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Lynd A, Gonahasa S, Staedke SG, Oruni A, Maiteki-Sebuguzi C, Hancock PA, Knight E, Dorsey G, Opigo J, Yeka A, Katureebe A, Kyohere M, Hemingway J, Kamya MR, McDermott D, Lucas ER, Donnelly MJ. LLIN Evaluation in Uganda Project (LLINEUP)-effects of a vector control trial on Plasmodium infection prevalence and genotypic markers of insecticide resistance in Anopheles vectors from 48 districts of Uganda. Sci Rep 2024; 14:14488. [PMID: 38914669 PMCID: PMC11196729 DOI: 10.1038/s41598-024-65050-z] [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: 12/07/2023] [Accepted: 06/17/2024] [Indexed: 06/26/2024] Open
Abstract
Pyrethroid bednets treated with the synergist piperonyl butoxide (PBO) offer the possibility of improved vector control in mosquito populations with metabolic resistance. In 2017-2019, we conducted a large-scale, cluster-randomised trial (LLINEUP) to evaluate long-lasting insecticidal nets (LLINs) treated with a pyrethroid insecticide plus PBO (PBO LLINs), as compared to conventional, pyrethroid-only LLINs across 104 health sub-districts (HSDs) in Uganda. In LLINEUP, and similar trials in Tanzania, PBO LLINs were found to provide greater protection against malaria than conventional LLINs, reducing parasitaemia and vector density. In the LLINEUP trial, we conducted cross-sectional household entomological surveys at baseline and then every 6 months for two years, which we use here to investigate longitudinal changes in mosquito infection rate and genetic markers of resistance. Overall, 5395 female Anopheles mosquitoes were collected from 5046 households. The proportion of mosquitoes infected (PCR-positive) with Plasmodium falciparum did not change significantly over time, while infection with non-falciparum malaria decreased in An. gambiae s.s., but not An. funestus. The frequency of genetic markers associated with pyrethroid resistance increased significantly over time, but the rate of change was not different between the two LLIN types. The knock-down resistance (kdr) mutation Vgsc-995S declined over time as Vgsc-995F, the alternative resistance mutation at this codon, increased. Vgsc-995F appears to be spreading into Uganda. Distribution of LLINs in Uganda was previously found to be associated with reductions in parasite prevalence and vector density, but here we show that the proportion of infective mosquitoes remained stable across both PBO and non-PBO LLINs, suggesting that the potential for transmission persisted. The increased frequency of markers of pyrethroid resistance indicates that LLIN distribution favoured the evolution of resistance within local vectors and highlights the potential benefits of resistance management strategies.Trial registration: This study is registered with ISRCTN, ISRCTN17516395. Registered 14 February 2017, http://www.isrctn.com/ISRCTN17516395 .
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Affiliation(s)
- Amy Lynd
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Samuel Gonahasa
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Sarah G Staedke
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Ambrose Oruni
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | | | | | - Erin Knight
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Grant Dorsey
- University of California, San Francisco, San Francisco, CA, 94110, USA
| | | | - Adoke Yeka
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Agaba Katureebe
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Mary Kyohere
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Janet Hemingway
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Daniel McDermott
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Eric R Lucas
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Martin J Donnelly
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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2
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Okiring J, Gonahasa S, Maiteki-Sebuguzi C, Katureebe A, Bagala I, Mutungi P, Kigozi SP, Namuganga JF, Nankabirwa JI, Kamya MR, Donnelly MJ, Churcher TS, Staedke SG, Sherrard-Smith E. LLIN Evaluation in Uganda Project (LLINEUP): modelling the impact of COVID-19-related disruptions on delivery of long-lasting insecticidal nets on malaria indicators in Uganda. Malar J 2024; 23:180. [PMID: 38844987 PMCID: PMC11157881 DOI: 10.1186/s12936-024-05008-8] [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: 03/05/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Disruptions in malaria control due to COVID-19 mitigation measures were predicted to increase malaria morbidity and mortality in Africa substantially. In Uganda, long-lasting insecticidal nets (LLINs) are distributed nationwide every 3-4 years, but the 2020-2021 campaign was altered because of COVID-19 restrictions so that the timing of delivery of new nets was different from the original plans made by the National Malaria Control Programme. METHODS A transmission dynamics modelling exercise was conducted to explore how the altered delivery of LLINs in 2020-2021 impacted malaria burden in Uganda. Data were available on the planned LLIN distribution schedule for 2020-2021, and the actual delivery. The transmission model was used to simulate 100 health sub-districts, and parameterized to match understanding of local mosquito bionomics, net use estimates, and seasonal patterns based on data collected in 2017-2019 during a cluster-randomized trial (LLINEUP). Two scenarios were compared; simulated LLIN distributions matching the actual delivery schedule, and a comparable scenario simulating LLIN distributions as originally planned. Model parameters were otherwise matched between simulations. RESULTS Approximately 70% of the study population received LLINs later than scheduled in 2020-2021, although some areas received LLINs earlier than planned. The model indicates that malaria incidence in 2020 was substantially higher in areas that received LLINs late. In some areas, early distribution of LLINs appeared less effective than the original distribution schedule, possibly due to attrition of LLINs prior to transmission peaks, and waning LLIN efficacy after distribution. On average, the model simulations predicted broadly similar overall mean malaria incidence in 2021 and 2022. After accounting for differences in cluster population size and LLIN distribution dates, no substantial increase in malaria burden was detected. CONCLUSIONS The model results suggest that the disruptions in the 2020-2021 LLIN distribution campaign in Uganda did not substantially increase malaria burden in the study areas.
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Affiliation(s)
- Jaffer Okiring
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, PO Box 7475, Kampala, Uganda.
- Infectious Diseases Research Collaboration, Kampala, Uganda.
| | | | | | | | - Irene Bagala
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Peter Mutungi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Simon P Kigozi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Joaniter I Nankabirwa
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, PO Box 7475, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Martin J Donnelly
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
- Wellcome Sanger Institute, Hinxton, UK
| | - Thomas S Churcher
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Sarah G Staedke
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Ellie Sherrard-Smith
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
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Oruni A, Lynd A, Njoroge H, Onyige I, van’t Hof AE, Matovu E, Donnelly MJ. Pyrethroid resistance and gene expression profile of a new resistant An. gambiae colony from Uganda reveals multiple resistance mechanisms and overexpression of Glutathione-S-Transferases linked to survival of PBO-pyrethroid combination. Wellcome Open Res 2024; 9:13. [PMID: 38813466 PMCID: PMC11134160 DOI: 10.12688/wellcomeopenres.19404.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/31/2024] Open
Abstract
Background The effectiveness of long-lasting insecticidal nets (LLINs) are being threatened by growing resistance to pyrethroids. To restore their efficacy, a synergist, piperonyl butoxide (PBO) which inhibits cytochrome P450s has been incorporated into pyrethroid treated nets. A trial of PBO-LLINs was conducted in Uganda from 2017 and we attempted to characterize mechanisms of resistance that could impact intervention efficacy. Methods We established an Anopheles gambiae s.s colony in 2018 using female mosquitoes collected from Busia district in eastern Uganda. We first assessed the phenotypic resistance profile of this colony using WHO tube and net assays using a deltamethrin dose-response approach. The Busia colony was screened for known resistance markers and RT-qPCR targeting 15 genes previously associated with insecticide resistance was performed. Results The Busia colony had very high resistance to deltamethrin, permethrin and DDT. In addition, the colony had moderate resistance to alpha-cypermethrin and lambda-cyhalothrin but were fully susceptible to bendiocarb and fenitrothion. Exposure to PBO in combination with permethrin and deltamethrin resulted in higher mortality rates in both net and tube assays, with a higher mortality observed in net assays than tube assays. The kdr marker, Vgsc-995S was at very high frequency (91.7-98.9%) whilst the metabolic markers Coeae1d and Cyp4j5-L43F were at very low (1.3% - 11.5%) and moderate (39.5% - 44.7%) frequencies respectively. Our analysis showed that gene expression pattern in mosquitoes exposed to deltamethrin, permethrin or DDT only were similar in comparison to the susceptible strain and there was significant overexpression of cytochrome P450s, glutathione-s-transferases (GSTs) and carboxyl esterases (COEs). However, mosquitoes exposed to both PBO and pyrethroid strikingly and significantly only overexpressed closely related GSTs compared to unexposed mosquitoes while major cytochrome P450s were underexpressed. Conclusions The high levels of pyrethroid resistance observed in Busia appears associated with a wide range of metabolic gene families.
