Ashok K. Upadhyay

Wash-resistance and field evaluation of alphacypermethrin treated long-lasting insecticidal net (Interceptor) against malaria vectors Anopheles culicifacies and Anopheles fluviatilis in a tribal area of Orissa, India.

A field trial was conducted on the efficacy of Interceptor nets-a long-lasting insecticidal net (LLN) factory treated with alphacypermethrin 0.667% (w/w) corresponding to 200mg/m(2), against malaria vectors Anopheles culicifacies and Anopheles fluviatilis in one of the highly endemic areas of Orissa. The study area comprised 19 villages which were randomized into three clusters and designated as Interceptor net cluster, untreated net cluster, and no net cluster. Baseline studies showed that both the vector species An. culicifacies and An. fluviatilis were 100% susceptible to alphacypermethrin. Results of wash-resistance and bio-efficacy of Interceptor nets showed 100% mortality in An. culicifacies and An. fluviatilis even after 20 washings. Bioassays on the Interceptor nets while in use in the field conditions showed a knockdown effect on 70-90% mosquitoes during different months of intervention after 3 min of exposure and 100% mortality was recorded after 24h of recovery period. The median knockdown time for these species ranged between 4.10-5.25 min and 4.00-5.00 min respectively during intervention period. In Interceptor net study area, there was a significant reduction of 88.9, 96.3 and 90.6% in the entry rate of An. culicifacies, An. fluviatilis and other anopheline species respectively with an over all reduction of 87.5% in total mosquitoes. The overall feeding success rate of mosquitoes in the trial villages was only 12.8% in comparison to 35.0 and 78.8% in villages with untreated nets and no nets respectively. A significant reduction was also recorded in parity rate and human blood index of vector species in Interceptor net area. The results of the study showed that Interceptor nets are effective against the malaria vectors and may be used as a suitable intervention strategy in high-risk areas.

Wash Resistance and Bioefficacy of Olyset Net — A Long-Lasting Insecticide-Treated Mosquito Net Against Malaria Vectors and Nontarget Household Pests

Abstract During recent years, long-lasting insecticide-treated nets (LLINs) have been developed to overcome the problems of low retreatment rates, washing, and erratic dose of the insecticide resulting in the dilution of efficacy of the conventional insecticide-treated mosquito nets. These nets are treated at factory level with insecticide either incorporated into or coated around fibers. Olyset net, a polyethylene net with 2% permethrin incorporated within fibers, is one type of LLIN. Therefore, these nets were evaluated for their wash resistance and bioefficacy against malaria vectors Anopheles culicifacies Giles and Anopheles fluviatilis James (Diptera: Culicidae) and other nontarget species. Cone bioassay tests produced 100% mortality in these two vector species with 3-min exposure. Results of the bioassays on washed nets showed 100% mortality in An. fluviatilis even after 20 washings, whereas in An. culicifacies 100% mortality up to 11 washings and 80% mortality up to 20 washings were observed. Cone bioassay tests also were performed on nontarget mosquito species Culex quinquefasciatus Say; house fly, Musca domestica L.; American cockroach, Periplaneta americana (L.); head louse, Pediculus humanus capitis De Geer; and bed bug, Cimex lectularius L. with 30-min exposure. Except for bed bugs, 100% mortality was observed in these nontarget species after 24-h recovery period. In bed bugs, only 25% mortality was observed. The density of An. culicifacies and An. fluviatilis was significantly reduced in houses with Olyset nets compared with those with untreated nets or no nets. Thus, it may be concluded that Olyset nets are highly effective against malaria vectors and moderately against other nontarget household insects.

