Control C Control V Meme
Leana Eckes
My Facebook page has been exploding with pictures like that above. They are usually connected with some statistics about abortion killing 1.2 million per year whereas guns kill only around 2,000. The post then ends with challenging Congress or President Obama to fight the real war on women (or assault weapons).
I agree with the logic. I further understand the hypocrisy of turning a blind eye to the 55 million children legally aborted since 1973 while making it a mission to control guns which kill far less children per year. I get that.
Mostly because I fear that by conflating these two issues we are minimizing both the atrocity of abortion and the tragedy of events like Sandy Hook. We are politicizing pain. It is using one horrible act to make a point about another. Regardless of which of the points you intend to make you are minimizing the other.
Onchocerciasis control using ivermectin alone has been achieved in some endemic savannah zones of Africa. In the forest regions, the co-endemicity with Loa loa has led to severe adverse events (SAEs) resulting in poor adherence of community members to ivermectin mass drug administration (MDA). This may jeopardize achieving the interruption of transmission of onchocerciasis. Therefore, to accelerate the elimination of onchocerciasis in L. loa co-endemic zones, alternative treatment strategies (ATS) including ground larviciding may be necessary. This study aimed at identifying Simulium breeding sites, cytospecies, transmission profile, susceptibility of Simulium larvae to insecticide (temephos) and identification of some non-target aquatic fauna prior to the implementation of the COUNTDOWN consortium ground larviciding alternative strategy in the Meme River Basin in South West Cameroon.
A topographic map and entomological survey were used to determine breeding sites. Larvae and adults were identified using standard identification keys. Susceptibility tests were carried out on collected larvae by exposing them to decreasing concentrations of temephos and assessing survival rates while the cytospecies were identified using cytotaxonomy. Various entomological indicators were assessed from dissected flies. Fishing was used as proxy to traps to assess some aquatic fauna at different sites.
Onchocerciasis is being actively transmitted within the Meme River Basin. Simulium larvae are susceptible to temephos, and nine cytospecies are present. Non-target fauna observed included fishes, frogs, crabs and insects. Besides treatment with ivermectin, vector control through ground larviciding may be a complementary strategy to accelerate onchocerciasis elimination in the study area.
The advent of ivermectin and its donation by Merck & Co. (NJ, USA) [4] provided the opportunity for its large-scale use for the treatment of onchocerciasis by the African Programme for Onchocerciasis Control (APOC) in 20 endemic African countries. Ivermectin mass drug administration (MDA) has led to the interruption of transmission in some foci in Mali, Senegal, Sudan and Uganda [5,6,7,8]. Unfortunately, the same level of achievement has not been made in Cameroon, especially in the South West Region where onchocerciasis is co-endemic with loiasis.
In the South West Region of Cameroon, the persistence of onchocerciasis transmission is due to the existence of abundant breeding sites in fast-flowing rivers, which results in very high numbers of biting black flies transmitting the parasite and poor adherence of the community members to ivermectin mass drug administration [9, 10]. The poor adherence to ivermectin MDA is due to the fear of SAEs that follow ivermectin treatment of highly infected Loa loa individuals in co-endemic areas of onchocerciasis and L. loa [10, 11]. Faced with these challenges and coupled with the change in paradigm from onchocerciasis control to elimination, it was important for APOC to offer new approaches to improve or complement ivermectin MDA [12]. This led to adoption of alternative treatment strategies (ATS). These ATS include complementary vector control, enhanced community-directed treatment with ivermectin (CDTI), community-directed treatment (CDT) with drug combinations or new drugs and test-and-treat (TNT) strategies [13]. The ATS are essentially directed towards highly endemic onchocerciasis foci where the disease cannot be eliminated by annual CDTI alone.
The Meme River Basin of South West Cameroon has been under CDTI for > 18 years. A situational analysis of onchocerciasis conducted in this region by Wanji et al. [9] demonstrated persistent transmission despite ivermectin MDA with prevalence values as high as 52% [9]. This persistence in onchocerciasis transmission motivated the COUNTDOWN Consortium to evaluate implementation of one of the recommended ATS, ground larviciding, as a potential tool to accelerate the elimination of onchocerciasis in this endemic focus. Ground larviciding is known to significantly reduce the number of biting black flies, thus reducing disease transmission and infection rates. Pre-requisites to ground larviciding are: identification of breeding sites, susceptibility test of Simulium larvae to a larvicide of interest, identification of cytospecies in the river basin and identification of non-target aquatic fauna. In this study, we chose to use temephos (Abate 500 EC-BASF, Douala, Cameroon) as the larvicide. Temephos is an organophosphate larvicide which has been shown to be biodegradable and non-toxic to non-target fauna with a good carry during the rainy season. This article presents the breeding sites, identified Simulium cytospecies, current onchocerciasis transmission profile, susceptibility of Simulium damnosum larvae to temephos and a baseline survey of some non-target aquatic fauna present in the Meme River Basin prior to the implementation of the COUNTDOWN Consortium ground larviciding alternative strategy implementation trial.
