Climatic variables and malaria transmission dynamics in Jimma town, South West Ethiopia

Imported malaria at Buraidah Central Hospital, Qassim, Saudi Arabia: a retrospective analysis

BACKGROUND

Malaria is a major threat to global health and it is a widespread throughout tropical and subtropical countries with an increasing risk to travellers.

METHODS

A retrospective analysis was conducted to investigate the epidemiology of imported malaria at Buraidah in Qassim region, Saudi Arabia during the period of January 2010 through April 2013.

RESULTS

There were 46 imported malaria cases. These cases were Plasmodium vivax (89.1%), Plasmodium falciparum (0.02%) and were mixed in 4 cases. Their age range between 14 and 54 and the mean was 29.7 years. Around three quarter (71.2%) of the patients were males. Most of the patients were Indian (54.3%) and Pakistani (23.9%). Over half (54.3%) of the patients had severe malaria, mainly severe anaemia, jaundice and hypotension. There was no mortality among the patients.

CONCLUSIONS

Most of the detected malaria cases in this setting were among expatriates, particularly from the Indian subcontinent, while the predominant species was P. vivax. More than 50% of the cases presented with severe malaria.

Physico-chemical and biological characterization of anopheline mosquito larval habitats (Diptera: Culicidae): implications for malaria control

BACKGROUND

A fundamental understanding of the spatial distribution and ecology of mosquito larvae is essential for effective vector control intervention strategies. In this study, data-driven decision tree models, generalized linear models and ordination analysis were used to identify the most important biotic and abiotic factors that affect the occurrence and abundance of mosquito larvae in Southwest Ethiopia.

METHODS

In total, 220 samples were taken at 180 sampling locations during the years 2010 and 2012. Sampling sites were characterized based on physical, chemical and biological attributes. The predictive performance of decision tree models was evaluated based on correctly classified instances (CCI), Cohen's kappa statistic (κ) and the determination coefficient (R2). A conditional analysis was performed on the regression tree models to test the relation between key environmental and biological parameters and the abundance of mosquito larvae.

RESULTS

The decision tree model developed for anopheline larvae showed a good model performance (CCI = 84 ± 2%, and κ = 0.66 ± 0.04), indicating that the genus has clear habitat requirements. Anopheline mosquito larvae showed a widespread distribution and especially occurred in small human-made aquatic habitats. Water temperature, canopy cover, emergent vegetation cover, and presence of predators and competitors were found to be the main variables determining the abundance and distribution of anopheline larvae. In contrast, anopheline mosquito larvae were found to be less prominently present in permanent larval habitats. This could be attributed to the high abundance and diversity of natural predators and competitors suppressing the mosquito population densities.

CONCLUSIONS

The findings of this study suggest that targeting smaller human-made aquatic habitats could result in effective larval control of anopheline mosquitoes in the study area. Controlling the occurrence of mosquito larvae via drainage of permanent wetlands may not be a good management strategy as it negatively affects the occurrence and abundance of mosquito predators and competitors and promotes an increase in anopheline population densities.

Temporal and micro-spatial heterogeneity in the distribution of Anopheles vectors of malaria along the Kenyan coast

Background

The distribution of anopheline mosquitoes is determined by temporally dynamic environmental and human-associated variables, operating over a range of spatial scales. Macro-spatial short-term trends are driven predominantly by prior (lagged) seasonal changes in climate, which regulate the abundance of suitable aquatic larval habitats. Micro-spatial distribution is determined by the location of these habitats, proximity and abundance of available human bloodmeals and prevailing micro-climatic conditions. The challenge of analysing—in a single coherent statistical framework—the lagged and distributed effect of seasonal climate changes simultaneously with the effects of an underlying hierarchy of spatial factors has hitherto not been addressed.

Methods

Data on Anopheles gambiae sensu stricto and A. funestus collected from households in Kilifi district, Kenya, were analysed using polynomial distributed lag generalized linear mixed models (PDL GLMMs).

Results

Anopheline density was positively and significantly associated with amount of rainfall between 4 to 47 days, negatively and significantly associated with maximum daily temperature between 5 and 35 days, and positively and significantly associated with maximum daily temperature between 29 and 48 days in the past (depending on Anopheles species). Multiple-occupancy households harboured greater mosquito numbers than single-occupancy households. A significant degree of mosquito clustering within households was identified.

