Malaria remains a major cause of morbidity and mortality in the tropics, with Plasmodium falciparum responsible for the majority of the disease burden and P. vivax being the geographically most widely distributed cause of malaria. Gametocytes are the sexual-stage parasites that infect Anopheles mosquitoes and mediate the onward transmission of the disease. Gametocytes are poorly studied despite this crucial role, but with a recent resurgence of interest in malaria elimination, the study of gametocytes is in vogue. This review highlights the current state of knowledge with regard to the development and longevity of P. falciparum and P. vivax gametocytes in the human host and the factors influencing their distribution within endemic populations. The evidence for immune responses, antimalarial drugs, and drug resistance influencing infectiousness to mosquitoes is reviewed. We discuss how the application of molecular techniques has led to the identification of submicroscopic gametocyte carriage and to a reassessment of the human infectious reservoir. These components are drawn together to show how control measures that aim to reduce malaria transmission, such as mass drug administration and a transmission-blocking vaccine, might better be deployed.

Epidemiology and Infectivity of Plasmodium falciparum and Plasmodium vivax Gametocytes in Relation to Malaria Control and Elimination

Summary The world is becoming urban. The UN predicts that the world's urban population will almost double from 3·3 billion in 2007 to 6·3 billion in 2050. Most of this increase will be in developing countries. Exponential urban growth is having a profound effect on global health. Because of international travel and migration, cities are becoming important hubs for the transmission of infectious diseases, as shown by recent pandemics. Physicians in urban environments in developing and developed countries need to be aware of the changes in infectious diseases associated with urbanisation. Furthermore, health should be a major consideration in town planning to ensure urbanisation works to reduce the burden of infectious diseases in the future.

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Urbanisation and infectious diseases in a globalised world

The Global Malaria Eradication Program, launched in the middle of the last century, over-promised and under-delivered [1]. Decades of pessimism followed, during which malariologists were afraid to even mention the goal of this program by name [2]. The term eradication was often nervously referred to as “the E-word” by a disillusioned community that had learned from bitter experience that optimistic forecasts [3] had been based on an oversimplified view of transmission ecology [4]. Eradication of malaria remains beyond our grasp today, but is nevertheless firmly back on the global health agenda as a long-term target [5].

Ecology: a prerequisite for malaria elimination and eradication.

Recent research has raised the prospect of using insect fungal pathogens for the control of vector-borne diseases such as malaria. In the past, microbial control of insect pests in both medical and agricultural sectors has generally had limited success. We propose that it might now be possible to produce a cheap, safe and green tool for the control of malaria, which, in contrast to most chemical insecticides, will not eventually be rendered useless by evolution of resistance. Realizing this potential will require lateral thinking by biologists, technologists and development agencies.

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Can fungal biopesticides control malaria

As malaria declines in many African countries there is a growing realization that new interventions need to be added to the front-line vector control tools of long-lasting impregnated nets (LLINs) and indoor residual spraying (IRS) that target adult mosquitoes indoors. Larval source management (LSM) provides the dual benefits of not only reducing numbers of house-entering mosquitoes, but, importantly, also those that bite outdoors. Large-scale LSM was a highly effective method of malaria control in the first half of the twentieth century, but was largely disbanded in favour of IRS with DDT. Today LSM continues to be used in large-scale mosquito abatement programmes in North America and Europe, but has only recently been tested in a few trials of malaria control in contemporary Africa. The results from these trials show that hand-application of larvicides can reduce transmission by 70-90% in settings where mosquito larval habitats are defined but is largely ineffectual where habitats are so extensive that not all of them can be covered on foot, such as areas that experience substantial flooding. Importantly recent evidence shows that LSM can be an effective method of malaria control, especially when combined with LLINs. Nevertheless, there are a number of misconceptions or even myths that hamper the advocacy for LSM by leading international institutions and the uptake of LSM by Malaria Control Programmes. Many argue that LSM is not feasible in Africa due to the high number of small and temporary larval habitats for Anopheles gambiae that are difficult to find and treat promptly. Reference is often made to the Ross-Macdonald model to reinforce the view that larval control is ineffective. This paper challenges the notion that LSM cannot be successfully used for malaria control in African transmission settings by highlighting historical and recent successes, discussing its potential in an integrated vector management approach working towards malaria elimination and critically reviewing the most common arguments that are used against the adoption of LSM.

