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PubMed2001

Association of hepatomegaly and jaundice with acute renal failure but not with cerebral malaria in severe falciparum malaria in Thailand.

We conducted a case record study comparing liver tests abnormalities in 20 malaria-related acute renal failure cases without cerebral malaria, 52 cerebral malaria cases without other organ impairment, 189 cases of nonsevere malaria associated with a high parasite burden, and 131 cases of mild Plasmodiumfalciparum malaria. Jaundice and hepatomegaly were significantly associated with renal failure (adjusted odds ratio [AOR], 3.3, 95% confidence interval [CI], 1.3-8.6, P = 0.01; and AOR, 1.7 95% CI, 1.13-2.4, P = 0.01) but not with cerebral malaria (AOR, 1, 95% CI, 0.5-2, P = 0.8; and AOR, 1.08, 95% CI, 0.8-1.8, P = 0.5). Patients with acute renal failure were significantly older and had increased liver abnormalities compared with other groups. Although an increase in the proportion of mature schizonts over ring forms was significantly associated with cerebral malaria, it did not seem to have affected acute renal failure. These results suggested that cytoadherence was not the main determinant for renal failure and that jaundice itself may have potentiated the effects of hypovolemia.

Acute Kidney Injury↗
PubMed1994

[Malaria situation in the People's Republic of China in 1993. Advisory Committee on Malaria, MOPH].

According to case reporting from different provinces/autonomous regions/municipalities (P/A/M), the number of malaria cases amounted to 58,569 in the country (Taiwan not included) in 1993, the mean incidence being 4.982 per a hundred thousand, and the lethal cases due to malaria were 19. Among a total of 1.0862 billion population residing in areas where there were no reported malaria cases or the incidence was below 0.01%, 78.9 million in areas with an incidence of 0.10-1% and 10.6 million in areas with an incidence of 0.101-1% were detected. In Wanding City with a population of 10,000 on the border of Yunnan Province, high incidence of surpassing 1% was still revealed. The results of malaria surveillance in major endemic areas situated in 17 P/A/M with a coverage of 0.526 billion population indicated that 68,594 positive cases were detected from 12.423 million febrile patients undergone blood examination, showing a mean positive rate of 0.55%. 7,466 malaria parasite carriers were disclosed from target and migratory population in general examination, the mean parasite carrier rate being 1.26%. Because the province-based case reporting did not include migratory immigrants, and case missing was likely unavoidable during the reporting process at community level, the number of actual malaria cases was estimated to be no less than 100,000. 6,359 falciparum malaria cases (comprising mixed infections of Plasmodium falciparum and P. vivax) were detected in the whole country in 1993, accounting for 9.27% of the positive cases confirmed by blood examination; in addition three hundred and forty-four P. falciparum carriers were found.(ABSTRACT TRUNCATED AT 250 WORDS)

China↗
PubMed2000

Chloroquine or amodiaquine combined with sulfadoxine-pyrimethamine for treating uncomplicated malaria.

BACKGROUND: Amodiaquine and chloroquine give fast relief from malaria symptoms, particularly fever. When used alone in areas where there is some parasite resistance they do not completely clear parasites from the blood in all cases, and so not all patients are cured of infection. The major disadvantage of using sulfadoxine-pyrimethamine alone is that it takes a relatively long time to relieve fever. OBJECTIVES: To assess the effectiveness of chloroquine or amodiaquine given with sulfadoxine-pyrimethamine to treat uncomplicated falciparum malaria. SEARCH STRATEGY: The Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE, Science Citation Index, African Index Medicus and LILACS were searched. Experts in the field and drug companies were contacted. SELECTION CRITERIA: Randomised and quasi-randomised trials of chloroquine or amodiaquine given with sulfadoxine-pyrimethamine compared with either drug alone in adults or children with confirmed uncomplicated falciparum malaria. DATA COLLECTION AND ANALYSIS: Two people independently applied the inclusion criteria. Data were extracted by the reviewer and checked independently by another person. MAIN RESULTS: Five trials were included. Fever clearance time was reduced by combination therapy compared with sulfadoxine-pyrimethamine alone. Parasite clearance at day seven follow-up was not significantly different for chloroquine or amodiaquine treatment with or without sulfadoxine-pyrimethamine. Parasite clearance at day 28 was better with combination therapy compared with chloroquine or amodiaquine alone (odds ratio 14.28, 95% confidence interval 6.76 to 30.19), but not significantly better than sulfadoxine-pyrimethamine alone (odds ratio 3.17, 95% confidence interval 0.96 to 10.43). There was no evidence from the included trials of serious side effects with combination treatment. REVIEWER'S CONCLUSIONS: In areas where chloroquine or amodiaquine are still effective, despite some degree of resistance, using these drugs in combination with sulfadoxine-pyrimethamine, rather than sulfadoxine-pyrimethamine alone, may make people feel better faster and improve sustained parasites clearance.

