Malaria Bulletin: A Compendium of Current Literature

BACKGROUND: Malaria, caused by the parasitic protist Plasmodium falciparum, represents a major public health problem in the developing world. The P. falciparum genome has been sequenced, which provides new opportunities for the identification of novel drug targets. We report an exhaustive analysis of the P. falciparum genomic database (PlasmoDB) aimed at identifying and classifying all protein phosphatases (PP) in this organism. RESULTS: Using a variety of bioinformatics tools, we identified 26 malarial putative PP sequences within the four major established PP families, plus 7 sequences that we predict to dephosphorylate "non-protein" substrates. We constructed phylogenetic trees to position these sequences relative to PPs from other organisms representing all major eukaryotic phyla except Cercozoans (for which no full genome sequence is available). Predominant observations were: (i) P. falciparum possessed the smallest phosphatome of any of the organisms investigated in this study; (ii) no malarial PP clustered with the tyrosine-specific subfamily of the PTP group (iii) a cluster of 7 closely related members of the PPM/PP2C family is present, and (iv) some P. falciparum protein phosphatases are present in clades lacking any human homologue. CONCLUSION: The considerable phylogenetic distance between Apicomplexa and other Eukaryotes is reflected by profound divergences between the phosphatome of malaria parasites and those of representative organisms from all major eukaryotic phyla, which might be exploited in the context of efforts for the discovery of novel targets for antimalarial chemotherapy. 2: BMC Public Health. 2008 Sep 24;8(1):331. Bed net ownership, use, and perceptions among women seeking antenatal care in Kinshasa, Democratic Republic of the Congo (DRC): opportunities for improved maternal and child health. Full-text http://www.biomedcentral.com/1471-2164/9/412 Pettifor AE, Taylor E, Nku D, Duvall S, Tabala M, Meshnick S, Behets F. ABSTRACT: BACKGROUND: To describe malaria knowledge, attitudes toward malaria and bed net use, levels of ownership and use of bed nets, and factors associated with ownership and use among pregnant women attending their first antenatal care (ANC) visit in Kinshasa, DRC. METHODS: Women attending their first ANC visit at one maternity in Kinshsasa were recruited to take part in a study where they were given free insecticide treated bed nets(ITNs) and then followed up at delivery and BACKGROUND: To describe malaria knowledge, attitudes toward malaria and bed net use, levels of ownership and use of bed nets, and factors associated with ownership and use among pregnant women attending their first antenatal care (ANC) visit in Kinshasa, DRC. METHODS: Women attending their first ANC visit at one maternity in Kinshsasa were recruited to take part in a study where they were given free insecticide treated bed nets(ITNs) and then followed up at delivery and Environmental Health at USAID – Malaria Bulletin, October 2008 1 6 months post delivery to assess ITN use. This study describes the baseline levels of bed net ownership and use, attitudes towards net use and factors associated with net use RESULTS: Among 351 women interviewed at baseline, 115 (33%) already owned a bed net and 86 (25%) reported to have slept under the net the previous night. Cost was reported as the reason for not owning a net by 48% of the 236 women who did not own one. In multivariate analyses, women who had secondary school or higher education were 3.4 times more likely to own a net (95% CI 1.6, 7.3) and 2.8 times more likely to have used a net (95% CI 1.3, 6.0) compared to women with less education CONCLUSION: Distribution of ITNs in antenatal clinics in this setting is needed and feasible. The potential for ITN use by this target population is high. 3: BMC Public Health. 2008 Sep 21;8:321. Malaria prevalence and mosquito net coverage in Oromia and SNNPR regions of Ethiopia. Full-text http://www.biomedcentral.com/1471-2458/8/321\ Shargie EB, Gebre T, Ngondi J, Graves PM, Mosher AW, Emerson PM, Ejigsemahu Y, Endeshaw T, Olana D, WeldeMeskel A, Teferra A, Tadesse Z, Tilahun A, Yohannes G, Richards FO Jr. The Carter Center, Addis Ababa, Ethiopia. [email protected] BACKGROUND: Malaria transmission in Ethiopia is unstable and seasonal, with the majority of the country's population living in malaria-prone areas. Results from DHS 2005 indicate that the coverage of key malaria interventions was low. The government of Ethiopia has set the national goal of full population coverage with a mean of 2 long-lasting insecticidal nets (LLINs) per household through distribution of about 20 million LLIN by the end of 2007. The aim of this study was to generate baseline information on malaria parasite prevalence and coverage of key malaria control interventions in Oromia and SNNPR and to relate the prevalence survey findings to routine surveillance data just before further mass distribution of LLINs. METHODS: A 64 cluster malaria survey was conducted in January 2007 using a multi-stage cluster random sampling design. Using Malaria Indicator Survey Household Questionnaire modified for the local conditions as well as peripheral blood microscopy and rapid diagnostic tests, the survey assessed net ownership and use and malaria parasite prevalence in Oromia and SNNPR regions of Ethiopia. Routine surveillance data on malaria for the survey time period was obtained for comparison with prevalence survey results. RESULTS: Overall, 47.5% (95% confidence interval (CI) 33.5-61.9%) of households had at least one net, and 35.1% (95% CI 23.1-49.4%) had at least one LLIN. There was no difference in net ownership or net utilization between the regions. Malaria parasite prevalence was 2.4% (95% CI 1.6-3.5%) overall, but differed markedly between the two regions: Oromia, 0.9% (95% CI 0.5-1.6); SNNPR, 5.4% (95% CI 3.4-8.5), p < 0.001. This difference between the two regions was also reflected in the routine surveillance data. CONCLUSION: Household net ownership exhibited nearly ten-fold increase compared to the results of Demographic and Health Survey 2005 when fewer than 5% of households in these two regions owned any nets. The results of the survey as well as the routine surveillance data demonstrated that malaria continues to be a significant public health challenge in these regions-and more prevalent in SNNPR than in Oromia. 