Further studies on the phlebotomine sandflies of the kala-azar endemic lowlands of Humera-Metema (north-west Ethiopia) with observations on their natural blood meal sources

<p>Abstract</p> <p>Background</p> <p>Visceral leishmaniasis (VL) has been known to exist in northwest Ethiopia (Humera-Metema lowlands) since the early 1970s associated with large scale agricultural development activities, often resulting in outbreaks. The latest outbreak of the disease that has started around 1995 in both regions, has led to the present preliminary entomological surveys (1996-2005) the results of which are reported here. Sandflies were collected using CDC light traps and <it>Phlebotomus </it>females were dissected for <it>Leishmania </it>detection and isolation; freshly fed <it>Phlebotomus </it>females collected were subsequently tested for their blood meal sources using ELISA. All <it>Phlebotomus </it>collections were identified to species.</p> <p>Results</p> <p>During the surveys (1996-2005), a total of 1963 sandflies of six <it>Phlebotomus </it>species (<it>P. orientalis</it>, <it>P. papatasi</it>, <it>P. bergeroti, P. duboscqi</it>, <it>P. rodhaini </it>and <it>P. alexandri</it>) were recorded from the study areas: the predominant species was <it>P. orientalis </it>in both localities. None of the total 618 <it>P. orientalis </it>females dissected (506 from Metema and 112 from Humera), nor the total 114 females of four other species dissected (<it>P. papatasi</it>, <it>P. duboscqi</it>, <it>P. bergeroti </it>and <it>P. rodhaini</it>) was infected with <it>Leishmania </it>promastigotes. ELISA-based blood meal analysis of 273 fresh fed <it>P. orientalis </it>females collected from Metema revealed a remarkably high bovine blood feeds (92%) with only 2.2% of human blood feeds.</p> <p>Conclusion</p> <p>Based on abundance and other circumstantial evidences (its proven role in Sudan), <it>P. orientalis </it>is the most likely vector of VL in northwest Ethiopia, pending further clarifications. The zoophagic feeding behaviour of <it>P. orientalis </it>detected in the present study could have epidemiological significance, but more investigations are required in this and other behavioural characteristics towards appropriate management of the vector.</p

A zoonotic focus of cutaneous leishmaniasis in Addis Ababa, Ethiopia

<p>Abstract</p> <p>Background</p> <p>Cutaneous leishmaniasis (CL) is endemic in the highlands of Ethiopia, and almost always caused by <it>Leishmania aethiopica</it>. Hitherto, Addis Ababa (the capital city of Ethiopia) was not considered endemic for CL, mainly due to absence of epidemiological and field ecological studies. This report summarizes the preliminary epidemiological investigation that proved the existence of active transmission in southeastern Addis Ababa.</p> <p>Results</p> <p>Active case finding surveys were conducted in 3 localities, Saris, Kality, and Akaki, which are found in and around Bulbula-Akaki river gorges. During the surveys conducted in January 2005 - May 2006, a total of 35 cases with 9 active and 26 healed skin lesions were identified. Eighteen of the cases (51.4%) were found in Saris; while 10 (28.6%) and 7 (20%) cases were from Kality and Akaki respectively.</p> <p>Ten colonies of rock hyraxes (<it>Heterohyrax brucei</it>) were identified in the vicinities of the 3 localities. Three of the 48 hyraxes (6.3%) trapped from the surroundings harbored natural infections of <it>Leishmania aethiopica</it>. Confirmation of the <it>Leishmania </it>species of the 3 isolates was achieved by PCR amplification and RFLP analysis of the ribosomal DNA internal transcribed spacer (ITS) sequences. Based on sandfly species composition and proximity of resting sites to human settlements, <it>Phlebotomus longipes </it>is circumstantially proven to be the vector of CL in south east Addis Ababa.</p> <p>Conclusion</p> <p>The study proves the existence of isolated zoonotic foci of CL in south eastern Addis Ababa, with <it>P. longipes </it>as the likely vector and <it>H. brucei </it>as the natural reservoir host.</p

Why do people not attend for treatment for trachomatous trichiasis in Ethiopia? A study of barriers to surgery.

