nucleotide barcode method. The proportion of multi-clone infections was significantly higher in isolates collected during an infection outbreak in year 2007. Plasmodium vivax parasite isolates collected during a disease outbreak in year 2007 were more genetically diverse compared to those collected from other years. In-silico analysis using the 40 SNP barcode is a useful tool to track the origin of an isolate of uncertain origin, especially to differentiate indigenous from imported cases. However, an extended barcode with more SNPs may be needed to distinguish highly clonal populations within the country.

Coronavirus rumours and regulations mar Burkina Faso’s malaria fight

By Sam Mednick, Thomson Reuters Foundation: MOAGA, Burkina Faso – Health worker Estelle Sanon would hold the 18-month-old and administer the SMC dose herself, but because of coronavirus she has to keep a distance from her patients. “If I am standing and watching the mother do it, it’s as if I’m not doing my work,” said Sanon, a community health volunteer assisting in a seasonal campaign to protect children in the West African country from the deadly mosquito-borne disease.

Burkina Faso is one of the 10 worst malaria-affected nations in the world, accounting for 3% of the estimated 405,000 malaria deaths globally in 2018, according to the World Health Organization (WHO). More than two-thirds of victims are children under five. Now there are fears malaria cases could rise in Burkina Faso as restrictions due to coronavirus slow down a mass treatment campaign and rumours over the virus causing parents to hide their children, according to health workers and aid officials.

“COVID-19 has the potential to worsen Burkina Faso’s malaria burden,” said Donald Brooks, head of the U.S. aid group Initiative: Eau, who has worked on several public health campaigns in the country.  “If preventative campaigns can’t be thoroughly carried out and if people are too scared to come to health centres … it could certainly increase the number of severe cases and the risk of poor outcomes.”

During peak malaria season, from July to November, community health workers deploy across Burkina Faso to treat children with seasonal malaria chemoprevention (SMC). This is the second year the campaign will cover the whole country with more than 50,000 volunteers going door-to-door, said Gauthier Tougri, coordinator for the country’s anti-malaria programme. Logistics were already challenging. Violence linked to jihadists and local militias has forced more than one million people to flee their homes, shuttered health clinics and made large swathes of land inaccessible. Now the coronavirus has made the task even harder, health workers said.

People in Cape Verde evolved better malaria resistance in 550 years

Yes, we are still evolving. And one of the strongest examples of recent evolution in people has been found on the Cape Verde islands in the Atlantic, where a gene variant conferring a form of malaria resistance has become more common.

Portuguese voyagers settled the uninhabited islands in 1462, bringing slaves from Africa with them. Most of the archipelago’s half a million inhabitants are descended from these peoples. Most people of West African origin have a variant in a gene called DARC that protects.

Deadly malaria and cholera outbreaks grow amongst refugees as COVID pandemic strains health systems.

Apart from the strain on health facilities during the pandemic, in some countries such as Somalia, Kenya and Sierra Leone, we are seeing that a fear of exposure to COVID-19 has prevented parents from taking their children to hospital, delaying diagnosis and treatment of malaria and increasing preventable deaths. COVID restrictions in some countries have also meant pregnant women have missed antimalarial drugs. Untreated malaria in pregnant women can increase the risk of anaemia, premature births, low birth weight and infant death. According to the World Health Organization (WHO), 80% of programs designed to fight HIV, tuberculosis and malaria have been disrupted due to the pandemic and 46% of 68 countries report experiencing disruptions in the treatment and diagnosis of malaria.

First we look at how disease can influence urban planning. We have four news stories focus on field activities for vector control from Hyderabad, India, Borno State, Nigeria, Papua New Guinea and CHAD. Finally there is an ancestry article of sorts examining plasmodia in chimpanzees and humans. Click on the links to read full details.

Can Covid-19 inspire a new way of planning African cities?

Health crises are not new in Africa. The continent has grappled with infectious diseases on all levels, from local (such as malaria) to regional (Ebola) to global (Covid-19). The region has often carried a disproportionately high burden of global infectious outbreaks.
How cities are planned is critical for managing infectious diseases. Historically, many urban planning innovations emerged in response to health crises. The global cholera epidemic in the 1800s led to improved urban sanitation systems. Respiratory infections in overcrowded slums in Europe inspired modern housing regulations during the industrial era.