Conclusions

The PDL GLMMs developed here represent a generalizable framework for analysing hierarchically-structured data in combination with explanatory variables which elicit lagged effects. The framework is a valuable tool for facilitating detailed understanding of determinants of the spatio-temporal distribution of Anopheles. Such understanding facilitates delivery of targeted, cost-effective and, in certain circumstances, preventative antivectorial interventions against malaria.

Plasmodium ovale curtisi and Plasmodium ovale wallikeri in North-West Ethiopia

BACKGROUND

In Ethiopia Plasmodium falciparum and Plasmodium vivax are the dominant species accounting for roughly 60 and 40% of malaria cases, respectively. Recently a major shift from P. falciparum to P. vivax has been observed in various parts of the country but the epidemiology of the other human malaria species, Plasmodium ovale spp. and Plasmodium malariae remains poorly understood. The aim of this study was to assess P. ovale curtisi and wallikeri infection in north-west Ethiopia by using microscopy and nested PCR.

METHODS

A health institution-based survey using non-probability sampling techniques was conducted at Maksegnet, Enfranze and Kola Diba health centres and Metema hospital in North Gondar. Three-hundred patients with signs and symptoms consistent with malaria were included in this study and capillary blood was collected for microscopic examination and molecular analysis of Plasmodium species. Samples were collected on Whatman 903 filter papers, stored in small plastic bags with desiccant and transported to Vienna (Austria) for molecular analysis. Data from study participants were entered and analysed by SPSS 20 software.

RESULTS

Out of 300 study participants (167 males and 133 females), 184 samples were classified positive for malaria (133 P. falciparum and 51 P. vivax) by microscopy. By species-specific PCR 233 Plasmodium spp (95% CI: 72.6-82) were detected and the majority 155 (66.5%, 95% CI: 60.2-72.3) were P. falciparum followed by P. vivax 69 (29.6%, 95% CI; 24.1-35.8) and 9 (3.9%, 95% CI: 2-7.2) samples were positive for P. ovale. Seven of P. ovale parasites were confirmed as P. ovale wallikeri and two were confirmed as P. ovale curtisi. None of the samples tested positive for P. malariae. During microscopic examination there were high (16.3%) false negative reports and all mixed infections and P. ovale cases were missed or misclassified.

CONCLUSION

This study indicates that P. ovale malaria is under-reported in Ethiopia and provides the first known evidence of the sympatric distribution of indigenous P. ovale wallikeri and P. ovale curtisi in Ethiopia. Therefore, further studies assessing the prevalence of the rare species P. ovale and P. malariae are urgently needed to better understand the species distribution and to adapt malaria control strategies.

Evaluation of CareStart™ malaria Pf/Pv combo test for Plasmodium falciparum and Plasmodium vivax malaria diagnosis in Butajira area, south-central Ethiopia

Malaria is a major public health problem in Ethiopia. Plasmodium falciparum and Plasmodium vivax co-exist and malaria rapid diagnostic test (RDTs) is vital in rendering parasite-confirmed treatment especially in areas where microscopy from 2008 to 2010 is not available. CareStartTM Malaria Pf/Pv combo test was evaluated compared to microscopy in Butajira area, south-central Ethiopia. This RDT detects histidine-rich protein-2 (HRP2) found in P. falciparum, and Plasmodium enzyme lactate dehydrogenase (pLDH) for diagnosis of P. vivax. The standard for the reporting of diagnostic accuracy studies was complied. Among 2,394 participants enrolled, 10.9% (n=87) were Plasmodium infected (household survey) and 24.5% (n=392) health facility-based using microscopy. In the household surveys, the highest positivity was caused by P. vivax (83.9%, n=73), P. falciparum (15.0%, n=13), and the rest due to mixed infections of both (1.1%, n=1). In health facility, P. vivax caused 78.6% (n=308), P. falciparum caused 20.4% (n=80), and the rest caused by mixed infections 1.0% (n=4). RDT missed 9.1% (n=8) in household and 4.3% (n=17) in health facility-based surveys among Plasmodium positive confirmed by microscopy while 3.3% (n=24) in household and 17.2% (n=208) in health facility-based surveys were detected false positive. RDT showed agreement with microscopy in detecting 79 positives in household surveys (n=796) and 375 positives in health centre survey (n=1,598).RDT performance varied in both survey settings, lowest PPV (64.3%) for Plasmodium and P. falciparum (77.2%) in health centres; and Plasmodium (76.7%) and P. falciparum (87.5%) in household surveys. NPV was low in P. vivax in health centres (77.2%) and household (87.5%) surveys. Seasonally varying RDT precision of as low as 14.3% PPV (Dec. 2009), and 38.5% NPV (Nov. 2008) in health centre surveys; and 40-63.6% PPV was observed in household surveys. But the influence of age and parasite density on RDT performance was not ascertained. Establishing quality control of malaria RDT in the health system in areas with low endemic and where P. falciparum and P. vivax co-exist is recommendable. CareStartTM RDT might be employed for epidemiological studies that require interpreting the results cautiously. Future RDT field evaluation against microscopy should be PCR corrected.

