Evaluating indoor residual spray for reducing malaria infection prevalence in Eritrea: results from a community randomized control trial.

This paper examines the relationship between indoor residual spray (IRS) and malaria parasite infection in Gash Barka Zone, Eritrea, an area with near universal coverage of insecticide treated bednets (ITN) and already low malaria parasite prevalence. A community randomized control trial was conducted in 2009. Malaria parasite infection prevalence was 0.

Costs and cost-effectiveness of vector control in Eritrea using insecticide-treated bed nets.

Background: While insecticide-treated nets (ITNs) are a recognized effective method for preventing malaria, there has been an extensive debate in recent years about the best large-scale implementation strategy. Implementation costs and cost-effectiveness are important elements to consider when planning ITN programmes, but so far little information on these aspects is available from national programmes.

Methods: This study uses a standardized methodology, as part of a larger comparative study, to collect cost data and cost-effectiveness estimates from a large programme providing ITNs at the community level and ante-natal care facilities in Eritrea.

Costs and consequences of large-scale vector control for malaria.

Background: Five large insecticide-treated net (ITN) programmes and two indoor residual spraying (IRS) programmes were compared using a standardized costing methodology.

Methods: Costs were measured locally or derived from existing studies and focused on the provider perspective, but included the direct costs of net purchases by users, and are reported in 2005 USD. Effectiveness was estimated by combining programme outputs with standard impact indicators.

Effectiveness of malaria control during changing climate conditions in Eritrea, 1998-2003.

Objective: To assess the effectiveness of impregnated mosquito nets, indoor residual spraying and larval control relative to the impacts of climate variability in the decline of malaria cases in Eritrea.

Methods: Monthly data on clinical malaria cases by subzoba (district) in three zobas (zones) of Eritrea for 1998-2003 were used in Poisson regression models to determine whether there is statistical evidence for reduction in cases by DDT, malathion, impregnated nets and larval control used over the period, while analysing the effects of satellite-derived climate variables in the same geographic areas.

Results: Both indoor residual spraying (with DDT or malathion) and impregnated nets were independently and significantly negatively associated with reduction in malaria cases, as was larval control in one zoba.

Malaria stratification, climate, and epidemic early warning in Eritrea.

Eritrea has a successful malaria control program, but it is still susceptible to devastating malaria epidemics. Monthly data on clinical malaria cases from 242 health facilities in 58 subzobas (districts) of Eritrea from 1996 to 2003 were used in a novel stratification process using principal component analysis and nonhierarchical clustering to define five areas with distinct malaria intensity and seasonality patterns, to guide future interventions and development of an epidemic early warning system. Relationships between monthly clinical malaria incidence by subzoba and monthly climate data from several sources, and with seasonal climate forecasts, were investigated.

Mosquito larval habitats in a semiarid ecosystem in Eritrea: impact of larval habitat management on Anopheles arabiensis population.

This study investigated the impact of larval management and the temporal variation in larval productivity in Eritrea, a semiarid ecosystem. Results of this study show that mosquito breeding persists throughout the year mainly in stream bed pools. Anopheles arabiensis production in the ephemeral natural aquatic habitats such the streambed pools was high throughout the year and negatively associated with rainfall (r = -0.

Rolling out insecticide treated nets in Eritrea: examining the determinants of possession and use in malarious zones during the rainy season.

Objective: This paper describes determinants of insecticide treated net (ITN) ownership and use in malarious areas of Eritrea. With ITN distribution and re-treatment now free for all living in these areas, we examine barriers (other than cost) to access and use of ITNs. We explore the differences between use of an ITN as a proportion of all households in the survey (the roll back malaria indicator), and use of an ITN as a proportion of those households who already own an ITN.

Interpreting household survey data intended to measure insecticide-treated bednet coverage: results from two surveys in Eritrea.

Background: As efforts are currently underway to roll-out insecticide-treated bednets (ITNs) to populations within malarious areas in Africa, there is an unprecedented need for data to measure the effectiveness of such programmes in terms of population coverage. This paper examines methodological issues to using household surveys to measure core Roll Back Malaria coverage indicators of ITN possession and use.

Methods: ITN coverage estimates within Anseba and Gash Barka Provinces from the 2002 Eritrean Demographic and Health Survey, implemented just prior to a large-scale ITN distribution programme, are compared to estimates from the same area from a sub-national Bednet Survey implemented 18 months later in 2003 after the roll-out of the ITN programme.

Malaria prevalence and associated risk factors in Eritrea.

A parasitological cross-sectional survey was undertaken from September 2000 through February 2001 to estimate the prevalence of malaria parasitemia in Eritrea. A total of 12,937 individuals from 176 villages were screened for both Plasmodium falciparum and Plasmodium vivax parasite species using the OptiMal Rapid Diagnostic Test. Malaria prevalence was generally low but highly focal and variable with the proportion of parasitemia at 2.

Seasonal abundance, vector behavior, and malaria parasite transmission in Eritrea.

Entomological studies were conducted over a 24-month period in 8 villages to establish the behavior patterns, seasonal densities, and variation in entomological inoculation rates (EIRs) of Anopheles arabiensis, the main vector of malaria in Eritrea. A total of 5,683 anopheline mosquitoes were collected through indoor sampling (1,613), human-landing catches (2,711), and outdoor pit shelters (1,359). Overall, An.

Larval habitat diversity and ecology of anopheline larvae in Eritrea.

Studies on the spatial distribution of anopheline mosquito larvae were conducted in 302 villages over two transmission seasons in Eritrea. Additional longitudinal studies were also conducted at eight villages over a 24-mo period to determine the seasonal variation in anopheline larval densities. Eight anopheline species were identified with Anopheles arabiensis predominating in most of the habitats.

High seasonal variation in entomologic inoculation rates in Eritrea, a semi-arid region of unstable malaria in Africa.

Entomologic studies were conducted in eight villages to investigate the patterns of malaria transmission in different ecologic zones in Eritrea. Mosquito collections were conducted for 24 months between September 1999 and January 2002. The biting rates of Anopheles arabiensis were highly seasonal, with activity concentrated in the wet season between June and October in the highlands and western lowlands, and between December and March in the coastal region.

Distribution of anopheline mosquitoes in Eritrea.

The spatial distribution of anopheline mosquito species was studied throughout Eritrea during the 1999-2001 malaria transmission seasons from October to December for the highlands and western lowlands and February to April for the coastal region. Of the 302 villages sampled, 59 were visited in both the first and second year. Overall, 13 anopheline species were identified, with the Anopheles gambiae complex predominating during the first year (75.