BACKGROUND: Trachomatous trichiasis (TT) surgery is provided free or subsidised in most trachoma endemic settings. However, only 18-66% of TT patients attend for surgery. This study analyses barriers to attendance among TT patients in Ethiopia, the country with the highest prevalence of TT in the world. METHODOLOGY/PRINCIPAL FINDINGS: Participants with previously un-operated TT were recruited at 17 surgical outreach campaigns in Amhara Region, Ethiopia. An interview was conducted to ascertain why they had not attended for surgery previously. A trachoma eye examination was performed by an ophthalmologist. 2591 consecutive individuals were interviewed. The most frequently cited barriers to previous attendance for surgery were lack of time (45.3%), financial constraints (42.9%) and lack of an escort (35.5% in females, 19.6% in males). Women were more likely to report a fear of surgery (7.7% vs 3.2%, p<0.001) or be unaware of how to access services (4.5% vs 1.0% p<0.001); men were more frequently asymptomatic (19.6% vs 10.1%, p<0.001). Women were also less likely to have been previously offered TT surgery than men (OR = 0.70, 95%CI 0.53-0.94). CONCLUSIONS/SIGNIFICANCE: The major barriers to accessing surgery from the patients' perspective are the direct and indirect costs of surgery. These can to a large extent be reduced or overcome through the provision of free or low cost surgery at the community level. TRIAL REGISTRATION: ClinicalTrials.gov NCT00522860 and NCT00522912

A socio-ecological analysis of barriers to sustained adoption of rural sanitation in Ethiopia, a qualitative study

The objective of the study was to explore barriers influencing the sustained adoption and use of sanitation facilities. A qualitative study was conducted in rural Ethiopia using in-depth interview and focus group discussion techniques. A social-ecological model and IBM-WASH framework were employed for the designing and analysis. Barriers for sustained adoption and use of sanitation facilities were categorized into1)individual level (past latrine experience, lack of demand to improved latrine), 2) household level factors (unaffordability, lack of space and, absence of physically strong family member), 3) community level factors (lack of access to public latrine, lack of shared rules against open defecation, lack of financial access for the poor) and, 4) societal level factors (lack of strong local leadership, flooding, soil condition, lack of appropriate sanitation technology, lack of promotion and demand creation on improved latrine). Hence, there is a need to consider multi-level intervention to address the identified barriers

Intestinal parasitic infections in Western Abaya with special reference to Schistosomiasis mansoni

Abstract: A cross sectional investigation on the distribution and prevalence of intestinal parasitic infections was undertaken in Western Abaya, North Omo, in January 1995. As the area is potentially irrigable for modern agriculture, emphasis was placed to explore on the endemicity of schistosomiasis, including malacological assessments. Five percent of the whole population on 1473 people, in 16 villages of the area, were parasitologically examined for intestinal parasites. Among the intestinal parasitic infections, hookworm was demonstrated in all of the villages with prevalences ranging from 4.1% (Algie) to 75% (Wajifo). The majority of the villages (10/16=62.5%) had hookworm prevalences of over 50%. Schistosoma mansoni infections were found in 11 villages with prevalences of up to 53% with more males than females being affected (P&lt;0.001). Infected Biomphalaria sudanica snails with infection rates of up to 2.1% at two sites of Lake Abaya were also found. The importance of the dominant, S. mansoni and hookworm infections in the potentially irrigable area of Western Abaya and feasible measures of their control are discussed. [Ethiop. J. Health Dev. 1999;13(1):21-26