Association of weather and anthropogenic factors for transmission of Japanese encephalitis in an endemic area of India

Weather and anthropogenic factors are important determinants for Japanese encephalitis (JE) transmission. During 2008-2010, an increasing trend of JE was observed in Dibrugarh district of Northeast India. The JE cases were found to be clustered between June to October in each year. Monthly minimum temperature and rainfall were significantly associated with JE transmission at 1 and 2 months lagged. However, the relationship was more prominent at a lag of 1 month than that of two. Regression analysis suggested that rainfall, minimum and maximum temperature, and relative humidity at 6:00 h are significant predictors (P < 0.05) of quarterly occurrence of JE cases. Additional anthropogenic risk factors including the conditions such as pig sty/cattle shed around and lower part of the houses and proximity of rice field to the dwelling houses (P < 0.05) were also found to be predictors for JE occurrence. Meteorological and anthropogenic risk factors can be used to forecast JE outbreaks in Assam which in turn can help the local health authorities to protect communities in JE prone areas.

Community knowledge, attitude and practice about malaria in a low endemic setting of Shewa Robit Town, northeastern Ethiopia

Background

Since malaria is one of the foremost public health problems in Ethiopia, assessment of situation of the disease, and communities’ knowledge and perceptions about malaria is necesary to institute appropriate preventive and control measures. Thus, the aim of this study was to assess malaria prevalence and knowledge, attitude and practice (KAP) about the disease among ShewaRobit Town community, northeastern Ethiopia.

Methods

A community-based cross-sectional study was conducted in Shewa Robit Town from October to November 2011. A multi-stage random sampling technique was used to select the study participants. A total of 425 individuals were examined for malaria using thin and thick Giemsa stained blood film, and 284 of the participants were interviewed to assess their KAP about malaria. Logistic regression analysis was used to assess predictor factors for malaria prevalence.

Results

All respondents had ever heard of malaria. Most of the respondents (85.2%) attributed the cause of malaria to mosquito bite. However, some of the respondents (>20%) mentioned lack of personal hygiene, exposure to cold weather, hunger, chewing maize stalk, body contact with malaria patient and flies as the causes of malaria. Sleeping under mosquito nets, draining stagnant water and indoor residual spraying were the most frequently mentioned malaria preventive measures perceived and practiced by the respondents. Among 425 individuals examined for malaria, only 2.8% were positive for Plasmodium parasites. Living in houses made of wall without hole, sprayed with insecticide within the last 12 hours and located at a distance of greater than 500 meters from potential mosquito breeding sites as well as knowing and using of mosquito net were significant predictors of low malaria prevalence among the study participants.

Conclusions

A high level of knowledge about the cause, transmission and preventive methods of malaria was detected among the community in Shewa Robit Town. However, a considerable proportion had misconception about the cause and transmission of malaria suggesting the necessity of health education to raise the community’s awareness about the disease.

Epidemiology of Plasmodium knowlesi malaria in north-east Sabah, Malaysia: family clusters and wide age distribution

BACKGROUND

The simian parasite Plasmodium knowlesi is a common cause of human malaria in Malaysian Borneo, with a particularly high incidence in Kudat, Sabah. Little is known however about the epidemiology in this substantially deforested region.

METHODS

Malaria microscopy records at Kudat District Hospital were retrospectively reviewed from January 2009-November 2011. Demographics, and PCR results if available, were recorded for each positive result. Medical records were reviewed for patients suspected of representing family clusters, and families contacted for further information. Rainfall data were obtained from the Malaysian Meteorological Department.

