Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana (original) (raw)
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BMJ Global Health, 2019
BackgroundGlobal efforts to scale up malaria control interventions that work, are gaining momentum. These include the use of long-lasting insecticide nets, intermittent preventive treatment and test, treat and track using artemisinin-based combination therapies. Mass testing, treatment and tracking (MTTT) of the entire populations complemented by home-based management (HBM) using volunteers could be an effective approach at lower cost. MTTT of children in Ghana has demonstrated a parasite load reduction of 90%. However, unanswered questions include – Could this be scaled-up? What proportion of the community could be covered? What do we need? Can MTTT reduce asymptomatic parasitaemia levels in under-15 children?MethodsThe target population for this study was 5000 asymptomatic individuals in seven communities in the Pakro subdistrict in Ghana. A community register was developed following a census. Community volunteers conducted quarterly house-to-house testing (using RDTs) and treatin...
BMC Public Health
Background: Malaria remains endemic in Ghana despite several interventions. Studies have demonstrated very high levels of asymptomatic malaria parasitaemia in both under-five and school-age children. Mass testing, treatment and tracking (MTTT) of malaria in communities is being proposed for implementation with the argument that it can reduce parasite load, amplify gains from the other control interventions and consequently lead to elimination. However, challenges associated with implementing MTTT such as feasibility, levels of coverage to be achieved for effectiveness, community perceptions and cost implications need to be clearly understood. This qualitative study was therefore conducted in an area with ongoing MTTT to assess community and health workers' perceptions about feasibility of scale-up and effectiveness to guide scale-up decisions. Methods: This qualitative study employed purposive sampling to select the study participants. Ten focus group discussions (FGDs) were conducted in seven communities; eight with community members (n = 80) and two with health workers (n = 14). In addition, two in-depth interviews (IDI) were conducted, one with a Physician Assistant and another with a Laboratory Technician at the health facility. All interviews were recorded, transcribed, translated and analyzed using QSR NVivo 12. Results: Both health workers and community members expressed positive perceptions about the feasibility of implementation and effectiveness of MTTT as an intervention that could reduce the burden of malaria in the community. MTTT implementation was perceived to have increased sensitisation about malaria, reduced the incidence of malaria, reduced household expenditure on malaria and alleviated the need to travel long distances for healthcare. Key challenges to implementation were doubts about the expertise of trained Community-Based Health Volunteers (CBHVs) to diagnose and treat malaria appropriately, side effects of Artemisinin-based Combination Therapies (ACTs) and misconceptions that CBHVs could infect children with epilepsy. Conclusion: The study demonstrated that MTTT was perceived to be effective in reducing malaria incidence and related hospital visits in participating communities. MTTT was deemed useful in breaking financial and geographical barriers to accessing healthcare. The interventions were feasible and acceptable to community members, despite observed challenges to implementation such as concerns about CBHVs' knowledge and skills and reduced revenue from internally generated funds (IGF) of the health facility.
Advances in Infectious Diseases
Background: Malaria remains a dominant health issue among children in Ghana. We monitored the trend of long lasting insecticide net (LLIN) ownership and use and its impact on malaria and anaemia among children under five over the past decade in an area of intense, prolonged and seasonal malaria transmission. Methods: A total of 1717, 2155 and 1915 children were surveyed in June and 1717, 2155 and 1697 in November in 30 communities of the Hohoe Municipality in 2006, 2010 and 2015 respectively. The primary outcomes monitored were the trend of LLIN ownership, use and prevalence of malaria and anaemia through cross-sectional surveys. Findings: Results showed a significantly positive trend (p < 0.001) in ownership of LLIN at 20.8%, 64.8% and 83.2% for 2006, 2010 and 2016 respectively. The sharp increase in ownership between 2006 and 2010 accounted for a highly significant departure from trend (p < 0.001). Similarly, the prevalence of LLIN use was 15.1%, 42.2% and 68.3% for 2006, 2010 and 2016 respectively with a significant positive trend (p < 0.001). The prevalence of malaria parasitaemia in June showed no significant drop over the three years studied. Anaemia prevalence was 7.9%, 5.3% and 11.1% for 2006, 2010 and 2015 respectively-Anaemia significantly increased (p < 0.001) between 2010 and 2015 accounting for a significant departure from the initially decreasing trend (p < 0.001). Malaria parasitaemia over the November surveys was 40.4%, 33.2% and 26.
