People's perceptions about malaria transmission and control using mosquito repellent plants in a locality in Zimbabwe

Six decades of malaria vector control in southern Africa: a review of the entomological evidence-base

BACKGROUND

Countries in the southern Africa region have set targets for malaria elimination between 2020 and 2030. Malaria vector control is among the key strategies being implemented to achieve this goal. This paper critically reviews published entomological research over the past six decades in three frontline malaria elimination countries namely, Botswana Eswatini and Namibia, and three second-line malaria elimination countries including Mozambique, Zambia, and Zimbabwe. The objective of the review is to assess the current knowledge and highlight gaps that need further research attention to strengthen evidence-based decision-making toward malaria elimination.

METHODS

Publications were searched on the PubMed engine using search terms: "(malaria vector control OR vector control OR malaria vector*) AND (Botswana OR Swaziland OR Eswatini OR Zambia OR Zimbabwe OR Mozambique)". Opinions, perspectives, reports, commentaries, retrospective analysis on secondary data protocols, policy briefs, and reviews were excluded.

RESULTS

The search resulted in 718 publications with 145 eligible and included in this review for the six countries generated over six decades. The majority (139) were from three countries, namely Zambia (59) and Mozambique (48), and Zimbabwe (32) whilst scientific publications were relatively scanty from front-line malaria elimination countries, such as Namibia (2), Botswana (10) and Eswatini (4). Most of the research reported in the publications focused on vector bionomics generated mostly from Mozambique and Zambia, while information on insecticide resistance was mostly available from Mozambique. Extreme gaps were identified in reporting the impact of vector control interventions, both on vectors and disease outcomes. The literature is particularly scanty on important issues such as change of vector ecology over time and space, intervention costs, and uptake of control interventions as well as insecticide resistance.

CONCLUSIONS

The review reveals a dearth of information about malaria vectors and their control, most noticeable among the frontline elimination countries: Namibia, Eswatini and Botswana. It is of paramount importance that malaria vector research capacity and routine entomological monitoring and evaluation are strengthened to enhance decision-making, considering changing vector bionomics and insecticide resistance, among other determinants of malaria vector control.

Progress towards malaria elimination in Zimbabwe with special reference to the period 2003-2015

BACKGROUND

An intensive effort to control malaria in Zimbabwe has produced dramatic reductions in the burden of the disease over the past 13 years. The successes have prompted the Zimbabwe's National Malaria Control Programme to commit to elimination of malaria. It is critical to analyse the changes in the morbidity trends based on surveillance data, and scrutinize reorientation to strategies for elimination.

METHODS

This is a retrospective study of available Ministry of Health surveillance data and programme reports, mostly from 2003 to 2015. Malaria epidemiological data were drawn from the National Health Information System database. Data on available resources, malaria control strategies, morbidity and mortality trends were analysed, and opportunities for Zimbabwe malaria elimination agenda was perused.

RESULTS

With strong government commitment and partner support, the financial gap for malaria programming shrank by 91.4% from about US$13 million in 2012 to US$1 million in 2015. Vector control comprises indoor residual house spraying (IRS) and long-lasting insecticidal nets, and spray coverage increased from 28% in 2003 to 95% in 2015. Population protected by IRS increased also from 20 to 96% for the same period. In 2009, diagnostics improved from clinical to parasitological confirmation either by rapid diagnostic tests or microscopy. Artemisinin-based combination therapy was used to treat malaria following chloroquine resistance in 2000, and sulfadoxine-pyrimethamine in 2004. In 2003, there were 155 malaria cases per 1000 populations reported from all health facilities throughout the country. The following decade witnessed a substantial decline in cases to only 22 per 1000 populations in 2012. A resurgence was reported in 2013 (29/1000) and 2014 (39/1000), thereafter morbidity declined to 29 cases per 1000 populations, only to the same level as in 2013. Overall, morbidity declined by 81% from 2003 to 2015. Inpatient malaria deaths per 100,000 populations doubled in 4 years, from 2/100,000 to 4/100,000 populations in 2012-2015 respectively. Twenty of the 47 moderate to high burdened districts were upgraded from control to malaria pre-elimination between 2012 and 2015.

