F.C. Shenton

A malaria control trial using insecticide-treated bed nets and targeted chemoprophylaxis in a rural area of The Gambia, West Africa: 7. Impact of permethrin-impregnated bed nets on malaria vectors

The impact of permethrin-impregnated bed nets on malaria vectors was studied in 6 pairs of villages during the rainy season in 1989. In each pair, the residents of one village had their nets treated whilst those of the other remained untreated. Routine collections of mosquitoes were made outdoors in the early evening using human-biting collections, and indoors with insecticide sprays, light traps and by searches under bed nets. Mosquitoes of the Anopheles gambiae complex, An. gambiae sensu stricto, An. arabiensis and An. melas, were present in large numbers for 5 months of the study period. These mosquitoes were susceptible to permethrin as judged by bioassay results. Outdoor human-biting rates in the early evening in communities with treated bed nets were similar to those in communities with untreated nets. In villages with treated bed nets most biting occurred outdoors in the early evening with little taking place under impregnated nets. The insecticidal activity of permethrin-impregnated bed nets, dipped by the local population, provided good individual protection against mosquitoes throughout the rainy season and bed nets remained effective even when washed up to 3 times. There was little to suggest that the use of insecticide-treated nets reduced the survival of mosquito populations in villages with impregnated nets. The absence of the expected village-wide effects of net impregnation may have resulted from the circulation of mosquitoes between villages with treated and untreated nets. The proportion of mosquitoes which fed on humans did not differ significantly between villages with treated and untreated nets.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship between anthropometric measurements and measurements of iron status and susceptibility to malaria in Gambian children

Anthropometric measurements were made and serum iron and ferritin levels determined in a group of Gambian children at the beginning of the rainy season and these findings were related to the malaria experience of the children during the following malaria transmission season. Susceptibility to malaria was not correlated with prior weight-for-age, height-for-age, weight-for-height or serum albumin, or with serum iron, serum iron binding capacity nor serum ferritin. Thus, our findings do not provide any support for the view that poor nutritional status, as assessed by anthropometric measurements, or iron deficiency protect against malaria infection. Children who developed a clinical attack of malaria accompanied by a high level of parasitaemia tended to have a higher mean weight-for-age at the beginning of the rainy season than did children who had a clinical attack accompanied by a low level of parasitaemia, but the difference between groups was not statistically significant. However, they had a significantly higher mean serum ferritin level (P less than 0.01).

Ethnic differences in the prevalence of splenomegaly and malaria in The Gambia.

Significant variations in the prevalence of splenomegaly were found among members of the three main ethnic groups resident in North Bank Division, The Gambia. Among young children splenomegaly and malaria were less prevalent in Mandinkas than in Wollofs or Fulas, suggesting that some genetic or environmental factors protect Mandinka children from this infection. Among older children and adults splenomegaly was found most frequently in Fulas. Six of 22 adults with very large spleens had a high serum IgM level and probably had the hyperreactive malarial splenomegaly (tropical splenomegaly) syndrome. Four of these six subjects were Fulas. This finding, together with the results of a previous study in Nigeria, suggest that Fulas have a predisposition to this condition.

Responses of Anopheles gambiae complex mosquitoes to the use of untreated bednets in The Gambia.

ABSTRACT. Population dynamics of the Anopheles gambiae complex of malaria vector mosquitoes were studied in four small hamlets in The Gambia. Bednets were used to reduce man/vector contact in two of the hamlets. High densities of An. gambiae, sensu lato, were present for only 3–8 weeks during the rainy season, depending on the position of the hamlet within the study area. The proportions of blood‐fed mosquitoes caught indoors (83.0%) and exiting from houses (11.6%) were lower in hamlets where bednets were used than in hamlets without (96.5% and 33.1% respectively). Fewer of the blood‐fed mosquitoes had fed on man in houses where people slept under bednets (68.2%) than in those without (81.5%). However, the average number of infective bites received by children was still greater than one a year in hamlets where bednets were used. Consequently bednets are considered unlikely to be an effective malaria control measure so long as they are untreated with insecticide.

Factors influencing susceptibility to meningococcal disease during an epidemic in The Gambia, West Africa.

A study was made of factors that influenced susceptibility to group A meningococcal disease during an epidemic that affected The Gambia, West Africa during the dry season of 1982-83. No explanations were found for the distribution of cases between villages or within affected villages. Socio-economic status, crowding, nutrition and previous exposure to meningococcal disease all appeared to be unimportant. Examination of serum samples obtained before the outbreak from a few children who subsequently became patients and from an equal number of age-matched controls from the same village showed a higher mean serum IgA value in children who became patients than in controls. There were not, however, any significant differences found in the concentrations of IgG, IgM, complement or meningococcal antibody between the two groups. Four children who developed culture-proven group A meningococcal disease had raised titres of bactericidal antibody to the epidemic strain 2-3 months before their illnesses. Our findings suggest that some important risk factors for group A meningococcal disease remain to be identified.

