Small dams drive Anopheles abundance during the dry season in a high malaria burden area of Malawi.

This study explores the influence of small dams on the exposure to malaria vectors during the dry season in Kasungu district, Malawi, an area recently identified as high priority for malaria interventions by the National Malaria Control Programme. Small dam impoundments provide communities with a continuous supply of water for domestic and agricultural activities across sub-Saharan Africa and are considered vital to food security and climate change resilience. However, these permanent water bodies also create ideal breeding sites for mosquitoes in typically arid landscapes. The study focuses on a specific dam impoundment and its vicinity, aiming to assess its spatial and temporal influence on indoor vector densities. From May to August 2021, CDC light traps were used to measure indoor mosquito densities for two consecutive nights per month in three communities located at increasing distances from the dam (0, ~1 and ~2 km). Simultaneously, drone imagery was captured for each community, enabling the identification of additional standing water within approximately 400 m of selected households. Larval sampling was carried out within the impoundment periphery and in additional water bodies identified in the drone imagery. Generalised linear mixed models (GLMMs) were employed to analyse the indoor Anopheles abundance data, estimating the effects of household structure (open/closed eaves), month, temperature and water proximity on malaria vector exposure. Throughout 685 trapping nights, a total of 1256 mosquitoes were captured, with 33% (412) being female Anopheles. Among these, 91% were morphologically identified as Anopheles funestus s.l., and 5% as Anopheles gambiae s.l. Catches progressively decline in each consecutive trapping month as the environment became drier. This decline was much slower in Malangano, the community next to the dam, with abundance being notably higher in June and July. Further, the majority of An. gambiae s.l. were caught in May, with none identified in July and August. Anopheles larvae were found both in the impoundment and other smaller water bodies such as irrigation wells in each survey month; however, the presence of these smaller water bodies did not have a significant impact on adult female mosquito catches in the GLMM. The study concludes that proximity to the dam impoundment was the primary driver of differences between survey communities with the abundance in Chikhombwe (~1 km away) and Chiponde (~2 km away) being 0.35 (95% confidence interval [CI], 0.19-0.66) and 0.28 (95% CI, 0.16-0.47) lower than Malangano, respectively, after adjusting for other factors. These findings underscore the importance of targeted interventions, such as larval source management or housing improvements, near small dams to mitigate malaria transmission risks during the dry season. Further research is needed to develop cost-effective strategies for vector control within and around these impoundments.

Screening for chronic kidney disease in rural Malawi: results from a diabetic clinic.

OBJECTIVE: Patients with diabetes are at high risk of developing renal insufficiency and chronic kidney disease (CKD). As a result, screening for CKD is essential in diabetic patients as part of their care. This study investigated the prevalence of renal insufficiency, CKD, and correlates of CKD in diabetic patients attending Integrated Chronic Care Clinics in Neno District, Malawi. RESULTS: Of 203 diabetic patients, 148 (73%) were screened for CKD by measurement of serum creatinine and urinary protein between April 2016 and January 2019. 39.2% (n = 58) of the patients had abnormal estimated glomerular filtration rate (eGFR), as estimated by CKD Epidemiology Collaboration formula and/or ≥ 2+ urine protein. 13.5% (95% CI 8.4-20.0%, 20/148) of the patients had renal insufficiency based on eGFR of less than 60 ml/min/1.73 m2. 8.8% (95% CI 4.8-14.6%, 13/148) had CKD based on eGFR of less than 60 ml/min/1.73 m2 measured twice at least 3 months apart. In bivariate analysis, CKD was associated with older age, high systolic blood pressure and lower fasting blood sugar. Despite the low sample size, the study showed a moderately high prevalence of renal insufficiency and CKD in a rural cohort of diabetic patients in Malawi.

A 42-year-old woman with subacute reversible dementia: A cautionary tale.

A 42-year-old woman presented with a 6-month history of diffuse headache of moderate intensity and gradual onset of generalized weakness, imbalance, apathy, memory decline, hypophonia, dysphagia, constipation and urinary incontinence. Clinical examination revealed several elements of a frontal lobe dysfunction including apathy with motor impersistence, presence of primitive reflexes, generalized hyperreflexia with bilateral Hoffman sign and ankle clonus. The biological workup was unremarkable and a brain computed tomography scan identified a giant olfactory groove meningioma. A prompt neurosurgical intervention helped to reverse the symptoms. This case illustrates the benefits of actively looking for treatable conditions in young patients presenting with acute or subacute dementia and emphasizes the pivotal role of early brain imaging.