Reduction in Malaria Burden Following the Introduction of Indoor Residual Spraying in Areas Protected by Long Lasting Insecticidal Nets in Western Kenya, 2016 – 2018

Background: Long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are the main malaria vector control measures. Kenya has employed multiple approaches, including free mass net distribution campaigns, for distributing LLINs to the community that resulted in increased household ownership of one or more nets from 44% in 2010 to 63 % in 2015. Migori and Homa Bay Counties are among the malaria endemic counties in Western Kenya that benefitted from three free mass net distribution campaigns between 2012 and 2018.. Widespread pyrethroid resistance among the primary vectors in Western Kenya has necessitated the re-introduction of IRS using an organophosphate insecticide, pirimiphos-methyl (Actellic® 300CS), as part of a strategy to manage insecticide-resistance. Evaluation of the effectiveness of the combined use of non-pyrethroid IRS and LLINs have yielded varied results. We aimed to evaluate malaria indicators before and after the introduction of IRS in a high malaria transmission area compared with an adjacent area where IRS was not introduced until one year later to estimate the effect of the intervention in an area with pyrethroid resistance.Methods: We reviewed records (MoH 405 A, 405 B, and 706) and tallied monthly aggregate of outpatient department (OPD) attendance, suspected malaria cases, those tested for malaria and those testing positive for malaria at two health facilities, one from Nyatike, an intervention sub-county, and one from Suba, a comparison sub-county, both located in Western Kenya, from February 1, 2016, through March 31, 2018. The first round of IRS was conducted in February – March 2017 in Nyatike sub-county and the second round one year later in both Nyatike and Suba sub-counties while the mass distribution of LLINs has been conducted in both locations. We performed a descriptive analysis and estimated the effect of the interventions and temporal changes of malaria indicators using Poisson regression for a period before and after implementation of the first round of IRS.Results: A higher reduction in the intervention area in total OPD, the proportion of OPD visits due to suspected malaria, testing positivity rate and annual malaria incidences except for the total OPD visits among the under 5 children where 59% decrease was observed in the comparison area while 33% decrease was observed in the intervention area (net change -27%, P <0.001). The percentage decline in annual malaria incidence observed in the intervention area was more than twice the observed percentage decline in the comparison area across all the age groups. A marked decline in the monthly testing positivity rate (TPR) was noticed in the intervention area, while no major changes were observed in the comparison area upon introduction of the non-pyrethroid IRS in the intervention area. The monthly TPR reduced from 46% in February 2016 (start of review period) to 11% in February 2018 (end of review period), representing a 76% absolute decrease in TPR among all ages (RR=0.24, 95% CI 0.12–0.46). In the comparison area, TPR was 16% in both February 2016 and February 2018 (RR=1.0, 95% CI 0.52–2.09). A month-by-month comparison revealed that the TPR in Year 2 remained lower than in Year 1 in the intervention area for most of the one year after the introduction of the IRS.Conclusions: Our findings demonstrated a reduced malaria burden among population protected by both non-pyrethroid IRS and LLINs implying a possible additional benefit afforded by the combined intervention in malaria endemic zone.

Pemberdayaan Keluarga Sebagai Upaya Menurunkan Kepadatan Larva Aedes spp. dalam Pencegahan Penularan Demam Berdarah Dengue

One House One Jumantik Programme (G1R1J) has been launched by the Indonesian governmentsince 2015. This programme emphasizes the participation of family members as jumantik rumah bymonitoring and controlling larvae in their houses. Family’s coaching in the G1R1J’s programme is carried outby each jumantik coordinator. Tasikmalaya and Cimahi were Dengue endemic areas with high cases in thelast five years. This study aimed to determine the effect of family empowerment by the Jumantik Coordinatorin reducing the density of Aedes spp. larvae, reducing the number of DHF cases and increasing familyparticipation in vector surveillance. The study was located in the Tasikmalaya and Cimahi areas andconducted with an intervention. The interventions included RW-level workshops, coaching, and observationby jumantik coordinator. The sample unit is a family, consist of 400 unit in the intervention area and 200unit in the comparison area. The results showed that there were significant differences in the status ofcommunity participation in eradicating mosquito nests (PSN). The presence of dengue patients and thepresence of Aedes spp mosquito larvae were different between before and after the intervention both inTasikmalaya and Cimahi. In addition, there are significant differences in the status of communityparticipation in PSN, the presence of dengue cases, the presence of Aedes spp. larvae and theimplementation of vector surveillance by families in the intervention and comparison areas. The resultsconcluded that family coaching interventions and observations by the Jumantik Coordinator, proved to havean effect on community participation in PSN, decreasing dengue cases, increasing larvae free index (ABJ)and vector surveillance implementation by families.Keywords: Society participation, Dengue cases, Jumantik House, One House One Jumantik

The study of indoor concentrations of organic compounds in school classrooms and accumulated blood xenobiotic levels in children

