Incremental impact upon malaria transmission of supplementing pyrethroid-impregnated long-lasting insecticidal nets with indoor residual spraying using pyrethroids or the organophosphate, pirimiphos methyl

Background Long-lasting, insecticidal nets (LLINs) and indoor residual spraying (IRS) are the most widely accepted and applied malaria vector control methods. However, evidence that incremental impact is achieved when they are combined remains limited and inconsistent. Methods Fourteen population clusters of approximately 1000 residents each in Zambia’s Luangwa and Nyimba districts, which had high pre-existing usage rates (81.7 %) of pyrethroid-impregnated LLINs were quasi-randomly assigned to receive IRS with either of two pyrethroids, namely deltamethrin [Wetable granules (WG)] and lambdacyhalothrin [capsule suspension (CS)], with an emulsifiable concentrate (EC) or CS formulation of the organophosphate pirimiphos methyl (PM), or with no supplementary vector control measure. Diagnostic positivity of patients tested for malaria by community health workers in these clusters was surveyed longitudinally over pre- and post-treatment periods spanning 29 months, over which the treatments were allocated and re-allocated in advance of three sequential rainy seasons. Results Supplementation of LLINs with PM CS offered the greatest initial level of protection against malaria in the first 3 months of application (incremental protective efficacy (IPE) [95 % confidence interval (CI)] = 0.63 [CI 0.57, 0.69], P < 0.001), followed by lambdacyhalothrin (IPE [95 % CI] = 0.31 [0.10, 0.47], P = 0.006) and PM EC (IPE, 0.23 [CI 0.15, 0.31], P < 0.001) and then by deltamethrin (IPE [95 % CI] = 0.19 [−0.01, 0.35], P = 0.064). Neither pyrethroid formulation provided protection beyond 3 months after spraying, but the protection provided by both PM formulations persisted undiminished for longer periods: 6 months for CS and 12 months for EC. The CS formulation of PM provided greater protection than the combined pyrethroid IRS formulations throughout its effective life IPE [95 % CI] = 0.79 [0.75, 0.83] over 6 months. The EC formulation of PM provided incremental protection for the first 3 months (IPE [95 % CI] = 0.23 [0.15, 0.31]) that was approximately equivalent to the two pyrethroid formulations (lambdacyhalothrin, IPE [95 % CI] = 0.31 [0.10, 0.47] and deltamethrin, IPE [95 % CI] = 0.19 [−0.01, 0.35]) but the additional protection provided by the former, apparently lasted an entire year. Conclusion Where universal coverage targets for LLIN utilization has been achieved, supplementing LLINs with IRS using pyrethroids may reduce malaria transmission below levels achieved by LLIN use alone, even in settings where pyrethroid resistance occurs in the vector population. However, far greater reduction of transmission can be achieved under such conditions by supplementing LLINs with IRS using non-pyrethroid insecticide classes, such as organophosphates, so this is a viable approach to mitigating and managing pyrethroid resistance

A case of osteosarcoma presenting primarily as breast mass

Osteosarcoma presenting as a breast mass is a rare disease. We present a case of a 22 year old female who was admitted to our hospital with a complaint of left sided breast mass of 6months duration. On physical examination she had a huge mass on the left breast with no skin lesion and no lymph nodes. Pathology from biopsy showed osteosarcoma. Here we report the findings in detail along with current review of literature. Keywords: Osteosarcoma, Breas

Mean Field Theory of Josephson Junction Arrays with Charge Frustration

Using the path integral approach, we provide an explicit derivation of the equation for the phase boundary for quantum Josephson junction arrays with offset charges and non-diagonal capacitance matrix. For the model with nearest neighbor capacitance matrix and uniform offset charge $q/2e=1/2$, we determine, in the low critical temperature expansion, the most relevant contributions to the equation for the phase boundary. We explicitly construct the charge distributions on the lattice corresponding to the lowest energies. We find a reentrant behavior even with a short ranged interaction. A merit of the path integral approach is that it allows to provide an elegant derivation of the Ginzburg-Landau free energy for a general model with charge frustration and non-diagonal capacitance matrix. The partition function factorizes as a product of a topological term, depending only on a set of integers, and a non-topological one, which is explicitly evaluated.Comment: LaTex, 24 pages, 8 figure

Evaluation of alternative mosquito sampling methods for malaria vectors in Lowland South - East Zambia.