Mass testing and treatment for malaria in low transmission areas in Amhara Region, Ethiopia
Mass testing and treatment for malaria in low transmission areas in Amhara Region, Ethiopia, 2016
Background: In areas with ongoing malaria transmission, strategies to clear parasites from populations can reduce infection and transmission. The objective of this paper was to describe a malaria mass testing and treatment (MTAT) intervention implemented in six kebeles (villages) in Amhara Region, Ethiopia, at the beginning of the 2014 transmission season. Methods: Intervention kebeles were selected based on incidence of passively detected Plasmodium falciparum and mixed (P. falciparum and P. vivax) malaria cases during the 2013 malaria transmission season. All households in intervention kebeles were targeted; consenting residents received a rapid diagnostic test (RDT) and RDT-positive individuals received artemether-lumefantrine for P. falciparum/mixed infections or chloroquine for P. vivax. Data were collected on MTAT participation, sociodemographic characteristics, malaria risk factors, and RDT positivity. Results: Of 9162 households targeted, 7974 (87.0 %) participated in the MTAT. Among the 35,389 residents of these households, 30,712 (86.8 %) received an RDT. RDT-positivity was 1.4 % (0.3 % P. vivax, 0.7 % P. falciparum, 0.3 % mixed), ranging from 0.3 to 5.1 % by kebele; 39.4 % of RDT-positive individuals were febrile, 28.5 % resided in the same household with another RDT-positive individual, 23.0 % were not protected by vector control interventions [mosquito net or indoor residual spray (IRS)], and 7.1 % had travel history. For individuals under 10 years of age, the odds of being RDTpositive was significantly higher for those with fever, recent use of anti-malarial drugs or residing in the same household with another RDT-positive individual; 59.0 % of RDT-positive individuals had at least one of these risk factors. For individuals 10 years of age and older, the odds of being RDT positive was significantly higher for those with reported travel, fever, recent use of anti-malarial drugs, no use of vector control, and those residing in the same household as another RDT-positive individual; 71.2 % of RDT-positive individuals had at least one of these risk factors. Conclusions: In the Ethiopia setting, an MTAT intervention is operationally feasible and can be conducted with high coverage. RDT-positivity is low and varies widely by kebele. While several risk factors are significantly associated with RDT-positivity, there are still many RDT-positive individuals who do not have any of these risk factors. Strategies that target populations for testing and treatment based on these risk factors alone are likely to leave many infections undetected.
Malaria Journal, 2024
Background Progress toward malaria elimination is increasing as many countries near zero indigenous malaria cases. In settings nearing elimination, interventions will be most effective at interrupting transmission when targeted at the residual foci of transmission. These foci may be missed due to asymptomatic infections. To solve this problem, the World Health Organization recommends reactive case detection (RACD). This case study was conducted to identify individuals with asymptomatic malaria, their predisposing risk factors and recommend RACD in Asutsuare, Ghana based on literature review and a cross sectional study. Methods The study involved a search on PubMed and Google Scholar of literature published between 1st January, 2009-14th August, 2023 using the search terms "malaria" in "Asutsuare". Furthermore, structured questionnaires were administered to one hundred individuals without symptoms of malaria and screened using rapid diagnostic test (RDT) kits, microscopy and real-time polymerase chain reaction (rt-PCR). Malaria prevalence based on the three diagnostic techniques as well as potential malaria risk factors were assessed through questionnaires in a cross-sectional study. Results Cumulatively, sixty-four (64) studies (Google Scholar, 57 and PubMed, 7) were reviewed and 22 studies included in the literature on malaria in Asutsuare, Ghana. Significant risk factors were occupation, distance from a house to a waterbody, age group and educational level. Out of the 100 samples, 3 (3%) were positive by RDT, 6 (6%) by microscopy and 9 (9%) by rt-PCR. Ages 5-14.9 years had the highest mean malaria parasite densities of 560 parasites/µl with Plasmodium falciparum as the dominant species in 4 participants. Moreover, in the age group ≥ 15, 2 participants (1 each) harboured P. falciparum and Plasmodium malariae parasites. RDT had a higher sensitivity (76.54%; CI 95 66.82-85.54) than rt-PCR (33.33%; CI 95 4.33-77.72), while both rt-PCR and RDT were observed to have a higher specificity (92.55; CI 95 85.26-96.95) and (97.30; CI 95 93.87-99.13), respectively in the diagnosis of malaria.
