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Archive for "Seasonal Malaria Chemoprevention"

Sahel &Seasonal Malaria Chemoprevention Bill Brieger | 11 Mar 2024

Enhancing Malaria Prevention in Mali: A Call for Collaborative Action

Sue Lee has posted about the progress being made with Seasonal Malaria Chemoprevention in Mali on the class blog site for Social and Behavioral Foundations for Primary Health Care. Learn more about the issue below.

As highlighted by the U.S. President’s Malaria Initiative, Mali’s Kita district is grappling with a significant health challenge — malaria. Seasonal Malaria Chemoprevention (SMC) has emerged as a potent strategy to combat this, yet hurdles such as inadequate healthcare infrastructure, logistical issues, and insufficient community education hamper effective delivery. We advocate for policy enhancements and increased funding to improve the healthcare delivery system for SMC in Kita, Mali.

The Ministry of Public Health and Hygiene plays a crucial role. By highlighting SMC’s successes in similar settings and urging the integration of these strategies into national policies, supported by evidence, we can persuade the MoH to prioritize improved healthcare delivery mechanisms for SMC, ultimately enhancing child health in Kita.

Collaborating with the Malaria Consortium offers technical expertise and resources, which could amplify our efforts, ensuring the program’s best practices and enhancing our advocacy and fundraising capabilities.

Community Health Workers (CHWs) face challenges due to inadequate resources and training, particularly concerning SMC. Enhanced education and financial support for CHWs can bridge the gap between communities and healthcare services, allowing higher community engagement and effective delivery of health interventions.

Engaging local community leaders, such as village heads, through informational sessions and providing them with educational materials can foster community support and amplify SMC acceptance.

Caregivers of children under five are central to the success of the SMC program; Engaging caregivers through targeted awareness campaigns and providing clear, simple information about SMC’s benefits can foster trust and increase program uptake.

Lastly, the Global Fund’s role is also crucial. By crafting detailed proposals that resonate with their strategic objectives, we can secure the necessary funds and support to expand our SMC initiatives effectively.

The fight against malaria in Kita requires collective action to overcome logistical and educational barriers, ensuring all children under five are not just survivors but thrivers in the face of malaria. By uniting stakeholders, from government officials to local communities, we can transform the landscape of malaria prevention in Mali, ensuring a healthier future for the most vulnerable. Join us in this critical mission to combat malaria and safeguard our children’s futures

CHW &Integration &IPTi &IPTp &Malaria in Pregnancy &Maternal Health &Seasonal Malaria Chemoprevention Bill Brieger | 12 Dec 2022

Malaria Chemoprevention in 2021 as Seen in The World Malaria Report of 2022

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, reminds us in this year’s edition of the World Malaria Report (WMR 2022) that, “Although hard hit, most countries held the line and were able to maintain services to prevent, detect and treat malaria – a remarkable feat in the midst of a pandemic. Nonetheless, more than 600 000 people still die of malaria every year – most of them children. Even with the heroic efforts to maintain services during the pandemic, malaria control efforts face many hurdles in addition to the already significant COVID-related disruptions and other health system challenges.”

Even though there was an increase in cases between 2020 and 2021, there are now more strategies in the malaria control and elimination toolkit than ever before. One in particular is an updated take on an old concept of chemoprophylaxis, which fell out of use due to mounting drug resistance. Years of research with pregnant women and young children led to the development over time of using regularly scheduled treatment doses of malaria medicines as chemoprevention. Intermittent Preventive Treatment for pregnant women (IPTp) and Seasonal Malaria Chemoprevention for young children, both targeted to appropriate epidemiological settings, are now common. Countries are also exploring IPT for children in other settings.

We were, therefore, curious what the current WMR shares on chemoprevention initiatives. Specifically, the WMR summarized WHO recommendations as follows: “Updated guidelines provide recommendations on intermittent preventive treatment of malaria in pregnancy (IPTp), perennial malaria chemoprevention (PMC) and seasonal malaria chemoprevention (SMC), intermittent preventive treatment of malaria in school-aged children (IPTsc), post-discharge malaria chemoprevention (PDMC), mass drug administration (MDA) and elimination.”

In summary, WMR 2022 notes that, “The average number of children treated per cycle of SMC increased from about 0.2 million in 2012 to almost 45 million in 2021,” and “Using data from 33 countries in the WHO African Region, the percentage of IPTp use by dose was computed. In 2021, 72% of pregnant women used ANC services at least once during their pregnancy. About 55% of pregnant women received one dose of IPTp, 45% received two doses and 35% received three doses.” This is not just progress over time, but also represents an expansion targets and work required for success. For pregnant women the increase represented a change in target from only two doses during pregnancy to a minimum of three. Starting with pilot efforts, SMC now covers children in 15 countries.

