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Evaluation of the relationship between risk factors for malaria increase and the impact of climate change and ecological environment around hydroelectric, irrigational buildings in Gia Lai province

Thứ sáu, 27/2/2015, 0:0 , Lượt đọc : 83

Name of investigators: Dr. Nguyen Xuan Quang, BA. Le Giap Ngo, BA. Vu Tuan Anh Technician. Le Hoang Dung, Technician. Le Dinh Vinh, Nurse. Trinh Thi Nhu

Introduction

Malaria situation in the Central â€“ Western Highlands in 2013 and the first ninemonths of 2014 tended to decrease. However in the last 2 months of 2014 (October, November), malaria was recorded with unexpected occurrence in the Centralâ€“ Western Highlands areas, the proportion of malaria patients and parasites increasedin almost every province. In particular,in October and November 2014, parasite rate of Gia Laiprovince increased from 71.38 to 168.89% compared to the same period in 2013.Therefore, we conducted surveys, epidemiological surveillance of malaria and the variation, distribution and behaviour of Anopheles mosquitoes in order to attain the objectives:

1.Evaluation of indicators of malaria in the community

2.Determination of the species composition, the number of species, density of malaria vectorsin Ia Mla commune.

3.Dissection and conduction of ELISAtests to evaluate the proportion of mosquitos infected with Plasmodium parasite.

II.Location, duration, object andmethodology

2.1. Location: !important;Ia Mla commune, KrongPadistrict, GiaLaiprovince

2.2. Duration: !important; From 12/16/2014 to 12/28/2014 (13 days).

2.3. Research design: The cross-sectional and retrospective study

2.4. Object of study

- Local people (especially forest goers, field-hut sleepers)

- Malaria transmitting Anopheles mosquitoes

2.5. The techniquesand methods ofinvestigation

2.5.1.Epidemiological investigationof malaria

- Epidemiological situationof malariainthe locality

- Examination anddetermination of clinical malaria cases and conduction of smear tests for 400 people to identify Plasmodium parasite in Ia Mla community.

2.5.2.Surveyinsect indicators

-Implement measures to investigate, monitor, collect adult mosquitoes and larvae due tothe method ofWHO (1994) andthe National Institute of Malariology and Parasitology and Entomology, Ha Noi (2011).

-Species composition, Anopheles larval and mosquito densities.

-Ecology and behaviour of vectors such as biting and resting behaviour, host preference.

2.5.3 Mosquitodissection:Determine the rateof mosquitoes infected with malaria parasite

(Alive mosquitoes were dissected for oocyste, sporozoits and lay egg or not yet).

III. Results and discussions

a.The situation of malaria in the Ia Mla commune in 2014(data district health)

Table 1: Malaria situation in 2014 comparedto the same period in 2013

Indicator	Year	Commune Ia MlÃ¡ â€“ Themonthsin2014												Total
Indicator	Year	1	2	3	4	5	6	7	8	9	10	11	12	Total
Patients withmalaria	2014	9	19	5	2	3	0	3	3	19	13	36	29	141
	2013	5	15	9	5	2	10	16	16	25	48	28	15	194
	%(+,-)	+280	-40	-44,4	-60	+50	-100	-81,3	-81,3	-24	-72,9	+28,6	+93,3	-27,3
Slides, test strips	2014	61	89	40	34	28	52	58	132	75	76	120	100	865
Slides, test strips	2013	47	58	66	58	36	36	78	79	61	133	115	86	853
Parasites	2014	19	9	5	2	3	0	3	3	19	13	36	29	141
	2013	5	14	9	5	2	10	16	16	25	48	28	15	193
	%(+,-)	+280	-35,7	-44,4	-60	+50	-100	-81,3	-81,3	-24	-72,9	+28,6	+93,3	-26,9

Malaria situation in Ia Mla commune in 2014:

- The proportion of Plasmodium /slides + test stripsin 2014 is 16.3% (141/865).

