Efficacy Of Nets Research Articles

How important is the angle of tilt in the WHO cone bioassay?

BackgroundThe World Health Organization (WHO) cone bioassay plays an integral role in the evaluation of the efficacy of long-lasting insecticidal nets as well as insecticides used in indoor residual spraying. The test is used on a variety of treated substrates, such as pieces of bed nets, mud, cement and wood. The cone setup assumes a wide variety of angles under different settings in which it is applied. However, the guidelines provided for the performance of the assay do not specify the angle at which the test must be performed.MethodsLaboratory colonies of Anopheles gambiae Kisumu-1 and Anopheles stephensi STI were tested in the WHO cone bioassay at four different angles (0°, 45°, 60° and 90°) following the WHO guidelines against net pieces of Olyset Plus and Netprotect. The tests were repeated after 20 washes of the nets. Individual mosquitoes were also exposed at 0° and 60° and the amount of time each spent in contact with the net was recorded.ResultsMosquitoes spent more time on the net at 60° as compared to 0° (coefficient = 45.8, 95 % CI 34.6–55.6, p < 0.001) and were more likely to die when the test was done at 45° (OR 3.3, 95 % CI 1.7–6.3, p = 0.001), 60° (OR 3.1, 95 % CI 1.7–5.9, p < 0.001) and 90° (OR 6.0, 95 % CI 1.9–18.5, p = 0.002) as compared to 0°.ConclusionThe angle at which the test is performed significantly affects the amount of time mosquitoes spend resting on the nets, and subsequently mortality. Angle must thus be considered as an important component in the performance of the assay and duly incorporated into the guidelines.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1303-9) contains supplementary material, which is available to authorized users.

Determinants of Impregnated Net Ownership and Utilization in Rural Community on the Thai-Myanmar Border in Prachuab Khiri Khan, Thailand

Efficacy of Insecticide-treated Nets (ITNs), Long Lasting Insecticidal Nets (LLINs) and Indoor Residual Spraying (IRS) in reducing malaria transmission are strongly presented in various countries. ITNs, LLINs and IRS free-of-charge have been used to control among Thai vulnerable populations since 2008. Studies found that the utilization of impreganted net among vulnerable Thai was low. This study investigated factors associated with impregnated net ownership and utilization among population living in rural community. Random samples of 1,673 respondents living in 678 households on the Thai-Myanmar border in Prachuab Khiri Khan province were interviewed from October 2010 to May 2011. The prevalence of impregnated nets ownership was 41%, and 70% of their own utilized them. In multivariate analysis, Thaipladthin ethnicity (adjusted Odds ratio (aOR) 2.1; 95% CI: 1.2-3.6) and access to IRS (aOR 2.3; 95% CI: 1.6-3.1) were associated with impregnated net ownership. Malaria infection (aOR 4.2; 95% CI: 1.8-9.4), and irregularly use of electric fan (aOR 2.0; 95% CI: 1.3-3.1) were positively associated with net utilization. Whereas, high level of barrier to ITN/LLIN utilization (aOR 0.6; 95% CI: 0.4-0.9) was associated with net utilization. Our findings reflect an existing gap between net ownership and utilization. To scale-up the adoption of impregnated net utilization, enforcing ownership through sustainable strategies that involved social marketing should be addressed.

Efficacy of insect-proof nets used in Tunisian tomato greenhouses against Tuta absoluta (Meyrick) (Lepidoptera: Gelechiidae) and potential impact on plant growth and fruit quality

