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Research Article Pages: 1 - 6

Detection of Asymptomatic Plasmodium Falciparum Infections by PCR: A Cross-sectional Survey during the Malaria Elimination Programme in Jazan Province, Saudi Arabia

Ibrahim Elhassan*, Ahmed Sahly, Seham Elamin, Aymen Abdelhaleem, Robert W. Snow and Mohammed Elfaki

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Background: While the world has made great strides against malaria continuing to be a public health challenge, especially in areas approaching elimination, the situation in the Jazan Province of Saudi Arabia is a bit more optimistic. Saudi Arabia has spent significant efforts since 2004 controlling Plasmodium falciparum transmission and as a result has lowered the rate of locally acquired P. falciparum cases to only two recorded cases as of 2018. That being said, asymptomatic and submicroscopic cases could undermine elimination efforts. This study examined the prevalence of asymptomatic infections in a low transmission setting through molecular diagnostics.

Methods: A cross-sectional community-based survey was carried out In Samtah Province in southeastern Jazan. Blood samples were collected from 230 healthy, asymptomatic individuals ages 2–65 and were tested by microscopy, by Rapid Diagnostic Tests (RDTs) and by real time Polymerase Chain Reaction (PCR). DNA was extracted from dried blood spots using the QIAamp DNA Mini Kit (Hilden, Germany) and the samples were analyzed using the FTD Malaria PCR Kit (Cat# FTD-39-64, Luxembourg).

Results: By microscopy and RDTs, we found no malaria and a 0% prevalence with standard methods. The PCR detection showed P. falciparum DNA in three individuals, equating to a 1.3%-point prevalence. These infections were asymptomatic, submicroscopic infections which were also not detected by routine diagnostics. While local transmission appears to be decreasing, imported cases and hidden reservoirs present some of the greatest challenges to elimination.

Conclusion: surveillance systems should incorporate molecular diagnostics that identify low-density infections in order to eradicate and sustain malaria. Active case detection and the integration of sensitive tools into national programs should to be prioritized, especially in low-endemic conditions.

Research Article Pages: 1 - 9

Assessment of the Climatic and Environmental Factors on the Spatial Distribution of Malaria in Amhara Region, North-West Ethiopia

Haile Mekonnen Fenta, Lijalem Melie Tesfaw, Awoke Seyoum Tegegne, Denekew Bitew Belay, Godada Keleb Lake, Muluwork Ayele Derebe, Abay Kassa Teklie*, Eyerus Asmare and Mollalign Tarekegn Minwagaw

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Background: Malaria is a major global public health problem, particularly in developing nations. Its transmission in Ethiopia is primarily cyclical and unstable. The objective of this study was to assess factors affecting the spatial distribution of malaria in the Amhara region.

Methods: One hundred nine woredas were included in the study. The spatial autocorrelation of malaria incidence and hotspot analysis was determined by Moran’s diagram and local Moran’s I index, respectively. The relationships between malaria incidence and the ecological predictors of transmission were analyzed in all 93 geopolitical areas.

Results: A quarter of woredas in the Amhara region had precipitation equal to 73.67 mm. Among the covariates, aridity (SAC=-0.019, pvalue< 0.001), temperature (SAC=-0.438, p-value<0.001), enhancement of vegetation index (SAC=-0.001, p-value<0.001), land surface temperature (SAC=11436, p-value<0.001), daytime wet (SAC=0.037, p-value<0.05), daytime land surface temperature (SAC=-5718, pvalue< 0.001), diurnal temperature range (SAC=0.1082, p-value<0.001), insecticide-treated bed nets (SAC=0.001, p-value<0.01), the amount of stagnant water (SAC=0.001, P-value<0.05) and average nighttime luminosity (SAC=-0.015, p-value<0.01) significantly affected the prevalence of malaria in the study area.

Conclusion: Among the different districts, Asagirt woreda had the highest prevalence (83.3%) and the minimum prevalence in the study areas was 1.89%. On average about 18% of individuals who visited the hospitals for checkups became malaria positive. Health-related education should be strengthened on removing stagnant water by discarding old tires that may collect rainwater, and removing debris from streams so streams flow more freely.