A novel video-tracking system to quantify the behaviour of nocturnal mosquitoes attacking human hosts in the field

Many vectors of malaria and other infections spend most of their adult life within human homes, the environment where they bloodfeed and rest, and where control has been most successful. Yet, knowledge of peri-domestic mosquito behaviour is limited, particularly how mosquitoes find and attack human hosts or how insecticides impact on behaviour. This is partly because technology for tracking mosquitoes in their natural habitats, traditional dwellings in disease-endemic countries, has never been available. We describe a sensing device that enables observation and recording of nocturnal mosquitoes attacking humans with or without a bed net, in the laboratory and in rural Africa. The device addresses requirements for sub-millimetre resolution over a 2.0 x 1.2 x 2.0 m volume while using minimum irradiance. Data processing strategies to extract individual mosquito trajectories and algorithms to describe behaviour during host/net interactions are introduced. Results from UK laboratory and Tanzanian field tests showed that Culex quinquefasciatus activity was higher and focused on the bed net roof when a human host was present, in colonized and wild populations. Both C. quinquefasciatus and Anopheles gambiae exhibited similar behavioural modes, with average flight velocities varying by less than 10%. The system offers considerable potential for investigations in vector biology and many other fields

Host-seeking activity of a Tanzanian population of Anopheles arabiensis at an insecticide treated bed net

Background: Understanding how mosquitoes respond to long lasting insecticide treated nets (LLINs) is fundamental to sustaining the effectiveness of this essential control tool. We report on studies with a tracking system to investigate behaviour of wild anophelines at an LLIN, in an experimental hut at a rural site in Mwanza, Tanzania. Methods: Groups of adult female mosquitoes (n = 10 per replicate) reared from larvae of a local population, identified as predominantly (95%) Anopheles arabiensis, were released in the hut. An infrared video tracking system recorded flight and net contact activity over 1 h as the mosquitoes attempted to reach a supine human volunteer within a bed net (either a deltamethrin-treated LLIN or an untreated control net). A range of activities, including flight path, position in relation to the bed net and duration of net contact, were quantified and compared between treatments. Results: The total time that female An. arabiensis spent in flight around LLINs was significantly lower than at untreated nets [F(1,10) = 9.26, p = 0.012], primarily due to a substantial reduction in the time mosquitoes spent in persistent ‘bouncing’ flight [F(1,10) = 18.48, p = 0.002]. Most activity occurred at the net roof but significantly less so with LLINs (56.8% of total) than untreated nets [85.0%; Χ2 (15) = 234.69, p < 0.001]. Activity levels at the bed net directly above the host torso were significantly higher with untreated nets (74.2%) than LLINs [38.4%; Χ2 (15) = 33.54, p = 0.004]. ‘Visiting’ and ‘bouncing’ rates were highest above the volunteer’s chest in untreated nets (39.9 and 50.4%, respectively) and LLINs [29.9 and 42.4%; Χ2 (13) = 89.91, p < 0.001; Χ2 (9) = 45.73, p < 0.001]. Highest resting rates were above the torso in untreated nets [77%; Χ2 (9) = 63.12, p < 0.001], but in LLINs only 33.2% of resting occurred here [Χ2 (9) = 27.59, p = 0.001], with resting times spread between the short vertical side of the net adjacent to the volunteer’s head (21.8%) and feet (16.2%). Duration of net contact by a single mosquito was estimated at 204–290 s on untreated nets and 46–82 s on LLINs. While latency to net contact was similar in both treatments, the reduction in activity over 60 min was significantly more rapid for LLINs [F(1,10) = 6.81, p = 0.026], reiterating an ‘attract and kill’ rather than a repellent mode of action. Conclusions: The study has demonstrated the potential for detailed investigations of behaviour of wild mosquito populations under field conditions. The results validate the findings of earlier laboratory studies on mosquito activity at LLINs, and reinforce the key role of multiple brief contacts at the net roof as the critical LLIN mode of action

Metalevel algorithms for variant satisfiability

Variant satisfiability is a theory-generic algorithm to decide quantifier-free satisfiability in an initial algebra when its corresponding theory has the finite variant property and its constructors satisfy a compactness condition. This paper: (i) gives a precise definition of several meta-level sub-algorithms needed for variant satisfiability; (ii) proves them correct; and (iii) presents a reflective implementation in Maude 2.7 of variant satisfiability using these sub-algorithms.NSF CNS 13-19109Ope

Health worker motivation in the context of HIV care and treatment challenges in Mbeya Region, Tanzania: A qualitative study