Insect-proof screens constitute efficient physical means of protecting horticultural crops against insect pests and their use has become widespread. However, they may have a negative impact on plant growth and fruit quality by modifying climatic parameters of greenhouses. In case of tomato crops, they are used mainly against white flies and the tomato leaf miner &lt;em&gt;Tuta absoluta&lt;/em&gt; (Meyrick). In Tunisia, tomato plastic tunnels are often netted following two modalities: i) complete netting of the greenhouse under the plastic screen (total netting); or ii) netting only doors and lateral aeration windows (partial netting). Weekly monitoring of &lt;em&gt;T. absoluta&lt;/em&gt; in two tomato greenhouses with different netting setups using pheromone traps and sampling of leaves and fruits showed no differences in the levels of infestation by the pest with a maximum average values of 6.66 eggs/leaf, 4.16 larvae/leaf and 4.16 mines/leaf. The maximum infestation rate of leaves was 86.66% and that of fruits was 10.83%. No effects of the netting setup used on plant growth parameters were detected. However, the study of fruit quality parameters revealed significant decrease in sugar contents in tomato fruits when using total netting setup (4.26°Brix &lt;em&gt;versus&lt;/em&gt; 3.68°Brix). Recommendations regarding the combined use of pheromones traps and insect-proof nets are given and possibilities to enhance the efficiency of nets as physical barrier against &lt;em&gt;T. absoluta&lt;/em&gt; are explored.

Rise of multiple insecticide resistance in Anopheles funestus in Malawi: a major concern for malaria vector control.

BackgroundDeciphering the dynamics and evolution of insecticide resistance in malaria vectors is crucial for successful vector control. This study reports an increase of resistance intensity and a rise of multiple insecticide resistance in Anopheles funestus in Malawi leading to reduced bed net efficacy.MethodsAnopheles funestus group mosquitoes were collected in southern Malawi and the species composition, Plasmodium infection rate, susceptibility to insecticides and molecular bases of the resistance were analysed.ResultsMosquito collection revealed a predominance of An. funestus group mosquitoes with a high hybrid rate (12.2 %) suggesting extensive species hybridization. An. funestus sensu stricto was the main Plasmodium vector (4.8 % infection). Consistently high levels of resistance to pyrethroid and carbamate insecticides were recorded and had increased between 2009 and 2014. Furthermore, the 2014 collection exhibited multiple insecticide resistance, notably to DDT, contrary to 2009. Increased pyrethroid resistance correlates with reduced efficacy of bed nets (<5 % mortality by Olyset® net), which can compromise control efforts. This change in resistance dynamics is mirrored by prevalent resistance mechanisms, firstly with increased over-expression of key pyrethroid resistance genes (CYP6Pa/b and CYP6M7) in 2014 and secondly, detection of the A296S-RDL dieldrin resistance mutation for the first time. However, the L119F-GSTe2 and kdr mutations were absent.ConclusionsSuch increased resistance levels and rise of multiple resistance highlight the need to rapidly implement resistance management strategies to preserve the effectiveness of existing insecticide-based control interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0877-y) contains supplementary material, which is available to authorized users.

Do holes in long-lasting insecticidal nets compromise their efficacy against pyrethroid resistant Anopheles gambiae and Culex quinquefasciatus? Results from a release–recapture study in experimental huts

BackgroundResistance of malaria vectors to pyrethroids threatens the effectiveness of long-lasting insecticidal nets (LLINs) as a tool for malaria control. Recent experimental hut and observational studies in Benin show that pyrethroid resistance reduces the insecticidal effect and personal protection of LLINs especially when they become torn. The World Health Organization has proposed a threshold for when nets are “too torn” at 1,000 cm2 for rectangular holes and 790 cm2 for round holes. This study examines whether there is a threshold above which LLINs no longer reduce malaria transmission.MethodsIntact and artificially-holed LLINs under three months old and untreated nets were tested by releasing mosquitoes from a susceptible Anopheles gambiae colony, a pyrethroid-resistant An. gambiae population and a resistant Culex quinquefasciatus population in closed experimental huts in Southern Benin, West Africa. The efficacy of LLINs and untreated nets was evaluated in terms of protection against blood feeding, insecticidal effect and potential effect on malaria transmission.ResultsPersonal protection by both LLINs and untreated nets decreased exponentially with increasing holed surface area, without evidence for a specific threshold beyond which LLINs could be considered as ineffective. The insecticidal effect of LLINs was lower in resistant mosquitoes than in susceptible mosquitoes, but holed surface area had little or no impact on the insecticidal effect of LLINs. LLINs with 22,500 cm2 holed surface area and target insecticide content provided a personal protection of 0.60 (95 % CI 0.44–0.73) and a low insecticidal effect of 0.20 (95 % CI 0.12–0.30) against resistant An. gambiae. Nevertheless, mathematical models suggested that if 80 % of the population uses such nets, they could still prevent 94 % (95 % CI 89–97 %) of transmission by pyrethroid-resistant An. gambiae.ConclusionsEven though personal protection by LLINs against feeding mosquitoes is strongly reduced by holes, the insecticidal effect of LLINs is independent of the holed surface area, but strongly dependent on insecticide resistance. Badly torn nets that still contain insecticide have potential to reduce malaria transmission. The relationship between LLIN integrity and efficacy needs to be understood in order to guide LLIN distribution policy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0836-7) contains supplementary material, which is available to authorized users.

