Literature review on malaria
Of biometrics & the best use of scientific research and information from our 700+ peer reviewed, open access journals that operates with the help of 50,000+ editorial board members and esteemed reviewers and 1000+ scientific associations in medical, clinical, pharmaceutical, engineering, technology and management inspiring speakers and experts at our 3000+ global conferenceseries events with over 600+ conferences, 1200+ symposiums and 1200+ workshops l, pharma, engineering, science, technology and ch article open access. Date: september 14, 2016; accepted date: september 26, 2016; published date: october 07, on: ramji a, rene a, garza t, ory mg (2016) a literature review of ention in zanzibar. Visit for more related articles l of biometrics & ives: this review examines malaria control and treatment interventions in zanzibar. This review seeks to identify current malaria prevention and control intervention strategies, to better understand cultural barriers to intervention, and to make recommendations on how malaria prevention and treatment activities might be adapted to address underlying cultural barriers that would otherwise impede intervention efforts. Methods: the review documents published data from 36 studies on the current malaria intervention activities in zanzibar; and identifies whether extant literature includes attention to cultural barriers as part of the implementation and dissemination of interventions. The beliefs and cultural practices of patients are largely related to the success of malaria control programs. The most commonly described malaria prevention and treatment interventions in zanzibar are indoor residual spraying, insecticide treated nets, sulphadoxine-pyrimethamine, and artemisinin based combination therapy. Conclusions: integration of culture practices with malaria control strategies is the ideal solution to effectively reach a; zanzibar; malaria estimated 219 million cases of malaria occur worldwide each year and of these cases, 660, 000 people will die. This review reflects on the types of interventions in zanzibar reported in literature and barriers to implementation, rather than the effectiveness of interventions per region with the heaviest malaria burden is sub-sahara africa. Sub-sahara africa reports 90% of the total malaria related deaths worldwide [1], and foreshadows what is happening globally. Despite this heavy burden, there are illustrative incremental gains toward malaria elimination [1], which have prompted researchers to discuss final eradication of malaria from the region. If malaria could be wiped out from the most burden-felt region, then researchers could work outwardly from such a starting point to eradicate the disease. However, zanzibar does fear the potential of malaria to rebound quickly as the parasites develop resistance to available drugs and current treatments. This presents a significant problem because malaria-carrying mosquitoes lead to continued spread of the disease. Mosquito resistance to insecticides and patient resistance to current pharmaceutical treatment are emerging as serious potential threats to effective and affordable malaria literature review combines a summary and synthesis of scholarly articles, books, and other sources relevant to malaria interventions and socio-cultural research in zanzibar, tanzania. Search terms were purposely broad in order to identify all possible intervention activities in zanzibar, which then allowed for a secondary search for documents that explicitly described cultural practices in relation to malaria prevention and treatment. Studies from cochrane summaries served to validate malaria’s current trend and status in zanzibar. The studies had to be empirical, because the purpose of this systematic review was to address components related to outcomes from malaria interventions. 1: systematic review protocol coding ing the preferred reporting items for systematic reviews and meta-analyses (prisma) [2] standards, this study evaluated the search results (figure 1). After full-text review of each study, the sample size was 36 studies, which also included the eligibility phase. During the screening and extraction process, two raters discussed their rationale for accepting or rejecting a study followed by examining each other’s data entry on the systematic review protocol. Also, there was a wide range of topics related to malaria, which are organized in a matrix (table 2). Rs to interventions or lar , indoor residual spraying (irs), and malaria of staff at clinics, too few llins distributed, inadequate malaria ll et al. Evaluation toward diagnosing malaria malaria species that are not picked up by diagnostic na et al. Able medicines facility-malaria (amfm), ion of net cost and usage during the hot ance and rejection of (indoor residual spraying). E in malaria transmission before rates a decline in malaria before act, itns, and irs on the zanzibar movement phone data -adherence to drugs (artesunate-amodiaaquine, asaq). Trends for lower mortality due to malaria for children (1-36 months; n=42,546) in the rd et al. Of iron deficiency in early r risk of serious adverse events from malaria + iron folic of iron deficiency in children younger than age and folic acid in areas of high malaria transmission is tological cy of sulfadoxine-pyrimethamine (sp) and amodiaquine (aq). Cy of asaq and artemether-lumefantrine (al) – ison of different s of vitamin a and sp on erythropoietin production in severely anemic n a lowered erythropoietin alleles of malaria (cyp2c8). Dose iron a infection was not icide african network for monitoring antimalarial treatment (eanmat), larial drug (sulfadoxine-pyrimethamine), act (artemisinin-based combination therapy). Irs = indoor residual spraying; itn = insecticide treated nets; long-lasting insecticidal treated nets (llin); act = artemisinin combination therapy; aq = amodiaquine; asaq = artesunate-amodiaquine*barriers or consequences were not explicitly stated in the 2: matrix of malaria topics and intervention activities in al barriers: although no cultural barriers were identified for zanzibar, other studies in sub-saharan africa do describe such barriers. Reported that the continued persistence of malaria in africa appears to be largely due to socio-cultural factors, which are often at variance with standard control methods. Jombo’s study was designed to ascertain the socio-cultural factors affecting the control of malaria in makurdi, nigeria [5]. Of these, 83% (n=1,671) did not consider malaria to be a serious health problem needing urgent attention. Accessibility to information on malaria and general knowledge of the modes of transmission and control was generally low, and to a large extent influenced by cultural beliefs, values, and economic status. The latest information available comes from the zanzibar health sector public expenditure review of 2006 (zhsper) [6]. Activities related to malaria prevention rely highly on external support such as global fund and presidential malaria initiative (pmi, n. This is critical in terms of sustainability for malaria interventions such as procurement of bed nets, indoor residual spraying, and community mobilization because not all individuals can afford these prevention household budget survey indicated that approximately 2. However, high cost for individual spending on malaria impedes the overall prevention and treatment from the disease because of individuals in -cultural factors: in recent years emphasis has been placed in investigating socio-cultural factors that influence health-seeking behavior for malaria and cause delay in utilizing health facilities [9]. The beliefs and cultural practices of patients are largely related to the success of a malaria control program (pmi, n. Williams and jones conducted a literature review on behavioral issues related to malaria control in sub-saharan africa [10]. In their study health care providers reported cultural practices related to malaria in some regions of zanzibar: 1) newborns are vaccinated in a timely manner [considered a common practice]; 2) women do not make decisions concerning their children [considered a social barrier]; 3) herbal medicine use is a generational tradition [considered a cultural factor]; and 4) sickness is caused by the gods [considered a belief factor]. Of malaria in sub-saharan african communities requires knowledge of the modes of spread and the factors that enhance its control and prevention by the population of the affected region. An ethnographic study of childhood malaria in southeastern tanzania revealed that individuals made a clear distinction between normal malaria and cerebral malaria characterized by convulsions [11]. Malaria with convulsion (degedege) in children seems to be perceived differently in some households, with popular beliefs regarding evil spirits or demons attacking the child. Parents often do not seek care at health facilities when their children experience this symptom, but rely on traditional healers for treating the children with severe malaria [12]. Religious beliefs can also deter individuals from receiving malaria tanzania, as in most sub-saharan africa, prompt diagnosis and effective treatment is the main control strategy. Since malaria presents in different forms such as convulsions, altered consciousness, or coma, community perception of underlying causes may differ. Early research to identify viable solutions for malaria treatment through vitamin and mineral supplements resulted in the investigation into the effects of vitamin a, zinc, and iron, which were hypothesized to work against malaria infection. While controversy that iron increased malaria infection has not been proven [7] harmful effects of iron and folic acid supplementation resulting in increased malaria risk were identified [14,15] a cost analysis of iron and folic acid therapy to children in nepal and zanzibar found increased adverse effects to children who were not iron deficient [16].
