Control In Africa Research Articles

Monitoring mosquito net coverage for malaria control in Africa: possession vs. use by children under 5 years.

To investigate the strengths and weaknesses of the indicators 'proportion of households possessing mosquito net(s)' and 'proportion of children under 5 years of age who slept under a net the preceding night' for monitoring malaria control. Review of data from household surveys including demographic and health surveys in sub-Saharan African countries. Net possession ranged among 14 surveyed regions from 0.1% to 28.5% for insecticide-treated nets (ITNs) and among 69 regions from 3.6% to 79.7% for any net. Reported use during the preceding night by children under 5 years of age was between 0% and 16% for ITNs and between 0.7% and 74.5% for any net. On average, in households owning ITN(s), 55% of children slept under it (R2 = 0.97, P < 0.001). For any net, use was -4.2% + 0.875 x possession (R2 = 0.89, P < 0.001); the use of nets, however, also varied somewhat among the surveyed countries (P = 0.003). In-depth surveys suggested that use was lower than possession because: (i). nets were scarce (mean 1.8 per possessing household); (ii). nets were not always used for children and (iii). use was lower during hot, dry months than during cool rainy months, and many surveys had been conducted in the dry season. Not all mosquito nets owned by African households are being used for young children. Household education on the consistent use of nets for this vulnerable group is called for in malaria control programmes. Regular, district-level rapid assessments of household possession of nets should complement ongoing in-depth surveys. Data on 'use during the preceding night' must be interpreted taking the survey season into account.

Experimental studies on the transmission of Onchocerca volvulus by its vector in the Sanaga valley (Cameroon): Simulium squamosum B. Intake of microfilariae and their migration to the haemocoel of the vector.

As large-scale ivermectin distribution is becoming the mainstay of onchocerciasis control in Africa, the issue of its impact on local transmission is increasing in importance. The vector competence of Simulium squamosum B in the severe focus of the Sanaga valley, Cameroon, was therefore investigated, by feeding 1320 flies on 14 carriers of Onchocerca volvulus microfilariae (mff). The results enabled the relationships between skin microfilarial load, microfilarial intake by the flies, the proportion and mean number of ingested mff that succeed in reaching the fly's haemocoel, and the frequency distribution of the ingested mff to be described, as functions of time post-engorgement (p.e.) and parasite density (while taking account of possible measurement error in the predictor variable). The proportion of flies with haemocoelic mff and the mean number of mff/fly increased up to 3 h p.e. The proportion of flies with ingested mff was non-linearly related to mean intake, via the negative-binomial distribution, with the overdispersion parameter k best described as an increasing (power) function of the mean. Approximately one in every three ingested mff escaped imprisonment by the peritrophic matrix, irrespective of the skin microfilarial load or the intake of mff. The relationship between successful and input mff is nearly linear (indicating proportionality) in S. squamosum B. These results are compared with those from O. volvulus-S. damnosum s.l. combinations in other West African foci.

Efficacy of artesunate plus chloroquine for the treatment of uncomplicated malaria in children in Burkina Faso: a double-blind, randomized, controlled trial

Chloroquine (CQ)-resistant Plasmodium falciparum is compromising malaria control in Africa. Combining artesunate (AS) with standard antimalarial drugs increases cure rates and may delay drug resistance. We compared the safety and efficacy of CQ alone and CQ combined with AS (CQ-AS) for treating uncomplicated P. falciparum malaria in Burkina Faso between August 1999 and August 2000. Chloroquine (25 mg/kg over 3 d) combined with AS or placebo (4 mg/kg/d for 3 d) was administered to 300 children aged 6 to 59 months in a randomized, double-blind study. Follow-up extended over 28 d. No adverse drug reactions were recorded. By day 14, parasites were cleared in 120/147 (81.6%) CQ-AS-treated children compared with 53 143 (37.1%) CQ-treated children (odds ratio [OR] = 7.55, 95% CI 4.27–13.43, P < 0.001). Corresponding rates for day 28 were 71 145 (49.0%) vs. 27/142 (19.0%) (OR= 4.09, 95% CI 2.33–7.21, P < 0.001). Children who received CQ-AS had significantly faster parasite and fever clearance. Despite the beneficial effects of adding AS, the high failure rate at day 28 of CQ-AS precludes its use as the first-line regimen for treating CQ-resistant P. falciparum in Burkina Faso.

