Int. J. Trop. Med.

, 6 (3): 44-51, 2011

International Journal of Tropical Medicine 6 (3): 44-51, 2011 ISS : 1!16331" Med#ell Journal$, 2011

Anopheles Species Diversity and Breeding Habitat Distribution and the Prospect for Focused Malaria Control in the Western Highlands of Kenya
%&S& Mula'(ala), 1*& & Sia'(a, 2M&M& +ei,#a and 3J&M& -ulule .*epart'ent of /iolo+ical Science$, Ma$inde Muliro 0ni1er$it, of Science and Tec)nolo+,, 2&3& /o4 1"0 2o$tcode 50100, 5a6a'e+a *epart'ent of /iolo+ical Science$, 0ni1er$it, of Moi, 2&3& /o4 1125, 7ldoret, 5en,a .5en,a Medical 8e$earc) In$titute, 2&3& /o4 159! 2o$tcode 40100 5i$u'u, 5en,a
1 2

:($tract: Malaria in t)e #e$tern )i+)land$ of 5en,a i$ unpredicta(le and occur$ in for' of $e1ere out(rea6$ and
epide'ic$ re$ultin+ in lo$$ of life and e4ert$ a $train on pu(lic )ealt) $er1ice$& T)i$ underlie$ t)e continued need for (etter under$tandin+ of t)e di$ea$e deter'inant$ to for'ulate $pecific and focu$ed inter1ention $trate+ie$& : 1 ,ear $tud, #a$ underta6en in t#o $tud, $ite$ in andi di$trict to deter'ine Anopheles $pecie$ di1er$it,, a(undance and (reedin+ )a(itat di$tri(ution& Indoor and outdoor adult :nop)ele$ 'o$;uitoe$ #ere collected (i#ee6l, fro' rando'l, $elected )ou$e$ (, p,ret)ru' $pra, capture 'et)od and li+)t trap$, re$pecti1el,& :nop)ele$ lar1al $ta+e$ #ere collected fro' (reedin+ $ite$ (, $tandard dipper$ and reared into adult$ under la(orator, condition$& :dult Anopheles $pecie$ #ere identified (a$ed on 'orp)olo+ical feature$ and $i(lin+ $pecie$ (, 2ol,'era$e %)ain 8eaction (2%8)& Anopheles ga !"ae sens# lato #a$ t)e 'o$t pre1alent 6no#n 1ector contri(utin+ "5&4<, An. $#nest#s and An. ara!"ens"s eac) 2&3<& :ll An.ga !"ae s.l $a'ple$ #ere identified (, 2%8 a$ An. ga !"ae sens# str"%to $u++e$tin+ t)at t)i$ could (e t)e onl, $i(lin+ $pecie$ of t)e An. ga !"ae co'ple4 pre$ent in $tud, $ite$& T)e epide'iolo+ical and pu(lic )ealt) $i+nificance of 6no#n 'alaria 1ector$ and non-1ector anop)ele$ $pecie$ i$ di$cu$$ed&

5e, #ord$: /reedin+ )a(itat$=$ite$, 'alaria 1ector, $i(lin+ $pecie$, pol,'era$e c)ain reaction, tran$'i$$ion, 5 e n , a

I T83*0%TI3
Malaria in t)e #e$tern )i+)land$ of 5en,a i$ unpredicta(le di$ea$e #it) increa$in+ fre;uenc, and inten$it, in tran$'i$$ion& T)e e$ta(li$)'ent and $pread of t)e di$ea$e in t)i$ )i+)land area depend$ on t)e pre$ence of and relation$)ip of $e1eral epide'iolo+ical factor$ t)e 'o$t i'portant (ein+, t)e )o$t, t)e a+ent and t)e en1iron'ent& Man i$ t)e 1erte(rate )o$t and t)e :nop)ele$ 'o$;uito in t)e a+ent of tran$'i$$ion=1ector #)erea$ t)e 2la$'odiu' para$ite i$ t)e cau$ati1e a+ent of 'alaria& Malaria 1ector and non-1ector $pecie$ population $tructure and den$it, in an, localit, i$ not $tatic (*uff,, 1"99)& Malaria 1ector ($) and non-1ector$ 'a, periodicall, e4tend t)eir ran+e (e,ond t)eir nor'al area of di$tri(ution #)en te'porar, $uita(le condition$ occur in nei+)(orin+ area$ (>?3, 2010)& Mo$t Anopheles $pecie$ are 6no#n to c)an+e t)eir ecolo+ical ran+e, (e)a1ior (, adaptin+ to ne# cli'atic, ecolo+ical and )u'an induced c)an+e$ (Muriu et al., 200!)& T)i$ 'a, not (e fre;uent (ut it doe$ occur particularl, in t)i$ era of +lo(al #ar'@ and 'a, re$ult in $eriou$ pu(lic )ealt)

i'plication$& ?u'an acti1itie$ particularl, related to land-u$e e1ident in t)e $tud, area could pro'ote c)an+e$ in 1ector and non- 1ector $pecie$ di1er$it, and 'alaria tran$'i$$ion in & future in $e1eral #a,$ a$ reported el$e#)ere (>al$) et al., 1""3A 2atB et al., 2000)& Cor in$tance 'an-'ade acti1itie$ $uc) a$ $#a'p recla'ation and (ric6 'a6in+ create$ 'ore )u'an-'ade a;uatic )a(itat$ for t)e Anopheles $pecie$& Increa$ed cattle +raBin+ create 'ore open )a(itat$ #it) ele1ated te'perature t)at fa1or fa$ter :nop)ele$ lar1al de1elop'ent )ence increa$ed adult den$it, and po$$i(le 'alaria tran$'i$$ion (Mina6a#a et al., 2004)& Man-'ade en1iron'ental c)an+e$ 'a, al$o )a1e a (earin+ on t)e di1er$it, of t)e 1ectorial $,$te'$ of an area and $u($e;uentl, re$ult in eco-epide'iolo+ical $tratification and in& 1a$ion of area (, ne# 1ector$& ?u'an acti1itie$ and topo+rap), could al$o )a1e an effect on t)e di1er$it, and di$tri(ution of di$ea$e 1ector (reedin+ )a(itat$& T)erefore, #e ),pot)e$iBed t)at )u'an acti1itie$, en1iron'ental c)an+e$ and re+ular tra1el to and fro' t)e

