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Antimicrobial and antiplasmodial activity displayed by actinomycetes isolated from soils from Kavango and Hardap regions in Namibia
(2018) Iikasha, Albertina M.; Dushimemaria, Florence; Mbewe, Maria; Eiman, H.; Mumbengegwi, Davis R.
Plasmodium falciparum and multidrug resistant bacteria such as Mycobacterium avium, Staphylococcus aureus and Escherichia coli are among the top causes of morbidity and mortality especially in developing countries. These pathogens are responsible for the reported antibiotic resistance incidents globally. Due to the increase in antibiotic resistance worldwide, there is an urgent need for new bioactive compounds. This study aimed at determining the antiplasmodial and antimicrobial activity of secondary metabolites produced by soil actinomycetes. Soil samples were collected from Kavango and Hardap regions and cultured on various media to isolate and identify actinomycetes. Secondary metabolites produced were extracted using different solvents. The antimicrobial activity of different isolated secondary metabolites was determined against M. avium, S. aureus and E. coli. Antiplasmodial activity of four bioactive fractions with potent antibacterial activity was further determined against a chloroquine resistant (D10) P. falciparum strain at various concentrations. Bioactive compounds from two isolates displayed activity against M. avium, whilst another two showed activity against E. coli. None of the secondary metabolites displayed activity against S. aureus. A concentration dependent reduction in parasitaemia for P. falciparum was observed across all four fractions both after 24 and 48 h. These results display a vast potential antibacterial and antiplasmodial activity and should be considered for future drug development.
Assessing malaria risk at night-time venues in a low-transmission setting: A time-location sampling study in Zambezi, Namibia
(2011) Jacobson, Jerry O.; Smith, Jennifer L.; Cueto, Carmen; Chisenga, Mukosha; Roberts, Kathryn W.; Hsiang, M.; Gosling, Roly; Mumbengegwi, Davis R.; Bennett, Adam
Background:Identifying efficient and effective strategies to reach and monitor populations at greatest risk of malaria in low-transmission settings is a key challenge for malaria elimination. In Namibia’s Zambezi Region, transmis-sion is ongoing yet its drivers remain poorly understood. A growing literature suggests that night-time social activities may lead to malaria exposure that is beyond the reach of conventional preventive interventions, such as insecticide treated bed nets and indoor residual spraying.Methods:Formative research was conducted with community members in March, 2015 in the catchment areas of six randomly selected health facilities in the western Zambezi Region to identify night-time locations where large numbers of individuals regularly congregate. Using time-location sampling, a survey was conducted between March and May, 2015 at community-identified venues (bars and evening church services) to develop representative esti-mates of the prevalence of parasite infection and risk factors among venue-goers.Results:When compared to a contemporaneous household survey of the general population aged 15 and older (N =1160), venue-goers (N =480) were more likely to have spent the night away from their home recently (17.3% vs. 8.9%, P =0.008), report recent fever (65.2% vs. 36.9%, P < 0.001), and were less likely to have sought care for fever (37.9% vs. 52.1%, P =0.011). Venue-goers had higher, but not significantly different, rates of malaria infection (4.7% vs. 2.8%, P =0.740). Risk factors for malaria infection among venue-goers could not be determined due to the small number of infections identified, however self-reported fever was positively associated with outdoor livelihood activi-ties (adjusted odds ratio [AOR] =1.9, 95% CI 1.0–3.3), not wearing protective measures at the time of the survey (AOR =6.8, 9% CI 1.4–33.6) and having been bothered by mosquitos at the venue (AOR =2.7, 95% CI 1.5–4).Conclusions:Prevention measures and continued surveillance at night-time venues may be a useful complement to existing malaria elimination efforts.
Assessment of microbiological properties, mycotoxins, and heavy metals in underprized raw Kalahari truffles sold in Namibia
(Journal of Food Quality and Hazards Control, 2022) Hainghumbi, T.A.
