In vivo antiplasmodial properties of fractions and flavonoids of Pseudarthria hooheri Wight & Arn. (Fabaceae)

Malaria is regarded as one of the most lethal diseases. Resistance to artemisinin and its derivatives jeopardises effective malaria treatment. Finding novel antimalarial chemicals is critical given the existing treatment situation. This work aimed to examine the antiplasmodial capabilities of <i>Pseudarthria hookeri</i> fractions and flavonoids in vivo. The fractions and compounds antiplasmodial activity were evaluated on male Swiss albino mice infected with <i>Plasmodium berghei</i>, and on healthy female Swiss albino mice, the crude extract's acute toxicity was assessed. The EtOAc fraction had significant antiplasmodial activity (32.53 percent suppression at 500 mg/kg BW) and considerably prolonged the survival period of infected mice (9.8 days) compared to control mice (7.8 days). Parasitaemia was dramatically reduced (85.01, 59.41, and 70.39 percent), and the mean survival time extended (11.33, 10.00, and 9.33 days) with 15, 20 and 35 mg/kg of quercetin (<b>1</b>), 7-O-benzyl-6-prenylpinocembrin (<b>6</b>) and 6,8-diprenyleriodictyol (<b>11</b>) (isolates of the EtOAc fraction), respectively. BW loss and PCV reduction were also averted. Moreover, at 2500 mg/kg, the crude extract of <i>P. hookeri</i> showed no acute toxicity in mice. LC-MS analysis of the EtOAc fraction enabled the identification of nine flavonoids, with <b>8</b> and <b>11</b> being the main components. The present investigation confirmed <i>P. hookeri</i>'s antiplasmodial action, substantiating its ethnomedicinal application for malaria treatment.

Does Patient Demand Contribute to the Overuse of Prescription Drugs?

In an experiment in Mali, we tested whether patients pressure providers to prescribe unnecessary medical treatment. We varied patients’ information about a discount for antimalarial tablets and measure demand for both tablets and costlier antimalarial injections. We find evidence of patient-driven demand: informing patients about the discount, instead of letting providers decide to share this information, increased discount use by 35 percent and overall malaria treatment by 10 percent. These marginal patients rarely had malaria, worsening the illness-treatment match. Providers did not use the information advantage to sell injections—their use fell in both information conditions. (JEL D83, I11, I12, O15)

Cross-sectional study to predict subnational levels of health workers’ knowledge about severe malaria treatment in Kenya

ObjectivesThis study applied a Bayesian hierarchical ecological spatial model beyond predictor analysis to test for the best fitting spatial effects model to predict subnational levels of health workers’ knowledge of severe malaria treatment policy, artesunate dosing, and preparation.SettingCounty referral government and major faith-based hospitals across 47 counties in Kenya in 2019.Design and participantsA secondary analysis of cross-sectional survey data from 345 health workers across 89 hospitals with inpatient departments who were randomly selected and interviewed.Outcome measuresThree ordinal outcome variables for severe malaria treatment policy, artesunate dose and preparation were considered, while 12 individual and contextual predictors were included in the spatial models.ResultsA third of the health workers had high knowledge levels on artesunate treatment policy; almost three-quarters had high knowledge levels on artesunate dosing and preparation. The likelihood of having high knowledge on severe malaria treatment policy was lower among nurses relative to clinicians (adjusted OR (aOR)=0.48, 95% CI 0.25 to 0.87), health workers older than 30 years were 61% less likely to have high knowledge about dosing compared with younger health workers (aOR=0.39, 95% CI 0.22 to 0.67), while health workers exposed to artesunate posters had 2.4-fold higher odds of higher knowledge about dosing compared with non-exposed health workers (aOR=2.38, 95% CI 1.22 to 4.74). The best model fitted with spatially structured random effects and spatial variations of the knowledge level across the 47 counties exhibited neighbourhood influence.ConclusionsKnowledge of severe malaria treatment policies is not adequately and optimally available among health workers across Kenya. The factors associated with the health workers’ level of knowledge were cadre, age and exposure to artesunate posters. The spatial maps provided subnational estimates of knowledge levels for focused interventions.