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Affiliation(s)
- Ambrose Oruni
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Central Region, Uganda
| | - Amy Lynd
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK
| | - Harun Njoroge
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Ismail Onyige
- Infectious Diseases Research Collaboration, Kampala, Central Region, Uganda
| | - Arjen E. van’t Hof
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK
| | - Enock Matovu
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Central Region, Uganda
| | - Martin J. Donnelly
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK
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Xu E, Goel V, Baguma E, Ayebare E, Hollingsworth BD, Brown-Marusiak A, Giandomenico D, Reyes R, Ntaro M, Mulogo EM, Boyce RM. Evolution of Spatial Risk of Malaria Infection After a Pragmatic Chemoprevention Program in Response to Severe Flooding in Rural Western Uganda. J Infect Dis 2024; 229:173-182. [PMID: 37584317 PMCID: PMC10786254 DOI: 10.1093/infdis/jiad348] [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: 12/29/2022] [Revised: 04/21/2023] [Accepted: 08/14/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Malaria epidemics result from extreme precipitation and flooding, which are increasing with global climate change. Local adaptation and mitigation strategies will be essential to prevent excess morbidity and mortality. METHODS We investigated the spatial risk of malaria infection at multiple timepoints after severe flooding in rural western Uganda employing longitudinal household surveys measuring parasite prevalence and leveraging remotely sensed information to inform spatial models of malaria risk in the 3 months after flooding. RESULTS We identified clusters of malaria risk emerging in areas (1) that showed the greatest changes in Normalized Difference Vegetation Index from pre- to postflood and (2) where residents were displaced for longer periods of time and had lower access to long-lasting insecticidal nets, both of which were associated with a positive malaria rapid diagnostic test result. The disproportionate risk persisted despite a concurrent chemoprevention program that achieved high coverage. CONCLUSIONS The findings enhance our understanding not only of the spatial evolution of malaria risk after flooding, but also in the context of an effective intervention. The results provide a "proof of concept" for programs aiming to prevent malaria outbreaks after flooding using a combination of interventions. Further study of mitigation strategies-and particularly studies of implementation-is urgently needed.
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Affiliation(s)
- Erin Xu
- School of Medicine, UNC School of Medicine
| | - Varun Goel
- Department of Geography
- Carolina Population Center, University of North Carolina at Chapel Hill
| | - Emmanuel Baguma
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Uganda
| | - Emmanuel Ayebare
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Uganda
| | | | | | | | | | - Moses Ntaro
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Uganda
| | - Edgar M Mulogo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Uganda
| | - Ross M Boyce
- Carolina Population Center, University of North Carolina at Chapel Hill
- Department of Epidemiology, Gillings School of Global Public Health
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill
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Akuoko OK, Dhikrullahi SB, Hinne IA, Mohammed AR, Owusu-Asenso CM, Coleman S, Dadzie SK, Kyerematen R, Boakye DA, Wilson MD, Afrane YA. Biting behaviour, spatio-temporal dynamics, and the insecticide resistance status of malaria vectors in different ecological zones in Ghana. Parasit Vectors 2024; 17:16. [PMID: 38195546 PMCID: PMC10775458 DOI: 10.1186/s13071-023-06065-9] [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: 01/22/2023] [Accepted: 11/20/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND A significant decrease in malaria morbidity and mortality has been attained using long-lasting insecticide-treated nets and indoor residual spraying. Selective pressure from these control methods influences changes in vector bionomics and behavioural pattern. There is a need to understand how insecticide resistance drives behavioural changes within vector species. This study aimed to determine the spatio-temporal dynamics and biting behaviour of malaria vectors in different ecological zones in Ghana in an era of high insecticide use for public health vector control. METHODS Adult mosquitoes were collected during the dry and rainy seasons in 2017 and 2018 from five study sites in Ghana in different ecological zones. Indoor- and outdoor-biting mosquitoes were collected per hour from 18:00 to 06:00 h employing the human landing catch (HLC) technique. Morphological and molecular species identifications of vectors were done using identification keys and PCR respectively. Genotyping of insecticide-resistant markers was done using the TaqMan SNP genotyping probe-based assays. Detection of Plasmodium falciparum sporozoites was determined using PCR. RESULTS A total of 50,322 mosquitoes belonging to four different genera were collected from all the study sites during the sampling seasons in 2017 and 2018. Among the Anophelines were Anopheles gambiae s.l. 93.2%, (31,055/33,334), An. funestus 2.1%, (690/33,334), An. pharoensis 4.6%, (1545/33,334), and An. rufipes 0.1% (44/33,334). Overall, 76.4%, (25,468/33,334) of Anopheles mosquitoes were collected in the rainy season and 23.6%, (7866/33,334) in the dry season. There was a significant difference (Z = 2.410; P = 0.0160) between indoor-biting (51.1%; 15,866/31,055) and outdoor-biting An. gambiae s.l. (48.9%; 15,189/31,055). The frequency of the Vgsc-1014F mutation was slightly higher in indoor-biting mosquitoes (54.9%) than outdoors (45.1%). Overall, 44 pools of samples were positive for P. falciparum CSP giving an overall sporozoite rate of 0.1%. CONCLUSION Anopheles gambiae s.l. were more abundant indoors across all ecological zones of Ghana. The frequency of G119S was higher indoors than outdoors from all the study sites, but with higher sporozoite rates in outdoor mosquitoes in Dodowa and Kpalsogu. There is, therefore, an urgent need for a supplementary malaria control intervention to control outdoor-biting mosquitoes.
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Affiliation(s)
- Osei K Akuoko
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- African Regional Post-Graduate Programme in Insect Science, College of Basic and Applied Science, University of Ghana, Legon, Accra, Ghana
| | - Shittu B Dhikrullahi
- Department of Medical Microbiology, Centre for Vector-Borne Diseases Research, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Isaac A Hinne
- Department of Medical Microbiology, Centre for Vector-Borne Diseases Research, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
- Department of Biochemistry and Molecular Biology, CABNR, University of Nevada, Reno, NV, USA
| | - Abdul R Mohammed
- African Regional Post-Graduate Programme in Insect Science, College of Basic and Applied Science, University of Ghana, Legon, Accra, Ghana
- Department of Medical Microbiology, Centre for Vector-Borne Diseases Research, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Christopher M Owusu-Asenso
- Department of Medical Microbiology, Centre for Vector-Borne Diseases Research, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Sylvester Coleman
- Department of Clinical Microbiology - Vector Biology Laboratory, School of Medicine and Dentistry (SMD)-College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Samuel K Dadzie
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Rosina Kyerematen
- African Regional Post-Graduate Programme in Insect Science, College of Basic and Applied Science, University of Ghana, Legon, Accra, Ghana
- Department of Animal Biology and Conservation Science, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Daniel A Boakye
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Michael D Wilson
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Yaw A Afrane
- Department of Medical Microbiology, Centre for Vector-Borne Diseases Research, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana.
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Dyer NA, Lucas ER, Nagi SC, McDermott DP, Brenas JH, Miles A, Clarkson CS, Mawejje HD, Wilding CS, Halfon MS, Asma H, Heinz E, Donnelly MJ. Mechanisms of transcriptional regulation in Anopheles gambiae revealed by allele specific expression. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.22.568226. [PMID: 38045426 PMCID: PMC10690255 DOI: 10.1101/2023.11.22.568226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Malaria control relies on insecticides targeting the mosquito vector, but this is increasingly compromised by insecticide resistance, which can be achieved by elevated expression of detoxifying enzymes that metabolize the insecticide. In diploid organisms, gene expression is regulated both in cis, by regulatory sequences on the same chromosome, and by trans acting factors, affecting both alleles equally. Differing levels of transcription can be caused by mutations in cis-regulatory modules (CRM), but few of these have been identified in mosquitoes. We crossed bendiocarb resistant and susceptible Anopheles gambiae strains to identify cis-regulated genes that might be responsible for the resistant phenotype using RNAseq, and cis-regulatory module sequences controlling gene expression in insecticide resistance relevant tissues were predicted using machine learning. We found 115 genes showing allele specific expression in hybrids of insecticide susceptible and resistant strains, suggesting cis regulation is an important mechanism of gene expression regulation in Anopheles gambiae. The genes showing allele specific expression included a higher proportion of Anopheles specific genes on average younger than genes those with balanced allelic expression.
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Affiliation(s)
- Naomi A Dyer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Eric R Lucas
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Sanjay C Nagi
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Daniel P McDermott
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Jon H Brenas
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Alistair Miles
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Chris S Clarkson
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Henry D Mawejje
- Infectious Diseases Research Collaboration (IDRC), Plot 2C Nakasero Hill Road, P.O.Box 7475, Kampala, Uganda
| | - Craig S Wilding
- School of Biological and Environmental Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Marc S Halfon
- Department of Biochemistry, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo-State University of New York, 955 Main Street, Buffalo, New York 14203, USA
| | - Hasiba Asma
- Department of Biochemistry, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo-State University of New York, 955 Main Street, Buffalo, New York 14203, USA
| | - Eva Heinz
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Martin J Donnelly
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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7
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Msugupakulya BJ, Urio NH, Jumanne M, Ngowo HS, Selvaraj P, Okumu FO, Wilson AL. Changes in contributions of different Anopheles vector species to malaria transmission in east and southern Africa from 2000 to 2022. Parasit Vectors 2023; 16:408. [PMID: 37936155 PMCID: PMC10631025 DOI: 10.1186/s13071-023-06019-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Malaria transmission in Africa is facilitated by multiple species of Anopheles mosquitoes. These vectors have different behaviors and vectorial capacities and are affected differently by vector control interventions, such as insecticide-treated nets and indoor residual spraying. This review aimed to assess changes in the contribution of different vector species to malaria transmission in east and southern Africa over 20 years of widespread insecticide-based vector control. METHODS We searched PubMed, Global Health, and Web of Science online databases for articles published between January 2000 and April 2023 that provided species-specific sporozoite rates for different malaria vectors in east and southern Africa. We extracted data on study characteristics, biting rates, sporozoite infection proportions, and entomological inoculation rates (EIR). Using EIR data, the proportional contribution of each species to malaria transmission was estimated. RESULTS Studies conducted between 2000 and 2010 identified the Anopheles gambiae complex as the primary malaria vector, while studies conducted from 2011 to 2021 indicated the dominance of Anopheles funestus. From 2000 to 2010, in 57% of sites, An. gambiae demonstrated higher parasite infection prevalence than other Anopheles species. Anopheles gambiae also accounted for over 50% of EIR in 76% of the study sites. Conversely, from 2011 to 2021, An. funestus dominated with higher infection rates than other Anopheles in 58% of sites and a majority EIR contribution in 63% of sites. This trend coincided with a decline in overall EIR and the proportion of sporozoite-infected An. gambiae. The main vectors in the An. gambiae complex in the region were Anopheles arabiensis and An. gambiae sensu stricto (s.s.), while the important member of the An. funestus group was An. funestus s.s. CONCLUSION The contribution of different vector species in malaria transmission has changed over the past 20 years. As the role of An. gambiae has declined, An. funestus now appears to be dominant in most settings in east and southern Africa. Other secondary vector species may play minor roles in specific localities. To improve malaria control in the region, vector control should be optimized to match these entomological trends, considering the different ecologies and behaviors of the dominant vector species.
