Frequency of blood donation and malaria occurrence among blood donors in a tertiary hospital, Nigeria

Context: Malaria is a significant cause of morbidity and mortality in Sub-Saharan Africa (SSA). Transfusion transmitted malaria contributes significantly to the burden of malaria in SSA. The safety of blood transfusion as it relates to frequency of blood donation and malaria occurrence on the part of donors is an aspect that has not been properly investigated hence this study. Objectives: This study was conducted to assess the frequency of blood donation and occurrence of malaria among blood donors at OAUTHC, Ile-Ife. Materials and methods: This was a cross-sectional study. Ethical approval was obtained. One hundred and thirty-three consenting blood donors aged between 18-50 years were recruited for the study. Two milliliter's of blood were collected from each study participant and immediately transported to the laboratory for processing. Giemsa-stained films of the samples were viewed under the oil immersion objective of the microscope. Questionnaires were administered to the study participants to obtain relevant information. Data generated were analyzed using descriptive and inferential statistics with SPSS software version 20. The level of significance was set at p < 0.05. Results: The prevalence of malaria among the blood donors was 21.1% with the highest rate among commercial donors (33.3%) followed by family donors (12.9%) then voluntary donors (11.9%). Evaluation of the frequency of donation showed that malaria occurred more in recurring donors (77.78%) than first time donors (22.22%).

Couverture de la chimio ­ prévention du paludisme saisonnier chez les enfants de 3 à 59 mois au Bénin en 2023 / Coverage of seasonal malaria chemoprevention in children from 3 to 59 months of age in Benin in 2023

Introduction : la Chimioprévention du Paludisme Saisonnier (CPS) est une intervention pouvant réduire la survenue des cas de paludisme chez les enfants de 3 à 59 mois. L'objectif de cette étude était de mesurer la couverture de la CPS chez les enfants de 3 à 59 mois pendant la campagne (juillet à octobre 2023) vivant dans la zone d'intervention au Bénin. Matériels et méthodes : une étude enquête transversale descriptive et analytique a été conduite du 30 novembre au 14 décembre 2023. Un échantillonnage en grappe à trois degrés a permis de tiré au sort 3573 en milieux urbain et rural dans 172 Zones de Dénombrements (ZD) réparties dans les 15 communes d'intervention. Résultats : l'enquête a révélé que 87,3% des enfants ciblés ont été touchés par la campagne de CPS 2023. Sur les quatre passages, la couverture complète était respectivement de 84,4%, 81,7%, 77,7% et 62,2%. La couverture complète pour les douze doses était de 59,8%. Conclusion : la couverture en CPS a diminué au fur et à mesure des doses. Les refus persistent et proviennent des personnes clés des ménages qui décident de l'accès aux soins. Le plan de communication et les stratégies de déploiement de la CPS doit être investigué et renforcé en vue d'améliorer la couverture.

Introduction: Seasonal malaria chemoprevention (SMC) is an intervention that can reduce the occurrence of malaria in children aged 3-59 months. The study aimed to measure the coverage of SMC among children aged 3 to 59 months from July to October 2023 living in the intervention zone in Benin. Materials and methods: A cross-sectional survey was conducted from 30 November to 14 December 2023. Three-stage sampling was used to randomly select 3573 people in urban and rural areas in 172 enumeration zones (ED) in the 15 intervention municipalities. Results: Of the targeted children, 87.3% of had been reached by the 2023 CPS campaign Over the four rounds, full coverage was 84.4%, 81.7%, 77.7% and 62.2% respectively. Full coverage for the twelve doses was 59.8%. Conclusion: The SMC coverage decreased with each dose and varied across areas. The SMC communication plan and implementation needs to be strengthened to improve coverage

Mort in utero tardive: fréquence, facteurs associés et méthodes de déclenchement du travail à Kisangani, République Démocratique du Congo / Late fetal death: frequency, associated factors and methods of labor induction in Kisangani, Democratic Republic of Congo

La mort fœtale tardive fait référence à la mort in utéro (MIU) de survenue spontanée à partir de 22 semaines d'aménorrhée (SA), mais avant tout début du travail d'accouchement, ce qui constitue une tragédie pour la mère, les membres de la famille et du personnel soignant. La présente étude a déterminé l'ampleur, les facteurs associés et les méthodes de déclenchement artificiel du travail d'accouchement sur MIU. Méthodes : Il s'est agi d'une étude transversale descriptive, multicentrique menée dans 3 hôpitaux de Kisangani, pendant une période de 3 ans. La collecte des données était rétrospective, des cas de MIU à partir de 28 SA. Résultats : La fréquence de MIU tardive était de 6,48%. Les principaux facteurs associés étaient l'infection urinaire (35,4%), le paludisme sur grossesse (27,5%) et l'hypertension artérielle gravidique (27,5%). Le taux de participation aux consultations prénatales (CPN) n'était que de 63,5 %. Les méthodes de déclenchement artificiel du travail d'accouchement utilisées étaient le Misoprostol (42,7%), l'ocytocine (17,7%) soit les deux combinées (25%). La césarienne était indiquée à un taux de 26,4%. Conclusion : la fréquence de MIU tardive est élevée à Kisangani. L'infection urinaire, le paludisme et l'hypertension artérielle en constituaient les principaux facteurs associés. Le Misoprostol était la méthode de déclenchement du travail les plus utilisées. Un suivi régulier des CPN pourrait réduire le taux de MIU.