Pengobatan Malaria di Perkotaan dan Pedesaan di Indonesia (Analisis Lanjut Riskesdas 2013)

Malaria control in Indonesia still against many challenges, especially in terms of malaria treatment. One of the causes of low coverage of Artemisin Based Combination Therapy (ACT) is that several locations are no longer malaria endemic, being negligent with malaria cases coming from endemic areas, so that patients are not immediately diagnosed as malaria patients. The purpose of this further analysis was to describe malaria treatment based on Plasmodium species associated with access, time, and administration of ACT treatment between urban and rural areas. The method used is descriptive analysis of secondary data from Basic Health Research in 2013 as many as 1,027,763 people by taking the unit of analysis of individuals who have been diagnosed with malaria by health personnel and individuals whose blood test results are positive for malaria. The results of the analysis provide information that in urban and rural areas, the treatment of P. falciparum and P. vivax is classified as good, namely the majority received ACT treatment, the time to receive ACT treatment was within the first 24 hours, and ACT treatment was given within 3 days of being drunk. However, it was found that in rural areas, P. vivax treatment was still not good because the majority did not receive ACT treatment. The implementation of malaria control in areas that are easily accessible and well-targeted are groups that can afford the costs involved in accessing targeted interventions by public subsidized programs. This encourages all regions to have good health services that provide better access to malaria control interventions.

Ghanaian women’s knowledge on whether malaria treatment is covered by the national health insurance: A multilevel regression analysis of national data

Background To obviate malaria and other healthcare costs and enhance healthcare utilization, the government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2005. Nonetheless, there is dearth of empirical evidence on Ghanaian women’s knowledge about whether malaria treatment is covered by the NHIS or not. The current study, therefore, investigated factors associated with knowledge of malaria treatment with the NHIS among women aged 15-49 in Ghana. Methods The study is a secondary analysis of data from women respondents in the 2014 Ghana Demographic and Health Survey. A total of 2,560 women participated in this study. Descriptive computation of the weighted proportion of women who knew that malaria is covered by NHIS was conducted at 95% confidence interval (CI). A multilevel logistic regression analyses was carried out with Stata’s MLwinN package version 3.05. We declared significance at 5% alpha. Findings from the models were reported as adjusted odds ratios (aOR) and credible intervals (CrIs). Results In all, 81.0% of Ghanaian women included in the study knew that NHIS covers malaria treatment. Women aged 45-49 had higher odds of knowing that NHIS covers malaria relative to those aged 15-19 age category [aOR=1.5;95%crl=1.2-2.1]. Women with higher education (post-secondary) had higher odds of knowing that NHIS covers malaria treatment compared with women who had no formal education [aOR=1.6;95%Crl=1.2-2.0]. Richest women were more likely to know that NHIS covers malaria treatment compared to the poorest women [aOR=1.3;95%Crl=1.2-1.7]. Women who had subscribed to the NHIS were more likely to report that NHIS covers malaria treatment [aOR=1.5;95%Crl=1.2-1.8]. The study revealed that the variance in the tendency for a woman to be aware that NHIS covers malaria treatment is attributable to 10.8% community level factors. Conclusion This study has shown that individual, community and regional level factors affect women’s knowledge on whether NHIS covers malaria treatment or not. As knowledge that malaria treatment is covered by NHIS may increase use of malaria prevention and treatment services in health facilities, we recommend that the Ghana Health Service intensifies community level education and awareness creation efforts, targeted at women among whom awareness levels are currently low.

Health worker compliance with severe malaria treatment guidelines in the context of implementing pre-referral rectal artesunate: an operational study in three high burden countries

Background: Appropriate clinical management of severe malaria is critical to avert morbidity and death. Recommended treatment consists of an injectable antimalarial followed by a full course of oral artemisinin-based combination therapy (ACT). Children who cannot access prompt parenteral treatment should be administered a single dose of rectal artesunate (RAS) and promptly referred to an appropriate facility for further care. This study aimed to assess compliance with the treatment recommendation in children under 5 years diagnosed with severe malaria and admitted to referral facilities in 3 high-burden sub-Saharan African countries. Methods and Findings: This study accompanied the implementation of RAS as a pre-referral treatment in the Democratic Republic of the Congo (DRC), Nigeria and Uganda. Children under 5 who were admitted at a referral health facility (RHF) with a diagnosis of severe malaria were included. Type and dosage of antimalarial treatment at RHFs was assessed for children referred from a community-based provider and those directly attending the RHF. We used multivariable regression models to assess factors associated with administration of compliant treatment. RHF data of 7,983 children was analysed for compliance with regards to antimalarials, a subsample of 3,449 children was assessed in more detail for schedule and dosage compliance and method of ACT provision. Overall, 42.0% (3,356/7,983) of admitted children were administered full treatment consisting of a parenteral antimalarial and an ACT, with large variation among study countries (2.7% in Nigeria, 44.5% in Uganda and 50.3% in DRC). Children receiving RAS from a community-based provider were more likely to be administered compliant post-referral medication at RHFs in DRC (adjusted odds ratio (aOR) =2.19, 95% CI 1.60-2.99), but less likely in Uganda (aOR = 0.43, 95% CI 0.19-0.96). Use of injectable antimalarials was very high in all three countries (99.2% (1,344/1,355) in Uganda, 98.1% (413/421) in Nigeria and 94.4% (1,580/1,673) in DRC), with most children receiving the recommended minimum of three doses (99.0% (1,331/1,344) in Uganda, 95.5% (1,509/1,580) in DRC and 92.0% (380/413) in Nigeria). Rather than being administered in the RHF, ACTs were often prescribed at discharge in Nigeria (54.4%, 229/421) and Uganda (53.0%, 715/1,349), while this was rarely done in DRC (0.8%, 14/1,669) where inpatient administration was more common. Conclusions: Directly observed treatment with both a parenteral antimalarial and an ACT was rare and variable between countries, bearing a high risk for incomplete parasite clearance and disease recrudescence. Parenteral artesunate not followed up with a full course of oral ACT constitutes an artemisinin monotherapy and may favour the selection or development of resistant parasites. Stricter health worker compliance with the WHO severe malaria treatment guidelines is therefore needed to effectively manage this disease and further reduce child mortality.

