Individual, household and neighborhood risk factors for malaria in the Democratic Republic of the Congo support new approaches to programmatic intervention

Carrel, Margaret; Kim, Seungwon; Mwandagalirwa, Melchior Kashamuka; Mvuama, Nono; Bala, Joseph A.; Nkalani, Marthe; Kihuma, Georges; Atibu, Joseph; Diallo, Alpha Oumar; Goel, Varun; Thwai, Kyaw L.; Juliano, Jonathan J.; Emch, Michael; Tshefu, Antoinette; Parr, Jonathan B.

doi:10.1016/j.healthplace.2021.102581

Cited by 13 publications

(15 citation statements)

References 73 publications

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“…This has also been reported in previous studies, from both endemic and non-endemic countries and increased risk in family members is likely explained by similar exposure to infective Anopheles mosquitoes. 25 Therefore, testing family members for malaria should be considered around confirmed cases. Interestingly, within the identified family clusters in our study, multiple Plasmodium species were often found, indicating a high concomitant transmission of P. falciparum, P. ovale and P. malariae in refugee camps and other areas of residence in Uganda.…”

Section: Discussionmentioning

confidence: 99%

“…, Sierra Leone (1), Tanzania (16), Zambia (22), Zimbabwe (4), Missing data (1) b Other Sub-Saharan country: Burundi (4), Cameroon (4), CAR (4) Eritrea (27), Eswatini (7), Gambia (6), Ghana (4), Guinea (1), Ivory Coast (2), Kenya (31), Malawi (26), Mali (2), Mauretania (2) Niger (35), Nigeria (11), Senegal (4), Sierra Leone (1), South Africa (4), Tanzania (21), Zambia (40), Missing data (107) c Headache (n=29), stomach-ache (18), cough (8), other (25), confirmed fever ≥38•0°C (3) d Anaemia was defined according to the WHO definition, Haemoglobin <110g/L in ages 0-5 years, <115g/L in ages 5-11 years, <120 g/L in ages 12-14 years, <120 g/L in non-pregnant adult women and <110 g/L in pregnant women, and <130 g/L in men aged >15 years. Severe anaemia was defined as haemoglobin <80g/L, except in children under 5 and during pregnancy when instead <70g/L was the cut-of (25).…”

Section: Discussionmentioning

confidence: 99%

“…Mixed infection consisted of P. falciparum and P. ovale (3), P. falciparum and P. malariae (3), P. vivax and P. malariae (2), P. ovale and P. malariae (1), P. falciparum, P. ovale and P. malariae (2), and P. falciparum, P. vivax, P. ovale and P. malariae (1) b Reported symptoms consisted of cough (3) or body pain (1) in P. ovale, cough (1) or body pain (1) in P. malariae and headache (1) in the mixed Plasmodium infection. c According to WHO, see table 1 for definition(25).…”

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confidence: 99%

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Malaria parasite prevalence in asymptomatic migrants residing in Sweden

Wångdahl

Bogale

Eliasson

et al. 2022

Preprint

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Background Asymptomatic infections with malaria parasites are common in populations in endemic areas. These infections may persist in migrants after arrival in a non-endemic area. Screening to find and clear these infections is generally not implemented in non-endemic countries, despite a potential negative health impact. We performed a study to evaluate the Plasmodium parasite prevalence in migrants living in Sweden. Methods Adults and children born in Sub-Saharan Africa (SSA) were invited in the study between April 2019 and June 2022 at 10 different sites. Rapid diagnostic tests (RDT) and real-time PCR were used to detect malaria parasites. Prevalence and test sensitivity were calculated with 95% confidence intervals (CI). Univariate and multivariable logistic regression were used to evaluate associations with PCR positivity. Findings In total, 789 individuals were screened for Plasmodium spp., of which 71 (9.0%) were detected by PCR and 18 (2.3%) were also RDT positive. A high prevalence was detected in migrants with Uganda as the country of last residence, 53/187 (28.3%), particularly in children, 29/81 (35.8%). Among the PCR positive, 47/71 (66.2%) belonged to families with at least one other member testing positive (OR 43.4 (95% CI 19.0-98.9), and the time lived in Sweden ranged between 6-386 days. Interpretation A high malaria parasite prevalence was found in migrants from SSA, particularly in children. Awareness of asymptomatic malaria infection is needed and screening for malaria in migrants arriving from high endemic countries should be considered. Funding Swedish Research Council, Stockholm County Council and Centre for Clinical Research, Vastmanland, Sweden.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Malaria parasite prevalence in asymptomatic migrants residing in Sweden

