Deltamethrin treated bednets for control of malaria transmitted by Anopheles culicifacies (Diptera: Culicidae) in India

Biomarkers of oral subacute toxicity of deltamethrin in exposed male Albino rats

Deltamethrin is one of the most effective pyrethroid compounds, widely employed in veterinary medicine, public health, and farming. Deltamethrin-triggered oxidative stress largely causes serious harm to an organism. Acute toxicity of this compound was extensively investigated, while less information is available on its oral sub-acute effects. This study assessed, in the male Albino rats, the effects of oral gavage of either 0.874 mg/kg (0.01 LD50) or 8.740 mg/kg (0.10 LD50) of deltamethrin for successive 14 days to investigate its effects on biomarkers and to detect the tissue injury in rats following subacute deltamethrin treatment. It was found that levels of glutathione peroxidase, superoxide dismutase, and catalase in the brain, kidney, and liver, alkaline phosphatase (ALP), and uric acid in serum, hematocrit, mean corpuscular volume (MCV), white blood cells (WBC)s, eosinophils, and basophils were significantly reduced compared with untreated rats. However, when rats were treated with deltamethrin for successive 14 days, alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) activities in serum and the levels of thiobarbituric acid reactive substances (TBARs) in brain, kidney, and liver, red blood cell distribution width (RDW-CV), total protein, monocytes, and basophils and the ratios of neutrophils to lymphocytes, an aggregated marker of systemic inflammation and systemic immune inflammation indexes, significantly increased compared with the control group. Histologic lesions were observed in the liver, kidney, brain, testis, and epidemies in rats exposed to subacute deltamethrin for 14 days, and most tissues of rats treated with 0.10 LD50 of deltamethrin were more affected than those treated with 0.01 LD50. These findings strongly suggest that subacute exposure to deltamethrin caused significant systemic toxicity through oxidative stress resulting in biochemical and histological changes in the studied tissues. These findings highlight the potential harmful effects of deltamethrin and emphasize the importance of understanding the subacute effects of this compound, particularly in the context of veterinary medicine, public health, and farming.

Mediation of oxidative stress toxicity induced by pyrethroid pesticides in fish

Organophosphate and organochlorine pesticides are banned in most countries because they cause high toxicity and bioaccumulation in non-target organisms. Pyrethroid pesticides have been applied to agriculture and aquaculture since the 1970s to replace traditional pesticides. However, pyrethroids are approximately 1000 times more toxic to fish than to mammals and birds. Fish-specific organs such as the gills and their late metabolic action against this type of pesticide make fish highly susceptible to the toxicity of pyrethroid pesticides. Oxidative stress plays an important role in the neurological, reproductive, and developmental toxicity caused by pyrethroids. Deltamethrin, cypermethrin, and lambda-cyhalothrin are representative pyrethroid pesticides that induce oxidative stress in tissues such as the gills, liver, and muscles of fish and cause histopathological changes. Although they are observed in low concentrations in aquatic environments such as rivers, lakes, and surface water they induce DNA damage and apoptosis in fish. Pyrethroid pesticides cause ROS-mediated oxidative stress in fish species including carp, tilapia, and trout. They also cause lipid peroxidation and alter the state of DNA, proteins, and lipids in the cells of fish. Moreover, changes in antioxidant enzyme activity following pyrethroid pesticide exposure make fish more susceptible to oxidative stress caused by environmental pollutants. In this review, we examine the occurrence of pyrethroid pesticides in the aquatic environment and oxidative stress-induced toxicity in fish exposed to pyrethroids.

Deltamethrin toxicity: A review of oxidative stress and metabolism

Deltamethrin is widely used worldwide due to its valuable insecticidal activity against pests and parasites. Increasing evidence has shown that deltamethrin causes varying degrees of toxicity. Moreover, oxidative stress and metabolism are highly correlated with toxicity. For the first time, this review systematically summarizes the deltamethrin toxicity mechanism from the perspective of oxidative stress, including deltamethrin-mediated oxidative damage, antioxidant status, oxidative signaling pathways and modulatory effects of antagonists, synergists and placebos on oxidative stress. Further, deltamethrin metabolism, including metabolites, metabolic enzymes and pathways and deltamethrin metabolite toxicity are discussed. This review will shed new light on deltamethrin toxicity mechanisms and provide effective strategies to ensure pest control and prevention of human and animal poisoning.

