bims-mosdis Biomed News
on Mosquito distribution and disease
Issue of 2022‒08‒21
fourteen papers selected by
Richard Halfpenny
Staffordshire University
  1. Surveillance of Zika and Dengue viruses in field-collected Aedes aegypti mosquitoes from different states of India.
  2. Larval Anopheles Species Composition and Diversity at Different Habitats and Seasons of Gondar Zuria District, Ethiopia.
  3. Integrated Forecasts Based on Public Health Surveillance and Meteorological Data Predict West Nile Virus in a High-Risk Region of North America.
  4. Multiple Novel Clades of Anopheline Mosquitoes Caught Outdoors in Northern Zambia.
  5. Control methods for Aedes aegypti: Have we lost the battle?
  6. Vectorial capacities for malaria in eastern Amazonian Brazil depend on village, vector species, season, and parasite species.
  7. Quantitative Trait Locus Determining the Time of Blood Feeding in Culex pipiens (Diptera: Culicidae).
  8. West Nile virus: another emerging arboviral risk for travelers?
  9. Asymptomatic and low-density Plasmodium infections in India: an unexplored link.
  10. The Relationship between Vector Species Richness and the Risk of Vector-Borne Infectious Diseases.
  11. A cross-sectional study to assess the epidemiological situation and associated risk factors of dengue fever; knowledge, attitudes, and practices about dengue prevention in Khyber Pakhtunkhwa Province, Pakistan.
  12. Spatiotemporal mapping of malaria incidence in Sudan using routine surveillance data.
  13. West Nile Virus Seroprevalence and Cross-Neutralization in Sera from Eastern and Central Sudan.
  14. Epidemiology of malaria and anemia in high and low malaria-endemic North-Eastern districts of India.
  1. Virology. 2022 Aug 06. pii: S0042-6822(22)00109-X. [Epub ahead of print]574 96-101
    Surveillance of Zika and Dengue viruses in field-collected Aedes aegypti mosquitoes from different states of India.
    Nasreen Akhtar, Sanjeev Kumar Gupta, Himmat Singh.
      The emergence of Zika created a panic situation worldwide and burdened the public health system of the affected countries. In India, Zika outbreak occurred in 2017 and in July 2021 one laboratory-confirmed case was also reported in Kerala state. The study aimed to assess any positivity in field-collected mosquitoes for ZIKV and DENV during 2016-2021. Mosquito samples were received from 4 Zika affected citites, whereas samples were collected from Delhi. Out of 2346 pools, 4 pools for ZIKV, and 23 pools for DENV were found positive. ZIKV positive pools were from Shastri Nagar, Jaipur (2 pools), Rajpur Hotel, Jaipur (1 pool) and Kanpur (1 pool). Ten localities of Delhi were found positive for DENV. It was observed that the maximum positivity rate for both viruses were found in September-October. The active role of the vector in local transmission of ZIKV warrants regular surveillance and monitoring of Aedes vectors in India.
    Keywords:  DENV; Entomological surveillance; RT-PCR; ZIKV
    DOI:  https://doi.org/10.1016/j.virol.2022.07.004
  2. J Trop Med. 2022 ;2022 9767155
    Larval Anopheles Species Composition and Diversity at Different Habitats and Seasons of Gondar Zuria District, Ethiopia.
    Yelfwagash Asmare, Melaku Wale, Sualih Adem.
      Anopheles species' larval habitats are diversified and season dependent. Anopheles larvae can be found at different habitats and their preference may vary seasonally. Knowledge of species diversity and distribution helps plan malaria control interventions. Anopheles larvae were sampled using the WHO standard 350 ml dipper from breeding habitats of irrigation, pond, sewage, stream, and swamp. The collected sample larvae were identified microscopically to species using morphological keys. Among Anopheles species recorded, Anopheles gambiae complex was the most abundant followed by Anopheles christyi, Anopheles cinereus, Anopheles demeilloni, and Anopheles pharoensis in descending order. Anopheles species occurred more in January than in other months of the study period and less in March and April. For any particular mosquito species, larval abundance did not significantly vary between the habitats; in other words, all habitats contributed equally. In this study, we confirmed that Anopheles mosquito larval population varied more with respect to species than to habitats and months. Interventions could be launched targeting each habitat; during the month, numbers were high.