'A bite before bed': exposure to malaria vectors outside the times of net use in the highlands of western Kenya.

BackgroundThe human population in the highlands of Nyanza Province, western Kenya, is subject to sporadic epidemics of Plasmodium falciparum. Indoor residual spraying (IRS) and long-lasting insecticide treated nets (LLINs) are used widely in this area. These interventions are most effective when Anopheles rest and feed indoors and when biting occurs at times when individuals use LLINs. It is therefore important to test the current assumption of vector feeding preferences, and late night feeding times, in order to estimate the extent to which LLINs protect the inhabitants from vector bites.MethodsMosquito collections were made for six consecutive nights each month between June 2011 and May 2012. CDC light-traps were set next to occupied LLINs inside and outside randomly selected houses and emptied hourly. The net usage of residents, their hours of house entry and exit and times of sleeping were recorded and the individual hourly exposure to vectors indoors and outdoors was calculated. Using these data, the true protective efficacy of nets (P*), for this population was estimated, and compared between genders, age groups and from month to month.ResultsPrimary vector species (Anopheles funestus s.l. and Anopheles arabiensis) were more likely to feed indoors but the secondary vector Anopheles coustani demonstrated exophagic behaviour (p < 0.05). A rise in vector biting activity was recorded at 19:30 outdoors and 18:30 indoors. Individuals using LLINs experienced a moderate reduction in their overall exposure to malaria vectors from 1.3 to 0.47 bites per night. The P* for the population over the study period was calculated as 51% and varied significantly with age and season (p < 0.01).ConclusionsIn the present study, LLINs offered the local population partial protection against malaria vector bites. It is likely that P* would be estimated to be greater if the overall suppression of the local vector population due to widespread community net use could be taken into account. However, the overlap of early biting habit of vectors and human activity in this region indicates that additional methods of vector control are required to limit transmission. Regular surveillance of both vector behaviour and domestic human-behaviour patterns would assist the planning of future control interventions in this region.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0766-4) contains supplementary material, which is available to authorized users.

The Anopheles gambiae cE5 salivary protein: a sensitive biomarker to evaluate the efficacy of insecticide-treated nets in malaria vector control

Evaluation of vector control is crucial for improving malaria containment and, according to World Health Organization, new complementary indicators would be very valuable. In this study the IgG response to the Anopheles-specific cE5 salivary protein was tested as a tool to evaluate the efficacy of insecticide-treated nets in reducing human exposure to malaria vectors. Sera collected during a longitudinal study carried out in Angola, and including entomological and parasitological data, were used to assess the IgG response to the Anopheles gambiae cE5 in both children and adults, before and after the application of insecticide-treated nets. Seasonal fluctuation of specific IgG antibody levels according to exposure was only found in children (up to ≈14 years old) whose anti-cE5 IgG response dropped after bed nets installation. These results were fully consistent with previous findings obtained with the same set of sera and indicating a substantial reduction of human-vector contact shortly after nets implementation. Overall, children IgG response to the cE5 protein appeared a very sensitive biomarker, which allowed for the detection of even weak exposure to Anopheles bites, indicating it may represent a reliable additional tool to evaluate the efficacy of vector control interventions.

Insecticide resistance status in Culex quinquefasciatus in Benin.

