Andrew K. Githeko

Climate change and vector-borne diseases: a regional analysis

Current evidence suggests that inter-annual and inter-decadal climate variability have a direct influence on the epidemiology of vector-borne diseases. This evidence has been assessed at the continental level in order to determine the possible consequences of the expected future climate change. By 2100 it is estimated that average global temperatures will have risen by 1.0-3.5 degrees C, increasing the likelihood of many vector-borne diseases in new areas. The greatest effect of climate change on transmission is likely to be observed at the extremes of the range of temperatures at which transmission occurs. For many diseases these lie in the range 14-18 degrees C at the lower end and about 35-40 degrees C at the upper end. Malaria and dengue fever are among the most important vector-borne diseases in the tropics and subtropics; Lyme disease is the most common vector-borne disease in the USA and Europe. Encephalitis is also becoming a public health concern. Health risks due to climatic changes will differ between countries that have developed health infrastructures and those that do not. Human settlement patterns in the different regions will influence disease trends. While 70% of the population in South America is urbanized, the proportion in sub-Saharan Africa is less than 45%. Climatic anomalies associated with the El Niño-Southern Oscillation phenomenon and resulting in drought and floods are expected to increase in frequency and intensity. They have been linked to outbreaks of malaria in Africa, Asia and South America. Climate change has far-reaching consequences and touches on all life-support systems. It is therefore a factor that should be placed high among those that affect human health and survival.

Predicting malaria epidemics in the Kenyan highlands using climate data: a tool for decision makers.

While the underlying cause of malaria epidemics in the East African highlands remains a subject of debate, we argue that permissive climatic conditions in the normally cool highlands are required for the epidemics to occur. Analysis of climate data from East Africa suggested that, over the last decade, there has been an increase in the frequency and intensity of anomalies in the mean monthly maximum temperatures. We found an association between rainfall and unusually high maximum temperatures and the number of inpatient malaria cases 3–4 months later. A malaria epidemic prediction model was then constructed.

Integrated malaria vector control with microbial larvicides and insecticide-treated nets in western Kenya: a controlled trial

OBJECTIVE To assess the contributions of both microbial larvicides and insecticide-treated nets (ITNs) in terms of reducing malaria incidence in an integrated vector management programme in an area moderately endemic for malaria in the western Kenyan highlands. METHODS A pre-post, control group design was used. Larval and adult vector populations were surveyed weekly in six separate valley communities. The incidence of Plasmodium infections in children 6 months to 13 years of age was measured during the long and short rainy seasons each year. Baseline data were collected for 17 months, after which Bacillus-based larvicides were applied weekly to aquatic habitats in three of the valleys for another 19 months. At around the same time the larviciding was initiated, ITNs were introduced gradually into all study communities by the National Malaria Control Programme. The effect of larviciding, ITNs and other determinants of malaria risk was assessed by means of generalized estimating equations. FINDINGS The risk of acquiring new parasite infections in children was substantially and independently reduced by ITN use (odds ratio, OR: 0.69; 95% confidence interval, CI: 0.48-0.99) and larvicide application (OR: 0.44; 95% CI: 0.23-0.82), after adjusting for confounders. CONCLUSION Vector control with microbial larvicides enhanced the malaria control achieved with ITNs alone. Anti-larval measures are a promising complement to ITN distribution in the economically important highland areas and similar transmission settings in Africa.

The Effects of Climatic Factors on the Distribution and Abundance of Malaria Vectors in Kenya

Abstract Since 1988 malaria epidemics have occurred in multiple sites in western Kenya highlands. Climatic variability has been associated with some of the recent epidemics. We examined influences of climatic factors on the distribution and abundance of three malaria vector species, Anopheles gambiae, Anopheles arabiensis, and Anopheles funestus in western Kenya and in the Great Rift Valley. Mosquito samples were collected from the lowland and highland areas with various climatic conditions. The three vector species were abundant in the lower part of western Kenya. An. arabiensis was not found in the areas above 1,400 m elevation in western Kenya. Although An. gambiae and An. funestus were found in the sites above 1,700 m in western Kenya, their densities were <1 per house. In the Great Rift Valley, An. gambiae was not recorded. An. funestus was more widely distributed than the other two species. A stepwise multiple regression analysis found that moisture index was the most important variable in shaping species composition of the An. gambiae complex. Relative abundance of An. gambiae was positively associated with moisture index, suggesting that An. gambiae is more adapted to moist climate. Seasonal differences in species composition were significant in western Kenya, and the proportion of An. funestus was higher in the dry season than the rainy season. Influence of temperature on vector density was significant for all three species. These results imply that climate changes alter the distribution and abundance of malaria vectors in future.

