How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years:findings from 19 sub-Saharan African countries

Background Prompt and appropriate clinical management of malaria is critical for reducing the continued high burden of malaria among children under five years in sub-Saharan countries.However,more remains to be known about how a patient’s socioeconomic status(SES)would affect the access to diagnosis of malaria.Methods In this cross-sectional study using the Demographic and Health Survey and Malaria Indicators Survey,we pooled the data of 38,567 febrile under-five children in 2016–2018 from 19 sub-Saharan countries.Multivariable logistic regression was used to assess the associations between SES and two binary outcomes:the visit to a health facility and a blood test for fever.Stratified analyses were further conducted by the type of health facilities(public hospitals/public primary healthcare facilities/private hospitals/private primary healthcare facilities)for the latter outcome.Results Fifty-eight percent of the febrile children were taken to health facilities,among whom only 55%took blood tests.Compared to children from households in the highest wealth quintile,children in the lowest quintile were less likely to be taken to medical facilities[adjusted odds ratio(aOR)=0.775,95%confidence interval(CI):0.675–0.889].Parents with more than secondary education were more likely to seek care(aOR=1.830,95%CI:1.561–2.145)and to have blood tests(aOR=1.729,95%CI:1.436–2.082)for their febrile children than parents without formal education.The probabilities of receiving blood tests at public hospitals and public primary healthcare facilities stayed relatively high across parental education levels and wealth quintiles,while these probabilities remained the lowest at private primary healthcare facilities,ranging from 0.100(95%CI:0.074–0.127)to 0.139(95%CI:0.083–0.194)across parental education levels and from 0.104(95%CI:0.078–0.130)to 0.125(95%CI:0.090–0.160)across wealth quintiles.Conclusions Significant socioeconomic disparities existed both in the access to health facilities and laboratory diagnosis of malaria in children in sub-Saharan African countries.These disparities were particularly evident in the private sector.Universal health coverage needs to be further strengthened to make formal healthcare in general and the laboratory diagnosis of malaria more accessible and affordable.

Comparative evaluation of microscopy,OptiMAL® and 18S rRNA gene based multiplex PCR for detection of Plasmodium falciparum & Plasmodium vivax from field isolates of Bikaner,India

Objective:To evaluate microscopy,OptiMAL? and multiplex PCR for the identification of Plasmodium falciparum（P.falciparum） and Plasmodium vivax（P.vivax） from the field isolates of Bikaner,Rajasthan（Northwest India）.Methods:In this study,a multiplex PCR（P.falciparum and P.vivax） was further developed with the incorporation of Plasmodium malariae（P.malariae） specific primer and also a positive control.The performance of microscopy,plasmodium lactate dehydrogenase（pLDH） based malaria rapid diagnostic test OptiMAL? and 18S rRNA gene based multiplex PCR for the diagnosis of P.falciparum and P.vivax was compared.Results:The three species multiplex PCR if.falciparum,P.vivax and P.malariae) with an inbuilt positive control was developed and evaluated.In comparison with multiplex PCR,which showed the sensitivity and specificity of 99.36%（95%CI,98.11%-100.00%） and 100.00%（95%CI,100.00%-100.00%）,the sensitivity and specificity of microscopy was 90.44%（95%CI,88.849-95.04%） and 99.22%（95% CI,97.71%-100.00%）,and OptiMAL? was 93.58%（95%CI,89.75%-97.42%） and 97.69%（95%CI, 95.10%-100.00%）.The efficiencies were 99.65%,95.10%and 95.45%for multiplex PCK.microscopy and OptiMAL?.respectively.Conclusions:Our results raise concerns over the overall sensitivities of microscopy and OptiMAL?,when compared to the multiplex PCR and thus stress the need for new molecular interventions in the accurate detection of the malarial parasites.This further highlights the fact that further developments are needed to improve the performance of rapid diagnostic tests at field level.

DETECTION OF PLASMODIUM FALCIPARUM LACTATE DEHYDROGENASE A PROMISING APPROACH TO QUICK DIAGNOSIS OF MALARIA

To establish a quick and applicable diagnostic method has been a major target in immunological research on malaria. Of all approaches studied, circulating antigen (CAg) detection seems to be the most promising. Scientists have encountered tough difficulties in the analysis and purification of malaria parasite antigen because of its high complexity. Studies showed that plasmadium falciparum (P.f) lactate dehydrogenase (pLDH), as a specific CAg of malaria parasite. is apparently different from that of human erythrocytes (rLDH) both in their physical and biochemical characteristics. and is very easy to be identifed. Consequently, pLDH detection has a great potential to be developed into a method for assessing parasitemia. This paper reviewed the methods for the purification. separation, identification of pLDH and the prospect of its clinical applications as an ideal detector of the presence of malaria parasite in order to speed up this research.

Evaluation of ECL Labeled DNA Probe for the Diagnosis of Falciparum Malaria

A commercially available non—radioactive DNA labelling kit "enhanced chemiluminescence"(ECL) was evaluated for the diagnosis of falciparum malaria. The results showed that ECL labeled probe successfully detected as little as 25 pg. Purified DNA of 0.001％ parasitemia of cultured Plasmodium falciparum and did not react with human

Discovery of a natural fluorescent probe targeting the Plasmodium falciparum cysteine protease falcipain-2

The Plasmodium falciparum cysteine protease falcipain-2(FP-2) is an attractive antimalarial target. Here, we discovered that the natural compound NP1024 is a nonpeptidic inhibitor of FP-2 with an IC50 value of 0.44 μmol L–1. The most exciting finding is that both in vitro and in vivo, NP1024 directly targets FP-2 in malaria parasite-infected erythrocytes as a natural fluorescent probe, thereby paving the way for an integration of malaria diagnosis and treatment.