Breeding Sites of Aedes aegypti

Background and Objectives. Entomological survey was carried out from May-June to September-October 2014 to investigate the presence of dengue vectors in discarded tires and artificial water containers in houses and peridomestic areas. Methods. A cross-sectional immature stage survey was done indoors and outdoors in 301 houses. Mosquito larval sampling was conducted using pipette or dipper depending on container types. Larvae were identified morphologically and larval indices were also calculated. Results. A total of 750 containers were inspected, and of these 405 were positive for mosquito larvae. A total of 1,873 larvae were collected and morphologically identified as Aedes aegypti (n=1580: 84.4%) and Culex (n=293: 15.6%). The larval indices, house index, container index, and breteau index, varied from 33.3 to 86.2, from 23.2 to 73.9, and from 56.5 to 188.9, respectively. Conclusion. Aedes aegypti is breeding in a wide range of artificial containers. To control these mosquitoes, the integration of different methods should be taken into consideration

Human-biting activities of Anopheles species in south-central Ethiopia.

BACKGROUND: Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are the key malaria vector control interventions in Ethiopia. The success of these interventions rely on their efficacy to repel or kill indoor feeding and resting mosquitoes. This study was undertaken to monitor human-biting patterns of Anopheles species in south-central Ethiopia. METHODS: Human-biting patterns of anophelines were monitored for 40 nights in three houses using human landing catches (HLC) both indoors and outdoors between July and November 2014, in Edo Kontola village, south-central Ethiopia. This time coincides with the major malaria transmission season in Ethiopia, which is usually between September and November. Adult mosquitoes were collected from 19:00 to 06:00 h and identified to species. Comparisons of HLC data were done using incidence rate ratio (IRR) calculated by negative binomial regression. The nocturnal biting activities of each Anopheles species was expressed as mean number of mosquitoes landing per person per hour. To assess malaria infections in Anopheles mosquitoes the presence of Plasmodium falciparum and P. vivax circumsporozoite proteins (CSP) were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: Altogether 3,408 adult female anophelines were collected, 2,610 (76.6 %) outdoors and 798 (23.4 %) indoors. Anopheles zeimanni was the predominant species (66.5 %) followed by An. arabiensis (24.8 %), An. pharoensis (6.8 %) and An. funestus (s.l.) (1.8 %). The overall mean anopheline density was 3.3 times higher outdoors than indoors (65.3 vs 19.9/person/night, IRR: 3.3, 95 % CI: 1.1-5.1, P = 0.001). The mean density of An. zeimanni, An. pharoensis and An. funestus (s.l.) collected outdoors was significantly higher than indoors for each species (P < 0.05). However, the mean An. arabiensis density outdoors was similar to that indoors (11.8 vs 9.4/person/night, IRR: 1.3, 95 % CI: 0.8-1.9, P = 0.335). The mean hourly human-biting density of An. arabiensis was greater outdoors than indoors and peaked between 21:00 and 22:00 h. However, An. arabiensis parous population showed high indoor man biting activities during bedtimes (22:00 to 05:00 h) when the local people were indoor and potentially protected by IRS and LLINs. All mosquito samples tested for CSP antigen were found negative to malaria parasites. CONCLUSIONS: Results show much greater mosquito human-biting activities occurring outdoors than indoors and during early parts of the night, implying higher outdoor malaria transmission potential in the area. However, high bedtime (22:00 to 05:00 h) indoor biting activities of parous An. arabiensis suggest high potential intervention impact of IRS and LLINs on indoor malaria transmission

Comparison of two adult mosquito sampling methods with human landing catches in south-central Ethiopia.

