Effectiveness of public health education on the uptake of iron and folic acid supplements among pregnant women: a stepped wedge cluster randomised trial.

INTRODUCTION: Iron deficiency is the most prevalent micronutrient deficiency in pregnancy globally responsible for nearly 120 000 maternal deaths per year and a fifth of maternal mortality. Over 46% of pregnant women in Africa and 62% of pregnant women in Kenya are anaemic. Anaemia has severe economic and health consequences. Daily iron and folic acid supplementation (IFAS) is an efficacious strategy recommended in pregnancy to reduce the risk of anaemia and improve maternal and neonatal survival. However, most pregnant women do not consume IFAS as recommended. Limited knowledge on IFAS, its benefits and its connection with anaemia, and mitigation of its side effects lead to poor consumption. The main objective of this trial is to determine the effectiveness of public health education on uptake of antenatal IFAS. METHODS AND ANALYSIS: A stepped wedge cluster randomised trial with antenatal clinics as units of randomisation. Twelve clusters will be randomised to receive the intervention and levels of IFAS uptake compared with preintervention period. The 9-month trial will enrol 1205 pregnant women. The primary outcome will be the proportion of pregnant women effectively taking up IFAS measured through self-reports, residual pill count and inspection of pill reminder cards. Routine clinical data on haemoglobin counts and fetal growth monitoring will also be used. Descriptive and bivariate analysis will be conducted in Stata using Pearson's χ2 test for association, and multivariate logistic regression to identify determinants of uptake. The potential public health benefits will be estimated using the number needed to treat and the preventable fraction. ETHICS AND DISSEMINATION: Ethical approval was granted by Kenyatta University Ethics Review Committee (PKU/2443/11575). The research permit is obtained from Kenya National Commission for Science, Technology and Innovation (NACOSTI/P/22/16168). Findings will be disseminated through peer-reviewed publications and public health conferences. TRIAL REGISTRATION NUMBER: PACTR202202775997127.

Current Status of Soil-Transmitted Helminths among School Children in Kakamega County, Western Kenya.

Background. School age children are at high risk of soil-transmitted helminth (STH) worldwide. In Kenya, STH infections in children remain high despite the periodic administration of anthelmintic drugs. Our study assessed the prevalence and intensity of STH in primary school-aged children in Kakamega County, western Kenya. Methodology. We carried out a cross-sectional study on a population of 731 children attending 7 primary schools in March 2014. Children aged 4-16 years were examined for STH by the quantitative Kato-Katz technique. Infection intensities were expressed as eggs per gram (epg) of faeces. Findings. Among 731 school children examined for STH, 44.05% were infected. Highest prevalence of STH was in Shitaho primary school where 107 participants were examined and 62.6% were infected with mean intensity of 11667 epg. Iyenga had the least prevalence where 101 participants were examined and 26.7% were infected with mean intensity of 11772 epg. A. lumbricoides was the most prevalent STH species with 43.5% infected, while hookworm infections were low with 1.8% infected. Conclusion. Prevalence of STHs infections in Kakamega County remains high. We recommend guidelines and other control strategies to be scaled up to break transmission cycles.

Cross-sectional survey of Rift Valley fever virus exposure in Bodhei village located in a transitional coastal forest habitat in Lamu county, Kenya.

Few studies have focused on Rift Valley fever virus (RVFV) transmission in less arid, transitional landscapes surrounding known high-risk regions. The objective of this study was to identify evidence of RVFV exposure in Bodhei Village in a forested area at the edge of the RVFV-epidemic Garissa region. In a household cluster-based survey conducted between epidemics in early 2006, 211 participants were enrolled. Overall seroprevalence for anti-RVFV was high (18%) and comparable with rates in the more arid, dense brush regions farther north. Seroprevalence of adults was 28%, whereas that of children was significantly lower (3%; P < 0.001); the youngest positive child was age 3 years. Males were more likely to be seropositive than females (25% versus 11%; P < 0.01), and animal husbandry activities (birthing, sheltering, and butchering) were strongly associated with seropositivity. The results confirm that significant RVFV transmission occurs outside of recognized high-risk areas and independent of known epidemic periods.