RESULTS

"Plasmodium malariae" mixed or mono-infection was diagnosed by microscopy in 517/653 (79%) patients. Of these, PCR was performed in 445 (86%) and was positive for P. knowlesi mono-infection in 339 (76%). Patients with knowlesi malaria demonstrated a wide age distribution (median 33, IQR 20-50, range 0.7-89 years) with P. knowlesi predominating in all age groups except those <5 years old, where numbers approximated those of Plasmodium falciparum and Plasmodium vivax. Two contemporaneous family clusters were identified: a father with two children (aged 10-11 years); and three brothers (aged one-11 years), all with PCR-confirmed knowlesi malaria. Cases of P. knowlesi demonstrated significant seasonal variation, and correlated with rainfall in the preceding three to five months.

CONCLUSIONS

Plasmodium knowlesi is the most common cause of malaria admissions to Kudat District Hospital. The wide age distribution and presence of family clusters suggest that transmission may be occurring close to or inside people's homes, in contrast to previous reports from densely forested areas of Sarawak. These findings have significant implications for malaria control. Prospective studies of risk factors, vectors and transmission dynamics of P. knowlesi in Sabah, including potential for human-to-human transmission, are needed.

Battling malaria iceberg incorporating strategic reforms in achieving Millennium Development Goals & malaria elimination in India

Malaria control in India has occupied high priority in health sector consuming major resources of the Central and State governments. Several new initiatives were launched from time to time supported by foreign aids but malaria situation has remained static and worsened in years of good rainfall. At times malaria relented temporarily but returned with vengeance at the local, regional and national level, becoming more resilient by acquiring resistance in the vectors and the parasites. National developments to improve the economy, without health impact assessment, have had adverse consequences by providing enormous breeding grounds for the vectors that have become refractory to interventions. As a result, malaria prospers and its control is in dilemma, as finding additional resources is becoming difficult with the ongoing financial crisis. Endemic countries must contribute to make up the needed resources, if malaria is to be contained. Malaria control requires long term planning, one that will reduce receptivity and vulnerability, and uninterrupted financial support for sustained interventions. While this seems to be a far cry, the environment is becoming more receptive for vectors, and epidemics visit the country diverting major resources in their containment, e.g. malaria, dengue and dengue haemorrhagic fevers, and Chikungunya virus infection. In the last six decades malaria has taken deep roots and diversified into various ecotypes, the control of these ecotypes requires local knowledge about the vectors and the parasites. In this review we outline the historical account of malaria and methods of control that have lifted the national economy in many countries. While battles against malaria should continue at the local level, there is a need for large scale environmental improvement. Global Fund for AIDS, Tuberculosis and Malaria has provided huge funds for malaria control worldwide touching US$ 2 billion in 2011. Unfortunately it is likely to decline to US$ 1.5 billion in the coming years against the annual requirement of US$ 5 billion. While appreciating the foreign assistance, we wish to highlight the fact that unless we have internal strength of resources and manpower, sustained battles against malaria may face serious problems in achieving the final goal of malaria elimination.

Association between climatic variables and malaria incidence: a study in Kokrajhar district of Assam, India

A favorable climatic condition for transmission of malaria prevails in Kokrajhar district throughout the year. A sizeable part of the district is covered by forest due to which dissimilar dynamics of malaria transmission emerge in forest and non-forest areas. Observed malaria incidence rates of forest area, non-forest area and the whole district over the period 2001-2010 were considered for analyzing temporal correlation between malaria incidence and climatic variables. Associations between the two were examined by Pearson correlation analysis. Cross-correlation tests were performed between pre-whitened series of climatic variable and malaria series. Linear regressions were used to obtain linear relationships between climatic factors and malaria incidence, while weighted least squares regression was used to construct models for explaining and estimating malaria incidence rates. Annual concentration of malaria incidence was analyzed by Markham technique by obtaining seasonal index. Forest area and non-forest area have distinguishable malaria seasons. Relative humidity was positively correlated with forest malaria incidence, while temperature series were negatively correlated with non-forest malaria incidence. There was higher seasonality of concentration of malaria in the forest area than non-forest area. Significant correlation between annual changes in malaria cases in forest area and temperature was observed (coeff=0.689, p=0.040). Separate reliable models constructed for forecasting malaria incidence rates based on the combined influence of climatic variables on malaria incidence in different areas of the district were able to explain substantial percentage of observed variability in the incidence rates (R2adj=45.4%, 50.6%, 47.2%; p&lt; .001 for all). There is an intricate association between climatic variables and malaria incidence of the district. Climatic variables influence malaria incidence in forest area and non-forest area in different ways. Rainfall plays a primary role in characterizing malaria incidences in the district. Malaria parasites in the district had adapted to a relative humidity condition higher than the normal range for transmission in India. Instead of individual influence of the climatic variables, their combined influence was utilizable for construction of models.

