Community-based malaria control in Tigray, northern Ethiopia

Community-based control activities have been a major component of the Tigray regional malaria control programme since 1992. A team of 735 volunteer community health workers treat on average 60,000 clinical malaria cases monthly during the high malaria transmission season. Ensuring access for the rural population to early diagnosis and treatment has contributed to a significant decrease in death rate in under-five children at the village level from 1994 to 1996. Mapping and geographic information system (GIS) technologies have been introduced to support planning for control by assessment of community-based coverage. With further development, GIS will be used in stratification, and to assess the impact of water resources development on malaria transmission and intensity.     

Ecological succession and its impact on malaria vectors and their predators in borrow pits in western Ethiopia

Soil pits excavated for home construction are important larval habitats for malaria vectors in certain parts of Africa. Borrow pits in diverse stages of ecological succession in a maize‐farming region of Western Ethiopia were surveyed to assess the relationships between stage of succession and the structure and composition of invertebrate and plant communities, with particular attention to Anopheles gambiae s.l. and An. coustani, the primary local malaria vectors. An array of 82 borrow pits was identified in a multi‐lobed drainage basin in the community of Woktola. Each pit was evaluated on its physical features and by faunal and floral surveys during August, 2011, at the height of the longer rainy season (kiremt). Anopheles gambiae s.l. and An. coustani were the sole immature anophelines collected, often coexisting with Culex spp. Sedges were the most common plants within these pits, and included Cyperus elegantulus, C. flavescens, C. erectus and C. assimilis. The legume Smithia abyssinica, Nile grass (Acroceras macrum), cutgrass (Leersia hexandra), clover (Trifolium spp.), and the edible herb Centella asiatica, were also common in these habitats. No plant species in particular was strongly and consistently predictive of the presence or absence of mosquito immatures, particularly with regard to An. coustani. The presence of An.gambiae s.l. immatures in borrow pit habitats was negatively correlated with the presence of backswimmers (Notonectidae) (Z = −2.34, P = 0.019). Young (freshly excavated) borrow pits more likely contained immature An. gambiae s.l. (Z =‐2.86, P=0.004). Ecological succession was apparent in older pits, and as they aged, they became less likely to serve as habitats for An. gambiae s.l. (Z=0.26, P=0.796), and more likely to support An. coustani (Z=0.728, P=0.007). As borrow pits age they become less suitable for An. gambiae s.l. breeding and more likely to harbor An. coustani. The abundance of notonectids in habitats was a negative indicator for An. gambiae s.l. abundance. Plant species are not reliable indicators for the presence or absence of malaria vectors in borrow pits.     

Antibody to fibrinogen/fibrin products (Anti-F) in malaria, babesiosis, and trypanosomiasis of rodents.

Antibody to fibrinogen/fibrin related products (Anti-F) was stimulated during the course of Plasmodium chabaudi, Babesia rodhaini, and Trypanosoma lewisi infections in rats. Titers of this autoantibody remained elevated in serum from rats that had recovered from each of the infections. Column chromatographic studies indicated that Anti-F was a 19S globulin, possibly IgM. During acute infections high titers of Anti-F were associated with elevated titers of cold-active hemagglutinin (CAH) and immunoconglutinin (IK) and all were associated with anemia and elevated parasitemia. Titers of Anti-F and IK, but not CAH, remained elevated in serum of recovered rats. The presence of Anti-F indicated that the coagulation system had been activated during each infection to release fibrinogen/fibrin-related products (FRP) to serve as antigen(s) for Anti-F. Since IK is antibody to the third component of fixed complement, it could be assumed that complement fixing antigen-antibody complexes were also present during the acute stage of each infection. The possibility that complexes of FRP and Anti-F could have contributed to anemia in each infection is discussed.     

Prevalence and risk factors of malaria in Ethiopia

ABSTRACT: BACKGROUND: More than 75% of the total area of Ethiopia is malarious, making malaria the leading public health problem in Ethiopia. The aim of this study was to investigate the prevalence rate and the associated socio-economic, geographic and demographic factors of malaria based on the rapid diagnosis test (RDT) survey results. METHODS: From December 2006 to January 2007, a baseline malaria indicator survey in Amhara, Oromiya and Southern Nation Nationalities and People (SNNP) regions of Ethiopia was conducted by The Carter Center. This study uses this data. The method of generalized linear model was used to analyse the data and the response variable was the presence or absence of malaria using the rapid diagnosis test (RDT). RESULTS: The analyses show that the RDT result was significantly associated with age and gender. Other significant covariates confounding variables are source of water, trip to obtain water, toilet facility, total number of rooms, material used for walls, and material used for roofing. The prevalence of malaria for households with clean water found to be less. Malaria rapid diagnosis found to be higher for thatch and stick/mud roof and earth/local dung plaster floor. Moreover, spraying anti-malaria to the house was found to be one means of reducing the risk of malaria. Furthermore, the housing condition, source of water and its distance, gender, and ages in the households were identified in order to have two-way interaction effects. CONCLUSION: Individuals with poor socio-economic conditions are positively associated with malaria infection. Improving the housing condition of the household is one of the means of reducing the risk of malaria. Children and female household members are the most vulnerable to the risk of malaria. Such information is essential to design improved strategic intervention for the reduction of malaria epidemic in Ethiopia.     

