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Costs of early detection systems for epidemic malaria in highland areas of Kenya and Uganda
Dirk H Mueller, Tarekegn A Abeku, Michael Okia, Beth Rapuoda, Jonathan Cox
Malaria Journal , 2009, DOI: 10.1186/1475-2875-8-17
Abstract: An economic costing was carried out from the health service provider's perspective in both countries. Staff time for data entry and processing, as well as supervising and coordinating EDS activities at district and national levels was recorded and associated opportunity costs estimated. A threshold analysis was carried out to determine the number of DALYs or deaths that would need to be averted in order for the EDS to be considered cost-effective.The total costs of the EDS per district per year ranged between US$ 14,439 and 15,512. Salaries were identified as major cost-drivers, although their relative contribution to overall costs varied by country. Costs of relaying surveillance data between facilities and district offices (typically by hand) were also substantial. Data from Uganda indicated that 4% or more of overall costs could potentially be saved by switching to data transfer via mobile phones. Based on commonly used thresholds, 96 DALYs in Uganda and 103 DALYs in Kenya would need to be averted annually in each district for the EDS to be considered cost-effective.Results from this analysis suggest that EDS are likely to be cost-effective. Further studies that include the costs and effects of the health systems' reaction prompted by EDS will need to be undertaken in order to obtain comprehensive cost-effectiveness estimates.Despite continuing research on the epidemiology and control of malaria epidemics, little is known about the public health burden associated with these events [1]. The data that are available indicate that epidemics can cause widespread morbidity, and that epidemic-related risks of severe disease and death are relatively high across all age groups affected [2-4]. Moreover, little is known about the economic burden of epidemics, or the costs of interventions used for epidemic prevention and control. Without reliable information in this area policy makers are unable to make informed resource allocation decisions based on sound evidence [5].For
Malaria treatment-seeking behaviour and recovery from malaria in a highland area of Kenya
Peter O Sumba, S Lindsey Wong, Hemal K Kanzaria, Kelsey A Johnson, Chandy C John
Malaria Journal , 2008, DOI: 10.1186/1475-2875-7-245
Abstract: To assess treatment-seeking behaviour for malaria in these areas, a questionnaire was administered to 117 randomly selected households in the highland area of Kipsamoite, Kenya. Self-reported episodes of malaria occurred in 100 adults and 66 children.The most frequent initial sources of treatment for malaria in adults and children were medical facilities (66.0% and 66.7%) and local shops (19.0% and 30.3%). Adults and children who initially visited a medical facility for treatment were significantly more likely to recover and require no further treatment than those who initially went to a local shop (adults, 84.9% v. 36.8%, P < 0.0001, and children, 79.6% v. 40.0%, P = 0.002, respectively). Individuals who attended medical facilities recalled receiving anti-malarial medication significantly more frequently than those who visited shops (adults, 100% vs. 29.4%, and children, 100% v. 5.0%, respectively, both P < 0.0001).A significant proportion of this highland population chooses local shops for initial malaria treatment and receives inappropriate medication at these localshops, reslting in delay of effective treatment. Shopkeeper education has the potential to be a component of prevention or containment strategies for malaria epidemics in highland areas.Malaria is a leading cause of death in children under the age of five years in sub-Saharan Africa [1]. The Roll-Back Malaria (RBM) initiative is working to improve prevention efforts in affected countries, through insecticide-treated nets (ITNs), indoor residual spraying (IRS) of pesticides, and intermittent preventive treatment (IPT) for pregnant women [2]. RBM also focuses on intervention efforts via effective anti-malarial regimens like artemesinin-based combination therapy (ACT), pre-empting epidemics in epidemic-prone areas, and improving home management of the disease. Rapid, effective treatment response with ACT is currently the most effective treatment option in sub-Saharan Africa, considering the current state
Community participation in malaria epidemic control in highland areas of southern Oromia, Ethiopia
Wakgari Deressa, Dereje Olana, Shelleme Chibsa
Ethiopian Journal of Health Development , 2005,
Abstract: Background: Satisfactory strategies for the timely and effective control of malaria epidemics have not yet been established in epidemic-prone areas. A devastating malaria epidemic occurred in mid 2000 in four districts of Borena Zone in Oromia Regional State. Objective: To assess and highlight the importance of community participation particularly that of village malaria workers (VMWs) in the control of malaria epidemics. Methods: Epidemic-affected peasant associations (PAs) were initially identified from each of the affected districts. One VMW residing in the PA was selected, and training on health education, diagnosis of suspected malaria cases and treatment by Sulfadoxine-Pyrimethamine (SP), referral of severe cases, source reduction of mosquito breeding sites, registration and reporting of treated cases, consumed antimalarials, registration of deaths and assessment of the overall status of the epidemic in their particular PAs was given for three days. Results: One hundred twenty-four epidemic affected PAs were identified by the