Search

Background: Despite significant distribution of insecticide-treated net (ITNs) by the Government of Uganda to refugees, malaria is major cause of mortality and morbidity among children under five years in refugee settlements. This highlights the persistent challenges and complexities surrounding malaria control and prevention efforts in these settings. Studies that focus on the determinants of ITN utilization among children under five years in refugee settlements in Uganda are not available. Using the 2018–2019 Uganda's Malaria Indicator Survey (UMIS) data, analysis of the individual and household factors associated with utilization of ITN among children under five in refugee settlements of Uganda was conducted. Methods: This study focused on 589 children under five staying in refugee settlements located in Uganda. The extracted variables from the UMIS included social-economic factors associated with ITN utilization. Descriptive analysis was performed to generate summarized statistics, while inferential statistics by way of bivariate analysis were performed to assess the association between the outcome and the independent variables using the chi-square test, and multivariable logistic regression modelling to assess the magnitude of the associations after controlling for other covariates. All analyses considered the survey sampling design and sampling weights, and are conducted in Stata version 18. Results: The odds of children sleeping under ITN were higher if their mothers had secondary and higher education (8.1 times) as well as primary education (1.5 times). The odds of children sleeping under ITN reduced by 50% if their mothers were pregnant. Interestingly, the odds of children sleeping under ITN were 70% lower if their mothers knew that 'not sleeping in nets' caused malaria. Mothers who were exposed to malaria messages had lower odds of their children sleeping under ITNs. Conclusions: The results highlight areas of intervention that can increase ITN use in refugee settlements of Uganda. Improving access to education for mothers, providing targeted health education on the importance of ITN, dispelling misconceptions about malaria transmission, facilitating the proper installation of ITNs among others, can all contribute to increased ITN utilization among children under five. [ABSTRACT FROM AUTHOR]

Malaria remains a significant public health challenge, particularly in low- and middle-income countries, despite ongoing efforts to eradicate the disease. Recent advancements, including the rollout of malaria vaccines, such as RTS,S/AS01 and R21/Matrix-M™, offer new avenues for prevention. However, the rise of resistance to anti-malarial medications necessitates innovative strategies. This review explores the potential integration of CRISPR/Cas9 gene drive technology with malaria vaccination efforts to enhance vector control and reduce transmission. By employing gene drive mechanisms for population suppression and replacement of malaria-transmitting Anopheles mosquitoes, combined with the immunogenic properties of vaccines, a synergistic approach can be established. This paper discussed the need for integrated strategies to address the biological complexities of malaria and socio-economic factors influencing its prevalence. Challenges such as regulatory hurdles, community acceptance, ecological impacts, and sustainable funding are examined, alongside strategies for implementation within existing malaria control programmes. This integrated approach could significantly contribute to achieving the World Health Organization's targets for malaria reduction by 2030, ultimately enhancing public health outcomes and supporting broader socio-economic development. [ABSTRACT FROM AUTHOR]

Background: Global progress toward malaria elimination and eradication goals has stagnated in recent years, with many African countries reporting increases in malaria morbidity and mortality. Insecticide-treated nets and indoor residual spraying are effective, but the emergence and increased intensity of insecticide resistance and the challenge of outdoor transmission are undermining their impact. New tools are needed to get back on track towards global targets. This Perspective explores the major challenges hindering wider-scale implementation of larviciding in Africa and identifies potential solutions and opportunities to overcome these barriers. Larviciding in Africa: overview, challenges, and solutions Larviciding is a valuable vector control tool with strong potential for regional scale-up. There is considerable evidence of its effectiveness, and the World Health Organization (WHO) recommends it as a supplemental intervention. However, malaria programmes hoping to implement larviciding face significant barriers, including (1) poor global technical, policy, and funding support; (2) fragmented implementation and experience; (3) high complexity of delivery and impact evaluation; and (4) limited access to the full range of WHO prequalified larvicide products. Strategic barriers related to global policy and donor hesitancy can be overcome through a coordinated demonstration of cost-effectiveness. Technological advancements and strengthened operational capacity have already overcome technical barriers related to larvicide delivery, targeting, coverage, and evaluation. Developing a Community of Practice platform for larviciding has strong potential to consolidate efforts, addressing the challenge of fragmented implementation and experience. Such a platform can serve as a resource center for African malaria programmes, collating and disseminating technical guidance, facilitating the exchange of best practices, and aiding malaria programmes and partners in designing and evaluating larviciding projects. Conclusion: The global shift toward targeted and adaptive interventions enables the incorporation of larviciding into an expanded vector control toolbox. As more African countries implement larvicide programmes, establishing a regional Community of Practice platform for exchanging experiences and best practices is necessary to strengthen the evidence base for cost-effective implementation, advocate for support, and inform policy recommendations, thus supporting Africa's progress toward malaria elimination. [ABSTRACT FROM AUTHOR]

Background: The increased occurrence of malaria among Africa's displaced communities poses a new humanitarian problem. Understanding malaria epidemiology among the displaced population in African refugee camps is a vital step for implementing effective malaria control and elimination measures. As a result, this study aimed to generate comprehensive and conclusive data from diverse investigations undertaken in Africa. Methods: This review adhered to PRISMA standards, involving searches across electronic data bases such as Google Scholar, PubMed, Web of Science, Scopus, and Science Direct. In addition, grey literature was retrieved from several professional associations. The quality of selected studies was evaluated using the Newcastle–Ottawa Quality Assessment Scale. Data extraction was executed using Microsoft Excel, and the meta-analysis was performed with STATA 14 software. A random-effects model was used to estimate the pooled prevalence and associated factors of malaria. Meta-regression and subgroup analysis were used to identify heterogeneity, while funnel plots and Egger's statistical tests assessed the publication bias. Furthermore, a sensitivity analysis was performed. Results: The overall random-effects pooled prevalence of malaria infection (comprising symptomatic and asymptomatic cases) across all included studies was 35.93% (95% CI 24.71–47.15). This study showed a high level of heterogeneity between studies (I2 = 97.1; P < 0.001). Of the identified Plasmodium species, Plasmodium falciparum constituted 99.3%. The frost plot indicated that the overall prevalence of P. falciparum was 34.94% (95% CI 24.34–45.53). Subgroup analysis revealed significant variation (P < 0.001) in malaria prevalence between asymptomatic and symptomatic cases, with a prevalence of 4.39% (95% CI 2.57–6.21) and 45.10% (95% CI 27.28–62.92), respectively. Lack of insecticide-treated mosquito net utilization (AOR 2.43; 95% CI 1.01–5.88) and living near mosquito breeding sites (AOR 2.76, 95% CI 1.56–4.87) were risk factors of malaria. Conclusion: This study determined that the pooled prevalence of malaria among displaced individuals in refugee camps was high and exhibited variations across different population groups. This signifying there is still a need to improve and recheck existing malaria prevention and control strategies to establish an effective malaria control and elimination programme in Africa. [ABSTRACT FROM AUTHOR]

Background: The Anopheles culicifacies complex is one of the most important malaria vectors in Southeast Asia and Southeastern Iran. Although the sibling species within this complex are morphologically indistinguishable, they differ significantly in their disease transmission potential, blood-feeding behaviour, and other biological traits. Cytogenetic and chromosomal studies have identified five sibling species within this complex: A, B, C, D, and E. Understanding the species composition and distribution of this complex is crucial for malaria control strategies. Objectives: This study aimed to identify the sibling species of the An. culicifacies complex in Qaleh Ganj County, Kerman Province, Southeastern Iran. Specifically, the study sought to determine the presence of species A, which is known to be a primary vector of malaria in the region. Methods: We employed allele-specific PCR and sequencing PCR techniques to identify the sibling species. DNA was extracted from mosquito specimens, and the D3 region of the 28S rDNA gene and a segment of the COII gene from the mitochondrial genome (mtDNA) were targeted for amplification and sequencing. Results: Data analysis revealed a positive correlation between An. culicifacies s.l. specimens and altitude, with most specimens collected from mountainous areas. Both allele-specific PCR and sequencing PCR confirmed the presence of species A in the study areas of Kerman Province. Conclusions: Given that species A is a primary malaria vector, the findings of this study provide valuable insights for guiding malaria control strategies in Southeastern Iran. Further studies are recommended to assess the vector competence and ecological dynamics of other species within the An. culicifacies complex in the region. [ABSTRACT FROM AUTHOR]

Plasmodium vivax is the predominant malaria parasite in Latin America. Its colonization history in the region is rich and complex, and is still highly debated, especially about its origin(s). Our study employed cutting-edge population genomic techniques to analyze whole genome variation from 620 P. vivax isolates, including 107 newly sequenced samples from West Africa, Middle East, and Latin America. This sampling represents nearly all potential source populations worldwide currently available. Analyses of the genetic structure, diversity, ancestry, coalescent-based inferences, including demographic scenario testing using Approximate Bayesian Computation, have revealed a more complex evolutionary history than previously envisioned. Indeed, our analyses suggest that the current American P. vivax populations predominantly stemmed from a now-extinct European lineage, with the potential contribution also from unsampled populations, most likely of West African origin. We also found evidence that P. vivax arrived in Latin America in multiple waves, initially during early European contact and later through post-colonial human migration waves in the late 19th-century. This study provides a fresh perspective on P. vivax's intricate evolutionary journey and brings insights into the possible contribution of West African P. vivax populations to the colonization history of Latin America. Author summary: Our study investigates the origins and spread of Plasmodium vivax in Latin America, the primary malaria parasite in this region. By analyzing genetic data from 620 P. vivax samples worldwide, including new samples from West Africa, the Middle East, and Latin America, we were able to reconstruct the evolutionary history of the parasite in this region. Our findings indicate that the current P. vivax strains in Latin America mainly descended from a now-extinct European lineage. Additionally, we found evidence suggesting that several migration waves following human migrations waves may have contributed to the parasite diversity, with possible contributions from West African populations during the transatlantic slave trade (16th to 19th century) and further input from Europe during post-colonial human migrations in the late 19th century. This study offers a fresh perspective on how historical human migrations have shaped the genetic landscape of P. vivax in Latin America. These insights are valuable for understanding the parasite evolution and may help inform strategies for malaria control and prevention in the future. [ABSTRACT FROM AUTHOR]

