Combining unrelated insecticides for improved control and management of insecticide resistant African malaria vectors

It is now generally accepted that if nothing is done and insecticide resistance in malaria vectors especially to pyrethroids eventually led to widespread failure of current vector control strategies, the progress achieved so far in reducing the burden of malaria could be reversed. Interventions and operational tactics capable of controlling insecticide resistant malaria vector populations and delaying the evolution of resistance need to be urgently identified and properly investigated. One important insecticide resistance management strategy is to expose vector populations to a combination of unrelated insecticides. In this study I investigated the potential of this combination concept to control and manage the spread of indoor resting insecticide resistant African malaria vectors. A series of field evaluations were performed in experimental huts in selected malaria endemic sites to investigate; 1.the impact of combining non-pyrethroid IRS or wall linings with pyrethroid LLINs against malaria vector populations with different levels of insecticide resistance and 2.The efficacy of LLINs treated with a pyrethroid and an alternative compound against pyrethroid resistant mosquitoes. The capacity of the combined intervention approach to delay the spread of insecticide resistance genes was investigated via genotyping studies. I demonstrate that the use of combined interventions and mixture net with unrelated insecticides is an effective way to improve the control of pyrethroid resistance malaria vectors. However, the performance of these combinations will undoubtedly depend on the levels and type of resistance encountered. Where resistance to both insecticides exists, improved control is unlikely. While the use of single interventions would likely exacerbate resistance the combinations would be less beneficial for preventing selection of insecticide resistance when resistance genes are already well established. The impact of these findings on malaria vector control and resistance management is discussed

Challenges and Opportunities Of A Unified Health Information System: Focus On The Cameroonian Health Sector

The information landscape in every industry is the core to improving efficiency and quality. This is not different for the health Information system which when harnessed and improved can help the healthcare industry to meet its goals faster and better. In order to develop a healthcare information system that relies on the power of technology to solve issues, it must be carefully analyzed and designed to match the needs of the environment in which it is deployed.EHealth and mHealth are the keys to harnessing the power of technology in a one and unified system. Cameroon has a very low usage of IT which can be enhanced by slowly developing a health infrastructure in which we initiate every stakeholder into the technological system to interact with every other stakeholder in ways that were traditionally done physically. The demand for such a system can be seen as the overall development of ICT has already penetrated the healthcare sector in telephones and computers which already serve real purposes. Carrying out research in the Cameroonian health sector further exposed the opportunities and challenges for such a system

Unsupervised Labeling Of Data For Supervised Learning And Its Application To Medical Claims Prediction

The task identifying changes and irregularities in medical insurance claim pay-ments is a difficult process of which the traditional practice involves queryinghistorical claims databases and flagging potential claims as normal or abnor-mal. Because what is considered as normal payment is usually unknown andmay change over time, abnormal payments often pass undetected; only to bediscovered when the payment period has passed.This paper presents the problem of on-line unsupervised learning from datastreams when the distribution that generates the data changes or drifts overtime. Automated algorithms for detecting drifting concepts in a probabilitydistribution of the data are presented. The idea behind the presented driftdetection methods is to transform the distribution of the data within a slidingwindow into a more convenient distribution. Then, a test statistics p-value ata given significance level can be used to infer the drift rate, adjust the windowsize and decide on the status of the drift. The detected concepts drifts areused to label the data, for subsequent learning of classification models by asupervised learner. The algorithms were tested on several synthetic and realmedical claims data sets

The Role of Big Data in Healthcare: The Revolution of African Healthcare.

African healthcare has continuously evolved in quality, diversity, and adoption of technology over the years. Over these years, huge volumes of data have been collected from numerous patients in several countries. Most of this data has never been revisited as it exists mostly in written forms. All this data past present and future encompasses big data in healthcare, and harnessing the power of data analytics will uncover patterns that will not only improve the quality of health to save lives but will relatively reduce the cost of implementing this healthcare. Big data through data analytics and its components such as data mining, predictive analysis, and technologies such as cloud computing are the future of African healthcare. With good governance and investment in quality infrastructure, the hope of one day seeing an expert and advanced healthcare in African economies at international standards is no longer a dream but a reality for all

Learning Tasks for Multitask Learning: Heterogenous Patient Populations in the ICU

Machine learning approaches have been effective in predicting adverse outcomes in different clinical settings. These models are often developed and evaluated on datasets with heterogeneous patient populations. However, good predictive performance on the aggregate population does not imply good performance for specific groups. In this work, we present a two-step framework to 1) learn relevant patient subgroups, and 2) predict an outcome for separate patient populations in a multi-task framework, where each population is a separate task. We demonstrate how to discover relevant groups in an unsupervised way with a sequence-to-sequence autoencoder. We show that using these groups in a multi-task framework leads to better predictive performance of in-hospital mortality both across groups and overall. We also highlight the need for more granular evaluation of performance when dealing with heterogeneous populations.Comment: KDD 201

Combining indoor residual spraying with chlorfenapyr and long-lasting insecticidal bed nets for improved control of pyrethroid-resistant Anopheles gambiae: an experimental hut trial in Benin.