Comparaison des coûts du traitement du paludisme en biomédecine et en médecine traditionnelle à Niono (Mali) / Comparison of costs of treatment of malaria in biomedicine and traditional medicine in Niono (Mali)

Introduction. Au Mali, la prise en charge du paludisme se fait à travers la médecine conventionnelle et la médecine traditionnelle, mais peu d'évaluation existe sur les implications fi nancières de ces approches qui coexistent et qui sont pratiqués parfois de manière concomitante. L'objectif de cette étude était d'évaluer les coûts fi nanciers de ces deux approches du point de vue des patients. Méthodes. Ainsi, une étude transversale descriptive impliquant des patients ont été sélectionnés dans trois aires de santé et plus précisément dans des ménages, structures de santé conventionnelle et chez les praticiens de la médecine traditionnelle de Niono, Sirabala et N'Debougou. Des questionnaires structurés ont été utilisés pour collecter des informations. Le calcul du coût de traitement a été utilisé pour comparer le coût moyen de traitement du paludisme en médecine conventionnelle et traditionnelle. Résultats. Au total, 300 patients ont été sélectionnés. 52,7% des patients avaient recouru à la médecine conventionnelle, contre 32% pour l'automédication et 15,3% pour la médecine traditionnelle. Les patients avaient utilisé les ressources de ces trois systèmes de santé pour quatre principaux motifs. Le coût moyen du traitement par épisode de paludisme était estimé à 12,97 Euro en médecine conventionnelle contre 6,24 Euros en médecine traditionnelle. Le coût moyen du traitement de paludisme en automédication à base de médicaments conventionnels ou traditionnels était de 0,82 Euros. Conclusion. Dans notre étude, même si le coût du traitement du paludisme en médecine conventionnelle reste plus élevé que celui en médecine traditionnelle, contrairement aux idées reçues, les coûts des ressources de la médecine traditionnelle ne sont pas aussi bas qu'on le croit.

Introduction. In Mali, malaria management is done through conventional and traditional medicine, but little evaluation exists on the fi nancial implications of these approaches which coexist and are sometimes practiced concomitantly. The objective of this study was to evaluate the fi nancial costs of these two approaches from the patients' point of view. Methods. Thus, a descriptive cross-sectional study involving patients selected in three health areas and more precisely in households, conventional health structures and traditional medicine practitioners in Niono, Sirabala and N'Debougou. Structured questionnaires were used to collect information. The calculation of the cost of treatment was used to compare the average cost of treating malaria in conventional and traditional medicine. Results. Finally, 300 patients were selectionned and 52.7% of patients had used conventional medicine, compared to 32% for self-medication and 15.3% for traditional medicine. Patients had used the resources of these three health systems for four main reasons. The average cost of treatment per malaria episode was estimated at 12.97 Euros for conventional medicine versus 6.24 Euros for traditional medicine. The average cost of treatment of malaria by self-medication with conventional or traditional medicines was 0.82 Euros. Conclusion. In our study, even if the cost of treating malaria with conventional medicine remains higher than with traditional medicine, contrary to popular belief, the resource costs of traditional medicine are not as low as one might think

Determination of knowledge, attitude, and practice of Chinese and local people towards malaria prevention in Kano State, Nigeria

To date, malaria is still a major public health issue in the world. Africa remains the most affected continent with the highest malaria cases and deaths. Since more than one thousand Chinese citizens are living in Nigeria, examination of their knowledge, attitude, and practice compared with those of the local people may be essential towards malaria prevention. This study adopted cross-sectional research. A total of 137 Chinese people and 299 local people residing in Kano State, Nigeria constituted the study subjects. A questionnaire was used for the collection of data on socio-demography and predictors of attitudes. The Cronbach alpha statistic was used to analyze these data. Insecticide spraying, mosquito repellents, wearing protective clothing at night are the malaria preventive measures by both the local and Chinese people living in Kano state, Nigeria. However, there is a significant difference (p < 0.05) between the two groups, with a duration of stay in Nigeria, the use of mosquito, attitude, and practices playing impactful roles among the Chinese people. Hence, Chinese people demonstrated better knowledge and control of malaria transmission and prevention than the local people living in Kano state. In conclusion, attitudes and practices toward malaria diseases are the major causes of a high rate of malaria in Nigeria, particularly in Kano State.

