Malaria vectors in a traditional dry zone village in Sri Lanka.

Malaria transmission by anopheline mosquitoes was studied in a traditional tank-irrigation-based rice-producing village in the malaria-endemic low country dry zone of northcentral Sri Lanka during the period August 1994-February 1997. Adult mosquitoes were collected from human and bovid bait catches, bovid-baited trap huts, indoor catches, and pit traps. Mosquito head-thoraces were tested for the presence of Plasmodium falciparum and P. vivax, and blood-engorged abdomens for the presence of human blood by ELISAs. House surveys were done at two-day intervals to record cases of blood film-confirmed malaria among the villagers. A total of 7,823 female anophelines representing 14 species were collected. Trends in anopheline abundance were significantly correlated with rainfall of the preceding month in An. annularis, An. barbirostris, An. subpictus, An. vagus, and An. varuna, but were not significant in An. culicifacies and An. peditaeniatus. Malaria parasite infections were seen in seven mosquito species, with 75% of the positive mosquitoes containing P. falciparum and 25% P. vivax. Polymorph PV247 was recorded from a vector (i.e., An. varuna) for the first time in Sri Lanka. Computations of mean number of infective vector (MIV) rates using abundance, circumsporozoite (CS) protein rate, and human blood index (HBI) showed the highest rate in An. culicifacies. A malaria outbreak occurred from October 1994 to January 1995 in which 45.5% of village residents experienced at least a single disease episode. Thereafter, malaria incidence remained low. Anopheles culicifacies abundance lagged by one month correlated positively with monthly malaria incidence during the outbreak period, and although this species ranked fifth in terms of abundance, infection was associated with a high MIV rate due to a high CS protein rate and HBI. Abundance trends in other species did not correlate significantly with malaria. It was concluded that An. culicifacies was epidemiologically the most important vector in the study area.     

3种检测方法在中缅边境疟疾无症状感染者筛查中的比较

目的比较3种不同检测方法对疟疾无症状感染者的检出能力,并了解中缅边境地区的疟疾无症状感染水平。方法2014年7月在中缅边境地区云南省盈江县选择那邦镇、支那乡和缅甸拉咱安置点等3个调查点,采集调查对象血样,制作厚薄血膜和滤纸血标本,分别采用显微镜观察、荧光定量PCR和超敏PCR检测疟原虫感染情况。结果共采集387份血样,显微镜观察检出6例无症状感染者(间日疟5例、恶性疟1例),感染检出率为1.6%;荧光定量PCR检出13例无症状感染者(间日疟12例、恶性疟1例),感染检出率为3.4%;超敏PCR检出38例无症状感染者(间日疟29例、恶性疟9例),感染检出率为9.8%。以显微镜观察为疟原虫感染诊断的金标准,荧光定量PCR检测无症状感染者的灵敏度为100%,特异性为98.2%;超敏PCR检测无症状感染者的灵敏度为100%,特异性91.6%。超敏PCR结果显示,那邦镇的无症状感染检出率最高,为17.1%(22/129),其次为缅甸拉咱难民安置点,为10.0%(11/110),支那乡最低,为3.4%(5/148),3个调查点的感染检出率差异有统计学意义(P<0.05)。检出虫种以间日疟原虫为主,占76.3%,恶性疟原虫占23.7%;女性无症状感染检出率为10.7%(23/215),高于男性的8.7%(15/172),两者差异无统计学意义(P>0.05)。不同年龄组以15~29岁的无症状感染检出率最高,为17.5%(10/57),各年龄组间差异无统计学意义(P>0.05)。结论超敏PCR对疟疾无症状感染者的检出率高于荧光定量PCR和显微镜观察。中缅边境地区人群中存在一定比例的疟疾无症状感染者。     

Performance appraisal of rapid on-site malaria diagnosis (ICT malaria Pf/Pv test) in relation to human resources at village level in Myanmar.