Efficacy of permethrin treated long-lasting insecticidal nets on malaria transmission and observations on the perceived side effects, collateral benefits and human safety in a hyperendemic tribal area of Orissa, India

Studies were conducted on the efficacy of Olyset nets-a long-lasting insecticidal net (LLIN) factory treated with 2% (w/w) permethrin on malaria transmission in an area under the influence of pyrethroid susceptible vector species Anopheles culicifacies and A. fluviatilis in Sundargarh District, Orissa, India. The study area comprised 22 villages that were randomized into three clusters and designated as Olyset net, untreated net, and no net area. Malaria incidence in the study population was measured through longitudinal active surveillance at fortnightly intervals. There was a reduction of 65-70% in malaria incidence in Olyset net area as compared to the control areas. The attack rate of Plasmodium falciparum or number of episodes per person per year in different age groups also showed significant reduction in Olyset net area as compared to untreated net and no net areas. Cross-sectional point prevalence surveys showed 45.7% reduction of malaria prevalence in Olyset net users, whereas there was an increase of 33.3% and 51% in untreated net and no net villages respectively. The compliance rate of Olyset net usage in the study population was 80-98% during different months, whereas it was between 70% and 90% for untreated nets. There were minimal complains of skin irritation (4%), itching (8%) and eye irritation (1.2%). However, these effects were only transitory in nature lasting for few hours of the first usage. Olyset nets also provided collateral benefits in terms of relief not only from mosquitoes and malaria but also from other household pests such as head lice, bed bugs, cockroaches, ants and houseflies. The Olyset nets were found to be safe to humans as no adverse event was recorded in the net users that can be attributed to the use of net. The study showed that Olyset nets are effective personal protection tool that can be used in a community based intervention programme.

Field Evaluation of Olyset Nets: A Long-Lasting Insecticidal Net Against Malaria Vectors Anopheles culicifacies and Anopheles fluviatilis in a Hyperendemic Tribal Area of Orissa, India

ABSTRACT A village-scale trial was conducted on the efficacy of Olyset nets: a long-lasting insecticidal net (LLIN) factory treated with 2% wt:wt permethrin against malaria vectors Anopheles culicifacies Giles and Anopheles fluviatilis James, in Sundargarh District, Orissa, India. The study area comprised 22 villages that were randomized into three clusters and designated as Olyset net, untreated net, and no net clusters. Baseline studies showed that both vector species were 100% susceptible to permethrin. Results of wash resistance and bioefficacy of Olyset nets showed 100% mortality in An culicifacies up to 11 washings, whereas 100% mortality was observed in An. fluviatilis even after 20 washings. The median knock-down time for these species ranged between 4.55–6.00 and 4.45–5.45 min, respectively, during 1 yr of intervention. In the Olyset net study area, there was a significant reduction of 80.6, 94.1, and 76.7% in the entry rate of An. culicifacies, An. fluviatilis, and other anopheline species, respectively, with an overall reduction of 63.5% in total mosquitoes. Floor sheet collections in houses with Olyset nets indicated 39% immediate mortality in total mosquitoes. The overall feeding success rate of mosquitoes in the trial village was only 18.0% in comparison to 44.2 and 79.1% in villages with untreated nets and no nets, respectively. A significant reduction was also recorded in parity rate and human blood index of vector species in the Olyset net area. This study showed that Olyset nets are an effective personal protection tool that can be used in a community-based intervention program.

Building small dams can decrease malaria: A comparative study from Sundargarh District, Orissa, India

The adverse health effect of environmental changes brought about with the construction of large and small dams has often been reported. Here, we present results of a 5-year (2001-2005) study documenting the positive effect of such developmental projects in reducing malaria in an area where malaria transmission is mainly due to the highly efficient anthropophagic vector Anopheles fluviatilis with some contribution from Anopheles culicifacies. The former breeds exclusively in the slow-flowing streams and the latter breeds in a variety of habitats. The study was conducted in San Dulakudar village and comparisons were made with two control villages situated near the stream with similar topography and malaria transmission pattern. Epidemiological data was collected through longitudinal weekly surveillance and cross-sectional surveys in all the study villages. The mean annual malaria incidence rates due to Plasmodium falciparum in children of 1-5 years age group during 2001 before construction of dam was 1304.3 and 785.7 cases/1000 population in dam site village and control villages, respectively. However, after construction of dam, there was gradual reduction in the malaria cases in dam site village and during 2005 the incidence was significantly reduced to 181.8 (P<0.01) whereas it was increased to 1000 in control villages without any significant change in comparison to baseline year (P>0.05). A significant reduction in malaria incidence and parasite rate was also recorded in all the age groups in dam site village without registering any significant change in control villages. The construction of a small dam in the study village altered the water flow above and below the dam thereby making it unfavourable for the breeding of A. fluviatilis which in turn brought about significant impact on malaria transmission.