Sampling malaria vectors and measuring their biting density is of paramount importance for entomological surveys of malaria transmission. Human landing catch (HLC) has been traditionally regarded as a gold standard method for surveying human exposure to mosquito bites. However, due to the risk of human participant exposure to mosquito-borne parasites and viruses, a variety of alternative, exposure-free trapping methods were compared in lowland, south-east Zambia. Centres for Disease Control and Prevention miniature light trap (CDC-LT), Ifakara Tent Trap model C (ITT-C), resting boxes (RB) and window exit traps (WET) were all compared with HLC using a 3 × 3 Latin Squares design replicated in 4 blocks of 3 houses with long lasting insecticidal nets, half of which were also sprayed with a residual deltamethrin formulation, which was repeated for 10 rounds of 3 nights of rotation each during both the dry and wet seasons. The mean catches of HLC indoor, HLC outdoor, CDC-LT, ITT-C, WET, RB indoor and RB outdoor, were 1.687, 1.004, 3.267, 0.088, 0.004, 0.000 and 0.008 for Anopheles quadriannulatus Theobald respectively, and 7.287, 6.784, 10.958, 5.875, 0.296, 0.158 and 0.458, for An. funestus Giles, respectively. Indoor CDC-LT was more efficient in sampling An. quadriannulatus and An. funestus than HLC indoor (Relative rate [95% Confidence Interval] = 1.873 [1.653, 2.122] and 1.532 [1.441, 1.628], respectively, P < 0.001 for both). ITT-C was the only other alternative which had comparable sensitivity (RR = 0.821 [0.765, 0.881], P < 0.001), relative to HLC indoor other than CDC-LT for sampling An. funestus. While the two most sensitive exposure-free techniques primarily capture host-seeking mosquitoes, both have substantial disadvantages for routine community-based surveillance applications: the CDC-LT requires regular recharging of batteries while the bulkiness of ITT-C makes it difficult to move between sampling locations. RB placed indoors or outdoors and WET had consistently poor sensitivity so it may be useful to evaluate additional alternative methods, such as pyrethrum spray catches and back packer aspirators, for catching resting mosquitoes

Influencing preventive behavior with regard to HIV/AIDS among the Police Force of Harari Region, Eastern Ethiopia, 2011

Background: HIV/AIDS has emerged as one of the serious public health challenges in Ethiopia. This disease has individual and institutional impacts, making difficult for the police services to act effectively in protecting the public from crime.Objective: To assess factors that influence HIV/AIDS prevention among police personnel in Harari Region, Ethiopia, 2010.Methodology: A cross-sectional study was conducted in January 2010 involving 310 out of the 790 police personnel found in the Region. A simple random sampling technique was used to select study participants by using their identification numbers as sampling frame from registration books of the Personnel Department of the Regional Police Commission. Both bivariate and multivariate analyses were used to identify  determinants of sexual behavior.Results: Attitudes and perceptions of study participants showed significant association with their sexual behavior. Fifty two percent of the respondents were engaged in risky sexual practices and believed that they are susceptible to HIV infection. Twenty-nine percent had multiple sexual partners of which 60% did not use condom consistently. Overall, the study participants were of young age group and have habits of consuming alcohol. Almost all have access to VCT services and opportunities for peer education.Conclusion: The study participants were at risk of HIV because of their sexual behavior and misconceptions related to the risk factors and means of prevention. Hence, basic police training should include BCC on HIV/AIDS, expansion of HIV counseling and testing services, strengthening of peer education and establishing anti-AIDS clubs.[Ethiop. J.Health Dev. 2012;26(1):3-8

