Genetic Diversity of Anopheles coustani (Diptera: Culicidae) in Malaria Transmission Foci in Southern and Central Africa

AbstractDespite ongoing malaria control efforts implemented throughout sub-Saharan Africa, malaria remains an enormous public health concern. Current interventions such as indoor residual spraying with insecticides and use of insecticide-treated bed nets are aimed at targeting the key malaria vectors that are primarily endophagic and endophilic. While these control measures have resulted in a substantial decline in malaria cases and continue to impact indoor transmission, the importance of alternative vectors for malaria transmission has been largely neglected. Anopheles coustani, an understudied vector of malaria, is a species previously thought to exhibit mostly zoophilic behavior. However, recent studies from across Africa bring to light the contribution of this and ecologically similar anopheline species to human malaria transmission. Like many of these understudied species, An. coustani has greater anthropophilic tendencies than previously appreciated, is often both endophagic and exophagic, and carries Plasmodium falciparum sporozoites. These recent developments highlight the need for more studies throughout the geographic range of this species and the potential need to control this vector. The aim of this study was to explore the genetic variation of An. coustani mosquitoes and the potential of this Anopheles species to contribute to malaria parasite transmission in high transmission settings in Nchelenge District, Zambia, and the Kashobwe and Kilwa Health Zones in Haut-Katanga Province, the Democratic Republic of the Congo (DRC). Morphologically identified An. coustani specimens that were trapped outdoors in these study sites were analyzed by PCR and sequencing for species identification and blood meal sources, and malaria parasite infection was determined by ELISA and qPCR. Fifty specimens were confirmed to be An. coustani by the analysis of mitochondrial DNA cytochrome c oxidase subunit I (COI) and ribosomal internal transcribed spacer region 2 (ITS2). Further, maximum likelihood phylogenetic analysis of COI and ITS2 sequences revealed two distinct phylogenetic groups within this relatively small regional collection. Our findings indicate that both An. coustani groups have anthropophilic and exophagic habits and come into frequent contact with P. falciparum, suggesting that this potential alternative malaria vector might elude current vector controls in Northern Zambia and Southern DRC. This study sets the groundwork for more thorough investigations of bionomic characteristics and genetic diversity of An. coustani and its contribution to malaria transmission in these regions.

Download Full-text

Transcriptomic analysis of resistance and short-term induction response to pyrethroids, in Anopheles coluzzii legs

10.21203/rs.3.rs-904452/v1 ◽

2021 ◽

Author(s):

Mary Kefi ◽

Jason Charamis ◽

Vasileia Balabanidou ◽

Panagiotis Ioannidis ◽

Hilary Ranson ◽

...

Keyword(s):

Salivary Gland ◽

Resistant Strain ◽

Indoor Residual Spraying ◽

Control Measures ◽

Sub Saharan Africa ◽

Detoxification Enzymes ◽

Bed Nets ◽

Anopheles Coluzzii ◽

Short Term ◽

Susceptible Population

Abstract BackgroundInsecticide-treated bed nets and indoor residual spraying comprise the major control measures against Anopheles gambiae sl, the dominant vector in sub-Saharan Africa. The primary site of contact with insecticide is through the mosquitoes’ legs, which represents the first barrier insecticides have to bypass to reach their neuronal targets. Proteomic changes and leg cuticle modifications have been associated with insecticide resistance that may reduce the rate of penetration of insecticides. Here, we performed a multiple transcriptomic analyses focusing on An. coluzzii legs. ResultsFirstly, leg-specific enrichment analysis identified 359 genes including the pyrethroid-binder SAP2 and 2 other chemosensory proteins, along with 4 ABCG transporters previously shown to be leg enriched. Enrichment gene families included those involved in detecting chemical stimuli including gustatory and ionotropic receptors and genes implicated in hydrocarbon-synthesis. Subsequently, we compared transcript expression in the legs of a highly resistant strain (VK7-HR) to both a strain with very similar genetic background which has reverted to susceptibility after several generations without insecticide pressure (VK7-LR) and a lab susceptible population. 232 differentially expressed genes (73 up-regulated and 159 down-regulated) were identified in the resistant strain when compared to the two susceptible counterparts, indicating an over-expression of phase I detoxification enzymes and cuticular proteins, with decrease in hormone-related metabolic processes in legs from the insecticide resistant population. Finally, we analysed the short-term effect of pyrethroid exposure on An. coluzzii legs, comparing 1hour-deltamethrin-exposed (VK7-IN) to unexposed (VK7-HR) leg transcriptomes and identified 348 up-regulated genes including those encoding for GPCRs, ABC transporters, odorant-binding proteins and members of the divergent salivary gland protein family. ConclusionsThe data on An. coluzzii leg-specific transcriptome provides valuable insights into the first line of defense in pyrethroid resistant and short-term deltamethrin-exposed mosquitoes. Our results suggest that xenobiotic detoxification is likely occurring in legs, while the enrichment of sensory proteins, ABCG transporters and cuticular genes is also evident. Constitutive resistance is primarily associated with elevated levels of detoxification and cuticular genes, while short-term insecticide-induced tolerance is linked with overexpression of transporters, GPCRs and GPCR-related genes, sensory/binding and salivary gland proteins.

