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Contains fulltext : 153165.pdf (Publisher’s version ) (Open Access) Direct skin feeding experiments are sensitive assays to determine human infectiousness to mosquitoes but are rarely used in malaria epidemiological surveys. We determined the infectiousness of inhabitants of a malaria hypoendemic area in Senegal. Gametocyte prevalence by microscopy was 13.5% (26 of 192). Of all individuals who were gametocyte positive, 44.4% (11 of 25) infected >/= 1 Anopheles arabiensis mosquito and 10.8% (54 of 500) of mosquitoes became infected. Of all individuals who were gametocyte negative by microscopy, 4.3% (7 of 162) infected >/= 1 mosquito and 0.4% (12 of 3240) of mosquitoes became infected. The 18.2% (12 of 66) of all mosquito infections was a result of submicroscopic gametocyte carriage and two individuals without asexual parasites or gametocytes by microscopy were infectious to mosquitoes. When infectivity and local demography was taken into account, children 5-14 years of age contributed 50.8% of the human infectious reservoir for malaria. Adults and submicroscopic gametocyte carriers may contribute considerably to onward malaria transmission in our setting.

Larviciding to control malaria was assessed in rural areas with extensive seasonal flooding. Larval and adult mosquitoes and malaria incidence were surveyed routinely in four 100-km(2) areas either side of the Gambia River. Baseline data were collected in 2005. Microbial larvicide was applied to all water bodies by hand application with water-dispersible granular formulations and corn granules weekly from May to November in two areas in 2006 and in the other two areas in 2007 in a cross-over design. The intervention was associated with a reduction in habitats with late stage anopheline larvae and an 88% reduction in larval densities (P < 0.001). The effect of the intervention on mosquito densities was not pronounced and was confounded by the distance of villages to the major breeding sites and year (P = 0.002). There was no reduction in clinical malaria or anemia. Ground applications of non-residual larvicides with simple equipment are not effective in riverine areas with extensive flooding, where many habitats are poorly demarcated, highly mobile, and inaccessible on foot.

In a randomized controlled trial, chloroquine monotherapy was compared with the combination of artesunate and chloroquine for treating uncomplicated Plasmodium falciparum malaria in 536 Gambian children. Chloroquine-treated children exhibited a 28-day clinical failure rate of 15% (95% confidence interval [CI] = 9.2-22%) compared with 11% (7.8-15%) among children receiving the combination (P = 0.08, by Wilcoxon test). Seventy-three percent of chloroquine-treated children exhibited parasitemia during follow-up compared with 49% of children receiving the combination (relative risk = 1.5, 95% CI = 1.3-1.7; chi2 = 21.18, P < 0.001). A significant reduction in clinical and parasitologic treatment failure in the combination group occurred in the first two weeks following treatment, but this was eroded over weeks three and four of follow-up. The impact of combination therapy on the transmission of chloroquine-resistant parasites is discussed. Chloroquine plus artesunate is not sufficiently efficacious to justify its introduction as a replacement for chloroquine monotherapy in The Gambia.