%orre$pondin+ :ut)or: %&S& Mula'(ala), *epart'ent of /iolo+ical Science$,

Ma$inde Muliro 0ni1er$it, of Science and Tec)nolo+,, 2&3& /o4 1"0 2o$tcode 50100, 5a6a'e+a, 5en,a 44

nei+)(orin+ Da6e -ictoria lo#land$ could re$ult in c)an+e$ in Anopheles $pecie$ co'po$ition #)ic) 'a, )a1e i'plication$ on tran$'i$$ion, epide'iolo+, and control of not onl, of 'alaria (ut al$o ot)er 1ector-(orne di$ea$e$& T)e purpo$e of t)e $tud, #a$ to a$$e$$ t)e Anopheles $pecie$ di1er$it, and locate and identif, (reedin+ )a(itat$ in t#o $ite$ in a 'alaria epide'ic-prone area in t)e #e$tern )i+)land$ of 5en,a& M:T78I:DS : * M7T?3*S Stud, $ite$: T)e $tud, #a$ conducted in & ort) andi *i$trict E0F21.52 and 0F1656 in lon+itude and 35F5.20F7 and 34F5".9 7 in latitudeG in t)e )i+)land area$ of 5ip$a'oite and 5ap$i$i,#a eac) #it) 9 and 10 1illa+e$, re$pecti1el,& T)e $tud, $ite$ #ere $elected (ecau$e, t)e, #ere located 1500 ' a(o1e $ea le1el, an altitude defined a$ c)aracteriBin+ t)e )i+)land area and 'alaria epide'ic$ and out(rea6$ )ad (een reported #it)in t)e $ite$ pre1iou$l,& T)e topo+rap), of t)e $tud, $ite$ co'pri$e$ )ill$, 1alle,$ and plateau$& 8i1er$ and $trea'$ run alon+ t)e 1alle, (otto'$ in & t)e 1alle, eco$,$te' and reclai'ed and natural $#a'p$ are a co''on feature& T)e $tud, area )a$ t#o rain, $ea$on$, lon+ rain$ $ea$on fro' Marc) to Ma,, referred to lon+ rain$ on t)e account of duration and )i+) a'ount of rainfall recei1ed in& 'an, part$ of t)e )i+)land$& T)e $econd $ea$on i$ t)e $)ort rain$ fro' t)e 'ont)$ of 3cto(er to *ece'(er durin+ #)ic) period, t)e area e4perience$ depre$$ed rainfall t)at i$ al$o poorl, di$tri(uted (ot) in $pace and ti'e& T)ere are 1ariation$ in te'perature t)e #anne$t te'perature$ are e4perienced in Marc) and t)e colde$t in Jul, #it) t)e 'ean 'ont)l, te'perature$ ran+in+ fro' 19-1"24!F%&

anop)eline lar1ae in eac) )a(itat #a$ deter'ined (, u$in+ a $tandard dipper for lar+e )a(itat$ (J0&5 ' 2) for $'aller a;uatic )a(itat$ (K0&5 '2) li6e foot=)oof print$ a $'all $ie1e and pipette #ere u$ed to $coop #ater& : dipper (13 c' in dia'eter and 6&5 c' deep) #it) a )andle)=$ie1e=pipette #a$ +entl, lo#ered at an an+le of 45F% Iu$t (elo# t)e #ater $urface $o t)at #ater flo#ed into it or $uc6ed ((, pipette) to+et)er #it) an, lar1ae t)at 'i+)t (e pre$ent& *urin+ dippin+, care #a$ ta6en not to di$tur( #ater too 'uc) and 'a6e lar1ae $#i' do#n#ard$& T)e filled dipper=$ie1e=pipette #a$ carefull, lifted, ta6in+ care not to $pill t)e #ater contain & + t)e lar1ae& T)e dra#n #ater containin+ t)e lar1ae #a$ poured into #)ite rectan+ular tra,$ and c)ec6ed 1i$uall, and lar1al $a'ple$ #)en pre$ent #ere collected (, pipette& Ten dipper=pipette=$ie1e collection$ #ere 'ade per eac) a;uatic )a(itat& If none )ad anop)eline lar1ae t)en t)e $ite #a$ declared anop)eline ne+ati1e& T)e lar1al $a'ple$ fro' eac) )a(itat #ere tran$ferred into la(eled (#it) date, collection $ite and t,pe of )a(itat) 1ial$ and tran$ported to 5en,a Medical 8e$earc) In$titute (57M8I) for rearin+ into adult$ and $u($e;uent identification of adult$& T)e identified anop)eline po$iti1e (reedin+ $ite$ #ere noted, location recorded, counted and cate+oriBed a$ :nop)ele$ lar1al collection point$ for outdoor collection$& T)e re$ult$ of t)e rain, and dr, $ea$on (reedin+ )a(itat nu'(er are $)o#n in& Ta(le 1& %ollection of outdoor lar1ae and adult Anopheles $pecie$: :nop)ele$ lar1al collection fro' identified (reedin+ $ite$ #a$ carried out e1er, 2 #ee6$ fro' 0600-0"00 )& T)e collected lar1al $a'ple$ #ere pac6et in cool-(o4 and tran$ported to t)e 5en,a Medical 8e$earc) In$titute (57M8I) la(orator, and reared to adult$ under t)e follo#in+ condition$: te'perature 29F%, !0< relati1e )u'idit, and 12:12 li+)t: dar6 $c)edule and (re#er.$ ,ea$t a$ food& 0pon e'er+ence fro' pupa, t)e adult$ #ere identified (, 'orp)olo+ical feature$ u$in+ identification 6e,$& 3ut-door adult :nop)ele$ 'o$;uitoe$ in ani'al $)elter$ #ere collected (, u$e of %enter$ for *i$ea$e %ontrol (%*%) 'iniature li+)t trap$ (J&>& ?oc6 Dtd, Lain$1ille, Cl&, 0S:)&

Anopheles $pecie$ $a'plin+ point$: :nop)ele$ 'o$;uito $a'ple$

#ere collected fro' Januar, to *ece'(er 200! in a total of 19 1illa+e$ #it)in 5ip$a'oite and 5ap$i$i,#a $tud, $ite$& T)e 40< (n H 656) of t)e )ou$e)old$ #ere rando'l, $elected, coded and u$ed a$ $a'plin+ porn& t$ di$tri(uted a$ follo#$: 5ip$a'oite #it) a total of 666 )ou$e)old$ out of #)ic) 265 (40<) #ere $a'pledA 5ap$i$i,#a #it) a total of "!2 out of #)ic) 3"1 (40<) #ere $a'pled&

