In regions where malaria transmission persists, the implementation of approaches aimed at eliminating parasites from the population can effectively decrease both burden of disease and transmission of infection. Thus, mass strategies that target symptomatic and asymptomatic infections at the same time may help countries to reduce transmission. This systematic review assessed the potential benefits and harms of mass testing and treatment (MTaT) to reduce malaria transmission. Searches were conducted in March 2021 and updated in April 2022 and included cluster-randomized controlled trials (cRCTs) as well as nonrandomized studies (NRSs) using malaria infection incidence, clinical malaria incidence, or prevalence as outcomes. The risk of bias was assessed with Cochrane’s risk of bias (RoB2) tool and Risk of Bias Tool in Nonrandomized Studies – of Interventions (ROBINS-I), and the certainty of evidence (CoE) was graded for each outcome. Of 4,462 citations identified, seven studies (four cRCTs and three NRSs) contributed outcome data. The analysis revealed that MTaT did not reduce the incidence (risk ratio [RR]: 0.95, 95% CI: 0.87–1.04; 1,181 participants; moderate CoE) or prevalence (RR: 0.83, 95% CI: 0.67–1.01; 7,522 participants; moderate CoE) of malaria infection but resulted in a small reduction in clinical malaria (RR: 0.82; 95% CI: 0.70–0.95; 334,944 participants; moderate CoE). Three studies contributing data on contextual factors concluded that MTaT is an acceptable, feasible, and cost-effective intervention. Mathematical modeling analyses (n = 10) suggested that MTaT effectiveness depends on the baseline transmission level, diagnostic test performance, number of rounds, and other co-interventions. Based on the limited evidence available, MTaT has little to no impact on reducing malaria transmission.

: In low– to very low–malaria transmission areas, most infections may be accrued within specific groups whose behaviors or occupations put them at increased risk of infection. If these infections comprise a large proportion of the reservoir of infection, targeting interventions to these groups could reduce transmission at the population level. We conducted a systematic review to assess the impact of providing antimalarials to groups of individuals at increased risk of malaria whose infections were considered to comprise a large proportion of the local reservoir of infections (targeted drug administration [TDA]). A literature search was conducted in March 2021 and updated in April 2022. Two reviewers screened titles, abstracts, and full-text records. The Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the certainty of the evidence (CoE) for each outcome. Out of 2,563 records, we identified five studies for inclusion: two cluster-randomized controlled trials (cRCTs) in Uganda and Kenya; one controlled before-after study in Ghana; and two uncontrolled before-after studies in Sri Lanka and Greece. Compared with no intervention, TDA resulted in little to no difference in the prevalence of infection at the population level (risk ratio [RR]: 0.85, 95% CI: 0.73–1.00; one cRCT, high CoE), although TDA likely resulted in a large reduction in prevalence among those targeted by the intervention (RR: 0.15, 95% CI: 0.06–0.38; two cRCTs, moderate CoE). Although TDA may reduce the burden of malaria among those receiving antimalarials, we found no evidence that it reduces transmission at the population level.

As countries approach elimination of malaria, groups with increased exposure to malaria vectors or poor access to health services may serve as important human reservoirs of infection that help maintain transmission in the community. Parasitological testing and treatment targeted to these groups may reduce malaria transmission overall. This systematic review assessed the effectiveness of targeted testing and treatment (TTaT) to reduce malaria transmission, the contextual factors, and the results of modeling studies that estimated the intervention’s potential impact. Bibliographic searches were conducted in March 2021 and updated in April 2022, and a total of 1,210 articles were identified. Three studies were included for outcome data: one factorial cluster randomized controlled trial (cRCT) in Kenya (5,233 participants), one cRCT in Ghana (3,046 participants), and one controlled before-and-after cohort study in schoolchildren in Malawi (786 participants). Nine reports were included for contextual factors, and two were included for mathematical modeling. Data on outcomes from the three studies suggested that at the community level, TTaT would result in little to no difference in the incidence of malaria infection (measured via active surveillance), adverse events, and severe AEs. In contrast, the effects of TTaT on prevalence (malaria parasitemia) among those targeted by the intervention were found to include a short-term impact on reducing transmission but little to no impact on transmission for extended periods. Future iterations of this review should ensure consideration for populations proven to host the vast majority of the reservoir of infection in lower-transmission settings to determine the effectiveness of the intervention.

As countries approach malaria elimination, imported cases of malaria make up a larger proportion of all cases and may drive malaria transmission. Targeted test and treat (TTaT) at points of entry (POEs) is a strategy that aims to reduce the number of imported infections in countries approaching elimination by testing and treating individuals at border crossings. No evidence has been systematically collected and evaluated to assess the impact and operational feasibility of this strategy. This systematic review gathered empirical evidence on the effectiveness of the intervention, contextual factors, and results of modeling studies that estimate its potential impact. Bibliographic searches were conducted in March 2021 and updated in April 2022, and a total of 1,569 articles were identified. All study designs were included, but none of them were intervention studies set up to measure the impact of TTaT at POEs. Seven nonrandomized observational studies were eligible for assessment of outcome data in terms of describing the extent of positive cases among people crossing borders. Also included in the review were three studies for assessment of acceptability and feasibility of the intervention and three for assessment of mathematical modeling. The positivity rates reported in the seven studies ranged between 0.0% and 70.0%, which may be attributable to the different settings and operational feasibility. Overall, there is limited evidence of the effect of TTaT at POEs on the prevalence of infection, and the certainty of the evidence was very low owing to critical risk of bias, serious inconsistency, and serious indirectness.

