What should the African health workforce know about disasters? Proposed competencies for strengthening public health disaster risk management education in Africa.

BACKGROUND: As part of efforts to implement the human resources capacity building component of the African Regional Strategy on Disaster Risk Management (DRM) for the health sector, the African Regional Office of the World Health Organization, in collaboration with selected African public health training institutions, followed a multistage process to develop core competencies and curricula for training the African health workforce in public health DRM. In this article, we describe the methods used to develop the competencies, present the identified competencies and training curricula, and propose recommendations for their integration into the public health education curricula of African member states. METHODS: We conducted a pilot research using mixed methods approaches to develop and test the applicability and feasibility of a public health disaster risk management curriculum for training the African health workforce. RESULTS: We identified 14 core competencies and 45 sub-competencies/training units grouped into six thematic areas: 1) introduction to DRM; 2) operational effectiveness; 3) effective leadership; 4) preparedness and risk reduction; 5) emergency response and 6) post-disaster health system recovery. These were defined as the skills and knowledge that African health care workers should possess to effectively participate in health DRM activities. To suit the needs of various categories of African health care workers, three levels of training courses are proposed: basic, intermediate, and advanced. The pilot test of the basic course among a cohort of public health practitioners in South Africa demonstrated their relevance. CONCLUSIONS: These competencies compare favourably to the findings of other studies that have assessed public health DRM competencies. They could provide a framework for scaling up the capacity development of African healthcare workers in the area of public health DRM; however further validation of the competencies is required through additional pilot courses and follow up of the trainees to demonstrate outcome and impact of the competencies and curriculum.

Anopheles coluzzii larval habitat and insecticide resistance in the island area of Manoka, Cameroon.

BACKGROUND: The effectiveness of Long-Lasting Insecticidal Nets and Indoor Residual Spraying in malaria vector control is threatened by vector resistance to insecticides. Knowledge of mosquito habitats and patterns of insecticide resistance would facilitate the development of appropriate vector control strategies. Therefore, we investigated An. coluzzii larval habitats and resistance to insecticides in the Manoka rural island area compared with the Youpwe suburban inland area, in Douala VI and II districts respectively. METHODS: Anopheline larvae and pupae were collected from open water bodies in December 2013 and April 2014 and reared until adult emergence. Two to four day old emerging females were morphologically identified as belonging to the An. gambiae complex and used for WHO susceptibility tests with 4 % DDT, 0.75 % permethrin, and 0.05 % deltamethrin, with or without piperonyl butoxide (PBO) synergist. Control and surviving specimens were identified down to the species using a PCR-RFLP method. Survivors were genotyped for kdr L1014 mutations using Hot Oligonucleotide Ligation Assay. RESULTS: In both study sites, ponds, residual puddles, boats, and drains were identified as the major An. gambiae s.l. larval habitats. A total of 1397 females, including 784 specimens from Manoka and 613 from Youpwe, were used for resistance testing. The two mosquito populations displayed resistance to DDT, permethrin and deltamethrin, with variable mortality rates from 1 % to 90 %. The knock-down times were also significantly increased (at least 2.8 fold). Pre-exposure of mosquitoes to PBO did not impact on their mortality to DDT, conversely the mortality rates to permethrin and deltamethrin were significantly increased (7.56 ≤ X(2) ≤ 48.63, df = 1, p < 0.01), suggesting involvement of P450 oxidases in pyrethroid resistance. A subsample of 400 An. gambiae s.l. specimens including 280 control and 120 survivors from bioassays were all found to be An. coluzzii species. Only the kdr 1014 F mutation was found in survivors, with 88.5 % (N = 76) and 75 % (N = 44) frequencies in Youpwe and Manoka respectively. CONCLUSION: This is the first report of An. coluzzii resistance to insecticides in an insular area in Cameroon. Since permanent larval habitats have been identified, larval source management strategies may be trialed in this area as complementary vector control interventions.

Strengthening health disaster risk management in Africa: multi-sectoral and people-centred approaches are required in the post-Hyogo Framework of Action era.

