Monitoring the durability of long-lasting insecticidal nets in field conditions in Nepal.

Understanding and improving the durability of long-lasting insecticidal nets (LLINs) in the field is critical for the success of malaria prevention using mosquito nets, as well as contributing to procurement decisions based on the number of years of protection, rather than the current practice of unit cost. Using the recently published guidelines from the World Health Organization (WHO) some progress has been made in the monitoring and assessment of performance of nets in the field. This paper describes the protocol of an ongoing retrospective study of the attrition rate, physical integrity and bioefficacy of three polyester LLIN products that were distributed during 2010 to 2013 in Nepal. It is hoped that robust and auditable data on net survival (physical integrity and bioefficacy) of these three brands in different environments will assist the Nepal National Malaria Control Programme in planning future LLIN-replacement strategies, including behaviourchange communication about LLIN care and maintenance. The advantages and disadvantages of prospective and retrospective cross-sectional approaches are discussed, including appropriate strategies to validate the timing for mass distribution of nets. Similar studies should be done in other countries to (i) track LLIN durability to support management of resupply, and (ii) inform procurement decisions at the global level. New, more predictive, textile laboratory testing is also urgently needed.

Aedes aegypti disregard humidity-related conditions with adequate nutrition

Weather variations have clear associations with the epidemiology of dengue fever and populations of Aedes aegypti mosquitoes. Data on humidity associations, however, lags with respect to its effect on host-biting, nectar-seeking and survival. This experimental study on Ae. aegypti, sourced from the arid tropics, investigated the effect of low and high relative humidity and diet in relation to host-biting, temporal variations in feeding frequency, and mosquito mortality. In each environmental setting, 10 replicates, containing one male and five female mosquitoes, were challenged with different nutritional sources every six hours over 12 days. Results showed that host-biting did not diminish in low humidity and was six times higher than expected. Sucrose feeding was observed to significantly moderate hostbiting and water alone was inadequate for survival. The high host-biting rates help to explain the intensity of dengue epidemics, while the ability of the mosquito to disregard adverse humidity-related conditions helps to explain how dengue epidemics in arid tropical regions can be just as devastating as those in the wet tropics.

Diagnosis of Plasmodium falciparum infection using ParaSight(R)-F test in blood and urine of Papua New Guinean children.

Rapid, simple, accurate and cheap methods are required for the diagnosis of malaria in endemic areas. The ParaSight(R)-F test, which is based on qualitative detection by monoclonal antibody of the Plasmodium falciparum (Pf) histidin-rich protein-II in the blood, showed promising results. As some antigens of Pf have been detected in the urine, we assessed the efficiency of the ParaSight(R)-F test in the whole blood and in the urine using microscopy and PCR as gold standards. One hundred and twelve children living in the East Sepik Province of Papua New Guinea (PNG) were recruited during a cross-sectional community survey. When using microscopy as reference, the ParaSight(R)-F test applied to whole blood had 84% sensitivity and 77% specificity. The semi-quantitative assessment showed that the intensity of the color on the wick correlated with parasite density. The ParaSight(R)-F test performed on urine had 81% sensitivity but only 26% specificity. Very similar results for blood and urine were obtained when using PCR as reference. The present evaluation of the ParaSight(R)-F test applied to blood compares well with findings in endemic areas of Africa or Asia, and confirms its usefulness to diagnose Pf infection in endemic areas of the South Pacific. Because of the lack of specificity, the ParaSight(R)-F test performed on urine cannot be recommended.

Sustainability of a successful malaria surveillance and treatment program in a Runggus community in Sabah, east Malaysia.