Disability inclusion in malaria services in western Tanzania: A rapid barrier analysis

Background: Persons with disabilities generally face greater challenges in accessing healthcare and interventions compared with the general population. Malaria is one of the diseases that can seriously affect individuals with disabilities, as it requires early diagnosis and prompt treatment. Objective: This study explores the extent to which locally available malaria services and interventions are inclusive of persons with disabilities and identifies associated access barriers. Method: A qualitative case study focusing on social, cultural and health system factors associated with the inclusion of persons with disabilities in malaria services was conducted in Kigoma Region, western Tanzania. Thematic analysis of emerging themes identified barriers affecting access to locally available malaria services and interventions. Results: Inclusion of persons with disabilities in planning, implementation and reporting of health issues in different malaria programmes was reported to be limited. Persons with disabilities were unable to access malaria services because of different barriers such as the distance of the service provision sites, communication and information issues and a lack of financial resources. Conclusion: Persons with disabilities are widely excluded from malaria care provision across the entire health services paradigm, impacting access and utilisation to this vulnerable population. Barriers to malaria service access among persons with disabilities were physical, attitudinal, financial and informational. Contribution: The findings of this study identify that malaria intervention stakeholders need to take a holistic approach and fully involve individuals with disabilities at all levels and scope of malaria service planning and provision.

SD bioline malaria rapid diagnostic test performance and time to become negative after treatment of malaria infection in southwest Nigerian children

Context and Aim: Given the challenges of microscopy, we compared its performance with SD Bioline malaria rapid diagnostic test (MRDT) and polymerase chain reaction (PCR) and evaluated the time it took for positive results to become negative after treatment of children with acute uncomplicated malaria. Subjects and Methods: We present the report of 485 participants with complete MRDT, microscopy, and PCR data out of 511 febrile children aged 3­59 months who participated in a cohort study over a 12 month period in rural and urban areas of Ibadan, Nigeria. MRDT positive children received antimalaria and tested at every visit over 28 days. Speciation was also carried out by PCR. Results: With microscopy as the gold standard, SD-Bioline™ had 95.2% sensitivity, 66.4% specificity, 67.5% positive predictive value (PPV), and 94.9 negative predictive value (NPV), while with PCR the findings were 84.3% sensitivity, 66.5% specificity, 72.7% PPV, and 80.1% NPV. PCR speciation of malaria parasites revealed 91.6% Plasmodium falciparum, 18.9% Plasmodium malariae, and 4.4% Plasmodium ovale. Among the 47 children with P. malariae infections, 66.0% were coinfected with P. falciparum, while 54.6% cases of P. ovale occurred as coinfections with P. falciparum. The median time to a negative MRDT was 23.2 days, while the median time to a negative malaria microscopy was 3.8 days. The two survival curves were significantly different. Conclusions: The SD BiolineTM MRDT performed well, with remarkable persistence of rapid test-positive for an average of 23 days post treatment. The prevalence of P. malaria is somewhat greater than expected.

Factors associated with anaemia in under-five children in Zambia: Secondary analysis of the 2021 Malaria Indicator Survey Data

Introduction:Anaemia is one of the major public health concerns in many developing countries including Zambia. Unless it is acute, the consequences of anaemia are not immediate but have long-term debilitating effects such as growth and intellectual retardation and as such it does not receive the necessary attention it deserves. This study set out to assess the prevalence and associated factors of anaemia in under-five children in Zambia. Methods:This study was a secondary analysis of the 2021 Malaria Indicator Survey. We extracted data from the data sets at the National Malaria Elimination Centre after obtaining permission from the Ministry of Health. The extracted data was analysed in STATA14, summarised in frequencies, cross-tabulations between independent variables and the outcome and multivariable logistic regression was used to assess the associations between variables and anaemia. Findings:The prevalence of anaemia was found to be 53.8%. Anaemia was found to be associated more with children below one year compared to older children, children whose household heads had no or only have primary education compared to those with secondary or tertiary education and in the northern parts of the country such as Luapula and Northern provinces compared to the southern province. Further anaemia was more common in those with malaria than those without malaria and those with febrile illnesses than those without febrile illnesses. In addition, anaemia was less common in those who slept under insecticide-treated nets. Conclusion: Anaemia in Zambia has been found to be higher than the average in Southern Africa, it is associated with younger age groups, poverty conditions and where diseases like malaria and other febrile illnesses are more common than where they are not. The use of interventions like insecticide-treated nets is associated with reduced prevalence of anaemia.

