Cost effectiveness of malaria vector control activities in Sudan.

BACKGROUND: Malaria vector control activities in Sudan rely largely on Long-Lasting Insecticidal Nets (LLINs), Indoor Residual Spray (IRS) and Larval Source Management (LSM). The present study attempted to determine cost effectiveness of inputs and operations of vector control interventions applied in different environmental settings in central and eastern Sudan, as well as their impact. METHODS: The inputs utilized and cost of each vector control activity, operational achievements and impact of the applied malaria vector control activities; IRS, LLINs and LSM were determined for eight sites in Al Gazira state (central Sudan) and Al Gadarif state (eastern Sudan). Operational costs were obtained from data of the National Malaria Control Program in 2017. Impact was measured using entomological indicators for Anopheles mosquitoes. RESULTS: The total cost per person per year was $1.6, $0.85, and $0.32 for IRS, LLINs and LSM, respectively. Coverage of vector control operations was 97%, 95.2% and 25-50% in IRS, LLINs and LSM, respectively. Vectorial capacity of malaria vectors showed statistically significant variations (P < 0.034) and ranged 0.294-0.65 in areas implemented LSM in comparison to 0.097-0.248 in areas applied IRS and LLINs, respectively. Both indoor and outdoor biting Anopheles mosquitoes showed noticeable increase that reached 3-12 folds in areas implemented LSM in comparison to areas implemented IRS and LLINs. Annual malaria prevalence was 13.1-21.1% in areas implemented LSM in comparison to 3.20%, 4.77% in areas implemented IRS and LLINs, respectively. CONCLUSION: IRS and LLINs are cost effective control measures due to adequate inputs and organized process. However, the unit cost of LSM intervention per outcome and subsequently the impact is hugely affected by the low coverage. The very weak support for implementation of LSM which includes inputs resulted in weakness of its process and consequently its impact. Implementation of LSM by local government in urban settings is challenged by many factors the most important are maintenance of adequate stable level of funding, un-adequate number of well trained health workers, unstable political and administrative conditions and weak infrastructure. These challenges are critical for proper implementation of LSM and control of malaria in urban settings in Sudan.

Challenges and epidemiological implications of the first outbreak of dengue and chikungunya in Sudan.

Background: Dengue and chikungunya are mosquito-borne infections that are spreading rapidly worldwide. The highest burden lies in tropical and subtropical countries. In 2022 Sudan encountered the most widespread infection of both diseases. Aim: To describe the magnitude of the first outbreak of dengue and chikungunya infections in Tandalti Town, White Nile State, southern part of Sudan. Methods: Following the report of a high number of undifferentiated febrile illnesses in 32 health clinics in Tandalti Town, an area with high densities of Aedes aegypti, we collected blood samples from symptomatic suspected cases. The samples were tested for major arboviral infections using arboviral-specific enzyme-linked immunosorbent assays (IgM capture ELISA), and serologically positive samples were confirmed using commercially available Real Time RT-PCR Kits. Results: Out of 773 suspected cases, 63 (8.15%) were confirmed. Eleven (17.46%) of the confirmed cases were DENV, 49 (77.77%) were CHIKV, and 3 (4.76%) were DENV and CHIKV co-infections. The outbreak started at the beginning of October and ended by mid December 2022. Both dengue and chikungunya infection was higher (41(65.08%)) among young females than males (22 (34.92%)). Conclusions: White Nile State may experience larger outbreaks of dengue and chikungunya in the future, there is, therefore, an urgent need for proper vector control interventions in the state and nearby states.

Population Genetic Analysis of Aedes aegypti Mosquitoes From Sudan Revealed Recent Independent Colonization Events by the Two Subspecies.