Colonial wildlife conservation and the origins of the Society for the Preservation of the Wild Fauna of the Empire (1903–1914)

Fauna &amp; Flora International (FFI) celebrates its centenary in 2003. It was founded as the Society for the Preservation of the Wild Fauna of the Empire (SPWFE) in London in 1903. This paper analyses the events, people, and debates behind its formation and early development. It discusses why the Society was formed, how it worked, and what its main concerns were. It considers the nature and success of the Society's work from 1903 to 1914 in influencing the British Colonial Office's policy on issues such as game reserves, hunting and wildlife clearance for tsetse control in Africa. The SPWFE drew together an elite group of colonial administrators, hunters and other experts on game in Africa, and was effective in lobbying the Colonial Office about preservation. Many of its concerns, and ideas about how to address them, are similar to those that are current today, a century after its establishment.

The missionary position: NGOs and development in Africa

This article traces the evolution of development non–governmental organizations (NGOs) in Africa, and suggests that their role represents a continuation of the work of their precursors, the missionaries and voluntary organizations that cooperated in Europe’s colonization and control of Africa. The authors maintain that the work of the NGOs today contributes marginally to the relief of poverty in Africa, and significantly undermines the struggle of the African people to emancipate themselves from economic, social and political oppression. Development NGOs have, unwittingly or otherwise, become a part of the neo–liberal system that has resulted in widespread impoverishment and the loss of the authority of African states to determine their own agenda. NGOs could, and some do, play a role in supporting an emancipatory agenda in Africa, but it involves breaking with the ‘missionary position’ by disengaging from their paternalistic role in development

Highly active antiretroviral therapy and tuberculosis control in Africa: synergies and potential.

HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) and TB (tuberculosis) are two of the world's major pandemics, the brunt of which falls on sub-Saharan Africa. Efforts aimed at controlling HIV/AIDS have largely focused on prevention, little attention having been paid to care. Work on TB control has concentrated on case detection and treatment. HIV infection has complicated the control of tuberculosis. There is unlikely to be a decline in the number of cases of TB unless additional strategies are developed to control both this disease and HIV simultaneously. Such strategies would include active case-finding in situations where TB transmission is high, the provision of a package of care for HIV-related illness, and the application of highly active antiretroviral therapy. The latter is likely to have the greatest impact, but for this therapy to become more accessible in Africa the drugs would have to be made available through international support and a programme structure would have to be developed for its administration. It could be delivered by means of a structure based on the five-point strategy called DOTS, which has been adopted for TB control. However, it may be unrealistic to give TB control programmes the responsibility for running such a programme. A better approach might be to deliver highly active antiretroviral therapy within a comprehensive HIV/AIDS management strategy complementing the preventive work already being undertaken by AIDS control programmes. TB programmes could contribute towards the development and implementation of this strategy.

Recent progress in Desert and Migratory Locust management in Africa. Are preventative actions possible ?

Locust control in Africa has been the focus of considerable controversy over the last 15 y. Many control aspects were called into question following the last large plagues of 1987–88 (Desert Locust) and 1996–2000 (Malagasy Migratory Locust): recommended preventative strategy, environmental impact of insecticides used, socioeconomic importance of the locusts. Many projects were launched to improve survey and control methods and find alternative solutions to chemical pesticide treatments. Recent progress is reviewed. Survey and application techniques showed dramatic improvements with GIS, GPS technology and precision spraying. Barrier applications are again available, thanks to new persistent pesticides. Biological control with mycopesticides now appears very promising and undoubtedly the technique will gradually be adopted. The environmental aspects are taken into better account and an IPM approach is now possible. The EMPRES program of FAO is committed to reinforcing national early warning and early reaction capacities for preventative control of the Desert Locust. In Madagascar a new National Locust Center has recently been set up. In many places local research capabilities are improving.However, certain very fundamental aspects remain unsolved. Among others, the sustainability of preventative control systems is an important concern. Many affected countries are amongst the poorest in the world. They currently do not have sufficient financial resources to fund intensive control campaigns, nor even the basic minimum to ensure prevention. A realistic solution to prevent locust plagues requires stronger commitment of governments and donors, sustainable small but flexible national locust control units for prevention, and especially the creation of emergency action plans, ready to quickly mobilize and organize complementary resources in the event of an upsurge. Emergency funds are thus essential and should be created. Locust control seems now to depend more on political and institutional choices than on scientific and technological innovations.

The past, present and future of childhood malaria mortality in Africa.

During the past few years, there has been a historic series of declarations of renewed commitment to malaria control in Africa. Whether the burden of malaria is increasing in Africa is a moot point. This article attempts to re-construct the evidence for the trends in childhood mortality as a result of Plasmodium falciparum infection over the last century in Africa.

A new global commitment to disease control in Africa.

