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Ngufor C, Govoetchan R, Fongnikin A, Hueha C, Ahoga J, Syme T, Agbevo A, Daleb A, Small G, Nimmo D, Bradley J, Aikpon R, Iyikirenga L, Osse R, Tokponnon F, Padonou GG. Community evaluation of VECTRON™ T500, a broflanilide insecticide, for indoor residual spraying for malaria vector control in central Benin; a two arm non-inferiority cluster randomised trial. Sci Rep 2023; 13:17852. [PMID: 37857762 PMCID: PMC10587144 DOI: 10.1038/s41598-023-45047-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023] Open
Abstract
VECTRON™ T500 is a wettable powder IRS formulation of broflanilide, a newly discovered insecticide. We performed a two-arm non-inferiority community randomised evaluation of VECTRON™ T500, compared to Fludora® Fusion against pyrethroid-resistant Anopheles gambiae s.l. in an area of high coverage with pyrethroid-only nets in the Za-Kpota District of central Benin. One round of IRS was applied in all consenting households in the study area. Sixteen clusters were randomised (1:1) to receive VECTRON™ T500 (100 mg/m2 for broflanilide) or Fludora® Fusion (200 mg/m2 for clothianidin and 25 mg/m2 for deltamethrin). Surveys were performed to assess adverse events and the operational feasibility and acceptability of VECTRON™ T500 among spray operators and household inhabitants. Human landing catches were conducted in 6 households every 1-2 months for up to 18 months post-intervention to assess the impact on vector densities, sporozoite rates and entomological inoculation rates. Bottle bioassays were performed to monitor vector susceptibility to pyrethroids, broflanilide and clothianidin. Monthly wall cone bioassays were conducted for 24 months to assess the residual efficacy of the IRS formulations using susceptible and pyrethroid-resistant An. gambiae s.l. A total of 26,562 female mosquitoes were collected during the study, of which 40% were An. gambiae s.l., the main malaria vector in the study area. The vector population showed high intensity pyrethroid resistance but was susceptible to broflanilide (6 µg/bottle) and clothianidin (90 µg/bottle). Using a non-inferiority margin of 50%, vector density indicated by the human biting rate (bites/person/night) was non-inferior in the VECTRON™ T500 arm compared to the Fludora® Fusion arm both indoors (0.846 bites/p/n in Fludora® Fusion arm vs. 0.741 bites/p/n in VECTRON™ T500 arm, IRR 0.54, 95% CI 0.22-1.35, p = 0.150) and outdoors (0.691 bites/p/n in Fludora® Fusion arm vs. 0.590 bites/p/n in VECTRON™ T500 clusters, IRR 0.75, 95% CI 0.41-1.38, p = 0.297). Sporozoite rates and entomological inoculation rates did not differ significantly between study arms (sporozoite rate: 0.9% vs 1.1%, p = 0. 0.746, EIR: 0.008 vs 0.006 infective bites per person per night, p = 0.589). Cone bioassay mortality with both VECTRON™ T500 and Fludora® Fusion was 100% for 24 months post-IRS application on both cement and mud treated house walls with both susceptible and pyrethroid-resistant strains of An. gambiae s.l. Perceived adverse events reported by spray operators and householders were generally very low (< 6%) in both study arms. VECTRON™ T500 was non-inferior to Fludora® Fusion in reducing the risk of malaria transmission by pyrethroid resistant vectors when applied for IRS in communities in central Benin. The insecticide showed prolonged residual efficacy on house walls, lasting over 24 months and had a high acceptability with homeowners. Community application of VECTRON™ T500 for IRS provides improved and prolonged control of pyrethroid resistant malaria vectors and enhances our capacity to manage insecticide resistance.
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Affiliation(s)
- Corine Ngufor
- London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT, UK.
- Centre de Recherches Entomologiques de Cotonou (CREC), Cotonou, Benin.
