BackgroundPersonal hypertension management is a cornerstone in the prevention of hypertension complications. In Eritrea, the increase in the national life expectancy rate has been accompanied by an increase in hypertension complications such as stroke. Hence, this study was designed to identify barriers and facilitates to hypertension management from the perspective of the patients.MethodsThis was a qualitative study of a total of 48 individual in-depth interviews and two focus group discussions. It was conducted among hypertensive patients who were attending outpatient services at two hospitals in Asmara, Eritrea.ResultsThis study identified barriers and facilitators of hypertension management related to the individual patient, family and community, and healthcare system. With respect to individual factors, economic barriers, stress, non-adherence to medications due to the use of traditional remedies, and difficulties and misconceptions about following physical activity guidelines were mentioned as barriers to hypertension management. Related to the community and healthcare system, low community awareness, community stigma, and inadequate health promotion materials were stated as barriers. Individual knowledge, family, and government support were reported as very important factors to the patient’s success in the personal hypertension management.ConclusionsCounseling patients about adherence to medication, strengthening family and government support, and empowering families and the community with appropriate knowledge of hypertension management could potentially help in an individual’s adherence.

Background. Malaria risk stratification is essential to differentiate areas with distinct malaria intensity and seasonality patterns. The development of a simple prediction model to forecast malaria incidence by rainfall offers an opportunity for early detection of malaria epidemics. Objectives. To construct a national malaria stratification map, develop prediction models and forecast monthly malaria incidences based on rainfall data. Methods. Using monthly malaria incidence data from 2012 to 2016, the district level malaria stratification was constructed by nonhierarchical clustering. Cluster validity was examined by the maximum absolute coordinate change and analysis of variance (ANOVA) with a conservative post hoc test (Bonferroni) as the multiple comparison test. Autocorrelation and cross-correlation analyses were performed to detect the autocorrelation of malaria incidence and the lagged effect of rainfall on malaria incidence. The effect of rainfall on malaria incidence was assessed using seasonal autoregressive integrated moving average (SARIMA) models. Ljung–Box statistics for model diagnosis and stationary R-squared and Normalized Bayesian Information Criteria for model fit were used. Model validity was assessed by analyzing the observed and predicted incidences using the spearman correlation coefficient and paired samples t-test. Results. A four cluster map (high risk, moderate risk, low risk, and very low risk) was the most valid stratification system for the reported malaria incidence in Eritrea. Monthly incidences were influenced by incidence rates in the previous months. Monthly incidence of malaria in the constructed clusters was associated with 1, 2, 3, and 4 lagged months of rainfall. The constructed models had acceptable accuracy as 73.1%, 46.3%, 53.4%, and 50.7% of the variance in malaria transmission were explained by rainfall in the high-risk, moderate-risk, low-risk, and very low-risk clusters, respectively. Conclusion. Change in rainfall patterns affect malaria incidence in Eritrea. Using routine malaria case reports and rainfall data, malaria incidences can be forecasted with acceptable accuracy. Further research should consider a village or health facility level modeling of malaria incidence by including other climatic factors like temperature and relative humidity.

Background As much as malaria control interventions may be directed at restricting transmission through mosquito control and treatment of symptomatic cases, the effect of asymptomatic cases in the transmission of malaria has not been given too much attention. On the other hand, asymptomatic carriers do not seek treatment, becoming permanent reservoirs, and hence creating a real pose to the public health. Objective The purpose of the study was to determine the prevalence of asymptomatic malaria and its associated factors in Leaiten village, Eritrea. Methods 322 eligible participants were randomly selected and interviewed. Thin and thick blood films were collected and Giemsa-stained to determine blood parasitaemia and speciation using light microscopy. Multivariate Logistic Regression was used to assess relationship between the potential factors identified and asymptomatic malaria. Results The prevalence of asymptomatic malaria was 5.9%, with a predominantly higher proportion (P) of Plasmodium Falciparum (P= 94.7%, n=18) than Plasmodium Vivax (P= 5.3%, n=1). Most of the infections were low density and at their ring form (P = 94.7%, n = 18). Only one subject had medium density and a gametocyte stage infection (P = 5.3%). The odds of asymptomatic malaria by sex, age, occupation or education was not significantly different. Bed net usage in comparison to no usage was not a significant predictor of asymptomatic malaria (5.5% vs. 7.6, p-value = 0.519). Those with asymptomatic malaria who had previous malaria sickness (4.2%) was not significantly different to those who had never been sick (7.3%), (OR = 0.56, p-value = 0.248). People who lived near water body (8.5%) were equally likely to be asymptomatic to those who didn’t live near water body (4.9%), (OR = 1.82, p-value = 0.215), out of which, those who lived near open water body had no difference in acquiring asymptomatic malaria to those who lived near closed water body (OR = 2.26, p-value = 0.457). Conclusion This study indicated the hidden impact of asymptomatic malaria in perpetuating malaria transmission in the village. Further assessment of the impact of asymptomatic malaria, on malaria transmission, is needed based on a larger and more sensitive method.