Wångdahl

Bogale

Eliasson

et al. 2022

Preprint

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“…The first phase of the cohort was conducted from 2015-2017 [5,6] followed by a second phase conducted from 2018-2022 (the Longitudinal Epidemiological and Entomological Study of Malaria and its Vectors in Kinshasa Province). This cross-sectional sub-study was conducted among samples from individuals during the second phase baseline household visit.…”

Section: Data Source and Study Populationmentioning

confidence: 99%

Impact of malaria diagnostic choice on monitoring ofPlasmodium falciparumprevalence estimates in the Democratic Republic of the Congo and relevance to control programs in high-burden countries

Diallo

Banek

Kashamuka

et al. 2022

Preprint

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Malaria programs rely upon a variety of diagnostic assays, including rapid diagnostic tests (RDTs), microscopy, polymerase chain reaction (PCR), and bead-based immunoassays (BBA), to monitor malaria prevalence and support control and elimination efforts. Data comparing these assays are limited, especially from high-burden countries like the Democratic Republic of the Congo (DRC). Using cross-sectional and routine data, we compared diagnostic performance andPlasmodium falciparum prevalence estimates across health areas of varying transmission intensity to illustrate the relevance of assay performance to malaria control programs. Data and samples were collected between March-June 2018 during a cross-sectional household survey across three health areas with low, moderate, and high transmission intensities within two health zones of Kinshasa province, DRC. Samples from 1,431 participants were evaluated using RDT, microscopy, PCR, and BBA.P. falciparumparasite prevalence varied between diagnostic methods across all health areas, with the highest prevalence estimates observed in Bu (57.4-72.4% across assays), followed by Kimpoko (32.6-53.2%), and Voix du Peuple (3.1-8.4%). Using latent class analysis to compare these diagnostic methods against an “alloyed gold standard,” the most sensitive diagnostic method was BBA in Bu (high prevalence) and Voix du Peuple (low prevalence), while PCR diagnosis was most sensitive in Kimpoko (moderate prevalence). RDTs were consistently the most specific diagnostic method in all health areas. Among 9.0 million people residing in Kinshasa Province in 2018, the estimatedP. falciparum prevalence by microscopy, PCR, and BBA were nearly double that of RDT. Comparison of malaria RDT, microscopy, PCR, and BBA results confirmed differences in sensitivity and specificity that varied by endemicity, with PCR and BBA performing best for detecting anyP. falciparuminfection. Prevalence estimates varied widely depending on assay type for parasite detection. Inherent differences in assay performance should be carefully considered when using community survey and surveillance data to guide policy decisions.

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“…However, in 2010, 200 million school-age children between 5 and 15 years of age were estimated to be at risk of malaria in Africa, compared with 125 million children under five years of age [ 8 ]; thereby highlighting a shortfall in the structure of malaria screening. The school-age group is at high risk for both asymptomatic and symptomatic malaria infections [ 9 , 10 , 11 , 12 , 13 ]. Roughly 97% of the population of DRC lives in stable malaria transmission zones, in which transmission occurs for 8 to 12 months of the year [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

It Is Time to Strengthen the Malaria Control Policy of the Democratic Republic of Congo and Include Schools and School-Age Children in Malaria Control Measures

et al. 2022

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Despite a decade of sustained malaria control, malaria remains a serious public health problem in the Democratic Republic of Congo (DRC). Children under five years of age and school-age children aged 5–15 years remain at high risk of symptomatic and asymptomatic malaria infections. The World Health Organization’s malaria control, elimination, and eradication recommendations are still only partially implemented in DRC. For better malaria control and eventual elimination, the integration of all individuals into the national malaria control programme will strengthen malaria control and elimination strategies in the country. Thus, inclusion of schools and school-age children in DRC malaria control interventions is needed.

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Individual, household and neighborhood risk factors for malaria in the Democratic Republic of the Congo support new approaches to programmatic intervention

Cited by 13 publications

References 73 publications

Malaria parasite prevalence in asymptomatic migrants residing in Sweden

Malaria parasite prevalence in asymptomatic migrants residing in Sweden

Impact of malaria diagnostic choice on monitoring ofPlasmodium falciparumprevalence estimates in the Democratic Republic of the Congo and relevance to control programs in high-burden countries

It Is Time to Strengthen the Malaria Control Policy of the Democratic Republic of Congo and Include Schools and School-Age Children in Malaria Control Measures

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