Susceptibility Status of Malaria Vectors to Insecticides Commonly used for Malaria Control in Tanzania.

The aim of the study was to monitor the insecticide susceptibility status of malaria vectors in 12 sentinel districts of Tanzania. WHO standard methods were used to detect knock-down and mortality in the wild female Anopheles mosquitoes collected in sentinel districts. The WHO diagnostic doses of 0.05% deltamethrin, 0.05% lambdacyhalothrin, 0.75% permethrin and 4% DDT were used. The major malaria vectors in Tanzania, Anopheles gambiae s.l., were susceptible (mortality rate of 98-100%) to permethrin, deltamethrin, lambdacyhalothrin and DDT in most of the surveyed sites. However, some sites recorded marginal susceptibility (mortality rate of 80-97%); Ilala showed resistance to DDT (mortality rate of 65% [95% CI, 54-74]), and Moshi showed resistance to lambdacyhalothrin (mortality rate of 73% [95% CI, 69-76]) and permethrin (mortality rate of 77% [95% CI, 73-80]). The sustained susceptibility of malaria vectors to pyrethroid in Tanzania is encouraging for successful malaria control with Insecticide-treated nets and IRS. However, the emergency of focal points with insecticide resistance is alarming. Continued monitoring is essential to ensure early containment of resistance, particularly in areas that recorded resistance or marginal susceptibility and those with heavy agricultural and public health use of insecticides

Knowledge and perceptions about indoor residual spray for malaria prevention in Mumberes division, Nandi County in Central province of Kenya

Background: Malaria control and intervention tools usage and coverage in community depend on community acceptability and compliance. Indoor residual spray (IRS) and long lasting insecticide treated nets (LLINs) are the preferred and recommended intervention tools. This study assessed the knowledge and perceptions about indoor residual spraying for malaria prevention in Mumberes division, Nandi County in Central Kenya. This cross-sectional study was carried out to determine KAP on malaria using IRS as a control tool for malaria transmission of the communities in Mumberes division of Koibatek district.Methods: Household heads were interviewed on the socio-demographic characteristics, knowledge about IRS, role played by IRS in control of malaria, role of household heads in IRS programme and frequency of spraying. The study used scheduled questionnaires to obtain the information from household members.Results: A total of 348 household members were involved in the study. This study indicated that age, marital status, occupation and income levels were the significant (P<0.05) determinants of utilization of IRS among the rural communities in Mumberes division.Conclusion: This study has demonstrated that, malaria control through the use of IRS in the rural community can be conducted with full participation of the local community members.

Daily temperature profiles in and around Western Kenyan larval habitats of Anopheles gambiae as related to egg mortality

BACKGROUND: Anopheles gambiae eggs are more frequently found on soil around puddle habitats of the larvae, than on the water surface itself in Western Kenya. Thus, eggs can experience temperatures more wide-ranging and lethal than those experienced by larvae or pupae confined within puddles. METHODS: Small batches of eggs from house-collected An. gambiae as well as from the Kisumu laboratory strain were bathed for defined times in water whose temperature was precisely controlled. Daily temperature profiles were recorded by an infrared thermometer on seven different days in and around three types of typical An. gambiae larval habitats at Kisian. RESULTS: For wild eggs, significant mortality occurred upon brief heating between 42 – 44°C. Few eggs hatched after 10 min at 45°C and none hatched above this temperature. A similar pattern occurred for eggs of the Kisumu strain, except it was shifted downwards by 1°C. Egg mortality was time-dependent above 40°C. Temperatures of water in the three types of larval habitats never exceeded 35°C. Wet or damp mud rarely and only briefly exceeded 40°C; thus, water and mud would be highly conducive to egg survival and development. However, dry soils frequently reached 40 – 50°C for several h. Eggs stranded on dry surfaces would experience substantial mortality on hot, sunny days. CONCLUSION: Moist mud around puddles constitutes suitable habitat for An. gambiae eggs; however, eggs on the surface of dry soil under direct sunlight are unlikely to survive for more than a few hours

Malaria “hotspots” within a larger hotspot; what’s the role of behavioural factors in fine scale heterogeneity in western Kenya?

