Using an Educational Training Module to Increase Knowledge, Attitudes and Practices of Malaria among Medicine Vendors in Yobe, Nigeria

This training module focuses on providing basic guidance on the current recommended approaches regarding malaria basic information, signs/symptoms, case detection, treatment, referral, and effective prevention strategies. The module can be used for in-service training programs on malaria or to assist in improving other health educator’s work as well as serve as referral handbook for practicing health professionals. It can thus be used as a stand-alone training or together with modules dealing with other aspects of malaria control, prevention and elimination. The module uses a problem-solving approach to facilitate understanding and thereby motivate trainees on improved malaria case management. In essence, the training aims to generally improve the knowledge, attitudes and practices (KAP) of the most common handlers of malaria cases in this part of the world, the training module is then expected to improve services obtained by the majority of patients on malaria. On completion of training using this module, trainees will have acquired appreciable knowledge and skills on malaria basic-information, signs/symptoms, case detection/differentials, recommended drug treatment/appropriate dosing, indication for referral of complicated cases, effective prevention methods and the need to sensitise communities to stand up against malaria.

New Challenges in Malaria Elimination

In recent years, efforts to eliminate malaria has gained a tremendous momentum, and many countries have achieved this goal — but it has faced many challenges. Recent COVID-19 pandemic has compounded the challenges due to cessation of many on-field operations. Accordingly, the World Health Organization (WHO) has advocated to all malaria-endemic countries to continue the malaria elimination operations following the renewed protocols. The recent reports of artemisinin resistance in Plasmodium falciparum followed by indication of chloroquine resistance in P. vivax, and reduced susceptibility of synthetic pyrethroids used in long lasting insecticide nets are some issues hindering the elimination efforts. Moreover, long distance night migration of vector mosquitoes in sub-Saharan Africa and invasion of Asian vector Anopheles stephensi in many countries including Africa and Southeast Asia have added to the problems. In addition, deletion of histidine rich protein 2 and 3 (Pfhrp2/3) genes in P. falciparum in many countries has opened new vistas to be addressed for point-of-care diagnosis of this parasite. It is needed to revisit the strategies adopted by those countries have made malaria elimination possible even in difficult situations. Strengthening surveillance and larval source management are the main strategies for successful elimination of malaria. New technologies like Aptamar, and artificial intelligence and machine learning would prove very useful in addressing many ongoing issues related to malaria elimination.

Prompt and Accurate Diagnosis, A Veritable Tool in Malaria Elimination Efforts

The concept of malaria elimination is to get rid of local transmission of malaria parasites in a defined geographical area. Among the measures required for malaria elimination is prompt and accurate diagnosis. Malaria diagnostic tools currently in use: clinical diagnosis, Malaria Rapid Diagnostic Tests (mRDT) and molecular diagnosis, have limitations. Clinical diagnosis can be used as first step in making prompt malaria diagnosis, but cannot confirm cases. Malaria RDTs satisfies the need for prompt diagnosis but has low accuracy in confirming cases. Accuracy of microscopy depends on making good blood films, and accurate film interpretation. Molecular diagnosis required for species-specific diagnosis of malaria parasites, and determination of genes that confers drug resistance to Plasmodium species is not available for routine use. As part of elimination efforts, there is development of mRDT kits that utilize urine or saliva instead of blood specimen, microscopy digital image recognition and different technologies for molecular diagnosis. So far, none of these diagnostic tools has satisfied the need for prompt and accurate diagnosis. It is therefore recommended that more than one diagnostic tool is needed for malaria elimination to be achieved in a given area. This will ensure early detection and treatment of cases, as well as prevent the re-establishment of transmission.

Malaria Lethality in Children under 5 Years of Age and Study of Risk Factors in MbujiMayi Paediatric Environment, a Neglected Deadly Epidemic in the Democratic of Republic of Congo

The objective of this study was to determine the risk factors for malaria lethality in the MbujiMayi paediatric environment, a follow-up study of hospitalised cases over 5 years was conducted between January 2016 and December 2020 in the four hospitals. The case rate was 6.9% for the total (139 cases of death for 2017 cases of severe malaria for 5 years,) and varied from year to year (10.7% in 2016 to 4.6% in 2020). Cox Proportional Risk Model results including significant covariates in multivariate analysis [HR (IC95%)]. In multivariate analysis, two models were considered. The case-fatality rate was independently associated with late arrival after 48 hours [3.1 (1.9–5.1); p < 0.001], types of pre-hospital recourse such as recourse to the church [1.4 (1.1–2.1),; p = 0.042) and tradipractor [3.2 (1.8–6.1); p < 0.001] for severe malaria, children under 12 months of age [1.8 (1.2–2.8); p < 0.001], those with circulatory collapse [2.6 (1.1–6.1); p < 0.001] and those in deep coma [1.9 (1.1–3.4); p = 0.016]. The second model with the number of associated syndromes, showed that the risk was 1.7 plus for children with a complex clinical picture, made up of the combination of several signs [1.7 (1.1–2.6); p < 0.001]. These results highlight the need for more information campaigns to encourage people to seek institutional care for malaria. Our results also suggest that prophylactic treatment may be advisable for children under 5 years of age.

Plasmodium vivax and Plasmodium ovale in the Malaria Elimination Agenda in Africa

In recent times, several countries in sub-Saharan Africa have reported cases of Plasmodium vivax (Pv) with a considerable number being Duffy negative. Current efforts at malaria elimination are focused solely on Plasmodium falciparum (Pf) excluding non-falciparum malaria. Pv and Plasmodium ovale (Po) have hypnozoite forms that can serve as reservoirs of infection and sustain transmission. The burden of these parasites in Africa seems to be more than acknowledged, playing roles in migrant and autochthonous infections. Considering that elimination and eradication is a current aim for WHO and Roll Back Malaria (RBM), the inclusion of Pv and Po in the elimination agenda cannot be over-emphasized. The biology of Pv and Po are such that the same elimination strategies as are used for Pf cannot be applied so, going forward, new approaches will be required to attain elimination and eradication targets.