Impact of Education on Knowledge and Practice of Kala Azar Preventive Measures among Seasonal and Migrant Agricultural Workers in Northwest Ethiopia.

Kala azar occurs among seasonal and migrant agricultural workers in northwest Ethiopia and accounts for almost 60% of the disease burden in the country. We conducted a quantitative study on the level of knowledge and practice of this vulnerable group in relation to kala azar transmission and acceptability of its vector control tools. A total of 403 workers were randomly selected from eight farms using a purposive sampling technique. Knowledge and practice scores were calculated based on 12 and 9 core questions, respectively. Binary logistic regression was used to identify factors associated with knowledge and practice. A large gap in knowledge of the disease and the vector was evident with 61.8%, 24.6%, and 13.6% of the workers having poor, moderate, and good levels of knowledge scores, respectively. Similarly, 95% of the seasonal workers reported poor level of use of protective measures against the bite of the sand fly vector. Good level of knowledge about kala azar and its sand fly vector was statistically associated with formal education (adjusted odds ratio [AOR] = 2.11; 95% CI = 1.17, 3.80; P < 0.05) and previous exposure to health education (AOR = 4.72; 95% CI = 1.99, 11.16; P < 0.001). Despite poor current knowledge and practice, a large proportion of the study participants showed interest in using vector control tools if made available, with 78% of the seasonal and migrant workers expressing some willingness to pay for different measures that can protect against sand fly bites. Therefore, we strongly recommend that comprehensive health education and vector control programs should be provided to these workers.

Lessons learned, challenges and outlooks for decision-making after a decade of experience monitoring the impact of indoor residual spraying in Benin, West Africa.

BACKGROUND: Since 2008, Indoor Residual Spraying (IRS) has been performed in Benin in 19 districts, including 4 in southern Benin, 9 in Atacora, and 8 in Atacora, Alibori and Donga in northern Benin. However, Benin still struggles with questions about IRS cost-benefit and epidemiological impact. Lessons learned and challenges from 10 years of IRS in Benin to be shared with the stakeholders involved in vector control implementation for decision-making. METHODS: Entomological parameters have been assessed entomological parameters in IRS communes since 2008. In all IRS intervention communes, decreases in human biting rate (HBR) of Anopheles gambiae, blood feeding inhibition and entomological inoculation rate (EIR) as compared to control district have been measured. RESULTS: EIR was reduced by 80-90%, which is encouraging, but should be observed with caution because: (i) the reduction may be insufficient to decrease epidemiological indicators given that the residual EIR in IRS districts is still higher than it is in some regions of stable malaria; (ii) the reduction in EIR is based on comparisons with control communes, but it is difficult to select control areas with the same environmental characteristics as intervention areas; (iii) despite the reduction, half of all mosquitoes that entered IRS-treated houses succeeded in taking human blood meals. Further, there are behaviours among Benin's population that limit IRS efficacy, including recent data showing that > 90% of people are not protected by IRS between 7 and 10 p.m. This is due to the fact that they remain outdoors and that most people are not protected from mosquito bites after 10 p.m. because they either sleep outdoors without IRS protection or indoors without an ITN. Moreover, people have large amounts of clothing hanging on walls where mosquitoes can rest instead of IRS-treated walls. Finally, other components are important to consider in implementing IRS among which: (i) Vector resistance management strategies are sometimes poorly understood; this is actually different from the need to replace one insecticide with another after the emergence of resistance; (ii) African countries should prepare to finance IRS themselves. CONCLUSION: To curtail residual malaria transmission, additional interventions able to target vectors escaping IRS should be prioritized.

Laboratory assessment of the anti-feeding effect for up to 12 months of a slow release deltamethrin collar (Scalibor®) against the sand fly Phlebotomus perniciosus in dogs.