BACKGROUND: In November 2012, the 62nd session of the Regional Committee for Africa adopted a comprehensive 10-year regional strategy for health disaster risk management (DRM). This was intended to operationalize the World Health Organization's core commitments to health DRM and the Hyogo Framework for Action 2005-2015 in the health sectors of the 47 African member states. This study reported the formative evaluation of the strategy, including evaluation of the progress in achieving nine targets (expected to be achieved incrementally by 2014, 2017, and 2022). We proposed recommendations for accelerating the strategy's implementation within the Sendai Framework for Disaster Risk Reduction. METHODS: This study used a mixed methods design. A cross-sectional quantitative survey was conducted along with a review of available reports and information on the implementation of the strategy. A review meeting to discuss and finalize the study findings was also conducted. RESULTS: In total, 58 % of the countries assessed had established DRM coordination units within their Ministry of Health (MOH). Most had dedicated MOH DRM staff (88 %) and national-level DRM committees (71 %). Only 14 (58 %) of the countries had health DRM subcommittees using a multi-sectoral disaster risk reduction platform. Less than 40 % had conducted surveys such as disaster risk analysis, hospital safety index, and mapping of health resources availability. Key challenges in implementing the strategy were inadequate political will and commitment resulting in poor funding for health DRM, weak health systems, and a dearth of scientific evidence on mainstreaming DRM and disaster risk reduction in longer-term health system development programs. CONCLUSIONS: Implementation of the strategy was behind anticipated targets despite some positive outcomes, such as an increase in the number of countries with health DRM incorporated in their national health legislation, MOH DRM units, and functional health sub-committees within national DRM committees. Health system-based, multi-sectoral, and people-centred approaches are proposed to accelerate implementation of the strategy in the post-Hyogo Framework of Action era.

Integrated vector management: the Zambian experience.

BACKGROUND: The Zambian Malaria Control Programme with the Roll Back Malaria (RBM) partners have developed the current National Malaria Strategic Plan (NMSP 2006-2011) which focuses on prevention based on the Integrated Vector Management (IVM) strategy. The introduction and implementation of an IVM strategy was planned in accordance with the World Health Organization (WHO) steps towards IVM implementation namely Introduction Phase, Consolidation Phase and Expansion Phase. ACHIEVEMENTS: IVM has created commitment for Legal and Regulatory policy review, monitoring, Research and a strong stewardship by the chemical suppliers. It has also leveraged additional resources, improved inter-sectoral collaboration, capacity building and enhanced community participation which facilitated a steady scaling up in coverage and utilisation of key preventive interventions. Thus, markedly reducing malaria incidence and case fatalities in the country. CONCLUSION: Zambia has successfully introduced, consolidated and expanded IVM activities. Resulting in increased coverage and utilization of interventions and markedly reducing malaria-related morbidity and mortality while ensuring a better protection of the environment.

Malaria vectors and transmission dynamics in coastal south-western Cameroon.

BACKGROUND: Malaria is a major public health problem in Cameroon. Unlike in the southern forested areas where the epidemiology of malaria has been better studied prior to the implementation of control activities, little is known about the distribution and role of anophelines in malaria transmission in the coastal areas. METHODS: A 12-month longitudinal entomological survey was conducted in Tiko, Limbe and Idenau from August 2001 to July 2002. Mosquitoes captured indoors on human volunteers were identified morphologically. Species of the Anopheles gambiae complex were identified using the polymerase chain reaction (PCR). Mosquito infectivity was detected by the enzyme-linked immunosorbent assay and PCR. Malariometric indices (plasmodic index, gametocytic index, parasite species prevalence) were determined in three age groups (<5 yrs, 5-15 yrs, >15 yrs) and followed-up once every three months. RESULTS: In all, 2,773 malaria vectors comprising Anopheles gambiae (78.2%), Anopheles funestus (17.4%) and Anopheles nili (7.4%) were captured. Anopheles melas was not anthropophagic. Anopheles gambiae had the highest infection rates. There were 287, 160 and 149 infective bites/person/year in Tiko, Limbe and Idenau, respectively. Anopheles gambiae accounted for 72.7%, An. funestus for 23% and An. nili for 4.3% of the transmission. The prevalence of malaria parasitaemia was 41.5% in children <5 years of age, 31.5% in those 5-15 years and 10.5% in those >15 years, and Plasmodium falciparum was the predominant parasite species. CONCLUSION: Malaria transmission is perennial, rainfall dependent and An. melas does not contribute to transmission. These findings are important in the planning and implementation of malaria control activities in coastal Cameroon and West Africa.

A preliminary test of the protective efficacy of permethrin-treated bed nets in an area of Anopheles gambiae metabolic resistance to pyrethroids in north Cameroon.

A trial of permethrin-treated nets (PTNs) versus untreated nets (UTNs) was conducted in Pitoa (north Cameroon), where the main malaria vectors, Anopheles gambiae s.l. and Anopheles arabiensis, show metabolic-based permethrin resistance. The deterrent effect of permethrin greatly reduced A. gambiae biting rate inside rooms where PTNs were installed. After 3 months of net use, malaria reinfection rate was significantly lower in children sleeping under a PTN, but no such effect was observed after 6 months. Parasitaemia was not significantly different between the two arms. These findings suggest good, although transitory, personal protection against malaria conferred by PTNs in an area of metabolic-based permethrin resistance.

