Impact of insecticide resistance in Anopheles arabiensis on malaria incidence and prevalence in Sudan and the costs of mitigation.

Insecticide-based interventions have contributed to ∼78% of the reduction in the malaria burden in sub-Saharan Africa since 2000. Insecticide resistance in malaria vectors could presage a catastrophic rebound in disease incidence and mortality. A major impediment to the implementation of insecticide resistance management strategies is that evidence of the impact of resistance on malaria disease burden is limited. A cluster randomized trial was conducted in Sudan with pyrethroid-resistant and carbamate-susceptible malaria vectors. Clusters were randomly allocated to receive either long-lasting insecticidal nets (LLINs) alone or LLINs in combination with indoor residual spraying (IRS) with a pyrethroid (deltamethrin) insecticide in the first year and a carbamate (bendiocarb) insecticide in the two subsequent years. Malaria incidence was monitored for 3 y through active case detection in cohorts of children aged 1 to <10 y. When deltamethrin was used for IRS, incidence rates in the LLIN + IRS arm and the LLIN-only arm were similar, with the IRS providing no additional protection [incidence rate ratio (IRR) = 1.0 (95% confidence interval [CI]: 0.36-3.0; P = 0.96)]. When bendiocarb was used for IRS, there was some evidence of additional protection [interaction IRR = 0.55 (95% CI: 0.40-0.76; P < 0.001)]. In conclusion, pyrethroid resistance may have had an impact on pyrethroid-based IRS. The study was not designed to assess whether resistance had an impact on LLINs. These data alone should not be used as the basis for any policy change in vector control interventions.

Cost-Effectiveness of PBO versus Conventional Long-Lasting Insecticidal Bed Nets in Preventing Symptomatic Malaria in Nigeria: Results of a Pragmatic Randomized Trial.

Insecticide treated nets (ITNs) have been the major tool in halving malaria's burden since 2000, but pyrethroid insecticide resistance threatens their ongoing effectiveness. In 2017, the WHO concluded that long-lasting ITNs (LLINs) with a synergist, piperonyl butoxide (PBO), provided additional public health benefit over conventional (pyrethroid-only) LLINs alone in areas of moderate insecticide resistance and endorsed them as a new class of vector control products. We performed an economic appraisal of PBO nets compared with conventional LLINs in 2019 US$ from prevention and health systems perspectives (including treatment cost offsets). We used data from a pragmatic randomized 2012-2014 trial in Nigeria with epidemiological outcomes in an area with confirmed pyrethroid resistance. Each village had 50 months of epidemiologic data, analyzed by village by month, using negative binomial regression. Compared with LLINs, although adding $0.90 per net delivered, PBO nets reduced symptomatic malaria cases by 33.4% (95% CI 10.2-50.6%). From a prevention perspective, the incremental cost-effectiveness ratio was $11 (95% CI $8-$37) per disability-adjusted life year averted. From the health systems perspective, PBO nets were significantly cost-saving relative to conventional LLINs. The benefit-cost analysis found that the added economic benefits of PBO nets over LLINs were $201 (95% CI $61-$304) for every $1 in incremental costs. Growing pyrethroid resistance is likely to strengthen the economic value of PBO nets over LLINs. Beyond their contribution to reducing malaria, PBO nets deliver outstanding economic returns for a small additional cost above conventional LLINs in locations with insecticide resistance.

Influence of aphid species and barley yellow dwarf virus on soft red winter wheat yield.

Yield loss in soft red winter wheat, Triticum aestivum L., caused by aphid-transmitted barley yellow dwarf virus (family Luteoviridae, genus Luteovirus, BYDV) was measured over a 2-yr period in central Missouri. Rhopalosiphum padi (L.) was the most common and economically important species, accounting for > 90% of the total aphids. Schizaphis graminum (Rondani), Rhopalosiphum maidis (Fitch), and Sitobion avenae (F.) made up the remainder of the aphids. Aphid numbers peaked at wheat stem elongation in 2003 with 771 R. padi per meter-row. In the 2003-2004 growing season, aphid numbers averaged seven aphids per meter-row in the fall and peaked at 18 aphids per meter-row at jointing. Wheat grain yield was reduced 17 and 13% in 2003 and 2004, respectively. Thousand kernel weights were reduced 10 and 5% in the untreated plots compared with the treated control in 2003 and 2004, respectively. Padi avenae virus was the predominate strain, accounting for 81 and 84% of the symptomatic plots that tested positive for BYDV in 2003 and 2004. Our results indicate that economic thresholds for R. padi are 16 aphids per meter-row in the fall and 164 aphids per meter-row at jointing.