Unexpected high losses of Anopheles gambiae larvae due to rainfall.

Background Immature stages of the malaria mosquito Anopheles gambiae experience high mortality, but its cause is poorly understood. Here we study the impact of rainfall, one of the abiotic factors to which the immatures are frequently exposed, on their mortality. Methodology/Principal Findings We show that rainfall significantly affected larval mosquitoes by flushing them out of their aquatic habitat and killing them. Outdoor experiments under natural conditions in Kenya revealed that the additional nightly loss of larvae caused by rainfall was on average 17.5% for the youngest (L1) larvae and 4.8% for the oldest (L4) larvae; an additional 10.5% (increase from 0.9 to 11.4%) of the L1 larvae and 3.3% (from 0.1 to 3.4%) of the L4 larvae were flushed away and larval mortality increased by 6.9% (from 4.6 to 11.5%) and 1.5% (from 4.1 to 5.6%) for L1 and L4 larvae, respectively, compared to nights without rain. On rainy nights, 1.3% and 0.7% of L1 and L4 larvae, respectively, were lost due to ejection from the breeding site. Conclusions/Significance This study demonstrates that immature populations of malaria mosquitoes suffer high losses during rainfall events. As these populations are likely to experience several rain showers during their lifespan, rainfall will have a profound effect on the productivity of mosquito breeding sites and, as a result, on the transmission of malaria. These findings are discussed in the light of malaria risk and changing rainfall patterns in response to climate change.

Landscape determinants and remote sensing of anopheline mosquito larval habitats in the western Kenya highlands

BackgroundIn the past two decades the east African highlands have experienced several major malaria epidemics. Currently there is a renewed interest in exploring the possibility of anopheline larval control through environmental management or larvicide as an additional means of reducing malaria transmission in Africa. This study examined the landscape determinants of anopheline mosquito larval habitats and usefulness of remote sensing in identifying these habitats in western Kenya highlands.MethodsPanchromatic aerial photos, Ikonos and Landsat Thematic Mapper 7 satellite images were acquired for a study area in Kakamega, western Kenya. Supervised classification of land-use and land-cover and visual identification of aquatic habitats were conducted. Ground survey of all aquatic habitats was conducted in the dry and rainy seasons in 2003. All habitats positive for anopheline larvae were identified. The retrieved data from the remote sensors were compared to the ground results on aquatic habitats and land-use. The probability of finding aquatic habitats and habitats with Anopheles larvae were modelled based on the digital elevation model and land-use types.ResultsThe misclassification rate of land-cover types was 10.8% based on Ikonos imagery, 22.6% for panchromatic aerial photos and 39.2% for Landsat TM 7 imagery. The Ikonos image identified 40.6% of aquatic habitats, aerial photos identified 10.6%, and Landsate TM 7 image identified 0%. Computer models based on topographic features and land-cover information obtained from the Ikonos image yielded a misclassification rate of 20.3–22.7% for aquatic habitats, and 18.1–25.1% for anopheline-positive larval habitats.ConclusionOne-metre spatial resolution Ikonos images combined with computer modelling based on topographic land-cover features are useful tools for identification of anopheline larval habitats, and they can be used to assist to malaria vector control in western Kenya highlands.