CONCLUSIONS

A significant progress to reduce malaria transmission in Zimbabwe has been made. While a great potential and opportunities to eliminate malaria in the country exist, elimination is not a business as usual approach. Instead, it needs an improved, systematic and new programmatic strategy supported strongly by political will, sustained funding, good leadership, community engagement, and a strong monitoring and evaluation system all year round until the cessation of local transmission.

Lippia javanica (Burm.f.) Spreng.: Traditional and Commercial Uses and Phytochemical and Pharmacological Significance in the African and Indian Subcontinent

Lippia javanica occurs naturally in central, eastern, and southern Africa and has also been recorded in the tropical Indian subcontinent. The potential of L. javanica as herbal or recreational tea and herbal medicine and its associated phytochemistry and biological properties are reviewed. The extensive literature survey revealed that L. javanica is used as herbal tea and has ethnomedicinal applications such as in colds, cough, fever, malaria, wounds, diarrhoea, chest pains, bronchitis, and asthma. Multiple classes of phytochemicals including volatile and nonvolatile secondary metabolites such as alkaloids, amino acids, flavonoids, iridoids, and triterpenes as well as several minerals have been identified from L. javanica. Scientific studies on L. javanica indicate that it has a wide range of pharmacological activities which include anticancer, antiamoebic, antidiabetic, antimalarial, antimicrobial, antioxidant, antiplasmodial, and pesticidal effects. Although many of the traditional uses of L. javanica have been validated by phytochemical and pharmacological studies, there are still some gaps where current knowledge could be improved. Lippia javanica is popular as both herbal and recreational tea, but there is need for more precise studies to evaluate the safety and clinical value of its main active crude and pure compounds and to clarify their mechanisms of action.

Medicinal plants used by traditional healers for the treatment of malaria in the Chipinge district in Zimbabwe

ETHNOPHARMACOLOGICAL RELEVANCE

Because about 50% of the Zimbabwean population is at risk of contracting malaria each year, the majority of people, especially in rural areas, use traditional plant-based medicines to combat malaria. This explorative ethnobotanical survey was undertaken to document how malaria is conceptualized and diagnosed by traditional healers, and to record the medicinal plants used in the prevention and treatment of malaria, their mode of preparation and administration.

MATERIALS AND METHODS

The research was conducted in three villages in Headman Muzite׳s area and in Chiriga village. These villages are located in the Chipinge district in the Manicaland Province in Zimbabwe.Traditional healers were selected with the assistance of the headman of the Muzite area and a representative of the Zimbabwe National Traditional Healers Association. Semi-structured interviews were conducted with 14 traditional healers from four villages in the Chipinge district in Zimbabwe.

RESULTS

In total, 28 plants from 16 plant families are used by the healers who manage malaria with medicinal plants. The most cited plant is Cassia abbreviata Oliv. (Leguminosae) followed by Aristolochia albida Duch (Aristolociaceae) and Toddalia asiatica (L.) Lam. (Rutaceae). Roots (55.3%) are the most common part used. Most of the plant parts used to treat malaria are stored as dried powders in closed bottles. The powders are soaked in hot or cold water and the water extract is taken as the active medicine. The healers consider their medicinal knowledge as a spiritual family heritage. Only 25% of the healers refer the malaria patients that do not respond to their treatment to hospital - they believe evil spirits cause their remedies to failure and they would rather try a different plant or perform a cleansing ceremony.

CONCLUSIONS

Local knowledge of medicinal plants in the treatment of malaria still exists in all four villages surveyed and traditional healers appear to play an important role in primary health care services in this remote rural area in Zimbabwe. This explorative survey underscores the need to preserve and document traditional healing for managing malaria and for more future scientific research on the plants to determine their efficacy and their safety. This could improve their traditional anti-malarial recipes and might contribute to a better integration of Zimbabwean traditional medicine into the national health system in the future.