Logistic, economic and technical factors limit rapid access to microscopic confirmation of symptomatic diagnosis of malaria in many rural areas in endemic countries such as Myanmar. A study was conducted to evaluate a rapid on-site immunochromatographic test (ICT Malaria Pf/Pv) for detection of Plasmodium falciparum and P. vivax in two villages in the Taikkyi region of Myanmar. The ICT Malaria tests were performed by a volunteer health worker (VHW) in Yae-Aye-San village and by a professionally trained midwife (MW) in Kankone village. A total of 1000 symptomatic patients participated in the study by providing blood samples for an ICT test and for microscopy. The ICT performance indices, relative to microscopy, were better for the trained MW compared with the less experienced VHW. For P. falciparum and/or P. vivax infections, the sensitivities were 82.7% for the VHW compared with 93.7% for the MW. For P. falciparum infections, the sensitivities were 82.2% for the VHW and 91.3% for the MW, while the corresponding values for P. vivax infections were 66.7 and 79%, respectively. Although the test kit appeared to perform better in more experienced hands, this study questions whether this difference is related to the use of the ICT Malaria Pf/Pv test kit, or related to other factors such as differences in the quality of blood slides prepared by the VHW and MW for microscopic examination. Overall, the results suggest that a rapid diagnostic assay such as the ICT Malaria Pf/Pv test kit can be used in rural settings by relatively inexperienced persons, such as VHWs, with a reasonable degree of sensitivity, thus providing on-site confirmation of symptomatic diagnosis of malaria.     

2005-2012年上海市疟疾监测结果分析

目的 目的 了解上海市疟疾监测和疫情变化情况, 为评价和推进消除疟疾工作提供科学依据。方法 方法 收集 2005-2012年上海市疟疾监测年报、 疟疾疫情数据和人口资料, 分析该市发热病人疟原虫血检情况、 血检阳性率、 人群疟原 虫带虫率、 人群疟疾抗体水平, 以及传疟蚊媒的种群和密度等。结果 结果 2005-2012年, 上海市累计血检发热病人400 177人 次, 血检率为 0.36%, 各年份的血检率在0.15% ~ 0.83%, 其中2010年前的年血检率均低于0.20%, 之后血检率明显升高。8 年间共发现疟原虫阳性者604例, 血检阳性率为0.15%, 其中阳性者以2006-2008年为多, 2009年后逐年减少, 2012年仅有 26例, 2011年后的所有病例均为国外感染。各年份的血检阳性率从0.61%逐渐降低至0.03%。血检对象中本市居民占 79.02%, 而血检阳性者中外来流动人员占83.44%。8年期间主动病例筛查15 759人次, 分别于2007年和2008年发现5例 疟原虫带虫者。对1 239 440人次的流动人员进行疟疾抗体检测, 阳性率为0.04%, 抗体阳性者均未查出疟原虫; 对7 065人 次的本地小学生进行疟疾抗体检测, 未发现抗体阳性者。2005-2011年开展蚊媒监测216点次, 在城区观察点未发现按蚊, 郊区观察点监测到按蚊蚊种为中华按蚊。按蚊叮人率季节高峰为7月底至8月底, 郊区、 近郊区和远郊区的按蚊叮人率未 发现地区分布差异。结论 结论 上海市已全方位地开展了疟疾监测工作, 并已进入消除疟疾阶段, 今后的疟疾监测以有境外 疟疾流行病学史的人群为重点监测对象, 维持并提高二、 三级医疗机构的疟疾血检能力, 确保能及时、 准确发现疟疾病 例。     

A comparison of two rapid field immunochromatographic tests to expert microscopy in the diagnosis of malaria

In Myanmar, we tested two rapid malaria immunochromatographic kits: the OptiMAL assay for the detection of parasite lactate dehydrogenase (pLDH), and the ICT Malaria P.f./P.v. test for histidine-rich protein 2 (PfHRP2) and panmalarial antigens. A total of 229 patients were examined, of whom 133 were found to be malaria positive by Giemsa microscopy. Both OptiMAL and ICT gave lower sensitivities than previously reported. ICT sensitivity for Plasmodium falciparum and non-falciparum parasites were 86.2 and 2.9%, respectively; specificity was 76.9 and 100%, respectively. OptiMAL sensitivity for P. falciparum and non-falciparum parasites were 42.6 and 47.1%, respectively; specificity was 97.0 and 96.9%, respectively. The sensitivity of both tests for the detection of both P. falciparum and non-falciparum parasites increased with parasite density. Several explanations for these results are explored. Our results raise particular concern over batch quality variations of malaria rapid diagnostic devices (MRDDs).     

