Geographical and temporal variation in reduction of malaria infection among children under five years of age throughout Nigeria

Abstract

BackgroundGlobal progress in reducing malaria has stalled since 2015. Analysis of the situation is particularly needed in Nigeria, the country with by far the largest share of the burden, where approximately a quarter of all cases in the world are estimated to occur.MethodsWe analysed data from three nationwide surveys (Malaria Indicator Surveys in 2010 and 2015, and a National Demographic and Health Survey in 2018), with malaria parasite prevalence in children under five years of age determined by sampling from all 36 states of Nigeria, and blood slide microscopy performed in the same accredited laboratory for all samples. Changes over time were evaluated by calculating prevalence ratio (PR) values with 95% confidence intervals (CI) for each state, together with Mantel-Haenszel adjusted prevalence ratios (PRadj) for each of the six major geopolitical zones of the country.ResultsBetween 2010 and 2018 there were significant reductions in parasite prevalence in 25 states, but not in the remaining 11 states. Prevalence decreased most in southern zones of the country (South West PRadj = 0.53; South East PRadj = 0.59; South South PRadj = 0.51) and the North Central zone (PRadj = 0.36). Changes in the north were less marked, but were significant and indicated overall reductions by more than 20% (North West PRadj = 0.74; North East PRadj = 0.76). Changes in the south occurred mostly between 2010 and 2015, whereas those in the north were more gradual and most continued after 2015. Recent changes were not correlated with survey-reported variation in use of preventive measures.ConclusionReductions in malaria infection in children under five have occurred in most individual states in Nigeria since 2010, but substantial geographical variation in the timing and extent indicate challenges to be overcome to enable global malaria reduction.

Detection of Malaria Parasite Protein in Urine of Patients with Acute Uncomplicated Malaria Using Rapid Diagnostic Test Kits

“…Previous studies have described the detection of parasite biomarkers, Plasmodium falciparum histidine-rich protein II, and Plasmodium Lactate dehydrogenase in patients' saliva with varying degrees of sensitivity using enzyme immunoassays, rapid diagnostic test kits, or molecular tools [12,15,16]. In addition, the possibility of excretion of malarial antigens and antibodies into the urine during malaria infection has been described [9], and Plasmodium falciparum histidine-rich protein II has been confirmed in urine samples of patients with acute uncomplicated malaria using Urine Malaria Test™ [17,18] and QDx™ rapid malaria test [19]. Unfortunately, the sensitivity of detection of P. falciparum histidine-rich protein II in urine with different optimization strategies was low in the reported studies [17][18][19].…”

“…In addition, the possibility of excretion of malarial antigens and antibodies into the urine during malaria infection has been described [9], and Plasmodium falciparum histidine-rich protein II has been confirmed in urine samples of patients with acute uncomplicated malaria using Urine Malaria Test™ [17,18] and QDx™ rapid malaria test [19]. Unfortunately, the sensitivity of detection of P. falciparum histidine-rich protein II in urine with different optimization strategies was low in the reported studies [17][18][19]. More studies are still required to provide high-quality surveillance data for decision-making on the eligibility of urine as a non-invasive malaria diagnostic technique.…”