Background: Malaria remains a major public health problem in Kenya accounting for the highest morbidity and mortality especially among children. Previous reports indicate that infectious agents display heterogeneity in both space and time and malaria is no exception. Heterogeneity has been shown to reduce the effectiveness of interventions. Previous studies have implicated genetic (both human and parasite) and environmental factors as mainly responsible for variation in malaria risk. Human behaviour and its potential risk for contributing to variation in malaria risk has not been extensively explored.Objective: To determine if there were behavioural differences between the people living in hotspots (high malaria burden) and cold spots (low malaria burden) within a geographically homogeneous and high malaria transmission region.Design: A prospective closed cohort study.Setting: The study was conducted in the Health and Demographic Surveillance Site in Bungoma East sub-County.Subjects: A total of 400 people in randomly selected households in both the fever hotspots and cold spots were tested for malaria at quarterly intervals using malaria rapid diagnostic tests (RDTs).Results: Significant heterogeneity in malaria incidence and prevalence was observed between villages. Incidence of malaria was significantly higher in the hotspots (high malaria burden areas) compared to the cold spots (low malaria burden) (49 episodes per 1000 person months compared to 26/1000, t test p < 0.001). The incidence also varied significantly among the individual villages by season (P: 0.0071). Knowledge on malaria therapy was significantly  associated with whether one was in the cold spot or hotspot (P: 0.033). Behavioural practices relating to ITN use were significantly associated with region during particular seasons (P: 0.0001 and P: 0.0001 respectively).Conclusion: There is marked and significant variation in the incidence of malaria among the villages creating actual hotspots of malaria within the larger hotspot. There is a significant difference in malaria infections between the hotspots and cold spots. Knowledge on malaria therapy and behavioural factors such as ITN use may contribute to the observed differences during some seasons

Malaria “hotspots” within a larger hotspot; what’s the role of behavioural factors in fine scale heterogeneity in western Kenya?

Background: Malaria remains a major public health problem in Kenya accounting for the highest morbidity and mortality especially among children. Previous reports indicate that infectious agents display heterogeneity in both space and time and malaria is no exception. Heterogeneity has been shown to reduce the effectiveness of interventions. Previous studies have implicated genetic (both human and parasite) and environmental factors as mainly responsible for variation in malaria risk. Human behaviour and its potential risk for contributing to variation in malaria risk has not been extensively explored.Objective: To determine if there were behavioural differences between the people living in hotspots (high malaria burden) and coldspots (low malaria burden) within a geographically homogeneous and high malaria transmission region.Design: A prospective closed cohort study.Setting: The study was conducted in the Health and Demographic Surveillance Site in Bungoma East sub-County.Subjects: A total of 400 people in randomly selected households in both the fever hotspots and cold spots were tested for malaria at quarterly intervals using malaria rapid diagnostic tests (RDTs).Results: Significant heterogeneity in malaria incidence and prevalence was observed between villages. Incidence of malaria was significantly higher in the hotspots (high malaria burden areas) compared to the coldspots (low malaria burden) (49 episodes per 1000 person months compared to 26/1000, ttest p < 0.001). The incidence also varied significantly among the individual villages by season (P: 0.0071). Knowledge on malaria therapy was significantly associated with whether one was in the cold spot or hotspot (P: 0.033). Behavioural practices relating to ITN use were significantly associated with region during particular seasons (P: 0.0001 and P: 0.0001 respectively).Conclusion: There is marked and significant variation in the incidence of malaria among the villages creating actual hotspots of malaria within the larger hotspot. There is a significant difference in malaria infections between the hotspots and cold spots. Knowledge on malaria therapy and behavioural factors such as ITN use may contribute to the observed differences during some seasons

Prevalence, heterogeneity of asymptomatic malaria infections and associated factors in a high transmission region

