Effects of temperature on members of the Anopheles gambiae complex (Diptera: Culicidae) in South Africa : implications for malaria transmission and control.

Thesis (Ph.D)-University of Natal, Pietermaritzburg, 1996.This study investigated the effects of temperature and relative humidity (both controlled and natural) on the lifecyle and morphology of adults of members of the Anopheles gambiae complex in northern KwaZulu-Natal, South Africa. Laboratory investigations into the effects of simulated temperature and relative humidity regimes concentrated on seasonal differences in longevity, egg hatchability, reproductive potential and adult survivorship of An. arabiensis. Differences were found in the life table parameters when these mosquitoes were reared under conditions of seasonal temperature and relative humidity. During the cool season the lifespan and adult survivorship of mosquitoes were greater than those reared during the warm season. In summer, the egg hatchability and reproductive potential were greatest whereas in winter An. arabiensis underwent gonotrophic dissociation although these females were found to take blood meals readily. The influence of seasonal temperature and relative humidity on the body size of An. arabiensis was investigated, both in the laboratory and under field conditions. In both environments, these factors were found to significantly influence body size. In winter, there was a 13% increase in wing size compared to summer bred mosquitoes. A comparison of body size of An. arabiensis, An. merus and An. gambiae reared under laboratory conditions of seasonal temperature and relative humidity showed that the wing size of An. arabiensis was greater than that of An. merus and An. gambiae. The effect of temperature and relative humidity on morphological criteria used in species separation was also investigated. Seasonal differences in wing spot size were compared for An. arabiensis, An. merus and An. gambiae. From this investigation it was concluded that the pale and dark spots on the wing of Anopheles mosquitoes could not be used in species identification due to the large degree of inter-species overlap in the wing spot measurements. The measurement of the pale band at the junction of the 3rd and 4th tarsomere on the hind leg was also investigated for its use in species separation and were found to be useful within the An. gambiae complex. The implications of this study on the transmission and control of malaria are discussed with reference to the late season transmission during March to May that is characteristic of the region

Five Years of Antimalarial Resistance Marker Surveillance in Gaza Province, Mozambique, Following Artemisinin-Based Combination Therapy Roll Out

Antimalarial drug resistance is a major obstacle to malaria control and eventual elimination. The routine surveillance for molecular marker of resistance is an efficient way to assess drug efficacy, which remains feasible in areas where malaria control interventions have succeeded in substantially reducing malaria transmission. Community based asexual parasite prevalence surveys were conducted annually in sentinel sites in Gaza Province, Mozambique from 2006 until 2010, before, during and after antimalarial policy changes to artesunate plus sulfadoxine-pyrimethamine in 2006 and to artemether-lumefantrine in 2008. Genetic analysis of dhfr, dhps, crt, and mdr1 resistant genes was conducted on 3 331 (14.4%) Plasmodium falciparum PCR positive samples collected over the study period from 23 229 children aged 2 to 15 years. The quintuple dhfr/dhps mutation associated with sulfadoxine-pyrimethamine resistance increased from 56.2% at baseline to 75.8% by 2010. At baseline the crt76T and mdr186Y mutants were approaching fixation, 96.1% and 74.7%, respectively. Following the deployment of artemisinin-based combination therapy, prevalence of both these chloroquine-resistance markers began declining, reaching 32.4% and 30.9%, respectively, by 2010. All samples analysed over the 5-year period possessed a single copy of the mdr1 gene. The high and increasing prevalence of the quintuple mutation supports the change in drug policy from artesunate plus sulfadoxine-pyrimethamine to artemether-lumefantrine in Mozambique. As chloroquine related drug pressure decreased in the region, so did the molecular markers associated with chloroquine resistance (crt76T and mdr186Y). However, this reversion to the wild-type mdr186N predisposes parasites towards developing lumefantrine resistance. Close monitoring of artemether-lumefantrine efficacy is therefore essential, particularly given the high drug pressure within the region where most countries now use artemether-lumefantrine as first line treatment

