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Birth Control For Mosquitoes – Is This The Malaria Cure?

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The buzzing of a single mosquito is enough to break a good night’s sleep.

So imagine when that same sound is multiplied a hundred times – it can at best be described as eerie.

Especially when these mosquitoes are in a white mesh cage, in a vacuum-sealed laboratory, and it’s around feeding time.

It is at this opportune moment that Lizette Koekemoer, dressed in a red jersey and white lab coat, sticks her hand into the cage.

While most would squirm at the thought of dozens of mosquitoes making a blood meal of your arm, Koekemoer hardly seems to notice. For her, feeding mosquitoes is as normal as breathing; she has done it so many times she no longer gets itchy from the bites.

“When you are working on them, you learn to appreciate them as a living organism. When you put a mosquito under a microscope, they are actually beautiful. I think people laugh when I tell them I work on mosquitoes and I get paid for it,” says Koekemoer.

For 23 years, Koekemoer has been at the forefront researching these insects across Africa. She is part of the Malaria Entomology Research Unit on the 10th floor of the Faculty of Health Sciences building at the University of the Witwatersrand in Johannesburg.

Koekemoer’s passion goes beyond the laboratory to barbeques where she gets excited to tell you what species you’ve just squashed on your leg, having been bitten more times than most she would know.

The reason we are here today, in this sealed laboratory with Koekemoer’s arm in a cage and mosquitoes sucking her dry, is to talk about a mosquito called Anopheles vaneedeni, discovered by her team on the Makhathini Flats, in northern KwaZulu-Natal (KZN).

“Anopheles vaneedeni has been known about since 1977, it has never – before now – been identified as a malaria-carrying vector in nature,” says Koekemoer.

Up until now it was thought two other mosquitoes, called anopheles arabiensis and anopheles funestus, were the main vectors of malaria transmission. Vectors are living organisms that can transmit infectious diseases between humans or from animals to humans.

Lizette Koekemoer sticks her arm in a mosquito-infested mesh cage in her laboratory. (Photo by Jay Caboz)

It is not just a new carrier species that has Koekemoer worried. On the rise are mosquitoes with an increased resistance to insecticides.

According to the scientist, conventional insecticide-based mosquito control methods, such as bed nets and repellents are now becoming redundant.

“A mosquito’s whole body is designed to keep it alive. If you have one female that has formed a resistance, when she lays eggs, you then have gene resistance going all over the place. You need to monitor this and then move on to a new insecticide to kill those ones.”

While these methods may have proven to be effective tackling funestus, which prefers to feed on humans indoors, it means arabiensis and now vaneedeni can never be completely eradicated. This is because both arabiensis and vaneedeni snack on people outdoors.

“All malaria species are active from dusk to dawn. That’s their peak period. As soon as the sun goes down, they start feeding. People socialize at night, when it’s warm. They don’t go to bed. Bed nets only protect you when you are sleeping. They don’t protect you when you are outside cooking and socializing,” says Koekemoer.

Sterilized males to combat malaria

Back in the lab, it is Koekemoer’s job to come up with ways of controlling malaria vectors. One of the team’s more radical solutions is sterilizing males with radiation.

“We’ve got a gamma radiator. So it’s fast and quick – 60 seconds. We put the pupae in a radiation chamber, put them on a jig and then one minute later, they are sterilized.”

Called the Sterile Insect Technique (SIT), Koekemoer wants to build a rearing facility that will pump out 50,000 sterilized males per week. Once nuked, these sterile males are reared and released into the wild to mate with wild females.

“At a small scale, it works really well. The key to this research is female mosquitoes mate only once in their lifetime and if the male is sterile, she will not produce viable eggs. It’s like birth control… In the lab we have up to 96% reduction in progeny,” says Koekemoer.

READ MORE: The Rat Race Against The Silent Killer

It has taken seven years of research to get to this point. Once built, Koekemoer estimates they would need R1.5 million ($113,000) to R2 million ($150,000) per year for SIT to run successfully.

“The thing to remember is a lot of research is done in colonized mosquitoes, in a controlled environment in a lab set-up. It’s difficult when you take this into the field, when your situation is a lot more complex and there is more than one species of mosquito,” says Koekemoer.