    DOI:  https://doi.org/10.1155/2022/9767155
  3. Environ Health Perspect. 2022 Aug;130(8): 87006
    Integrated Forecasts Based on Public Health Surveillance and Meteorological Data Predict West Nile Virus in a High-Risk Region of North America.
    Michael C Wimberly, Justin K Davis, Michael B Hildreth, Joshua L Clayton.
      BACKGROUND: West Nile virus (WNV), a global arbovirus, is the most prevalent mosquito-transmitted infection in the United States. Forecasts of WNV risk during the upcoming transmission season could provide the basis for targeted mosquito control and disease prevention efforts. We developed the Arbovirus Mapping and Prediction (ArboMAP) WNV forecasting system and used it in South Dakota from 2016 to 2019. This study reports a post hoc forecast validation and model comparison.OBJECTIVES: Our objective was to validate historical predictions of WNV cases with independent data that were not used for model calibration. We tested the hypothesis that predictive models based on mosquito surveillance data combined with meteorological variables were more accurate than models based on mosquito or meteorological data alone.
    METHODS: The ArboMAP system incorporated models that predicted the weekly probability of observing one or more human WNV cases in each county. We compared alternative models with different predictors including a) a baseline model based only on historical WNV cases, b) mosquito models based on seasonal patterns of infection rates, c) environmental models based on lagged meteorological variables, including temperature and vapor pressure deficit, d) combined models with mosquito infection rates and lagged meteorological variables, and e) ensembles of two or more combined models. During the WNV season, models were calibrated using data from previous years and weekly predictions were made using data from the current year. Forecasts were compared with observed cases to calculate the area under the receiver operating characteristic curve (AUC) and other metrics of spatial and temporal prediction error.
    RESULTS: Mosquito and environmental models outperformed the baseline model that included county-level averages and seasonal trends of WNV cases. Combined models were more accurate than models based only on meteorological or mosquito infection variables. The most accurate model was a simple ensemble mean of the two best combined models. Forecast accuracy increased rapidly from early June through early July and was stable thereafter, with a maximum AUC of 0.85. The model predictions captured the seasonal pattern of WNV as well as year-to-year variation in case numbers and the geographic pattern of cases.
    DISCUSSION: The predictions reached maximum accuracy early enough in the WNV season to allow public health responses before the peak of human cases in August. This early warning is necessary because other indicators of WNV risk, including early reports of human cases and mosquito abundance, are poor predictors of case numbers later in the season. https://doi.org/10.1289/EHP10287.
    DOI:  https://doi.org/10.1289/EHP10287
  4. Front Trop Dis. 2021 ;pii: 780664. [Epub ahead of print]2
    Multiple Novel Clades of Anopheline Mosquitoes Caught Outdoors in Northern Zambia.