Download Full-text

Mosquitoes and Malaria Control – A Complex Problem for Entomologists to Unravel

Outlooks on Pest Management ◽

10.1564/v30_oct_07 ◽

2019 ◽

Vol 30 (5) ◽

pp. 213-216

Author(s):

Basil Brooke

Keyword(s):

Vector Control ◽

Malaria Vector ◽

Malaria Control ◽

Life Stage ◽

Indoor Residual Spraying ◽

Transmission Intensity ◽

Sub Saharan Africa ◽

Malaria Vectors ◽

Bed Nets ◽

Vector Species

The control of malaria transmitting mosquitoes hinges on accurate species identification. This enables assessments of insecticide susceptibilities and important behavioural characteristics (such as feeding and resting behaviours) by species, leading to the design of coherent insecticide-based control strategies that can be enhanced by additional methodologies for malaria elimination. Malaria is a mosquito-borne parasitic disease that affects many vertebrates including humans. Prior to the 20th century the human malarias (Plasmodium falciparum, P. vivax, P. malariae, P. ovale and P. knowlesi) occurred in tropical and temperate regions but their distribution has since reduced to the tropical belt with by far the highest incidence in sub-Saharan Africa. Global incidence for 2017 was estimated by the WHO at 219 million cases corresponding to 435 000 deaths. It is also estimated that investment in malaria control and elimination amounted to $3.1 billion in 2017. The control (and elimination) of malaria largely hinges on the suppression of mosquito vectors, accurate diagnosis and case detection, and case management using appropriate antimalarial drug regimens. Controlling malaria vector mosquitoes (and of course other mosquito-borne diseases) means being able to identify that which needs to be controlled. This is not unlike the maxim of knowing one's enemy, and disease vector control is often phrased in militaristic terms. The arsenal of tools in the war against malaria vectors includes insecticides, bed nets, repellents, larvicides, endectocides, toxic baits and even modified genes. This call to arms against the transmitters of a deadly disease presupposes that the enemy can be identified, which, unfortunately, is not as easy as it sounds. Identifying malaria vectors to species has posed a significant challenge ever since Ronald Ross and Giovanni Grassi implicated dappled-winged Anopheles mosquitoes in malaria transmission. They could not have known the Pandora's Box they had opened, because several Anopheles species are cryptic. Many hide in cryptic species complexes and groups that confound straightforward morphological methods of identifying them. A species complex is a group of morphologically identical species that are very closely related, but nevertheless vary significantly in their feeding and resting behaviours, and mate assortatively (i.e. they recognise and tend only to mate with conspecific partners) enough that hybridisations between them are rare. Many member species of these complexes are sufficiently diverged that cross-mating between them yields infertile or non-viable offspring, but not in all cases. A species group is a looser assortment of related species whose morphological features match to a point where they are very nearly identical, often requiring specimens from more than one life stage to identify them. They also mate assortatively, and hybrids are rarer or simply never occur. The problem for malaria control is that several vector species, including many primary vectors, are members of cryptic complexes or groups. These invariably contain vector and non-vector species, requiring a complex and laborious system to unravel them and ascribe unambiguous genetic methods for their identification. Added to this complexity is the possibility that any Anopheles. species that takes human blood is a potential vector of the human malarias, with the added caveat that not all populations within a species are vectors. Some member species, and even populations within a species, feed either exclusively on humans (anthropophagy) and are potentially high transmission intensity vectors, or exclusively on livestock animals (zoophagy) making them non-vectors, or take blood from a range of sources including humans, becoming potential vectors of low to medium transmission intensity. An added layer of complexity is genetic heterogeneity between populations within a species. It can be argued that this complexity is not necessarily a problem for malaria control. After all, the aim of suppressing or even eliminating vector populations is the interruption of transmission, regardless of what species they are. But mosquito adaptability dictates otherwise. This is because the primary method of malaria vector control is deployment of specially formulated insecticides against adult mosquitoes, either by indoor residual spraying (IRS) or the treatment of bed nets. Mosquito adaptability has enabled a powerful response to these interventions, with resistance to insecticides becoming so widespread that fully insecticide susceptible malaria vector populations are now quite rare.