SIT was first used to control screwworm fly in America in the 1950s.

“It hasn’t been done with malaria, because malaria is complicated. Countries that are affected by malaria are also often not politically stable and financial resources are limited,” says Koekemoer.

The threat of new species?

Although vaneedeni’s emergence is worrying, it’s not yet time to panic.

“To put it into perspective, we collected a large number of species. So percentage wise, it’s not high. Out of the 3,000 we have collected, we had one KZN sample that was infected,” says Koekemoer.

Vaneedeni is also considered a minor vector because the mosquito prefers to feed on livestock rather than humans.

The question the team are trying to answer is why now? One theory they have is because of the changing environment in KZN. At the time the team found the mosquito, the area was drought-stricken.

“We need to look at the bigger picture of the environmental impact. Was it a once-off because it was so dry? That’s what we need to determine. Your environmental factors influence everything. Because there was drought, the impact on the number of cattle available, or the availability of water might have diminished, which is their preferred host and sites. If you are the only blood source, then the mosquito has no choice but to come to you and you could get affected,” says Koekemoer.

The field site is naturally isolated, between a mountain range and the ocean, in the Mamfene district 60kms from Sodwana and close to the town of Ndumu. A team member collects mosquitoes twice a week throughout the year. The mosquitoes fly into clay pot traps and are then catalogued by species.

“The fact that we now know about vaneedeni means we can target our research towards knowing more about this vector’s behavior,” says Koekemoer.

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Until effective controls for outdoor mosquitoes are developed, eliminating local malaria transmission in southern Africa will be extremely difficult.

“Thanks to other malaria control measures, the number of cases is down to around 9,000 per year from over 60,000 in 2000, but it has proven hard to bring the insect population – and infection rates – down any further using the traditional method of indoor residual spraying,” says Koekemoer.

“There are countries that have resistance to all the classes of insecticides. There are only four classes approved by the World Health Organization for mosquitoes. In some countries, there is resistance to all four classes. It highlights the need to invest and start looking into alternative control methods.”

Coming up with new methods is a race to diffuse a ticking time bomb.

“These genes will eventually move into our borders whether it is the mosquito or the parasite, it’s only a matter of time, it will come into South Africa. You need to be one step ahead. If something happens, what’s Plan B? ”

Thanks to a buzzing mosquito in a pot and a little radiation therapy, scientists are a step closer to solving the malaria malaise. Until then, it’s sleepless nights for them.

Mosquitoes suck blood from Lizette Koekemoer’s arm. (Photo by Jay Caboz)

Facts About Malaria

Malaria is a life-threatening disease caused by parasites transmitted to people through the bites of infected female Anopheles mosquitoes.

According to the latest WHO estimates, released in December 2016, there were 212 million cases of malaria in 2015 and 429,000 deaths.

The WHO African Region carries a disproportionately high share of the global malaria burden. In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths.

In 2015, 91 countries and areas had ongoing malaria transmission.

Between 2010 and 2015, malaria incidence among populations at risk (the rate of new cases) fell by 21% globally. In that same period, malaria mortality rates among populations at risk fell by 29% globally among all age groups, and by 35% among children under 5.

Vector-borne diseases account for more than 17% of all infectious diseases, causing more than one million deaths annually.

[Source: WHO]

Health

Millennial Burnout: Building Resilience Is No Answer – We Need To Overhaul How We Work

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In a popular BuzzFeed article, Anne Helen Petersen describes how millennials (people born between 1981 and 1996) became “the burnout generation”. She describes some of the stark consequences of edging towards burnout and identifies what she calls “errand paralysis”, marked by a struggle to do even simple or mundane tasks.

Many of the factors contributing to this burnout are rooted in the challenging job and economic conditions that millennials face, according to Petersen. She also describes “intensive parenting” as a contributing factor, because millennials have been relentlessly trained and prepared for the workplace by their parents. They have internalised the idea that they need to be working all the time or engaging in the never-ending pursuit of self-optimisation.