https://researchonline.lshtm.ac.uk/20922/1/1475%2D2875%2D10%2D353.pdf

Larval source management for malaria control in Africa: myths and reality

By 2030, more than 50% of the African population will live in urban areas. Controlling malaria reduces the disease burden and further improves economic development. As a complement to treated nets and prompt access to treatment, measures targeted against the larval stage of Anopheles sp. mosquitoes are a promising strategy for urban areas. However, a precise knowledge of the geographic location and potentially of ecological characteristics of breeding sites is of major importance for such interventions. In total 151 km2 of central Dar es Salaam, the biggest city of Tanzania, were systematically searched for open mosquito breeding sites. Ecologic parameters, mosquito larvae density and geographic location were recorded for each site. Logistic regression analysis was used to determine the key ecological factors explaining the different densities of mosquito larvae. A total of 405 potential open breeding sites were examined. Large drains, swamps and puddles were associated with no or low Anopheles sp. larvae density. The probability of Anopheles sp. larvae to be present was reduced when water was identified as "turbid". Small breeding sites were more commonly colonized by Anopheles sp. larvae. Further, Anopheles gambiae s.l. larvae were found in highly organically polluted habitats. Clear ecological characteristics of the breeding requirements of Anopheles sp. larvae could not be identified in this setting. Hence, every stagnant open water body, including very polluted ones, have to be considered as potential malaria vector breeding sites.

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Habitat characterization and spatial distribution of Anopheles sp. mosquito larvae in Dar es Salaam (Tanzania) during an extended dry period

BACKGROUND

Malaria control in Africa is most tractable in urban settlements yet most research has focused on rural settings. Elimination of malaria transmission from urban areas may require larval control strategies that complement adult mosquito control using insecticide-treated nets or houses, particularly where vectors feed outdoors.

METHODS AND FINDINGS

Microbial larvicide (Bacillus thuringiensis var. israelensis (Bti)) was applied weekly through programmatic, non-randomized community-based, but vertically managed, delivery systems in urban Dar es Salaam, Tanzania. Continuous, randomized cluster sampling of malaria infection prevalence and non-random programmatic surveillance of entomological inoculation rate (EIR) respectively constituted the primary and secondary outcomes surveyed within a population of approximately 612,000 residents in 15 fully urban wards covering 55 km(2). Bti application for one year in 3 of those wards (17 km(2) with 128,000 residents) reduced crude annual transmission estimates (Relative EIR [95% Confidence Interval] = 0.683 [0.491-0.952], P = 0.024) but program effectiveness peaked between July and September (Relative EIR [CI] = 0.354 [0.193 to 0.650], P = 0.001) when 45% (9/20) of directly observed transmission events occurred. Larviciding reduced malaria infection risk among children < or =5 years of age (OR [CI] = 0.284 [0.101 to 0.801], P = 0.017) and provided protection at least as good as personal use of an insecticide treated net (OR [CI] = 0.764 [0.614-0.951], P = 0.016).

CONCLUSIONS

In this context, larviciding reduced malaria prevalence and complemented existing protection provided by insecticide-treated nets. Larviciding may represent a useful option for integrated vector management in Africa, particularly in its rapidly growing urban centres.

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Microbial Larvicide Application by a Large-Scale, Community-Based Program Reduces Malaria Infection Prevalence in Urban Dar Es Salaam, Tanzania

As the population of Africa rapidly urbanizes it may be possible to protect large populations from malaria by controlling aquatic stages of mosquitoes. Here we present a baseline evaluation of the ability of community members to detect mosquito larval habitats with minimal training and supervision in the first weeks of an operational urban malaria control program.

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Community-based surveillance of malaria vector larval habitats: a baseline study in urban Dar es Salaam, Tanzania

This study sought to analyze factors influencing implementation of competitive strategies among electronic retail firms in Nairobi County. The study used descriptive research design. Records from the Ministry of Industrialization and Enterprise Development shows that there 3445 registered electronic retail enterprises that informed the target population of the study. From the target population of 3445 the researcher used stratified random sampling to get a sample size of 346. Primary data was gathered via a questionnaire. Statistical Package for Social Sciences (Version 26) was used to examine quantitative data. Descriptive statistics of frequency, percentage were calculated. The results from the regression showed that organization culture had the highest effect on implementation of competitive strategies with a coefficient of 0.133, followed by resource allocation, organization environment with a coefficient of 0.347, strategic communication with a coefficient of 0.150, organization environment with a coefficient of 0.167 and resource allocation with a coefficient of 0.296. The study recommends that an organization need to ensure that when implementing competitive strategies, they need to consider all the variables of the study as they had influences on the execution of competitive strategies. 

Michael Kiama

Papers

Habitat characterization and spatial distribution of Anopheles sp. mosquito larvae in Dar es Salaam (Tanzania) during an extended dry period

Microbial Larvicide Application by a Large-Scale, Community-Based Program Reduces Malaria Infection Prevalence in Urban Dar Es Salaam, Tanzania

Community-based surveillance of malaria vector larval habitats: a baseline study in urban Dar es Salaam, Tanzania

Analysis of Factors Influencing Implementation of Competitive Strategies among Electronic Retail Firms in Nairobi CBD, Nairobi County, Kenya