Integrated Mapping of Neglected Tropical Diseases: Epidemiological Findings and Control Implications for Northern Bahr-el-Ghazal State,Southern Sudan

Background

There are few detailed data on the geographic distribution of most neglected tropical diseases (NTDs) in post-conflict Southern Sudan. To guide intervention by the recently established national programme for integrated NTD control, we conducted an integrated prevalence survey for schistosomiasis, soil-transmitted helminth (STH) infection, lymphatic filariasis (LF), and loiasis in Northern Bahr-el-Ghazal State. Our aim was to establish which communities require mass drug administration (MDA) with preventive chemotherapy (PCT), rather than to provide precise estimates of infection prevalence.

Methods and Findings

The integrated survey design used anecdotal reports of LF and proximity to water bodies (for schistosomiasis) to guide selection of survey sites. In total, 86 communities were surveyed for schistosomiasis and STH; 43 of these were also surveyed for LF and loiasis. From these, 4834 urine samples were tested for blood in urine using Hemastix reagent strips, 4438 stool samples were analyzed using the Kato-Katz technique, and 5254 blood samples were tested for circulating Wuchereria bancrofti antigen using immunochromatographic card tests (ICT). 4461 individuals were interviewed regarding a history of ‘eye worm’ (a proxy measure for loiasis) and 31 village chiefs were interviewed regarding the presence of clinical manifestations of LF in their community. At the village level, prevalence of Schistosoma haematobium and S. mansoni ranged from 0 to 65.6% and from 0 to 9.3%, respectively. The main STH species was hookworm, ranging from 0 to 70% by village. Infection with LF and loiasis was extremely rare, with only four individuals testing positive or reporting symptoms, respectively. Questionnaire data on clinical signs of LF did not provide a reliable indication of endemicity. MDA intervention thresholds recommended by the World Health Organization were only exceeded for urinary schistosomiasis and hookworm in a few, yet distinct, communities.

Conclusion

This was the first attempt to use an integrated survey design for this group of infections and to generate detailed results to guide their control over a large area of Southern Sudan. The approach proved practical, but could be further simplified to reduce field work and costs. The results show that only a few areas need to be targeted with MDA of PCT, thus confirming the importance of detailed mapping for cost-effective control.     

Targeting Trachoma Control through Risk Mapping: The Example of Southern Sudan

Background

Trachoma is a major cause of blindness in Southern Sudan. Its distribution has only been partially established and many communities in need of intervention have therefore not been identified or targeted. The present study aimed to develop a tool to improve targeting of survey and control activities.

Methods/Principal Findings

A national trachoma risk map was developed using Bayesian geostatistics models, incorporating trachoma prevalence data from 112 geo-referenced communities surveyed between 2001 and 2009. Logistic regression models were developed using active trachoma (trachomatous inflammation follicular and/or trachomatous inflammation intense) in 6345 children aged 1–9 years as the outcome, and incorporating fixed effects for age, long-term average rainfall (interpolated from weather station data) and land cover (i.e. vegetation type, derived from satellite remote sensing), as well as geostatistical random effects describing spatial clustering of trachoma. The model predicted the west of the country to be at no or low trachoma risk. Trachoma clusters in the central, northern and eastern areas had a radius of 8 km after accounting for the fixed effects.

Conclusion

In Southern Sudan, large-scale spatial variation in the risk of active trachoma infection is associated with aridity. Spatial prediction has identified likely high-risk areas to be prioritized for more data collection, potentially to be followed by intervention.     

Prevalence and Risk Factors for Trachoma in Central and Southern Malawi

Background

Trachoma, one of the neglected tropical diseases is suspected to be endemic in Malawi. Objectives: To determine the prevalence of trachoma and associated risk factors in central and southern Malawi.