Health worker motivation can potentially affect the provision of health services. The HIV pandemic has placed additional strain on health service provision through the extra burden of increased testing and counselling, treating opportunistic infections and providing antiretroviral treatment. The aim of this paper is to explore the challenges generated by HIV care and treatment and their impact on health worker motivation in Mbeya Region, Tanzania. Thirty in-depth interviews were conducted with health workers across the range of health care professions in health facilities in two high HIV-prevalence districts of Mbeya Region, Tanzania. A qualitative framework analysis was adopted for data analysis. The negative impact of HIV-related challenges on health worker motivation was confirmed by this study. Training seminars and workshops related to HIV contributed to the shortage of health workers in the facilities. Lower status workers were frequently excluded from training and were more severely affected by the consequent increase in workload as seminars were usually attended by higher status professionals who controlled access. Constant and consistent complaints by clients have undermined health workers' expectations of trust and recognition. Health workers were forced to take responsibility for dealing with problems arising from organisational inefficiencies within the health system. HIV-related challenges undermine motivation among health workers in Mbeya, Tanzania with the burden falling most heavily on lower status workers. Strained relations between health workers and the community they serve, further undermine motivation of health workers

To err is human, to correct is public health: a systematic review examining poor quality testing and misdiagnosis of HIV status.

INTRODUCTION: In accordance with global testing and treatment targets, many countries are seeking ways to reach the "90-90-90" goals, starting with diagnosing 90% of all people with HIV. Quality HIV testing services are needed to enable people with HIV to be diagnosed and linked to treatment as early as possible. It is essential that opportunities to reach people with undiagnosed HIV are not missed, diagnoses are correct and HIV-negative individuals are not inadvertently initiated on life-long treatment. We conducted this systematic review to assess the magnitude of misdiagnosis and to describe poor HIV testing practices using rapid diagnostic tests. METHODS: We systematically searched peer-reviewed articles, abstracts and grey literature published from 1 January 1990 to 19 April 2017. Studies were included if they used at least two rapid diagnostic tests and reported on HIV misdiagnosis, factors related to potential misdiagnosis or described quality issues and errors related to HIV testing. RESULTS: Sixty-four studies were included in this review. A small proportion of false positive (median 3.1%, interquartile range (IQR): 0.4-5.2%) and false negative (median: 0.4%, IQR: 0-3.9%) diagnoses were identified. Suboptimal testing strategies were the most common factor in studies reporting misdiagnoses, particularly false positive diagnoses due to using a "tiebreaker" test to resolve discrepant test results. A substantial proportion of false negative diagnoses were related to retesting among people on antiretroviral therapy. Conclusions HIV testing errors and poor practices, particularly those resulting in false positive or false negative diagnoses, do occur but are preventable. Efforts to accelerate HIV diagnosis and linkage to treatment should be complemented by efforts to improve the quality of HIV testing services and strengthen the quality management systems, particularly the use of validated testing algorithms and strategies, retesting people diagnosed with HIV before initiating treatment and providing clear messages to people with HIV on treatment on the risk of a "false negative" test result

Assessment of quality assurance in HIV testing in health facilities in Lake Victoria zone, Tanzania

Tanzania is currently implementing the antiretroviral treatment programme, and has a target of putting about 400,000 eligible HIV infected individuals on treatment by 2008. This will involve screening a large number of people, which will require non-laboratory personnel to be involved in doing HIV testing. In order to guarantee reliable and quality HIV test results, there is a need to ensure that quality assurance (QA) procedures are followed from specimen collection, testing and reporting of results. In light of the above a survey was conducted to assess QA in HIV testing in health facilities in Lake Victoria zone, Tanzania. A total of 89 health facilities (29 hospitals, 34 health centres, 9 dispensaries and 17 voluntary and counselling testing centres) were surveyed. Only three (10.3%) health facilities reported performing Uniform II ELISA for HIV diagnosis. All other health facilities reported to be using HIV rapid tests Capillus and Determine. Five (5.6%) of health facility laboratories performed CD4 counts. Internal quality control (IQC) were performed in 21 (63.6%) of the hospitals. Kits for HIV testing were reported to be readily available by 54 (60.7%) of the facilities. Only 16 (18%) of the health facilities had standard operating procedures in place. Systems of equipment calibration were reported by 13 (14.6%) of the health facilities. Counselling services were available in all health facilities and all counsellors had received the 6-week mandatory training course. These findings show that most of health facilities in the Lake Victoria zone do not adhere to QA procedures in HIV testing. There is therefore, a need to establish a monitoring system to laboratories performing HIV testing for the purpose of ensuring QA procedures are done. Personnel doing HIV testing should be re-trained at a regular basis to cope with new techniques and ensure QA procedures are followed

Assessment of quality assurance in HIV testing in health facilities in Lake Victoria zone, Tanzania

