1887
Volume 2024, Issue 4
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Malaria continues to pose a significant public health challenge in Africa, where 95% of global malaria cases and deaths occur in Sub-Saharan Africa (SSA). Cerebral malaria (CM) is a fatal type of severe malaria primarily caused by species and disproportionately affects children under five years. Despite ongoing control efforts, CM persists as one of the most prevalent presentations of severe malaria with surprisingly high prevalences even in regions with lower endemicity and transmission rates. This commentary presents an updated compilation of key CM-related public health challenges, including delayed presentation of cases and a lack of diagnostic tools in resource-limited African communities, leading to misdiagnosis. Further challenges include insufficient provision of anti-malarial drugs and inaccessibility in rural and remote areas, coupled with emerging resistance to the gold-standard therapy (artemisinin combination therapy). CM carries a high risk of long-term neurological complications and is seen in almost half of the survivors. These complications severely impair their daily quality of life and extend to social and financial challenges. CM survivors also suffer from the lack of appropriate health services such as continuous rehabilitation, medical care, and psychological support. Despite its burden, interventional research in CM management remains insufficient, particularly regarding short- and long-term neurological complications. Local African governments have occupied the backseat for the length of this continental health crisis. It is crucial for them to occupy a proactive role in supporting healthcare infrastructure and delivering high-quality health services. Intragovernmental collaborations and establishing a regional health network within Africa can ensure realistic and accurate surveillance data tracking. From this, strategic healthcare planning, control measures, and source allocation could be better observed and tailored to the needs of different African subpopulations.

© 2024 Abdelmalik, Kashbour, licensee HBKU Press.
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2024-12-31
2026-03-07