Optimizing insecticide allocation strategies based on houses and livestock shelters for visceral leishmaniasis control in Bihar, India.

Visceral leishmaniasis (VL) is the most deadly form of the leishmaniasis family of diseases, which affects numerous developing countries. The Indian state of Bihar has the highest prevalence and mortality rate of VL in the world. Insecticide spraying is believed to be an effective vector control program for controlling the spread of VL in Bihar; however, it is expensive and less effective if not implemented systematically. This study develops and analyzes a novel optimization model for VL control in Bihar that identifies an optimal (best possible) allocation of chosen insecticide (dichlorodiphenyltrichloroethane [DDT] or deltamethrin) based on the sizes of human and cattle populations in the region. The model maximizes the insecticide-induced sandfly death rate in human and cattle dwellings while staying within the current state budget for VL vector control efforts. The model results suggest that deltamethrin might not be a good replacement for DDT because the insecticide-induced sandfly deaths are 3.72 times more in case of DDT even after 90 days post spray. Different insecticide allocation strategies between the two types of sites (houses and cattle sheds) are suggested based on the state VL-control budget and have a direct implication on VL elimination efforts in a resource-limited region.

Cost-effectiveness and sustainability of lambdacyhalothrin-treated mosquito nets in comparison to DDT spraying for malaria control in western Thailand.

The cost-effectiveness of lambdacyhalothrin-treated nets in comparison with conventional DDT spraying for malaria control among migrant populations was evaluated in a malaria hyperendemic area along the Thai-Myanmar border. Ten hamlets of 243 houses with 948 inhabitants were given only treated nets. Twelve hamlets of 294 houses and 1,315 population were in the DDT area, and another 6 hamlets with 171 houses and 695 inhabitants were in the non-DDT-treated area. The impregnated net program was most cost-effective (US$1.54 per 1 case of prevented malaria). Spraying with DDT was more cost-effective than malaria surveillance alone ($1.87 versus $2.50 per 1 case of prevented malaria). These data suggest that personal protection measures with insecticide-impregnated mosquito net are justified in their use to control malaria in highly malaria-endemic areas in western Thailand.

Permethrin-treated chaddars and top-sheets: appropriate technology for protection against malaria in Afghanistan and other complex emergencies.

Insecticide-treated mosquito nets (ITN) provide excellent protection against malaria; however, they have a number of shortcomings that are particularly evident in politically unstable countries or countries at war: not everyone at risk can necessarily afford a net, nets may be difficult to obtain or import, nets may not be suitable for migrants or refugees sleeping under tents or plastic shelter. There is a need to develop cheaper, locally appropriate alternatives for the most impoverished and for victims of complex emergencies. Afghan women, in common with many Muslim peoples of Asia, wear a veil or wrap known as a chaddar to cover the head and upper body. This cloth doubles as a sheet at night, when they are used by both sexes. A randomized controlled trial was undertaken in which 10% of the families of an Afghan refugee camp (population 3950) in north-western Pakistan had their chaddars and top-sheets treated with permethrin insecticide at a dosage of 1 g/m2 while a further 10% had their chaddars treated with placebo formulation. Malaria episodes were recorded by passive case detection at the camp's health centre. From August to November the odds of having a falciparum or vivax malaria episode were reduced by 64% in children aged 0-10 years and by 38% in refugees aged < 20 years in the group using permethrin-treated chaddars and top-sheets. Incidence in refugees over 20 years of age was not significantly reduced. The cost of the permethrin treatment per person protected (US$0.17) was similar to that for treating bednets (and cost only 10-20% of the price of a new bednet). An entomological study simulating real-life conditions indicated that host-seeking mosquitoes were up to 70% less successful at feeding on men sleeping under treated chaddars and some were killed by the insecticide. Permethrin-treated top-sheets and blankets should provide appropriate and effective protection from malaria in complex emergencies. In Islamic and non-Islamic countries in Asia, treated chaddars and top-sheets should offer a satisfactory solution for the most vulnerable who cannot afford treated nets.

Financial analysis of animal trypanosomiasis control using cypermethrin pour-on in Kenya.