BACKGROUND: Leishmaniosis/leishmaniasis consists of a wide group of diseases, caused by different Leishmania species and having different hosts. Leishmaniosis caused by Leishmania infantum, a disease primarily of dogs and humans, occurs after susceptible hosts are exposed to the feeding behavior of infected sand flies. A one-year laboratory study in dogs was designed to determine the 364-day anti-feeding efficacy of a slow release deltamethrin collar against the sand fly P. perniciosus, a common host of L. infantum in the Mediterranean basin. METHODS: In this assessor-blinded study, 16 Beagle dogs were randomized into two groups using P. perniciosus engorgement rates from a Day -7 challenge. On Day 0, dogs in Group 1 received a placebo collar, while dogs in Group 2 received a deltamethrin collar (Scalibor® Protector Band). All dogs were caged, sedated and then exposed for 1 h to 85 (± 10) female and 15 (± 5) male P. perniciosus on Day 7 and every 28 days through Day 364. All flies, alive and dead, were aspirated from cages and from dogs, immediately counted and then frozen for assessment of blood engorgement. Anti-feeding efficacy was determined by comparing the arithmetic means of engorged female flies (alive, dead and moribund) in the deltamethrin group to the control group means. Insecticidal efficacy at the time flies were retrieved was assessed by comparisons between groups of mean live female fly counts. RESULTS: In the deltamethrin group, relative to the control group, there was a significant reduction in arithmetic mean numbers of engorged P. perniciosus of 94-98% from Day 7 through Day 364. On Day 28, in the treated group relative to the control group, there was a 74% reduction in mean live fly counts, with between-group differences significant from Days 7 through 196, although insecticidal activity remained less than 50% from Day 56. CONCLUSION: Deltamethrin collar application to dogs reduced sand fly feeding by ≥ 94%, relative to unprotected control dogs, for 364 days. Thus, one collar applied to a dog can prevent or reduce the risk of sand fly transmission of Leishmania for one full year.

Community participation in mosquito breeding site control: an interdisciplinary mixed methods study in Curaçao.

BACKGROUND: As the arboviral diseases dengue, chikungunya and Zika emerge in the Americas, so does the need for sustainable vector control policies. To successfully achieve mosquito control, joint efforts of both communities and governments are essential. This study investigates this important, but by-and-large neglected topic. METHODS: In June and July 2015, a cross-sectional mixed methods study applying a survey questionnaire (response rate of 82.5%; n = 339), in-depth interviews (n = 20) and focus group discussions (n = 7; 50 participants) was performed in Curaçao. The study was designed based on an integrated theoretical framework of the Health Belief Model and the Theory of Planned Behaviour. RESULTS: Participants showed a good knowledge of, and a high-level performance of mosquito breeding site control (MBSC) practices. Personal protection against mosquitoes (e.g. topical repellents) was perceived as relatively less effective thus practiced to lower extent compared to MBSC practices (i.e. larval source management). A lower intention to perform MBSC was independently associated with: (i) satisfaction on governmental MBSC (P = 0.012); (ii) barriers to perform MBSC practices, i.e. 'Government doesn't control other breeding sites' (P = 0.005), 'Don't know how to control breeding sites' (P = 0.041), and 'a mosquito does not transmit dengue' (P = 0.016), (iii) attitudes towards MBSC (P = 0.001) and self-efficacy (person's perceived ability to act) to perform MBSC (P = 0.002). Mixed-methods evidence highlights three possible ways of improving community participation in MBSC. First, it highlights the need for ongoing media coverage, targeting (i) communities' perceptions on transmission routes of dengue and chikungunya, and (ii) presence of car tires in yards. Secondly, it shows that promotion of governmental activities in MBSC can enhance MBSC of communities, if people develop a sense of responsibility to perform MBSC at their own properties. Thirdly, this study describes the presence of key persons in communities, who could be engaged in mosquito control policies to improve MBSC in neighbourhoods. CONCLUSION: This study reveals gaps between policy and communities' lived realities. These gaps might be overcome with the proposed interventions, resulting in a higher performance of MBSC in the community in Curaçao. Furthermore, this study shows how interdisciplinary mixed methods research can provide important, comprehensive, and in-depth insights to inform mosquito control policies.

Combining Synthetic Human Odours and Low-Cost Electrocuting Grids to Attract and Kill Outdoor-Biting Mosquitoes: Field and Semi-Field Evaluation of an Improved Mosquito Landing Box.

