Tropical Health Matters

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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