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Passah M, Nengnong CB, Wilson ML, Carlton JM, Kharbamon L, Albert S. Implementation and acceptance of government-sponsored malaria control interventions in Meghalaya, India. Malar J 2022; 21:200. [PMID: 35739533 PMCID: PMC9223263 DOI: 10.1186/s12936-022-04223-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/09/2022] [Indexed: 11/19/2022] Open
Abstract
Background India has made considerable progress in malaria reduction over the past two decades, with government-sponsored indoor residual spraying (IRS) and insecticide-treated bed net (ITN) or long-lasting insecticidal nets (LLIN) distribution being the main vector-related prevention efforts. Few investigations have used non-participant observational methods to assess malaria control measures while they were being implemented, nor documented people’s perceptions and acceptance of IRS or LLINs in India, and none have done so in the northeast region. This study evaluated household (HH)-level operation of IRS and distribution of LLINs by India’s National Vector Borne Disease Control Programme (NVBDCP) in 50 villages of Meghalaya state, and documented their acceptance and use. Methods Study field teams accompanied the government health system teams during August-October, 2019 and 2020 to observe deployment of LLINs, and record HH-level data on LLIN numbers and use. In addition, NVBDCP spray teams were followed during 2019–2021 to observe IRS preparation and administration. HH members were interviewed to better understand reasons for acceptance or refusal of spraying. Results A total of 8386 LLINs were distributed to 2727 HHs in 24 villages from five Primary Health Centres, representing 99.5% of planned coverage. Interviews with 80 HH residents indicated that they appreciated the LLIN dissemination programme, and generally made regular and appropriate use of LLINs, except during overnight travel or when working in agricultural fields. However, HH-level IRS application, which was observed at 632 HHs, did not always follow standard insecticide preparation and safety protocols. Of 1,079 occupied HHs visited by the spray team, 632 (58.6%) refused to allow any spraying. Only 198 (18.4%) HHs agreed to be sprayed, comprising 152 (14.1%) that were only partly sprayed, and 46 (4.3%) that were fully sprayed. Reasons for refusal included: inadequate time to rearrange HH items, young children were present, annoying smell, staining of walls, and threat to bee-keeping or Eri silk moth cultivation. Conclusions These findings are among the first in India that independently evaluate people's perceptions and acceptance of ongoing government-sponsored IRS and LLIN programmes for malaria prevention. They represent important insights for achieving India's goal of malaria elimination by 2030.
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Affiliation(s)
- Mattimi Passah
- Indian Institute of Public Health Shillong, Shillong, Meghalaya, 793001, India. .,Martin Luther Christian University, Shillong, Meghalaya, 793006, India.
| | - Carinthia Balabet Nengnong
- Indian Institute of Public Health Shillong, Shillong, Meghalaya, 793001, India.,Martin Luther Christian University, Shillong, Meghalaya, 793006, India
| | - Mark L Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jane M Carlton
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA.,Department of Epidemiology, College of Global Public Health, New York University, New York, NY, 10012, USA
| | - Larry Kharbamon
- Department of Health, National Vector Borne Disease Control Programme, Shillong, Meghalaya, India
| | - Sandra Albert
- Indian Institute of Public Health Shillong, Shillong, Meghalaya, 793001, India. .,Martin Luther Christian University, Shillong, Meghalaya, 793006, India.
