Sunil Dhiman

Socio-economic determinants for malaria transmission risk in an endemic primary health centre in Assam, India

BackgroundMalaria is a major cause of morbidity and mortality in Northeast India. As there is limited information available on the potential influence of socio-economic variables on malaria risk, the present study was conducted to assess the influence of demographic factors, the socio-economic status, and knowledge, awareness and education on malaria occurrence.MethodsDemographics, malaria knowledge and socio-economic variables were collected in four randomly selected health sub-centres of the Orang primary health centre in the Udalguri district, Assam and the association of malaria occurrence with different variables were analysed. The trend of malaria occurrence for different income groups, proximity to health centres and number of mosquito bites per day was also determined using the chi-square test. Relative risk (RR) for gender, house type, knowledge and use of bed nets was determined using Katz approximation.ResultsOut of the 71 household heads interviewed, 70.4% (50/71) were males. About half (54.9%, 39/71) of the participants had a history of malaria in the last two years, of which 64.1% (25/39) were males, while 35.9% (14/39) were females (χ2 = 5.13; p = 0.02; RR = 1.79). Of the total population surveyed, 49.3% lived in bamboo houses and 35.2% lived at a distance of >3 km from the nearest health centre. The number of participants who had a history of malaria decreased with an increasing monthly income (p < 0.0001). Malaria occurrence was higher among the households living in bamboo houses (69.2%), as compared to Kucha houses (20.5%) and Pucca houses (10.3%). No significant association was observed between education level and malaria occurrence (p = 0.93). The participants who did not use bed nets regularly reported a high occurrence of malaria infection as compared to those who used bed nets everyday (p < 0.0001).ConclusionsLower income, house type, distance to health sub-centre, knowledge and awareness about malaria, number of mosquito bites per day and use of bed nets were positively associated with malaria occurrence. Increasing the number of health sub-centres close to rural areas, improving the economic status and increasing awareness about malaria prevention measures will thus help to reduce malaria-associated morbidities.

Prioritizing areas for malaria control using geographical information system in Sonitpur district, Assam, India

OBJECTIVE To identify the malaria hot spots at health subcentre level in an endemic district using a geographical information system (GIS). The results will be useful for rapid retrieval of malaria information, and to prioritize malaria control efforts in identified hot spots. STUDY DESIGN Extraction, analysis and synthesis of relevant data. METHODS Malaria epidemiological data from 2006 to 2009 were analysed to determine the annual parasitic index, slide positivity rate, annual blood examination rate and Plasmodium falciparum percentage for each health subcentre in the district. Maps were produced using GIS, and integrated to identify the malaria hotspots. RESULTS Out of 288 health subcentres, GIS identified 10 hot spots at extremely high risk of malaria and 14 hot spots at high risk of malaria. Malaria may flare up in these hot spots whenever favourable transmission conditions arise. Health authorities have been advised to establish control measures in these selected hot spots for timely prevention. CONCLUSION There is a need for adequate monitoring and allocation of available resources for better interventions in the malaria hotspots. The GIS model used in this study can be used, even at village or cluster level, to pin point the malaria hot spots, and information can be updated and retrieved easily.

Essential oil based polymeric patch development and evaluating its repellent activity against mosquitoes.

Essential oil based insect repellents are environment friendly and provide dependable personal protection against the bites of mosquitoes and other blood-sucking insects. In the present study, optimized mixture of three essential oils was embedded into the ethylcellulose (EC) and polyvinylpyrrolidone (PVP K-30) polymers to develop essential oils based patch type mosquito repellent formulation. The developed formulation was characterized for various physico-chemical properties, oil release efficiency and essential oil-polymer interaction. Repellent activity of the formulation was evaluated against Ae. (S) albopictus mosquitoes and compared with commercially available synthetic insecticide based mosquito repellent cream Odomos(®) in the laboratory. The developed patches were 100% flat and there was no interaction between oil components and the excipients. Patches were smooth, homogenous and provided excellent mosquito repellent activity comparable to Odomos(®) under laboratory condition. Morphological and physico-chemical characterization indicated that the formulation was stable and suitable with the polymeric combination. The patch formulation did not show any inhalation toxicity in experimental Wistar rat. The repellent patches developed and evaluated currently, may provide a suitable, eco-friendly, acceptable and safe alternative to the existing synthetic repellent formulations for achieving protection against mosquitoes.