BACKGROUND: On-going malaria transmission is increasingly mediated by outdoor-biting vectors, especially where indoor insecticidal interventions such as long-lasting insecticide treated nets (LLINs) are widespread. Often, the vectors are also physiologically resistant to insecticides, presenting major obstacles for elimination. We tested a combination of electrocuting grids with synthetic odours as an alternative killing mechanism against outdoor-biting mosquitoes. METHODS: An odour-baited device, the Mosquito Landing Box (MLB), was improved by fitting it with low-cost electrocuting grids to instantly kill mosquitoes attracted to the odour lure, and automated photo switch to activate attractant-dispensing and mosquito-killing systems between dusk and dawn. MLBs fitted with one, two or three electrocuting grids were compared outdoors in a malaria endemic village in Tanzania, where vectors had lost susceptibility to pyrethroids. MLBs with three grids were also tested in a large semi-field cage (9.6 × 9.6 × 4.5m), to assess effects on biting-densities of laboratory-reared Anopheles arabiensis on volunteers sitting near MLBs. RESULTS: Significantly more mosquitoes were killed when MLBs had two or three grids, than one grid in wet and dry seasons (P<0.05). The MLBs were highly efficient against Mansonia species and malaria vector, An. arabiensis. Of all mosquitoes, 99% were non-blood fed, suggesting host-seeking status. In the semi-field, the MLBs reduced mean number of malaria mosquitoes attempting to bite humans fourfold. CONCLUSION: The improved odour-baited MLBs effectively kill outdoor-biting malaria vector mosquitoes that are behaviourally and physiologically resistant to insecticidal interventions e.g. LLINs. The MLBs reduce human-biting vector densities even when used close to humans, and are insecticide-free, hence potentially antiresistance. The devices could either be used as surveillance tools or complementary mosquito control interventions to accelerate malaria elimination where outdoor transmission is significant.

Lessons from the implementation of LLIN distribution campaign in Ilorin Kwara State, Nigeria.

BACKGROUND: Studies implemented to evaluate the success of Long-lasting insecticidal nets (LLIN) distribution campaigns are often limited to ownership and utilization rates, neglecting other factors that directly affect the efficacy of the tool in malaria control. This study investigates sleeping habits and net maintenance behaviour in addition to LLIN ownership, utilization and the challenges associated with LLIN use among residents in Ilorin City where the tool has been massively distributed. METHODS: A cross-sectional survey was conducted using pre-tested interviewer-administered questionnaire to obtain information from randomly selected household respondents in Ilorin, the Kwara State Capital. The study was conducted in July 2012, about sixteen months after the March 2011 distribution of LLIN in the locality. The results were analyzed using the EPI INFO 2007 version. RESULTS: LLIN ownership (85%) and utilization (37%) rates improved compared to earlier reports, though 29% of net users have noticed holes in the nets even as 26% claimed to have actually experienced mosquito bites under it. Most (92%) of the respondents who slept under LLIN the previous night before the study spent the first five hours of the night (19.00-23.00 hr) outdoors while 88% also engage in inappropriate net washing practices. All the LLIN users claimed to have experienced at least one malaria episode while 43% have had two or more episodes within the past twelve months. CONCLUSION: The use of LLIN among the respondents in this study was accompanied by chancy sleeping habits, inappropriate net maintenance practices and repeated experience of mosquito bites under the nets. This shows the need to sustain the will and confidence of LLIN users in this area through frequent monitoring and surveillance visits targeted at enlightening the people on habits that increase malaria exposure risks as well as proper use and maintenance of LLIN for maximum malaria vector control benefits.

Do topical repellents divert mosquitoes within a community? Health equity implications of topical repellents as a mosquito bite prevention tool.