Anopheles $pecie$ (reedin+ )a(itat identification: Mo$;uitoe$ are

capa(le of coloniBin+ Iu$t a(out 1er, concei1a(le t,pe of #ater (od, e4cept fa$t runnin+ #ater in ri1er$ and $trea'$& S,$te'atic +round $ur1e,$ #ere conducted at 2 #ee6$ inter1al$ in 'ont)$ of Januar, to *ece'(er repre$entin+ t)e dr, and ra' & , $ea$on to deter'ine t)e po$$i(le :nop)ele$ a;uatic (reedin+ )a(itat$& T)i$ e4cluded fa$t nu'in& + #ater (ecau$e 'o$;uitoe$ (reed in& cal', $lo#, 'o1in+ #ater and #ater in container$ in )ou$e$ (ecau$e it #a$ 'eant for )ou$e)old u$e and tree )ole$ (ecau$e of non acce$$i(ilit,& T)e follo#in+ a;uatic )a(itat$ #ere found pre$ent in& t)e $tud, $ite$ and con$tituted potential (reedin+ $ite$: pool$ and puddle$, foot=)oof print$, drain$ and ditc)e$, $trea'$ and ri1er ed+e$, pond$, natural= di$tur(ed $#a'p$ and 'ar$)e$, (ore )ole$, #ell$ and $pun & +$& T)e occurrence of

Int. J. Trop. Med., 6 (3): 44-51, 2011

: L 16!6 1"00 :/ % * 7 C L ? I J 5 D M

32M8S

Int. J. Trop. Med., 6 (3): 44-51, 2011 #ater collection point$ in (ot) dr, and #et $ea$on& /ore )ole$ co''on in tree nur$erie$ and )o'e$ )ad #ater t)rou+)out t)e ,ear& ?oof=foot print$ in drained $#a'p$, pa$ture$ #ere i'portant (reedin+ $ite$ durin+ dr, $ea$on& atural $prin+$, undi$tur(ed $#a'p$, 'ar$)e$ #ere i'portant per'anent (reedin+ $ite$ particularl, $unlit ed+e$ #it) le$$ 1e+etation& In ri1er$ and $trea'$, (reedin+ #a$ co''on on t)e ed+e$ #)ere #ater flo# #a$ $lo# and cal'& *urin+ )ea1, rain$ #)en 'o$t of t)e c)annel$ (eco'e fa$t flo#in+ $trea'$=ri1er$, t)e :nop)ele$ $)ifted (reedin+ to #ater collection$ in cattle )oof print$ in t)e reclai'ed $#a'p$& /ric6 'a6in+ #a$ a co''on econo'ic acti1it, t)at created $uita(le 'o$;uito (reedin+ +round$& /ric6 'a6in+ re$ulted in innu'era(le (orro# pit$ (flooded depre$$ion$ left (, $oil e4ca1ation for (ric6 'aterial) pro1ided prolific (reedin+ $ite$ for 1ector$& Mo$t of t)e (reedin+ $ite$ ea$il, dried up in & a fe# da,$ of dr, $pell, a fe# (eco'e 'ore confined to#ard$ t)e 1alle, (otto'$ and reappeared after rainfall #)ile ot)er$ #ere ea$il, #a$)ed out (flu$)-out effect) follo#in+ )ea1, do#npour& : 1ariet, of anop)eline lar1al )a(itat$ identified in t)e $tud, area #ere ri1er$, $trea'$, (ore)ole$, $prin+$, $#a'p$ and ani'al )oof-print$ t)at #ere 'ore open to $unli+)t and plent, of al+ae& : 'aIorit, of t)e' #ere cate+oriBed a$ 'an-'ade& *urin+ t)e rain, $ea$on, 16" a;uatic )a(itat$ #ere identified a$ potential (reedin+ )a(itat$ and anop)eline lar1ae #ere found in & 92 (43<) )a(itat$& In t)e dr, $ea$on, t)e potential (reedin+ )a(itat$ identified #ere "0 and 3"< of t)e' #ere anop)eline po$iti1e lar1al )a(itat$ (Ta(le 1)& Man-'ade )a(itat$ for in$tance depre$$ion$ a$$ociated #it) (ric6-'a6in+ $upported :nop)ele$ 'o$;uitoe$ in o1erco'in+ t)e cit, period in 'an, area$& T)e$e and ot)er 'an-'ade )a(itat$ pla,ed a role in 'aintainin+ (reedin+ t)rou+)out t)e ,ear& 8e$ult$ of t)e +round $ur1e, $)o#ed t)at t)e nu'(er of potential anop)eline a;uatic )a(itat$ increa$ed 1&" fold durin+ t)e rain, $ea$on o1er t)e dr, $ea$on (16" 1$& "0)& ?o#e1er, t)ere #a$ no $i+nificant difference (: 