It has various side effects, so it is highly recommended that you talk to your doctor before starting a dose. Whether or not you are on antimalarials, you should still be very careful to avoid getting bitten by mosquitos as the tablets do not stop you getting malaria entirely, they just lessen the effects.
Therefore, it is crucial that you take all necessary steps to prevent bites. Check Price. This includes wearing a good strength repellent at all times Bushmans DEET is recommended or alternatively Picaridin insect repellent , dressing in long clothing to minimise your exposed skin, and sleeping under a mosquito net. Most hotels will provide mosquito nets, and if camping, make sure you check the tent lining for any holes, and spray inside the tent to avoid getting any mosquitos inside which is not only dangerous, but really annoying.
You can also use mosquito coils which can keep mosquitos away from areas you are staying. These particularly come in handy if you are camping, as they can be left around the site to keep the mosquitos away. Nowhere near all bites will result in malaria.
About Us. Contact Us. Focus Areas. Tools Our resources will help you develop effective SBC programs. Subscribe to CCP's monthly newsletter. Current interventions in place to protect people from malaria — most notably insecticide-treated mosquito nets and indoor spraying — work well, but new CCP research suggests that, in many places, more is needed to eliminate the threat.
Share on facebook. Share on twitter. Share on linkedin. Average percentage of ITN use by hour across shehia observed in the rainy season, among participants in the peri-domestic space. Average level of ITN use for participants aged under 5 years and 5 years and over, by hour, across seasons. Of the Anopheles caught with the double net trap, the mean vector biting was the highest in Mbaleni, followed by Miwani and Donge Mchangani.
No Anopheles were caught using this method in the other three sites. Anopheles gambiae s. PCR analysis was carried out for of the An. Other Anopheles species caught included Anopheles squamosus 5 females indoors and 48 females outdoors and Anopheles coustani 1 female outdoors and none indoors. No Plasmodium sporozoite positive mosquitoes were identified. Outdoor biting rates remained relatively consistent throughout the night, while indoor biting peaked in the middle of the night when the highest percentage of the human population was observed to be indoors Fig.
Proportion of human population indoors and awake, indoors and asleep, and outdoors throughout the night, overlaid with directly measured indoor and outdoor biting rates for Anopheles gambiae s.
Of An. Average pattern of exposure to Anopheles gambiae s. When accounting for the percentage of the study population using an ITN for every hour of the night Fig. A better understanding of intervention use, human activity and sleeping patterns, and how they overlap with local vector behaviour, can provide an improved understanding of persistent malaria transmission and guide interventions to protect people when and where they need it.
While increasing and sustaining ITN access and use is critical across settings, malaria control and elimination programmes should also consider the limitations of current interventions. Perhaps the most important finding from this work was that current levels of ITN use are estimated to directly prevent less than half of exposure to malaria vector bites.
Remaining exposure to vector bites is likely driven by both sub-optimal levels of ITN use in some sites as well as exposure that cannot be prevented by ITN use. However, variation in levels of use was observed across locations suggesting additional gains could be achieved in some communities. Distribution and promotion of ITNs should continue across sites, with targeted social and behaviour change interventions focused on locations with lower access and UAR such as Miwani and Tunduni.
In addition to optimizing the impact of core vector control interventions, it is important to consider gaps that remain. For ITN users, approximately three quarters of remaining exposure occurred outdoors, largely in the hours before sleeping.
Qualitative research findings from in-depth interviews and direct observation of nighttime community events in the same study sites provide in-depth information on nighttime activities that can help to inform context-appropriate interventions [ 37 ].
Common nighttime activities in these sites included small-scale routine social activities such as gathering to socialize and play cards in the evening, watching television and football matches next to small shops, and entertainment such as going to bars on the weekend. Livelihood activities, lasting all or part of the night, were also commonly reported including security jobs, hunting, and working in hotels or fishing in coastal areas, as well as staying outdoors to guard crops from theft before harvest.
Large-scale events, such as weddings, funerals, and religious events, were observed and reported to last all or most of the night [ 37 ]. Other studies have found challenges to malaria prevention away from home, including logistic and social barriers to ITN use [ 12 , 38 ]. However, the feasibility of intervention use may differ depending on the nature of activity. For example, ITN use could be promoted while traveling or visiting friends and family, while supplemental prevention measures would likely be needed to protect people during activities such as socio-cultural events, nighttime occupations, and entertainment which often occur outdoors.
Although the World Health Organization WHO does not yet recommend the large-scale deployment of supplemental vector control tools, research is underway to evaluate the effectiveness of interventions such as topical and spatial repellents, insecticide-treated clothing, and improved housing, as well as attractive targeted sugar baits, outdoor traps, and systemic insecticides applied to livestock [ 39 ].
Larval source management, which could reduce both indoor and outdoor-biting vector populations, is another option that could be considered. Operational research could be useful in Zanzibar and beyond to better understand where and how to deploy these supplemental tools for maximum impact.
An increasing number of countries are now within reach of malaria elimination with 46 countries reporting fewer than 10, indigenous cases in [ 36 ]. The epidemiology of malaria has changed in many of these contexts, with cases increasingly clustered geographically and among certain demographic groups [ 40 ]. Often, a high proportion of cases are observed among men and hard to reach groups, such as migrant populations, and current malaria interventions are unlikely to adequately address these changes [ 40 ].
