Clifford Mutero

Malaria and urbanization in sub-Saharan Africa

There are already 40 cities in Africa with over 1 million inhabitants and the United Nations Environmental Programme estimates that by 2025 over 800 million people will live in urban areas. Recognizing that malaria control can improve the health of the vulnerable and remove a major obstacle to their economic development, the Malaria Knowledge Programme of the Liverpool School of Tropical Medicine and the Systemwide Initiative on Malaria and Agriculture convened a multi-sectoral technical consultation on urban malaria in Pretoria, South Africa from 2nd to 4th December, 2004. The aim of the meeting was to identify strategies for the assessment and control of urban malaria. This commentary reflects the discussions held during the meeting and aims to inform researchers and policy makers of the potential for containing and reversing the emerging problem of urban malaria.

Bed net use and associated factors in a rice farming community in Central Kenya

BackgroundUse of insecticide-treated nets (ITNs) continues to offer potential strategy for malaria prevention in endemic areas. However their effectiveness, sustainability and massive scale up remain a factor of socio-economic and cultural variables of the local community which are indispensable during design and implementation stages.MethodsAn ethnographic household survey was conducted in four study villages which were purposefully selected to represent socio-economic and geographical diversity. In total, 400 households were randomly selected from the four study villages. Quantitative and qualitative information of the respondents were collected by use of semi-structured questionnaires and focus group discussions.ResultsMalaria was reported the most frequently occurring disease in the area (93%) and its aetiology was attributed to other non-biomedical causes like stagnant water (16%), and long rains (13%). Factors which significantly caused variation in bed net use were occupant relationship to household head (χ2 = 105.705; df 14; P = 0.000), Age (χ2 = 74.483; df 14; P = 0.000), village (χ2 = 150.325; df 6; P = 0.000), occupation (χ2 = 7.955; df 3; P = 0.047), gender (χ2 = 4.254; df 1; P = 0.039) and education levels of the household head or spouse (χ2 = 33.622; df 6; P = 0.000). The same variables determined access and conditions of bed nets at household level. Protection against mosquito bite (95%) was the main reason cited for using bed nets in most households while protection against malaria came second (54%). Colour, shape and affordability were some of the key potential factors which determined choice, use and acceptance of bed nets in the study area.ConclusionThe study highlights potential social and economic variables important for effective and sustainable implementation of bed nets-related programmes in Sub-Saharan Africa.

Malaria vector control practices in an irrigated rice agro-ecosystem in central Kenya and implications for malaria control

BackgroundMalaria transmission in most agricultural ecosystems is complex and hence the need for developing a holistic malaria control strategy with adequate consideration of socio-economic factors driving transmission at community level. A cross-sectional household survey was conducted in an irrigated ecosystem with the aim of investigating vector control practices applied and factors affecting their application both at household and community level.MethodsFour villages representing the socio-economic, demographic and geographical diversity within the study area were purposefully selected. A total of 400 households were randomly sampled from the four study villages. Both semi-structured questionnaires and focus group discussions were used to gather both qualitative and quantitative data.ResultsThe results showed that malaria was perceived to be a major public health problem in the area and the role of the vector Anopheles mosquitoes in malaria transmission was generally recognized. More than 80% of respondents were aware of the major breeding sites of the vector. Reported personal protection methods applied to prevent mosquito bites included; use of treated bed nets (57%), untreated bed nets (35%), insecticide coils (21%), traditional methods such as burning of cow dung (8%), insecticide sprays (6%), and use of skin repellents (2%). However, 39% of respondents could not apply some of the known vector control methods due to unaffordability (50.5%), side effects (19.9%), perceived lack of effectiveness (16%), and lack of time to apply (2.6%). Lack of time was the main reason (56.3%) reported for non-application of environmental management practices, such as draining of stagnant water (77%) and clearing of vegetations along water canals (67%).ConclusionThe study provides relevant information necessary for the management, prevention and control of malaria in irrigated agro-ecosystems, where vectors of malaria are abundant and disease transmission is stable.

Spatial distribution of Anopheles gambiae and Anopheles funestus and malaria transmission in Suba District, Western Kenya