The financial impact of use of cypermethrin pour-on (Ectopor(R)) in control of animal trypanosomiosis was determined in a trial undertaken by the Kenya Trypanosomiasis Research Institute (KETRI). This trial started in December 1990 and ended in February 1992. It was undertaken in two adjacent ranches in the coast province of Kenya. The trial site was in an area of high apparent density (AD) of tsetse flies, and at the start of the trial no cattle were kept in this area. Cypermethrin was applied fortnightly to the 1100 steers which were kept in pour-on ranch 'A' while another 100 steers were kept in control ranch 'B' to act as control sentinels. From the main pour-on group, 100 animals were identified as the pour-on sentinels and compared to the control sentinels which received no pour-on.Pour-on application led to a significant decrease in the tsetse AD in the pour-on ranch A to 90% of the initial AD in some areas. The animals treated with pour-on had a significantly higher mean packed-cell volume (PCV). The weekly prevalence of trypanosome infections in animals treated with pour-on was <4% with only one exception when it was <10%. In the control animals, the prevalence ranged between 10 and 50% (with a few exceptions when it was <10%). The incidence of tick-borne diseases was lower in the pour-on animals. The mean monthly weights of the pour-on animals was significantly higher, and at the end of the trial the pour-on animals had a mean weight gain of 136.70+/-16.7kg while the control animals had gained 97.16+/-22.6kg. The financial net return of using cypermethrin pour-on was positive and the financial rate of return of 122.6% indicated that use of the pour-on was highly beneficial despite the high cost of the product.

The cost-effectiveness of permethrin impregnated bednets in preventing child mortality in Kassena-Nankana district of Northern Ghana.

Permethrin impregnated bednets are now being widely promoted as an effective means of protecting African children against malaria, but there is little evidence of their cost-effectiveness. The impact on child mortality of introducing permethrin impregnated bednets was evaluated in a rural district of northern Ghana in a controlled trial. The cost-effectiveness of the intervention is reported in this paper. The total cost of the intervention over the 2 years of follow-up was US $148,245. Cost per impregnated bednet per year and per person protected per year was US $2.4 and 1.2, respectively. Approximately 16,800 child years were protected and 74 child deaths averted at an estimated cost of US $8.8 per child year protected and US $2003 per death averted. In this rural community, where life expectancy at the mean age of death of trial children was 57.5 years, the estimated cost per discounted healthy life-year gained was US $73.5. Sensitivity analysis suggested that this cost-effectiveness ratio might be reduced substantially by feasible changes in programme implementation. This study supports the argument that the cost-effectiveness of bednet impregnation is sufficiently attractive to make it part of a package of high priority interventions for children. Issues of how to finance the provision of nets and insecticide, and especially the relative contribution of governments, households and donors, need urgently to be addressed.

Economic considerations associated with Pediculus humanus capitis infestation.

An estimated 6 to 12 million head lice infestations occur in the United States annually, with children ages 3 to 12 most likely to be affected. There are significant direct costs associated with treatment and indirect costs due to lost time from school. Anecdotal reports suggest that direct costs of treatment are in the hundreds of millions of dollars annually. Indirect costs are also substantial but more difficult to quantify. Examples of indirect costs include missed days from schools that use a "no nit" policy, lost wages for parents who must stay home with children, and costs of daycare for parents who cannot miss work. Contributors to the expense of treating head lice include misdiagnosis, and, consequently unneeded treatment; treatment failure due to misuse of pediculicides or other agents; and developing resistance, particularly to over-the-counter pyrethroid agents. An overview of direct and indirect costs of infestation are included in this review, along with a discussion of factors that lead to misuse and overuse of pediculicides. More accurate diagnosis of head lice infestation may provide the most effective means of controlling the costs of care and ensuring proper use of pediculicides.

Relative cost-effectiveness of treatment of feedlot calves with ivermectin versus treatment with a combination of fenbendazole, permethrin, and fenthion.

OBJECTIVE: To compare growth performance, animal health characteristics, and carcass characteristics of feedlot calves treated with ivermectin topically with that of feedlot calves treated with a combination of fenbendazole orally and permethrin and fenthion topically. DESIGN: Clinical trial. ANIMALS: 14,184 British crossbred steer calves (mean weight, 286 kg [630 lb]) in 30 pens at a commercial feedlot in Nebraska. PROCEDURE: On arrival at the feedlot, calves were randomly assigned to be treated with ivermectin topically or with a combination of fenbendazole orally and permethrin and fenthion topically (control). At the time of assignment to treatment groups, fecal samples were collected from 5% of the calves. Growth performance, carcass characteristics, and health information were recorded. RESULTS: Geometric mean fecal egg counts at the time of arrival at the feedlot were not significantly different between groups. Final weight, weight gain, average daily gain, and the dry matter intake-to-gain ratio were significantly improved for calves in the ivermectin group. The percentage of carcasses classified as quality grade choice was higher for the ivermectin group than the control group; however, the percentage of carcasses classified as yield grade 1 and the dressing percentage were higher for the control group than for the ivermectin group. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that topical administration of ivermectin to feedlot calves is relatively more cost-effective than administration of a combination of fenbendazole orally and permethrin and fenthion topically.