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Dev V, Manguin S. Defeating malaria in the North-East region: the forerunner for malaria elimination in India. Acta Trop 2021; 222:106040. [PMID: 34252384 DOI: 10.1016/j.actatropica.2021.106040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/30/2022]
Abstract
India is a malaria endemic country which is targeting malaria elimination by 2027. Transmission intensities are low-to-moderate depending on the region supported by multiple disease vectors. Among these, comparatively North-East India contributes to high proportions of malaria cases annually, the majority of which are due to Plasmodium falciparum (90%). Anopheles minimus and An. baimaii (sibling species in the An. dirus complex) are widely prevalent and incriminated as vectors of malaria. Number of intervention tools were field-evaluated beginning 1988 to date against disease vectors and causative parasites to contain the spread of malaria. These included (i) insecticide-treated netting materials (ITNs) for vector control, (ii) rapid diagnostic tests (RDTs) for in situ diagnosis, and (iii) therapeutic efficacy of artemisinin-based combination therapies (ACTs) for improved drug-policy; all of which were incorporated in healthcare services resulting in substantial disease transmission reduction. Populations of both An. minimus and An. baimaii were observed depleting, instead An. culicifacies s.l. recorded to be fast invading degraded forests and assessed to be resistant to multiple insecticides. Of the two prevalent Plasmodium species, while P. vivax continued to be susceptible to chloroquine therapy, P. falciparum had emerged resistant to most available antimalarial drugs except ACTs over space and time and spreading to peninsular India threatening elimination efforts. Disease transmission trends were observed to be declining for which the state of Assam has made huge strides reporting steady fall in cases each passing year vis-à-vis Meghalaya, Mizoram and Tripura (all sharing international border with Bangladesh), in which malaria transmission remained uninterrupted. Consequently, control of malaria in the North-East region of India is of immediate importance and needs prioritization for intensified disease surveillance and control interventions coupled with improved access to healthcare services mitigating risk of disease outbreaks and spread of drug-resistant malaria helping realize the goal of malaria elimination in the country.
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Affiliation(s)
- Vas Dev
- ICMR, National Institute of Malaria Research, New Delhi, 110 077, India
| | - Sylvie Manguin
- HydroSciences Montpellier (HSM), University Montpellier, CNRS, IRD, 34093 Montpellier, France.
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Karl S, Katusele M, Freeman TW, Moore SJ. Quality Control of Long-Lasting Insecticidal Nets: Are We Neglecting It? Trends Parasitol 2021; 37:610-621. [PMID: 33773912 DOI: 10.1016/j.pt.2021.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/25/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022]
Abstract
Over 2.2 billion long-lasting insecticidal nets (LLINs) for malaria control have been delivered to recipient countries. LLINs are the largest single item in the global malaria control budget. To be eligible for donor-funded procurement and distribution schemes, LLIN products must attain and retain World Health Organization (WHO) prequalification status by passing safety, quality, and efficacy benchmarks. Predelivery inspections further test product quality before distribution. We have shown that, despite these quality-assurance measures, substandard LLINs were distributed in Papua New Guinea (PNG) for at least 6 years (2013-2019). Other countries may have received similar LLINs. Here, we discuss the most important weaknesses of the current LLIN quality-assurance framework that have made this possible.
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Affiliation(s)
- Stephan Karl
- Australian Institute of Tropical Health and Medicine, James Cook University, 1/14-88 McGregor Road, Smithfield, QLD, 4870, Australia; Vector Borne Disease Research Unit, PNG Institute of Medical Research, P.O. Box 378, Madang, 511, Madang Province, Papua New Guinea.