- In 2014, Plasmodiumin January increased by 280% while reduced from 24 to 100% in other months. Especially the last 2 months (November and December) of 2014, Plasmodium parasite surged from 28.6 to 93.3% in comparison with the same period in 2013.

- The overall number of Plasmodium reduced 26.9% in 2014 compared with the same period in 2013.

Graph 1: Performance ratioPlasmodium/slides+test strips in 2014of Ia Mla commune

3.2. Results of the survey oÂn the prevalenceof malaria in the Ia Mla communeGraph 1: Performance ratioPlasmodium/slides+test strips in 2014of Ia Mla commune

Table 2: Results of cross-sectional survey oÂn the prevalence of malaria in the IaMla commune

Group age	Number	Clinical malaria		Spleen		Parasites
Group age	Number	N.	%	N.	%	N.	%	*P.f*	*P.v*	PH	GB
< 1	0	0	0	0	0	0	0	0	0	0	0
1 - 2	2	0	0	0	0	0	0	0	0	0	0
3 - 4	10	0	0	0	0	0	0	0	0	0	0
5 - 8	46	0	0	0	0	0	0	0	0	0	0
9 - 16	65	0	0	0	0	1	1,5	1	0	0	1
>16	277	6	2,17	0	0	6	2,17	2	3	1	2
Total	400	6	1,5	0	0	7	1,75	3	3	1	3

Conducting smear examination and blood tests for 400people in the IaMla commune, 6 patients were found with clinical malaria, accounting for 1.5% and 7 blood tests foundthe malaria parasites, accounting for 1.75% and notfoundspleen.

3.3.Results of survey oÂnsocialinsectsin IaMla commune

Table 3: Anopheles mosquitospecies composition in the Ia Mla commune

No.	Species	In hamlet				Buffer zone (near forest)				In upland forest
		Mosquitoes		Larvae		Mosquitoes		Larvae		Mosquitoes		Larvae
		N.	(%)	N.	(%)	N.	(%)	N.	(%)	N.	(%)	N.	(%)
1	An.aconitus	0	0	0	0	20	17,7	0	0	6	12,5	0	0
2	An.barbirostris	8	6,4	4	5,8	5	4,4	0	0	0	0	0	0
3	*An.dirus*	0	0	0	0	2	1,8	0	0	19	39,6	0	0
4	An.kochi	14	11,2	0	0	8	7,1	0	0	0	0	0	0
5	An.maculatus	8	6,4	0	0	15	13,3	0	0	8	16,7	8	16,7
6	An.peditaeniatus	21	16,8	15	21,7	16	14,2	14	31,8	8	16,7	16	33,3
7	An.philippinensis	6	4,8	0	0	0	0	0	0	0	0	0	0
8	An.sinensis	25	20,0	18	26,1	11	9,7	12	27,3	7	14,5	24	50,0
9	An.splendidus	18	14,4	0	0	14	12,4	0	0	0	0	0	0
10	An.vagus	25	20,0	32	46,4	22	19,4	18	40,9	0	0	0	0
	Total	125	100	69	100	113	100	44	100	48	100	48	100

- In the hamlet, 8 species of anopheles were found notcatching the diseasevectors. In thehamlet, An. vagus and An. sinensis predominate.

- In the buffer zone (near the forest), 9 species of !important; Anopheles were found, including the presence of main malaria vector - An. dirus and sub vector - An. aconitus and An. maculatus. In the buffer zone, An. aconitus and An. vagus dominate.

- In theplot-huts, 5 species of Anopheles were found, including the presence of main malaria vector - An. dirus and 2 sub vector - An. aconitus andAn. maculatus. In the forests, An. dirus predominate.