The study concluded that strategies to improve iron supplement therapies were needed where the health systems were use of vitamin a, zinc, and iron is now overshadowed by educational outreach interventions, such as the zanzibar school malaria program, which provides information and skills on malaria prevention and information on symptoms and treatment [17]. Interventions: the most commonly described malaria prevention and treatment interventions in zanzibar, addressed in 23 studies, were indoor residual spraying, long-lasting insecticide treated nets, insecticide treated nets, sulphadoxine-pyrimethamine, and artemisinin based combination therapy. The use of sulphadoxinepyrimethamine is related to malaria programs that target pregnant women, since a fetus can contract malaria if the mother is infected. Rapid diagnostic tests and microscopy are the most common form of diagnostic -up initiatives, such as the president’s malaria initiative, are addressed in the literature to a lesser degree than treatment. Facilities are often headed by unskilled personnel, thus most health practices are poor in terms of reporting, confirmation, response, and control of malaria. The following barriers were identified: lack of education about malaria, lack of funding and other resources, and lack of qualified staff to diagnose and treat malaria. Specifically, if zanzibar is to eliminate malaria, funding is required for health professionals and community education. Additional studies explored the molecular mechanism of artemisinin based combination therapy, but these studies were excluded if they were not tied to intervention main findings of this review indicate more quantitative studies (33) as compared to qualitative. Effectiveness of these interventions increased when they were used vector control programs have eradicated malaria from several other nations, vector control in zanzibar differs because the tropical climate, which is ideal for vector breeding. In conjunction with vector control and malaria case prevention, zanzibar has constructed a surveillance system to monitor the malaria outbreaks [6]. Most effective interventions in zanzibar are integrated and generally involve indoor residual spraying, long-lasting insecticide treated nets, sulphadoxine-pyrimethamine to treat pregnant women for malaria, rapid diagnostic tests, and artemisinin based combination therapies [1,20]. This review identified only one study describing a scaleup initiative, the finding is significant because a scale-up initiative makes use of proven interventions and increases intervention reach. However, non-government entities such as the gates foundation have participated and advocated for malaria eradication [21]. From this review indicate a lack of education, funding, and trained professionals are barriers to addressing primary factors in malaria control and prevention. Funding is limited and dependent on global economics, the other two identified barriers of malaria prevention can be evaluated for potential solutions. Educational programs can be implemented to help the community understand malaria and contribute to prevention and control. Although not entirely focused on cultural practices, these studies provide insight into the social and belief systems of individuals that can be barriers to malaria control and prevention programs. Therefore, investigating specific cultural practices in zanzibar by using a qualitative approach could shed light into underlying causes for why individuals disregard current malaria control and prevention programs; adding to the literature further successful methods for prevention and studies were identified that contribute to intervention (figure 2). The effectiveness of indoor residual spraying, long-lasting insecticide-treated nets, artemisinin based combination therapy rapid diagnostic tests, and malaria policies, along with scaleup initiatives, reflected the breath of quantitative studies. Qualitative studies considered cultural practices and their possible influence on malaria prevention and 2: distribution of studies by identification of cultural practices in zanzibar can be of value, because in other countries, such as ghana and kenya, some cultural practices reduce the impact of malaria programs [25,26]. While there is lack of information concerning cultural practices and how they affect malaria programs, this type of research has the potential to increase the overall understanding of improved effectiveness of integrated scale-up initiatives currently established in ation of culture practices with malaria control strategies is the ideal solution to effectively reach a community. Sustained research and development is needed to create a diverse array of treatment and prevention methods and avoid overreliance on a small set of anti-malaria tools. More effective policies and increased funding to secure lasting gains against malaria are ationally speaking, intervention activity in zanzibar is defined and guided by global initiatives such as the who malaria policy advisory committee and secretariat [20]. However, little is known concerning the impact cultural practices on the effectiveness of malaria is clear that addressing health determinants for malaria control in zanzibar remains a challenge. Financial sustainability is the main key area for policy makers to consider in combating malaria in the island [28,29]. Socioeconomic status and cultural issues should be a consideration in long term national malaria policy advisory committee and secretariat (2012) inaugural meeting of the malaria policy advisory committee to the who: conclusions and recommendations. Malaria journal 11: ti a, altman dg, tetzlaff j, mulrow c, gøtzsche pc, et al. 2009) the prisma statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. British medical d, liberati a, tetzlaff j, altman dg, the prisma group (2009) preferred reporting items for systematic reviews and meta-analyses: the prisma statement. 2010) choices of drugs for self-treatment of malaria among adult women in a nigerian city: implications for the success of the ongoing ‘roll back’ malaria programme. Journal of microbiology and antimicrobials 2: ar malaria control programme (2010) zanzibar malaria performance review tu t, stoltzfus rj, chwaya hm, jape jk, savioli l, et al. 2004) low-dose daily iron supplementation for 12 months does not increase the prevalence of malarial infection or density of parasites in young zanzibari children. 2005) short-term effects of vitamin a and antimalarial treatment on erythropoiesis in severely anemic zanzibari preschool children. American journal of clinical nutrition 82: m, vlassoff c (1998) treatment seeking behaviour for malaria: a typology based on endemicity and gender. Social science & medicine 46: ms ha, jones coh (2004) a critical review of behavioral issues related to malaria control in sub-saharan africa: what contributions have social scientists made? Social science & medicine 59: sh, ribera jm, tanner m (1998) fake malaria and hidden parasites: the ambiguity of malaria. Evaluation & health professions 31: i ea, mboera le, malebo hm, kitua ay (2007) priority setting on malaria interventions in tanzania: strategies and challenges to mitigate against the intolerable burden. Food and nutrition bulletin 28: nzi r, makumbi f (2010) assessing the effect of a combined malaria prevention education and free insecticide-treated bed nets program on self-reported malaria among children in a conflict affected setting in northern uganda. Research triangle park, nc: rti international ow ml, masanja mi, abdulla sm, kahigwa e, kachur sp (2008) challenges in routine implementation and quality control of rapid diagnostic tests for malaria-rufiji district, tanzania. 2013) perception of malaria risk in a setting of reduced malaria transmission: a qualitative study in zanzibar. Malaria journal 12: malaria policy advisory committee and secretariat (2013) malaria policy advisory committee to the who: conclusions and recommendations of march 2013 meeting. British medical journal malaria policy advisory committee and secretariat (2012) malaria policy advisory committee to the who: conclusions and recommendations of september 2012 meeting. Malaria journal 11: health organization (2012) world malaria lg, asante kp, dzorgbo ds, senah ka, letsa ts, et al. Malaria journal 12: d, yamo e, collymore y, ba-nguz a, bingham a (2011) perceptions of malaria and vaccines in kenya. Eighth annual report to ational labour organization (2010) social protection expenditure and performance review and social jm, khatry sk, stoltzfus rj, katz j, lecerq sc, et al. 2006) effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomized, placebo-controlled trial. Click here to reviewed the best use of scientific research and information from our 700 + peer reviewed, open access ormatics & systems ss & ics & nmental cs & molecular y & earth logy & cience & g & health ceutical & political al & medical es & altherapy & uctive ational inspiring speakers and experts at our 3000+ global annual ences by l & clinical es & care cs & molecular ative al therapy l ethics & health uctive medicine & women ences by ceutical marketing & s & materials nmental y & earth & aquaculture journals. Ript ript raduate research e ture review: insights into formulating a protective malarial : padhmanand sudhakar and prasanth ution: 's engineering college, anna university date: january a, unlike many diseases, has evolved as a result of millions of years of interactions at various levels with the mammalian system and hence has found ways to gather resistance to drugs and insensitivity to other treatment modalities. This paper's core idea is to give an extensive overview on the latest developments of anti-malarial vaccine technology. Modern malarial vaccines, as against conventional ones, incorporate many antigens from various stages of the parasite's life cycle, so that the immune response is multi-gated.