BackgroundCulex quinquefasciatus, an arboviral and filarial vector, is present year round in several cities of the Republic of Benin. There is more information on the resistance status to malaria vectors compared to Culicines. It is therefore unfortunate that the international focus is on Anopheles control and not so much done against Cx. quinquefasciatus, a rather more resilient mosquito to many insecticides that deserves attention. The present study aims to assess the resistance status of Cx. quinquefasciatus to carbamates, pyrethroids and organochlorine and discuss the implications for vector control in four contrasting localities of the country.MethodsFour contrasting localities of the country were selected for mosquito collection during the dry season based on their variation in agricultural production, use of insecticides and/or ecological settings. Bioassay were performed on adults collected from the field to assess the susceptibility of Cx. quinquefasciatus to insecticide-impregnated papers (permethrin 0.75%, delthamethrin 0.05%, DDT 4%, and bendiocarb 0.1%) following WHOPES guidelines. Molecular assays were carried out to detect the presence of knock down resistance (kdr) and acetylcholinesterase (ace. 1) mutations in surviving specimens using PCR techniques.ResultsWHO diagnostic tests showed high frequency of resistance in Cx. quinquefasciatus to permethrin (ranging from 4 to 24% mortality), deltamethrin (24 to 48%), DDT (4 to 12%) and bendiocarb (60 to 76%) in the four selected areas. This was consistent with the presence of target site insensitivity due to kdr and ace.1 mutations, which were significantly higher in areas where farmers used insecticides for pests control than in areas where no insecticides were used (p < 0.05.).ConclusionThese findings showed that wild populations of Cx. quinquefasciatus have developed resistance against pyrethroids, organochlorine and carbamate. This situation of resistance may seriously jeopardize the efficacy of Insecticide Residual Spray (IRS) and Long-Lasting Insecticide nets (LLINs) on which, most African countries including Benin, rely to reduce malaria transmission.

Efficacy of insecticide-impregnated nets in German cockroach management under laboratory conditions

Efficacy of insecticide-impregnated nets in German cockroach management under laboratory conditions

Usage pattern, physical integrity & insecticidal efficacy of long-lasting insecticidal nets in Odisha State, India.

Background & objectives:One of the major strategies being pursued for malaria control by the National Vector Borne Disease Control Programme is the distribution of long lasting insecticidal nets (LLINs) in endemic areas since 2009. Information on durability of insecticidal efficacy and physical integrity of LLINs and community usage at different time intervals of their use is essential to plan net replacements to maintain universal coverage for an effective and sustainable malaria control strategy. Therefore, a study was undertaken to assess these parameters in two malaria endemic districts of the Odisha State.Methods:A total of 309 households were selected in 15 villages of two community health centres (CHCs) (Borigumma and Laxmipur) from Koraput district and one (Khairput) from Malkangiri district. Data on net usage were collected during March to July 2014 using semi-structured questionnaires. PermaNet 2.0 were sampled from all households, replaced with new ones, and bioassays were carried out to determine the insecticidal efficacy of LLINs after four and half, four and two years of field use following the standard procedure of World Health Organization.Results:LLIN use rate varied from 57.9 to 90.2 per cent in the study CHCs. The annual washing rate per net in Borigumma, Khairput and Laxmipur was 6.6, 3.2 and 4.8, respectively. The LLINs used two years in the field caused 100 per cent mortality and four to four and half years caused below 80 per cent mortality, except one net.Interpretation & conclusions:Nearly 20 per cent of the people were out of net coverage and hence the Programme to ensure 100 per cent coverage. The community should adequately be educated so as to increase the net use rate and avoid incorrect washing practices.

Do Size and Insecticide Treatment Matter? Evaluation of Different Nets against Phlebotomus argentipes, the Vector of Visceral Leishmaniasis in Nepal.