Effect of predation on Anopheles larvae by five sympatric insect families in coastal Kenya.

BACKGROUND & OBJECTIVES: The use of insecticides to eliminate mosquito larvae from ground pools may disrupt atural predator-induced control of mosquito larvae. Detrimental effects on predators may be directly from toxicity or by eliminating prey organisms. Identifying the principal predators responsible for mosquito suppression is needed to select non-target indicator species for insecticide studies. In this study, we sought to determine trophic level interactions between predators and immature stages of Anopheles gambiae Giles mosquitoes under experimental conditions in the coastal region of Kenya. METHODS: To identify effective predation pattern, a series of prey choice experiments was conducted. The relative abilities of five common species of aquatic insects found in the malaria-endemic coastal region of Kenya were assessed in a series of experiments. Experiments were conducted in semi-field conditions at Jaribuni, near the sites of insect collection. RESULTS: In single predator experiments, notonectids consumed most of the mosquito larvae; hydrometrids consumed about half of the mosquito larvae in treatments. Veliids and gerrids had significant, but small effects on larval survivorship. Dytiscids did not have a significant effect on mosquito larvae survivorship. In a two-predator experiment, notonectids significantly decreased survivorship of dytiscids without a change in suppressive effects on mosquito larvae. Of the five common predators evaluated, notonectids were clearly the most voracious consumers of mosquito larvae. The predation pressure on mosquito larvae was not affected by the addition of additional prey items, consisting of small dytiscid beetles. The importance of this notonectid species in coastal Kenya suggests that it would be a valuable non-target indicator species for insecticide studies. Hydrometrids were also efficient at consuming mosquito larvae. INTERPRETATION & CONCLUSION: Of the five common predators from the Kenyan coast evaluated in this study, notonectids were the most voracious consumers of immature mosquitoes. Their predation pressure on mosquito larvae was not affected by the addition of additional prey items, consisting of small dytiscid beetles.

Prevalence of intestinal parasitic infections in certified food-handlers working in food establishments in the City of Nairobi, Kenya.

Most intestinal parasites are cosmopolitan with the highest prevalence in the tropics and subtopics. Rural-to-urban migration rapidly increases the number of food eating places in towns and their environs. Some of these eating estabishments have poor sanitation and are overcrowded, facilitating disease transmission, especially through food-handling. Our investigations in Nairobi, therefore, were set to determine the presence of intestinal parasites in food-handlers with valid medical certificates. Direct and concentrated stool processing techniques were used. Chisquare test and ANOVA were used for data analysis. The parasites Ascaris lumbricoides, Entamoeba histolytica and Giardia lamblia were observed in certified food-handlers. Significant difference was found in parasite frequency by eating classes and gender (χ(2) = 9.49, P = 0.73), (F = 1.495, P = 0.297), but not in parasite occurrence between age brackets (χ(2) = 6.99, P = 0.039). The six-month medical certificate validity period may contribute significantly to the presence of intestinal parasites in certified food-handlers.

Lifestyles and practices that enhance malaria and typhoid fever in Njoro District, Kenya.

Unhygienic practices have been associated with the spread of parasitic and bacterial infections in rural areas. This study was designed to verify the link between the frequencies of malaria and typhoid fever with selected rural practices in Njoro District, Kenya. A cross-sectional study involving observations, questionnaires and interviews was conducted to determine the socio-economic variables and practices/lifestyles in 336 randomly selected homesteads. Frequencies of malaria and typhoid fever in two randomly selected health centers were determined through a retrospective study for the period from 2004 to 2009. The respondents had large families (68%), low education level (67%) and high responsibility burden (67%). Individuals who did not boil drinking water constituted 61%. Boiling drinking water was less common among the poor, Odds Ratio (OR) of 2.36, χ(2) = 9.88, 95% Confidence Interval (CI) of 1.38-4.03. Respondents who washed their hands in a basin after using the latrines comprised 79.8% while 4.8% did not. 18.5% of the respondents did not use a soap to wash their hands after using the latrine. One third (33.6%) of the homesteads had dirty and inappropriate pit latrines while 2.7% of the homesteads lacked latrines. Failure to use mosquito bed nets was more likely to occur among the poor respondents, OR of 1.44, χ(2) = 1.74, 95% CI of 0.84-2.48. The frequencies of malaria and typhoid fever were an average of 29 and 24% respectively. Malaria and typhoid fever cases were relatively frequent due to adoption of inappropriate lifestyles and practices that predisposed the residents to infectious agents. Poverty seemed to play a significant role in the spread of malaria and typhoid fever.