BACKGROUND: Neither indoor residual spraying (IRS) nor long-lasting insecticidal nets (LLINs) are able to fully interrupt transmission in holoendemic Africa as single interventions. The combining of IRS and LLINs presents an opportunity for improved control and management of pyrethroid resistance through the simultaneous presentation of unrelated insecticides. METHOD: Chlorfenapyr IRS and a pyrethroid-impregnated polyester LLIN (WHO approved) were tested separately and together in experimental huts in southern Benin against pyrethroid resistant Anopheles gambiae and Culex quinquefasciatus. The bed nets were deliberately holed with either six or 80 holes to examine the effect of increasing wear and tear on protectiveness. Anopheles gambiae were genotyped for the kdr gene to assess the combination's potential to prevent the selection of pyrethroid resistance. RESULTS: The frequency of kdr was 84%. The overall mortality rates of An. gambiae were 37% and 49% with the six-hole and 80-hole LLINs, respectively, and reached 57% with chlorfenapyr IRS. Overall mortality rates were significantly higher with the combination treatments (82-83%) than with the LLIN or IRS individual treatments. Blood feeding (mosquito biting) rates were lowest with the 6-hole LLIN (12%), intermediate with the 80-hole LLIN (32%) and highest with untreated nets (56% with the 6-hole and 54% with the 80-hole nets). Blood feeding (biting) rates and repellency of mosquitoes with the combination of LLIN and chlorfenapyr IRS showed significant improvement compared to the IRS treatment but did not differ from the LLIN treatments indicating that the LLINs were the primary agents of personal protection. The combination killed significantly higher proportions of Cx. quinquefasciatus (51%, 41%) than the LLIN (15%, 13%) or IRS (32%) treatments. CONCLUSION: The chlorfenapyr IRS component was largely responsible for controlling pyrethroid-resistant mosquitoes and the LLIN component was largely responsible for blood feeding inhibition and personal protection. Together, the combination shows potential to provide additional levels of transmission control and personal protection against pyrethroid-resistant mosquitoes, thereby justifying the additional resources required. Chlorfenapyr has potential to manage pyrethroid resistance in the context of an expanding LLIN/IRS strategy

Combining organophosphate-treated wall linings and long-lasting insecticidal nets fails to provide additional control over long-lasting insecticidal nets alone against multiple insecticide-resistant <i>Anopheles gambiae</i> in Côte d’Ivoire: an experimental hut trial

&lt;b&gt;Background&lt;/b&gt; Insecticide-treated wall lining (ITWL) is a new concept in malaria vector control. Some &lt;i&gt;Anopheles gambiae&lt;/i&gt; populations in West Africa have developed resistance to all the main classes of insecticides. It needs to be demonstrated whether vector control can be improved or resistance managed when non-pyrethroid ITWL is used alone or together with long-lasting insecticidal nets (LLINs) against multiple insecticide-resistant vector populations.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt; Two experimental hut trials were carried out as proofs of concept to evaluate pirimiphos methyl (p-methyl)-treated plastic wall lining (WL) and net wall hangings (NWH) used alone and in combination with LLINs against multiple insecticide-resistant &lt;i&gt;An. Gambiae&lt;/i&gt; in Tiassalé, Côte d’Ivoire. Comparison was made to commercial deltamethrin WL and genotypes for &lt;i&gt;kdr&lt;/i&gt; and &lt;i&gt;ace-1R&lt;/i&gt; resistance were monitored.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt; The &lt;i&gt;kdr&lt;/i&gt; and &lt;i&gt;ace-1R&lt;/i&gt; allele frequencies were 0.83 and 0.44, respectively. &lt;i&gt;Anopheles gambiae&lt;/i&gt; surviving discriminating concentrations of deltamethrin and p-methyl in WHO resistance tests were 57 and 96%, respectively. Mortality of free-flying &lt;i&gt;An. Gambiae&lt;/i&gt; in huts with p-methyl WL and NWH (66 and 50%, respectively) was higher than with pyrethroid WL (32%; P &lt; 0.001). Mortality with LLIN was 63%. Mortality with the combination of LLIN plus p-methyl NWH (61%) or LLIN plus p-methyl WL (73%) did not significantly improve upon the LLIN alone or p-methyl WL or NWH alone. Mosquitoes bearing the &lt;i&gt;ace-1R&lt;/i&gt; were more likely to survive exposure to p-methyl WL and NWH. Selection of heterozygote and homozygote &lt;i&gt;ace-1R&lt;/i&gt; or &lt;i&gt;kdr&lt;/i&gt; genotypes was not less likely after exposure to combined LLIN and p-methyl treatments than to single p-methyl treatment. Blood-feeding rates were lower in huts with the pyrethroid LLIN (19%) than with p-methyl WL (72%) or NWH (76%); only LLIN contributed to personal protection.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt; Combining p-methyl WL or NWH with LLINs provided no improvement in &lt;i&gt;An. Gambiae&lt;/i&gt; control or personal protection over LLIN alone in southern Côte d’Ivoire; neither did the combination manage resistance. Additional resistance mechanisms to &lt;i&gt;kdr&lt;/i&gt; and &lt;i&gt;ace-1R&lt;/i&gt; probably contributed to the survival of pyrethroid and organophophate-resistant mosquitoes. The study demonstrates the challenge that malaria control programmes will face if resistance to multiple insecticides continues to spread.&lt;p&gt;&lt;/p&gt

