Caretakers’ self adherence to artemisinin lumefantrine in Nyando district, Kenya

Artemisinin combination therapies (ACTs) are effective and tolerant. However, the continuous development of <em>Plasmodium</em> strains resistance to cost effective monotherapies such as chloroquine and sulphadoxinepyrimethamine, remains the greatest setback to the global fight against malaria. Recent studies indicate that <em>Plasmodium</em> parasites are already becoming resistance to ACTs. A number of factors such as poor adherence can cause drug failure. Non-adherence is one of the major challenges facing optimal use of ACTs in real life settings. The objective of this study was to describe and identify factors associated with non-adherence to artemisinin lumefantrine (AL) among malaria-ailing caretakers seen in Nyando district hospital who also had children under the age of five ailing from malaria. From our study we concluded that the consents, follow-ups, strict adherence to the Kenya National Strategy for Control and Treatment of Malaria guidelines and availability of AL during the study may have influenced the observed high adherence rates. Therefore, it is critical to adequately stock health facilities with AL to enhance adherence. More specifically, healthcare providers need to educate malaria-ailing caretakers on the AL regimen as well as its possible side effects to promote adherence to the antimalarial at a household level.

Evaluating the use of microscopic examination and rapid diagnostic tests to diagnose malaria in North Central Nigeria

The global impact of malaria has spurred interest in developing prompt and accurate diagnostic strategies to provide an effective management of the disease. The aim of this study was to compare rapid diagnostic tests (RDTs) for malaria with routine microscopy. Samples were collected randomly from 364 febrile out-patients with clinical suspicion of malaria from four hospitals in North Central Nigeria. Results from the rapid diagnostic kits were analysed and compared to those obtained by general microscopy. Of the 364 out-patients involved in the study, 218 (59.89%) tested positive for <em>Plasmodium falciparum</em> by RDTs, whereas 263 (72.256%) tested positive by microscopy. There are significant differences (P&lt;0.05) in infection rates between RDT and microscopy. The sensitivity, specificity and negative predictive values of RDTs compared to microscopy are low, while the positive predictive value is high. Evaluation of RDTs against the parasite-positive panel with parasite densities of &lt;1000 parasites/μL, between 1000-5000 parasites/μL and above 5000 parasites/ μL was 11.73, 30.61, 57.65% for RDTs compared to 6.11, 27.95 and 65.94% for microscopy, respectively. Test line intensity increases with increase in parasite densities for both methods.

A rapid, low-cost methodology for longitudinal evaluation of insecticide treated bednet distributions: a pilot survey coupling bednet usage with malaria prevalence at the household level

Tanzania’s National Malaria Control Program distributed 23.3 million insecticidetreated bed nets (ITNs) between 2009 and 2011. Annual randomized household surveys were conducted from 2009 to 2011 to assess the incremental effects of the distribution campaign on malaria prevalence and bednet usage in Kijumbura village in Kagera, Tanzania. Data was collected about household ITN ownership and individual use, and each household member was given a rapid malaria diagnostic test (RDT). In total, 1247 individuals from 285 households participated. From 2009 to 2011, household ITN ownership increased from 50.6 to 95.3% and individual usage increased from 9.7 to 55.3% in 2011. Malaria point prevalence decreased from 15.8% in 2009 to 6.5% in 2010, and increased from 6.5% in 2010 to 10.7% in 2011. The survey cost in 2011 was 23.50 USD per household; major expenses were transportation, personnel payment, and the purchase of the RDTs. Evaluations of bednet distribution programs generally rely on distribution data and selfreported net ownership, but it is important to also assess the goal endpoint of reduction in malaria prevalence. We show that this can be achieved quickly and cost-effectively through randomized surveys measuring bednet usage coupled with malaria prevalence at the household level.