Impact of Six Years Community Directed Treatment with Ivermectin in the Control of Onchocerciasis,Western Ethiopia

Background

The African Program for Onchocerciais Control (APOC) with a main strategy of community directed treatment with ivermectin (CDTI) was established with the aim of eliminating Onchocerciasis as a disease of public health and socio-economic importance. The study area was a hyper endemic area just before the implementation of CDTI. It has been implemented for six years in this district but yet not been evaluated. So, the objective of this study was to evaluate the impact of six years CDTI on parasitological and clinical indices of Onchocerciasis

Methods

This study employed a pre-post impact evaluation design. The minimum sample size for this study was 1318; the respondents were selected by multi-stage sampling technique. Data on socio-demographic characteristics using a semi-structured questionnaire, clinical examination for skin signs and symptoms of Onchocerciasis and two bloodless skin snips from each side of the gluteal fold were taken from the entire study participants. SPSS version 16.0 and Medcalc version 12.2.1.0 were used for analysis.

Result

The microfilaridermia reduced from the pre-intervention value of 74.8% to 40.7%, indicating a 45.6% reduction, mean intensity from 32.1(SD = 61.5) mf/mg skin snip to 18.7(SD = 28.7)indicating 41.75% reduction, CMFL from 19.6 mf/mg skin snip to 4.7 indicating 76% reduction. The result also showed that microfilaridermia and mean intensity decreased as the number of treatment taken increased. Pruritis, leopard skin, onchocercomata and hanging groin reduced by 54.4%, 61.3%, 77.7% and 88.5% respectively.

Conclusions

The implementation of CDTI significantly reduced the parasitological and clinical indices of Onchocerciasis, so, efforts should be made to improve the annual treatment coverage and sustainability of CDTI to drastically reduce the micro filarial load to the level the disease would no longer be a public health problem.     

The shrubland vegetation in western Shewa,Ethiopia and its possible recovery

Shrubland vegetation and environmental data in western Shewa, Ethiopia have been analysed. Vegetation data include cover-abundance values of vascular plant species; environmental data comprise physical and chemical properties of the soil, altitude, slope, grazing and browsing pressure. The vegetation data were subj ected to hierarchical and non-hierarchical classification and ordination with correspondence analysis. The classification resulted in seven different vegetation types, ranging from grassland with scattered shrubs to degenerated forest. Ordination of the data and biplot analysis showed that the vegetation is influenced by anthropogenic factors and altitudinal variation. Sand content is related to a low level of anthropogenic influence whereas silt content is related to a high level. This is explained by historical events rather than by the present situation. Total nitrogen, organic carbon, altitude and slope are positively correlated and these variables are negatively related to anthropogenic influences. The shrubland vegetation may have expanded from lower altitudes and drier sites as forests gradually disappeared. The recovery of an economically more rewarding vegetation type may be achieved through pro viding alternative sources of fuel and construction and through prohibiting cultivation and grazing in the shrublands on the hillsides. Regeneration can be accelerated by actively introducing seedlings of tree species that do not need a heavy canopy cover for establishment and growth.     

Onchocerciasis in Minnesota cattle.

Umbilical hides from 536 dairy cattle in Minnesota were tested for the microfilarial stage of Onchocerca species to determine the distribution of onchocerciasis in the state. The infection was widespread as microfilariae were obtained from 214 (40%) of the animals, representing nearly all areas of the state. Adult Onchocerca parasites were collected primarily from nodules associated with tibial bones but also were found to a lesser extent within the gastrosplenic ligament. Specific identity of these organisms is unclear as they exhibit certain morphological features previously described as being characteristic of either Onchocerca gutturosa, Onchocerca lienalis, or Onchocerca stilesi.     

The community-based malaria control programme in Tigray, northern Ethiopia. A review of programme set-up, activities, outcomes and impact.

