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        <title>Frontiers in Malaria | Case Management section | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/malaria/sections/case-management</link>
        <description>RSS Feed for Case Management section in the Frontiers in Malaria journal | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-05-08T20:11:34.350+00:00</pubDate>
        <ttl>60</ttl>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2025.1667330</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2025.1667330</link>
        <title><![CDATA[Genomic dynamics of clinical Plasmodium vivax: comparative genomic hybridization in severe malaria cases]]></title>
        <pubdate>2025-11-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Sampreeti Tahbildar</author><author>Pon Arunachalam Boopathi</author><author>Sanjay Kumar Kochar</author><author>Dhanpat Kumar Kochar</author><author>Mohamed Aiyaz</author><author>Raja C. Mugasimangalam</author><author>Sudha N. Rao</author><author>Ashis Das</author>
        <description><![CDATA[BackgroundCopy number variations (CNVs) in the Plasmodium vivax genome can influence key parasite traits such as erythrocyte invasion, immune evasion, drug resistance, and survival in the human host. Their potential role in severe manifestations of P. vivax malaria, such as cerebral malaria (CM) remains underexplored. In regions like India, where P. vivax is endemic, understanding genomic factors that contribute to disease severity is crucial. Given the limited understanding of genomic factors contributing to disease severity in P. vivax, this study aims to investigate genome-wide CNVs in clinical isolates from patients with cerebral and uncomplicated malaria.MethodsWe employed a high-resolution, custom-designed 2 × 400K tiling microarray for array-based comparative genomic hybridization (aCGH), using probes with an average spacing of 56 base pairs covering the entire P. vivax genome. Genomic DNA from cerebral malaria isolates was differentially labeled and hybridized against reference DNA from uncomplicated malaria isolates. CNVs were inferred based on fluorescence intensity ratios, indicating chromosomal regions with copy number gains or losses.ResultsUtilizing probes based on the P. vivax Sal-1 reference genome, we detected significant CNVs across all 14 chromosomes, affecting 2,138 genes. CNVs ranged from 100 bp to approximately 1,429 kb in cerebral malaria isolates compared to uncomplicated cases. Altered regions having gains or losses included genes encoding surface antigens such as 6-cysteine proteins, tryptophan-rich antigens (TRAGs), serine-repeat antigen (SERA), apical membrane antigen (AMA), as well as drug resistance markers. The most extensive CNV spanned ~1,450 kb on chromosome 12. CNVs were also observed in intergenic regions, suggesting potential regulatory impacts.DiscussionThis study identifies CNVs in the genome of P. vivax isolates from cerebral malaria cases, in genes involved in immune evasion, drug resistance, and host-pathogen interactions. Although the precise impact of these CNVs on disease severity remains unclear, the findings highlight genetic differences between isolates from severe and uncomplicated malaria cases, including variations in intergenic regions. These findings emphasize the need to further investigate CNVs that may contribute to P. vivax pathogenesis and resistance. A deeper understanding of these variations could aid in identifying biomarkers for severe disease and support the development of more effective malaria control and treatment strategies.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2025.1604498</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2025.1604498</link>
        <title><![CDATA[Efficacy of low-dose primaquine plus artemether-lumefantrine or dihydroartemisinin-piperaquine for radical cure of Plasmodium vivax in the Solomon Islands: a randomised clinical trial]]></title>
        <pubdate>2025-10-03T00:00:00Z</pubdate>
        <category>Clinical Trial</category>
        <author>Robert James</author><author>Thomas Obadia</author><author>Lyndes Wini</author><author>Albino Bobogare</author><author>Sarah Charnaud</author><author>Shazia Ruybal-Pesántez</author><author>Caitlin Bourke</author><author>Jacob E. Munro</author><author>Brioni R. Moore</author><author>Madhu Page-Sharp</author><author>Laurens Manning</author><author>Urijah Liligeto</author><author>Sophie G. Zaloumis</author><author>J. Kevin Baird</author><author>Harin Karunajeewa</author><author>Ivo Mueller</author>
        <description><![CDATA[BackgroundPrimaquine (PQ) remains the only 8-aminoquinoline endorsed by the WHO for treatment of latent Plasmodium vivax liver-stage parasites. PQ is a prodrug, with metabolism and therapeutic activity influenced by inherent human CYP2D6 polymorphisms and by poorly understood interactions with variably co-administered blood schizontocidal therapies. With widespread chloroquine resistance in P. vivax, radical cure now requires use of one of several artemisinin-based combination therapies (ACTs).MethodsFrom September 2017 to February 2019, a randomised clinical trial was conducted in Guadalcanal, Solomon Islands, to evaluate the safety and efficacy of PQ (0·25 mg/kg/day × 14 days) given concurrently with standard doses of either dihydroartemisinin–piperaquine (DP) or artemether–lumefantrine (AL). A relapse control arm received AL without PQ. The 384 enrolled subjects were followed for 180 days to assess efficacy against relapse, along with CYP2D6 genotyping, methaemoglobin monitoring, and measurement of PQ absorption and metabolism.ResultsBoth PQ treatment arms had significantly reduced rates of current P. vivax parasitamiea (PQ-AL: HR=0·50, CI95[0·33–0·75], PQ-DP: HR=0·34, CI95[0·22–0·52] P < 0·001) relative to no PQ. However, neither regimen provided adequate clinical efficacy (PQ-AL: 43·7%, PQ-DP: 34·1%). No significant differences were observed between PQ-AL and PQ-DP in CYP2D6 genotype-predicted activity scores, methaemoglobin levels, or concentrations of PQ and its metabolites (5,6-OQ and CPQ) on day 7 post-initation of dosing.ConclusionsThe dose of PQ administered in this study appears equally inadequate when used in combination with either DP or AL for radical cure. Higher PQ doses are required for effective radical cure in the Western Pacific, where PQ-tolerant Chesson-like strains still appear to commonly occur.Clinical trial registrationhttps://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372150, identifier ANZCTR 12617000329369, Universal Trial Number (UTN) U1111-1191-4968.