Background: In Myanmar, progress towards malaria elimination has stagnated in some areas requiring deployment of new tools and approaches to accelerate malaria elimination. While there is evidence that networks of community-based malaria workers and insecticide-treated nets (ITNs) can reduce malaria transmission in a variety of settings, evidence for the effectiveness of other interventions, such as topical repellents, is limited. Since malaria transmission in Myanmar occurs outdoors, mainly among forest-goers, this study tested the effectiveness of topical repellents in combination with supplemental ITN distribution and strengthened networks of malaria workers. Methods: Thirty-eight villages in the Tanintharyi Region and Rakhine State were initially selected for the study based on malaria incidence in previous years. An additional 31 villages were included as comparison areas. The implementation of interventions began in March 2020 and continued through June 2021. Malaria cases were detected in all villages through surveillance at health facilities and a network of malaria workers. Data were analysed by interrupted time series. A nested case–control study was also conducted where forest-goers who tested positive for malaria by RDT were matched to up to three forest-goers who tested negative. Results: A decrease in mean monthly incidence was observed in the intervention villages from 6.0 (95% CI 4.9–7.1) to 3.7 (95% CI 2.4–4.9) cases per 1000 people at risk before and after the interventions. For the comparison villages, the mean monthly incidence increased from 1.1 (95% CI 0.8–1.5) to 5.7 (95% CI 2.1–9.3) cases per 1000 people at risk. Malaria incidence was significantly lower following the implementation of the interventions (RR = 0.117; 95% CI 0.061–0.223; p < 0.001) in the intervention villages, whereas that of comparison villages was higher after the implementation of the interventions (RR = 3.558; 95% CI 0.311–40.750; p = 0.308). However, a significant trend for increasing malaria incidence after implementation was observed in the intervention villages (RR = 1.113; 95% CI 1.021–1.214, p = 0.015), suggesting a waning effect. The nested case–control analysis showed that the odds of topical repellent use were significantly lower among cases than controls (aOR: 0.063, 95% CI 0.013–0.313, p < 0.001). Conclusion: The tailored intervention package for forest-goers helped reduce malaria incidence in Myanmar. Topical repellents may help to further reduce malaria transmission in elimination settings where high-risk populations such as forest-goers do not have easy access to routine health services or are less likely to use ITNs for malaria prevention. [ABSTRACT FROM AUTHOR]

The effective prevention of many infectious and non-infectious diseases relies on people concurrently adopting multiple prevention behaviors. Individual characteristics, opinion leaders, and social networks have been found to explain why people take up specific prevention behaviors. However, it remains challenging to understand how these factors shape multiple interdependent behaviors. We propose a multilevel social network framework that allows us to study the effects of individual and social factors on multiple disease prevention behaviors simultaneously. We apply this approach to examine the factors explaining eight malaria prevention behaviors, using unique interview data collected from 1529 individuals in 10 hard-to-reach, malaria-endemic villages in Meghalaya, India in 2020–2022. Statistical network modelling reveals exposure to similar behaviors in one's social network as the most important factor explaining prevention behaviors. Further, we find that households indirectly shape behaviors as key contexts for social ties. Together, these two factors are crucial for explaining the observed patterns of behaviors and social networks in the data, outweighing individual characteristics, opinion leaders, and social network size. The results highlight that social network processes may facilitate or hamper disease prevention efforts that rely on a combination of behaviors. Our approach is well suited to study these processes in the context of various diseases. [ABSTRACT FROM AUTHOR]

Spatial repellent products are used for prevention of insect bites, and a body of evidence exists on spatial repellent entomological efficacy. A new option for vector control, spatial repellent products are designed to release active ingredient into the air for disruption of human–vector contact thereby reducing human exposure to mosquito-borne pathogens. Clinical trials have shown spatial repellent epidemiological efficacy against Aedes -borne viruses but inconclusive outcomes against malaria. We aimed to show and quantify the protective efficacy of spatial repellents in reducing malaria infection incidence in Busia County, Kenya. A prospective, cluster-randomised, controlled trial in Busia County, western Kenya was done to quantify the efficacy of a transfluthrin-based spatial repellent against human malaria infection following mass distribution of insecticide treated nets. Investigators, staff, and study participants were masked to cluster allocation. Infection incidence was measured by microscopy in children aged 6 months to younger than 10 years during a 4-month baseline (March–July 2021) and 24-month follow-up period with intervention (October, 2021–October, 2023). From 58 clusters (29 intervention, 29 placebo), a total of 1526 and 1546 participants from two consecutive, 12-month cohorts were assessed for first-time malaria infection (primary endpoint) by survival analysis at interim and end-of-trial timepoints, respectively. This trial is registered with ClinicalTrials.gov , NCT04766879 and is complete. The outcome of the primary endpoint indicated that spatial repellents significantly reduced the hazard rate of first-time malaria infection by 33·4% (95% CI 11·1–50·1; p=0·0058) and the hazard rate of overall new malaria infections by 32·1% (15·9–45·2; p=0·0004). No reported adverse events and serious adverse events were deemed to be associated with the spatial repellent. Our trial provides the first evidence of a demonstrative spatial repellent protective efficacy in reducing risk of malaria infection in an African setting characterised by high malaria transmission, pyrethroid resistant malaria vectors, and high coverage of insecticide treated nets. Results support spatial repellent products as a beneficial component of malaria prevention. This study was funded by Unitaid to the University of Notre Dame. [ABSTRACT FROM AUTHOR]

Malaria remains a critical public health challenge, especially in regions like southeastern Tanzania. Understanding the intricate relationship between environmental factors and malaria incidence is essential for effective control and elimination strategies. Cohort study. This cohort study, conducted between Jan 2016 and October 2021 across three districts in southeastern Tanzania, utilized advanced machine learning techniques, specifically the Extreme Gradient Boosting (XGBoost) model, to examine the impact of climate factors on malaria incidence. SHapley Additive exPlanations (SHAP) values were applied to interpret model predictions, highlighting the roles of normalized difference vegetation index (NDVI), temperature, and rainfall in shaping malaria transmission dynamics. Analysis revealed considerable heterogeneity in malaria incidence across southeastern Tanzania, with Kibiti experiencing the highest number of cases (15,308) over the study period. Seasonal peaks corresponded with rainy periods, though incidence rates varied by district. Incorporating lagged climate variables and seasonal trends significantly improved forecast accuracy, with the one-month lag model achieving the lowest mean absolute error (MAE = 175.46) and root mean squared error (RMSE = 228.24). SHAP analysis identified seasonality (mean SHAP 29.6), followed by lagged temperature (13.8), rainfall (12.4), and NDVI (5.96), as the most influential factors, reflecting the biological underpinnings of malaria transmission. This study demonstrates the utility of machine learning and explainable SHAP in malaria epidemiology, providing a data-driven framework to guide targeted, climate-informed malaria control strategies. By capturing seasonal and climate-linked risks, these methods hold promise for enhancing public health planning and adaptive response in malaria-endemic regions. [ABSTRACT FROM AUTHOR]

Over the past few decades, national malaria control efforts in Thailand have focused on eliminating the disease, resulting in a sharp decline in the number of cases throughout the country. Sisaket Province has achieved a remarkable success, reducing the number of malaria cases from over a thousand to just two between 2012 and 2023, with no significant resurgence. The province has implemented the 1-3-7 surveillance strategy and fostered multisectoral collaborations in-country and with neighboring Cambodia, positioning it on the path to malaria elimination. The success achieved in Sisaket Province offers a wealth of lessons for scaling up malaria control strategies at national and international levels. Success in the national control of malaria during the past decades has led to the reorientation of Thailand's program toward the elimination of this disease. The country established and implemented a National Malaria Elimination Strategy, resulting in a substantial decline in cases. Although the reduction varied, Sisaket Province stands out as a success. In accordance with the national strategy, the province adopted a 1-3-7 surveillance strategy and engaged in multisectoral collaboration, positioning itself to achieve malaria-free status and advancing to the prevention of re-establishment (PoR) phase. Scaling up this approach and applying the lessons learned from the success in Sisaket Province, as a solid foundation, could prove beneficial at both the national and international levels. [ABSTRACT FROM AUTHOR]