Table 4: Results of investigation of Anopheles mosquitoes inresidential areas in the Ia Mla commune

No.	Species	Total	Collection Methods
			Light trap in door		Light trap out door		Collected by the human bait in door		Collected by the human bait out door		Collection in door-daytime		Catch mosquitoes cattle
			N.	Density	N.	density	N.	density	N.	density	N.	density	N.	density
1	An.barbirostris	8	0	0	0	0	0	0	0	0	0	0	8	2,0
2	An.kochi	14	0	0	0	0	0	0	0	0	0	0	14	3,5
3	An.maculatus	8	1	0,17	0	0	0	0	2	1,0	0	0	5	1,25
4	An.peditaeniatus	21	2	0,33	1	0,17	4	2,0	3	1,5	0	0	11	2,75
5	An.philippinensis	6	0	0	0	0	0	0	0	0	0	0	6	1,5
6	An.sinensis	25	4	0,67	1	0,17	8	4,0	3	1,5	0	0	9	2,25
7	An.splendidus	18	2	0,33	2	0,33	3	1,5	4	2,0	0	0	7	1,75
8	An.vagus	25	2	0,33	0	0	0	0	0	0	0	0	23	5,75
	Total	125	11	1,83	4	0,67	15	7,5	12	6,0	0	0	83	20,75

Investigation of mosquitoes in residential areas showed that the main malaria vectors - An. dirus, An. Minimus were not found !important; only found the sub vector -An. maculatus.

Table 5: Results of the survey oÂn Anopheles mosquitoes in the buffer zoneof the Ia Mla commune

No.	Species	Total	Collection Methods
			Light trap in door		Light trap out door		Collected by the bait in door		Collected by the bait out door		Collection in door-nighttime		Catch mosquitoes cattle
			N.	density	N.	density	N.	density	N.	density	N.	density	N.	density
1	An.aconitus	20	9	1,5	0	0	2	1,0	3	1,5	0	0	6	1,5
2	An.barbirostris	5	0	0	0	0	0	0	0	0	0	0	5	1,25
3	*An.dirus*	2	2	0,33	0	0	0	0	0	0	0	0	0	0
4	An.kochi	8	0	0	0	0	0	0	0	0	0	0	8	2,0
5	An.maculatus	15	3	0,5	0	0	1	0,5	4	2,0	0	0	7	1,75
6	An.peditaeniatus	16	2	0,33	2	0,33	0	0	3	1,5	0	0	9	2,25
7	An.sinensis	11	2	0,33	0	0	2	1,0	1	0,5	0	0	6	1,5
8	An.splendidus	14	2	0,33	1	0,17	0	0	1	0,5	0	0	10	2,5
9	An.vagus	22	1	0,17	0	0	0	0	0	0	0	0	21	5,25
	Total	113	21	3,5	3	0,5	5	2,5	12	6,0	0	0	72	18,0

Investigation of mosquitoes has found that the main malaria vector is An. Dirus in the buffer zone, with a density of 0.33mosquito/trap/night and also found thesub vectors: An. aconitus and An. maculatus.

Table 6: Results of investigation of Anopheles mosquito in the plot-huts in the Ia Mla commune

No.	Species	Total	Collection Methods
			Light trap in door		Light trap out door		Collected by the human bait in door		Collected by the human bait out door		Collection in door-nighttime
			N.	density	N.	density	N.	density	N.	Density	N.	density
1	An.aconitus	6	4	0,67	0	0	0	0	2	0,5	0	0
2	*An.dirus*	19	8	1,33	1	0,17	4	1,0	6	1,5	0	0
3	An.maculatus	8	3	0,5	0	0	2	0,5	3	0,75	0	0
4	An.peditaeniatus	8	3	0,5	2	0,33	1	0,25	2	0,5	0	0
5	An.sinensis	7	2	0,33	0	0	2	0,5	3	0,75	0	0
	Total	48	20	3,33	3	0,5	9	2,25	16	4,0	0	0

Investigation of mosquitoes in the plot-hutshas found that the main malaria vector is An. Dirus, with a density of 1.0-1.5 mosquito/person/night and 0.17 to 1.33 mosquito/trap/night !important; in addition the sub vectors An. maculatus and An. Aconitu are also found.