The study reported here evaluated the distribution, relative abundance, and malaria transmission potential of Anopheles mosquitoes at 30 sites representing different ecological strata in western Kenya. Seasonal variation in anopheline densities and transmission potential, as expressed by Entomological inoculation rates (EIR), was investigated. Of the 6491 indoor resting anopheline mosquitoes collected at the 30 sites, 91.3 % (n = 5926) were An. gambiae s.l. and 8.7 % (n = 565) were An. funestus with an average house density of 6.58 and 0.63, respectively. Analysis of the data indicated significant variation in mosquito densities between study sites, species and season. High densities of both An. gambiae and An. funestus were recorded in the northern and northeastern parts of the district, while generally low densities were recorded in the south. Anopheles gambiae s.s. and An. arabiensis comprised 60.3 % (n = 3573) and 39.7 % (n = 2352) of the total number of An. gambiae s.l. mosquitoes collected, respectively. The composition of the An. gambiae s.l. sibling species showed temporal and spatial variation. Entomologic inoculation rates were estimated at 1.55 and 0.12 infective bites per person per month for An. gambiae s.l. and An. funestus, respectively. This study reveals considerable seasonal and site-specific variation in vector distribution, composition and transmission potential. Application of control interventions must therefore consider seasonal variations since the vectorial system changes quite rapidly over a short period of time.RésuméL’étude présentée ici évalue la distribution, l’abondance relative, et le potentiel de transmission du paludisme par des moustiques anophèles dans 30 localités représentatives des différentes conditions écologiques de l’Ouest du Kenya. La variation saisonnière des densités d’anophèles et du potentiel de transmission, exprimées par les taux d’inoculations Entomologiques (EIR), est examinée. Sur les 6491 anophèles récoltées au repos à l’intérieur des maisons dans les 30 localités, 91,3% (n=5926) sont des An. gambiae s.l. et 8,7% sont des An. funeslus avec une densité moyenne par maison de 6,58 et 0,63 respectivement. L’analyse des données indique une variation significative des densités de moustiques entre les sites étudiés, l’espèce et la saison. Des densités élevées à la fois d’An, gambiae s.l. et An. funestus ont été observées dans le nord et le nord est du district, alors que des densités généralement faibles ont été observées dans le sud. An. gambiae s.S. et An. arabiensis représentent respectivement 60,3% (n=3573) et 39,7% (n=2352) du nombre total de An. gambiae s.l récolté. La composition des 2 espèces d’An, gambiae s.l. montre une variation temporelle et spatiale. Les taux d’inoculations entomologiques sont estimés respectivement à 1,55 et 0,12 piqûres infestantes par personne et par mois pour’An. gambiae s.l. et An. funestus. Cette étude révèle une variation considérable de la distribution, de la composition et du potentiel de transmission des vecteurs selon la saison et la localité. La réalisation de campagnes de lutte doit par conséquent prendre en compte les variations saisonnières puisque le complexe vectoriel change très rapidement en un temps très court.

An Assessment of Participatory Integrated Vector Management for Malaria Control in Kenya

Background The World Health Organization (WHO) recommends integrated vector management (IVM) as a strategy to improve and sustain malaria vector control. However, this approach has not been widely adopted. Objectives We comprehensively assessed experiences and findings on IVM in Kenya with a view to sharing lessons that might promote its wider application. Methods The assessment used information from a qualitative external evaluation of two malaria IVM projects implemented between 2006 and 2011 and an analysis of their accumulated entomological and malaria case data. The project sites were Malindi and Nyabondo, located in coastal and western Kenya, respectively. The assessment focused on implementation of five key elements of IVM: integration of vector control methods, evidence-based decision making, intersectoral collaboration, advocacy and social mobilization, and capacity building. Results IVM was more successfully implemented in Malindi than in Nyabondo owing to greater community participation and multistakeholder engagement. There was a significant decline in the proportion of malaria cases among children admitted to Malindi Hospital, from 23.7% in 2006 to 10.47% in 2011 (p < 0.001). However, the projects’ operational research methodology did not allow statistical attribution of the decline in malaria and malaria vectors to specific IVM interventions or other factors. Conclusions Sustaining IVM is likely to require strong participation and support from multiple actors, including community-based groups, non-governmental organizations, international and national research institutes, and various government ministries. A cluster-randomized controlled trial would be essential to quantify the effectiveness and impact of specific IVM interventions, alone or in combination. Citation Mutero CM, Mbogo C, Mwangangi J, Imbahale S, Kibe L, Orindi B, Girma M, Njui A, Lwande W, Affognon H, Gichuki C, Mukabana WR. 2015. An assessment of participatory integrated vector management for malaria control in Kenya. Environ Health Perspect 123:1145–1151; http://dx.doi.org/10.1289/ehp.1408748

Systemwide initiative on malaria and agriculture : an innovative framework for research and capacity building

The Systemwide Initiative on Malaria and Agriculture (SIMA) is an initiative of international agricultural research centers to promote research and capacity building on the links between malaria and agriculture and to validate innovative interventions that would strengthen and complement existing malaria-control strategies in clearly defined settings. Knowledge regarding the nature and dynamics of agroecosystems is particularly needed for the purpose of developing appropriate farmer-managed preventive measures against malaria. SIMA research aims to make use of new and existing information on biomedical and socioeconomic determinants of malaria risks in formulating and evaluating the feasibility of integrated strategies. The initiative is especially interested and proactive in promoting and facilitating transdisciplinary and participatory research in relation to malaria. The convening institute for SIMA is the International Water Management Institute at its Africa Regional Office in Pretoria, South Africa. This article outlines SIMA’s objectives and scope of activities and also highlights achievements, challenges, and opportunities for future collaboration.