EFFECTIVENESS OF MOSQUITO NETS TREATED WITH A TABLET FORMULATION OF DELTAMETHRIN FOR MALARIA CONTROL IN A HYPERENDEMIC TRIBAL AREA OF SUNDARGARH DISTRICT, ORISSA, INDIA

ABSTRACT A village-scale trial on the efficacy of mosquito nets treated with a tablet formulation of deltamethrin (K-OTAB®) against malaria in comparison to untreated nets or no net was conducted in Sundargarh District of Orissa, India, which is characterized by perennial transmission with Plasmodium falciparum accounting for more than 80% of malaria cases. Three villages with similar topographical and epidemiological situations were selected and randomly assigned to 3 arms of the study: treated net, untreated net, and no net. Distribution of nets, based on a sleeping pattern survey, was carried out to cover 100% of the population in treated-net and untreated-net villages. Longitudinal and cross-sectional surveys were conducted to measure malaria incidence, prevalence, and splenomegaly. Malaria incidence was reduced by 64.3% in the village with treated nets, 45.2% in the village with plain nets, and 21.4% in the control village without nets. Comparison of malaria incidence data after 1 year of intervention showed significant difference between villages with treated net vs. untreated net (P < 0.05) and treated net vs. no net (P < 0.005). The incidence of clinical attack rate due to P. falciparum was significantly lower in the population using treated nets than in those using untreated nets and no nets. However, no age-specific protective efficacy of treated nets or untreated nets was observed. A significant reduction occurred in spleen rate and parasite rate in children aged 2–9 years using treated nets or untreated nets. An overall significant reduction was found in parasite rate in the total population using treated and untreated nets as compared to nonusers.

Impact of changing over of insecticide from synthetic pyrethroids to DDT for indoor residual spray in a malaria endemic area of Orissa, India