Background: Although current reports have shown a reduction in malaria cases, the disease still remains a major public health problem in Kenya. In most endemic regions, the majority of infections are asymptomatic which means those infected may not even know and yet they remain infectious to the mosquitoes. Asymptomatic infections are a major threat to malaria control programs since they act as silent reservoirs for the malaria parasites.Objective: The study sought to determine the prevalence of asymptomatic malaria infections, whether they show heterogeneity spatially, across age groups and across time as well as their determinants in a high transmission region.Study Design: This was part of a larger prospective cohort study on malaria indices in the HDSS.Study Setting: The study was conducted in the Webuye Health and Demographic Surveillance Site in Bungoma East Sub-County.Study Subjects: Quarterly parasitological surveys were conducted for a cohort of 400 participants from randomly selected households located in known fever “hotspots” and “coldspots”. Follow-up of all the participants continued for a period of one year. Generalized estimating equations were used to model risk factors associated with asymptomatic parasitemia.Results: Of the total 321 malaria infections detected during the five cross-sectional surveys conducted over the period of one year, almost half (46.3%) of these were asymptomatic. Overall, most of the asymptomatic cases (67%) were in households within known fever “hotspots”. The proportion of infections that were asymptomatic in the coldspots were 73.1%, 31.8%, 13.3%, 55.6% and 48.2% during the first, second, third, fourth and fifth visits respectively. In the known fever “hotspots”, the proportion of infections without symptoms was 47.7%, 48.5%, 35%, 41.3% and 47.5% during the first, second, third, fourth and fifth visits respectively. Factors associated with asymptomatic malaria include; the village one lives: people living in village M were twice likely to be asymptomatic (A.O.R: 2.141, C.I: 0.03 - 1.488), age: children aged between 6 to 15 years were more than twice likely to be asymptomatic (A.O.R: 2.67, C.I. 0.434 - 1.533) and the season: infections during the dry season (January) were less likely to be asymptomatic (A.O.R: 0.26, C.I: -2.289 - 0.400).Conclusion: The prevalence of asymptomatic infections in this region is still very high. The highest proportion of asymptomatic infections was registered in a fever coldpspot village which may explain why the village is a fever coldspot in the first place. There is a need for active surveillance to detect the asymptomatic cases as well as treat them in-order to reduce the reservoir. Targeting interventions to the asymptomatic individuals will further reduce the transmission within this region

Time-to-infection by Plasmodium falciparum is largely determined by random factors

BACKGROUND: The identification of protective immune responses to P. falciparum infection is an important goal for the development of a vaccine for malaria. This requires the identification of susceptible and resistant individuals, so that their immune responses may be studied. Time-to-infection studies are one method for identifying putative susceptible individuals (infected early) versus resistant individuals (infected late). However, the timing of infection is dependent on random factors, such as whether the subject was bitten by an infected mosquito, as well as individual factors, such as their level of immunity. It is important to understand how much of the observed variation in infection is simply due to chance. METHODS: We analyse previously published data from a treatment-time-to-infection study of 201 individuals aged 0.5 to 78 years living in Western Kenya. We use a mathematical modelling approach to investigate the role of immunity versus random factors in determining time-to-infection in this cohort. We extend this analysis using a modelling approach to understand what factors might increase or decrease the utility of these studies for identifying susceptible and resistant individuals. RESULTS: We find that, under most circumstances, the observed distribution of time-to-infection is consistent with this simply being a random process. We find that age, method for detection of infection (PCR versus microscopy), and underlying force of infection are all factors in determining whether time-to-infection is a useful correlate of immunity. CONCLUSIONS: Many epidemiological studies of P. falciparum infection assume that the observed variation in infection outcomes, such as time-to-infection or presence or absence of infection, is determined by host resistance or susceptibility. However, under most circumstances, this distribution appears largely due to the random timing of infection, particularly in children. More direct measurements, such as parasite growth rate, may be more useful than time-to-infection in segregating patients based on their level of immunity

HIV prevalence and associated risk factors among individuals aged 13-34 years in Rural Western Kenya.

