Malaria incidence is generally lower in cities than rural areas. However, reported urban malaria incidence may not accurately reflect the level of ongoing transmission, which has potentially large implications for prevention efforts. To guide mosquito net distribution, we assessed the extent of malaria transmission in Conakry, Guinea, in 2018. We found evidence of active malaria transmission.

Data on fever and malaria cases reported by health facilities are used for tracking incidence and quantification of malaria commodity needs in Guinea. Periodic assessments of the quality of malaria case management and routine data are a critical activity for the malaria program. In May-June 2018, survey teams visited 126 health facilities in six health districts purposefully selected to represent a spectrum (Stratum 1-high, Stratum 2-intermediate, and Stratum 3-low) of perceived quality of case management and reporting, as assessed from an a priori analysis of routine data. Surveyors performed exit interviews with 939 outpatients and compared results with registry data for interviewed patients. Availability of rapid diagnostic tests (RDTs) and artemisinin-based combination therapies (ACTs) was 100% in Strata 1 and 2, compared with 82% (95% CI: 63-92%) for RDTs and 86% (68-95%) for any formulation of ACT in Stratum 3. Correct case management for suspect malaria cases was 85% in both Stratum 1 (95% CI: 78-90%) and Stratum 2 (79-89%), but only 52% (37-67%) in Stratum 3. Concordance between exit interviews and registry entries for key malaria indicators was significantly higher in Strata 1 and 2 than in Stratum 3. Both adherence to national guidelines for testing and treatment and data quality were high in Strata 1 and 2, but substandard in Stratum 3. The survey results reflected the trends seen in the routine data, suggesting that analysis of routine data can identify areas requiring more attention to improve malaria case management and reporting.

The World Health Organization recommends the use of artemisinin-based combination therapy (ACT) to treat uncomplicated malaria for the control of malaria across the world. There are several types of ACT used across malaria-endemic countries, yet there is little information about preferences and adherence practices regarding different types of ACT. The objective of this study was to evaluate levels of adherence to two types of ACT, artemether–lumefantrine (AL) and artesunate + amodiaquine (ASAQ), for the treatment of uncomplicated malaria among prescribers and patients in Guinea in 2016.

To confirm and investigate possible explanations for unusual trends in malaria indicators, a protocol for rapid, focal assessment of malaria transmission and control interventions was piloted in N'Zérékoré and Macenta Prefectures, which each reported surprisingly low incidence of malaria during the peak transmission months during 2017 in holoendemic Forested Guinea. In each prefecture, epidemiological and entomological cross-sectional surveys were conducted in two sub-prefectures reporting high incidence and one sub-prefecture reporting low incidence. Investigators visited six health facilities and 356 households, tested 476 children, performed 14 larval breeding site transects, and conducted 12 nights of human landing catches during the 2-week investigation. Rapid diagnostic test positivity in the community sample of children under five ranged from 23% to 68% by subprefecture. Only 38% of persons with fever reported seeking care in the public health sector; underutilization was confirmed by verification of health facility and community healthcare worker (CHW) registries. High numbers of Anopheles mosquitoes were collected in human landing collections in N'Zérékoré (38 per night in combined indoor and outdoor collections) and Macenta (87). Most of the detected breeding sites positive for Anopheles larvae (83%) were shallow roadside puddles. In the investigated prefectures, malaria rates remain high and the low reported incidence likely reflects low utilization of the public health-care sector. Strengthening the CHW program to rapidly identify and treat malaria cases and elimination of roadside puddles as part of routine cleanup campaigns should be considered. Systematic joint epidemiological/entomological investigations in areas reporting anomalous signals in routine data can allow control programs to respond with tailored local interventions.

