Mosquitoes were caught in bedrooms in Tanzanian villages by humanbiting catches and in light-traps set close to occupied untreated bed nets. Catches by each method were carried out on pairs of nights in the same week at different seasons and in different villages. The pairs of adjacent catches by the different methods showed a strong correlation. Analysis of the ratio between the catches by the two methods on pairs of nights in the same week indicated that on average three light-traps caught about the same number of mosquitoes as a team of two human catchers. The ratio did not differ significantly between Anopheles gambiae Giles (sensu lato), A. funestus Giles, and Culex quinquefasciatus Say, nor between the villages, or between times when mosquito populations were high or low. The distribution of numbers of ovarian dilatations differed significantly between catches in different villages and seasons but not between pairs of catches by the two methods. Similarly, the parity and sporozoite rates agreed between pairs of light-trap and house-resting catches, but differed markedly between villages and seasons. Thus it is concluded that light-traps used in conjunction with bed nets catch a representative sample of the vectors which would have bitten humans in bedrooms in this area.

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SummaryObjectives To investigate (1) benefits due to personal protection of individual net users vs. mass killing of mosquitoes within villages as a result of widespread net usage; (2) sustainability over several years of benefits against malarial morbidity of insecticide-treated nets; (3) distribution of the benefits in different age groups of children and (4) whether, as a result of fading immunity, older age groups 'paid for' the benefits which they had enjoyed when younger.Methods (1) Tabulation of earlier data to compare personal and community-wide effects against mosquito vectors; (2) two cross-sectional surveys for malaria parasitaemia, malarial fever, anaemia and splenomegaly in children in eight Tanzanian villages, in which there had been community-wide use of bednets which had been annually re-treated with alphacypermethrin for 3-4 years; (3) comparison between children of different age groups and with intact, torn or no nets in these villages and in 4-6 villages without nets.Results A 90-95% reduction in infective bites outside nets in netted villages and an additional 54-82% reduction of bites among individual net users. Highly significant reductions (by 55-75%) in malarial morbidity for children aged 6 months to 2 years were found in netted villages with, for some outcomes, better results among individuals who themselves had intact treated nets. For older children, benefits were less clear or absent, but there was no sign that the benefits early in life were 'paid for' by worse outcomes in the netted villages later in childhood. ConclusionsThe overall benefits to the community of widespread use of treated nets are sustainable and are not reversed in 3-4 years as a result of fading immunity. It is important to ensure high enough coverage to realize the full potential of the treated net method. By showing an impact on the vector population in the community these results provide a strong argument for organized free provision of net treatment, rather than relying on marketing.keywords insecticide-treated bednets, malarial morbidity, marketing vs. free provision, mass effect, sustainability of impact, Tanzania correspondence Prof. C.F. Curtis,

SummaryIn an intensely malarious area in north-east Tanzania, microencapsulated lambdacyhalothrin was used in four villages for treatment of bednets (provided free of charge) and in another four villages the same insecticide was used for house spraying. Another four villages received neither intervention until the end of the trial but were monitored as controls. Bioassays showed prolonged persistence of the insecticidal residues. Light traps and ELISA testing showed reduction of the malaria vector populations and the sporozoite rates, leading to a reduction of about 90% in the entomological inoculation rate as a result of each treatment.Collections of blood fed mosquitoes showed no diversion from biting humans to biting animals. Incidence of re-infection was measured by weekly monitoring of cohorts of 60 children per village, after clearing preexisting infection with chlorproguanil-dapsone. The vector control was associated with a reduction in probability of re-infection per child per week by 54-62%, with no significant difference between the two vector control methods. Cross-sectional surveys for fever, parasitaemia, haemoglobin and weight showed association of high parasitaemia with fever and anaemia and beneficial effects of each intervention in reducing anaemia. However, passive surveillance by resident health assistants showed no evidence for reduced prevalence of fever or parasitaemia. Net treatment consumed only about one sixth as much insecticide as house spraying and it was concluded that the former intervention would work out cheaper and nets were actively demanded by the villagers, whereas spraying was only passively assented to. keywords impregnated bednets, house spraying, lambdacyhalothrin, Tanzania, malaria correspondence C. F. Curtis,

Comparisons of bednets treated either with alphacypermethrin or lambdacyhalothrin showed similar effectiveness by various entomological criteria. Lambdacyhalothrin was associated with significantly more reports of nasal irritation than alphacypermethrin. The 2 net treatments were equally effective in reducing incidence of new malaria infections and the treated nets were much more effective than untreated nets. These measurements were made after clearing existing infections with chlorproguanil-dapsone. This drug combination was more than 99% effective in clearing infections 1 week after treatment and a study of children taken to an altitude with no malaria transmission showed that there were very few recrudescences.

A mark-recapture experiment was carried out in northern Tanzania to determine whether Anopheles arabiensis exhibits memory, by investigating if bloodfed individuals would return to either the location or the host where or on which they had obtained a previous bloodmeal, behaviours termed site-fidelity and host-fidelity respectively. Over 4300 mosquitoes were collected from 2 houses, marked with different fluorescent colours according to whether they were caught in cattle sheds, 'cattle-fed', or within human bednets, 'human-fed', at either location, then released from a third location. Over 17,000 mosquitoes were collected and examined over the next 8 days. In total, 1% of released mosquitoes were recaptured. Of these, 68% had returned to the house where they were first caught, demonstrating site-fidelity (P = 0.007). However, 86% of recaptured mosquitoes were caught on cattle regardless of where they were initially caught (P = 0.185). Bloodmeal identification showed that a high proportion of mosquitoes classed as human-fed contained bovine blood, thereby confounding the investigation into host-fidelity. Notably, the proportion of mosquitoes with mixed bloodmeals depended on the proximity of cattle and humans, with significantly higher proportions of mixed bloodmeals occurring when cattle and humans slept in close proximity. The effects of the observed behaviours on malaria epidemiology are discussed.

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Background: Pain is a significant burden experienced by patients admitted to the adult Intensive Care Unit (ICU). Acute