3-:, p H 0&436) (et#een t)e nu'(er of anop)eline-po$iti1e (reedin+ )a(itat$ in t)e rain, and in t)e dr, $ea$on& :nop)eline lar1al )a(itat$ #ere clu$tered at 1alle, (otto'$ and co'po$ed of 'ainl, 'an-'ade )a(itat$& Anopheles $pecie$ di1er$it, and a(undance: : total of 3!9 fe'ale adult :nop)ele$ (elon+in+ to 11 $pecie$ collected fro' $tud, area& T)e, #ere identified (, t)eir 'orp)olo+ical feature$ and cate+oriBed in& non-1ector$ and 6no#n 'alaria 1ector$& T)e non1ector$ (elon+ed to ! $pecie$ co'pri$in+ of An. %hr"st&" e#$tead and %arter, t)e 'o$t predo'inant ant $pecie$ and ance$tor of all 'alaria 1ector$ (:nt)on, et al., 1""") follo#ed (, An. de e"llon" 71an$, An. %o#stan" De1aran, An. s'#a os#s T)eo(ald and An. harper" 71an$& 3t)er $pecie$ found in lo# nu'(er$ #ere: An. ("e ann" Lrun(er+, An. leeson" 71an$ and An. long"palp"s T)eo(ald& T)e 6no#n )u'an 'alaria 1ector$ #ere An. ga !"ae, An. $#nest#s and An. ara!"ens"s co'pri$in+ 11< in 3 $pecie$& An. ga !"ae s.l. #a$ t)e 'o$t predo'inant 6no#n 'alaria 1ector $pecie$ #)ile t)e ot)er t#o $pecie$ #ere rare& :ll 6no#n 'alaria 1ector$ #ere collected fro' indoor$ an indication of t)eir clo$e a$$ociation #it) )u'an )a(itation& T)e di1er$it,, relati1e a(undance of 1ector and non-1ector :nop)ele$ 'o$;uitoe$ in t)e $tud, area i$ $)o#n in Ta(le 2& 2%8 a$$a, of anop)ele$ +a'(iae: T)e 41 An. ga !"ae $a'ple $peci'en$ collected fro' t)e $tud, $ite$ #ere anal,Bed (, 2ol,'era$e %)ain 8eaction (2%8)& :ll #ere found to (elon+ to one $i(lin+ $pecie$ An. ga !"ae sens# str"%to (s.)) dicatin& + t)at it #a$ po$$i(l, t)e onl, $i(lin+ $pecie$ fro' t)e An. ga !"ae co'ple4 circulation in t)e $tud, area& Cor ;ualit, a$$urance and co'parati1e purpo$e$, a run containin+ (ot) An. ga !"ae and An. ara!"ens"s #a$ done to $)o# )o# t)e re$ult$ #ould )a1e (een in & ca$e t)e ot)er $i(lin+ $pecie$ Anopheles ara!"ens"s #ould )a1e (een pre$ent in t)e $a'ple$& In (ot) ca$e$, $in+le (and$ #ere 1i$ualiBed at different le1el$ and p)oto+rap)ed for An. ara!"ens"s and An. ga !"ae s.s. T)e re$ult$ are pre$ented in for' of p)oto+rap)ed +el under 0- li+)t in (Ci+& 1)& *IS%0SSI3 T)e $tud, area i$ c)aracteriBed (, )ill-1alle, topo+rap),& T)e$e topo+rap)ical feature$ deter'ine t)e for'ation of a;uatic )a(itat$& ?ill-1alle, topo+rap), facilitate$ run-off do#n-)ill to $ettle in t)e 1alle, (otto'$ for'in+ a;uatic )a(itat$ $uc) a$ $prin+$, $trea'$, ri1er$ and $#a'p$& T)e a;uatic )a(itat$ $ur1e,ed indicated t)at :nop)ele$ (reedin+ $ite$ #ere confined at t)e 1alle, (otto'$ 'ainl, in te'porar,, 'an-'ade )a(itat$& It i$ $u++e$ted t)at pro(a(l, Anopheles $pecie$ prefer open $unlit 'an-'ade )a(itat$ in #)ic) predation on lar1ae i$ le$$ pre1alent in te'porar, )a(itat$ t)an it i$ in lar+e per'anent )a(itat$ and co'petition for re$ource$ i$ le$$ co''on in ne#l, created 'an-'ade )a(itat$ (Ser1ice et al., 1"99A >a$)(urn, 1""5)& In related $tudie$, Mina6a#a et al. (2004) reported a $i'ilar An. ga !"ae s.s lar1al )a(itat di$tri(ution in a )i+)land $ite in 5en,a& T)e location$ of (reedin+ $ite$ at 1alle, (otto'$ $u++e$t t)at t)e$e location$ could (e a$$ociated #it) )i+)er ri$6 of