Changes in the burden of malaria following scale up of malaria control interventions in Mutasa District, Zimbabwe

Background

To better understand trends in the burden of malaria and their temporal relationship to control activities, a survey was conducted to assess reported cases of malaria and malaria control activities in Mutasa District, Zimbabwe.

Methods

Data on reported malaria cases were abstracted from available records at all three district hospitals, three rural hospitals and 25 rural health clinics in Mutasa District from 2003 to 2011.

Results

Malaria control interventions were scaled up through the support of the Roll Back Malaria Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and The President’s Malaria Initiative. The recommended first-line treatment regimen changed from chloroquine or a combination of chloroquine plus sulphadoxine/pyrimethamine to artemisinin-based combination therapy, the latter adopted by 70%, 95% and 100% of health clinics by 2008, 2009 and 2010, respectively. Diagnostic capacity improved, with rapid diagnostic tests (RDTs) available in all health clinics by 2008. Vector control consisted of indoor residual spraying and distribution of long-lasting insecticidal nets. The number of reported malaria cases initially increased from levels in 2003 to a peak in 2008 but then declined 39% from 2008 to 2010. The proportion of suspected cases of malaria in older children and adults remained high, ranging from 75% to 80%. From 2008 to 2010, the number of RDT positive cases of malaria decreased 35% but the decrease was greater for children younger than five years of age (60%) compared to older children and adults (26%).

Conclusions

The burden of malaria in Mutasa District decreased following the scale up of malaria control interventions. However, the persistent high number of cases in older children and adults highlights the need for strategies to identify locally effective control measures that target all age groups.

Malaria epidemiology and control in Southern Africa

The burden of malaria has decreased dramatically within the past several years in parts of sub-Saharan Africa, following the scale-up of interventions supported by the Roll Back Malaria Partnership, the President's Malaria Initiative and other partners. It is important to appreciate that the reductions in malaria have not been uniform between and within countries, with some areas experiencing resurgence instead. Furthermore, while interventions have greatly reduced the burden of malaria in many countries, it is also recognized that the malaria decline pre-dated widespread intervention efforts, at least in some cases where data are available. This raises more questions as what other factors may have been contributing to the reduction in malaria transmission and to what extent. The International Center of Excellence for Malaria Research (ICEMR) in Southern Africa aims to better understand the underlying malaria epidemiology, vector ecology and parasite genomics using three contrasting settings of malaria transmission in Zambia and Zimbabwe: an area of successful malaria control, an area of resurgent malaria and an area where interventions have not been effective. The Southern Africa ICEMR will capitalize on the opportunity to investigate the complexities of malaria transmission while adapting to intervention and establish the evidence-base to guide effective and sustainable malaria intervention strategies. Key approaches to attain this goal for the region will include close collaboration with national malaria control programs and contribution to capacity building at the individual, institutional and national levels.

Fresh, dried or smoked? Repellent properties of volatiles emitted from ethnomedicinal plant leaves against malaria and yellow fever vectors in Ethiopia

BACKGROUND

In the search for plant-based mosquito repellents, volatile emanations were investigated from five plant species, Corymbia citriodora, Ocimum suave, Ocimum lamiifolium, Olea europaea and Ostostegia integrifolia, traditionally used in Ethiopia as protection against mosquitoes.

METHODS

The behaviour of two mosquitoes, the malaria vector Anopheles arabiensis and the arbovirus vector Aedes aegypti, was assessed towards volatiles collected from the headspace of fresh and dried leaves, and the smoke from burning the dried leaves in a two-choice landing bioassay and in the background of human odour.