Adult↗
PubMed2004

Evaluation of the RealArt Malaria LC real-time PCR assay for malaria diagnosis.

PCR-based methods have advantages over traditional microscopic methods for the diagnosis of malaria, especially in cases of low parasitemia and mixed infections. However, current PCR-based assays are often labor-intensive and not readily quantifiable and have the potential for contamination due to a requirement for postamplification sample handling. Real-time PCR can address these limitations. This study evaluated the performance characteristics of a commercial malaria real-time PCR assay (RealArt Malaria LC Assay; Artus GmbH, Hamburg, Germany) on the LightCycler platform for the detection of malaria parasites in 259 febrile returned travelers. Compared to nested PCR as the reference standard, the real-time assay had a sensitivity of 99.5%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 99.6% for the detection of malaria. Our results indicate that the RealArt assay is a rapid (<45 min), sensitive, and specific method for the detection of malaria in returned travelers.

Animals↗
PubMed2006

[Retrospective analysis of 107 imported adult cases of malaria. Experience report of uncomplicated falciparum malaria treatment in adults with oral atovaquone-proguanil].

OBJECTIVES: The principal aim of this study was to assess the efficacy of the combination of oral atovaquone and proguanil (AP) in routine treatment of uncomplicated falciparum malaria in recent visitors to the tropics. We also analyzed the epidemiologic, clinical and hematologic characteristics of these patients with imported malaria. METHODS: This retrospective study reviewed the records of 107 cases of imported malaria, treated in the Tropical Disease Unit of Bordeaux University Hospital (France). RESULTS: More than 75% had uncomplicated falciparum malaria; 10 developed complications, and one died. Average time from fever onset to first medical consultation was 4.8 days. Less than 10% had used physical measures of prevention against mosquito bites, and nearly 65% had not used chemoprophylaxis. The most frequent hematologic abnormalities were eosinopenia (84%) and thrombocytopenia (75%). In more than 30% of cases, another disease was also present. The oral AP combination was administered to more than 86% of patients with uncomplicated falciparum malaria (n=72). Tolerance was excellent and only one treatment failure was observed, associated with digestive disorders. CONCLUSION: Better information for travelers and general practitioners is required to reduce the number of cases of imported malaria and to shorten the delay between symptom onset and specific treatment. The oral AP combination appears to be a safe and effective treatment for uncomplicated imported falciparum malaria.

Administration, Oral↗
PubMed2005

TNF as a malaria candidate gene: polymorphism-screening and family-based association analysis of mild malaria attack and parasitemia in Burkina Faso.

We have previously obtained strong evidence for linkage of mild malaria attack to the MHC region, with a peak close to the tumor necrosis factor (TNF) gene. We screened, for polymorphisms, the entire TNF gene in the same sample of 34 families comprising 197 individuals living in a Plasmodium falciparum endemic area and we found 17 polymorphisms. In a longitudinal study, we investigated whether the 11 most frequent and informative polymorphisms were associated with mild malaria attack and maximum parasitemia, which was the highest parasitemia in each individual over 2 years. Mild malaria attack and maximum parasitemia were positively correlated. Transmission disequilibrium tests showed nominal evidence for association between TNF-1031, TNF-308, TNF851 and TNF1304 polymorphisms, and mild malaria attack on the one hand, and between TNF-238, TNF851 and TNF1304 polymorphisms, and maximum parasitemia on the other hand. After accounting for multiple tests, we confirmed the association of TNF-238 with maximum parasitemia and the association of TNF1304 and TNF851 with maximum parasitemia and mild malaria attack. The association tests with mild malaria attack suggest a moderate effect of TNF-308 polymorphism. In conclusion, our study suggests that several TNF variants may be part of the genetic determinants for maximum parasitemia and/or mild malaria attack.