The targeted three doses for IPTp shows that two thirds of women who register for antenatal (prenatal) care (ANC), fail to achieve full coverage. Stronger collaboration is needed between malaria control and maternal health programs to ensure that pregnant women actually attend ANC and do so early and often enough to receive 3 monthly doses minimum in their second and third trimesters. More emphasis is needed on community IPTp distribution, since we know that community health workers have been crucial in achieving SMC as well as integrated community case management efforts.

Similar challenges exist for SMC as research looks into whether additional doses are needed based on mosquito breeding and malaria transmission season factors in endemic countries. Adding extra months to the program will tax resources, but also save lives.

Both maternal and child efforts at chemoprevention will need to address research that first shows increasing resistance to the common medicines used, and the potential for introducing new drug combinations in light of that resistance. Challenges here reflect another aspect of SMC, the need for CHWs to guarantee that on any given distribution round, three doses on medicine are required. Recent reports show that within any given round, community adherence to SMC has been good. We need to apply those lessons to IPTp when the regimen changes.

Ultimately, chemoprevention has proven to be an important life saving tool. The challenges of multiple contacts and doses that lead to success rely not only on having effective medicines, but also on culturally appropriate behavior change strategies and well-funded efforts to strengthen the health systems that deliver preventive treatments.



Children &Seasonal Malaria Chemoprevention Bill Brieger | 02 Nov 2022

Sponsorship of target children during the Seasonal Malaria Chemoprevention (SMC): a new strategy for coverage

San Barro, Ousmane Badolo, Mathurin Bonzi, Moumouni Bonkoungou Youssouf Sawadogo, Andre Kone, Thierry Ouedraogo, Mathurin Dodo, Lolade Oseni, Gladys Tetteh, and William Brieger explain an innovation of Sponsorship of target children during the Seasonal Malaria Chemoprevention (SMC) campaign in order to improve malaria prevention follow-up and coverage in the Reo health district of Burkina Faso in 2021.

Malaria is a major public health problem in Burkina Faso. According to health statistics for 2020, malaria accounted for 39.8% of health center consultations, 54.1% of hospitalizations and 27.4% of deaths. Children under 5 years of age pay the highest toll with 72.4% of deaths.

In 2021, the Reo Health District and the other six districts of the Centre-Ouest region were supported by the PMI Impact Malaria Project to implement Seasonal Malaria Chemoprevention (SMC). This includes monthly preventive doses of Sulfadoxine-pyrimethamine/amodiaquine for 4 months during the main malaria transmission season. A recent multi-country article in The Lancet showed that while 75% of eligible children received a dose in any given month, only 53% received a dose on all four months.

Coverage reports indicate that better follow-up is needed once children start the SMC process. Thus, during the SMC Campaign, the district management team introduced an innovation  consisting of “sponsorship” of SMC target children as a new follow-up mechanism. These sponsors are Community Distributors (CDs) or Community Based Organizations (CBOs). They voluntarily agreed to follow up with five children each, between July and October 2021 in order …

  1. To ensure that the children actually took the medication
  2. To monitor whether these children did not get sick between two cycles
  3. To inform the nurse in charge of the health center in case of illness of a sponsored child
  4. To encourage parents to use bed nets to protect their children. In total, 1468 children were monitored and 224 (15.26%) had malaria.

This innovation on SMC distribution contributed to protect 84% of the children. Challenges include the lack of financial resources to support the sponsors and the inaccessibility of some areas due to the rains. When medicines are correctly administered to children and they are regularly monitored, protection is better.

Monitoring &Seasonal Malaria Chemoprevention Bill Brieger | 01 Nov 2022

Evaluation of the Implementation of Seasonal Malaria Chemoprevention (SMC) through Independent Monitoring in Burkina Faso

Moumouni Bonkoungou, Ousmane Badolo, Mathurin Bonzi, Youssouf Sawadogo, Andre Kone, Thierry Ouedraogo, Mathurin Dodo, Lolade Oseni, Gladys Tetteh, and William Brieger shared information on ?Evaluation of the Implementation of Seasonal Malaria Chemoprevention (SMC) through Independent Monitoring in Burkina Faso during the 2022 Annual Meeting of the American Society of Tropical Medicine and Hygiene.?

