Demographic and health community-based surveys to inform a malaria elimination project in Magude district, southern Mozambique

ObjectivesA Demographic and Health Platform was established in Magude in 2015, prior to the deployment of a project aiming to evaluate the feasibility of malaria elimination in southern Mozambique, named the Magude project. This platform aimed to inform the design, implementation and evaluation of the Magude project, through the identification of households and population; and the collection of demographic, health and malaria information.SettingMagude is a rural district of southern Mozambique which borders South Africa. It has nine peripheral health facilities and one referral health centre with an inpatient ward.InterventionA baseline census enumerated and geolocated all the households, and their resident and non-resident members, collecting demographic and socio-economic information, and data on the coverage and usage of malaria control tools. Inpatient and outpatient data during the 5 years (2010 to 2014) before the survey were obtained from the district health authorities. The demographic platform was updated in 2016.ResultsThe baseline census conducted in 2015 reported 48 448 (92.1%) residents and 4133 (7.9%) non-residents, and 10 965 households. Magude’s population is predominantly young, half of the population has no formal education and the main economic activities are agriculture and fishing. Houses are mainly built with traditional non-durable materials and have poor sanitation facilities. Between 2010 and 2014, malaria was the most common cause of all-age inpatient discharges (representing 20% to 40% of all discharges), followed by HIV (12% to 22%) and anaemia (12% to 15%). In early 2015, all-age bed-net usage was between 21.8% and 27.1% and the reported coverage of indoor residual spraying varied across the district between 30.7% and 79%.ConclusionThis study revealed that Magude has limited socio-economic conditions, poor access to healthcare services and low coverage of malaria vector control interventions. Thus, Magude represented an area where it is most pressing to demonstrate the feasibility of malaria elimination.Trial registration numberNCT02914145; Pre-results.

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Malaria epidemiology and stratification of incidence in the malaria elimination setting in Harari Region, Eastern Ethiopia

Infectious Diseases of Poverty ◽

10.1186/s40249-020-00773-5 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Endashaw Esayas ◽

Asefa Tufa ◽

Fekadu Massebo ◽

Abdulhamid Ahemed ◽

Ibssa Ibrahim ◽

...

Keyword(s):

Malaria Transmission ◽

Incidence Rate ◽

Malaria Elimination ◽

Malaria Incidence ◽

Indoor Residual Spraying ◽

District Level ◽

District Health ◽

Eastern Ethiopia ◽

Intervention Coverage ◽

Malaria Epidemiology

Abstract Background Ethiopia has shown notable progress in reducing the burden of malaria over the past two decades. Because of this progress, the country has shifted efforts from control to elimination of malaria. This study was conducted to analyse the malaria epidemiology and stratification of incidence in the malaria elimination setting in eastern Ethiopia. Methods A retrospective study was conducted to analyse the epidemiology of malaria by reviewing the district health office data from 2013 to 2019 in Harari Region. In addition, three years of sub-district level malaria data were used to stratify the malaria transmission intensity. Malaria interventions (Long-lasting insecticidal nets [LLIN] and indoor residual spraying [IRS]) employed were reviewed to analyse the intervention coverage at the Regional level. Descriptive statistics were used to show the malaria transmission in terms of years, season and species of the malaria parasite. Incidence rate per 1000 population and death rate per 1 000 000 population at risk were computed using the total population of each year. Results In the Harari Region, malaria incidence showed a more pronounced declining trend from 2017 to 2019. Plasmodium falciparum, P. vivax and mixed infections accounted for 69.2%, 30.6% and 0.2% of the cases, respectively. There was an increment in malaria intervention coverage and improved malaria diagnosis. In the year 2019 the coverage of LLIN and IRS in the Region were 93.4% and 85.1% respectively. The annual malaria incidence rate dropped from 42.9 cases per 1000 population in 2013 to 6.7 cases per 1000 population in 2019. Malaria-related deaths decreased from 4.7 deaths per 1 000 000 people annually in 2013 to zero, and there have been no deaths reported since 2015. The malaria risk appears to be heterogeneous and varies between districts. A higher number of malaria cases were recorded in Erer and Jenella districts, which constitute 62% of the cases in the Region. According to the sub-district level malaria stratification, there was shrinkage in the malaria transmission map and about 70% of the sub-districts have achieved elimination targets. Conclusions In the Harari Region, malaria morbidity and mortality have been significantly declined. Thus, if this achievement is sustained and scaling-up of the existing malaria prevention and control strategies by focusing on those populations living in the higher malaria transmission districts and sub-districts, planning of malaria elimination from the study area might be feasible.