Background: Since 2005, the Government of Ghana and its partners, in concerted efforts to control malaria, scaled up the use of artemisinin‑based combination therapy (ACT) and insecticide‑treated nets (ITNs). Beginning in 2011, a mass campaign of long‑lasting insecticidal nets (LLINs) was implemented, targeting all the population. The impact of these interventions on malaria cases, admissions and deaths was assessed using data from district hospitals. Methods: Records of malaria cases and deaths and availability of ACT in 88 hospitals, as well as at district level, ITN distribution, and indoor residual spraying were reviewed. Annual proportion of the population potentially protected by ITNs was estimated with the assumption that each LLIN covered 1.8 persons for 3 years. Changes in trends of cases and deaths in 2015 were estimated by segmented log‑linear regression, comparing trends in post‑scale‑up (2011– 2015) with that of pre‑scale‑up (2005–2010) period. Trends of mortality in children under 5 years old from population‑ based household surveys were also compared with the trends observed in hospitals for the same time period. Results: Among all ages, the number of outpatient malaria cases (confirmed and presumed) declined by 57% (95% confidence interval [CI], 47–66%) by first half of 2015 (during the post‑scale‑up) compared to the pre‑scale‑up (2005–2010) period. The number of microscopically confirmed cases decreased by 53% (28–69%) while microscopic testing was stable. Test positivity rate (TPR) decreased by 41% (19–57%). The change in malaria admissions was insig‑ nificant while malaria deaths fell significantly by 65% (52–75%). In children under 5 years old, total malaria outpa‑ tient cases, admissions and deaths decreased by 50% (32–63%), 46% (19–75%) and 70% (49–82%), respectively. The proportion of outpatient malaria cases, admissions and deaths of all‑cause conditions in both all ages and children under five also fell significantly by >30%. Similar decreases in the main malaria indicators were observed in the three epidemiological strata (coastal, forest, savannah). All‑cause admissions increased significantly in patients covered by the National Health Insurance Scheme (NHIS) compared to the non‑insured. The non‑malaria cases and non‑malaria deaths increased or remained unchanged during the same period. All‑cause mortality for children under 5 years old in household surveys, similar to those observed in the hospitals, declined by 43% between 2008 and 2014. Conclusions: The data provide compelling evidence of impact following LLIN mass campaigns targeting all ages since 2011, while maintaining other anti‑malarial interventions. Malaria cases and deaths decreased by over 50 and 65%, respectively. The declines were stronger in children under five. Test positivity rate in all ages decreased by >40%. The decrease in malaria deaths was against a backdrop of increased admissions owing to free access to
Malaria Journal, 2007
Background: The goal of Roll Back Malaria (RBM) is to reduce malaria morbidity and mortality by 50% by the year 2010, and still further thereafter until the disease becomes no more a threat to public health. To contribute to the monitoring and evaluation process of this goal, two surveys were carried out in 2000 and 2003 in households and health facilities in the Kassena-Nankana district, northern Ghana using the RBM-WHO/AFRO monitoring and evaluation tools for malaria control activities. Methods: Data were collected from mothers/caretakers on signs/symptoms of the most recent malaria attack for their under five year old children; the management actions that they took and their perception of health services provided at the health facilities, bednet use, antenatal attendance and place of delivery for the most recent pregnancy, malaria prophylaxis during their last pregnancy. Community health workers and herbalist/traditional healers were also interviewed about the types of health services they provide to community members. Results: The results revealed a significant improvement in knowledge among mothers/caretakers over the three-year period; this affected caretakers' initial management of illnesses of their young children. The management in terms of the type and dosage of drugs used also improved significantly (p < 0.0001) over the period. Reported insecticide-treated bed net use among children under-five years and pregnant women significantly increased between 2000 and 2003 (p < 0.0001). Health professionals had improved on adoption of their quality of care roles. The intensification of malaria control activities and awareness creation in this district over a three year period had started demonstrating positive results towards reducing malaria disease burden. Conclusion: Periodic performance assessments through surveys as described and prompt feedback of results to stakeholders in the locality serves as a catalyst to improving malaria control in malaria-endemic countries.