Kalahari truffle (Kalaharituber pfeilii) is found in the Kalahari desert and nearby regions (Africa). This study assessed the microbiological quality and safety, mycotoxins, and heavy metals contents of raw Kalahari truffle sold in Namibia. Methods: Batches of Kalahari truffles were purchased from informal markets and different vendors in Namibia. Total aerobic, coliform, yeast, and moulds counts, and Salmonella were assessed. Also, some mycotoxins and heavy metals were determined. Data were analyzed using SPSS Statistics Software, Version 25. Results: Total aerobic count of unwashed truffles ranged from 4.4 to 7.3 log Colony Forming Unit (CFU)/g. Total coliform counts detected in truffles were 6.0 log CFU/g. Salmonella was not detected. Doxynivalenol was the most prevalent mycotoxin. Fumonisin B1 levels ranged from 17.4 to 142.1 µg/kg. Ochratoxin A levels in unwashed truffles ranged from 0.1 to 48.5 µg/kg. Total aflatoxin levels were 26.3 to 27.5 µg/kg, while zearalenone levels ranged from 45.0 to 9,680 µg/kg. The iron content was up to 746.72 mg/kg. Cadmium and zinc were detected in the studied samples, but mercury and nickel were no detectable in any samples. Conclusion: The studied truffle samples were safe in terms of Salmonella, mercury, and nickel. However, some of the detected microorganisms, mycotoxins, and heavy metals in underprized Kalahari truffles may impair the safety, shelf life, and human health. Thus, they should be subjected to appropriate processing before consumption. © 2022, Shahid Sadoughi University of Medical Sciences. This is an open access article under the Creative Commons Attribution 4.0 International License.
Baseline characterization of entomological drivers of malaria transmission in Namibia
(MBC, 2023) Lukubwe, Ophilia; Mwema, Tabeth; Joseph, Rosalia; Maliti, Deodatus; Litula, Litula; Katokele, Stark; Uusiku, Petrina; Walusimbi, Dennis; Ogoma, Sheila B.; Gueye, Cara S.; Vajda, Elodie; Tatarsky, Allison; Thomsen, Edward; Tambo, Munya; Mumbengegwi, Davis; Lobo, Neil F.
Background Namibia’s focus on the elimination of malaria requires an evidence-based strategy directed at understanding and targeting the entomological drivers of malaria transmission. In 2018 and 2019, the Namibia National Vector-borne Diseases Control Program (NVDCP) implemented baseline entomological surveillance based on a question-based approach outlined in the Entomological Surveillance Planning Tool (ESPT). In the present study, we report on the findings of the ESPT-based NVDCP on baseline vector species composition and bionomic traits in malaria endemic regions in northern Namibia, which has the aim of generating an evidence base for programmatic decision-making.Methods Nine representative sentinel sites were included in the 2018 entomological surveillance program (Kunene, Omusati, Oshana, Ohangwena, Oshikoto, Otjozondjupa, Kavango West, Kavango East and Zambezi); the number was reduced to four sites in 2019 due to limited funding (Ohangwena, Kavango West, Kavango East, and Zambezi). In the 2018 baseline collections, multiple sampling methods (human landing catches, pyrethroid spray catches, U.S. Centers for Disease Control and Prevention light traps [CDC-LTs], resting boxes [RBs] and larval sampling) were utilized to evaluate indoor/outdoor human biting rates, resting behaviors and insecticide resistance (IR). CDC-LTs and RBs were not used in 2019 due to low and non-representative sampling efcacies. Results Overall, molecular evidence demonstrated the presence of three primary mosquito vectors, namely Anopheles arabiensis, rediscovered Anopheles gambiae sensu stricto and Anopheles funestus sensu stricto, alongside Anopheles squamosus and members of the Anopheles coustani complex. Vectors were found to bite throughout the night (1800 hours 0600 hours) both indoors and outdoors, with An. arabiensis having the highest biting rates outdoors. Low numbers of indoor resting Anopheles point to possible low indoor residual spraying (IRS) efcacy—with An. arabiensis found to be the major vector species resting indoors. The IR tests demonstrated varying country-wide resistance levels to the insecticide deltamethrin, with the resistance levels confrmed to have increased in 2019, evidence that impacts national programmatic decision-making. Vectors demonstrated susceptibility to the insecticides dichlorodiphenyltrichloroethane, bendiocarb and Actellic 300CS in 2018, with mosquitoes from only one site (Kavango West) demonstrating possible resistance to DDT. Targeted and question-based entomological surveillance enabled a rapid and focused evidence base to be built, showing where and when humans were being bitten and providing entomological data on long-lasting insecticidal nets, IRS efcacy and insecticide resistance, which the Ministry of Health and Social Services-Namibia can use to further build a