Alleles↗
PubMed1999

Increased prevalence of malaria in HIV-infected pregnant women and its implications for malaria control.

OBJECTIVES: To examine in pregnant women the relationship between HIV infection and malaria prevalence and to determine, in relation to HIV infection, the effectiveness of sulphadoxine-pyrimethamine in clearing P. falciparum infection. METHOD: Descriptive cross-sectional analysis of P. falciparum prevalence in pregnant women at first antenatal visit and of women at delivery who had received two sulphadoxine-pyrimethamine treatments for malaria. HIV status was assessed in 621 women who attended for antenatal care and for delivery at two rural hospitals in southern Malawi in 1993-94. Information was collected on maternal age, parity and gestational age. Prevalence of P. falciparum was measured at first antenatal visit and delivery. Women were given two routine treatment doses of sulphadoxine-pyrimethamine (SP), at first antenatal visit and between 28 and 34 weeks gestation, conforming to Malawi government policy on antimalarial control during pregnancy. RESULTS: Prevalence of HIV infection was 25.6% and all infections were HIV type-1. In primigravidae malaria prevalence at recruitment was 56.3% in HIV-infected and 36.5% in HIV-uninfected women (P=0.04). The corresponding figures for multigravidae were 23.8% and 11.0%, respectively (P<0.01). HIV-infected primigravidae had increased malaria prevalence at all gestational ages. Peak parasite prevalence occurred earlier in gestation in HIV-infected primigravidae (16-19 weeks if HIV-infected; 20-23 weeks if HIV-uninfected). The relative risk for parasitaemia in HIV-infected compared to HIV-uninfected women was significantly increased in three of five parity groups, including the two highest ones (parity>3), indicating parity-specific immunity to malaria was impaired. Malaria prevalence at delivery remained high in HIV-infected women despite prior routine treatment with sulphadoxine-pyrimethamine in pregnancy There was no significant difference in parasite prevalence at delivery between women who did or did not use sulphadoxine-pyrimethamine. CONCLUSIONS: HIV infection is associated with a significant increase in malaria prevalence in pregnant women of all parities with the effect apparent from early in gestation. Two treatment doses of sulphadoxine-pyrimethamine were inadequate to clear parasitaemia in many women by the time of delivery and this occurred independently of HIV status and despite high sensitivity to SP in this area. There is a need to undertake longitudinal studies to determine the incidence of P. falciparum infection in HIV-infected and uninfected pregnant women and to reassess the frequency and timing of sulphadoxine-pyrimethamine treatment doses in these women. Late pregnancy re-infections with P. falciparum probably explain the high parasite prevalence at delivery following sulphadoxine-pyrimethamine treatment at 28-34 weeks gestation.

AIDS-Related Opportunistic Infections↗
PubMed2005

Estimating medium- and long-term trends in malaria transmission by using serological markers of malaria exposure.

The implementation and evaluation of malaria control programs would be greatly facilitated by new tools for the rapid assessment of malaria transmission intensity. Because acquisition and maintenance of antimalarial antibodies depend on exposure to malaria infection, such antibodies might be used as proxy measures of transmission intensity. We have compared the prevalence of IgG antibodies with three Plasmodium falciparum asexual stage antigens in individuals of all ages living at varying altitudes encompassing a range of transmission intensities from hyper- to hypoendemic in northeastern Tanzania, with alternative measures of transmission intensity. The prevalence of antibodies to merozoite surface protein-1(19) was significantly more closely correlated with altitude than either point-prevalence malaria parasitemia or single measures of hemoglobin concentration. Analysis of age-specific seroprevalence rates enabled differentiation of recent (seasonal) changes in transmission intensity from longer-term transmission trends and, using a mathematical model of the annual rate of seroconversion, estimation of the longevity of the antibody response. Thus, serological tools allow us to detect variations in malaria transmission over time. Such tools will be invaluable for monitoring trends in malaria endemicity and the effectiveness of malaria control programs.

Adult↗
PubMed2004

Comparison of blood smear, antigen detection, and nested-PCR methods for screening refugees from regions where malaria is endemic after a malaria outbreak in Quebec, Canada.