Modern vaccines rely on the fact that if natural immunity could be mimicked, then vaccination would prevent severe malaria and malaria-related deaths. If this is the case, then the malaria genome and snp projects may provide the essential foundation for duplicating this whole-organism immunity. In this article, we would like to address the latest research and developments on the integration of new technologies like reverse vaccinology, vaccinomics, microarrays, along with providing a better understanding of the pathogenesis of the malarial infection and the omics' revolution to herald the profiling of new candidate antigens responsible for engendering naturally acquired immunity, which will enable the formulation of protective a has been one of the most prominent and ancient diseases which has been profiled and studied. This dreadful disease, caused by four different agents (plasmodium falciparum, plasmodium vivax, plasmodium malariae and plasmodium ovale) of the same genus, is a major health problem in most of the countries in the tropics. Malaria affects more than 2400 million people, over 40% of the world's population, in more than 100 countries in the tropics from south america to the indian peninsula. Over the years, as per statistical records, it has been estimated that there may be three hundred to five hundred million new infections and one to three million infection related deaths annually caused by malaria, and it has also been found that more than 90% of these deaths occur in the regions in and around sub-saharan africa. Estimated worldwide expenditure on malaria research comes down to us$ 58 million, one thousandth of the us$ 56 billion spent globally on health research annually. Even with this overwhelming fatality and infection rates, epidemiological analyses in recent times have shown that the medical impact of malaria may have been significantly underestimated (breman 2001). Inspite of all this, the enormous economic impact of malaria has never been adequately considered (gallup and sachs 2001). Malaria imposes a huge burden on human resources of a nation and in consequence, the gross domestic product of the country gets reduced by as much as 1. The intolerable impact of malaria has been sometimes fully or partially attributed to the increasing resistance of the plasmodium parasite to chemoprophylactic and chemotherapeutic agents, and the resistance of the anopheles sp. Adding to these is the inability of the health, public and civic work departments of the affected countries in mobilizing and sustaining the resources required for malarial control. For example, there has been a resurgence of malaria in areas formerly free of the disease. Considering these predictions as well as the current situation at hand, it is the duty of the scientific community to focus on the prospects and possibilities of developing a vaccine for malaria. In our review, we would like to outline the recent multidimensional efforts aimed at adopting suitable methods by which natural immunity like responses can be generated by a malarial vaccine. The pith of this work is to give a precise description on the various parasitic and host factors which are taken into consideration in modern malarial hysiology and lifecycle of the malarial parasite:Figure 1. Schematic representation of the malarial parasite's life life cycle of the malarial parasite is very complex (figure 1). Vivax (mendis et al 2001) are the main causes of disease and death due to malaria. The outcome of the infections differs from person to person and this is another manifestation of the highly variant factors (figure 2) involved in malarial infection and 2. Factors affecting the ultimate disease outcome in malarial are red blood cells plagued by the malarial parasite? The trap protein interacts with skeletal proteins in malarial sporozoites and in toxoplasma gondii (kappe et al 1999), but the equivalent molecule for merozoites has yet to be p. A recent study by chotivanich of severe malaria compared to uncomplicated falciparum malaria suggested a similar pattern, with the virulent p. Most cases, the binding to host endothelium does not lead to pathogenesis, as most infections result in malaria that is devoid of complications. What leads to the transition from uncomplicated to a serious infection such as cerebral malaria is unclear at present. The recent advances in adhesion research will hopefully provide leads for the mechanism of adhesion related responses against the malarial parasite:Antibodies and the proinflammatory response (figure 3) protect against the asexual blood stages of some rodent malarias and probably also human malaria. It is perfectly logical that these are involved in bone marrow suppression and cerebral malaria, but the data are lacking to prove this role. One hypothesis suggests that tnf- induces endothelial cells from brain to express icam-1 (wong et al 1992) as vessels in the brain have increased expression of icam-1 in cerebral malaria. Although no has been proposed as the cause of cerebral malaria, no is at higher levels systemically in uncomplicated malaria than in cerebral malaria (levesque et al 1999). Indeed, total nitrate plus nitrite levels in the csf of children with cerebral malaria are low, and it has been suggested that this may exacerbate n-methyl-d-aspartate-mediated neurotoxicity due to excitotoxins such as quinolinic 3. Immune responses elicited during different stages of the malarial parasite's life suggesting that a toxin of malarial origin drives the proinflammatory response are interesting, but the physiologic significance is unproven at present. Modifications in the immune response to malaria that may not be malaria specific have been identified. In an animal model, infection with a rodent malaria to which they had previously been exposed led to apoptosis of t cells immune to malaria and not those immune to ova, a malaria-unrelated antigen. The cells that were eliminated were proinflammatory t cells, producing ifn- and il-2, but not cations in malarial infections:Malaria is one disease which complicates itself so much that common modes of treatment and prophylaxis (desjardins et al 1988) cannot be drawn on a single level basis. Generalized immunosuppression by the parasite, presence of t-cell independent antigens which fail to induce immune response, inhibition of b-cell proliferation, and extreme polymorphism or clonal variation of immunologically relevant antigens could be the causes for the poor immune response in malaria (sokhna et al 2000 and neva et al 1970). Exposure to repeated mosquito bites and re-infection is the most profiled cause for recurrence of malaria. The patient is exposed to fresh mosquito bites soon after completing the anti malarial treatment. There is no immunity from the past infection and to worsen the situation, the antimalarials do not prevent establishment of the fresh infection. Malariae infections, the parasites can remain in the blood for months or even years and cause recurrent symptoms from time to time. In falciparum malaria, such recrudescence can occur within 28 days of the primary attack and may indicate partial resistance to chloroquine. One should consider the possibility of re-infection in most of these ance to antimalarial drugs is proving to be a challenging problem in malaria control in most parts of the world. Since