Methodology/Principal Findings

A population based survey conducted in randomly selected clusters in Chikwawa district (population 438,895), southern Malawi and Mchinji district (population 456,558), central Malawi. Children aged 1–9 years and adults aged 15 and above were assessed for clinical signs of trachoma. In total, 1010 households in Chikwawa and 1016 households in Mchinji districts were enumerated within 108 clusters (54 clusters in each district). A total of 6,792 persons were examined for ocular signs of trachoma. The prevalence of trachomatous inflammation, follicular (TF) among children aged 1–9 years was 13.6% (CI 11.6–15.6) in Chikwawa and 21.7% (CI 19.5–23.9) in Mchinji districts respectively. The prevalence of trachoma trichiasis (TT) in women and men aged 15 years and above was 0.6% (CI 0.2–0.9) in Chikwawa and 0.3% (CI 0.04–0.6) in Mchinji respectively. The presence of a dirty face was significantly associated with trachoma follicular (TF) in both Chikwawa and Mchinji districts (P<0.001).

Conclusion/Significance

Prevalence rates of trachoma follicles (TF) in Central and Southern Malawi exceeds the WHO guidelines for the intervention with mass antibiotic distribution (TF>10%), and warrants the trachoma SAFE control strategy to be undertaken in Chikwawa and Mchinji districts.     

Rapid Assessment of Trachoma in Underserved Population of Car-Nicobar Island,India

Purpose

To determine the burden of trachoma and its related risk factors amongst the native population of Car-Nicobar Island in India.

Methods

Rapid assessment for trachoma was conducted in ten villages of Car- Nicobar Island according to standard WHO guidelines. An average of 50 children aged 1–9 years were assessed clinically for signs of active trachoma and facial cleanliness in each village. Additionally, all adults above 15 years of age in these households were examined for evidence of trachomatous trichiasis and corneal opacity. Environmental risk factors contributing to trachoma like limited access to potable water & functional latrine, presence of animal pen and garbage within the Nicobari hut were also noted in all villages.

Results

Out of a total of fifteen villages in Car-Nicobar Island, ten villages were selected for trachoma survey depending on evidence of socio-developmental indicators like poverty and decreased access to water, sanitation and healthcare facilities. The total population of the selected clusters was 7277 in the ten villages. Overall, 251 of 516 children (48.6%;CI: 46.5–55.1) had evidence of follicular stage of trachoma and 11 children (2.1%;CI:1.0–3.4) had evidence of inflammatory stage of trachoma. Nearly 15%(CI:12.1–18.3) children were noted to have unclean faces in the ten villages. Trachomatous trichiasis was noted in 73 adults (1.0%;CI:0.8–1.2). The environmental sanitation was not found to be satisfactory in the surveyed villages mainly due to the co-habitance of Nicobari people with domestic animals like pigs, hens, goats, dogs, cats etc in most (96.4%) of the households.

Conclusion

Active trachoma and trachomatous trichiasis was observed in all the ten villages surveyed, wherein trachoma control measures are needed.     

Southern and Northern analysis

This review on Southern and Northern analysis, rather than providing step-by-step protocols, focuses on a critical evaluation of the existing experimental methods and modifications thereof. Principal parameters influencing electrophoresis of DNA/RNA in agarose gels are outlined and at the same time alterations in these parameters for optimal resolution of DNA of varying length are discussed. Further, methods for evaluating the quality of DNA/RNA size separation in agarose gels are described. Since efficient transfer of DNA/RNA from the gel onto a membrane support is critical in both methods, several experimental approaches for transfer are compared. Also discussed in this review are alternative methods for radioactive and non-radioactive labelling of DNA probes. Finally, detailed protocols are provided for an effective hybridization of Southern and Northern blots.     

Fish communities in the eastern,seasonal-floodplain of the Sudd,Southern Sudan

Annual flooding of the permanent Sudd swamps innundates large areas of Oryza longistaminata grasslands. Fish migration into a southeast section of the seasonal floodplain was led by Clarias gariepinus, Polypterus senegalus and several small species which were intent on spawning. Channa obscura and juveniles of Oreochromis niloticus were prominent among later entrants. From a total of 23 species caught in seasonal habitats, 7 contributed over 97% of total estimated numerical and biomass densities. The latter ranged from 435–580 kg ha^–1. In the 1982–83 flood-season entry to the floodplain was essentially restricted to species tolerant of oxygen-deficient waters and thereby able to penetrate the papyrus and Typha swamps of the permanent wetland. Migrants became stranded in temporary pools and subject to heavy cropping by birds.     