Int. J. Trop. Med., 6 (3): 44-51, 2011

'alaria (ecau$e t)e, are 'ore li6el, to (eco'e 'alaria )ot $pot$ (tran$'i$$ion focal point$) (7rn$t et al., 2006)& T)erefore, co''unitie$ li1in+ near 1alle,$ )a1e a )i+)er ri$6 of contractin+ di$ea$e t)an t)o$e li1in+ up)ill (Dind(lade et al., 2000A /all$ et al., 2004)& T)i$ i$ in contra$t to t)e lo#land area of Da6e -ictoria /a$in #)ic) i$ +enerall, a flat terrain and :nop)ele$ (reedin+ )a(itat$ are 'an, and #idel, di$per$ed (L'& et al., 2001A Mina6a#a et al., 2002a, ()& T)e$e +enerate )i+) 'alaria 1ector den$itie$ t)rou+)out t)e ,ear )ence perennial 'alaria tran$'i$$ion in t)e lo#land$ (/od6er et al., 2003) co'pared to $ea$onal tran$'i$$ion in t)e )i+)land$& T)e findin+ t)at lar1al )a(itat di$tri(ution #a$ a++re+ated and 'o$tl, 'an-'ade $u++e$ted t)at lar1al control in t)e $tud, area could (e tar+eted to t)e a;uatic )a(itat$ at t)e 1alle, (otto'$& Lit)e6o et al. (2006) $u++e$ted t)at in $uc) $ituation, effecti1e 1ector control could tar+et t)e confined (reedin+ $ite$ at $pecific $ite$ and could al$o in1ol1e co''unit, participation& Tar+eted lar1al control in & t)e $tud, area #ould (e e1en 'ore effecti1e if underta6en durin+ t)e dr, $ea$on Iu$t (efore t)e on$et of rain, $ea$on #)en (reedin+ )a(itat di$tri(ution i$ li'ited (, )i+) e1aporation rate leadin+ to dr,in+ of 'o$t of t)e a;uatic )a(itat$& :nd t)e fe# t)at re'ained #ere 'ore confined to#ard$ 1alle, (otto'$& It i$ $u++e$ted t)at $ource reduction (lar1al control) i$ t)e 'et)od of c)oice for 'o$;uito control #)en 'o$;uito $pecie$ tar+eted are concentrated in $'all nu'(er of di$crete )a(itat$ a$ i$ t)e ca$e in & t)e $tud, $ite$& ?o#e1er, in $e1ere epide'ic $ituation$ a$ i$ co''on in t)e #e$tern )i+)land$ of 5en,a, it #ould (e prudent to appl, Inte+rated -ector Mana+e'ent (I-M)& In t)i$ re+ard, $ource reduction (Lit)e6o et al., 2006) and tar+eted I8S (%)ri$p'& u$ et al., 2011) #ould (e appropriate control $trate+ie$& Source reduction )a$ (een one of t)e i'portant 'alaria 'ea$ure$ u$ed to $uppre$$ 'alaria in /raBil (Soper and >il$on, 1"43), TanBania (/an+ et al., 1"95, 1"99) and 0nited State$, I$rael, Ital, (5itron and Spiel'an, 1"!")& ?u'an acti1itie$ particularl, related to land-u$e e1ident in t)e $tud, area are li6el, to pro'ote 'alaria tran$'i$$ion in future in $e1eral #a,$ a$ reported el$e#)ere (>al$) et al., 1""3A 2atB et al., 2000)& Cor in$tance $#a'p recla'ation create$ 'ore 'an-'ade a;uatic )a(itat$ for t)e local An. ga !"ae s.s, t)e predo'inant ant 'alaria 1ector in & t)e area& Increa$ed cattle +raBin+ create$ 'ore open )a(itat$ #it) ele1ated te'perature t)at fa1or fa$ter 1ector lar1al de1elop'ent )ence in & crea$ed adult 1ector den$it, and 'alaria tran$'i$$ion (Mina6a#a et al., 1""", 2004)& ?i+)er adult den$itie$ of Anopheles ga !"ae co'ple4 )a1e (een reported in )ou$e$ near e$ta(li$)ed 'alaria 1ector (reedin+ )a(it$ in $o'e )i+)land area$ (Jo)n et al., 2004) and people li1in+ near 1alle, (otto'$ (near to (reedin+ )a(itat$) are li6el, )a1e 'ore 1ector-)u'an contact t)an t)o$e up-)ill and t)erefore 'ore 'alaria ca$e$& 7nto'olo+ical re$ult$ indicate t)e pre$ence of (ot) 6no#n 'alaria 1ector$ and non-1ector $pecie$ in & t)e $tud, area& T)e $i+nificance of Anopheles $pecie$ not 6no#n to act a$ 1ector$ i$ not clear& ?o#e1er, it i$ po$$i(le t)at $o'e of t)e $pecie$ pre$ent a nui$ance of 'o$;uito-(ite$ rat)er t)an tran$'it 'alaria (5oenraadt, 2003)& T)e $tud, $ite$ #ere c)aracteriBed #it) lar+e )erd$ of li1e$toc6 (cattle, $)eep and +oat$) t)at #ere often 6ept near=around )u'an )a(itation$& Cor t)e Boop)ilic= antropop)ilic $pecie$ in t)i$ +roup (includin+ An. %hr"st&, An. de "llon, An. harper", An. leeson" and An. long"palp"s), t)e initial attraction e'anatin+ fro' cattle=+oat$=$)eep 6ept in$ide or around )u'an )ou$e$ 'a, in& fluence t)eir feedin+ (e)a1ior (3,e#ole et al., 2009)& :$ $uc) a po$$i(le c)an+e in (e)a1ior in )o$t $ee6in+ :nop)ele$ 'a, increa$e t)e ri$6 of 'an (eco'in+ a re+ular $ource of (lood 'eal (, (ot) Boop)ilic and ant)ropop)ilic $pecie$& T)i$ could create a clo$e lin6 (et#een 'an-ani'al-'o$;uito fa1ora(le for t)e tran$'i$$ion of ot)er 'o$;uito-(orne di$ea$e$ in ani'al$ and 'an& Cor in& $tance, An. %o#stan" la1eran #ide$pread and a(undant o1er 'uc) of t)e :frican continent al$o encountered in t)e $tud, area readil, feed$ on )u'an$ outdoor$ (%oetBee, 1 "!3) and pla, a role in t)e tran$'i$$ion of di$ea$e ar(o1iru$e$ (Do+an et al., 1""1A Lordon et al., 1""2A %oetBee, 1""4)& 3t)er non 'alaria 1ector $pecie$ of t)e ga !"ae and$#nest#s co'ple4e$ are 6no#n to tran$'it 0 *n&ong n&ong +"r#$ in& 7a$t :frica (>illia'$ et al., 1"65)& It i$ po$$i(le t)at $o'e of t)e non-1ector anop)ele$ $pecie$ 'a, (e of local i'portance in di$ea$e tran$'i$$ion a$ in & cidental 1ector$ a$ reported el$e#)ere (Lillie$ and *e Meillon, 1"6!A Lillie$ and %oetBee, 1"!9)& In t)i$ re+ard t)e non-'alaria 1ector$ $)ould not (e i+nored& 7ffort$ to eli'inate t)e' could turn out to (e a co''unit, 'oti1ation for adoptin+ 'alaria control and pre1ention 'et)od$ in t)e pre$ent $tud, area #)ere adoption of 'alaria control 'ea$ure$ i$ lo# (ecau$e of t)e $poradic nature of t)e di$ea$e& T)e 6no#n 'alaria 1ector$ pre$ent in $tud, area #ere Anopheles ga !"ae, An. $#nest#s and An. Ara!"ens"s. T)e t)ree Anopheles $pecie$ are 6no#n to (e t)e 'o$t efficient 'alaria 1ector$ in & t)e #orld (/e$an$6,, 1""")& T)i$ i$ (ecau$e of t)eir 'ar6ed preference for )u'an en1iron'ent$ and for )u'an$ a$ )o$t$ and due to t)eir

"