early 1960s the sensitivity of the parasites to chloroquine, the best and most widely used drug for treating malaria, has been on the decline. Newer antimalarials were discovered in an effort to tackle this problem, but all these drugs are either expensive or have undesirable side effects. Resistance to chloroquine is most prevalent, while resistances to most other antimalarials like pyrimethamine, quinine, mefloquine, artemesin and quinoline (ward et al 1997) compounds have also been reported. These developments further justify the cause and urgency for formulating an effective vaccine against y requirements of malarial vaccines:From experience, it is learnt that different populations demand different types of malarial vaccines making use of the different arms of the natural immune response system (figure 3). The basic purpose of a vaccine is to reduce the incidence of severe malaria, and malaria-associated mortality in infants and children with heavy exposure to plasmodium falciparum, such as those living in sub-saharan africa. This constitutes a type 1 the other extreme is the requirement to prevent all clinical manifestations of malaria in individuals from areas with no exposure who travel to regions where malaria is endemic, primarily malaria caused by arum and . This extreme approach to malaria vaccine development does not take into account specifically populations affected by malaria that fall between these extremes, such as individuals in endemic regions at high risk of infections (mendis et al 2001). In areas with extremely intense transmission, it is primarily infants who are dying of malaria, with severe anemia as the major cause of death. In areas with less intense transmission, it appears to be 2 to 5 year olds who are at risk of dying with cerebral malaria (mendis et al 2001). It is a definite possibility that different vaccines, tailored to the predominant pathophysiology of the parasite in a particular region, or different vaccination strategies, targeting the age groups at greatest risk may be the most effective response to this heterogenous rly, the target populations are also varied for type 2 vaccine designed to prevent all clinical manifestations of malaria in non-immune travelers to malaria-endemic areas.
It is a general conception that the major recipients for this type of vaccine would be travelers from highly developed malaria-free-countries, but there are hundreds of millions of people living in non-malarious areas of malaria endemic countries, who travel to malarious areas of their own country. Surprisingly, there is little mention in the malaria literature of the increasing number of non-immune individuals living in countries with endemic malaria, who must receive short-term protection against malaria by a vaccine. Because of their susceptibility to the rapidly developing severe disease, and because of their brief exposure to transmission, it is generally thought that these in-country travelers, and their children, would require a vaccine with the same protective profile as a vaccine for travelers from highly developed malaria-free ly, a type 3 vaccine has also been developed for the sole purpose of blocking transmission. Such a vaccine unquestionably would be of great value on islands with malaria, and in areas with only modest transmission. Thus the general idea is to block transmission along with eliciting protection against the ideal malaria vaccine would prevent all infection by priming the immune system to destroy all parasites, whether free swimming in the blood, while in the liver, or even, theoretically, while in red blood cells. This would not prevent infection but would limit the severity of the disease and help prevent malaria ideal malarial vaccine:An ideal malarial vaccine will have a range of properties satisfying many conditions towards which future research efforts will be directed at. The ideal malarial vaccine will be highly effective in all age ranges, that is, it must elicit protective immunity in infants, children and adults. Last, but not the least, the vaccine should be easy and inexpensive to manufacture and be affordable in low-resource s relating to whole parasite elicited immunity:Children who survive to the age of 7-10 years rarely develop life-threatening arum infections and rarely die of malaria in areas of sub-saharan africa, which has the most intense malaria transmission rates as well as the highest rates of malaria associated mortality and morbidity. It was found that mice immunized with radiation-attenuated rodent malaria sporozoites were protected against challenge (nussenzweig et al 1967). A vaccine encompassing such properties will prove to be as good as both type 1 and type 2 nges in formulating an effective malarial vaccine:The development of a malarial vaccine requires more than understanding the molecular, pathogenic, parasitic and epidemiologic aspects of the plasmodium species. Despite the knowledge that our immune system can control malaria, there is currently no vaccine in the market against this dreaded disease. The approach has been to try to determine the immune responses responsible for the protective immunity seen in these two models, and the parasite life cycle stages and proteins, against which this protective immunity is directed, and then to develop vaccine delivery systems that would induce the required responses against the identified t and future advances in understanding human immunology and the biology of the malarial parasites, many of which will be dependent on the data from the human genome sequencing projects (lander et al 2001 and venter et al 2001) and the malaria genome projects (bowman et al 1999, gardner et al 1998 and gardner et al 1999), should allow the identification of key antigens associated with the protection and the formulation of vaccines effective in all recipients, regardless of their genetic background. The availability of the entire arum genome has provided a major boost in increasing the number of identified candidate antigens and has significantly brightened the prospects of developing an effective malarial tic complexity:Figure 4. Stage-wise distribution of the antigenic profile of the malarial al parasites are much more complex than other microbes such as viruses or bacteria which have been controlled extensively by vaccination. The complexity of the malarial parasites is reflected by their life cycle which has many stages, each of which is characterized by the expression of different and unique proteins (figure 4). These asexual erythrocytic stage parasites are responsible for the clinical manifestations and pathology of malaria. In summary, whole-parasite induced immunity could be directed at many of the 5000-6000 malaria parasite proteins. Knowledge of all these potential targets and their variability at the epitope level has been documented a great deal after the publishing of the malarial parasite's genome and also the snp (single nucleotide polymorphisms) profiles of the genes coding for many of the potential g the field trials:Clinical trials are primary manifestations of the scientific methodologies employed in medical pharmacology. Currently, the task is to get enough potential malaria vaccines to and through the series of clinical trials needed to bring to the world a licensed product. It is important to determine whether there are measurable