Comparative efficacy of two poeciliid fish in indoor cement tanks against chikungunya vector Aedes aegypti in villages in Karnataka, India

<p>Abstract</p> <p>Background</p> <p>In 2006, severe outbreaks of <it>Aedes aegypti</it>-transmitted chikungunya occurred in villages in Karnataka, South India. We evaluated the effectiveness of combined information, education and communication (IEC) campaigns using two potential poeciliid larvivorous fish guppy (<it>Poecilia reticulata</it>) and mosquitofish (<it>Gambusia affinis</it>), in indoor cement tanks for <it>Aedes </it>larval control.</p> <p>Methods</p> <p>Trials were conducted in two villages (Domatmari and Srinivaspura) in Tumkur District from March to May 2006 for <it>Poecilia </it>and one village (Balmanda) in Kolar District from July to October 2006 for <it>Gambusia</it>. A survey on knowledge, attitude and practice (KAP) on chikungunya was initially conducted and IEC campaigns were performed before and after fish release in Domatmari (IEC alone, followed by IEC + <it>Poecilia</it>) and Balmanda (IEC + <it>Gambusia</it>). In Srinivaspura, IEC was not conducted. Larval surveys were conducted at the baseline followed by one-week and one-month post-intervention periods. The impact of fish on <it>Aedes </it>larvae and disease was assessed based on baseline and post-intervention observations.</p> <p>Results</p> <p>Only 18% of respondents knew of the role of mosquitoes in fever outbreaks, while almost all (<it>n </it>= 50 each) gained new knowledge from the IEC campaigns. In Domatmari, IEC alone was not effective (OR 0.54; <it>p </it>= 0.067). Indoor cement tanks were the most preferred <it>Ae. aegypti </it>breeding habitat (86.9%), and had a significant impact on <it>Aedes </it>breeding (Breteau Index) in all villages in the one-week period (<it>p </it>< 0.001). In the one-month period, the impact was most sustained in Domatmari (OR 1.58, <it>p </it>< 0.001) then Srinivaspura (OR 0.45, <it>p </it>= 0.063) and Balmanda (OR 0.51, <it>p </it>= 0.067). After fish introductions, chikungunya cases were reduced by 99.87% in Domatmari, 65.48% in Srinivaspura and 68.51% in Balmanda.</p> <p>Conclusions</p> <p><it>Poecilia </it>exhibited greater survival rates than <it>Gambusia </it>(86.04 <it>vs</it>.16.03%) in cement tanks. Neither IEC nor <it>Poecilia </it>alone was effective against <it>Aedes </it>(<it>p </it>> 0.05). We conclude that <it>Poecilia </it>+ IEC is an effective intervention strategy. The operational cost was 0.50 (US$0.011, 1 US$= 47) per capita per application. Proper water storage practices, focused IEC with <it>Poecilia </it>introductions and vector sanitation involving the local administration and community, is suggested as the best strategy for <it>Aedes </it>control.</p

A community-based health education programme for bio-environmental control of malaria through folk theatre (Kalajatha) in rural India

BACKGROUND: Health education is an important component in disease control programme. Kalajatha is a popular, traditional art form of folk theatre depicting various life processes of a local socio-cultural setting. It is an effective medium of mass communication in the Indian sub-continent especially in rural areas. Using this medium, an operational feasibility health education programme was carried out for malaria control. METHODS: In December 2001, the Kalajatha events were performed in the evening hours for two weeks in a malaria-affected district in Karnataka State, south India. Thirty local artists including ten governmental and non-governmental organizations actively participated. Impact of this programme was assessed after two months on exposed vs. non-exposed respondents. RESULTS: The exposed respondents had significant increase in knowledge and change in attitude about malaria and its control strategies, especially on bio-environmental measures (p < 0.001). They could easily associate clean water with anopheline breeding and the role of larvivorous fish in malaria control. In 2002, the local community actively co-operated and participated in releasing larvivorous fish, which subsequently resulted in a noteworthy reduction of malaria cases. Immediate behavioural changes, especially maintenance of general sanitation and hygiene did not improve as much as expected. CONCLUSION: This study was carried out under the primary health care system involving the local community and various potential partners. Kalajatha conveyed the important messages on malaria control and prevention to the rural community. Similar methods of communication in the health education programme should be intensified with suitable modifications to reach all sectors, if malaria needs to be controlled

Exploring provider and community responses to the new malaria diagnostic and treatment regime in Solomon Islands

<p>Abstract</p> <p>Background</p> <p>Improvements in availability and accessibility of artemisinin-based combination therapy (ACT) for malaria treatment and the emergence of multi-drug-resistant parasites have prompted many countries to adopt ACT as the first-line drug. In 2009, Solomon Islands (SI) likewise implemented new national treatment guidelines for malaria. The ACT, Coartem^®(artemether-lumefantrine) is now the primary pharmacotherapy in SI for <it>Plasmodium falciparum </it>malaria, <it>Plasmodium vivax </it>malaria or mixed infections. Targeted treatment is also recommended in the new treatment regime through maintenance of quality microscopy services and the introduction of Rapid Diagnostic Tests (RDTs). Ascertaining the factors that influence community and provider acceptance of and adherence to the new treatment regime will be vital to improving the effectiveness of this intervention and reducing the risk of development of drug resistance.</p> <p>Methods</p> <p>In order to understand community and prescriber perceptions and acceptability of the new diagnostic and treatment interventions, 12 focus group discussions (FGDs) and 12 key informant interviews (KII) were carried out in rural and urban villages of Malaita Province, Solomon Islands four months subsequent to roll out of these interventions.</p> <p>Results</p> <p>Lack of access to microscopy or distrust in the accuracy of diagnostic tools were reported by some participants as reasons for the ongoing practice of presumptive treatment of malaria. Lack of confidence in RDT accuracy has negatively impacted its acceptability. Coartem^®had good acceptability among most participants, however, some rural participants questioned its effectiveness due to lack of side effects and the larger quantity of tablets required to be taken. Storing of left over medication for subsequent fever episodes was reported as common.</p> <p>Conclusion</p> <p>To address these issues, further training and supportive supervision of healthcare workers will be essential, as will the engagement of influential community members in health promotion activities to improve acceptability of RDTs and adherence to the new treatment regime. Exploring the extent of these issues beyond the study population must be a priority for malaria programme managers. Practices such as presumptive treatment and the taking of sub-curative doses are of considerable concern for both the health of individuals and the increased risk it poses to the development of parasite resistance to this important first-line treatment against malaria.</p