Evaluation of acute toxicity of triazophos and deltamethrin and their inhibitory effect on AChE activity in Channa punctatus

Pesticides are applied to control the pests indoor and outdoor; however, their remarkable amount reaches to the aquatic system through various routes like run-off, leaching, spray-drift, effluent from factories. These are reported to have negative metabolic impact on different non-target aquatic organisms like fishes. Thus, present study is aimed to evaluate the acute toxicity of two groups of pesticides, organophosphate and pyrethroid, namely triazophos and deltamethrin, respectively. The test was conducted for 96 h period in a freshwater teleost, Channa punctatus. The LC₅₀ values for triazophos and deltamethrin after 96 h treatment was found to be 0.069 mg/L and 7.33 μg/L. The deltamethrin was found to be about ten times more toxic than triazophos to the fish. In treated fish, alterations in various behavioural patterns were observed with increasing concentrations of both the pesticides as compared to control. Further, tissue specific as well as dose dependent inhibition in the acetylcholinesterase (AChE, EC 3.1.1.7) activity was found in brain, muscle and gills in Channa punctatus exposed to both the insecticides. However, the effect was more pronounced in triazophos treated fishes than the deltamethrin. A futuristic approach on biochemical and molecular studies may throw light on the mechanism of action of these pesticides.

Effectiveness of insecticide-treated and untreated nets to prevent malaria in India

OBJECTIVES

India is the most malaria-endemic country in South-East Asia, resulting in a high socio-economic burden. Insecticide-treated or untreated nets are effective interventions to prevent malaria. As part of an Indian first-aid guideline project, we aimed to investigate the magnitude of this effect in India.

METHODS

We searched MEDLINE, Embase and Central to systematically review Indian studies on the effectiveness of treated or untreated vs. no nets. Parasite prevalence and annual parasite incidence served as malaria outcomes. The overall effect was investigated by performing meta-analyses and calculating the pooled risk ratios (RR) and incidence rate ratios.

RESULTS

Of 479 articles, we finally retained 16 Indian studies. Untreated nets decreased the risk of parasite prevalence compared to no nets [RR 0.69 (95% CI; 0.55, 0.87) in high-endemic areas, RR 0.49 (95% CI; 0.28, 0.84) in low-endemic areas], as was the case but more pronounced for treated nets [RR 0.35 (95% CI; 0.26, 0.47) in high-endemic areas, risk ratio 0.16 (95% CI; 0.06, 0.44) in low-endemic areas]. Incidence rate ratios showed a similar observation: a significantly reduced rate of parasites in the blood for untreated nets vs. no nets, which was more pronounced in low-endemic areas and for those who used treated nets. The average effect of treated nets (vs. no nets) on parasite prevalence was higher in Indian studies (RR 0.16-0.35) than in non-Indian studies (data derived from a Cochrane systematic review; RR 0.58-0.87).

CONCLUSIONS

Both treated and untreated nets have a clear protective effect against malaria in the Indian context. This effect is more pronounced there than in other countries.

Effects of deltamethrin on biometric parameters and liver biomarkers in common carp (Cyprinus carpio L.)

The present study is aimed to evaluate the effect of sublethal exposure to the pyrethroid pesticide deltamethrin, according to biometric parameters and important liver biomarkers in the common carp (Cyprinus carpio). Fish were exposed for 4, 15 and 30 days to deltamethrin mixed to the aquaria water at the concentrations of 0.08, 0.4 and 0.8μg/L. The exposure did not affect fish biometric parameters. Glutathione-S-transferase (GST) activity in liver (hepatopancreas) increased in fish exposed to the high concentration of pesticide only after 30 days when compared to controls. A significant increase of malondialdehyde (MDA) content (79.4% and 90.2% of control) was remarked after 15 and 30 days of exposure to the highest concentration of pesticide. Catalase activities (CAT) went up after 4 days of was to the concentration of 0.4μg/L and 0.8μg/L and at 15 days of exposure to 0.4μg/L. The most significant change of glutathione reductase (GR) activity was recorded at the fourth day, when GR activity was significantly increased after exposure to the concentrations of 0.4μg/L and 0.8μg/L of deltamethrin.

Contact irritant responses of Aedes aegypti Using sublethal concentration and focal application of pyrethroid chemicals

BACKGROUND

Previous studies have demonstrated contact irritant and spatial repellent behaviors in Aedes aegypti following exposure to sublethal concentrations of chemicals. These sublethal actions are currently being evaluated in the development of a push-pull strategy for Ae. aegypti control. This study reports on mosquito escape responses after exposure to candidate chemicals for a contact irritant focused push-pull strategy using varying concentrations and focal application.