outcome variables that have a high predictive value for severe disease and malaria-associated discussed before, ideal vaccines are just virtual benchmarks which will be used as references for optimization. Malarial vaccines are thought to have multiple and complex mechanisms of protection, including antibodies and cell-mediated immunity. Malarial infection comes with biggest problem that it has a strong possibility of reactivation following a temporal period of relapse. So, one of the major visions of malarial vaccine research is to employ the best methodology and technology available in clinical trials and in animal models to analyze those immune responses that correlate best with protection. Furthermore, expression of immunity in some parasitic diseases such as malaria cannot simply be analyzed in view of the development of polarized th1 or th2 responses because infection with this parasite is a multifocal is very little doubt that immune responses against plasmodium falciparum can protect against malaria, probably by destroying the infectious agent as such or the host cells in which they reside, and also by inhibiting a function of the infectious agent critical for its survival. In naturally acquired immunity, all the arms of the immune system are probably activated against all stages of the parasite l responses against malarial invasion:To generalize, three important responses are thought to be very critical in governing the progress of the initial infection. The pathogenesis of the disease may be mediated by these same host-derived biologically active molecules, perhaps elicited by putative malarial toxins released from the infected erythrocytes (clark et al 2000, playfair et al 1996 and schofield et al 2002). Mediated responses against malarial invasion:T cell mediated immunity plays a very significant role in perpetrating the resistance against the malarial parasite's invasion. Humans immunized with radiation-attenuated sporozoites (malik et al 1991 and wizel et al 1995) and also humans naturally exposed to malaria (aidoo et al 1995, doolan et al 1997, flanagan et al 2001, lalvani et al 1996 and sedegah et al 1992) have been shown to have cd8+ cytotoxic lymphocytes and cd8+ t cell derived interferon-gamma responses against pre-erythrocytic stage proteins. Another area requiring attention is the human genetic polymorphism which is associated with resistance to malaria as in the cases of a and b thalassemia, haemoglobin c, g6pd deficiency, haemoglobin s and haemoglobin e, abo blood groups (fya and fyb) host genetics, transmission dynamics of the parasite, and probably the age of the host contribute to the overwhelming complexity associated with the development of an effective vaccine against malaria. In areas in which transmission is most intense, infants are at the highest risk of developing severe and fatal malaria, whereas in areas with less intense transmission, older children have a higher incidence of severe and fatal disease than t trends and developments in malarial vaccine discovery:Figure 5. Different types of malarial vaccines, their antigenic composition and essential e developers around the world are trying to develop all three types of malaria vaccine: pre-erythrocytic, blood stage, and transmission blocking (figure 5). As noted above, the optimal malaria vaccine will likely combine antigens from all three stages of the malaria parasite's life cycle. Many single-antigen malaria vaccine candidates are being readied for clinical trials, and combination studies are being planned. The deployment of an effective malaria vaccine will take several years, but it will happen. Optimization of immune responses elicited by single stage targeted vaccines:As of now, malarial vaccine development is being pursued by three different methods. One of the most intriguing developments in this field has been that of the malarial multiple antigen peptide vaccine. It has also been demonstrated that a synthetic triepitope polyoxime malaria vaccine containing b cell epitopes and a universal t cell epitope of plasmodium falciparum csp has immunogenicity (alonso et al 1994). Vaccines targeting erythrocytic schizogony:Vaccines which target the erythrocytic stages of the malarial parasite's lifecycle obstruct the asexual stage of the parasite. Utilitiesjournals in ncbi databasesmesh databasencbi handbookncbi help manualncbi news & blogpubmedpubmed central (pmc)pubmed clinical queriespubmed healthall literature resources... Toall how tochemicals & bioassaysdna & rnadata & softwaredomains & structuresgenes & expressiongenetics & medicinegenomes & mapshomologyliteratureproteinssequence analysistaxonomytraining & tutorialsvariationabout ncbi accesskeysmy ncbisign in to ncbisign : abstractformatsummarysummary (text)abstractabstract (text)medlinexmlpmid listapplysend tochoose destinationfileclipboardcollectionse-mailordermy bibliographycitation managerformatsummary (text)abstract (text)medlinexmlpmid listcsvcreate file1 selected item: 18455095formatsummarysummary (text)abstractabstract (text)medlinexmlpmid listmesh and other datae-mailsubjectadditional texte-maildidn't get the message? A in pregnancy: a literature erg information1center for community health and education, new york-presbyterian hospital, newyork, ny, usa. Rl2392@tractpregnant women are more likely than nonpregnant women to become infected with malaria and to have severe infection. The effects of malaria during pregnancy include spontaneous abortion, preterm delivery, low birth weight, stillbirth, congenital infection, and maternal death. Malaria is caused by the four species of the protozoa of the genus plasmodium, which is transmitted by the bite of the female anopheline mosquito, congenitally, or through exposure to infected blood products. This article reviews the epidemiology, pathology, clinical symptoms, diagnosis, and treatment of malaria in pregnant women. Interventions to prevent malaria include intermittent preventive treatment, insecticide-treated nets, and case management of malaria infection and : 18455095 doi: 10. Indexed for medline] sharepublication type, mesh terms, substancespublication typereviewmesh termsanemia/complicationsanimalsanopheles/parasitologyantimalarials/therapeutic usefemalehumansinsect vectors/parasitologymalaria*/diagnosismalaria*/physiopathologymalaria*/therapymalaria*/transmissionplasmodium/physiologypregnancypregnancy complications, parasitic*/diagnosispregnancy complications, parasitic*/physiopathologypregnancy complications, parasitic*/therapypyrimethamine/therapeutic usesulfadoxine/therapeutic usesubstancesantimalarialssulfadoxinepyrimethaminelinkout - more resourcesfull text sourceselsevier sciencewileyovid technologies, lmalaria - genetic alliancepregnancy - genetic alliancemalaria - medlineplus health informationmiscellaneouspyrimethamine - hazardous substances data bankpubmed commons home. Commentshow to join pubmed commonshow to cite this comment:Ncbi > literature > a research can play a vital role in addressing the malaria burden in malawi. An organized approach in addressing malaria in malawi started in 1984 by the establishment of the first national malaria control programme and research was recognized to be significant. This study aimed to assess the type and amount of malaria research conducted in malawi from 1984 to 2016 and its related source of funding.
