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1.
Malar J ; 21(1): 121, 2022 Apr 12.
Article in English | MEDLINE | ID: covidwho-1789122

ABSTRACT

Malaria is one of the most serious infectious diseases affecting predominantly low- and middle-income countries, where pregnant women are among the populations at risk. There are limited options to prevent or treat malaria in pregnancy, particularly in the first trimester, and existing ones may not work optimally in areas where the threat of drug resistance is rising. As malaria elimination is a key goal of the global health community, the inclusion of pregnant women in the adult population to protect from malaria will be key to achieving success. New, safe, and effective options are needed but it can take decades of evidence-gathering before a medicine is recommended for use in pregnancy. This is because pregnant women are typically not included in pre-registration clinical trials due to fear of causing harm. Data to support dosing and safety in pregnancy are subsequently collected in post-licensure studies. There have been growing calls in recent years that this practice needs to change, amplified by the COVID-19 pandemic and increasing public awareness that newly developed medicines generally cannot be administered to pregnant women from the onset. The development of new anti-malarials should ensure that data informing their use in pregnancy and breastfeeding are available earlier. To achieve this, a mindset change and a different approach to medications for pregnant women are needed. Changes in non-clinical, translational, and clinical approaches in the drug development pathway, in line with recent recommendations from the regulatory bodies are proposed in this Comment. The new approach applies to any malaria-endemic region, regardless of the type of Plasmodium responsible for malaria cases. By incorporating intentional and systematic data collection from pre-registration stages of development through post-licensure, it will be possible to inform on the benefit/risk balance of a new anti-malarial earlier and help ensure that the needs of pregnant individuals are addressed in a more timely and equitable manner in the future.


Subject(s)
Antimalarials , COVID-19 , Malaria , Adult , Antimalarials/therapeutic use , Drug Development , Female , Humans , Malaria/drug therapy , Malaria/epidemiology , Malaria/prevention & control , Pandemics , Pregnancy , Pregnant Women
2.
OMICS ; 26(4): 179-188, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1784298

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a systemic disease, impacting multiple organs in the human body. But COVID-19 also impacts other diseases of relevance to public and planetary health. To understand and respond to the COVID-19 pandemic, we need an intersectional conceptual lens and systems thinking. For example, the strain on health care systems due to COVID-19 has adversely impacted global malaria elimination programs. With many epidemiological, clinical, and biological parallels documented, we examined in this study the scenario of malaria and COVID-19 syndemic in India. The disruptive influence of COVID-19 on the National Framework for Malaria Elimination (NFME), impact of unintended chemoprophylaxis, population genetic influences, and the shifting patterns of epidemiology are compared. Importantly, a time series analysis forecasted the burden of malaria increasing in the upcoming years. Although reported malaria cases showed a decline in 2020 compared to the previous years, an increase in cases was documented in 2021, with nine states reporting an increase up to July 2021. Pandemics often cause crosscutting disruptions in health care. Reshaping the priorities of the malaria elimination program and a diligent implementation of the priorities in the NFME would, therefore, be well-advised: (1) vector control, (2) antimalarial therapy recommendations, (3) monitoring drug resistance, (4) prevention of the spread of asymptomatic disease-causing low-density transmission, and (5) large-scale testing measures. In conclusion, the findings from the present study inform future comparative studies in other world regions to better understand the broader, systemic, temporal, and spatial impacts of the COVID-19 pandemic on existing and future diseases across public health systems and services.