OBJECTIVES: Repellents do not kill mosquitoes--they simply reduce human-vector contact. Thus it is possible that individuals who do not use repellents but dwell close to repellent users experience more bites than otherwise. The objective of this study was to measure if diversion occurs from households that use repellents to those that do not use repellents. METHODS: The study was performed in three Tanzanian villages using 15%-DEET and placebo lotions. All households were given LLINs. Three coverage scenarios were investigated: complete coverage (all households were given 15%-DEET), incomplete coverage (80% of households were given 15%-DEET and 20% placebo) and no coverage (all households were given placebo). A crossover study design was used and coverage scenarios were rotated weekly over a period of ten weeks. The placebo lotion was randomly allocated to households in the incomplete coverage scenario. The level of compliance was reported to be close to 100%. Mosquito densities were measured through aspiration of resting mosquitoes. Data were analysed using negative binomial regression models. FINDINGS: Repellent-users had consistently fewer mosquitoes in their dwellings. In villages where everybody had been given 15%-DEET, resting mosquito densities were fewer than half that of households in the no coverage scenario (Incidence Rate Ratio [IRR]=0.39 (95% confidence interval [CI]: 0.25-0.60); p<0.001). Placebo-users living in a village where 80% of the households used 15%-DEET were likely to have over four-times more mosquitoes (IRR=4.17; 95% CI: 3.08-5.65; p<0.001) resting in their dwellings in comparison to households in a village where nobody uses repellent. CONCLUSIONS: There is evidence that high coverage of repellent use could significantly reduce man-vector contact but with incomplete coverage evidence suggests that mosquitoes are diverted from households that use repellent to those that do not. Therefore, if repellents are to be considered for vector control, strategies to maximise coverage are required.

Bed bug detection: current technologies and future directions.

Technologies to detect bed bugs have not kept pace with their global resurgence. Early detection is critical to prevent infestations from spreading. Detection based exclusively on bites is inadequate, because reactions to insect bites are non-specific and often misdiagnosed. Visual inspections are commonly used and depend on identifying live bugs, exuviae, or fecal droplets. Visual inspections are inexpensive, but they are time-consuming and unreliable when only a few bugs are present. Use of a dog to detect bed bugs is gaining in popularity, but it can be expensive, may unintentionally advertise a bed bug problem, and is not foolproof. Passive monitors mimic natural harborages; they are discreet and typically use an adhesive to trap bugs. Active monitors generate carbon dioxide, heat, a pheromone, or a combination to attract bed bugs to a trap. New technologies using DNA analysis, mass spectrometry, and electronic noses are innovative but impractical and expensive for widespread use.

Venom immunotherapy for preventing allergic reactions to insect stings.

BACKGROUND: Venom immunotherapy (VIT) is commonly used for preventing further allergic reactions to insect stings in people who have had a sting reaction. The efficacy and safety of this treatment has not previously been assessed by a high-quality systematic review. OBJECTIVES: To assess the effects of immunotherapy using extracted insect venom for preventing further allergic reactions to insect stings in people who have had an allergic reaction to a sting. SEARCH METHODS: We searched the following databases up to February 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1806), AMED (from 1985), LILACS (from 1982), the Armed Forces Pest Management Board Literature Retrieval System, and OpenGrey. There were no language or publication status restrictions to our searches. We searched trials databases, abstracts from recent European and North American allergy meetings, and the references of identified review articles in order to identify further relevant trials. SELECTION CRITERIA: Randomised controlled trials of venom immunotherapy using standardised venom extract in insect sting allergy. DATA COLLECTION AND ANALYSIS: Two authors independently undertook study selection, data extraction, and assessment of risk of bias. We identified adverse events from included controlled trials and from a separate analysis of observational studies identified as part of a National Institute for Health and Clinical Excellence Health Technology Assessment. MAIN RESULTS: We identified 6 randomised controlled trials and 1 quasi-randomised controlled trial for inclusion in the review; the total number of participants was 392. The trials had some risk of bias because five of the trials did not blind outcome assessors to treatment allocation. The interventions included ant, bee, and wasp immunotherapy in children or adults with previous systemic or large local reactions to a sting, using sublingual (one trial) or subcutaneous (six trials) VIT. We found that VIT is effective for preventing systemic allergic reaction to an insect sting, which was our primary outcome measure. This applies whether the sting occurs accidentally or is given intentionally as part of a trial procedure.In the trials, 3/113 (2.7%) participants treated with VIT had a subsequent systemic allergic reaction to a sting, compared with 37/93 (39.8%) untreated participants (risk ratio [RR] 0.10, 95% confidence interval [CI] 0.03 to 0.28). The efficacy of VIT was similar across studies; we were unable to identify a patient group or mode of treatment with different efficacy, although these analyses were limited by small numbers. We were unable to confirm whether VIT prevents fatal reactions to insect stings, because of the rarity of this outcome.Venom immunotherapy was also effective for preventing large local reactions to a sting (5 studies; 112 follow-up stings; RR 0.41, 95% CI 0.24 to 0.69) and for improving quality of life (mean difference [MD] in favour of VIT 1.21 points on a 7-point scale, 95% CI 0.75 to 1.67).We found a significant risk of systemic adverse reaction to VIT treatment: 6 trials reported this outcome, in which 14 of 150 (9.3%) participants treated with VIT and 1 of 135 (0.7%) participants treated with placebo or no treatment suffered a systemic reaction to treatment (RR 8.16, 95% CI 1.53 to 43.46; 2 studies contributed to the effect estimate). Our analysis of 11 observational studies found systemic adverse reactions occurred in 131/921 (14.2%) participants treated with bee venom VIT and 8/289 (2.8%) treated with wasp venom VIT. AUTHORS' CONCLUSIONS: We found venom immunotherapy using extracted insect venom to be an effective therapy for preventing further allergic reactions to insect stings, which can improve quality of life. The treatment carries a small but significant risk of systemic adverse reaction.