Introduction: Tobacco and other similar/related products represent a substantial proportion of recreationally-used substances in Malawi. Ngirimbo is a smokeless substance taken orally to reduce tobacco smoking. This study aimed to determine the toxicological characteristics of Ngirimbo in terms of pesticide residues, microbial, trace and heavy metal contaminants, herbal compounds, and nicotine, moisture, and pH levels. Methods: Samples were analysed using atomic absorption spectrophotometry, titration, X-ray fluorescence spectroscopy, UV-visible Spectrophotometer, gas chromatography-mass spectrometry, pH and gravimetric analysis, ISO4833, ISO21527, ISO16654, and ISO6579. Results: From a total of 12 samples, 5 samples contained nicotine ranging from 0.08–0.84%, while the remaining 7 samples showed no trace of nicotine. Sample pH ranged from 6.68 to 8.32, and moisture content from 12.87–47.11%. Samples had no detectable contamination with chlorine or pesticide residue. Heavy metals tested: Cadmium, Nickel, Lead, and Copper were found to be below the detection limit of 0.01mg/kg. On the other hand, X-ray fluorescence spectroscopy analysis revealed the presence of Nickel, Bromine, Rubidium, Strontium, Zirconium, Molybdenum, Rhodium, Cadmium, Chromium, and Tellurium. Samples had good levels of Calcium, Iron, Potassium, Sodium, and Zinc ranging from 23mg/kg to 57,800mg/kg. Samples contained phytocompounds and herbal material of medicinal relevance. In terms of the microbiological content, Escherichia coli and Salmonella were absent, while Moulds and Yeast were present at a level of <1cfu/g, with the total plate count varying across all samples between 1,400cfu/g and 640,000cfu/g. Conclusion: These findings demonstrate that the current state of Ngirimbo available in Malawi is toxic and a hazard to human health. Implications: Prolonged use of Ngirimbo may lead to users developing mouth cancers or thermal burns to the oral mucosal membrane. Further, Ngirimbo consumers are at risk of developing dental caries, known to harbour microorganisms and development of infectious diseases. The control and regulation of Ngirimbo is highly recommended to maximise its capacity for use as a treatment/medication for tobacco replacement while minimising the negative impact on public health. Further work needs to be done to quantify the contents of Ngirimbo, and develop tolerance limits so that it may be used as a nicotine and tobacco replacement product.

Background: The African health sector continue to pay little attention to understand concentrations and effects of different poisons in age groups. Meanwhile, age and being male is considered as a risk for neurodegenerative disorders such as dementia in mid‐life. Thus this study, aims to summarize the ages of males exposed to different poisons diagnosed at a tertiary hospital in northern Malawi to address and initiate the need for robust epidemiological, biomedical neuroscience data and novel tests for poison dementia identification, health outcomes and disease variations. Method: Retrospective data of hospitalized males, diagnosed of poisoning, from January 2022 and December 2023 at Mzuzu Central Hospital was collected and analyzed following the world health organization age group standardization. Descriptive analysis included the diagnosed poison, age, length of hospital stay, and outcomes. Result: From 208 cases of poisoning diagnosis, alcohol intoxication ( n = 136, 65%) was highest, in 25 to 29 ( n = 29, 13.94%) age group, followed by 30 to 34 ( n = 26, 12.50%), 35 to 39 ( n = 21, 10.10%), 40 to 44 ( n = 19, 9.13%), and 20 to 24 ( n = 18, 8.65%). Organophosphate poisoning accounted for 19.71% ( n = 41), common in 25 to 29 ( n = 12, 5.77%) and 30 to 34 ( n = 8, 3.85%) age groups. General poisoning was 2.40% ( n = 5), in persons aged 20 to 24 years. Meanwhile food poisoning was 6.25% ( n = 13), sharing equal proportion of 1.92% ( n = 4) in 15 to 19 and 20 to 24 ages respectively. Drug poisoning was in 40 to 44 age group ( n = 1, 0.48%). Interestingly, alcohol intoxication in dementia risk age group of 65 to 69 was 0.96% ( n = 2), sharing proportion in 70 to 74 ( n = 1, 0.48%) age group for organophosphate poisoning. Median age of the patients was 31 years (range: 15‐71years) with a hospital stay of 3 days (interquartile range 2–4 days). Regarding outcome, there was no follow up on discharge patients (93.27%), those that left without completing treatment and physicians’ knowledge (1.44%), and (5.29%) that died while admitted. Conclusion: The study shows that adolescents and middle aged adults are highly exposed to substances that induce electrolytes imbalance and make the brain vulnerable to young onset of poison dementia.