BACKGROUND: The human landing catch (HLC) is the standard reference method for measuring human exposure to mosquito bites. However, HLC is labour-intensive, exposes collectors to infectious mosquito bites and is subjected to collector bias. These necessitate local calibration and application of alternative methods. This study was undertaken to determine the relative sampling efficiency (RSE) of light traps with or without yeast-produced carbon dioxide bait vs. HLC in south-central Ethiopia. METHODS: The experiment was conducted for 39 nights in a 3 × 3 Latin square randomized design with Anopheles arabiensis as the target species in the period between July and November 2014 in Edo Kontola village, south-central Ethiopia. Center for Disease Control and Prevention light trap catches (LTC) and yeast-generated carbon dioxide-baited light trap catches (CB-LTC) were each evaluated against HLC. The total nightly mosquito catches for each Anopheles species in either method was compared with HLC by Pearson correlation and simple linear regression analysis on log-transformed [log10(x + 1)] values. To test if the RSE of each alternative method was affected by mosquito density, the ratio of the number of mosquitoes in each method to the number of mosquitoes in HLC was plotted against the average mosquito abundance. RESULTS: Overall, 7606 Anopheles females were collected by the three sampling methods. Among these 5228 (68.7%) were Anopheles ziemanni, 1153 (15.2%) An. arabiensis, 883 (11.6%) Anopheles funestus s.l., and 342 (4.5%) Anopheles pharoensis. HLC yielded 3392 (44.6%), CB-LTC 2150 (28.3%), and LTC 2064 (27.1%) Anopheles females. The RSEs of LTC and HLC for An. arabiensis were significantly correlated (p < 0.001) and density independent (p = 0.65). However, for outdoor collection of the same species, RSEs of LTC and CB-LTC were density dependent (p < 0.001). It was estimated that on average, indoor LTC and CB-LTC each caught 0.35 and 0.44 times that of indoor HLC for An. arabiensis respectively. CONCLUSIONS: Results showed that HLC was the most efficient method for sampling An. arabiensis. LTC can be used for large-scale indoor An. arabiensis surveillance and monitoring when it is difficult to use HLC. CB-LTC does not substantially improve sampling of this major vector compared to LTC in this setting. Trial registration PACTR201411000882128 (retrospectively registered 8 September, 2014)

Insecticide resistance in Anopheles arabiensis (Diptera: Culicidae) from villages in central, northern and south west Ethiopia and detection of kdr mutation

<p>Abstract</p> <p>Background</p> <p><it>Anopheles arabiensis </it>is the major vector of malaria in Ethiopia. Malaria vector control in Ethiopia is based on selective indoor residual spraying using DDT, distribution of long lasting insecticide treated nets and environmental management of larval breeding habitats. DDT and pyrethroid insecticides are neurotoxins and have a similar mode of action on the sodium ion channel of insects. It was therefore necessary to verify the insecticide susceptibility status of <it>An. arabiensis</it>, to better understand the status of cross-resistance between DDT and the pyrethroids in this species as well as to detect a resistant gene.</p> <p>Methods</p> <p>Standard WHO insecticide susceptibility tests were conducted on adults reared from larval and pupal collections from breeding sites at three villages namely: Sodere in the Rift Valley, Gorgora in the north and Ghibe River Valley in the south west of Ethiopia. The occurrence of cross-resistance between pyrethroids and DDT was determined using a DDT selected laboratory colony originally collected from Gorgora. Phenotypically characterized mosquitoes were tested for the presence of knockdown resistance (<it>kdr</it>) alleles using the standard polymerase chain reaction assay.</p> <p>Results</p> <p>All <it>An. gambiae </it>s.l. specimens assayed by PCR were identified as <it>An. arabiensis</it>. The knockdown and mortality results showed <it>An. arabiensis </it>resistance to DDT in all villages, resistance to deltamethrin and permethrin in the Ghibe River Valley and permethrin resistance in Gorgora. Bioassay susceptibility tests also indicated the presence of cross-resistance between DDT and permethrin, but not between DDT and deltamethrin. The knockdown resistance <it>(kdr) </it>mutation of leucine to phenylalanine in the sodium ion channel gene was detected in populations from Gorgora and the Ghibe River Valley.</p> <p>Conclusion</p> <p>Since <it>An. arabiensis </it>shows high levels of resistance to DDT in all villages tested and varying pyrethroid resistance in Gorgora and the Ghibe River valley, precautionary measures should be taken in future vector control operations. Moreover, the status of resistance in other locations in Ethiopia and the spread of resistant gene (s) should be investigated.</p