Linking human behaviours and malaria vector biting risk in south-eastern Tanzania

To accelerate malaria elimination in areas where core interventions such as insecticide-treated nets (ITNs) are already widely used, it is crucial to consider additional factors associated with persistent transmission. Qualitative data on human behaviours and perceptions regarding malaria risk was triangulated with quantitative data on Anopheles mosquito bites occurring indoors and outdoors in south-eastern Tanzania communities where ITNS are already used but lower level malaria transmission persists. Each night (18:00h-07:00h), trained residents recorded human activities indoors, in peri-domestic outdoor areas, and in communal gatherings. Host-seeking mosquitoes were repeatedly collected indoors and outdoors hourly, using miniaturized exposure-free double net traps (DN-Mini) occupied by volunteers. In-depth interviews were conducted with household representatives to explore perceptions on persistent malaria and its control. Higher proportions of people stayed outdoors than indoors in early-evening and early-morning hours, resulting in higher exposures outdoors than indoors during these times. However, exposure during late-night hours (22:00h-05:00h) occurred mostly indoors. Some of the popular activities that kept people outdoors included cooking, eating, relaxing and playing. All households had at least one bed net, and 83.9% of people had access to ITNs. Average ITN use was 96.3%, preventing most indoor exposure. Participants recorgnized the importance of ITNs but also noted that the nets were not perfect. No complementary interventions were reported being used widely. Most people believed transmission happens after midnight. We conclude that insecticide-treated nets, where properly used, can still prevent most indoor exposures, but significant risk continues unabated before bedtime, outdoors and at communal gatherings. Such exposure is greatest for rural and low-income households. There is therefore an urgent need for complementary interventions, particularly those targeting outdoor-biting and are applicable for all people including the marginalised populations such as migratory farmers and fishermen. Besides, the differences in community understanding of ongoing transmission, and feedback on imperfections of ITNs should be considered when updating malaria-related communication and interventions

Detection of malaria parasites in dried human blood spots using mid-infrared spectroscopy and logistic regression analysis

Background: Epidemiological surveys of malaria currently rely on microscopy, polymerase chain reaction assays (PCR) or rapid diagnostic test kits for Plasmodium infections (RDTs). This study investigated whether mid-infrared (MIR) spectroscopy coupled with supervised machine learning could constitute an alternative method for rapid malaria screening, directly from dried human blood spots. Methods: Filter papers containing dried blood spots (DBS) were obtained from a cross-sectional malaria survey in 12 wards in southeastern Tanzania in 2018/19. The DBS were scanned using attenuated total reflection-Fourier Transform Infrared (ATR-FTIR) spectrometer to obtain high-resolution MIR spectra in the range 4000 cm−1 to 500 cm−1. The spectra were cleaned to compensate for atmospheric water vapour and CO2 interference bands and used to train different classification algorithms to distinguish between malaria-positive and malaria-negative DBS papers based on PCR test results as reference. The analysis considered 296 individuals, including 123 PCR-confirmed malaria positives and 173 negatives. Model training was done using 80% of the dataset, after which the best-fitting model was optimized by bootstrapping of 80/20 train/test-stratified splits. The trained models were evaluated by predicting Plasmodium falciparum positivity in the 20% validation set of DBS. Results: Logistic regression was the best-performing model. Considering PCR as reference, the models attained overall accuracies of 92% for predicting P. falciparum infections (specificity = 91.7%; sensitivity = 92.8%) and 85% for predicting mixed infections of P. falciparum and Plasmodium ovale (specificity = 85%, sensitivity = 85%) in the field-collected specimen. Conclusion: These results demonstrate that mid-infrared spectroscopy coupled with supervised machine learning (MIR-ML) could be used to screen for malaria parasites in human DBS. The approach could have potential for rapid and high-throughput screening of Plasmodium in both non-clinical settings (e.g., field surveys) and clinical settings (diagnosis to aid case management). However, before the approach can be used, we need additional field validation in other study sites with different parasite populations, and in-depth evaluation of the biological basis of the MIR signals. Improving the classification algorithms, and model training on larger datasets could also improve specificity and sensitivity. The MIR-ML spectroscopy system is physically robust, low-cost, and requires minimum maintenance

Moderate-to-vigorous physical activity is associated with cardiorespiratory fitness among primary schoolchildren living in Côte d'Ivoire, South Africa, and Tanzania

