Effect of community-wide use of insecticide-treated nets for 3-4 years on malarial morbidity in Tanzania.

OBJECTIVES: To investigate (1) benefits due to personal protection of individual net users vs. mass killing of mosquitoes within villages as a result of widespread net usage; (2) sustainability over several years of benefits against malarial morbidity of insecticide-treated nets; (3) distribution of the benefits in different age groups of children and (4) whether, as a result of fading immunity, older age groups 'paid for' the benefits which they had enjoyed when younger. METHODS: (1) Tabulation of earlier data to compare personal and community-wide effects against mosquito vectors; (2) two cross-sectional surveys for malaria parasitaemia, malarial fever, anaemia and splenomegaly in children in eight Tanzanian villages, in which there had been community-wide use of bednets which had been annually re-treated with alphacypermethrin for 3-4 years; (3) comparison between children of different age groups and with intact, torn or no nets in these villages and in 4-6 villages without nets. RESULTS: A 90-95% reduction in infective bites outside nets in netted villages and an additional 54-82% reduction of bites among individual net users. Highly significant reductions (by 55-75%) in malarial morbidity for children aged 6 months to 2 years were found in netted villages with, for some outcomes, better results among individuals who themselves had intact treated nets. For older children, benefits were less clear or absent, but there was no sign that the benefits early in life were 'paid for' by worse outcomes in the netted villages later in childhood. CONCLUSIONS: The overall benefits to the community of widespread use of treated nets are sustainable and are not reversed in 3-4 years as a result of fading immunity. It is important to ensure high enough coverage to realize the full potential of the treated net method. By showing an impact on the vector population in the community these results provide a strong argument for organized free provision of net treatment, rather than relying on marketing.

Evidence for memorized site-fidelity in Anopheles arabiensis.

A mark-recapture experiment was carried out in northern Tanzania to determine whether Anopheles arabiensis exhibits memory, by investigating if bloodfed individuals would return to either the location or the host where or on which they had obtained a previous bloodmeal, behaviours termed site-fidelity and host-fidelity respectively. Over 4300 mosquitoes were collected from 2 houses, marked with different fluorescent colours according to whether they were caught in cattle sheds, 'cattle-fed', or within human bednets, 'human-fed', at either location, then released from a third location. Over 17,000 mosquitoes were collected and examined over the next 8 days. In total, 1% of released mosquitoes were recaptured. Of these, 68% had returned to the house where they were first caught, demonstrating site-fidelity (P = 0.007). However, 86% of recaptured mosquitoes were caught on cattle regardless of where they were initially caught (P = 0.185). Bloodmeal identification showed that a high proportion of mosquitoes classed as human-fed contained bovine blood, thereby confounding the investigation into host-fidelity. Notably, the proportion of mosquitoes with mixed bloodmeals depended on the proximity of cattle and humans, with significantly higher proportions of mixed bloodmeals occurring when cattle and humans slept in close proximity. The effects of the observed behaviours on malaria epidemiology are discussed.

Comparison of bednets impregnated with different pyrethroids for their impact on mosquitoes and on re-infection with malaria after clearance of pre-existing infections with chlorproguanil-dapsone.

Comparisons of bednets treated either with alphacypermethrin or lambdacyhalothrin showed similar effectiveness by various entomological criteria. Lambdacyhalothrin was associated with significantly more reports of nasal irritation than alphacypermethrin. The 2 net treatments were equally effective in reducing incidence of new malaria infections and the treated nets were much more effective than untreated nets. These measurements were made after clearing existing infections with chlorproguanil-dapsone. This drug combination was more than 99% effective in clearing infections 1 week after treatment and a study of children taken to an altitude with no malaria transmission showed that there were very few recrudescences.

A comparison of use of a pyrethroid either for house spraying or for bednet treatment against malaria vectors.