In the Indian subcontinent, Leishmania donovani, the parasite causing visceral leishmaniasis (VL) is transmitted by the sand fly vector Phlebotomus argentipes. Long lasting insecticide treated nets (LN) have been postulated as alternative or complement to Indoor Residual Spraying but there are few field studies evaluating the entomological efficacy of different nets against this vector. We conducted two crossover trials in a VL endemic area in Nepal to compare the barrier effect of (1) LN with different mesh sizes (156 holes/inch2 vs 625 holes/inch2) and (2) alpha-cypermethrin treated LN and untreated nets having the same mesh size (156 holes/inch2). Each crossover trial had two arms consisting of a sequence of two different nets for 8 nights. We used 10 cattle sheds per trial. A cow placed under the net was used as bait. CDC light traps placed inside the nets were used to evaluate the number of P. argentipes crossing the net barrier. Negative binomial generalized estimating equation (GEE) population-averaged models adjusted by night and sequence were used to estimate the barrier effect of the different nets. The crossover trials conducted in a rural village in Morang district (South-eastern Nepal) demonstrated that reducing the size of the holes in treated nets (625 holes/inch2) increased the barrier effect of LN by 77% (95% confidence interval (CI): 56%–88%) compared with treated nets with larger holes (156 holes/inch2). Treating nets with alpha-cypermethrin reduced the number of P. argentipes captured inside the nets by 77% (95% CI: 27%–93%) compared with untreated nets. The effectiveness and acceptability of finer mesh pyrethroid treated LN should be tested for VL prevention in a randomized controlled trial.

Power analysis for generalized linear mixed models in ecology and evolution.

‘Will my study answer my research question?’ is the most fundamental question a researcher can ask when designing a study, yet when phrased in statistical terms – ‘What is the power of my study?’ or ‘How precise will my parameter estimate be?’ – few researchers in ecology and evolution (EE) try to answer it, despite the detrimental consequences of performing under- or over-powered research. We suggest that this reluctance is due in large part to the unsuitability of simple methods of power analysis (broadly defined as any attempt to quantify prospectively the ‘informativeness’ of a study) for the complex models commonly used in EE research. With the aim of encouraging the use of power analysis, we present simulation from generalized linear mixed models (GLMMs) as a flexible and accessible approach to power analysis that can account for random effects, overdispersion and diverse response distributions.We illustrate the benefits of simulation-based power analysis in two research scenarios: estimating the precision of a survey to estimate tick burdens on grouse chicks and estimating the power of a trial to compare the efficacy of insecticide-treated nets in malaria mosquito control. We provide a freely available R function, sim.glmm, for simulating from GLMMs.Analysis of simulated data revealed that the effects of accounting for realistic levels of random effects and overdispersion on power and precision estimates were substantial, with correspondingly severe implications for study design in the form of up to fivefold increases in sampling effort. We also show the utility of simulations for identifying scenarios where GLMM-fitting methods can perform poorly.These results illustrate the inadequacy of standard analytical power analysis methods and the flexibility of simulation-based power analysis for GLMMs. The wider use of these methods should contribute to improving the quality of study design in EE.

Efficacy of insect nets for cabbage production and pest management depending on the net removal frequency and microclimate

In Africa, synthetic pesticide applications are overly frequent and above labelled rates. We assessed the efficacy of an insect net physical control system on field cabbage (Brassica oleracea var. capitata) production in France and Benin. Various mesh sizes and netting removal frequencies were compared under contrasting climatic conditions. Studies under Mediterranean climatic conditions (spring season) compared two mesh sizes (0.73 mm and 1.6 mm). Studies under subequatorial climatic conditions (cool and hot seasons) tested nets of mesh size 0.4 mm and 0.9 mm used either as permanent cover, removed daily, or 3 days per week. The results showed that a fine mesh did not improve the netting efficacy against pests but had a major impact on the microclimate. In Mediterranean climatic conditions, the netting efficacy and beneficial microclimate improved crop yields. In subequatorial conditions, crop yields were lowest with permanent net protection due to high temperatures under the nets and poor aphid and Spodoptera littoralis control. Removing the nets 3 days per week was a good technical/economic trade-off, ensuring acceptable efficacy with minimal effects on the microclimate.

Evaluation of the efficacy of DDT indoor residual spraying and long-lasting insecticidal nets against insecticide resistant populations of Anopheles arabiensis Patton (Diptera: Culicidae) from Ethiopia using experimental huts.