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2025.1582682</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2025.1582682</link>
        <title><![CDATA[Knowledge, beliefs and adherence to antimalarial medications among patients in the Ga East Municipality of Ghana]]></title>
        <pubdate>2025-08-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Michelle Akua Amoako</author><author>Victor Collins Wutor</author><author>Benoit Banga N’guessan</author>
        <description><![CDATA[Treatment adherence is necessary for several reasons, including preventing the development of resistance and avoiding progression to a severe form of the disease. This study explored patients’ beliefs and their impact on adherence to antimalarial medications (orthodox and herbal medicines). A cross-sectional survey was conducted over three weeks in the Ga East Municipal District of Ghana. The study involved 346 participants and employed comprehensive questionnaires to gather data, which was analyzed using STATA version 14. Despite the high prevalence of malaria in the district, adherence to antimalarial medication remained a challenge. The study revealed varying opinions among participants regarding the safety and efficacy of different antimalarial treatments. The research highlighted the connection between patients’ beliefs, age, knowledge, and adherence. Younger individuals showed higher adherence rates, emphasizing the need for age-specific interventions. Comprehensive knowledge also correlated with better adherence, highlighting the role of education. The study recommended the development of tailored educational campaigns that address misconceptions and foster trust between healthcare providers and patients. Innovative interventions, such as mobile phone-based reminders and incentives, were suggested to improve adherence. The research emphasized the importance of holistic malaria prevention strategies, including robust educational initiatives, targeted interventions in hotspot districts, and widespread distribution of insecticide-treated nets. The study’s insights offer actionable recommendations to enhance malaria control efforts in the Ga East Municipal District and beyond.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2025.1460491</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2025.1460491</link>
        <title><![CDATA[Dynamic shift of malaria cases in northwest Ethiopia: a 10-year retrospective cohort data analysis from 2012 to 2021]]></title>
        <pubdate>2025-07-25T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Aberham Abere</author><author>Solomon Ayalew</author><author>Bealemlay Wondale</author><author>Fentahun Tigabu</author><author>Nigus Gizachew</author><author>Takele Tesfaye</author><author>Getnet Ayalew</author><author>Banchamlak Tegegne</author><author>Mulat Yimer Melaku</author><author>Yibeltal Aschale</author><author>Adane Tilahun</author><author>Mebratu Tamir</author><author>Fentahun Megabiaw</author><author>Tegegne Eshetu</author><author>Adane Derso</author>
        <description><![CDATA[BackgroundDespite the WHO’s extensive efforts to eliminate malaria from sub-Saharan Africa, including Ethiopia, it remains the most serious public health issue, with seasonal variations and high mortality. This study aimed to assess the 10-year trend in the prevalence of malaria in northwest Ethiopia.MethodsA retrospective study was carried out at the Maraki Health Center, northwest Ethiopia. Blood film results from a 10-year period (from January 2012 to December 2021) were recorded using a data extraction sheet, with data sourced from a laboratory logbook. The 10-year trend of malaria incidence was observed by year, month, and season, with respect to age and gender. The species distribution of the causative agents was determined in the study area.ResultsOver 10 years, 15,978 blood films were requested for malaria diagnosis, and 57.5% were from male respondents. Approximately 68.0% of the respondents were under the age group of 15 years old. The mean prevalence rate of malaria was 25.2% (n = 4,019) (95% CI: 23.83–26.59). The highest peaks of total malaria cases were observed in 2012 and October, whereas the lowest peaks were observed in 2016 and April (mean annual case = 401.9). Plasmodium falciparum was the dominant malaria species throughout the 10-year study period. The highest and lowest Plasmodium vivax counts were observed in 2012 and 2018, respectively.ConclusionThe study revealed a drop in annual transmission rates in 2016–2017; however, to date, there has been a gradual rise. Moreover, shifts in the predominant malaria species were observed in 2012, 2014, and 2015, with P. falciparum as the dominant species. Sustained efforts are still essential to decrease the transmission of malaria to a level where it no longer threatens public health.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2025.1596496</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2025.1596496</link>
