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A Decade of Progress Accelerating Malaria Control in Mali: Evidence from the West Africa International Center of Excellence for Malaria Research.

ABSTRACT: This article highlights over a decade of signature achievements by the West Africa International Centers for Excellence in Malaria Research (WA-ICEMR) and its partners toward guiding malaria prevention and control strategies. Since 2010, the WA-ICEMR has performed longitudinal studies to monitor and assess malaria control interventions with respect to space-time patterns, vector transmission indicators, and drug resistance markers. These activities were facilitated and supported by the Mali National Malaria Control Program. Research activities included large-scale active and passive surveillance and expanded coverage of universal long-lasting insecticide-treated bed nets and seasonal malaria chemoprevention (SMC). The findings revealed substantial declines in malaria occurrence after the scale-up of control interventions in WA-ICEMR study sites. WA-ICEMR studies showed that SMC using sulfadoxine-pyrimethamine plus amodiaquine was highly effective in preventing malaria among children under 5 years of age. An alternative SMC regimen (dihydroartemisinin plus piperaquine) was shown to be potentially more effective and provided advantages for acceptability and compliance over the standard SMC regimen. Other findings discussed in this article include higher observed multiplicity of infection rates for malaria in historically high-endemic areas, continued antimalarial drug sensitivity to Plasmodium falciparum, high outdoor malaria transmission rates, and increased insecticide resistance over the past decade. The progress achieved by the WA-ICEMR and its partners highlights the critical need for maintaining current malaria control interventions while developing novel strategies to disrupt malaria transmission. Enhanced evaluation of these strategies through research partnerships is particularly needed in the wake of reported artemisinin resistance in Southeast Asia and East Africa.

SUBMITTER: Doumbia S

PROVIDER: S-EPMC9662231 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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A Decade of Progress Accelerating Malaria Control in Mali: Evidence from the West Africa International Center of Excellence for Malaria Research.

Doumbia Seydou S Sogoba Nafomon N Diakite Mahamadou M Toure Mahamoudou M Keita Moussa M Konaté Drissa D Diawara Sory I SI Diarra Ayouba A Sanogo Daouda D Kane Fousseyni F Diakite Seidina A S SAS Traore Karim K Thiam Sidibé M'Baye SM Traoré Sékou F SF Cisse Idrissa I Mihigo Jules J Coulibaly Mamadou B MB Dabitao Djeneba D Alifrangis Michael M Barry Alyssa E AE Müller Günter C GC Beier John C JC Shaffer Jeffrey G JG

The American journal of tropical medicine and hygiene 20221011 4_Suppl

This article highlights over a decade of signature achievements by the West Africa International Centers for Excellence in Malaria Research (WA-ICEMR) and its partners toward guiding malaria prevention and control strategies. Since 2010, the WA-ICEMR has performed longitudinal studies to monitor and assess malaria control interventions with respect to space-time patterns, vector transmission indicators, and drug resistance markers. These activities were facilitated and supported by the Mali Nati ...[more]

PMID: 36228923

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Project description:BackgroundThe aim of this field trial was to evaluate the efficacy of attractive toxic sugar baits (ATSB) in Mali, where sustained malaria transmission occurs despite the use of long-lasting insecticidal nets (LLINs). ATSB bait stations were deployed in seven of 14 similar study villages, where LLINs were already in widespread use. The combined use of ATSB and LLINs was tested to see if it would substantially reduce parasite transmission by Anopheles gambiae sensu lato beyond use of LLINs alone.MethodsA 2-day field experiment was conducted to determine the number of mosquitoes feeding on natural sugar versus those feeding on bait stations containing attractive sugar bait without toxin (ASB)-but with food dye. This was done each month in seven random villages from April to December 2016. In the following year, in seven treatment villages from May to December 2017, two ATSB bait stations containing the insecticide dinotefuran were placed on the outer walls of each building. Vector population density was evaluated monthly by CDC UV light traps, malaise traps, pyrethrum spray (PSCs) and human landing catches (HLCs). Female samples of the catch were tested for age by examination of the ovarioles in dissected ovaries and identification of Plasmodium falciparum sporozoite infection by ELISA. Entomological inoculation rates (EIR) were calculated, and reductions between treated and untreated villages were determined.ResultsIn the 2-day experiment with ASB each month, there was a lower number of male and female mosquitoes feeding on the natural sugar sources than on the ASB. ATSB deployment reduced CDC-UV trap female catches in September, when catches were highest, were by 57.4% compared to catches in control sites. Similarly, malaise trap catches showed a 44.3% reduction of females in August and PSC catches of females were reduced by 48.7% in September. Reductions of females in HLCs were lower by 19.8% indoors and 26.3% outdoors in September. The high reduction seen in the rainy season was similar for males and reductions in population density for both males and females were > 70% during the dry season. Reductions of females with ≥ 3 gonotrophic cycles were recorded every month amounting to 97.1% in October and 100.0% in December. Reductions in monthly EIRs ranged from 77.76 to 100.00% indoors and 84.95% to 100.00% outdoors. The number of sporozoite infected females from traps was reduced by 97.83% at treated villages compared to controls.ConclusionsAttractive toxic sugar baits used against Anopheles mosquitoes in Mali drastically reduced the density of mosquitoes, the number of older females, the number of sporozoite infected females and the EIR demonstrating how ATSB significantly reduces malaria parasite transmission.