| | - Michelle Katusele
- Vector Borne Disease Research Unit, PNG Institute of Medical Research, P.O. Box 378, Madang, 511, Madang Province, Papua New Guinea
| | - Timothy W Freeman
- Rotarians Against Malaria, P.O. Box 3686, Port Moresby, 121, NCD, Papua New Guinea
| | - Sarah J Moore
- Vector Control Product Testing Unit, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania; Swiss Tropical and Public Health Institute, Vector Biology Unit, Department of Epidemiology and Public Health Socinstrasse, 57, CH-4002 Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
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Kessler A, Shylla B, Singh US, Lyngdoh R, Mawkhlieng B, van Eijk AM, Sullivan SA, Das A, Walton C, Wilson ML, Carlton JM, Albert S. Spatial and temporal village-level prevalence of Plasmodium infection and associated risk factors in two districts of Meghalaya, India. Malar J 2021; 20:70. [PMID: 33541366 PMCID: PMC7859895 DOI: 10.1186/s12936-021-03600-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/20/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Despite declining incidence over the past decade, malaria remains an important health burden in India. This study aimed to assess the village-level temporal patterns of Plasmodium infection in two districts of the north-eastern state of Meghalaya and evaluate risk factors that might explain these patterns. METHODS Primary Health Centre passive malaria case data from 2014 to 2018 were analysed to characterize village-specific annual incidence and temporal trends. Active malaria case detection was undertaken in 2018 and 2019 to detect Plasmodium infections using PCR. A questionnaire collected socio-demographic, environmental, and behavioural data, and households were spatially mapped via GPS. Adult mosquitoes were sampled at a subset of subjects' houses, and Anopheles were identified by PCR and sequencing. Risk factors for Plasmodium infection were evaluated using bivariate and multivariate logistic regression analysis, and spatial cluster analysis was undertaken. RESULTS The annual malaria incidence from PHC-based passive surveillance datasets in 2014-2018 was heterogenous but declining across villages in both districts. Active surveillance in 2018 enrolled 1468 individuals from 468 households (West Jaintia Hills) and 1274 individuals from 359 households (West Khasi Hills). Plasmodium falciparum prevalence per 100 people varied from 0 to 4.1% in the nine villages of West Jaintia Hills, and from 0 to 10.6% in the 12 villages of West Khasi Hills. Significant clustering of P. falciparum infections [observed = 11, expected = 2.15, Relative Risk (RR) = 12.65; p < 0.001] was observed in West Khasi Hills. A total of 13 Anopheles species were found at 53 houses in five villages, with Anopheles jeyporiensis being the most abundant. Risk of infection increased with presence of mosquitoes and electricity in the households [Odds Ratio (OR) = 1.19 and 1.11], respectively. Households with reported animals had reduced infection risk (OR = 0.91). CONCLUSION Malaria incidence during 2014-2018 declined in all study villages covered by the passive surveillance data, a period that includes the first widespread insecticide-treated net campaign. The survey data from 2018 revealed a significant association between Plasmodium infection and certain household characteristics. Since species of Plasmodium-competent mosquito vectors continue to be abundant, malaria resurgence remains a threat, and control efforts should continue.
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Affiliation(s)
- Anne Kessler
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
| | - Badondor Shylla
- Indian Institute of Public Health-Shillong, Shillong, Meghalaya, 793001, India
- Martin Luther Christian University, Shillong, Meghalaya, 793006, India
| | - Upasana Shyamsunder Singh
- Department of Earth and Environmental Sciences, School of Natural Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Rilynti Lyngdoh
- Department of Health Services (Malaria), National Vector Borne Disease Programme, Lawmali, Pasteur Hill, Shillong, Meghalaya, 793001, India
| | | | - Anna Maria van Eijk
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
| | - Steven A Sullivan
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
| | - Aparup Das
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, 482003, India
| | - Catherine Walton
- Department of Earth and Environmental Sciences, School of Natural Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Mark L Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jane M Carlton
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA.
- Department of Epidemiology, College of Global Public Health, New York University, New York, NY, 10012, USA.
| | - Sandra Albert
- Indian Institute of Public Health-Shillong, Shillong, Meghalaya, 793001, India.
- Martin Luther Christian University, Shillong, Meghalaya, 793006, India.