monitoring and evaluation framework for understanding the drivers of transmission. Conclusion Identifcation and characterization of species-specifc bionomic traits allows for an understanding of where and when vector human contact may occur as well as the potential impact of interventions. Low indoor resting rates as well as the presence of insecticide resistance (and the increase in its frequency) point to the need for mosquito-behavior-directed and appropriate interventions as well as the requirement for a resistance mitigation strategy. The ESPT-based question- and minimal essential indicator-based operational research strategy provides programs with directed and focused data for facilitating decision-making while requiring limited funding and capacity. Keywords Entomological drivers, Malaria, Namibia
Benguela community/ UNAM wind power demonstration project—Experiences in implementation
(David, 2014) Davidson, Innocent
Abstract: The government of Namibia has committed itself to promote the use of economically viable RE (renewable energy) technologies, as a complement to grid electrification, and to improve energy provision to rural areas. This paper presents the implementation of the Benguela Community-UNAM Wind-Power Demonstration Project, which is a community-run wind-power mini-generation pilot plant in Luderitz, Namibia. Luderitz is located in South-Western Namibia along the Namib Desert. The region experiences abundant south-westerly winds and the coastal weather conditions make it a suitable location for wind energy. This project is an initiative from the community of Luderitz and a first of its kind in Namibia. It demonstrates the application of small-scale wind energy systems in Namibia and contributes to the growing national awareness of RE and use of wind power in the country. Through its activities, the project has created a dialogue between the local authorities, business community, schools and the greater community. The balance of the paper discusses lessons learned; envisaged future development plans; highlights technical, administrative and management activities; as well as potential for replication and barriers encountered during the project implementation including institutional constraints. The solution-methods developed are presented and discussed.
Chapter 4 - Clove (Syzygium aromaticum) polysaccharides
(Elsevier, 2022) Cheikhyoussef, Ahmad
Clove (Syzygium aromaticum (L.) Merr. & Perry) is an essential herb with well-documented health beneﬁts. Carbohydrates were detected in the ethanolic bud extract of S. aromaticum. Two antithrombotic polysaccharides were isolated from the ﬂower buds of clove by anion-exchange chromatography, hydrophobic interaction column chromatography, and size exclusion chromatography with molecular weight ranging from ca. 34,000 to ca. 103,000 Da. Clove polysaccharides have the backbone of type I rhamnogalacturonan, and the side chain of arabinan with the sulfate is being positioned at 6 of 3-linked galactosyl residues. Although polysaccharides from cloves have an antithrombotic ability, their activities in vitro are lower than that of heparin. Sulfated polysaccharides from cloves show a slightly lower salt concentration due to their relatively low sulfate/sugar ratio, which gives distinctive structural characteristics compared to other polysaccharides such as algae polysaccharides. The anticoagulation action with no toxicity in vivo of low molecular weight sulfated polysaccharide may represent a valuable and safe antithrombotic agent. This chapter gives an overview of polysaccharides from S. aromaticum, their characteristics, and their potential applications.
Characterization of schinziophyton rautanenii (Manketti) nut oil from Namibia rich in conjugated fatty acids and tocopherol
(Elsevier, 2018) Cheikhyoussef, Natascha
The Schinziophyton rautanenii tree is an important food source for many communities of the African continent. Oil extracted from the Manketti nut is of great economic value, due to its unique composition and properties. In this study, the physical and chemical characteristics of the oil obtained from three extraction methods – cold pressed, traditional and Soxhlet extraction – were investigated and compared. Oil yield of the nut was found to be 42.6 ± 0.84%. Good quality characteristics, including saponification values (184–189 mg KOH/g), iodine values (120–131 g/100 g), acid values (0.959–2.44 mg KOH/g) and peroxide values (1.80–3.98 meqO2/kg) were found for the Manketti nut oil. The total tocopherol content was in the range of 144–206 mg/100 g of oil, with γtocopherol as the dominant tocopherol. The oil was rich in conjugated fatty acids, α-eleostearic (9Z,11E,13Eoctadecatrienoic acid) (24–36%) and linoleic acid (9Z,12Z-octadeca-9,12-dienoic acid) (31–32%), making it a potential candidate in the nutraceutical and cosmetics industry.