The burden of diabetes mellitus during pregnancy in low- and middle-income countries : a systematic review

Peer reviewedPublisher PD

Trauma in Ethiopia Revisited: A systematic Review

Background: This is a systematic review on trauma/injury incidents which has tried to examine the variety of socio-demographic, vehicular,  environmental, and behavioral factors that are associated with injury and its outcome across different settings.Data Sources: Electronic searches for trauma/injuries from peer-reviewed literature and websites from 1960 to August 2013.Study Selection: 36 studies met the study inclusion criteria.Data Extraction: A systematic narrative summary was conducted that included study design, methodology, risk factors, and other study variables.Results: A higher proportion of injury was found in economically active age groups of 15-59 years (Range 56.4 %–80%) across all studies. Similarly majority of the articles reported a higher proportion (Mostly 2/3rd) of injuries among male than female patients (range 53.9 %-91.2 %). Eventhough in all studies injuries were a concern for every population, some studies [12, 13, 15, and, 29] showed a higher incidence among farmers, students and house wife that other occupation. Unintentional injuries were the primary cause for the majority of injury-related reports made withthe weighted pool average percentage of 60.7% (range from 44.6 %11 to 98%20). MVIs were the leading cause of injury among lists of unintentional injuries followed by Falls (16%) machine/tools injury (5.9%), burn (5.3%), poisoning (1.0%) and Animal bite (1.3%). Trauma from interpersonalviolence (Homicide) is the leading causes of intentional injury (24.4%) reported followed by disproportionately low incidence of Fire arm(5%) and Self-harm injuries( 2.1%). Nine of the 36 articles reported percentage distribution of Mortality by Mechanism of injury and the rates of deathfrom MVIs and homicide are generally higher with an average weighted pool percentage of 37.5% and 24.1% respectively.Conclusion: The review showed injury as a significant cause of morbidity and mortality in Ethiopia. Based on the available data, possible strategies relating to trauma prevention are discussed. Because of the uncertainties about the quality and the absence of some data in certain region of Ethiopia, we recommend a need to more accurately define this burden at a national scale.Key words: Trauma, Injury, Accident, Ethiopi

Pattern of Injury and Associated Variables as Seen in the Emergency Department at Tikur Anbessa Specialized Referral Hospital, Addis Ababa, Ethiopia

Background: Traumatic injuries represent a significant and growing disease burden in the developing world, and now represent one of the leading causes of death in economically active adults in many low- and middle-income countries. This study was aimed at determining the patternof injuries and variables associated among patients visiting Emergency Department (ED) due to injury at Black Lion Hospital, Addis Ababa, Ethiopia.Methods: This was a prospective cross sectional hospital based study done with a systematic random sampling method. The study was done in Tikur Anbessa specialized referral hospital. The study was conducted in between February 1 to April 30, 2013. Results: A total of 3287 new patients were seen in the ED, of whom 989 (32.5%) reported to be injury victims, of them 321 patients were included in the study. The M: F ratio is3.58:1.  More than 41% of patients were aged between 20 and 29.The most  frequent cause of injury was Road Traffic Accident (RTAs), 123(38.3%), followed by stuck/hit by a person or object, 101(31.5%), and fall accident 68(21.2%).Further analysis showed that the odds of injury of assault to be increased for males (P= 0.037, AOR, 2.528, 95%CI (1.058-6.037),  patients with monthly income &lt; 650 Ethiopian birr{(P= 0.002, AOR 2.91, 95% CI (1.493-5.705)},and age&lt; 40 years old is significantly associated with injury of assault {(P= 0.004, AOR 3.27, 95%CI(1.451-7.375)}. Injury of assault is 61% less likely to be occurred in rural areas than the urban dwellers {(P= 0.002, AOR 0.39%CI (.219-.707)}.Conclusion: Appropriate interventions to reduce the occurrences of injuries should be instituted by the local authorities and other responsible body. There is also a need to educate the community members particularly risk groups on how to prevent injuries. Key Words: Injury, Variables associated with injury, Emergency departmen

Using a New Odour-Baited Device to Explore Options for Luring and Killing Outdoor-Biting Malaria Vectors: A Report on Design and Field Evaluation of the Mosquito Landing Box.