Malaria Control in South Africa 2000–2010: Beyond MDG6

Background: Malaria is one of the key targets within Goal 6 of the Millennium Development Goals (MDGs), whereby the disease needs to be halted and reversed by the year 2015. Several other international targets have been set, however the MDGs are universally accepted, hence it is the focus of this manuscript. Methods: An assessment was undertaken to determine the progress South Africa has made against the malaria target of MDG Goal 6. Data were analyzed for the period 2000 until 2010 and verified after municipal boundary changes in some of South Africa’s districts and subsequent to verifying actual residence of malaria positive cases. Results: South Africa has made significant progress in controlling malaria transmission over the past decade; malaria cases declined by 89.41% (63663 in 2000 vs 6741 in 2010) and deaths decreased by 85.4% (453 vs 66) in the year 2000 compared to the year 2010. Coupled with this, malaria cases among children under five years of age have also declined by 93% (6791 in 2000 vs 451 in 2010). This has resulted in South Africa achieving and exceeding the malaria target of the MDGs. A series of interventions have attributed to this decrease, these include: drug policy change from monotherapy to artemisinin combination therapy, insecticide change from pyrethroids back to DDT; cross border collaboration (South Africa with Mozambique and Swaziland through the Lubombo Spatial Development Initiative– LSDI) and financial investment in malaria control. The KwaZulu-Natal Province has seen the largest reduction in malaria cases and deaths (99.1% cases- 41786 vs 380; and 98.5% deaths 340 vs 5), when comparing the year 2000 with 2010. The Limpopo Province recorded the lowest reduction in malaria cases compared to the other malaria endemic provinces (56.1% reduction- 9487 vs 4174; when comparing 2000 to 2010). Conclusions: South Africa is well positioned to move beyond the malaria target of the MDGs and progress towards elimination. However, in addition to its existing interventions, the country will need to sustain its financing for malaria control and support programmed reorientation towards elimination and scale up active surveillance coupled with treatment at the community level. Moreover cross-border malaria collaboration needs to be sustained and scaled up to prevent the re-introduction of malaria into the country

Sustaining control : lessons from the Lubombo spatial development initiative in southern Africa

BACKGROUND : The Lubombo Spatial Development Initiative (LSDI) was a tri-country project between South Africa, Swaziland and Mozambique with the aim of accelerating socio-economic development in the region. The malaria component of the project was introduced to decrease the transmission of malaria in the region. This goal was met but with termination of this project resulted in an upsurge of malaria cases in the sub-region mainly as a result of migration from high transmission areas to low transmission ones. The movement of people across borders in southern Africa remains a challenge in sustaining malaria control and elimination. METHODS : Malaria case data for Swaziland and South Africa were obtained from their respective national Malaria Information Systems. Data for Mozambique was obtained from the Mozambican Ministry of Health. Data obtained during the course of the LSDI project was compared to the case data post the termination of the LSDI. RESULTS : The 12-year period of the LSDI showed a substantial decrease in disease burden amongst the three countries involved when compared to the baseline year of 2000. The decrease in malaria cases was 99 % in South Africa and 98 % in Swaziland. Malaria prevalence in Mozambique decreased by 85 % over the same period. However, after the LSDI ended, between 2012 and 2014, there was an upward trend in case data that was counter to the goal of elimination. CONCLUSION : South Africa and Swaziland benefitted from the LSDI and were able to sustain malaria control and progress to the stage of elimination. Mozambique could not sustain the gains made during the LSDI and case numbers increased. Technical and financial resources are key challenges for malaria control and elimination interventions.Data used in this study are available from the Ministries of Health in South Africa, Swaziland and Mozambique.No direct funding was received for this study however the original LSDI study was made possible by funds received from the Global Fund to fight AIDS, TB and Malariahttp://www.malariajournal.comam2016School of Health Systems and Public Health (SHSPH

Decadal epidemiology of malaria in KwaZulu‑Natal, a province in South Africa targeting elimination

