Climate Drivers of Malaria Transmission Seasonality and Their Relative Importance in Sub-Saharan Africa

A new database of the Entomological Inoculation Rate (EIR) was used to directly link the risk of infectious mosquito bites to climate in Sub-Saharan Africa. Applying a statistical mixed model framework to high-quality monthly EIR measurements collected from field campaigns in Sub-Saharan Africa, we analyzed the impact of rainfall and temperature seasonality on EIR seasonality and determined important climate drivers of malaria seasonality across varied climate settings in the region. We observed that seasonal malaria transmission was within a temperature window of 15°C-40°C and was sustained if average temperature was well above 15°C or below 40°C. Monthly maximum rainfall for seasonal malaria transmission did not exceed 600 in west Central Africa, and 400 mm in the Sahel, Guinea Savannah, and East Africa. Based on a multi-regression model approach, rainfall and temperature seasonality were found to be significantly associated with malaria seasonality in all parts of Sub-Saharan Africa except in west Central Africa. Topography was found to have significant influence on which climate variable is an important determinant of malaria seasonality in East Africa. Seasonal malaria transmission onset lags behind rainfall only at markedly seasonal rainfall areas such as Sahel and East Africa; elsewhere, malaria transmission is year-round. High-quality EIR measurements can usefully supplement established metrics for seasonal malaria. The study's outcome is important for the improvement and validation of weather-driven dynamical mathematical malaria models that directly simulate EIR. Our results can contribute to the development of fit-for-purpose weather-driven malaria models to support health decision-making in the fight to control or eliminate malaria in Sub-Saharan Africa.

The impact of regional climate change on malaria risk due to greenhouse forcing and land-use changes in tropical Africa

BACKGROUND

Climate change will probably alter the spread and transmission intensity of malaria in Africa.

OBJECTIVES

In this study, we assessed potential changes in the malaria transmission via an integrated weather-disease model.

METHODS

We simulated mosquito biting rates using the Liverpool Malaria Model (LMM). The input data for the LMM were bias-corrected temperature and precipitation data from the regional model (REMO) on a 0.5° latitude-longitude grid. A Plasmodium falciparum infection model expands the LMM simulations to incorporate information on the infection rate among children. Malaria projections were carried out with this integrated weather-disease model for 2001 to 2050 according to two climate scenarios that include the effect of anthropogenic land-use and land-cover changes on climate.

RESULTS

Model-based estimates for the present climate (1960 to 2000) are consistent with observed data for the spread of malaria in Africa. In the model domain, the regions where malaria is epidemic are located in the Sahel as well as in various highland territories. A decreased spread of malaria over most parts of tropical Africa is projected because of simulated increased surface temperatures and a significant reduction in annual rainfall. However, the likelihood of malaria epidemics is projected to increase in the southern part of the Sahel. In most of East Africa, the intensity of malaria transmission is expected to increase. Projections indicate that highland areas that were formerly unsuitable for malaria will become epidemic, whereas in the lower-altitude regions of the East African highlands, epidemic risk will decrease.

CONCLUSIONS

We project that climate changes driven by greenhouse-gas and land-use changes will significantly affect the spread of malaria in tropical Africa well before 2050. The geographic distribution of areas where malaria is epidemic might have to be significantly altered in the coming decades.

Development of a new version of the Liverpool Malaria Model. II. Calibration and validation for West Africa

Background

In the first part of this study, an extensive literature survey led to the construction of a new version of the Liverpool Malaria Model (LMM). A new set of parameter settings was provided and a new development of the mathematical formulation of important processes related to the vector population was performed within the LMM. In this part of the study, so far undetermined model parameters are calibrated through the use of data from field studies. The latter are also used to validate the new LMM version, which is furthermore compared against the original LMM version.

Methods

For the calibration and validation of the LMM, numerous entomological and parasitological field observations were gathered for West Africa. Continuous and quality-controlled temperature and precipitation time series were constructed using intermittent raw data from 34 weather stations across West Africa. The meteorological time series served as the LMM data input. The skill of LMM simulations was tested for 830 different sets of parameter settings of the undetermined LMM parameters. The model version with the highest skill score in terms of entomological malaria variables was taken as the final setting of the new LMM version.

Results

Validation of the new LMM version in West Africa revealed that the simulations compare well with entomological field observations. The new version reproduces realistic transmission rates and simulated malaria seasons are comparable to field observations. Overall the new model version performs much better than the original model. The new model version enables the detection of the epidemic malaria potential at fringes of endemic areas and, more importantly, it is now applicable to the vast area of malaria endemicity in the humid African tropics.

Conclusions

A review of entomological and parasitological data from West Africa enabled the construction of a new LMM version. This model version represents a significant step forward in the modelling of a weather-driven malaria transmission cycle. The LMM is now more suitable for the use in malaria early warning systems as well as for malaria projections based on climate change scenarios, both in epidemic and endemic malaria areas.

Development of a new version of the Liverpool Malaria Model. I. Refining the parameter settings and mathematical formulation of basic processes based on a literature review

Background

A warm and humid climate triggers several water-associated diseases such as malaria. Climate- or weather-driven malaria models, therefore, allow for a better understanding of malaria transmission dynamics. The Liverpool Malaria Model (LMM) is a mathematical-biological model of malaria parasite dynamics using daily temperature and precipitation data. In this study, the parameter settings of the LMM are refined and a new mathematical formulation of key processes related to the growth and size of the vector population are developed.

Methods

One of the most comprehensive studies to date in terms of gathering entomological and parasitological information from the literature was undertaken for the development of a new version of an existing malaria model. The knowledge was needed to allow the justification of new settings of various model parameters and motivated changes of the mathematical formulation of the LMM.

Results

The first part of the present study developed an improved set of parameter settings and mathematical formulation of the LMM. Important modules of the original LMM version were enhanced in order to achieve a higher biological and physical accuracy. The oviposition as well as the survival of immature mosquitoes were adjusted to field conditions via the application of a fuzzy distribution model. Key model parameters, including the mature age of mosquitoes, the survival probability of adult mosquitoes, the human blood index, the mosquito-to-human (human-to-mosquito) transmission efficiency, the human infectious age, the recovery rate, as well as the gametocyte prevalence, were reassessed by means of entomological and parasitological observations. This paper also revealed that various malaria variables lack information from field studies to be set properly in a malaria modelling approach.

Conclusions

Due to the multitude of model parameters and the uncertainty involved in the setting of parameters, an extensive literature survey was carried out, in order to produce a refined set of settings of various model parameters. This approach limits the degrees of freedom of the parameter space of the model, simplifying the final calibration of undetermined parameters (see the second part of this study). In addition, new mathematical formulations of important processes have improved the model in terms of the growth of the vector population.

Sonographic findings in primary carcinoma of the gallbladder

The sonographic appearance in 4 cases of primary carcinoma of the gallbladder is correlated with the surgical and pathological findings. A fungating tumor had the greatest chance of resection, with findings dependent on the location and size of the mass. Infiltrating lesions were highly malignant. In less advanced cases, tumor infiltration caused irregular thickness of the gallbladder wall which was readily distinguishable from edema due to cholecystitis. In advanced cases, gallstones and stone shadowing coexistent with the tumor were important diagnostic clues, permitting differentiation between primary gallbladder carcinoma and neoplasms originating elsewhere. Sonography can provide critical diagnostic information which cannot be obtained by other conventional procedures.