- Panafrican Malaria Vector Research Consortium (PAMVERC), Cotonou, Benin.
| | - Renaud Govoetchan
- London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT, UK
- Centre de Recherches Entomologiques de Cotonou (CREC), Cotonou, Benin
- Panafrican Malaria Vector Research Consortium (PAMVERC), Cotonou, Benin
| | - Augustin Fongnikin
- Centre de Recherches Entomologiques de Cotonou (CREC), Cotonou, Benin
- Panafrican Malaria Vector Research Consortium (PAMVERC), Cotonou, Benin
| | - Corneille Hueha
- Centre de Recherches Entomologiques de Cotonou (CREC), Cotonou, Benin
- Panafrican Malaria Vector Research Consortium (PAMVERC), Cotonou, Benin
| | - Juniace Ahoga
- Centre de Recherches Entomologiques de Cotonou (CREC), Cotonou, Benin
- Panafrican Malaria Vector Research Consortium (PAMVERC), Cotonou, Benin
| | - Thomas Syme
- London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT, UK
- Centre de Recherches Entomologiques de Cotonou (CREC), Cotonou, Benin
- Panafrican Malaria Vector Research Consortium (PAMVERC), Cotonou, Benin
| | - Abel Agbevo
- London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT, UK
- Centre de Recherches Entomologiques de Cotonou (CREC), Cotonou, Benin
- Panafrican Malaria Vector Research Consortium (PAMVERC), Cotonou, Benin
| | - Abdoulaye Daleb
- Centre de Recherches Entomologiques de Cotonou (CREC), Cotonou, Benin
| | - Graham Small
- Innovative Vector Control Consortium, Liverpool, UK
| | - Derric Nimmo
- Innovative Vector Control Consortium, Liverpool, UK
| | - John Bradley
- London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT, UK
| | - Rock Aikpon
- National Malaria Control Programme, Ministry of Health, Cotonou, Benin
| | | | - Razaki Osse
- Centre de Recherches Entomologiques de Cotonou (CREC), Cotonou, Benin
| | - Filemon Tokponnon
- Centre de Recherches Entomologiques de Cotonou (CREC), Cotonou, Benin
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2
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Keïta M, Sissoko I, Sogoba N, Konaté M, Diawara SI, Kané F, Thiam S, Touré M, Konaté D, Diakité M, Beier JC, Doumbia S. Resurgence of Malaria Transmission and Incidence after Withdrawal of Indoor Residual Spraying in the District of Koulikoro, Mali. Am J Trop Med Hyg 2023; 109:616-620. [PMID: 37549902 PMCID: PMC10484277 DOI: 10.4269/ajtmh.22-0808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/25/2023] [Indexed: 08/09/2023] Open
Abstract
In Mali, malaria vector control relies mostly on long-lasting insecticidal nets and indoor residual spraying (IRS). From 2008 to 2016, an IRS program was implemented in the district of Koulikoro. After a significant reduction in malaria indicators, IRS was stopped in 2016. This study evaluated the effect of IRS withdrawal on entomological parameters of malaria transmission and incidence in children aged 6 months to 10 years in the district of Koulikoro. Entomological parameters of malaria transmission during the last year of IRS implementation in 2016 were compared with those obtained 2 years after IRS withdrawal in 2018 in two villages of Koulikoro. Mosquito vectors were collected by mouth aspiration and pyrethrum spray catches in the villages to monitor these transmission parameters. A sharp increase (10.8 times higher) in vector abundance after IRS withdrawal was observed. The infection rate of Anopheles gambiae sensu lato to Plasmodium falciparum increased from zero during IRS implementation to 14.8% after IRS withdrawal. The average entomological inoculation rate, which was undetectable before, was 1.22 infected bites per person per month 2 years after IRS was withdrawn, and the cumulative malaria incidence rate observed after IRS was 4.12 times (15.2% versus 3.7%) higher than that observed in 2016 in the villages before IRS withdrawal. This study showed a resurgence of malaria transmission and incidence in the Koulikoro health district after IRS was withdrawn. Thus, to manage the potential consequences of malaria transmission resurgence, alternative approaches are needed when stopping successful malaria control interventions.
