RESUMO
BACKGROUND: Malaria vector dynamics are relevant prior to commencement of mining activities. A baseline entomology survey was conducted in Asutifi and Tano (referred to as Ahafo) in the Brong-Ahafo geo-political region of Ghana during preparatory stages for mining by Newmont Ghana Gold Limited. METHODS: Between November 2006 and August 2007, eight Centre for Disease Control light traps were set daily (Monday-Friday) to collect mosquitoes. Traps were hanged in rooms that were selected from a pool of 1,100 randomly selected houses. Types of materials used in construction of houses were recorded and mosquito prevention measures were assessed from occupants. RESULTS: A total of 5,393 mosquitoes were caught that comprised Anopheles gambiae (64.8%), Anopheles funestus (4.2%), as well as Culicines, comprising of Culex (30.4%) and Aedes species (0.6%). The entomological inoculation rate in Asutifi (279 infective bites/person/month) and Tano (487 infective bites/person/month) demonstrate relatively high malaria transmission in Ahafo. The presence or absence of Anopheles vectors in rooms was influenced by the type of roofing material (OR 2.33, 95%CI: 1.29-4.22, p = 0.01) as well as the presence of eaves gaps (OR 1.80, 95%CI: 1.37-2.37, p < 0.01). It was also associated with bed net availability in the room (OR 1.39, 95%CI: 1.08-1.80, p = 0.01). Over 80% of the houses were roofed with corrugated zinc sheets. Over 60% of the houses in Ahafo had no eaves gaps to give access to mosquito entry and exit into rooms and mosquito bed net coverage was over 50%. Other measures used in preventing mosquito bites included; coil (22.1%), insecticide spray (9.4%), repellent cream (4.0%) and smoky fires (1.1%), contributed minimally to individual mosquito preventive measures in impact areas. Similarly, levels of protection; coil (16.9%), insecticide spray (2.8%) and repellent cream (0.3%) for the non-impact areas, depict low individual prevention measures. CONCLUSIONS: The survey identified areas where intensified vector control activities would be beneficial. It also demonstrates that transmission in Asutifi and Tano is high even before the commencement of mining operations. This study serves as baseline information to assess impact of mining activities in relation to future vector control interventions.
Assuntos
Culicidae/parasitologia , Malária/prevenção & controle , Malária/transmissão , Animais , Gana/epidemiologia , Humanos , Mosquiteiros Tratados com Inseticida , Malária/epidemiologia , Controle de Mosquitos/métodos , Controle de Mosquitos/estatística & dados numéricos , Características de Residência/estatística & dados numéricosRESUMO
BACKGROUND: Malaria is a leading cause of morbidity and mortality among young children and is estimated to cause at least 1 million deaths each year especially among pregnant women and young children under the age of five years. Vitamin A supplementation is known to reduce morbidity and mortality in young children. Zinc is required for growth and immunity and we sought to replicate the study by Zeba et al. which showed 30% lower cases of clinical malaria in children on a combination of zinc and a large dose of vitamin A compared with children on vitamin A alone based on the hypothesis that combined vitamin A and zinc reduced symptomatic malaria compared to vitamin A alone. OBJECTIVES: The primary objective was to determine the effect of vitamin A alone vs. vitamin A and zinc supplements on the incidence of clinical malaria and other anthropometric indices. It also sought to assess the effects on the incidence of anaemia, diarrhoea and pneumonia. METHODS: The study was community-based and 200 children between the ages of 6-24 months were randomised to receive either vitamin A (100,000 IU for infants less than 12 months & 200,000 IU for children greater than 12 months and 10 mg daily zinc in the intervention group or vitamin A and zinc placebo for 6 months in the control group. RESULTS: The number of children who were diagnosed with uncomplicated malaria in the intervention group was 27% significantly lower compared with the children in the control group (p = 0.03). There were, however, no effects on severe malaria, pneumonia, anaemia and diarrhea. CONCLUSIONS: Our study confirms a significant role of vitamin A and zinc in reducing malaria morbidity.