A malaria control trial using insecticide-treated bed nets and targeted chemoprophylaxis in a rural area of The Gambia, west Africa. 3. Entomological characteristics of the study area.

Baseline entomological surveillance was carried out in a rural area of The Gambia during the rainy season in 1988, one year before the implementation of a malaria control programme using insecticide-impregnated nets and targeted chemoprophylaxis in villages with a primary health care (PHC) system. Mosquito collections took place in 6 pairs of settlements each with untreated bed nets; within each pair there was a large PHC village with a resident village health worker (VHW) and traditional birth attendant (TBA) and a smaller non-PHC village without either a VHW or a TBA. The most common vectors in the study area were Anopheles gambiae sensu stricto and, to a lesser extent, An. arabiensis. These mosquitoes were found in appreciable numbers for at least 4 months of the year (geometric mean/bedroom/night = 32.5, 95% confidence interval 18.2-57.3). Numbers of mosquitoes collected in PHC villages or non-PHC villages were not significantly different. Greater numbers of mosquitoes were found in villages closer to the River Gambia than in those further away. Evidence for DDT resistance due to elevated glutathione S-transferase activity was found in one of the 12 villages, but there was no evidence of resistance to organophosphate or carbamate insecticides as suggested by the low esterase levels and carbamate sensitive acetylcholinesterase.

Epidemiology of rotavirus in a periurban Gambian community.

Short, well demarcated epidemics of rotavirus diarrhoea were observed during two consecutive cool, dry seasons in The Gambia. This seasonal pattern has now been documented for 4 consecutive years. During the 1985/86 epidemic, transmission was intense, with a clinical attack rate for infants of 36%. During this outbreak it was estimated that asymptomatic virus-shedding was two-thirds as common as symptomatic infection. Rotavirus diarrhoea was more severe than diarrhoea due to all other causes and clinical rotavirus infection was associated with weight loss in the post-infection period. Non-epidemic periods were characterized by very occasional mild cases and asymptomatic virus-shedding in neonates. There was a change in RNA electropherotypes from a predominantly long pattern in 1983/84 and 1984/85 to short patterns in 1985/86.

An ELISA test for detecting chloroquine in urine

Two ELISA tests for detecting chloroquine in urine have been developed using polyclonal and monoclonal antibodies which react with the 7-chloro-4-amino-quinoline part of the chloroquine molecule and thus recognize chloroquine, its metabolites, and amodiaquine. The ELISAs were sensitive and specific and did not cross-react with other commonly used antimalarials. In a field trial the chloroquine ELISA performed better than the Dill Glazko or Haskins colorimetric tests. A small proportion of urines gave an apparently false positive reaction when tested at a dilution of 1:10, but not when tested at higher dilution.

Sporozoite antibodies and malaria in children in a rural area of The Gambia.

Sporozoite antibody levels were measured in a group of children aged one to nine years resident in a rural area of The Gambia, using an ELISA to the repeat peptide (NANP)40. The prevalence and titre of antibodies varied with age but not with sex or ethnic group. Significant variations in prevalence were recorded within a group of adjacent villages. Children who were seropositive at the beginning of the dry season had higher spleen and parasite rates both at this time and at the end of the subsequent rainy season than did seronegative children, suggesting that they were exposed more frequently to infection. However, seropositive children had fewer episodes of fever accompanied by high levels of parasitaemia than did seronegative children, suggesting that they had a greater degree of clinical immunity. No differences were found in seroprevalence rates or in mean antibody titres between children who slept under conventional or Permethrin treated bed nets and those who did not, even though bed nets significantly reduced the number of bites by vector mosquitoes.

A comparison of two DNA probes, one specific for Plasmodium falciparum and one with wider reactivity, in the diagnosis of malaria

The sensitivity and specificity of 2 probes for the detection of malarial infection was studied. 399 blood samples from Gambian children were tested in a deoxyribonucleic acid (DNA) hybridization assay, and the results compared with the microscopical findings from thick blood films. 8 additional pure Plasmodium malariae and 14 pure P. vivax samples were also assayed. One probe, containing a 21 base pair tandem repeat and highly specific for P. falciparum, detected this species in all except 2 of 74 samples with a parasitaemia of 250 per microliter or more; the overall sensitivity of the probe was 76%. The other probe, a 6 kilobase pair organelle DNA, is conserved in all Plasmodium species so far tested. Its sensitivity for P. falciparum was lower than the 21 base pair repeat, but it detected P. vivax and P. malariae at low levels of parasitaemia, and thus could be useful in field studies.