Africa Health and Development International

Despite the significant impact of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) on malaria, 597,000deaths from malaria were still recorded in 2023. Additional measures are clearly needed to complement current tools. We assessed the efficacy of insecticide-treated window screens (a piece of PermaNet 3.0 containing deltamethrin + piperonyl butoxide) versus untreated window screening and eave tube inserts treated withβ-cyfluthrin as household interventions againstAnopheles gambiaesensu lato. Between August and October 2022, five experimental houses in Kolongonouan village, central Côte d'Ivoire, were used under semi-field conditions to evaluate the following interventions: (i) standard control house with small openings in the eaves and no window screens (SCH); (ii) insecticide-treated screening (ITS) of windows with small openings in the eaves (ITS op); (iii) ITS of windows with eaves blocked to prevent mosquito entry via eaves (ITS blq); (iv) insecticide treatment applied to the eaves using In2Care eave tubes, without window screening (ET); and (v) untreated window screening together with insecticide-treated eave tubes (SET). The efficacy of these treatments on the indoor and outdoor density of naturally recruiting Anopheles gambiae mosquitoes was assessed by human landing catches from 6:00pm to 8:00am. The impact of these treatments on mosquito mortality and blood-feeding rates was further assessed using release-recapture experiments, in which large enclosures were built around individual houses and approximately 100 non-blood-fed femaleAn. gambiae were released each night over 15 nights. In addition, for the ITS blq treatment, the importance of physical integrity was assessed by evaluating the effect of damaging the screening with two or four 4cm × 4cm holes in each screened window. Insecticide-treated window screening plus eave blocking (ITS blq) significantly reduced by 31.8% the number of An. gambiae entering houses overnight relative to standard control houses (SCH) (P < 0.001). The use of untreated screening + eave tubes (SET) induced a similar reduction (27.0%, P < 0.001). The house entry reduction magnitude for eave tubes alone (ET) was lower (23.5%), though it remained significant relative to the control (P < 0.001). The impact of the ITS op (insecticide-treated window screening with open eaves) was lower and nonsignificant (18.1%; P = 0.4019). There were no significant differences in house entry rates between ET, ITS blq, and ITS op (P > 0.05). The peak in mosquito abundance within houses occurred between 11:00pm and 3:00am. There were no significant differences between treatments in the numbers of mosquitoes collected outdoors. In the release-recapture experiments, all treatments significantly reduced the blood-feeding rate and increased the mortality of An. gambiae, with again a similar impact for ITS blq and SET. Damaging the ITS with two holes still led to a significant reduction in blood-feeding rate, but protection was lost with four holes. Mortality rate also declined with increasing levels of damage, although it remained significantly higher than that with the untreated window screening. This study demonstrated that the combination (insecticide-treated window screening and blocking of eave access) reduced mosquito entry, increased mortality, and lowered blood-feeding rates of An. gambiae to levels comparable to insecticide-treated eave tubes combined with untreated window screening (SET). A previous cluster randomized controlled trial of SET in this area demonstrated a significant reduction in malaria incidence and prevalence. Insecticide-treated window screens could therefore yield a similar epidemiological impact while potentially being simpler and less expensive to implement. Larger-scale epidemiological trials involving communities are needed to test this assumption and further optimize the approach.

IntroductionPatients receiving antiretroviral therapy (ART) require routine monitoring to track response to treatment and assess for treatment failure. This study aims to identify gaps in monitoring practices in Kenya and Uganda.MethodsWe conducted a systematic retrospective chart review of adults who initiated ART between 2007 and 2012. We assessed the availability of baseline measurements (CD4 count, weight, and WHO stage) and ongoing CD4 and weight monitoring according to national guidelines in place at the time. Mixed-effects logistic regression models were used to analyze facility and patient factors associated with meeting monitoring guidelines.ResultsFrom 2007 to 2012, at least 88% of patients per year in Uganda had a recorded weight at initiation, while in Kenya there was a notable increase from 69% to 90%. Patients with a documented baseline CD4 count increased from 69% to about 80% in both countries. In 2012, 83% and 86% of established patients received the recommended quarterly weight monitoring in Kenya and Uganda, respectively, while semiannual CD4 monitoring was less common (49% in Kenya and 38% in Uganda). Initiating at a more advanced WHO stage was associated with a lower odds of baseline CD4 testing. On-site CD4 analysis capacity was associated with increased odds of CD4 testing at baseline and in the future.DiscussionSubstantial gaps were noted in ongoing CD4 monitoring of patients on ART. Although guidelines have since changed, limited laboratory capacity is likely to remain a significant issue in monitoring patients on ART, with important implications for ensuring quality care.

At present, malaria rapid diagnostic tests (RDTs) are widely available and used in parts of Asia and Latin America. In Africa, their use has been limited mainly to private health facilities. With the adoption of artemisinin combination therapies (ACTs) by most African countries as first line treatment for malaria, an effective, but expensive treatment is available, and the case for an expanded role for rapid diagnostics in the fight against malaria is clear. Despite this perceived potential role for RDTs, some challenges hinder their introduction and scale-up in the public health sector. Among the requirements are significant investments in policy development, training, infrastructure, and supply chain and quality assurance systems. African Journal of Health Sciences Vol. 14 (3-4) 2007: pp. 114-117

Community-based reproductive health services (CBRHS) have been in implementation in Ethiopia for over a decade. This paper assesses the impact of such programmes on contraceptive use. The data were obtained from the 2000 Ethiopian Demographic and Health Survey (DHS) and the 2003 Contraceptive Prevalence Survey (CPS). While the 2000 DHS contained a nationally representative random sample of women of reproductive age, the 2003 CPS focused on areas with active CBRHS programmes. The findings indicate that expanding the current CBRHS programme has the potential of doubling the current national contraceptive prevalence rate.