    Southern Central Africa International Centers of Excellence for Malaria Research
      Residual vector populations that do not come in contact with the most frequently utilized indoor-directed interventions present major challenges to global malaria eradication. Many of these residual populations are mosquito species about which little is known. As part of a study to assess the threat of outdoor exposure to malaria mosquitoes within the Southern and Central Africa International Centers of Excellence for Malaria Research, foraging female anophelines were collected outside households in Nchelenge District, northern Zambia. These anophelines proved to be more diverse than had previously been reported in the area. In order to further characterize the anopheline species, sequencing and phylogenetic approaches were utilized. Anopheline mosquitoes were collected from outdoor light traps, morphologically identified, and sent to Johns Hopkins Bloomberg School of Public Health for sequencing. Sanger sequencing from 115 field-derived samples yielded mitochondrial COI sequences, which were aligned with a homologous 488 bp gene segment from known anophelines (n = 140) retrieved from NCBI. Nuclear ITS2 sequences (n = 57) for at least one individual from each unique COI clade were generated and compared against NCBI's nucleotide BLAST database to provide additional evidence for taxonomical identity and structure. Molecular and morphological data were combined for assignment of species or higher taxonomy. Twelve phylogenetic groups were characterized from the COI and ITS2 sequence data, including the primary vector species Anopheles funestus s.s. and An. gambiae s.s. An unexpectedly large proportion of the field collections were identified as An. coustani and An. sp. 6. Six phylogenetic groups remain unidentified to species-level. Outdoor collections of anopheline mosquitoes in areas frequented by people in Nchelenge, northern Zambia, proved to be extremely diverse. Morphological misidentification and underrepresentation of some anopheline species in sequence databases confound efforts to confirm identity of potential malaria vector species. The large number of unidentified anophelines could compromise the malaria vector surveillance and malaria control efforts not only in northern Zambia but other places where surveillance and control are focused on indoor-foraging and resting anophelines. Therefore, it is critical to continue development of methodologies that allow better identification of these populations and revisiting and cleaning current genomic databases.
    Keywords:  Anopheles; Zambia; malaria; mosquito; phylogenetics; residual transmission
    DOI:  https://doi.org/10.3389/fitd.2021.780664
  5. Travel Med Infect Dis. 2022 Aug 16. pii: S1477-8939(22)00174-0. [Epub ahead of print] 102428
    Control methods for Aedes aegypti: Have we lost the battle?
    Camila Lorenz, Francisco Chiaravalloti-Neto.
      The past twenty years have been a period of remarkable innovation in Aedes vector control, and several methods with varying success rates have been used. Here we discussed the main intervention categories of vector control applied nowadays and their main weaknesses. It is urgent to have more efficient design and management of control programs, and the requirement for studies to evaluate and compare methods must be prioritised. The world must better articulate actions and cooperate with other sectors beyond health; it is necessary to work together with managers and entomologists in action plans and adapt them to the condition of each region.
    Keywords:  Arboviruses; Dengue; Mosquito; Vaccine
    DOI:  https://doi.org/10.1016/j.tmaid.2022.102428
  6. Malar J. 2022 Aug 16. 21(1): 237
    Vectorial capacities for malaria in eastern Amazonian Brazil depend on village, vector species, season, and parasite species.
    Robert H Zimmerman, Allan K R Galardo, L Philip Lounibos, Clicia Galardo, A Kadir Bahar, Edzard van Santen.
      BACKGROUND: The vector species in the Amazon River Basin are regionally and locally diverse, which makes it imperative to understand and compare their roles in malaria transmission to help select appropriate methods of intervention and evaluation. The major aim of this study was to measure the vectorial capacity of five Anopheles species in three neighbouring villages, for two Plasmodium parasite species affecting humans.METHODS: From 32 consecutive months of sampling in three villages, 1.5-7.0 km apart, on the Matapi River, Amapá State, Brazil, vectorial capacities (C) were estimated as time series for An. darlingi, An. marajoara, An. nuneztovari, An. triannulatus, and An. intermedius. Monthly parity measurements for each vector species were used to estimate daily survivorship and compared to estimates of survivorship from mark-release-recapture experiments. Gonotrophic cycle lengths were estimated through a time-series analysis of parity data, and durations of sporogony at study site temperatures for the two malaria parasite species were estimated from previous literature.
    RESULTS: The absolute abundances of five vector species were strongly tracked by the spatial variation in C among villages. Temporally, C varied between wet and dry seasons, with An. darlingi, An. marajoara and An. triannulatus exhibiting higher C in the dry season from August to December, and An. nuneztovari its highest C early in the rainy season in January and February. Anopheles intermedius exhibited higher C in the rainy season from April to June than in the dry season. Significant differences in overall survival for each independent variable, and a significant difference in C between wet and dry seasons, among villages, and among vector species for both Plasmodium falciparum and Plasmodium vivax. A generalized linear mixed model (GLMM) analysis by village showed significant effects of vector species on C in only one village, but significant effects of parasite species in all three. Although the GLMM analysis detected no significant parasite x vector species interaction effects on C, effects on C of spline regressions of C dynamics x vector species interactions were significant in all villages.
