CDC light traps underestimate the protective efficacy of an indoor spatial repellent against bites from wild Anopheles arabiensis mosquitoes in Tanzania

BACKGROUND: Methods for evaluating efficacy of core malaria interventions in experimental and operational settings are well established but gaps exist for spatial repellents (SR). The objective of this study was to compare three different techniques: (1) collection of blood-fed mosquitoes (feeding), (2) human landing catch (HLC), and (3) CDC light trap (CDC-LT) collections for measuring the indoor protective efficacy (PE) of the volatile pyrethroid SR product Mosquito Shield() METHODS: The PE of Mosquito Shield() against a wild population of pyrethroid-resistant Anopheles arabiensis mosquitoes was determined via feeding, HLC, or CDC-LT using four simultaneous 3 by 3 Latin squares (LS) run using 12 experimental huts in Tanzania. On any given night each technique was assigned to two huts with control and two huts with treatment. The LS were run twice over 18 nights to give a sample size of 72 replicates for each technique. Data were analysed by negative binomial regression. RESULTS: The PE of Mosquito Shield() measured as feeding inhibition was 84% (95% confidence interval (CI) 58-94% [Incidence Rate Ratio (IRR) 0.16 (0.06-0.42), p < 0.001]; landing inhibition 77% [64-86%, (IRR 0.23 (0.14-0.36) p < 0.001]; and reduction in numbers collected by CDC-LT 30% (0-56%) [IRR 0.70 (0.44-1.0) p = 0.160]. Analysis of the agreement of the PE measured by each technique relative to HLC indicated no statistical difference in PE measured by feeding inhibition and landing inhibition [IRR 0.73 (0.25-2.12) p = 0.568], but a significant difference in PE measured by CDC-LT and landing inhibition [IRR 3.13 (1.57-6.26) p = 0.001]. CONCLUSION: HLC gave a similar estimate of PE of Mosquito Shield() against An. arabiensis mosquitoes when compared to measuring blood-feeding directly, while CDC-LT underestimated PE relative to the other techniques. The results of this study indicate that CDC-LT could not effectively estimate PE of the indoor spatial repellent in this setting. It is critical to first evaluate the use of CDC-LT (and other tools) in local settings prior to their use in entomological studies when evaluating the impact of indoor SR to ensure that they reflect the true PE of the intervention

A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi

BACKGROUND: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC). METHODS: We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20-40 households for monthly (or more frequent) visits. FINDINGS: The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (-0.8 percentage points (pp) (95% credible interval: -2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: -0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (-0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (-0.6 per 1000 (95% CI -2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges. INTERPRETATION: CHW programmes can be successfully expanded to more comprehensively address health needs in a population, although programmes should be carefully tailored to CHW and health system capacity

Precipitation gradients drive high tree species turnover in the woodlands of eastern and southern Africa

Savannas cover one-fifth of the Earth's surface, harbour substantial biodiversity, and provide a broad range of ecosystem services to hundreds of millions of people. The community composition of trees in tropical moist forests varies with climate, but whether the same processes structure communities in disturbance-driven savannas remains relatively unknown. We investigate how biodiversity is structured over large environmental and disturbance gradients in woodlands of eastern and southern Africa. We use tree inventory data from the Socio-Ecological Observatory for Studying African Woodlands (SEOSAW) network, covering 755 ha in a total of 6780 plots across nine countries of eastern and southern Africa, to investigate how alpha, beta, and phylogenetic diversity varies across environmental and disturbance gradients. We find strong climate-richness patterns, with precipitation playing a primary role in determining patterns of tree richness and high turnover across these savannas. Savannas with greater rainfall contain more tree species, suggesting that low water availability places distributional limits on species, creating the observed climate-richness patterns. Both fire and herbivory have minimal effects on tree diversity, despite their role in determining savanna distribution and structure. High turnover of tree species, genera, and families is similar to turnover in seasonally dry tropical forests of the Americas, suggesting this is a feature of semiarid tree floras. The greater richness and phylogenetic diversity of wetter plots shows that broad-scale ecological patterns apply to disturbance-driven savanna systems. High taxonomic turnover suggests that savannas from across the regional rainfall gradient should be protected if we are to maximise the conservation of unique tree communities

The Southern Africa Fire Network (SAFNet) Regional Burned-area Product-validation Protocol

The development of appropriate validation techniques is critical to assess uncertainties associated with satellite-data-based products, to identify needed product improvements and to allow products to be used appropriately. At regional to global scales, there are several outstanding issues in the development of robust validation methodologies, including the need to increase the quality and economy of product validation by developing and promoting international validation standards and protocols. This paper describes a protocol developed to validate a regional southern Africa burned-area product derived from Moderate Resolution Imaging Spectroradiometer (MODIS) 500m time series data. The protocol is based upon interpretations by members of the Southern Africa Fire Network (SAFNet) of multitemporal Landsat Enhanced Thematic Mapper plus (ETM + ) data to derive maps of the location and approximate date of burning. The validation data are derived using Landsat ETM+ scenes distributed to encompass representative regional variation in the conditions for which the MODIS burned-area product was generated and to capture the more important factors that influence product performance. The protocol was developed by consensus to ensure inter-comparison of the independent data derived by the different SAFNet members and to allow these data to be scaled up to provide regional validation of the MODIS burned-area product. Biomass burning in southern Africa, the ETM+ sampling rationale, the interpretation and mapping approach, SAFNet member fire activities, and illustrative 2001 results and difficulties encountered with the protocol are described