BACKGROUND : Although malaria remains a noteworthy disease in South Africa, the provinces are at differing stages of the malaria elimination continuum. KwaZulu-Natal has consistently reported the lowest number of cases over the past 5 years and it is expected that the goal of elimination will be achieved in this province over the next few years. The study reports on few key indicators that realistically represents the provinces progress over the past decade. Local and imported morbidity and mortality is seen as the key indicator as is malaria in children under the age of five and pregnant women. The only vector control intervention in the province is indoor residual spraying (IRS) and this gives an estimate of the population protected by this intervention. METHODS : Trend analysis was used to examine the changing epidemiology in KwaZulu-Natal over the past decade from 2008 to 2018. The data used in this decadal analysis was obtained from the provincial Department of Health. Since malaria is a medically notifiable disease, all malaria cases diagnosed in the province are reported from health facilities and are captured in the malaria information system in the province. RESULTS : The results have shown that imported cases are on the increase whilst local cases are decreasing, in keeping with an elimination objective. Preventing secondary cases is the key to reaching elimination. Only 10% of the cases reported occur in children under 5 years whereas the cases in pregnant women account for about 1% of the reported cases. Over 85% of the houses receive IRS and this is also the same proportion of the population protected by the intervention. CONCLUSION : Several challenges to elimination have been identified but these are not insurmountable. Although there are major impediments to achieving elimination, the changing epidemiology suggests that major strides have been made in the past 10 years and KwaZulu-Natal is on track to achieving this milestone in the next few years.A South African Medical Research Council Intramural Research Awardhttp://www.malariajournal.comam2020School of Health Systems and Public Health (SHSPH

Screening for adulticidal activity against Anopheles arabiensis in ten plants used as mosquito repellent in South Africa

BACKGROUND : Due to the development of resistance to synthetic insecticides, adverse effects to human health, non-target organisms and the environment, there is an urgent need to develop new insecticides, which are effective, safe, biodegrable and target-specific. This study was undertaken to evaluate the adulticidal activity of 10 plants used traditionally as mosquito repellents in South Africa. METHODS : The dried plant materials were extracted with dichloromethane (DCM) and ethanol (EtOH). The extracts were evaluated for adulticidal activity against Anopheles arabiensis mosquitoes, a potent malaria vector in South Africa. Adult mortality was observed after 24 hours of exposure. RESULTS : All the extracts showed adulticidal activity. The highest activity was observed in both DCM and EtOH extracts of Aloe ferox leaves with 98 and 86% mosquito mortality, respectively. The DCM extract of A. ferox leaves was then subjected to a dose-dependent bioassay to determine the EC50 value. The extract exhibited an EC50 value of 4.92 mg/ml. CONCLUSION : The results of the present study showed that the DCM extract of A. ferox leaves may have the potential to be used as an insecticide against An. arabiensis. Further studies to isolate and identify active compounds are in progress.The South African Medical Research Councilhttp://www.malariajournal.com/content/13/1/173am201

Screening for adulticidal bioactivity of South African plants against Anopheles arabiensis

<p>Abstract</p> <p>Background</p> <p>This study was conducted to evaluate whether a selection of South African ethnomedicinal plants included in this study displayed insecticidal properties when screened against adult stages of the mosquito.</p> <p>Methods</p> <p>381 crude extracts of 80 plant taxa in 42 families were sprayed onto ceramic tiles and screened using the cone bio-assay method for insecticide efficacy testing. Blood-fed, female <it>Anopheles arabiensis </it>mosquitoes were exposed to the treated tiles for a period of sixty minutes. Mosquito mortality was monitored for twenty-four hours.</p> <p>Results</p> <p>Of all the extracts analysed, the highest activity was observed in <it>Ptaeroxylon obliquum </it>(Ptaeroxylaceae) and <it>Pittosporum viridiflorum </it>(Pittosporaceae), a single extract from each, exhibiting more than 50% mortality. A large proportion (81.63%) of the extracts tested displayed low levels of mosquitocidal activity. The remainder of the extracts (17.85%) exhibited no bioactivity (0% mortality).</p> <p>Conclusions</p> <p>The screening results have shown that in accordance with WHO standards, none of the crude extracts tested had exhibited greater than 60% mortality against the adult stages of the malaria vector <it>Anopheles arabiensis</it>.</p