Background: The Lihir Islands of Papua New Guinea, located in an area with high burden of malaria and hosting a large mining operation, offer a unique opportunity to study transmission. There, we investigated human and vector factors influencing malaria transmission. Methods: In 2019, a cross-sectional study was conducted on 2,914 individuals assessing malaria prevalence through rapid diagnostic tests (RDT), microscopy, and quantitative PCR (qPCR). A logistic regression analysis identified infection-associated factors. Anopheles species distribution, biting behaviours, and sporozoite carriage were assessed through human landing catches and larval surveys. Results: Overall malaria prevalence (any species) was 3.6% by RDT, 4.5% by microscopy, and 15.0% by qPCR. P. vivax accounted for 37.1% of infections, P. falciparum for 34.6%, P. malariae for 3.0%, P. ovale 0.2%, and mixed infections for 24.5%. Prevalence (qPCR) varied across geographic areas, from 8.5% in the mine-impacted zone (MIZ) to 27.0% in the non-MIZ. Other factors independently associated with infection risk included cohabiting with an infected individual (aOR = 1.94, 95%CI: 1.56–2.42), and residing in traditional housing (aOR = 1.65, 95%CI: 1.21–2.25). Children had double the infection risk compared to adults, and the use of long-lasting insecticidal-treated nets did not decrease risk of infection. An. punctulatus was the major vector in one of the four geographical areas; while An. farauti was predominant in the rest of them, both with an early biting behaviour but with different biting intensities by geographical area. Entomological inoculation rates ranged from 26.9 (95%CI: 12.3–45.2) infective bites per person-year in the MIZ to 441.3 (95%CI: 315.7–572.1) in the non-MIZ. Conclusions: Malaria transmission and infection was lower in the MIZ compared to other areas. Measures focusing on at-risk groups, including vector-control and transmission interruption methods, could be taken into account by the mine and the healthcare authorities to reduce malaria burden outside the MIZ. Author summary: The Lihir Islands of Papua New Guinea host a mining operation on Aniolam, the main island, which implements specific vector control strategies in the mine-impacted zone (MIZ); whereas the remaining areas rely solely on distribution of long-lasting insecticidal-treated nets (LLIN). Our study compared transmission dynamics in the different geographic areas and demonstrated lower malaria incidence, prevalence, Anopheles density and biting intensities in the MIZ. Living outside the MIZ on Aniolam and on Malie Island was associated with a higher risk of infection, with transmission metrics rarely seen outside high burden countries in sub-Saharan Africa. Besides the geographic area, other risk factors for infection included younger age, cohabiting with infected individuals, and living in traditional housing; while the use of LLINs was not associated with a reduction of infection risk. Our results highlight the need for tailored strategies based on local transmission patterns and could be beneficial for ongoing initiatives aimed at malaria control and elimination. In Lihir, there is an opportunity to invest and improve the collaboration between the mine company and public health authorities. Such a public-private partnership could enhance control efforts, including expansion of diagnostics and treatments, the vector control program and community education beyond the MIZ. [ABSTRACT FROM AUTHOR]

Vector resistance, human population movement, and cross-border malaria continue to pose a threat to the attainment of malaria elimination goals. Border malaria is prominent in border regions characterised by poor access to health services, remoteness, and vector abundance. Human socio-economic behaviour, vectoral behaviour, access and use of protective methods, age, sex, and occupation have been identified in non-border regions as key predictors for malaria. We conducted a systematic and meta-analysis review to characterise and establish pooled effect sizes of the factors associated with the occurrence of border malaria. An exhaustive search was done in EBSCOHost (Medline Full Text), Health Source, Google Scholar, Regional Office for Africa Library, African Index Medicus, and PubMed databases. A total of 847 articles were identified from the search and after screening for quality and eligibility, twelve (12) articles were included in the review. Pooled odds ratios, inverse variance statistic (I2), Luis Furuya-Kanamori (LFK) index, and forest plot were computed. Findings from this study suggest night outdoor activities (POR 2.87 95% CI, 1.17 7,01), engaging in forestry activities (POR 2.76 95% CI, 2.08 3.67), working in mines (POR 197 95% CI, 175 22171), access to poor housing structure (POR 3.42 95% CI, 2.14 5.46), and cross-border movement (POR 50.86 95% CI, 12.88 200.85) none use of insecticide-treated nets (POR 5.09 95% CI, 2.44 10.63) were all significantly associated with contracting malaria within border regions. The use of insecticide-treated nets (ITN) (POR 0.61 95% CI, 0.50 0.76) and indoor residual spraying (IRS) (POR 0.61 95% CI, 0.47 0.79) were protective. Risk factors for border malaria are comparable to non-border malaria. Effective border malaria control requires an integrated and targeted approach that addresses socio-economic, environmental, and behavioural drivers. Established vector control interventions remain protective and should be sustained to mitigate the border malaria burden effectively. Novel strategies should be developed to address the unique challenge of cross-border human population movement underpinned by robust regional, bilateral, and multi-sectoral collaborative initiatives. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effectiveness and cost‐effectiveness of integrating seasonal malaria chemoprevention (SMC) with mass drug administration for helminth control among school‐aged children living in communities where the burden of malaria and helminths is high in Ghana, West Africa. Methods: This cluster randomised controlled trial will enrol 1200 children aged 5–10 years. Eligible children randomised to intervention clusters will receive SMC drugs (sulphadoxine‐pyrimethamine plus amodiaquine) and anthelminthic drugs for soil‐transmitted helminths—(albendazole), and for schistosomiasis (praziquantel), while children randomised to control clusters will receive SMC drugs alone. Pre‐ and post‐intervention blood, urine and stool samples will be collected from children in both clusters. The effectiveness of the concomitant delivery will be determined by checking whether the combination of SMC and anthelminthic drugs prevents anaemia in the children randomised to the intervention clusters compared to the children in the control clusters. Cost analysis and cost‐effectiveness of this integrated delivery approach will be determined by estimating the incremental costs and effects of co‐administration of SMC drugs with mass drug administration of anthelminthic drugs compared to SMC alone, including cost savings due to cases of moderate and severe anaemia averted. Expected findings: The findings of this study will provide evidence to inform public health recommendations for an integrated control of malaria and helminths among children living in the poorest countries of the world. [ABSTRACT FROM AUTHOR]

The article focuses on the global impact of malaria, its origins, and its continued burden, especially in sub-Saharan Africa. Topics include the spread of malaria through Anopheles mosquitoes, the high mortality rate in children under five, and the ecological factors that influence malaria transmission and its control.

Case management of malaria in Africa has evolved markedly over the past 20 years and updated cost estimates are needed to guide malaria control policies. We estimated the cost of malaria illness to households and the public health service and assessed the equity of these costs in Uganda. From December 2021 to May 2022, we conducted a costing exercise in eight government-run health centres covering seven sub-regions, collecting health service costs from patient observations, records review and a time-and-motion study. From November 2021 to January 2022, we gathered data on households' cost of illness from randomly selected households for 614 residents with suspected malaria. Societal costs of illness were estimated and combined with secondary data sources to estimate the total economic burden of malaria in Uganda. We used regression analyses and concentration curves to assess the equity of household costs across age, geographic location and socio-economic status. The mean societal economic cost of treating suspected malaria was $15.12 [95% confidence interval (CI): 12.83–17.14] per outpatient and $27.21 (95% CI: 20.43–33.99) per inpatient case. Households incurred 81% of outpatient and 72% of inpatient costs. Households bore nearly equal costs of illness, regardless of socio-economic status. A case of malaria cost households in the lowest quintile 26% of per capita monthly consumption, while a malaria case only cost households in the highest quintile 8%. We estimated the societal cost of malaria treatment in Uganda was $577 million (range: $302 million–1.09 billion) in 2021. The cost of malaria remains high in Uganda. Households bear the major burden of these costs. Poorer and richer households incur the same costs per case; this distribution is equal, but not equitable. These results can be applied to parameterize future economic evaluations of malaria control interventions and to evaluate the impact of malaria on Ugandan society, informing resource allocations in malaria prevention. [ABSTRACT FROM AUTHOR]

Malaria remains a significant public health concern in several developing countries. Tropical weather, coupled with poor environmental and socioeconomic conditions, increases mosquito activity and disease transmission in impoverished nations. The most effective strategy to prevent and control malaria is the use of long-lasting insecticidal nets, or LLINs. Ensuring that LLINs are effectively and equitably distributed to those who need them most is crucial yet challenging, especially since financial and health resources are scarce in endemic countries. Through a real-world case study conducted in the Brazilian Amazon, which accounts for 99% of malaria cases in Brazil, we propose a Malaria Vulnerability Index (MVI). This composite index encompasses epidemiological, socioeconomic, and environmental factors. Using the MVI, we developed a prioritization-based location-allocation model to maximize the benefits of targeting the most vulnerable municipalities for malaria interventions. Our mathematical model relies on discrete coverage levels, which makes the allocation of LLINs more flexible while ensuring community-wide protection. We also explore the theoretical relationship between our proposed model and classical demand covering problems. Finally, we discuss some approaches to delivering more equitable solutions by minimizing the number of underserved areas. Our results include comparisons between various malaria interventions and provide practical insights. In particular, we show that we can drastically reduce the number of underserved areas without compromising the effectiveness of the LLINs allocation through lexicographic optimization. The results also reveal that with investment levels up to 50% of the ideal, we can fully protect the endemic area after 2 years of successive interventions. [ABSTRACT FROM AUTHOR]

Background: WHO and its partners have adopted alternative control interventions since the failure to eradicate malaria worldwide in the 1960s and 1970s. The aim of these interventions has been to redesign the control interventions to make them more effective and more efficient. The purpose of this study is to assess the population impact of control interventions implemented at the community health area level. Methods: The analysis used data from the health information system on malaria cases and interventions (distribution of long-lasting insecticide-treated nets (LLINs), seasonal malaria chemoprevention (SMC), access to rapid diagnostic tests (RDT), intermittent preventive treatment for pregnant women (IPTp)) collected in the Kati health district from 2017 to 2020. And the contextual parameters (temperature, normal difference vegetation index (NDVI) and rainfall) were obtained by remote sensing. A generalized additive model was used to assess the impact of malaria control interventions on malaria cases as a function of meteorological factors. Results: The incidence of malaria varies from year to year and from health area to health area, as do meteorological factors in the study area. The distribution of long-lasting insecticide-treated nets, chemoprevention of seasonal malaria in children and access to rapid diagnostic tests for malaria were found to have a significant impact on the incidence of malaria in the population. Seasonal malaria chemoprevention was effective in reducing the incidence of malaria, while distribution of long-lasting insecticide-treated nets and access to rapid diagnostic tests increased with the number of malaria cases, reflecting efforts to distribute and use bed nets and to diagnose malaria cases among the population in the study area. Conclusion: The study showed the impact of SMC on reducing malaria cases in the population and the significant efforts in LLIN distribution and malaria case diagnosis. To further reduce the burden of malaria, sustained efforts and new interventions are needed, including improving access to rapid diagnosis and treatment in communities by developing community health workers and locally tailored mass drug administration. [ABSTRACT FROM AUTHOR]

