Abstract: As the scale and volume of China-African cooperation continue to expand, the opportunities inherent in China-African public health cooperation are also on the rise. Malaria prevention and control is one of the primary domains of China-African public health cooperation. Especially after China's elimination of malaria, incorporating China's experience into the local context to accelerate the control and elimination of malaria in Africa, is a critical scientific problem. This article retrospectively analyses the historical China-African cooperative projects on malaria prevention and control such as the artemisinin compound project for rapid clearance of malaria, the China-UK-Tanzania pilot project, and the institution-based network of China-Africa cooperation on malaria elimination (INCAM), cooperation with the World Health Organization, and the contribution of domestic non-governmental organizations. The article also examines the challenges faced in the China-African cooperation for controlling and eliminating malaria and envisions future cooperation directions.

Objective　To analyze the characteristics of the malaria epidemic and the indicators for "1-3-7" from 2021 to 2023 in China, understand the effectiveness and challenges in preventing re-establishment malaria in China, propose response strategies, and provide references for consolidating the achievements of malaria elimination. Methods　The individual malaria case data and focus data from 2021 to 2023 in the "Information System for Infectious Disease Surveillance" and the "Information System for Parasitic Diseases Prevention and Control" were collected, and epidemiological characteristics and indicators for “1-3-7” were analyzed. Results　From 2021 to 2023, a total of 4 132 malaria cases were reported in 31 provinces and Xinjiang Production and Construction Corps, with mainly falciparum malaria (59.2%, 2 445/4 132). The national malaria epidemic reached a historical low of 799 cases in 2021, before rebounding significantly to 2 488 cases in 2023. The top five provinces for malaria cases were Yunnan, Guangdong, Henan, Sichuan, and Shandong, accounting for 49.4% of the total (2 043/4 132) cases. Except for two long incubation cases infected with P. malariae and one non-mosquito-transmitted case, the remaining cases were imported from abroad, mainly from African countries (81.7%, 3 374/4 129), with P. vivax malaria mainly coming from Myanmar (63.7%, 638/1 001). Malaria cases mainly occur in middle-aged men and migrant overseas workers. 142 severe cases and 21 deaths of malaria were reported. 81.8% (3 378/4 132) of malaria cases sought medical attention within 3 days of symptom onset, and the initial diagnosis institutions were mainly county-level, municipal, and provincial hospitals(77.2%), with an accuracy malaria diagnosis rate of above 80.0%. The completion rates of the malaria indicators for "1-3-7" were all above 90.0%. Conclusions　Since the malaria elimination in China, there has been no re-establishment of malaria, and the surveillance response capability has been maintained at a high level. However, the epidemic of imported malaria continued to rise, severely endangering public health in China, especially in areas such as the China-Myanmar border where the risk of re-establishment was high. Currently, it is necessary to further enhance the awareness of the key populations about timely medical consultation for malaria, as well as healthcare workers' vigilance, diagnostic capabilities, and awareness of timely referrals. Efforts should be maintained to investigate and manage epidemics, strengthen prevention and control in key areas such as the China-Myanmar border in Yunnan, and continuously consolidate elimination achievements.

Objective To establish a high-throughput method that can simultaneously, quickly, and accurately detect main malaria-transmitting Anopheles species and their resistance genes in China, providing a high-throughput monitoring tool for monitoring the main malaria vectors in China after malaria elimination. Methods In different sampling locations, including Tengchong City, Yunnan Province; Wenchang City, Hainan Province; and Donggang City, Liaoning Province, adult specimens of mosquitoes, including Anopheles sinensis, Anopheles minimus, Anopheles dirus, and Anopheles anthropophagus, were collected. Polymerase chain reaction (PCR) technology and Sanger sequencing were employed to detect the ITS2, kdr (L1014), rdl (A296), and ace-1 (G119) genes in individual mosquitoes. For the analysis of mixed samples, an optimized multiplex PCR reaction system, custom-designed dual barcode primers, and next-generation sequencing (NGS) technology were utilized to detect the aforementioned genes. The consistency was assessed using Kappa consistency tests and Chi-square tests for multiple rates. Sensitivity, specificity, and the Youden index were calculated using a four-grid table calculation method. The costs associated with each step of the normal operational process for each method were statistically summarized, and the optimal quantity of mixed samples for detection was determined by a comprehensive approach. Results Conventional PCR amplification of gDNA from 300 mosquitoes resulted in 144 individuals of Anopheles sinensis, 53 individuals of Anopheles dirus, 62 individuals of Anopheles anthropophagus, and 41 individuals of Anopheles minimus, as identified by Sanger sequencing. The mutation frequencies of resistance genes kdr (L1014), rdl (A296), and ace-1 (G119) were found in 73, 27, and 41 specimens, respectively. Using a newly established multiplex PCR reaction system based on custom dual barcode and NGS sequencing technology, samples corresponding to Sanger sequencing were detected under different sample sizes. The two methods showed high consistency in the results (all Kappa>0.900). Multiple comparison tests showed significant differences in the consistencies of the two methods across different sample sizes N (40, 80, 160), N (120, 200, 240, 280), and N (300) (χ2=26.547, P<0.001). The new method demonstrated high sensitivity and specificity across various sample sizes, with the Youden index ranging from highest to lowest as follows: 1 (40, 80, 160)>0.994 (120)>0.990 (280)>0.988 (200)>0.987 (240)>0.985 (300). With an increase in sample size from 40 to 300, the cost per sequencing site for the new method decreased from 20.0 yuan to 8.3 yuan, while the cost per sequencing site for the conventional method decreased from 16.7 yuan to 15.4 yuan. The optimal mixed sample size for the new method was determined to be 280. Conclusion The newly developed multiplex PCR and barcode NGS detection method enables simultaneous screening of four major malaria vector mosquito species and the presence of mutations in the ace-1, kdr, and rdl resistance genes, exhibiting excellent stability, high sensitivity, and specificity. It allows for the efficient analysis of large sample sizes in a single run, offering a cost-effective alternative compared to other types of detection methods.