    CONCLUSIONS: These detailed analyses of entomological and parasitological variables revealed hidden complexities of malaria epidemiology at local scales in neighbouring riverine villages of the Amazon Region.
    Keywords:  Amazon; Anopheles; Malaria; Vectorial capacity
    DOI:  https://doi.org/10.1186/s12936-022-04255-x
  7. J Med Entomol. 2022 Aug 17. pii: tjac118. [Epub ahead of print]
    Quantitative Trait Locus Determining the Time of Blood Feeding in Culex pipiens (Diptera: Culicidae).
    Paul V Hickner, Akio Mori, Samuel S C Rund, David W Severson.
      Mosquitoes and other blood feeding arthropods are vectors of pathogens causing serious human diseases, such as Plasmodium spp. (malaria), Wuchereria bancrofti (lymphatic filariasis), Borrelia burgdorferi (Lyme disease), and viruses causing dengue, Zika, West Nile, chikungunya, and yellow fever. Among the most effective strategies for the prevention of vector-borne diseases are those aimed at reducing human-vector interactions, such as insecticide applications and insecticide-treated bed nets (ITNs). In some areas where ITNs are widely used, behavioral adaptations have resulted in mosquitoes shifting their time of blood feeding to earlier or later in the night when the bed nets are not being employed. Little is known about the genetic basis of these behavioral shifts. We conducted quantitative trait locus (QTL) analysis using two strains of Culex pipiens sensu lato with contrasting blood feeding behaviors, wherein the lab adapted Shasta strain blood feeds at any time of the day or night, while the newly established Trinidad strain feeds only at night. We identified a single locus on chromosome 2 associated with the observed variation in feeding times. None of the core clock genes period, timeless, clock, cycle, PAR-domain protein 1, vrille, discs overgrown, cryptochrome 1, or cryptochrome 2 were located within the QTL region. We then monitored locomotor behavior to determine if they differed in their flight activity. The highly nocturnal Trinidad strain showed little daytime activity while the day-feeding Shasta strain was active during the day, suggesting blood feeding behavior and flight activity are physiologically linked.
    Keywords:  circadian rhythm; diel activity; locomotory behavior; sleep and wake cycle
    DOI:  https://doi.org/10.1093/jme/tjac118
  8. Curr Infect Dis Rep. 2022 Aug 04. 1-12
    West Nile virus: another emerging arboviral risk for travelers?
    Chinmay Jani, Loukas Kakoullis, Nour Abdallah, Christian Mouchati, Stephanie Page, Robert Colgrove, Lin H Chen.
      Purpose of Review: West Nile virus (WNV) is an arbovirus transmitted by mosquitos of the genus Culex. Manifestations of WNV infection range from asymptomatic to devastating neuroinvasive disease leading to flaccid paralysis and death. This review examines WNV epidemiology and ecology, with an emphasis on travel-associated infection.Recent Findings: WNV is widespread, including North America and Europe, where its range has expanded in the past decade. Rising temperatures in temperate regions are predicted to lead to an increased abundance of Culex mosquitoes and an increase in their ability to transmit WNV. Although the epidemiologic patterns of WNV appear variable, its geographic distribution most certainly will continue to increase. Travelers are at risk for WNV infection and its complications. Literature review identified 39 cases of documented travel-related WNV disease, the majority of which resulted in adverse outcomes, such as neuroinvasive disease, prolonged recovery period, or death.
    Summary: The prediction of WNV risk is challenging due to the complex interactions of vector, pathogen, host, and environment. Travelers planning to visit endemic areas should be advised regarding WNV risk and mosquito bite prevention. Evaluation of ill travelers with compatible symptoms should consider the diagnosis of WNV for those visiting in endemic areas as well as for those returning from destinations with known WNV circulation.