Background:; Physical inactivity and low cardiorespiratory fitness (CRF) are independent cardiovascular risk factors among children, but have rarely been investigated concurrently in sub-Saharan Africa. The purpose of this study was to compare physical activity (PA) and CRF of primary schoolchildren living in Côte d'Ivoire (CI), South Africa (ZA), and Tanzania (TZ), to test sex- and age-related differences, and to examine whether PA and CRF are associated with each other.; Methods:; Baseline data from an ongoing cluster-randomized controlled trial were used, including 499 children from CI (Taabo, 49% girls,; M; = 8.0 ± 1.6 years), 1,074 children from ZA (Gqeberha, 49% girls,; M; = 8.3 ± 1.4 years), and 593 children from TZ (Ifakara, 51% girls,; M; = 9.4 ± 1.7 years). PA was assessed by accelerometry and CRF by a 20 m shuttle-run test. The data were analyzed using multi-/univariate analyses of variance and mixed linear models.; Results:; Most children met recommendations put forward by the World Health Organization for moderate-to-vigorous PA (MVPA) and achieved high CRF scores. In CI, 89.6% of the children met MVPA recommendations (boys: 91.7%, girls: 87.4%), whereas this rate was 76.9% in ZA (boys: 91.0%, girls: 62.4%), and 93.8% in TZ (boys: 95.5%, girls: 92.0%). Children from TZ had the highest CRF and MVPA levels, followed by children from CI and ZA. Boys had higher MVPA levels than girls, whereas girls engaged in more sedentary behavior. Sex differences were strongest in ZA. Sedentary behavior and MVPA were higher among older schoolchildren compared to their younger peers. Higher MVPA, but not sedentary behavior, was associated with better CRF.; Conclusions:; In all three settings, higher levels of MVPA were associated with higher CRF scores. Nevertheless, children living in the most urbanized setting (such as observed in ZA) were physically less active and had lower CRF than peers living in more rural areas (such as observed in CI and TZ). Particularly for girls, urbanization might increase the risk for insufficient MVPA, which may have negative effects on their CRF, thus negatively influencing health and well-being at later age

Correlation of Cytokines with Parasitic Infections, Undernutrition and Micronutrient Deficiency among Schoolchildren in Rural Tanzania: A Cross-Sectional Study

Malnutrition and parasitic infections are often interconnected in a vicious cycle. Malnutrition can lead to changes in immune response, which may affect cytokine concentrations and potentially increase susceptibility to infections. In turn, parasitic infections can exacerbate malnutrition by impairing nutrient absorption. This cross-sectional study aimed to explore this interplay. Schoolchildren aged 6–12 years living in rural Tanzania (n = 120) provided blood, stool and urine samples to determine the relationship between cytokine concentrations (interleukin 4 (IL-4), interferon gamma (IFNγ) and interleukin 17A (IL-17A)), parasitic infections, undernutrition and micronutrient deficiency adjusting for sex, age, inflammatory markers, socioeconomic status and school categories. All schoolchildren had a normal blood cell count. The concentration of IL-4 was significantly higher in schoolchildren diagnosed with stunting, Schistosoma mansoni infection, a high C-reactive protein concentration, nausea, poor housing and increasing age. The concentration of IFNγ was associated with Plasmodium falciparum and Entamoeba histolytica/Entamoeba dispar/Entamoeba moshkovskii infections, vitamin A deficiency, attending the most remote schools and low socioeconomic status. Our study confirms a potential relationship between cytokine concentrations and parasitic infections, malnutrition and low socioeconomic status. A better understanding of long-term effects of parasitic infections and malnutrition on the immune function could help in designing tailored and effective interventions

Efficacy and user acceptability of transfluthrin-treated sisal and hessian decorations for protecting against mosquito bites in outdoor bars

