scholarly journals Sero-epidemiological evaluation of malaria transmission in The Gambia before and after mass drug administration

2020 ◽  
Author(s):  
Lindsey Wu ◽  
Julia Mwesigwa ◽  
Muna Affara ◽  
Mamadou Bah ◽  
Simon Correa ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
West Coast ◽  
Malaria Infection ◽  
Malaria Incidence ◽  
The Gambia ◽  
Community Based Interventions ◽  
The West ◽  
Conversion Rates ◽  
Antibody Levels

AbstractBackgroundAs The Gambia aims to achieve elimination by 2030, serological assays are a useful surveillance tool to monitor trends in malaria incidence and evaluate community-based interventions.MethodsWithin a mass drug administration (MDA) study in The Gambia, where reduced malaria infection and clinical disease were observed after the intervention, a serological sub-study was conducted in four study villages. Spatio-temporal variation in transmission was measured with a panel of recombinant Pf antigens on a multiplexed bead-based assay. Village-level antibody levels were quantified as under-15 sero-prevalence, sero-conversion rates, and age-adjusted antibody acquisition rates. Antibody levels prior to MDA were assessed for association with persistent malaria infection after community chemoprophylaxis.ResultsSeasonal changes in antibodies to Etramp5.Ag1 were observed in children under 15 in two transmission settings – the West Coast and Upper River Regions (4·32% and 31·30% Pf prevalence, respectively). At the end of the malaria season, short-lived antibody responses to Etramp5.Ag1, GEXP18, HSP40.Ag1, EBA175 RIII-V, and Rh2.2030 were lower amongst 1-15 year olds in the West Coast compared to the Upper River, reflecting known differences in transmission. Prior to MDA, individuals in the top 50th percentile of antibody levels had two-fold higher odds of clinical malaria during the transmission season, consistent with previous findings where individuals infected pre-MDA had 2-fold higher odds of re-infection post-MDA.ConclusionSerological markers can serve dual functions as indicators of malaria exposure and incidence. Further studies, particularly cluster randomised trials, can help establish standardised serological protocols to measure transmission across endemic settings.

scholarly journals Sero-epidemiological evaluation of malaria transmission in The Gambia before and after mass drug administration

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Lindsey Wu ◽  
Julia Mwesigwa ◽  
Muna Affara ◽  
Mamadou Bah ◽  
Simon Correa ◽  
...  
Keyword(s):  
Malaria Transmission ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
West Coast ◽  
Malaria Infection ◽  
The Gambia ◽  
Antibody Responses ◽  
The West ◽  
Conversion Rates ◽  
Antibody Levels

Abstract Background As The Gambia aims to achieve malaria elimination by 2030, serological assays are a useful surveillance tool to monitor trends in malaria incidence and evaluate community-based interventions. Methods Within a mass drug administration (MDA) study in The Gambia, where reduced malaria infection and clinical disease were observed after the intervention, a serological sub-study was conducted in four study villages. Spatio-temporal variation in transmission was measured with a panel of recombinant Pf antigens on a multiplexed bead-based assay. Village-level antibody levels were quantified as under-15 sero-prevalence, sero-conversion rates, and age-adjusted antibody acquisition rates. Antibody levels prior to MDA were assessed for association with persistent malaria infection after community chemoprophylaxis. Results Seasonal changes in antibodies to Etramp5.Ag1 were observed in children under 15 years in two transmission settings—the West Coast and Upper River Regions (4.32% and 31.30% Pf prevalence, respectively). At the end of the malaria season, short-lived antibody responses to Etramp5.Ag1, GEXP18, HSP40.Ag1, EBA175 RIII-V, and Rh2.2030 were lower amongst 1–15 year olds in the West Coast compared to the Upper River, reflecting known differences in transmission. Prior to MDA, individuals in the top 50th percentile of antibody levels had two-fold higher odds of clinical malaria during the transmission season, consistent with previous findings from the Malaria Transmission Dynamics Study, where individuals infected before the implementation of MDA had two-fold higher odds of re-infection post-MDA. Conclusions Serological markers can serve dual functions as indicators of malaria exposure and incidence. By monitoring age-specific sero-prevalence, the magnitude of age-stratified antibody levels, or identifying groups of individuals with above-average antibody responses, these antigens have the potential to complement conventional malaria surveillance tools. Further studies, particularly cluster randomised trials, can help establish standardised serological protocols to reliably measure transmission across endemic settings.