The importation of malaria into a region where it is not endemic raises many concerns, including the timely delivery of appropriate care, safety of the blood supply, and the risk of autochthonous transmission. There is presently no consensus on the best way to screen mobile populations for malaria. Between August 2000 and March 2001, 535 refugees arrived in Quebec, Canada, from Tanzanian camps. Within 4 weeks of resettlement of the first group of 224, the McGill University Centre for Tropical Diseases noted an outbreak of malaria across the province (15 cases over a 3-week period). This group (group 1) was traced and screened for malaria between 3 and 4 months after arrival in Canada. Subsequent groups of 106 and 205 refugees were screened immediately upon arrival in Canada (group 2) and immediately prior to their departure from refugee camps (group 3), respectively. A single EDTA-blood sample was obtained from 521 refugees for testing by thick and thin blood smears (groups 1 and 2), antigen detection (ICT Malaria Pf and OptiMAL; group 1 only), and nested PCR (all groups). Overall, 98 of 521 refugees were found to be infected (18.8%). The vast majority of infections (81 of 98) were caused by Plasmodium falciparum alone. Using PCR as the "gold standard," both microscopy (sensitivity, 50%; specificity, 100%) and antigen detection (ICT sensitivity, 37.5%; ICT specificity, 100%; OptiMAL sensitivity, 29.1%; OptiMAL specificity, 95.6%) performed poorly. None of the PCR-positive subjects were symptomatic at the time of testing, and only two had recently had symptoms compatible with malaria (with or without diagnosis and treatment). Active surveillance of migrants from regions of intense malaria transmission can reduce the risk of morbidity in the migrant population and mitigate against transmission to the host population. Our data demonstrate that PCR is, by far, the most powerful tool for such surveillance.

Adolescent↗
PubMed2005

The unexpected importance of mosquito oviposition behaviour for malaria: non-productive larval habitats can be sources for malaria transmission.

BACKGROUND: Mosquitoes commute between blood-meal hosts and water. Thus, heterogeneity in human biting reflects underlying spatial heterogeneity in the distribution and suitability of larval habitat as well as inherent differences in the attractiveness, suitability and distribution of blood-meal hosts. One of the possible strategies of malaria control is to identify local vector species and then attack water bodies that contain their larvae. METHODS: Biting and host seeking, not oviposition, have been the focus of most previous studies of mosquitoes and malaria transmission. This study presents a mathematical model that incorporates mosquito oviposition behaviour. RESULTS: The model demonstrates that oviposition is one potential factor explaining heterogeneous biting and vector distribution in a landscape with a heterogeneous distribution of larval habitat. Adult female mosquitoes tend to aggregate around places where they oviposit, thereby increasing the risk of malaria, regardless of the suitability of the habitat for larval development. Thus, a water body may be unsuitable for adult mosquito emergence, but simultaneously, be a source for human malaria. CONCLUSION: Larval density may be a misleading indicator of a habitat's importance for malaria control. Even if mosquitoes could be lured to oviposit in sprayed larval habitats, this would not necessarily mitigate -- and might aggravate -- the risk of malaria transmission. Forcing mosquitoes to fly away from humans in search of larval habitat may be a more efficient way to reduce the risk of malaria than killing larvae. Thus, draining, fouling, or filling standing water where mosquitoes oviposit can be more effective than applying larvicide.

Animals↗
PubMed2006

Modelling entomological-climatic interactions of Plasmodium falciparum malaria transmission in two Colombian endemic-regions: contributions to a National Malaria Early Warning System.