3.4 Activityofanopheles mosquito

Table 7: Activities of Anopheles mosquitoesin the upland forest of Ia Mla commune

TT	Species	Total	Operation ofhourlyanopheles
			18-19		19-20		20-21		21-22		22-23		23-24		0-1
			I	O	I	O	I	O	I	O	I	O	I	O	I	O
1	An.aconitus	2	0	0	0	0	0	0	0	1	0	1	0	0	0	0
2	An.dirus	10	0	0	0	0	1	2	2	2	1	1	0	1	0	0
3	An.maculatus	5	0	0	0	0	0	1	1	1	1	1	0	0	0	0
4	An.peditaeniatus	3	0	0	0	0	0	0	1	1	0	1	0	0	0	0
5	An.sinensis	5	0	0	0	0	1	1	0	1	1	1	0	0	0	0
	Total	25	0	0	0	0	2	4	4	6	3	5	0	1	0	0

Noted: I: Collected by the human bait indoor !important; O: Collected by the human bait outdoor

Anopheles mosquitos fly and bite after 8 p.m., after 23p.m. due to bad weather conditions: cold, windy, Anopheles mosquitos were not caught.

Graph 2: ActivitiesofAnopheles mosquitos inthefields

3.5.Results of dissection

Table 8: Resultsof dissectingAnopheles mosquitospecies

No.	Species	Quantity	Sella	Sporozoit		Stomach		Ovaries
No.	Species	Quantity	Sella	N.	Sporozoit	N.	Oocyste	Parous	Nulliparous
1	An.aconitus	20	12^I8^II	20	0	12	0	13	7
2	An.dirus	18	10^I8^II	18	0	10	0	11	7
3	An.maculatus	24	14^I10^II	24	0	14	0	9	15
	Total	62	36^I26^II	62	0	36	0	33	29

- Oocyste and sporozoite were not found (salivary gland and stomach).

- Laying mosquito rate is 53.2%.

IV. Conclusionsandsuggestions:

4.1 Conclude

4.1.1Results of retrospectivestudy and epidemiological investigation of malaria in the Ia Mla commune

- The proportion of parasites/slides +test strips in 2014 in Ia Mla commune is 16.3%.

- In 2014, malaria parasites increased by 280% in January andreduced from 24%to 100% in other months. In particular, in the last 2 months (November and December), malaria parasites surged from 28.6% to 93.3% in comparison with the same period in 2013.

- The overall number of malaria parasitesreduced 26.9% in comparison with the same period in 2013.

- Conducting smearexamination and blood tests on 400 people in the IaMla commune, which found 6 patients withclinical malaria, accounting for 1.5%. Seven malaria parasites were found in blood tests, accounting for 1.75% and spleens were not found.

4.1.2. Species composition, density of malaria vector in the commune Ia Mla

Of the Anopheles mosquitoes collected in Ia Mla, there are 268 adult Anopheles mosquito species and 161 larval (of 10 species). In particular the main malariavector An.dirus was found with a density of 1.0-1.5 mosquito/person/night and 0.17 to 1.33 mosquito/trap/nightand sub vectors such as An. aconitus, An. maculatus and An. Vagus were also found.

4.1.3. Results of mosquito dissection

- 62 Anopheles mosquitoes were dissected (of 3 species). They were main and sub malaria vectors, but oocyste and sporozoite were not found (salivary gland and stomach of mosquitoes).

- Laying mosquito rate is 53.2%

4.2. Suggestion

Through the result of retrospectivedata in CHC in health station and investigationgroup, we suggest:

- More funds, malaria epidemiology supervision, especially the people who are entering the forests and sleeping in plot-huts and comeback from the long-time trip.

- Provide communication and education regularly aboutmalaria control measures so that everybody knows to protect themselves and their families.

- The forest-goers and plot-huts sleepers should bring bed-nets and hammock nets when they go to work and sleep in the forest and plot-huts.

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