Integrated Rapid Mapping of Neglected Tropical Diseases in Three States of South Sudan: Survey Findings and Treatment Needs

Background

Integrated rapid mapping to target interventions for schistosomiasis, soil-transmitted helminthiasis (STH) and lymphatic filariasis (LF) is ongoing in South Sudan. From May to September 2010, three states – Unity, Eastern Equatoria and Central Equatoria – were surveyed with the aim of identifying which administrative areas are eligible for mass drug administration (MDA) of preventive chemotherapy (PCT).

Methods and Principal Findings

Payams (third administrative tier) were surveyed for Schistosoma mansoni, S. haematobium and STH infections while counties (second administrative tier) were surveyed for LF. Overall, 12,742 children from 193 sites were tested for schistosome and STH infection and, at a subset of 50 sites, 3,980 adults were tested for LF. Either S. mansoni or S. haematobium or both species were endemic throughout Unity State and occurred in foci in Central and Eastern Equatoria. STH infection was endemic throughout Central Equatoria and the western counties of Eastern Equatoria, while LF was endemic over most of Central- and Eastern Equatoria, but only in selected foci in Unity. All areas identified as STH endemic were co-endemic for schistosomiasis and/or LF.

Conclusions

The distribution and prevalence of major NTDs, particularly schistosomiasis, varies considerably throughout South Sudan. Rapid mapping is therefore important in identifying (co)-endemic areas. The present survey established that across the three surveyed states between 1.2 and 1.4 million individuals are estimated to be eligible for regular MDA with PCT to treat STH and schistosomiasis, respectively, while approximately 1.3 million individuals residing in Central- and Eastern Equatoria are estimated to require MDA for LF.     

The burden of trachoma in Ayod County of Southern Sudan

Background

Blindness due to trachoma is avoidable through Surgery, Antibiotics, Facial hygiene and Environmental improvements (SAFE). Recent surveys have shown trachoma to be a serious cause of blindness in Southern Sudan. We conducted this survey in Ayod County of Jonglei State to estimate the need for intervention activities to eliminate blinding trachoma.

Methodology and Findings

A cross-sectional two-stage cluster random survey was conducted in November 2006. All residents of selected households were clinically assessed for trachoma using the World Health Organization (WHO) simplified grading scheme. A total of 2,335 people from 392 households were examined, of whom 1,107 were over 14 years of age. Prevalence of signs of active trachoma in children 1–9 years of age was: trachomatous inflammation follicular (TF) = 80.1% (95% confidence interval [CI], 73.9–86.3); trachomatous inflammation intense (TI) = 60.7% (95% CI, 54.6–66.8); and TF and/or TI (active trachoma) = 88.3% (95% CI, 83.7–92.9). Prevalence of trachomatous trichiasis (TT) was 14.6% (95% CI, 10.9–18.3) in adults over 14 years of age; 2.9% (95% CI, 0.4–5.3) in children 1–14 years of age; and 8.4% (95% CI, 5.5–11.3) overall. The prevalence of corneal opacity in persons over 14 years of age with TT was 6.4% (95% CI, 4.5–8.3). No statistically significant difference was observed in the prevalence of trachoma signs between genders. Trachoma affected almost all households surveyed: 384/392 (98.0%) had at least one person with active trachoma and 130 (33.2%) had at least one person with trichiasis.

Conclusions

Trachoma is an unnecessary public health problem in Ayod. The high prevalence of active trachoma and trichiasis confirms the severe burden of blinding trachoma found in other post-conflict areas of Southern Sudan. Based on WHO recommended thresholds, all aspects of the SAFE strategy are indicated to eliminate blinding trachoma in Ayod.     