BACKGROUND: Malaria has recently re-emerged as a public health burden in Colombia. Although the problem seems to be climate-driven, there remain significant gaps of knowledge in the understanding of the complexity of malaria transmission, which have motivated attempts to develop a comprehensive model. METHODS: The mathematical tool was applied to represent Plasmodium falciparum malaria transmission in two endemic-areas. Entomological exogenous variables were estimated through field campaigns and laboratory experiments. Availability of breeding places was included towards representing fluctuations in vector densities. Diverse scenarios, sensitivity analyses and instabilities cases were considered during experimentation-validation process. RESULTS: Correlation coefficients and mean square errors between observed and modelled incidences reached 0.897-0.668 (P > 0.95) and 0.0002-0.0005, respectively. Temperature became the most relevant climatic parameter driving the final incidence. Accordingly, malaria outbreaks are possible during the favourable epochs following the onset of El Niño warm events. Sporogonic and gonotrophic cycles showed to be the entomological key-variables controlling the transmission potential of mosquitoes' population. Simulation results also showed that seasonality of vector density becomes an important factor towards understanding disease transmission. CONCLUSION: The model constitutes a promising tool to deepen the understanding of the multiple interactions related to malaria transmission conducive to outbreaks. In the foreseeable future it could be implemented as a tool to diagnose possible dynamical patterns of malaria incidence under several scenarios, as well as a decision-making tool for the early detection and control of outbreaks. The model will be also able to be merged with forecasts of El Niño events to provide a National Malaria Early Warning System.

Animals↗
PubMed1998

Efficacy of sulfadoxine-pyrimethamine for prevention of placental malaria in an area of Kenya with a high prevalence of malaria and human immunodeficiency virus infection.

A fever case management (CM) approach using sulfadoxine-pyrimethamine (SP) was compared with two presumptive intertmittent SP treatment regimens in the second and third trimesters in pregnant primigravidae and secundigravidae in an area of intense Plasmodium falciparum malaria transmission in western Kenya. The investigation evaluated efficacy of the antimalarial regimens for prevention of placental malaria and examined the effect of human immunodeficiency virus (HIV) infection on antimalarial drug efficacy and adverse drug reactions. Twenty-seven percent (93 of 343) of pregnant women in the CM group had placental malaria compared with 12% (38 of 330; P < 0.001) of women who received two doses of SP and compared with 9% (28 of 316; P < 0.001) of women who received monthly SP. Fourteen percent (49 of 341) of women in the CM group delivered low birth weight (LBW) infants compared with 8% (27 of 325; P=0.118) of women who received two doses of SP and compared with 8% (26 of 331; P=0.078) of women who received monthly SP. Seven percent (7 of 99) of the HIV-negative women on the two-dose SP regimen had placental malaria compared with 25% (10 of 39; P=0.007) of HIV-positive women on the same regimen; the rate of placental malaria in HIV-positive women was reduced to 7% (2 of 28; P=-0.051) for women on the monthly SP regimen. Less than 2% of women reported adverse drug reactions, with no statistically significant differences between HIV-positive and HIV-negative women. Intermittent treatment with SP is safe and efficacious for the prevention of placental malaria in pregnant primigravidae and secundigravidae in sub-Saharan Africa. While a two-dose SP regimen may be effective in areas with low HIV seroprevalence, administration of SP monthly during the second and third trimesters of pregnancy should be considered in areas of high HIV seroprevalence to prevent the effects of maternal malaria on the newborn.

Adolescent↗
PubMed2026

Malaria Risk among Internally Mobile Individuals and Heterogeneous Mobility Patterns in Two Hypoendemic Communities: Implications for Malaria Elimination in the Peruvian Amazon.

BACKGROUND: Human mobility is increasingly recognized as a key factor influencing malaria transmission dynamics, particularly in low-transmission settings approaching elimination. This study aimed to assess mobility patterns and their association with malaria risk in two hypoendemic communities in the Peruvian Amazon. METHOD: A longitudinal study was conducted in the communities of Libertad and Urcomira&#xf1;o (Maz&#xe1;n River basin). Monthly population screenings were combined with weekly active and passive case detection. A total of 678 individuals were enrolled. Mobility patterns were assessed through structured questionnaires, and social network analysis was used to characterize travel connections. Log-binomial regression analysis was applied to identify risk factors associated with malaria infection. RESULT: Internally, mobile individuals in Libertad showed a higher malaria incidence (>32.47 cases per 1,000 person-months) than those in Urcomira&#xf1;o (<10.15 cases per 1,000 person-months). Travel networks were mainly connected to Mazan district and Iquitos city, followed by local streams such as Armas and Arahuana. Mobility was primarily driven by family, administrative and occupational activities. Male sex (PR = 2.15, 95% CI: 1.37 - 3.37) and age &#x2265;15 years (PR = 1.98, 95% CI: 1.24 - 3.19) were significantly associated with malaria infection (p-value < 0.05). CONCLUSION: Internally mobile populations represent a key high-risk group sustaining malaria transmission in hypoendemic settings. Targeted interventions focusing on mobile individuals should be integrated into malaria elimination strategies in the Peruvian Amazon and similar endemic regions.

