The causes of the recent reemergence of Plasmodium falciparum epidemic malaria in the East African highlands are controversial. Regional climate changes have been invoked as a major factor; however, assessing the impact of climate in malaria resurgence is difficult due to high spatial and temporal climate variability and the lack of long-term data series on malaria cases from different sites. Climate variability, defined as short-term fluctuations around the mean climate state, may be epidemiologically more relevant than mean temperature change, but its effects on malaria epidemics have not been rigorously examined. Here we used nonlinear mixed-regression model to investigate the association between autoregression (number of malaria outpatients during the previous time period), seasonality and climate variability, and the number of monthly malaria outpatients of the past 10–20 years in seven highland sites in East Africa. The model explained 65–81% of the variance in the number of monthly malaria outpatients. Nonlinear and synergistic effects of temperature and rainfall on the number of malaria outpatients were found in all seven sites. The net variance in the number of monthly malaria outpatients caused by autoregression and seasonality varied among sites and ranged from 18 to 63% (mean = 38.6%), whereas 12–63% (mean = 36.1%) of variance is attributed to climate variability. Our results suggest that there was a high spatial variation in the sensitivity of malaria outpatient number to climate fluctuations in the highlands, and that climate variability played an important role in initiating malaria epidemics in the East African highlands

BackgroundThe impact of insecticide treated nets (ITNs) on reducing malaria incidence is shown mainly through data collection from health facilities. Routine evaluation of long-term epidemiological and entomological dynamics is currently unavailable. In Kenya, new policies supporting the provision of free ITNs were implemented nationwide in June 2006. To evaluate the impacts of ITNs on malaria transmission, we conducted monthly surveys in three sentinel sites with different transmission intensities in western Kenya from 2002 to 2010.Methods and FindingsLongitudinal samplings of malaria parasite prevalence in asymptomatic school children and vector abundance in randomly selected houses were undertaken monthly from February 2002. ITN ownership and usage surveys were conducted annually from 2004 to 2010. Asymptomatic malaria parasite prevalence and vector abundances gradually decreased in all three sites from 2002 to 2006, and parasite prevalence reached its lowest level from late 2006 to early 2007. The abundance of the major malaria vectors, Anopheles funestus and An. gambiae, increased about 5–10 folds in all study sites after 2007. However, the resurgence of vectors was highly variable between sites and species. By 2010, asymptomatic parasite prevalence in Kombewa had resurged to levels recorded in 2004/2005, but the resurgence was smaller in magnitude in the other sites. Household ITN ownership was at 50–70% in 2009, but the functional and effective bed net coverage in the population was estimated at 40.3%, 49.4% and 28.2% in 2010 in Iguhu, Kombewa, and Marani, respectively.ConclusionThe resurgence in parasite prevalence and malaria vectors has been observed in two out of three sentinel sites in western Kenya despite a high ownership of ITNs. The likely factors contributing to malaria resurgence include reduced efficacy of ITNs, insecticide resistance in mosquitoes and lack of proper use of ITNs. These factors should be targeted to avoid further resurgence of malaria transmission.

Abstract. Studies were conducted to characterize larval habitats of anopheline mosquitoes and to analyze spatial heterogeneity of mosquito species in the Suba District of western Kenya. A total of 128 aquatic habitats containing mosquito larvae were sampled, and 2,209 anopheline and 10,538 culicine larvae were collected. The habitats were characterized based on size, pH, distance to the nearest house and to the shore of Lake Victoria, coverage of canopy, surface debris, algae and emergent plants, turbidity, substrate, and habitat types. Microscopic identification of thirdand fourth-instar anopheline larvae did not yield any Anopheles funestus or other anophelines.

We examined the effects of land cover type on survivorship and productivity of Anopheles gambiae in Kakamega in the western Kenyan highlands (elevation = 1,420-1,580 meters above sea level). Under natural conditions, An. gambiae sensu lato adults emerged only from farmland habitats, with an estimated productivity of 1.82 mosquitoes/meter(2)/week, but not from forest and swamp habitats. To determine the effects of intraspecific competition and land cover types, semi-natural larval habitats were created within three land cover types (farmland, forest, and natural swamp), and three different densities of An. gambiae sensu stricto larvae were introduced to the larval habitats. The mosquito pupation rate in farmland habitats was significantly greater than in swamp and forest habitats, and larval-to-pupal development times were significantly shorter. At higher densities, the larvae responded to increased intraspecific competition by extending their development time and emerging as smaller adults, but initial larval density showed no significant effects on pupation rate. Land cover type may affect larval survivorship and adult productivity through its effects on water temperature and nutrients in the aquatic habitats, as shown by the significantly higher water temperature in farmland habitats, enhanced pupation rates and shortened development times from the addition of food to habitats, and a significant negative correlation of the occurrence of An. gambiae larvae with canopy cover and emergent plants in natural habitats. These results suggest that deforestation and cultivation of natural swamps in the western Kenyan highland create conditions favorable for the survival of An. gambiae larvae, and consequently increase the risks of malaria transmission to the human population.