Use of local knowledge for assessing vegetation changes in the Southern Gadarif Region,Sudan

The vegetation cover in Gadarif Region, Sudan, underwent drastic changes within the last 60 years because of the combined effect of anthropogenic and climatic factors. As a consequence, a large number of plant species are threatened or even became extinct, and vast areas are now deforested. The purpose of this study is to use the local knowledge as a tool to identify and describe patterns of vegetation changes associated with the introduction of mechanized rain‐fed agriculture in the southern Gadarif Region. Data were collected by interviewing 10 key informants and 41 large‐scale farmers. The results provided rich ethnobotanical knowledge and a clear historical perspective of vegetation changes including plant species which have disappeared, decreased and increased in the area. The main factors leading to changes in plant species composition and abundance were vegetation clearance, charcoal and firewood production, wood cuttings, grazing and recently herbicides application. Respondents acknowledged that grazing, duration of abandonment, length of cultivation period, amount and variability of rainfall, fire events and weed composition are the major factors determining succession on fallow land. Farmers showed interest to preserve some multi‐purpose woody species (e.g. Acacia senegal, Balanites aegyptiaca) in their land. Such species should be given priority in rehabilitation activities.     

华北棉区各代棉铃虫生命表及南北棉铃虫发生特征研究

通过对以河北饶阳为代表的华北棉区棉铃虫动态的研究,建立了各代棉铃虫自然种群生命表．结果表明,华北棉区第l-4代棉铃虫总死亡率分别为98．3％、98．34％;98.69%和9.13%,各代棉铃虫种群的趋势指数I值分别为3.97、1.50、1.41和1.09.与以江苏南通为代表的南方棉区生命表参数相比较发现,无论是在南方还是在北方,棉铃虫的存活率曲线都属于A型曲线,即卵至2龄期死亡率较大,3龄以后死亡率较小的凹型曲线。南方棉区棉铃虫消亡的关键因子是风雨冲刷作用,而北方则是天敌的捕食作用;南北棉区的棉铃虫孵化期为1龄期,易受不良环境的影响,死亡率较大,为关键虫期;北方棉区主要危害世代是2、3代棉铃虫,南方棉区为3、4代棉铃虫,由此讨论了南北棉区各世代棉铃虫的发生危害特点。     

Distinct haplotypes and free movement of Aedes aegypti in Port Sudan,Sudan

Any attempt to control a mosquito-borne disease should primarily focus on controlling its vector. In Sudan, arboviral infections are a major health problem where periodical outbreaks of arboviruses transmitted by Aedes aegypti have been reported. This preliminary study was performed to uncover the population genetic diversity of Aedes aegypti from Red Sea State, Sudan, using mtDNA-COI gene. We performed morphological identification, PCR and DNA nucleotide sequencing and analysed the genetic polymorphism, and isolation by distance of Aedes aegypti from four sites. Of the 55 samples successfully sequenced, six haplotypes were revealed. Global haplotype network revealed that the predominant haplotype in Sudan (Hap1; 31 sequences = 56.4%), the second most frequent haplotype (Hap2; 13 sequences = 23.6%) and Hap 5 (3.6%) were identical or genetically close to isolates seen in different countries distributed in the United States, South America, Europe, Asia and two African isolates, one from Kenya and the other from Europa Island (Mozambique Channel). Haplotype 4 (3.6%) appeared closely related to mosquitoes sampled from Cameroon, Kenya, Sri Lanka and India and belonged to a lineage that contained isolates from all over the geographical expansion. Haplotype 6 (1.8%) seemed quite distant from any other sequenced mtDNA. To summarize, four haplotypes were found only in Sudan, and one rare haplotype appeared genetically distant from all other haplotypes, suggesting a local origin. Subdivision measures and testing suggested a probable free (or almost free) migration between the different sites sampled.     