READ MORE | Burnout, stress lead more companies to try a four-day work week

Similarity to work burnout

Millennial burnout has a lot of similarities with regular burnout, otherwise known as work burnout. Burnout is a response to prolonged stress and typically involves emotional exhaustion, cynicism or detachment, and feeling ineffective. The six main risk factors for work burnout are having an overwhelming workload, limited control, unrewarding work, unfair work, work that conflicts with values and a lack of community in the workplace.

People who have to navigate complex, contradictory and sometimes hostile environments are vulnerable to burnout. If millennials are found to be suffering higher levels of burnout, this might indicate that they face more problematic environments. It is quite possibly the same stuff that stresses everyone, but it is occurring in new, unexpected or greater ways for millennials, and we haven’t been paying attention.

For example, we know that traditional social comparison plays a role in work burnout. For millennials, social competition and comparison are continually reinforced online, and engaging with this has already been shown to be associated with depressive symptoms in young people.

READ MORE | 10 Rules Of Email That Will Reduce Your Stress Levels

Even if you avoid social media, using technology and going online can be physically and emotionally exhausting. Excessive internet use has been linked to burnout at school. These are just some of the ways that millennials have been increasingly exposed to the same stressors that we know can negatively affect people in the workplace.

We know very little about how millennials experience burnout. Early research suggests there are generational differences. Specifically, millennials respond to emotional exhaustion (often the first stage of burnout) differently to baby boomers (people born between 1946 and 1964). When feeling emotionally exhausted, millennials are more likely to feel dissatisfied and want to leave their job than baby boomers.

Burnout research shows that complex environments and stressors, coupled with high expectations, create the conditions for traditional work burnout. The same can be said for the millennial burnout, which draws on similar notions of perfectionism.

Perfectionists, especially the self-critical ones, are at greater risk of burnout. Naturally, the self-critical type of perfectionist works hard to avoid failure, thereby putting themselves at high risk of burnout.

Resilience as protection

A recent approach to tackling work burnout is to train people to be more resilient. This is underpinned by the assumption that highly competent people can improve their working practices to avoid burnout. However, as I recently argued in an editorial in the BMJ, highly competent, psychologically healthy and seemingly resilient people are likely to face an increased risk of burnout.

It seems counterintuitive, but one of the earliest studies on workplace burnout showed that workers who were happier, less anxious and more able to relieve stress were more likely to develop burnout than those in a comparison group without these traits.

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This largely forgotten study involved air traffic controllers in the US in the 1970s; it followed over 400 of them for three years. Most of the cohort (99%) had served in the US Armed Forces, so we can expect that they had experience of extreme stress and most likely had developed resilience.

This study shows us some of the conditions for creating burnout in this seemingly high functioning and resilient group. Their work was continually becoming more complex, with new technologies being introduced, without the necessary training to use them. They worked long shifts without breaks and had poor environments to work in. Their hours and rotas were challenging and could be unpredictable. These characteristics probably look quite familiar to millennials and anyone working in the gig economy.

Opposite effect

The recent focus on training workers to avoid burnout by encouraging them to be more resilient is likely to become another stress, pressure or high ideal. It is likely that this serves to increase the risk for burnout, especially for the types of perfectionists who are highly self-critical.

The importance of our ideals, our view of what we are and should be, also shows us why labelling millennials as “snowflakes” is probably harmful. Similarly, any intensive parenting that attempts to create resilient children may be counterproductive. This is because the core messages of intensive parenting are actually about social control and conformity, and these probably feed into children’s internal and external ideals for the future.

What we can learn from burnout trends is that work is becoming rapidly and overwhelmingly more difficult and complex. This is driving higher burnout levels in many professions and in informal workers, such as caregivers, and also, potentially, in millennials. The solution is to simplify complex, contradictory and hostile work and personal environments, rather than giving us all another job of training ourselves to be more resilient to these environments.

-Rajvinder Samra; Lecturer in Health, The Open University

The Conversation

The Conversation

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Kenyan Hospital Opens Human Milk Bank – A Rarity In Sub-Saharan Africa

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Kenya’s first human milk bank has opened at Pumwani Maternity Hospital. Moina Spooner, from The Conversation Africa, spoke to the team spearheading APHRC’s research efforts in the establishment of Kenya’s first milk bank.

How long has it taken to open? What were the biggest obstacles?