The year 2013 will mark the completion of a centenary of the Indian Journal of Medical Research (IJMR). These 100 years also symbolize the fruition of science and research in India which was splashed with ink all over the pages of IJMR through these years. From July 2012, as we begin with year-long celebrations of this glorious centenary year for the most celebrated biomedical journal of the country, we take this opportunity to look back at the voluminous work done during the last 99 years and hope to continue forward with a rejuvenated momentum for another 100 years. IJMR came in to the world of medical journals in July 1913 with its first issue brought out by Thacker Spink and Co., Calcutta ( now Kolkata) with 16 articles. The first issue carried an article by Lt. Col. C. Donovan on “Kala azar, its distribution and the probable modes of infection” and four articles on cholera by Maj. E D W Greig. IJMR was started as a quarterly journal under the authority of Director-General of Indian Medical Services, in collaboration with Public Health Commissioner with the Government of India, and the Director of Medical Research. The office of IJMR was opened in the Central Research Institute (CRI), Kasauli, Himachal Pradesh, and the Directors of CRI used to be the editors of the IJMR. It was in 1949 that the Indian Council of Medical Research (ICMR) came into existence after being rechristened from Indian Research Fund Association (IRFA, established in 1911), and since then the IJMR is being published under the auspices of ICMR. Till 1939, the IJMR was published quarterly but for a brief period in 1940 and then again from 1943 to 1946 it became half yearly with only two issues a year. The year 1964 breathed in a new air of periodicity in the life of IJMR and it became a monthly journal with 12 issues a year. Since 1977, the Journal is being brought out in 2 volumes, 12 issues a year. For a brief duration of five years (1989-1993) the IJMR was bifurcated into two Sections viz., Infectious Diseases (Section A) and Biomedical Research other than Infectious Diseases (Section B). The IJMR has completed a long untiring journey of uninterrupted publication and is today at the top of Indian biomedical journals with current impact factor of 1.837. Thanks to our contributors, readers, reviewers, editorial team and Editorial Board members, the IJMR has been able to publish ‘good’ articles. Being the oldest journal of the country and still being at the top of its class adds another feather in the cap of this prestigious Journal. The 99 year old journey also symbolizes the transition of IJMR into electronic era with online editorial processing and an easy access to free of cost digitized archive across the globe. IJMR being a general biomedical journal has maintained its basic orientation and kept pace with rapidly developing science. The centenary year celebrations will witness several new initiatives. Apart from being brought out with a new get up, the Journal will have a new section on “Clinical Images”, the first contribution under this section being published in this issue. Beginning with this issue, we also will be bringing out some centenary special state-of- art review articles which will provide a historical background of the topic as also the current scenario. Our intention is to publish information on some issues widely prevalent in India or first reported from India. Browsing through the digitized content of 99 years of IJMR we were purely overwhelmed to witness several classic contributions of the stalwarts of yesteryears. These are not just momentous contributions to the world of medical science but also to the mankind with long lasting inferences on public health. One cannot move forward without recognizing the greatness and might of the past contributors and with this notion in our hearts and minds beginning with this issue as part of the centenary celebrations, IJMR classic articles will also be featured in each issue. Though we all would agree that in earlier days man was equipped with meager means for dissemination of what has been published in print in one part of the globe to other, but in the current world of internet and e-journal publishing all these restrictions and boundaries have been broken. Acknowledging non-availability of hi-tech tools in the yesteryears that hampered widespread dissemination of publications, it has been decided to re-publish the most cited articles published in the IJMR in the last five decades. Thirteen such articles have been selected for publication in an ascending order during the centenary year (from July 2012 to July 2013). July 2013 issue of the IJMR will mark the end of centenary celebrations and will be the first issue of 101st year. This exercise of searching for classic articles and most cited articles also provided us an opportunity to see as to what was most significant published in the IJMR and what was considered most significant by others! A journal is viewed as a mirror of time and in the years to come we intend to publish novel research, innovative reviews, and new discoveries in biomedical science to quench the thirst of educated minds of scientific community. The process of evolving ourselves towards being better and more efficient is an unceasing task and our target will remain to serve the needs of the scientific community. We would be happy to involve you with our centenary celebrations. Your valuable views and suggestions are welcome. Tell us how we can improve further. Share what you expect from us.I accept my new leadership role as Editor of The Indian Journal of Medical Research (IJMR) with great humility. The Journal is highly reputed among Indian biomedical journals and is almost a century old. As usual for the newcomer, I being no exception have some new ideas for its improvement and at the same time the Journal also faces several challenges. Though I am not new to the IJMR as I have been nurturing the IJMR for the past two decades in various capacities (Assistant editor and Associate editor). During this period I got ample opportunities to understand the mechanics and dynamics as well as complexities associated with journal publication. I consider myself privileged to have worked with three former editors of the IJMR (Drs G. V. Satyavati, N. Medappa and K. Satyanarayana) who brought the IJMR to the current prestigious position. It is from their rich expertise that I have gained certain unparalleled principles of discipline, importance of punctuality, honouring the timelines, strictness, rigidity with quality maintenance, and flexibility and friendliness with contributors and reviewers. The whole experience has allowed me to acquire some of the finer details of editorship for which I shall always remain beholden to them. The IJMR has a long and distinguished history and will soon enter into the centenary year. It enjoys a great