Insecticide-treated net (ITN) ownership, usage, and malaria transmission in the highlands of western Kenya

BackgroundInsecticide-treated bed nets (ITNs) are known to be highly effective in reducing malaria morbidity and mortality. However, usage varies among households, and such variations in actual usage may seriously limit the potential impact of nets and cause spatial heterogeneity on malaria transmission. This study examined ITN ownership and underlying factors for among-household variation in use, and malaria transmission in two highland regions of western Kenya.MethodsCross-sectional surveys were conducted on ITN ownership (possession), compliance (actual usage among those who own ITNs), and malaria infections in occupants of randomly sampled houses in the dry and the rainy seasons of 2009.ResultsDespite ITN ownership reaching more than 71%, compliance was low at 56.3%. The compliance rate was significantly higher during the rainy season compared with the dry season (62% vs. 49.6%). Both malaria parasite prevalence (11.8% vs. 5.1%) and vector densities (1.0 vs.0.4 female/house/night) were significantly higher during the rainy season than during the dry season. Other important factors affecting the use of ITNs include: a household education level of at least primary school level, significantly high numbers of nuisance mosquitoes, and low indoor temperatures. Malaria prevalence in the rainy season was about 30% lower in ITN users than in non-ITN users, but this percentage was not significantly different during the dry season.ConclusionIn malaria hypo-mesoendemic highland regions of western Kenya, the gap between ITNownership and usage is generally high with greater usage recorded during the high transmission season. Because of the low compliance among those who own ITNs, there is a need to sensitize households on sustained use of ITNs in order to optimize their role as a malaria control tool.

Topography and malaria transmission heterogeneity in western Kenya highlands: prospects for focal vector control

BackgroundRecent resurgence of malaria in the highlands of Western Kenya has called for a more comprehensive understanding of the previously neglected complex highland vector ecology. Besides other drivers of malaria epidemiology, topography is likely to have a major effect on spatial vector and parasite distribution. The aim of this study was to determine the effects of topography on malaria spatial vector distribution and parasite prevalence.MethodologyIndoor resting adult malaria vectors and blood parasites were collected in three villages along a 4 km transect originating from the valley bottom and ending at the hilltop for 13 months. Members of the Anopheles gambiae complex were identified by PCR. Blood parasites were collected from children 6–13 years old and densities categorized by site of home location and age of the children.ResultsNinety eight percent (98%) of An. gambiae s.s. and (99%) Anopheles funestus were collected in houses located at the edge of the valley bottom, whereas 1% of An. gambiae s.s. were collected at mid hill and at the hilltop respectively. No An. funestus were collected at the hilltop. Malaria prevalence was 68% at the valley bottom, 40.2% at mid hill and 26.7% at the hilltop. Children aged six years and living at the edge of the valley bottom had an annual geometric mean number of 66.1 trophozoites for every 200 white blood cells, while those living at mid-hill had a mean of 84.8, and those living at hilltop had 199.5 trophozoites.ConclusionMalaria transmission in this area is mainly confined to the valley bottom. Effective vector control could be targeted at the foci. However, the few vectors observed at mid-hill maintained a relatively high prevalence rate. The higher variability in blood parasite densities and their low correlation with age in children living at the hilltop suggests a lower stability of transmission than at the mid-hill and valley bottom.

Origin of blood meals in indoor and outdoor resting malaria vectors in western Kenya.

Blood meals were obtained from indoor and outdoor resting malaria vectors in three villages of western Kenya and tested by sandwich ELISA to determine host preferences and their human blood index (HBI). Anopheles gambiae s.s. collected indoors at Kisian village had a HBI of 0.97 while that of Anopheles arabiensis collected at Ahero was 0.23. However, the HBI of A. arabiensis varied depending on the availability of outdoor resting shelters. Most female A. arabiensis (98.9%) collected outdoors in granaries at Ahero had fed on cattle. Indoor-collected female Anopheles funestus had mainly fed on people (93.0%), but taken at least some of their blood (20.2%) from cattle. Although small numbers of A. arabiensis fed on sheep or goats and birds, none of the female A. gambiae s.s. and A. funestus tested had fed on these hosts. The absence of human-fed A. arabiensis in outdoor shelters indicated that exiting after feeding, a behaviour pattern that mitigates indoor insecticidal spraying, is not prevalent in this species in western Kenya.

Climate change (Communication arising): Regional warming and malaria resurgence

Disease outbreaks are known to be often influenced by local weather, but how changes in disease trends might be affected by long-term global warming is more difficult to establish. In a study of malaria in the African highlands, Hay et al. found no significant change in long-term climate at four locations where malaria incidence has been increasing since 1976. We contend, however, that their conclusions are likely to be flawed by their inappropriate use of a global climate data set. Moreover, the absence of a historical climate signal allows no inference to be drawn about the impact of future climate change on malaria in the region.