Background: In western Kenya, a cluster-randomized trial is assessing the impact of attractive targeted sugar baits (ATSBs) on malaria in children enrolled in three consecutive cohorts. Here, characteristics of children and households at enrolment, and factors associated with baseline malaria prevalence are described. Methods: Children aged 1 to < 15 years were randomly selected by cluster (n = 70) from a census database. Cohorts were enrolled in March–April 2022, September–October 2022, and March–April 2023. ATSBs were deployed in March 2022. At enrolment, all participants were tested for malaria by rapid diagnostic test (RDT). After enrolment a household survey was conducted. Household structures were classified as 'improved' (finished walls and roofs, and closed eaves) or 'traditional' (all other construction). A generalized linear mixed model was used to assess factors associated with malaria prevalence. Results: Of 3705 children screened, 220 declined and 523 were excluded, due to plans to leave the study area (n = 392), ineligible age (n = 64) or other reason (n = 67). Overall, 2962 children were enrolled. Bed net use the previous night was more common in children aged 1–4 years (746/777 [96%]) than those aged 5–<15 years (1806/2157 [84%], p < 0.001). Of the 2644 households surveyed (for 2,886 participants), information on house construction was available for 2595. Of these, only 199 (8%) were categorized as 'improved', as most houses had open eaves. While 99% of households owned at least one bed net, only 51% were adequately covered (one net per two household residents). Among 999 children enrolled in the first cohort (baseline), 498 (50%) tested positive by RDT. In an adjusted multivariable analysis, factors associated with RDT positivity included sub-county (Alego-Usonga vs Rarieda, adjusted odds ratio [aOR] 4.81; 95% CI: 2.74–8.45; p < 0.001), house construction (traditional vs improved, aOR 2.80; 95% CI: 1.59–4.95; p < 0.001), and age (5–< 15 vs 1–4 years, aOR 1.64; 95% CI: 1.13–2.37; p = 0.009). Conclusions: In western Kenya, the burden of malaria in children remains high. Most households owned a bed net, but coverage was inadequate. Residents of Alego-Usonga sub-county, those living in traditionally constructed households, and older children were more likely to test positive by RDT. Additional tools are needed to effectively control malaria in this area. Trial registration The ATSB trial is registered under Clinicaltrials.gov NCT05219565 [ABSTRACT FROM AUTHOR]

Background: Malaria is a significant public health challenge in Uganda, with Plasmodium falciparum (P. falciparum) responsible for most of malaria infections. The high genetic diversity and multiplicity of infection (MOI) associated with P. falciparum complicate treatment and prevention efforts. This study investigated temporal changes in P. falciparum genetic diversity and MOI across three sites with varying malaria transmission intensities. Understanding these changes is essential for informing effective malaria control strategies for the different malaria transmission settings. Methods: A total of 220 P. falciparum-positive dried blood spot (DBS) filter paper samples from participants in a study conducted during 2011–2012 and 2015–2016 were analyzed. Genotyping utilized seven polymorphic markers: Poly-α, TA1, TA109, PfPK2, 2490, C2M34–313, and C3M69–383. Genetic diversity metrics, including the number of alleles and expected heterozygosity, were calculated using GENALEX and ARLEQUIN software. MOI was assessed by counting distinct genotypes. Multi-locus linkage disequilibrium (LD) and genetic differentiation were evaluated using the standardized index of association (IAS) and Wright's fixation index (FST), respectively. Statistical comparisons were made using the Kruskal–Wallis test, and temporal trends were analyzed using the Jonckheere–Terpstra test, with statistical significance set at p < 0.05. Results: Of the 220 samples, 180 were successfully amplified. The majority of participants were males (50.6%) and children aged 5–11 years (46.7%). Genetic diversity remained high, with mean expected heterozygosity (He) showing a slight decrease over time (range: 0.73–0.82). Polyclonal infections exceeded 50% at all sites, and mean MOI ranged from 1.7 to 2.2, with a significant reduction in Tororo (from 2.2 to 2.0, p = 0.03). Linkage disequilibrium showed a slight increase, with Kanungu exhibiting the lowest IAS in 2011–2012 (0.0085) and Jinja the highest (0.0239) in 2015–2016. Overall genetic differentiation remained low, with slight increases in pairwise FST values over time, notably between Jinja and Tororo (from 0.0145 to 0.0353). Conclusions: This study highlights the genetic diversity and MOI of P. falciparum in Uganda's malaria transmission settings, noting a slight decrease in both genetic diversity and MOI overtime. Continued surveillance and targeted control strategies are essential for monitoring the impact of malaria control efforts in Uganda. [ABSTRACT FROM AUTHOR]

A better understanding of malaria epidemiology in both asymptomatic and symptomatic individuals is essential for developing strategies to control the disease. This study was conducted to determine Plasmodium infection prevalence and its associated factors among people living in Franceville (urban area) and in the villages of Pana and Mvengue (rural areas) in south‐east Gabon between April and July 2022. This cross‐sectional study was conducted among all consenting residents of Franceville, Mvengue, and Pana between April and July 2022. After obtaining informed consent, Plasmodium sp. infection was screened by microscopy, and a structured questionnaire was developed to record sociodemographic data, attitudes, and practices regarding malaria. A total of 976 participants were included, with 491 in urban areas and 485 in rural areas. The overall prevalence of Plasmodium sp. infection was 21.62% (211/976; 95% confidence interval (CI) [19.15–24.31]). The prevalence was highest in children aged 6–11 years. In urban areas, the prevalence was 19.35% (95/491; 95% CI [16.10–23.07]), and 96.84% of infections were asymptomatic. The most infected age group was 18–23 years. In rural areas, the prevalence was 23.92% (116/485, 95% CI [20.34–27.91], and 93.97% (109/116) of infections were asymptomatic. Socioeconomic characteristics, attitudes, and practices towards Plasmodium sp. infection were not associated with a risk of asymptomatic malaria infection. This study highlights the importance of asymptomatic Plasmodium sp. infection in south‐east Gabon and the need for control strategies adapted to different areas and age groups. Detection and treatment of asymptomatic carriers could be an important lever for malaria control and elimination in the country. [ABSTRACT FROM AUTHOR]

Background: The national malaria control programmes in Cambodia, Nepal, and Bhutan aim to achieve malaria elimination by 2025–2030. While the vivax malaria burden remains challenging, the consistent decline in falciparum malaria in these countries over the last five years suggests that the goal is achievable. However, unexpected cases in previously falciparum malaria-free districts continue to occur. A virtual meeting was convened in May 2024, followed by smaller meetings, to discuss and share experiences among regional partners, focusing on falciparum malaria elimination. Main text: The discussion among regional partners from these three countries was prompted by an isolated outbreak of falciparum malaria in April 2022 in a previously malaria-free district in Pursat province, Cambodia. The National Center for Parasitology, Entomology and Malaria Control (CNM) worked with stakeholders to contain the outbreak, which was likely to have originated in forest goers. Community-based village malaria workers (VMWs) were augmented with the additional resources required to test and treat malaria among forest goers under the supervision of health centres and district hospitals. This response rapidly reduced malaria cases in the subsequent months. Regional partners from Nepal and Bhutan, who are also engaged in the final phase of malaria elimination, reported that isolated malaria outbreaks in their countries were not unusual and were mostly imported from a neighbouring country, India. Importation of cases was facilitated by unsupervised transborder travel including the movement of migrant workers. The imported cases were only established during the case investigation such as when responding to the isolated outbreaks. In contrast, in Cambodia, spread of malaria was known to be facilitated by mobile and migrant workers, and forest goers within the country. The specific differences between Nepal and Bhutan (South Asia), and Cambodia (Greater Mekong Subregion) offered insights into strategies for malaria elimination. A relevant component for countries embarking on malaria elimination included strengthening of local malaria surveillance and response in collaboration with the community health workers, and community members targeting the 'at risk' population. Conclusion: In countries approaching malaria elimination, resourcing community-based health workers could play a critical role in enhancing malaria surveillance, early case detection and treatment, including interventions targeting migrant populations such as forest goers and seasonal migrant workers. [ABSTRACT FROM AUTHOR]

Background: Malaria remains the leading cause of under-five morbidity and mortality in low- and middle-income countries. Sleeping under mosquito nets, especially insecticide-treated nets (ITNs), is one of the best ways to prevent malaria as they form a physical and chemical barrier against mosquitoes. Therefore, the present study aimed to assess not only mosquito net use, but also how environmental factors, specifically land surface temperature, contribute to malaria prevention among households with children under 5 years of age in Lao PDR. Methods: The most recent Multiple Indicator Cluster Survey datasets of Lao PDR 2017 and the Japan Aerospace Exploration Agency (JAXA) Public Health Monitoring and Analysis Platform (JPMAP) were used. Data from 51,948 households were used in the analysis. A bivariate logistic regression analysis was followed by a multivariate logistic regression analysis to determine the factors influencing mosquito net use with children under five. Results: In this study, 77.8% of all households with children under 5 years of age slept under mosquito nets. Of these, 80.5% were ITNs (Olyset, Permanent, and other brands). Multivariate logistic regression analysis revealed that mosquito net use was significantly associated with the land surface temperature, ethno-linguistic group (Lao-Tai, Mon-Khmer, Hmong-Mien, Chinese-Tibetan, and other), education level of the household head, and wealth index quintile. Conclusions: The analysis of the present study suggested measures to intensify the use of mosquito nets with an emphasis on ethnic minorities living in hot areas to bring Lao PDR closer to the day that mosquito-borne infections such as malaria can be eliminated. [ABSTRACT FROM AUTHOR]