reputation and is placed on a respectable platform today. An editors role is that of an energetic enthusiast who always aims to improve the journal further and I shall be no exception. It is, therefore, incumbent upon me to make sincere efforts to win the situation with the support of our editorial team and Editorial Board, and uninterrupted quality contributions from academia and researchers. Over the past few years the IJMR has undergone major changes and has shown a considerable improvement in the quality of its editorial content. The impact factor (IF) has increased and the Journal has attained a new position among the top slot of Indian biomedical journals - an uphill task has been achieved. Introduction of new sections and several modifications in the publication policy were some of the major changes that were made during the last few years. With the advent of Clinical Trial Registry – India (CTR-I), the Journal took a lead role in preparing the guidelines for publication of clinical trials in Indian biomedical journals. Online processing of articles was made possible with the availability of advanced technology and new tools. Access to free full-text of the IJMR was provided to the readers across the globe. A Herculean task of preparing the digital archive since the inception of the IJMR (1913) has been recently completed. Today the IJMR has a good reputation, but we editors live in a world of rankings and IF. Faced with the challenge of achieving a respectable impact factor for the journal, the editor is bestowed with the dual burden of improving the journal content as well as impact factor (though both are complementary to each other). The IJMR currently has an impact factor of 1.826 from a meager 0.45 in 2002-2003, a task which looked impossible in early last decade. The bigger challenge at present is not only to sustain this position but to move further along, reaching a new height. Attracting high quality research articles is one important option for further development of the Journal. I consider it as my first target as an editor. We are living in an era of ever changing technology and sea of information. A large number of journals are coming up every day and due to fierce competition with ever increasing specialty journals, it will not be an easy task and I need to be careful as well as cautious in my approach. Journal editing is not merely a job but a passion which many of my fellow editors understand. My vision is to make IJMR an international journal truly representing quality biomedical/clinical research with public health implications. I envisage IJMR in the hands of all postgraduate medical students preparing for the examinations, and Ph.D. students pursuing their research career in medical colleges and universities and the junior and senior faculty members of medical schools. The medical researchers should eagerly look forward to read the latest issue of the IJMR in hope of getting some new information. As a part of the new vision, some changes are in the pipeline. There will be minor cosmetic changes in the text. Among the new s0 ections “Clinical Images” will be introduced from July 2012 and this will coincide with the beginning of centenary year of the IJMR - a proud moment for all of us. We also intend prioritizing articles with innovative novel information for fast track processing and rapid dissemination. We already have special issues and special sections on topics of contemporary interest and importance and wish to expand this activity further with high priority. Systematic and evidence based reviews will be preferred over narrative reviews. We intend to provide timely service to our readers, contributors and reviewers. Online processing of manuscripts has provided some relief to us and our contributors. We will work hard to bring out each issue of the Journal in the first week of the respective month. These are some of my initial thoughts which I am sharing with you. More will come in due course of time. We would welcome new ideas with an open mind. All our readers will agree with me that each idea takes time to shape up and I am sure to get that time. Wishing all our readers, contributors, reviewers and subscribers a very happy and prosperous new year 2012!Background & objectives: Development of insecticide resistance in malaria vectors has been a major problem for achieving effective vector control. Due to limited availability of insecticides, the only option is management of resistance by judiciously using the insecticides and rotating them to maintain their effectiveness. This study was carried out in a malaria endemic area of Sundergarh district in Orissa where synthetic pyrethroids (SP) were in use for the last couple of years. The change-over from SP to DDT was done in one arm of study, and the other two arms remained on SP and insecticide-treated nets (ITN). Entomological and parasitological monitoring was done to assess the impact. Methods: The study design comprised of three arms (i) two rounds of indoor residual spraying (IRS) with DDT 1g/m2 as a change-over insecticide in areas previously under synthetic pyrethroids; (ii) two rounds of IRS with synthetic pyrethroid (alphacypermethrin, ACM) @ 25 mg/m2; and (iii) an unsprayed area under ITN/long lasting insecticide nets (LNs). Indoor residual spraying was undertaken under strict supervision to maintain quality and coverage. Contact bioassays were conducted to know the persistence of insecticide on sprayed surfaces and adult vector density was monitored in fixed and randomly selected houses. Malaria incidence was measured through fortnightly domiciliary surveillance under primary health care system in all the study villages. Results: The insecticide susceptibility tests showed that An.culicifacies was resistant to DDT but susceptible to malathion and ACM. However, An. fluviatilis was susceptible to all the three insecticides. ACM was effective in killing An. culicifacies on mud and wooden sprayed surfaces and maintained effective bioefficacy ranging from 92 to 100 per cent up to five months, whereas DDT failed to achieve effective mortality in An.culicifacies. However, there was significant decline in the density of An.culicifacies in ACM and DDT areas in comparison to ITNs/LNs. There was 61 per cent reduction in the slide positivity rate in ACM area in comparison to 48 and 51 per cent in DDT and ITN/LNs areas, respectively. The adjusted incidence rate of malaria cases per 1000 population in three study areas also showed significant declines within each group. Interpretation & conclusions: The present findings show that the change-over of insecticide from synthetic pyrethroids to DDT brings about the same epidemiological impact as envisaged from continuing SP spray or distributing insecticide treated nets/long-lasting insecticidal nets provided there is a good quality spray and house coverage.