Field trial efficacy of Anvil 10+10 and Biomist 31:66 against Ochlerotatus sollicitans in Delaware.

Anvil 10+10 (hereafter Anvil) and Biomist 31:66 (hereafter Biomist) were applied by ground ultra-low volume (ULV) methods to determine the effectiveness of each formulation against Ochlerotatus sollicitans. Each formulation was tested at 50, 67, and 100% of respective maximum label dosage rates. Mosquitoes were exposed in cages on a 3 x 3 grid at distances of 30.5, 60.9, and 91.4 m. Mortality data were collected at intervals of 1, 4, and 12 h after treatment. No significant differences (P > or = 0.05) were found among formulations at applications of 100% of the label rate and no significant differences (P > or = 0.05) were found between Anvil applied at 100% of the label rate and Biomist applied at 50 and 67% of label rates. Ground ULV applications of Anvil at 100% label rate and Biomist at all tested rates were effective (> or = 95% mortality) adulticides. Applications of Anvil at 50 and 67% label rates were significantly less effective (P < or = 0.05) than applications of Biomist at equal percentages of the maximum label rate. Applications of Anvil at rates of 50 and 67% were not effective.

Cost-effectiveness analysis of lambdacyhalothrin-treated nets for malaria control: the patients' perspective.

The present study was undertaken to evaluate the cost-effectiveness of lambdacyhalothrin-treated nets in comparison with conventional DDT-spraying as a method of malaria control according to the patients' perspective among migrant populations in a high-risk area along the Thai-Myanmar border in Thailand. Ten hamlets comprising 243 houses with 948 inhabitants were given only treated nets. Twelve hamlets comprising 294 houses and 1,315 inhabitants represented the DDT-treated area and another six hamlets with 171 houses and 695 inhabitants served as controls. Information as to consumer costs was obtained by interviewing 3,214 patients seeking care at all levels of the health care system in the study area. Analysis showed that the impregnated-net program was more cost-effective than the DDT-spraying program or surveillance alone (US$ 0.59 vs US$ 0.74 vs US$ 0.79 per 1 case of prevented malaria). We conclude that in a high-risk area such as along the Thai-Myanmar border in western Thailand, integrating the use of impregnated nets with large-scale primary health care programs is likely to constitute the most cost-effective method for controlling malaria according to the patients' perspective.

[Low adherence and high cost as factors in the failure of the use of insecticide-impregnated mosquito bed nets in the control of malaria in the Brazilian Amazon]. / Baixa aderência e alto custo como fatores de insucesso do uso de mosquiteiros impregnados com inseticida no controle da malária na Amazônia Brasileira.

In 1992 during a trial with deltamethrin-impregnated bed nets conducted in Porto Murtinho, municipality of Costa Marques, Rondônia, in the Brazilian Amazon, we investigated community compliance and the economic aspects capable of reducing the impact of this intervention on malaria morbidity. Impregnated bed nets were well accepted by the local population. However, compliance was found to be very low among adults over 15 years of age and mainly during the dry season. The cost of impregnated bed nets was US$18.83 for double-bed nets and US$13.82 for single bed nets. Despite the economic advantages of using impregnated bed nets subsidized by the government, the low compliance and local epidemiological factors do not allow to indicate the use of impregnated bed nets for mass malaria control in the Amazon region.

Efficacy of slow-release tags impregnated with aggregation-attachment pheromone and deltamethrin for control of Amblyomma variegatum on St. Kitts, West Indies.

BACKGROUND: Amblyomma variegatum is an important cause of morbidity, mortality and economic losses in Africa and the West Indies. Attempts to control and/or eradicate the tick from the Caribbean have largely been unsuccessful because of difficulties relating to the biology of the three-host tick and problems with applying acaricides on a regular basis to free-ranging domestic ruminants. While plastic collars impregnated with insecticides are widely and effectively used in companion animals to control external parasites there is little information on this technology in ruminants. METHODS: Over 21 months we tested the efficacy of slow-release plastic tags impregnated with deltamethrin (7%) and aggregation-attachment pheromones (DPITs) in controlling A. variegatum on free-ranging cattle on two farms on St. Kitts. The tags were replaced every three months or when found to be lost. RESULTS: On sentinel animals fitted with tags containing only aggregation-attachment pheromones there were an average of 23.1 ticks per semi-monthly visit although this number varied considerably, peaking in the dry season around May and being lowest in August to October during the wet season. Significantly fewer ticks (3.5 on average) were found on cattle with DPITs at each visit (P < 0.001). Although the DIPTs provided good control (92% on average), they did not significantly reduce A. variegatum in the environment with tick numbers on sentinels being higher in the second year of the study, despite up to 44% of animals being fitted with DPITs. The tags were economical, costing 0.2% of the 1% flumethrin pour-on treatment widely recommended for A. variegatum control in the Caribbean. The major problem encountered was that 38% of tail tags were lost before they were due for replacement every three months. CONCLUSIONS: Our study has shown that DPITs are cheap to produce, easy to place, only require handling of animals every three months, and are very effective in protecting cattle from A. variegatum. Before DPITs can be considered for eradication programs the problems needing to be addressed include loss of tail tags, particularly in thick vegetation, and the optimum number of animals that must be treated to reduce numbers of ticks in the environment.