Subject(s)
Antimalarials , COVID-19 , Malaria , Antimalarials/therapeutic use , COVID-19/epidemiology , Humans , Malaria/epidemiology , Malaria/prevention & control , Pandemics/prevention & control , Population Surveillance
3.
Front Public Health ; 9: 742378, 2021.
Article in English | MEDLINE | ID: covidwho-1775900

ABSTRACT

Despite the scale-up of vector control, diagnosis and treatment, and health information campaigns, malaria persists in the forested areas of South-Central Vietnam, home to ethnic minority populations. A mixed-methods study using an exploratory sequential design was conducted in 10 Ra-glai villages in Bac Ai district of Ninh Thuan province to examine which social factors limited the effectiveness of the national malaria elimination strategy in the local setting. Territorial arrangements and mobility were found to directly limit the effectiveness of indoor residual spraying and long-lasting insectidical treated nets (LLINs). Households (n=410) were resettled in the "new villages" by the government, where they received brick houses (87.1%) and sufficient LLINs (97.3%). However, 97.6% of households went back to their "old villages" to continue slash-and-burn agriculture. In the old village, 48.5% of households lived in open-structured plot huts and only 5.7% of them had sufficient LLIN coverage. Household representatives believed malaria could be cured with antimalarials (57.8%), but also perceived non-malarial medicines, rituals, and vitamin supplements to be effective against malaria. Household members (n = 1,957) used public health services for their most recent illness (62.9%), but also reported to buy low-cost medicines from the private sector to treat fevers and discomfort as these were perceived to be the most cost-effective treatment option for slash-and-burn farmers. The study shows the relevance of understanding social factors to improve the uptake of public health interventions and calls for contextually adapted strategies for malaria elimination in ethnic minority populations in Vietnam and similar settings.


Subject(s)
Malaria , Humans , Malaria/drug therapy , Malaria/prevention & control , Minority Groups , Vietnam/epidemiology
4.
Malar J ; 21(1): 103, 2022 Mar 24.
Article in English | MEDLINE | ID: covidwho-1759754

ABSTRACT

BACKGROUND: Seasonal malaria chemoprevention (SMC) is a WHO-recommended intervention for children aged 3-59 months living in areas of high malaria transmission to provide protection against malaria during the rainy season. Operational guidelines were developed, based on WHO guidance, to support countries to mitigate the risk of coronavirus disease 2019 (COVID-19) transmission within communities and among community distributors when delivering SMC. METHODS: A cross-sectional study to determine adherence to infection prevention and control (IPC) measures during two distribution cycles of SMC in Nigeria, Chad and Burkina Faso. Community distributors were observed receiving equipment and delivering SMC. Adherence across six domains was calculated as the proportion of indications in which the community distributor performed the correct action. Focus group discussions were conducted with community distributors to understand their perceptions of the IPC measures and barriers and facilitators to adherence. RESULTS: Data collectors observed community distributors in Nigeria (n = 259), Burkina Faso (n = 252) and Chad (n = 266) receiving IPC equipment and delivering SMC. Adherence to IPC indications varied. In all three countries, adherence to mask use was the highest (ranging from 73.3% in Nigeria to 86.9% in Burkina Faso). Adherence to hand hygiene for at least 30 s was low (ranging from 3.6% in Nigeria to 10.3% in Burkina Faso) but increased substantially when excluding the length of time spent hand washing (ranging from 36.7% in Nigeria to 61.4% in Burkina Faso). Adherence to safe distancing in the compound ranged from 5.4% in Chad to 16.4% in Nigeria. In Burkina Faso and Chad, where disinfection wipes widely available compliance with disinfection of blister packs for SMC was low (17.4% in Burkina Faso and 16.9% in Chad). Community distributors generally found the IPC measures acceptable, however there were barriers to optimal hand hygiene practices, cultural norms made social distancing difficult to adhere to and caregivers needed assistance to administer the first dose of SMC. CONCLUSION: Adherence to IPC measures for SMC delivery during the COVID-19 pandemic varied across domains of IPC, but was largely insufficient, particularly for hand hygiene and safe distancing. Improvements in provision of protective equipment, early community engagement and adaptations to make IPC measures more feasible to implement could increase adherence.