Download Full-text

Transcriptomic analysis of resistance and short-term induction response to pyrethroids, in Anopheles coluzzii legs

BMC Genomics ◽

10.1186/s12864-021-08205-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

M. Kefi ◽

J. Charamis ◽

V. Balabanidou ◽

P. Ioannidis ◽

H. Ranson ◽

...

Keyword(s):

Salivary Gland ◽

Resistant Strain ◽

Indoor Residual Spraying ◽

Control Measures ◽

Sub Saharan Africa ◽

Detoxification Enzymes ◽

Bed Nets ◽

Anopheles Coluzzii ◽

Short Term ◽

Susceptible Population

Abstract Background Insecticide-treated bed nets and indoor residual spraying comprise the major control measures against Anopheles gambiae sl, the dominant vector in sub-Saharan Africa. The primary site of contact with insecticide is through the mosquitoes’ legs, which represents the first barrier insecticides have to bypass to reach their neuronal targets. Proteomic changes and leg cuticle modifications have been associated with insecticide resistance that may reduce the rate of penetration of insecticides. Here, we performed a multiple transcriptomic analyses focusing on An. coluzzii legs. Results Firstly, leg-specific enrichment analysis identified 359 genes including the pyrethroid-binder SAP2 and 2 other chemosensory proteins, along with 4 ABCG transporters previously shown to be leg enriched. Enrichment of gene families included those involved in detecting chemical stimuli, including gustatory and ionotropic receptors and genes implicated in hydrocarbon-synthesis. Subsequently, we compared transcript expression in the legs of a highly resistant strain (VK7-HR) to both a strain with very similar genetic background which has reverted to susceptibility after several generations without insecticide pressure (VK7-LR) and a lab susceptible population (NG). Two hundred thirty-two differentially expressed genes (73 up-regulated and 159 down-regulated) were identified in the resistant strain when compared to the two susceptible counterparts, indicating an over-expression of phase I detoxification enzymes and cuticular proteins, with decrease in hormone-related metabolic processes in legs from the insecticide resistant population. Finally, we analysed the short-term effect of pyrethroid exposure on An. coluzzii legs, comparing legs of 1 h-deltamethrin-exposed An. coluzzii (VK7-IN) to those of unexposed mosquitoes (VK7-HR) and identified 348 up-regulated genes including those encoding for GPCRs, ABC transporters, odorant-binding proteins and members of the divergent salivary gland protein family. Conclusions The data on An. coluzzii leg-specific transcriptome provides valuable insights into the first line of defense in pyrethroid resistant and short-term deltamethrin-exposed mosquitoes. Our results suggest that xenobiotic detoxification is likely occurring in legs, while the enrichment of sensory proteins, ABCG transporters and cuticular genes is also evident. Constitutive resistance is primarily associated with elevated levels of detoxification and cuticular genes, while short-term insecticide-induced tolerance is linked with overexpression of transporters, GPCRs and GPCR-related genes, sensory/binding and salivary gland proteins.

Download Full-text

Community Knowledge, Perceptions, And Practices Regarding Malaria and Its Control In Jabi Tehnan District, Amhara Region, Northwest Ethiopia

10.21203/rs.3.rs-489446/v1 ◽

2021 ◽

Author(s):

Abebe Asale ◽

Zewdu Abro ◽

Bayu Enchalew ◽

Alayu Tesager ◽

Aklilu Belay ◽

...