Background: Ethiopia has been progressing very well in controlling malaria in the past few years. However, shortly after the COVID-19 pandemic, an unpredictable malaria resurgence was observed in almost all malaria-endemic areas of the country, although the exact cause of which has not yet been identified. Therefore, this study aimed to investigate malaria burden and associated risk factors in one of the endemic zones of Ethiopia. Methods: A health facility-based retrospective and cross-sectional study design was conducted in the Kaffa zone, southwest of Ethiopia. Hence, a seven-year retrospective data on malaria positivity rate, interventional activities undertaken in the area, and climatic variables were collected from the patient's medical records, district health bureau, and meteorological institute, respectively. For the cross-sectional study, all malaria-suspected patients seeking medication at the health facilities in the Kaffa Zone administrative centre, Bonga town, during the study period (January–June 2024), were recruited in the study. Data on the patient's socio-demographic, socio-economic, behavioural, health facilities and environmental factors were collected using a structured face-to-face interview questionnaire. Data was analysed using Statistical Package for Social Science software (SPSS) (version 26) and the statistical tools used were descriptive statistics and logistic regression models. A significant level was considered at p < 0.05. Results: The study findings revealed a significant increment in malaria positivity trend (39.43%, n = 188,201/477,276, p < 0.0001) between July 2018 and June 2024. Also, the malaria positivity rate documented in the cross-sectional study was 50.72% (n = 315/621). Plasmodium falciparum was the dominant malaria parasite. The study identified weakened control measures (p = 0.006), limited awareness of the population (p < 001), and socio-demographic factors such as education (p = 0.037), age (p = 0.008), housing condition (p < 0.0001), low-income level (p < 001), and travel history to malaria-endemic areas (p = 0.001)] as risk factors associated with high malaria positivity rate. In addition, indoor residual spraying (IRS) and mean maximum temperature activity increased by 1 unit, and the malaria positivity rate decreased by 28 times (p < 0.0001) and 1.3 (p = 0.003), respectively. The months of July and September were strongly and positively associated with higher malaria positivity in the area (p < 0.05). Conclusion: Even though Ethiopia was able to achieve a remarkable malaria burden reduction in the past few years, the recent interrupted malaria control activities, seasonal variability, and patient and health facility-associated factors have contributed to the current high malaria positivity rate documented in Kaffa zone, Southwest Ethiopia. This urges the need for immediate community sensitization activities to enhance the awareness of malaria, besides designing integrated vector control interventional strategies to tackle the current alarming situation in the zone. [ABSTRACT FROM AUTHOR]

Background: Molecular methods play an important role in clinical trials assessing anti-malarial drugs and vaccines, as well as in epidemiological studies aimed at detecting Plasmodium species, especially when dealing with large sample sizes. Molecular techniques are more sensitive and generally have a higher throughput compared to the gold standard microscopy. Further optimization can be achieved with automation of nucleic acid isolation, allowing for rapid and precise extraction. This study evaluated the isolation of total nucleic acids from Plasmodium falciparum mocked samples using an automated extraction method with a magnetic bead-based kit compared to a manual silica column-based kit. Additionally, two different RNA preservation solutions were compared. Methods: Plasmodium falciparum Dd2 parasites were serially diluted and spiked into whole blood. The dilutions were stored in two different RNA preservation solutions and total nucleic acids extracted with an automated magnetic bead-based kit and a manual silica column-based kit. Subsequently, a reverse transcription (RT) qPCR for Plasmodium detection targeting Plasmodium 18S rRNA and DNA in a single reaction was performed and the quantification cycle (Cq) values across the different sample groups were compared. Results: Comparable Cq values across the various sample preparations were obtained, suggesting minimal influence from RNA preservation solutions (p = 0.686) or extraction methods (p = 0.119) on RT-qPCR outcomes. Automated nucleic acids extraction allowed processing numerous samples in a shorter timeframe and showed similar efficiency in detecting Plasmodium in blood samples by RT-qPCR as manual extraction. Conclusions: The automated method for nucleic acid isolation is a valuable tool for the detection of Plasmodium infections in large-scale studies. It is efficient, reliable, and cost-effective. Its potential applications extend to other molecular surveillance studies to support malaria control measures. [ABSTRACT FROM AUTHOR]

Background: Ghana adopted the policy on Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) in 2004. Notwithstanding the government's and other stakeholders' efforts in Ghana, optimal uptake (three or more doses of IPTp-SP) has slightly declined since 2016. The study examined the individual and community-level correlates of pregnant women who take optimal or none/partial doses (less than three doses) of IPTp-SP using the Ghana Malaria Indicator Survey (GMIS) 2019. Methods: We conducted a secondary analysis of the GMIS 2019 data. Our analytical sample included 1,151 women aged 15-49 with their most recent birth in the last two years before the survey. Results: The overall uptake among participants was approximately 8.2% for none, 30.15% for 1–2 (partial), and 61.6% for 3 or more (optimal) doses of IPTp-SP. The level of uptake differs depending on the individual rather than community-level characteristics of pregnant women. Individual-level demographic factors— residents in Upper East (OR 3.0, 95% CI; 1.2–7.3) and Upper West (OR 5.3, 95% CI; 1.9–14.7) —and health-related factors—the four or more antenatal (ANC) visits (OR 3.3, 95% CI; 1.8–6.0) were associated with optimal IPTp-SP uptake among pregnant women in Ghana. However, late scheduling of the first ANC visit in the second trimester (OR 0.7, 95% CI; 0.5–1.0)— predicted less IPTp-SP uptake. Conclusions: Few regions (Upper East and West) are doing better than the capital, Greater Accra Region, in terms of optimal uptake. Also, early scheduling of ANC in the first trimester and increased ANC attendance are key for increased uptake. There is a need for policy, interventions, and research on malaria prevention in pregnancy to improve the decline in uptake. [ABSTRACT FROM AUTHOR]

Between 2000 and 2019, malaria cases witnessed a global decline. Recent WHO data indicates a reversal of these gains, threatening the goal to eliminate malaria by 2030. In Guyana, malaria is concentrated in remote regions and among itinerant gold miners who have limited access to malaria health services and will thus often self-medicate or delay care. The government implemented a volunteer malaria tester (VMT) program to increase access to malaria testing and treatment in mining communities. Social and behavior change (SBC) interventions targeting psychosocial determinants of malaria-related behaviors complement this program. The "Lil Mosquito, Big Problem" (LMBP) campaign promotes malaria prevention, testing, and treatment behaviors among miners. This campaign, designed and implemented through a participatory human-centered design process, used the ideation model as its conceptual framework to address knowledge, attitudes, beliefs, and social norms to influence malaria-related behaviors. Surveys conducted in 2019 and 2022 among gold miners in regions 7 and 8 showed increased knowledge and improved psychosocial determinants associated with malaria prevention and treatment. Exposure to the combined VMT and LMBP interventions was associated with significantly higher levels of prompt care-seeking. Interventions should consider attitudes and perceptions and address descriptive norms and the benefits of prompt care-seeking and treatment adherence. Changes in the mining population and economic hardships impact these results. Theory-driven programs systematically designed and implemented through stakeholder involvement and engagement are practical and applicable to similar settings and SBC interventions on other global health issues. [ABSTRACT FROM AUTHOR]

Background: Effective vector control interventions, notably insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are indispensable for malaria control in Tanzania and elsewhere. However, the emergence of widespread insecticide resistance threatens the efficacy of these interventions. Monitoring of insecticide resistance is, therefore, critical for the selection and assessment of the programmatic impact of insecticide-based interventions. Methods: The study was conducted country-wide across 22 sentinel districts of Tanzania between May and July 2023 using standard World Health Organization susceptibility test with 1×, 5×, and 10× of deltamethrin, permethrin, and alpha-cypermethrin and discriminating concentrations of 0.25% pirimiphos-methyl. Synergist assays were conducted to explore the underlying mechanisms of the observed phenotypic pyrethroid-resistant mosquitoes. Three- to five-day-old wild adult females in the first filiar generation of Anopheles gambiae sensu lato (s.l.) were used for the susceptibility bioassays. Results: Anopheles gambiae s.l. were resistant to all pyrethroids at the discriminating dose in most sentinel districts except in Rorya, which remains fully susceptible, and Ushetu, which remains susceptible to deltamethrin but not permethrin. In 5 sites (Bukombe, Ukerewe, Kilwa, Kibondo, and Kakonko), the An. gambiae s.l. species exhibited strong resistance to pyrethroids surviving the 10 X concentrations (mortality rate < 98%). However, they remained fully susceptible to pirimiphos-methyl in almost all the sites except in Kibondo and Shinyanga. Likewise, there was full restoration to susceptibility to pyrethroid following pre-exposure of An. gambiae s.l. to piperonyl-butoxide (PBO) in 13 out of 16 sites. The 3 sites that exhibited partial restoration include Kakonko, Tandahimba, and Newala. Conclusion: The evidence of widespread pyrethroid resistance of the major malaria vector justifies the decision made by the Tanzania National Malaria Control Programme to transition to PBO-based ITNs. Without this switch, the gains achieved in malaria control could be compromised. Equally important, the lack of full restoration to susceptibility observed in three sentinel districts upon pre-exposure to PBO merits close monitoring, as there could be other underlying resistance mechanisms besides oxidase metabolic resistance. [ABSTRACT FROM AUTHOR]

Background: Progress towards malaria elimination in the Greater Mekong Subregion has left much of the residual malaria transmission concentrated among forest-exposed populations for whom traditional domicile focused malaria vector control is unlikely to be effective. New tools to protect these populations from vector biting outdoors are needed. Methods: Alongside implementation research on the deployment of a "forest pack" consisting of a volatile pyrethroid (transfluthrin)-based spatial repellent (VPSR), a picaridin-based topical repellent and etofenprox treatment of clothing, an assessment was made of participant willingness to pay for the forest packs and variants of the packs using a discrete choice experiment. Results: Participants showed willingness to pay for forest packs consistent with full-cost recovery for VPSR devices. The inclusion of a full malaria season's worth of VPSR devices increased the willingness to pay for a forest pack by 15% (p = 0.061). At a price of approximately 10 USD, approximately 50% of participants were willing to pay for a forest pack which included a full season's worth of VPSR. Conclusion: Forest packs which include VPSR are likely to be acceptable to the target forest-exposed populations, and those which include VPSR products may even have potential for commercial sales or some cost-recovery. [ABSTRACT FROM AUTHOR]