METHODS

Contact irritancy (escape) behavior, knockdown and 24 hour mortality rates were quantified in populations of female Ae. aegypti under laboratory conditions and validated in the field (Thailand and Peru) using experimental huts. Evaluations were conducted using varying concentrations and treatment surface area coverage (SAC) of three pyrethroid insecticides: alphacypermethrin, lambacyhalothrin and deltamethrin.

RESULTS

Under laboratory conditions, exposure of Ae. aegypti to alphacypermethrin using the standard field application rate (FAR) resulted in escape responses at 25% and 50% SAC that were comparable with escape responses at 100% SAC. Significant escape responses were also observed at <100% SAC using ½FAR of all test compounds. In most trials, KD and 24 hour mortality rates were higher in mosquitoes that did not escape than in those that escaped. In Thailand, field validation studies indicated an early time of exit (by four hours) and 40% increase in escape using ½FAR of alphacypermethrin at 75% SAC compared to a matched chemical-free control. In Peru, however, the maximum increase in Ae. aegypti escape from alphacypermethrin-treated huts was 11%.

CONCLUSIONS/SIGNIFICANCE

Results presented here suggest a potential role for sublethal and focal application of contact irritant chemicals in an Ae. aegypti push-pull strategy to reduce human-vector contact inside treated homes. However, the impact of an increase in escape response on dengue virus transmission is currently unknown and will depend on rate of biting on human hosts prior to house exiting.

The dominant Anopheles vectors of human malaria in the Asia-Pacific region: occurrence data, distribution maps and bionomic précis

BACKGROUND

The final article in a series of three publications examining the global distribution of 41 dominant vector species (DVS) of malaria is presented here. The first publication examined the DVS from the Americas, with the second covering those species present in Africa, Europe and the Middle East. Here we discuss the 19 DVS of the Asian-Pacific region. This region experiences a high diversity of vector species, many occurring sympatrically, which, combined with the occurrence of a high number of species complexes and suspected species complexes, and behavioural plasticity of many of these major vectors, adds a level of entomological complexity not comparable elsewhere globally. To try and untangle the intricacy of the vectors of this region and to increase the effectiveness of vector control interventions, an understanding of the contemporary distribution of each species, combined with a synthesis of the current knowledge of their behaviour and ecology is needed.

RESULTS

Expert opinion (EO) range maps, created with the most up-to-date expert knowledge of each DVS distribution, were combined with a contemporary database of occurrence data and a suite of open access, environmental and climatic variables. Using the Boosted Regression Tree (BRT) modelling method, distribution maps of each DVS were produced. The occurrence data were abstracted from the formal, published literature, plus other relevant sources, resulting in the collation of DVS occurrence at 10116 locations across 31 countries, of which 8853 were successfully geo-referenced and 7430 were resolved to spatial areas that could be included in the BRT model. A detailed summary of the information on the bionomics of each species and species complex is also presented.

CONCLUSIONS

This article concludes a project aimed to establish the contemporary global distribution of the DVS of malaria. The three articles produced are intended as a detailed reference for scientists continuing research into the aspects of taxonomy, biology and ecology relevant to species-specific vector control. This research is particularly relevant to help unravel the complicated taxonomic status, ecology and epidemiology of the vectors of the Asia-Pacific region. All the occurrence data, predictive maps and EO-shape files generated during the production of these publications will be made available in the public domain. We hope that this will encourage data sharing to improve future iterations of the distribution maps.

Wash-resistance and field evaluation of alphacypermethrin treated long-lasting insecticidal net (Interceptor) against malaria vectors Anopheles culicifacies and Anopheles fluviatilis in a tribal area of Orissa, India

