Bridging the quality gap in diagnosis and treatment of malaria

Ikeda, Daniel J; Gosling, Roly; Eliades, M. James; Chung, Amanda Marr; Murungu, Joseph; Agins, Bruce

doi:10.1136/bmj.m1176

Cited by 6 publications

(7 citation statements)

References 24 publications

(24 reference statements)

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“…But this study primarily focused on facility-level factors due to the lack of data on patient characteristics. Other single-country studies also explored the potential predictors of quality from the perspective of the health system, such as the availability of diagnostic tools, antimalarial medicines, and health workers [ 18 , 19 , 21 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years: findings from 19 sub-Saharan African countries

Liang

Cao

et al. 2023

Infect Dis Poverty

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Background Prompt and appropriate clinical management of malaria is critical for reducing the continued high burden of malaria among children under five years in sub-Saharan countries. However, more remains to be known about how a patient’s socioeconomic status (SES) would affect the access to diagnosis of malaria. Methods In this cross-sectional study using the Demographic and Health Survey and Malaria Indicators Survey, we pooled the data of 38,567 febrile under-five children in 2016–2018 from 19 sub-Saharan countries. Multivariable logistic regression was used to assess the associations between SES and two binary outcomes: the visit to a health facility and a blood test for fever. Stratified analyses were further conducted by the type of health facilities (public hospitals/public primary healthcare facilities/private hospitals/private primary healthcare facilities) for the latter outcome. Results Fifty-eight percent of the febrile children were taken to health facilities, among whom only 55% took blood tests. Compared to children from households in the highest wealth quintile, children in the lowest quintile were less likely to be taken to medical facilities [adjusted odds ratio (aOR) = 0.775, 95% confidence interval (CI): 0.675–0.889]. Parents with more than secondary education were more likely to seek care (aOR = 1.830, 95% CI: 1.561–2.145) and to have blood tests (aOR = 1.729, 95% CI: 1.436–2.082) for their febrile children than parents without formal education. The probabilities of receiving blood tests at public hospitals and public primary healthcare facilities stayed relatively high across parental education levels and wealth quintiles, while these probabilities remained the lowest at private primary healthcare facilities, ranging from 0.100 (95% CI: 0.074–0.127) to 0.139 (95% CI: 0.083–0.194) across parental education levels and from 0.104 (95% CI: 0.078–0.130) to 0.125 (95% CI: 0.090–0.160) across wealth quintiles. Conclusions Significant socioeconomic disparities existed both in the access to health facilities and laboratory diagnosis of malaria in children in sub-Saharan African countries. These disparities were particularly evident in the private sector. Universal health coverage needs to be further strengthened to make formal healthcare in general and the laboratory diagnosis of malaria more accessible and affordable. Graphical abstract

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Section: Introductionmentioning

confidence: 99%

How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years: findings from 19 sub-Saharan African countries

Liang

Cao

et al. 2023

Infect Dis Poverty

View full text Add to dashboard Cite

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“…Drug-based therapy is the mainstream treatment measure. However, the increasing occurrence of antimalarial drug resistance, poor treatment access, and the lack of new antimalarial drugs pose severe challenges to successfully treating malaria. , There is an urgent need to develop new and effective pharmaceutical dosage forms for malaria therapy, particularly for CM treatment …”

Section: Introductionmentioning

confidence: 99%

“…7,8 There is an urgent need to develop new and effective pharmaceutical dosage forms for malaria therapy, particularly for CM treatment. 9 Nanocarriers are versatile tools to improve the pharmacokinetics of effective drugs by delivering drugs specifically to the pharmacological site of action. 10−12 Nanocarriers are increasingly being researched for malaria diagnosis, 13,14 therapeutics, 12 and vaccine formulation, 15 but the exploration of bionic cell membrane nanotechnology to treat malaria has never been reported.…”