Children with Plasmodium vivax infection previously observed in Namibia, were Dufy negative and carried a c.136G>A mutation
(BMC, 2021) Haihambo, Daniel H
In a previous study, using a molecular approach, we reported the presence of P. vivax in Namibia. Here, we have extended our investigation to the Dufy antigen genetic profle of individuals of the same cohort with and without Plasmodium infections. Methods: Participants with P. vivax (n=3), P. falciparum (n=23) mono-infections and co-infections of P. vivax/P. falciparum (n=4), and P. falciparum/P. ovale (n=3) were selected from seven regions. Participants with similar age but without any Plasmodium infections (n=47) were also selected from all the regions. Dufy allelic profle was examined using standard PCR followed by sequencing of amplifed products. Sequenced samples were also examined for the presence or absence of G125A mutation in codon 42, exon 2. Results: All individuals tested carried the − 67 T>C mutation. However, while all P. vivax infected participants carried the c.G125A mutation, 7/28 P. falciparum infected participants and 9/41 of uninfected participants did not have the c.G125A mutation. The exon 2 region surrounding codon 42, had a c.136G>A mutation that was present in all P. vivax infections. The odds ratio for lack of this mutation with P. vivax infections was (OR 0.015, 95% CI 0.001–0.176;p=0.001). Conclusion: We conclude that P. vivax infections previously reported in Namibia, occurred in Dufy negative participants, carrying the G125A mutation in codon 42. The role of the additional mutation c.136 G>A in exon 2 in P. vivax infections, will require further investigations.
Clove (Syzygium aromaticum) phenolics: Extraction, compositions, and biological activities
(Elsevier, 2022) Cheikhyoussef, Ahmad
Clove (Syzygium aromaticum L.) is a dried ﬂower bud belonging to the Myrtaceae family indigenous to Indonesia. Recently, it has been farmed in diﬀerent places worldwide with potential food and nutraceutical applications. Clove volatile compounds contribute to the smell and unique aroma; meanwhile, nonvolatile compounds in the clove are mainly responsible for the taste. Clove is well known for its high level of antioxidants because of the ﬂavonoids, hydroxy benzenes, phenylpropanoids, and other reducing substances. Clove phenolics comprise between 8% and 12% (w/w) gallic acid equivalents and are mainly composed of hydrolyzable tannins, phenolic acids, ﬂavonoids, and eugenol, major bioactive molecules in this valuable herb. Gallic acid is the highest among the phenolic acids in clove and other gallic acid derivatives such as hydrolyzable tannins, which are also present in higher concentrations. Other phenolic acids found in the clove are ellagic, ferulic, caﬀeic, and salicylic acids. In addition, ﬂavonoids such as quercetin and kaempferol were reported. This chapter will focus on clove phenolics’ structure, composition, and biological activities.
Community acceptance of reactive focal mass drug administration and reactive focal vector control using indoor residual spraying, a mixed‐methods study in Zambezi region, Namibia
(MBC, 2021) Roberts, Kathryn W.
Abstract Background: In Namibia, as in many malaria elimination settings, reactive case detection (RACD), or malaria testing and treatment around index cases, is a standard intervention. Reactive focal mass drug administration (rfMDA), or treatment without testing, and reactive focal vector control (RAVC) in the form of indoor residual spraying, are alternative or adjunctive interventions, but there are limited data regarding their community acceptability. et al. Malar J (2021) 20:162 https://doi.org/10.1186/s12936-021-03679-1 Malaria Journal Methods: A parent trial aimed to compare the effectiveness of rfMDA versus RACD, RAVC versus no RAVC, and rfMDA + RAVC versus RACD only. To assess acceptability of these interventions, a mixed-methods study was conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in three rounds (pre-trial and in years 1 and 2 of the trial), and an endline survey. Results: In total, 17 KIIs, 49 FGDs were conducted with 449 people over three annual rounds of qualitative data collection. Pre-trial, community members more accurately predicted the level of community acceptability than key stakeholders. Throughout the trial, key participant motivators included: malaria risk perception, access to free community-based healthcare and IRS, and community education by respectful study teams. RACD or rfMDA were offered to 1372 and 8948 individuals in years 1 and 2, respectively, and refusal rates were low (< 2%). RAVC was offered to few households (n = 72) in year 1. In year 2, RAVC was offered to more households (n = 944) and refusals were < 1%. In the endline survey, 94.3% of 2147 respondents said they would participate in the same intervention again. Conclusions: Communities found both reactive focal interventions and their combination highly acceptable. Engaging communities and centering and incorporating their perspectives and experiences during design, implementation, and evaluation of this community-based intervention was critical for optimizing study engagement. Keywords: Malaria, Plasmodium falciparum, Malaria elimination, Namibia, Mass drug administration, Indoor residual spraying, Reactive case detection, Community acceptability, Qualitative and Mixed Methods
A comparative study of medicinal plants used in rural areas of Namibia and Zimbabwe
(2015) Maroyi, A.