A field trial was conducted on the efficacy of Interceptor nets-a long-lasting insecticidal net (LLN) factory treated with alphacypermethrin 0.667% (w/w) corresponding to 200mg/m(2), against malaria vectors Anopheles culicifacies and Anopheles fluviatilis in one of the highly endemic areas of Orissa. The study area comprised 19 villages which were randomized into three clusters and designated as Interceptor net cluster, untreated net cluster, and no net cluster. Baseline studies showed that both the vector species An. culicifacies and An. fluviatilis were 100% susceptible to alphacypermethrin. Results of wash-resistance and bio-efficacy of Interceptor nets showed 100% mortality in An. culicifacies and An. fluviatilis even after 20 washings. Bioassays on the Interceptor nets while in use in the field conditions showed a knockdown effect on 70-90% mosquitoes during different months of intervention after 3 min of exposure and 100% mortality was recorded after 24h of recovery period. The median knockdown time for these species ranged between 4.10-5.25 min and 4.00-5.00 min respectively during intervention period. In Interceptor net study area, there was a significant reduction of 88.9, 96.3 and 90.6% in the entry rate of An. culicifacies, An. fluviatilis and other anopheline species respectively with an over all reduction of 87.5% in total mosquitoes. The overall feeding success rate of mosquitoes in the trial villages was only 12.8% in comparison to 35.0 and 78.8% in villages with untreated nets and no nets respectively. A significant reduction was also recorded in parity rate and human blood index of vector species in Interceptor net area. The results of the study showed that Interceptor nets are effective against the malaria vectors and may be used as a suitable intervention strategy in high-risk areas.

Modulatory effects of deltamethrin on antioxidant defense mechanisms and lipid peroxidation in Carassius auratus gibelio liver and intestine

Pyrethroids, such as deltamethrin, are toxic substances that lead to generation of reactive oxygen species, which harm living organisms. We assessed the level and patterns of imbalance evolved by a single dose of 2 microg/L deltamethrin on the lipid peroxidation (LPO) and the antioxidant defense system of Carassius auratus gibelio liver and intestine, and monitored the recovery dynamics of these parameters during a 14-day post-exposure period. LPO and antioxidative defense mechanisms displayed different responses in the investigated tissues. Sudden increase of LPO in the liver, persisting at this elevated level throughout the test period, was observed on the third day post-exposure, while in the intestine significant enhancement of this parameter was recorded from the seventh day. Reduced glutathione (GSH) showed a transient increase in the liver, and was depleted in the intestine by the second day of exposure, with signs of recovery by the end of the experimental tenure. In the liver of fish a temporary inhibition of superoxide dismutase (SOD) and catalase (CAT) activity, and activation of glutathione peroxidase (GPX), glutathione transferase (GST), and glutathione reductase (GR) enzymes was observed, with maximum thresholds recorded on the third and second days, respectively. In the intestine a relevant increase in CAT and GST activity up to the second day and almost complete recovery by the end of the experiment was recorded, while for GR a continuous enhancement was apparent.

Effect of village-wide use of long-lasting insecticidal nets on visceral Leishmaniasis vectors in India and Nepal: a cluster randomized trial

Background

Visceral leishmaniasis (VL) control in the Indian subcontinent is currently based on case detection and treatment, and on vector control using indoor residual spraying (IRS). The use of long-lasting insecticidal nets (LN) has been postulated as an alternative or complement to IRS. Here we tested the impact of comprehensive distribution of LN on the density of Phlebotomus argentipes in VL-endemic villages.

Methods

A cluster-randomized controlled trial with household P. argentipes density as outcome was designed. Twelve clusters from an ongoing LN clinical trial—three intervention and three control clusters in both India and Nepal—were selected on the basis of accessibility and VL incidence. Ten houses per cluster selected on the basis of high pre-intervention P. argentipes density were monitored monthly for 12 months after distribution of LN using CDC light traps (LT) and mouth aspiration methods. Ten cattle sheds per cluster were also monitored by aspiration.

Findings

A random effect linear regression model showed that the cluster-wide distribution of LNs significantly reduced the P. argentipes density/house by 24.9% (95% CI 1.80%–42.5%) as measured by means of LTs.

Interpretation

The ongoing clinical trial, designed to measure the impact of LNs on VL incidence, will confirm whether LNs should be adopted as a control strategy in the regional VL elimination programs. The entomological evidence described here provides some evidence that LNs could be usefully deployed as part of the VL control program.