        <title><![CDATA[Prevalence of Plasmodium falciparum infection in school-aged children in urban and peri-urban schools of Bamako, Mali]]></title>
        <pubdate>2025-06-27T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Mahamoudou Toure</author><author>Fousseyni Kane</author><author>Daouda Sanogo</author><author>Soumba Keita</author><author>Bourama Keita</author><author>Abdoul Zamilou Aro</author><author>Moussa Keita</author><author>Drissa Konate</author><author>Sory I. Diawara</author><author>Alpha S. Yaro</author><author>Aissata Kone</author><author>Mahamadou Magassa</author><author>Salim Kante</author><author>Cheick O. Tangara</author><author>Karamoko Tangara</author><author>Hamady Coulibaly</author><author>Bourema Cisse</author><author>Sidibe M’Baye Thiam</author><author>Amadou S. Traore</author><author>Jeffrey G. Shaffer</author><author>Nafomon Sogoba</author><author>Mahamadou Diakite</author><author>Seydou Doumbia</author>
        <description><![CDATA[BackgroundUrban malaria is an increasing public health issue for Africans in cities experiencing rapid demographic growth. School children bear the high burden of malaria, which affects their health and education; however, they are not covered by control strategies such as seasonal malaria chemoprevention. This study aims to evaluate the school-based prevalence of Plasmodium falciparum infection to inform targeted malaria control strategies in urban and peri-urban settings of Bamako, Mali.MethodsThe city of Bamako in Mali was divided into four ecological strata based on the risk for malaria transmission using GIS tools (urban center, high altitude, riverside, and peripheral neighborhoods). Within each stratum, three schools close to the community health center were chosen to randomly select 200 to 230 children aged 6 to 13 years old per school to collect information on malaria risk factors and test for P. falciparum infection using malaria rapid diagnostic tests (mRTDs) and microscopy.ResultsOverall, the prevalence of P. falciparum infection varied from 0% to 15.5% between study sites. Travel history and fever were not associated with an increased risk of infection (p > 0.05). The odds of malaria infection increased by 2.4 among children with anemia (OR = 2.38, 95% CI = 1.57, 3.61) and 3.8 among children living in an urban site along the Niger River (OR = 3.37, 95% CI = 2.05, 7.45).ConclusionThis study shows significant spatial variation of P. falciparum infection within Bamako urban settings. The results suggest that, as in rural villages of Mali, school-aged children should be considered a major malaria parasite reservoir in the urban settings of Bamako. Interventions targeting this specific age group could reduce the malaria burden in this area.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2025.1557371</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2025.1557371</link>
        <title><![CDATA[Targeting mucosal immunity in malaria control: the underexplored role of IgA]]></title>
        <pubdate>2025-06-25T00:00:00Z</pubdate>
        <category>Mini Review</category>
        <author>Haruna Muwonge</author><author>Isaac Ssewanyana</author><author>Adoke Yeka</author><author>Pauline Byakika-Kibwika</author>
        <description><![CDATA[Malaria remains a global health crisis, causing an estimated 263 million cases and 597,000 deaths in 2023. Current measures—including insecticide-treated nets, ACTs, and the RTS,S vaccine—have stalled in reducing mortality, highlighting the need for novel strategies. While studies IgG and IgM have dominated malaria immunology research, recent data reveal a broader role for Immunoglobulin A (IgA). Evidence suggests that IgA can block parasite entry, activate complement, and modulate inflammation, although its protective efficacy has yet to be established. This review synthesizes the emerging literature on sporozoite- and merozoite-specific IgA responses, examines how IgA arises in a “non-mucosal” infection like malaria, and explores vaccine platforms-oral, nasal, or prime-boost-that might harness IgA alongside IgG. We also identify critical gaps in correlating IgA levels with clinical immunity, emphasizing the need for specialized animal models and longitudinal human cohorts. Ultimately, leveraging IgA-driven mucosal immunity could significantly reinforce existing malaria interventions by preventing parasite establishment at mucosal or skin interfaces. By uniting mucosal and systemic immunity, research on IgA-based vaccines promises a next-generation approach to reducing malaria transmission, thereby creating a path towards global eradication.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2025.1497613</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2025.1497613</link>
        <title><![CDATA[Quantification of Plasmodium falciparum: validation of quantitative polymerase chain reaction assays for detection of parasites in controlled human malaria infection studies]]></title>
        <pubdate>2025-04-09T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Elizabeth Kibwana</author><author>Domtila Kimani</author><author>Nick J. Edwards</author><author>Kelvias Keter</author><author>Agnes Mutiso</author><author>Lydia Nyamako</author><author>Rose Gatheru</author><author>Adrian V. S. Hill</author><author>Philip Bejon</author><author>Katie J. Ewer</author><author>Melissa C. Kapulu</author>