Factors associated with default from treatment among tuberculosis patients in Nairobi province, Kenya: a case control study.

BACKGROUND: Successful treatment of tuberculosis (TB) involves taking anti-tuberculosis drugs for at least six months. Poor adherence to treatment means patients remain infectious for longer, are more likely to relapse or succumb to tuberculosis and could result in treatment failure as well as foster emergence of drug resistant tuberculosis. Kenya is among countries with high tuberculosis burden globally. The purpose of this study was to determine the duration tuberculosis patients stay in treatment before defaulting and factors associated with default in Nairobi. METHODS: A Case-Control study; Cases were those who defaulted from treatment and Controls those who completed treatment course between January 2006 and March 2008. All (945) defaulters and 1033 randomly selected controls from among 5659 patients who completed treatment course in 30 high volume sites were enrolled. Secondary data was collected using a facility questionnaire. From among the enrolled, 120 cases and 154 controls were randomly selected and interviewed to obtain primary data not routinely collected. Data was analyzed using SPSS and Epi Info statistical software. Univariate and multivariate logistic regression analysis to determine association and Kaplan-Meier method to determine probability of staying in treatment over time were applied. RESULTS: Of 945 defaulters, 22.7% (215) and 20.4% (193) abandoned treatment within first and second months (intensive phase) of treatment respectively. Among 120 defaulters interviewed, 16.7% (20) attributed their default to ignorance, 12.5% (15) to traveling away from treatment site, 11.7% (14) to feeling better and 10.8% (13) to side-effects. On multivariate analysis, inadequate knowledge on tuberculosis (OR 8.67; 95% CI 1.47-51.3), herbal medication use (OR 5.7; 95% CI 1.37-23.7), low income (OR 5.57, CI 1.07-30.0), alcohol abuse (OR 4.97; 95% CI 1.56-15.9), previous default (OR 2.33; 95% CI 1.16-4.68), co-infection with Human immune-deficient Virus (HIV) (OR 1.56; 95% CI 1.25-1.94) and male gender (OR 1.43; 95% CI 1.15-1.78) were independently associated with default. CONCLUSION: The rate of defaulting was highest during initial two months, the intensive phase of treatment. Multiple factors were attributed by defaulting patients as cause for abandoning treatment whereas several were independently associated with default. Enhanced patient pre-treatment counseling and education about TB is recommended.

Anopheles larval abundance and diversity in three rice agro-village complexes Mwea irrigation scheme, central Kenya.

BACKGROUND: The diversity and abundance of Anopheles larvae has significant influence on the resulting adult mosquito population and hence the dynamics of malaria transmission. Studies were conducted to examine larval habitat dynamics and ecological factors affecting survivorship of aquatic stages of malaria vectors in three agro-ecological settings in Mwea, Kenya. METHODS: Three villages were selected based on rice husbandry and water management practices. Aquatic habitats in the 3 villages representing planned rice cultivation (Mbui Njeru), unplanned rice cultivation (Kiamachiri) and non-irrigated (Murinduko) agro-ecosystems were sampled every 2 weeks to generate stage-specific estimates of mosquito larval densities, relative abundance and diversity. Records of distance to the nearest homestead, vegetation coverage, surface debris, turbidity, habitat stability, habitat type, rice growth stage, number of rice tillers and percent Azolla cover were taken for each habitat. RESULTS: Captures of early, late instars and pupae accounted for 78.2%, 10.9% and 10.8% of the total Anopheles immatures sampled (n = 29,252), respectively. There were significant differences in larval abundance between 3 agro-ecosystems. The village with 'planned' rice cultivation had relatively lower Anopheles larval densities compared to the villages where 'unplanned' or non-irrigated. Similarly, species composition and richness was higher in the two villages with either 'unplanned' or limited rice cultivation, an indication of the importance of land use patterns on diversity of larval habitat types. Rice fields and associated canals were the most productive habitat types while water pools and puddles were important for short periods during the rainy season. Multiple logistic regression analysis showed that presence of other invertebrates, percentage Azolla cover, distance to nearest homestead, depth and water turbidity were the best predictors for Anopheles mosquito larval abundance. CONCLUSION: These results suggest that agricultural practices have significant influence on mosquito species diversity and abundance and that certain habitat characteristics favor production of malaria vectors. These factors should be considered when implementing larval control strategies which should be targeted based on habitat productivity and water management.