Int. J. Trop. Med., 6 (3): 44-51, 2011 rapid adaptation to c)an+e$ in t)e en1iron'ent induced (, )u'an )a(itation and a+ricultural de1elop'ent (%ollin$ and /e$an$6,, 1""4A 2o#ell et al., 1""")& An. ga !"ae #a$ a(undant 'alaria 1ector and t)e 'o$t pre1alent of t)e t)ree $pecie$ in t)e pre$ent $tud,& T)e$e findin+$ #ere con$i$tence #it) related $tudie$ in t)e $a'e or nei+)(orin+ $ite$ a$ #ell a$ ot)er )i+)land re+ion$ in :frica (%ollin$ et al., 1"!!A 2etrarca et al., 1""1)& 2re1iou$ 1ector $tudie$ in andi indicated 'alaria 1ector co'po$ition of "!< An. ga !"ae co'ple4 and 2< An. $#nest#s (8o(ert$, 1"64A 7rn$t et al., 2006)& In related $tudie$ in 'an, part$ of :frica, An. ga !"ae i$ found to+et)er #it) t)e e;uall, i'portant 1ector An. $#nest#s (%)arl#ood et al., 2003A 6uo-:6enIi et al., 2006)& An. $#nest#s and An. ara!"ens"s #ere rarel, encountered #it) onl, one $peci'en of eac) collected tran$latin+ into 2&4< of t)e total 'alaria 1ector$& T)i$ could (e (ecau$e t)e t#o $pecie$ )a1e difficultie$=apparent failure to coloniBe )i+) altitude$ $ucce$$full,& ?o#e1er, t)ere i$ need for e4ten$i1e $tudie$ on lar1al and adult $ur1e,$ and di$per$al e4peri'ent$ tar+etin+ t)e$e $pecie$ to co'e up #it) a clear picture on di1er$it, in t)e $tud, area& Malaria 1ector ($) and non-1ector$ 'a, periodicall, e4tend t)eir ran+e (e,ond t)eir nor'al area of di$tri(ution #)en te'poraril, $uita(le condition$ occur in nei+)(orin+ area$ (>?3, 1 ""!)& T)i$ 'a, e4plain t)e pre$ence of An. ("e ann" in $tud, area #)ic) i$ #idel, encountered in >e$t :frica e4tendin+ to 7t)iopia #it) $cant,, localiBed di$tri(ution in 7a$t :frica (Lillie$ and *e Meillon, 1 "6!)& In 5en,a, it )a$ (een pre1iou$l, reported 'ainl, in t)e lo# land$ of Da6e -ictoria (a$in (5)a'ala, 1"91A 5a'au et al., 2006)& In t)e pre$ent $tud,, t)e $pecie$ #a$ encountered (ut it$ 1ectorial i'portance i$ not clear alt)ou+), it i$ 6no#n to (e $u$cepti(le to and can 'aintain 'alaria para$ite$ (Lillie$ and *e Meillon, 1 "6!), feed$ on (ot) 'an and ani'al$ (5a'au et al., 2006)& T)e $pecie$ 'a, (e under+oin+ a p)a$e of adaptation to li1e in )i+)land area$ in pro4i'it, to t)e nor'al )a(itat, t)e lo#land$& T)ere i$ need for furt)er field and e4peri'ental $tudie$ on An. ("e ann" a$ re+ard$ po$$i(le role in & 'alaria tran$'i$$ion in (ot) lo# and )i+) altitude area$& T)e pre$ence of a $pecie$ of #ell 6no#n 'alaria 1ector, An. ara!"ens"s, a predo'inant ant 1ector in lo#land$ at )i+) altitude rai$e$ curio$it,& If deter'ined and confir'ed in lar+er lon+-ter' $tudie$, t)e pre$ence of An. ara!"ens"s at t)e pre$ent )i+) altitude area #ould $upport $cant, report$ t)at t)e $pecie$ i$ capa(le of (reedin+ and tran$'ittin+ 'alaria in a )i+)land area (%)en et al., 2006)& It i$ po$$i(le t)at re+ular tra1el (et#een Da6e -ictoria lo#land$ and t)e #e$tern )i+)land$ could introduce t)e 1ector into )i+)land$& /ot) An. ga !"ae s.s and An. ara!"ens"s )a1e $i'ilar re;uire'ent$ for t)eir lar1al en1iron'ent (Ser1ice et al., 1"99A Li'ni+ et al., 2001)& T)erefore, t)ere i$ a po$$i(ilit, t)at An. ara!"ens"s i'ported into t)e )i+)land$ could (eco'e e$ta(li$)ed and (eco'e an i'portant 'alaria 1ector to+et)er #it) An. ga !"ae s.s in future& >)ene1er t)e$e t#o $pecie$ occur to+et)er, population$ of An. ara!"ens"s are 6no#n to $ur1i1e t)e dr, $ea$on (etter #)ile population$ of An. ga !"ae s.s. pea6 $)ortl, after on$et of rain & , $ea$on (5oenraadt, 2003)& If t)i$ $cenario i$ e$ta(li$)ed, t)en 'alaria tran$'i$$ion in t)e #e$tern )i+)land$ of 5en,a could (eco'e perennial a$ oppo$ed to t)e current $ea$onal tran$'i$$ion& %3 %D0SI3 Malaria tran$'i$$ion in t)e #e$tern )i+)land$ of 5en,a i$ $ea$onal, focal in& nature, $poradic #it) 'ore ca$e$ reported in& co''unitie$ li1in+ at 1alle, (otto'$ #)ere )i+)e$t concentration of (reedin+ )a(itat$ are located& It i$ concluded t)at inter1ention $trate+ie$ $)ould t)erefore (e appropriatel, focu$ed at t)e$e point$ #)en identified for co$t effecti1ene$$ and (etter re$ult$& :%5 3>D7*L7M7 TS T)e re$earc)er$ ac6no#led+e tec)nical and field a$$i$tance fro' t)e *i1i$ion of -ector-/orne *i$ea$e$ E*-/*G, 5ap$a(et Station and t)e Mini$tr, of ?ealt), 5en,a and 5en,a Medical 8e$earc) In$titute E57 78IG, 5i$u'u, 5en,a& 87C787 %7S :nt)on,, T&L&, 8&7& ?ar(ac) and I&J& 5itc)in+, 1"""& 2),lo+en, of t)e p,retop)oru$ $erie$ of Anopheles $u(+enu$ ,el"a (*iptera:%ulicidae)& S,$t& 7nto'ol&, 24: 1"3-205& /all$, M&, 8& /od6er, %&J& T)o'a$, >& 5i$inBa, ?&:& M$an+eni and S&>& Dind$a,, 2004& 7ffect of topo+rap), on t)e ri$6 of 'alaria infection in t)e 0$a'(ara Mountain$, TanBania& Tran$& 8& Soc& Trop& Med& ?,+iene, "!: 400-40!& /an+, N&?&, C&M& Mrope and I&/& Sa(uni, 1"99& %)an+e$ in 'o$;uito population$ a$$ociated #it) ur(aniBation in TanBania& 7a$t :fr& Med& J&, 54: 403-410& /an+, N&?&, I&/& Mrope and 8&I& Sa(uni, 1"95& Inte+rated control of ur(an 'o$;uitoe$ in *ar-e$-$alaa' u$in+ co''unit, $anitation $upple'ented (, lar1icidin+& 7a$t :fr& Med& J&, 52: 59!-5!!& /e$an$6,, &J&, 1"""& %o'ple4itie$ in t)e anal,$i$ of cr,ptic ta4a #it)in t)e +enu$ Anopheles. 2ara$itolo+ia, 41: "9-100&

