Evaluating Malaria Rapid Diagnostic Tests and Microscopy for Detecting Plasmodium Infection and Status of Plasmodium falciparum Histidine-Rich Protein 2/3 Gene Deletions in Southeastern Nigeria.

Delays in malaria diagnosis increase treatment failures and deaths. In endemic regions, standard diagnostic methods are microscopy and malaria rapid diagnostic tests (mRDTs) detecting Plasmodium falciparum histidine-rich protein 2/3 (PFHRP2/PFHRP3), but gene deletions can allow certain parasites to remain undetected. We enlisted a cohort comprising 207 symptomatic individuals, encompassing both children and adults, at a hospital in Nnewi, Nigeria. The prevalence of parasites was determined using a highly sensitive, species-specific quantitative polymerase chain reaction (SS-qPCR). Within a subset of 132 participants, we assessed the sensitivity and specificity of microscopy and HRP2-mRDTs in comparison to SS-qPCR for the detection of P. falciparum. We also investigated the prevalence of pfhrp2/pfhrp3 gene deletions. Greater sensitivity was achieved with mRDTs (95%) compared with microscopy (77%). Also, mRDTs exhibited greater specificity (68%) than microscopy (44%). The positive predictive value of mRDTs (89%) surpassed that of microscopy (80%), suggesting a greater probability of accurately indicating the presence of infection. The negative predictive value of mRDTs (82%) was far greater than microscopy (39%). Of the 165 P. falciparum-positive samples screened for pfhrp2/pfhrp3 gene deletions, one gene deletion was detected in one sample. Regarding infection prevalence, 84% were positive for Plasmodium spp. (by reverse transcription [RT]-qPCR), with P. falciparum responsible for the majority (97%) of positive cases. Thus, exclusive reliance on microscopy in endemic areas may impede control efforts resulting from false negatives, underscoring the necessity for enhanced training and advocating for high-throughput molecular testing such as RT-qPCR or qPCR at referral centers to address limitations.

Effectiveness of antenatal intermittent preventive treatment for malaria with sulphadoxine-pyrimethamine on peripartum outcomes.

Background: Following the World Health Organization (WHO) recommendations for 4-weekly antenatal intermittent preventive treatment of malaria in pregnancy using sulphadoxine-pyrimethamine (IPTp-SP), there is a need to evaluate the drug performance in order to determine their effectiveness as tools in malaria control policy. Objectives: To determine prevalence of cord blood malaria, compliance gap and adverse pregnancy outcomes (anaemia, preterm delivery, spontaneous abortion, intra-uterine foetal death and low birth weight) among antenatal IPTp-SP users compared with non-users. Methods: A cross-sectional analytical study was conducted among consenting 390 participants who were administered a questionnaire, and paired blood samples were collected from the venous blood of participants and neonatal cord immediately after delivery. The participants were categorised as IPTp-SP users and non-users. Adverse pregnancy outcomes were assessed. Neonatal birth weights were also measured within 1 h after delivery. Malaria parasitaemia and anaemia were analysed using standard parasitological and haematological methods of examination. Data were analysed using SPSS version 25 for Windows and p-value of < 0.05 considered significant. Results: Of 390 women, 336 (86.2%) were IPTp-SP users, while 54 (13.8%) were non-users. The compliance gap was 13.8%. Malaria parasitemia in pregnant women (21.7% versus 53.7%; p < 0.001) and their babies (12.2% versus 25.4%; p = 0.002) were observed for IPTp-SP users and non-users, respectively. The prevalence of maternal anaemia was 27(8.0%) in IPTp-SP users and 5 (9.3%) in non-users (p = 0.789). Mean parasite density was reduced in IPTp-SP users than in non-users (p < 0.001). Correlation of birth weight according to their sex showed a weak correlation [correlation coefficient (r) = 0.027; p = 0.736]. Pregnant women with preterm delivery, spontaneous abortion, intra-uterine foetal death, and low birth weight were significantly lower (p < 0.001, for all) in IPTp-SP users compared with non-users. Conclusion: Although the compliance gap was low, IPTp-SP users had significantly better pregnancy and foetal outcomes compared with non-users. Efforts should be intensified towards achieving total compliance in IPTp-SP usage by pregnant women.

Malaria surveillance amongst pregnant women attending antenatal care in private hospitals in Onitsha metropolis, South Eastern Nigeria.

Background: Recent reports suggest that pregnant women living in holoendemic regions of sub-Sahara Africa die in great numbers annually due to malaria disease resulting from their higher susceptibility, reduced immunity and demographic associated factors. This work investigated the prevalence of Plasmodium falciparum in pregnant women attending antenatal care (ANC) in selected private hospitals in Onitsha metropolis South East Nigeria. Methods: Venous blood samples were collected from 270 pregnant women during ANC visits between October 2016 and December 2017. A questionnaire was used to collect demographic data, gestational age, knowledge of malaria and preventive measures while clinical presentations and symptoms were extracted from the physician's clerking form. Laboratory diagnosis was done using microscopy. The effect of the demographic variables and other associated factors on prevalence and parasite densities was studied using Chi-square and ANOVA tests. Results: The overall P. falciparum prevalence was 42.6%. Prevalence varied with the maternal age, gestational age, preventive measures adopted by the pregnant women and clinical presentations. 27.8 % of the infected women were highly parasitized (>5000 parasites/µl); 67% had a moderate parasite density (1,000-4,999 parasites/µl) and 5.2% showed a low parasite density (1-999 parasites/µl). We observed that 35.2%, 30%, 18.9% and 5.2% of the study cohorts preferred and used treated bed nets, insecticides, windows and door screening and non-treated bed nets respectively as malaria preventive measures. 5.9% did not use any protection. Conclusions: The findings of this study revealed high prevalence of malaria among pregnant women living in Onitsha metropolis with high mean parasite densities despite strong adherence to use of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy (IPTp) and other malaria preventive measures.