In Burkina Faso, malaria is the leading cause of children < 5 morbidity (40.6% of severe cases), and 72.4% of death   in 2020. Seasonal malaria chemoprevention (SMC) was recommended by WHO in 2012, and since 2014, it has been implemented in Burkina Faso. SMC consists monthly doses (03 doses) of Amodiaquine Plus Sulfadoxine-Pyrimethamine to all eligible children (3-59 months) during the season of high malaria transmission.

To ensure the quality of the intervention and the coverage achieved, two independent monitoring surveys were conducted at the first (C1) and fourth (C4) rounds (of 2020?). In order to minimize bias, non-health care workers (mainly teachers) were recruited, trained and supervised for the purpose of this survey.

Monitoring was conducted in 43 districts, including 19 in the PMI/USAID Impact Malaria project area, where 838,000 children received treatment. The number of children seen in the houses was 6752 at C1 and 6608 at C4 (10 houses per selected village).

The results show that 98% and 98.2% of the targeted children received treatment at C1 and C4, respectively; 78.8% presented evidence of treatment (cards or empty drug packs) at C1. At C4, 65% of children (73) who did not receive treatment were ineligible. During this cycle, only 57% had cards and 75.6% of the cards were correctly filled in on Day2 and Day3 by the parents.

We also note that 97.1% of the children took the treatment at Day2 and Day3 according to the parent’s declaration at C4 and 97.4% at C1. 2.4% of the parents did not give the medication at Day2 or Day3 compared to the fourth visit. Also, 99.9% (2274) of the parents were satisfied with the SMC at C4, they were 99.7% at C1.

These results show an overall good implementation   in accordance with the guidelines of SMC. We note a reduction of lethality in many districts like Kampti (78%).  However, challenges exist such as outreach communication which needs to be improved, availability and proper storage of treatment cards, referral of cases requiring to be seen by a health care worker. Independent monitoring shows a better figure of the SMC coverage and allow the implementation of qualitative SMC campaign.

Seasonal Malaria Chemoprevention Bill Brieger | 01 Nov 2022

Early Seasonal Malaria Chemoprevention (SMC) Implementation Contributed to Reducing Malaria Incidence

Ousmane Badolo, Mathurin Bonzi, Moumouni Bonkoungou, Youssouf Sawadogo, Gauthier Tougri, Mathurin Dodo, Gladys Tetteh, William Brieger reported on Early Seasonal Malaria Chemoprevention (SMC) Implementation Contributed to Reducing Malaria Incidence in Sud-Ouest Region in Burkina Faso at the 2022 Annual meeting of the American Society of Tropical Medicine and Hygiene in Seattle.

They explained that in Burkina Faso, malaria remains a major public health problem. According to 2020 health statistics, malaria accounted for 40% of health service consultations, 54% of hospitalizations, and 27% of deaths. Children under 5 years of age account for 72% of malaria deaths.

To help reduce this burden, the Ministry of Health, with the support of its partners, has organized annual Seasonal Malaria Chemoprevention (SMC) campaigns since 2014 during the high malaria transmission period (July, August September, and October). In 2021, the U.S. PMI Impact Malaria project provided support to the National Malaria Control Program to implement SMC in 19 districts from three regions (Centre-Est, Centre-Ouest, and Sud-Ouest).

One of the innovations of the 2021 SMC campaign was the introduction of five cycles in 7 of these 19 districts, compared to four cycles elsewhere. Therefore, SMC started earlier (in June) while all the others started in July. We compared the incidence of malaria (in the 5 districts of the Sud-Ouest region) in 2020 to that of 2021 when the SMC started earlier.

The malaria incidence is estimated based on the weekly disease surveillance form where the number of malaria cases is recorded, using updated population census data as a denominator. In 2020, the average malaria incidence from May 31 to October 6 in the Sud-Ouest region was 51.44/1000. In 2021, during the same period malaria incidence was 40.94/1000 (a decrease of 20%) The SMC coverage was 103% and 104% respectively in 2020 and 2021.

Starting SMC early can contribute to reduced malaria incidence but key challenges need to be addressed: i) Underestimation of the target population due to IDPs and gold miners; ii) youngest children are with their mothers on the farm so cannot be found at home; iii) insufficient cards for the SMC.

Children &Mortality &Seasonal Malaria Chemoprevention Bill Brieger | 31 Oct 2022

Contribution of Seasonal Malaria Chemoprevention (SMC) to the Reduction of Malaria Burden in Children Under 5 Years of Age in the Sud-Ouest Region, Burkina Faso

Moumouni Bonkoungou, Ousmane Badolo, Mathurin Bonzi, Youssouf Sawadogo, Andre Kone, Thierry Ouedraogo, Gauthier Tougri, Mathurin Dodo, Edward Kenyi, Gladys Tetteh, and William Brieger working with the US PMI Impact Malaria project implemented Seasonal Malaria Chemoprevention (SMC) in collaboration with the National Malaria Control Program (NMCP) of Burkina Faso in 3 regions. Their findings are seen below and are presented at the Annual Meeting of the American Society of Tropical Medicine and Hygiene in Seattle.