Urban planning in Africa during colonisation followed a similar pattern. In Anglophone Africa, cholera and bubonic plague outbreaks in Nairobi (Kenya) and Lagos (Nigeria) led to new urban planning strategies. These included slum clearance and urban infrastructure upgrades. Urban planning in French colonial Africa similarly focused on health and hygiene issues, but also safety and security.

Unfortunately regional experiences with cholera, malaria and even Ebola in African cities provide little evidence that they have triggered a new urban planning ethic that prioritises infectious outbreaks. Our recent research paper discusses three areas that can transform urban planning in the continent to prepare for future infectious outbreaks, using lessons from Covid-19.

The Coronavirus and other viruses like Ebola have always been ‘out there’ in nature.

But it’s only when we disrupt the natural habitats of the wild animals. Deadly viruses stay beneath the surface and need just one moment of triggering to emerge in the atmosphere and take the world by storm – historian Dr Mark Honigsbaum. The point is we cannot prevent all spillover events or predict precisely when or where the next one will happen. What we can do — and should do often — is invest in local laboratories and diagnostic services so that we can spot unusual outbreaks early and close them down quickly

We should note that Plasmidium Knowlesi is an example of a form of malaria from monkeys that arose because of urban expansion on forest habitats.

Hyderabad: People sensitised on mosquito breeding

As part of a novel initiative, every Sunday 10 am, 10 minute programme, the entomology wing of Greater Hyderabad Municipal Corporation conducted awareness drive on mosquito breeding grounds at various places on Sunday. They explained the importance of cleanliness and the ways the mosquito breeding takes place in stagnated water. Speaking on the occasion, Banjara Hills Corporator Gadwal Vijayalaxmi called upon everyone not to allow accumulation of water in containers, utensils and surroundings.

Borno, WHO Administer Malaria Prevention Drug on 2.1m Children

WHO National Coordinator Malaria Emergencies in Nigeria, Dr. Iniabasi Nglas gave the figure during a four round Malaria Chemoprevention Campaigns (MPCs aka SMC) in 25 of the 27 local government areas of Borno State. During the advocacy, Nglas said the IDP camps “are given special attention for there is high threat of malaria infection due to the environment. Record has shown that the treatment has reduced malaria morbidity in the state.” She revealed that during the first cycle, 1.9 million children were targeted but due to high reception 2.1 million children were administered with the drug.

Rotary Against Malaria Distributes Nets in PNG

ROTARY Against Malaria has finally completed its distribution of bed net mosquito nets throughout the Eastern Highlands Province (EHP) after three months. Team leader of Rotary Against Malaria in the province, Helmut Magino, during a ceremony in Goroka, acknowledged his working staff, the Eastern Highlands Provincial Health Authority, district health officers, logistic company Mapai Transport, Summer Institute of Linguistics (SIL)
and the communities in Papua New Guinea.

“Without these partners, our work in distributing mosquito nets wouldn’t have been successful,” Mr Magino said. “Mapai Transport assisted with vehicles to travel to the remote parts in Okapa, Henganofi and Lufa. “SIL assisted with distribution via airplane to remote parts which are not connected by road like in Obura-Wonenara district.” The volunteer-run organisation funded by Global Fund, a US-based organisation, distributed 145,900 mosquito nets in the province. “We distributed around 45,000 nets to Okapa and Lufa, 35,000 to Obura-Wonenara and 66,900 to rural areas in Goroka district. “We will visit EHP again next year to distribute nets …”

Donating Emergency IRS Supplies to CHAD

Last week, despite the COVID-19 pandemic, a Hercules military transport aircraft took off from an Israeli military base in the south, filled to capacity with items donated by Israeli Flying Aid IFA and the American Jewish Committee (AJC) — 2,000 six-person tents, personal protection equipment (PPE) for medical teams, backpack sprayers to eradicate malaria-carrying mosquitos, and more.

Why humans can run marathons and apes cannot (implication for plasmodium species)

Chimpanzees share more than 99 percent of their genes with modern humans, but the CMAH gene is one of the areas of difference. Two to three million years ago, gorillas, chimpanzees, and other primates were dying from a type of malaria called Plasmodium reichenowi (Science, 2011;331:540-542). At that time, all primates had a surface protein called Neu5Gc on their cells that was made from Neu5Ac. Then along came a primate with a gene that had lost its ability to make Neu5Gc from Neu5Ac, so it had only Neu5Ac (Proc Natl Acad Sci USA, Sept 6, 2005;102(36):12819-12824).