Health medicines prepared from wild plants play an important role in the primary healthcare needs of people living in developing countries. A comparative ethnobotanical study was undertaken to document medicinal plants used in rural areas of Namibia and Zimbabwe. In order to document medicinal plants used for primary healthcare in rural areas of Namibia and Zimbabwe, 56 traditional healers were identified using the Participatory Rapid Appraisal approach.
Core concepts of human rights and inclusion of vulnerable groups in the disability and rehabilitation policies of Malawi, Namibia, Sudan, and South Africa
(2012) Mannan, Hasheem; McVeigh, Joanne; Amin, Mutamad; MacLachlam, Malcolm; Swartz, Leslie; Munthali, Alister; Van Rooy, Gert
In recent decades, there has been a push to incorporate the World Health Organization “Health for All” principles in national, regional, and local health policy documents. However, there is still no methodology guiding the appraisal of such policies with regard to the extent that they address social inclusion. In this article, the authors report on the development of EquiFrame, a novel policy analysis framework that was used to evaluate the disability and rehabilitation policies of Malawi, Namibia, Sudan, and South Africa. The policies were assessed in terms of their commitment to 21 predefined core concepts of human rights and inclusion of 12 vulnerable groups. Substantial variability was identified in the degree to which the core concepts and vulnerable groups were featured in these policy documents. The overall summary rankings for the disability policies of the countries studied were as follows: Namibia–High, Malawi–Low, and Sudan–Low. The rehabilitation policy of South Africa was ranked as Low. The results support the idea that adequate disability and rehabilitation policies remain mostly undefined.
Cost and cost effectiveness of reactive case detection (RACD), reactive focal mass drug administration (rfMDA) and reactive focal vector control (RAVC) to reduce malaria in the low endemic setting of Namibia: an analysis alongside a 2×2 factorial design cluster randomised controlled trial
(MBJ, 2022) Ntuku, Henry
Objectives To estimate the cost and cost effectiveness of reactive case detection (RACD), reactive focal mass drug administration (rfMDA) and reactive focal vector control (RAVC) to reduce malaria in a low endemic setting. Setting The study was part of a 2×2 factorial design cluster randomised controlled trial within the catchment area of 11 primary health facilities in Zambezi, Namibia. Participants Cost and outcome data were collected from the trial, which included 8948 community members that received interventions due to their residence within 500 m of malaria index cases. Ntuku H, et al. BMJ Open 2022;12:e049050. doi:10.1136/bmjopen-2021-049050 Outcome measures The primary outcome was incremental cost effectiveness ratio (ICER) per in incident case averted. ICER per prevalent case and per disability- adjusted life years (DALY) averted were secondary outcomes, as were per unit interventions costs and personnel time. Outcomes were compared as: (1) rfMDA versus RACD, (2) RAVC versus no RAVC and (3) rfMDA+RAVC versus RACD only. Results rfMDA cost 1.1x more than RACD, and RAVC cost 1.7x more than no RAVC. Relative to RACD only, the cost of rfMDA+RAVC was double ($3082 vs $1553 per event). The ICERs for rfMDA versus RACD only were $114, $1472 and $842, per incident case averted, respectively. Using prevalent infections and DALYs as outcomes, trends were similar. the median personnel time to implement rfMDA was 20% lower than for RACD (30 vs 38 min per person). The median personnel time for RAVC was 34 min per structure sprayed. Conclusion Implented alone or in combination, rfMDA and RAVC were cost effective in reducing malaria incidence and prevalence despite higher implementation costs in the intervention compared with control arms. compared with RACD, rfMDA was time saving. Cost and time requirements for the combined intervention culd be decreased by implementing rfMDA and RAVC simultaneously by single team. Trial registration number NCT02610400; Post results