The PASS-model: a model for guiding health-seeking behavior and access to care research

The mobilization of affordable measures and treatments has brought health services and health care tools closer to the poor. This is particularly the case in the context of malaria control and elimination efforts. Still, the other side of delivery is use: the targeted populations have to access and accept these resources. Although the need to better align the delivery and user sides is increasingly recognised, there still is a gap between this awareness and researchers&rsquo; response to adequately address the community side in a way that actionable results can be achieved. In order to avoid actions based on preconceptions, practical applications should draw from theoretical knowledge. Furthermore, in order to get a total view, such applications should consider the full array of potential factors relevant for access to care or health-seeking behavior (HSB). We believe that one of the reasons why theoretically-based, holistic approaches to HSB and access to care still are scarce is the lack of a hands-on and easy-to-use model that allows the researcher to ask the right questions and to interpret the results. In this article, we present such a model, the PASSmodel for HSB and access to care. Founded on theory, the model facilitates the formulation of questions to cover the broad array of elements that guide HSB and access to care. It is adaptable to different contexts and research questions. The goal is that any researcher interested in situating health behavior in a given social, political, and economic landscape can use this tool for any health condition, in low income as well as high income countries.

A comparison of microscopic examination and rapid diagnostic tests used in Guyana to diagnose malaria

The aim of this study was to compare rapid diagnostic tests (RDTs) for malaria with routine microscopy for a prompt and accurate diagnosis of malaria and to provide an effective disease management in Guyana. Blood samples were collected randomly from 624 patients with clinical suspicion of malaria from four private hospitals in Georgetown, Guyana. The five different test methods [Paramax-3, Optimal-IT, VISITECT Malaria Combo PAN/Pf, Standard Diagnostic (SD) Bioline and conventional Giemsa stain microscopy] were performed independently by well trained and competent laboratory staff to assess the presence of malaria parasites. Results from the rapid diagnostic kits were analyzed and compared to those obtained by general microscopy. Of the 624 patients involved in the study, 197 (31.6%) tested positive and 427 (68.4%) tested negative to RDT whereas 190 (30.4%) tested positive and 434 (69.6%) tested negative to microscopy. The positive agreement index between RDT and microscopy was 89%. A comparison of microscopy with the RDTs, Paramax, Opitmal- IT, Omega, SD, showed a positive agreement index of 93%, 86%, 80% and 86%, respectively. The study, therefore, highlights the importance of both methods in diagnosis of malaria in endemic areas. Microscopy is the more reliable method in rural areas where malaria is most prevalent. RDT offers a good alternative, being an easy and rapid method that does not require an experienced laboratory technician.

Ownership and disuse of bed nets in Kenyan children under five years of age

Recent campaigns to increase the percentage of households owning a bed net have been very successful yet there remains a subset of the population who do not sleep under bed nets. We used data from the 2008 Kenya Demographic and Health Survey (KDHS) to compare children under the age of five years of age who slept under any bed net to children sleeping without a bed net who resided in households with: i) no bed net; ii) all bed nets used (intra-household access); and iii) at least one unused bed net. Ownership, intra-household access, and non-use of available bed nets were all associated with the child&rsquo;s age and the mother&rsquo;s relationship to the head of the household. Intra-household access was strongly associated with provincial residence, where the child was born and frequency of reading newspapers. Furthermore, disuse of available nets for children was associated with marital status, bed net use of the head of the household, and residing in rural communities at higher elevations. Improving bed net/long-lasting insecticide treated nets (LLIN) use in Kenya requires a multi-faceted approach that addresses the complexity of the behavioral, social and economic drivers of non-use.

Anopheles plumbeus Stephens, 1828: a neglected malaria vector in Europe

Traditionally field and laboratory research about malaria vectors in Europe have been mainly focused on the species of the <em>Anopheles maculipennis</em> complex. However, although malaria is essentially a rural disease, potential urban vectors merit attention. Because only a few European <em>Anopheles</em> species can breed in urban environments, improving knowledge about their bioecology is necessary to implement effective control measures. Among these opportunistic species, <em>Anopheles plumbeus</em> has a distinctive dendrolimnic behavior, being able to complete its larval development in small containers. The aim of this paper is to provide a thorough review of the limited studies on An. plumbeus with the aim of providing useful epidemiological information.

Malaria Reports, a new journal

International funding for malaria control has raised significantly in the past decade, leading to large-scale indoor residual spraying campaigns, to the distribution of insecticidetreated bed nets, and to the introduction of artemisinin-based combination treatments. An encouraging reduction of malaria cases has been reported in a number of countries, but malaria remains a major public health problem worldwide (WHO, 2010). People living in the poorest countries are the most vulnerable. Therefore, it remains a challenge to ensure that high levels of coverage and caution are maintained and that efforts aimed at developing an effective and affordable vaccine would be amplified.