study, that and 115 VMWs were deployed to control the epidemic. A total of 72,998 suspected malaria patients were treated by VMWs using SP. Only 11,994 clinical cases of malaria were treated by ordinary health workers at field levels from June–August 2000. A total of 1,323 deaths were reported both by health professionals and the VMWs. Five hundred sixty eight confirmed malaria cases were treated during out patient consultations at Hagere Mariam Hospital during the three month period. In addition, 191 admitted malaria patients and 36 malaria deaths were identified from the Hospital during the June- August 2000 epidemic. The case fatality rate and proportionate mortality ratio for malaria were 20.8% and 90.9% in August, respectively, in the Hospital. Conclusion: Although health professionals of various categories were mobilized, the epidemic covered wide geographical areas and caused high morbidity and mortality within a short period of time. Therefore, mobilizing of the necessary human and material resources, particularly the community itself is extremely important in the control of malaria epidemics. Ethiopian Journal of Health Development Vol. 19(1) 2005: 3-10
Identification of malaria transmission and epidemic hotspots in the western Kenya highlands: its application to malaria epidemic prediction
Christine L Wanjala, John Waitumbi, Guofa Zhou, Andrew K Githeko
Parasites & Vectors , 2011, DOI: 10.1186/1756-3305-4-81
Abstract: The study was conducted in five sites in the western Kenya highlands, two U-shaped valleys (Iguhu, Emutete), two V-shaped valleys (Marani, Fort-Ternan) and one plateau (Shikondi) for 16 months among 6-15 years old children. Exposure to malaria was tested using circum-sporozoite protein (CSP) and merozoite surface protein (MSP) immunochromatographic antibody tests; malaria infections were tested by microscopic examination of thick and thin smears, the children's homes were georeferenced using a global positioning system. Paired t-test was used to compare the mean prevalence rates of the sites, K-function was use to determine if the clustering of malaria infections was significant.The mean antibody prevalence was 22.6% in Iguhu, 24% in Emutete, 11.5% in Shikondi, 8.3% in Fort-Ternan and 9.3% in Marani. The mean malaria infection prevalence was 23.3% in Iguhu, 21.9% in Emutete, 4.7% in Shikondi, 2.9% in Fort-Ternan and 2.4% in Marani. There was a significant difference in the antibodies and malaria infection prevalence between the two valley systems, and between the two valley systems and the plateau (P < 0.05). There was no significant difference in the antibodies and malaria infection prevalence in the two U-shaped valleys (Iguhu and Emutete) and in the V-shaped valleys (Marani and Fort Ternan) (P > 0.05). There was 8.5- fold and a 2-fold greater parasite and antibody prevalence respectively, in the U-shaped compared to the V-shaped valleys. The plateau antibody and parasite prevalence was similar to that of the V-shaped valleys. There was clustering of malaria antibodies and infections around flat areas in the U-shaped valleys, the infections were randomly distributed in the V-shaped valleys and less clustered at the plateau.This study showed that the V-shaped ecosystems have very low malaria prevalence and few individuals with an immune response to two major malaria antigens and they can be considered as epidemic hotspots. These populations are at higher risk of se
Evaluation of Lambda-Cyhalothrin Persistence on Different Indoor Surfaces in a Malaria Epidemic-Prone Area in Kenya
C.S. Mulambalah,D.N. Siamba,M.M. Ngeiywa,J.M. Vulule
Research Journal of Biological Sciences , 2012, DOI: 10.3923/rjbsci.2010.258.263
Abstract: The residual life of pyrethroid insecticide lambdacyhalothrin (trade name: ICON) on indoor surfaces was evaluated under field conditions in villages in a highland area of Kipsamoite, North Nandi District of Kenya. About 10% lambda-cyhalthrin wettable powder was sprayed at the rate of 0.02-0.03 g m-2 on the indoor wall surface of randomly selected local houses. Its effect on mortality of Anopheles gambiae s.s as test vector was assessed from January to April 2007. Wall bioassays were conducted on different treated wall surfaces using plastic cones attached to treated surfaces at fortnightly intervals. Mortality rate in mosquitoes exposed to treated surfaces varied according to the type of wall that received the insecticide. ICON was more stable and lasted longer on mud and wood surfaces. There was significant difference between persistence of ICON on mud and other surfaces tested. For the insecticide formulation used, the duration of the residual effect was satisfactory up to the WHOPES recommended post spray period. Beyond this period, persistence declined rapidly on metal and cemented/brick plastered surfaces. The low effectiveness of the formulation on metal and cement surfaces should be considered together with the importance of residual spraying as a vector control method in the area. We concluded that the use of ICON in IRS could be a single and effective strategy to control endophiliic and antropophilic malaria vectors in malaria hypoendemic area. This is based on the findings that the local vector is susceptible to ICON and most of the houses had mud surfaces and malaria transmission is seasonal. In this regard, one round of ICON spray would be sufficient to interrupt 3-4 month seasonal malaria transmission in the study area. Apart from its toxicity to mosquitoes, ICON also agitates and repels mosquitoes that do not come in contact with it and therefore an added benefit of reducing the indoor malaria vector densities. This would drastically reduce human-vector contact and overall decline in community malaria prevalence.