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Affiliation(s)
- Betwel J Msugupakulya
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, PO Box 53, Ifakara, Tanzania.
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Naomi H Urio
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, PO Box 53, Ifakara, Tanzania
- School of Life Science and Bioengineering, The Nelson Mandela African Institution of Sciences & Technology, Arusha, Tanzania
| | - Mohammed Jumanne
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, PO Box 53, Ifakara, Tanzania
| | - Halfan S Ngowo
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, PO Box 53, Ifakara, Tanzania
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Prashanth Selvaraj
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, USA
| | - Fredros O Okumu
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, PO Box 53, Ifakara, Tanzania.
- School of Life Science and Bioengineering, The Nelson Mandela African Institution of Sciences & Technology, Arusha, Tanzania.
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Park Town, Johannesburg, Republic of South Africa.
| | - Anne L Wilson
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK.
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Lynd A, Gonahasa S, Staedke SG, Oruni A, Maiteki-Sebuguzi C, Hancock P, Knight E, Dorsey G, Opigo J, Yeka A, Katureebe A, Kyohere M, Hemingway J, Kamya MR, McDermott D, Lucas ER, Donnelly MJ. LLIN Evaluation in Uganda Project (LLINEUP) - Plasmodium infection prevalence and genotypic markers of insecticide resistance in Anopheles vectors from 48 districts of Uganda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.31.23293323. [PMID: 37577716 PMCID: PMC10418296 DOI: 10.1101/2023.07.31.23293323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background In 2017-2019, we conducted a large-scale, cluster-randomised trial (LLINEUP) to evaluate long-lasting insecticidal nets (LLINs) treated with a pyrethroid insecticide plus the synergist piperonyl butoxide (PBO LLINs), as compared to conventional, pyrethroid-only LLINs across 104 health sub-districts (HSDs) in Uganda. In LLINEUP, and similar trials in Tanzania, PBO LLINs were found to provide greater protection against malaria than conventional LLINs, reducing parasitaemia and vector density. In the LLINEUP trial, cross-sectional entomological surveys were carried out at baseline and then every 6 months for two years. In each survey, ten households per HSD were randomly selected for indoor household entomological collections. Results Overall, 5395 female Anopheles mosquitoes were collected from 5046 households. The proportion of mosquitoes infected with Plasmodium falciparum did not change significantly over time, while infection with non-falciparum malaria decreased in An. gambiae s.s, but not An. funestus. The frequency of genetic markers associated with pyrethroid resistance increased significantly over time, but the rate of change was not different between the two LLIN types. The knock-down resistance (kdr) mutation Vgsc-995S declined over time as Vgsc-995F, the alternative resistance mutation at this codon, increased. Vgsc-995F appears to be spreading into Uganda. Conclusions Distribution of LLINs in Uganda was associated with reductions in parasite prevalence and vector density, but the proportion of infective mosquitoes remained stable, suggesting that the potential for transmission persisted. The increased frequency of markers of pyrethroid resistance indicates that LLIN distribution favoured the evolution of resistance within local vectors and highlights the potential benefits of resistance management strategies.Trial registration:: This study is registered with ISRCTN, ISRCTN17516395. Registered 14 February 2017, http://www.isrctn.com/ISRCTN17516395.
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Affiliation(s)
- Amy Lynd
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Samuel Gonahasa
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Sarah G Staedke
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Ambrose Oruni
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | | | | | - Erin Knight
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Grant Dorsey
- University of California, San Francisco, San Francisco, CA 94110 USA
| | | | - Adoke Yeka
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Agaba Katureebe
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Mary Kyohere
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Janet Hemingway
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Moses R Kamya
- Makerere University College of Health Sciences
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Daniel McDermott
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Eric R Lucas
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Martin J Donnelly
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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9
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Unwin HJT, Sherrard-Smith E, Churcher TS, Ghani AC. Quantifying the direct and indirect protection provided by insecticide treated bed nets against malaria. Nat Commun 2023; 14:676. [PMID: 36750566 PMCID: PMC9905482 DOI: 10.1038/s41467-023-36356-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/27/2023] [Indexed: 02/09/2023] Open
Abstract
Long lasting insecticidal nets (LLINs) provide both direct and indirect protection against malaria. As pyrethroid resistance evolves in mosquito vectors, it will be useful to understand how the specific benefits LLINs afford individuals and communities may be affected. Here we use modelling to show that there is no minimum LLIN usage needed for users and non-users to benefit from community protection. Modelling results also indicate that pyrethroid resistance in local mosquitoes will likely diminish the direct and indirect benefits from insecticides, leaving the barrier effects intact, but LLINs are still expected to provide enhanced benefit over untreated nets even at high levels of pyrethroid resistance.
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Affiliation(s)
- H Juliette T Unwin
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK.
| | - Ellie Sherrard-Smith
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
| | - Thomas S Churcher
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
| | - Azra C Ghani
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
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10
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Maiteki-Sebuguzi C, Gonahasa S, Kamya MR, Katureebe A, Bagala I, Lynd A, Mutungi P, Kigozi SP, Opigo J, Hemingway J, Dorsey G, Donnelly MJ, Staedke SG. Effect of long-lasting insecticidal nets with and without piperonyl butoxide on malaria indicators in Uganda (LLINEUP): final results of a cluster-randomised trial embedded in a national distribution campaign. THE LANCET. INFECTIOUS DISEASES 2023; 23:247-258. [PMID: 36174592 DOI: 10.1016/s1473-3099(22)00469-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Long-lasting insecticidal nets (LLINs) are the foundation of malaria control but resistance of mosquito vectors to pyrethroids threatens their effectiveness. We embedded a cluster-randomised trial into Uganda's 2017-18 campaign to distribute LLINs. LLINs with piperonyl butoxide (PBO) reduced parasite prevalence more effectively than conventional LLINs (without PBO) for 18 months. Here, we report the final 25-month survey results. METHODS LLINEUP was a cluster-randomised trial conducted in 48 districts in eastern and western Uganda. 104 health subdistricts (clusters) without ongoing or planned indoor residual spraying with pirimiphos-methyl (Actellic, Basel, Switzerland) were eligible for inclusion in the trial. Clusters were randomly assigned to PBO LLINs (PermaNet 3.0 or Olyset Plus) and conventional LLINs (PermaNet 2.0 or Olyset Net) with proportionate randomisation using STATA version 14.2. LLINs were delivered from March 25, 2017, to March 18, 2018. Between April 23, 2019, and Sept 13, 2019, community surveys were conducted in 50 randomly selected households per cluster; ten households per cluster were randomly selected for entomology surveys. Mosquitoes were collected in the morning from indoor surfaces of households using Prokopack aspirators. Due to COVID-19 restrictions, only 90 of the 104 clusters were surveyed at 25 months. The primary outcome was parasite prevalence by microscopy in children aged 2-10 years, assessed in the as-treated population, determined using the results from the 6-month household survey on the type of LLINs received in each cluster. This trial is registered with ISRCTN, ISRCTN17516395, and is now completed. FINDINGS In the as-treated analysis, two clusters were excluded (no predominant LLIN received) and four were reassigned; 40 PBO LLIN clusters (30 PermaNet 3.0, ten Olyset Plus) and 48 non-PBO LLIN (36 PermaNet 2.0, 12 Olyset Net) were included. Parasite prevalence was 17·1% (506 of 2958 participants) in the PBO group and 19·8% (701 of 3534) in the non-PBO group (prevalence ratio adjusted for baseline 0·80 [95% CI 0·69-0·93], p=0·0048). Comparing within-treatment group parasite prevalence to baseline, parasite prevalence ratios were lower in the PBO groups at all timepoints, but the difference was greatest at 6 months (PBO LLINs parasite prevalence at baseline 28·8% [1001 of 3472, 95% CI 27·3-30·4] vs at 6 months 12·0% [361 of 3009, 10·9-13·2], prevalence ratio [PR] 0·43 [95% CI 0·36-0·52], p<0·0001; non-PBO LLINs parasite prevalence at baseline 25·4% [1015 of 4004, 24·0-26·7] vs 6 months 14·8% [526 of 3551, 13·7-16·0], PR 0·60 [0·54-0·68], p<0·0001) and 25 months (PBO LLINs parasite prevalence at 25 months 17·1% [506 of 2958, 15·8-18·5], PR 0·63 [95% CI 0·57-0·71], p<0·0001; non-PBO LLINs parasite prevalence at 25 months 19·8% [701 of 3534, 18·5-21·2], PR 0·79 [0·73-0·86], p<0·0001). INTERPRETATION In Uganda, PBO LLINs outperformed pyrethroid-only LLINs for 25 months. WHO concluded that PBO LLINs are more effective against malaria than non-PBO LLINs when resistance to pyrethroids is high and issued a conditional recommendation suggesting PBO LLINs should be deployed in areas of pyrethroid resistance. FUNDING The Against Malaria Foundation, UK Department for International Development, Innovative Vector Control Consortium, and Bill and Melinda Gates Foundation.