Subject(s)
Antimalarials , COVID-19 , Malaria , Antimalarials/therapeutic use , Burkina Faso/epidemiology , COVID-19/prevention & control , Chad , Chemoprevention , Child , Child, Preschool , Cross-Sectional Studies , Humans , Infant , Malaria/prevention & control , Nigeria/epidemiology , Pandemics/prevention & control , Seasons
8.
BMC Public Health ; 22(1): 373, 2022 02 21.
Article in English | MEDLINE | ID: covidwho-1700500

ABSTRACT

BACKGROUND: Despite efforts to avert the negative effects of malaria, there remain barriers to the uptake of prevention measures, and these have hindered its eradication. This study explored the factors that influence uptake of malaria prevention strategies among pregnant women and children under-five years and the impact of COVID-19 in a malaria endemic rural district in Uganda. METHODS: This was a qualitative case study that used focus group discussions, in-depth interviews, and key informant interviews involving pregnant women, caregivers of children under-five years, traditional birth attendants, village health teams, local leaders, and healthcare providers to explore malaria prevention uptake among pregnant women and children under-five years. The interviews were audio-recorded, transcribed and data were analyzed using thematic content approach. RESULTS: Seventy-two participants were enrolled in the Focus Group Discussions, 12 in the in-depth interviews, and 2 as key informants. Pregnant women and caregivers of children under-five years were able to recognize causes of malaria, transmission, and symptoms. All participants viewed malaria prevention as a high priority, and the use of insecticide-treated mosquito bed nets (ITNs) was upheld. Participants' own experiences indicated adverse effects of malaria to both pregnant women and children under-five. Home medication and the use of local herbs were a common practice. Some participants didn't use any of the malaria prevention methods due to deliberate refusal, perceived negative effects of the ITNs, and family disparity. The Corona Virus Disease-2019 (COVID-19) control measures did not abate the risk of malaria infection but these were deleterious to healthcare access and the focus of malaria prevention. CONCLUSIONS: Although pregnant women and caregivers of children under-five years recognized symptoms of malaria infection, healthcare-seeking was not apt as some respondents used alternative approaches and delayed seeking formal healthcare. It is imperative to focus on the promotion of malaria prevention strategies and address drawbacks associated with misconceptions about these interventions, and promotion of health-seeking behaviors. As COVID-19 exacerbated the effect of malaria prevention uptake and healthcare seeking, it's critical to recommit and integrate COVID-19 prevention measures in normative living and restrict future barriers to healthcare access.


Subject(s)
COVID-19 , Malaria , Caregivers , Child , Female , Health Knowledge, Attitudes, Practice , Humans , Malaria/drug therapy , Malaria/epidemiology , Malaria/prevention & control , Pandemics , Pregnancy , Pregnant Women , Rural Population , SARS-CoV-2 , Uganda/epidemiology
9.
Malar J ; 21(1): 48, 2022 Feb 14.
Article in English | MEDLINE | ID: covidwho-1686016