Prevalence of malaria and economic loss in two major iron ore mines in Sundargarh district, Orissa.

A cross-sectional study on malaria was undertaken in May 1989 in the settlements of Kalta and Barsuan iron ore mines situated in a hilly area of Sundargarh district. Fever surveys revealed slide positivity rates of 33.9% and 34.8% in Kalta and Barsuan, respectively. Malaria infection rates as recorded through mass blood surveys in the resident population were 23.5 and 13.8%, respectively. Children up to 9 years age suffered most from malaria and in the age group of 2-9 years 37.3%, children had enlarged spleens with an average enlarged spleen (AES) index of 1.7. P. falciparum was the most prevalent species followed by P. vivax and P. malariae. Malaria vectors viz., An. fluviatilis and An. culicifacies were present in high densities. The present paper also brings out the economic loss due to malaria to the mining industry.     

Malaria prevalence and a brief entomological survey in a village surrounded by rice fields in Khammouan province, Lao PDR

We surveyed Nongceng, a village in a south-eastern province of Lao PDR, for malaria and its vectors. Nongceng is situated in a basin and surrounded by rice fields. In February 1998 (dry season), 28.6% of 126 villagers were infected with malaria, and in September 1998 (rainy season), 16.3% of 147 villagers. The prevalence of malaria infection was consistently high in children under 10, and the predominant malaria species was Plasmodium falciparum. In brief surveys of the mosquitoes performed on the same day as the malaria surveys, 2007 Anopheles females from 12 species were collected by means of human bait, animal bait and resting collections. Of the vector species known to be important in transmitting malaria in neighbouring Thailand - An. minimus, An. dirus, and An. maculatus groups - only An. minimus was found. Its density was, however, very low in both seasons and it was therefore unlikely to be the vector. In fact, An. nivipes accounted for more than 65% of all mosquitoes collected and was the most common species collected from human baits. The results of this study show that endemic areas of malaria in Lao PDR are not necessarily related to forest. Rather, An. nivipes is suspected to be the most important vector.     

Evaluation of Diagnos Malaria Stix test (antigen detection assay) for diagnosis of malaria

Malaria is one of the most common parasitic infection in India. The diagnosis largely depends on peripheral blood smear examination. Newer diagnostic methods like various antigen detection assays are now in use for prompt diagnosis and treatment. This study was done to determine the effectiveness of Diagnos Malaria Stix (antigen detection) assay in diagnosis of malaria. This involves detection of PfHRP-2 antigen and P.V. specific pLDH antigen. 162 patients with signs and symptoms of malaria included in the study. Leishman stained blood smear examination was done for all patients. Commercially available Diagnos Malaria Stix assay was used. Diagnos Malaria Stix showed sensitivity, specificity positive and negative predictive values of 100% each while Sensitivity, specificity, positive and negative predictive values of Leishman stained blood smear examination were 45.45%, 100%, 100% and 92% respectively.     

Natural infectivity of Anopheles species from the Pacific and Atlantic Regions of Colombia

Malaria is an important public health problem in Colombia. Among the major vectors in Colombia, Anopheles albimanus is recognized for its importance on the Pacific Coast where it is the predominant species; it is also found in the Atlantic Coast, although its vectorial role in this region is not clear. We examined the occurrence of An. albimanus in four localities of the Pacific and three of the Atlantic Coast. Morphological identification of problematic specimens was confirmed by a molecular assay. All identified mosquitoes at these sites, including An. albimanus, were also tested for malaria parasite infection. From 12,189 anophelines collected, 6370 were from the Pacific Coast, and corresponded to 99% An. albimanus, 0.8% Anopheles neivai, and three other species at <0.2%. From the Atlantic Coast we identified 5819 specimens with 61% An. albimanus, 36% Anopheles triannulatus s.l. and five other species at <2%. In both coasts, species present at lower percentages included several incriminated as vectors in neighboring countries. Six Pacific Coast specimens were infected with malaria parasites: four An. albimanus, two with Plasmodium vivax VK247, one with P. vivax VK210 and one with Plasmodium falciparum; two An. neivai with P. falciparum. Our data support the continued predominance of An. albimanus in the Pacific Coast, and demonstrate that this species is the most abundant in the Atlantic Coast as well.     