Artemisinin drug resistance and monitoring: a narrative review

Artemisinin drug resistance is one of the major reasons for malaria treatment failures in the sub-Saharan African countries where artemisinin-based combination therapy (ACT) is the first-line treatment for uncomplicated malaria. The occurrence of single nucleotide polymorphisms (SNPs) is found to correlate with antimalarial drug resistance. With artemisinin, the SNPs occurs at the Kelch 13-propeller gene locus on chromosome 13. The artemisinin drug resistance surveillance strategy involves continuous monitoring of Kelch 13-propeller biomarker to detect emergence of mutations which could herald drug resistance in the region. In this narrative review paper, we examined existing literature to bridge the knowledge gap and accentuate the importance of routine surveillance for artemisinin resistance in sub-Saharan Africa. We conducted our search on PubMed database and Google Scholar to identify peer-reviewed articles, reports, and abstracts on artemisinin drug resistance using the following keywords; 'artemisinin drug resistance', 'antimalarial drug resistance', 'artemisinin-based combination therapy', 'Kelch 13-propeller', 'K13- propeller gene', and 'K13 molecular marker'. The review provided pertinent information on artemisinin derivatives, artemisinin-based combination therapy, molecular action of artemisinin, definition of artemisinin resistance, genetic basis of artemisinin drug resistance and discovery of Kelch 13, and the importance of artemisinin resistance surveillance. Molecular surveillance can provide healthcare policy makers a forecast of impending threats to malaria treatment. This is more so when drugs are in combination therapy, for instance, molecular surveillance can give a hint that one drug is failing despite the fact that in combination, it is still apparently clinically effective.

Artemisinin drug resistance and monitoring: a narrative review

Artemisinin drug resistance is one of the major reasons for malaria treatment failures in the sub-Saharan African countries where artemisinin-based combination therapy (ACT) is the first-line treatment for uncomplicated malaria. The occurrence of single nucleotide polymorphisms (SNPs) is found to correlate with antimalarial drug resistance. With artemisinin, the SNPs occurs at the Kelch 13-propeller gene locus on chromosome 13. The artemisinin drug resistance surveillance strategy involves continuous monitoring of Kelch 13-propeller biomarker to detect emergence of mutations which could herald drug resistance in the region. In this narrative review paper, we examined existing literature to bridge the knowledge gap and accentuate the importance of routine surveillance for artemisinin resistance in sub-Saharan Africa. We conducted our search on PubMed database and Google Scholar to identify peer-reviewed articles, reports, and abstracts on artemisinin drug resistance using the following keywords; 'artemisinin drug resistance', 'antimalarial drug resistance', 'artemisinin-based combination therapy', 'Kelch 13-propeller', 'K13- propeller gene', and 'K13 molecular marker'. The review provided pertinent information on artemisinin derivatives, artemisinin-based combination therapy, molecular action of artemisinin, definition of artemisinin resistance, genetic basis of artemisinin drug resistance and discovery of Kelch 13, and the importance of artemisinin resistance surveillance. Molecular surveillance can provide healthcare policy makers a forecast of impending threats to malaria treatment. This is more so when drugs are in combination therapy, for instance, molecular surveillance can give a hint that one drug is failing despite the fact that in combination, it is still apparently clinically effective.

La résistance aux médicaments à base d'artémisinine est l'une des principales raisons des échecs du traitement du paludisme dans les pays d'Afrique subsaharienne où la polythérapie à base d'artémisinine (ACT) est le traitement de première intention du paludisme simple. L'apparition de polymorphismes mononucléotidiques (SNP) est corrélée à la résistance aux médicaments antipaludiques. Avec l'artémisinine, les SNP se produisent au locus du gène Kelch 13- propeller sur le chromosome 13. La stratégie de surveillance de la résistance aux médicaments à base d'artémisinine implique une surveillance continue du biomarqueur Kelch 13-propeller pour détecter l'émergence de mutations qui pourraient annoncer une résistance aux médicaments dans la région. Dans cet article de revue narrative, nous avons examiné la littérature existante pour combler le manque de connaissances et accentuer l'importance de la surveillance de routine de la résistance à l'artémisinine en Afrique subsaharienne. Nous avons effectué notre recherche sur la base de données PubMed et Google Scholar pour identifier des articles, des rapports et des résumés évalués par des pairs sur la résistance aux médicaments à base d'artémisinine en utilisant les mots-clés suivants; «résistance aux médicaments à base d'artémisinine¼, «résistance aux médicaments antipaludiques¼, «thérapie combinée à base d'artémisinine¼, «Kelch 13-propeller¼, «gène K13-propeller¼ et «marqueur moléculaire K13¼. L'examen a fourni des informations pertinentes sur les dérivés de l'artémisinine, la polythérapie à base d'artémisinine, l'action moléculaire de l'artémisinine, la définition de la résistance à l'artémisinine, la base génétique de la résistance aux médicaments à base d'artémisinine et la découverte de Kelch 13, ainsi que l'importance de la surveillance de la résistance à l'artémisinine. La surveillance moléculaire peut fournir aux responsables des politiques de santé une prévision des menaces imminentes pour le traitement du paludisme. C'est d'autant plus vrai lorsque les médicaments sont en thérapie combinée, par exemple, la surveillance moléculaire peut donner un indice qu'un médicament échoue malgré le fait qu'en combinaison, il est toujours apparemment cliniquement efficace.