ABSTRACT

BACKGROUND: Rwanda has achieved impressive reductions in malaria morbidity and mortality over the past two decades. However, the disruption of essential services due to the current Covid-19 pandemic can lead to a reversal of these gains in malaria control unless targeted, evidence-based interventions are implemented to mitigate the impact of the pandemic. The extent to which malaria services have been disrupted has not been fully characterized. This study was conducted to assess the impact of Covid-19 on malaria services in Rwanda. METHODS: A mixed-methods study was conducted in three purposively selected districts in Rwanda. The quantitative data included malaria aggregated data reported at the health facility level and the community level. The data included the number of malaria tests, uncomplicated malaria cases, severe malaria cases, and malaria deaths. The qualitative data were collected using focus group discussions with community members and community health workers, as well as in-depth interviews with health care providers and staff working in the malaria programme. Interrupted time series analysis was conducted to compare changes in malaria presentations between the pre-Covid-19 period (January 2019 to February 2020) and Covid-19 period (from March 2020 to November 2020). The constant comparative method was used in qualitative thematic analysis. RESULTS: Compared to the pre-Covid-19 period, there was a monthly reduction in patients tested in health facilities of 4.32 per 1000 population and a monthly increase in patients tested in the community of 2.38 per 1000 population during the Covid-19 period. There was no change in the overall presentation rate for uncomplicated malaria. The was a monthly reduction in the proportion of severe malaria of 5.47 per 100,000 malaria cases. Additionally, although healthcare providers continued to provide malaria services, they were fearful that this would expose them and their families to Covid-19. Covid-19 mitigation measures limited the availability of transportation options for the community to seek care in health facilities and delayed the implementation of some key malaria interventions. The focus on Covid-19-related communication also reduced the amount of health information for other diseases provided to community members. CONCLUSION: The Covid-19 pandemic resulted in patients increasingly seeking care in the community and poses challenges to maintaining delivery of malaria services in Rwanda. Interventions to mitigate these challenges should focus on strengthening programming for the community and home-based care models and integrating malaria messages into Covid-19-related communication. Additionally, implementation of the interrupted interventions should be timed and overlap with the malaria transmission season to mitigate Covid-19 consequences on malaria.


Subject(s)
COVID-19 , Malaria , Community Health Workers , Humans , Malaria/epidemiology , Malaria/prevention & control , Pandemics , Rwanda/epidemiology , SARS-CoV-2
10.
Malar J ; 20(1): 481, 2021 Dec 20.
Article in English | MEDLINE | ID: covidwho-1623634

ABSTRACT

BACKGROUND: Malaria causes more than 200 million cases of illness and 400,000 deaths each year across 90 countries. The World Health Organization (WHO) set a goal for 35 countries to eliminate malaria by 2030, with an intermediate milestone of 10 countries by 2020. In 2017, the WHO established the Elimination-2020 (E-2020) initiative to help countries achieve their malaria elimination goals and included 21 countries with the potential to eliminate malaria by 2020. METHODS: Across its three levels of activity (country, region and global), the WHO developed normative and implementation guidance on strategies and activities to eliminate malaria; provided technical support and subnational operational assistance; convened national malaria programme managers at three global meetings to share innovations and best practices; advised countries on strengthening their strategy to prevent re-establishment and preparing for WHO malaria certification; and contributed to maintaining momentum towards elimination through periodic evaluations, monitoring and oversight of progress in the E-2020 countries. Changes in the number of indigenous cases in E-2020 countries between 2016 and 2020 are reported, along with the number of countries that eliminated malaria and received WHO certification. RESULTS: The median number of indigenous cases in the E-2020 countries declined from 165.5 (interquartile range [IQR] 14.25-563.75) in 2016 to 78 (IQR 0-356) in 2020; 12 (57%) countries reported reductions in indigenous cases over that period, of which 7 (33%) interrupted malaria transmission and maintained a malaria-free status through 2020 and 4 (19%) were certified malaria-free by the WHO. Two countries experienced outbreaks of malaria in 2020 and 2021 attributed, in part, to the COVID-19 pandemic. CONCLUSIONS: Although the E-2020 countries contributed to the achievement of the 2020 global elimination milestone, the initiative highlights the difficulties countries face to interrupt malaria transmission, even when numbers of cases are very low. The 2025 global elimination milestone is now approaching, and the lessons learned, experience gained, and updated guidance developed during the E-2020 initiative will help serve the countries seeking to eliminate malaria by 2025.