Keyword(s):

Vector Control ◽

Malaria Control ◽

Community Education ◽

Indoor Residual Spraying ◽

Community Empowerment ◽

Malaria Episode ◽

Malaria Vectors ◽

Bed Nets ◽

Health Seeking ◽

Malaria Parasites

Abstract Background: Key program components of malaria control in Ethiopia include community empowerment and mobilization, vector control using long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS), prompt diagnosis and treatment, and disease surveillance. However, the effectiveness of these interventions is often undermined by various challenges, including insecticide and drug resistance, the plasticity of malaria vectors feeding and biting behavior, and certain household factors that lead to misuse and poor utilization of LLINs. The primary objective of this study was to document households’ perceptions towards malaria and assess the prevalence of the disease and the constraints related to the ongoing interventions in Ethiopia (LLINs, IRS, community mobilization house screening). Method: The study was conducted in Jabi Tehnan district, Northwestern Ethiopi,a from November 2019 to March 2020. A total of 3,010 households distributed over 38 kebeles (villages) were randomly selected for socio-economic and demographic survey. Focus group discussions (FGDs) were conducted in 11 different health clusters taking into account agro-ecological differences. A total of 1,256 children under 10 years of age were screened for malaria parasites using microscopy in order to determine malaria prevalence. Furthermore, five-year malaria trend analysis was undertaken based on data obtained from the district health office to understand the disease dynamics.Result: Malaria knowledge in the area was high as all FGD participants correctly identified mosquito bites during the night as sources of malaria transmission. Delayed health seeking behavior remains a key behavioral challenge in malaria control as it took patients on average 4 days before reporting the case at the nearby health facility. On average households lost 2.53 working days per person-per malaria episode and theey spent US$ 18 per person perepisode. Out of the 1,256 randomly selected under 10 children tested for malaria parasites, 11 (0.89%) were found to be positive. Malaria disproportionately affected the adult segment of the population more, 50% of the total cases reported from households whose age was 15 and beyond. The second most affected group was the age group between 5 and 14 years followed by children under 10, with 31% and 14% burden,respectively.Conclusion: Despite the achievement of universal coverage in terms of LLINs access, utilization of vector control interventions in the area remained low.Using bed nets for unintended purposes remained a major challenge. Therefore, continued community education and communication work should be prioritised in the study area to bring about the desired behavioral changes.

Download Full-text

Impact of insecticide resistance in Anopheles arabiensis on malaria incidence and prevalence in Sudan and the costs of mitigation

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1713814114 ◽

2017 ◽

Vol 114 (52) ◽

pp. E11267-E11275 ◽

Cited By ~ 12

Author(s):

Hmooda Toto Kafy ◽

Bashir Adam Ismail ◽

Abraham Peter Mnzava ◽

Jonathan Lines ◽

Mogahid Shiekh Eldin Abdin ◽

...

Keyword(s):

Insecticide Resistance ◽

Pyrethroid Resistance ◽

Malaria Incidence ◽

Disease Incidence ◽

Indoor Residual Spraying ◽

Sub Saharan Africa ◽

Malaria Vectors ◽

Incidence And Mortality ◽

Additional Protection ◽

The Impact

Insecticide-based interventions have contributed to ∼78% of the reduction in the malaria burden in sub-Saharan Africa since 2000. Insecticide resistance in malaria vectors could presage a catastrophic rebound in disease incidence and mortality. A major impediment to the implementation of insecticide resistance management strategies is that evidence of the impact of resistance on malaria disease burden is limited. A cluster randomized trial was conducted in Sudan with pyrethroid-resistant and carbamate-susceptible malaria vectors. Clusters were randomly allocated to receive either long-lasting insecticidal nets (LLINs) alone or LLINs in combination with indoor residual spraying (IRS) with a pyrethroid (deltamethrin) insecticide in the first year and a carbamate (bendiocarb) insecticide in the two subsequent years. Malaria incidence was monitored for 3 y through active case detection in cohorts of children aged 1 to <10 y. When deltamethrin was used for IRS, incidence rates in the LLIN + IRS arm and the LLIN-only arm were similar, with the IRS providing no additional protection [incidence rate ratio (IRR) = 1.0 (95% confidence interval [CI]: 0.36–3.0; P = 0.96)]. When bendiocarb was used for IRS, there was some evidence of additional protection [interaction IRR = 0.55 (95% CI: 0.40–0.76; P < 0.001)]. In conclusion, pyrethroid resistance may have had an impact on pyrethroid-based IRS. The study was not designed to assess whether resistance had an impact on LLINs. These data alone should not be used as the basis for any policy change in vector control interventions.

Download Full-text

Current status of Plasmodium knowlesi vectors: a public health concern?