The prevention of canine leishmaniasis and its impact on public health.

Canine leishmaniasis (CanL) caused by Leishmania infantum is a vector-borne disease of great veterinary and medical significance. Prevention of CanL requires a combined approach including measures focused on dogs and the environment where the vectors perpetuate. Over past decades, considerable effort has been put towards developing novel and cost-effective strategies against CanL. Vaccination is considered among the most promising tools for controlling CanL, and synthetic pyrethroids are useful and cost-effective in reducing risk of L. infantum infection in dogs. The effectiveness of the use of vaccines plus repellents in preventing L. infantum infection and subsequent disease development should be assessed by means of large-scale, randomized controlled field trials because this combined strategy may become the next frontier in the control of CanL.

Control of malaria vectors: cost analysis in a province of northern Vietnam.

The cost of permethrin-treated bednets (50% EC; 0.2 g/m2, 2 rounds per year) was compared to the cost of residual spraying with lambdacyhalothrin 10% WP (0.03 g/m2, once yearly) in Hoa Binh, a mountainous province in northern Vietnam. Calculations of the amounts of insecticides needed were based on national guidelines, on data from a cross-sectional survey and on district activity reports. The actual cost of insecticide required per person per year was lower for impregnation (US$ 0.26) than for spraying (US$ 0.36), but the difference was smaller than expected. The total cost for impregnated bednets per person per year amounted to US$ 0.90 compared to USS 0.47 for spraying. The determining factor was the cost of the net, amounting to US$ 0.58 per person per year, assuming a 5-year life of the net. Other material (excluding nets), labour and transport combined, accounted for only 17% of the impregnation cost and 23% of spraying expenses. However, for the National Malaria Control Programme of Vietnam, the cost per person per year for impregnated bednets amounted to US$ 0.32 only, because the vast majority of nets are bought by the population. For spraying, the programme had to bear the entire cost.

Economic aspects of the use of impregnated mosquito nets for malaria control.

The use of pyrethroids to impregnate mosquito nets has had a good impact on the incidence of morbidity and mortality from malaria. These nets are therefore likely to be used on a large scale as an important strategy of malaria control in the future. Published information on the cost and effectiveness of mosquito nets is presented and analysed. In two examples, from Malawi and Cameroon, the per household expenditure to purchase and use impregnated mosquito nets compares favourably with the costs of malaria. Thus, we expect that the economic losses from malaria would be reduced by 37.3% over a 3-year period in Malawi. Even if the impact of malaria on productivity is not taken into account, the introduction of nets will result in gains, as shown in Cameroon; savings of 9.3% and 11.2% in two places resulted as a consequence of a diminished need for case treatment. The role of government programmes in the promotion of bednets is indirect and concerned mainly with facilitation and the dissemination of information. Much depends on the capability of the private sector and the willingness of the target population to buy the nets for a programme to be effective. Specific studies by health economists on this subject are lacking.

Impact of residual spraying on Rhodnius prolixus and Triatoma dimidiata in the department of Zacapa in Guatemala.

As a vector control program to control Chagas disease in Guatemala, residual spraying of Rhodnius prolixus and Triatoma dimidiata was performed, and its impact was measured in the department of Zacapa. In order to identify infested villages and determine the degree of infestation, a baseline entomological survey to identify municipalities infested with vectors followed by an additional vector survey in areas known to be infested was conducted. Residual spraying using pyrethroid insecticides was performed at all the villages identified as being infested with the vectors. The residual spraying was shown to be highly effective against both vectors by the decrease in infestation indices after spraying. Analysis of the cost-effectiveness of the spraying showed that the average cost of insecticides per house is high when compared with that in Southern Cone countries.