Insecticide susceptibility and dengue vector status of wild Stegomyia albopicta in a strategically important area of Assam, India

BackgroundDengue vector control programmes are facing operational challenges due to resistance against commonly used insecticides throughout the endemic countries. Recently, there has been appreciable increase in the dengue cases in India, however, no recent data are available on susceptible status of dengue vectors. We have studied the susceptibility level of St. albopicta to commonly used insecticides in India. Adult mosquitoes were tested for the presence of dengue virus.MethodsSt. albopicta larval bioassays were carried out to determine the lethal concentrations (LC10, LC50 and LC99) and the resistance ratios (RR10, RR50 and RR99) for temephos. Susceptibility to 4% DDT, 0.05% deltamethrin and 5% malathion was assessed following standard procedure. Knock-down times (KDT10, KDT50 and KDT99) were estimated and knock-down resistance ratios (KRR10, KRR50 and KRR99) were calculated. VectorTest™ dengue antigen assay was used to detect the dengue virus in the field collected mosquitoes.ResultsIn larval bioassays, the RR ranged from 1.4 (for RR99) to 1.7 (for RR50), which suggested that the tested St. albopicta were susceptible to temephos. There was no deviation among the lethal concentration data from linearity (r2 = 0.61). Adult St. albopicta mosquitoes were resistant to DDT, while fully susceptible to deltamethrin and malathion. The knock-down values (KDT10, KDT50 and KDT99) obtained for DDT displayed straight line in log-dose-probit analysis and follow linear regression model. The KRR99 for DDT was 4.9, which indicated a 4.9 folds increase in knock-down resistance to DDT. However, for malathion and deltamethrin, the KRR99 values were 1.6 and 1.5 respectively suggesting that mosquitoes were knock-down sensitive. None of the mosquito pool was dengue virus positive.ConclusionSt. albopicta showed resistance to DDT and reduced sensitivity to deltamethrin and malathion. This data on insecticide resistance could help public health authorities in India to design more effective vector control measures. More dengue vector specimens need to be scanned to identify the potential dengue vector.

Polymerase chain reaction detection of human host preference and Plasmodium parasite infections in field collected potential malaria vectors.

Abstract This study was carried out to determine the human host preference and presence of Plasmodium parasite in field collected Anopheles mosquitoes among four villages around a military cantonment located in malaria endemic Sonitpur district of Assam, India. Encountered malaria vector mosquitoes were identified and tested for host preference and Plasmodium presence using PCR method. Human host preference was detected using simple PCR, whereas vectorial status for Plasmodium parasite was confirmed using first round PCR with genus specific primers and thereafter nested PCR with three Plasmodium species specific primers. Out of 1874 blood fed vector mosquitoes collected, 187 (10%) were processed for PCR, which revealed that 40·6% had fed on human blood; 9·2% of human blood fed mosquito were harbouring Plasmodium parasites, 71·4% of which were confirmed to Plasmodium falciparum. In addition to An. minimus, An. annularis and An. culicifacies were also found positive for malaria parasites. The present study exhibits the human feeding tendency of Anopheles vectors highlighting their malaria parasite transmission potential. The present study may serve as a model for understanding the human host preference of malaria vectors and detection of malaria parasite inside the anopheline vector mosquitoes in order to update their vectorial status for estimating the possible role of these mosquitoes in malaria transmission. The study has used PCR method and suggests that PCR-based method should be used in this entire malarious region to correctly report the vectorial position of different malaria vectors.

Repellent Activity of Some Essential Oils Against Simulium Species in India

Abstract Use of repellents seems to be most reliable method of personal protection against annoyance and infections associated with haematophagous insects. We have investigated the biting activity of Simulium and tested the repellency of five essential oils extracted from Homalomena aromatica Schott (Alismatales: Araceae), Pogostemon heyneanus Bentham (Lamiales: Lamiaceae), Citrus aurantifolia Swingle (Sapindales: Rutaceae), Vitex negundo L. (Lamiales: Lamiaceae), and Ageratum conzoides L. (Asterales: Asteraceae) on the human volunteers against Simulium (blackflies) in three locations of Arunachal Pradesh, India. Blackflies preferred biting legs (> 79%) as compared to hand and face with profound biting activity during 1000–1100 h (> 23%) and 1500 – 1600 h (> 28%). The essential oil extracted from Homalomena aromatica, Vitex negundo and Ageratum conizoides provided > 2 h protection at 5% concentration and > 5 h protection at 10% concentration in all the three testing locations. The repellency of Homalomena aromatica, Vitex negundo and Ageratum conizoides essential oils after 6 h application was > 50% at 5% concentration and > 90% at 10% concentration. The study provides evidence for the potential of these essential oils in developing new repellents against blackflies.

A longitudinal study of malaria associated with deforestation in Sonitpur district of Assam, India

Assam–Arunachal forest fringed foothill area is endemic for malaria incidence. The present study deals with the temporal analysis of malaria incidence and determines its association with deforestation in 24 villages along the Assam–Arunachal forest fringed foothill area of Sonitpur district of Assam. Malaria epidemiological survey has been carried out in the study area from the year 1994 to 2005. Remote sensing (RS) technique has been used to map the areas of forest changes from the year 2000 to 2005. Geographical information system (GIS) was used to map the malaria incidence and forest cover. The study villages are endemic to malaria infections and there was increasing trend of malaria incidence over the years. The slide positivity rate (SPR) ranged from 5.1% in 1997 to 44.4% in 2005. The percentage forest cover decreased significantly from 23.6% during 2000 to 15.4% during 2005, whereas SPR was increased during 2000–2005. The present study is the first attempt to understand the role of deforestation in malaria incidence using RS and GIS in the north-eastern region of India at a micro-geographic level. The study suggests that the area is endemic to malaria transmission. The decrease in forest cover is a serious ecological concern besides its role in elevating the malaria incidence in the study area.