Kitobo Forest of Kenya, a unique hotspot of herpetofaunal diversity  [cached]
Vincent Muchai,Beryl A. Bwong,Vincent Muchai
Acta Herpetologica , 2011,
Abstract: Herpetologically, the remoteness of Kitobo forest in south-eastern Kenya has partly contributed to it remaining virtually un-explored until 2007. Three surveys were conducted in December 2007, December 2009 and April 2010 aimed at generating a comprehensive list of the forest amphibians and reptiles. Using largely timed-species count method, 13 species of amphibians representing eight families and 32 reptiles belonging to 11 families were recorded. Overall species diversity was highest during the 2007 sampling. The richness and abundance of amphibians was highest during the April 2010 sampling period when the amount of rainfall was also highest. The results of species accumulation curves of the three sampling periods did not plateau demonstrating that more species occur in this forest. Pressure on this forest fragment from the adjacent local people is high which in addition to the annual floods threatens its long-term survival. For example the distribution and abundance of some forest associated species such as the tree frogs Leptopelis flavomaculatus and Hyperolius puncticulatus appear to fluctuate with flood events and may decline in future. Considering the forest associated herpetofanua recorded, Kitobo forest is zoogeographically assignable to the East African coastal forest biodiversity hotspot. The documentation of high species richness and diversity in this small forest fragment strongly highlight its biodiversity importance and place it among the most important sites for the conservation of reptiles and amphibians in Kenya.
New records of Anopheles arabiensis breeding on the Mount Kenya highlands indicate indigenous malaria transmission
Hong Chen, Andrew K Githeko, Guofa Zhou, John I Githure, Guiyun Yan
Malaria Journal , 2006, DOI: 10.1186/1475-2875-5-17
Abstract: A survey on 31 aquatic sites for the malaria-vector mosquitoes was carried out along the primary road on the highlands around Mount Kenya and the nearby Mwea lowland during April 13 to June 28, 2005. Anopheline larvae were collected and reared into adults for morphological and molecular species identification. In addition, 31 families at three locations of the highlands were surveyed using a questionnaire about their history of malaria cases during the past five to 20 years.Specimens of Anopheles arabiensis were molecularly identified in Karatina and Naro Moru on the highlands at elevations of 1,720 – 1,921 m above sea level. This species was also the only malaria vector found in the Mwea lowland. Malaria cases were recorded in the two highland locations in the past 10 years with a trend of increasing.Local malaria transmission on the Mount Kenya highlands is possible due to the presence of An. arabiensis. Land use pattern and land cover might be the key factors affecting the vector population dynamics and the highland malaria transmission in the region.More than 3 million malaria cases, with one million deaths due to malaria, are reported in sub-Saharan Africa, each year [1]. Historically, no malaria case has been reported on the Mount Kenya highlands in central Kenya [2]. The residents on the highlands west of the mountain began to notice this disease about 10 years ago. Originally, it was believed that malaria was introduced from the Mwea lowland where most vehicular traffic passes through onto the highlands, and where the vector is Anopheles arabiensis. An alternative hypothesis was that a vector and parasite were introduced and malaria was transmitted locally on the highlands. However, no malaria-vector mosquito has so far been recorded on the Mount Kenya highlands [3,4], thereby arguing against this hypothesis. A third possibility was that the malaria was latent in the highlands until ecological and climatic changes modify the transmission patterns.The emergen
Molecular epidemiology of drug-resistant malaria in western Kenya highlands
Daibin Zhong, Yaw Afrane, Andrew Githeko, Liwang Cui, David M Menge, Guiyun Yan
BMC Infectious Diseases , 2008, DOI: 10.1186/1471-2334-8-105
Abstract: Using parasites from highland and lowland areas of western Kenya, we examined key mutations associated with Plasmodium falciparum resistance to sulfadoxine – pyrimethamine and chloroquine, including dihydrofolate reductase (pfdhfr) and dihydropteroate synthetase (pfdhps), chloroquine resistance transporter gene (pfcrt), and multi-drug resistance gene 1 (pfmdr1).We found that >70% of samples harbored 76T pfcrt mutations and over 80% of samples harbored quintuple mutations (51I/59R/108N pfdhfr and 437G/540E pfdhps) in both highland and lowland samples. Further, we did not detect significant difference in the frequencies of these mutations between symptomatic and asymptomatic malaria volunteers, and between highland and lowland samples.These findings suggest that drug resistance of malaria parasites in the highlands could be contributed by the mutations and their high frequencies as found in the lowland. The results are discussed in terms of the role of drug resistance as a driving force for malaria outbreaks in the highlands.Malaria is a major public health problem in sub-Saharan Africa and Plasmodium falciparum infection