ELISA检测云南按蚊环子孢子蛋白的评价

目的　采用酶联免疫吸附测定(ELISA)技术检测疟疾媒介按蚊环子孢子蛋白(CSP),评价ELISA用于云南疟疾媒介按蚊传疟效能调查的可行性。　方法　现场捕获疟疾媒介按蚊经产蚊,每只蚊镜检3叶唾腺子孢子感染率,ELISA检测另3叶唾腺CSP;用含间日疟原虫配子体的患者血人工喂饲微小按蚊,11d后同法镜检唾腺子孢子感染率及ELISA检测唾腺CSP。在种植场捕获8种按蚊(微小按蚊、中华按蚊、多斑按蚊、迷糊按蚊、可赫按蚊、带足按蚊、菲律宾按蚊和须喙按蚊 )各龄成蚊,ELISA检测唾腺CSP。　结果　①现场捕获经产蚊1010只,镜检唾腺子孢子阳性7只,阳性率为0.69%;ELISA检测唾腺CSP阳性8只,阳性率为0.79%;其中6只蚊两项检测均为阳性,阳性率为0.59%。两法比较,差异无显著性意义(P>0.05)。②人工感染36只微小按蚊,镜检唾腺子孢子阳性27只,阳性率为75.0%;ELISA检测唾腺CSP阳性29只,阳性率为80.6%;其中有26只蚊两项检测(Pv2 10CSP)均阳性,阳性率为72.2%。两法比较,差异无显著性意义(P>0.05)。③种植场捕获8种按蚊各龄成蚊4675只,ELISA检测唾腺CSP阳性11只,阳性率为0.24%;其中Pv210阳性9只,Pf2A10阳性2只;微小按蚊、中华按蚊和多斑按蚊ELISA检测阳性     

Effect of rice cultivation on malaria transmission in central Kenya

A 12-month field study was conducted between April 2004 and March 2005 to determine the association between irrigated rice cultivation and malaria transmission in Mwea, Kenya. Adult mosquitoes were collected indoors twice per month in three villages representing non-irrigated, planned, and unplanned rice agro-ecosystems and screened for blood meal sources and Plasmodium falciparum circumsporozoite proteins. Anopheles arabiensis Patton and An. funestus Giles comprised 98.0% and 1.9%, respectively, of the 39,609 female anophelines collected. Other species including An. pharoensis Theobald, An. maculipalpis Giles, An. pretoriensis Theobald, An. coustani Laveran, and An. rufipes Gough comprised the remaining 0.1%. The density of An. arabiensis was highest in the planned rice village and lowest in the non-irrigated village and that of An. funestus was significantly higher in the non-irrigated village than in irrigated ones. The human blood index (HBI) for An. arabiensis was significantly higher in the non-irrigated village compared with irrigated villages. For An. funestus, the HBI for each village differed significantly from the others, being highest in the non-irrigated village and lowest in the planned rice village. The sporozoite rate and annual entomologic inoculation rate (EIR) for An. arabiensis was 1.1% and 3.0 infective bites per person, respectively with no significant difference among villages. Sporozoite positive An. funestus were detected only in planned rice and non-irrigated villages. Overall, 3.0% of An. funestus samples tested positive for Plasmodium falciparum sporozoites. The annual EIR of 2.21 for this species in the non-irrigated village was significantly higher than 0.08 for the planned rice village. We conclude that at least in Mwea Kenya, irrigated rice cultivation may reduce the risk of malaria transmission by An. funestus but has no effect on malaria transmission by An. arabiensis. The zoophilic tendency of malaria vectors in irrigated areas accounts partly for low malaria transmission rates despite the presence of higher vector densities, highlighting the potential of zooprophylaxis in malaria control.     