Despite the availability of effective therapies in developed nations, infectious diseases continue to take a grave toll on the population and economy of sub-Saharan Africa. Aside from a few successes, the global donor community has not adequately helped African governments meet these health challenges. However, if annual donor contributions increased approximately 10-20-fold, millions of lives could be saved, helping Africa escape the cycle of disease and impoverishment.

The malaria burden and Africa.

The malaria burden and Africa.

Reality vs. rhetoric – a survey and evaluation of tsetse control in East Africa

Odor baited methods of controlling tsetse have received considerable attention as ecologically friendly ways for African farmers to reduce their levels of livestock trypanosomosis. Over the last decade, a number of tsetse control projects have been set up in East Africa using these methods. Although much has been written, few hard data are available regarding their ongoing success, problems, and sustainability. To evaluate the situation on the ground, the authors conducted a series of site visits to a number of such tsetse control projects in Kenya. A comparison of these projects with others across the region identified the possible constraints to a wider uptake of these methods. Poor information, coupled with inappropriate research and development policies, were found to be the key constraints. These could be overcome with a farmer-based approach to control, with a better application of existing techniques, and with a greater role for veterinarians. Tsetse control needs to become demand rather than supply driven, if it is to bean important component of livestock disease control in Africa.

Can Roll Back Malaria Achieve its Goal?: A Challenge

Worldwide interest in combating malaria has once again been sparked and several initiatives for malaria control in Africa have been established that are well-motivated and enthusiastically supported by International Agencies and major research organizations. While this has been done with good intentions, one cannot help but wonder where and by whom the agendas were set, and to what extent people involved with control of malaria were consulted.

Economic impact assessment of rinderpest control in Africa.

The authors assess the economic impact of the Pan-African Rinderpest Campaign (PARC). The PARC programme commenced in 1986 with the objective to control and ultimately eradicate rinderpest from Africa. From among the thirty-five countries that participated in PARC, ten countries were selected for the analysis, based on data availability. The three following key socio-economic issues were addressed: cost-effectiveness, returns to investment and the welfare gains of the intervention. The standard cost-benefit approach based on a computer spreadsheet model was used to assess the economic impact of rinderpest control. Benefits of the intervention consisted of increased revenue due to avoided production losses. Estimates of the value of production losses were obtained under both 'with PARC' and 'without PARC' scenarios and the incremental benefits were derived as the difference between the two scenarios. In addition, an economic surplus model was used to assess the distribution of welfare effects generated by the intervention. Analysis of funding for the national campaigns showed roughly equal commitment to the programme by national governments and the principal donor, the European Union. Examination of the implementation costs in the ten countries indicated that with the exception of one country, PARC was implemented in a cost-effective manner with average costs appearing within a relatively narrow range. The figures obtained in ECU (European currency units) were between ECU0.27 and ECU0.60 per head of cattle vaccinated. The estimated average return from the ten countries (ECU1.8 for each ECU invested in the campaign) demonstrates that based on the sample of countries, rinderpest control in Africa has been economically profitable. In each of the ten countries, estimated benefits at least covered the value of the investment in PARC. The programme has provided a total net present value of ECU29 million for the ten countries, suggesting that the implementation of PARC has been a wise public investment decision. Analysis of the distribution of the welfare gains from PARC revealed that producers derived the greater share of the ECU58 million in net value of production losses avoided due to rinderpest control in the ten countries. Consumer gains accounted for approximately one-fifth of the total, due to lower prices from increased supplies.

Changing home treatment of childhood fevers by training shop keepers in rural Kenya.

Malaria control in Africa relies primarily on early effective treatment for clinical disease, but most early treatments for fever occur through self-medication with shop-bought drugs. Lack of information to community members on over-the-counter drug use has led to widespread ineffective treatment of fevers, increased risks of drug toxicity and accelerating drug resistance. We examined the feasibility and measured the likely impact of training shop keepers in rural Africa on community drug use. In a rural area of coastal Kenya, we implemented a shop keeper training programme in 23 shops serving a population of approximately 3500, based on formative research within the community. We evaluated the training by measuring changes in the proportions of drug sales where an adequate amount of chloroquine was purchased and in the percentage of home-treated childhood fevers given an adequate amount of chloroquine. The programme was assessed qualitatively in the community following the shop keeper training. The percentage of drug sales for children with fever which included an antimalarial drug rose from 34.3% (95% CI 28.9%-40.1%) before the training to a minimum of 79.3% (95% CI 71.8%-85.3%) after the training. The percentage of antimalarial drug sales where an adequate amount of drug was purchased rose from 31.8% (95% CI 26.6%-37.6%) to a minimum of 82.9% (95% CI 76.3%-87.3%). The percentage of childhood fevers where an adequate dose of chloroquine was given to the child rose from 3.7% (95% CI 1.2%-9.7%) before the training to a minimum of 65.2% (95% CI 57.7%-72.0%) afterwards, which represents an increase in the appropriate use of over-the-counter chloroquine by at least 62% (95% CI 53.7%-69.3%). Shop keepers and community members were strongly supportive of the aims and outcome of the programme. The large shifts in behaviour observed indicate that the approach of training shop keepers as a channel for information to the community is both feasible and likely to have a significant impact. Whilst some of the impact seen may be attributable to research effects in a relatively small scale pilot study, the magnitude of the changes support further investigation into this approach as a potentially important new strategy in malaria control.