The district of Kudat has one of the highest and most persistent malaria transmission levels in Sabah, Malaysia, with annual parasite incidence of 102 per 1,000 inhabitants per year. Due to this situation and the failure of DDT spraying to control malaria, a community participation health program (Sukarelawan Penjagaan Kesihatan Primer or SPKP) was developed as an adjunct to current anti-malarial measures during 1987-1991. SPKP is made up of unpaid community workers known as village health volunteers (VHVs). VHVs are selected by a village development and security committees training and supervision a member of the Vector-Borne Diseases Control Program (VBDCP). The beneficiaries of SPKP consisted primarily of Runggus people and other remote, and mobile populations who visit the home of a VHV for diagnosis and treatment. This group of febrile patients and their children who attend a participating school submit finger prick blood and personal details to the VHV. and receive a presumptive treatment for malaria. Thick and thin blood smears are examined by a VBDCP microscopist who then prepare and forward a radical or curative treatment to the VHV so that it can be administered to the microscopically-positive patient free of charge. Between June 1987 to June 1991, VHVs from 32 kampungs (villages) and 22 schools collected 56,245 slides representing 24.7% of total slide collection compared to 74.9% collected by passive case detection (PCD) posts in health centers and district hospital. The average volunteer treated 11.8 (range 10.4-13.4) and 31.4 (range 26-49) patients per month in kampungs and schools respectively. In contrast, non-SPKP posts in a district hospital, health centers and flying doctor service treated an average of 616.3 patients per month (range 134.8-1032.8). The slide positivity rate of blood smears taken by VHVs was 8.43% compared with 7.37% for non-SPKP posts. Average slide collection and slide positivity rates varied considerably from one community to another, despite their close geographic proximity. The monthly number of VHV-diagnosed patients from the school and kampungs communities and the monthly number of true malaria patients in the two groups were significantly correlated. Sustainability of SPKP was linked to an ongoing process of social change which involved co-operative networking between the government health sector and the community. This in turn provided a stimulus for malaria abatement efforts. When Runggus people themselves control and maintain ownership of community-based malaria programs, the function of SPKP as a malaria surveillance system and an antimalarial drug distribution network is vastly improved.

Outcomes of empiric antiarrhythmic drug therapy for ventricular tachyarrhythmias: a comparison of amiodarone and sotalol

The aim of this study is to review the long-term outcomes of a series of patients with ventricular tachyarrhythmias who commenced empiric treatment with either amiodarone or sotalol in the period before electrophysiologic studies were used routinely at our institution. We compared these two class III drugs as first line therapy in survivors of sustained ventricular tachycardia or cardiac arrest. Between April 1987 and August 1992, 68 male patients (mean age 68 + ou - 11 years) who had either documted sustained ventricular tachycardia (VT), cardiac arrest due to ventricular fibrillation, or syncope in the presence of underlying heart for 27-80 months (mean follow-up of 39 +/- 23 monts). The major findings in this retrospective, non-randomized study include: (1) no significant differences between sotalol and amiodarone groups with respect to total mortality, sudden death, or combined VT and sudden death: (2) a significantly higher incidence of recurrent non-fatal VT in the sotalol group; and (3) ageater incidence of adverse drug reactions in patients receiving sotalol therapy.

Giving bednets "fair" tests in field trials against malaria:a case from Sabah, East Malaysia.

Insecticide-impregnated bednets appear to be a potentially cost-effective intervention against endemic malaria in the tropics, but this has yet to be confirmed by field trials. There are two aspects to consider in assessing such trials: (1) the extent to which subjects use nets regularly and properly, and (2) the effectiveness of nets which are truly used regularly and properly in reducing malaria transmission. The second aspect is currently of primary concern, to determine if human-vector relationships for a particular at-risk population are such that bednets can be effective. But to give bednets a "fair" test in this regard requires regular and proper use in the first place. The study described here suggests they did not get a "fair" test in one field trial in Sabah, East Malaysia. The study also strongly suggests that direct observations, rather than post hoc questioning of subjects, may be essential to accurately gauge bednet usage rates. Accurate usage rates are required to determine what proportion of a population needs to use nets to reduce malaria transmission, and to evaluate the effectiveness of promotional programs over time. Direct observations can also yield valuable data on night-time activities that increase malaria risk, such as television viewing that keeps people awake and out of bednets.

Enzyme polymorphism of the malaria vector, An. balabacensis (Diptera: Culicidae) revisited--why sample natural populations?