        <description><![CDATA[BackgroundControlled human malaria infection (CHMI) studies are considered a powerful tool for assessing the efficacy of malaria vaccines and investigating immunity against infection. The monitoring of infection has historically been carried out by microscopy and/or more recently sensitive quantitative polymerase chain reaction (qPCR) based on the 18S ribosomal RNA (rRNA) gene. Here we describe the validation of a molecular assay previously developed to quantify malaria parasites in CHMI.MethodsWe used primers and probes for the 18S rRNA Plasmodium falciparum gene. The validation of the assay was performed using cultured 3D7 parasites to generate standards of known quantities of parasites. We determined the specificity, accuracy, precision, lower limit of detection, linearity, and robustness. We also evaluated the effect of using different volumes of whole blood for DNA extraction on the assay performance.ResultsThe validation revealed: (1) specificity of 100% (n=5 independent experiments); (2) linearity with R2 values ≥ 0.98, a slope of −3.8 to −3.1, and efficiency 89–100%; (3) lower limit of detection of 0.3 parasites/microliter and lower limit of quantification of 2.6 parasites/microliter; (4) precision with both inter-assay repeatability and intra-assay reproducibility with coefficients of variation (CV) values of <10%; and (5) accuracy and good extraction efficiency of >90%. The use of large blood volumes for extraction had an adverse effect on precision.ConclusionWe show that this qPCR method for P. falciparum parasite quantification from whole blood is specific, precise, sensitive, accurate, and robust. However, our whole blood qPCR method is not suitable when DNA extraction is from large blood volumes, where using a larger extraction volume of 1000 µl has a considerable effect on the robustness, reproducibility, and repeatability of qPCR, highlighting the importance of standardized protocols in DNA extraction. Other qPCR methods should be considered where high volumes of blood are required.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2025.1544378</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2025.1544378</link>
        <title><![CDATA[Primaquine-induced hemoglobinuria: a case report of a G6PD deficient malaria patient with Mahidol trait from Bandarban, Bangladesh]]></title>
        <pubdate>2025-03-28T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Md Fahad Zamil</author><author>Ching Swe Phru</author><author>Anamul Hasan</author><author>Afrida Tabassum Trina</author><author>Mohammad Shahbaz</author><author>Shahrear Tanvir Ahmed</author><author>Mohammad Sharif Hossain</author><author>Mohammad Shafiul Alam</author>
        <description><![CDATA[We report a case of Primaquine (PQ) induced hemoglobinuria in a patient with the glucose-6-phosphate dehydrogenase (G6PD) Mahidol variant from Bandarban, Bangladesh. The patient presented with mixed Plasmodium falciparum and Plasmodium vivax malaria and was recommended to be treated according to national guidelines with Artemether-Lumefantrine for three days and PQ for 14 days. Ten days later, the patient developed a fever and jaundice, followed by hemoglobinuria twelve days after the initial diagnosis. This highlighted the need for G6PD testing, which was subsequently confirmed by both Point-of-Care (POC) testing and spectrophotometry. The POC test showed a G6PD activity of 2.6 IU/g Hb, while spectrophotometry measured 1.47 IU/g Hb, both indicating G6PD deficiency (<30% activity). As a result, PQ was discontinued, and the patient received four units of blood transfusion. Additionally, genotyping was carried out, confirming the Mahidol variant. This case highlights the importance of routine G6PD screening before PQ administration, especially in malaria-endemic regions with different G6PD variants.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2025.1518778</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2025.1518778</link>
        <title><![CDATA[Malaria case management over 15 years (2006–2021) in Jakiri North-West Region Cameroon]]></title>
        <pubdate>2025-02-25T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ndong Henry Ndang</author><author>Njodzela Christian Mengnjo</author><author>Palmer Masumbe Netongo</author><author>Olajoju Temidayo Soniran</author><author>Chuo Ennestine Chu</author><author>Eugene Chiabi</author><author>Alfred Amambua-Ngwa</author><author>Ndong Ignatius Cheng</author>
        <description><![CDATA[BackgroundMalaria remains a serious health challenge; thus, the need for continual improvements in treatment regimens and the adoption of new treatment guidelines to enhance case management is vital. We report trends in malaria case management over 15 years at the Jakiri Health Centre in Cameroon, an area that has been plagued with civil unrest since 2016.MethodsData were collected retrospectively from consultation, laboratory, antenatal care (ANC) and prescription registers, and double entered into Excel. Analysis was conducted using SPSS statistics and Microsoft Excel.ResultsA total of 3,800 febrile patients visited the outpatient department (OPD), and patients received 8,324 prescriptions. Of these, 11.6% (964/8324) were anti-malarials, 3.5% (291/8324) were ferrous sulfate (FS), 40.8% (3,396/8324) were antibiotics (AB), and 44.1% (3,673/8324) were analgesics. The antimalarials prescribed were artemisinin-based combination therapies (ACTs) 83.2% (802/964) and quinine (Q) 16.8% (162/964). No ACTs were prescribed between 2006 and 2011. The 5 to <15 years age group received the most proportion of ACTs 42.3% (189/447), followed by the 1 to <5 years age group 31.8% (127/399). Males were more likely to be prescribed ACTs than females were (OR= 1.336, 95% CI 1.141–1.564; p<0.0001). Between 2006 and 2013, the number of quinine prescriptions increased from 17.2% (21/122) in 2006 to a peak of 26.1% (30/115) in 2009. Antibiotic prescription rates were high across all age groups. The prescription of antimalarials to malaria-negative patients was relatively low over time. ACTs were prescribed to all participants attending the ANC who were confirmed malaria-positive. 97.7% of SP was prescribed as intermittent preventive treatment in pregnancy (IPTp) with highest prescription rates observed among women in their third trimester 96.2% (76/79).ConclusionThis study demonstrated that recommended malaria treatment guidelines have been adopted by the Jakiri Health Centre, which has transitioned from quinine as a first-line treatment to ACTs. ACTs were not used in the facility until 2012. Though anti-malaria prescription was largely appropriate, antibiotics and analgesics were highly over prescribed. There is great need for continuous monitoring and refresher training for health workers to enforce adherence to the guidelines.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2025.1336324</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2025.1336324</link>