Assessment of the short-term systemic effect of and acute phase response to mulesing and other options for controlling breech flystrike in Merino lambs.

BACKGROUND: Mulesing is an important method of preventing flystrike of Merino sheep in Australia, but because there are important short-term welfare issues associated with mulesing, alternative methods of removing the skin folds for breech flystrike prevention are being investigated. OBJECTIVE: To examine the short-term systemic effects of mulesing and two proposed alternatives, compared with two control methods, for controlling breech flystrike. METHOD: The five treatment groups comprised 10 lambs each: (1) mulesing, (2) intradermal-cetrimide treatment, (3) clip application, (4) tail docking only and (5) no treatment. Changes in body weight, haematological and biochemical profiles, and concentrations of fibrinogen, haptoglobin and serum amyloid A were measured repeatedly for 29 days post treatment. RESULTS: The mulesing and intradermal-cetrimide groups were the only treatment groups to lose weight during the first week, with greater weight loss in the mulesing group. The mulesing group had the most marked increases in all three acute-phase protein concentrations, closely followed by the intradermal-cetrimide group, with a mild increase observed for the clip group and even less for the tail-docked group. The mulesing group was the only group to develop mild anaemia, transient hyperglycaemia and a persistent decreased albumin : globulin ratio. The neutrophil : lymphocyte ratio was above the upper reference limit for both the mulesing and intradermal-cetrimide groups. CONCLUSION: Mulesing had the greatest systemic effect in terms of the magnitude and duration of increased acute-phase protein concentrations and haematological, biochemical and body weight changes. The clips had a significantly reduced systemic effect compared with mulesing, with the intradermal-cetrimide treatment in between the two. Tail docking had a minimal systemic effect.

Results preliminary attempts to control the larvae of Leptoconops (Holoconops) kerteszi Kieffer, 1908 (Diptera, Ceratopogonidae) in the coastal wetlands of Tuscany, Italy.

Leptoconops spp. are small midges, members of the family Ceratopogonidae, that are relatively widespread in wetlands with sandy or silty-clay soils, including many tourist sites. Although very few of the species are proven vectors of pathogens, the blood-feeding females attack mammals, including humans, in large swarms and their painful bites may cause severe reactions, especially in children. Although Leptoconops spp. may limit the socio-economic development of an area, there are currently no effective methods for the control of their natural populations, and the repellents and netting used against mosquitoes are ineffective against these midges. The diurnal control of the adults with pesticides may have unacceptable impacts on non-target species, including humans, and be ineffective because the adult females can easily be carried, from untreated areas to treated, on the wind. In the present study, the use of a diflubenzuron-based insecticide against the larvae of Leptoconops (Holoconops) kerteszi Kieffer, 1908 - a sand-reproducing species that is widespread in certain coastal areas of the Italian province of Grosseto - was explored. In Grosseto, in summer, attacks by swarms of adult L. kerteszi create problems for the local people and the many tourists. The encouraging results of preliminary tests are discussed in relation to the potential use of diflubenzuron for the integrated control of L. kerteszi populations.

Advancing the science of EPA guidelines for sponsor-financed topical insect repellent efficacy studies.

In 1999, the US Environmental Protection Agency (EPA) published guidelines for product performance testing of skin-applied insect repellents, which provide guidance for topical insect repellent efficacy studies. EPA subsequently uses these sponsor-financed studies in their evaluation of proposed label claims. This paper reviews some of the statistical flaws in the proposed revisions to these guidelines and suggests possible improvements. This review is important because EPA's revisions to the 1999 guidelines do not address these issues.