The process of establishment of human milk banking in Kenya started in 2016. It was spearheaded by the NGO PATH, in partnership with APHRC and Kenya’s Ministry of Health, among other partners. It was rolled out in two phases.

During phase one we assessed people’s perceptions and acceptability of using donated human milk. We also looked at how feasible it would be to set a bank up. The results were encouraging. About 90% of participants were positive about it, 80% would donate their breast milk, and about 60% indicated that they would allow their children to be fed with donated human milk.

A committee was also set-up to provide oversight and guidance on human milk bank work in Kenya. They were sent to South Africa to learn more about the human milk banking process. Finally, local strategies were developed.

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We are now in phase two of the project: the establishment of a pilot human milk bank in Pumwani Maternity Hospital. This includes the launch of a research project which examines its feasibility, effectiveness, acceptability and aims to estimate the cost of establishing an actual human milk bank in Kenya.

There have been challenges. Being a new concept, there have been some logistical challenges, for instance some of the equipment wasn’t locally available so it took longer to get it all done and installed.

There have also been concerns by some community members and health workers over the safety and quality of the donor human milk.

However, we’ve had support from the government which has been critical in addressing the logistical challenges. Advocacy and communication activities are also being rolled out to create awareness on human milk banking and address any concerns.

What is a milk bank and how does it work?

Human milk banks are facilities that systematically collect, pasteurise, test, store, and distribute donated breast milk.

An effective system has many operational processes to ensure it provides safe, high quality donor milk. They start with screening and recruiting donors who must be healthy mothers with surplus milk beyond the needs of their own child’s. Donors must undergo health checks including tests that screen for HIV, syphilis, and hepatitis B and C. Diseases could be passed to children through breastmilk.

READ MORE | Kenyan Approach Holds Promise for Boosting Early Childhood Education

Donors must then express milk in hygienic conditions, after which the milk is pasteurised. This involves heating the milk in a water bath at 62.5°c for 30 minutes followed by rapid cooling.

At the bank, the milk is frozen and stored at -20c. When needed, it’s thawed to room temperature and issued to children who don’t have access to their own mothers’ milk. A prescription by a qualified health professional is needed for this.

Why are they needed?

Although breastfeeding is the most natural and best way to feed infants, many babies may lack access to their mother’s milk. This could’ve happened for many reasons – maybe the mother is sick, hasn’t got enough breast milk or is dead.

From our formative research, 44% of newborns in urban health facilities were separated from their mothers for varying periods of time. This ranged from less than an hour to more than 6 hours and even days after birth. Of these infants, only 14% were fed on mother’s own milk during separation. 36% of the newborns weren’t fed on anything during this period and an additional 23% were fed on formula or cow’s milk.

When breastfeeding is not an option, the World Health Organisation (WHO) recommends donated human milk as a lifesaving alternative. Particularly for babies that were born early, have low birth weight, are orphaned, malnourished or are severely ill.

Evidence paints a very strong picture in favour of donated human milk over infant formula. It’s more effective in reducing the risk of disease and infections – like inflammatory bowel disease, leukemia and respiratory tract infections – in newborn babies and is better tolerated by babies that are born prematurely.

In the US and Brazil, the use of donated human milk was reported to reduce the length of hospital stay for sick infants and save on the cost of health care.

Given the benefits of using donated human milk over infant formula, the WHO has called for the global scale-up of human milk banks. These are expected to increase access to safe donor human milk.

Is this the first of many?

Although WHO recommends that the milk banks be set up, Kenya is just the second, after South Africa, to establish a human milk bank in sub-Saharan Africa – even though it is a pilot.

We hope that human milk banking will be scaled up in Kenya and the rest of sub-Saharan Africa, using the evidence we generate from our research.

-The Conversation

-Elizabeth Kimani-Murage; Research Scientist at the African Population and Health Research Center and Adjunct Assistant Professor, Brown University

-Milka Wanjohi, Taddese Zerfu, Esther Anono and Eva Kamande from the African Population and Health Research Center contributed to the writing of this article.

The Conversation

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10 Rules Of Email That Will Reduce Your Stress Levels

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Email and smart phones can be stressful. Academics are calling this constant work connection “technostress”. Consequently, many European countries are now offering employees the “right to disconnect”.