        <title><![CDATA[Malaria “chemoprevention and vaccination strategies” for children living in endemic areas of Africa: a review]]></title>
        <pubdate>2025-02-24T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Winnie Nambatya</author><author>Moses Ocan</author><author>Bjarne Robberstad</author><author>Jane Achan</author><author>Richard Idro</author>
        <description><![CDATA[There has been significant progress in malaria prevention over the past 20 years, but the impact of current interventions may have peaked and in moderate to high malaria transmission areas, the earlier gains either have since stalled or reversed. Newer and more innovative strategies are urgently needed. These may include different chemoprevention strategies, vaccines, and injectable forms of long-acting antimalarial drugs used in combination with other interventions. In this paper, we describe the different chemoprevention strategies; their efficacy, cost-effectiveness, uptake, potential impact, and contextual factors that may impact implementation. We also assess their effectiveness in reducing the malaria burden and emerging concerns with uptake, drug resistance, stock-outs, funding, and equity and suggestions to improve application.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2025.1545825</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2025.1545825</link>
        <title><![CDATA[High rate of false positive malaria rapid diagnostic tests in a district hospital in Uganda]]></title>
        <pubdate>2025-01-31T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Susanne E. Mortazavi</author><author>Allan Lugaajju</author><author>Anna-Clara Ivarsson</author><author>Sara Karlsson Söbirk</author><author>Hans Norrgren</author><author>Kristina E. M. Persson</author>
        <description><![CDATA[BackgroundMalaria remains a significant health burden, particularly in Uganda, which has one of the highest incidence rates globally. Rapid diagnostic tests (RDTs) are widely used for malaria diagnosis due to their ease of use and affordability in resource-limited settings. However, false-positive RDT results may lead to unnecessary antimalarial treatments and missed diagnoses of other febrile conditions. This study aimed to evaluate the diagnostic accuracy of RDT compared to microscopy and loop-mediated isothermal amplification (LAMP) in a malaria-endemic region of Uganda.MethodsA prospective study was conducted with 225 febrile individuals diagnosed with malaria using RightSign Malaria Ag HRPII/Pan Plasmodium Aldolase RDT (Hangzhou Biotest Biotech Co., Ltd., China) at Iganga General Hospital, Uganda. Blood samples were analyzed using microscopy and LAMP. Demographic information, malaria history, and parasitemia levels were also recorded.ResultsAmong the RDT-positive participants, 48% tested negative by microscopy, and 45% of these were also negative by LAMP, indicating that 20% of all RDT-positive individuals were likely false positives. Overall, 66% (149/225) of RDT-positive cases were confirmed as true positives.ConclusionsThis study identified a high rate of false positives with the tested RDT, risking inappropriate treatment and missed diagnoses of other illnesses. It is essential that healthcare facilities use RDTs validated and recommended by the World Health Organization (WHO) to ensure high specificity and accuracy, particularly in resource-limited settings where alternative diagnostic methods may not be available.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2025.1519846</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2025.1519846</link>
        <title><![CDATA[Parasitological and clinical correlates of Plasmodium–Schistosoma mansoni co-infection and its determinants among Plasmodium-infected patients in the Wolaita Zone, South Ethiopia regional state]]></title>
        <pubdate>2025-01-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Kemal Mohamed</author><author>Tariku Belay</author><author>Ahmed Zeynudin</author>
        <description><![CDATA[BackgroundMalaria and schistosomiasis are among the most important parasitic diseases with overlapping geographical distribution in Ethiopia. The objective of this study, therefore, was to assess parasitological and clinical correlates and determinants of co-infection among malaria patients.MethodsA health facility-based comparative cross-sectional study was conducted among malaria patients attending public health facilities in Damot Woyide district, Wolaita zone, South Ethiopia regional state, from December 2020 to June 2021. A total of 246 (123 Plasmodium-only and 123 Plasmodium–Schistosoma mansoni co-infected) study participants were sampled consecutively. A pre-tested structured questionnaire was used to collect data on demographic and risk factors. Detection and quantification of Schistosoma mansoni ova and malaria parasites were done with the Kato–Katz technique and blood film, respectively. Determination of hematological and biochemical parameters was done by the aLCose®HemoGo test system and the Cobas C 311 chemistry analyzer, respectively.ResultsThe prevalence of Plasmodium–Schistosoma mansoni