Assuntos
Suplementos Nutricionais , Malária/prevenção & controle , Saúde da População Rural , Vitamina A/uso terapêutico , Zinco/uso terapêutico , Anemia/epidemiologia , Anemia/prevenção & controle , Desenvolvimento Infantil , Pré-Escolar , Países em Desenvolvimento , Diarreia/epidemiologia , Diarreia/prevenção & controle , Suplementos Nutricionais/efeitos adversos , Feminino , Gana/epidemiologia , Humanos , Incidência , Lactente , Estudos Longitudinais , Perda de Seguimento , Malária/sangue , Malária/epidemiologia , Malária/fisiopatologia , Masculino , Morbidade , Cooperação do Paciente , Pneumonia/epidemiologia , Pneumonia/prevenção & controle , Índice de Gravidade de Doença , Vitamina A/administração & dosagem , Vitamina A/efeitos adversos , Zinco/efeitos adversos , Zinco/sangueRESUMO
IMPORTANCE: In sub-Saharan Africa, malaria is a leading cause of childhood morbidity and iron deficiency is among the most prevalent nutritional deficiencies. In 2006, the World Health Organization and the United Nations Children's Fund released a joint statement that recommended limiting use of iron supplements (tablets or liquids) among children in malaria-endemic areas because of concern about increased malaria risk. As a result, anemia control programs were either not initiated or stopped in these areas. OBJECTIVE: To determine the effect of providing a micronutrient powder (MNP) with or without iron on the incidence of malaria among children living in a high malaria-burden area. DESIGN, SETTING, AND PARTICIPANTS: Double-blind, cluster randomized trial of children aged 6 to 35 months (n = 1958 living in 1552 clusters) conducted over 6 months in 2010 in a rural community setting in central Ghana, West Africa. A cluster was defined as a compound including 1 or more households. Children were excluded if iron supplement use occurred within the past 6 months, they had severe anemia (hemoglobin level <7 g/dL), or severe wasting (weight-for-length z score <-3). INTERVENTIONS: Children were randomized by cluster to receive a MNP with iron (iron group; 12.5 mg/d of iron) or without iron (no iron group). The MNP with and without iron were added to semiliquid home-prepared foods daily for 5 months followed by 1-month of further monitoring. Insecticide-treated bed nets were provided at enrollment, as well as malaria treatment when indicated. MAIN OUTCOMES AND MEASURES: Malaria episodes in the iron group compared with the no iron group during the 5-month intervention period. RESULTS: In intention-to-treat analyses, malaria incidence overall was significantly lower in the iron group compared with the no iron group (76.1 and 86.1 episodes/100 child-years, respectively; risk ratio (RR), 0.87 [95% CI, 0.79-0.97]), and during the intervention period (79.4 and 90.7 episodes/100 child-years, respectively; RR, 0.87 [95% CI, 0.78-0.96]). In secondary analyses, these differences were no longer statistically significant after adjusting for baseline iron deficiency and anemia status overall (adjusted RR, 0.87; 95% CI, 0.75-1.01) and during the intervention period (adjusted RR, 0.86; 95% CI, 0.74-1.00). CONCLUSION AND RELEVANCE: In a malaria-endemic setting in which insecticide-treated bed nets were provided and appropriate malaria treatment was available, daily use of a MNP with iron did not result in an increased incidence of malaria among young children. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01001871.
Assuntos
Anemia Ferropriva/prevenção & controle , Ferro/administração & dosagem , Malária/epidemiologia , Malária/prevenção & controle , Anemia Ferropriva/epidemiologia , Pré-Escolar , Suplementos Nutricionais/efeitos adversos , Método Duplo-Cego , Feminino , Gana/epidemiologia , Humanos , Incidência , Lactente , Mosquiteiros Tratados com Inseticida , Ferro/efeitos adversos , Masculino , RiscoRESUMO
BACKGROUND: Plasmodium falciparum malaria remains endemic in sub-Saharan Africa including Ghana. The epidemiology of malaria in special areas, such as mining areas needs to be monitored and controlled. Newmont Ghana Gold Limited is conducting mining activities in the Brong Ahafo Region of Ghana that may have an impact on the diseases such as malaria in the mining area. METHODS: Prior to the start of mining activities, a cross-sectional survey was conducted in 2006/2007 to determine malaria epidemiology, including malaria parasitaemia and anaemia among children < 5 years and monthly malaria transmission in a mining area of Ghana. RESULTS: A total of 1,671 households with a child less than five years were selected. About 50% of the household heads were males. The prevalence of any malaria parasitaemia was 22.8% (95% CI 20.8-24.9). Plasmodium falciparum represented 98.1% (95% CI 96.2-99.2) of parasitaemia. The geometric mean P. falciparum asexual parasite count was 1,602 (95% CI 1,140-2,252) and 1,195 (95% CI 985-1,449) among children < 24 months and ≥ 24 months respectively. Health insurance membership (OR 0.60, 95% CI 0.45-0.80, p = 0.001) and the least poor (OR 0.57, 95% CI 0.37-0.90, p = 0.001) were protected against malaria parasitaemia. The prevalence of anaemia was high among children < 24 months compared to children ≥ 24 months (44.1% (95% CI 40.0-48.3) and 23.8% (95% CI 21.2-26.5) respectively. About 69% (95% CI 66.3-70.9) of households own at least one ITN. The highest EIRs were record in May 2007 (669 ib/p/m) and June 2007 (826 ib/p/m). The EIR of Anopheles gambiae were generally higher than Anopheles funestus. CONCLUSION: The baseline malaria epidemiology suggests a high malaria transmission in the mining area prior to the start of mining activities. Efforts at controlling malaria in this mining area have been intensified but could be enhanced with increased resources and partnerships between the government and the private sector.