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Ivermectin as an endectocide may boost control of malaria vectors in India and contribute to elimination

Parasites & Vectors ◽

10.1186/s13071-021-05124-3 ◽

2022 ◽

Vol 15 (1) ◽

Author(s):

Sundus Shafat Ahmad ◽

Manju Rahi ◽

Poonam Saroha ◽

Amit Sharma

Keyword(s):

Vector Control ◽

Malaria Elimination ◽

Control Strategies ◽

Mosquito Species ◽

Indoor Residual Spraying ◽

World Health ◽

Malaria Vectors ◽

Bed Nets ◽

Malaria Vector Control ◽

Indian Government

AbstractMalaria constitutes one of the largest public health burdens faced by humanity. Malaria control has to be an efficient balance between diagnosis, treatment and vector control strategies. The World Health Organization currently recommends indoor residual spraying and impregnated bed nets as two malaria vector control methods that have shown robust and persistent results against endophilic and anthropophilic mosquito species. The Indian government launched the National Framework for Malaria Elimination in 2016 with the aim to achieve the elimination of malaria in a phased and strategic manner and to sustain a nation-wide malaria-free status by 2030. India is currently in a crucial phase of malaria elimination and novel vector control strategies maybe helpful in dealing with various challenges, such as vector behavioural adaptations and increasing insecticide resistance among the Anopheles populations of India. Ivermectin can be one such new tool as it is the first endectocide to be approved in both animals and humans. Trials of ivermectin have been conducted in endemic areas of Africa with promising results. In this review, we assess available data on ivermectin as an endectocide and propose that this endectocide should be explored as a vector control tool for malaria in India. Graphical Abstract

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Impact of seasonality and malaria control interventions on Anopheles density and species composition from three areas of Uganda with differing malaria endemicity

Malaria Journal ◽

10.1186/s12936-021-03675-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Henry Ddumba Mawejje ◽

Maxwell Kilama ◽

Simon P. Kigozi ◽

Alex K. Musiime ◽

Moses Kamya ◽

...

Keyword(s):

Species Composition ◽

Vector Control ◽

Malaria Control ◽

Mosquito Species ◽

Density Ratio ◽

Indoor Residual Spraying ◽

Sub Saharan Africa ◽

Malaria Vector Control ◽

Vector Density ◽

Llin Distribution

Abstract Background Long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are the malaria control interventions primarily responsible for reductions in transmission intensity across sub-Saharan Africa. These interventions, however, may have differential impact on Anopheles species composition and density. This study examined the changing pattern of Anopheles species in three areas of Uganda with markedly different transmission intensities and different levels of vector control. Methods From October 2011 to June 2016 mosquitoes were collected monthly using CDC light traps from 100 randomly selected households in three areas: Walukuba (low transmission), Kihihi (moderate transmission) and Nagongera (high transmission). LLINs were distributed in November 2013 in Walukuba and Nagongera and in June 2014 in Kihihi. IRS was implemented only in Nagongera, with three rounds of bendiocarb delivered between December 2014 and June 2015. Mosquito species were identified morphologically and by PCR (Polymerase Chain Reaction). Results In Walukuba, LLIN distribution was associated with a decline in Anopheles funestus vector density (0.07 vs 0.02 mosquitoes per house per night, density ratio [DR] 0.34, 95% CI: 0.18–0.65, p = 0.001), but not Anopheles gambiae sensu stricto (s.s.) nor Anopheles arabiensis. In Kihihi, over 98% of mosquitoes were An. gambiae s.s. and LLIN distribution was associated with a decline in An. gambiae s.s. vector density (4.00 vs 2.46, DR 0.68, 95% CI: 0.49–0.94, p = 0.02). In Nagongera, the combination of LLINs and multiple rounds of IRS was associated with almost complete elimination of An. gambiae s.s. (28.0 vs 0.17, DR 0.004, 95% CI: 0.002–0.009, p < 0.001), and An. funestus sensu lato (s.l.) (3.90 vs 0.006, DR 0.001, 95% CI: 0.0005–0.004, p < 0.001), with a less pronounced decline in An. arabiensis (9.18 vs 2.00, DR 0.15 95% CI: 0.07–0.33, p < 0.001). Conclusions LLIN distribution was associated with reductions in An. funestus s.l. in the lowest transmission site and An. gambiae s.s. in the moderate transmission site. In the highest transmission site, a combination of LLINs and multiple rounds of IRS was associated with the near collapse of An. gambiae s.s. and An. funestus s.l. Following IRS, An. arabiensis, a behaviourally resilient vector, became the predominant species, which may have implications for malaria vector control activities. Development of interventions targeted at outdoor biting remains a priority.