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Affiliation(s)
- Catherine Maiteki-Sebuguzi
- Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Medicine, Makerere University, Kampala, Uganda
| | | | - Irene Bagala
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Amy Lynd
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Peter Mutungi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Simon P Kigozi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Janet Hemingway
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Martin J Donnelly
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK; Wellcome Sanger Institute, Hinxton, UK
| | - Sarah G Staedke
- Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
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11
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Mawejje HD, Weetman D, Epstein A, Lynd A, Opigo J, Maiteki-Sebuguzi C, Lines J, Kamya MR, Rosenthal PJ, Donnelly MJ, Dorsey G, Staedke SG. Characterizing pyrethroid resistance and mechanisms in Anopheles gambiae ( s.s.) and Anopheles arabiensis from 11 districts in Uganda. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2023; 3:100106. [PMID: 36590346 PMCID: PMC9798136 DOI: 10.1016/j.crpvbd.2022.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/09/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
Insecticide resistance threatens recent progress on malaria control in Africa. To characterize pyrethroid resistance in Uganda, Anopheles gambiae (s.s.) and Anopheles arabiensis were analyzed from 11 sites with varied vector control strategies. Mosquito larvae were collected between May 2018 and December 2020. Sites were categorized as receiving no indoor-residual spraying ('no IRS', n = 3); where IRS was delivered from 2009 to 2014 and in 2017 and then discontinued ('IRS stopped', n = 4); and where IRS had been sustained since 2014 ('IRS active', n = 4). IRS included bendiocarb, pirimiphos methyl and clothianidin. All sites received long-lasting insecticidal nets (LLINs) in 2017. Adult mosquitoes were exposed to pyrethroids; with or without piperonyl butoxide (PBO). Anopheles gambiae (s.s.) and An. arabiensis were identified using PCR. Anopheles gambiae (s.s.) were genotyped for Vgsc-995S/F, Cyp6aa1, Cyp6p4-I236M, ZZB-TE, Cyp4j5-L43F and Coeae1d, while An. arabiensis were examined for Vgsc-1014S/F. Overall, 2753 An. gambiae (s.l.), including 1105 An. gambiae (s.s.) and 1648 An. arabiensis were evaluated. Species composition varied by site; only nine An. gambiae (s.s.) were collected from 'IRS active' sites, precluding species-specific comparisons. Overall, mortality following exposure to permethrin and deltamethrin was 18.8% (148/788) in An. gambiae (s.s.) and 74.6% (912/1222) in An. arabiensis. Mortality was significantly lower in An. gambiae (s.s.) than in An. arabiensis in 'no IRS' sites (permethrin: 16.1 vs 67.7%, P < 0.001; deltamethrin: 24.6 vs 83.7%, P < 0.001) and in 'IRS stopped' sites (permethrin: 11.3 vs 63.6%, P < 0.001; deltamethrin: 25.6 vs 88.9%, P < 0.001). When PBO was added, mortality increased for An. gambiae (s.s.) and An. arabiensis. Most An. gambiae (s.s.) had the Vgsc-995S/F mutation (95% frequency) and the Cyp6p4-I236M resistance allele (87%), while the frequency of Cyp4j5 and Coeae1d were lower (52% and 55%, respectively). Resistance to pyrethroids was widespread and higher in An. gambiae (s.s.). Where IRS was active, An. arabiensis dominated. Addition of PBO to pyrethroids increased mortality, supporting deployment of PBO LLINs. Further surveillance of insecticide resistance and assessment of associations between genotypic markers and phenotypic outcomes are needed to better understand mechanisms of pyrethroid resistance and to guide vector control.
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Affiliation(s)
- Henry Ddumba Mawejje
- Infectious Diseases Research Collaboration, Kampala, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - David Weetman
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Adrienne Epstein
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Amy Lynd
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jimmy Opigo
- National Malaria Control Division, Uganda Ministry of Health, Kampala, Uganda
| | - Catherine Maiteki-Sebuguzi
- Infectious Diseases Research Collaboration, Kampala, Uganda.,National Malaria Control Division, Uganda Ministry of Health, Kampala, Uganda
| | - Jo Lines
- London School of Hygiene and Tropical Medicine, London, UK
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Martin J Donnelly
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, USA
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12
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Mawejje HD, Asiimwe JR, Kyagamba P, Kamya MR, Rosenthal PJ, Lines J, Dorsey G, Staedke SG. Impact of different mosquito collection methods on indicators of Anopheles malaria vectors in Uganda. Malar J 2022; 21:388. [PMID: 36536428 PMCID: PMC9761930 DOI: 10.1186/s12936-022-04413-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Methods used to sample mosquitoes are important to consider when estimating entomologic metrics. Human landing catches (HLCs) are considered the gold standard for collecting malaria vectors. However, HLCs are labour intensive, can expose collectors to transmission risk, and are difficult to implement at scale. This study compared alternative methods to HLCs for collecting Anopheles mosquitoes in eastern Uganda. METHODS Between June and November 2021, mosquitoes were collected from randomly selected households in three parishes in Tororo and Busia districts. Mosquitoes were collected indoors and outdoors using HLCs in 16 households every 4 weeks. Additional collections were done indoors with prokopack aspirators, and outdoors with pit traps, in these 16 households every 2 weeks. CDC light trap collections were done indoors in 80 households every 4 weeks. Female Anopheles mosquitoes were identified morphologically and Anopheles gambiae sensu lato were speciated using PCR. Plasmodium falciparum sporozoite testing was done with ELISA. RESULTS Overall, 4,891 female Anopheles were collected, including 3,318 indoors and 1,573 outdoors. Compared to indoor HLCs, vector density (mosquitoes per unit collection) was lower using CDC light traps (4.24 vs 2.96, density ratio [DR] 0.70, 95% CIs 0.63-0.77, p < 0.001) and prokopacks (4.24 vs 1.82, DR 0.43, 95% CIs 0.37-0.49, p < 0.001). Sporozoite rates were similar between indoor methods, although precision was limited. Compared to outdoor HLCs, vector density was higher using pit trap collections (3.53 vs 6.43, DR 1.82, 95% CIs 1.61-2.05, p < 0.001), while the sporozoite rate was lower (0.018 vs 0.004, rate ratio [RR] 0.23, 95% CIs 0.07-0.75, p = 0.008). Prokopacks collected a higher proportion of Anopheles funestus (75.0%) than indoor HLCs (25.8%), while pit traps collected a higher proportion of Anopheles arabiensis (84.3%) than outdoor HLCs (36.9%). CONCLUSION In this setting, the density and species of mosquitoes collected with alternative methods varied, reflecting the feeding and resting characteristics of the common vectors and the different collection approaches. These differences could impact on the accuracy of entomological indicators and estimates of malaria transmission, when using the alternative methods for sampling mosquitos, as compared to HLCs.
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Affiliation(s)
- Henry Ddumba Mawejje
- Infectious Diseases Research Collaboration, Kampala, Uganda. .,London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Jo Lines
- London School of Hygiene and Tropical Medicine, London, UK
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, USA
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13
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Namuganga JF, Nankabirwa JI, Maiteki-Ssebuguzi C, Gonahasa S, Opigo J, Staedke SG, Rutazaana D, Ebong C, Dorsey G, Tomko SS, Kizza T, Mawejje HD, Arinaitwe E, Rosenthal PJ, Kamya MR. East Africa International Center of Excellence for Malaria Research: Impact on Malaria Policy in Uganda. Am J Trop Med Hyg 2022; 107:33-39. [PMID: 36228904 PMCID: PMC9662221 DOI: 10.4269/ajtmh.21-1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/16/2022] [Indexed: 12/24/2022] Open
Abstract
Malaria is the leading cause of disease burden in sub-Saharan Africa. In 2010, the East Africa International Center of Excellence for Malaria Research, also known as the Program for Resistance, Immunology, Surveillance, and Modeling of Malaria (PRISM), was established to provide a comprehensive approach to malaria surveillance in Uganda. We instituted cohort studies and a robust malaria and entomological surveillance network at selected public health facilities that have provided a platform for monitoring trends in malaria morbidity and mortality, tracking the impact of malaria control interventions (indoor residual spraying of insecticide [IRS], use of long-lasting insecticidal nets [LLINs], and case management with artemisinin-based combination therapies [ACTs]), as well as monitoring of antimalarial drug and insecticide resistance. PRISM studies have informed Uganda's malaria treatment policies, guided selection of LLINs for national distribution campaigns, and revealed widespread pyrethroid resistance, which led to changes in insecticides delivered through IRS. Our continuous engagement and interaction with policy makers at the Ugandan Ministry of Health have enabled PRISM to share evidence, best practices, and lessons learned with key malaria stakeholders, participate in malaria control program reviews, and contribute to malaria policy and national guidelines. Here, we present an overview of interactions between PRISM team members and Ugandan policy makers to demonstrate how PRISM's research has influenced malaria policy and control in Uganda.