Section: ■ Introductionmentioning

confidence: 99%

A Nanodrug Coated with Membrane from Brain Microvascular Endothelial Cells Protects against Experimental Cerebral Malaria

et al. 2021

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Human malaria is a global life-threatening infectious disease. Cerebral malaria (CM) induced by Plasmodium falciparum parasites accounts for 90% of malaria deaths. Treating CM is challenging due to inadequate treatment options and the development of drug resistance. We describe a nanoparticle formulation of the antimalarial drug dihydroartemisinin that is coated in a biomimetic membrane derived from brain microvascular endothelial cells (BMECs) and test its therapeutic efficacy in a mouse model of experimental cerebral malaria (ECM). The membrane-coated nanoparticle drug has a prolonged drug-release profile and enhanced dual targeting killing efficacy toward parasites residing in red blood cells (iRBCs) and iRBCs obstructed in the BMECs (for both rodent and human). In a mice ECM model, the nanodrug protects the brain, liver, and spleen from infection-induced damage and improves the survival rate of mice. This so-called nanodrug offers new insight into engineering nanoparticle-based therapeutics for malaria and other parasitic pathogen infections.

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“…However, when a policy is implemented on a large scale under real-life conditions, the use of observational studies can be suitable and is often the only feasible option to identify both interventional and non-interventional determinants of performance [19]. Recent studies across Africa have suggested a variety of factors associated with health workers' compliance with the test-based management of malaria [8,[22][23][24]. However, these studies were commonly undertaken at a single point in time [8,22], focusing on only one of the outcomes (e.g.…”

Section: Introductionmentioning

confidence: 99%

Determinants of improvement trends in health workers’ compliance with outpatient malaria case-management guidelines at health facilities with available “test and treat” commodities in Kenya

et al. 2021

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Background Health workers’ compliance with outpatient malaria case-management guidelines has been improving in Africa. This study examined the factors associated with the improvements. Methods Data from 11 national, cross-sectional health facility surveys undertaken from 2010–2016 were analysed. Association between 31 determinants and improvement trends in five outpatient compliance outcomes were examined using interactions between each determinant and time in multilevel logistic regression models and reported as an adjusted odds ratio of annual trends (T-aOR). Results Among 9,173 febrile patients seen at 1,208 health facilities and by 1,538 health workers, a higher annual improvement trend in composite “test and treat” performance was associated with malaria endemicity-lake endemic (T-aOR = 1.67 annually; p<0.001) and highland epidemic (T-aOR = 1.35; p<0.001) zones compared to low-risk zone; with facilities stocking rapid diagnostic tests only (T-aOR = 1.49; p<0.001) compared to microscopy only services; with faith-based/non-governmental facilities compared to government-owned (T-aOR = 1.15; p = 0.036); with a daily caseload of >25 febrile patients (T-aOR = 1.46; p = 0.003); and with under-five children compared to older patients (T-aOR = 1.07; p = 0.013). Other factors associated with the improvement trends in the “test and treat” policy components and artemether-lumefantrine administration at the facility included the absence of previous RDT stock-outs, community health workers dispensing drugs, access to malaria case-management and Integrated Management of Childhood Illness (IMCI) guidelines, health workers’ gender, correct health workers’ knowledge about the targeted malaria treatment policy, and patients’ main complaint of fever. The odds of compliance at the baseline were variable for some of the factors. Conclusions Targeting of low malaria risk areas, low caseload facilities, male and government health workers, continuous availability of RDTs, improving health workers’ knowledge about the policy considering age and fever, and dissemination of guidelines might improve compliance with malaria guidelines. For prompt treatment and administration of the first artemether-lumefantrine dose at the facility, task-shifting duties to community health workers can be considered.

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Bridging the quality gap in diagnosis and treatment of malaria

Abstract: Controlling and eliminating malaria will require intensified efforts to improve the quality of diagnosis and treatment argue Daniel Ikeda and colleagues

Cited by 6 publications

References 24 publications

How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years: findings from 19 sub-Saharan African countries

How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years: findings from 19 sub-Saharan African countries

A Nanodrug Coated with Membrane from Brain Microvascular Endothelial Cells Protects against Experimental Cerebral Malaria

Determinants of improvement trends in health workers’ compliance with outpatient malaria case-management guidelines at health facilities with available “test and treat” commodities in Kenya

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