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References

  1. World Health Organization. World malaria report 2022. World Health Organization; 2022.
    [Google Scholar]
  2. Tuteja R. Malaria—An overview. FEBS J. 2007; 274:(18):4670–9. https://doi.org/10.1111/j.1742-4658.2007.05997.x
     [Google Scholar]
  3. Degarege A, Fennie K, Degarege D, Chennupati S, Madhivanan P. Improving socioeconomic status may reduce the burden of malaria in sub Saharan Africa: A systematic review and meta-analysis. PLoS One. 2019; 14:(1):e0211205. https://doi.org/10.1371/journal.pone.0211205
     [Google Scholar]
  4. De Silva PM, Marshall JM. Factors contributing to urban malaria transmission in sub-Saharan Africa: A systematic review. J Trop Med. 2012; 2012:1–10. https://doi.org/10.1155/2012/819563
     [Google Scholar]
  5. Severe malaria. Trop Med Int Health. 2014; 19:(Suppl 1):7–131. https://doi.org/10.1111/tmi.12313_2
     [Google Scholar]
  6. Reyburn H. Association of transmission intensity and age with clinical manifestations and case fatality of severe Plasmodium falciparum malaria. JAMA. 2005; 293:(12):1461. https://doi.org/10.1001/jama.293.12.1461
     [Google Scholar]
  7. O’Meara WP, Bejon P, Mwangi TW, Okiro EA, Peshu N, Snow RW, et al.. Effect of a fall in malaria transmission on morbidity and mortality in Kilifi, Kenya. Lancet. 2008; 372:(9649):1555–62. https://doi.org/10.1016/s0140-6736(08)61655-4
     [Google Scholar]
  8. Guinovart C, Sigaúque B, Bassat Q, Loscertales MP, Nhampossa T, Acácio S, et al.. The epidemiology of severe malaria at Manhiça District Hospital, Mozambique: A retrospective analysis of 20 years of malaria admissions surveillance data. Lancet Glob Health. 2022; 10:(6):e873–81. https://doi.org/10.1016/S2214-109X(22)00125-5
     [Google Scholar]
  9. Carneiro I, Roca-Feltrer A, Griffin JT, Smith L, Tanner M, Schellenberg JA, et al.. Age-patterns of malaria vary with severity, transmission intensity and seasonality in sub-Saharan Africa: A systematic review and pooled analysis. PLoS Oone. 2010; 5:(2):e8988. https://doi.org/10.1371/journal.pone.0008988
     [Google Scholar]
  10. Roca-Feltrer A, Carneiro I, Smith L, Schellenberg JRA, Greenwood B, Schellenberg D. The age patterns of severe malaria syndromes in sub-Saharan Africa across a range of transmission intensities and seasonality settings. Malar J. 2010; 9:(1):282. https://doi.org/10.1186/1475-2875-9-282
     [Google Scholar]
  11. Bailey JW, Williams J, Bain BJ, Parker-Williams J, Chiodini PL; General Haematology Task Force of the British Committee for Standards in Haematology. Guideline: The laboratory diagnosis of malaria. General Haematology Task Force of the British Committee for Standards in Haematology. Br J Haematol. 2013; 163:(5):573–80. https://doi.org/10.1111/bjh.12572
     [Google Scholar]
  12. Borgstein A, Zhang B, Lam C, Gushu MB, Liomba AW, Malenga A, et al.. Delayed presentation to hospital care is associated with sequelae but not mortality in children with cerebral malaria in Malawi. Malar J. 2022; 21:(1):60. https://doi.org/10.1186/s12936-022-04080-2
     [Google Scholar]
  13. Chukwuocha UM, Okpanma AC, Nwakwuo GC, Dozie IN. Determinants of delay in seeking malaria treatment for children under-five years in parts of South Eastern Nigeria. J Community Health. 2014; 39:(6):1171–8. https://doi.org/10.1007/s10900-014-9872-4
     [Google Scholar]
  14. Sinclair D, Donegan S, Isba R, Lalloo DG. Artesunate versus quinine for treating severe malaria. Cochrane Database Syst Rev. 2012Jun13; 2012:(6):CD005967. https://doi.org/10.1002/14651858.cd005967.pub4
     [Google Scholar]
  15. World Health Organization. WHO guidelines for malaria; 2023March14. https://apps.who.int/iris/handle/10665/366432
     [Google Scholar]
  16. Balikagala B, Fukuda N, Ikeda M, Katuro OT, Tachibana S-I, Yamauchi M, et al.. Evidence of artemisinin-resistant malaria in Africa. N Engl J Med. 2021; 385:(13):1163–71. https://doi.org/10.1056/NEJMoa2101746
     [Google Scholar]
  17. Mutabingwa TK. Artemisinin-based combination therapies (ACTs): Best hope for malaria treatment but inaccessible to the needy!. Acta Trop. 2005; 95:(3):305–15. https://doi.org/10.1016/j.actatropica.2005.06.009
     [Google Scholar]
  18. Nayyar GM, Breman JG, Newton PN, Herrington J. Poor-quality antimalarial drugs in southeast Asia and sub-Saharan Africa [published correction appears in Lancet Infect Dis. 2012 Jul;12(7):506]. Lancet Infect Dis. 2012; 12:(6):488–96. https://doi.org/10.1016/S1473-3099(12)70064-6
     [Google Scholar]
  19. Search of cerebral malaria - list results - ClinicalTrials.gov. classic.clinicaltrials.gov. https://classic.clinicaltrials.gov/ct2/results?cond=cerebral+malaria&term=&cntry=&state=&city=&dist= (accessed August 11, 2023).
     [Google Scholar]
  20. Langfitt JT, McDermott MP, Brim R, Mboma S, Potchen MJ, Kampondeni SD, et al.. Neurodevelopmental impairments 1 year after cerebral malaria. Pediatrics. 2019; 143:(2):e20181026. https://doi.org/10.1542/peds.2018-1026
     [Google Scholar]
  21. Mbale EW, Taylor T, Brabin B, Mallewa M, Gladstone M. Exploring neurodevelopmental outcome measures used in children with cerebral malaria: The perspectives of caregivers and health workers in Malawi. BMC Pediatr. 2017; 17:(1):9. https://doi.org/10.1186/s12887-016-0763-y
     [Google Scholar]
  22. Esu EB, Oringanje C, Meremikwu MM. Intermittent preventive treatment for malaria in infants. Cochrane Database Syst Rev. 2021Jul17; 7:(7):CD011525. https://doi.org/10.1002/14651858.CD011525.pub3.
     [Google Scholar]
  23. Rts SC. Efficacy and safety of RTS, S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: Final results of a phase 3, individually randomised, controlled trial. Lancet. 2015Jul4; 386:(9988):31–45. https://doi.org/10.1016/S0140-6736(15)60721-8
     [Google Scholar]
  24. Datoo MS, Dicko A, Tinto H, Ouédraogo JB, Hamaluba M, Olotu A, et al.. Safety and efficacy of malaria vaccine candidate R21/Matrix-M in African children: A multicentre, double-blind, randomised, phase 3 trial. Lancet. 2024Feb10; 403:(10426):533–44. https://doi.org/10.1016/S0140-6736(23)02511-4
     [Google Scholar]
  25. Pryce J, Richardson M, Lengeler C. Insecticide-treated nets for preventing malaria. Cochrane Database Syst Rev. 2018; 11:(11). https://doi.org/10.1002/14651858.cd000363.pub3
     [Google Scholar]
  26. Walshe DP, Garner P, Adeel AA, Pyke GH, Burkot TR. Larvivorous fish for preventing malaria transmission. Cochrane Database Syst Rev. 2013Dec 10:(12):CD008090. https://doi.org/10.1002/14651858.cd008090.pub3
     [Google Scholar]
  27. Conteh L, Shuford K, Agboraw E, Kont M, Kolaczinski J, Patouillard E. Costs and Cost-Effectiveness of Malaria Control Interventions: A Systematic Literature Review. Value Health. 2021Aug; 24:(8):1213–22.
    [Google Scholar]
  28. Nkfusai CN, Ngou O, Subi CE, Mohlin S, Bemadoum F, Teboh S, et al.. Malaria elimination: What can Africa learn from China? Int J MCH AIDS. 2022; 11:(2):e526. https://doi.org/10.21106/ijma.526
     [Google Scholar]
/content/journals/10.5339/qmj.2024.55
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Africa’s public health battle with cerebral malaria: What are we up against?
Qatar Medical Journal 2024, 55 (2024); https://doi.org/10.5339/qmj.2024.55
/content/journals/10.5339/qmj.2024.55
/content/journals/10.5339/qmj.2024.55
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  • Article Type: Editorial
Keyword(s): antimalarials, cerebral malaria, Malaria, Plasmodium falciparum, public health and Sub-Saharan Africa

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