Efficacy of Royal Guard, a new alpha-cypermethrin and pyriproxyfen treated mosquito net, against pyrethroid-resistant malaria vectors.

Royal Guard is a new insecticide-treated bed-net incorporated with a mixture of alpha-cypermethrin and pyriproxyfen (an insect growth regulator). We assessed its efficacy and wash-resistance in laboratory and experimental hut studies following WHO guidelines. Mosquitoes that survived exposure to the net were kept in separate oviposition chambers and observed for the reproductive effects of pyriproxyfen. In laboratory assays, Royal Guard induced > 80% mortality and > 90% blood-feeding inhibition of An. gambiae sl mosquitoes before and after 20 standardised washes and sterilised blood-fed mosquitoes which remained alive after exposure to the net. In an experimental hut trial against wild free-flying pyrethroid-resistant An. gambiae sl in Cové Benin, Royal Guard through the pyrethroid component induced comparable levels of mortality and blood-feeding inhibition to a standard pyrethroid-only treated net before and after 20 washes and sterilised large proportions of surviving blood-fed female mosquitoes through the pyriproxyfen component; Royal Guard induced 83% reduction in oviposition and 95% reduction in offspring before washing and 25% reduction in oviposition and 50% reduction in offspring after 20 washes. Royal Guard has the potential to improve malaria vector control and provide better community protection against clinical malaria in pyrethroid-resistant areas compared to standard pyrethroid-only LLINs

Efficacy of Fludora® Fusion (a mixture of deltamethrin and clothianidin) for indoor residual spraying against pyrethroid-resistant malaria vectors: laboratory and experimental hut evaluation.

BACKGROUND: A new generation of IRS insecticides which can provide improved and prolonged control of pyrethroid-resistant malaria vector populations are being developed. Fludora® Fusion is a new IRS insecticide containing a mixture of deltamethrin and clothianidin, a neonicotinoid. METHODS: The efficacy of Fludora® Fusion IRS was evaluated over 11-12 months on concrete and mud substrates in laboratory bioassays and experimental huts against wild free-flying pyrethroid-resistant Anopheles gambiae (sensu lato) in Cové, Benin. A comparison was made with the two active ingredients of the mixture; clothianidin and deltamethrin, applied alone. CDC bottle bioassays were also performed to investigate resistance to clothianidin in the wild vector population. RESULTS: Fludora® Fusion induced > 80% laboratory cone bioassay mortality with both susceptible and pyrethroid-resistant An. gambiae (s.l.) for 7-9 months on concrete block substrates and 12 months on mud block substrates. The vector population at the experimental hut site was fully susceptible to clothianidin in CDC bottle bioassays. Overall mortality rates of wild free-flying pyrethroid-resistant An. gambiae (s.l.) entering the experimental huts during the 11-month trial were  80%) only declined by 50% after 8 months. Monthly in situ wall cone bioassay mortality of susceptible mosquitoes was > 80% for 9-12 months with Fludora® Fusion and clothianidin alone. Fludora® Fusion induced significantly higher levels of early exiting of mosquitoes compared to clothianidin alone (55-60% vs 37-38%, P < 0.05). CONCLUSIONS: Indoor residual spraying with Fludora® Fusion induced high and prolonged mortality of wild pyrethroid-resistant malaria vectors for 7-10 months mostly due to the clothianidin component and substantial early exiting of mosquitoes from treated huts due to the pyrethroid component. Fludora® Fusion is an important addition to the current portfolio of IRS insecticides with the potential to significantly reduce transmission of malaria by pyrethroid-resistant mosquito vectors