Abstract Background A number of mosquito vectors bite and rest outdoors, which contributes to sustained residual malaria transmission in endemic areas. Spatial repellents are thought to create a protective “bubble” within which mosquito bites are reduced and may be ideal for outdoor use. This study builds on previous studies that proved efficacy of transfluthrin-treated hessian strips against outdoor biting mosquitoes. The goal of this study was to modify strips into practical, attractive and acceptable transfluthrin treated sisal and hessian emanators that confer protection against potential infectious bites before people use bed nets especially in the early evening and outdoors. This study was conducted in Kilombero Valley, Ulanga District, south-eastern Tanzania. Results The protective efficacy of hand-crafted transfluthrin-treated sisal decorative baskets and hessian wall decorations against early evening outdoor biting malaria vectors was measured by human landing catches (HLC) in outdoor bars during peak outdoor mosquito biting activity (19:00 to 23:00 h). Treated baskets and wall decorations reduced bites of Anopheles arabiensis mosquitoes by 89% (Relative Rate, RR = 0.11, 95% confidence interval, CI: 0.09–0.15, P < 0.001) and 86% (RR = 0.14, 95% CI: 0.11–0.18, P < 0.001), respectively. In addition, they significantly reduced exposure to outdoor bites of Culex spp. by 66% (RR = 0.34, 95% CI: 0.22–0.52, P < 0.001) and 56% (RR = 0.44, 95% CI: 0.29–0.66, P < 0.001), respectively. Conclusion Locally hand-crafted transfluthrin-treated sisal decorative baskets and hessian wall decorations are readily acceptable and confer protection against outdoor biting malaria vectors in the early evening and outdoors: when people are resting on the verandas, porches or in outdoor social places such as bars and restaurants. Additional research can help support the use of such items as complementary interventions to expand protection to communities currently experiencing outdoor transmission of mosquito-borne pathogens

Dietary diversity among households living in Kilombero district, in Morogoro region, South-Eastern Tanzania

Background: Adequate nutrition is essential for good health and active life. However, diets in most low and middle-income households lack diversity, especially in settings where people eat predominantly starchy foods. In this study, we assessed the associations between socio-economic status and household dietary diversity in families living in South-eastern Tanzania. Method: A cross-sectional questionnaire was administered to 925 parents of school children in four wards in South-eastern Tanzania, as part of a trial; assessing the effects of physical activity and micronutrient supplementation on overall growth, health and well-being of school children. The dietary intake was assessed by 24-h dietary recall and dietary diversity score (DDS) was calculated. Socio-economic status was derived from a weighted score using principal component analysis (PCA). Multinomial logistic regression was used to investigate the association between dietary diversity and socio-economic status. This baseline data assessment was completed in July and August 2019. Results: Cereals, oils and fats were the most consumed food groups, legumes were the most common source of protein and fish was the most common animal protein. More than three quarters of the households had medium dietary diversity (MDD). Higher household education and large farm size were the only factors significantly associated with having high dietary diversity. Conclusion: A majority of the households in South-eastern Tanzania have medium dietary diversity, comprised of cereal, fats and oils and proteins. Having high dietary diversity was associated with higher education and large farm sizes. Improving community members’ knowledge and awareness of nutritional benefits could improve the dietary diversity at household level

Is grip strength linked to body composition and cardiovascular risk markers in primary schoolchildren? Cross-sectional data from three African countries

Muscular strength represents a specific component of health-related fitness. Hand grip strength (HGS) is used as an indicator for musculoskeletal fitness in children. HGS can also be used as a marker of cardiometabolic risk, but most available HGS data are derived from Western high-income countries. Therefore, this study examines whether HGS is associated with body composition and markers of cardiovascular risk in children from three sub-Saharan African countries.; Cross-sectional study.; Public primary schools (grade 1-4) in Taabo (Côte d'Ivoire), Gqeberha (South Africa) and Ifakara (Tanzania).; Data from 467 children from Côte d'Ivoire (210 boys, 257 girls), 864 children from South Africa (429 boys, 435 girls) and 695 children from Tanzania (334 boys, 361 girls) were analysed.; Body composition (assessed via bioelectrical impedance analysis) was the primary outcome. Cardiovascular risk markers were considered as secondary outcome. Blood pressure was measured with an oscillometric monitor, and blood markers (cholesterol, triglycerides, glycated haemoglobin) via Afinion point-of-care testing. HGS (independent variable) was assessed with a hydraulic hand dynamometer. Inferential statistics are based on mixed linear regressions and analyses of covariance.; Across all study sites, higher HGS was associated with lower body fat, higher muscle mass and higher fat-free mass (; p; <0.001, 3.9%-10.0% explained variance), both in boys and girls. No consistent association was found between HGS and cardiovascular risk markers.; HGS assessment is popular due to its simplicity, feasibility, practical utility and high reliability of measurements. This is one of the first HGS studies with children from sub-Saharan Africa. There is a great need for further studies to examine whether our findings can be replicated, to develop reference values for African children, to establish links to other health outcomes, and to explore whether HGS is associated with later development of cardiovascular risk markers.; ISRCTN29534081.Keywords: community child health; public health; sports medicine