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Kilian A, Obi E, Mansiangi P, Abílio AP, Haji KA, Blaufuss S, Olapeju B, Babalola S, Koenker H. Variation of physical durability between LLIN products and net use environments: summary of findings from four African countries. Malar J 2021; 20:26. [PMID: 33413388 PMCID: PMC7791654 DOI: 10.1186/s12936-020-03549-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/12/2020] [Indexed: 11/14/2022] Open
Abstract
Background Physical durability of long-lasting-insecticidal nets (LLIN) is an important aspect of the effectiveness of LLIN as a malaria prevention tool, but there is limited data on performance across locations and products. This secondary analysis of data from the VectorWorks project from 10 sites in four African countries involving six LLIN brands provides such data. Methods A total of 4672 campaign nets from 1976 households were recruited into prospective cohort studies 2–6 months after distribution through campaigns and followed for 3 years in Mozambique, Nigeria, DRC and Zanzibar, Tanzania. LLIN products included two 100 denier polyester LLIN (DawaPlus® 2.0, PermaNet® 2.0) distributed in five sites and four 150 denier polyethylene LLIN (Royal Sentry®, MAGNet®, DuraNet©, Olyset™ Net) distributed in five sites. Primary outcome was LLIN survival in serviceable condition and median survival in years. Net use environment and net care variables were collected during four household surveys. Determinants of physical durability were explored by survival analysis and Cox regression models with risk of failure starting with the first hanging of the net. Results Definite outcomes for physical durability were obtained for 75% of study nets. After 31 to 37 months survival in serviceable condition varied between sites by 63 percentage-points, from 17 to 80%. Median survival varied by 3.7 years, from 1.6 to 5.3 years. Similar magnitude of variation was seen for polyethylene and polyester LLIN and for the same brand. Cox regression showed increasing net care attitude in combination with exposure to net related messages to be the strongest explanatory variable of survival. However, differences between countries also remained significant. In contrast, no difference was seen for LLIN material types. Conclusions Variation in net use environment and net care is the main reason for differences in the physical durability of LLIN products in different locations. While some of these factors have been identified to work across countries, other factors remain poorly defined and further investigation is needed in this area. Grouping LLIN brands by similar textile characteristics, such as material or yarn strength, is insufficient to distinguish LLIN product performance suggesting a more differentiated, composite metric is needed.
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Affiliation(s)
- Albert Kilian
- PMI VectorWorks Project, Tropical Health LLP, Montagut, Spain.
| | - Emmanuel Obi
- PMI VectorWorks Project, Tropical Health LLP, Abuja, Nigeria
| | - Paul Mansiangi
- Ecole de Santé Publique, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Khamis Ameir Haji
- Zanzibar Malaria Elimination Programme, Stone Town, Zanzibar, Tanzania
| | - Sean Blaufuss
- PMI VectorWorks Project, JHU Center for Communication Programs, Baltimore, MD, USA
| | - Bolanle Olapeju
- PMI VectorWorks Project, JHU Center for Communication Programs, Baltimore, MD, USA
| | - Stella Babalola
- PMI VectorWorks Project, JHU Center for Communication Programs, Baltimore, MD, USA
| | - Hannah Koenker
- PMI VectorWorks Project, JHU Center for Communication Programs, Baltimore, MD, USA
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Sahu SS, Keshaowar AV, Thankachy S, Panigrahi DK, Acharya P, Balakrishnan V, Kumar A. Evaluation of bio-efficacy and durability of long-lasting insecticidal nets distributed by malaria elimination programme in Eastern India. Malar J 2020; 19:186. [PMID: 32448316 PMCID: PMC7247230 DOI: 10.1186/s12936-020-03260-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-lasting insecticidal nets (LLINs) are the most favoured vector control tools worldwide. Timely monitoring and evaluation of LLINs is important to sustain the impact of this promising vector control method and for replacement of worn-out and those rendered ineffective. During the mid-2017, LLINs were distributed by the National Vector Borne Disease Control Programme (NVBDCP) in high malaria endemic districts of the eastern coastal state of Odisha. The study was carried out to assess the field performance of the LLINs post 30 months of distribution in Koraput district of Odisha state. METHODS A total of 130 households were randomly selected from three villages of Laxmipur CHC in Koraput district, Odisha, India; one each from hilltop, foothill and plain terrain. The net users were interviewed to elicit information on usage, washing practices, physical integrity, bio-efficacy and survivorship of LLINs to confirm the claimed three-year life of the LLINs. RESULTS 74.8% of the LLINs were physically present after 30 months of distribution. The numbers (%) of LLINs used previous night varied from 30 to 61% between study villages. 74% respondents were using the LLINs throughout the year and 26% only seasonally. Of the total, 85% of the nets were reported to be washed and 95% nets were dried under shade as recommended. Altogether, 58% of the surveyed nets were found torn with holes. Of these, 74 (57%) nets were in good condition, 10 (8%) nets were in serviceable and 45 (35%) nets were badly torn and needed replacement. A total of 45 (93.75%), 68 (80%) and 71 (63.8%) LLINs were physically present in hilltop, foothill and plain villages, respectively. The LLINs did meet the efficacy criteria, given the 100% mortality to the exposed Anopheles jeyporiensis mosquitoes post 30 months distribution. CONCLUSIONS The findings of this study were communicated to the programme officials of the state and LLINs were replenished soon after 31st month post-distribution of LLINs.