10

Int. J. Trop. Med., 6 (3): 44-51, 2011

/od6er, 8&, J& :6ida, *& S)a,o, >& 5i$inBa, ?&:& M$an+ani, 7&M& 2eder$on and S&>& Dind$a,, 2003& 8elation$)ip (et#een altitude and inten$it, of 'alaria tran$'i$$ion in t)e 0$a'(ara Mountain$, TanBania& J& Med& 7nto'ol&, 40: 906-919& %)arl#ood, J&*&, 8& T)o'p$on and ?& Mad$en, 2003& 3($er1ation$ on t)e $#ar'in+and 'atin+ (e)a1ior of Anopheles $#nest#s fro' Sout)ern MoBa'(i;ue& Malaria J&, 2: 2-2& %)en, ?&, :&5& Lit)e6o, L& O)ou, J&I Lit)ure and L& Nan, 2006& e# record$ of Anopheles ara!"ens"s (reedin+ on Mount 5en,a )i+)land$ indicate indi+enou$ 'alaria tran$'i$$ion& Malaria J&, 5: 19-21& %)ri$pinu$, M&S&, S& & *onald and &M& Mo$e$ and M&-& Jo)n, 2011& Tar+eted indoor in$ecticide and 'alaria control in t)e #e$tern )i+)land$ of 5en,a& J& Infect& *i$& I''unit,, 3: 50-5!& %oetBee, M&, 1"!3& %)ro'o$o'al and cro$$-'atin+ e1idence for t#o $pecie$ #it) Anopheles (:) %ou$tani (*iptera: %ulicidae)& S,$t& 7nto'ol&, !: 139-141& %oetBee, M&, 1""4& Anopheles %l&pt"%#s, ne# $pecie$ fro' Sout) :frica i$ di$tin+ui$)ed fro' Anopheles %o#stan" (*iptera: %ulicidae)& Mo$;uito S,$t&, 26: 125-131& %ollin$, C&?& and & /e$an$6,, 1""4& -ector (iolo+, and t)e control of 'alaria in :frica& Science, 264: 1!94-1!95& %ollin$, C&?&, -& 2etrarca, S& Mpofu, :&*& /randlin+/ennett, J&/& >ere, M&3& 8a$'u$$en and -& Cinnert,, 1"!!& %o'pari$on of * : pro(e and c,to+enetic 'et)od$ for identif,in+ field collected Anopheles ga !"ae co'ple4 'o$;uitoe$& :'& J& Trop& Med& ?,+iene, 3": 545-550& *uff,, J&, 1"99& -enture$ in t)e >orld ?ealt)& T)e Me'oir$ of Cred Do#e Soper& 2an :'erican ?ealt) 3r+aniBation, >a$)in+ton, *%& 7rn$t, 5&%&, S&3& :do6a, *&3& 5o#our, M&D& >il$on and %&%& Jo)n, 2006& Malaria )ot$pot area$ in a )i+)land 5en,a $ite are con$i$tent in epide'ic and non- epide'ic ,ear$ and are a$$ociated #it) ecolo+ical factor$& Malaria J&, 5: 9!!2& Lillie$, M&T& and /& *e Meillon, 1"6!& T)e :nop)elinae of :frica $out) of t)e Sa)ara (7t)iopian Ooo+eo+rap)ical 8e+ion)& 2nd 7dn&, 2u(lication$ of t)e Sout) :frica In$titute for Medical 8e$earc), Jo)anne$(ur+, Sout) :frica, pp: 343& Lillie$, M&T& and M& %oetBee, 1"!9& : Supple'ent to t)e :nop)elinae of :frica Sout) of t)e Sa)ara (:frotropical 8e+ion)& Sout) :frican In$titute for Medical 8e$earc), Jo)anne$(ur+, IS/ -13: "9!06201 03213, pp: 143& Li'ni+, J&7&, M& 3'(o6, D& 5a'au and >&:& ?a#le,, 2001& %)aracteri$tic$ of :nop)eline (*iptera: %ulicidae) )a(itat$ in #e$tern 5en,a& J& Med& 7nto'ol&, 3!: 2!2-2!!& Lit)e6o, :&5&, J&M& :,i$i, 2&5& 3dada, C&5& :tieli, /&:& den+a, J&I& Lit)ure and L& Nan, 2006& Topo+rap), and

'alaria tran$'i$$ion )etero+eneit, in #e$tern 5en,a )i+)land$: 2ro$pect$ for focal control& Malaria J&, 5: 109109& Lordon, S&>&, 8&C& Ta''ariello, 5&J& Dincit)icu', *&J& *o)', J&2& *i+outte and M&:& %al1o->il$on, 1""2& :r(o1iru$ i$olation fro' 'o$;uitoe$ collected durin+ 1"!! in t)e Sene+al 8i1er /a$in& :'& J& Trop& Med& ?,+iene, 49: 94294!& Jo)n, %&%&, /&*& /,rd and C&P& 3'lin, 2004& Cield a$$e$$'ent$ in #e$tern 5en,a lin6 'alaria 1ector$ to en1iron'entall, di$tur(ed )a(itat$ durin+ dr, $ea$on& /M% 2u(lic ?ealt), 4: 33-33& 5a'au, D&, & Mula,a and J&M& -ulule, 2006& 71aluation of potential role of Anopheles ("e ann" in 'alaria tran$'i$$ion in >e$tern 5en,a& J& Med& 7nto'ol&, 43: 994-996& 5)a'ala, %&2&M&, 1"91& T)e (itin+ flie$ of t)e 5ano plain$, 5en,a: 2art II& Dar1al )a(itat$ of co''on 'o$;uito $pecie$ (*iptera: %ulicidae)& /ull& 7nto'ol& 8e$&, 61: 2""309& 5itron, 0& and :& Spiel'an, 1"!"& Suppre$$ion of tran$'i$$ion of 'alaria t)rou+) $ource reduction: anti-anop)eline 'ea$ure$ applied in I$rael, 0nited State$ and Ital,& 8e1& Infect& *i$&, 11: 3"1-406& 5oenraadt, %&J&M&, 2003& Mo$;uitoe$, 'en and 'alaria in 5en,a: : $tud, on ecolo+ical factor$ affectin+ 'alaria ri$6& 2)&*& T)e$i$, >a+enin+en 0ni1er$it,, et)erland$ Dind(lade, 5&:&, 7&*& >al6er, :&>& 3napa, J& 5itun+u and M&D& >il$on, 2000& Dand-u$e c)an+e alter$ 'alaria tran$'i$$ion para'eter$ (, 'odif,in+ te'perature in a )i+)land area of 0+anda& Trop& Med& Int& ?ealt), 5: 263294& Do+an, T&M&, 5&J& Dint)icu', 2&%& T)ande, J& & >a+ate) and %&8& 8o(ert$, 1""1& Mo$;uito $pecie$ collected fro' a 'ar$) in #e$tern 5en,a durin+ t)e lon+ rain$& J& :'& Mo$;& %ontrol :$$oc&, 9: 3"5-3""& Mina6a#a, &, %&M& Mutero, J&I& Lit)ure, J&%& /eier and L& Nan, 1"""& Spatial di$tri(ution and )a(itat c)aracteriBation of :nop)eline 'o$;uitoe$ in #e$tern 5en,a& :'& J& Trop& Med& ?,+iene, 61: 101 0-1016& Mina6a#a, &, L& Son,e, M& Mo+i and L& Nan, 2004& ?a(itat c)aracteriBation of Anopheles ga !"ae S$& lar1ae in a 5en,an )i+)land& Med& -et& 7nto'ol&, 1!: 301-305&

