Investigating the association between household exposure to Anopheles stephensi and malaria in Sudan and Ethiopia: A case-control study protocol.

BACKGROUND: Endemic African malaria vectors are poorly adapted to typical urban ecologies. However, Anopheles stephensi, an urban malaria vector formerly confined to South Asia and the Persian Gulf, was recently detected in Africa and may change the epidemiology of malaria across the continent. Little is known about the public health implications of An. stephensi in Africa. This study is designed to assess the relative importance of household exposure to An. stephensi and endemic malaria vectors for malaria risk in urban Sudan and Ethiopia. METHODS: Case-control studies will be conducted in 3 urban settings (2 in Sudan, 1 in Ethiopia) to assess the association between presence of An. stephensi in and around households and malaria. Cases, defined as individuals positive for Plasmodium falciparum and/or P. vivax by microscopy/rapid diagnostic test (RDT), and controls, defined as age-matched individuals negative for P. falciparum and/or P. vivax by microscopy/RDT, will be recruited from public health facilities. Both household surveys and entomological surveillance for adult and immature mosquitoes will be conducted at participant homes within 48 hours of enrolment. Adult and immature mosquitoes will be identified by polymerase chain reaction (PCR). Conditional logistic regression will be used to estimate the association between presence of An. stephensi and malaria status, adjusted for co-occurrence of other malaria vectors and participant gender. CONCLUSIONS: Findings from this study will provide evidence of the relative importance of An. stephensi for malaria burden in urban African settings, shedding light on the need for future intervention planning and policy development.

Phytochemical Screening and in-vitro Efficacy of Calpurnia aurea Against Two Transovarial Vectors: Amblyomma variegatum and Rhipicephalus microplus.

Background: Ticks are the second most common vector of human infectious diseases after mosquitoes. Their transovarial transmission contributes to the maintenance of environmental diseases. This study evaluates the phytochemical screening and in vitro efficacy of Calpurnia aurea against the adult survival and egg hatchability of two transovarial transmission vectors: Amblyomma variegatum and Rhipicephalus microplus. Methods: Plant material was extracted using maceration techniques, and concentrated solutions of 12.5, 25, 50, 100, 200, and 400 ppm were prepared. Distilled water and diazinon were used as negative and positive controls, respectively. Ten adult ticks were exposed for 10 minutes, and dead ticks were counted after 24 hours of recovery. Twenty 15-day-old eggs were immersed for 10 minutes, and after 15 days of incubation, hatched and unhatched eggs were tallied. Preliminary phytochemical constituents were screened. A one-way analysis of variance and the probit regression model determined mean mortality and hatchability and estimated lethal and inhibitory concentrations, respectively. Results: The ethanolic and aqueous leaf extracts caused 10±0.0% mortality in adult A. variegatum and R. microplus. The effective dose was LC50 of 27 and 29 ppm and LC50 of 37 and 41 ppm, respectively. At 400 ppm, the leaf ethanolic and aqueous extracts showed 18.7±0.9% and 18.3±1.7%; 18.3±1.2% and 19.7±0.3% egg hatching inhibition, respectively. The effective dose had an IC50 of 50 ppm and IC50s of 91 and 79 ppm, respectively. Flavonoids and saponins were found in both leaf and pod extracts. Conclusion: C. aurea extracts showed a more promising effect on tick survival and hatchability than synthetic diazinon. The susceptibility test indicated that the leaf extract could control vectors and contribute to environmental disease maintenance. Complex phytochemicals, especially phenolic compounds, are additional evidence of effectiveness in vector control. Further investigation of in vivo efficacy and advanced fractionation of phytochemicals is needed.

Spatiotemporal distribution and bionomics of Anopheles stephensi in different eco-epidemiological settings in Ethiopia.

BACKGROUND: Malaria is a major public health concern in Ethiopia, and its incidence could worsen with the spread of the invasive mosquito species Anopheles stephensi in the country. This study aimed to provide updates on the distribution of An. stephensi and likely household exposure in Ethiopia. METHODS: Entomological surveillance was performed in 26 urban settings in Ethiopia from 2021 to 2023. A kilometer-by-kilometer quadrant was established per town, and approximately 20 structures per quadrant were surveyed every 3 months. Additional extensive sampling was conducted in 50 randomly selected structures in four urban centers in 2022 and 2023 to assess households' exposure to An. stephensi. Prokopack aspirators and CDC light traps were used to collect adult mosquitoes, and standard dippers were used to collect immature stages. The collected mosquitoes were identified to species level by morphological keys and molecular methods. PCR assays were used to assess Plasmodium infection and mosquito blood meal source. RESULTS: Catches of adult An. stephensi were generally low (mean: 0.15 per trap), with eight positive sites among the 26 surveyed. This mosquito species was reported for the first time in Assosa, western Ethiopia. Anopheles stephensi was the predominant species in four of the eight positive sites, accounting for 75-100% relative abundance of the adult Anopheles catches. Household-level exposure, defined as the percentage of households with a peridomestic presence of An. stephensi, ranged from 18% in Metehara to 30% in Danan. Anopheles arabiensis was the predominant species in 20 of the 26 sites, accounting for 42.9-100% of the Anopheles catches. Bovine blood index, ovine blood index and human blood index values were 69.2%, 32.3% and 24.6%, respectively, for An. stephensi, and 65.4%, 46.7% and 35.8%, respectively, for An. arabiensis. None of the 197 An. stephensi mosquitoes assayed tested positive for Plasmodium sporozoite, while of the 1434 An. arabiensis mosquitoes assayed, 62 were positive for Plasmodium (10 for P. falciparum and 52 for P. vivax). CONCLUSIONS: This study shows that the geographical range of An. stephensi has expanded to western Ethiopia. Strongly zoophagic behavior coupled with low adult catches might explain the absence of Plasmodium infection. The level of household exposure to An. stephensi in this study varied across positive sites. Further research is needed to better understand the bionomics and contribution of An. stephensi to malaria transmission.