C. F. Curtis

Experimental hut trials of permethrin‐impregnated mosquito nets and eave curtains against malaria vectors in Tanzania

ABSTRACT. Permethrin impregnated netting was tested against Tanza‐nian populations of Anopheles arabiensis Patton, An.gambiae Giles and An.funestus Giles in experimental huts fitted with traps to catch samples of the mosquitoes exiting during the night. Treated bednets killed some mosquitoes and increased the tendency of survivors to exit during the night. Treated cotton did not perform so well as treated nylon bednets. An impregnated bednet in which holes had been cut, to simulate a torn net, reduced the number of mosquitoes which fed and survived approximately as well as an intact untreated net. Treated curtains around the eaves of experimental huts did not perform so well as bednets but caused considerable reductions in the number of mosquitoes which fed and survived. However, there was no such effect when treated netting was placed around the eaves of a dwelling house. When one child slept under a treated net and another slept outside the net in the same hut, the number of bites on the latter child was less than if neither child had been under a net. Various aspects of the applicability of permethrin impregnated nets on a community basis are discussed.

Trial of pyrethroid impregnated bednets in an area of Tanzania holoendemic for malaria. Part 2. Effects on the malaria vector population.

The malaria vector population consisted mainly of Anopheles gambiae s.s. with a small contribution from An. funestus and An. rivulorum. The mosquitoes coming to bite in bedrooms were monitored with light traps set beside untreated bednets. When impregnated bednets were provided for all the other beds in a village the Anopheles populations declined but the Culex quinquefasciatus populations were unaffected. The survival of An. gambiae (as measured by the mean number of ovarian dilatations) and the sporozoite rate declined following introduction of the nets and the estimated sporozoite inoculation rates into people not under their nets declined by more than 90%. The net introductions caused sharp declines in the number of mosquitoes resting indoors, but the evidence was inconclusive regarding diversion to outdoor resting, animal biting, earlier biting or outdoor biting. DDT spraying greatly reduced the Anopheles populations.

WHO, the Global Fund, and medical malpractice in malaria treatment

Amir Attaran and colleagues highlight a very serious public-health issue. Provision of ineffective drugs for a life-threatening disease is indefensible. There is no doubt that chloroquine is now ineffective for the treatment of falciparum malaria in nearly all tropical countries and that its usual successor sulfadoxine-pyrimethamine is falling fast to resistance. As a result malaria mortality in eastern and southern Africa where hundreds of thousands of children die each year from the infection has doubled in the past decade. We have failed to roll back malaria and we in the developed world bear the responsibility for this humanitarian disaster. Malaria is not an insoluble problem. We already have the tools (insecticides bednets highly effective drugs) to reduce substantially the terrible death toll. But we are not providing them to the people who need them desperately but who cannot pay for them. Only a tiny fraction of the millions with malaria today receive highly effective treatments. The donors must take some responsibility for this failure. Given the choice between receiving donor support for ineffective chloroquine or sulfadoxine-pyrimethamine and receiving nothing most countries have naturally opted for the former. It is not easy to protest particularly when the main donors and the representatives of international organisations both claim these drugs are still “programmatically effective”. (excerpt)

MONITORING HUMAN BITING MOSQUITOES (DIPTERA: CULICIDAE) IN TANZANIA WITH LIGHT TRAPS HUNG BESIDE MOSQUITO NETS

Mosquitoes were caught in bedrooms in Tanzanian villages by human-biting catches and in light-traps set close to occupied untreated bed nets. Catches by each method were carried out on pairs of nights in the same week at different seasons and in different villages. The pairs of adjacent catches by the different methods showed a strong correlation. Analysis of the ratio between the catches by the two methods on pairs of nights in the same week indicated that on average three light-traps caught about the same number of mosquitoes as a team of two human catchers. The ratio did not differ significantly between Anopheles gambiae Giles ( sensu lato ), A. funestus Giles, and Culex quinquefasciatus Say, nor between the villages, or between times when mosquito populations were high or low. The distribution of numbers of ovarian dilatations differed significantly between catches in different villages and seasons but not between pairs of catches by the two methods. Similarly, the parity and sporozoite rates agreed between pairs of light-trap and house-resting catches, but differed markedly between villages and seasons. Thus it is concluded that light-traps used in conjunction with bed nets catch a representative sample of the vectors which would have bitten humans in bedrooms in this area.