Ten year trend analysis of malaria prevalence in Kola Diba, North Gondar, Northwest Ethiopia

BACKGROUND

Malaria is caused by protozoan parasites of the genus Plasmodium. It is one of the leading causes of illness and death in the world. It is a major public health problem in Ethiopia. Over the past years, the disease has been consistently reported as the first leading cause of outpatient visits, hospitalization and death in health facilities across the country.

METHODS

A retrospective study was conducted to determine the prevalence of malaria from peripheral blood smear examinations from the Kola Diba Health Center of Ethiopia. The case notes of all malaria cases reported between 2002-2011 were carefully reviewed and analyzed. Additionally, any malaria intervention activities that had been taken to control malaria were collected using a well-prepared checklist from the study area.

RESULTS

Within the last decade (2002-2011) a total of 59, 208 blood films were requested for malaria diagnosis in Kola Diba health center and 23,473 (39.6%) microscopically confirmed malaria cases were reported in the town with a fluctuating trend. Regarding the identified plasmodium species, Plasmodium falciparum and Plasmodium vivax accounted for 75% and 25% of malaria morbidity, respectively. Malaria was reported in all age groups and both sexes, but the 15-44 year age group and males were more affected. Despite the apparent fluctuation of malaria trends in the area, the highest peak of malaria cases was reported during spring seasons.

CONCLUSION

Comparatively, after the introduction of the current malaria control strategies, the morbidity and mortality by malaria is decreasing but malaria is still a major health problem and the deadly species P. falciparium is predominant. Therefore, control activities should be continued in a strengthened manner in the study area considering both P. falciparium and P. vivax.

Severe Plasmodium vivax malaria among sudanese children at New Halfa Hospital, Eastern Sudan

BACKGROUND

There are few published reports on severe Plasmodium vivax malaria in Africa.

METHODS

Clinical pattern/manifestations of severe P. vivax were described in children admitted at New Halfa Hospital in Sudan between September 2009-December 2011.

RESULTS

Eighteen children were admitted at the hospital during the study period with different manifestations of severe P. vivax malaria namely: severe anaemia (6, 33.3%), jaundice (5, 27.8%), thrombocytopenia (4, 22.2%), hypotension (3, 16.7%), cerebral malaria (2, 11.1%), epistaxis (2, 11.1%), renal impairment (1, 5.5%), hypogylcaemia and more than one manifestation (5, 27.8%).

CONCLUSION

Severe P. vivax malaria is an existing entity in eastern Sudan. Further studies are required to understand emergence of severe P. vivax malaria.

Malaria pattern observed in the highland fringe of Butajira, Southern Ethiopia: a ten-year retrospective analysis from parasitological and metrological data

Background

Studying the magnitude of highland malaria is necessary to implement effective control measures in highland fringes of Ethiopia. Since repeated epidemics were reported in Butajira, this study hypothesized autochthonous transmission in the highland fringes of Butajira. Thus we aimed to determine the malaria occurrence and its association with meteorological variables in the highland fringe of Butajira, Southern Ethiopia from parasitological and metrological data.

Methods

Retrospective monthly malaria case data was collected from monthly outpatient morbidity reports of the Butajira Health Center, for January 2000 to December 2009. Monthly total rainfall and average temperature (maximum and minimum), which was recorded in Butajira weather station, was obtained from National Meteorological Agency, for the same period. Spearman correlation coefficient was used to quantify the strength of linear relationships between meteorological variables and malaria cases. The effect of each independent variable on malaria cases was assessed using multiple linear regression.

Results

During the study period, a fluctuating trend of malaria cases was observed with Plasmodium vivax (62.5%) dominancy. The highest occurrence of malaria was recorded in 2003, 2004, 2008 and 2009 and the least was recorded in 2000-2002. None of the meteorological variables was positively correlated with monthly malaria cases at zero months lag. However, minimum temperature was positively correlated with total malaria cases, P. vivax and P. falciparum with one month lag. Correlation analysis showed that all of the meteorological variables, except maximum temperature at one month lag, were not significant with total monthly malaria cases and each species of malaria (P-value >0.05) at zero and one month lag effect. Nevertheless, after adjusting for the effect of other variables the linear regression analysis indicated that cumulative monthly rainfall (Beta= -0.24; 95% CI: -0.47, -0.02) at zero months lag and maximum temperature (Beta= -12.13; 95% CI: -23.43, -0.82) at one month lag had a significant negative effect on the total malaria count.