District‑level approach for tailoring and targeting interventions: A new path for malaria control and elimination
(2020) Gosling, Roly; Chimumbwa, John; Uusiku, Petrina; Rossi, Sara; Ntuku, Henry; Harvard, Kelly; White, Chris; Tatarsky, Allison; Chandramohan, Daniel; Chen, Ingrid
Despite huge investments and implementation of effective interventions for malaria, progress has stalled, with transmission being increasingly localized among difficult-to-reach populations and outdoor-biting vectors. Targeting difficult pockets of transmission will require the development of tailored and targeted approaches suited to local context, drawing from insights close to the frontlines. Districts are best placed to develop tailored, locally appropriate approaches. We propose a reorganization of how malaria services are delivered. Firstly, enabling district health officers to serve as conduits between technical experts in national malaria control programmes and local community leaders with knowledge specific to local, at-risk populations; secondly, empowering district health teams to make malaria control decisions. This is a radical shift that requires the national programme to cede some control. Shifting towards a district or provincial level approach will necessitate deliberate planning, and repeated, careful assessment, starting with piloting and learning through experience. Donors will need to alter current practice, allowing for flexible funding to be controlled at sub-national levels, and to mix finances between case management, vector control and surveillance, monitoring and evaluation. System-wide changes proposed are challenging but may be necessary to overcome stalled progress in malaria control and elimination and introduce targeted interventions tailored to the needs of diverse malaria affected populations.
Dominant lactic acid bacteria and their antimicrobial profile from three fermented milk products from northern Namibia
(2014) Heita, Lusia; Cheikhyoussef, Ahmad
The present study focused on the isolation, identification and antimicrobial profile of the dominant lactic acid bacteria from three traditional fermented milk products namely: Omashikwa, Mabisi and Mashini Ghamushikwa from the north-central and north-eastern parts of Namibia. The microbiological and antimicrobial activities of these products fluctuate from one region to another depending on the local indigenous microflora. Omashikwa and Mashini Ghamushikwa fermentation processes involves the addition of Boscia albitrunca root (Omunkuzi) and butter churning. The root contributes to the flavor of the product, increasing the milk fermentation rate and churning. Mabisi is produced by letting the milk to ferment naturally until the water is separated from the whey. The water is then decanted, and the whey is shaken until it is smooth without removal of fat. A total of 180 isolates of Lactic acid bacteria (LAB) were obtained and identified based on their phenotypical characterization. Cell free supernatants (CFS) of the 180 LAB isolates were evaluated for antimicrobial activities against selected food borne pathogens; Escherichia coli ATCC 25,922, Staphylococcus aureus ATCC 25,923, Bacillus cereus ATTC 10,876, Candida famata and Geotrichum klebahnii using the well diffusion assay. Twenty LAB isolates having the highest inhibitory effects were selected for biochemical identification using API 50 kit and these were identified as being; Lactobacillus plantarum (53%), Lactobacillus rhamnosus (29%), Pediococcus pentosaceus (6%), Lactobacillus paracasei ssp. paracasei (6%) and Lactococcus lactic ssp. lactis (6%). Pediococcus pentosaceus showed the highest inhibitory effect on all the indicator strains. This study provides an insight into LAB diversity of unstudied Namibian fermented milk products and reports a potential production of antimicrobial compounds which is significant in the standardization of protective starter cultures which can be used to control fermentation process and shelf life extension of dairy products in Namibia.