COVID-19 infection: Knowledge, attitude, practices, and impact among healthcare workers in a South-Eastern Nigerian state.

INTRODUCTION: The coronavirus disease (COVID-19) infection rate and mortality among Nigerian health care workers appear to be on the increase. This study determined the level of knowledge, attitude, practices, and impact of COVID-19 infection on healthcare workers (HCWs) working in a South-Eastern Nigerian state. METHODOLOGY: This was a web-based, cross-sectional study conducted among healthcare workers in South-eastern, Nigeria during the lockdown period. Socio-demographic profile, knowledge of COVID-19, fears and impact concerning COVID-19, attitude of health workers to work, preventive practices during this pandemic period were obtained. Data were analysed using STATA 16.0. Chi-square and Fisher's exact tests of association were used to determine the association between variables, with the significance level set at p < 0.05. RESULTS: A total of 403 health care workers participated in the study. Majority of participants (n = 357, 88.59%) had good knowledge and good preventive practices (n = 328, 81.39%) of COVID-19. A significant proportion of respondents had a poor attitude to work (n = 101, 25.06%) and an attitude of indifference (n = 233, 57.82%). Almost half (48.64%) of participants had been negatively affected by COVID-19. Knowledge significantly influenced practice (p = 0.029). Lack of Personal protective equipment, fear of dying and going to common places, had a significant impact on the attitude of workers. CONCLUSION: Good knowledge which influenced practice, high use of preventive practices, with associated poor and indifferent attitude was noted among healthcare workers. Fear of death and lack of personal protective equipment had a strong impact on attitude. Female HCWs had poorer attitude to work than males.

COVID-19 infection: Knowledge, attitude, practices, and impact among healthcare workers in a South-Eastern Nigerian state

Introduction: The coronavirus disease (COVID-19) infection rate and mortality among Nigerian health care workers appear to be on the increase. This study determined the level of knowledge, attitude, practices, and impact of COVID-19 infection on healthcare workers (HCWs) working in a South-Eastern Nigerian state.Methodology: This was a web-based, cross-sectional study conducted among healthcare workers in South-eastern, Nigeria during the lockdown period. Socio-demographic profile, knowledge of COVID-19, fears and impact concerning COVID-19, attitude of health workers to work, preventive practices during this pandemic period were obtained. Data were analysed using STATA 16.0. Chi-square and Fisher's exact tests of association were used to determine the association between variables, with the significance level set at p < 0.05. Results: A total of 403 health care workers participated in the study. Majority of participants (n = 357, 88.59%) had good knowledge and good preventive practices (n = 328, 81.39%) of COVID-19. A significant proportion of respondents had a poor attitude to work (n = 101, 25.06%) and an attitude of indifference (n = 233, 57.82%). Almost half (48.64%) of participants had been negatively affected by COVID-19. Knowledge significantly influenced practice (p = 0.029). Lack of Personal protective equipment, fear of dying and going to common places, had a significant impact on the attitude of workers. Conclusion: Good knowledge which influenced practice, high use of preventive practices, with associated poor and indifferent attitude was noted among healthcare workers. Fear of death and lack of personal protective equipment had a strong impact on attitude. Female HCWs had poorer attitude to work than males

Prevalence, pattern, and determinants of placental malaria in a population of southeastern Nigerian parturients.

BACKGROUND: Placental malaria is a complication of malaria in pregnancy and is associated with adverse outcomes. Its burden is highest in Sub-Saharan Africa, but despite this, data based on histological analysis are scarce from this region. METHODS: Questionnaires administered by the researchers were used to obtain information from parturients at a university teaching hospital in southeastern Nigeria between April and November 2010. Maternal blood and placental blood were collected for analysis. Placental blocks were taken for histological analysis. Statistical analyses were done using SPSS v. 17. RESULTS: Three hundred and sixty-five placentas were analyzed, out of which 254 showed histological evidence of malaria parasitization, giving a prevalence of 69.6%. Of the 254 placentas, 23 (9.0%) showed active infection and 196 (77.2%) showed active-on-past infection, while 35 (13.8%) showed past infection. Rural residence, hemoglobin genotype AA, not receiving intermittent preventive treatment in pregnancy (IPTp), and not sleeping under insecticide-treated bed nets (ITN) were significantly associated with placental malaria. Placental parasite density was inversely related to parity. CONCLUSIONS: This study showed that the prevalence of placental malaria in southeastern Nigeria is high, and demonstrated that the mean parasite density was inversely related to parity. Significant factors associated with placental malaria were also identified. Appreciation of these significant factors will assist program managers in implementing the strategies for the prevention of malaria in pregnancy.