The way email is used is complex, it cannot simply be labelled as “good” or “bad” and research shows that personality, the type of work people do and their goals can influence the way they react to email.

Good practice with email use is not just about limiting the amount of emails sent, but improving the quality of communication.

Here are ten tips to reduce the stress of email at work:

1. Get the subject line right

Use clear and actionable subject lines.

The subject line should communicate exactly what the email is about in six to ten words, to allow the recipient to prioritise the email without even opening it. On mobile devices, many people only see the first 30 characters of a subject line. So keep it short. But make it descriptive enough to give an idea of what the email is about from just the subject line.

READ MORE | Burnout, stress lead more companies to try a four-day work week

2. Ask yourself: is email the right medium?

Are you in the same office? Could you go and speak to the person? Could you call? Often these other forms of communication can avoid the inefficient back and forth of emailing.

Instant messaging and video calling platforms like Slack and Skype could be more appropriate for quick internal back and forth messaging. Also, remember that most of the advice below applies to all types of electronic communication.

3. Don’t email out of office hours

Research shows that out-of-hours emails make it harder for people to recover from work stress.

Try and influence your company culture by avoiding sending or replying to emails outside your normal working hours.

Management should lead by example and avoid contacting their staff outside of their normal working hours. Some workplaces even switch off email access to employees out of hours. Consider implementing this while keeping a backup phone system for emergency contact only.

New research has also shown that just the expectation of 24-hour contact can negatively affect employee health.

READ MORE | A Career Secret Weapon: Thank-You Notes

4. Use the delay delivery option

Some people like integrating their work and family lives and often continue working from home during their off-job time. If you are one of these people, or if you work across time zones, consider using the delay delivery option so your emails do not send until the next working day and do not interfere with other people’s off-job time.

5. Keep it positive

Think about the quality of email communication. Not just the quantity. Changes to email use should also focus on the quality of what is being sent and take into consideration the emotional reaction of the recipient.

Research suggests that conflicts are far easier to escalate and messages to be misinterpreted when communicated via email. Therefore, if it is bad news, think back to rule #2: is email the right medium?

6. Try ‘no email Friday’

In order to shift company culture and get people thinking about other methods of communication than email, try a “no email Friday” on the first Friday of every month, or maybe even every week. This is an initiative suggested by experts from the National Forum for Health and Wellbeing at Work, and is being used by businesses around the globe. Employees are encouraged to arrange face-to-face meetings or pick up the phone – or just get on top of the many emails they already have in their inbox on that day.

READ MORE | The 12 Biggest Career Crashes Of 2018

7. Make your preferences known

Research has shown that not only too much but also too little email can cause stress due to a mismatch between the communication preferences of different people. Some people may like being emailed and cope much better with high email traffic than other means of communication. For these people, reducing the amount of emails they receive may cause more stress than it alleviates.

So consider people’s individual differences and make yours known. Add your preferred contact preferences to your email signature whether it is email, text or instant messages or a phone call.

8. Consider a holiday ‘bounce back’

Having a backlog of emails that builds up over the week appears to be one of the most commonly mentioned sources of technostress for workers. Think about setting up a system where emails are bounced back to the sender when someone is on holiday, with an alternative contact email for urgent requests. This would let you come back to a manageable inbox.

9. Have a separate work phone

Make this the only mobile device you can access work emails on, which gives you the freedom to switch it off after work hours. Also consider turning off email “push” (this is where your email server sends each new email to your phone when it arrives at the server) and instead choose a regular schedule (such as once per hour) for emails to be delivered to your phone (this also increases battery life).

10. Avoid late night screen time

Research suggests that late night smart phone use reduces our ability to get to sleep and also leads to constant thoughts and stress about work. This in turn reduces your sleep quality. Make the bed a phone-free zone to improve your sleep hygiene.

The Conversation

-The Conversation

-Ricardo Twumasi; Lecturer in Organisational Psychology, University of Manchester

-Cary Cooper; 50th Anniversary Professor of Organisational Psychology and Health, University of Manchester

Lina Siegl; PhD Researcher, University of Manchester

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