Malaria elimination↗
PubMed2001

Urban malaria treatment behaviour in the context of low levels of malaria transmission in Lagos, Nigeria.

Urban malaria in West Africa is not well documented. While rapid urbanisation may create environmental conditions that favour mosquito breeding, urban pollution may inhibit the growth of Anopheles species. In 1996, the Basic Support for Institutionalizing Child Survival (BASICS) Project of the U.S. Agency for International Development (USAID) started building urban community health coalitions in Lagos, Nigeria, to empower communities to provide prompt treatment and appropriate prevention for major causes of childhood morbidity and mortality, including malaria, diarrhoeal disease, acute respiratory infections and vaccine preventable diseases. Intervention against malaria was predicated on national policies that assumed Nigeria was holo-endemic for malaria and that prompt treatment of febrile illness with anti-malarial drugs was an appropriate action. At the suggestion and with the assistance of another USAID programme, the Environmental Health Project (EHP), BASICS embarked on a rapid assessment of the epidemiological, entomological and sociological situation of malaria transmission and case management in three Lagos communities. During April and May 1998, blood film investigation of 916 children between the ages of 6 months and 5 years yielded a parasite prevalence rate of 0.9%. Night knockdown collections of mosquitoes in rooms yielded only C. quinquefasciatus and A. aegypti. The same results were obtained for night landing collections on human bait. Very low densities of A. gambiae larvae were found in breeding sites in Lagos Island (0.7) and Ajegunle (0.3). In contrast, community members, during focus group discussion identified malaria, in it various culturally defined forms, as a major health problem. Among the children examined clinically, 186 (20.3%) reported an illness, which they called "malaria" in the previous two weeks, and 180 had sought treatment for this illness. Data obtained from 303 shops in the area documented that a minimum of US dollars 4,000 was spent on purchases of anti-malarial drugs in the previous week. The implications of these findings for both professional and community education are discussed.

Animals↗
PubMed1991

[From malaria chemoprophylaxis to malaria self-treatment (1975-1989)].

Swissair's 3000-odd cockpit and cabin personnel spend an aggregate total of one year in the tropics for every ten years of flight service with the airline. Since 1975, company policy has been to issue all crews with a 'treatment dose' of anti-malaria medication to be taken if malaria contraction is suspected. Up until 1985, this treatment dose medication was recommended to crews for cases in which malaria was suspected even though chemoprophylactic medication had been taken. Since 1985, crews have been advised to rely solely on the treatment dose (i.e. not take any chemoprophylactic medication) if they are exposed to only low or moderate malaria risk. Experience so far has been encouraging: There has been no increase in incidences of malaria; the approach has been widely accepted among crews; the treatment dose (1%) has been judiciously used; the amount of chemoprophylactic tablets issued has declined; the number of repellents issued has increased; and the fear of side-effects from anti-malaria medication has decreased. The risk of contracting malaria-about one case per 200 to 300 years of service-is accepted. The question of whether and to what extent these experiences, which have been recorded among a small and selected group of the population, can be applied to other frequent flyers merits further investigation.

Animals↗
PubMed1993

[Malaria situation in the People's Republic of China in 1992. Advisory Committee on Malaria, MOPH].

According to the case reporting system, the number of malaria cases accounted for 73,955 in the nation (Taiwan not included) in 1992, the incidence being 6.391 per a hundred thousand, and the lethal cases caused by malaria were 52 in number. In comparison with the data of 1991, the case number declined by 27,681 and the incidence, by 27.99%. In areas where there were no reported malaria cases or the incidence was below 1/1000, the residents totalled 1.0566 billion, whereas incidence of 1-10/1000 was noted in areas with people of 84.5 million, and 10.1-100/1000 in areas with people of 16 million. In a border city of Yunnan where resided merely 10,000 people, the incidence was more than 100 per 10,000. In the southern part, except for the resurgence of the disease in Guangxi, a decrease in the incidence at various extents was demonstrated in the other 6 provinces. Nonetheless, incidence fluctuation was revealed in some prefectures and cities, and the occurrence of several focal outbreaks was also recorded. Malaria cases in the preceding 7 provinces/autonomous region totalled 55,896, amounting to 75.6% of the entire number of malaria cases in China. In the middle and eastern parts, apart from the increase in case number due to the expansion of exogenous cases in Hunan, steady diminution of malaria incidence was evidenced in the other 8 provinces/municipality. The reported malaria cases for these areas were 17,819, accounting for 24.1% of the total cases in the country.(ABSTRACT TRUNCATED AT 250 WORDS)

China↗
PubMed2000

Iron chelating agents for treating malaria.