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What was the impact of a participatory research project in Australian Indigenous primary healthcare services? Applying a comprehensive framework for assessing translational health research to Lessons for the Best

BMJ Open ◽

10.1136/bmjopen-2020-040749 ◽

2021 ◽

Vol 11 (2) ◽

pp. e040749

Author(s):

Shanthi Ann Ramanathan ◽

Sarah Larkins ◽

Karen Carlisle ◽

Nalita Turner ◽

Ross Stewart Bailie ◽

...

Keyword(s):

Learning Community ◽

Primary Healthcare ◽

Health Research ◽

Return On Investment ◽

Health Centre ◽

Healthcare Services ◽

Secondary Outcome ◽

Cost Consequence ◽

Comprehensive Framework ◽

The Impact

ObjectivesTo (1) apply the Framework to Assess the Impact from Translational health research (FAIT) to Lessons from the Best to Better the Rest (LFTB), (2) report on impacts from LFTB and (3) assess the feasibility and outcomes from a retrospective application of FAIT.SettingThree Indigenous primary healthcare (PHC) centres in the Northern Territory, Australia; project coordinating centre distributed between Townsville, Darwin and Cairns and the broader LFTB learning community across Australia.ParticipantsLFTB research team and one representative from each PHC centre.Primary and secondary outcome measuresImpact reported as (1) quantitative metrics within domains of benefit using a modified Payback Framework, (2) a cost-consequence analysis given a return on investment was not appropriate and (3) a narrative incorporating qualitative evidence of impact. Data were gathered through in-depth stakeholder interviews and a review of project documentation, outputs and relevant websites.ResultsLFTB contributed to knowledge advancement in Indigenous PHC service delivery; enhanced existing capacity of health centre staff, researchers and health service users; enhanced supportive networks for quality improvement; and used a strengths-based approach highly valued by health centres. LFTB also leveraged between $A1.4 and $A1.6 million for the subsequent Leveraging Effective Ambulatory Practice (LEAP) Project to apply LFTB learnings to resource development and creation of a learning community to empower striving PHC centres.ConclusionRetrospective application of FAIT to LFTB, although not ideal, was feasible. Prospective application would have allowed Indigenous community perspectives to be included. Greater appreciation of the full benefit of LFTB including a measure of return on investment will be possible when LEAP is complete. Future assessments of impact need to account for the limitations of fully capturing impact when intermediate/final impacts have not yet been realised and captured.

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Addressing key gaps in implementation of mosquito larviciding to accelerate malaria vector control in southern Tanzania: results of a stakeholder engagement process in local district councils

Malaria Journal ◽

10.1186/s12936-021-03661-x ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Salum A. Mapua ◽

Marceline F. Finda ◽

Ismail H. Nambunga ◽

Betwel J. Msugupakulya ◽

Kusirye Ukio ◽

...

Keyword(s):

Malaria Control ◽

Public Engagement ◽

Indoor Residual Spraying ◽

Malaria Vectors ◽

Malaria Vector Control ◽

Production Plant ◽

Community Members ◽

Key Informants ◽

Larval Source Management ◽

Source Management

Abstract Background Larval source management was historically one of the most effective malaria control methods but is now widely deprioritized in Africa, where insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are preferred. However, in Tanzania, following initial successes in urban Dar-es-Salaam starting early-2000s, the government now encourages larviciding in both rural and urban councils nationwide to complement other efforts; and a biolarvicide production-plant has been established outside the commercial capital. This study investigated key obstacles and opportunities relevant to effective rollout of larviciding for malaria control, with a focus on the meso-endemic region of Morogoro, southern Tanzania. Methods Key-informants were interviewed to assess awareness and perceptions regarding larviciding among designated health officials (malaria focal persons, vector surveillance officers and ward health officers) in nine administrative councils (n = 27). Interviewer-administered questionnaires were used to assess awareness and perceptions of community members in selected areas regarding larviciding (n = 490). Thematic content analysis was done and descriptive statistics used to summarize the findings. Results A majority of malaria control officials had participated in larviciding at least once over the previous three years. A majority of community members had neutral perceptions towards positive aspects of larviciding, but overall support for larviciding was high, although several challenges were expressed, notably: (i) insufficient knowledge for identifying relevant aquatic habitats of malaria vectors and applying larvicides, (ii) inadequate monitoring of programme effectiveness, (iii) limited financing, and (iv) lack of personal protective equipment. Although the key-informants reported sensitizing local communities, most community members were still unaware of larviciding and its potential. Conclusions The larviciding programme was widely supported by both communities and malaria control officials, but there were gaps in technical knowledge, implementation and public engagement. To improve overall impact, it is important to: (i) intensify training efforts, particularly for identifying habitats of important vectors, (ii) adopt standard technical principles for applying larvicides or larval source management, (iii) improve financing for local implementation and (iv) improve public engagement to boost community awareness and participation. These lessons could also be valuable for other malaria endemic areas wishing to deploy larviciding for malaria control or elimination.