Increases in arbovirus outbreaks in Sudan are vectored by Aedes aegypti, raising the medical importance of this mosquito. We genotyped 12 microsatellite loci in four populations of Ae. aegypti from Sudan, two from the East and two from the West, and analyzed them together with a previously published database of 31 worldwide populations to infer population structure and investigate the demographic history of this species in Sudan. Our results revealed the presence of two genetically distinct subspecies of Ae. aegypti in Sudan. These are Ae. aegypti aegypti in Eastern Sudan and Ae. aegypti formosus in Western Sudan. Clustering analysis showed that mosquitoes from East Sudan are genetically homogeneous, while we found population substructure in West Sudan. In the global context our results indicate that Eastern Sudan populations are genetically closer to Asian and American populations, while Western Sudan populations are related to East and West African populations. Approximate Bayesian Computation Analysis supports a scenario in which Ae. aegypti entered Sudan in at least two independent occasions nearly 70-80 years ago. This study provides a baseline database that can be used to determine the likely origin of new introductions for this invasive species into Sudan. The presence of the two subspecies in the country should be consider when designing interventions, since they display different behaviors regarding epidemiologically relevant parameters, such as blood feeding preferences and ability to transmit disease.

Retrospective hospital-based study on snakebite envenomation in Sudan.

BACKGROUND: Snakebite statistics are lacking in Sudan despite the high estimated burden. In this study we aimed to describe the incidence of snakebite envenomation and death in Sudan and to show the state-wise distribution of snakebite episode. METHODS: We retrospectively analyzed hospital-based data on snakebite for 2014-2018. Data were obtained from the annual health statistical reports of the Ministry of Health. Descriptive statistics were used to illustrate the results. RESULTS: A total of 63 160 people were envenomed during 2014-2018 with an average of 12 632 cases/year. The death rate between inpatient cases was 2.5%. The annual incidence was 18- 47 cases/100 000 population. Gadarif state recorded the highest incidence (132/100 000 population) of snakebite envenomation in Sudan whereas Northern state had the least incidence (5/100 000 population). The 15-24 y age group experienced the highest risk of snakebite and males were more exposed to snakebites than females. CONCLUSIONS: Although hospital-based records underestimate the burden of snakebite, they can still provide an insight regarding the actual numbers. Here, we highlight the at-risk states in Sudan to be targeted for further questionnaire-based epidemiological studies and to guide health authorities to reduce the burden of snakebite envenomation by insuring proper antivenom distribution to the highly affected areas.

Comparison of the temporal efficacy of Aquatain surface films for the control of Anopheles arabiensis and Ochlerotatus caspius larvae from Sudan.

Aquatain mosquito formulation (AMF) is a surfactant that spreads across the surface of water bodies to produce a monomolecular film. This study experimentally evaluates the temporal efficacy of AMF against aquatic stages of Anopheles arabiensis and Ochlerotatus caspius under laboratory conditions. Using the recommended application dose of 1 ml m-2, a large species-specific difference in the median lethal time for L3-L4 larvae was observed. The median lethal time to 50% mortality (LT50) and 90% mortality (LT90) was 1.3 h, 95% CI [1.2, 1.4] and 3.8 h, 95% CI [3.6, 4.0], respectively, for Oc. caspius. The corresponding values for An. arabiensis were 8.1 h, 95% CI [7.3, 9.0] and 59.6 h, 95% CI [48.5, 76.2]. Based on data from published laboratory studies for a total of seven mosquito species, drawn from four genera, results in the following three groups, [LT50 = 1-2 h, Culex quinquefasciatus, Ochlerotatus caspius] [LT50 = 8-24, hours, Anopheles minimus, Anopheles arabiensis, Anopheles gambiae s.s.] and [LT50 = 72-143 h, Anopheles stephensi, Aedes aegypti]. In all experiments, 100% mortality was achieved given sufficient time. The potential relevance of mortality rate estimates, in the context of other studies, on the use of monomolecular films for the control of malaria and arbovirus diseases is discussed.

Culex/ mosquitoes (Diptera: Culicidae) recorded along the Nile River in central and northern Sudan, with a key for the identification of all species of the genus known to occur in the country.

