Reduction in symptomatic malaria prevalence through proactive community treatment in rural Senegal.

OBJECTIVES: We piloted a community-based proactive malaria case detection model in rural Senegal to evaluate whether this model can increase testing and treatment and reduce prevalence of symptomatic malaria in target communities. METHODS: Home care providers conducted weekly sweeps of every household in their village throughout the transmission season to identify patients with symptoms of malaria, perform rapid diagnostic tests (RDT) on symptomatic patients and provide treatment for positive cases. The model was implemented in 15 villages from July to November 2013, the high transmission season. Fifteen comparison villages were chosen from those implementing Senegal's original, passive model of community case management of malaria. Three sweeps were conducted in the comparison villages to compare prevalence of symptomatic malaria using difference in differences analysis. RESULTS: At baseline, prevalence of symptomatic malaria confirmed by RDT for all symptomatic individuals found during sweeps was similar in both sets of villages (P = 0.79). At end line, prevalence was 16 times higher in the comparison villages than in the intervention villages (P = 0.003). Adjusting for potential confounders, the intervention was associated with a 30-fold reduction in odds of symptomatic malaria in the intervention villages (AOR = 0.033; 95% CI: 0.017, 0.065). Treatment seeking also increased in the intervention villages, with 57% of consultations by home care providers conducted between sweeps through routine community case management. CONCLUSIONS: This pilot study suggests that community-based proactive case detection reduces symptomatic malaria prevalence, likely through more timely case management and improved care seeking behaviour. A randomised controlled trial is needed to further evaluate the impact of this model.

The Impact of Hurricane Irma on Our Community and the Collier Mosquito Control District's Mission.

The Collier Mosquito Control District, located in southwest Florida, is uniquely positioned in a subtropical environment between the Gulf of Mexico and Everglades National Park. The District's mission is focused on the control of disease vector and nuisance mosquitoes in Collier County, which is accomplished through integrated mosquito management. Hurricane Irma made landfall in the county on September 10, 2017, leaving in its wake tremendous property and infrastructure damage, and it also disrupted communications and airport operations. These factors greatly affected the District's operations and its ability to meet its mission. In addition, the lengthy loss of electrical power forced most residents outdoors, increasing their exposure to mosquitoes. From challenges in completing poststorm treatments to outdated policies that caught us off-guard, the event prompted a new hurricane policy and plan to ensure improved preparedness for the next natural disaster. The poststorm environment also provided a rich foundation for research into mosquito populations after tropical disturbances of this scale. Here we report the impact on the District's aerial mosquito control operations, changes to internal policies, and mosquito population abundance following Hurricane Irma.

The Impact of Hurricane Irma on Population Density of the Black Salt-Marsh Mosquito, Aedes taeniorhynchus, in Collier County, Florida.

In 2017, the southeastern USA and Caribbean endured an extremely active year for tropical storm and hurricane activity. On September 10, 2017, Hurricane Irma made a 2nd landfall in Florida, striking Collier County-including Naples and Marco Island, FL. Areas affected by Hurricane Irma are abundant in salt-marsh and mangrove swamps, prime habitats for the black salt-marsh mosquito, Aedes taeniorhynchus. Using both human landing rate and Biogents BG-Counter trap data, here we report the year-to-year fluctuations in population density of Ae. taeniorhynchus. In 2017, Collier County experienced a population explosion of Ae. taeniorhynchus, with daily landing rates reaching as high as 150 adult females/2-min period. The following year a dramatic population crash of Ae. taeniorhynchus was observed, representing some of the lowest Ae. taeniorhynchus numbers ever recorded in Collier County. Analysis of human landing rate and trap data following major hurricane strikes, including Hurricane Irma (2017) and Hurricane Wilma (2005), have revealed severe reductions in Ae. taeniorhynchus populations. Because Ae. taeniorhynchus accounts for a large majority of adulticiding missions in the state of Florida, an enhanced understanding of the factors contributing to Ae. taeniorhynchus population dynamics may allow for improved operational planning and decision-making.

Implementing visual cervical cancer screening in Senegal: a cross-sectional study of risk factors and prevalence highlighting service utilization barriers.

BACKGROUND: Senegal ranks 15th in the world in incidence of cervical cancer, the number one cause of cancer mortality among women in this country. The estimated participation rate for cervical cancer screening throughout Senegal is very low (6.9% of women 18-69 years old), especially in rural areas and among older age groups (only 1.9% of women above the age of 40 years). There are no reliable estimates of the prevalence of cervical dysplasia or risk factors for cervical dysplasia specific to rural Senegal. The goals of this study were to estimate the prevalence of cervical dysplasia in a rural region using visual inspection of the cervix with acetic acid (VIA) and to assess risk factors for cervical cancer control. PATIENTS AND METHODS: We conducted a cross-sectional study in which we randomly selected 38 villages across the Kédougou region using a three-stage clustering process. Between October 2013 and March 2014, we collected VIA screening results for women aged 30-50 years and cervical cancer risk factors linked to the screening result. RESULTS: We screened 509 women; 5.6% of the estimated target population (9,041) in the region. The point prevalence of cervical dysplasia (positive VIA test) was 2.10% (95% confidence interval [CI]: 0.99-3.21). Moreover, 287 women completed the cervical cancer risk factor survey (56.4% response rate) and only 38% stated awareness of cervical cancer; 75.9% of the screened women were less than 40 years of age. CONCLUSION: The overall prevalence of dysplasia in this sample was lower than anticipated. Despite both overall awareness and screening uptake being less than expected, our study highlights the need to address challenges in future prevalence estimates. Principally, we identified that the highest-risk women are the ones least likely to seek screening services, thus illustrating a need to fully understand demand-side barriers to accessing health services in this population. Targeted efforts to educate and motivate older women to seek screenings are needed to sustain an effective cervical cancer screening program.