A sizeable proportion of households is forced to share single long-lasting insecticide treated net (LLIN). However, the relationship between increasing numbers of people sharing a net and the risk for Plasmodium infection is unclear. This study revealed whether risk for Plasmodium falciparum infection is associated with the number of people sharing a LLIN in a holoendemic area of Kenya. Children ⩽5 years of age were tested for P. falciparum infection using polymerase chain reaction. Of 558 children surveyed, 293 (52.5%) tested positive for parasitaemia. Four hundred and fifty-eight (82.1%) reported sleeping under a LLIN. Of those, the number of people sharing a net with the sampled child ranged from 1 to 5 (median = 2). Children using a net alone or with one other person were at lower risk than non-users (OR = 0.29, 95% CI 0.10-0.82 and OR = 0.47, 95% CI 0.22-0.97, respectively). On the other hand, there was no significant difference between non-users and children sharing a net with two (OR = 0.88, 95% CI 0.44-1.77) or more other persons (OR = 0.75, 95% CI 0.32-1.72). LLINs are effective in protecting against Plasmodium infection in children when used alone or with one other person compared with not using them. Public health professionals should inform caretakers of the risks of too many people sharing a net.

There is an urgent need to develop an automated malaria diagnostic system that can easily and rapidly detect malaria parasites and determine the proportion of malaria-infected erythrocytes in the clinical blood samples. In this study, we developed a quantitative, mobile, and fully automated malaria diagnostic system equipped with an on-disc SiO 2 nanofiber filter and blue-ray devices. The filter removes the leukocytes and platelets from the blood samples, which interfere with the accurate detection of malaria by the blue-ray devices. We confirmed that the filter, which can be operated automatically by centrifugal force due to the rotation of the disc, achieved a high removal rate of leukocytes (99.7%) and platelets (90.2%) in just 30 s. The automated system exhibited a higher sensitivity (100%) and specificity (92.8%) for detecting Plasmodium falciparum from the blood of 274 asymptomatic individuals in Kenya when compared to the common rapid diagnosis test (sensitivity = 98.1% and specificity = 54.8%). This indicated that this system can be a potential alternative to conventional methods used at local health facilities, which lack basic infrastructure. Globally, malaria is one of the "big three" infectious diseases with an incidence rate of 57 cases per 1000 individuals 1. Malaria is a vector-borne disease, which is caused by infection from Plasmodium spp. and is transmitted by Anopheles mosquitoes. The United Nations Sustainable Development Goals had proposed to end the epidemic of malaria by 2030 2. Although the annual fatality rate has decreased since 2016, about 405,000 malaria-related deaths were reported in 2018. Similarly, new malaria cases have increased slightly since 2014 with 231 million recorded cases in 2017 and 228 million recorded cases in 2018 3. Several factors have stagnated global progress in eradicating malaria 4. Particularly, most tools to tackle the current malaria infection were developed before 2000. Thus, there is a need to develop new tools using novel technologies to accelerate the efforts toward malaria elimination 4 .

Introduction Snakebites are a major cause of permanent injury and death among poor, rural populations in developing countries, including those in East Africa. This research characterizes snakebite incidence, risk factors, and subsequent health-seeking behaviors in two regions of Kenya using a mixed methods approach. Methods As a part of regular activities of a health demographic surveillance system, household-level survey on snakebite incidence was conducted in two areas of Kenya: Kwale along the Kenyan Coast and Mbita on Lake Victoria. If someone in the home was reported to have been bitten in the 5 years previous to the visit, a survey instrument was administered. The survey gathered contextual information on the bite, treatment-seeking behavior and clinical manifestations. To obtain deeper, contextual information, respondents were also asked to narrate the bite incident, subsequent behavior and outcomes. Results 8775 and 9206 households were surveyed in Kwale and Mbita, respectively. Out of these, 453 (5.17%) and 92 (1.00%) households reported that at least one person had been bitten by a snake in the past 5 years. Deaths from snakebites were rare (4.04%), but patterns of treatment seeking varied. Treatment at formal care facilities were sought for 50.8% and at traditional healers for 53.3%. 18.4% sought treatment from both sources. Victims who delayed receiving treatment from a formal facility were more likely to have consulted a traditional healer (OR 8.8995% CI [3.83, 20.64]). Delays in treatment seeking were associated with significantly increased odds of having a severe outcome, including death, paralysis or loss of consciousness (OR 3.47 95% CI [1.56; 7.70]). Conclusion Snakebite incidence and outcomes vary by region in Kenya, and treatment-seeking behaviors are complex. Work needs to be done to better characterize the spatial distribution of snakebite incidence in Kenya and efforts need to be made to ensure that victims have sufficient access to effective treatments to prevent death and serious injury.

22We improved a previously developed quantitative malaria diagnostic system based on fluorescent 23 Blue-ray optical device. Here, we first improved the diagnostic system to enable fully automated 24 operation and the field application was evaluated in Kenya. We detected Plasmodium falciparum in 25 blood samples collected from 288 individuals aged 1-16 years using nested polymerase chain 26 reaction (nPCR), rapid diagnostic test (RDT), and automated system. Compared to RDT, the 27 automated system exhibited a higher sensitivity (100%; 95% confidence interval [CI], 93.3-100%) 28 and specificity (92.8%; 95%CI, 88.5-95.8%). The limit of detection was 0.0061%. Linear regression 29 analysis revealed a correlation between the automated system and microscopic examination for 30 detecting parasitemia (adjusted R 2 value=0.63, P=1.13×10 -12 ). The automated system exhibited a 31 stable quantification of parasitemia and a higher diagnostic accuracy for parasitemia than RDT. This 32 indicates the potential of this system as a valid alternative to conventional methods used at local 33 health facilities, which lack basic infrastructure. 34 35