Rectal artesunate for severe malaria, implementation research, Zambia

Objective To determine whether the positive results of a single-district pilot project focused on rectal artesunate administration at the community level in Zambia could be replicated on a larger scale. Methods In partnership with government, in 10 rural districts during 2018­2021 we: (i) trained community health volunteers to administer rectal artesunate to children with suspected severe malaria and refer them to a health facility; (ii) supported communities to establish emergency transport, food banks and emergency savings to reduce referral delays; (iii) ensured adequate drug supplies; (iv) trained health workers to treat severe malaria with injectable artesunate; and (v) monitored severe malaria cases and associated deaths via surveys, health facility data and a community monitoring system. Results Intervention communities accessed quality-assured rectal artesunate from trained community health volunteers, and follow-on treatment for severe malaria from health workers. Based on formal data from the health management information system, reported deaths from severe malaria reduced significantly from 3.1% (22/699; 95% confidence interval, CI: 2.0­4.2) to 0.5% (2/365; 95% CI: 0.0­1.1) in two demonstration districts, and from 6.2% (14/225; 95% CI: 3.6­8.8) to 0.6% (2/321; 95% CI: 0.0­1.3) in eight scale-up districts. Conclusion Despite the effects of the coronavirus disease, our results confirmed that pre-referral rectal artesunate administered by community health volunteers can be an effective intervention for severe malaria among young children. Our results strengthen the case for wider expansion of the pre-referral treatment in Zambia and elsewhere when combined with supporting interventions.

Prevalence and seroprevalence of COVID-19 in suspected malaria during the second wave in Yaounde, Cameroon

Background. The COVID-19 pandemic has added an additional burden in countries with already fragile health systems. Our objective was to determine the prevalence and seroprevalence of COVID-19 in suspected malaria during the second wave in Yaounde. Methods. A descriptive cross-sectional study was conducted at the Jordan Medical Services for 8 weeks from April 19 to June 13, 2021, i.e., during the second wave in Cameroon. For the 86 patients with suspected malaria, nasopharyngeal and blood samples were taken for SARS-CoV-2 antigen and anti-SARS-CoV-2 IgG and IgM using the STANDARD TM Q COVID-19 Ag kit from SD BIOSENSOR, Korea, 2020 and Standard TM Q COVID 19 Ac IgG/IgM kit from SD BIOSENSOR, Korea, 2020 respectively. Confirmation of malaria was done by microscopic examination of stained blood smears. Results. Malaria was confirmed in 20.9% (18) of cases. The prevalences of COVID-19 and COVID-19/malaria co-infection were 8.1% and 0.9% respectively. Of the 25.6% (54) of patients with anti-COVID-19 IgM, no positive microscopic cases were found. On the other hand, a little more than half of the patients had IgG antibodies against COVID-19 whether they had a positive thick drop or not (56.0% (42/75) and 52.2% (71/136) respectively). Conclusion. In case of suspicion of malaria in a malaria area, it seems important to consider COVID-19 as a differential diagnosis.

Introduction. La pandémie de la COVID-19 a ajouté un fardeau supplémentaire dans les pays aux systèmes de santé déjà fragiles. Objectif : déterminer la prévalence et la séroprévalence de la COVID-19 en cas de suspicion du paludisme au cours de la deuxième vagueà Yaoundé. Méthodologie. Une étude transversale descriptive a été menée au Centre Médical le Jourdain pendant 8 semaines du 19 Avril au 13 Juin 2021 soit durant la deuxième vague au Cameroun. Pour les 86 patients avec suspicion de paludisme, des prélèvements nasopharyngé et sanguins ont été réalisés pour la recherche d'antigène du SRAS- CoV 2 et des IgG et IgM anti-SARS-CoV-2 grâce aux kits STANDARDTM Q COVID-19 Ag de SD BIOSENSOR, Corée, 2020 et StandardTM Q COVID 19 Ac IgG/IgM de SD BIOSENSOR, Corée, 2020 respectivement. La confirmation du paludisme a été faite grâce à l'examen microscopique des étalements de sang colorés. Résultats. Le paludisme était confirmé dans 20,9% (18) des cas. Les prévalences de la COVID-19 et de la coïnfection COVID19/Paludisme étaient de 8,1% et de 0,9% respectivement. Sur les 25,6% (54) des patients avec des IgM anti-COVID-19, aucun cas de microscopie positive n'a été retrouvé. Par ailleurs un peu plus de la moitié des patients avaient des anticorps IgG anti-COVID-19 qu'ils aient une goutte épaisse positive ou pas soit 56,0% (42/75) et 52,2% (71/136) respectivement. Conclusion. En cas de suspicion du paludisme en zone impaludée, il parait non négligeable de considérer la COVID-19 comme un diagnostic différentiel.