Factors Influencing Caregivers’ Health Seeking Behavior for Malaria Treatment of Children Under 5 Years in Busia Municipality, Uganda

Background: Malaria remains a serious cause of under-five mortality and morbidity worldwide and Uganda inclusive. This burden can be minimized by promptly seeking health care. In Uganda, however, studies around malaria health-seeking behaviors for under-five children in the most malaria prevalent areas are very few. This study aimed at determining the factors influencing caregivers’ health-seeking behavior for malaria treatment of children under five years in Busia Municipality, Uganda. Methods: A cross-sectional research design was used with a structured questionnaire to collect data. Data were analyzed using SPSS Version 22 to establish relationships between the variables. Results: The results showed that the current health-seeking behaviors of the caregivers of under-five children in Busia municipality are associated with caregiver education level (p= 0.008), the health worker’s behavior towards the client (p=0.015), the severity of fever (p<0.001), the severity of last malaria episode (p<0.001), waiting time (p=0.001), the quality of health services (p= 0.001) and age of caregiver (p<0.001). Traditional medicine and home remedies are the most utilized means of malaria management in under-five children in Busia Municipality. Conclusions: Caregivers need to be sensitized about the proper health-seeking behaviors for the management of malaria in children under-five years through radio shows, television, community engagement meetings among others to enhance the knowledge and understanding of communities about the recommended malaria treatment-seeking practices. There is a need to continuously train medical workers on client engagement skills to promote a good relationship with patients and encourage their return.

Knowledge and Social Beliefs of Malaria and Prevention Strategies Among Itinerant Nomadic Arabs, Fulanis and Dagazada groups in Chad: A Mixed Method Study

Background: Nomadic populations in Chad are at increased risk of contracting malaria because of their lifestyle. Being highly mobile they are often excluded from disease control programs, and access to preventive measures and treatment is more difficult. Effective malaria control interventions take account of local modes of transmission, patterns of care-seeking behavior and community perceptions of cause and prevention practices. There is currently little information about malaria knowledge and perceptions among nomadic groups in Chad, or their awareness of malaria control interventions and this study sought to address this knowledge gap. Methods: A mixed methods study, including a cross-sectional survey with men and women (n = 78) to determine the level of knowledge and use of malaria prevention strategies among Arabs, Peuls and Dagazada nomadic groups. Three focus group discussions were conducted with women to explore their representation of malaria and knowledge of preventive methods. Key informant interviews were held with leaders of nomadic groups (n = 6) to understand perception of malaria risk among itinerant communities.Results: nomads are aware of the risk of malaria, recognize the symptoms and have local explanations for the disease. Reported use of preventive interventions such as Seasonal Malaria Chemoprophylaxis (SMC) for children and Intermittent Preventive Treatment (IPT) of malaria in pregnancy was very low. However, 42.3% of respondents reported owning at least one LLIN and 60% said they slept under an LLIN the night before the survey. In case of a malaria episode, nomads seek clinicians, informal drug sellers in the street or market for self-medication, or traditional medicine depending on their financial means. Interviews with nomad leaders and discussions with women provide key themes on: (i) social representation of malaria risk and (ii) social representation of malaria and (iii) perspectives on malaria prevention and (iv) malaria treatment practices.Conclusion: The nomadic groups included in this study are aware of risk of malaria and their level of exposure. Local interpretations of the cause of malaria could be addressed through tailored and appropriate health education. Except for LLINs, malaria prevention interventions are not well known or used. Financial barriers lowered access to both mosquito nets and malaria treatment. Reducing the barriers highlighted in this study will improve access to the healthcare system for nomadic groups, and increase the opportunity to create awareness of and improve uptake of SMC and IPT among women and children.