That pre-human did not die from malaria like other primates, his and her children lived and proliferated, and today their descendants (all humans) have a gene that makes Neu5Ac instead of Neu5Gc. As often happens in nature, the malaria parasite then modified its genetic makeup into a variant called Plasmodium falciparum which can infect humans, but not chimpanzees, so today humans can be infected only with Plasmodium falciparum and chimpanzees can be infected only with Plasmodium reichenowi. This same genetic mutation gave homo sapiens greater endurance so they were able to run long distances while the apes could not, which gave humans an advantage in hunting for food (J Hum Evol, 2014;66:64-82).

Abstracts and news look at mosquito control measures including screening eaves and indoor residual spraying from Malaria Journal. Mosquito-associated bacteria, fungi, and even viruses represent untapped tools. Finally one can buy and wear a face mask and help eliminate malaria. Click the links to get more information

Evaluating effectiveness of screening house eaves

… a potential intervention for reducing indoor vector densities and malaria prevalence in Nyabondo, western Kenya. Mosquito-proofing of houses using wire mesh screens is gaining greater recognition as a practical intervention for reducing exposure to malaria transmitting mosquitoes. Screening potentially protects all persons sleeping inside the house against transmission of mosquito-borne diseases indoors. The study assessed the effectiveness of house eaves screening in reducing indoor vector densities and malaria prevalence in Nyabondo, western Kenya. 160 houses were selected for the study, with half of them randomly chosen for eaves screening with fibre-glass coated wire mesh (experimental group) and the other half left without screening (control group).

At all the three parasitological follow-up survey points, house screening significantly reduced the malaria prevalence by 100% (p?<?0.001), 63.6% (p?=?0.026), and 100% (p?<?0.001) in the 1st, 2nd and 3rd follow-up surveys respectively. The study demonstrated that house eave screening has potential to reduce indoor vector densities and malaria prevalence in high transmission areas.

Rapid reduction of malaria transmission following the introduction of indoor residual spraying

… in previously unsprayed districts: an observational analysis of Mopti Region, Mali, in 2017. The National Malaria Control Programme (NMCP) of Mali has had recent success decreasing malaria transmission using 3rd generation indoor residual spraying (IRS) products in areas with pyrethroid resistance, primarily in Ségou and Koulikoro Regions. In 2015, national survey data showed that Mopti Region had the highest under 5-year-old (u5) malaria prevalence at 54%—nearly twice the national average—despite having high access to long-lasting insecticidal nets (LLINs) and seasonal malaria chemoprevention (SMC). Accordingly, in 2016 the NMCP and other stakeholders shifted IRS activities from Ségou to Mopti. A set of retrospective, eco-observational time-series analyses were performed using monthly incidence rates of rapid diagnostic test (RDT)-confirmed malaria cases reported in the District Health Information System 2 (DHIS2) from January 2016 until February 2018.

At HFs in communities of Mopti where IRS was introduced in 2017, peak incidence fell by an average of 42% (CI95 31–63%) between these years, a significantly greater decrease (p?=?0.040) almost double what was seen in the comparator HFCAs. The opposite effect was observed in Ségou Region, where peak incidence at those HFs where IRS was withdrawn after the 2016 campaign increased by an average of 106% (CI95 63–150%) from year to year, also a significant difference-in-differences compared to the comparator no-IRS HFs (p?<?0.0001).

Annual IRS campaigns continue to make dramatic contributions to the seasonal reduction of malaria transmission in communities across central Mali, where IRS campaigns were timed in advance of peak seasonal transmission and utilized a micro-encapsulated product with an active ingredient that was of a different class than the one found on the LLINs used throughout the region and to which local malaria vectors were shown to be susceptible. Strategies to help mitigate the resurgence of malaria cases that can be expected should be prioritized whenever the suspension of IRS activities in a particular region is considered.

COVID-19 Mask Raises Money for Malaria Elimination

Goodbye Malaria was founded by African entrepreneurs who truly believe African creativity is the key to solving Africa’s biggest problems. “From saving lives to saving livelihoods – the birth of the Goodbye Malaria mask.”  Mask initiative helps to raise funds support on-the-ground malaria elimination in Southern Africa. it empowers local crafters to create stylish merchandise using Goodbye Malaria’s iconic shwe shwe fabric. Goodbye Malaria co-founder Kim Lazarus said: “We have never asked the public for donations, instead, offering consumers an opportunity to support malaria elimination efforts through their purchase of our merchandise.” (see photo above)

Prospects and Pitfalls: Next-Generation Tools to Control Mosquito-Transmitted Disease

Annual Review of Microbiology reports that Mosquito-transmitted diseases, including malaria and dengue, are a major threat to human health around the globe, affecting millions each year. A diverse array of next-generation tools has been designed to eliminate mosquito populations or to replace them with mosquitoes that are less capable of transmitting key pathogens. Many of these new approaches have been built on recent advances in CRISPR/Cas9-based genome editing. These initiatives have driven the development of pathogen-resistant lines, new genetics-based sexing methods, and new methods of driving desirable genetic traits into mosquito populations.