scholarly journals PO 8302 IMPACT OF TWO ANNUAL ROUNDS OF MASS DRUG ADMINISTRATION WITH DIHYDROARTEMISININ-PIPERAQUINE ON MALARIA TRANSMISSION IN A PROSPECTIVE COHORT STUDY

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A28.2-A28
Author(s):  
Julia Mwesigwa ◽  
Jane Achan ◽  
Miriam Wathuo ◽  
Archibald Worwui ◽  
Nuredin Mohammed ◽  
...  
Keyword(s):  
Cohort Study ◽  
Malaria Transmission ◽  
Drug Administration ◽  
Prospective Cohort Study ◽  
Mass Drug Administration ◽  
Prospective Cohort ◽  
Malaria Infection ◽  
Clinical Malaria ◽  
The Gambia ◽  
Transmission Season

BackgroundMass drug administration (MDA) may reduce malaria transmission in low-transmission areas and interrupt transmission. The impact of MDA with dihydroartemisinin-piperaquine (DP) on malaria infection and clinical malaria was determined in a prospective cohort study in The Gambia.MethodsSingle annual MDA rounds with DP were done in 2014 and 2015 in a prospective cohort among residents aged >6 months in twelve villages in The Gambia at the start of the transmission season in June. Monthly blood samples for microscopy and PCR were collected during the transmission season from July to December, post MDA and once before MDA during the dry season in April. The incidence of infection and clinical malaria post-MDA were compared to 2013 and mixed effects logistic regression models assessed the efficacy and risk of re-infection post MDA.ResultsCoverage of 3 DP doses was 68.22% in 2014 and 65.60% in 2015. Compliance to 3 doses was high, 83.11% in 2014 and 85.93% in 2015. Incidence of infection in 2014 (2014: IR=0.23 PPY, 2013: IR=1.12 PPY, p<0.01) and clinical malaria in 2014 (2014: IR=0.08 PPY, 2013: IR=0.39: IRR=0.22, p<0.01) and 2015 (2015: IR=0.19, 2013:IR=0.38, IRR=0.50, p<0.01) was significantly lower after MDA compared to 2013. The incidence of clinical malaria remained higher in eastern Gambia compared to the western region. Subjects that took 3 DP doses had lower odds of infection in 2014 at 28 days (OR=0.61, 95% CI: 0.38–0.99) and 42 days (2014: OR=0.52, 95% CI: 0.29–0.89)ConclusionA single annual MDA round with DP temporarily reduced malaria infection and clinical disease during the transmission season and subjects that took 3 doses had lower risk of infection. However, several MDA rounds covering the entire transmission season and some targeting the human reservoir during the dry season, are needed to achieve a more marked sustained reduction of transmission.

scholarly journals Five-year Surveillance of Malaria in Hotspot and Ivermectin Mass-drug Administration Zone of Amhara Regional State, Ethiopia

2021 ◽  
Author(s):  
Chalachew Yenew ◽  
Sileshi Mulatu ◽  
Asaye Alamneh
Keyword(s):  
Data Analysis ◽  
Incidence Rate ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Malaria Incidence ◽  
Reduction Rate ◽  
Supportive Supervision ◽  
Standard Format ◽  
Regional State ◽  
Malaria Incidence Rate

Abstract Objectives: Evaluate the five-year surveillance of malaria in the hotspot and Ivermectin mass-drug administration Zone of Amhara Regional State, Ethiopia.Methods: - A descriptive prevalence study design was employed and incorporated 25 study health institutions into the survey using the purposive sampling technique. Data were obtained by the standard format of systematic evaluation of four surveillance units from January to August 2020 through observation, document review, and interviewing surveillance officers and focal persons using a semi-structured Survey and generated the statistical analysis, tabular, and graphical output using the open-source statistical program R. Results: - Average report fullness and aptness were 97.9% and 96% subsequently. The average annual malaria incidence rate declined in terms of place and time, from the year 2015 to 2019 with an average reduction rate of 5.5% and the average annual parasitic incidence rate was 52%. The study identifies high endemicity of malaria due to no program-specific supportive supervision of public health emergency management and no routine data analysis.Conclusions: This result revealed that the malaria incidence rate showed a remarkable decline. However, the annual parasitic incidence rate remains constant. The study also indicated that ivermectin did not affect malaria elimination. Hence, the districts and sub-city health offices should conduct regular surveillance data analysis, perform supportive supervision, avail budgets, and further laboratory investigations to investigate the effect of ivermectin on the parasites under laboratory conditions.