In Zanzibar, a higher percentage of males was recorded to be away throughout the night compared to females, and qualitative research findings suggest males are more likely to engage in nighttime occupations, to travel, and to stay outdoors later socializing at night, all of which may impact exposure to malaria vectors. Likewise, travel to and from mainland Tanzania has been found to be a risk factor for malaria infection in Zanzibar [ 1 ].
In these contexts, effective targeting of interventions is critical and finer scale information on the epidemiological, ecological, and socio-cultural context is needed, including identification of locations and groups at risk [ 41 ]. Additional investigation to better understand networks of higher-risk groups and scenarios, research to link specific activities to malaria infection, and programmes targeting these groups with appropriate packages of interventions could be explored in low transmission settings such as Zanzibar.
This study builds on previous studies that have quantified human—vector interaction [ 25 , 27 , 29 , 32 ] to provide programmatically useful information on when and where people are exposed to malaria vectors as well as the activities that may put people at risk.
However, variation was observed in both vector and human behaviour across sites. This finding suggests the value of vector and human behavioural data at the community level to inform targeting of interventions to address specific gaps in protection, particularly in low transmission settings. Despite the importance of human behaviour to understanding patterns of risk, a review of published literature on nighttime human behaviour found fewer than a dozen studies over the past two decades that integrated human and vector data [ 42 ].
Collecting human and vector data together can provide an improved understanding of exposure patterns and inform when and where supplemental tools might be needed and could be considered in future entomological monitoring and research activities. This work has a number of limitations. Recruitment of households took place on 1 day in each site. Households that were away during the time of recruitment or that would be traveling when data collection began were not included in the study.
It is possible that the households that were present to consent on the day of recruitment were different from the households that were not or that households that consented may have been different from the few households than those that refused.
However, the study team worked with community leaders to schedule recruitment activities during times when a majority of households were likely to be home.
Further, the recorded biting rates may have been impacted by the trapping method used. While, a study by Tangena et al.
When tested by Ifakara Health Institute, the absolute numbers of mosquitoes collected were much lower for the miniaturized double net trap compared to HLC, however indoor and outdoor biting proportions, hourly biting patterns, and species diversities matched previous indoor and outdoor estimates obtained using HLC from the same villages [ 15 ].
Despite the potential limitation on absolute numbers, the miniaturized double net trap provided the benefit of an exposure-free option for mosquito collectors, increasing the safety of their work while still allowing the relative biting risk indoors and outdoors to be estimated. Another potential limitation is where mosquitoes were collected.
Mosquito collections were carried out in the peri-domestic setting, leaving a gap in data for places people go when away from home, within their community and beyond. Likewise, it was not possible to measure time spent outdoors or under an ITN for people who were recorded to be away from home.
Given that many nighttime activities away from home occur outdoors, the estimate of human exposure to malaria vectors occurring indoors and prevented by ITN use in the peri-domestic setting is likely an over-estimate for the study population as a whole. This finding underscores the importance of addressing outdoor exposure in this context, both in the peri-domestic setting and away from home, and the potential value of mosquito collections in places where people frequently gather at night.
When utilizing direct observation, there is also the potential for reactivity, a phenomenon in which people change their behaviour due to the presence of an observer [ 43 ]. However, reactivity tends to decrease with the length of the observation and in previous studies was found to have little impact on behaviours of interest [ 44 , 45 ]. Finally, this study did not look at parasite prevalence in the human population or link exposure to vector bites to malaria infection.
There is an opportunity to do so in the future for a more complete picture of residual malaria transmission dynamics in Zanzibar and beyond.
Despite the limitations, this study provided a high level of information on human behaviour as it relates to exposure to malaria vectors. In contexts such as Zanzibar, where malaria elimination is in sight, it becomes increasingly important to target interventions effectively. Understanding human behaviour and where it intersects with vector behaviour will be important for getting to zero locally acquired cases.
In the study sites, overall access to ITNs was high and estimated exposure to malaria vectors was low. Opportunities were identified in specific locations and among certain groups to optimize access to and use of ITNs.
Additional gaps in protection were identified when participants were outdoors and away from home. The proportion of exposure to malaria vectors occurring outside of sleeping hours suggests that testing of supplemental tools could be explored to enhance elimination efforts.
These results should be taken together with data on travel and migration patterns as well as malaria infection dynamics to guide context-appropriate malaria interventions. From high to low malaria transmission in Zanzibar—challenges and opportunities to achieve elimination. BMC Med. Article Google Scholar. Mapping hotspots of malaria transmission from pre-existing hydrology, geology and geomorphology data in the pre-elimination context of Zanzibar, United Republic of Tanzania.
Parasit Vectors. Tanzania Malaria Operational Plan Accessed 15 Jan The researchers found little evidence of people using protection against mosquitoes outdoors. In low-transmission settings like Zanzibar, children under five are no longer considered the population most at risk for malaria infection. They are sleeping under their nets and are typically at home or near home after dark.
It is men who are often outside at night, whether working or socializing, which could put them at higher risk. Zanzibar is made up of a series of islands in the Indian Ocean off the coast of Tanzania, where transmission of malaria is more common. Travelers from the mainland are understood to bring many of the malaria cases found in Zanzibar with them. When a mosquito bites a person infected with the parasite, it infects the mosquito which can then transmit the disease to someone else.
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