Background Malaria eradication globally is yet to be achieved and transmission is sustained in many endemic countries. Plasmodium falciparum continues to develop resistance to currently available anti-malarial drugs, posing great problems for malaria elimination. This study evaluates the frequencies of asymptomatic infection and multidrug resistance-1 ( mdr-1 ) gene mutations in parasite isolates, which form the basis for understanding persistently high incidence in South West, Nigeria. Methods A total of 535 individuals aged from 6 months were screened during the epidemiological survey evaluating asymptomatic transmission. Parasite prevalence was determined by histidine-rich protein II rapid detection kit (RDT) in healthy individuals. Plasmodium falciparum mdr-1 gene mutations were detected by polymerase chain reaction (PCR) followed by restriction enzyme digest and electrophoresis to determine polymorphism in parasite isolates. Sequencing was done to confirm polymorphism. Proportions were compared using Chi-square test at p value < 0.05. Results Malaria parasites were detected by RDT in 204 (38.1%) individuals. Asymptomatic infection was detected in 117 (57.3%) and symptomatic malaria confirmed in 87 individuals (42.6%). Overall, individuals with detectable malaria by RDT was significantly higher in individuals with symptoms, 87 of 197 (44.2%), than asymptomatic persons; 117 of 338 (34.6%), p = 0.02. In a sub-set of 75 isolates, 18(24%) and 14 (18.6%) individuals had Pfmdr1 86Y and 1246Y mutations. Conclusions There is still high malaria transmission rate in Nigeria with higher incidence of asymptomatic infections. These parasites harbour mutations on Pfmdr1 which contribute to artemisinin partner drug resistance; surveillance strategies to reduce the spread of drug resistance in endemic areas are needed to eliminate the reservoir of malaria parasites that can mitigate the eradication of malaria in Nigeria.

National social health insurance scheme aims to improve the health of citizens and provide equal access to health care across different income classes. This empirical datasets describes quality of health, insurance subscription, awareness, health care coverage and benefits in different socio-economic class of workers in Ota and Lagos, Nigeria. The perception of individual׳s state of health and level of satisfaction of accessed health care are reported and opinions on ways to meet the health needs of workers in a developing country such as Nigeria.

In recent years there has been a global decrease in the prevalence of malaria due to scaling up of control measures, hence global control efforts now target elimination and eradication of the disease. However, a major problem associated with elimination is asymptomatic reservoir of infection especially in endemic areas. This study aims to determine the efficiency of histidine rich protein II (HRP-2) based rapid diagnostic tests (RDT) for monitoring transmission intensities in an endemic community in Nigeria during the pre-elimination stage. Plasmodium falciparum asymptomatic malaria infection in healthy individuals and symptomatic cases were detected using HRP-2. RDT negative tests were rechecked by microscopy and by primer specific PCR amplification of merozoite surface protein 2 (msp-2) for asexual parasites and Pfs25 gene for gametocytes in selected samples to detect low level parasitemia undetectable by microscopy. The mean age of the study population (n=280) was 6.12 years [95% CI 5.16-7.08, range 0.5-55], parasite prevalence was 44.6% and 36.3% by microscopy and RDT respectively (p =0.056). The parasite prevalence of 61.5% in children aged >2-10 years was significantly higher than 3.7% rate in adults >18years (p < 0.0001, χ 2 = 60.45). RDT detected additional 29.6% asymptomatic cases but a lower specificity of 68.8% in symptomatic carriers. In 15 selected RDT positive samples, only 6 were positive by PCR and no gametocyte was detected. The results indicate that HRP-2 RDTs are a vital tool for understanding transmission dynamics and detecting immune-suppressed, recent and asymptomatic infections, thus crucial to tackle low level transmission and eliminating malaria in endemic areas.

Antimalarial drug resistance is the major challenge in the treatment of malaria all over the world. Plasmodium species are the parasite that causes malaria. Plasmodium falciparum is the most prevalent species found in sub-Saharan Africa that records the highest infections and death caused by malaria worldwide. Resistance to P. falciparum is caused by mutations in some target genes of the parasite, which includes Plasmodium falciparum: Na + / H + exchanger (Pfnhe-1), chloroquine resistance transporter (Pfcrt), dihydropteroate synthase (Pfdhps), dihydrofolate reductase (Pfdhfr), multidrug resistance 1 gene (Pfmdr1), cytochrome b, multidrug resistance-associated protein 1 (Pfmrp1), cg2 (Pfcg2), Ca 2+ −ATPase (PfATPase6) and kelch 13 gene. Most of these mutations are single nucleotide polymorphisms and has led to the decrease in susceptibility of some drugs like chloroquine, quinine, mefloquine, amodiaquine, sulphadoxine/pyrimethamine, lumefantrine and artemisinins in the treatment of malaria. The aim of this review was to survey on the existing antimalarial drug resistance in endemic areas of Africa and suggests a way forward in combating drug-resistant malaria in this region.

Introduction: Plasmodium falciparum has developed resistance to artemisinin drugs in Southeast Asia, and its reduced sensitivity has been reported in other regions. This study aims to determine parasite susceptibility to the bioactive form of artemisinin derivatives- dihydroartemisinin (DHA)-, and to detect the K13 polymorphism in isolates from an endemic area of Nigeria. Methods: Ex-vivo response in 55 parasites isolates obtained from malaria-positive patients were exposed to pulse DHA concentration and cultured for 66 hours ex-vivo. Parasite ring stage survival (RSAex-vivo) relative to unexposed matched control was determined by microscopy, and parasite growth was compared using Mann-Whitney U-test at a significance level of P<0.05. The Kelch propeller gene was amplified using specific primers, then sequenced and analyzed for single nucleotide polymorphisms (SNPs), which were compared to reference PF3D7_1343700. Results: Overall, 151 of 375 (40.2%) individuals were positive during the study period. In 55 selected isolates, there was increased growth in unexposed wells but growth was inhibited in DHA-exposed wells, with growth rate between 14.9 – 96.7%. The mean RSAex-vivo value was 0.18 ± 0.09%, 95% CI (0.15-0.20). There was no significant mutation of the K13 gene in the parasite isolates evaluated. Conclusions: Plasmodium falciparum isolates from this endemic area show high sensitivity to dihydroartemisinin ex-vivo, with no mutations conferring artemisinin resistance. Continuous monitoring of parasite susceptibility to artemisinin combination drugs should be intensified to reduce chances of artemisinin resistance in endemic areas.