Trial registration

ClinicalTrials.gov CT-2005-015374

Visceral leishmaniasis (VL) is a vector-borne disease causing at least 60,000 deaths each year amongst an estimated half million cases, and until recently there have been no significant initiatives to reduce this burden. However, in 2005, the governments of India, Bangladesh and Nepal signed a memorandum of understanding at the World Health Assembly in Geneva for the elimination of the disease by 2015. In the absence of an effective vaccine, the program will rely on the active detection and prompt treatment of cases throughout the endemic region, combined with a recurrent indoor residual spraying (IRS) of all villages at risk. Vector control programs based on IRS are notorious for failing to maintain comprehensive spray coverage over time owing to logistical problems and lack of compliance by householders. Long-lasting insecticidal nets (LNs) have been postulated as an alternative or complement to IRS. Here we describe how comprehensive coverage of LN in trial communities reduced the indoor density of sand flies by 25% compared to communities without LNs. This provides an indication that LNs could be usefully deployed as a component of the VL control program in the Indian subcontinent.

Field evaluation of Olyset nets: a long-lasting insecticidal net against malaria vectors Anopheles culicifacies and Anopheles fluviatilis in a hyperendemic tribal area of Orissa, India

A village-scale trial was conducted on the efficacy of Olyset nets: a long-lasting insecticidal net (LLIN) factory treated with 2% wt:wt permethrin against malaria vectors Anopheles culicifacies Giles and Anopheles fluviatilis James, in Sundargarh District, Orissa, India. The study area comprised 22 villages that were randomized into three clusters and designated as Olyset net, untreated net, and no net clusters. Baseline studies showed that both vector species were 100% susceptible to permethrin. Results of wash resistance and bioefficacy of Olyset nets showed 100% mortality in An. culicifacies up to 11 washings, whereas 100% mortality was observed in An. fluviatilis even after 20 washings. The median knock-down time for these species ranged between 4.55-6.00 and 4.45-5.45 min, respectively, during 1 yr of intervention. In the Olyset net study area, there was a significant reduction of 80.6, 94.1, and 76.7% in the entry rate of An. culicifacies, An. fluviatilis, and other anopheline species, respectively, with an overall reduction of 63.5% in total mosquitoes. Floor sheet collections in houses with Olyset nets indicated 39% immediate mortality in total mosquitoes. The overall feeding success rate of mosquitoes in the trial village was only 18.0% in comparison to 44.2 and 79.1% in villages with untreated nets and no nets, respectively. A significant reduction was also recorded in parity rate and human blood index of vector species in the Olyset net area. This study showed that Olyset nets are an effective personal protection tool that can be used in a community-based intervention program.

Effectiveness of mosquito nets treated with a tablet formulation of deltamethrin for malaria control in a hyperendemic tribal area of Sundargarh District, Orissa, India

A village-scale trial on the efficacy of mosquito nets treated with a tablet formulation of deltamethrin (K-OTAB) against malaria in comparison to untreated nets or no net was conducted in Sundargarh District of Orissa, India, which is characterized by perennial transmission with Plasmodium falciparum accounting for more than 80% of malaria cases. Three villages with similar topographical and epidemiological situations were selected and randomly assigned to 3 arms of the study: treated net, untreated net, and no net. Distribution of nets, based on a sleeping pattern survey, was carried out to cover 100% of the population in treated-net and untreated-net villages. Longitudinal and cross-sectional surveys were conducted to measure malaria incidence, prevalence, and splenomegaly. Malaria incidence was reduced by 64.3% in the village with treated nets, 45.2% in the village with plain nets, and 21.4% in the control village without nets. Comparison of malaria incidence data after 1 year of intervention showed significant difference between villages with treated net vs. untreated net (P < 0.05) and treated net vs. no net (P < 0.005). The incidence of clinical attack rate due to P. falciparum was significantly lower in the population using treated nets than in those using untreated nets and no nets. However, no age-specific protective efficacy of treated nets or untreated nets was observed. A significant reduction occurred in spleen rate and parasite rate in children aged 2-9 years using treated nets or untreated nets. An overall significant reduction was found in parasite rate in the total population using treated and untreated nets as compared to nonusers.

Modulatory effect of cadmium exposure on deltamethrin-induced oxidative stress in Channa punctata Bloch