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Affiliation(s)
- Jane F. Namuganga
- Infectious Diseases Research Collaboration, Kampala, Uganda;,Address correspondence to Jane F. Namuganga, Plot 2C Nakasero Hill, P.O. Box 7475 Kampala, Uganda. E-mail:
| | - Joaniter I. Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda;,Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Sarah G. Staedke
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Damian Rutazaana
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Chris Ebong
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Sheena S. Tomko
- Department of Biology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy Kizza
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | - Philip J. Rosenthal
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda;,Makerere University College of Health Sciences, Kampala, Uganda
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14
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Njoroge H, van't Hof A, Oruni A, Pipini D, Nagi S, Lynd A, Lucas ER, Tomlinson S, Grau‐Bove X, McDermott D, Wat'senga FT, Manzambi EZ, Agossa FR, Mokuba A, Irish S, Kabula B, Mbogo C, Bargul J, Paine MJI, Weetman D, Donnelly MJ. Identification of a rapidly-spreading triple mutant for high-level metabolic insecticide resistance in Anopheles gambiae provides a real-time molecular diagnostic for antimalarial intervention deployment. Mol Ecol 2022; 31:4307-4318. [PMID: 35775282 PMCID: PMC9424592 DOI: 10.1111/mec.16591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 12/01/2022]
Abstract
Studies of insecticide resistance provide insights into the capacity of populations to show rapid evolutionary responses to contemporary selection. Malaria control remains heavily dependent on pyrethroid insecticides, primarily in long lasting insecticidal nets (LLINs). Resistance in the major malaria vectors has increased in concert with the expansion of LLIN distributions. Identifying genetic mechanisms underlying high-level resistance is crucial for the development and deployment of resistance-breaking tools. Using the Anopheles gambiae 1000 genomes (Ag1000g) data we identified a very recent selective sweep in mosquitoes from Uganda which localized to a cluster of cytochrome P450 genes. Further interrogation revealed a haplotype involving a trio of mutations, a nonsynonymous point mutation in Cyp6p4 (I236M), an upstream insertion of a partial Zanzibar-like transposable element (TE) and a duplication of the Cyp6aa1 gene. The mutations appear to have originated recently in An. gambiae from the Kenya-Uganda border, with stepwise replacement of the double-mutant (Zanzibar-like TE and Cyp6p4-236 M) with the triple-mutant haplotype (including Cyp6aa1 duplication), which has spread into the Democratic Republic of Congo and Tanzania. The triple-mutant haplotype is strongly associated with increased expression of genes able to metabolize pyrethroids and is strongly predictive of resistance to pyrethroids most notably deltamethrin. Importantly, there was increased mortality in mosquitoes carrying the triple-mutation when exposed to nets cotreated with the synergist piperonyl butoxide (PBO). Frequencies of the triple-mutant haplotype remain spatially variable within countries, suggesting an effective marker system to guide deployment decisions for limited supplies of PBO-pyrethroid cotreated LLINs across African countries.
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Affiliation(s)
- Harun Njoroge
- Department of Vector BiologyLiverpool School of Tropical MedicineLiverpoolUK
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine CoastKEMRI‐Wellcome Trust Research ProgrammeKilifiKenya
| | - Arjen van't Hof
- Department of Vector BiologyLiverpool School of Tropical MedicineLiverpoolUK
| | - Ambrose Oruni
- Department of Vector BiologyLiverpool School of Tropical MedicineLiverpoolUK
- College of Veterinary MedicineAnimal Resources and Bio‐securityMakerere UniversityKampalaUganda
| | - Dimitra Pipini
- Department of Vector BiologyLiverpool School of Tropical MedicineLiverpoolUK
| | - Sanjay C. Nagi
- Department of Vector BiologyLiverpool School of Tropical MedicineLiverpoolUK
| | - Amy Lynd
- Department of Vector BiologyLiverpool School of Tropical MedicineLiverpoolUK
| | - Eric R. Lucas
- Department of Vector BiologyLiverpool School of Tropical MedicineLiverpoolUK
| | - Sean Tomlinson
- Department of Vector BiologyLiverpool School of Tropical MedicineLiverpoolUK
| | - Xavi Grau‐Bove
- Department of Vector BiologyLiverpool School of Tropical MedicineLiverpoolUK
| | - Daniel McDermott
- Department of Vector BiologyLiverpool School of Tropical MedicineLiverpoolUK
| | | | - Emile Z. Manzambi
- Institut National de Recherche BiomédicaleKinshasaDemocratic Republic of Congo
| | - Fiacre R. Agossa
- USAID President's Malaria Initiative, VectorLink Project, Abt AssociatesRockvilleMarylandUSA
| | - Arlette Mokuba
- USAID President's Malaria Initiative, VectorLink Project, Abt AssociatesRockvilleMarylandUSA
| | - Seth Irish
- U.S. President's Malaria Initiative and Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Bilali Kabula
- Amani Research CentreNational Institute for Medical ResearchTanzania
| | - Charles Mbogo
- Population Health UnitKEMRI‐Wellcome Trust Research ProgrammeNairobiKenya
- KEMRI‐Centre for Geographic Medicine Research CoastKilifiKenya
| | - Joel Bargul
- Department of BiochemistryJomo Kenyatta University of Agriculture and TechnologyJujaKenya
- The Animal Health DepartmentInternational Centre of Insect Physiology and EcologyNairobiKenya
| | - Mark J. I. Paine
- Department of Vector BiologyLiverpool School of Tropical MedicineLiverpoolUK
| | - David Weetman
- Department of Vector BiologyLiverpool School of Tropical MedicineLiverpoolUK
| | - Martin J. Donnelly
- Department of Vector BiologyLiverpool School of Tropical MedicineLiverpoolUK
- Parasites and Microbes ProgrammeWellcome Sanger InstituteCambridgeUK
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15
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Batume C, Akol AM, Mukwaya LG, Birungi J, Kayondo JK. Life-history attributes of juvenile Anopheles gambiae s.s. in central Uganda; implications for malaria control interventions. MEDICAL AND VETERINARY ENTOMOLOGY 2022; 36:212-222. [PMID: 35388913 PMCID: PMC9322574 DOI: 10.1111/mve.12568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
Malaria is among the leading causes of death in Uganda, and Anopheles gambiae sensu stricto (s.s.) is the predominant vector. Although current vector control interventions have greatly reduced the malaria burden, the disease persists. New interventions are needed in order to eradicate them. Evaluation of new tools will require the availability of well-characterized test vector populations. Juvenile An. gambiae s.s. from Kibbuye and Kayonjo-derived populations were characterized under semi-field and laboratory conditions, given that various vector traits, including abundance and fitness are dependent on development profiles at this life stage. Ten replicates comprising 30 first instar larvae each were profiled for various life-history attributes (egg hatching, larval development time, larval survivorship, pupal weight and pupation rate). All parameters were similar for the two sites under laboratory conditions. However, the similarities or differences between field and laboratory development were parameter-specific. Whereas, larval survivorship and pupal weight were similar across seasons and laboratory in colonies from both sites, in the semi-field settings, pupation rate and larval survivorship differed between seasons in both sites. In addition, the average larval development time during the wet season was longer than that of the laboratory for both sites. Availability of mirror field sites is important for future tool evaluations.