Factors associated with community engagement in areas with high and low incidence of local malaria cases in Zanzibar

Introduction: the prevalence of asymptomatic infection in the general population in Zanzibar has declined from above 25% in 2005 to less than 1% in 2010. Despite these achievements, in 2021, the number of malaria cases increased by two folds. This study aimed at understanding the levels of community engagement towards malaria elimination and factors associated with them to provide recommendations that can be used to reinforce community engagement. Methods: a descriptive cross-sectional survey was conducted using structured questionnaires to 431 randomly selected households. The interviewees were the heads of households or representative adults above 18 years. Univariate and multivariate analysis was done to determine the association between social demographic characteristics, malaria knowledge, practicing malaria prevention interventions and status of community engagement. Statistical significance test was declared at P- value <0.05. Results: of all respondents, 261 (60.6%) were not engaged in either planning or implementation of malaria interventions, of which 120 (45.9%) participants were in the high malaria transmission and 141 (54.0%) from the low malaria transmission (P=0.018). Factors significantly associated with increased odds of community engagement were the level of knowledge on malaria (P= 0.002) and factors independently associated with reduced odds of community engagement was the level of malaria burden (P= 0.01). Conclusion: level of malaria knowledge and malaria burden were associated with community engagement. There is a need to increase malaria knowledge in the community based on the existing gaps as this study suggests that having high malaria knowledge can significantly contribute to increased opportunity for community engagement.

Les perturbations des enzymes ASAT, ALAT et LDH au cours du paludisme de l'adulte au Nord-est de la RDC / NA

Introduction : la présente étude avait pour objectif de ressortir certaines anomalies des enzymes hépatiques portant sur l'ASAT, l'ALAT et la LDH chez les patients impaludés en vue de contribuer à la prise en charge diagnostique du paludisme dans la ville de Butembo. Méthodes. Cette étude est descriptive. Elle a été réalisée dans le service de Médecine Interne et de Parasitologie de l'Hôpital Matanda du 1er juillet 2020 au 2 novembre 2020 soit pendant une période de 4 mois. Elle a porté sur une série de 100 patients impaludés avec goutte épaisse positive. Les paramètres d'intérêt étaient les caractéristiques sociodémographiques, les anomalies des enzymes hépatiques (ASAT, ALAT, LDH) et la densité parasitaire. Résultats : 100 patients ont été sélectionnés au cours de notre étude parmi lesquels 54 sujets de sexe féminin et 46 de sexe masculin. Le taux de LDH était élevé dans 73% des cas. Les transaminases ASAT et ALAT étaient élevées dans 28% et 31% des cas respectivement. Aucune corrélation significative n'a été retrouvée entre la densité parasitaire et les anomalies enzymatiques observées dans notre étude. Conclusion. Des variations notables des paramètres biologiques portant sur les anomalies de enzymes hépatiques dont l'ASAT, l'ALAT et la LDH ont été enregistrés au cours de l'accès palustre à Plasmodium falciparum chez l'adulte de la ville de Butembo. Ces paramètres pourraient avoir une utilité dans le diagnostic du paludisme et /ou constituer un indicateur de la sévérité de la maladie, spécialement lorsque les résultats parasitologiques ne sont pas disponibles ou sont incertains.

Cholesterolemia and triglyceridemia changes in adult with malaria in a hypo-endemic malaria region, Butembo-DR Congo

changes occur commonly among patients affected with malaria. This study aimed to assess lipid changes in blood among patients with malaria in Butembo, a hypoendemic region. Methods: This cross-sectional study, conducted in the Departments of Internal and Parasitology of Matanda Hospital, located in Butembo, from July 1st, 2020, to November 2, 2020; involved 100 patients diagnosed with malaria. Biochemical analyses carried out by three lab technicians were performed among patients who had positive malaria using positive thick film. Plasmodial species, the parasite density, the triglycerides, the total cholesterol, the HDL-cholesterol, the LDL-cholesterol were assessed. Results: Cholesteroleamia and HDLemia demonstrated a low level in 93% and in 61% of participants respectively; whereas 73% of cases showed an increased level of triglycerides in the blood. Lipidemia profile was independently associated with parasite density among patients with malaria. Conclusion: Although the lipid changes in the blood are not specific in the diagnosis of malaria, this study highlighted their status among patients with malaria. Further researches should be conducted to determine their impact on malaria outcomes. Therefore, dyslipidemia could be used in malaria screening.