RESULTS

Volatile extracts from the smoke of burning dried leaves were found to be more repellent than those from fresh leaves, which in turn were more repellent to mosquitoes than volatiles from dried leaves. Of all smoke and fresh volatile extracts, those from Co. citriodora (52-76%) and Oc. suave (58-68%) were found to be the most repellent, Os. integrifolia (29-56%) to be intermediate while Ol. europaea (23-40%) and Os. integrifolia (19-37%) were the least repellent. One volatile present in each of the fresh leaf extracts of Co. citriodora, Oc. suave and Os. integrifolia was ß-ocimene. The levels of ß-ocimene reflected the mosquito repellent activity of these three fresh leaf extracts. Female host-seeking mosquitoes responded dose-dependently to ß-ocimene, both physiologically and behaviourally, with a maximal behavioural repulsion at 14% ß-ocimene. ß-ocimene (14%) repels mosquitoes in our 6-minute landing assays comparable to the synthetic insect repellent N,N-diethyl-m-toluamide (10% DEET).

CONCLUSIONS

Volatiles in the smoke of burning as well as fresh leaves of Co. citriodora and Oc. suave have significant repellent properties against host seeking An. arabiensis and Ae. aegypti mosquitoes. ß-ocimene, present in the fresh leaf headspace of Co. citriodora, Oc. suave and Os. integrifolia, is a significantly effective volatile mosquito repellent in the laboratory. In addition to its repellent properties, ß-ocimene has long approved safe for use in food and cosmetics, making this volatile an intriguing compound to pursue in further tests in the laboratory and field to validate its mosquito repellent activity and potential for use in a commercial product. Also, the landing bioassay with humanised membranes is a potentially useful repellent screening technique that does not require the exposure of humans to the vectors, however further tests in parallel with conventional techniques are advised.

An ethnobotanical survey of mosquito repellent plants in uMkhanyakude district, KwaZulu-Natal province, South Africa

ETHNOPHARMACOLOGICAL RELEVANCE

The aim of the study was to document plants traditionally used to repel mosquitoes in the uMkhanyakude district, KwaZulu-Natal, South Africa. The specific objectives of the study were to: (1) identify plant species and their parts being used; (2) determine the condition of plant material used and the method of application.

MATERIALS AND METHODS

Data was collected from 60 respondents in five villages in the district using standardised and pre-tested questionnaires.

RESULTS

Thirteen plant species are used in the study area to repel mosquitoes. These species belong to 11 genera from 9 families. Meliaceae and Anacardiaceae were the most represented families with two species each. The most frequently recorded species were Lippia javanica (91.67%), followed by Aloe ferox (11.67%), Sclerocarya birrea (5%), Melia azedarach (3%), Balanite maughamii (3%) and Mangifera indica (3%). Leaves were the most (38%) common plant part used. The majority (82%) of the plant parts were used in a dry state. Burning of plant materials to make smoke was the most (92%) common method of application. Nine plant species, namely: A. ferox, Calausena anista, Croton menyharthii, S. birrea, B. maughamii, Olax dissitiflora, Trichilia emetic, M. indica, and Atalaya alata are documented for the first time as mosquito repellents.

CONCLUSION

This documentation provides the basis for further studies in developing new, effective, safe and affordable plant-derived mosquito repellents especially for Africa where malaria is highly prevalent. The study also plays a part in documenting and conserving traditional knowledge of mosquito repellent plants for future use.

Knowledge attitudes and practices of grade three primary schoolchildren in relation to schistosomiasis, soil transmitted helminthiasis and malaria in Zimbabwe

BACKGROUND

Helminth infection rates in grade three children are used as proxy indicators of community infection status and to guide treatment strategies in endemic areas. However knowledge, attitudes and practices (KAP) of this target age group (8-10 years) in relation to schistosomiasis, soil transmitted helminthiasis (STHs) and malaria is not known at a time when integrated plasmodium - helminth control strategies are being advocated. This study sought to assess KAP of grade 3 children in relation to schistosomiasis, STHs and malaria in order to establish an effective school based health education for disease transmission control.