Contribution of different aquatic habitats to adult Anopheles arabiensis and Culex quinquefasciatus (Diptera: Culicidae) production in a rice agroecosystem in Mwea, Kenya.

Studies were conducted to determine the contribution of diverse larval habitats to adult Anopheles arabiensis Patton and Culex quinquefasciatus Say production in a rice land agro-ecosystem in Mwea, Kenya. Two sizes of cages were placed in different habitat types to investigate the influence of non-mosquito invertebrates on larval mortalities and the contribution of each habitat type to mosquito productivities, respectively. These emergence traps had fine netting material covers to prevent adult mosquitoes from ovipositing in the area covered by the trap and immature mosquitoes from entering the cages. The emergence of Anopheles arabiensis in seeps, tire tracks, temporary pools, and paddies was 10.53%, 17.31%, 12.50%, and 2.14%, respectively, while the corresponding values for Cx. quinquefasciatus were 16.85% in tire tracks, 8.39% in temporary pools, and 5.65% in the paddies from 0.125 m3 cages during the study. Cages measuring 1 m3 were placed in different habitat types which included paddy, swamp, marsh, ditch, pool, and seep to determine larval habitat productivity. An. arabiensis was the predominant anopheline species (98.0%, n = 232), although a few Anopheles coustani Laveran (2.0%, n = 5) emerged from the habitats. The productivity for An. arabiensis larvae was 6.0 mosquitoes per m2 for the temporary pools, 5.5 for paddy, 5.4 for marsh, 2.7 for ditch, and 0.6 for seep. The Cx. quinquefasciatus larval habitat productivity was 47.8 mosquitoes per m2 for paddies, 35.7 for ditches, 11.1 for marshes, 4.2 for seeps, 2.4 for swamps, and 1.0 for temporary pools. Pools, paddy, and marsh habitat types were the most productive larval habitats for An. arabiensis while paddy, ditch, and marsh were the most productive larval habitats for Cx. quinquefasciatus. The most common non-mosquito invertebrate composition in the cages included Dytiscidae, Notonectidae, Belostomatidae, and Ephemerellidae, and their presence negatively affected the number of emergent mosquitoes from the cages. In conclusion, freshly formed habitats are the most productive aquatic habitats, while old and more permanent habitats are the least productive due to natural regulation of mosquito immatures.

Malaria vector control practices in an irrigated rice agro-ecosystem in central Kenya and implications for malaria control.

BACKGROUND: Malaria transmission in most agricultural ecosystems is complex and hence the need for developing a holistic malaria control strategy with adequate consideration of socio-economic factors driving transmission at community level. A cross-sectional household survey was conducted in an irrigated ecosystem with the aim of investigating vector control practices applied and factors affecting their application both at household and community level. METHODS: Four villages representing the socio-economic, demographic and geographical diversity within the study area were purposefully selected. A total of 400 households were randomly sampled from the four study villages. Both semi-structured questionnaires and focus group discussions were used to gather both qualitative and quantitative data. RESULTS: The results showed that malaria was perceived to be a major public health problem in the area and the role of the vector Anopheles mosquitoes in malaria transmission was generally recognized. More than 80% of respondents were aware of the major breeding sites of the vector. Reported personal protection methods applied to prevent mosquito bites included; use of treated bed nets (57%), untreated bed nets (35%), insecticide coils (21%), traditional methods such as burning of cow dung (8%), insecticide sprays (6%), and use of skin repellents (2%). However, 39% of respondents could not apply some of the known vector control methods due to unaffordability (50.5%), side effects (19.9%), perceived lack of effectiveness (16%), and lack of time to apply (2.6%). Lack of time was the main reason (56.3%) reported for non-application of environmental management practices, such as draining of stagnant water (77%) and clearing of vegetations along water canals (67%). CONCLUSION: The study provides relevant information necessary for the management, prevention and control of malaria in irrigated agro-ecosystems, where vectors of malaria are abundant and disease transmission is stable.