Unrecognised infection hinders STD control in Africa

Unrecognised infection hinders STD control in Africa

Useful Plants in Traditional Control of Insect Pests

ABSTRACT A survey conducted in Kaduna State, Nigeria, identified plants and methodologies used by local people in insect control. Plants used in insect control practices included Adansonia digitata, Cyperus rotundus, Newbouldia laevis, Striga senegalense, Anona senegalense, Swartzia Madagascariensis, Hydropogon contortus and Parkia clappertonia. The use of plants for insect control in Africa has been practiced for ages.

The challenge of establishing community-directed treatment with Mectizan in Uganda.

Onchocerciasis is a major public health problem in Uganda, affecting 17 of the country's 39 districts. 1995 data indicate that of the 19 million Ugandans, 1.8 million were at risk of infection and 1.36 million were already infected. 1.3 million Ugandans in 2255 villages are currently being targeted for annual treatment with Mectizan (ivermectin, MSD). 74% of the targeted villages are hyperendemic and 18% are meso-endemic for the disease. The control of onchocerciasis in Uganda through the mass distribution of Mectizan began in the early 1990s, as a result of collaboration between the Ministry of Health and 4 nongovernmental development organizations. With the aim of eliminating onchocerciasis as a public health problem in Uganda, the national program now reaches all communities known to be affected by the disease in all but 1 district, and achieved a mean treatment coverage of 75% in 1995 and 1996. However, with results of a 1996 World Health Organization study suggesting that community-directed treatment should be the main method of onchocerciasis control in Africa, Uganda's national onchocerciasis task force must now reorient its current program from community-based to community-directed treatment. This latter approach gives communities a greater role in distributing Mectizan.

Injury control in Africa: getting governments to do more.

Despite increasing recognition of injury as a major public health problem worldwide, it has received limited attention and resources. This lack of attention is most notable in low-income countries. As part of efforts to develop coordinated injury control activities in Africa, a round table session was held at the Third International Conference on Injury Prevention and Control in Melbourne, Australia. The aims of the forum were to provide injury control researchers from Africa the opportunity to come together and reflect on issues of injury control in Africa, to deliberate on strategies of getting African governments to show more interest in injury control, and to solicit more assistance from the international donor community Participants from Ghana, Kenya, South Africa and Zimbabwe presented the magnitude of the injury burden in their respective countries, reflected on current research efforts and highlighted the preventive efforts being undertaken. The forum made many recommendations including several regarding specific actions required of African governments, individual researchers and donor agencies.

Onchocerciasis and Chagas' disease control: the evolution of control via applied research through changing development scenarios.

This paper addresses the development of control strategies of two different parasitic diseases and identifies commonalities which have contributed to the success of regional intercountry programmes of onchocerciasis control in Africa, the Onchocerciasis Control Programme (OCP), and the new African Programme for Onchocerciasis Control (APOC) and the Chagas' Disease Control Programme in the southern cone of South America.

Malaria: an emerging and re-emerging global plague.

Worldwide, malaria is the most prevalent infectious disease affecting humans. Malaria parasites presently infect more than 500 million people annually, killing up to 2 million and causing at least 100 million cases of acute illness. At the macroepidemiologic level, malaria is therefore an established, endemic public health plague for about one-third of the world's population. At the microepidemiologic level, malaria is a highly dynamic infection and disease. Although some countries have effectively managed the threat of malaria, there has been a dramatic, worldwide increase in malaria-related morbidity and mortality over the past 2 decades. In many parts of the globe, malaria is both a major threat to public health and a major obstacle to development given its ability to create high public health costs, lost productivity, and impaired individual growth. Plasmodium falciparum infections, regional differences and changes in malaria epidemiology, drug resistance, changing malaria control strategies, and implementing malaria control in Africa are discussed.