BACKGROUND: Mortality from Plasmodium falciparum malaria remains high; death and sequelae occur in even in patients treated with antimalarial drugs. Researchers are exploring the effects of adding treatments to the main antimalarial regimens in an attempt to reduce mortality. Iron chelation is one potential chemotherapeutic adjuvant treatment. Before advocating adjunctive therapy, the effects of iron chelators in improving patient outcomes needs to be examined. OBJECTIVES: To assess the effects of iron-chelating agents combined with antimalarial drugs, or iron chelators alone, for treating Plasmodium falciparum malaria in adults and children, in relation to mortality, coma recovery time, parasite clearance, and adverse effects. SEARCH STRATEGY: Electronic searches of the Cochrane Library, MEDLINE, and EMBASE, using the standard Cochrane search strategy. Bibliographies of retrieved studies were scrutinized in order to identify further relevant trials. Organisations, experts and other individuals in malaria research were contacted for unpublished studies. SELECTION CRITERIA: All randomised controlled trials of adults or children with P.falciparum malaria. DATA COLLECTION AND ANALYSIS: Trials were identified and extracted by a single reviewer (HS) and checked by a second (MM). Inclusion criteria were applied, and data were extracted independently by both reviewers. Authors were contacted for missing and additional data. Meta-analysis used Relative Risk (RR) and 95% Confidence Intervals. MAIN RESULTS: No evidence of benefit or harm were shown in relation to mortality, but studies were small, and one trial was tending towards more deaths with the intervention when it was stopped. The risk of experiencing persistent seizures was significantly lower with desferrioxamine compared to placebo treatment (RR 0.80, 95% CI 0.67 to 0.95). Many adverse effects were more common in participants treated with desferrioxamine. REVIEWER'S CONCLUSIONS: Trends suggestive of both harm (death) and potential benefit (fewer seizures) are demonstrated in this review. It is not possible to comment on time to event outcomes that include coma recovery or parasitaemia as we are clarifying data with the trialists. Whether to conduct further trials will depend on a judgement about potential benefit.

Adult↗
PubMed2002

Performance appraisal of rapid on-site malaria diagnosis (ICT malaria Pf/Pv test) in relation to human resources at village level in Myanmar.

Logistic, economic and technical factors limit rapid access to microscopic confirmation of symptomatic diagnosis of malaria in many rural areas in endemic countries such as Myanmar. A study was conducted to evaluate a rapid on-site immunochromatographic test (ICT Malaria Pf/Pv) for detection of Plasmodium falciparum and P. vivax in two villages in the Taikkyi region of Myanmar. The ICT Malaria tests were performed by a volunteer health worker (VHW) in Yae-Aye-San village and by a professionally trained midwife (MW) in Kankone village. A total of 1000 symptomatic patients participated in the study by providing blood samples for an ICT test and for microscopy. The ICT performance indices, relative to microscopy, were better for the trained MW compared with the less experienced VHW. For P. falciparum and/or P. vivax infections, the sensitivities were 82.7% for the VHW compared with 93.7% for the MW. For P. falciparum infections, the sensitivities were 82.2% for the VHW and 91.3% for the MW, while the corresponding values for P. vivax infections were 66.7 and 79%, respectively. Although the test kit appeared to perform better in more experienced hands, this study questions whether this difference is related to the use of the ICT Malaria Pf/Pv test kit, or related to other factors such as differences in the quality of blood slides prepared by the VHW and MW for microscopic examination. Overall, the results suggest that a rapid diagnostic assay such as the ICT Malaria Pf/Pv test kit can be used in rural settings by relatively inexperienced persons, such as VHWs, with a reasonable degree of sensitivity, thus providing on-site confirmation of symptomatic diagnosis of malaria.

Animals↗