Effectiveness of reactive focal mass drug administration and reactive focal vector control to reduce malaria transmission in the low malaria-endemic setting of Namibia: A cluster-randomised controlled, open-label, two-by-two factorial design trial
(Lancet, 2020) Hsiang, Michelle S
Background In low malaria-endemic settings, screening and treatment of individuals in close proximity to index cases, also known as reactive case detection (RACD), is practised for surveillance and response. However, other approaches could be more effective for reducing transmission. We aimed to evaluate the effectiveness of reactive focal mass drug administration (rfMDA) and reactive focal vector control (RAVC) in the low malaria-endemic setting of Zambezi (Namibia). Methods We did a cluster-randomised controlled, open-label trial using a two-by-two factorial design of 56 enumeration area clusters in the low malaria-endemic setting of Zambezi (Namibia). We randomly assigned these clusters using restricted randomisation to four groups: RACD only, rfMDA only, RAVC plus RACD, or rfMDA plus RAVC. RACD involved rapid diagnostic testing and treatment with artemether-lumefantrine and single-dose primaquine, rfMDA involved presumptive treatment with artemether-lumefantrine, and RAVC involved indoor residual spraying with pirimiphos-methyl. Interventions were administered within 500 m of index cases. To evaluate the effectiveness of interventions targeting the parasite reservoir in humans (rfMDA vs RACD), in mosquitoes (RAVC vs no RAVC), and in both humans and mosquitoes (rfMDA plus RAVC vs RACD only), an intention-to-treat analysis was done. For each of the three comparisons, the primary outcome was the cumulative incidenc e of locally acquired malaria cases. This trial is registered with ClinicalTrials.gov, number NCT02610400. Findings Between Jan 1, 2017, and Dec 31, 2017, 55 enumeration area clusters had 1118 eligible index cases that led to 342 interventions covering 8948 individuals. The cumulative incidence of locally acquired malaria was 30·8 per 1000 person-years (95% CI 12·8–48·7) in the clusters that received rfMDA versus 38·3 per 1000 person-years (23·0–53·6) in the clusters that received RACD; 30·2 per 1000 person-years (15·0–45·5) in the clusters that received RAVC versus 38·9 per 1000 person-years (20·7–57·1) in the clusters that did not receive RAVC; and 25·0 per 1000 person-years (5·2–44·7) in the clusters that received rfMDA plus RAVC versus 41·4 per 1000 person-years (21·5–61·2) in the clusters that received RACD only. After adjusting for imbalances in baseline and implementation factors, the incidence of malaria was lower in clusters receiving rfMDA than in those receiving RACD (adjusted incidence rate ratio 0·52 [95% CI 0·16–0·88], p=0·009), lower in clusters receiving RAVC than in those that did not (0·48 [0·16–0·80], p=0·002), and lower in clusters that received rfMDA plus RAVC than in those receiving RACD only (0·26 [0·10–0·68], p=0·006). No serious adverse events were reported. Interpretation In a low malaria-endemic setting, rfMDA and RAVC, implemented alone and in combination, reduced malaria transmission and should be considered as alternatives to RACD for elimination of malaria
EquiFrame: A framework for analysis of the inclusion of human rights and vulnerable groups in health policies
(2011) Amin, Mutamad; MacLachlan, Malcolm; El Tayeb, Shahla; El Khatim, Amani; Swartz, Leslie; Munthali, Alister; Van Rooy, Gert; McVeigh, Joanne; Eide, Arne H.; Schneider, Marguerite
Ensuring that health policies uphold core concepts of human rights and are inclusive of vulnerable groups are imperative aspects of providing equity in health care, and of realizing the United Nations’ call for Health for All. We outline the process of extensive consultation undertaken across countries and stakeholders culminating in the development of EquiFrame, in conjunction with its associated definitions of core concepts of human rights and vulnerability. EquiFrame is a systematic policy analysis framework that assesses the degree to which 21 core concepts of human rights and 12 vulnerable groups are mentioned and endorsed in health policy documents. We illustrate the scope of the framework by reporting the results of its application to two health policy documents from (Northern) Sudan: the rather generalist Health Policy of (Northern) Sudan, and the more specific National Drug Policy of (Northern) Sudan. We outline some limitations of the framework and highlight issues for consideration in its interpretation. EquiFrame offers a systematic approach to analyzing and facilitating the inclusion of core concepts of human rights and vulnerability in existing or developing health policies and ultimately to promoting greater equity in health care.
Equity and core concepts of human rights in Namibian health policies
(2013) Amadhila, Elina; Van Rooy, Gert; McVeigh, Joanne; Mannan, Hasheem; MacLachlan, Malcolm; Amin, Mutamad
Delivering health services to vulnerable populations is a significant challenge in many countries. Groups vulnerable to social, economic, and environmental challenges may not be considered or may be impacted adversely by the health policies that guide such services.We report on the application of EquiFrame, a novel policy analysis framework, to ten Namibian health policies, representing the top ten health conditions in Namibia identified by the World Health Organization. Health policies were assessed with respect to their commitment to 21 Core Concepts of human rights and their inclusion of 12 Vulnerable Groups. Substantial variation was identified in the extent to which Core Concepts of human rights and Vulnerable Groups are explicitly mentioned and addressed in these health policies. Four health policies received an Overall Summary Ranking of High quality; three policies were scored as having Moderate quality; while three were assessed to be of Low quality. Health service provision that is equitable, universal, and accessible is instigated by policy content of the same. EquiFrame may provide a novel and valuable tool for health policy appraisal, revision, and development.