Therapeutic potential of concurrent administration of Hippocratea africana and Eremomastax speciosa in the treatment of Plasmodium berghei infected mice

Context: Despite the commonness of polyherbal therapy among the locals in the treatment of malaria in Nigeria, there are no adequate data on the therapeutic potentials and safety profile of these herbal combinations. The use of these plants in combination in the treatment of suspected and confirmed malaria infection is very common among the Niger Delta dwellers in Nigeria. Aim: To evaluate the therapeutic potential of co-administration of Hippocratea Africana, a medicinal plant with well documented antimalarial properties, and Eremomastax speciosa, a tropical plant with well reported antianaemic potential and haematoprotective properties. Materials and Methods: Thirty albino mice, whose weights ranged between 32 - 37g, were divided into five groups having six mice in each. Clinical features, weight changes and parasite clearance were evaluated to determine therapeutic potential of treatments. An inoculum which consisted of 5 x 107 Plasmodium berghei infested erythrocytes per ml of blood from a donor mouse with 64% parasitaemia was injected into each mouse by intraperitoneal route. The mice were kept at room temperature of 28.0 ± 20C for 7 days for the parasite to develop. A non-parasitized mice group served as normal control. After parasitaemia was confirmed using standard procedure, 200mg/kg and 300mg/Kg body weights of Hippocratea Africana root bark and Eremomastax speciosa leaf extracts respectively, were administered by oral routes to the respective groups of mice for 6 days. A parasitized group was treated with fixed doses of 3mg/kg body weight of Artemether and 18mg/kg body weight of Lumefantrine. Another parasitized group was left untreated. Results: Mice treated concurrently with the extracts of H. africana and E. speciosa showed a significant improvement in clinical signs in comparison to the untreated group. The mean body weights of mice administered both extracts was significantly (P < 0.05) increased when compared to the parasitized untreated mice and those treated with extracts separately. The mice treated concurrently with the two extracts also showed significant (P < 0.05) reduction in percentage parasitaemia and significant (P < 0.05) increase in percentage parasite clearance comparable to that of Artemether-lumefantrine. The parasitized untreated group recorded 50% mortality, while the group treated concurrently with the two extracts did not record any mortality.

Lessons learnt from UNAIDS virtual technical support to countries applying for funding from the Global Fund COVID-19 Response Mechanism

In 2020 the Global Fund for AIDS, Tuberculosis and Malaria initiated a new funding modality, the COVID-19 Response Mechanism, to mitigate the pandemic's effects on HIV, TB and malaria programmes and health systems in implementer countries. In 2021 UNAIDS introduced an innovative technical virtual support mechanism for COVID-19 Response Mechanism proposal development to help countries quickly implement COVID-19 interventions while at the same time adapting HIV and related services to the pandemic's circumstances and mitigate its impact while maintaining hard-won gains. It also intended to ensure more attention was paid to communities, human rights and gender considerations in proposal development, resulting in successful proposals to mitigate COVID-19's impact, bring human rights-based and people-centred HIV programmes back on track and even expand their reach through using new delivery platforms. In 2021, applications from 18 sub-Saharan African and Asian countries received in-depth remote peer reviews. We discuss the reviews' key findings and recommendations to improve proposal quality and identify future opportunities for virtual technical support. The model was successful and contributed to better quality funding applications, but also highlighted challenges in pandemic mitigation, adaptations and innovations of HIV programmes. Countries still fell short on comprehensive community, human rights and gender interventions, as well as innovations in HIV service delivery, especially in prevention and gender-based violence. Several other weaknesses meant that some countries would have to refine their programme design and implementation model in the final version of their funding application. There are implications for future assistance to countries trying to mitigate the impact of COVID-19 on their health programmes and innovative ways to deliver technical support using new technologies and local expertise.

Malaria and COVID-19 prevalence in a population of febrile children and adolescents living in Libreville

Background: Patients with acute febrile illness need to be screened for malaria and coronavirus disease 2019 (COVID-19) in malaria-endemic areas to reduce malaria mortality rates and to prevent the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objectives: To estimate the frequency of children and adolescents with COVID-19 and/or malaria among febrile patients attending for malaria diagnosis Method: This cross-sectional study was conducted in a sentinel site for malaria surveillance during the SARS-CoV-2 pandemic (Omicron variant), from October 2021 to December 2021 in Gabon. All febrile patients were tested for malaria using microscopy. Severe acute respiratory syndrome coronavirus 2 was detected by real time polymerase chain reaction (RT-PCR) and rapid antigen tests developed by Sansure Biotech®. Results: A total of 135 patients were screened. Their median age was 6 (interquartile range [IQR]: 3­14) years. Malaria was confirmed for 49 (36.3%) patients, 29 (32.5%) children, 13 (59.0%) adolescents and 7 (29.2%) adults. The frequency of COVID-19 cases was 7.4% (n = 10/135), and it was comparable between children (n = 6; 6.7%), adolescents (n = 2; 9.1%) and adults (n = 2; 8.3%) (p = 0.17). Malaria and COVID-19 co-infections were diagnosed in 3 (6.1%) patients from all the age groups. Participants with a co-infection had a higher median temperature, a higher median parasitaemia, and were mostly infected with non-falciparum malaria. Conclusion: COVID-19 cases and cases of malaria/COVID-19 co-infections were found in febrile children and adolescents. SARS-CoV-2 testing should be included in the screening of suspected malaria cases.

