Accuracy of a rapid diagnostic test on the diagnosis of malaria infection and of malaria - attributable fever during low and high transmission season in Burkina Faso

Abstract Background. Azithromycin is a broad-spectrum antibiotic that has moderate antimalarial activity and has been shown to reduce all-cause mortality when biannually administered to children under five in high mortality settings in sub-Saharan Africa. One potential mechanism for this observed reduction in mortality is via a reduction in malaria transmission.Methods. We evaluated whether a single oral dose of azithromycin reduces malaria positivity by rapid diagnostic test (RDT). We conducted an individually randomized placebo-controlled trial in Burkina Faso during the high malaria transmission season in August 2020. Children aged 8 days to 59 months old were randomized to a single oral dose of azithromycin (20 mg/kg) or matching placebo. At baseline and 14 days following treatment, we administered a rapid diagnostic test (RDT) to detect Plasmodium falciparum and measured tympanic temperature for all children. Caregiver-reported adverse events and clinic visits were recorded at the day 14 visit. Results. We enrolled 449 children with 221 randomized to azithromycin and 228 to placebo. The median age was 32 months and 48% were female. A total of 8% of children had a positive RDT for malaria at baseline and 11% had a fever (tympanic temperature ³37.5°C). In the azithromycin arm, 8% of children had a positive RDT for malaria at 14 days compared to 7% in the placebo arm (P=0.65). Fifteen percent of children in the azithromycin arm had a fever ³37.5°C compared to 21% in the placebo arm (P=0.12). Caregivers of children in the azithromycin group had lower odds of reporting fever as an adverse event compared to children in the placebo group (OR 0.41, 95% CI 0.18-0.96, P=0.04). Caregiver-reported clinic visits were uncommon, and there were no observed differences between arms (P=0.32).Conclusions. We did not find evidence that a single oral dose of azithromycin reduced malaria positivity during the high transmission season. Caregiver-reported fever occurred less often in children receiving azithromycin compared to placebo, indicating that azithromycin may have some effect on non-malarial infections. Trial Registration: NCT03676751

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Asymptomatic malaria and anaemia among pregnant women during high and low malaria transmission seasons in Burkina Faso: household-based cross-sectional surveys in Burkina Faso, 2013 and 2017

Malaria Journal ◽

10.1186/s12936-021-03703-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Toussaint Rouamba ◽

Sékou Samadoulougou ◽

Mady Ouédraogo ◽

Hervé Hien ◽

Halidou Tinto ◽

...

Keyword(s):

Burkina Faso ◽

Pregnant Women ◽

Malaria Transmission ◽

Asymptomatic Malaria ◽

Cross Sectional ◽

Transmission Season ◽

Low Transmission ◽

High Transmission ◽

Asymptomatic Carriage ◽

Low Malaria Transmission

Abstract Background Malaria in endemic countries is often asymptomatic during pregnancy, but it has substantial consequences for both the mother and her unborn baby. During pregnancy, anaemia is an important consequence of malaria infection. In Burkina Faso, the intensity of malaria varies according to the season, albeit the prevalence of malaria and anaemia as well as their risk factors, during high and low malaria transmission seasons is underexplored at the household level. Methods Data of 1751 pregnant women from October 2013 to March 2014 and 1931 pregnant women from April 2017 to June 2017 were drawn from two cross-sectional household surveys conducted in 24 health districts of Burkina Faso. Pregnant women were tested for malaria in their household after consenting. Asymptomatic carriage was defined as a positive result from malaria rapid diagnostic tests in the absence of clinical symptoms of malaria. Anaemia was defined as haemoglobin level less than 11 g/dL in the first and third trimester and less than 10.5 g/dL in the second trimester of pregnancy. Results Prevalence of asymptomatic malaria in pregnancy was estimated at 23.9% (95% CI 20.2–28.0) during the high transmission season (October–November) in 2013. During the low transmission season, it was 12.7% (95% CI 10.9–14.7) between December and March in 2013–2014 and halved (6.4%; 95% CI 5.3–7.6) between April and June 2017. Anaemia prevalence was estimated at 59.4% (95% CI 54.8–63.8) during the high transmission season in 2013. During the low transmission season, it was 50.6% (95% CI 47.7–53.4) between December and March 2013–2014 and 65.0% (95% CI 62.8–67.2) between April and June, 2017. Conclusion This study revealed that the prevalence of malaria asymptomatic carriage and anaemia among pregnant women at the community level remain high throughout the year. Thus, more efforts are needed to increase prevention measures such as IPTp–SP coverage in order to reduce anaemia and contribute to preventing low birth weight and poor pregnancy outcomes.