Costs and cost-effectiveness of vector control in Eritrea using insecticide-treated bed nets.

BACKGROUND: While insecticide-treated nets (ITNs) are a recognized effective method for preventing malaria, there has been an extensive debate in recent years about the best large-scale implementation strategy. Implementation costs and cost-effectiveness are important elements to consider when planning ITN programmes, but so far little information on these aspects is available from national programmes. METHODS: This study uses a standardized methodology, as part of a larger comparative study, to collect cost data and cost-effectiveness estimates from a large programme providing ITNs at the community level and ante-natal care facilities in Eritrea. This is a unique model of ITN implementation fully integrated into the public health system. RESULTS: Base case analysis results indicated that the average annual cost of ITN delivery (2005 USD 3.98) was very attractive when compared with past ITN delivery studies at different scales. Financing was largely from donor sources though the Eritrean government and net users also contributed funding. The intervention's cost-effectiveness was in a highly attractive range for sub-Saharan Africa. The cost per DALY averted was USD 13 - 44. The cost per death averted was USD 438-1449. Distribution of nets coincided with significant increases in coverage and usage of nets nationwide, approaching or exceeding international targets in some areas. CONCLUSION: ITNs can be cost-effectively delivered at a large scale in sub-Saharan Africa through a distribution system that is highly integrated into the health system. Operating and sustaining such a system still requires strong donor funding and support as well as a functional and extensive system of health facilities and community health workers already in place.

Assessment of knowledge and usage custom of traditional insect/mosquito repellent plants in Addis Zemen Town, South Gonder, North Western Ethiopia.

AIM OF THE STUDY: A cross-sectional descriptive study was carried out to assess the knowledge and usage custom of traditional insect/mosquitoes repellent plants among the inhabitants in Addis Zemen Town, Ethiopia. MATERIALS AND METHODS: Stratified, systematic random sampling was used for selection of 393 households from the total of 5161 households. One adult from each household was interviewed. The ethnobotonical survey was carried out during the period February 2007 to March 2007. Data analysis was carried out using SPSS, version 9.0. Range and mean were analysed and appropriate tables, graphs and percentage were displayed. Level of significance also determined by using 95% of confidence intervals and p-value. RESULTS: Overall, 97.2% of the respondents had ample knowledge and usage custom concerning traditional insect/mosquito repellent plants. Application of smoke (91.55%) was one of the most commonly well-known methods amongst local community by burning the plant parts such as leaves, stems and roots. Leaves were used by 90.2% for the application smoke. Knowledge and usage custom of traditional insect/mosquito repellent plants had significantly associated with sex (p=0.013) and lower income of respondents (p=0.002). In spite of this, knowledge and usage custom had no significant association with age and educational status. Furthermore, the survey also indicated that most commonly known traditional insect/mosquito repellent plants were Woira*(1) (Olea europaea) 44%, Tinjut* (Ostostegia integrifolia) 39%, Neem* (Azadirachta indica) 14.1%, Wogert* (Silene macroserene) 1.4%, and Kebercho* (Echinops sp.) 1.1%. CONCLUSIONS: Indigenous traditional insect/mosquito repellent plants have been used by local hamlet since ancient times for various medicinal purposes. Besides, they are not toxic like existing modern synthetic chemical repellents. Therefore, the traditional use of repellent plants should be encouraged and promoted among the local community.

Is there safety in numbers? The effect of cattle herding on biting risk from tsetse flies.