Mosquitoes that bite people outdoors can sustain malaria transmission even where effective indoor interventions such as bednets or indoor residual spraying are already widely used. Outdoor tools may therefore complement current indoor measures and improve control. We developed and evaluated a prototype mosquito control device, the 'Mosquito Landing Box' (MLB), which is baited with human odours and treated with mosquitocidal agents. The findings are used to explore technical options and challenges relevant to luring and killing outdoor-biting malaria vectors in endemic settings. Field experiments were conducted in Tanzania to assess if wild host-seeking mosquitoes 1) visited the MLBs, 2) stayed long or left shortly after arrival at the device, 3) visited the devices at times when humans were also outdoors, and 4) could be killed by contaminants applied on the devices. Odours suctioned from volunteer-occupied tents were also evaluated as a potential low-cost bait, by comparing baited and unbaited MLBs. There were significantly more Anopheles arabiensis, An. funestus, Culex and Mansonia mosquitoes visiting baited MLB than unbaited controls (P<=0.028). Increasing sampling frequency from every 120 min to 60 and 30 min led to an increase in vector catches of up to 3.6 fold (P<=0.002), indicating that many mosquitoes visited the device but left shortly afterwards. Outdoor host-seeking activity of malaria vectors peaked between 7:30 and 10:30pm, and between 4:30 and 6:00am, matching durations when locals were also outdoors. Maximum mortality of mosquitoes visiting MLBs sprayed or painted with formulations of candidate mosquitocidal agent (pirimiphos-methyl) was 51%. Odours from volunteer occupied tents attracted significantly more mosquitoes to MLBs than controls (P<0.001). While odour-baited devices such as the MLBs clearly have potential against outdoor-biting mosquitoes in communities where LLINs are used, candidate contaminants must be those that are effective at ultra-low doses even after short contact periods, since important vector species such as An. arabiensis make only brief visits to such devices. Natural human odours suctioned from occupied dwellings could constitute affordable sources of attractants to supplement odour baits for the devices. The killing agents used should be environmentally safe, long lasting, and have different modes of action (other than pyrethroids as used on LLINs), to curb the risk of physiological insecticide resistance

Entomological Surveillance of Behavioural Resilience and Resistance in Residual Malaria Vector Populations.

The most potent malaria vectors rely heavily upon human blood so they are vulnerable to attack with insecticide-treated nets (ITNs) and indoor residual spraying (IRS) within houses. Mosquito taxa that can avoid feeding or resting indoors, or by obtaining blood from animals, mediate a growing proportion of the dwindling transmission that persists as ITNs and IRS are scaled up. Increasing frequency of behavioural evasion traits within persisting residual vector systems usually reflect the successful suppression of the most potent and vulnerable vector taxa by IRS or ITNs, rather than their failure. Many of the commonly observed changes in mosquito behavioural patterns following intervention scale-up may well be explained by modified taxonomic composition and expression of phenotypically plastic behavioural preferences, rather than altered innate preferences of individuals or populations. Detailed review of the contemporary evidence base does not yet provide any clear-cut example of true behavioural resistance and is, therefore, consistent with the hypothesis presented. Caution should be exercised before over-interpreting most existing reports of increased frequency of behavioural traits which enable mosquitoes to evade fatal contact with insecticides: this may simply be the result of suppressing the most behaviourally vulnerable of the vector taxa that constituted the original transmission system. Mosquito taxa which have always exhibited such evasive traits may be more accurately described as behaviourally resilient, rather than resistant. Ongoing national or regional entomological monitoring surveys of physiological susceptibility to insecticides should be supplemented with biologically and epidemiologically meaningfully estimates of malaria vector population dynamics and the behavioural phenotypes that determine intervention impact, in order to design, select, evaluate and optimize the implementation of vector control measures