4: BMC Public Health. 2008 Sep 16;8(1):317. Obstacles to prompt and effective malaria treatment lead to low community-coverage in two rural districts of Tanzania. Full-text http://www.biomedcentral.com/1471-2458/8/317 Environmental Health at USAID – Malaria Bulletin, October 2008 2 Hetzel MW, Obrist B, Lengeler C, Msechu JJ, Nathan R, Dillip A, Makemba AM, Mshana C, Schulze A, Mshinda H. ABSTRACT: BACKGROUND: Malaria is still a leading child killer in sub-Saharan Africa. Yet, access to prompt and effective malaria treatment, a mainstay of any malaria control strategy, is sub-optimal in many settings. Little is known about obstacles to treatment and community-effectiveness of case-management strategies. This research quantified treatment seeking behaviour and access to treatment in a highly endemic rural Tanzanian community. The aim was to provide a better understanding of obstacles to treatment access in order to develop practical and cost-effective interventions. METHODS: We conducted community-based treatmentseeking surveys including 226 recent fever episodes in 2004 and 2005. The local Demographic Surveillance System provided additional household information. A census of drug retailers and health facilities provided data on availability and location of treatment sources. RESULTS: After intensive health education, the biomedical concept of malaria has largely been adopted by the community. 87.5% (78.2-93.8) of the fever cases in children and 80.7% (68.1-90.0) in adults were treated with one of the recommended antimalarials (at the time SP, amodiaquine or quinine). However, only 22.5% (13.9-33.2) of the children and 10.5% (4.0-21.5) of the adults received prompt and appropriate antimalarial treatment. Health facility attendance increased the odds of receiving an antimalarial (OR=7.7) but did not have an influence on correct dosage. The exemption system for under-fives in public health facilities was not functioning and drug expenditures for children were as high in health facilities as with private retailers. CONCLUSIONS: A clear preference for modern medicine was reflected in the frequent use of antimalarials. Yet, quality of case-management was far from satisfactory as was the functioning of the exemption mechanism for the main risk group. Private drug retailers played a central role by complementing existing formal health services in delivering antimalarial treatment. Health system factors like these need to be tackled urgently in order to translate the high efficacy of newly introduced artemisininbased combination therapy (ACT) into equitable community-effectiveness and healthimpact. BACKGROUND: Malaria is still a leading child killer in sub-Saharan Africa. Yet, access to prompt and effective malaria treatment, a mainstay of any malaria control strategy, is sub-optimal in many settings. Little is known about obstacles to treatment and community-effectiveness of case-management strategies. This research quantified treatment seeking behaviour and access to treatment in a highly endemic rural Tanzanian community. The aim was to provide a better understanding of obstacles to treatment access in order to develop practical and cost-effective interventions. METHODS: We conducted community-based treatmentseeking surveys including 226 recent fever episodes in 2004 and 2005. The local Demographic Surveillance System provided additional household information. A census of drug retailers and health facilities provided data on availability and location of treatment sources. RESULTS: After intensive health education, the biomedical concept of malaria has largely been adopted by the community. 87.5% (78.2-93.8) of the fever cases in children and 80.7% (68.1-90.0) in adults were treated with one of the recommended antimalarials (at the time SP, amodiaquine or quinine). However, only 22.5% (13.9-33.2) of the children and 10.5% (4.0-21.5) of the adults received prompt and appropriate antimalarial treatment. Health facility attendance increased the odds of receiving an antimalarial (OR=7.7) but did not have an influence on correct dosage. The exemption system for under-fives in public health facilities was not functioning and drug expenditures for children were as high in health facilities as with private retailers. CONCLUSIONS: A clear preference for modern medicine was reflected in the frequent use of antimalarials. Yet, quality of case-management was far from satisfactory as was the functioning of the exemption mechanism for the main risk group. Private drug retailers played a central role by complementing existing formal health services in delivering antimalarial treatment. Health system factors like these need to be tackled urgently in order to translate the high efficacy of newly introduced artemisininbased combination therapy (ACT) into equitable community-effectiveness and healthimpact. 5: Genetics. 2008 Sep 14. Use of a Drosophila Model to Identify Genes Regulating Plasmodium Growth in the Mosquito. Full-text http://www.genetics.org/cgi/rapidpdf/genetics.108.089748v1 Brandt SM, Jaramillo-Gutierrez G, Kumar S, Barillas-Mury C, Schneider DS. Institute of Environmental Science and Research Limited. We performed a forward genetic screen, using Drosophila as a surrogate mosquito, to identify host factors required for the growth of the avian malaria parasite, Plasmodium gallinaceum. We identified 18 presumed loss-of-function mutants that reduced the growth of the parasite in flies. Presumptive mutation sites were identified in 14 of the mutants on the basis of the insertion site of a transposable element. None of the identified genes have been previously implicated in innate immune responses or interactions with Plasmodium. The functions of 5 Anopheles gambiae homologs were tested by using RNAi to knock down gene function followed by measuring the growth of the rodent parasite, Plasmodium berghei. Lossof-function of four of these genes in the mosquito affected Plasmodium growth, suggesting that Drosophila can be used effectively as a surrogate mosquito to identify relevant host factors in the mosquito. Environmental Health at USAID – Malaria Bulletin, October 2008 3 6: Global Health. 2008 Sep 19;4:9. Adaptation costs for climate change-related cases of diarrhoeal disease, malnutrition, and malaria in 2030. Full-text http://www.globalizationandhealth.com/content/4/1/9