co-infection was 18.2%. Plasmodium–Schistosoma mansoni co-infected with a heavy intensity of Schistosoma mansoni had the highest parasitemia and was also significantly associated with malaria attack. In addition, anemia was associated with the presence of Plasmodium–Schistosoma mansoni co-infection. Schistosoma mansoni co-infection among malaria patients significantly increased mean Plasmodium density, serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, alkaline phosphatase, direct bilirubin, and total protein. Hemoglobin and hematocrit were significantly lower among co-infected individuals. On multivariate analysis, being male (AOR=3.03, CI: 1.56-5.91,p=0.001), being in the 6-15 years age group (AOR = 5.85, CI: 2.45–13.93,p=0.00), the presence of stream (AOR = 4.1, CI: 1.65–10.15,p=0.002), having a water body distance of less than 1,000 m (AOR=2.33, CI: 1.23–4.41,p=0.009), and presence of irrigation practice (AOR= 3.24, CI: 1.69–6.18,p=0.00) were found to be significant risk factors of co-infection.ConclusionMalaria attack and level of parasitemia were associated with the intensity of concurrent Schistosoma mansoni infection. Co-infection results in the change of Plasmodium density, hematological, and biochemical parameters in malaria patients.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2024.1469790</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2024.1469790</link>
        <title><![CDATA[Factors affecting treatment delays among malaria patients presenting at health facilities in Guinea, 2022–2023]]></title>
        <pubdate>2024-11-12T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Elhadj Marouf Diallo</author><author>Karifa Kourouma</author><author>Nouman Diakite</author><author>Abdourahamane Diallo</author><author>Marie Blanquet</author><author>Abdoulaye Toure</author><author>Laurent Gerbaud</author><author>Alioune Camara</author>
        <description><![CDATA[BackgroundEarly identification and management of cases are key for controlling and eliminating malaria. This study aimed to assess the factors associated with the delay malaria treatment in Guinea.MethodsCross-sectional study was conducted at 60 health facilities in eight administrative regions from December 2022 to March 2023. Patients with a diagnosis of malaria through either microscopy or a rapid diagnostic test (RDT), were interviewed using a standardized questionnaire. Treatment delays were defined as seeking care 48 hours after the onset of symptoms. Logistic regression was performed to assess factors associated with treatment delay. Adjusted odds ratio (OR) and confidence interval (CI) were used to explain the associated factors.Results3,300 malaria patients were included and the findings showed a median time of symptoms onset and access of malaria treatment was 3.04 days. Alarmingly, only 800 (24.24%) of all cases sought and received treatment within 48 hours of symptom onset. The multivariate logistic regression indicated that children under 5 years of age who attempted self-medication for fever were 4.32 times more likely to experience a delay in treatment than those who sought immediate medical care in health facilities (OR:4.32, 95% CI: 2.96–6.36). Children whose parents had no formal education were 3.05 times more likely to experience a delay in treatment (OR:3.05, 95% CI: 1.66–5.60). Moreover, when the disease was considered non-severe the first time by caregivers, OR = 1.71 (95% CI: 1.26–2.33). For those 5 years old and above, using university hospital OR = 4.01, (95% CI: 2.01–8.44), living in Forest Guinea OR = 3.14, (95% CI 1.93–5.10) and Middle Guinea OR = 1.46 (95% CI: 1.09–1.95) were more likely to experience delay treatment.ConclusionsThe proportion of malaria patients with treatment within 48 is low, significantly falling short of the national targets. This substantial delay in treatment was attributed to factors such the lack of formal education, self-medication practices, and failure to recognize the illness severity. These findings underscore the urgent need for NMCP to enhance awareness regarding the importance of early presentation at health facilities, with targeted interventions.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2024.1362585</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2024.1362585</link>
        <title><![CDATA[Agreement between serological data on schoolchildren and the number of malaria cases in the remaining high-burden villages of Indonesia]]></title>
        <pubdate>2024-06-20T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Ayleen Kosasih</author><author>Retno Ayu Setya Utami</author><author>Rintis Noviyanti</author><author>Iqbal R. F. Elyazar</author><author>Karina Dian Lestari</author><author>Valentinus Seran Raimanus</author><author>Rhea J. Longley</author><author>J. Kevin Baird</author><author>Leanne J. Robinson</author><author>Inge Sutanto</author><author>Ivo Mueller</author>
        <description><![CDATA[IntroductionIn areas where malaria transmission has been successfully reduced, surveillance based solely on clinical cases becomes increasingly challenging. Antibodies generated by the host in response to malaria infections may persist in the circulation for several months or longer. We assessed a serological surveillance tool to measure malaria transmission in eastern Indonesia where reported cases have been recently declining.MethodsIn June 2021, we conducted a cross-sectional survey of elementary schoolchildren aged 5 to 14 years residing in six villages in an endemic area of West Timor, Indonesia. Annual Parasite Incidence (API, cases/1,000 residents/year) of these villages ranged from 0.0 to 4.1 in 2021. Finger-prick plasma samples were tested using a multiplexed Luminex MAGPIX® bead array system to measure IgG antibodies against a panel of 8 Plasmodium vivax antigens. Using a random forest classification algorithm, individuals with predicted exposure to P. vivax in the prior 9 months were identified.Results15 of 398 (4%) schoolchildren were seropositive for recent P. vivax exposure. Remarkably, 87% (13/15) of seropositive children were from one village, the one with the highest API (4.1). In contrast, one seropositive child was from a village with an API of 1.3, and another from a village with an API of 0.0.ConclusionOur serological survey data confirms the reported malaria cases from PHC in the villages with likely ongoing transmission. Malaria programs may consider Lamea as the target for intervention.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2024.1250220</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2024.1250220</link>