Field Evaluation of a Previously Untested Strain of Biolarvicide (Bacillus thuringiensis israelensis H14) for Mosquito Control in an Urban Area of Orissa, India

ABSTRACT A previously untested strain of Bacillus thuringiensis israelensis (Bti) serotype H14 (ID No. VCRC B17) has been evaluated under field conditions in an urban area of Rourkela city, India for its impact on the larval density of different mosquito species in a variety of habitats. The persistence of the biolarvicide used in an aqueous solution varied in different habitats. The lowest field application rate of 0.5 ml/m2 remained effective for about 10–12 days and provided 80–100% reduction in larval abundance of anopheline species, including Anopheles culicifacies breeding in unpolluted water bodies. However, in stagnant polluted waters in drains and cesspools supporting culicine breeding, the biocide at the same rate persists for 5–6 days only. An application rate of 1 ml/m2 to stagnant drains and cesspools, resulted in 84–100% reduction in the larval population of Culex quinquefasciatus over a period of 2 wk. Based on the field observations, an operational dose of 0.5 ml/m2 at fortnightly intervals is suggested for clean water sources supporting anopheline breeding. However, to control breeding of culicine mosquitoes in stagnant and polluted waters, an operational dose of 1 ml/m2 at fortnightly intervals is required. The study showed that Bti serotype H14 (VCRC B17) is a suitable biolarvicide that can be used against different mosquitoes in different types of urban habitats.

Efficacy, Human Safety and Collateral Benefits of Alphacypermethrin TreatedLong-Lasting Insecticidal Net (Interceptorî) in a Hyperendemic Tribal Area ofOrissa, India

Interceptor net® is a long-lasting insecticidal net (LN) made of multifilament polyester fabric in which the insecticide alphacypermethrin is incorporated directly into the polymers at a dose of 200 mg/m2. This paper presents the results of an efficacy trial on Interceptor nets on malaria transmission in an area under the influence of pyrethroid susceptible vector species Anopheles culicifacies and A. fluviatilis in Sundargarh District, Orissa, India. There was a reduction of 57-76% in malaria incidence in Interceptor net area as compared to the control areas. Cross-sectional point prevalence surveys showed a reduction of 73.1% and 40% in malaria prevalence in Interceptor net and untreated net users respectively, whereas there was an increase of 17% in no net villages. The net usage rate in the study population was between 80-98% during different months. With respect to the adverse effects of the insecticide, people reported skin irritations but transitory in nature hence did not pose any danger. Interceptor nets also provided collateral benefits in terms of relief from other household pests such as head lice, bed bugs, cockroaches, ants and houseflies.