Conclusion

There was no significant association between malaria occurrences and meteorological variables between January 2000 and December 2009; therefore non-climatic factors together with climatic variables should be assessed to know the spread and intensity of malaria in the highland fringe of Butajira. This report also warrants the Ministry of Health to include highland areas in its current malaria controlling campaign so as to address those non-endemic foci of the country.

Random repeated cross sectional study on breeding site characterization of Anopheles sinensis larvae in distinct villages of Yongcheng City, People's Republic of China

BACKGROUND

Characterizing the breeding site of Anopheles sinensis is of major importance for the transition from malaria control to elimination in China. However, little information is available especially regarding the characteristics and influencing factors of breeding sites of An. sinensis in Yongcheng City, a representative region of unstable malaria transmission in the Huang-Huai River region of central China. The aims of this study were to determine the breeding site characteristics of An. sinensis and related environmental and physicochemical parameters, to find out which breeding site characteristics could best explain the presence of An. sinensis larvae, and to determine whether the breeding habit of An. sinensis has changed or not.

METHODS

Random repeated cross sectional study was undertaken in six villages of the Yongcheng city characterized by different levels of the historical incidence of P. vivax malaria. The potential breeding sites of An. sinensis larvae in each village were examined twice per month both in the household courtyards and the village surroundings. The larval sampling was done by the standard dipping method. Some important breeding site characterizations were recorded and characterized. The anopheline mosquito larvae and emerged adults were identified to the species level morphologically and to sub-species by the ribosomal DNA PCR technique. Chi-square analysis and logistic regression analysis were applied to determine the importance of factors for explaining the presence or absence of An. sinensis larvae.

RESULTS

According to the ribosomal DNA PCR assay, all sampled anopheline mosquito larvae and emerged adults belonged to An. sinensis. Only 3 containers that were sampled from the household courtyards were found to contain An. sinensis larvae. There were no differences in the species composition of mosquito larvae among containers that contained water in the household courtyards (P > 0.05). An. sinensis larvae were shown to be present in a total of 60 breeding sites in the village surroundings, this included 8 (13.3%) river fringes, 26 (43.3%) ponds, 23 (38.3%) puddles, and 3 (5.0%) irrigation/drainage ditches. Logistic regression analysis revealed that the breeding site type, water depth, chemical oxygen demand (COD), ammonia nitrogen, and sulphate were found to be the key factors determining the presence of An. sinensis larvae. Approximately 94.9% of An. sinensis larvae inhabited relatively large and medium-sized water bodies, with depths between 0.5 m and 1.0 m (73.3%), COD lower than 2 mg/L (75%), ammonia nitrogen lower than 0.4 mg/L (86.7%), and sulphate lower than 150 mg/L (58.3%), respectively.

CONCLUSION

These results indicate that the majority of An. sinensis larval breeding sites were relatively large and medium-sized water bodies with depths between 0.5 m and 1.0 m, and containing low levels of COD, ammonia nitrogen, and sulphate, respectively. For effective An. sinensis larval control, the type of breeding site, water depth, COD, ammonia nitrogen, and sulphate should be given higher priority over other factors in areas where it is the primary vector.

Prevalence of malaria infection in Butajira area, south-central Ethiopia

Background

In 2005, the Ethiopian government launched a massive expansion of the malaria prevention and control programme. The programme was aimed mainly at the reduction of malaria in populations living below 2,000 m above sea level. Global warming has been implicated in the increase in the prevalence of malaria in the highlands. However, there is still a paucity of information on the occurrence of malaria at higher altitudes. The objective of this study was to estimate malaria prevalence in highland areas of south-central Ethiopia, designated as the Butajira area.

Methods

Using a multi-stage sampling technique, 750 households were selected. All consenting family members were examined for malaria parasites in thick and thin blood smears. The assessment was repeated six times for two years (October 2008 to June 2010).

Results

In total, 19,207 persons were examined in the six surveys. From those tested, 178 slides were positive for malaria, of which 154 (86.5%) were positive for Plasmodium vivax and 22 (12.4%) for Plasmodium falciparum; the remaining two (1.1%) showed mixed infections of Plasmodium falciparum and Plasmodium vivax. The incidence of malaria was higher after the main rainy season, both in lower lying and in highland areas. The incidence in the highlands was low and similar for all age groups, whereas in the lowlands, malaria occurred mostly in those of one to nine years of age.