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Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-045343 ◽

2021 ◽

Vol 11 (3) ◽

pp. e045343

Author(s):

Ray Moynihan ◽

Sharon Sanders ◽

Zoe A Michaleff ◽

Anna Mae Scott ◽

Justin Clark ◽

...

Keyword(s):

Systematic Review ◽

Primary Outcome ◽

Unmet Need ◽

Healthcare Utilisation ◽

Healthcare Services ◽

Risk Of Bias ◽

Secondary Outcome ◽

Severe Illness ◽

Service Utilisation ◽

Registration Number

ObjectivesTo determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic.DesignSystematic review.EligibilityEligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19.Data sourcesPubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact.Data analysisRisk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis.Outcome measuresPrimary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores).Results3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference.ConclusionsHealthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery.PROSPERO registration numberCRD42020203729.

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Effectiveness of a national mass distribution campaign of long-lasting insecticide-treated nets and indoor residual spraying on clinical malaria in Malawi, 2018–2020

BMJ Global Health ◽

10.1136/bmjgh-2021-005447 ◽

2021 ◽

Vol 6 (5) ◽

pp. e005447

Author(s):

Hillary M Topazian ◽

Austin Gumbo ◽

Katerina Brandt ◽

Michael Kayange ◽

Jennifer S Smith ◽

...

Keyword(s):

Mass Distribution ◽

Indoor Residual Spraying ◽

Malaria Risk ◽

Bed Nets ◽

Insecticide Treated Nets ◽

District Health ◽

High Transmission ◽

Limited Effectiveness ◽

Mass Distribution Campaign ◽

Distribution Campaign

IntroductionMalawi’s malaria burden is primarily assessed via cross-sectional national household surveys. However, malaria is spatially and temporally heterogenous and no analyses have been performed at a subdistrict level throughout the course of a year. The WHO recommends mass distribution of long-lasting insecticide-treated bed nets (LLINs) every 3 years, but a national longitudinal evaluation has never been conducted in Malawi to determine LLIN effectiveness lifespans.MethodsUsing District Health Information Software 2 (DHIS2) health facility data, available from January 2018 to June 2020, we assessed malaria risk before and after a mass distribution campaign, stratifying by age group and comparing risk differences (RDs) by LLIN type or annual application of indoor residual spraying (IRS).Results711 health facilities contributed 20 962 facility reports over 30 months. After national distribution of 10.7 million LLINs and IRS in limited settings, malaria risk decreased from 25.6 to 16.7 cases per 100 people from 2018 to 2019 high transmission seasons, and rebounded to 23.2 in 2020, resulting in significant RDs of −8.9 in 2019 and −2.4 in 2020 as compared with 2018. Piperonyl butoxide (PBO)-treated LLINs were more effective than pyrethroid-treated LLINs, with adjusted RDs of −2.3 (95% CI −2.7 to −1.9) and −1.5 (95% CI −2.0 to −1.0) comparing 2019 and 2020 high transmission seasons to 2018. Use of IRS sustained protection with adjusted RDs of −1.4 (95% CI −2.0 to −0.9) and −2.8% (95% CI −3.5 to −2.2) relative to pyrethroid-treated LLINs. Overall, 12 of 28 districts (42.9%) experienced increases in malaria risk in from 2018 to 2020.ConclusionLLINs in Malawi have a limited effectiveness lifespan and IRS and PBO-treated LLINs perform better than pyrethroid-treated LLINs, perhaps due to net repurposing and insecticide-resistance. DHIS2 provides a compelling framework in which to examine localised malaria trends and evaluate ongoing interventions.

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Efficacy of broflanilide (VECTRON T500), a new meta-diamide insecticide, for indoor residual spraying against pyrethroid-resistant malaria vectors

Scientific Reports ◽

10.1038/s41598-021-86935-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Corine Ngufor ◽

Renaud Govoetchan ◽

Augustin Fongnikin ◽

Estelle Vigninou ◽

Thomas Syme ◽

...