The risk of pathogenic intestinal parasite infections in Kisii Municipality, Kenya.

BACKGROUND: Intestinal parasitic infections are among the most common infections worldwide. Various epidemiological studies indicate that the prevalence of intestinal parasites is high especially in developing countries, although in many of these, the environmental risk factors have not been clearly elucidated. The objective of this study was to determine the risk of pathogenic intestinal parasites infections in Kisii Municipality. METHODS: Random sampling was used in the selection of the study samples. Stool parasitological profiles of food handlers were done by direct smear and formalin-ethyl acetate sedimentation method. Both vegetable and meat samples were examined for the presence of intestinal parasites. The storage and meat handling practices of the various butcheries were observed. RESULTS: Types of samples examined for occurrence of intestinal parasites includes, a total of 84 vegetable, 440 meat and 168 stool samples. Fifty five (65.5%) vegetable, 334 (75.9%) meat and 69 (41.1%) of the stool samples were found positive for intestinal parasites indicating a high overall risk (66.18%) for intestinal parasite infections. Of the parasites detected, the most common parasites infesting the foodstuffs and infecting the food handlers were Ascaris lumbricoides and Entamoeba histolytica. Parasites were significantly less likely to be present on meat that was refrigerated during display than meat that was displayed at ambient temperature. CONCLUSION: There is a high risk of infection with intestinal parasites in the sampled Municipal markets. About half of the food handlers surveyed (41.1 %) at the Municipal Hospital had one or more parasitic infections. Furthermore, meat (65.5%) and vegetables (75.9%) sold at the Municipal market were found to be contaminated with parasites hence the inhabitants requires a need for education on food safety, good distribution practices and improvement on sanitary conditions.

Distribution of mosquito larvae within the paddy and its implication in larvicidal application in Mwea rice irrigation scheme, Central Kenya.

Distribution of mosquito larvae in inundated rice fields is poorly known despite its profound implications in implementation of vector control programs. Based on oviposition behavior of gravid females and biotic and abiotic conditions of the rice field, distribution of mosquito larvae within the paddy may vary greatly. As a guide to implementation of mosquito vector control program targeting the aquatic stages in the rice fields in Mwea, studies were conducted to determine the distribution of mosquito larvae within the paddy. Twenty-eight cages measuring 50 cm3 were distributed randomly within the paddy during the transplanting stage of the rice growth cycle, and were examined twice per week up to the flowering stage to determine mosquito oviposition pattern. A total of 17,218 mosquito larvae were collected at the periphery and a further 17,570 at the center of the paddy. These comprised 7,461 larvae from the genus Anopheles and 27,327 from genus Culex. The number of pupae collected at the periphery was 1,004 and 1.5 times greater than the number collected at the center. Significantly higher counts of Anopheles larvae were collected at the center (1.00 +/- 0.11) than at the periphery (0.55 +/- 0.05) of the paddy during transplanting stage, but the difference was not significant during the tillering stage. In contrast, significantly higher numbers of Culex larvae were collected from the periphery (3.09 +/- 0.39) than at the center (2.81 +/- 0.24) of the paddy. More pupae were also collected at the center than at the periphery of the paddy. These findings indicate the distribution of Anopheles and Culex larvae in rice fields to be nonrandom; however, for successful achievement of an integrated vector control program targeting the diverse mosquito fauna occurring in rice fields, there is need to target the whole paddy for larvicidal application.

Influence of biological and physicochemical characteristics of larval habitats on the body size of Anopheles gambiae mosquitoes (Diptera: Culicidae) along the Kenyan coast.