Systematic literature search was conducted in the medline/pubmed database for malawian publications and approved malaria studies from two ethical committees were examined. Most researchers were affiliated to the malawi-liverpool wellcome trust, college of medicine, blantyre malaria project, ministry of health, and malaria alert centre. The major malaria research funders were the national institute for health/usa, wellcome trust and the us agency for international development. Out of 118 journals publishing research on malaria in malawi were from africa and the malaria journal, with 76 (15. Published in the local malawi medical al and basic research, which is mostly funded externally, in the fields of malaria in pregnancy, severe malaria and vector and/or agent dynamics dominated, while health policy and system research was least supported. The quantity may reflect scientific research activity but the initial primary impact is contribution to policy dsmalaria researchfundinghealth oundresearch is defined as an organized curiosity leading to a systematic enquiry, with the purpose of understanding the subject at hand and generating new knowledge. Malaria is ranked third on major disease burdens in malawi [6] with an estimated four million cases occurring annually, mostly in pregnant women and children under 5 years old [7]. An organized approach in addressing the malaria burden in malawi started in 1984 by the establishment of the first national malaria control programme (nmcp) and the development of its national malaria control policy. One of the policy directions was to conduct viable research to guide the development of policies in malaria treatment, control and prevention [8]. It is imperative to assess whether these efforts have had any impact through the health research output in malaria as recommended by the organization for economic cooperation and development (oecd) in describing research activity for a country [9]. Aim of this study was to assess the malaria research output by mapping the type and amount of malaria research conducted in malawi since 1984 when the first nmcp was established to 2016 when this study was conducted. The assessment also describes affiliations, level of collaborations and the sources of funding for malaria research in malawi. This assessment also forms part of a larger study promoting malaria research utilization in policy development that should eventually lead to the development of evidence-based interventions to address the malaria burden in malawi. The research promotion will be instituted by the development of a contextual malaria research-to-policy framework. One of the initial steps in the development of this framework is to verify the availability of malaria research conducted in malawi and create a malaria research san online systematic literature search was conducted for published primary research from malawi and the examination of approved malaria studies by the two ethical committees (ecs) in malawi, namely the national health sciences research committee (nhsrc) and the college of medicine research and ethics committee (comrec). Online medline/pubmed database search was conducted to capture malaria publications from malawi since 1984–2016, with the latest search conducted on 9 january 2017. The medline/pubmed, an online international database, was chosen as the only database searched because it freely provides access to over 5000 peer reviewed indexed journals which are periodically updated by the us national library of medicine and hence it is bound to capture a large number of viable research publications [10, 11]. The medical subject headings (mesh) tool was used by combining boolean ‘and’ of malaria and malawi terms as follows: (‘malaria’ [mesh terms] or ‘malaria’ [all fields]) and (‘malawi’ [mesh terms] or ‘malawi’ [all fields]) and (‘1984/01/01’ [pdat]: ‘2016/12/31’ [pdat]). And exclusion y malaria research conducted in malawi was included in the review, and multi-country primary research that involved collection of primary data from malawi. The study excluded commentaries, systematic reviews and meta-analyses, and research articles that only referenced malaria research conducted in malawi. However, original studies from malawi referenced and included in the systematic reviews and meta-analysis were sought and incorporated in the ed malaria studies. List of approved malaria studies from the two ecs in malawi, nhsrc and comrec was obtained. The nhsrc, under the research unit in the ministry of health, was established in 1988 and mandated to review and clear all health research conducted in malawi. However, with growing research demand, comrec, under the college of medicine (com) in the university of malawi, was established in 1996 and mandated to facilitate the review of proposals of faculty members and students of com and kamuzu college of nursing, and their affiliates which include the malawi-liverpool wellcome (mlw) trust, blantyre malaria project (bmp), malaria alert centre (mac), and centre for reproductive health (crh). This study was purely descriptive by examining the amount, trends, institutional affiliations of first and last authors, types, and sources of funding for malaria research conducted in malawi. In addition, various relationships of the variables were established through analysis focused on providing outputs of the following: (1) amount of malaria research conducted in malawi from 1984 to 2016; (2) type of malaria research studies conducted in that period; (3) institutional affiliations of first and senior/last authors in addition to local and international collaborations; and, (4) source of malaria research funding. Categorization of malaria research into various types was through inspection of the titles, abstracts and full papers, where possible. For the purposes of this review, the type of malaria research were first categorized into primary and secondary then the focus on primary research was later grouped into basic, epidemiological, clinical, and health policy and systems research (hpsr) (table 1; fig. Analysis was further extended to areas of focus for malaria research, which included malaria in pregnancy, immunology, severe malaria, drug evaluation, morbidity, diagnosis, vector and/or agent dynamics, drug discovery, malaria vaccine, co-infections, hpsr, and prevention (research on long-lasting treated nets, indoor residual spraying, environmental sanitation, and personal protection). This categorization was done by two independent reviewers and differences were resolved on consensus and to measure the level of agreement a cohen’s kappa score of 0. Health workers’ compliance to rapid diagnostic tests (rdts) to guide malaria treatment: a systematic review and meta-analysis. Restriction to gene flow is associated with changes in the molecular basis of pyrethroid resistance in the malaria vector anopheles funestus. Provider and user acceptability of intermittent screening and treatment for the control of malaria in pregnancy in malawi. After applying the inclusion and exclusion criteria to the publications, 483 publications were assessed for type and amount of malaria research from malawi, of which 412 (85. Flow chart of the selection process of studies and publication of malaria research since number and trend of malaria publication records for each year are presented in fig. It is evident that there has been a slow increase in the number of malaria publications from 1984 to 2001 with exceptions in 1994 and 1996 and increasing steadily from 2002 to 2016. However, there was an average of 15 publications per of malaria publications in ed studies from ecs showed a steady increase with 2014 approving 27 studies and uniquely in 2007 when 21 studies were approved compared to the previous and later years until 2014 (fig. Of malaria approved studies in hing journals for malaria research in were a total of 118 journals that published malaria research from malawi with only three (2. Ls publishing malaria research from rizing studies into specific types posed a challenge as many studies overlapped. The first categorization of type on malaria research was based on either research being basic, clinical, epidemiological, or hpsr. The hpsr in the approved studies (n = 39) shows that 18 (46%) were implementation, 13 (33%) operational, six (16%) health systems, and two (5%) health policy of malaria research conducted in areas for malaria research conducted in a research was also assessed in relation to areas of focus. In severe malaria with only one publication on malaria vaccine, while morbidity studies 33 (20%), severe malaria 28 (17%) and hpsr 24 (14. Thirty-three (79%) out of 42 publications were on hiv and aids and malaria co-infection, followed by four (2%) on nutritional problems; the 12 approved studies identified were on co-infection research of malaria and hiv and ation of first and senior/last utional affiliations of first and senior/last authors were assessed by examining whether they were affiliated to a malawian or foreign institution. Table 4 shows that 20 (23%) pis were affiliated to com and 12 (14%) to mac, bmp and unc project ations of principal investigators (pis) in e of medicine, university of malawi20 (23%)malaria alert centre12 (14%)blantyre malaria project12 (14%)university of north carolina project12 (14%)malawi-liverpool wellcome trust11 (13%)ministry of health10 (11%)malawi college of health sciences3 (3%)unicef/malawi2 (2%)mzuzu university1 (1%)chancellor college1 (1%)deayang luke hospital1 (1%)john hopkins research project/malawi1 (1%)reach trust1 (1%)save the children international1 (1%)total88 (100%). However, it is a requirement that foreign institutions conducting research in the country should be affiliated to a local institution and incorporate local researchers for purposes of collaboration and capacity s of malaria research funding in g acknowledgements were assessed in the accessed full papers. Funded malaria research type in sionthe review focused on assessing the type and amount of malaria research conducted in malawi from 1984 to 2016 and its related source of funding. Bibliometric analysis was utilized to measure the number of publications from primary malaria research conducted in malawi as a measure of scientific research activity. A total of 483 publications of primary malaria research originating from malawi were online and 165 malaria approved studies from ecs. Malaria research activity in malawi has steadily grown from two publications in 1984 to 51 in 2015 and 41 in 2016, and from one approved study in 2005 to 26 in 2016. Other notable research institutions conducting malaria research in malawi include the university of north carolina (unc) project, and the ministry of health.