The modulatory effect of cadmium pretreatment (0.2 mg/kg b.w. i.p.) on deltamethrin-induced oxidative stress and alterations of antioxidants was studied in freshwater fish Channa punctata Bloch. Lipid peroxidation (LPO) was measured as one of the indicators of oxidative stress. Activities of glutathione peroxidase, glutathione reductase, and glutathione-S-transferase were also studied in liver, kidney, and gills. Levels of reduced glutathione (GSH) were measured in various tissues. Fish pretreated with cadmium and subsequently exposed to deltamethrin showed significantly reduced LPO values when compared with deltamethrin-exposed fish. Conversely, in the kidney, a potentiation response was observed. Deltamethrin exposure in fish resulted in significant alteration in activities of glutathione-dependent antioxidant enzymes. In the cadmium preexposed fish, which were subsequently exposed to deltamethrin, antioxidant enzymes showed a tendency toward normalization over deltamethrin-only exposed fish in liver and gills. GSH also showed a similar pattern in liver and gills but in kidney it remained elevated. Cadmium alone had no significant effect on various parameters at the concentration used in this study. When metallothionein (MT) induction was studied, only liver showed an MT-like protein band in sodium dodecylsulfate-polyacrylamide gel electrophoresis analysis. These results demonstrate a modulatory role of cadmium on the oxidative stress and other related parameters in liver and gills. These findings are important in the context of exposure to a mixture of pollutants in aquatic environment.

Village-scale evaluation of mosquito nets treated with a tablet formulation of deltamethrin against malaria vectors

A field trial was carried out in the Sundargarh district of Orissa, India on the efficacy of mosquito nets treated with a tablet formulation of deltamethrin (K-O TAB) against malaria vectors. Treated nets were used in one village, and in the two control villages, one used untreated nets and the other used indoor spraying with DDT, without nets. In this area the primary malaria vectors are Anopheles culicifacies Giles sensu lato (Diptera: Culicidae) and An. fluviatilis James s.l., which are both endophagic and endophilic, and fully susceptible to deltamethrin. Treatment of a 10-m(2) mosquito net with one of the tablets gave a deltamethrin deposit of 25 mg/m(2). Bioassays repeated on domestically used nets over 7 months showed persistence of almost 100% mortality of An. fluviatilis, whereas An. culicifacies showed a decline from 100% to 71% mortality over this period, after which the nets were re-treated and bioassays were not continued. The sum of collections of mosquitoes resting in village houses and those in exit traps and dead on floor sheets showed a reduction in the numbers of the two vector species due to the treated nets, compared with untreated or no nets, but no reduction in other anophelines or Culex species. Large proportions of the collections of the vector and non-vector anophelines were dead on the floor sheets, but among Culex, mortality was delayed. Treated and untreated nets reduced the proportion of anophelines that had blood-fed; the treated nets did so more effectively than the untreated in the case of An. culicifacies and of Culex mosquitoes. In rooms with treated nets a larger proportion of the total collections [dead + live] were in the exit traps, which can be attributed to the excito-repellent effect of deltamethrin. It is easier to pack and handle tablets of insecticide than liquid concentrate and the use of one tablet per net may be preferable to making up a large volume of diluted insecticide and dipping many nets at a time.

Persistence and wash-resistance of insecticidal efficacy of nettings treated with deltamethrin tablet formulation (K-O TAB) against malaria vectors

Persistence, wash-resistance, and shelf life of mosquito nets treated with a water-dispersible tablet formulation of synthetic pyrethroid insecticide deltamethrin (K-O TAB) at 25 mg/m2 was evaluated against malaria vectors in India. During June 2001, treated and untreated polyester, nylon, and cotton nets were separately distributed in 3 villages and cone bioassays were performed on Anopheles culicifacies and An. stephensi 1 day after treatment and thereafter every month for 12 months. The mosquitoes were exposed for 3 min on the nettings (treated and unwashed, or treated and washed once or twice in 3 months, and untreated) and knock-down (1 h) and 24 h postexposure mortality were recorded. Unwashed polyester nets, and those washed once 1 month after treatment, gave 100% mortality in An. culicifacies for 6 months. A 2nd wash at 3 months after treatment marginally reduced the insecticidal action. Anopheles stephensi was fully susceptible up to 4 months when exposed to unwashed nets but washing considerably reduced insecticidal action (65-78% after 2 washes). Treated nylon and cotton nets were effective for 4 months on both vectors. Treated nets kept on shelf retained 100% efficacy for 10 months. Overall, the treated nets gave a considerably long persistence of insecticidal action even after a single wash. Treated polyester nets were found most effective. Compared with our earlier experiences of using liquid formulations, the tablet formulation is likely to have a better community acceptance in treating nets.