    Keywords:  Culex mosquito; Emerging infection; Epidemiology; Flavivirus; Imported; Neuroinvasive; One Health
    DOI:  https://doi.org/10.1007/s11908-022-00783-4
  9. Pathog Glob Health. 2022 Aug 18. 1-2
    Asymptomatic and low-density Plasmodium infections in India: an unexplored link.
    Gaurav Kumar, Hari Shankar, Shweta Pasi, Jaspreet Kaur.
      Presently in India, high endemic zones of malaria are shifting towards low endemic zones and in this changing scenario, tackling the asymptomatic and low-density infections (LDI) would be an important factor. Role of the asymptomatic and LDI in transmitting parasites successfully to mosquito vectors needs to be systematically investigated. We here highlight the limited work done on the burden of asymptomatic Plasmodium infections in India with an emphasis on its infectiousness, and infrastructure available for the detection of LDI. Studies reporting the threshold of gametocytes required for transmission of parasites are lacking for Indian malaria vectors. In the wake of malaria elimination target by 2030, specific point of care test is required to be developed for the detection of low density infections and/or asymptomatic patients. Also, mapping of asymptomatic malaria burden pan India and the role of LDI in vector infectivity would guide the way forward in achieving malaria elimination goal in India.
    Keywords:  Asymptomatic malaria; gametocyte density; low density infection; malaria elimination; mass drug administration; vector infectivity
    DOI:  https://doi.org/10.1080/20477724.2022.2113304
  10. Am Nat. 2022 Sep;200(3): 330-344
    The Relationship between Vector Species Richness and the Risk of Vector-Borne Infectious Diseases.
    Gaku Takimoto, Harumasa Shirakawa, Takuya Sato.
      AbstractInfectious diseases can impact human welfare and impede wildlife management. Much recent research explores whether biodiversity increases or decreases infectious disease risk. Here, we theoretically study the relationship between vector species richness and the risk of vector-borne diseases using an epidemiological model of a single host and multiple vectors. The model considers that vectors are involved in interspecific feeding interference that causes transmission interference and in interspecific recruitment competition that mediates susceptible vector regulation. The model reveals three possible shapes of the vector richness-disease risk relationship: monotonic amplification, hump-shaped, and monotonic dilution patterns. The monotonic amplification pattern occurs across a wide parameter region. The hump-shaped and monotonic dilution patterns are found when transmission interference is strong and recruitment competition is weak. Unexpectedly, susceptible vector regulation not only promotes dilution but can strengthen amplification if coupled with strong transmission interference. Our results suggest that vector richness might be more likely to cause amplification rather than dilution, and shifts in the community mean trait values of vectors could also affect disease risk along the vector richness gradient.
    Keywords:  amplification; biodiversity; dilution; pathogen; transmission; vector-borne disease
    DOI:  https://doi.org/10.1086/720403
  11. Front Public Health. 2022 ;10 923277
    A cross-sectional study to assess the epidemiological situation and associated risk factors of dengue fever; knowledge, attitudes, and practices about dengue prevention in Khyber Pakhtunkhwa Province, Pakistan.
    Jehangir Khan, Muhammad Adil, Gang Wang, Tsheten Tsheten, Dongjing Zhang, Wenjie Pan, Munir Ahmad Khan, Inayat Ur Rehman, Xiaoying Zheng, Zhongdao Wu, Yu Wu.
      Background: Dengue fever has been responsible for around 12 countrywide large outbreaks in Pakistan, resulting in 286,262 morbidities and 1,108 deaths. Khyber Pakhtunkhwa (KP) is the most recently impacted province. This study aimed to investigate the molecular, epidemiological, and potential elements that contribute to increasing dengue transmission patterns, and knowledge, attitude, and practice (KAP) toward dengue in KP province.Method: This cross-sectional community-based study was conducted (June-December, 2021) in two phases. Phase I involved the epidemiological (n = 5,242) and molecular analysis of DENV in 500 randomly collected blood samples of the 2021 dengue outbreak in KP. Phase II focused on assessing dengue-KAP levels in healthy communities (n = 14,745, aged >18 years), adopting a cross-sectional clustered multistage sampling in eight districts (dengue-hotspot vs. non-hotspot) of KP. Chi-square tests and logistic regression analysis were applied.