Despite the importance of Culex species as major vectors of Rift Valley fever virus, West Nile virus and the microfilariae that cause lymphatic filariasis, information on these mosquitoes in Sudan is limited to works published 65 years ago in the former Anglo-Egyptian Sudan, where some species were only recorded from areas of the territory now known as South Sudan. In this paper, we provide updated information on Culex mosquitoes collected indoors during surveillance studies conducted along the Nile River in central and northern areas of Sudan between 2012 and 2019. Of 3,411 female mosquitoes collected in Khartoum and northern states along the river, 2,560 (75%) were specimens of Culex belonging to 12 species: Cx. (Culex) antennatus (Becker, 1903), Cx. (Cux.) laticinctus Edwards, 1913, Cx. (Cux.) neavei Theobald, 1906, Cx. (Cux.) pipiens Linnaeus, 1758, Cx. (Cux.) perexiguus Theobald, 1903, Cx. (Cux.) poicilipes (Theobald, 1903), Cx. (Cux.) quinquefasciatus Say, 1823, Cx. (Cux.) simpsoni Theobald, 1905, Cx. (Cux.) sinaiticus Kirkpatrick, 1925, Cx. (Cux.) theileri Theobald, 1903, Cx. (Cux.) tritaeniorhynchus Giles, 1901 and Cx. (Culiciomyia) macfiei Edwards, 1923. This is the first record for Cx. tritaeniorhynchus and Cx. macfiei in central Sudan. The relative abundance of each species varied in different areas and seasons, but Cx. antennatus and Cx. quinquefasciatus were the most abundant indoor resting species. We provide an updated dichotomous key for the identification of the adults of Culex mosquitoes known to occur in the Republic of the Sudan.

A possible role for ticks in the transmission of Madurella mycetomatis in a mycetoma-endemic village in Sudan.

BACKGROUND: Currently there is a wide knowledge gap in our understanding of mycetoma epidemiological characteristics, including the infection route. METHODS: A cross-sectional descriptive epidemiological study was carried out to determine the role of exposure to animals and insects such as ticks in the transmission of eumycetoma in two adjacent villages at eastern Sudan. RESULTS: Significant differences were found between the two villages in the level of contact and exposure to animals and ticks, the percentages of people bitten by ticks, participation in cleaning animal pens and knowledge of the medical importance of ticks. In the village with a high mycetoma prevalence rate, there were high infestation rates of ticks in domestic animals. Hyalomma and Rhipicephalus species were the most prevalent species in houses with mycetoma patients and together they constituted 83% of the total collection. Pool screening of vectors for the detection of Madurella mycetomatis recombinant RNA genes showed one positive pool from Rhipicephalus evertsi following amplification of the universal fungal primer and one positive sample from Hyalomma rufipes following the use of a specific primer. CONCLUSION: The findings indicate a possible role of ticks in the transmission of eumycetoma causative agents. However, further in-depth studies are needed to verify this.

Stegomyia indices of Aedes aquatic stages in El Geneina town, Western Sudan.

BACKGROUND: Darfur in Western Sudan has the most volatile camps of internally displaced persons (IDPs) and has experienced several outbreaks of dengue, chikungunya and yellow fever. AIMS: To determine the prevalence and Stegomyia indices of Aedes aquatic stages in El Geneina town, Western Darfur. METHODS: Cross-sectional entomological surveys of immature stages of Aedes were carried out during August-November 2019 in 4 sites with IDP camps and a residential area with no camp. RESULTS: We searched 17 730 houses, IDP camps and buildings of governmental corporations for Aedes larvae, and 6809 (38.4%) were positive for Aedes aquatic stages. Both Aedes aegypti and Aedes vittatus larvae were found. However, Ae. aegypti constituted > 90% of the larvae. Six positive water containers were recorded: tyres, clay pots, barrels, plastic water tanks, flower vases and old cars: 26% of 92 tyres contained Aedes larvae compared to 23.8% of 21 old cars and 17.1% of 44 198 clay pots. This suggested that clay pots were the main source of Aedes. The results showed high infestation of El Geneina town with Aedes immature stages in all study sites including public buildings and residential areas with no IDP camps. Stegomyia indices varied among study sites, and were more elevated in sites with IDP camps. For all sites, House index = 38.40, Container Index = 11.40, Breateu index = 13.60 and Pupa Index = 27. CONCLUSION: Multisectoral response coupled with community participation are urgently needed to reduce the burden of Aedes-borne diseases in the unstable El Geneina town.