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Affiliation(s)
- Moussa Keïta
- West African International Center for Excellence in Malaria Research/Malaria Research and Training Center/International Center for Excellence in Research/University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ibrahim Sissoko
- West African International Center for Excellence in Malaria Research/Malaria Research and Training Center/International Center for Excellence in Research/University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Nafomon Sogoba
- West African International Center for Excellence in Malaria Research/Malaria Research and Training Center/International Center for Excellence in Research/University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Moussa Konaté
- West African International Center for Excellence in Malaria Research/Malaria Research and Training Center/International Center for Excellence in Research/University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sory Ibrahim Diawara
- West African International Center for Excellence in Malaria Research/Malaria Research and Training Center/International Center for Excellence in Research/University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Fousseyni Kané
- West African International Center for Excellence in Malaria Research/Malaria Research and Training Center/International Center for Excellence in Research/University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Salif Thiam
- West African International Center for Excellence in Malaria Research/Malaria Research and Training Center/International Center for Excellence in Research/University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mahamoudou Touré
- West African International Center for Excellence in Malaria Research/Malaria Research and Training Center/International Center for Excellence in Research/University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Drissa Konaté
- West African International Center for Excellence in Malaria Research/Malaria Research and Training Center/International Center for Excellence in Research/University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mahamadou Diakité
- West African International Center for Excellence in Malaria Research/Malaria Research and Training Center/International Center for Excellence in Research/University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - John C. Beier
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Seydou Doumbia
- West African International Center for Excellence in Malaria Research/Malaria Research and Training Center/International Center for Excellence in Research/University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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3
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Kwi PN, Ewane EE, Moyeh MN, Tangi LN, Ntui VN, Zeukeng F, Sofeu-Feugaing DD, Achidi EA, Cho-Ngwa F, Amambua-Ngwa A, Bigoga JD, Apinjoh TO. Diversity and behavioral activity of Anopheles mosquitoes on the slopes of Mount Cameroon. Parasit Vectors 2022; 15:344. [PMID: 36171589 PMCID: PMC9520907 DOI: 10.1186/s13071-022-05472-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria remains endemic in Cameroon, with heterogeneous transmission related to eco-climatic variations, vector diversity and spatial distribution. The intensification of malaria prevention and control through the free distribution of insecticide-treated nets in recent years may have altered the composition, geographic distribution and natural infection rate of Anopheles species, with implications for malaria transmission dynamics. The present study seeks to assess the vectorial diversity, dynamics and infectivity across different seasons and altitudes in relationship to parasite prevalence around the slopes of Mount Cameroon, southwestern region. METHOD Mosquitoes were sampled (indoors and outdoors) in 11 eco-epidemiological settings at low (18-197 m), intermediate (371-584 m) and high (740-1067 m) altitude by nightly human landing catches. The mosquitoes were identified morphologically and Anopheles gambiae sibling species identified by PCR. Parity status was ascertained by examining the ovaries and the entomological inoculation rates (EIR) determined by Plasmodium falciparum circumsporozoite antigen ELISA of the head-thorax. The prevalence of Plasmodium infection across target communities was assessed using rapid diagnostic tests. RESULTS A total of 7327 (18.0 mosquitoes/trap/night) mosquitoes were trapped, mainly during the rainy season (5678, 77.5%) and at low altitude (3669, 50.1%). Anopheles spp. (5079, 69.3%) was the most abundant genera and An. gambiae complex (2691, 36.7%) the major vector, varying with altitude (χ2 = 183.87, df = 8, P < 0.001) and season (χ2 = 28.14, df = 4, P < 0.001). Only An. gambiae (s.s.) was identified following molecular analysis of An. gambiae complex siblings. The overall biting peak for An. gambiae complex was 2-3 a.m. Anopheles cinctus was the most abundant secondary vector in the area. The average EIR in the area was 2.08 infective bites per person per night (ib/p/n), higher at low (2.45 ib/p/n) than at intermediate altitude (1.39 ib/p/n) and during the rainy (1.76 ib/p/n) compared to the dry season (0.34 ib/p/n). Anopheles funestus was most infectious overall (28.1%, 16/57) while An. gambiae had the highest inoculation rates averaging 1.33 ib/p/n. Most Anopheles species across all altitudes and seasons were parous, highest in communities with the highest proportion of malaria parasite infections. CONCLUSION Anopheles gambiae (s.s.) remains the major malaria vector in the area and An. cinctus possibly a secondary vector of the disease in the slopes of Mt. Cameroon. The seasonal and altitudinal effects on the distribution of these mosquitoes may have implications for the transmission of malaria and its control strategies in the area. Regular monitoring of the bionomics of local Anopheles vector species and targeted control interventions in the 'hotspots' is necessary to curb the prevalence of the infection and incidence of disease.