Subject(s)
Disease Eradication , Global Health , Malaria/epidemiology , Malaria/prevention & control , World Health Organization , Endemic Diseases/prevention & control , Guidelines as Topic , Humans , Malaria/transmission , Population Surveillance
11.
Front Cell Infect Microbiol ; 11: 805482, 2021.
Article in English | MEDLINE | ID: covidwho-1581379

ABSTRACT

Control measures have significantly reduced malaria morbidity and mortality in the last two decades; however, the downward trends have stalled and have become complicated by the emergence of COVID-19. Significant efforts have been made to develop malaria vaccines, but currently only the RTS,S/AS01 vaccine against Plasmodium falciparum has been recommended by the WHO, for widespread use among children in sub-Saharan Africa. The efficacy of RTS,S/AS01 is modest, and therefore the development of more efficacious vaccines is still needed. In addition, the development of transmission-blocking vaccines (TBVs) to reduce the parasite transmission from humans to mosquitoes is required toward the goal of malaria elimination. Few TBVs have reached clinical development, and challenges include low immunogenicity or high reactogenicity in humans. Therefore, novel approaches to accelerate TBV research and development are urgently needed, especially novel TBV candidate discovery. In this mini review we summarize the progress in TBV research and development, novel TBV candidate discovery, and discuss how to accelerate novel TBV candidate discovery.


Subject(s)
COVID-19 , Malaria Vaccines , Malaria, Falciparum , Malaria , Animals , Child , Humans , Malaria/prevention & control , Malaria, Falciparum/prevention & control , Plasmodium falciparum , SARS-CoV-2
12.
Pan Afr Med J ; 38: 119, 2021.
Article in French | MEDLINE | ID: covidwho-1547723

ABSTRACT

Long-lasting insecticidal mosquito nets (LLIMNs) are needed for malaria vector control. However, their distribution is not yet optimal in sub-Saharan regions. According to projections, COVID-19 pandemic will further delay the distribution of LLIMNs. In Niger, a distribution campaign of LLIMNs with a multi-sectoral approach (state-partner-civil society) was organized in compliance with barrier measures for preventing transmission of COVID-19. A door-to-door strategy was chosen to implement this campaign, in order to avoid entry into confined spaces and to engage community. A total of 13,994,681 people received LLIMNs (reflecting a success rate of 101%) in six targeted regions. A collective effort is needed to sustain the fight against malaria in the COVID-19 era.


Subject(s)
COVID-19/prevention & control , Insecticide-Treated Bednets/supply & distribution , Malaria/prevention & control , COVID-19/epidemiology , Humans , Mosquito Control , Mosquito Vectors , Niger
14.
Acta Parasitol ; 67(1): 55-60, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1525614

ABSTRACT

Plasmodium resistance to antimalarial drugs is an obstacle to the elimination of malaria in endemic areas. This situation is particularly dramatic for Africa, which accounts for nearly 92% of malaria cases worldwide. Drug pressure has been identified as a key factor in the emergence of antimalarial drug resistance. Indeed, this pressure is favoured by several factors, including the use of counterfeit forms of antimalarials, inadequate prescription controls, poor adherence to treatment regimens, dosing errors, and the increasing use of other forms of unapproved antimalarials. This resistance has led to the replacement of chloroquine (CQ) by artemisinin-based combination therapies (ACTs) which are likely to become ineffective in the coming years due to the uncontrolled use of Artemisia annua in the sub-Saharan African region for malaria prevention and COVID-19. The use of Artemisia annua for the prevention of malaria and COVID-19 could be an important factor in the emergence of resistance to Artemisinin-based combination therapies.


Subject(s)
Antimalarials , Artemisia annua , Artemisinins , COVID-19 , Malaria, Falciparum , Malaria , Plasmodium , Antimalarials/pharmacology , Antimalarials/therapeutic use , Artemisinins/pharmacology , Artemisinins/therapeutic use , COVID-19/prevention & control , Humans , Malaria/drug therapy , Malaria/epidemiology , Malaria/prevention & control , Malaria, Falciparum/drug therapy , Plasmodium falciparum
15.
Ghana Med J ; 55(2 Suppl): 56-63, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1502654