Background: An estimated 40% of the world's population lives in malaria-prone areas, there are 300–500 million malaria episodes worldwide, and at least one million malaria fatalities occur each year which makes malaria is a major public health concern [1]. In sub-Saharan Africa, malaria claims the lives of about 90% of all people worldwide. Today, there is a growing interest in using ITNs as one of the leading strategies for the prevention and control of malaria. Many studies on ITN use and associated factors have shown that factors influencing ITN use differ from place to place, with very few similarities; specifically, there are no studies conducted in the study area on ITN ownership, utilization, or associated factors. Methods: A community-based cross-sectional study was conducted from April 2023 to June 2023. A multistage sampling technique was employed to recruit the study participants. From twenty Malaria kebeles, six kebeles were selected by the lottery method, and study households were selected by the systematic random sample technique. A total of 770 planned sample sizes were calculated by using a single population formula. A trained data collector was used to collect the data, and the data entry and analysis were performed with SPSS 27.0. Simple frequency distribution and descriptive analyses were performed to describe participants' sociodemographic, ownership, and utilization. Bivariate and multivariate analyses were performed to determine associations between dependent and independent variables, with a p-value < 0.05 indicating statistical significance. Results: Data were collected from a total of 766 study participants, for a response rate of 99.5%. The majority (89%) of the respondents had at least one ITN, and 83.5% of the households reported sleeping under the ITN the night preceding the survey. Knowledge about ITN as a preventive agent for malaria [AOR 2.028, 95% CI: 1.010, 4.070], the presence of pregnant mothers in the household [AOR 4.373, 95% CI: 1.70, 11.203], willingness to buy ITN [AOR 2.106, 95% CI: 1.330, 3.335] and home visited by health extension workers [AOR 2.002, 95% CI: 1.228, 4.540] were identified as factors associated with ITN utilization by households. Conclusion: ITN ownership and utilization were 89% and 83.5%, respectively. Knowledge about the use of the ITN for preventing malaria, the presence of pregnant mothers in the household, willingness to buy the ITN, and home visits by HEW were identified as factors associated with ITN utilization. The ITN distribution for malaria cases and the mechanism for accessing the ITN in the market need to be considered by health authorities. Continuing to apply IEC/BCC interventions to increase the knowledge of the community on the ITN and of home visits and support the proper utilization of the ITN is highly important. [ABSTRACT FROM AUTHOR]

Malaria is a mosquito-borne infectious disease caused by protozoa of the genus Plasmodium. Despite of the progress in malaria control in the last decades, malaria remains a major public health problem, contributing to increased morbidity and mortality in tropical and subtropical countries. Among American countries, Bolivia, Venezuela, and Brazil account for 73% of the cases. In Brazil, the majority of malaria cases is concentrated in Amazon region. This study estimated health-related quality of life (HRQoL) losses due to malaria in endemic areas of the Brazilian Amazon using the EQ-5D-3L instrument. We collected data from a convenience sample of 1,179 individuals aged 18 years or older. To measure the HRQoL loss, we matched individuals from the treatment group (with recent malaria) to those from the control group (without recent malaria) using Propensity Score Matching (PSM) and compared the difference in mean health utility between the groups. The results show a significant loss of HRQoL due to malaria. The mean utility was 0.69 and 0.83 for the treatment and control groups, respectively, representing a loss of quality of life of approximately 16.3% for individuals with recent malaria episodes. These findings underscore the importance of effective malaria prevention and treatment strategies, especially in areas where adverse socioeconomic conditions and a challenging epidemiological context exacerbate the impact of the disease. Continued investment in malaria control programs and improved access to health services are essential to mitigate the negative impact of this disease on the quality of life of affected populations. Author summary: Malaria is an infectious disease transmitted by mosquitoes, primarily affecting tropical and subtropical regions worldwide. Despite significant efforts to control malaria, the rates of illness and death are still important. In the Americas, Brazil, Venezuela, and Bolivia account for more than 50% of the cases. This study focuses on the Brazilian Amazon, where malaria is most prevalent, accounting for 99.5% of all reported cases in the country. We aimed to understand how malaria affects individuals' health-related quality of life (HRQoL) in these endemic areas. Using the EQ-5D-3L instrument, we collected data from over 1,100 adults in endemic municipalities of the Brazilian Amazon. We compare the EQ-5D-3L utility scores for those who recently had malaria with those who did not by means of Propensity Score Matching. Our findings revealed that individuals who recently had malaria experienced a significant reduction in HRQoL. Specifically, there was a 16.3% decrease in EQ-5D-3L utility for those affected by recent malaria episodes. These results highlight the urgent need for malaria prevention and treatment programs. Effective strategies and better access to healthcare are key in reducing the disease's impact on individuals' lives, especially in regions with challenging health environments, and poor socioeconomic conditions and infrastructure. [ABSTRACT FROM AUTHOR]

Background: Senegal has made significant progress in reducing the burden of malaria, but transmission remains highly heterogeneous, with specific population subgroups likely at higher risk. Consultations with the National Malaria Control Programme (NMCP) and a review of available data identified nomadic pastoralists, gold miners, and Koranic school students as potential high-risk populations (HRPs). This study aimed to evaluate whether these populations are at higher risk of malaria and better characterize their exposure patterns to inform the design of targeted intervention strategies. Methods: A mixed-methods study was conducted in the districts of Ranérou, Kaolack, and Saraya between November 2020 and December 2021. A formative assessment including key informant interviews (KII) and focus group discussions (FGD) was conducted with non-HRP and HRP members (nomadic pastoralists, gold miners, Koranic school students). A health facility-based case–control study was then conducted in nine health facilities across the three districts. 501 confirmed malaria cases and 1002 non-malaria controls were frequency matched by age and sex with a ratio of 1:2. A standardized questionnaire was administered to collect sociodemographic information, including occupation, use of malaria prevention measures, mosquito exposure, and travel history. Multivariable logistic regression was used to identify malaria risk factors. Results: KIIs and FGDs indicated that nomadic pastoralists, gold miners and Koranic school students have high exposure to mosquito bites through outdoor sleeping, spending time outside at night and sleeping in informal structures, with important gaps in the coverage of indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) and limited access to health services. Compared to controls, cases had higher odds of being a nomadic pastoralist (odds ratio (OR) 4.67 95% CI 1.96–11.11) or gold miner (OR 1.92 95% CI 1.20–3.07). No evidence was found of an association with being a Koranic school student (OR 1.39 95% CI 0.80–2.39). Conclusions: Nomadic pastoralists and gold miners in the study areas are at higher risk of malaria. Targeted interventions are needed to cover gaps in malaria prevention coverage and access to health services. [ABSTRACT FROM AUTHOR]

Rapid diagnostic tests (RDTs) are crucial for diagnosing malaria in resource-limited settings. These tests, which detect the histidine-rich protein 2 (PfHRP2) and its structural homologue PfHRP3, are specifically designed to identify Plasmodium falciparum. Deletion of the Pfhrp2 gene in parasite has been reported in India and other malaria-endemic countries. Therefore, periodic surveillance of Pfhrp2 and Pfhrp3 genetic deletions is crucial. We conducted a study to examine these gene deletions in P. falciparum isolates from nine malaria-endemic states in India. In this study, we analyzed 1,558 samples that were microscopically confirmed to be P. falciparum positive. We isolated genomic DNA from all the aforementioned samples, followed by PCR amplification of the Pfhrp2/3 gene. The results showed that the deletion rates for Pfhrp2 and Pfhrp3 genes were 0.44% and 1.47%, respectively. These findings indicate that the gene deletions in all nine states are at low level. Despite these low deletion rates, continuous surveillance is crucial to monitor the efficiency of HRP2 based malaria RDTs. It is recommend that conducting large-scale studies which include other endemic states in India to gain a more comprehensive understanding of the prevalence and impact of these gene deletions over time. This ongoing surveillance will ensure that diagnostic strategies remain effective and that any emerging trends in gene deletions are promptly addressed to achieve the malaria control and elimination. [ABSTRACT FROM AUTHOR]

Background: Neglected tropical diseases (NTDs) afflict nearly 2 billion people worldwide and are caused by various pathogens, such as bacteria, protozoa, and trypanosoma, prevalent in tropical and subtropical regions. Among the 17 NTDs recognized by the World Health Organization (WHO), protozoal infections caused by Plasmodium, Entamoeba, Leishmania, and Trypanosoma are particularly prominent and pose significant public health. Indonesia, endowed with a rich biodiversity owing to its tropical climate, harbors numerous plant species with potent biological activities that hold promise for therapeutic interventions. Hence, efforts have been directed towards exploring Indonesian plant extracts and isolated compounds for their potential in combating protozoal diseases. Methods: This study evaluated the antiprotozoal properties of 48 plant extracts sourced from the Cratoxylum, Diospyros, and Artocarpus genera. These extracts were screened using cell-based assays against Plasmodium falciparum (Pf), Entamoeba histolytica (Eh), Leishmania donovani (Ld), Trypanosoma brucei rhodesiense (Tbr), and Trypanosoma cruzi (Tc). Results: Extracts derived from the roots of Cratoxylum arborescens, obtained through dichloromethane extraction, exhibited significant activity against protozoa, with an IC50 value ranging from 0.1 to 8.2 µg/mL. Furthermore, cochinchinone C was identified as an active compound capable of inhibiting the growth of Pf, Eh, Ld, and Tbr, Tc trypomastigote, and Tc epimastigote with IC50 values of 5.8 µM, 6.1 µM, 0.2 µM, 0.1 µM, 0.7 µM, and 0.07 µM, respectively. Cochinchinone C is the first compound reported to exhibit activity against protozoal neglected tropical diseases, showing low cytotoxicity with a selectivity index greater than 10 when tested against carcinoma and normal cell lines. This suggests indicating its potential as a candidate for further drug development. This is the first report of cochinchinone C's activity against these protozoans. Conclusion: These findings establish cochinchinone C as a strong candidate for antiprotozoal drug development, highlighting the untapped therapeutic potential of Indonesia's rich plant biodiversity. [ABSTRACT FROM AUTHOR]