The analysis of multicomponent chemical composition of atmospheric air and the air of residential and public premises, including school indoor air, is an urgent task of modern hygienic studies devoted to environmental quality and risk assessment of adverse health effects of dangerous chemicals. The priority sources of air pollution inside classrooms are finishing materials (linoleum, wallpaper, varnishes, paints, etc.) and emissions of monomers from furniture made of chipboards processed with polymer resins. The article demonstrates the results of screening tests establishing the levels of airborne toxic organic compounds (phenol, formaldehyde, benzene, toluene, ethylbenzene, and xylene) both inside and outside educational premises affected by various environmental exposures (conditional areas of observation and comparison). To assess the chemical body burden, blood levels of certain chemicals were measured in schoolchildren dwelling in the observation (study) and comparison (control) areas. Blood tests were accompanied by indoor and outdoor air monitoring in the educational establishments. We examined the total of 424 children including 231 students from primary, secondary and high schools of the city of Perm (observation area) and 193 schoolchildren of grades 1–11 living in the town of Kungur (comparison area). We established that the average daily concentrations of phenol and formaldehyde in indoor air in Perm were 2.4 and 5.6 times higher (р < 0.05) than those in Kungur. Outdoor concentrations of phenol and formaldehyde in Perm were 2.6 and 3.7 times higher than those in Kungur. The analysis of blood levels of certain organic compounds in the primary, secondary and high school children in Perm showed significantly higher concentrations of phenol, benzene, and toluene (p < 0.05) (1.5, 1.1, and 1.2 times, respectively). The average blood concentration of formaldehyde in the study group was 1.3 times higher (p < 0.05) than that in children of the comparison area. No significant differences between the comparison and observation groups (p < 0.05) were found in blood levels of xylene and ethylbenzene. Children’s blood concentrations of the identified organic compounds indicate the presence of external sources of exposure to these toxicants.

Matematika pada kompetensi teknik dan bisnis sepeda motor

This study aims to describe the mathematical needs that support competency in the Technical and Business of Motorcycle. This study involved the participation of teachers of Technical and Motorcycle Business and automotive engineering academics. Participants were vocational teachers and lecturers in the Ciamis and Tasikmalaya areas who were accessed by researchers. Data on mathematical needs in technical and motorcycle business are obtained from views of participants and vocational document searches. Participants identify the mathematical needs of the basic competencies in subjects of expertise competency (C3). The results of the study were obtained: (1) measurement, numbers, geometry, algebra, and statistics is the scope of mathematics that supports the competency in the Technical and Business of Motorcycle with an emphasis on the concept of comparison, area, volume, function, and conversion; (2) mathematical relational understanding is needed to solve problems. These results indicate that mathematics with mathematical understanding is needed in the Technical and Motorcycle Business Competencies.

QUANTITATIVE PARAMETERS OF NITRATES IN URINE AND N-NITROSODIMETHYLAMINE IN BLOOD AS MARKERS OF THE ORAL EXPOSURE TO NITRATES INTRODUCED WITH DRINKING WATER

Introduction. The nitrate entry into the body with drinking water might lead to endogenous nitrotyrosine and N-nitrosamine formation. The study aims to prove quantitative measurement of N-nitrosodimethylamine in blood and nitrates in urine as markers of the exposure to nitrates entering the body with drinking water. Material and methods. Analysis of blood samples for N-nitrosodimethylamine was carried out using Agilent gas chromatograph with quadrupole mass spectrometric detector. When preparing blood samples, an automatic system for solid extraction Sepaths was used. Studies of urine samples for nitrates were carried out using the system of capillary electrophoresis “Kapel”. The target audience includes two groups. Children consuming drinking water with nitrate level exceeding hygienic norm by 1.2 times and N-nitrosodimethylamine level exceeding by 1.6 times. The second group included children consuming drinking water of satisfactory quality. The establishment of cause-effect relationships is carried out using the package of applied programs Statistica 6.0. Results. The nitrate level in drinking water of target area was 51.7 mg/dm3, what is by 4.7 times higher than in comparison area of 10.9 mg/dm3. The N-nitrosodimethylamine level was at the level of 0.016 mg/dm3, which is by 2.5 higher than in the comparison area of 0.0065 mg/dm3. Discussion. The long-term exposure to nitrate and N-nitrosodimethylamine in the drinking water was found out to form in the children’s blood of first group the N-nitrosodimethylamine accounted of 0.0045±0.0014 mg/dm3 i.e. by 1.5 times higher in comparison with the second group (0.003±0.0009 mg/dm3). In the urine of children from the first group, the nitrates were by 1.5 times more than in the urine of children in the second group. Experimental studies proved that the concentration of nitrates in the urine and N-nitrosodimethylamine in the blood might be considered as markers of the oral exposure and correspond to the permitted level for nitrates in the urine of 43.7 mg/dm3 and N-nitrosodimethylamine in the blood of 0.003 mg/dm3 when nitrate concentration in drinking water is from of 45-51.7 mg/dm3 and N-nitrosodimethylamine from of 0.01-0.016 mg/dm3.

PREFERENCE FOR CHILDREN AND SUBSEQUENT FERTILITY IN MATLAB: DOES WIFE-HUSBAND AGREEMENT MATTER?