11

Int. J. Trop. Med., 6 (3): 44-51, 2011

Mina6a#a, &, L& Son,e, M& Mo+i, :& Lit)e6o and L& Nan, 2002(& T)e effect$ of cli'ate factor$ on t)e di$tri(ution and a(undance of 'alaria 1ector$ in 5en,a& J& Med& 7nto'ol&, 3": !33-!41& Mina6a#a, -., 2& Seda and L& Nan, 2002a& Influence of )o$t and lar1al )a(itat di$tri(ution on t)e a(undance of :frican 'alaria 1ector$ in #e$tern 5en,a& :'& J& Trop& Med& ?,+&, 69: 32-3!& Muriu, S&M&, 7&J& Muturi, J&I& S)ililu, %&M& M(o+o and J&M& M#an+an+i et al., 200!& ?o$t c)oice$ and 'ultiple (lood feedin+ (e)a1ior of 'alaria 1ector$ and ot)er anop)eline$ in M#ea rice Sc)e'e, 5en,a& Malaria J&, 9: 43-4"& 6uo-:6enIi, T&, & & tonifor, M&/& du6u', ?&5& 5i'(i and 7&D& :(on+#a et al., 2006& 7n1iron'ental factor$ affectin+ 'alaria para$ite pre1alence in rural /olifa'(a, Sout)->e$t %a'eroon& :fr& J& ?ealt) Sci&, 13: 40-46& 3,e#ole, I&3&, T&S& :#olola, %&:& I(ida(o, :&3& 3duola, 3&3& 36#a and J&:& 3(an$a, 2009& /e)a1ior and population d,na'ic$ of 'aIor anop)eline 1ector$ in a 'alaria ende'ic area in $out)ern i+eria& J& -ector /orne *i$&, 44: 56-64& 2atB, J&:&, T&5& LracB,6, & Leller and :&N& -itter, 2000& 7ffect$ of en1iron'ental c)an+e on e'er+in+ para$itic di$ea$e$& Int& J& 2ara$itol 30: 13"5-1405& 2etrarca, -&, J&%& /eier, C& 3n,ann+o, J& 5oro$, %& :$ia+o, *&5& 5oec) and %&8& 8o(ert$, 1""1& T)e $pecie$ co'po$ition of Anopheles ga !"ae co'ple4 (*iptera: %ulicidae) at t#o $ite$ in #e$tern 5en,a& J& Med& 7nto'ol&, 2!: 309-313& 2o#ell, J&8&, -&:& 2etrarca, *& Tone, :& %accone and M& %oluBBi, 1"""& 2opulation $tructure, $peciation, and intro+re$$ion in t)e Anopheles ga !"ae co'ple4& 2ara$itolo+ ia, 41: 101-113& 8o(ert$, J&M&*&, 1"64& T)e control of epide'ic 'alaria in t)e )i+)land$ of #e$tern 5en,a& 2art III& :fter t)e ca'pai+n& J& Trop& Med& ?,+&, 69: 230-239&

Scott, J&:&, >&L& /ro+don and C&?& %ollin$, 1""3& Identification of $in+le $peci'en$ of t)e Anopheles ga !"ae co'ple4 (, t)e pol,'era$e c)ain reaction& :'& J& Trop& Med& ?,+iene, 4": 520-52"& Ser1ice, M&>&, L&2& Jo$)i and L&*& 2rad)an, 1"99& : $ur1e, of Anopheles ga !"ae ($pecie$ :) and Anopheles ara!"ens"s ($pecie$ /) of Anopheles ga !"ae co'ple4 in 5i$u'u area follo#in+ in$ecticidal $pra,in+ #it) 3MS43 (Cenitrot)ion)& :nn& Trop& Med& 2ara$itol&, 92: 3993!6& Soper, C&D& and *&/& >il$on, 1"43& Anopheles ga !"ae in /raBil: 1"30-1"40& 8oc6feller Coundation, e# Nor6& >?3, 1"95& Manual on 2ractical 7nto'olo+, in Malaria& 2art II& Met)od$ and Tec)ni;ue$& -ol& 3, >orld ?ealt) 3r+ani$ation, Lene1a, pp: 1-1"9& >?3, 1""!& Llo(al 'alaria pro+ra''e& >?3=M:D="!& 10!4& >?3, 2010& >?3 +lo(al 'alaria pro+ra''e& >orld Malaria 8eport, 2010& )ttp:==#);li(doc&#)o&int= pu(lication$=2010="9!"241564106 en+ &pdf& >al$), J&C&, *&?& Mol,neau4 and M&?& /irle,, 1""3& *efore$tation: 7ffect$ on 1ector-(orne di$ea$e$& 2ara$itolo+,, 106: 55-95& >a$)(urn, J&0&, 1""5& 8e+ulator, factor$ affectin+ lar1al 'o$;uito population$ in container and pool )a(itat$: I'plication$ for (iolo+ical control& J& :'& Mo$;uito %ontrol :$$oc&, 11: 29"-2!3& >illia'$, M&%&, J&2& >oodall, 2&S& %or(et and J&*& Lillet, 1"65& 3.n,on+ n,on+ fe1er: :n epide'ic 1iru$ di$ea$e in 7a$t :frica& -III& -iru$ i$olation fro' Anopheles 'o$;uitoe$& Tran$& 8& Soc& Trop& Med& ?,+iene, 5": 300306&

12