Introduction: Asymptomatic malaria infection is now recognized as a potential threat to malaria control. However, its prevalence and its dynamics are poorly documented especially in a perennial context of high seasonal transmission. A longitudinal study was conducted in southern Benin to investigate the dynamics of asymptomatic malaria infection and to identify factors influencing it. Methods: A cohort of 377 participants was recruited, stratified into three age groups (under 5 years, between 5 and 15 years, over 15 years). After inclusion, two visits were made one-month apart between August and November 2021. Malaria infection was diagnosed by microscopy and PCR and questionnaires were administered to the participants. The dynamics of malaria infection, both submicroscopic (positive PCR / negative blood smear) and microscopic (positive blood smear), and related factors were determined using a mixed ordinal polytomous regression model and a multistate Markov model. Results: The human infectious reservoir consisted primarily of asymptomatic submicroscopic infections (289/512 (56.4%)), followed by asymptomatic microscopic infections (182/512 (35.5%)) and symptomatic infections (41/512 (8%)). The prevalence of asymptomatic infection was highly related to age-group (5–15 years: OR: 4.12 [2.55–6.67] and > 15 years OR: 2.80 [1.73–4.54] compared to the under 5 years old group). The children under 15 years with asymptomatic infection had the highest risk of becoming symptomatic. The mean duration of asymptomatic infections in 5–15-year-olds was the longest (76.7 days (53.8–109.1)). Conclusion: This study revealed a persistent asymptomatic malaria reservoir over the follow-up period, with substantial variations between age-groups. These findings are important elements to consider for an optimal deployment of malaria control interventions. [ABSTRACT FROM AUTHOR]

Malaria remains a critical public health challenge in Africa, demanding innovative control strategies. This study introduces a novel approach using Microsporidia MB -infected mosquitoes and stochastic optimal control within a Lévy process framework to regulate mosquito release strategies. The primary goal is to optimize Microsporidia MB prevalence within mosquito populations to disrupt Plasmodium transmission to humans. By incorporating Lévy noise into the modeling process, we capture the inherent randomness of mosquito dynamics, improving intervention accuracy. The model, guided by the Hamilton–Jacobi–Bellman (HJB) equation, optimizes release protocols while accounting for key environmental factors like seasonality and temperature fluctuations. Results show that intervention success depends on local climatic conditions, underscoring the need for flexible, region-specific strategies in malaria-endemic areas. Focus regions include Kenya, Ghana, Niger, and Benin, where Microsporidia MB has been confirmed. Findings suggest that targeted mosquito releases could significantly reduce malaria transmission, offering valuable insights for public health efforts. [ABSTRACT FROM AUTHOR]

Vector mosquito control is an integral part of malaria control. The global emergence of insecticide resistance in malaria-transmitting Anophelines has become an impediment and has created an urgent need for novel mosquito control approaches. Here, we show that a biopesticide derived from the soil-dwelling bacterium Chromobacterium sp. Panama (Csp_P) kills insecticide-resistant Anopheles mosquitoes, regardless of their resistance mechanisms. In addition, sublethal dose of Csp_P acts as a synergist to now used chemical insecticides across multiple classes. Moreover, Csp_P reduces host-seeking behavior and malaria parasite infection in vector mosquitoes in ways that further decrease transmission. Mosquito glutathione S-transferases are essential for Csp_P's mosquito-killing mechanism. Enclosed field trials in Burkina Faso, conducted in diverse ecological settings and supported by a mathematical model, have now demonstrated its potential for malaria control in settings with widespread insecticide resistance. [ABSTRACT FROM AUTHOR]

Background: Madagascar has made significant progress in the fight against malaria. However, the number of malaria cases yearly increased since 2012. ITNs and IRS are key interventions for reducing malaria in Madagascar. Given the increasing number of cases and limited resources, understanding the cost-effectiveness of these strategies is essential for policy development and resource allocation. Methods: Using a societal perspective, this study aims to estimate the cost of the National Malaria Control Program (NMCP) through the first national malaria strategic plan (implemented over the period 2009–2013) and to assess the cost-effectiveness of two individually implemented malaria control interventions (ITNs and IRS) in two districts, Ankazobe and Brickaville. The cost-effectiveness ratio (CER) of ITN intervention was then compared to the CER of IRS intervention to identify the most cost-effective intervention. The cost of the NMCP and the costs incurred in the implementation of each intervention at the district level were initially estimated. On the basis of two results, the CERs of ITN or IRS correspond to the total cost of ITN or IRS divided by the number of people protected or the number of disability-adjusted life years (DALYs) averted. A deterministic univariate sensitivity analysis was conducted to assess the robustness of the results with a discount rate of 2.5% (0–5%) (costs and DALYs) and a 95% CI (person protected). Results: From 2009 to 2013, the NMCP cost USD 45.4 million (USD 43.5–47.5, r = 0–5%) per year, equivalent to USD 2.0 per capita per year. IRS implementation costs were four times higher than those of ITNs. The CER of IRS per case protected (USD 295.1 [285.1-306.1], r = 0–5%) was higher than the CER of ITNs (USD 48.6 [USD 46.0-51.5, r = 0–5%] in Ankazobe and USD 26.5 [USD 24.8–28.4, r = 0–5%] in Brickaville). The CERs per DALY averted of IRS was USD 427.6 [USD 413.0-546.3, r = 0–5%] in Ankazobe and, for ITNs, it was USD 85.4 [USD 80.8–90.5, r = 0–5%] in Ankazobe and USD 45.3 [USD 42.2–48.4, r = 0–5%] in Brickaville. Compared to the country GDP per capita (USD PPP 1494.6 in 2013), ITN intervention was "highly cost-effective" while the CER for IRS interventions was sensitive to parameter variation (CI, 95% of persons protected), which ranges from highly cost-effective to only cost-effective (USD 291.5–2004, r = 2.5%). Conclusion: In the Malagasy context, IRS intervention cost more and was less effective than ITN intervention. Willingness to pay for IRS is questioned. A relevant budget impact analysis should be conducted before a potential extension of this intervention. [ABSTRACT FROM AUTHOR]

Malaria remains one of the causes of extreme mortality in southern Africa and Southeast Asia. Despite extreme efforts to control and eliminate malaria, the appearance of drug-resistant parasites and their spread is a major concern. In this context various therapeutic, diagnostics, and technological advancements need to be studied and implemented in the near future. Nanoparticles have a crucial role in enhancing intracellular retention, subcellular target specificity, and even drug escape from intracellular enzymatic inactivation. Additionally, the selectivity and specificity of anti-malarial against the target were increased by the functionalization of nanoparticles, which led to improved safety and efficacy. Recent studies show the efficacy of metallic nanoparticles against the vector Anopheles mosquito and the malaria parasite Plasmodium species. So, here in the present review, we will discuss the various metal-based nanoparticles that have been studied for malaria treatment or used for the development of detection and diagnosis between the year 2013 and till date. This review also covers the future prospects of these nanoparticles in this field. [ABSTRACT FROM AUTHOR]

In malaria-endemic regions, Plasmodium vivax and Plasmodium falciparum coexist and may interact. For instance, fevers induced by P. falciparum might activate dormant P. vivax parasites and concurrent radical cure of both species has been proposed to prevent relapses. Heterogeneous mosquito exposure may contribute to the dependence of both parasites. We conducted a literature review on their respective prevalence and that of co-infections. The data revealed a positive correlation between P. vivax and P. falciparum prevalence, and co-infection prevalences exceeding expectations assuming infections occur independently. We used the review data to fit a compartmental model of co-infections that features heterogenous mosquito exposure. The fit suggests that heterogeneous exposure sufficiently explains the observed departure from independence. Finally, we performed simulations under the model assessing the impact on P. vivax prevalence of the activation-by-fever hypothesis and the radical cure proposition. We demonstrated a moderate impact of allowing P. falciparum fevers to reactivate P. vivax and a substantial impact of treating P. falciparum cases with radical cure. Our model highlights dependence between P. falciparum and P. vivax and emphasizes the influence of heterogeneous mosquito exposure. This simple framework can inform the design of more complex models assessing integrated malaria control strategies in coendemic regions. [ABSTRACT FROM AUTHOR]

The increased resistance of Plasmodium falciparum to artemisinin and its partner drugs poses a serious challenge to global malaria control and elimination programs. This study aimed to investigate the therapeutic potential of Mesua ferrea Linn., a medicinal plant, as a source for novel antimalarial compounds. In this study, we conducted in vitro assays to evaluate the antimalarial activity and cytotoxicity of crude extracts derived from M. ferrea L. leaves and branches. Subsequently, the most promising extracts were subjected to assessments of their antimalarial efficacy and acute oral toxicity tests in mouse models. Furthermore, selected crude extracts underwent gas chromatography-mass spectrometry (GC-MS) analysis to identify their phytochemical compositions. Our findings revealed that the ethanolic extract of M. ferrea L. branches (EMFB) exhibited high antimalarial activity, with an IC50 value of 4.54 μg/mL, closely followed by the ethanolic extract of M. ferrea L. leaves (EMFL), with an IC50 value of 6.76 μg/mL. Conversely, the aqueous extracts of M. ferrea L. branches (AMFB) and leaves (AMFL) exhibited weak and inactive activity, respectively. The selected extracts, EMFB and EMFL, demonstrated significant dose-dependent parasitemia suppression, reaching a maximum of 62.61% and 54.48% at 600 mg/kg body weight, respectively. Furthermore, the acute oral toxicity test indicated no observable toxicity at a dosage of 2,000 mg/kg body weight for both extracts. GC-MS analysis revealed abundant compounds in the EMFB, such as oleamide, cis-β-farnesene, alloaromadendrene, physcion, palmitic acid, 5-hydroxymethylfurfural, and 4H-pyran-4-one, 2,3-dihydro-3,5-dihydroxy-6-methyl-, while the EMFL contained friedelin, friedelinol, betulin, β-caryophyllene, oleamide, and 5-hydroxymethylfurfural. Notably, both extracts shared several phytochemical compounds, including 4H-pyran-4-one, 2,3-dihydro-3,5-dihydroxy-6-methyl-, 5-hydroxymethylfurfural, α-copaene, cyperene, β-caryophyllene, alloaromadendrene, palmitic acid, ethyl palmitate, and oleamide. Additionally, further study is needed to isolate and characterize these bioactive compounds from M. ferrea L. leaves and branches for their potential utilization as scaffolds in the development of novel antimalarial drugs. [ABSTRACT FROM AUTHOR]