In an intensely malarious area in north-east Tanzania, microencapsulated lambdacyhalothrin was used in four villages for treatment of bednets (provided free of charge) and in another four villages the same insecticide was used for house spraying. Another four villages received neither intervention until the end of the trial but were monitored as controls. Bioassays showed prolonged persistence of the insecticidal residues. Light traps and ELISA testing showed reduction of the malaria vector populations and the sporozoite rates, leading to a reduction of about 90% in the entomological inoculation rate as a result of each treatment. Collections of blood fed mosquitoes showed no diversion from biting humans to biting animals. Incidence of re-infection was measured by weekly monitoring of cohorts of 60 children per village, after clearing preexisting infection with chlorproguanil-dapsone. The vector control was associated with a reduction in probability of re-infection per child per week by 54-62%, with no significant difference between the two vector control methods. Cross-sectional surveys for fever, parasitaemia, haemoglobin and weight showed association of high parasitaemia with fever and anaemia and beneficial effects of each intervention in reducing anaemia. However, passive surveillance by resident health assistants showed no evidence for reduced prevalence of fever or parasitaemia. Net treatment consumed only about one sixth as much insecticide as house spraying and it was concluded that the former intervention would work out cheaper and nets were actively demanded by the villagers, whereas spraying was only passively assented to.

Trial of pyrethroid impregnated bednets in an area of Tanzania holoendemic for malaria. Part 1. Operational methods and acceptability.

In five Tanzanian villages, nets impregnated with permethrin or lambdacyhalothrin were given out. The people received them enthusiastically and brought their nets for re-impregnation at six monthly intervals. Bioassays showed that the insecticidal power of permethrin impregnated nets remained adequate for six months unless the nets were washed. Nets with 30 mg lambdacyhalothrin/m2 retained high insecticidal power despite washing, but this dose caused temporary cold-like symptoms in those sleeping under freshly treated dry nets. Methods by which durable bednets might be made affordable by Tanzanian villagers are discussed.

Trial of pyrethroid impregnated bednets in an area of Tanzania holoendemic for malaria. Part 2. Effects on the malaria vector population.

The malaria vector population consisted mainly of Anopheles gambiae s.s. with a small contribution from An. funestus and An. rivulorum. The mosquitoes coming to bite in bedrooms were monitored with light traps set beside untreated bednets. When impregnated bednets were provided for all the other beds in a village the Anopheles populations declined but the Culex quinquefasciatus populations were unaffected. The survival of An. gambiae (as measured by the mean number of ovarian dilatations) and the sporozoite rate declined following introduction of the nets and the estimated sporozoite inoculation rates into people not under their nets declined by more than 90%. The net introductions caused sharp declines in the number of mosquitoes resting indoors, but the evidence was inconclusive regarding diversion to outdoor resting, animal biting, earlier biting or outdoor biting. DDT spraying greatly reduced the Anopheles populations.

Seasonal patterns of rodents, fleas and plague status in the Western Usambara Mountains, Tanzania.

Field and commensal rodents were live-trapped at three villages in an active focus of plague (Yersinia pseudotuberculosis pestis) in Lushoto District, Western Usambara Mountains, Tanga Region, Tanzania, from December 1983 to November 1984. Their flea ectoparasites were collected, identified and counted. The rodent carcasses were serologically examined for specific plague antibodies and antigens, and bacteriologically examined for bipolar staining bacilli. A total of 1758 traps were set during the 12-month period and 924 animals were caught. From these, 1037 fleas were collected. Rattus rattus (L.), Praomys natalensis (Smith) and Lophuromys flavopunctatus Thomas comprised the largest proportions of the rodent population, while Dinopsyllus lypusus Jordan & Rothschild, Ctenophthalmus calceatus Waterston and Xenopsylla brasiliensis (Baker) were the dominant flea species. Rodents were most abundantly trapped during December and January. Flea indices were highest from December to May. Human plague was most active from November to March. Rodents contained plague antibodies every month except May and July, with a peak in September. Plague antigens and bipolar bacilli were detected in rodent organs during January-April. From the product of abundance and infection rate, the most prevalent rodent hosts of plague appeared to be R. rattus, Otomys angoniensis Wroughton, P. natalensis and Pelomys fallax (Peters). Continuous integrated control of rodents and fleas was recommended, reinforced by quarantine and maintenance of a surveillance service for clinical detection, diagnosis and treatment of patients in the plague endemic area.