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Affiliation(s)
- Pilate N Kwi
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon
| | - Elvis E Ewane
- Department of Medical Laboratory Sciences, University of Buea, Buea, Cameroon
| | - Marcel N Moyeh
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon.,Department of Chemical and Biological Engineering, The University of Bamenda, Bamenda, Cameroon
| | - Livinus N Tangi
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Vincent N Ntui
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon
| | - Francis Zeukeng
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon.,Laboratory for Vector Biology and Control, The Biotechnology Centre, University of Yaounde 1, Yaounde, Cameroon
| | | | - Eric A Achidi
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon
| | - Fidelis Cho-Ngwa
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon.,Department of Chemical and Biological Engineering, The University of Bamenda, Bamenda, Cameroon
| | - Alfred Amambua-Ngwa
- Medical Research Council Unit The Gambia at London, School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Jude D Bigoga
- Laboratory for Vector Biology and Control, The Biotechnology Centre, University of Yaounde 1, Yaounde, Cameroon
| | - Tobias O Apinjoh
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon. .,Department of Chemical and Biological Engineering, The University of Bamenda, Bamenda, Cameroon.
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4
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Yokoly FN, Zahouli JBZ, Small G, Ouattara AF, Opoku M, de Souza DK, Koudou BG. Assessing Anopheles vector species diversity and transmission of malaria in four health districts along the borders of Côte d'Ivoire. Malar J 2021; 20:409. [PMID: 34663359 PMCID: PMC8524949 DOI: 10.1186/s12936-021-03938-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although malaria and Anopheles mosquito vectors are highly prevalent in Côte d'Ivoire, limited data are available to help understand the malaria vector density and transmission dynamics in areas bordering the country. To address this gap, the Anopheles mosquito species diversity, the members of the Anopheles gambiae complex and the transmission of malaria were assessed in four health districts along the borders of Côte d'Ivoire. METHODS From July 2016 through December 2016 and July 2017 through December 2017, adult Anopheles mosquitoes were collected in four health districts of Côte d'Ivoire (Aboisso, Bloléquin, Odienné and Ouangolodougou) using standardized window exit trap (WET) and pyrethrum knockdown spray collection (PSC) methods. The collected mosquitoes were identified morphologically at species level and the members of the An. gambiae complex were separated using short interspersed nuclear element-based polymerase chain reaction (SINE-PCR). Anopheles gambiae sensu lato (s.l.), Anopheles funestus s.l. and Anopheles nili specimens were analysed for malaria Plasmodium parasite detection using the cytochrome oxidase I gene (COX-I), and malaria prevalence among human population through local Ministry of Health (MoH) statistical yearbooks. RESULTS A total of 281 female Anopheles were collected in Aboisso, 754 in Bloléquin, 1319 in Odienné and 2443 in Ouangolodougou. Seven Anopheles species were recorded including An. gambiae s.l. (94.8-99.1%) as the main vector, followed by An. funestus s.l. (0.4-4.3%) and An. nili (0-0.7%). Among An. gambiae s.l., Anopheles coluzzii represented the predominant species in Aboisso (89.2%) and Bloléquin (92.2%), while An. gambiae sensu stricto (s.s.) was the major species in Odienné (96.0%) and Ouangolodougou (94.2%). The Plasmodium sporozoite infection rate in An. gambiae s.l. was highest in Odienné (11.0%; n = 100) followed by Bloléquin (7.8%, n = 115), Aboisso (3.1%; n = 65) and Ouangologoudou (2.5%; n = 120). In An. funestus s.l., Plasmodium falciparum sporozoite infection rate was estimated at 6.2% (n = 32) in Bloléquin, 8.7% (n = 23) in Odienné. No An. funestus s.l. specimens were found infected with P. falciparum sporozoite infection in Ouangolodougou and Aboisso. No P. falciparum sporozoite was detected in An. nili specimens in the four health districts. Among the local human populations, malaria incidence was higher in Odienné (39.7%; n = 45,376) and Bloléquin (37.6%; n = 150,205) compared to that in Ouangolodougou (18.3%; n = 131,629) and Aboisso (19.7%; n = 364,585). CONCLUSION Anopheles vector species diversity, abundance and Plasmodium sporozoite infection were high within the health districts along the borders of the country of Côte d'Ivoire, resulting in high malaria transmission among the local populations. Anopheles gambiae s.l. and An. funestus s.l. were found to be highly infected with Plasmodium in the health districts of Bloléquin and Odienné where higher malaria incidence was observed than the other districts. This study provides important information that can be used to guide Côte d'Ivoire National Malaria Control Programme for vector control decision-making, mainly in districts that are at the country borders.