        <title><![CDATA[Metrics to guide development of machine learning algorithms for malaria diagnosis]]></title>
        <pubdate>2024-04-17T00:00:00Z</pubdate>
        <category>Methods</category>
        <author>Charles B. Delahunt</author><author>Noni Gachuhi</author><author>Matthew P. Horning</author>
        <description><![CDATA[Automated malaria diagnosis is a difficult but high-value target for machine learning (ML), and effective algorithms could save many thousands of children’s lives. However, current ML efforts largely neglect crucial use case constraints and are thus not clinically useful. Two factors in particular are crucial to developing algorithms translatable to clinical field settings: (i) clear understanding of the clinical needs that ML solutions must accommodate; and (ii) task-relevant metrics for guiding and evaluating ML models. Neglect of these factors has seriously hampered past ML work on malaria, because the resulting algorithms do not align with clinical needs. In this paper we address these two issues in the context of automated malaria diagnosis via microscopy on Giemsa-stained blood films. The intended audience are ML researchers as well as anyone evaluating the performance of ML models for malaria. First, we describe why domain expertise is crucial to effectively apply ML to malaria, and list technical documents and other resources that provide this domain knowledge. Second, we detail performance metrics tailored to the clinical requirements of malaria diagnosis, to guide development of ML models and evaluate model performance through the lens of clinical needs (versus a generic ML lens). We highlight the importance of a patient-level perspective, interpatient variability, false positive rates, limit of detection, and different types of error. We also discuss reasons why ROC curves, AUC, and F1, as commonly used in ML work, are poorly suited to this context. These findings also apply to other diseases involving parasite loads, including neglected tropical diseases (NTDs) such as schistosomiasis.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2024.1340276</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2024.1340276</link>
        <title><![CDATA[Supplementing routine hospital surveillance of malaria to capture excess mortality and epidemiological trends: a five-year observational study]]></title>
        <pubdate>2024-04-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jean-Bertin Bukasa Kabuya</author><author>Caitlin Bond</author><author>Manuela Hauser</author><author>Jay Sikalima</author><author>Bruce Phiri</author><author>Dickson Phiri</author><author>Japhet Matoba</author><author>Jayme Hughes</author><author>Proscovia Miiye Banda</author><author>James Sichivula Lupiya</author><author>Gershom Chongwe</author><author>Philip E. Thuma</author><author>William J. Moss</author><author>Matthew M. Ippolito</author>
        <description><![CDATA[IntroductionMalaria surveillance in Africa is conducted largely through health facility-based health management information systems (HMIS) which provide aggregated data to malaria control programs. Supplementation of HMIS surveillance with other routinely collected hospital data can provide vital statistics on malaria control in regions of high burden.MethodsTo assess the utility of supplementing HMIS data, we implemented a pilot program of enhanced malaria surveillance in a district hospital in northern Zambia over a five-year period. Data were tabulated from existing nursing records, central pharmacy inventories, laboratory logbooks, and ward registers and cross-referenced with routinely collected HMIS data.ResultsThe additional data collections captured excess malaria deaths resulting from pharmacy and blood bank stockouts (10.3 excess deaths/year) and revealed small but significant changes over time in the age distribution of patients that likely reflect underlying shifts in the local epidemiology due to malaria control programming or other factors (median age from 1.9 to 2.4 months old, P=0.001).DiscussionReadily available data can supplement existing HMIS surveillance in high malaria burden areas to provide actionable information about the local epidemiology and impacts of control efforts. Excess malaria deaths due to health systems factors can be feasibly captured and tracked and fed back to national malaria control programs and the World Health Organization to present a fuller picture of malaria burden.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2023.1303980</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2023.1303980</link>
        <title><![CDATA[Application of multiple binding sites for LAMP primers across P. falciparum genome improves detection of the parasite from whole blood samples]]></title>
        <pubdate>2023-12-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Cavin Mgawe</author><author>Clement Shilluli</author><author>Steven Nyanjom</author><author>Eddy Odari</author><author>Jacqueline C. Linnes</author><author>Bernard N. Kanoi</author><author>Jesse Gitaka</author><author>Lucy Ochola</author>