Tanzania is currently implementing the antiretroviral treatment programme, and has a target of putting about 400,000 eligible HIV infected individuals on treatment by 2008. This will involve screening a large number of people, which will require non-laboratory personnel to be involved in doing HIV testing. In order to guarantee reliable and quality HIV test results, there is a need to ensure that quality assurance (QA) procedures are followed from specimen collection, testing and reporting of results. In light of the above a survey was conducted to assess QA in HIV testing in health facilities in Lake Victoria zone, Tanzania. A total of 89 health facilities (29 hospitals, 34 health centres, 9 dispensaries and 17 voluntary and counselling testing centres) were surveyed. Only three (10.3%) health facilities reported performing Uniform II ELISA for HIV diagnosis. All other health facilities reported to be using HIV rapid tests Capillus and Determine. Five (5.6%) of health facility laboratories performed CD4 counts. Internal quality control (IQC) were performed in 21 (63.6%) of the hospitals. Kits for HIV testing were reported to be readily available by 54 (60.7%) of the facilities. Only 16 (18%) of the health facilities had standard operating procedures in place. Systems of equipment calibration were reported by 13 (14.6%) of the health facilities. Counselling services were available in all health facilities and all counsellors had received the 6-week mandatory training course. These findings show that most of health facilities in the Lake Victoria zone do not adhere to QA procedures in HIV testing. There is therefore, a need to establish a monitoring system to laboratories performing HIV testing for the purpose of ensuring QA procedures are done. Personnel doing HIV testing should be re-trained at a regular basis to cope with new techniques and ensure QA procedures are followed

Patterns of malaria related mortality based on verbal autopsy in Muleba District, north-western Tanzania

Reliable malaria related mortality data is important for planning appropriate interventions. However, there is scarce information on the pattern of malaria related mortality in epidemic prone districts of Tanzania. This study was carried out to determine malaria related mortality and establish its trend change over time in both epidemic and non-epidemic areas of Muleba District of north-western Tanzania. A verbal autopsy survey was conducted to obtain data on all deaths of individuals who died in six randomly selected villages from 1997 to 2006. Relatives of the deceased were interviewed using a standardized questionnaire. Communicable diseases accounted for about two thirds (61.9%) of deaths among ≥5 years individuals and 84.8% in ≤5 years. Non-communicable diseases accounted for 28.9% and 14.1% deaths in ≥5 years and ≤5 years, respectively. Malaria was the leading cause of deaths in all age groups (40.3%) and among children <5 years (73.8%). Infants accounted for about two third (64.5%) of all malaria related deaths in children <5 years. Peak of malaria proportional mortality was highest during malaria epidemics. Most of the malaria-related deaths in this group were among 1-12 months (64.5%) followed by 13-24 months (20.9%), and 25- 59months (14.8%). Cerebral malaria accounted for 18.9% (N=32) of death related to malaria in all age groups; 12.1% (17/141) were in under-five, 42.9% (6/14) were in 5-14 years and 64.3% (9/14) in 15-70 years old. More than half of malaria related deaths (61.0%) in <5 years children were associated with severe anaemia followed by diarrhoeal disease (24.1%), cerebral malaria (12.5%) and respiratory infection (8.5%) as common conditions. The majority of the deceased caretakers first sought treatment at health facilities within 24hr of the onset of illness. Significantly a higher proportion of caretakers of the underfives in the epidemic area sought treatment within 24hr than in non-epidemic area (39.3% vs. 18.5%; P=0.0385). In conclusion, malaria accounts for majority of deaths in Muleba district, with substantial proportion being attributed to malaria epidemics

Patterns of malaria related mortality based on verbal autopsy in Muleba District, north-western Tanzania

Reliable malaria related mortality data is important for planning appropriate interventions. However, there is scarce information on the pattern of malaria related mortality in epidemic prone districts of Tanzania. This study was carried out to determine malaria related mortality and establish its trend change over time in both epidemic and non-epidemic areas of Muleba District of north-western Tanzania. A verbal autopsy survey was conducted to obtain data on all deaths of individuals who died in six randomly selected villages from 1997 to 2006. Relatives of the deceased were interviewed using a standardized questionnaire. Communicable diseases accounted for about two thirds (61.9%) of deaths among ≥5 years individuals and 84.8% in ≤5 years. Non-communicable diseases accounted for 28.9% and 14.1% deaths in ≥5 years and ≤5 years, respectively. Malaria was the leading cause of deaths in all age groups (40.3%) and among children <5 years (73.8%). Infants accounted for about two third (64.5%) of all malaria related deaths in children <5 years. Peak of malaria proportional mortality was highest during malaria epidemics. Most of the malaria-related deaths in this group were among 1-12 months (64.5%) followed by 13-24 months (20.9%), and 25- 59months (14.8%). Cerebral malaria accounted for 18.9% (N=32) of death related to malaria in all age groups; 12.1% (17/141) were in under-five, 42.9% (6/14) were in 5-14 years and 64.3% (9/14) in 15-70 years old. More than half of malaria related deaths (61.0%) in <5 years children were associated with severe anaemia followed by diarrhoeal disease (24.1%), cerebral malaria (12.5%) and respiratory infection (8.5%) as common conditions. The majority of the deceased caretakers first sought treatment at health facilities within 24hr of the onset of illness. Significantly a higher proportion of caretakers of the underfives in the epidemic area sought treatment within 24hr than in non-epidemic area (39.3% vs. 18.5%; P=0.0385). In conclusion, malaria accounts for majority of deaths in Muleba district, with substantial proportion being attributed to malaria epidemics