Ethnobotanical knowledge on indigenous fruits in Ohangwena and Oshikoto regions in Northern Namibia
(2013) Cheikhyoussef, Ahmad; Embashu, Werner
Background: Indigenous communities in Namibia possess a rich indigenous knowledge expressed within many practices of these communities. Indigenous wild edible fruits are available along the Namibian 13 regions of which it forms a rich source of vitamins, fibres, minerals and a heterogeneous collection of bioactive compounds referred to as phytochemicals for indigenous people’s diet. The aim of this study was to record the different IKS practices on the indigenous fruit trees in Ohangwena and Oshikoto regions of Namibia. Methods: An ethnobotanical survey was undertaken to collect information from local communities from 23-29 October 2011. Data was collected through the use of questionnaires and personal interviews during field trips in the Ohangwena and Oshikoto regions. A total of 65 respondents were interviewed; 54% women, 38% men and 8% both in group interviews. Results: The majority of the people interviewed were in their thirty’s, with the youngest being 18 years old and the oldest being 98 years old. Forty three plant specimens were collected from the two regions; these specimens belong to 20 genera and 25 species. Regarding to the indigenous knowledge; 87% of the respondents indicated that their knowledge on indigenous fruits was learnt mainly through their parent. Indigenous people’s perception on declining indigenous fruits revealed that 56.3% of the respondents reported that indigenous fruits were declining. Only a 42.2% indicated that the indigenous fruits populations are increasing. Regarding to the management practices to improve the production of these indigenous fruit trees; 38.6% reported that there are some efforts on management practices; on the other hand 61.4% reported there are no management practices on the indigenous fruit trees in their areas. Four species were found to be the most frequently used and mentioned fruits which need to be given high preference in terms of conservation are: Berchemia discolor, Hyphaene petersiana, Sclerocarya birrea and Diospyros mespiliformis. The following diseases and ailments have been reported to be treated by the indigenous fruit trees which include: toothache, diarrhoea, cough, tonsillitis, burns, skin allergy, stomach ache, snake bit, constipation, etc. 28% of the respondents mentioned an ethno veterinary use(s) of these fruits, e.g. the use of the Ziziphus mucronata roots to treat diarrhoea in cattle, the bark of eembe (Berchemia discolor) to treat calf weakness. Conclusions: The local communities in Oshikoto and Ohangwena regions have relatively good knowledge and practices regarding the indigenous fruit. This study enhances our understanding on the indigenous fruit in Namibia and their uses by local communities.
Ethnobotanical study of indigenous knowledge on medicinal plant use by traditional healers in Oshikoto region, Namibia
(2011) Cheikhyoussef, Ahmad; Shapi, Martin K.; Matengu, Keneth K.; MuAshekele, Hina
The objective of this study was to establish a regional profile of the indigenous knowledge system (IKS) for medicinal plant use and cultural practices associated with the healing process of these plants by traditional healers in the Oshikoto region, Namibia. An ethnobotanical survey was undertaken to collect information from traditional healers during September and October 2008. Data was collected through the use of questionnaires and personal interviews during field trips in the ten constituencies of the Oshikoto region. A total of 47 respondents were interviewed with most of them aged 66 and above. The traditional healers in Oshikoto region use 61 medicinal plant species that belong to 25 families for the treatment of various diseases and disorders with the highest number of species being used for mental diseases followed by skin infection and external injuries. Trees (28 species) were found to be the most used plants followed by herbs (15 species), shrubs (10 species) and climbers (4 species). The average of the informant consensus factor (FIC) value for all ailment categories was 0.75. High FIC values were obtained for Pergularia daemia, and Tragia okanyua, which were reported to treat weakness and dizziness problems, snake bite, swelling and cardiovascular problems indicating that these species traditionally used to treat these ailments are worth examining for bioactive compounds. The traditional healers in Oshikoto possess rich ethno-pharmacological knowledge. This study allows for identifying many high value medicinal plant species, indicating high potential for economic development through sustainable collection of these medicinal plants.

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