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Evaluation of a PfHRP-2 Based Rapid Diagnostic Test Versus Microscopy Method Among HIV-Positive and Unknown Serology Patients in Ouagadougou, Burkina Faso

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.13-0757 ◽

2015 ◽

Vol 92 (4) ◽

pp. 834-837 ◽

Cited By ~ 2

Author(s):

Arianna Andreoli ◽

Jaques Simpore ◽

Pier Francesco Giorgetti ◽

Virginio Pietra ◽

Alessia Melzani ◽

...

Keyword(s):

Burkina Faso ◽

Diagnostic Test ◽

Rapid Diagnostic Test ◽

Hiv Positive ◽

Microscopy Method

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Molecular Evidence of Malaria and Zoonotic Diseases Among Rapid Diagnostic Test–Negative Febrile Patients in Low-Transmission Season, Mali

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.16-0700 ◽

2016 ◽

Vol 96 (2) ◽

pp. 335-337 ◽

Cited By ~ 5

Author(s):

Mahamoudou Touré ◽

Pelle T. Petersen ◽

Sidy N'D. Bathily ◽

Daouda Sanogo ◽

Christian W. Wang ◽

...

Keyword(s):

Diagnostic Test ◽

Rapid Diagnostic Test ◽

Zoonotic Diseases ◽

Molecular Evidence ◽

Transmission Season ◽

Low Transmission

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A Cohort Study To Identify Risk Factors For Malaria In Burkinabe Children: Implications For Other High Burden High Impact Countries

10.21203/rs.3.rs-45492/v1 ◽

2020 ◽

Author(s):

Jean Baptiste Yaro ◽

Alphonse Ouedraogo ◽

Z Amidou Ouedraogo ◽

Amidou Diarra ◽

Malik Lankouande ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Burkina Faso ◽

Malaria Transmission ◽

Malaria Infection ◽

Economic Status ◽

Control Measures ◽

Previous Night ◽

Transmission Season ◽

Increased Risk

Abstract Background: Progress in controlling malaria has stalled in recent years. Today the malaria burden is increasingly concentrated in a few countries, including Burkina Faso, where malaria is not declining. We carried out a cohort study to identify risk factors for malaria infection in children in south-west Burkina Faso, an area with high insecticide-treated net (ITN) coverage and insecticide-resistant vectors.Methods: Incidence of malaria infection was measured in 252 children aged 5 to 15 years, using active and passive detection, during the 2017 transmission season, following clearance of infection. Demographic, socioeconomic, environmental and entomological risk factors, including use of ITNs and insecticide resistance were monitored. Results: During the six-month follow-up period, the overall incidence of Plasmodium falciparum infection, was 2.78 episodes per child (95% CI= 2.66-2.91) by microscopy, and 3.11 (95% CI= 2.95-3.28) by PCR. The entomological inoculation rate (EIR) was 80.4 infective bites per child over the six-month malaria transmission season. At baseline, 80.6% of children were reported as sleeping under an ITN the previous night, although at the last survey, 23.3% of nets were in poor condition and considered no longer protective. No association was found between the rate of P. falciparum infection and either EIR (Incidence Rate Ratio, IRR: 1.00, 95% CI: 1.00–1.00, p=0.08) or mortality in WHO tube tests when vectors were exposed to 0.05% deltamethrin (IRR: 1.05, 95% CI: 0.73–1.50, p=0.79). Travel history (IRR: 1.52, 95% CI: 1.45–1.59, p<0.001) and increasing socio-economic status were associated with an increased risk of P. falciparum infection (IRR: 1.05, 95% CI: 1.00–1.11, p=0.04).Conclusions: Malaria infection incidence remains overwhelmingly high in the study area. Our findings suggest that because of the exceptionally high levels of malaria transmission in the study area, malaria elimination cannot be achieved solely by mass deployment of ITNs and additional control measures are needed.

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