Background: Access to essential malaria commodities is a cornerstone in malaria control. However optimal availability and access to essential malaria commodities remain a challenge in Tanzania. Therefore, this study aimed to explore the factors affecting the accessibility of malaria commodities in Tanzania. Methods: This was a mixed-method cross-sectional study using both quantitative and qualitative approaches. Data were collected between February and March 2023 from health facilities, health facility staff, and patients. Results: Availability of malaria commodities in government health facilities was 100% for all items while in the private and faith-based facilities, this ranged from 10% to 80%. The reasons for stockouts in Government facilities were related to delayed and inadequate quantity delivery while in private facilities the main reason was the lack of cash for procurement. Both private facilities' clients and healthcare providers concurred that most people do not access complete treatment due to the high costs of prescribed medicines and poor stocking levels. Conclusion: The availability, hence the accessibility, of malaria commodities in private and faith-based health facilities is still sub-optimal. Logistic management needs to be improved to eliminate stockouts and malaria commodities high costs need a permanent solution. [ABSTRACT FROM AUTHOR]

The article discusses the methodology behind joint malaria prevention recommendations from Switzerland, Germany, Belgium, and The Netherlands. These countries have collaborated to align their recommendations based on epidemiological data quality and refined methodology. The process involves defining malaria risk categories, compiling data on malaria incidence, creating raw risk maps, adjusting maps based on expert discussions, and publishing final recommendations. The aim is to provide transparent and evidence-based recommendations for travel medicine advisors and travelers. [Extracted from the article]

Malaria control has been one of the defining goals in global health. Recently, strategies that aim to control the insect-borne disease by altering mosquito biology have gained interest. One such strategy currently in development is to engineer mosquitoes equipped with so-called gene drives: elements that increase the likelihood of a specific set of genes to be passed on to the next generation. The strategy encapsulates hopes of technological solutions in global health, as well as expectations for the applications of synthetic biology. Hence, gene drive research operates with the potential of genetically modified mosquitoes: to survive in the wild, to reproduce, and to perform the work expected of them in some future timeline. I examine gene drive research with the concept of potentiality and how establishing it has guided gene drive research. Knowledge and uncertainties about mosquitoes and mosquito ecologies emerged through working with the mosquito as a research animal in the laboratory, as population data, and as a regulatable biotechnology. Mathematical modelling made it possible to establish the potential to move from the lab to the wild. In modelling, the mosquito as a research object could be made to work as part of future projections that assembled different kinds of data. As gene drive research progresses, I suggest that the researchers are also modelling how biotechnology handles uncertainty that is related to the ways producing genetic modification in the lab and producing knowledge about their possible environmental effects and efficacy translates into landscapes and mosquito ecologies in the wild. [ABSTRACT FROM AUTHOR]

Behaviour change communication (BCC) remains a central component of the interventions used in the fight against malaria in Ghana. However, there is limited evidence of its effectiveness. This study evaluated the effects of BCC strategies on knowledge (symptoms, causes and prevention) and overall knowledge of malaria among Ghanaian women aged 15–49 years. The propensity score matching (PSM) approach and logistic regression were used to analyse data from the 2016 edition of the Malaria Indicator Survey (MIS). Women who participated in community-level education or heard/saw media messages on malaria, or both, had significantly more knowledge of the disease than women who lacked access to any of these mediums of communication. The effect of these strategies on women's overall knowledge of malaria is about 2% to 4% and is higher on their knowledge of the symptoms (3% to 6%) and prevention (2% to 4%) than the causes (2%). The combined effects of both mediums of communication are relatively higher than the effect of either of them as a single medium of communication. Further analysis showed that improved knowledge of the disease is associated with higher preventive measures taken by women for themselves and for their children. The results are more significant in rural and poor households than in urban and non-poor households. These findings underscore the need for the Ministry of Health and its partner institutions to adopt an innovative approach which combines the two strategies in intensively educating Ghanaians, and women in particular, on the symptoms and prevention of malaria, giving due cognisance to households' socioeconomic status and geographical location. [ABSTRACT FROM AUTHOR]

International travel among pregnant women has become increasingly common, prompting clinicians to seek evidence-based guidance of travel safety and precautions during pregnancy. This article provides a comprehensive summary of current literature and guidelines on international travel for pregnant women, addressing key concerns such as prevention of venous thromboembolism, advisability of travel vaccinations, and zoonotic diseases including malaria, Zika virus, yellow fever, rabies, and Japanese encephalitis. Additionally, this article covers food and water safety, focussing on pathogens responsible for travellers' diarrhoea, typhoid fever, and hepatitis A, and offers guidance on managing environmental factors of travel such as extremes of temperature, high-altitude travel, and air quality. Practical advice for pregnant travellers, including travel insurance and documentation should always be considered. This article aims to equip clinicians with the necessary knowledge to support women in making informed, evidence-based, and safe travel decisions during pregnancy. [ABSTRACT FROM AUTHOR]

Background: The integration of maternal and child health services (MCH) with routine immunization is an important global health strategy, particularly in low- and middle-income countries (LMICs). However, evidence is lacking regarding the best practices for service integration and the effect of integration on immunization and linked health service outcomes. Methods: We searched publication databases and gray literature for articles published between 2011 and 2020 that include approaches to integrating MCH services with immunizations during the first two years of life in LMICs. Abstracts and full-text articles were screened for eligibility. For the included articles, data extraction and analysis examined the descriptive characteristics of studies, outcomes, and implementation considerations. Results: Among the 16,578 articles screened, 44 met the criteria for inclusion, representing 34 studies, of which 29 were from Africa. The commonly linked MCH services were family planning (24%), human immunodeficiency virus (HIV) diagnosis or care (21%), and malaria prevention or control (21%). Multiple integration strategies were typically used; the co-location of linked services (65%), the provision of extra services by immunization staff (41%), and/or the provision of extra information by immunization staff (41%) were the most common. In general, integration improved MCH service outcomes (76%) and was either beneficial (55%) or neutral for immunization (35%), with some examples in family planning, malaria, and HIV where integrated services were not beneficial. Important implementation considerations included the careful matching of target populations in service re-design, ensuring support from policy, logistics, and information systems, the provision of adequate training and support of staff to avoid overload, clear client communication regarding service integration, and the need to address community concerns. Conclusions: Integrating MCH services with routine immunization can expand linked services and improve immunization coverage. This study has identified key implementation considerations relevant to both childhood and adult vaccination programs. More research is needed regarding costs and client preferences. [ABSTRACT FROM AUTHOR]

The mosquito-lethal effect of commercially available standard and long-lasting ivermectin formulations were evaluated in cattle and buffalo against wild-caught Anopheles on Sumba Island, Indonesia. Cattle have substantially higher blood-level concentrations of ivermectin compared to buffalo after receiving similar doses, irrespective of formulation. In total, nine Anopheles species were captured to assess the mosquito-lethal effects of ivermectin with susceptibility ranked from lowest to highest: An. flavirostris < An. aconitus < An. annularis < An. tessellatus < An. maculatus < An. sundaicus < An. vagus < An. kochi < An. barbirostris. The duration of mosquito-lethal effect of long-lasting ivermectin was superior to standard ivermectin and in cattle it well exceeded the WHO criteria for new endectocides having a mortality hazard ratio greater than 4 through 30 days after administration. Buffalo may require higher doses of long-lasting ivermectin to achieve similar mosquito-lethal effects observed in cattle. Of the four hosts evaluated buffalo were the most attractive to Anopheles followed by cattle then horse and finally humans. This study demonstrates, for the first time, the superiority of a commercially available long-lasting ivermectin formulation for the potential deployment of mass ivermectin treatment of livestock as a vector control tool for malaria elimination in Southeast Asia. [ABSTRACT FROM AUTHOR]

Malaria is preventable, but the burden of disease remains high with over 249 million cases and 608,000 deaths reported in 2022. Historically, the most important protective interventions have been vector control and chemopreventive medicines with over 50 million children receiving seasonal malaria chemoprevention in the year 2023. Two vaccines are approved and starting to be deployed, bringing additional protection for children up to 36 months. However, the impact of these currently available tools is somewhat limited on various fronts. Vaccines exhibit partial efficacy, are relatively costly, and not accessible in all settings. The challenges encountered with chemoprevention are barriers to acceptability and feasibility, including frequency of dosing, and the lack of options in the first trimester of pregnancy and for women living with HIV. Also, the emergence of resistance against chemopreventive medicines is concerning. To address these limitations, a target product profile (TPP) is proposed as a road map to guide innovation and to boost the quest for novel chemopreventive alternatives. This TPP describes the ideal product attributes, while acknowledging potential trade-offs that may be needed. Critically, it considers the target populations most at risk; primarily infants, children, and pregnant women. Malaria control and elimination requires appropriate chemoprevention, not only in areas of high endemicity and transmission, but also in lower transmission areas where immunity is declining, as well as for travellers from areas where malaria has been eliminated. New medicines should show acceptable safety and tolerability, with high and long protective efficacy. Formulations and costs need to support operational adherence, access, and effectiveness. Next generation long-acting oral and injectable drugs are likely to constitute the backbone of malaria prevention. Therefore, the perspectives of front-line experts in malaria prevention, researchers, and those involved in drug development are captured in the TPP. This inclusive approach aims at concentrating efforts and aligning responses across the community to develop new and transformative medicines. [ABSTRACT FROM AUTHOR]