This rise in research activity contributed to malawi being ranked eighth in the top african countries publishing malaria research between 1995 and 1997 [15]. A similar review of research on infectious and non-infectious diseases in malawi for the purposes of research gap analysis in the development of a national health research agenda revealed that clinical research was common while hpsr was the least [16]. The type of research reflects the research focus of com and its affiliates in conducting clinical and basic research in malaria in pregnancy, severe malaria, and vector and/or agent dynamics. This high reliance on external support for research funding is also reflected in the amount of funding from external support for malaria control [18]. However, the fact that they were published in reputable journals signifies that they underwent thorough peer review and were checked for quality. Malaria research from malawi was mainly published in international journals since only three african journal were identified in this study and these included the african journal of health sciences, african health sciences, and the malawi medical journal. The major publisher of malaria research from malawi is malaria journal, followed by the american journal of tropical medicine and hygiene and of special interest was the local malawi medical journal indexed in medline with 13 (2. However, as more local and regional journals, such as the malawi medical journal, are being indexed in the medline, this type of research should be encouraged for publication, undergo peer review and increase visibility and readability. Policies based on non-peer-reviewed work usually raise concerns on the quality of evidence used, which may later have implications on quality of services [23]. In addition due to time and staff capacity the broad term of ‘malaria’ was used in the search with the assumption of capturing all malaria-related terms. However, this may have missed out other potential publications with terms not associated to sionviable malaria research has been conducted in malawi since 1984 with clinical and basic research leading in both publications and funding. The major sources of funding for malaria research in malawi come from nih, usa, and the wellcome trust, uk, whose institutions, the bmp and mlw respectively, are affiliated to com. The research focus of these institutions is reflected in the findings of this review, as clinical and basic research dominate in the fields of malaria in pregnancy, severe malaria and vector and/or agent dynamics. Similarly, local malaria researchers should be aggressive in resource mobilization, such as grant applications, in order to conduct research that addresses local needs, as stipulated in the quantity of publications, which may reflect the scientific research activity of a country, does not alone reveal the primary impact of research [11], i. One immediate way of assessing this is to examine how development of health policies has been informed by local re malaria for disease for disease control health and human e of medicine research and ethics for reproductive policy and systems l subject -liverpool al health sciences research al institute of health, health and human al malaria control zation for economic co-operation and sity of north agency for international s’ contributionscam conceived and developed the idea, and prepared the manuscript. Estelle gobler, (librarian) for her assistance in the online literature authors declare that they have no competing bility of data and data that support the findings of this study are available from the corresponding author upon l clearance was obtained from the national health sciences research committee (ref no. Research funding by the university of pretoria institute for sustainable malaria control and sa mrc collaborating centre for malaria er nature remains neutral with regard to jurisdictional claims in published maps and institutional s’ affiliations(1)university of pretoria institute for sustainable malaria control (up ismc), school of health systems and public health, university of pretoria(2)icap at columbia university, mailman school of public health(3)population health, health systems and innovation, human sciences research council (hsrc)(4)international centre of insect physiology and ecology (icipe)(5)school of public health and family medicine, college of medicine, university of submitting a comment you agree to abide by our terms and community guidelines. Use cookies to improve your experience with our information about our cookie through the plos taxonomy to find articles in your more information about plos subject areas, patients with malaria-like symptoms seek treatment in private medicine retail outlets (pmr) that distribute malaria medicines but do not traditionally provide diagnostic services, potentially leading to overtreatment with antimalarial drugs. To achieve universal access to prompt parasite-based diagnosis, many malaria-endemic countries are considering scaling up malaria rapid diagnostic tests (rdts) in these outlets, an intervention that may require legislative changes and major investments in supporting programs and infrastructures. This review identifies studies that introduced malaria rdts in pmrs and examines study outcomes and success factors to inform scale up hed and unpublished studies that introduced malaria rdts in pmrs were systematically identified and reviewed. Literature published before november 2016 was searched in six electronic databases, and unpublished studies were identified through personal contacts and stakeholder meetings. Of those testing negative, provision of antimalarials varied from 2%-83% and was less than 20% in eight studies. Performance of rdts by pmr vendors was generally good, but disposal of medical waste and referral of patients to public facilities were common ing services of pmrs to include malaria diagnostic services may hold great promise to improve malaria case management and curb overtreatment with antimalarials. Plos one12(3):Backgroundprovision of artemisinin-based combination therapies (acts) and other antimalarials to patients without confirmed malaria frequently results in overtreatment, potentially delaying diagnosis and treatment of other causes of illness and reducing availability of acts for true malaria cases [1, 2]. Overuse of antimalarials by patients without malaria has been estimated to be half of global demand [3]. By recommendations from the world health organization in 2010 [4], national malaria programs in most endemic countries revised their diagnosis and treatment guidelines to emphasize the use of parasite-based diagnosis of malaria before treatment for all suspected malaria cases [5, 6]. Since then, procurement of malaria rapid diagnostic tests (rdts) has increased significantly in the public health care sector across much of sub-saharan africa [5, 7]. Efforts to improve or expand malaria case management in the private sector, as demonstrated in the affordable medicines facility- malaria (amfm) pilot, focused on treatment delivery, but did not promote the use of diagnostic testing [8]. Evidence shows that rdts or microscopy are available in less than 20% of pharmacies and drug shops selling antimalarials in six out of eight sub-saharan african countries surveyed in 2013 or 2014 [9]. Though treatment-seeking practices vary greatly between countries, overall approximately one-third of febrile children obtaining malaria drugs are treated by private providers with limited access to malaria diagnostic services [3]. In many countries, pmrs play a dominant role in the distribution and sale of antimalarials [9]. Pmrs are allowed to only carry over the counter drugs and in some cases a limited number of prescription drugs such as antimalarials and certain antibiotics. The importance of pmrs as a first source of care and antimalarial treatment, several endemic countries in sub-saharan africa and southeast asia are considering introducing and scaling up rdts in these outlets to achieve universal access to prompt parasite based diagnosis prior to treatment [17]. Without adequate oversight, public health officials fear that pmrs may misdiagnose patients or not treat patients according to malaria guidelines, providing antimalarials or antibiotics to patients that test negative for malaria [19]. Review identifies and synthesizes available evidence and explores how it can help inform decisions about scaling up rdts in iveswe undertook a systematic review of published and unpublished intervention studies to evaluate available evidence of the implementation and impact of rdt introduction in pmrs (pharmacies, drug stores, general stores, and/or itinerant vendors that sell medicines along with other household merchandise). The review aimed to:Examine outcomes pertaining to rdt uptake, provider adherence to test results, referral, cost and characteristics of each intervention to introduce rdt use (e. To increase the evidence base, recent studies