Keyword(s):

Indoor Residual Spraying ◽

Malaria Vectors ◽

Cross Resistance ◽

Malaria Vector Control ◽

Mosquito Vectors ◽

Experimental Huts ◽

Application Rates ◽

Wettable Powder ◽

Cone Bioassay ◽

Pirimiphos Methyl

AbstractThe rotational use of insecticides with different modes of action for indoor residual spraying (IRS) is recommended for improving malaria vector control and managing insecticide resistance. Insecticides with new chemistries are urgently needed. Broflanilide is a newly discovered insecticide under consideration. We investigated the efficacy of a wettable powder (WP) formulation of broflanilide (VECTRON T500) for IRS on mud and cement wall substrates in laboratory and experimental hut studies against pyrethroid-resistant malaria vectors in Benin, in comparison with pirimiphos-methyl CS (Actellic 300CS). There was no evidence of cross-resistance to pyrethroids and broflanilide in CDC bottle bioassays. In laboratory cone bioassays, broflanilide WP-treated substrates killed > 80% of susceptible and pyrethroid-resistant An. gambiae sl for 6–14 months. At application rates of 100 mg/m2 and 150 mg/m2, mortality of wild pyrethroid-resistant An. gambiae sl entering experimental huts in Covè, Benin treated with VECTRON T500 was similar to pirimiphos-methyl CS (57–66% vs. 56%, P > 0.05). Throughout the 6-month hut trial, monthly wall cone bioassay mortality on VECTRON T500 treated hut walls remained > 80%. IRS with broflanilide shows potential to significantly improve the control of malaria transmitted by pyrethroid-resistant mosquito vectors and could thus be a crucial addition to the current portfolio of IRS insecticides.

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Ayushman Bharat Yojana: a memorable health initiative for Indians

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20183043 ◽

2018 ◽

Vol 5 (8) ◽

pp. 3152 ◽

Cited By ~ 1

Author(s):

Rohit Dhaka ◽

Ramesh Verma ◽

Ginni Agrawal ◽

Gopal Kumar

Keyword(s):

Health Centre ◽

Tertiary Care ◽

Poverty Line ◽

Healthcare Services ◽

Communicable Diseases ◽

Health And Wellness ◽

Non Communicable Diseases ◽

Protection Scheme ◽

Insurance Cover ◽

The Government

India in a state of epidemiological health transition i.e shifting from communicable to non-communicable diseases. The annually 3.2% Indians falling below the poverty line and three forth Indians spending their entire income on health care and purchasing drugs. The government of India announced a Ayushman Bharat Yojana- National Health Protection Scheme (AB-NHPM) in the year 2018. The aim of this programme is to providing a service to create a healthy, capable and content new India and two goals are to creating a network of health and wellness infrastructure across the nation to deliver comprehensive primary healthcare services and to provide health insurance cover to at least 40% of India's population which is deprived of secondary and tertiary care services. This Yojana will be implemented through Health and Wellness Centres that are to be developed in the primary health centre or sub-centre in the village and that will provide preventive, promotive, and curative care for non-communicable diseases, dental, mental, geriatric care, palliative care, etc. These centres would be equipped with basic medical tests for hypertension, diabetic and cancer and they are connected to the district hospital for advanced tele-medical consultations. The government has aims to set up 1,50,000 health and wellness centres across the country by the year 2022.

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Residual and Fumigant Effects of Bendiocarb WP80 in a Malarious Areas in Borderline of Iran and Pakistan

10.21203/rs.3.rs-139001/v1 ◽

2021 ◽

Author(s):

Mohammad Reza Abai ◽

Hassan Vatandoost ◽

Hossein Dorzadeh ◽

Mansoreh Shayeghi ◽

Ahmad Ali Hanafi-bojd ◽

...

Keyword(s):

Vector Control ◽

Anopheles Stephensi ◽

Indoor Residual Spraying ◽

Residual Effect ◽

Malaria Vector Control ◽

Biological Assays ◽

The Public ◽

Main Activity ◽

Contact Bioassay ◽

Old Females

Abstract Background: Malaria and leishmaniasis are the public health problems in southern Iran. The main activity of vector control is indoor residual spraying using pyrethrpids. The aim of study was to evaluate the biological assays of bendiocarb WP at different surfaces of wall. Materials and Methods: The residual effect of bendicocarb WP80 at 400 mg/m2 was evauated on various local surfaces of rooms such as mud and plaster as well as thatch roofs and wooden. WHO standard cones using contact bioassays were carried out using laboratory reared sugar-fed, 48-72 h old females of Anopheles stephensi . Contact bioassays were carried out on sprayed surfaces for 150 days.Results: Contact bioassay on surfaces treated with bendicocarb WP80 diffferent surfaces was estimated about 2 months. Fumigant tests of bendicocarb WP80 at 400 mg/m2 revealed 50-93.83% mortality with one month persistency.Discussion: The rsults hsowed that carbamte insecticide could be used as rotation with pyrethroids for malaria vector control .

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