ABSTRACT

Malaria-endemic areas of the world are noted for high morbidity and mortality from malaria. Also noted in these areas is the majority of persons in the population having acquired malaria immunity. Though this acquired malaria immunity does not prevent infection, it resists the multiplication of Plasmodium parasites, restricting disease to merely uncomplicated cases or asymptomatic infections. Does this acquired malaria immunity in endemic areas protect against other diseases, especially outbreak diseases like COVID-19? Does malaria activation of innate immunity resulting in trained or tolerance immunity contribute to protection against COVID-19? In an attempt to answer these questions, this review highlights the components of malaria and viral immunity and explores possible links with immunity against COVID-19. With malaria-endemic areas of the world having a fair share of cases of COVID-19, it is important to direct research in this area to evaluate and harness any benefits of acquired malaria immunity to help mitigate the effects of COVID-19 and any possible future outbreaks. Funding: None declared.


Subject(s)
COVID-19 , Malaria , Humans , Malaria/epidemiology , Malaria/prevention & control , SARS-CoV-2
17.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 32(1): 7-9, 2020 Feb 27.
Article in Chinese | MEDLINE | ID: covidwho-1456574

ABSTRACT

Since the end of 2019, the coronavirus disease 2019 (COVID-19) has been extensively epidemic in China, which not only seriously threatens the safety and health of Chinese people, but also challenges the management of other infectious diseases. Currently, there are still approximately three thousand malaria cases imported into China every year. If the diagnosis and treatment of malaria cases as well as the investigation and response of the epidemic foci are not carried out timely, it may endanger patients'lives and cause the possible of secondary transmission, which threatens the achievements of malaria elimination in China. Due to the extensive spread and high transmission ability of the COVID-19, there is a possibility of virus infections among malaria cases during the medical care-seeking behaviors and among healthcare professionals during clinical diagnosis and treatment, sample collection and testing and epidemiological surveys. This paper analyzes the challenges of the COVID-19 for Chinese malaria elimination programme, and proposes the countermeasures in response to the COVID-19 outbreak, so as to provide the reference for healthcare professionals.


Subject(s)
Coronavirus Infections/epidemiology , Disease Outbreaks , Malaria , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , China , Coronavirus Infections/prevention & control , Humans , Malaria/epidemiology , Malaria/prevention & control , Malaria/transmission , National Health Programs , Pneumonia, Viral/prevention & control , SARS-CoV-2
20.
Glob Health Sci Pract ; 9(2): 344-354, 2021 06 30.
Article in English | MEDLINE | ID: covidwho-1352940

ABSTRACT

Cambodia has made impressive progress in reducing malaria trends and, in 2018, reported no malaria-related deaths for the first time. However, the coronavirus disease (COVID-19) pandemic presents a potential challenge to the country's goal for malaria elimination by 2025. The path toward malaria elimination depends on sustained interventions to prevent rapid resurgence, which can quickly set back any gains achieved.Malaria Consortium supported mobile malaria workers (MMWs) to engage with target communities to build acceptance, trust, and resilience. At the start of the pandemic, Malaria Consortium conducted a COVID-19 risk assessment and quickly developed and implemented a mitigation plan to ensure MMWs were able to continue providing malaria services without putting themselves or their patients at risk. Changes in malaria intervention coverage and community uptake have been monitored to gauge the indirect effects of COVID-19. Comparisons have been made between output indicators reported in 2020 and from the same month-period of the previous year.In general, malaria service intervention coverage and utilization rates did not decline in 2020. Rather, the reported figures show there was a substantial increase in service utilization. Preliminary internal reviews and community meetings show that despite a heightened public risk perception toward COVID-19, malaria testing motivation has been well sustained throughout the pandemic. This may be attributable to proactive program planning and data monitoring and active engagement with the communities and the national authorities to circumvent the indirect effect of COVID-19 on intervention coverage in Cambodia during the pandemic.


Subject(s)
COVID-19 , Community Health Services , Malaria/prevention & control , Pandemics , Cambodia , Disease Eradication , Goals , Health Planning , Humans , Malaria/diagnosis , Mass Screening , Residence Characteristics , Risk Assessment , SARS-CoV-2
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