Two separate observations from recent electrophoretic studies of the systematics and population genetics of laboratory-reared populations which had a long history of colonization in various laboratories, were found to be inconsistent with the present study which used wild-caught populations from East Malaysia. Reanalysis of the two data sets generally indicated a low amount of genetic variation in laboratory colonies. The latter is characterized by higher frequency of monomorphic loci, low average heterozygosity values and, in one extreme case, no variability at two loci. However, natural populations of An. balabacensis and An. leucosphyrus showed more protein variability by the use of polyacrylamide gel electrophoresis. Since laboratory-maintained mosquitoes are genetically and phenotypically different from those in the field, results of laboratory studies on the systematics and population genetics of Anopheles species complexes may be biased.

A serological survey of scrub, tick, and endemic typhus in Sabah, East Malaysia.

A seroepidemiological survey of 837 people and 383 febrile patients was performed in rural areas of Sabah. We determined that the rickettsial diseases scrub typhus and endemic typhus were uncommon causes of febrile illness, as was tick typhus, except in forest dwelling peoples. The rate of occurrence of SFGR specific antibody was 16.5% among 412 forest dwellers, indicating that tick typhus may be a frequent cause of illness in this population.

Evidence for the existence of genetic variability in the tendency of Anopheles balabacensis to rest in houses and to bite man.

Mark-release-recapture experiments were carried out in Sabah, East Malaysia on the malaria and filariasis vector, Anopheles balabacensis. Samples of wild females were marked with different colours of fluorescent pigments, released in man-baited huts fitted with exit traps. Simultaneous collections and releases were also made in night-biting catches on a water buffalo and on four men. All subsequent recaptures were made in the same situation in which the mosquitoes were marked. The same individual mosquitoes were caught biting men and buffalo on different occasions and the numbers caught showed a strong preference for man over buffalo. The length of the oviposition cycle in the field was found to be 3.0 days. After blood-feeding on man in a hut, An. balabacensis were found to exit on the night or early morning. The same individual mosquitoes were found resting in the hut or exit trap on different occasions. The results indicate that there is strong evidence for the existence of genetic variability in the tendency of An. balabacensis to rest in houses and to bite man and buffalo. The obvious existence of this phenomenon is considered discouraging for the prospects of interruption of malaria transmitted by An. balabacensis in nature.

Insecticide susceptibility studies of three cryptic species of the Anopheles balabacensis complex.

Susceptibilities of two colonies of the taxon An. dirus (one from Perlis and from Thailand) and one colony of An. balabacensis from Sabah to DDT, dieldrin, malathion, fenitrothion and propoxur were determined. DDT and fenitrothion tolerance was found in An. dirus species B and An. balabacensis. No resistant strain was isolated as the two colonies were not either homozygous or nearly so for resistance. Field testing of the susceptibility of the adults of An. balabacensis to DDT was carried out between 1957 to 1976. The results indicated a progressive rise in the LC50 levels greater than 1% in almost all instance. The variation in the number of sprays applied in some districts have resulted in varying sensitivities. Association between the changes in levels of DDT susceptibility and exophilic habit of An. balabacensis has been observed but needs further confirmation. The significance of these findings and the difficulties in distinguishing tolerant from truly resistant individuals are discussed in relation to accurate species identification.

Co-existence and attempted hybridization between Anopheles litoralis (King) and Anopheles sundaicus (Rodenwaldt) in Sabah, Malaysia.

Anopheles (Cellia) litoralis King and Anopheles (Cellia) sundaicus Rodenwaldt, vectors of malaria, were collected from the same brackis and sea-water habitats in six localities in Sabah. They share the same breeding habitats with predominance of one species over the other. The two species although distinct have small morphological differences and are taxonomically separated by certain wing characters. Hybridization between the two species was successful. Reciprocal crosses produced viable progeny which appeared to develop normally to adults. Hybridized females laid fewer viable eggs in comparison with the parents. The F1 hybrids resembled the litoralis parent in most characters. Backcrosses of both litoralis and sundaicus parents with the F1 hybrids yielded no eggs. F1 male hybrids were thus assumed to be sterile. The results obtained from cross matings between the two species suggested something more than subspecific status.