Objective To summarize the technique and clinical experience of hybrid procedure under cardiopulmonary bypass (CPB) in children with muscular ventricular septal defect (mVSD). Methods From January 2006 to June 2010, 45 cases of mVSD underwent hybrid procedure with CPB. mVSDs were closed with devices under direct vision in 45 cases. Of them, there were 20 males and 25 females. They ranged from 52 days to 12 years [mean (2.05 ±2.48) year] in age and from 3 to 30 kg [(11.93 ±7.70)kg] in body weight. Preoperatively, most of children were highly susceptible to respiratory tract infections. The hybrid approach was used in all patients with CPB under the guidance of transesophageal echocardiography (TEE). The diameter of mVSDs ranged from 2 to 7 mm under TEE. Of 45 cases, 40 patients had increased rates of pulmonary blood flow. 29 patients had left axis deviation and 12 cases had sinus arrhythmia on electrocardiography (ECG). 19 had other congenital heart lesions, including transposition of great arteries in 1 case, tetralogy of Fallot in 2, pulmonary artery stenosis in 3, patent ductus arteriosus in 6, atrial septal defects in 6) and aorta coactation in 1. The quantity of VSDs were from 1 to 7 (single, in 7; two, in 24 case; three, in 8 case; four, in 5 case and seven, in lease. 37 patients were combined with pulmonary hypertension in our cohort. 38 patients with another large VSD and 19 with other congenital heart lesions were required surgical repair at sometime. Results The hybrid procedures were undertaken in all 45 cases of this cohort. All cases were successful and no deaths occurred during operation. A total of 48 devices were implanted in 45 patients, including single devices in 42 cases (device size ranged from 4 to 10 mm) and two devices in 3 cases (device size ranged from 4 -7 mm). The average time on CPB was (58.28 ±20.70) min , while aortic crossclamp time was(34. 94 ± 14.75) min. In addition, the time on mechanical ventilation postoperatively ranged from 2 hours to 6 days. Compared to the older children, 20 infante aged less than 8 monhad a significant difference in cardiac function in the early postoperative period. One infant was given up treatment because of serious infection. Anather cases recovered with the use of supportive treatment, such as using vasoactive agents, digoxin, inhaling nitric oxide, diuresis, and so on. The enteric-coated aspirin was given at dose of 5 mg ? kg -1. day -1 for a period of 3 to 6 months as usual postoperatively. All patients attended follow-up at 1 week, 1 month, 3 months, 6 months, 1 year and 2 years post-procedure. No major complications were encountered during this period. All cases were no instance of migration of any of the devices, residual shunt, aortic regurgitation, atrioventricular valve dysfunction, Ⅲo atrial-ventricular conduction block, new arrhythmia, and so on. There are no death in long-term follow-up. Conclusion Hybrid procedure is safe and effective for the closure of congenital heart defects in children.

There are still multiple challenges in China during the malaria post-elimination phase, including a large number of imported malaria cases with widespread distribution, low awareness of timely healthcare seeking, insufficient malaria diagnosis and treatment capacity of medical institutions and insufficient malaria surveillance and response capability of disease control and prevention institutions. As the core technical institutions for preventing the re-establishment of malaria transmission, both medical institutions and disease control and prevention institutions are required to enhance the collaboration between clinical and public health services, improve the malaria diagnosis and quality management system, intensify case identification and epidemiological investigations, and improve the management mechanism of antimalarial drug reserves. In addition, doctors are encouraged to become the main force in the health education and promotion of malaria prevention to improve the public health literacy. These approaches are recommended to improve the overall capability of timely identification, standardized treatment and effective response of imported malaria cases, so as to continuously consolidate the malaria elimination achievements in China.

Malaria remains a global health challenge, although an increasing number of countries will enter pre-elimination and elimination stages. The prompt and precise diagnosis of symptomatic and asymptomatic carriers of Plasmodium parasites is the key aspect of malaria elimination. Since the launch of the China Malaria Elimination Action Plan in 2010, China has formulated clear goals for malaria diagnosis and has established a network of malaria diagnostic laboratories within medical and health institutions at all levels. Various external quality assessments were implemented, and a national malaria diagnosis reference laboratory network was established to strengthen the quality assurance in malaria diagnosis. Notably, no indigenous malaria cases have been reported since 2017, but the risk of re-establishment of malaria transmission cannot be ignored. This review summarizes the lessons about malaria diagnosis in the elimination phase, primarily including the establishments of laboratory networks and quality control in China, to better improve malaria diagnosis and maintain a malaria-free status. A reference is also provided for countries experiencing malaria elimination.
China/epidemiology* ; Clinical Laboratory Techniques ; Global Health ; Humans ; Laboratories ; Malaria/prevention & control*