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Affiliation(s)
- Sudhansu Sekhar Sahu
- Indian Council of Medical Research-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India.
| | - Amol Vasantrao Keshaowar
- Indian Council of Medical Research-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | - Sonia Thankachy
- Indian Council of Medical Research-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | - Dilip Kumar Panigrahi
- Indian Council of Medical Research-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | - Premalata Acharya
- Indian Council of Medical Research-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | - Vijayakumar Balakrishnan
- Indian Council of Medical Research-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | - Ashwani Kumar
- Indian Council of Medical Research-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
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Killeen GF. Control of malaria vectors and management of insecticide resistance through universal coverage with next-generation insecticide-treated nets. Lancet 2020; 395:1394-1400. [PMID: 32304648 DOI: 10.1016/s0140-6736(20)30745-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Gerry F Killeen
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania; School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland.
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Dev V, Manguin S. Biology, distribution and control of Anopheles (Cellia) minimus in the context of malaria transmission in northeastern India. Parasit Vectors 2016; 9:585. [PMID: 27846911 PMCID: PMC5111344 DOI: 10.1186/s13071-016-1878-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022] Open
Abstract
Among six dominant mosquito vector species involved in malaria transmission in India, Anopheles minimus is a major species in northeast India and held responsible for focal disease outbreaks characterized by high-rise of Plasmodium falciparum infections and attributable death cases. It has been now genetically characterized that among the three-member species of the Minimus Complex spread in Asia, An. minimus (former species A) is prevalent in India including northeastern states and east-central state of Odisha. It is recorded in all seasons and accounts for perennial transmission evidenced by records of sporozoite infections. This species is highly anthropophilic, and largely endophilic and endophagic, recorded breeding throughout the year in slow flowing seepage water streams. The populations of An. minimus in India are reported to be highly diverse indicating population expansion with obvious implications for judicious application of vector control interventions. Given the rapid ecological changes due to deforestation, population migration and expansion and developmental activities, there is scope for further research on the existence of potential additional sibling species within the An. minimus complex and bionomics studies on a large geographical scale for species sanitation. For control of vector populations, DDT continues to be applied on account of retaining susceptibility status even after decades of residual spraying. Anopheles minimus is a highly adaptive species and requires continuous and sustained efforts for its effective control to check transmission and spread of drug-resistant malaria. Anopheles minimus populations are reportedly diminishing in northeastern India whereas it has staged comeback in east-central State of Odisha after decades of disappearance with its eco-biological characteristics intact. It is the high time to siege the opportunity for strengthening interventions against this species for its population diminution to sub-optimal levels for reducing transmission in achieving malaria elimination by target date of 2030.
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Affiliation(s)
- Vas Dev
- National Institute of Malaria Research (Field Station), Guwahati, 781022, Assam, India
| | - Sylvie Manguin
- Institut de Recherche pour le Développement FRANCE (IRD), LIPMC, UMR-MD3, Faculté de Pharmacie, F-34093, Montpellier, France.
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