In sub-Saharan Africa, tsetse (Glossina spp.) transmit species of Trypanosoma which threaten 45-50 million cattle with trypanosomiasis. These livestock are subject to various herding practices which may affect biting rates on individual cattle and hence the probability of infection. In Zimbabwe, studies were made of the effect of herd size and composition on individual biting rates by capturing tsetse as they approached and departed from groups of one to 12 cattle. Flies were captured using a ring of electrocuting nets and bloodmeals were analysed using DNA markers to identify which individual cattle were bitten. Increasing the size of a herd from one to 12 adults increased the mean number of tsetse visiting the herd four-fold and the mean feeding probability from 54% to 71%; the increased probability with larger herds was probably a result of fewer flies per host, which, in turn, reduced the hosts' defensive behaviour. For adults and juveniles in groups of four to eight cattle, > 89% of bloodmeals were from the adults, even when these comprised just 13% of the herd. For groups comprising two oxen, four cows/heifers and two calves, a grouping that reflects the typical composition of communal herds in Zimbabwe, approximately 80% of bloodmeals were from the oxen. Simple models of entomological inoculation rates suggest that cattle herding practices may reduce individual trypanosomiasis risk by up to 90%. These results have several epidemiological and practical implications. First, the gregarious nature of hosts needs to be considered in estimating entomological inoculation rates. Secondly, heterogeneities in biting rates on different cattle may help to explain why disease prevalence is frequently lower in younger/smaller cattle. Thirdly, the cost and effectiveness of tsetse control using insecticide-treated cattle may be improved by treating older/larger hosts within a herd. In general, the patterns observed with tsetse appear to apply to other genera of cattle-feeding Diptera (Stomoxys, Anopheles, Tabanidae) and thus may be important for the development of strategies for controlling other diseases affecting livestock.

Personal-protection measures against mosquitoes: a study of practices and costs in a district, in the Indian state of Orissa, where malaria and lymphatic filariasis are co-endemic.

In a study undertaken among rural and urban communities in a district of Orissa, India, the personal-protection measures used against mosquitoes, and the household costs of these measures, were investigated. Most people living in the study communities perceived mosquitoes as a problem, both as a biting nuisance and as vectors of human disease. Almost all (99%) of the urban households investigated and most (84%) of the rural each reported the use of at least one measure against mosquitoes. Most of the study households (92% of the urban and 64% of the rural) used a 'modern' chemical method (coils, vaporizing mats, liquid vaporizers or sprays), with mosquito coils used more frequently than any other personal-protection measure. Untreated bednets were also used by most of the households investigated (76% of the urban and 58% of the rural) and some households (about 10% of the urban and 8% of the rural) still used the more traditional method of burning dried dung or vegetation indoors, specifically to create smoke to drive away mosquitoes. Setting, house type, as indicated by the material used as roofing, and number of people in the household were each a significant predictor of the use of personal protection, with households in an urban setting, large households, and households occupying a concrete-roofed building relatively more likely to use some form of personal protection. Although 'modern', chemical-based methods were frequently employed, about one in every two interviewees (57% of the urban and 43% of the rural) considered the use of such methods to be harmful to their health. The mean monthly expenditures on personal-protection measures were 101 Indian rupees (U.S.$2.20)/urban household and 72 Indian rupees (U.S.$1.60)/rural household. Setting, family income, family size and number of sleeping rooms in the house each affected such expenditure significantly. As a proportion of household income, expenditure on controlling mosquitoes was surprisingly high.

Evaluation of a mass distribution programme for fine-mesh impregnated bednets against visceral leishmaniasis in eastern Sudan.

During an epidemic of visceral leishmaniasis (VL) in eastern Sudan, Médecins Sans Frontières distributed 357,000 insecticide-treated bednets (ITN) to 155 affected villages between May 1999 and March 2001. To estimate the protective effect of the ITN, we evaluated coverage and use of ITN, and analysed VL incidence by village from March 1996 to June 2002. We provided ITN to 94% of the individuals >5 years old. Two years later, 44% (95% CI 39-48%) of nets were reasonably intact. Because ITN were mainly used as protection against nuisance mosquitoes, bednet use during the VL transmission season ranged from <10% during the hot dry months to 55% during the beginning of the rainy season. ITN were put up from 9 to 11 p.m., leaving children unprotected during a significant period of sandfly-biting hours after sunset. Regression analysis of incidence data from 114 villages demonstrated a significant reduction of VL by village and month following ITN provision. The greatest effect was 17-20 months post-intervention, with VL cases reduced by 59% (95% CI: 25-78%). An estimated 1060 VL cases were prevented between June 1999 and January 2001, a mean protective effect of 27%. Although results need to be interpreted with caution, this analysis indicates a potentially strong reduction in VL incidence following a community distribution of ITN. The effectiveness of ITN depends on behavioural factors, which differ between communities.