Malaria in displaced persons along the Thai-Burmese border

Malaria epidemiology in displaced Karen ethnic children along the Thai-Burmese (Myanmar) border was observed for 3 years. An active screening process in connection with malaria chemoprophylaxis trials showed a decrease in malaria prevalence over time in children not receiving chemoprophylaxis. The number of malaria cases detected at a primary health care clinic in the same area remained stable.     

The impact of a small-scale irrigation scheme on malaria transmission in Ziway area, Central Ethiopia

Objective To assess the impact of a small‐scale irrigation scheme in Ziway area, a semi‐arid area in the Central Ethiopian Rift Valley, on malaria transmission. Method Parasitological, entomological and socio‐economic studies were conducted in a village with and a village without irrigation. Blood smear samples were taken from individuals during the dry and wet seasons of 2005/2006. Socio‐economic data were collected from household heads and key agricultural and health informants through interviews and questionnaires. Larval and adult mosquitoes were sampled during the dry and short wet seasons of 2006. Female anopheline mosquitoes were tested by enzyme‐linked immunosorbent assay for blood meal sources and sporozoite infections. Results Malaria prevalence was higher in the irrigated village (19%, P < 0.05) than the non‐irrigated village (16%). In the irrigated village, malaria prevalence was higher in the dry season than in the wet season while the reverse occurred in the non‐irrigated village. Households with access to irrigation had larger farm land sizes and higher incomes, but also higher prevalence of malaria. Larval and adult abundance of the malaria vectors, Anopheles arabiensis and Anopheles pharoensis, was higher in the irrigated than in the non‐irrigated village throughout the study period. Furthermore, the abundance of An. pharoensis was significantly higher than that of An. arabiensis during the dry irrigated period of the year. Canal leakage pools, irrigated fields and irrigation canals were the major breeding habitats of the two vector mosquitoes. Plasmodium falciparum sporozoite infection rates of 1.18% and 0.66% were determined for An. arabiensis and An. pharoensis in the irrigated village. Peak biting activities of the vectors occurred before 22:00 h, which is a source of concern that the effectiveness of ITNs may be compromised as the mosquitoes feed on blood before people go to bed. Conclusion Irrigation schemes along the Ethiopian Rift Valley may intensify malaria by increasing the level of prevalence during the dry season. To reduce the intensity of malaria transmission in the small‐scale irrigation schemes currently in operation in Ethiopia, year‐round source reduction by using proper irrigation water management, coupled with health education, needs to be incorporated into the existing malaria control strategies.     

Investigation of malaria sporozoites by immunoradiometric assay

Two-site immunoradiometric assay (IRMA) (Zavala et al., 1982) using monoclonal antibodies to P. falciparum and P. vivax was applied to detect sporozoites in laboratory-maintained An. dirus and also mosquitoes collected from endemic areas of malaria in Thailand. Study in P. falciparum infected mosquitoes revealed that the circumsporozoite (CS) antigen was first found in the abdominal portion on day 10 post-infection, while it could be observed in the salivary glands from day 15 onwards. The head-thorax portion of wild-caught mosquitoes were investigated by IRMA compared with the dissection technique. The results showed that none of the mosquitoes collected from Phrae was positive for malaria. The mosquitoes collected from Chantaburi showed 4 out of 1243 An. dirus that were positive for P. falciparum by IRMA, with sporozoites ranging from 207 to 3875. Among 3123 An. minimus collected from Kanchanaburi, 3 were positive by IRMA, 2 for P. falciparum and one P. vivax with sporozoites found in head-thorax portion were 1880, 2380 and 1026 respectively. Not a single sporozoite was found in the mosquitoes collected from these areas by the dissection technique. However 7 out of 1219 An. minimus from Kanchanaburi were found to possess undeveloped oocysts in the stomach wall. It is evident that the IRMA is efficient, convenient and suitable for the investigation of sporozoites in this region. The application of this technique in further epidemiological study of malaria is in progress.     