This study examines wife–husband preference for children and subsequent fertility for a period of 5 years in the treatment and comparison areas of Matlab, Bangladesh. The two data sets used were: the In-depth Survey (1984) and the Demographic Surveillance System (1984–89). In the case of wives' preferences for children, subsequent childbearing was 13·8% higher than desired in the treatment area and 44·7% higher than desired in the comparison area. After controlling for all variables in the model, the likelihood of giving birth was 1·78 times higher for wives who wanted no more children, but whose husbands did want more, compared with couples where neither husband nor wife wanted more children. For couples where the wife wanted more, but the husband did not want more children, the likelihood of giving birth was 0·63 times that of couples where both the husband and wife wanted more children. This finding suggests that to enhance the decline in fertility in these two areas of Matlab, it will be necessary to motivate both wives and husbands to cease childbearing.

Impact of a Longitudinal Community HIV Intervention Targeting Injecting Drug Users' Stage of Change for Condom and Bleach Use

Purpose. To evaluate the impact of the Long Beach AIDS Community Demonstration Project, a community-based HIV-prevention intervention incorporating principles from the Transtheoretical model in its design and evaluation. Design. Repeated cross-sectional sampling with matched intervention and comparison communities. Setting. Neighborhoods in Long Beach, California, having a high prevalence of drug abuse and prostitution. Subjects. 3081 injecting drug users who were sexually active and/or shared injection equipment. Intervention. Trained peer volunteers distributed fliers featuring role model stories targeted to the population's stage of change. Fliers were packaged with bleaching kits and/or condoms. Measures. Primary outcome measures were exposure to the intervention, condom carrying, and stage of change for disinfecting injection equipment with bleach and for using condoms with main and other partners. Results. Toward the end of the study, 77% of injection drug users in the intervention area reported being exposed to the intervention. In the intervention area, rates of condom carrying increased from 10 to 27% (p <.001), and there was an increase from 2.32 to 3.11 in mean stage of change for using condoms with other partners, while stage of change decreased in the comparison area (p <.01). Mean stage of change for using condoms with a main partner also increased in the intervention area, but the difference was not significant after controlling for change in the comparison area. Subjects with recent project exposure had higher stage-of-change scores for using condoms with a main partner (p <.05) and other partners (p <.01) and for cleaning injection equipment with bleach (p <.05). Conclusions. The results demonstrate the effectiveness of the AIDS Community Demonstration Project intervention for reaching injecting drug users in the community and for motivating the adoption of risk-reducing practices.

Factors affecting use of contraception in Matlab, Bangladesh

SummaryThis study examines the relationship between family planning, perceived availability of contraceptives, and sociodemographic factors in rural Bangladesh. Data are from the 1990 KAP survey in the Matlab treatment and comparison areas, using a sample of about 8500 married women of reproductive age. The contraceptive prevalence rate was 57% in the treatment area but substantially lower in the comparison area where mainly traditional methods of family planning were used by women who did not know of a source of supply of contraceptives. Education has no effect on contraceptive use in the treatment area but in the comparison area, modest but consistent differentials in use by level of education were found. Number of living children is the best predictor for contraceptive use, followed by number of living sons, and the attitude of respondents and their husbands towards family planning.

Bancroftian filariasis in Pondicherry, South India – epidemiological impact of recovery of the vector population

SUMMARYAn Integrated Vector Management (IVM) strategy was implemented from 1981 to 1985 in one part of Pondicherry, South India, for the control of the bancroftian filariasis vector Culex quinquefasciatus (the IVM area). The rest of the town (the comparison area) received the conventional larvicidal input. After 1985 both the areas were managed conventionally. The switch to conventional strategy resulted in an increase of vector density in both areas. The microfilaraemia prevalence in humans showed a general decline (P < 0·05) from 1986 to 1989 only in the IVM area whereas its intensity did not change significantly in either area. While the age-specific rate of gain of infection was generally unchanged in the IVM area, an increase in all age classes was observed after 1985 in the comparison area, where the Annual Transmission Index was high during the previous years. In both areas the rate of loss of infection increased during 1986–9 compared to 1981–6. The results suggest that 3 years is too short a period to relate the changes in entomological parameters to those in the microfilaraemia status of the population.

Contraceptive use patterns in Matlab, Bangladesh: insights from a 1984 survey

SummaryAn experimental maternal and child health and family planning programme has been in existence in Matlab for almost 10 years. During this time the project has achieved remarkable success in the area of family planning. Based upon a 1984 survey, this study examines the pattern of contraceptive use in the Matlab treatment area, and contrasts it with the regular government programme in the neighbouring comparison area. Important differences between the two areas are observed, with the treatment area characterized by substantially higher levels of current contraceptive use, greater reliance upon temporary methods for birth spacing and, among acceptors of sterilization, more prior experimentation with other methods. In the comparison area lower rates of contraceptive use are observed, with heavy reliance upon tubectomy for limiting family size. The findings suggest that an intensive and innovative family planning programme in rural Bangladesh can achieve success not only in terms of contraceptive prevalence, but can also attract users interested in child spacing and others wanting to limit their family size, by offering the widest range of contraceptive methods.