Cost-effectiveness of malaria control interventions when malaria mortality is low: insecticide-treated nets versus in-house residual spraying in India

Malaria is one of the leading causes of morbidity and mortality in the developing world and a major public health problem in India. Disillusioned by in-house residual spraying (IRS), and increasingly aware that insecticide-treated nets (ITNs) have proved to be effective in reducing malaria mortality and morbidity in various epidemiological settings, policy-makers in India are keen to identify which is the more cost-effective malaria control intervention. A community randomised controlled trial was set up in Surat to compare the effectiveness and efficiency of IRS and ITNs. Both control strategies were shown to be effective in preventing malaria over the base-case scenario of early diagnosis and prompt treatment. The mean costs per case averted for ITNs was statistically significantly lower (Rs. 1848, 1567-2209; US$ 52) than IRS (Rs. 3121, 2386-4177, US$ 87). The incremental cost-effectiveness ratio for ITNs over IRS was Rs. 799 (US$ 22). The conclusions were robust to changes in assumptions. This study expands the scope of recent comparative economic evaluations of ITNs and IRS, since it was carried out in a low mortality malaria endemic area.

Insecticide-treated bed nets and curtains for preventing malaria

BACKGROUND

Malaria is an important cause of illness and death in many parts of the world, especially in sub-Saharan Africa. There has been a renewed emphasis on preventive measures at community and individual levels. Insecticide-treated nets (ITNs) are the most prominent malaria preventive measure for large-scale deployment in highly endemic areas.

OBJECTIVES

To assess the impact of insecticide-treated bed nets or curtains on mortality, malarial illness (life-threatening and mild), malaria parasitaemia, anaemia, and spleen rates.

SEARCH STRATEGY

I searched the Cochrane Infectious Diseases Group trials register (January 2003), CENTRAL (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to October 2003), EMBASE (1974 to November 2002), LILACS (1982 to January 2003), and reference lists of reviews, books, and trials. I handsearched journals, contacted researchers, funding agencies, and net and insecticide manufacturers.

SELECTION CRITERIA

Individual and cluster randomized controlled trials of insecticide-treated bed nets or curtains compared to nets without insecticide or no nets. Trials including only pregnant women were excluded.

DATA COLLECTION AND ANALYSIS

The reviewer and two independent assessors reviewed trials for inclusion. The reviewer assessed trial methodological quality and extracted and analysed data.

MAIN RESULTS

Fourteen cluster randomized and eight individually randomized controlled trials met the inclusion criteria. Five trials measured child mortality: ITNs provided 17% protective efficacy (PE) compared to no nets (relative rate 0.83, 95% confidence interval (CI) 0.76 to 0.90), and 23% PE compared to untreated nets (relative rate 0.77, 95% CI 0.63 to 0.95). About 5.5 lives (95% CI 3.39 to 7.67) can be saved each year for every 1000 children protected with ITNs. In areas with stable malaria, ITNs reduced the incidence of uncomplicated malarial episodes in areas of stable malaria by 50% compared to no nets, and 39% compared to untreated nets; and in areas of unstable malaria: by 62% for compared to no nets and 43% compared to untreated nets for Plasmodium falciparum episodes, and by 52% compared to no nets and 11% compared to untreated nets for P. vivax episodes. When compared to no nets and in areas of stable malaria, ITNs also had an impact on severe malaria (45% PE, 95% CI 20 to 63), parasite prevalence (13% PE), high parasitaemia (29% PE), splenomegaly (30% PE), and their use improved the average haemoglobin level in children by 1.7% packed cell volume.

REVIEWERS' CONCLUSIONS

ITNs are highly effective in reducing childhood mortality and morbidity from malaria. Widespread access to ITNs is currently being advocated by Roll Back Malaria, but universal deployment will require major financial, technical, and operational inputs.

Oxidative stress biomarkers of exposure to deltamethrin in freshwater fish, Channa punctatus Bloch

The pyrethroid class of insecticides, including deltamethrin, are being used as substitutes for organochlorines and organophosphates in pest-control programs because of their low environmental persistence and toxicity. Ecotoxicological consequences of deltamethrin, particularly its effects on antioxidants in fish and other aquatic organisms, are not well understood. We investigated the effect of deltamethrin (0.75 microg/L) on antioxidants in a freshwater fish, Channa punctatus Bloch, using standard laboratory conditions. A single exposure for 48 h caused induction of various antioxidant enzymes and nonenzymatic antioxidants in kidney and liver. The induction of these antioxidants was not very prominent in gills. In fact, certain antioxidants were found to be depleted in gills. Catalase activity was decreased in all the tissues. Deltamethrin also induced lipid peroxidation in all the tissues, gills showing the highest levels. Glutathione, which is an established nonenzymatic antioxidant in fish, was significantly (P<0.001) increased in all the tissues. Ascorbic acid content increased in kidney and liver while it decreased in gills. The findings of the present investigation show that deltamethrin has oxidative-stress-inducing potential in fish, and gills are the most sensitive organs. It is also interesting to note that gills are the primary sites of deltamethrin absorption and their antioxidant potential is also very poor. The various parameters studied in this investigation can also be used as biomarkers of exposure to deltamethrin. It is suggested that appropriate ecotoxicological risk assessment should be made in the areas where deltamethrin is proposed to be used in pest control activities.