Spectrum of metabolic-based resistance to DDT and pyrethroids in Anopheles gambiae s.l. populations from Cameroon.

Some populations of Anopheles gambiae s.l. from Cameroon were reported to develop resistance to DDT or pyrethroids but were free of the kdr mutation "Leucine-Phenylalanine" (Leu-Phe). This study reports on the metabolic activity of non-specific esterases (NSEs), mixed function oxidases (MFOs), and glutathione S-transferases (GSTs), three enzyme systems commonly involved in insecticide resistance. Biochemical assays were performed in DDT or pyrethroid-resistant populations of An. gambiae s.l. from Douala, Mbalmayo, Pitoa, and Simatou neighborhoods. Enzyme activity was compared to the Kisumu-susceptible reference strain using the Mann-Whitney test. Most of the tested samples had elevated NSE activity (P < 0.02). The Douala sample evenly displayed elevated GST activity (P < 0.001), while high MFO level was recorded in the Pitoa sample (P < 0.001). MFO or GST levels were sometimes lower or similar to that of the Kisumu strain. These results suggest metabolic detoxification is a major DDT or pyrethroid resistance mechanism and emphasize the need for further investigations on An. gambiae s.l. resistance mechanisms in Cameroon.

Climate change and vector-borne diseases: what are the implications for public health research and policy?

Vector-borne diseases continue to contribute significantly to the global burden of disease, and cause epidemics that disrupt health security and cause wider socioeconomic impacts around the world. All are sensitive in different ways to weather and climate conditions, so that the ongoing trends of increasing temperature and more variable weather threaten to undermine recent global progress against these diseases. Here, we review the current state of the global public health effort to address this challenge, and outline related initiatives by the World Health Organization (WHO) and its partners. Much of the debate to date has centred on attribution of past changes in disease rates to climate change, and the use of scenario-based models to project future changes in risk for specific diseases. While these can give useful indications, the unavoidable uncertainty in such analyses, and contingency on other socioeconomic and public health determinants in the past or future, limit their utility as decision-support tools. For operational health agencies, the most pressing need is the strengthening of current disease control efforts to bring down current disease rates and manage short-term climate risks, which will, in turn, increase resilience to long-term climate change. The WHO and partner agencies are working through a range of programmes to (i) ensure political support and financial investment in preventive and curative interventions to bring down current disease burdens; (ii) promote a comprehensive approach to climate risk management; (iii) support applied research, through definition of global and regional research agendas, and targeted research initiatives on priority diseases and population groups.

Reduced bio-efficacy of permethrin EC impregnated bednets against an Anopheles gambiae strain with oxidase-based pyrethroid tolerance.

BACKGROUND: Insecticide-treated nets (ITNs) are an integral component of malaria control programmes in Africa. How much pyrethroid resistance in malaria vectors will impact on the efficacy of ITNs is controversial. The purpose of this study was to evaluate knockdown and killing effects of ITNs on a metabolic-based resistant or tolerant malaria vector strain. METHODS: Bio-efficacy of 500 mg/m2 permethrin EC treated bednets was assessed on the OCEAC laboratory (OC-Lab) strain of Anopheles gambiae s.s.. This strain is resistant to DDT and tolerant to pyrethroids, with elevated mixed function oxidases. The Kisumu reference susceptible strain of A. gambiae s.s. was used as control. Nets were impregnated in February 1998 and used by households of the Ebogo village. Then they were collected monthly over six months for Bio-assays (WHO cone test). Knockdown and mortality rates were compared between the OC-Lab and the Kisumu strains, by means of the Mantel-Haenszel chi-square test. RESULTS: During the whole trial, permethrin EC knockdown rates were impressive (mostly higher than 97%). No significant difference was observed between the two strains. However, the mortality rates were significantly decreased in the OC-Lab strain (40-80%) compared with that of the Kisumu strain (75-100%). The decrease of killing effect on the OC-Lab strain was attributed to permethrin EC tolerance, due to the high oxidase metabolic activity. CONCLUSION: These data suggested an impact of pyrethroid tolerance on the residual activity of ITNs. More attention should be given to early detection of resistance using biochemical or molecular assays for better resistance management.

Insecticide susceptibility status of Anopheles gambiae s.l. (Diptera: Culicidae) in the Republic of Cameroon.