High frequency of genetic diversity of Plasmodium vivax field isolates in Myanmar

Malaria is one of the most serious problems threatening human health in Myanmar. Although the morbidity and mortality rates due to malaria have been gradually declining, Myanmar still contributes to a large proportion of malarial death in the South-East Asia region. However, little is known about the nature and extent of genetic diversity of the malarial parasites circulating in Myanmar. In this study, we investigated the overall infection status of Plasmodium and the population diversity of Plasmodium vivax by analyzing three genetic markers, circumsporozoite protein (CSP), merozoite surface protein-1 (MSP-1), and merozoite surface protein-3 (MSP-3α), of P. vivax field isolates collected from infected individuals. In 349 blood samples collected from the individuals who exhibited clinical symptoms associated with malaria, 63.0% showed a positive result for malaria (220/349). P. vivax was detected in 58.2% (128/220) and Plasmodium falciparum was detected in 29.1% (64/220). Mixed infections with both parasites were detected in 12.7% (28/220). The 116 blood samples in which single infection of P. vivax was confirmed were selected and subjected to further genetic analysis. Genotyping of the CSP gene of P. vivax showed that VK210 type (98.3%, 114/116) is predominant in Myanmar, but a significant level of mixed infections of VK210 and VK247 types (24.1%, 28/116) was also identified. Sequence analyses of MSP-1 and MSP-3α genes revealed a large number of distinguishable alleles: 12 for MSP-1 and 25 for MSP-3α. These results collectively suggest that the P. vivax population in Myanmar is highly diverse and multiple clonal infections are prevalent in the country.     

Eco-epidemiological characteristics of an unstable peri-urban focus of falciparum malaria

Two fever surveys were carried out in Shahbad dairy, Delhi in the post-monsoon months of October and November, 1996. Shahbad dairy is a peri-urban locality in the northern periphery of Delhi. The prevalence of fever was found to be 11.6% in October and 2% in November. In the two surveys a total of 21 (28%) fever cases were found infected with malaria (17 with P. falciparum and 4 with P. vivax). The prevalence of malaria in the surveyed population was lower (25%) in October than in November (36.8%). More adults and males suffered from malaria than other age groups and the females. In November the mean asexual parasitaemia, for P. falciparum infection, sharply declined among 5-14-years old children by 68%, but among adults it increased by 32%. Collection of adult mosquitoes, from human houses, revealed the presence of 5 species of anopheline mosquitoes comprising Anopheles culicifacies, An. stephensi, An. annularis, An. subpictus, and An. nigerrimus, and a culicine mosquito Culex vishnui complex. Extensive breeding of these mosquitoes was detected in the vicinity of Shahbad dairy. Characteristic ecological support system (ESS) for malaria transmission was identified at the peri-urban focus of Shahbad dairy.     

Evidence for transmission of Plasmodium vivax among a duffy antigen negative population in Western Kenya.

We present evidence that a parasite with characteristics of Plasmodium vivax is being transmitted among Duffy blood group-negative inhabitants of Kenya. Thirty-two of 4,901 Anopheles gambiae and An. funestus (0.65%) collected in Nyanza Province were ELISA positive for the P. vivax circumsporozoite protein VK 247. All positives were found late in the rainy season, when An. funestus predominated, and disproportionately many were found at a single village. A P. vivax specific sequence of the SSU rRNA gene was amplified from three of six ELISA-positive mosquitoes. Erythrocytes from 31 children, including 9 microscopically diagnosed as infected with P. vivax, were negative by flow cytometry for the Fy3 or Fy6 epitopes, which indicate Duffy blood group expression. A DNA fragment specific for the C terminus of the gene for P. vivax merozoite surface protein 1 (MSP-1) was amplified from the blood of four of these children and subsequently sequenced from two.     