BACKGROUND:The ongoing west Africa Ebola-virus-disease epidemic has disrupted the entire health-care system in affected countries. Because of the overlap of symptoms of Ebola virus disease and malaria, the care delivery of malaria is particularly sensitive to the indirect effects of the current Ebola-virus-disease epidemic. We therefore characterise malaria case management in the context of the Ebola-virus-disease epidemic and document the effect of the Ebola-virus-disease epidemic on malaria case management. METHODS:We did a cross-sectional survey of public health facilities in Guinea in December, 2014. We selected the four prefectures most affected by Ebola virus disease and selected four randomly from prefectures without any reported cases of the disease. 60 health facilities were sampled in Ebola-affected and 60 in Ebola-unaffected prefectures. Study teams abstracted malaria case management indicators from registers for January to November for 2013 and 2014 and interviewed health-care workers. Nationwide weekly surveillance data for suspect malaria cases reported between 2011 and 2014 were analysed independently. Data for malaria indicators in 2014 were compared with previous years. FINDINGS:We noted substantial reductions in all-cause outpatient visits (by 23 103 [11%] of 214 899), cases of fever (by 20249 [15%] of 131 330), and patients treated with oral (by 22 655 [24%] of 94 785) and injectable (by 5219 [30%] of 17 684) antimalarial drugs in surveyed health facilities. In Ebola-affected prefectures, 73 of 98 interviewed community health workers were operational (74%, 95% CI 65-83) and 35 of 73 were actively treating malaria cases (48%, 36-60) compared with 106 of 112 (95%, 89-98) and 102 of 106 (96%, 91-99), respectively, in Ebola-unaffected prefectures. Nationwide, the Ebola-virus-disease epidemic was estimated to have resulted in 74 000 (71 000-77 000) fewer malaria cases seen at health facilities in 2014. INTERPRETATION:The reduction in the delivery of malaria care because of the Ebola-virus-disease epidemic threatens malaria control in Guinea. Untreated and inappropriately treated malaria cases lead to excess malaria mortality and more fever cases in the community, impeding the Ebola-virus-disease response. FUNDING:Global Fund to Fight AIDS, Tuberculosis and Malaria, and President's Malaria Initiative.

South African Journal of EconomicsVolume 67, Issue 1 p. 78-79 Davidson on Corruption: A Reply C.C. OKEAHALAM, C.C. OKEAHALAM Donald Gordon Professor of Banking and Finance, Graduate School of Business Administration, University of the Witwatersrand and Lecturer in Economics, Department of Economics, University of the Witwatersrand, repectively.Search for more papers by this authorI. BAH, I. BAH Donald Gordon Professor of Banking and Finance, Graduate School of Business Administration, University of the Witwatersrand and Lecturer in Economics, Department of Economics, University of the Witwatersrand, repectively.Search for more papers by this author C.C. OKEAHALAM, C.C. OKEAHALAM Donald Gordon Professor of Banking and Finance, Graduate School of Business Administration, University of the Witwatersrand and Lecturer in Economics, Department of Economics, University of the Witwatersrand, repectively.Search for more papers by this authorI. BAH, I. BAH Donald Gordon Professor of Banking and Finance, Graduate School of Business Administration, University of the Witwatersrand and Lecturer in Economics, Department of Economics, University of the Witwatersrand, repectively.Search for more papers by this author First published: 18 August 2005 https://doi.org/10.1111/j.1813-6982.1999.tb01137.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume67, Issue1March 1999Pages 78-79 RelatedInformation

South African Journal of EconomicsVolume 66, Issue 3 p. 176-186 Perceived Corruption and Investment in Sub-Saharan Africa. C. C. Okeahalam, Professor of Banking and Finance, University of Namibia, Windhoek, and Assistant Lecturer in Economics, University of the Witwatersrand, Johannesburg, respectively. A first draft of this paper was presented at the 20th Southern African Universities Social Science Conference (SAUSSC) in Lusaka, Zambia, November 1997. With the usual disclaimer, we acknowledge the comments of participants and are grateful for the incisive comments of referees.Search for more papers by this authorI. Bah, Professor of Banking and Finance, University of Namibia, Windhoek, and Assistant Lecturer in Economics, University of the Witwatersrand, Johannesburg, respectively. A first draft of this paper was presented at the 20th Southern African Universities Social Science Conference (SAUSSC) in Lusaka, Zambia, November 1997. With the usual disclaimer, we acknowledge the comments of participants and are grateful for the incisive comments of referees.Search for more papers by this author C. C. Okeahalam, Professor of Banking and Finance, University of Namibia, Windhoek, and Assistant Lecturer in Economics, University of the Witwatersrand, Johannesburg, respectively. A first draft of this paper was presented at the 20th Southern African Universities Social Science Conference (SAUSSC) in Lusaka, Zambia, November 1997. With the usual disclaimer, we acknowledge the comments of participants and are grateful for the incisive comments of referees.Search for more papers by this authorI. Bah, Professor of Banking and Finance, University of Namibia, Windhoek, and Assistant Lecturer in Economics, University of the Witwatersrand, Johannesburg, respectively. A first draft of this paper was presented at the 20th Southern African Universities Social Science Conference (SAUSSC) in Lusaka, Zambia, November 1997. With the usual disclaimer, we acknowledge the comments of participants and are grateful for the incisive comments of referees.Search for more papers by this author First published: 18 August 2005 https://doi.org/10.1111/j.1813-6982.1998.tb01258.xCitations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Citing Literature Volume66, Issue3September 1998Pages 176-186 RelatedInformation