    Results: Peshawar district had the highest dengue cases (60.0%) associated with the predominant co-circulation of DENV-2 (45.8%) and DENV-3 (50.4%) serotypes. A rise in cases was reported in October (41.8%) followed by September (27.9%) and August (14.4%; p < 0.001). Males (63.7%, p < 0.001) and individuals aged 16-30 years (37.0%, p < 0.001) were highly affected. General workers (18.0%), families with a monthly income of 10,000-20,000 Pak rupees (50.5%), unmarried (71.0%), uneducated (31%), families with higher human density (>10 individuals per household), and those (29.0%) who faced power outages for more than 7/24 h were the most affected. Moreover, co-morbidities like renal failure and bronchial asthma were associated with disease severity. A community survey on KAP revealed that an average of 74, 60, and 43% of the participants demonstrated good knowledge, attitudes, and dengue preventive practices, respectively.
    Conclusion: Multiple poor socioeconomic elements are influencing dengue fever transmission in the province. Higher KAP levels may explain the low frequency of dengue in non-hotspot districts. Our study emphasizes the need for effective and long-term public health education, strengthened vector surveillance, and expanded laboratory capacity for better diagnosis and management of dengue cases to better predict the burden and seasonality of disease in the country.
    Keywords:  DENV; KAP; SES; epidemiology; serology
    DOI:  https://doi.org/10.3389/fpubh.2022.923277
  12. Sci Rep. 2022 Aug 18. 12(1): 14114
    Spatiotemporal mapping of malaria incidence in Sudan using routine surveillance data.
    Ahmed Elagali, Ayman Ahmed, Nada Makki, Hassan Ismail, Mark Ajak, Kefyalew Addis Alene, Daniel J Weiss, Abdalla Ahmed Mohammed, Mustafa Abubakr, Ewan Cameron, Peter Gething, Asmaa Elagali.
      Malaria is a serious threat to global health, with over [Formula: see text] of the cases reported in 2020 by the World Health Organization in African countries, including Sudan. Sudan is a low-income country with a limited healthcare system and a substantial burden of malaria. The epidemiology of malaria in Sudan is rapidly changing due to factors including the rapidly developing resistance to drugs and insecticides among the parasites and vectors, respectively; the growing population living in humanitarian settings due to political instability; and the recent emergence of Anopheles stephensi in the country. These factors contribute to changes in the distribution of the parasites species as well as malaria vectors in Sudan, and the shifting patterns of malaria epidemiology underscore the need for investment in improved situational awareness, early preparedness, and a national prevention and control strategy that is updated, evidence based, and proactive. A key component of this strategy is accurate, high-resolution endemicity maps of species-specific malaria. Here, we present a spatiotemporal Bayesian model, developed in collaboration with the Sudanese Ministry of Health, that predicts a fine-scale (1 km [Formula: see text] 1 km) clinical incidence and seasonality profiles for Plasmodium falciparum and Plasmodium vivax across the country. We use monthly malaria case counts for both species collected via routine surveillance between January 2017 and December 2019, as well as a suite of high-resolution environmental covariates to inform our predictions. These epidemiological maps provide a useful resource for strategic planning and cost-effective implementation of malaria interventions, thus informing policymakers in Sudan to achieve success in malaria control and elimination.
    DOI:  https://doi.org/10.1038/s41598-022-16706-1
  13. Vector Borne Zoonotic Dis. 2022 Aug 16.
    West Nile Virus Seroprevalence and Cross-Neutralization in Sera from Eastern and Central Sudan.
    Josephine Beier, Awadalkareem Adam, Christian Jassoy.