BackgroundIndoor Residual Spraying (IRS) and Long-Lasting Insecticidal nets (LLINs) are major malaria vector control tools in Ethiopia. However, recent reports from different parts of the country showed that populations of Anopheles arabiensis, the principal malaria vector, have developed resistance to most families of insecticides recommended for public health use which may compromise the efficacy of both of these key vector control interventions. Thus, this study evaluated the efficacy of DDT IRS and LLINs against resistant populations of An. arabiensis using experimental huts in Asendabo area, southwestern Ethiopia.MethodsThe susceptibility status of populations of An. arabiensis was assessed using WHO test kits to DDT, deltamethrin, malathion, lambda-cyhalothrin, fenitrothion and bendiocarb. The efficacy of LLIN (PermaNet® 2.0), was evaluated using the WHO cone bioassay. Moreover, the effect of the observed resistance against malaria vector control interventions (DDT IRS and LLINs) were assessed using experimental huts.ResultsThe findings of this study revealed that populations of An. arabiensis were resistant to DDT, deltamethrin, lambda-cyhalothrin and malathion with mortality rates of 1.3%, 18.8%, 36.3% and 72.5%, respectively but susceptible to fenitrothion and bendiocarb with mortality rates of 98.81% and 97.5%, respectively. The bio-efficacy test of LLIN (PermaNet® 2.0) against An. arabiensis revealed that the mosquito population showed moderate knockdown (64%) and mortality (78%). Moreover, mosquito mortalities in DDT sprayed huts and in huts with LLINs were not significantly different (p > 0.05) from their respective controls.ConclusionThe evaluation of the efficacy of DDT IRS and LLINs using experimental huts showed that both vector control tools had only low to moderate efficacy against An. arabiensis populations from Ethiopia. Despite DDT being replaced by carbamates for IRS, the low efficacy of LLINs against the resistant population of An. arabiensis is still a problem. Thus, there is a need for alternative vector control tools and implementation of appropriate insecticide resistance management strategies as part of integrated vector management by the national malaria control program.

The Impact of Pyrethroid Resistance on the Efficacy of Insecticide-Treated Bed Nets against African Anopheline Mosquitoes: Systematic Review and Meta-Analysis

Pyrethroid insecticide-treated bed nets (ITNs) help contribute to reducing malaria deaths in Africa, but their efficacy is threatened by insecticide resistance in some malaria mosquito vectors. We therefore assessed the evidence that resistance is attenuating the effect of ITNs on entomological outcomes. We included laboratory and field studies of African malaria vectors that measured resistance at the time of the study and used World Health Organization-recommended impregnation regimens. We reported mosquito mortality, blood feeding, induced exophily (premature exit of mosquitoes from the hut), deterrence, time to 50% or 95% knock-down, and percentage knock-down at 60 min. Publications were searched from 1 January 1980 to 31 December 2013 using MEDLINE, Cochrane Central Register of Controlled Trials, Science Citation Index Expanded, Social Sciences Citation Index, African Index Medicus, and CAB Abstracts. We stratified studies into three levels of insecticide resistance, and ITNs were compared with untreated bed nets (UTNs) using the risk difference (RD). Heterogeneity was explored visually and statistically. Included were 36 laboratory and 24 field studies, reported in 25 records. Studies tested and reported resistance inconsistently. Based on the meta-analytic results, the difference in mosquito mortality risk for ITNs compared to UTNs was lower in higher resistance categories. However, mortality risk was significantly higher for ITNs compared to UTNs regardless of resistance. For cone tests: low resistance, risk difference (RD) 0.86 (95% CI 0.72 to 1.01); moderate resistance, RD 0.71 (95% CI 0.53 to 0.88); high resistance, RD 0.56 (95% CI 0.17 to 0.95). For tunnel tests: low resistance, RD 0.74 (95% CI 0.61 to 0.87); moderate resistance, RD 0.50 (95% CI 0.40 to 0.60); high resistance, RD 0.39 (95% CI 0.24 to 0.54). For hut studies: low resistance, RD 0.56 (95% CI 0.43 to 0.68); moderate resistance, RD 0.39 (95% CI 0.16 to 0.61); high resistance, RD 0.35 (95% CI 0.27 to 0.43). However, with the exception of the moderate resistance category for tunnel tests, there was extremely high heterogeneity across studies in each resistance category (chi-squared test, p<0.00001, I² varied from 95% to 100%). This meta-analysis found that ITNs are more effective than UTNs regardless of resistance. There appears to be a relationship between resistance and the RD for mosquito mortality in laboratory and field studies. However, the substantive heterogeneity in the studies' results and design may mask the true relationship between resistance and the RD, and the results need to be interpreted with caution. Our analysis suggests the potential for cumulative meta-analysis in entomological trials, but further field research in this area will require specialists in the field to work together to improve the quality of trials, and to standardise designs, assessment, and reporting of both resistance and entomological outcomes.