scholarly journals Prevalence of sexually transmitted infections among pregnant women attending antenatal clinics in West Coast Region of The Gambia

2021 ◽  
Vol 21 (2) ◽  
pp. 585-592
Author(s):  
Alphonsus Isara ◽  
Aru-Kumba Baldeh
Keyword(s):  
Pregnant Women ◽  
Sexually Transmitted Infections ◽  
West Coast ◽  
Trichomonas Vaginalis ◽  
The Gambia ◽  
Age Group ◽  
The West ◽  
Sexually Transmitted ◽  
Neisseria Gonorrhoea ◽  
Coast Region

Background: Sexually Transmitted Infections (STI) are the second most common cause of healthy life years lost by women in the 15 – 44 years age group in Africa. Aim/Objective: To determine the prevalence of STIs among pregnant women attending antenatal care (ANC) clinics in the West Coast Region of The Gambia. Materials and Methods: Blood, urine, and high vaginal swabs samples from 280 pregnant women attending ANC in Brika- ma District Hospital, Brikama, and Bandung Maternity and Child Health Hospital, Bandung were examined. Serum samples were tested for HIV using western blot technique and for syphilis using the Venereal Disease Research Laboratory (VDRL) test, and rapid plasma regimen. Candida albicans, Group B Streptococcus and Neisseria gonorrhoea were identified using Analytical Profile Index (API). Direct urine microscopy was used to identify C. albicans and Trichomonas vaginalis while Chlamydia trachomatis was identified using Direct Fluorescent Antibody (DFA) test. Results: The overall prevalence of STIs was 53.6%. The pathogenic agents isolated were Candida albicans (31.8%), Strep- tococcus agalactiae (15.0%), Treponema pallidum (6.8%), HIV (5.7%), Trichomonas vaginalis (3.9%), Neisseria gonorrhoea (1.8%) and Chlamydia trachomatis (0.7%). STIs were more prevalent among women in the younger age group of 15 – 24 years (54.7%), unemployed (54.0%), Primipara (62.3%), and in the third trimester of pregnancy (72.7%). Conclusion: A high prevalence of STIs was found among pregnant women attending ANC in the West Coast region of The Gambia. Public health intervention programmes should be strengthened to promote the sexual and reproductive health of pregnant women in The Gambia. Keywords: Sexually transmitted infections; pregnant women; antenatal clinics; The Gambia.

scholarly journals Factors Associated with Non-Participation and Non-Adherence in Directly Observed Mass Drug Administration for Malaria in The Gambia

PLoS ONE ◽  
2016 ◽  
Vol 11 (2) ◽  
pp. e0148627 ◽  
Author(s):  
Susan Dierickx ◽  
Charlotte Gryseels ◽  
Julia Mwesigwa ◽  
Sarah O’Neill ◽  
Melanie Bannister-Tyrell ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
The Gambia ◽  
Factors Associated

scholarly journals Impact of a single round of mass drug administration with azithromycin on active trachoma and ocular Chlamydia trachomatis prevalence and circulating strains in The Gambia and Senegal

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Emma M. Harding-Esch ◽  
Martin J. Holland ◽  
Jean-François Schémann ◽  
Ansumana Sillah ◽  
Boubacar Sarr ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Clinical Signs ◽  
The Gambia ◽  
Whole Genome Sequence ◽  
Poor Correlation ◽  
Infection Prevalence ◽  
Active Trachoma ◽  
One Year

Abstract Background Mass drug administration (MDA) with azithromycin is a cornerstone of the trachoma elimination strategy. Although the global prevalence of active trachoma has declined considerably, prevalence persists or even increases in some communities and districts. To increase understanding of MDA impact, we investigated the prevalence of active trachoma and ocular C. trachomatis prevalence, organism load, and circulating strains at baseline and one-year post-MDA in The Gambia and Senegal. Methods Pre- and one-year post-MDA, children aged 0–9 years were examined for clinical signs of trachoma in six Gambian and 12 Senegalese villages. Ocular swabs from each child’s right conjunctiva were tested for evidence of ocular C. trachomatis infection and organism load (ompA copy number), and ompA and multi-locus sequence typing (MLST) was performed. Results A total of 1171 children were examined at baseline and follow-up in The Gambia. Active trachoma prevalence decreased from 23.9% to 17.7%, whereas ocular C. trachomatis prevalence increased from 3.0% to 3.8%. In Senegal, 1613 and 1771 children were examined at baseline and follow-up, respectively. Active trachoma prevalence decreased from 14.9% to 8.0%, whereas ocular C. trachomatis prevalence increased from 1.8% to 3.6%. Higher organism load was associated with having active trachoma and severe inflammation. Sequence typing demonstrated that all Senegalese samples were genovar A, whereas Gambian samples were a mix of genovars A and B. MLST provided evidence of clustering at village and household levels and demonstrated differences of strain variant frequencies in Senegal, indicative of an “outbreak”. MLST, including partial ompA typing, provided greater discriminatory power than complete ompA typing. Conclusions We found that one round of MDA led to an overall decline in active trachoma prevalence but no impact on ocular C. trachomatis infection, with heterogeneity observed between villages studied. This could not be explained by MDA coverage or number of different circulating strains pre- and post-MDA. The poor correlation between active trachoma and infection prevalence supports the need for further work on alternative indicators to clinical signs for diagnosing ocular C. trachomatis infection. MLST typing has potential molecular epidemiology utility, including better understanding of transmission dynamics, although relationship to whole-genome sequence variability requires further exploration.