METHODS

Grade 3 children (n = 172) attending four randomly selected primary schools (one in rural and 3 in the commercial farming areas) in Zimbabwe were interviewed using a pre-tested interviewer administered questionnaire. The urine filtration technique was used to determine S. haematobium infection status. Infection with S. mansoni and STHs was determined using a combination of results from the Kato Katz and formol ether concentration techniques. P. falciparum was diagnosed by examination of Giemsa stained thick blood smears.

RESULTS

It was observed that 32.0%, 19.2% and 4.1% of the respondents had correct knowledge about the causes of schistosomiasis, malaria and STHs, respectively, whilst 22.1%, 19.2% and 5.8% knew correct measures to control schistosomiasis, malaria and STHs. Sixty-two percent and 44.8% did not use soap to wash hands after toilet and before eating food respectively, whilst 33.1% never wore shoes. There were no functional water points and soap for hand washing after toilet at all schools. There was a high prevalence distribution of all parasites investigated in this study at Msapa primary school - S. haematobium (77.8%), S. mansoni (33.3%) hookworms (29.6%) and P. falciparum (48.1%). Reports that participant had suffered from schistosomiasis and malaria before were significant predictors of these diseases (p = 0.001 and p = 0.042, respectively). Report that participant had blood in urine on the day of examination was a significant predictor of schistosomiasis (p = 0.045).

CONCLUSION

There is a critical need for targeting health messages through schools in order to reach the most susceptible schoolchildren. This will empower the schoolchildren with the basic knowledge and skills ultimately protecting them from acquiring schistosomiasis, STHs and malaria.

Does Insecticide Treated Mosquito Nets (ITNs) prevent clinical malaria in children aged between 6 and 59 months under program setting?

Inconsistent use of the mosquito nets and other social and technical factors were shown to influence efficacy of mosquito nets at field trials. But to date, experience with local factors influencing effectiveness of ITN programs remain very limited. The objective of this study was to assess the effectiveness of ITNs for preventing clinical malaria in under-five children of Omo Nada Woreda, Jimma Zone South West Ethiopia. Matched case-control study was conducted in the catchments population of Asendabo and Nada health centers, Omo Nada Woreda, South West Ethiopia on a sample of 273 under-five children. Each case of fever and parasitemia in a child was paired with two controls. Cases and controls were compared with regard to ITN ownership and other factors assessed by a pre-coded, pre-tested structured questionnaire. Data was analyzed using EPI-INFO version 3.3.2 software. To control the effect of confounding variables, conditional logistic regression model was used. Sleeping under the mosquito net the night (OR = 8.28 95% CI: 0.96, 71.1) and the week (OR = 2.41 95% CI: 0.41, 14.0) before the survey date were strongly, but not significantly associated with clinical malaria. Mosquito net possession and appropriate utilization of mosquito net were not associated with clinical malaria. In the comparison of cases with all the controls rolling out of mosquito net & corrugated iron roof were found to be independent predictors of clinical malaria. Knowledge about the sign and symptoms of malaria and its modes of transmission were also independent predictors of clinical malaria in comparison of cases with health center and community controls, respectively. With the presence of many programmatic deficiencies like poor ITN distribution and re-treatment services, ITNs were not significantly associated with clinical malaria in under-five children when used during low-transmission period. Further research using a large sample size is required. In line with ITN scale up, information Education Communication (IEC) about the preventive practices against malaria, causes of malaria, treatment and sign and symptoms of malaria should be given to the community.

Assessment of knowledge and usage custom of traditional insect/mosquito repellent plants in Addis Zemen Town, South Gonder, North Western Ethiopia

AIM OF THE STUDY

A cross-sectional descriptive study was carried out to assess the knowledge and usage custom of traditional insect/mosquitoes repellent plants among the inhabitants in Addis Zemen Town, Ethiopia.