      Objectives: In regions with co-existing flaviviruses, the diagnosis of previous West Nile virus (WNV) infections is challenging due to cross-reacting antibodies. The aim of the study was to determine the frequency of previous WNV infections in sera from three Sudanese states by excluding potentially dengue virus (DENV) and ZIKV cross-reacting sera and to determine the percentage of WNV cross-neutralizing sera from individuals with previous DENV infection. Methods: Serum samples from Kassala, North Kordofan, and Red Sea state were screened for antibodies against DENV by ELISA. Sera without DENV antibodies (N = 106) and a matched set of sera with DENV antibodies (N = 108) was selected. In all blood samples the frequency of WNV-neutralizing antibodies and the antibody titers were measured with microplate neutralization assays. DENV and Zika virus (ZIKV) microplate neutralization assays were performed with all WNV neutralizing sera of the DENV negative group. Results: A fraction of 30.2% of the DENV antibody negative sera neutralized WNV. The seroprevalence increased with age from 9.5% to 41.7%. Men and women were equally affected. The percentage of DENV positive sera that neutralized WNV was 83.3%. DENV positive sera had higher WNV neutralization titers than DENV negative sera. Conclusions: A significant fraction of the DENV antibody negative sera from three regions in Sudan showed serologic evidence of previous WNV infection. In comparison, the large majority of DENV antibody positive sera had WNV neutralizing antibodies. Studies are needed to identify clinical cases of WNV infection and to determine whether individuals with cross-neutralizing antibodies are protected from WNV disease.
    Keywords:  Africa; Sudan; West Nile virus; cross-reaction; dengue virus; seroepidemiologic study
    DOI:  https://doi.org/10.1089/vbz.2022.0011
  14. Front Public Health. 2022 ;10 940898
    Epidemiology of malaria and anemia in high and low malaria-endemic North-Eastern districts of India.
    Hari Shankar, Mrigendra Pal Singh, Syed Shah Areeb Hussain, Sobhan Phookan, Kuldeep Singh, Neelima Mishra.
      Anemia and malaria are the two major public health problems that lead to substantial morbidity and mortality. Malaria infection destroys erythrocytes, resulting in low hemoglobin (Hb) levels known as anemia. Here we report the determinants of anemia in high and low malaria-endemic areas that would help understand which parasite densities, age, and gender-associated low Hb levels. Therefore, a cross-sectional mass survey (n = 8,233) was conducted to screen anemia and malaria in high and low malaria-endemic districts (HMED and LMED) of North-East India. Axillary body temperature was measured using a digital thermometer. The prevalence of anemia was found to be 55.3% (4,547/8,233), of which 45.1% had mild (2,049/4,547), 52.1% moderate (2,367/4,547) and 2.9% had severe anemia (131/4,547). Among anemic, 70.8% (3,219/4,547) resided in LMED and the rest in HMED. The median age of the anemic population was 12 years (IQR: 7-30). Overall, malaria positivity was 8.9% (734/8,233), of which HMED shared 79.6% (584/734) and LMED 20.4% (150/734) malaria burden. The village-wise malaria frequency was concordant to asymptomatic malaria (10-20%), which showed that apparently all of the malaria cases were asymptomatic in HMED. LMED population had significantly lower Hb than HMED [standardized beta (β) = -0.067, p < 0.0001] and low-density Plasmodium infections had higher Hb levels than high-density infections (β = 0.113; p = 0.031). Women of reproductive age had higher odds for malaria (OR: 1.42; 95% CI: 1.00-2.05; p = 0.04). Females (β = -0.193; p < 0.0001) and febrile individuals (β = -0.029; p = 0.008) have shown lower Hb levels, but malaria positivity did not show any effect on Hb. Young children and women of reproductive age are prone to anemia and malaria. Although there was no relation between malaria with the occurrence of anemia, we found low-density Plasmodium infections, female gender, and LMED were potential determinants of Hb.
    Keywords:  Plasmodium; anemia; epidemiology; hemoglobin; low-density malaria
    DOI:  https://doi.org/10.3389/fpubh.2022.940898
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