Long-Term Insecticidal Activity and Physical Integrity of Olyset Nets in Tafea Province, Vanuatu

The long-term efficacy of long-lasting insecticidal nets (LLINs) depends on both the physical condition of the net and the residual activity of the insecticide. This study focused on monitoring these parameters in Olyset nets (Sumitomo Chemical Co., Osaka, Japan) (n = 101) that had been used for 1-3 yr in Tafea Province, Vanuatu. Net usage and frequency of washing was ascertained by questionnaire; the nets were assessed with regards to cleanliness and damage owing to holes. Insecticide efficacy was determined with cone bioassays using Anophelesfarauti Laveran. Net usage was high and 86.1% (87 of 101) of villages stated that they used the net every night. Washing of nets was low (11.9%, 12 of 101), and most nets (79.2%, 80 of 101) were considered dirty. Most nets were damaged (73.4% had holes), and 22.8% (23 of 101) had large holes (>200 cm2). The 24-h mortality of An. farauti exposed to nets aged 1-2 yr was 79.4%, while the mortality for nets 3 yr of age was significantly lower at 73.7%. There was no difference in the insecticidal activity of clean compared with dirty nets (mean 24-h mortality: Clean = 76.7%, Dirty = 77.1%). Although the majority of nets had holes, the physical condition of 8.9-22.8% of nets was altered so severely to potentially affect efficacy. Although the 3-yr-old nets would still be providing significant levels of insecticidal and personal protection, consideration should be given to replacing nets >3 yr old.

Pediatric cerebral malaria pathology

Malaria kills more than half a million children a year in sub-Saharan Africa despite the availability of effective combination drug therapy, efficacy of bed nets, and environmental control measures. Cerebral malaria, a syndrome of coma in the setting of malaria infection, is one of the main causes of death in these children that has, to date, no effective interventions other than rapid administration of antimalarials. The principal finding in the brain of patients who die meeting the clinical case definition of cerebral malaria is the presence of densely packed Plasmodium falciparum parasite cytoadherent to human endothelial cells (i.e., sequestration). This finding was noted in the late 19th century and has remained a consistent feature to date. Extensive modern surveys of human pathology through autopsy have revealed new insights into the biology and mechanisms of death in pediatric patients as well as point to interventions that may impact the mortality rate in this disease. The Blantyre Malaria Project Autopsy series of 103 cases will be presented and discussed in detail as well as a review of the literature in pediatric disease.

The efficacy of long-lasting nets with declining physical integrity may be compromised in areas with high levels of pyrethroid resistance

BackgroundLong-lasting insecticide-treated mosquito nets (LLINs) are a primary malaria prevention strategy in sub-Saharan Africa. However, emergence of insecticide resistance threatens the effectiveness of LLINs.MethodsCross-sectional surveys of LLINs were conducted in houses of seven and four villages in Gem and Bungoma Districts in western Kenya, respectively. Condition (number and area of holes in the nets), number and species of mosquitoes resting inside them, and insecticidal activity of nets were quantified. Mosquitoes collected inside nets were allowed to lay eggs and progeny tested for susceptibility to deltamethrin and permethrin, pyrethoids commonly deployed in LLINs in western Kenya.ResultsIn Gem, 83.3% of nets were less than three years old and 32.4% had at least one hole of any size; while in Bungoma, 92% were less than three years old and 48% had at least one hole. No anopheline and five Culex spp. mosquitoes were found resting inside nets in Gem regardless of the number and size of holes, while 552 Anopheles gambiae s.l., five Anopheles funestus s.l. and 137 Culex spp. were in nets in Bungoma. The number of mosquitoes resting inside nets increased with hole areas >50 cm in Bungoma. In WHO resistance assays, f1 offspring of samples collected in nets in Bungoma were 94 and 65% resistant to deltamethrin and permethrin, respectively. Nets from Bungoma retained strong activity against a susceptible laboratory strain, but not against f1 offspring of field-collected An. gambiae s.s. All An. gambiae s.s. samples collected in nets were homozygous for the kdr genotype L1014S.ConclusionsIn areas with pyrethroid resistant vectors, LLINs with modest hole areas permit mosquito entry and feeding, providing little protection against the vectors. LLIN formulations develop large holes within three years of use, diminishing their presupposed lifetime effectiveness.