Parasitology ◽

10.1017/s0031182016000901 ◽

2016 ◽

Vol 145 (1) ◽

pp. 32-40 ◽

Cited By ~ 11

Author(s):

I. VYTHILINGAM ◽

M. L. WONG ◽

W. S. WAN-YUSSOF

Keyword(s):

Public Health ◽

Plasmodium Knowlesi ◽

Point Of View ◽

Control Measures ◽

Health Concern ◽

Current Status ◽

Malaria Vectors ◽

Future Studies ◽

Simian Malaria ◽

And Control

SUMMARYPlasmodium knowlesi a simian malaria parasite is currently affecting humans in Southeast Asia. Malaysia has reported the most number of cases and P. knowlesi is the predominant species occurring in humans. The vectors of P. knowlesi belong to the Leucosphyrus group of Anopheles mosquitoes. These are generally described as forest-dwelling mosquitoes. With deforestation and changes in land-use, some species have become predominant in farms and villages. However, knowledge on the distribution of these vectors in the country is sparse. From a public health point of view it is important to know the vectors, so that risk factors towards knowlesi malaria can be identified and control measures instituted where possible. Here, we review what is known about the knowlesi malaria vectors and ascertain the gaps in knowledge, so that future studies could concentrate on this paucity of data in-order to address this zoonotic problem.

Download Full-text

The Economics of Malaria Prevention

Oxford Research Encyclopedia of Economics and Finance ◽

10.1093/acrefore/9780190625979.013.252 ◽

2018 ◽

Author(s):

Bénédicte Apouey ◽

Gabriel Picone ◽

Joshua Wilde

Keyword(s):

Financial Constraints ◽

Intermittent Preventive Treatment ◽

Indoor Residual Spraying ◽

Preventive Treatment ◽

Malaria Prevention ◽

Sub Saharan Africa ◽

Bed Nets ◽

Preventive Behaviors ◽

Mosquito Net ◽

Positive Externalities

Malaria is a potentially life-threatening disease transmitted through the bites of female anopheline mosquitos infected with protozoan parasites. Malaria remains one of the major causes of mortality by infectious disease: in 2015, there were an estimated 212 million cases and 429,000 deaths globally, according to the 2016 World Malaria Report. Children under 5 years in sub-Saharan Africa bear the greatest burden of the disease worldwide. However, most of these cases could be prevented or treated. Several methods are highly effective in preventing malaria: in particular, sleeping under an insecticide-treated mosquito net (ITN), indoor residual spraying (IRS), and taking intermittent preventive treatment for pregnant women (IPTp). Regarding treatment, artesiminin-based combination therapy (ACT) is recommended as first-line treatment in many countries. Compared with other actions, malaria prevention behaviors have some specific features. In particular, they produce public health externalities. For example, bed net usage creates positive externalities since bed nets not only directly protect the user, but also reduce transmission probabilities through reduction in the number of disease hosts, and in the case of ITNs, reduction of the vector itself. In contrast, ACT uptake creates both positive externalities when individuals with malaria are treated, and negative externalities in the case of overtreatment that speeds up the spread of long-run parasite resistance. Moreover, ITNs, IPTp, and ACTs are experience goods (meaning individuals only ascertain their benefits upon usage), which implies that current preventive actions are linked to past preventive behaviors. Malaria prevention and eradication produce unambiguous benefits across various domains: economic conditions, educational outcomes, survival, fertility, and health. However, despite the high private returns to prevention, the adoption of antimalarial products and behaviors remains relatively low in malaria-affected areas. A variety of explanations have been proposed for low adoption rates, including financial constraints, high prices, and absence of information. While recent studies highlight that all of these factors play a role, the main barrier to adoption is probably financial constraints. This finding has implications regarding the appropriate pricing policy for these health products. In addition, there is a shortage of causally identified research on the effect of cultural and psychological barriers to the adoption of preventive behaviors. The literature which does exist is from a few randomized control trials of few individuals in very specific geographic and cultural contexts, and may not be generalizable. As a result, there are still ample opportunities for research on applying the insights of behavioral economics to malaria-preventive behavior in particular. Moreover, little research has been done on the supply side, such as whether free or heavily subsidized distribution of prevention technologies is fiscally sustainable; finding effective methods to solve logistical problems which lead to shortages and ineffective alternative treatments to fill the gap; or training sufficient healthcare workers to ensure smooth and effective delivery. Given these gaps in the literature, there are still multiple fruitful avenues for research which may have a first-order effect on reducing the prevalence of malaria in the developing world.

Download Full-text

Knowledge, Awareness and Practices on Dengue Fever in Rural and Urban Communities

Z H Sikder Women’s Medical College Journal ◽

10.47648/zhswmcj.2021.v0301.03 ◽

2021 ◽

Vol 3 (Number 1) ◽

pp. 10-14

Author(s):

Mohammad Nurunnabi ◽

Ferdous Hasan ◽

Nazia Chowdhury ◽

Farzana Arzu Khan ◽

Fazlur Rahim Kaiser ◽

...