A large-scale survey of Anopheles gambiae Giles, 1902 susceptibility to DDT, dieldrin, permethrin, and deltamethrin was conducted in the Republic of Cameroon. 15 field populations from various geographical areas were tested using World Health Organization test kits for adult mosquitoes. The laboratory Kisumu susceptible reference strain was tested as a control. Results showed that dieldrin and DDT resistance was still present in some populations, and indicated permethrin or deltamethrin resistance. Within the Anopheles gambiae complex, resistant individuals belonged to An. gambiae s.s. and An. arabiensis species. Both M and S molecular forms of An. gambiae s.s. were found resistant. In most of resistant populations, the knockdown times were 2-5-folds increased. However, none of the surviving mosquitoes was positive to the kdr "Leu-Phe" mutation using polymerase chain reaction (PCR) diagnostic test. These results likely suggested involvement of other resistance mechanism(s), such as enzyme detoxification or kdr "Leu-Ser" mutation. Researches on An. gambiae s.l. resistance should be promoted in Cameroon, to improve malaria vector control programs and to implement resistance management strategies.

Bioefficacy of cyfluthrin (SOLFAC EW050) impregnated bed-nets against Anopheles gambiae in southern Cameroon.

The bioefficacy of cyfluthrin-impregnated bed-nets was evaluated in the agro-industrial town of Mbandjock (southern Cameroon). The objectives were to assess the knockdown and mortality rates, the protection against bloodfeeding mosquitoes, and the irritant effect of cyfluthrin (SOLFAC EW050)-impregnated bed-nets against a susceptible strain of Anopheles gambiae. Polyester bed-nets were impregnated and distributed to inhabitants of Mbandjock for use, then nets were retreated after 6 months. The uptake of active ingredient on nets ranged from 30.8 mg/m2 to 75.1 mg/m2 at the initial treatment and from 131.0 mg/m2 to 225.0 mg/m2 at retreatment. The susceptible Kisumu reference strain of Anopheles gambiae reared in our laboratory was used for bioassays. The knockdown rate on freshly treated nets (2 wk after treatment) ranged from 93 to 96% and the mortality rate ranged from 52 to 70%. During the 12-month trial, knockdown and mortality rates showed 2 peaks, respectively, in the 4th month (94-97% knockdown and 61-96% mortality) and 7th month (i.e., soon after retreatment; 89-98% knockdown and 86-100% mortality), separated by breakdowns on the 5th through 6th and 12th months (46-77% knockdown and 8-69% mortality). Knockdown and mortality rates decreased faster on the lower part of nets than on the top, suggesting that some external factors such as dirt and daily hand manipulation could impede the efficacy of treated nets. Exceedingly dirty nets were less effective than clean nets. The protective rate against bloodfeeding mosquitoes ranged from 60 to 100% during the 1st 4 months and decreased at 40-70% during the 5th and 6th months after the initial treatment. After retreatment, the protective rate ranged from 50 to 90% for the 1st 5 months and from 35 to 64% at the 6th month. More than 70% of mosquitoes that attempt to feed through treated or retreated nettings died within 24 h after contact. Cyfluthrin was found to be mildly irritant during the whole evaluation. This trial reveals that cyfluthrin EW050-treated nets were effective against a susceptible strain of An. gambiae.

From Manaus to Maputo: toward a public health and biodiversity framework.

The linkages between human health, biodiversity, ecosystems, and the life-supporting services that they provide are varied and complex. The traditional neglect of this nexus by policy-makers perpetuates threats posed to ecosystems with potentially critical impacts on global health. The Convention on Biological Diversity and the World Health Organization recently co-convened two regional workshops on these intricate but vital linkages. From discussions held with policy-makers and experts in the biodiversity and health sectors, spanning some 50 countries in Africa and the Americas, we derive a broad framework for the development of national and regional public health and biodiversity strategies relevant to strategic planning processes in the emerging post-2015 development context.

Piloting a new approach for capacity building in entomology and vector control at the level of national malaria control programmes

Following a survey of entomology capacity in the African Region in 1999; a commitment to strengthen capacity was made and the African Network on Vector Resistance to Insecticides (ANVR) was launched in 2000. Its aim was to facilitate Member States to build capacity in vector control and to collaborate with institutions to standardize methods and approaches. In 2006 ANVR assessed capacity with regard to national malaria control programmes. This assessment provided data on the capacity of countries across the Region to undertake vector surveillance. Recommendations to improve the situation followed and in 2007; through the Bill and Melinda Gates Foundation; a project to strengthen infrastructure and capacity was begun. This article outlines the impressive results of the project and its wider implications for adopting similar approaches across the Region