Anopheles arabiensis in Sudan: a noticeable tolerance to urban polluted larval habitats associated with resistance to Temephos.

BACKGROUND: It has been documented that unplanned urbanization leads to the exposure of members of the Anopheles vectors to a range of water pollution in urban settings. Many surveys from African and Asian countries reported the presence of Anopheles larvae in polluted urban habitats. The present study documents an obvious tolerance of the melanic and normal forms of Anopheles arabiensis to urban polluted larval habitats accompanied by resistance to Temephos larvicide. METHODS: A cross-sectional survey was carried out to inspect apparently polluted An. arabiensis larval habitats during the hot dry season of 2015. Larval specimens were collected from only apparently polluted habitats after visual inspection from 5 localities in Khartoum State. After morphological and molecular identification of random samples of larvae the magnitude of water pollution was determined using nine abiotic factors. The susceptibility status of An. arabiensis larval forms from normal and polluted habitats to Temephos was tested using the WHO standard diagnostic concentration doses. RESULTS: Morphological and PCR analysis of anopheline larvae revealed the presence of An. arabiensis, a member of the Anopheles gambiae complex. Seven out of 9 physiochemical parameters showed higher concentrations in polluted larval habitats in comparison to control site. Anopheles arabiensis larvae were found in water bodies characterized by high mean of conductivity (1857.8 ± 443.3 uS/cm), turbidity (189.4 ± 69.1 NTU) and nitrate (19.7 ± 16.7 mg/l). The range of mortality rates of An. arabiensis larvae collected from polluted habitats in comparison to An. arabiensis larvae collected from non-polluted habitats was 6.7-64% (LD50 = 1.682) and 67.6-96% (LD50 = 0.806), respectively. CONCLUSIONS: The present study reveals that minor populations of An. arabiensis larval forms are adapted to breed in polluted urban habitats, which further influenced susceptibility to Temephos, especially for the melanic larval forms. This could have further implications on the biology of the malaria vector and on the transmission and epidemiology of urban malaria in Sudan.

Laboratory rearing of Anopheles arabiensis: impact on genetic variability and implications for Sterile Insect Technique (SIT) based mosquito control in northern Sudan.

BACKGROUND: Mosquito colony populations often show significant changes in their population genetic make-up compared to the field populations that were used as founding source. Most of the changes that have been reported are indicators of depletion in the overall genetic diversity of the colony populations. The Sterile Insect Techniques programme of mosquito control that is underway in Northern Sudan uses sterilized males produced from a laboratory-maintained colony population. The genetic diversity of an advanced generation of this colony population was quantitatively assessed and compared to the field population from which the colony was derived. METHODS: Anopheles arabiensis mosquito samples from the 13th generation of the colony, and from the locality that was the source of the first generation of the colony, were genotyped at 11 microsatellite loci distributed throughout the species' genome. Standard population genetic analyses were carried out to quantify and compare their population genetic make-up and diversities. RESULTS: The colony samples showed significant reduction in the total number of alleles, the numbers of rare and private alleles, and the fractions of heterozygote individuals at all the loci. The pattern of change is consistent with the expected effect of the use of a small number of mosquitoes when the colony was established. Departure from Hardy-Weinberg equilibrium in the direction of homozygote excess was observed at some loci and attributed to the presence of null-alleles. CONCLUSIONS: This study highlights the need for broad sampling when initiating colony populations and for ongoing assessment of the population genetic make-up of colony populations. Previous assessments of survivorship, dispersive behaviour and swarm formation indicate that the inbreeding and reduced genetic variability reported in this study may not have had direct fitness consequences yet. However, noting the lessons learned in other SIT programmes about the impact of colonization on male sexual behaviour and longevity, as well as other inbreeding related adverse effects, a systematic investigation of these potential effects is recommended because they have direct impact on the ultimate success of the programme.