is a leading cause of morbidity and mortality inflicting a huge economic burden in countries where the disease is endemic [1]. It is estimated that death toll of malaria exceeds one million people each year, and the victims are primarily children under the age of five [2]. Until the early 1980s, the African highlands (generally referred to areas of >1,500 m above sea level) were either free of malaria or had very low incidences of the disease; however, since the late 1980s a series of malaria epidemics has occurred [3-9]. Among the many factors that may contribute to the highland malaria epidemics, resistance of the parasites to multiple antimalarials has not been extensively investigated. Resistance to antimalarial drugs is one of the major obstacles for effective malaria control. The first case of chloroquine (CQ) resistance in Kenya was reported i
New highland distribution records of multiple Anopheles species in the Ecuadorian Andes
Lauren L Pinault, Fiona F Hunter
Malaria Journal , 2011, DOI: 10.1186/1475-2875-10-236
Abstract: Extensive field collections of larvae were undertaken in 2008, 2009 and 2010 throughout all regions of Ecuador (except the lower-altitude Amazonian plain) and compared to historical distribution maps reproduced from the 1940s. Larvae were identified using both a morphological key and sequencing of the 800 bp region of the CO1 mitochondrial gene. In addition, spatial statistics (Getis-Ord Hotspot Analysis: Gi*) were used to determine high and low-density clusters of each species in Ecuador.Distributions have been updated for five species of Anopheles in Ecuador: Anopheles albimanus, Anopheles pseudopunctipennis, Anopheles punctimacula, Anopheles eiseni and Anopheles oswaldoi s.l.. Historical maps indicate that An. pseudopunctipennis used to be widespread in highland Andean valleys, while other species were completely restricted to lowland areas. By comparison, updated maps for the other four collected species show higher maximum elevations and/or more widespread distributions in highland regions than previously recorded. Gi* analysis determined some highland hot spots for An. albimanus, but only cold spots for all other species.This study documents the establishment of multiple anopheline species in high altitude regions of Ecuador, often in areas where malaria eradication programs are not focused.Recently, there has been growing concern over the shifting distribution of malaria vectors due to land use alteration, changes to vector control measures, insecticide resistance, malaria treatment resistance, as well as local climate change [1-8]. Many reviews have discussed the hypothetical effects of climate change on insect-borne diseases, and some of these have stated the concern that malaria might be able to move into higher altitudes in the Andes, potentially affecting large cities such as Quito (2,800 m) [8-11]. Already, high-altitude malaria transmission has been recorded in a town in Bolivia at 2,300 m, vectored by Anopheles pseudopunctipennis [12]. However, the ef
Community-wide benefits of targeted indoor residual spray for malaria control in the Western Kenya Highland
Guofa Zhou, Andrew K Githeko, Noboru Minakawa, Guiyun Yan
Malaria Journal , 2010, DOI: 10.1186/1475-2875-9-67
Abstract: Indoor residual spray using lambda-cyhalothrin insecticide was carried out during the last week of April 2005 in 1,100 targeted houses, located in the valley bottom areas of Iguhu village, Kakamega district of western Kenya. Although the uphill areas are more densely populated, valleys are believed to be malaria transmission hotspots. The aim of the study was to measurably reduce the vector density and malaria transmission in uphill areas by focusing control on these hotspots. A cohort of 1,058 children from 1-5 yrs of age was randomly selected from a 4 km by 6 km study area for the baseline malaria prevalence survey after pre-clearing malaria infections during the third week of April 2005, and the prevalence of Plasmodium infections was tested bi-weekly. Seasonal changes in mosquito densities 12 months before the IRS and 12 months after the IRS was monitored quarterly based on 300 randomly selected houses. Monthly parasitological surveys were also carried out in the same area with 129-661 randomly selected school children of age 6-13 yrs.The result of monthly parasitological surveys indicated that malaria prevalence in school children was reduced by 64.4% in the intervention valley area and by 46.3% in the intervention uphill area after 12 months of follow-ups in contrast to nonintervention areas (valley or uphill). The cohort study showed an average of 4.5% fewer new infections biweekly in the intervention valley compare to nonintervention valley and the relative reduction in incidence rate by week 14 was 65.4%. The relative reduction in incidence rate in intervention uphill by week 14 was 46.4%. Anopheles gambiae densities were reduced by 96.8% and 51.6% in the intervention valley and intervention uphill, respectively, and Anopheles funestus densities were reduced by 85.3% and 69.2% in the intervention valley and intervention uphill, respectively.Vector control had significant indirect impact on the densely populated uphill areas when IRS was targeted to the high
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