Keyword(s):

Urban Communities ◽

Dengue Fever ◽

Control Measures ◽

Health Concern ◽

Bed Nets ◽

Mosquito Bite ◽

Preventive Practices ◽

Rural And Urban ◽

Window Screen ◽

Breeding Place

In the recent years dengue fever has become global public health concern as there has a dramatic increase of cases of dengue in tropical and subtropical regions around the world, predominantly in urban and rural areas. A community based cross sectional study was conducted among purposively selected 347 participants to ascertain the knowledge, awareness and practices on dengue fever in rural (n=196) and urban (n=151) communities of the Sylhet division, Bangladesh. Mosquito bite as mode of spread (61.22%, 82.12%), Aedes mosquito as the vector (40.83%, 64.52%), day as biting time (40.83%, 64.52%), stagnant water as breeding place (58.16%, 74.83%) and removal of water stagnation as eliminations of breeding place (40.31%, 64.90%) was mainly reported by study participants respectively in rural and urban communities. Fever (53.7%, 68.27%) was identified as a leading symptom of dengue fever. Using of bed nets (61.73%) was a conjoint recognition in rural whereas window screen (40.40%) in urban as effective measures for controlling mosquito bite. Besides preventive measures like use of bed nets (47.96%, 27.81%), window screen (7.14%, 48.34%) and for control measures removal of water stagnation (31.12%, 58.94%) was mostly utilized method in both settings. The awareness on dengue fever found good in both rural and urban communities but knowledge and preventive practices were considerably low which is predominant in rural. It could be improved through increase community participation and educational campaigns.

Download Full-text

Community knowledge, perceptions, and practices regarding malaria and its control in Jabi Tehnan district, Amhara Region, Northwest Ethiopia

Malaria Journal ◽

10.1186/s12936-021-03996-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Abebe Asale ◽

Zewdu Abro ◽

Bayu Enchalew ◽

Alayu Teshager ◽

Aklilu Belay ◽

...

Keyword(s):

Community Education ◽

Indoor Residual Spraying ◽

Northwest Ethiopia ◽

Primary Objective ◽

Malaria Episode ◽

Malaria Vectors ◽

Bed Nets ◽

Health Seeking ◽

District Health ◽

Malaria Parasites

Abstract Background Use of long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS), community-based malaria education, prompt diagnosis and treatment are key programme components of malaria prevention and control in Ethiopia. However, the effectiveness of these interventions is often undermined by various challenges, including insecticide and drug resistance, the plasticity of malaria vectors feeding and biting behaviour, and certain household factors that lead to misuse and poor utilization of LLINs. The primary objective of this study was to document households’ perceptions towards malaria and assess the prevalence of the disease and the constraints related to the ongoing interventions in Ethiopia (LLINs, IRS, community mobilization house screening). Methods The study was conducted in Jabi Tehnan district, Northwestern Ethiopia, from November 2019 to March 2020. A total of 3010 households from 38 villages were randomly selected for socio-economic and demographic survey. Focus group discussions (FGDs) were conducted in 11 different health clusters considering agro-ecological differences. A total of 1256 children under 10 years of age were screened for malaria parasites using microscopy to determine malaria prevalence. Furthermore, 5-year malaria trend analysis was undertaken based on data obtained from the district health office to understand the disease dynamics. Results Malaria knowledge in the area was high as all FGD participants correctly identified mosquito bites during the night as sources of malaria transmission. Delayed health-seeking behaviour remains a key behavioural challenge in malaria control as it took patients on average 4 days before reporting the case at the nearby health facility. On average, households lost 2.53 working days per person-per malaria episode and they spent US$ 18 per person per episode. Out of the 1256 randomly selected under 10 children tested for malaria parasites, 11 (0.89%) were found to be positive. Malaria disproportionately affected the adult segment of the population more, with 50% of the total cases reported from households being from among individuals who were 15 years or older. The second most affected group was the age group between 5 and 14 years followed by children aged under 5, with 31% and 14% burden, respectively. Conclusion Despite the achievement of universal coverage in terms of LLINs access, utilization of vector control interventions in the area remained low. Using bed nets for unintended purposes remained a major challenge. Therefore, continued community education and communication work should be prioritized in the study area to bring about the desired behavioural changes.

Download Full-text