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Affiliation(s)
- Firmain N Yokoly
- Unité de Formation et de Recherche Sciences de la Nature, Université Nangui Abrogoua, Abidjan, Côte d'Ivoire. .,Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
| | - Julien B Z Zahouli
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Centre d'Entomologie Médicale et Vétérinaire, Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Graham Small
- Innovative Vector Control Consortium (IVCC), Pembroke Place, Liverpool, L3 5QA, UK
| | - Allassane F Ouattara
- Unité de Formation et de Recherche Sciences de la Nature, Université Nangui Abrogoua, Abidjan, Côte d'Ivoire.,Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Millicent Opoku
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.,European & Developing Countries Clinical Trials Partnership, Cape Town, South Africa
| | - Dziedzom K de Souza
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Benjamin G Koudou
- Unité de Formation et de Recherche Sciences de la Nature, Université Nangui Abrogoua, Abidjan, Côte d'Ivoire.,Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
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5
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Namuganga JF, Epstein A, Nankabirwa JI, Mpimbaza A, Kiggundu M, Sserwanga A, Kapisi J, Arinaitwe E, Gonahasa S, Opigo J, Ebong C, Staedke SG, Shililu J, Okia M, Rutazaana D, Maiteki-Sebuguzi C, Belay K, Kamya MR, Dorsey G, Rodriguez-Barraquer I. The impact of stopping and starting indoor residual spraying on malaria burden in Uganda. Nat Commun 2021; 12:2635. [PMID: 33976132 PMCID: PMC8113470 DOI: 10.1038/s41467-021-22896-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/01/2021] [Indexed: 12/03/2022] Open
Abstract
The scale-up of malaria control efforts has led to marked reductions in malaria burden over the past twenty years, but progress has slowed. Implementation of indoor residual spraying (IRS) of insecticide, a proven vector control intervention, has been limited and difficult to sustain partly because questions remain on its added impact over widely accepted interventions such as bed nets. Using data from 14 enhanced surveillance health facilities in Uganda, a country with high bed net coverage yet high malaria burden, we estimate the impact of starting and stopping IRS on changes in malaria incidence. We show that stopping IRS was associated with a 5-fold increase in malaria incidence within 10 months, but reinstating IRS was associated with an over 5-fold decrease within 8 months. In areas where IRS was initiated and sustained, malaria incidence dropped by 85% after year 4. IRS could play a critical role in achieving global malaria targets, particularly in areas where progress has stalled.
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Affiliation(s)
| | - Adrienne Epstein
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
| | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Arthur Mpimbaza
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Child Health and Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Moses Kiggundu
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - James Kapisi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Chris Ebong
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Josephat Shililu
- US President's Malaria Initiative - VectorLink Uganda Project, Kampala, Uganda
| | - Michael Okia
- US President's Malaria Initiative - VectorLink Uganda Project, Kampala, Uganda
| | - Damian Rutazaana
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | | | - Kassahun Belay
- US President's Malaria Initiative, USAID/Uganda Senior Malaria Advisor, Kampala, Uganda
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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