Seasonally lagged effects of climatic factors on malaria incidence in South Africa

Globally, malaria cases have drastically dropped in recent years. However, a high incidence of malaria remains in some sub-Saharan African countries. South Africa is mostly malaria-free, but northeastern provinces continue to experience seasonal outbreaks. Here we investigate the association between malaria incidence and spatio-temporal climate variations in Limpopo. First, dominant spatial patterns in malaria incidence anomalies were identified using self-organizing maps. Composite analysis found significant associations among incidence anomalies and climate patterns. A high incidence of malaria during the pre-peak season (Sep-Nov) was associated with the climate phenomenon La Nina and cool air temperatures over southern Africa. There was also high precipitation over neighbouring countries two to six months prior to malaria incidence. During the peak season (Dec-Feb), high incidence was associated with positive phase of Indian Ocean Subtropical Dipole. Warm temperatures and high precipitation in neighbouring countries were also observed two months prior to increased malaria incidence. This lagged association between regional climate and malaria incidence suggests that in areas at high risk for malaria, such as Limpopo, management plans should consider not only local climate patterns but those of neighbouring countries as well. These findings highlight the need to strengthen cross-border control of malaria to minimize its spread

The emergence of insecticide resistance in central Mozambique and potential threat to the successful indoor residual spraying malaria control programme.

BACKGROUND: Malaria vector control by indoor residual spraying was reinitiated in 2006 with DDT in Zambézia province, Mozambique. In 2007, these efforts were strengthened by the President's Malaria Initiative. This manuscript reports on the monitoring and evaluation of this programme as carried out by the Malaria Decision Support Project. METHODS: Mosquitoes were captured daily through a series of 114 window exit traps located at 19 sentinel sites, identified to species and analysed for sporozoites. Anopheles mosquitoes were collected resting indoors and tested for insecticide resistance following the standard WHO protocol. Annual cross sectional household parasite surveys were carried out to monitor the impact of the control programme on prevalence of Plasmodium falciparum in children aged 1 to 15 years. RESULTS: A total of 3,769 and 2,853 Anopheles gambiae s.l. and Anopheles funestus, respectively, were captured from window exit traps throughout the period. In 2010 resistance to the pyrethroids lambda-cyhalothrin and permethrin and the carbamate, bendiocarb was detected in An. funestus. In 2006, the sporozoite rate in An. gambiae s.s. was 4% and this reduced to 1% over 4 rounds of spraying. The sporozoite rate for An. funestus was also reduced from 2% to 0 by 2008. Of the 437 Anopheles arabiensis identified, none were infectious. Overall prevalence of P. falciparum in the sentinel sites fell from 60% to 32% between October 2006 and October 2008. CONCLUSION: Both An. gambiae s.s. and An. funestus were controlled effectively with the DDT-based IRS programme in Zambézia, reducing disease transmission and burden. However, the discovery of pyrethroid resistance in the province and Mozambique's policy change away from DDT to pyrethroids for IRS threatens the gains made here

Evaluation of selected South African ethnomedicinal plants as mosquito repellents against the Anopheles arabiensis mosquito in a rodent model

<p>Abstract</p> <p>Background</p> <p>This study was initiated to establish whether any South African ethnomedicinal plants (indigenous or exotic), that have been reported to be used traditionally to repel or kill mosquitoes, exhibit effective mosquito repellent properties.</p> <p>Methods</p> <p>Extracts of a selection of South African taxa were tested for repellency properties in an applicable mosquito feeding-probing assay using unfed female <it>Anopheles arabiensis</it>.</p> <p>Results</p> <p>Although a water extract of the roots of <it>Chenopodium opulifolium </it>was found to be 97% as effective as DEET after 2 mins, time lag studies revealed a substantial reduction in efficacy (to 30%) within two hours.</p> <p>Conclusions</p> <p>None of the plant extracts investigated exhibited residual repellencies >60% after three hours.</p