scholarly journals From Informed Consent to Adherence: Factors Influencing Involvement in Mass Drug Administration With Ivermectin for Malaria Elimination in The Gambia

2020 ◽  
Author(s):  
Alexandra E. Fehr ◽  
Claudia Nieto-Sanchez ◽  
Joan Muela ◽  
Fatou Jaiteh ◽  
Omar Ceesay ◽  
...  
Keyword(s):  
Decision Making ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Social Dynamics ◽  
The Gambia ◽  
World Health ◽  
Cross Sectional Survey ◽  
Enabling Factors ◽  
Cross Sectional ◽  
Medication Costs

Abstract Background: The World Health Organization (WHO) recommends consideration of mass drug administration (MDA) for malaria control in low-endemic settings approaching elimination. However, MDA remains a controversial strategy, as multiple individual, social, and operational factors have shown to affect its acceptability at local levels. This is further complicated by inconsistent definitions of key indicators derived from individual and community involvement — coverage, adherence, and compliance— that cast doubts about the actual and potential epidemiological impact of MDA on disease control. This study aimed to identify limitations and enabling factors impacting involvement at different stages of a large cluster-randomized trial assessing the effect of combining dihydroartemisinin-piperaquine (DP) and ivermectin (IVM) in malaria transmission in The Gambia. Methods: This social science study used a mixed-methods approach. Qualitative data were collected in intervention and control villages through ethnographic methods, including in-depth interviews (IDIs), focus group discussions (FGDs), and participant observation conducted with trial participants and decliners, community leaders, and field staff. A cross-sectional survey was conducted in the intervention villages after the first year of MDA. Both strands of the study explored malaria knowledge and opinions, social dynamics influencing decision-making, as well as perceived risks, burdens, and benefits associated with this MDA.Results: 157 IDIs and 11 FGDs were conducted, and 864 respondents were included in the survey. Barriers and enabling factors to involvement were differentially influential at the various stages of the MDA. Issues of social influence, concerns regarding secondary effects of the medication, costs associated with malaria, and acceptability of the implementing organization, among other factors, differently affected the decision-making processes throughout the trial. Rather than a linear trajectory, involvement in this MDA trial was subjected to multiple revaluations from enrolment and consent to medicine intake and adherence to treatment. Conclusions: Our study went beyond the individual factors often associated with coverage and adherence, and found that nuanced social dynamics greatly influence the decision-making process at all phases of the trial. These issues need to be consider for MDA implementation strategies and inform discussions about more accurate ways of reporting on critical effectiveness indicators.

scholarly journals ‘We are always desperate and will try anything to conceive’: The convoluted and dynamic process of health seeking among women with infertility in the West Coast Region of The Gambia

PLoS ONE ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. e0211634 ◽  
Author(s):  
Susan Dierickx ◽  
Julie Balen ◽  
Chia Longman ◽  
Ladan Rahbari ◽  
Ed Clarke ◽  
...  
Keyword(s):  
Dynamic Process ◽  
West Coast ◽  
The Gambia ◽  
Health Seeking ◽  
The West ◽  
Coast Region

scholarly journals Trends of Malaria on Hotspot and Ivermectin Mass-drug Administration Zone of Amhara Regional State, 2020

2020 ◽  
Author(s):  
Chalachew Yenew ◽  
Sileshi Mulatu
Keyword(s):  
Public Health ◽  
Data Analysis ◽  
Incidence Rate ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Surveillance System ◽  
Malaria Incidence ◽  
Health Facilities ◽  
Supportive Supervision ◽  
Malaria Incidence Rate