Rapid and sensitive detection of DNA in Southern blots with chemiluminescence

A new chemiluminescent Southern blot procedure offers molecular biologists a safe, ultrasensitive and rapid alternative to conventional 32P-based systems. This new DNA detection system, SOUTHERN-LIGHT, has been developed by Tropix, Inc. The luminescent signal is produced from a direct chemiluminescent substrate, disodium 3-(4-methoxyspiro[1,2-dioxetane-3-2'-tricyclo-[3.3.1.1 .3,7]decan]-4-yl) phenyl phosphate (AMPPD), which decomposes upon dephosphorylation with alkaline phosphatase. SOUTHERN-LIGHT is an ultrasensitive, rapid detection kit for use with membrane-bound DNA. It is the first test kit to incorporate AMPPD. It requires no specialized equipment and results can be conveniently imaged on instant film or x-ray film within 5-60 min of exposure.     

Postbreeding elevational movements of western songbirds in Northern California and Southern Oregon

Migratory species employ a variety of strategies to meet energetic demands of postbreeding molt. As such, at least a few species of western Neotropical migrants are known to undergo short‐distance upslope movements to locations where adults molt body and flight feathers (altitudinal molt migration). Given inherent difficulties in measuring subtle movements of birds occurring in western mountains, we believe that altitudinal molt migration may be a common yet poorly documented phenomenon. To examine prevalence of altitudinal molt migration, we used 29 years of bird capture data in a series of linear mixed‐effect models for nine commonly captured species that breed in northern California and southern Oregon. Candidate models were formulated a priori to examine whether elevation and distance from the coast can be used to predict abundance of breeding and molting birds. Our results suggest that long‐distance migrants such as Orange‐crowned Warbler (Oreothlypis celata) moved higher in elevation and Audubon's Warbler (Setophaga coronata) moved farther inland to molt after breeding. Conversely, for resident and short‐distance migrants, we found evidence that birds either remained on the breeding grounds until they finished molting, such as Song Sparrow (Melospiza melodia) or made small downslope movements, such as American Robin (Turdus migratorius). We conclude that altitudinal molt migration may be a common, variable, and complex behavior among western songbird communities and is related to other aspects of a species’ natural history, such as migratory strategy.     

Contrasting diversity patterns of breeding Anatidae in the Northern and Southern Hemispheres

For sustaining ecosystem functions and services, environmental conservation strategies increasingly target to maintain the multiple facets of biodiversity, such as functional diversity (FD) and phylogenetic diversity (PD), not just taxonomic diversity (TD). However, spatial mismatches among these components of biodiversity can impose challenges for conservation decisions. Hence, understanding the drivers of biodiversity is critical. Here, we investigated the global distribution patterns of TD, FD, and PD of breeding Anatidae. Using null models, we clarified the relative importance of mechanisms that influence Anatidae community. We also developed random forest models to evaluate the effects of environmental variables on the Anatidae TD, FD, and PD. Our results showed that geographical variation in Anatidae diversity is hemispheric rather than latitudinal. In the species‐rich Northern Hemisphere (NH), the three diversity indices decreased with latitude within the tropical zone of the NH, but increased in the temperate zone reaching a peak at 44.5–70.0°N, where functional and phylogenetic clustering was a predominant feature. In the Southern Hemisphere (SH), Anatidae diversity increased poleward and a tendency to overdispersion was common. In NH, productivity seasonality and temperature in the coldest quarter were the most important variables. Productivity seasonality was also the most influential predictor of SH Anatidae diversity, along with peak productivity. These findings suggested that seasonality and productivity, both consistent with the energy‐diversity hypothesis, interact with the varying histories to shape the contrasting hemispheric patterns of Anatidae diversity. Phylogenetic diversity (PD) and FD underdispersion, widespread across the species‐rich, seasonally productive mid‐to‐high latitudes of the NH, reflects a rapid evolutionary radiation and resorting associated with Pleistocene cycles of glaciation. The SH continents (and southern Asia) are characterized by a widespread tendency toward PD and FD overdispersion, with their generally species‐poor communities comprising proportionately more older lineages in thermally more stable but less predictably productive environments.