MATERIALS AND METHODS

Stratified, systematic random sampling was used for selection of 393 households from the total of 5161 households. One adult from each household was interviewed. The ethnobotonical survey was carried out during the period February 2007 to March 2007. Data analysis was carried out using SPSS, version 9.0. Range and mean were analysed and appropriate tables, graphs and percentage were displayed. Level of significance also determined by using 95% of confidence intervals and p-value.

RESULTS

Overall, 97.2% of the respondents had ample knowledge and usage custom concerning traditional insect/mosquito repellent plants. Application of smoke (91.55%) was one of the most commonly well-known methods amongst local community by burning the plant parts such as leaves, stems and roots. Leaves were used by 90.2% for the application smoke. Knowledge and usage custom of traditional insect/mosquito repellent plants had significantly associated with sex (p=0.013) and lower income of respondents (p=0.002). In spite of this, knowledge and usage custom had no significant association with age and educational status. Furthermore, the survey also indicated that most commonly known traditional insect/mosquito repellent plants were Woira*(1) (Olea europaea) 44%, Tinjut* (Ostostegia integrifolia) 39%, Neem* (Azadirachta indica) 14.1%, Wogert* (Silene macroserene) 1.4%, and Kebercho* (Echinops sp.) 1.1%.

CONCLUSIONS

Indigenous traditional insect/mosquito repellent plants have been used by local hamlet since ancient times for various medicinal purposes. Besides, they are not toxic like existing modern synthetic chemical repellents. Therefore, the traditional use of repellent plants should be encouraged and promoted among the local community.

Laboratory evaluation of traditional insect/mosquito repellent plants against Anopheles arabiensis, the predominant malaria vector in Ethiopia

Laboratory study was carried out to evaluate the repellent efficiency of most commonly known four traditional insect/mosquito repellent plants Wogert [vernacular name (local native language, Amharic); Silene macroserene], Kebercho [vernacular name (local native language, Amharic); Echinops sp.], Tinjut [vernacular name (local native language, Amharic); Ostostegia integrifolia], and Woira[vernacular name (local native language, Amharic); Olea europaea] against Anopheles arabiensis under the laboratory conditions. One hundred (4-5 days old) female A. arabiensis were introduced into the both 'control' and 'test' repellent chamber through the hole on top. Traditional charcoal stoves were used for direct burning. The experiment was conducted by applying the smoke into the repellent "test" mosquito cage by direct burning of 25 gm of dried plant materials (leaves and roots) until plant materials completely burned. The number of mosquitoes driving away from the "test" and "control" cage was recorded for every 5 min. In the present investigation, the results clearly revealed that the roots of S. macroserene has potent repellent efficiency (93.61%) and was the most effective. The leaves of Echinops sp. (92.47%), leaves of O. integrifolia (90.10%) and O. europaea (79.78%) were also effective. Roots of S. macroserene exhibited the highest repellent efficiency by direct burning. The present study identified these four traditional indigenous insect/mosquito repellent plant materials are very promising and can be used as safer alternative to modern synthetic chemical repellents against mosquito vectors of disease. Since people have been using these plants for some medicinal purposes, no side effects have been found.

Towards empirical description of malaria seasonality in southern Africa: the example of Zimbabwe

BACKGROUND

Quantitative description and mapping of malaria seasonality is important for timely spatial targeting of interventions and for modelling malaria risk. There is a need for seasonality models that predict quantitative variation in transmission between months.

METHODS

We use Zimbabwe as an example for developing an empirical map of malaria seasonality. We describe the relationship between seasonality in malaria and environmental covariates for the period 1988--1999, by fitting a spatial-temporal regression model within a Bayesian framework to provide smoothed maps of the seasonal trend. We adapt a seasonality concentration index used previously for rainfall to quantify malaria case load during the peak transmission season based on monthly values.

