BackgroundDeforestation and land-use change have the potential to alter human exposure to malaria. A large percentage of Madagascar’s original forest cover has been lost to slash-and-burn agriculture, and malaria is one of the top causes of mortality on the island. In this study, the influence of land-use on the distribution of Plasmodium vectors and concomitant Plasmodium infection in humans and mosquito vectors was examined in the southeastern rainforests of Madagascar.MethodsFrom June to August 2013, health assessments were conducted on individuals living in sixty randomly selected households in six villages bordering Ranomafana National Park. Humans were screened for malaria using species-specific rapid diagnostic tests (RDTs), and surveyed about insecticide-treated bed net (ITN) usage. Concurrently, mosquitoes were captured in villages and associated forest and agricultural sites. All captured female Anopheline mosquitoes were screened for Plasmodium spp. using a circumsporozoite enzyme-linked immunosorbent assay (csELISA).ResultsAnopheles spp. dominated the mosquito communities of agricultural and village land-use sites, accounting for 41.4 and 31.4 % of mosquitoes captured respectively, whereas Anopheles spp. accounted for only 1.6 % of mosquitoes captured from forest sites. Interestingly, most Anopheles spp. (67.7 %) were captured in agricultural sites in close proximity to animal pens, and 90.8 % of Anopheles mosquitoes captured in agricultural sites were known vectors of malaria. Three Anopheline mosquitoes (0.7 %) were positive for malaria (Plasmodium vivax-210) and all positive mosquitoes were collected from agricultural or village land-use sites. Ten humans (3.7 %) tested were positive for P. falciparum, and 23.3 % of those surveyed reported never sleeping under ITNs.ConclusionsThis study presents the first report of malaria surveillance in humans and the environment in southeastern Madagascar. These findings suggest that even during the winter, malaria species are present in both humans and mosquitoes; with P. falciparum found in humans, and evidence of P. vivax-210 in mosquito vectors. The presence of P. vivax in resident vectors, but not humans may relate to the high incidence of humans lacking the Duffy protein. The majority of mosquito vectors were found in agricultural land-use sites, in particular near livestock pens. These findings have the potential to inform and improve targeted malaria control and prevention strategies in the region.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1164-2) contains supplementary material, which is available to authorized users.

Results: Assuming a per sex act transmission probability of 0.1% and a 3-month convalescent period, we found that sexual transmission would extend the epidemic by 83 days (95% CI: 68-98 days) on average. Strikingly, a 6-month convalescent period extended the average epidemic by 540 days (95% CI: 508-572 days), despite an insignificant rise in the number of new cases generated.Conclusion: Our results show that reductions in the per sex act transmission probability via abstinence and condom use should reduce the number of sporadic sexual transmission events, but will not significantly reduce the epidemic size and may only minimally shorten the length of time the public health community must maintain response preparedness. http://dx.

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The clinical management of Ebola created a significant challenge during the outbreak in West Africa, due to the paucity of previous research conducted into the optimum treatment regimen. That left many centres, to some extent, having to ‘work out’ best practice as they went along, and attempting to conduct real time prospective research. Médecins Sans Frontières (MSF) [1] were the only organization to have provided relatively in depth practical guidance prior to the outbreak and this manual was the basis of further planning between the WHO, national Ministry of Health and Sanitation in Sierra Leone, and other relevant stakeholders. Additionally, guidance changed over the epidemic as experience grew. This chapter will describe four key areas in the management of Ebola in West Africa. Firstly, it outlines the most recent WHO guidance; secondly, it looks back at how Ebola was managed in differing low and high resource settings; thirdly it outlines possible and optimal options for managing complications, paying particular attention to some of the controversies faced; fourthly it describes recent and ongoing studies into potential novel therapies that may shape future practice.

Background: University of Maryland undergraduate students, graduate students, and faculty from the Schools of Engineering and Public Health conducted field water tests and a health needs assessment in a traditional farming community in the Andean mountain region of Southern Peru. This innovative project focuses on health as a cross-cutting issue best addressed as an interdisciplinary team. The project provides an opportunity to develop relationships among different fields and expands leadership capacity through multi-level teams of undergraduate students, graduate students, and faculty. Structure/Method/Design: The first phase was a multi-method needs assessment to examine health issues and priorities among residents and to assess water quality. The public health team used principles of cultural competency and health literacy to develop a qualitative questionnaire. Fourteen interviews were conducted with health clinic staff, school personnel, community leaders, and community members. The teams worked together to conduct seven field tests of the local water supply at various points in the distribution system. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): Residents and leaders identified animal contamination, flooding, and standing water as health priorities. Some residents objected to neighbors' overuse of water, particularly at the end of the distribution branch. Without a consistent water supply, the community risked financial sustainability.Common health problems identified by residents and leaders were diarrhea, acute respiratory infections, cold/flu, alcoholism, and skin problems. Other issues were nutrition, general hygiene, and disorganization within the community. Social mapping analysis revealed that communication between residents and leaders is not prioritized.Total coliform results revealed that after incubation, contamination ranged from w10-108 CFU (EPA MCL ¼ 0), indicating high fecal coliform and E. coli contamination. Community leaders expressed interest in chlorination of the existing water supply system. While community members prioritize water quantity and reliability, they were aware of contamination. One resident boils water "because it is bad for us." Another resident noted that boiling water was practical, for "if we don't, there are little bugs and sand." However, researchers observed use of tap water to wash vegetables. Summary/Conclusion: Qualitative data from a representative sample of community members, school personnel, and health providers along with field water tests substantiated speculation by Engineers without Borders that health problems may be related to contaminated water. These data provided information to guide design of a water disinfection system and curriculum addressing the health issues identified by community members. This case study illustrates the opportunities of cross-discipline collaborations to simultaneously address technical, infrastructural, and behavioral challenges in sustainable global health projects.Guidelines for global hea...