Conclusion

This study documented a low prevalence of malaria that varied with season and altitudinal zone in a highland-fringe area of Ethiopia. Most of the malaria infections were attributable to Plasmodium vivax.

The abundance and host-seeking behavior of culicine species (Diptera: Culicidae) and Anopheles sinensis in Yongcheng city, People's Republic of China

Background

The knowledge of mosquito species diversity and the level of anthropophily exhibited by each species in a region are of great importance to the integrated vector control. Culicine species are the primary vectors of Japanese encephalitis (JE) virus and filariasis in China. Anopheles sinensis plays a major role in the maintenance of Plasmodium vivax malaria transmission in China. The goal of this study was to compare the abundance and host-seeking behavior of culicine species and An. sinensis in Yongcheng city, a representative region of P. vivax malaria. Specifically, we wished to determine the relative attractiveness of different animal baits versus human bait to culicine species and An. sinensis.

Results

Culex tritaeniorhynchus was the most prevalent mosquito species and An. sinensis was the sole potential vector of P. vivax malaria in Yongcheng city. There were significant differences (P < 0.01) in the abundance of both An. sinensis and Cx. tritaeniorhynchus collected in distinct baited traps. The relative attractiveness of animal versus human bait was similar towards both An. sinensis and Cx. tritaeniorhynchus. The ranking derived from the mean number of mosquitoes per bait indicated that pigs, goats and calves frequently attracted more mosquitoes than the other hosts tested (dogs, humans, and chickens). These trends were similar across all capture nights at three distinct villages. The human blood index (HBI) of female An. sinensis was 2.94% when computed with mixed meals while 3.70% computed with only the single meal. 19:00~21:00 was the primary peak of host-seeking female An. sinensis while 4:00~5:00 was the smaller peak at night. There was significant correlation between the density of female An. sinensis and the average relative humidity (P < 0.05) in Wangshanzhuang village.

Conclusions

Pigs, goats and calves were more attractive to An. sinensis and Cx. tritaeniorhynchus than dogs, humans, and chickens. Female An. sinensis host-seeking activity mainly occurred from 19:00 to 21:00. Thus, we propose that future vector control against An. sinensis and Cx. tritaeniorhynchus in the areas along the Huang-Huai River of central China should target the interface of human activity with domestic animals and adopt before human hosts go to bed at night.

Urban malaria and associated risk factors in Jimma town, south-west Ethiopia

Background

Malaria kills millions around the world. Until recently it was believed to be a disease of rural areas, since the Anopheles mosquito, which transmits Plasmodium species breeds in rural areas. Urban malaria is emerging as a potential, but "avertable" crisis, in Africa. In view of the rapidly growing number of small and medium-sized towns in Ethiopia there is a pressing need to improve the understanding of the epidemiology of malaria. Therefore, the aim of this study was to determine malaria prevalence and associated risk factors in Jimma town.

Methods

A cross-sectional study was carried out in Jimma town from April 1 to May 28, 2010. 804 study participants were included from 291 households for microscopic examination of malaria parasites. Socio-demography data and risk factors were collected using structured questionnaires. Logistic regression analysis was done using SPSS 15.0 statistical software.

Results

From a total of 804 study participants in current survey only 42 (5.2%) were positive for malaria parasites. Plasmodium vivax, Plasmodium falciparum and mixed infection accounted 71.4%, 26.2% and 2.4%, respectively. Higher malaria prevalence rate was observed among under-five children (11%). Those who do not use insecticide-treated bed nets (ITN) were more likely to be infected with malaria (OR = 13.6; 95% CI 4.9-37.2, p < 0.001) compared with those who use the ITN. Living in areas where stagnant water existed (OR = 2.1; 95% CI 1.00-4.2, p = 0.047) and its distance of existence <1 km from the house(OR = 2.1; 95% CI 2.0-15.8, p = 0.001) were more likely to be infected with malaria parasite compared with those who live away from stagnant at a distance greater than 1 km.

Conclusion

Malaria is a major health problem with P. vivax becoming a predominant species in the town. The prevalence was strongly associated with proximity of residence to potential mosquito breeding sites. Malaria is affecting significant proportions of the urban settlers and human activities nevertheless play an important role in bringing the mosquito breeding sites closer to residences.