Culminating anti-malaria efforts at long lasting insecticidal net?

BACKGROUND Long-lasting insecticidal nets (LLINs) are a primary method in malaria control efforts. However, a decline in the biological efficacy and physical integrity over a period of comparatively lesser time than claimed, waning of naturally acquired immunity among regular users and misuse of LLINs are serious concerns. SEARCH AND SELECTION OF LITERATURE The literature for the current review was searched in PubMed, SCOPUS Database and Google using combined search strings of related key-words. Literature with sufficient data and information on the current subject was selected to reach a valid conclusion. FINDINGS The World Health Organization (WHO) has emphasized that LLINs should be considered a public good for people inhabiting malaria endemic settings. LLINs exhibited a cumulative effect on the vector density and may force anthropophilic mosquito vectors to find alternative animal hosts for blood meal. However, the physical integrity and biological activity of LLINs declines faster than the anticipated time due to different operational conditions and the spread of insecticide resistance. LLINs have been successful in reducing malaria incidences by either reducing or not allowing human exposure to the vector mosquitoes, but at the same time, LLINs debilitate the natural protective immunity against malaria parasite. Misuse of LLINs for deviant purposes is common and is a serious environmental concern, as people believe that traditional methods of prevention against malaria that have enabled them to survive through a long time are effective and sufficient. Moreover, people are often ill-informed regarding the toxic effects of LLINs. CONCLUSIONS Specific criteria for determining the serviceable life and guidelines on the safe washing and disposal of LLINs need to be developed, kept well-informed and closely monitored. Malaria case management, environment management and community awareness to reduce the misuse of LLINs are crucial. Focused research on developing effective anti-malarial drugs, vaccines and new insecticides to reduce resistance is imperative to tackle malaria in the future.

Ultra low concentration deltamethrin loaded patch development and evaluation of its repellency against dengue vector Aedes (S) albopictus

BackgroundMosquito repellents and emanators confer protection against mosquito bites through spatial action of emanated vapours which are released into the adjoining environment. Synthetic insecticides released into the environment in ultra low volume vapour phase deter the mosquitoes from biting humans in a protected space.MethodsFormulation patches were prepared using the solvent evaporation method over a backing membrane and using Dibutylphthalate (DBT) as a plasticizer. The effect of formulation variables on the deltamethrin release from the patch matrices were studied under accelerated conditions, whereas, HPLC was used for quantitative estimation of deltamethrin. The prepared patch formulations were subjected to physicochemical studies, such as, deltamethrin content, thickness, weight variation, percent moisture content, moisture uptake, surface area and surface pH determination. Deltamethrin-polymer interaction and compatibility was ascertained using DSC and FT-IR, while surface morphology and deltamethrin distribution in the patch were studied using SEM technique. Repellent activity of the patch formulations was evaluated against Ae. albopictus mosquitoes.ResultsBlends of polymeric combinations of polyvinylpyrrolidone (PVP) and ethyl-cellulose (EC) with admixture of deltamethrin provided prolonged repellent activity against Ae. albopictus mosquitoes. Physicochemical characterisation indicated the suitability of deltamethrin patch formulation with the polymeric combinations of PVP and EC. Patches were very effective against laboratory reared Ae. albopictus mosquitoes. No significant difference was observed between the performance of test patches and commercially available repellent cream Mosqshield®.ConclusionDeltamethrin loaded patches provided effective repellency against Ae. albopictus mosquitoes. The study emphasised that deltamethrin released to the environment in low concentration could be an excellent spatial repellent against hematophagous mosquitoes.

Chemotherapy and drug resistance status of malaria parasite in northeast India

India reports the highest number of malaria cases in Southeast Asia, of which Plasmodium falciparum contribute more than half of the cases every year. North eastern states of India contribute only 3.96% of countrys population but account for >10% of total reported malaria cases, 11% of Plasmodium falciparum cases and 20% of malaria related deaths annually. In India, chloroquine resistance was reported for the first time from northeast region and since then chloroquine treatment failure is being reported from many parts of the region. Increased chloroquine treatment failure has led to change of the drug policy to artemisinin combination therapy as first line of malaria treatment in the region. However, replacing chloroquine to artemisinin combination therapy has not shown significant difference in the overall malaria incidence in the region. The present review addresses the current malaria situation of northeastern region of India in the light of antimalarials drug resistance.