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Affiliation(s)
- Charles Batume
- Department of EntomologyUganda Virus Research Institute (UVRI)EntebbeUganda
| | - Anne M. Akol
- Department of Zoology, Entomology and Fisheries SciencesCollege of Natural Sciences, Makerere University KampalaKampalaUganda
| | - Louis G. Mukwaya
- Department of EntomologyUganda Virus Research Institute (UVRI)EntebbeUganda
| | - Josephine Birungi
- Department of EntomologyUganda Virus Research Institute (UVRI)EntebbeUganda
- ILRI‐ BiosciencesInternational Livestock Research InstituteNairobiKenya
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16
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Boyce RM, Muhindo E, Baguma E, Muhindo R, Shem B, François R, Hawke S, Shook-Sa BE, Ntaro M, Nalusaji A, Nyehangane D, Reyes R, Juliano JJ, Siedner MJ, Staedke SG, Mulogo EM. Permethrin-treated baby wraps for the prevention of malaria: results of a randomized controlled pilot study in rural Uganda. Malar J 2022; 21:63. [PMID: 35197060 PMCID: PMC8864600 DOI: 10.1186/s12936-022-04086-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Progress against malaria has stalled and may even be slipping backwards in high-burden countries. This is due to a range of factors including insecticide resistance and mosquito feeding behaviours that limit contact with widely-employed interventions including long-lasting insecticidal nets and indoor-residual spraying. Thus, further innovations in malaria control are urgently needed. Methods The pilot was a randomized, placebo-controlled pilot study of permethrin-treated baby wraps—known locally as lesus—in children 6–18 months of age at a single site in rural western Uganda. Fifty mother–infant pairs were assigned to permethrin-treated or untreated lesus in a 1:1 allocation. Participants and clinical staff were blinded to group assignments through use of sham treatment and re-treatment of lesus. Participants attended scheduled clinic visits every 2 weeks for a total 12 weeks. The primary outcome of interest was the safety of the intervention, assessed as changes in the frequency of use, rates of discontinuation, and incidence of adverse events, such as skin rash. Secondary outcomes included acceptability and feasibility of the intervention as measured through participant satisfaction and completion of study activities, respectively. Results Overall, rates of retention and participation were relatively high with 86.0% (43 of 50) of participants completing all scheduled visits, including 18 (75.0%) and 25 (96.2%) in the intervention and control arms respectively. By the conclusion of the 12-week follow-up period, one adverse event (0.35 events per 100 person-weeks, one-sided 95% CI 0.0–1.65) was reported. Satisfaction with the lesu was high in both groups. In each study arm, there were five incident RDT positive results, but the only PCR-positive results were observed in the control group (n = 2). Conclusions Permethrin-treated baby wraps were well-tolerated and broadly acceptable. Adverse events were infrequent and mild. These findings support future trials seeking to determine the efficacy of treated wraps to prevent P. falciparum malaria infection in young children as a complementary tool to existing household-based interventions. Trial registration: ClinicalTrials.gov Identifier: NCT04102592, Registered 25 September 2019. Available at: https://clinicaltrials.gov/ct2/show/NCT04102592 Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04086-w.
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Affiliation(s)
- Ross M Boyce
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 230, RM 2151, Chapel Hill, NC, 27599, USA. .,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Enid Muhindo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emmanuel Baguma
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rabbison Muhindo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bwambale Shem
- Bugoye Level III Health Center, Uganda Ministry of Health, Kasese, Uganda
| | - Ruthly François
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Sam Hawke
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Bonnie E Shook-Sa
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Moses Ntaro
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Dan Nyehangane
- Epicentre Mbarara Research Centre, Mbarara, Uganda.,Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Raquel Reyes
- Division of Hospital Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jonathan J Juliano
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 230, RM 2151, Chapel Hill, NC, 27599, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Mark J Siedner
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Sarah G Staedke
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Edgar M Mulogo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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17
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Sherrard-Smith E, Winskill P, Hamlet A, Ngufor C, N'Guessan R, Guelbeogo MW, Sanou A, Nash RK, Hill A, Russell EL, Woodbridge M, Tungu P, Kont MD, Mclean T, Fornadel C, Richardson JH, Donnelly MJ, Staedke SG, Gonahasa S, Protopopoff N, Rowland M, Churcher TS. Optimising the deployment of vector control tools against malaria: a data-informed modelling study. Lancet Planet Health 2022; 6:e100-e109. [PMID: 35065707 DOI: 10.1016/s2542-5196(21)00296-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND Concern that insecticide resistant mosquitoes are threatening malaria control has driven the development of new types of insecticide treated nets (ITNs) and indoor residual spraying (IRS) of insecticide. Malaria control programmes have a choice of vector control interventions although it is unclear which controls should be used to combat the disease. The study aimed at producing a framework to easily compare the public health impact and cost-effectiveness of different malaria prevention measures currently in widespread use. METHODS We used published data from experimental hut trials conducted across Africa to characterise the entomological effect of pyrethroid-only ITNs versus ITNs combining a pyrethroid insecticide with the synergist piperonyl butoxide (PBO). We use these estimates to parameterise a dynamic mathematical model of Plasmodium falciparum malaria which is validated for two sites by comparing simulated results to empirical data from randomised control trials (RCTs) in Tanzania and Uganda. We extrapolated model simulations for a series of potential scenarios likely across the sub-Saharan African region and include results in an online tool (Malaria INtervention Tool [MINT]) that aims to identify optimum vector control intervention packages for scenarios with varying budget, price, entomological and epidemiological factors. FINDINGS Our model indicates that switching from pyrethroid-only to pyrethroid-PBO ITNs could averted up to twice as many cases, although the additional benefit is highly variable and depends on the setting conditions. We project that annual delivery of long-lasting, non-pyrethroid IRS would prevent substantially more cases over 3-years, while pyrethroid-PBO ITNs tend to be the most cost-effective intervention per case averted. The model was able to predict prevalence and efficacy against prevalence in both RCTs for the intervention types tested. MINT is applicable to regions of sub-Saharan Africa with endemic malaria and provides users with a method of designing intervention packages given their setting and budget. INTERPRETATION The most cost-effective vector control package will vary locally. Models able to recreate results of RCTs can be used to extrapolate outcomes elsewhere to support evidence-based decision making for investment in vector control. FUNDING Medical Research Council, IVCC, Wellcome Trust. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Ellie Sherrard-Smith
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK.
| | - Peter Winskill
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Arran Hamlet
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Corine Ngufor
- Centre de Recherches Entomologiques de Cotonou, Cotonou, Benin; London School of Hygiene and Tropical Medicine, London, UK
| | | | - Moussa W Guelbeogo
- Centre National de Recherche et de Formation sur le Paludisme, Burkina Faso
| | - Antoine Sanou
- Centre National de Recherche et de Formation sur le Paludisme, Burkina Faso
| | - Rebecca K Nash
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Alexander Hill
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Emma L Russell
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Mark Woodbridge
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Patrick Tungu
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Mara D Kont
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Tom Mclean
- Innovative Vector Control Consortium, Liverpool, UK
| | | | | | | | - Sarah G Staedke
- London School of Hygiene and Tropical Medicine, London, UK; Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | - Mark Rowland
- London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas S Churcher
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
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18
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A quasi-experimental study estimating the impact of long-lasting insecticidal nets with and without piperonyl butoxide on pregnancy outcomes. Malar J 2022; 21:5. [PMID: 34983550 PMCID: PMC8725517 DOI: 10.1186/s12936-021-04034-0] [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: 08/23/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Long-lasting insecticidal nets (LLINs) are the main vector control tool for pregnant women, but their efficacy may be compromised, in part, due to pyrethroid resistance. In 2017, the Ugandan Ministry of Health embedded a cluster randomized controlled trial into the national LLIN campaign, where a random subset of health subdistricts (HSDs) received LLINs treated with piperonyl butoxide (PBO), a chemical synergist known to partially restore pyrethroid sensitivity. Using data from a small, non-randomly selected subset of HSDs, this secondary analysis used quasi-experimental methods to quantify the overall impact of the LLIN campaign on pregnancy outcomes. In an exploratory analysis, differences between PBO and conventional (non-PBO) LLINs on pregnancy outcomes were assessed. Methods Birth registry data (n = 39,085) were retrospectively collected from 21 health facilities across 12 HSDs, 29 months before and 9 months after the LLIN campaign (from 2015 to 2018). Of the 12 HSDs, six received conventional LLINs, five received PBO LLINs, and one received a mix of conventional and PBO LLINs. Interrupted time-series analyses (ITSAs) were used to estimate changes in monthly incidence of stillbirth and low birthweight (LBW; <2500 g) before-and-after the campaign. Poisson regression with robust standard errors modeled campaign effects, adjusting for health facility-level differences, seasonal variation, and time-varying maternal characteristics. Comparisons between PBO and conventional LLINs were estimated using difference-in-differences estimators. Results ITSAs estimated the campaign was associated with a 26% [95% CI: 7–41] reduction in stillbirth incidence (incidence rate ratio (IRR) = 0.74 [0.59–0.93]) and a 15% [-7, 33] reduction in LBW incidence (IRR=0.85 [0.67–1.07]) over a 9-month period. The effect on stillbirth incidence was greatest for women delivering 7–9 months after the campaign (IRR=0.60 [0.41–0.87]) for whom the LLINs would have covered most of their pregnancy. The IRRs estimated from difference-in-differences analyses comparing PBO to conventional LLINs was 0.78 [95% CI: 0.52, 1.16] for stillbirth incidence and 1.15 [95% CI: 0.87, 1.52] for LBW incidence. Conclusions In this region of Uganda, where pyrethroid resistance is high, this study found that a mass LLIN campaign was associated with reduced stillbirth incidence. Effects of the campaign were greatest for women who would have received LLINs early in pregnancy, suggesting malaria protection early in pregnancy can have important benefits that are not necessarily realized through antenatal malaria services. Results from the exploratory analyses comparing PBO and conventional LLINs on pregnancy outcomes were inconclusive, largely due to the wide confidence intervals that crossed the null. Thus, future studies with larger sample sizes are needed.