Meme River Basin is situated in the rain forest of the South West Region of Cameroon approximately 60 km inland from the Atlantic Ocean. The topography is very diverse; the main feature is a mountain range (Rumpi Hills, characterized by a volcanic ridge culminating at 1764 m with a northeast orientation [14]. The volcanic ridge is broken by several valleys and constitutes a watershed that is the source for several rivers, the Manyu, Meme, Mungo and Ndian. These rivers go down steep slopes generating fast currents and appropriate flow rates that favour the establishment of permanent Simulium breeding sites conducive to high intensity of onchocerciasis transmission. The climate is characterized by 8 months of rainfall and a short dry season from December to March. The annual rainfall varies between 2500 and 4000 mm with annual temperatures ranging from 25 to 32 C.
River Meme and its tributaries originate from the Rumpi Hills and flow down precipitous slopes some kilometres from the selected communities. The main tributaries of the Meme River are the Mbile River, which flows pass Marumba I and II, and the Uve River in Bakumba and Big Massaka. These tributaries create important Simulium breeding sites as they enter the Meme River.
Potential Simulium breeding sites in the Meme River were selected using a topographical map of 1:200,000 scale [28] followed by an entomological survey to check for the presence of rapids, trailing vegetation and larvae to confirm that it is a breeding site. The Melange River in Ndian Division was set as the control area, which will be used to monitor the stability of entomological indicators after ground larviciding. The larvae and adults were identified using standard identification keys [15, 16]. All breeding sites were geo-referenced using a GPS. The co-ordinates were used to generate a topographical map of the breeding sites (Fig. 1a, b).
Map showing breeding sites geo-referenced using a GPS. a Map of the study and control area with prospected breeding sites. b Map showing productive and non-productive breeding sites of the study area
The study was conducted from March to July 2017. River Meme and its tributaries were surveyed, 20 breeding sites from 12 communities (Betenge, Small Massaka Lokando Big Butu, Small Butu, Big Massaka, Kumukumu, Bombele, Bobanda Kwakwa Nake and Marumba 1) were visited, but due to absence of larvae in some sites at the time of the study, only 8 sites from six communities (Betenge, Small Massaka, Big Massaka, Bombele, Kwakwa and Marumba 1) were chosen for fly and larvae collection. Due to accessibility, two sites near one community (Berenge) were surveyed in the Melange River Basin (control area). Flies were collected and dissected from one of the sites that had larvae to monitor the stability of entomological indicators in an untreated area after ground larviciding. Some sites in the Meme River Basin did not have enough larvae, so larvae for cytotaxonomy were collected only from three sites (Big Massaka, Bombele and Kwakwa). In the study arm, the breeding sites chosen were at:
Big Massaka (River Uve, tributary of Meme). A survey of this tributary revealed many breeding sites which contained S. damnosum larvae. A catching point was therefore located in this community.
Larvae of S. damnosum were collected from several breeding sites, namely Marumba 1, Big Massaka, Bombele and KwaKwa in the Meme River Basin located in the South West Region of Cameroon. These larvae were exposed using a bowl containing local bottled water (Supermont) to ten concentrations of temephos (0.0005 mg/l to 0.5 mg/l) (Additional file 1: Text S1) for a period of 3 h [17]. After this, mortality was determined by observation of larvae motility response to stimulation [18].
Simulium flies were collected from seven different sites: Bombele and Betenge (River Meme), Big Massaka (River Uve), Kwakwa and Marumba I (River Mbile), Small Massaka (River Ka) and Berenge (River Melange). Residents of endemic communities for onchocerciasis were trained to carry out collections; Simulium flies landing on exposed legs for a blood meal were captured using suction tubes or mouth aspirators (locally adapted) before they bit [21].
d3342ee215