BACKGROUND & OBJECTIVES: The number and productivity of larval habitats ultimately determine the density of adult mosquitoes. The biological and physicochemical conditions at the larval habitat affect larval development hence affecting the adult body size. The influence of biological and physicochemical characteristics on the body size of Anopheles gambiae was assessed in Jaribuni village, Kilifi district along the Kenyan Coast. METHODS: Ten cages measuring 1 x 1 x 1 m (1 m3) with a netting material were placed in 10 different aquatic habitats, which were positive for anopheline mosquito larvae. Emergent mosquitoes were collected daily by aspiration and the wing lengths were determined by microscopy. In the habitats, physicochemical parameters were assessed: pH, surface debris, algae and emergent plants, turbidity, substrate, nitrate, ammonia, phosphate and chlorophyll a content. RESULTS: A total of 685 anopheline and culicine mosquitoes were collected from the emergent cages. Only female mosquitoes were considered in this study. Among the Anopheles spp, 202 were An. gambiae s.s., eight An. arabiensis, two An. funestus, whereas the Culex spp was composed of 214 Cx. quinquefasciatus, 10 Cx. tigripes, eight Cx. annulioris and one Cx. cumminsii. The mean wing length of the female An. gambiae s.s. mosquitoes was 3.02 mm (n=157), while that of An. arabiensis was 3.09 mm (n=9). There were no associations between the wing lengths and the environmental and chemical parameters, except for a positive correlation between wing length of An. gambiae and chlorophyll a content (r = 0.622). The day on which the mosquitoes emerged was not significant for the anopheline (p = 0.324) or culicine mosquitoes (p = 0.374), because the mosquito emerged from the cages on a daily basis. INTERPRETATION & CONCLUSION: In conclusion, there was variability in production of emergent mosquitoes from different habitats, which means that there should be targeted control on these habitats based on productivity.

Mosquito species succession and physicochemical factors affecting their abundance in rice fields in Mwea, Kenya.

The succession of mosquito species and abiotic factors affecting their distribution and abundance in rice (Oryza spp.) fields was investigated over a 16-wk rice growing cycle covering the period between January and May 2006. Fifteen experimental rice plots were sampled for mosquito larvae and characterized based on rice height, number of tillers, floating vegetation cover, water depth, water temperature, turbidity, salinity, pH, dissolved oxygen, total dissolved solids, and conductivity. Microscopic identification of 3,025 larvae yielded nine mosquito species predominated by Anopheles arabiensis Patton (45.0%), Culex quinquefasciatus Say (35.8%), Anopheles pharoensis Theobald (9.0%) and Ficalbia splendens Theobald (7.1%). Other species, including Anopheles rufipes Gough, Anopheles coustani Laveran, Anonopheles maculipalpis Giles, Culex annulioris Theobald, and Culex poicilipes Theobald made up 3.1% of the total collection. Anopheles gambiae s.l., Cx. quinquefasciatus, and An. pharoensis occurred throughout the cycle, but they were more abundant up to 4 wk posttransplanting with peaks after fertilizer application. As rice plants became established, three groups of mosquitoes were recognized: the first groups included An. rufipes, Fl. splendens, and Cx. annulioris, which occurred throughout much of the second half of the rice cycle, whereas the second group included Cx. poicilipes, which was found in the middle of the rice cycle. An. coustani and An. maculipalpis formed the third group occurring toward the end of the cycle. Dissolved oxygen, number of tillers, and rice height were negatively associated with the abundance ofAn. arabiensis and Cx. quinquefasciatus larvae. In addition, Cx. quinquefasciatus also was associated with water depth (-ve) and turbidity (+ve). Abundance of An. pharoensis larvae was significantly associated with water temperature (+ve), the number of tillers (-ve), and rice height (-ve), whereas Fl. splendens was significantly associated with the number of tillers (+ve). The results demonstrate a complex nature of the interactions between some of the factors in the ecosystem and mosquito species abundance and calls for time-dependent and species-specific mosquito control operations.

Environmental covariates of Anopheles arabiensis in a rice agroecosystem in Mwea, Central Kenya.