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19
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Mechan F, Katureebe A, Tuhaise V, Mugote M, Oruni A, Onyige I, Bumali K, Thornton J, Maxwell K, Kyohere M, Kamya MR, Mutungi P, Kigozi SP, Yeka A, Opigo J, Maiteki-Sebuguzi C, Gonahasa S, Hemingway J, Dorsey G, Reimer LJ, Staedke SG, Donnelly MJ, Lynd A. LLIN evaluation in Uganda project (LLINEUP): The fabric integrity, chemical content and bioefficacy of long-lasting insecticidal nets treated with and without piperonyl butoxide across two years of operational use in Uganda. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2022; 2:100092. [PMID: 35734077 PMCID: PMC9207544 DOI: 10.1016/j.crpvbd.2022.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/06/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022]
Abstract
Long-lasting insecticidal nets (LLINs) supplemented with the synergist piperonyl butoxide have been developed in response to growing pyrethroid resistance; however, their durability in the field remains poorly described. A pragmatic cluster-randomised trial was embedded into Ugandaʼs 2017–2018 LLIN distribution to compare the durability of LLINs with and without PBO. A total of 104 clusters (health sub-districts) were included with each receiving one of four LLIN products, two with pyrethroid + PBO (Olyset Plus and PermaNet 3.0) and two pyrethroid-only (Olyset Net and PermaNet 2.0). Nets were sampled at baseline, 12 and 25 months post-distribution to assess physical condition, chemical content, and bioefficacy. Physical condition was quantified using proportionate Hole Index and chemical content measured using high-performance liquid chromatography. Bioefficacy was assessed with three-minute World Health Organisation (WHO) Cone and Wireball assays using pyrethroid-resistant Anopheles gambiae, with 1-h knockdown and 24-h mortality recorded. There was no difference in physical durability between LLIN products assessed (P = 0.644). The pyrethroid content of all products remained relatively stable across time-points but PBO content declined by 55% (P < 0.001) and 58% (P < 0.001) for Olyset Plus and PermaNet 3.0 respectively. Both PBO LLINs were highly effective against pyrethroid-resistant mosquitoes when new, knocking down all mosquitoes. However, bioefficacy declined over time with Olyset Plus knocking down 45.72% (95% CI: 22.84–68.62%, P = 0.021) and Permanent 3.0 knocking down 78.57% (95% CI: 63.57–93.58%, P < 0.001) after 25 months. Here we demonstrate that both Olyset Plus and PermaNet 3.0 are as durable as their pyrethroid-only equivalents and had superior bioefficacy against pyrethroid-resistant An. gambiae. However, the superiority of PBO-LLINs decreased with operational use, correlating with a reduction in total PBO content. This decline in bioefficacy after just two years is concerning and there is an urgent need to assess the durability of PBO LLINs in other settings. Olyset Plus and PermaNet 3.0 nets effective against pyrethroid-resistant Anopheles gambiae when new. Killing effect of both nets halved after two years. Nets in ‘traditional’ thatched-roof housing at high risk of damage.
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Affiliation(s)
- Frank Mechan
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
- Corresponding author.
| | | | | | | | - Ambrose Oruni
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Jonathan Thornton
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kilama Maxwell
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Mary Kyohere
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Uganda
- Makerere University - Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda
| | | | | | - Adoke Yeka
- Infectious Diseases Research Collaboration, Uganda
| | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | | | | | - Janet Hemingway
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, USA
| | - Lisa J. Reimer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sarah G. Staedke
- Infectious Diseases Research Collaboration, Uganda
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin J. Donnelly
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Amy Lynd
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
- Corresponding author.
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20
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Epstein A, Maiteki-Sebuguzi C, Namuganga JF, Nankabirwa JI, Gonahasa S, Opigo J, Staedke SG, Rutazaana D, Arinaitwe E, Kamya MR, Bhatt S, Rodríguez-Barraquer I, Greenhouse B, Donnelly MJ, Dorsey G. Resurgence of malaria in Uganda despite sustained indoor residual spraying and repeated long lasting insecticidal net distributions. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000676. [PMID: 36962736 PMCID: PMC10022262 DOI: 10.1371/journal.pgph.0000676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/27/2022] [Indexed: 11/19/2022]
Abstract
Five years of sustained indoor residual spraying (IRS) of insecticide from 2014 to 2019, first using a carbamate followed by an organophosphate, was associated with a marked reduction in the incidence of malaria in five districts of Uganda. We assessed changes in malaria incidence over an additional 21 months, corresponding to a change in IRS formulations using clothianidin with and without deltamethrin. Using enhanced health facility surveillance data, our objectives were to 1) estimate the impact of IRS on monthly malaria case counts at five surveillance sites over a 6.75 year period, and 2) compare monthly case counts at five facilities receiving IRS to ten facilities in neighboring districts not receiving IRS. For both objectives, we specified mixed effects negative binomial regression models with random intercepts for surveillance site adjusting for rainfall, season, care-seeking, and malaria diagnostic. Following the implementation of IRS, cases were 84% lower in years 4-5 (adjusted incidence rate ratio [aIRR] = 0.16, 95% CI 0.12-0.22), 43% lower in year 6 (aIRR = 0.57, 95% CI 0.44-0.74), and 39% higher in the first 9 months of year 7 (aIRR = 1.39, 95% CI 0.97-1.97) compared to pre-IRS levels. Cases were 67% lower in IRS sites than non-IRS sites in year 6 (aIRR = 0.33, 95% CI 0.17-0.63) but 38% higher in the first 9 months of year 7 (aIRR = 1.38, 95% CI 0.90-2.11). We observed a resurgence in malaria to pre-IRS levels despite sustained IRS. The timing of this resurgence corresponded to a change of active ingredient. Further research is needed to determine causality.
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Affiliation(s)
- Adrienne Epstein
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | | | | | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Sarah G Staedke
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Damian Rutazaana
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Samir Bhatt
- Department of Infectious Disease Epidemiology, Imperial College, St Mary's Hospital, London, United Kingdom
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Isabel Rodríguez-Barraquer
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Martin J Donnelly
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
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21
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Minakawa N, Kongere JO, Sonye GO, Lutiali PA, Awuor B, Kawada H, Isozumi R, Futami K. Long-Lasting Insecticidal Nets Incorporating Piperonyl Butoxide Reduce the Risk of Malaria in Children in Western Kenya: A Cluster Randomized Controlled Trial. Am J Trop Med Hyg 2021; 105:461-471. [PMID: 34125699 PMCID: PMC8437186 DOI: 10.4269/ajtmh.20-1069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
Malaria vectors have acquired an enzyme that metabolizes pyrethroids. To tackle this problem, we evaluated long-lasting insecticidal nets incorporating piperonyl butoxide (PBO-LLINs) with a community-based cluster randomized control trial in western Kenya. The primary endpoints were anopheline density and Plasmodium falciparum polymerase chain reaction (PCR)-positive prevalence (PCRpfPR) of children aged 7 months to 10 years. Four clusters were randomly selected for each of the treatment and control arms (eight clusters in total) from 12 clusters, and PBO-LLINs and standard LLINs were distributed in February 2011 to 982 and 1,028 houses for treatment and control arms, respectively. Entomological surveys targeted 20 houses in each cluster, and epidemiological surveys targeted 150 children. Cluster-level permutation tests evaluated the effectiveness using the fitted values from individual level regression models adjusted for baseline. Bootstrapping estimated 95% confidence intervals (CIs). The medians of anophelines per house were 1.4 (interquartile range [IQR]: 2.3) and 3.4 (IQR: 3.7) in the intervention and control arms after 3 months, and 0.4 (IQR: 0.2) and 1.6 (IQR: 0.5) after 10 months, respectively. The differences were -2.5 (95% CI: -6.4 to -0.6) and -1.3 (95% CI: -2.0 to -0.7), respectively. The datasets of 861 and 775 children were analyzed in two epidemiological surveys. The median PCRpfPRs were 25% (IQR: 11%) in the intervention arm and 52% (IQR: 11%) in the control arm after 5 months and 33% (IQR: 11%) and 45% (IQR: 5%) after 12 months. The PCRpfPR ratios were 0.67 (95% CI: 0.38, 0.91) and 0.74 (95% CI: 0.53, 0.90), respectively. We confirmed the superiority of PBO-LLINs.