Evaluation of New Tools for Malaria Vector Control in Cameroon: Focus on Long Lasting Insecticidal Nets

BackgroundFrom 2006 to 2011, biological activity of insecticides for Indoor Residual Spraying (IRS), conventional treatment of nets (CTNs) or long lasting insecticidal nets (LLINs) was evaluated before their approval in Cameroon. The objective of the study was to select the best tools for universal malaria vector control coverage.MethodologyBioassays were performed using WHO cones and the Kisumu susceptible strain of Anopheles gambiae s.s.. Among tested products, residual activity and wash resistance of Alpha-cypermethrin LLINs (Interceptor) and CTNs (Fendona) were assessed during 5 months in the Ntougou neighborhood.Principal FindingsAll the 14 tested products were found effective (95–100% knockdown and mortality rates), although a significant decrease of efficacy was seen with lambda-cyhalothrinWP IRS, alpha-cypermethrin CTNs and LLINs (p< 0.05). However, the efficacy of Interceptor nets did not decrease during the 5 months evaluation, even after 25 washes (0.07<p< 0.9). Meanwhile Fendona SC nets displayed a drastic decrease of activity after 5 washes, odds ratio was 3.07 (1.0–8.59).ConclusionThis study provided useful data for decision making and community education toward universal coverage of malaria vector control in Cameroon.

Examining the impact of larval source management and insecticide-treated nets using a spatial agent-based model of Anopheles gambiae and a landscape generator tool

BackgroundAgent-based models (ABMs) have been used to estimate the effects of malaria-control interventions. Early studies have shown the efficacy of larval source management (LSM) and insecticide-treated nets (ITNs) as vector-control interventions, applied both in isolation and in combination. However, the robustness of results can be affected by several important modelling assumptions, including the type of boundary used for landscapes, and the number of replicated simulation runs reported in results. Selection of the ITN coverage definition may also affect the predictive findings. Hence, by replication, independent verification of prior findings of published models bears special importance.MethodsA spatially-explicit entomological ABM of Anopheles gambiae is used to simulate the resource-seeking process of mosquitoes in grid-based landscapes. To explore LSM and replicate results of an earlier LSM study, the original landscapes and scenarios are replicated by using a landscape generator tool, and 1,800 replicated simulations are run using absorbing and non-absorbing boundaries. To explore ITNs and evaluate the relative impacts of the different ITN coverage schemes, the settings of an earlier ITN study are replicated, the coverage schemes are defined and simulated, and 9,000 replicated simulations for three ITN parameters (coverage, repellence and mortality) are run. To evaluate LSM and ITNs in combination, landscapes with varying densities of houses and human populations are generated, and 12,000 simulations are run.ResultsGeneral agreement with an earlier LSM study is observed when an absorbing boundary is used. However, using a non-absorbing boundary produces significantly different results, which may be attributed to the unrealistic killing effect of an absorbing boundary. Abundance cannot be completely suppressed by removing aquatic habitats within 300 m of houses. Also, with density-dependent oviposition, removal of insufficient number of aquatic habitats may prove counter-productive. The importance of performing large number of simulation runs is also demonstrated. For ITNs, the choice of coverage scheme has important implications, and too high repellence yields detrimental effects. When LSM and ITNs are applied in combination, ITNs’ mortality can play more important roles with higher densities of houses. With partial mortality, increasing ITN coverage is more effective than increasing LSM coverage, and integrating both interventions yields more synergy as the densities of houses increase.ConclusionsUsing a non-absorbing boundary and reporting average results from sufficiently large number of simulation runs are strongly recommended for malaria ABMs. Several guidelines (code and data sharing, relevant documentation, and standardized models) for future modellers are also recommended.