Artemisinin-based antimalarial combination therapy amongst healthcare professionals in a tertiary facility in south-south Nigeria: preferences, tolerability, and cost considerations

Background: Nigeria adopted the Artemisinin-Based Combination Therapy (ACT) as the mainstay of treating uncomplicated malaria in February 2005. However, the individual preferences for the use of these medicines by health care professionals (HCP) as distinct from their observed prescribing practices is largely unknown. This study determined the preferences, tolerability and cost of the ACTs among HCP in Benin-City. Methods: This descriptive cross-sectional study was conducted in the University of Benin Teaching Hospital, Benin-City, Nigeria. Consenting HCPs were recruited consecutively for the study. Semi structured questionnaires were administered to doctors, nurses and pharmacists in the hospital. Information obtained included demographics, treatment of malaria in the previous year, antimalarial medication preferences and tolerability as well as cost of ACT. Results: A total of 556 HCPs, 295 doctors (54.1%), nurses 200 (36.0%), pharmacists 61(11.0%) completed the questionnaire. In the previous year, 224 (75.9%) doctors, 153 (79.1%) nurses, and 48 (70.5%) pharmacists had treatment for malaria and self-medication was highest among doctors (228,77.3%). Artemether-Lumenfantrine was the most preferred antimalarial used, 294 (52.8%); however, 1.6% used chloroquine sulphate and ACTs were perceived to be ineffective by 25.4%. Adverse effects were experienced by 167 (29.1%) resulting in 50 (9.0%) discontinuing their medication. Between 500 and 1500 Naira (~US$1-4) was expended on ACT by 66.3% of the staff, while 21.4% were concerned about the high cost of medications. Conclusion: This study highlights the use and preferences, self-medication practices, perceived lack of effectiveness and high cost of ACTs from a HCP perspective. There is an urgent need to address these concerns in view of adverse consequences as well as the likely possibility of its the impact on prescribing practices.

Clinical and haematological determinants of outcome among children with cerebral malaria in a tertiary centre in Nigeria

Background: Many clinical and haematological changes occur as a result of severe malaria, of which cerebral malaria (CM) is a common entity. These changes affect virtually all organs and systems of the body. We identify various clinical and haematological determinants of outcome in CM so as to institute proactive management of such children.Methods: All children who met World Health Organization (WHO) diagnostic criteria for CM over 8 month-period were prospectively studied. The presenting symptoms and its duration, detailed physical examination and laboratory parameters were obtained. Logistic regression was employed to determine the prognostic significance of various clinical and laboratory parameters. Outcome indicators were full recovery, alive with neurological sequelae or death of the children. Results: Of the 892 children admitted into the Children Emergency Unit (CEU) over the study period, 50 (5.6%) had CM with M: F ratio of 1:1 and age range of 6 months to 12 years. Sixty percent were aged less than 5 years. The defining symptoms were fever (100%), coma (100%) and convulsion (98%). Forty-one (82%) patients survived, while nine (18%) died. Of the 41 survivors, 30 (73.2%) recovered fully, while 11 (26.8%) had neurological deficits at discharge. Identified clinical and laboratory predictors of mortality and neurological sequelae in CM included Blantyre coma score of 0-2(p = 0.018) prolonged coma recovery time > 26 hours (p = 0.026), abnormal breathing pattern (p = 0.0124), absent corneal reflex (p = 0.012), absent pupillary reflex (p = 0.012), depressed tendon reflex (p = 0.028), hyperreflexia (p =0.014), retinal haemorrhage (p =0.001), duration of admission (p=0.000), hyper parasitaemia (p=0.001), hypoglycemia (p= 0.014) and leucocytosis (p = 0.008). Independent determinants of immediate post-recovery neurological deficits and death were hyper-parasitaemia (OR = 8.657, p = 0.017.) and leucocytosis (OR = 1.090; p = 0.035 Conclusion: CM is a potentially reversible encephalopathy associated with high mortality and sequelae. Affected children with the above listed clinical / haematological parameters especially hyperparasitemia and leucocytosis should be given proactive management to improve the outcome.