Many other emerging tools involve microorganisms, including two strategies involving Wolbachia that are achieving great success in the field. At the same time, other mosquito-associated bacteria, fungi, and even viruses represent untapped sources of new mosquitocidal or antipathogen compounds. Although there are still hurdles to be overcome, the prospect that such approaches will reduce the impact of these diseases is highly encouraging.

Several reports and studies aim to help understand the malaria parasite and the human behavior surrounding its control. Cultural perceptions in Benin influence treatment seeking. Tracking cases in India aid in elimination efforts. The contrasts between in vivo and in vitro studies are examined. The factors associated with anemia among children and women in Ghana are traced to malaria and other factors. Finally both human and mosquito immunity are discussed. Click the links in each section to read details.

Demonstration of indigenous malaria elimination through Track-Test-Treat-Track (T4) strategy in a Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh

Using the current intervention and prevention tools along with optimum utilization of human resources,This project has revealed about 91% reduction of indigenous cases of malaria during the period from June 2017 to May 2020, through case management and vector control strategies. A total 357,143 febrile cases were screened, out of which 0.19% were found positive.

The reduction was similar in the three high prevalence blocks of the district. These results reveal that malaria elimination is achievable in India within a stipulated time frame. The reduction of malaria at the community level was further validated when zero malaria cases were diagnosed during hospital and community-based studies in Mandla. Prompt detection and treatment of imported/migratory cases may have prevented outbreaks in the district. This project has demonstrated that field programmes backed by adequate technical, management, operational, and financial controls with robust monitoring are needed for achieving malaria elimination.needed for achieving malaria elimination.

Risk factors for anaemia among Ghanaian women and children vary by population group and climate zone

Anaemia has serious effects on human health and has multifactorial aetiologies. This study aimed to determine putative risk factors for anaemia in children 6-59 months and 15- to 49-year-old non-pregnant women living in Ghana. Data from a nationally representative cross-sectional survey were analysed for associations between anaemia and various anaemia risk factors. National and stratum-specific multivariable regressions were constructed separately for children and women to calculate the adjusted prevalence ratio (aPR) for anaemia of variables found to be statistically significantly associated with anaemia in bivariate analysis. Nationally, the aPR for anaemia was greater in children with iron deficiency (ID; aPR 2.20; 95% confidence interval [CI]: 1.88, 2.59), malaria parasitaemia (aPR 1.96; 95% CI: 1.65, 2.32), inflammation (aPR 1.26; 95% CI: 1.08, 1.46), vitamin A deficiency (VAD; aPR 1.38; 95% CI: 1.19, 1.60) and stunting (aPR 1.26; 95% CI: 1.09, 1.46).

In women, ID (aPR 4.33; 95% CI: 3.42, 5.49), VAD (aPR 1.61; 95% CI: 1.24, 2.09) and inflammation (aPR 1.59; 95% CI: 1.20, 2.11) were associated with anaemia, whereas overweight and obese women had lower prevalence of anaemia (aPR 0.74; 95% CI: 0.56, 0.97). ID was associated with child anaemia in the Northern and Middle belts, but not in the Southern Belt; conversely, inflammation was associated with anaemia in both children and women in the Southern and Middle belts, but not in the Northern Belt. Anaemia control programmes should be region specific and aim at the prevention of ID, malaria and other drivers of inflammation as they are the main predictors of anaemia in Ghanaian children and women.

From Circulation to Cultivation: Plasmodium In Vivo versus In Vitro

Research on Plasmodium parasites has driven breakthroughs in reducing malaria morbidity and mortality. Standard in vitro culture environments differ dramatically from in vivo conditions in nutrient levels, hematocrit, and rheology and have lower variability in gas levels and temperature.