Water quality of aquatic habitats is an important determinant of female mosquito oviposition and successful larval development. This study examined the influence of environmental covariates on Anopheles arabiensis mosquito abundance in the Mwea Irrigation Scheme, Central Province of Kenya, prior to implementation of a malaria vector control program. Experimental rice plots were used to examine the environmental covariates responsible for regulating abundance and diversity of the aquatic stages of malaria vectors. Mosquito larval sampling and water quality analysis were done weekly from the flooding stage to the rice maturation stage. Sampling for mosquito larvae was conducted using standard dipping technique. During each larval collection, environmental covariates such as pH, temperature, conductivity, salinity, dissolved oxygen, water depth, and rice stage were measured. Anopheles arabiensis larval density was highest between 1 wk before transplanting and 4 wk after transplanting with peaks at weeks 0, 3, and 8. The fluctuation in values of the various environmental covariates showed characteristic patterns in different rice growth phases depending on the changes taking place due to the agronomic practices. Using a backward linear regression model, the factors that were found to be associated with abundance of An. arabiensis larvae at any of the rice growing phases included the following: dissolved oxygen, pH, turbidity, water depth, rice height, number of rice tillers, salinity, conductivity, and temperature. The environmental covariates associated with abundance of An. arabiensis were associated with early vegetative stage of the rice growth. For effective control of developmental stages of mosquito larvae, the application of larvicides should be done at the vegetative stage and the larvicides should persist until the beginning of the reproductive stage of the rice.

Survival of immature Anopheles arabiensis (Diptera: Culicidae) in aquatic habitats in Mwea rice irrigation scheme, central Kenya.

BACKGROUND: The survivorship and distribution of Anopheles arabiensis larvae and pupae was examined in a rice agro-ecosystem in Mwea Irrigation Scheme, central Kenya, from August 2005 to April 2006, prior to implementation of larval control programme. METHODS: Horizontal life tables were constructed for immatures in semi-field condition. The time spent in the various immature stages was determined and survival established. Vertical life tables were obtained from five paddies sampled by standard dipping technique. RESULTS: Pre-adult developmental time for An. arabiensis in the trays in the experimental set up in the screen house was 11.85 days from eclosion to emergence. The mean duration of each instar stage was estimated to be 1.40 days for first instars, 2.90 days for second instars, 1.85 days for third instars, 3.80 days for fourth instars and 1.90 days for pupae. A total of 590 individuals emerged into adults, giving an overall survivorship from L1 to adult emergence of 69.4%. A total of 4,956 An. arabiensis immatures were collected in 1,400 dips throughout the sampling period. Of these, 55.9% were collected during the tillering stage, 42.5% during the transplanting period and 1.6% during the land preparation stage. There was a significant difference in the An. arabiensis larval densities among the five stages. Also there was significant variation in immature stage composition for each day's collection in each paddy. These results indicate that the survival of the immatures was higher in some paddies than others. The mortality rate during the transplanting was 99.9% and at tillering was 96.6%, while the overall mortality was 98.3%. CONCLUSION: The survival of An. arabiensis immatures was better during the tillering stage of rice growth. Further the survival of immatures in rice fields is influenced by the rice agronomic activities including addition of nitrogenous fertilizers and pesticides. For effective integrated vector management, the application of larvicides should target An. arabiensis larvae at the tillering stage (early vegetative stage of rice) when their survival in the aquatic habitats is high to significantly reduce them and the larvicides should be long-lasting to have a significant impact on the malaria vector productivity on the habitats.

Relationship between malaria and filariasis transmission indices in an endemic area along the Kenyan Coast.

BACKGROUND AND OBJECTIVES: An entomological survey was conducted to determine the relationship between malaria and lymphatic filariasis transmission by Anopheles gambiae s.l. and An. funestus in two inland villages along the Kenyan coast. METHODS: Mosquitoes were sampled inside houses by pyrethrum spray sheet collection (PSC). In the laboratory, the mosquitoes were sorted to species, dissected for examination of filarial infection and the anophelines later tested for Plasmodium falciparum circumsporozoite proteins by an enzyme-linked immunosorbent assay (ELISA). RESULTS: From a total of 2,032 female mosquitoes collected indoors, An. gambiae s.l constituted 94.4% while the remaining 5.6% comprised of An. funestus and Culex quinquefasciatus. None of the Cx. quinquefasciatus was positive for filarial worms. P. falciparum sporozoite rate for An. gambiae s.l. from both villages was significantly higher than Wuchereria bancrofti infectivity rate. Similarly, the entomological inoculation rate for An. gambiae s.l. was significantly higher than the corresponding W. bancrofti infective biting rate and transmission potential for both the villages. Mass treatment of people with filaricidal drugs in Shakahola in the ongoing global elimination of lymphatic filariasis campaign seemed to have reduced the indices of filariasis transmission but had no effect on malaria transmission. INTERPRETATION AND CONCLUSION: These results indicate the intensity of malaria transmission by anophelines to be much higher than that of lymphatic filariasis in areas where both diseases co-exist and re-emphasise the need to integrate the control of the two diseases in such areas.