Project description:BackgroundSchistosomiasis is classically described as a rural disease that occurs in areas with poor sanitary conditions. However, over recent decades, there has been an expansion of schistosomiasis foci towards urban areas faced with a rapid and disordered urbanization. In Bamako, Mali, the impact of environmental change on vector-borne diseases such as schistosomiasis is not well known. This study sought to identify the presence of schistosomiasis transmission hotspots in Bamako. Using this perspective, we aimed to describe the risk factors of the endemization and maintenance of schistosomiasis.Materials and methodsA cross-sectional study was carried out in the six municipalities (communes) in Bamako. Environmental information was obtained from earth observation satellites in order to maximize ecological contrasts. Twenty-nine blocks of 200 m x 200 m were identified. We selected a school inside or nearest to each block for urine and stool samples examination. The study cohort was school children aged between eight and 15 years. The Kato-Katz technique and filtration were used for Schistosoma mansoni and S. haematobium ova research in stools and urine, respectively. The schools and snail breeding sites were georeferenced. Four malacological surveys were conducted between October 2011 and February 2012. Bivariate analysis was used to identify independent predictors of being infected with schistosomiasis.ResultsThe prevalence rate of S. haematobium was 14.7% (n = 1,761) and that of S. mansoni 1.5% (n = 1,491). Overall, the urinary form was endemic in 76.6% of schools. The infection significantly varied between the municipalities (p < 0.001). It was also more prevalent on the left side of the Niger River than the right side (17.4% vs. 9.5% respectively; p < 0.001). The vicinity to snail breeding sites (OR = 3.677; 95% IC [2.765-4.889]; p < 10 (-3) ) and parents' occupations (OR = 7.647; 95% IC [2.406-24.305]; p < 0.001) were the most important risk factors associated with S. haematobium infection exposure. Biomphalaria pfeifferi, Bulinus truncatus, and B. globosus were the intermediate hosts captured. The schistosome natural infection rates (SNIRs), which were low or nil in October and November, rose to 2.8% in January and 8.3% in February for B. pfeifferi and B. truncatus, respectively.ConclusionOur findings show that there is a high transmission risk for schistosomiasis in Bamako. Appropriate integrated control measures need to be introduced to control the transmission of this disease in the study area.

Project description:BACKGROUND/OBJECTIVE:Patient-centred attitudes have been shown to decline during medical training in high-income countries, yet little is known about attitudes among West African medical students. We sought to measure student attitudes towards patient-centredness and examine validity of the 18-item Patient-Practitioner Orientation Scale (PPOS) in this context. PARTICIPANTS/SETTING:430 medical students in years 1, 3, 5 and 6 of a 6-year medical training programme in Bamako, Mali. DESIGN:We conducted a cross-sectional survey, compared the proportion of students who agreed with each PPOS item by gender and academic year, and calculated composite PPOS scores. To examine psychometrics of the PPOS and its two subscales ('sharing' and 'caring'), we calculated internal consistency (Cronbach's alpha) and performed confirmatory and exploratory factor analyses (CFA and EFA). RESULTS:In seven of the nine 'sharing' items, the majority of students held attitudes favouring a provider-dominant style. For five of the nine 'caring' items, the majority of student responded consistently with patient-centred attitudes, while in the other four, responses indicated a disease-centred orientation. In eight items, a greater proportion of fifth/sixth year students held patient-centred attitudes as compared with first year students; there were few gender differences. Average PPOS scores indicated students were moderately patient-centred, with more favourable attitudes towards the 'caring' aspect than 'sharing'. Internal consistency of the PPOS was inadequate for the full scale (α=0.58) and subscales ('sharing' α=0.37; 'caring' α=0.48). CFA did not support the original PPOS factors and EFA did not identify an improved structure. CONCLUSIONS:West African medical students training in Bamako are moderately patient-centred and do not show the same declines in patient-centred attitudes in higher academic years as seen in other settings. Medical students may benefit from training in shared power skills and in attending to patient lifestyle factors. Locally validated tools are needed to guide West African medical schools in fostering patient-centredness among students.

Dataset Information

A Decade of Progress Accelerating Malaria Control in Mali: Evidence from the West Africa International Center of Excellence for Malaria Research.

Publications

A Decade of Progress Accelerating Malaria Control in Mali: Evidence from the West Africa International Center of Excellence for Malaria Research.

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