发作期与间歇期间日疟原虫在不同按蚊体内发育差异的研究

目的  比较临床发作期与间歇期间日疟原虫在中华按蚊和嗜人按蚊体内发育的差异。方法在我国间日疟流行区分别采集临床发作期与间歇期间日疟病例的血样，采用体外人工膜饲感染系统在实验室同时体外人工感染中华按蚊和嗜人按蚊，在感染后7～9 d和14 d分别解剖蚊胃和唾液腺，并检测蚊体内的卵囊和子孢子数。结果临床发作期间日疟原虫感染中华按蚊的卵囊阳性率和阳性蚊比率、子孢子阳性蚊比率和感染度均低于间歇期间日疟原虫感染，临床发作期间日疟原虫感染嗜人按蚊的子孢子阳性率、阳性蚊比率和卵囊阳性蚊比率均低于间歇期间日疟原虫感染，而子孢子感染度则高于间歇期疟原虫感染。结论临床发作期与间歇期间日疟原虫体外人工感染中华按蚊、嗜人按蚊卵囊和子孢子有差异     

Seasonal density, sporozoite rates and entomological inoculation rates of Anopheles gambiae and Anopheles funestus in a high-altitude sugarcane growing zone in western kenya

Summary An entomological study was conducted on vectors of malaria and their relative contribution to Plasmodium falciparum transmission in Mumias, a high-altitude site and large-scale sugarcane growing zone in Kakamega district, western Kenya. Anopheles gambiae s. l ., the predominant vector species, represented 84% ( n = 2667) of the total Anopheles mosquitoes collected with An. funestus comprising only 16%. Polymerase chain reaction (PCR) identified all 600 specimens of the An. gambiae complex tested as An. gambiae sensu stricto , an indication that it is the only sibling species represented in the high-altitude sites in western Kenya. Plasmodium falciparum sporozoite rates of 6.3% (133/2118) for An. gambiae s.l . and 9.5% (38/402) for An. funestus by ELISA were obtained in Mumias. None of 1600 mosquitoes tested for P. malariae sporozoites was positive. ELISA tests of mosquito blood meals indicated a high tendency of anthropophagy, a behaviour contributing significantly to malaria transmission by the vector species, with 95.9%, 4.86% and 0.2% having taken at least one blood meal on human, bovine and avian hosts, respectively.  Malaria transmission intensity was low as revealed by the low entomological inoculation rates (EIR) recorded. The EIR values for An. gambiae s.l . were 29.2 infective bites per person per year (ib/p/year) and 17.5 ib/p/year for An. funestus in Mumias. The highest inoculation rate for both vector species was 7.0 ib/p/month in July. Plasmodium falciparum parasite rate among asymptomatic children was 55.4% and 44% in the wet (July–September) and dry (December–February) seasons, respectively. These results indicate that malaria transmission intensity in the high-altitude site is low but perennial, with transmission being maintained by An. gambiae s.s . and An. funestus .     

Informed decision-making before changing to RDT: a comparison of microscopy, rapid diagnostic test and molecular techniques for the diagnosis and identification of malaria parasites in Kassala, eastern Sudan

Objectives Rapid diagnostic tests (RDTs) are promoted for the diagnosis of malaria in many countries. The question arises whether laboratories where the current method of diagnosis is microscopy should also switch to RDT. This problem was studied in Kassala, Sudan where the issue of switching to RDT is under discussion. Methods Two hundred and three blood samples were collected from febrile patients suspected of having malaria. These were subsequently analysed with microscopy, RDT (SD Bioline P.f/P.v) and PCR for the detection and identification of Plasmodium parasites. Results Malaria parasites were detected in 36 blood samples when examined microscopically, 54 (26.6%) samples were found positive for malaria parasites by RDT, and 44 samples were positive by PCR. Further analysis showed that the RDT used in our study resulted in a relatively high number of false positive samples. When microscopy was compared with PCR, an agreement of 96.1% and k = 0.88 (sensitivity 85.7% and specificity 100%) was found. However, when RDT was compared with PCR, an agreement of only 81.2 and k = 0.48 (sensitivity 69% and specificity 84%) was found. Conclusion PCR has proven to be one of the most specific and sensitive diagnostic methods, particularly for malaria cases with low parasitaemia. However, this technique has limitations in its routine use under resource‐limited conditions, such as our study location. At present, based on these results, microscopy remains the best option for routine diagnosis of malaria in Kassala, eastern Sudan.