Abstract Background:- Public health surveillance (PHS) is the continuing organized gathering, investigation, elucidation, and well-timed distribution of health-related information for activities and program evaluation. Conducting a surveillance system evaluation is crucial for monitoring the efficacy and effectiveness of intervention programs in health care systems. This study aimed to Evaluate the Trends of Malaria in the hotspot and Ivermectin mass-drug administration Zone of Amhara Regional State, Ethiopia, 2020.Methods: - A descriptive prevalence study design was used to evaluate the surveillance system of the Awi zone selected woreda. 25 study sources were incorporated in the survey (5 District Health Offices (5HOs), 10 Health Centers (10HCs), and 10 Health Posts (10 HPs). Purposive sampling techniques were utilized. Data were obtained by communicable diseases control the standard format of systematic evaluation of four surveillance units from January to August 2020 through observation, document review, and interviewing surveillance officers and focal persons using a semi-structured Survey.Results: - Average report fullness and aptness were 97.9% and 96% respectively. The average annual malaria incidence rate was a decline from the year 2015 to 2019 with an average reduction rate of 5.5% and the average annual parasitic incidence rate was 52 (22-199). In 2019/2020, 43131 Malaria cases were reported in the zone. Supervisions were made as integrated supportive supervision in the last six months. However, there was no program specific supportive supervision of public health emergency management. Data analysis was not routinely practiced in both visited districts and was not used for decision making.Conclusions: This result revealed that the malaria incidence rate showed a remarkable decline. However, the annual parasitic incidence rate remains constant. This indicates that ivermectin did not affect malaria elimination. The structure of the surveillance information transfer as of Kebel to Zone was well organized. However, coordination and supervision of the surveillanc activities were not frequent. From those supervised health facilities, most of them are not receiving feedback. There was no budget line, written feedback, epidemic and preparedness, and a response plan regular based on supportive supervision at all visited health facilities. Depending on this, we recommend that districts and sub-city health offices should conduct regular surveillance data analysis, perform supportive supervision, avail budgets and mitigate resource constraints and improve data quality on the job training and supportive supervision. Further laboratory investigations should be done to investigate the effect of ivermectin on the parasites under laboratory conditions.

scholarly journals Mass Drug Administration With Artemisinin-Piperaquine for the Elimination of Residual Foci of Malaria in São Tomé Island

2021 ◽  
Vol 8 ◽  
Author(s):  
Mingqiang Li ◽  
Fei Tuo ◽  
Ruixiang Tan ◽  
Hongying Zhang ◽  
Shaoqin Zheng ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Malaria Incidence ◽  
Parasite Prevalence ◽  
Control Site ◽  
Time Interval ◽  
Cumulative Number ◽  
Carriage Rate ◽  
Sao Tome And Principe

Background: Mass drug administration with artemisinin-piperaquine (AP-MDA) is being considered for elimination of residual foci of malaria in Democratic Republic of São Tomé and Principe.Methods: Three monthly rounds of AP-MDA were implemented from July to October 2019. Four zones were selected. A and B were selected as a study site and a control site, respectively. C and D were located within 1.5 and 1.5 km away from the study site, respectively. Parasite prevalence, malaria incidence, and the proportion of the Plasmodium falciparum malaria cases were evaluated.Results: After 3 monthly rounds of AP-MDA, the parasite prevalence and the gametocyte carriage rate of P. falciparum in zone A decreased from 28.29(‰) to 0 and 4.99(‰) to 0, respectively. Compared to zone B, the relative risk for the population with Plasmodium falciparum malaria in zone A was lower (RR = 0.458, 95% CI: 0.146–1.437). Malaria incidence fell from 290.49(‰) (the same period of the previous year) to 15.27(‰) (from the 29th week in 2019 to the 14th week in 2020), a decrease of 94.74% in zone A, and from 31.74 to 5.46(‰), a decline of 82.80% in zone B. Compared to the data of the same period the previous year, the cumulative number of P. falciparum malaria cases were lower, decreasing from 165 to 10 in zone A and from 17 to 4 in zone B. The proportion of the P. falciparum malaria cases on the total malaria cases of the country decreased of 90.16% in zone A and 71.34% in zone C.Conclusion: AP-MDA greatly curbed malaria transmission by reducing malaria incidence in the study site and simultaneously creating a knock-on effect of malaria control within 1.5 km of the study site and within the limited time interval of 38 weeks.

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