RESULTS

Combinations of mean monthly temperature (range 28--32 degrees C), maximum temperature (24--28 degrees C) and high rainfall provide suitable conditions for seasonal transmission. High monthly maximum and mean monthly minimum temperatures limit months of high transmission. The intensity of seasonal transmission was highest in the north western part of the country from February to May with the peak in April and lowest in the whole country from July to December. The north western lowlands had the highest concentration of malaria cases (>25%) followed by some districts in the north central and eastern part with a moderate concentration of cases (20-25%). The central highlands and south eastern part of the country had the lowest concentration of malaria cases (<20%). This pattern was closely associated to the geographic variation in the seasonality of climatic covariates particularly rainfall and temperature. Conclusions Our modelling approach quantifies the geographical variation in seasonal trend and the concentration of cases during the peak transmission season and therefore has potential application in malaria control. The use of a covariate adjusted empirical model may prove useful for predicting the seasonal risk pattern across southern Africa.

Perception of causes of malaria and treatment-seeking behaviour of nursing mothers in a rural community

OBJECTIVE

Maternal health care workers' recognition of malaria, its transmission and treatment of children's fever at community level.

DESIGN

Randomised sampling of households with children of 0-5 years.

SETTING

Rural community in a forest zone.

SUBJECTS

Fifty-five households at Ijegemo village, Ogun state, Nigeria were sampled and questionnaires administered to 200 mothers/care workers of children within the age group 0-5 years. Blood smears were obtained from finger pricks and level of parasitemia with malaria parasites determined for each child.

MAIN OUTCOME MEASURES

Interactions with the women during the survey empowered them with accurate knowledge of malaria recognition, transmission and management of children's fever at the community level.

RESULTS

Forty per cent of the respondents did not know the exact cause of malaria, 20% attributed the cause to sunlight, 16.5% to mosquitoes, 12.5% to poor hygiene, 4% to palm oil intake, 4% to blood shortage and 6% to a hot body. Of respondents 85.5% identified stagnant water as breeding site of mosquitoes but could not correlate it with the occurrence of malaria fever. Herbal concoction was the first treatment action. Some of these herbs are listed in the text. Plasmodium falciparum alone was identified in all blood smears. Children at two to three years of age were recorded with the highest percentage (67.5%) of parasite-positive cases with a mean value of 1237.04 +/- 2113.19.

CONCLUSION

This study highlights a critical need for targeting health messages towards poorly educated women in order to empower them with the knowledge and resources to recognise and manage their children's health problems.

Repellent effects on Anopheles arabiensis biting humans in Kruger Park, South Africa

Distribution of biting sites on the human body by the malaria vector Anopheles arabiensis Patton (Diptera: Culicidae) was investigated near a source of mosquitoes in the Kruger National Park, South Africa. Eight adult male volunteers (2 teams x 2 pairs of subjects) conducted human bait collections while seated on camp chairs in the open-air, wearing only short trousers (no shirt, socks or shoes). Mosquito collections during 18.30-22.30 hours on five consecutive nights in April 1998 yielded a total of 679 An. arabiensis females biting subjects with or without their ankles and feet treated with deet insect repellent (15% diethyl-3-methylbenzamide, Tabard lotion). On subjects whose feet and ankles were smeared with repellent, 160 An. arabiensis females were captured biting in 60 manhours: 88.1% on the legs, 1.4% on the arms and 1.2% on other parts of the body, but none on the repellent-treated feet or ankles. On subjects without repellent treatment, 519 An. arabiensis were caught biting in 60 man-hours: 81.1% on feet and ankles, 16.4% on legs, 1.4% on arms and 1.2% on the rest of the body. For individual subjects, the reduction of An. arabiensis bites ranged from 36.4 to 78.2% (mean protection 69.2%). Results of this study confirm previous findings that, in this part of South Africa - inhabited only by wildlife - when people sit outside during the evening An. arabiensis prefers to bite their lower limbs: 97.5% below the knees. Overall, the number of bites by the malaria vector An. arabiensis was reduced more than three-fold (from 26 to 8/person/evening), simply by treating ankles and feet with a consumer brand of deet repellent. Whether or not this provides a satisfactory degree of protection against malaria risk would depend on the malaria sporozoite rate in the malaria vector population.