House-scale evaluation of bifenthrin indoor residual spraying for malaria vector control in India

In an area of India where the main rural malaria vector, Anopheles culicifacies Giles, has developed triple resistance to DDT, HCH, and malathion sprayed indoors in antimalaria program, bifenthrin (10% wettable powder) was evaluated in a randomized house-scale trial between July 1999 and March 2000. Entomological impact of four serial doses of bifenthrin (25, 50, 100, and 200 mg/m2) sprayed in rooms in five villages was compared with malathion (2 g/m2) and unsprayed control. An. culicifacies was 100% susceptible to bifenthrin (0.1%), but only 57% to malathion (5%) test papers. Contact bioassays were carried out on sprayed surfaces for 24 wk, and 24 h mortality in An. culicifacies was recorded. Bifenthrin 100- and 200-mg doses caused > or = 80% mortality until 24 wk. The 50-mg dose caused > or = 80% mortality on tin, wood, and mud surfaces for 24 wk, and on brick walls for 16 wk. Bifenthrin 25-mg dose produced > or = 80% mortality for 24 wk on tin, 20 wk on mud walls, 16 wk on brick walls, and 8 wk on wood surfaces. Persistence of > or = 80% mortality did not differ for 25- and 50-mg doses on any surface except on wood (P < 0.05). Malathion sprayed in three rounds of 6 wk apart caused > or = 80% mortality for 16 wk on the brick and mud walls, and for 20 wk on the tin and wood surfaces. Bifenthrin 25- and 50-mg doses produced a similar impact on the densities of An. culicifacies and other mosquitoes but a superior one to malathion or control. Bifenthrin 25-mg dose caused least excitorepellency. Overall, efficacy of bifenthrin was superior to malathion. Considering the duration of the persistence of significant insecticidal action of bifenthrin on the most common surfaces (mud and brick walls), least excito-repellency and a relative impact on the mosquito densities, the 25-mg dose was the most superior among all the four doses evaluated.

Insecticide-treated bednets and curtains for preventing malaria

BACKGROUND

Malaria is an important cause of illness and death in many parts of the world, especially in Africa. There has been a renewed emphasis on preventive measures, both at community and at individual level. Insecticide treated bednets and curtains are a promising preventive measure.

OBJECTIVES

The objective of this review was to assess the effects of insecticide-treated bednets or curtains in preventing malaria

SEARCH STRATEGY

We searched the Cochrane Infectious Diseases Group trials register, Medline, Embase and the reference lists of articles. We handsearched journals, contacted researchers, funding agencies and net and insecticide manufacturers.

SELECTION CRITERIA

Randomized and quasi-randomized trials of insecticide-treated bednets or curtains with a sufficient dose of a suitable insecticide compared with nets without insecticide or no nets at all. Studies including pregnant women were excluded.

DATA COLLECTION AND ANALYSIS

Trial quality was assessed and data extracted by the reviewer. Trial inclusions/exclusions were reviewed by two independent individuals.

MAIN RESULTS

Of 65 identified studies, 18 were included. Of these, 11 were randomized by cluster rather than individually. Mortality in children under five was measured in four trials. When impregnated nets were compared with plain nets or no nets, the summary relative risk was 0. 83. This translates to an estimate of protective efficacy of 17%. For treated nets compared with untreated nets, the relative risk of child mortality was 0.77. About six lives can be saved each year for every 1000 children protected with insecticide-treated nets. Insecticide-treated nets also reduced the incidence of mild malarial episodes by 48% (controls=no nets) and 34% (controls=untreated nets).

REVIEWER'S CONCLUSIONS

Insecticide-treated nets appear to be effective in reducing childhood mortality and morbidity from malaria. Widespread access to insecticide-treated nets will require major financial, technical and operational inputs.