Concomitant infections of Plasmodium falciparum and Wuchereria bancrofti on the Kenyan coast.

BACKGROUND: Anopheles gambiae s.l. and An. funestus are important vectors of malaria and bancroftian filariasis, which occur as co-endemic infections along the Kenyan Coast. However, little is known about the occurrence and prevalence of concomitant infections of the two diseases in mosquito and human populations in these areas. This study reports the prevalence of concomitant infections of Plasmodium falciparum and Wuchereria bancrofti in mosquito and human populations in Jilore and Shakahola villages in Malindi, Kenya. METHODS: Mosquitoes were sampled inside houses by pyrethrum spray sheet collection (PSC) while blood samples were collected by finger prick technique at the end of entomological survey. RESULTS: A total of 1,979 female Anopheles mosquitoes comprising of 1,919 Anopheles gambiae s.l and 60 An. funestus were collected. Concomitant infections of P. falciparum sporozoites and filarial worms occurred in 1.1% and 1.6% of An. gambiae s.l collected in Jilore and Shakahola villages respectively. Wuchereria-infected mosquitoes had higher sporozoite rates compared to non-infected mosquitoes, but multiple infections appeared to reduce mosquito survivorship making transmission of such infections rare. None of the persons examined in Shakahola (n = 107) had coinfections of the two parasites, whereas in Jilore (n = 94), out of the 4.3% of individuals harbouring both parasites, 1.2% had P. falciparum gametocytes and microfilariae and could potentially infect the mosquito with both parasites simultaneously. CONCLUSION: Concerted efforts should be made to integrate the control of malaria and bancroftian filariasis in areas where they co-exist.

Distribution, description, and local knowledge of larval habitats of Anopheles gambiae s.l. in a village in western Kenya.

A sampling census revealed 104 aquatic habitats of 6 types for Anopheles gambiae s.l. larvae in a village in western Kenya, namely burrow pits, drainage channels, livestock hoof prints, rain pools, tire tracks, and pools in streambeds. Most habitats were created by human activity and were highly clustered in dispersion pattern within the village landscape. Landscape analysis revealed that six of forty-seven 0.09 km(2) cells superimposed over the village harbored 65% of all habitats. Focus group discussions and in-depth interviews with villagers revealed the extent of knowledge of the village residents of larval habitats, mosquito sources in the local environment, and what might be done to prevent mosquito breeding. Participants did not associate specific habitats with anopheline larvae, expressed reluctance to eliminate habitats because they were sources of domestic water supply, but indicated willingness to participate in a source reduction program if support were available.

Pupal habitat productivity of Anopheles gambiae complex mosquitoes in a rural village in western Kenya.

The productivity of larval habitats of the malaria vector Anopheles gambiae for pupae (the stage preceding adult metamorphosis) is poorly known, yet adult emergence from habitats is the primary determinant of vector density. To assess it, we used absolute sampling methods in four studies involving daily sampling for 25 days in 6 habitat types in a village in western Kenya. Anopheles gambiae s.s. comprised 82.5% of emergent adults and Anopheles arabiensis the remainder. Pupal production occurred from a subset of habitats, primarily soil burrow pits, and was discontinuous in time, even when larvae occupied all habitats continuously. Habitat stability was positively associated with pupal productivity. In a dry season, pupal productivity was distributed between burrow pits and pools in streambeds. Overall, these data support the notion that source reduction measures against recognizably productive habitats would be a useful component of an integrated management program for An. gambiae in villages.