Nutritional and physical differences lead to pronounced, and often rapid, changes in phenomenon, important for understanding virulence in Plasmodium. Parasite drug sensitivity may be altered due to culture adaptation selection, supraphysiological metabolite concentrations, and in vitro media formulations. Parasites propagated in vitro, versus in vivo, show altered transcriptomic and genomic patterns related to virulence factors, metabolism, gametocytogenesis, and more.

Direct-from-host methodologies avoid the impacts of in vitro culture adaptation but limit the types of assessments that can be performed as many experiments either require equipment not readily available in endemic settings or necessitate long-term manipulation….

Between traditional remedies and pharmaceutical drugs: prevention and treatment of “Palu” in households in Benin, West Africa

In Benin, malaria clinical cases, including the larger popular entity called “Palu” are evoked when people get fever. “Palu” is often self-diagnosed and self-medicated at home. This study aimed to describe the use of herbal medicine, and/or pharmaceutical medicines for prevention and treatment of malaria at home and the factors associated with this usage.

Methods. A cross-sectional survey was conducted in Benin in an urban and in a rural area in 2016. Around 600 households in each place were selected by using a random sampling of houses GPS coordinates of the families. The association between socio demographic characteristics and the use of herbal medicine was tested by using logistic regression models.

Results. In Cotonou (urban), 43.64% of households reported using herbal or pharmaceutical medicine to prevent “Palu”, while they were 53.1% in Lobogo (rural). To treat “Palu” in Cotonou, 5.34% of households reported using herbal medicine exclusively, 33.70% pharmaceutical medicine exclusively and 60.96% reported using both. In Lobogo, 4% reported using herbal medicine exclusively, 6.78% pharmaceutical medicine exclusively and 89.22% reported using both. In Cotonou, the factors “age of respondent”, “participation to a traditional form of savings” and “low socioeconomic level of the household” were associated with the use of herbal medicine.

Conclusions. This study shows the strong use of herbal medicine to prevent “Palu” or even treat it, and in this case it is mostly associated with the use of pharmaceutical medicine. It also highlights the fact that malaria control and care seeking behaviour with herbal medicine remain closely linked to household low-income status but also to cultural behaviour. The interest of this study is mostly educational, with regards to community practices concerning “Palu”, and to the design of adapted behaviour change communication strategies. Finally, there is a need to take into account the traditional habits of populations in malaria control and define a rational and risk-free use of herbal medicine as WHO-recommended.

Malaria parasite fools body with protein to dodge immune system

By SHIGEKO SEGAWA: OSAKA- The parasite responsible for malaria generates a look-alike of a human protein to suppress the workings of the immune system, leaving humans “defenseless” against infection, according to Japanese and British researchers.
A team comprised mainly of researchers from Osaka University and the University of Oxford said they hope the finding will help lead to new therapies for the mosquito-borne tropical disease.

As plasmodium is resistant to the immune system, the body’s self-defense system, humans can become infected repeatedly. Three years ago, the researchers realized that when plasmodium infects human red blood cells, it generates proteins called RIFINs, which send out signals for suppressing immunity. During the latest study, the researchers analyzed the structure of RIFIN in detail and found it closely resembles part of the structure of a specific human protein, which is involved in the mechanism for preventing the immune system from staging an attack on the body by mistake.

That protein combines with a molecule that suppresses the workings of the immune system. The scientists found the RIFIN that closely imitates the human protein in shape also combines with the same molecule and dodges attacks of the immune system. “We hope our findings will help develop vaccines and therapeutic drugs for malaria,” said Hisashi Arase, a professor of immunology with Osaka University, who is part of the research team. The research results were published in Nature, the British scientific journal.

Why Do Insect Vectors Not Get Ill from the Microbes They Transmit?

Some Evidence from Malaria-carrying Mosquitos by Kevin Noonan. The conservation of diverse and molecularly well-defined hemocyte types between distantly related mosquito genera and the apparent absence of megacytes in our Ae. aegypti mosquito dataset raise questions as to how the immune systems of these mosquito species have evolved to limit their capacity to transmit parasites and arboviruses to humans. This knowledge will ultimately underpin immunological strategies aimed at interrupting disease transmission by rendering mosquitoes resistant to such pathogens.

The conservation of diverse and molecularly well-defined hemocyte types between distantly related mosquito genera and the apparent absence of megacytes in our Ae. aegypti mosquito dataset raise questions as to how the immune systems of these mosquito species have evolved to limit their capacity to transmit parasites and arboviruses to humans. This knowledge will ultimately underpin immunological strategies aimed at interrupting disease transmission by rendering mosquitoes resistant to such pathogens.