Malaria infection among children under-five: the use of large-scale interventions in Ghana
BMC public health, 2018
Despite the significant investments to control malaria infection rates over the past years, infection rates remain significant in sub-Saharan Africa. This study investigates the association with use of large-scale malaria interventions such as: Indoor Residual Spraying (IRS), Insecticide Treated bed-Nets (ITN), and Behaviour Change Communication (BCC) strategies, and the prevalence of malaria among children under-five in Ghana. Cross-sectional data on 2, 449 children aged 6 to 59 months who were tested for malaria, through Rapid Diagnostic Test (RDT), are drawn from the recent wave of the Ghana Demographic and Health Surveys (GDHS 2014). We use a logit model to analyse the heterogeneous association between control measures and malaria infection among under five children of different age cohorts and household poverty statuses. Our estimates suggest that IRS offers much more protection than ITN use. The odds of malaria infection among children who sleep in IRS is significantly lower (...
Malaria Journal, 2022
Background: Malaria remains the biggest public health challenge globally, and Ghana is among the 15 highest burden malaria countries in the world, with 2% of global malaria cases and 3% deaths in 2019. This study sought to assess the impact of mass LLIN distribution campaign on malaria morbidity using all health facilities outpatient data across 15 regions of Ghana. Methods: Data for this study was obtained from the DHIMS2 for health facilities providing OPD and malaria services in Ghana. This was an ecological study that employed the difference-indifference approach to assess the change in proportion of uncomplicated confirmed malaria cases among OPDs in all types of health facilities in Ghana between 2015 and 2019 following the mass distribution campaign of LLINs in 2018. Malaria cases at the OPDs before and after the free LLIN mass distribution exercise were evaluated. Results: The trend of the proportion of OPD cases that were confirmed uncomplicated malaria cases increased from 14.8% in 2015 to 18.9% in 2019 at the national level. The average proportion of malaria cases among OPDs in Ghana in 2019 reduced against the expected by − 3.76% (95% CI − 4.69 to − 2.84], p<0.001) among all cases, − 4.52% (95% CI [− 5.70 to − 3.34], p<0.001) among children under-fives years, − 4.10% (95% CI − 5.3 to 2.9], p<0.001) among female children under-five and − 5.18% (95% CI [− 6.33 to − 4.02], p<0.001) among male children under-five. The reduction on the average proportion of malaria cases among OPDs varied significantly across regions and the type of health facilities. Conclusion: The mass distribution of LLINs across Ghana in 2018 can be associated with reduction in the proportion of malaria cases among OPDs across health facilities in Ghana. The study recommends the biannual mass distribution campaigns especially in the high-density regions.
Ghana Medical Journal
Background: We reviewed malaria morbidity data to assess compliance to malaria T3 strategy in Bosomtwi District, Ashanti Region, Ghana.Design: The study was descriptive secondary data analysisSetting: Bosomtwi DistrictData source: District Health Information Management Systems (DHIMS2)Main outcome: Proportion of recorded cases tested, proportion of tested cases treated and proportion of cases trackedResults: Data for suspected and tested malaria cases was complete for only 3 years (2014-2016). Malaria testing reduced from 84.4% in 2015 to 76.8% in 2016 (national average 77.3%; regional average 70%). The proportion of untested but treated malaria cases declined from 46.3% in 2015 to 4.9% in 2016. Proportion of confirmed malaria cases put on antimalarial drugs was highest in 2016 at 63.9%. Pramso sub-district although home to largest facility in the district, under prescribed antimalarial drugs. Reports generated on malaria showed information on only confirmed suspected cases, under f...