According to health statistics for 2020, in Burkina Faso, malaria accounts for 40% of medical consultations and 27% of deaths. Children under 5 years of age account for 72% of malaria deaths. 

In 2021, the SMC consists of the administration of three days of monthly treatments of amodiaquine plus sulfadoxine-pyrimethamine to all eligible children (3-59 months of age) during the high malaria transmission season (June to October). The objective is to maintain therapeutic concentrations of these antimalarials during the period of high transmission. 

In 2021, 19 of 70 health districts (27%) were supported by the project to implement SMC with more than 838,000 children under 5 years treated, including 180,000 from the Sud-Ouest region (Dano, Batie, Kampti, Gaoua, and Diebougou health districts). In this region of high rainfall, the number of severe malaria cases in children under 5 years decreased from 17,760 in 2017 (before SMC) to 14,609 in 2021 with SMC after 4 years of SMC implementation, i.e., a reduction of 17%. 

The number of malaria deaths also decreased from 133 in 2017 (before SMC) to 118 in 2021, a reduction of 11%. Kampti health district recorded the highest reduction of deaths of 78% [33 to 7 deaths] between 2017 and 2021 and Dano district had a reduction in severe malaria cases by 28% between 2017 and 2021. 

The main challenges with SMC include a delay in referral of fever cases by community distributors to health facilities during the campaign, management of vomiting during the 2nd or 3rd dose, and failure to retain the treatment cards by the parents. Seasonal Malaria Chemoprevention is a proven intervention and appears to be an important

component of the malaria prevention strategy in Burkina Faso but consideration should be given to address ongoing implementation challenges.

Children &Seasonal Malaria Chemoprevention Bill Brieger | 23 Aug 2022

Seasonal Malaria Chemoprophylaxis (SMC) more equitable than Long-Lasting Insecticide Treated Mosquito Nets (LLINS) in Senegal

Sarah McHugh  has contributed this posting to the Blog site for the JHU site for the course Social and Behavioral Foundations of Primary Health Care. This image has an empty alt attribute; its file name is senegal-nmcp-malaria-interventions.pngAlthough malaria transmission and infection rates in Senegal have declined in the past two decades from over 300 incidences of malaria infection per 1000 people at risk in 2000 to about 50 in 2020, malaria remains a burden and Senegal is still working with partners and stakeholders to research potential control and elimination strategies. Malaria is endemic in Senegal, where all of its inhabitants are at risk of contracting the disease and the country has a tropical zone of the country, where there is year-round transmission of malaria and a Sahelian zone, where transmission is high during and after the rainy season. (Map: Malaria interventions across transmission zones in Senegal) This image has an empty alt attribute; its file name is target-areas-for-smc-2021-2023-1.pngThe WHO currently recommends that children under five years of age who reside in areas that have high seasonal malaria transmission (where most of the annual malaria cases occur during four months of the year) receive SMC during the months of high transmission. Although not currently recommended by the WHO, Senegal is the only SMC country that includes children up to ten years of age in SMC distribution. (SMC District MAP: PMI supported SMC districts in Senegal)

Asymptomatic &Children &coinfection &IPTp &ITNs &Malaria in Pregnancy &Plasmodium/Parasite &Reproductive Health &Schools &Seasonal Malaria Chemoprevention Bill Brieger | 15 Oct 2020

Malaria News Today 2020-10-15

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

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

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

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

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

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

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

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

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

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

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

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

Scientists shed new light on mechanisms of malaria parasite motility

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

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

New Lancet Series: Malaria in early life

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

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

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

Cholera &commodities &Community &coronavirus &Costs &COVID-19 &Culture &Epidemiology &Guidelines &Health Systems &HIV &Microscopy &Mosquitoes &Plasmodium/Parasite &Refugee &Sahel &Seasonal Malaria Chemoprevention &Surveillance &Tuberculosis Bill Brieger | 22 Sep 2020

Malaria News Today 2020-09-22: covering three continents

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.

Indoor Residual Spraying &Integrated Vector Management &ITNs &Monkeys &Mosquitoes &Nigeria &Plasmodium/Parasite &Seasonal Malaria Chemoprevention &Urban &Vector Control Bill Brieger | 21 Sep 2020

Malaria News Today 2020-09-21: Vectors, Cities and Chimpanzees

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).

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