yet to be published at the time of the search were also included in the review. Principal investigators of published studies were also asked to provide clarifications and data on additional outcomes not reported in the performed a systematic literature search of electronic databases on november 16, 2016, including pubmed/medline, cochrane library online, wholis internet databases, ibss, web of science and ovid (embase, global health, and journals at ovid). Studies which were yet to be published were identified at a roll back malaria (rbm) case management working group, informal private sector task force meeting in april 2013 [22] and a consultative working meeting on fever case management in the private health care sector in africa, organized by act consortium in october 2015 [17]. Ture searches used synonyms and mesh terms for three concepts (i) ‘malaria’ (ii) ‘rapid diagnostic test’ and (iii) ‘private sector’. Search published studies the resulting titles and abstracts were reviewed independently by two authors (tv and kb) to select papers or reports to read in full text. Remaining papers were included in the systematic inclusion of unpublished studies, investigators were contacted initially to ascertain whether studies met the eligibility criteria, whether data would be available and/or computed within a given time frame and to reach agreement with investigators to include their unpublished findings in the review. Studies that met each of these criteria were subsequently included in the review and investigators asked to contribute results from their outcomes and extraction tables were used to collate information from both published and unpublished studies. The following diagnosis and treatment outcomes were compared across studies:Uptake: the proportion of patients seeking treatment for fever or suspected malaria who were tested with an positivity: the proportion of patients receiving a positive rdt provision: the proportion of patients seeking treatment for fever or suspected malaria who were sold acts, regardless of whether or not they were nce to negative or positive test results: the proportion of patients that were sold acts in the presence of a positive rdt result or the proportion of patients that that were not sold acts or other antimalarials in the presence of a negative rdt otic provision: the proportion of patients who were sold antibiotics in the presence of a positive rdt result; or the proportion of patients who were sold antibiotics in the presence of a negative rdt als: the proportion of patients referred to a public facility by the provider for further cy and safety: the proportion of pmr providers who accurately performed the rdt, read the result, and adequately disposed of the infectious hazardous retail price of a reported outcomes as proportions with comparable denominators where possible. To explore factors that appear to have supported rdt uptake and provider adherence to test results, outcomes across study arms were reviewed in terms of the characteristics of each intervention (length and content of trainings, supervision frequency, demand generation activities, recommended rdt retail price and referral policy). Two of these, a study in madagascar and a study in angola, were excluded, as data were not available at the time of this review. In all, six published [25–32] and six unpublished studies (please refer to the supporting information file s2 file) were included in the review, for a total of 12 1. The studies took place in areas of medium to high malaria transmission [33] and in rural, peri-urban, and urban settings. Data collection g and treatment 4 provides the diagnosis and treatment outcomes included in the review. Provision and rdt studies reported on act provision among all patients seeking treatment for fever or suspected malaria.
Overall, antimalarials were less commonly provided to rdt-negative patients than to rdt-positive and untested patients. In eight studies, the percentage of rdt-negative patients who received an unnecessary antimalarial was at or below 20% (ansah et al. 2013, 2015) found relatively low adherence, with 41% of patients testing negative receiving an antimalarial (22/54 household members reporting getting an rdt at a drug shop). Under review) and a study in uganda (at a subsidized price of $1, streat et al. Introduction of rdts in pmrs, a primary source of care in many settings, aims to improve case management of febrile illnesses through prompt and appropriate treatment of malaria and a reduction in delays to diagnosis and treatment of other illnesses. This review demonstrates that while rdt introduction can achieve this goal, such outcomes are not guaranteed. 2015) compared the uptake of rdts and adherence to national malaria guidelines under different training scenarios and found that longer and more comprehensive training (two days covering diagnosis and treatment versus one day with only a demonstration on how to use rdts) did not appear to affect uptake or adherence. In contrast, classroom-based trainings on malaria case management in a study in myanmar (aung et al. Under review), subsidizing the retail price of rdts by over 50% did not increase uptake compared with an unsubsidized price. Prior exposure of provider to malaria case management training), the timing of the evaluation (e. Under review), chose not to control the supply of rdts; pmrs were simply informed where they could procure rdts. Schools in an intervention arm of a study in nigeria (onwujekwe et al 2015) were supported to organize malaria events to promote uptake and adherence, but only half of the participating schools did geneity in outcomes following rdt introduction is not unique to the private sector [35–37]. While many public health facilities that increased diagnostic testing for malaria through the use of rdts also reported reductions in act provision, the availability of rdts alone does not seem sufficient to ensure the appropriate use of acts [38, 39]. Public and private providers alike have rationales for providing antimalarials to patients with a negative rdt result. Anxiety over the potential for patients to worsen without being given antimalarials seems paramount [40, 41], just as with antibiotics in other settings [42]. This is accentuated in contexts where antimalarials are expected, or even demanded, by patients or customers [43], and where clients can take their business elsewhere [44]. First, evidence is needed on how to integrate malaria testing into case management beyond malaria. Under review) that instructed providers to visit public health facilities to drop off waste had mixed success; many providers instead chose to bury or burn their waste. Finally, additional consideration must also be given to issues beyond malaria control, such as role of pmrs in the wider health system and the legal and regulatory frameworks for in vitro diagnostics. A sustained scale up of rdts in the private retail sector would require recognition from stakeholders, including regulatory bodies, that pmrs are a viable alternative to public sector provision of quality care for uncomplicated review employed a broad search strategy to identify all eligible studies where rdts were introduced in the private medicine retail sector. The studies included in the review were all small scale trials or pilots with short durations. Finally, studies included in the review did not address the potential regulatory and policy barriers of introducing rdts to pmrs. All of the studies, except in myanmar, were provided a waiver to perform sionssupporting the introduction of malaria rapid diagnostic testing in private medicine retail outlets has the potential to target antimalarial drugs more effectively. This review shows that a range of private providers in different countries can incorporate rdts into their practice, although with varying degrees of uptake and influence on case management. This review suggests investment in training and supervision may be beneficial to supporting rdt implementation. We also acknowledge the presidents malaria initiative and the act consortium in sponsoring the consultative meetings. We would also like to acknowledge the patients and health workers who contributed to each of the studies included in the tualization: ra lmb kb circ jc ds curation: kb circ tl igation: eka ja kb circ sec jlc ac ke gf sl km am oo jp sp es aw vw ology: kb km circ tl t administration: tv kb ces: ra eka ja sec jlc ac ke gf sl km am oo jp sp es aw vw ision: lmb circ jc ization: kb circ tl g – original draft: kb circ tl g – review & editing: eka ja lmb ib kb circ sec jlc jmc ac jc cd ke gf cg eh sl tl km am oo np jp sp es tv aw cjmw vw cj, chandler c, ansah e, leslie t, staedke sg. Effect of the affordable medicines facility—malaria (amfm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data. Medicine sellers and malaria treatment in sub-saharan africa: what do they do and how can their practice be improved? 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