Tigray, the northernmost state of Ethiopia, has a population of 3.5 million, 86% rural, and 56% living in malarious areas. In 1992 a Community-Based Malaria Control Programme was established to provide region-wide and sustained access to early diagnosis and treatment of malaria at the village level. 735 volunteer community health workers (CHWs) serve 2,327 villages with a population of 1.74 million, treating an average of 489,378 patients yearly from 1994 to 1997. Recognition of clinical malaria is similar for CHWs and health staff at clinics where there is no access to microscopy. In 1996 a pilot community-financing scheme of insecticide-treated bednets was well accepted, but re-impregnation rates fell in 1998 because of war-related social upheaval. Indicators from health institutions show a progressive increase in malaria morbidity from 1994 to 1998. Repeated mortality surveys show a 40% reduction in death rates in under-5 children from 1994 to 1996 and a 10% increase from 1996 to 1998. These trends may be related to increased malaria transmission with water resources development, increased seasonal labour migration to malarious lowlands, prolongation of the transmission season with climate changes, and increasing chloroquine resistance throughout Ethiopia. Progressive extension of CHW services to ensure better coverage of women, children, migrant workers and communities near water development projects, change to first-line treatment with sulfadoxine-pyrimethamine, extension of the impregnated bednet initiative, and development of a regional warning system for epidemics should result in a greater impact on morbidity and mortality.     

Drug resistance in malaria: three cases and a review.

Drug resistance has been well documented in two species of malarial parasites. Of greatest concern are the rapid developments in the resistance of Plasmodium falciparum to commonly used therapeutic and chemoprophylactic agents. This species, which is capable of producing life-threatening disease, has shown various levels of resistance in different parts of the world. Also, some strains of the most common species causing relapsing disease, P. vivax, exhibit resistance to primaquine. Three cases of malaria that demonstrate various types of drug resistance are presented in this paper.     

Social integration and identity of immigrants from western countries,the FSU and Ethiopia in Israel

This study of immigrants’ integration in Israel centers on one major subjective parameter, namely the immigrant's identity. To explain it we explore a series of possible factors: demographic variables, economic status, and human and social capital characteristics. Three recent immigrant groups are examined: from Western countries, from the former Soviet Union (FSU), and from Ethiopia. These immigrants came to Israel during the last two decades from different societies, following different immigration circumstances and various motives.

The findings, based on the 2007 Ruppin survey data, point to the significant impact of the identity as perceived by veteran Israelis on the immigrants’ self-identity for the three groups under study. Also, different variables affect each of the immigrant groups. FSU immigrants behaved according to most of our hypotheses, whereas Western and Ethiopian immigrants did not. Findings are discussed in light of the debate on measuring and defining immigrants’ identity.     

Integrating an NTD with one of "The big three": combined malaria and trachoma survey in Amhara Region of Ethiopia

Background

Amhara Regional State of Ethiopia has a population of approximately 19.6 million, is prone to unstable and epidemic malaria, and is severely affected by trachoma. An integrated malaria and trachoma control program is being implemented by the Regional Health Bureau. To provide baseline data, a survey was conducted during December 2006 to estimate malaria parasite prevalence, malaria indicators, prevalence of trachoma, and trachoma risk factors in households and people of all ages in each of the ten zones of the state, excluding three urban centers (0.4% of the population).

Methodology/Principal Findings

The study was designed to provide prevalence estimates at zone and state levels. Using multi-stage cluster random sampling, 16 clusters of 25 households were randomly selected in each of the ten zones. Household heads were interviewed for malaria indicators and trachoma risk factors (N = 4,101). All people were examined for trachoma signs (N = 17,242), and those in even-numbered households provided blood films for malaria parasite detection (N = 7,745); both thick and thin blood films were read.Zonal malaria parasite prevalence ranged from 2.4% to 6.1%, with the overall state-wide prevalence being 4.6% (95% confidence interval (CI): 3.8%–5.6%). The Plasmodium falciparum: Plasmodium vivax ratio ranged from 0.9–2.1 with an overall regional ratio of 1.2. A total of 14.8% of households reported indoor residual spraying in the past year, 34.7% had at least one mosquito net, and 16.1% had one or more long-lasting insecticidal net. Zonal trachoma prevalence (trachomatous inflammation follicular [WHO grade TF] in children aged 1–9 years) ranged from 12.6% to 60.1%, with the overall state-wide prevalence being 32.7% (95% CI: 29.2%–36.5%). State-wide prevalence of trachomatous trichiasis (TT) in persons aged over fifteen was 6.2% (95% CI: 5.3–7.4), and 0.3% (95% CI: 0.2–0.5) in children aged 0–14 years. Overall, an estimated 643,904 persons (lower bound 419,274, upper bound 975,635) have TT and require immediate corrective surgery.

Conclusions/Significance

The results provide extensive baseline data to guide planning, implementation, and evaluation of the integrated malaria and trachoma control program in Amhara. The success of the integrated survey is the first step towards demonstration that control of priority neglected tropical diseases can be integrated with one of the “big three” killer diseases.