        <description><![CDATA[IntroductionMalaria remains a significant health concern, particularly in regions with widespread prevalence. As the transmission rates decrease, there is a rise in low-density infections with the causative parasite, P. falciparum, that often escape detection through standard point-of-care diagnostic tools. In-low transmission areas, even few undetected cases can trigger outbreaks, necessitating rapid and sensitive diagnostics. Loop-mediated isothermal Amplification (LAMP) stands out as a nucleic acid technique that can easily utilizes un-processed samples such of saliva, urine, and lysed whole blood templates for a sensitive detection. However, most nucleic acid tests detect genes with few copies per parasite making it difficult to detect low-density parasitaemia.MethodsWe selected Pfr364 multi-copy repeats of the P. falciparum genome as a target for amplification due to their higher copy number, ideal for rapid amplification, addressing amplification drawbacks of limited parasites DNA. We used a sequence clustering approach to design a novel set of LAMP primers, capable of binding to multiple sites. Subsequently, we developed a hydroxynaphthol blue (HNB) colorimetric LAMP assay, using genomic DNA obtained from the 3D7 strain cultivated in vitro. This assay’s performance was validated using archived clinical samples of both whole blood and matched saliva, ensuring accuracy through comparative analysis against gold standard, nested PCR, targeting the 18S RNA gene.ResultsThe HNB-LAMP assay achieved rapid amplification within 15 minutes and exhibited high sensitivity with a limit of detection of 1 parasite. Further, the LAMP assay was robust in whole blood lysed with Triton X-100 and heat-treated saliva clinical samples. Against nested PCR, the assay showed sensitivity of 100% for whole blood and 40% for saliva samples. Moreover, co-analysis with the nested PCR showed a perfect agreement between the two techniques. (K = 0.99 for whole blood, and 0.66 for saliva).ConclusionOur study presents a method for detecting P. falciparum using LAMP, which results in increased sensitivity, shorter assay times, and a simpler workflow than nucleic acid tests relying on conventional DNA extraction and additional equipment for result interpretation. These findings hold great promise for improved malaria diagnosis, especially in settings where low-density parasitaemia is prevalent and rapid and accurate malaria detection is crucial.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fmala.2023.1148115</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fmala.2023.1148115</link>
        <title><![CDATA[Evaluation of an automated microscope using machine learning for the detection of malaria in travelers returned to the UK]]></title>
        <pubdate>2023-08-10T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Roxanne R. Rees-Channer</author><author>Christine M. Bachman</author><author>Lynn Grignard</author><author>Michelle L. Gatton</author><author>Stephen Burkot</author><author>Matthew P. Horning</author><author>Charles B. Delahunt</author><author>Liming Hu</author><author>Courosh Mehanian</author><author>Clay M. Thompson</author><author>Katherine Woods</author><author>Paul Lansdell</author><author>Sonal Shah</author><author>Peter L. Chiodini</author>
        <description><![CDATA[IntroductionLight microscopy remains a standard method for detection of malaria parasites in clinical cases but training to expert level requires considerable time. Moreover, excessive workflow causes fatigue and can impact performance. An automated microscopy tool could aid in clinics with limited access to highly skilled microscopists, where case numbers are excessive, or in multi-site studies where consistency is essential. The EasyScan GO is an automated scanning microscope combined with machine learning software designed to detect malaria parasites in field-prepared Giemsa-stained blood films. This study evaluates the ability of the EasyScan GO to detect, quantify and identify the species of parasite present in blood films compared with expert light microscopy.MethodsTravelers returning to the UK and testing positive for malaria were screened for eligibility and enrolled. Blood samples from enrolled participants were used to make Giemsa-stained smears assessed by expert light microscopy and the EasyScan GO to determine parasite density and species. Blood samples were also assessed by PCR to confirm parasite density and species present and resolve discrepancy between manual microscopy and the EasyScan GO.ResultsWhen compared to light microscopy, the EasyScan GO exhibited a sensitivity of 88% (95% CI: 80-93%) and a specificity of 89% (95% CI: 87-91%). Of the 99 samples labelled positive by both, manual microscopy identified 87 as Plasmodium falciparum (Pf) and 12 as non-Pf. The EasyScan GO correctly reported Pf for 86 of the 87 Pf samples and non-Pf for 11 of 12 non-Pf samples. However, it failed to distinguish between non-Pf species, reporting all as P. vivax. The EasyScan GO calculated parasite densities were within +/-25% of light microscopy densities for 33% of samples between 200 and 2000 p/µL, falling short of WHO level 1 (expert) manual microscopy competency (50% of samples should be within +/-25% of the true parasitemia).DiscussionThis study shows that the EasyScan GO can be proficient in detecting malaria parasites in Giemsa-stained blood films relative to expert light microscopy and accurately distinguish between Pf and non-Pf species. Performance at low parasite densities, distinguishing between non-Pf species and accurate quantitation of parasitemia require further development and evaluation.]]></description>
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