Theoretical models of the use of insecticide mixtures for the management of resistance

Simple one- and multi-generation models are used to show the essential features of the dynamics of selection for resistance to one insecticide or two unrelated insecticides in insect populations, part of which are unexposed to either compound. The use of a mixture appears advantageous provided that resistance is not fully dominant, but, if it is, linkage disequilibrium builds up rapidly and nullifies the advantage of the mixture

Comparison of house spraying and insecticide-treated nets for malaria control

The efficacies of using residual house spraying and insecticide-treated nets against malaria vectors are compared, using data from six recent comparisons in Africa, Asia and Melanesia. By all the entomological and malariological criteria recorded, pyrethroid-treated nets were at least as efficacious as house spraying with dichlorodiphenyltrichloroethane (DDT), malathion or a pyrethroid. However, when data from carefully monitored house spraying projects carried out between the 1950s and 1970s at Pare-Taveta and Zanzibar (United Republic of Tanzania), Kisumu (Kenya) and Garki (Nigeria) are compared with recent insecticide-treated net trials with apparently similar vector populations, the results with the insecticide-treated nets were much less impressive. Possible explanations include the longer duration of most of the earlier spraying projects and the use of non-irritant insecticides. Non-irritant insecticides may yield higher mosquito mortalities than pyrethroids, which tend to make insects leave the site of treatment (i.e. are excito-repellent). Comparative tests with non-irritant insecticides, including their use on nets, are advocated. The relative costs and sustainability of spraying and of insecticide-treated net operations are briefly reviewed for villages in endemic and epidemic situations and in camps for displaced populations. The importance of high population coverage is emphasized, and the advantages of providing treatment free of charge, rather than charging individuals, are pointed out.

Effect of community-wide use of insecticide-treated nets for 3-4 years on malarial morbidity in Tanzania

Objectives  To investigate (1) benefits due to personal protection of individual net users vs. mass killing of mosquitoes within villages as a result of widespread net usage; (2) sustainability over several years of benefits against malarial morbidity of insecticide‐treated nets; (3) distribution of the benefits in different age groups of children and (4) whether, as a result of fading immunity, older age groups ‘paid for’ the benefits which they had enjoyed when younger.

Comparison of different insecticides and fabrics for anti‐mosquito bednets and curtains

Abstract. Various formulations of six insecticides (a carbamate and five pyrethroids), were impregnated into bednets and curtains made from cotton, polyester, polyethylene or polypropylene fabric. For bioassays of insecticidal efficacy, female Anopheles gambiae mosquitoes were made to walk on the fabrics for 3 min and mortality was scored after 24 h. The main concentrations tested were: bendiocarb 400 mg/m2, cyfluthrin 30–50 mg/m2, deltamethrin 15–25 mg/m2, etofenprox 200 mg/m2, lambda‐cyhalothrin 5–15 mg/m2 and permethrin 200–500 mg/m2. Field trials in Tanzania used experimental huts (fitted with verandah traps) entered by wild free‐flying Anopheles gambiae, An. funestus and Culex quinquefasciatus mosquitoes.

The pyrethroid knock‐down resistance gene in the Anopheles gambiae complex in Mali and further indication of incipient speciation within An. gambiae s.s.

In Mali the Anopheles gambiae complex consists of An. arabiensis and Mopti, Savanna and Bamako chromosomal forms of An. gambiae s.s. Previous chromosomal data suggests a complete reproductive isolation among these forms. Sequence analysis of rDNA regions led to the characterization of two molecular forms of An. gambiae, named M‐form and S‐form, which in Mali correspond to Mopti and to Savanna/Bamako, respectively, while it has failed so far to show any molecular difference between Savanna and Bamako. The population structure of An. gambiae s.l. was analysed in three villages in the Bamako and Sikasso areas of Mali and the frequency of pyrethroid resistance of the knock‐down resistance (kdr) type was calculated. The results show that the kdr allele is associated only with the Savanna form populations and absent in sympatric and synchronous populations of Bamako, Mopti and An. arabiensis. This is the first molecular indication of barriers to gene flow between the Bamako and Savanna chromosomal forms. Moreover, analyses of specimens collected in the Bamako area in 1987 show that the kdr allele was already present in the Savanna population at that time, and that the frequency of this allele has gradually increased since then.

Scaling-up coverage with insecticide-treated nets against malaria in Africa: who should pay?

Insecticide-treated nets (ITNs) have been shown to reduce the burden of malaria in African villages by providing personal protection and, if coverage of a community is comprehensive, by reducing the infective mosquito population. We do not accept the view that scaling-up this method should be by making villagers pay for nets and insecticide, with subsidies limited so as not to discourage the private sector. We consider that ITNs should be viewed as a public good, like vaccines, and should be provided via the public sector with generous assistance from donors. Our experience is that teams distributing free ITNs, replacing them after about 4 years when they are torn and retreating them annually, have high productivity and provide more comprehensive and equitable coverage than has been reported for marketing systems. Very few of the free nets are misused or sold. The estimated cost would be an annual expenditure of about US