OBJECTIVES: To estimate HIV prevalence and characterize risk factors among young adults in Asembo, rural western Kenya. DESIGN: Community-based cross-sectional survey. METHODS: From a demographic surveillance system, we selected a random sample of residents aged 13-34 years, who were contacted at home and invited to a nearby mobile study site. Consent procedures for non-emancipated minors required assent and parental consent. From October 2003 - April 2004, consenting participants were interviewed on risk behavior and tested for HIV and HSV-2. HIV voluntary counseling and testing was offered. RESULTS: Of 2606 eligible residents, 1822 (70%) enrolled. Primary reasons for refusal included not wanting blood taken, not wanting to learn HIV status, and partner/parental objection. Females comprised 53% of 1762 participants providing blood. Adjusted HIV prevalence was 15.4% overall: 20.5% among females and 10.2% among males. HIV prevalence was highest in women aged 25-29 years (36.5%) and men aged 30-34 years (41.1%). HSV-2 prevalence was 40.0% overall: 53% among females, 25.8% among males. In multivariate models stratified by gender and marital status, HIV infection was strongly associated with age, higher number of sex partners, widowhood, and HSV-2 seropositivity. CONCLUSIONS: Asembo has extremely high HIV and HSV-2 prevalence, and probable high incidence, among young adults. Further research on circumstances around HIV acquisition in young women and novel prevention strategies (vaccines, microbicides, pre-exposure prophylaxis, HSV-2 prevention, etc.) are urgently needed

Laboratory tests of oviposition by the African malaria mosquito, Anopheles gambiae, on dark soil as influenced by presence or absence of vegetation

BACKGROUND: Physical objects like vegetation can influence oviposition by mosquitoes on soil or water substrates. Anopheles gambiae s. l. is generally thought to utilize puddles over bare soil as its prime larval habitat and to avoid standing water populated with vegetation. In Kisian, Kenya near Kisumu, water often pools in grassy drainage areas both during and after periods of infrequent rains, when typical puddle habitats become scarce because of drying. This raised the question of whether An. gambiae has the behavioural flexibility to switch ovipositional sites when puddles over bare soil are unavailable. METHODS: To test whether presence and height of grasses influenced oviposition, wild-caught gravid An. gambiae s. l. were offered paired choices between wet, bare soil and wet soil populated with mixed grasses or grasses of differing height. No-choice tests were also conducted by giving females either grassy soil or bare soil. RESULTS: In choice tests, females laid four times more eggs on bare, wet soil than soil populated with grasses. However in no-choice tests, egg output was not significantly different whether grasses were present or not. Females laid significantly more eggs on soil populated with short grass than with medium, or tall grass. CONCLUSION: This work shows An. gambiae s. l. has the capacity to oviposit into grassy aquatic habitats when typical puddles over bare soil are unavailable. This knowledge will need to be considered in the design and implementation of programmes aimed at reducing malaria transmission by suppression of An. gambiae s. l. immatures

Differential Gene Expression Analysis and Clinical Correlations within Endemic Burkitt Lymphoma

Endemic Burkitt lymphoma (eBL) is the most common pediatric cancer in equatorial Africa and is associated with malaria and Epstein-Barr virus co-infections. Molecular alterations within the eBL tumor genome and transcriptome have not been adequately investigated or compared to sporadic Burkitt lymphoma (sBL). Given that eBL has distinct clinical presentations in the jaw as opposed to the abdomen which are associated with survival, we hypothesize that transcriptome sequencing (RNA-seq) and potentially underlying genetic alterations will enhance our understanding of pathogenesis. Our results compare genome-wide RNA transcript abundances between eBL tumors from children (ages 6-7 yrs) with Stage I (Jaw tumor, n=14) and Stage II (abdominal, n=24) disease from Western Kenya to previously published work analyzing sBL which present in older children residing in developed countries and that tend not to be associated with EBV. Our initial analysis confirms mutational changes with likely functional alterations in the genes ID3 and TCF3, the key regulators of oncogenic pathways implicated in BL. However, the specific mutations observed in sBL are at lower frequency within eBL cases. This work represents the first comprehensive gene expression profile analysis of different eBL tumors. Hierarchical clustering, gene ontology and pathway analysis will provide insight into pathogenesis and new targets for chemotherapy