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Affiliation(s)
- Noboru Minakawa
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - James O. Kongere
- Kenya Medical Research Institute, Nairobi, Kenya
- Center for Research in Tropical Medicine and Community Development (CRTMCD), Nairobi, Kenya
| | | | - Peter A. Lutiali
- Kenya Medical Research Institute, Nairobi, Kenya
- Center for Research in Tropical Medicine and Community Development (CRTMCD), Nairobi, Kenya
| | | | - Hitoshi Kawada
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Rie Isozumi
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Kyoko Futami
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
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22
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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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23
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Genomic Variant Analyses in Pyrethroid Resistant and Susceptible Malaria Vector, Anopheles sinensis. G3-GENES GENOMES GENETICS 2020; 10:2185-2193. [PMID: 32423920 PMCID: PMC7341135 DOI: 10.1534/g3.120.401279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Anopheles sinensis is a major malaria vector in Southeast Asia. Resistance to pyrethroid insecticides in this species has impeded malaria control in the region. Previous studies found that An. sinensis populations from Yunnan Province, China were highly resistant to deltamethrin and did not carry mutations in the voltage-gated sodium channel gene that cause knockdown resistance. In this study, we tested the hypothesis that other genomic variants are associated with the resistance phenotype. Using paired-end whole genome sequencing (DNA-seq), we generated 108 Gb of DNA sequence from deltamethrin -resistant and -susceptible mosquito pools with an average coverage of 83.3× depth. Using a stringent filtering method, we identified a total of 916,926 single nucleotide variants (SNVs), including 32,240 non-synonymous mutations. A total of 958 SNVs differed significantly in allele frequency between deltamethrin -resistant and -susceptible mosquitoes. Of these, 43 SNVs were present within 37 genes that code for immunity, detoxification, cuticular, and odorant proteins. A subset of 12 SNVs were randomly selected for genotyping of individual mosquitoes by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and showed consistent allele frequencies with the pooled DNA-seq derived allele frequencies. In addition, copy number variations (CNVs) were detected in 56 genes, including 33 that contained amplification alleles and 23 that contained deletion alleles in resistant mosquitoes compared to susceptible mosquitoes. The genomic variants described here provide a useful resource for future studies on the genetic mechanism of insecticide resistance in this important malaria vector species.
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Cucchiaro G, Van Leeuwen J, Goodridge Y. Case Report: The Role of Spatial Repellant Devices to Prevent Malaria in Low-Income Countries. Am J Trop Med Hyg 2020; 102:1033-1036. [PMID: 32100683 DOI: 10.4269/ajtmh.19-0923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Malaria is the leading cause of morbidity and mortality in Uganda. The role of spatial repellent devices in preventing malaria is controversial. The goal of this study was to evaluate the populations' acceptability of a newly designed insecticide diffuser. We distributed to three families living in southern Uganda a device commercially available, the VAPE® portable set. This spatial repellent device offers several advantages compared with other traditional products. It is powered by lithium batteries that guarantee 20 days of uninterrupted delivery of insecticide; it contains two insecticides: empenthrin and transfluthrin; and it is simple to use, one switch to turn it "on" and/or "off." It is odorless, and it can be placed anywhere in the living/sleeping area. People can also carry it outside the house. We planned to evaluate people's compliance with its usage, its reliability, and its overall costs. We conducted a 5-month survey. We distributed the devices to three households, one device per bedroom. Ten males and 11 females, with a mean age of 26 ± 16 (range 10-51) years, lived in these houses. The compliance with the use of the device and its acceptability were high. No side effects were reported. No individual contracted malaria during the 5-month period. The major obstacle we found was the timely delivery of the devices to the evaluation area and initial compliance with the instructions on how to use the device. Larger randomized studies are needed to clarify whether there is a role for this type of spatial repellent devices in the global efforts to prevent malaria.
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Affiliation(s)
- Giovanni Cucchiaro
- 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | | | - Yvette Goodridge
- 3Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California
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Staedke SG, Gonahasa S, Dorsey G, Kamya MR, Maiteki-Sebuguzi C, Lynd A, Katureebe A, Kyohere M, Mutungi P, Kigozi SP, Opigo J, Hemingway J, Donnelly MJ. Effect of long-lasting insecticidal nets with and without piperonyl butoxide on malaria indicators in Uganda (LLINEUP): a pragmatic, cluster-randomised trial embedded in a national LLIN distribution campaign. Lancet 2020; 395:1292-1303. [PMID: 32305094 PMCID: PMC7181182 DOI: 10.1016/s0140-6736(20)30214-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/16/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Long-lasting insecticidal nets (LLINs) are the primary malaria prevention tool, but their effectiveness is threatened by pyrethroid resistance. We embedded a pragmatic cluster-randomised trial into Uganda's national LLIN campaign to compare conventional LLINs with those containing piperonyl butoxide (PBO), a synergist that can partially restore pyrethroid susceptibility in mosquito vectors. METHODS 104 health sub-districts, from 48 districts in Uganda, were randomly assigned to LLINs with PBO (PermaNet 3.0 and Olyset Plus) and conventional LLINs (PermaNet 2.0 and Olyset Net) by proportionate randomisation using an iterative process. At baseline 6, 12, and 18 months after LLIN distribution, cross-sectional surveys were done in 50 randomly selected households per cluster (5200 per survey); a subset of ten households per cluster (1040 per survey) were randomly selected for entomological surveys. The primary outcome was parasite prevalence by microscopy in children aged 2-10 years, assessed in the as-treated population at 6, 12, and 18 months. This trial is registered with ISRCTN, ISRCTN17516395. FINDINGS LLINs were delivered to households from March 25, 2017, to March 18, 2018, 32 clusters were randomly assigned to PermaNet 3.0, 20 to Olyset Plus, 37 to PermaNet 2.0, and 15 to Olyset Net. In the as-treated analysis, three clusters were excluded because no dominant LLIN was received, and four clusters were reassigned, resulting in 49 PBO LLIN clusters (31 received PermaNet 3.0 and 18 received Olyset Plus) and 52 non-PBO LLIN clusters (39 received PermaNet 2.0 and 13 received Olyset Net). At 6 months, parasite prevalence was 11% (386/3614) in the PBO group compared with 15% (556/3844) in the non-PBO group (prevalence ratio [PR] adjusted for baseline values 0·74, 95% CI 0·62-0·87; p=0·0003). Parasite prevalence was similar at month 12 (11% vs 13%; PR 0·73, 95% CI 0·63-0·85; p=0·0001) and month 18 (12% vs 14%; PR 0·84, 95% CI 0·72-0·98; p=0·029). INTERPRETATION In Uganda, where pyrethroid resistance is high, PBO LLINs reduced parasite prevalence more effectively than did conventional LLINs for up to 18 months. This study provides evidence needed to support WHO's final recommendation on use of PBO LLINs. FUNDING The Against Malaria Foundation, UK Department for International Development, Innovative Vector Control Consortium, and Bill and Melinda Gates Foundation.
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Affiliation(s)
- Sarah G Staedke
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Infectious Diseases Research Collaboration, Kampala, Uganda.
| | | | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Medicine, Makerere University, Kampala, Uganda
| | | | - Amy Lynd
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Mary Kyohere
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Peter Mutungi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Simon P Kigozi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Janet Hemingway
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Martin J Donnelly
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK; Wellcome Sanger Institute, Hinxton, UK
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LLIN Evaluation in Uganda Project (LLINEUP): factors associated with childhood parasitaemia and anaemia 3 years after a national long-lasting insecticidal net distribution campaign: a cross-sectional survey. Malar J 2019; 18:207. [PMID: 31234882 PMCID: PMC6591906 DOI: 10.1186/s12936-019-2838-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/14/2019] [Indexed: 12/31/2022] Open
Abstract
Background Recent reductions in malaria burden have been attributed largely to long-lasting insecticidal nets (LLINs). In March–June 2017, approximately 3 years after a national LLIN distribution campaign, a cross-sectional community survey was conducted to investigate factors associated with malaria parasitaemia and anaemia, in advance of Uganda’s 2017–2018 LLIN campaign. Methods Households from 104 clusters in 48 districts were randomly selected using two-staged cluster sampling; 50 households were enrolled per cluster. Eligible children aged 2–10 years had blood obtained for a thick blood smear and those aged 2–4 years had haemoglobin measured. Associations between outcomes and variables of interest were assessed using log-binomial regression with generalized estimating equations to adjust for household clustering. Results In total, 5196 households, 8834 children with blood smear results, and 3753 with haemoglobin results were included. Only 16% of children lived in households with adequate LLIN coverage. Overall, parasite prevalence was 26.0%, ranging from 8.0% in the South West to 53.1% in East Central. Limiting data to children 2–4 years of age, parasite prevalence was 21.4%, up from 16.9% in 2014–2015 following the national LLIN campaign. In a multivariate analysis, factors associated with parasitaemia included region (East-Central vs South-Western; adjusted prevalence ratio [aPR] 6.45, 95% CI 5.55–7.50; p < 0.001), older age (8–10 vs 2–3 years; aPR 1.57, 95% CI 1.43–1.72; p < 0.001), living in a poorer household (poorest vs least poor tercile; aPR 2.32, 95% CI 2.05–2.63; p < 0.001), one constructed of traditional materials (aPR 1.13, 95% CI 1.03–1.24; p = 0.008), or without adequate LLIN coverage (aPR 1.30, 95% CI 1.14–1.48; p < 0.001). Overall, the prevalence of anaemia (haemoglobin < 10 g/dL) was 15.1% and varied geographically. In a multivariate analysis, factors associated with anaemia included region, younger age, living in a traditional house, and parasitaemia, which was the strongest predictor (aPR 2.50, 95% CI 2.12–2.95; p < 0.001). Conclusions Three years after a national LLIN campaign, LLIN coverage was low and parasite prevalence had increased. Parasite prevalence varied widely across Uganda; older children, those living in poorer households, and those with inadequate LLIN coverage, were at highest risk of parasitaemia. LLINs may need to be distributed more frequently through mass campaigns or continuously through sustainable mechanisms. Targeting interventions to geographic areas and populations at highest risk should also be considered.
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