We recently developed a superhydrophobic cone-based method for the collection of mosquito excreta/feces (E/F) for the molecular xenomonitoring of vector-borne parasites showing higher throughput compared to the traditional approach. To test its field applicability, we used this platform to detect the presence of filarial and malaria parasites in two villages of Ghana and compared results to those for detection in mosquito carcasses and human blood. We compared the molecular detection of three parasites (Wuchereria bancrofti, Plasmodium falciparum and Mansonella perstans) in mosquito E/F, mosquito carcasses and human blood collected from the same households in two villages in the Savannah Region of the country. We successfully detected the parasite DNA in mosquito E/F from indoor resting mosquitoes, including W. bancrofti which had a very low community prevalence (2.5–3.8%). Detection in the E/F samples was concordant with detection in insect whole carcasses and human blood, and a parasite not vectored by mosquitoes was detected as well.Our approach to collect and test mosquito E/F successfully detected a variety of parasites at varying prevalence in the human population under field conditions, including a pathogen (M. perstans) which is not transmitted by mosquitoes. The method shows promise for further development and applicability for the early detection and surveillance of a variety of pathogens carried in human blood. Molecular xenomonitoring of parasites or viruses using mosquitoes as “flying syringes” is a promising and non-invasive tool for early detection and surveillance of various pathogens, particularly in low prevalence settings, but there is a need for cost-effective and higher throughput alternatives. We recently developed a novel approach based on the collection of mosquito excreta/feces (E/F) using a superhydrophobic cone that directs the sample into a tube at the bottom of the collection cup. We tested this method’s ability to detect the presence of filarial and malaria parasite DNA from households in two endemic rural communities of Ghana and compared it to the molecular detection from blood and mosquito carcass samples from corresponding households. The detection of parasite DNA in mosquito E/F was successful for all three pathogens, and it showed good concordance with the detection in the insects’ whole carcasses. Given the successful detection of Mansonella perstans, which is not transmitted by mosquitoes, our tool shows promise for use as an alternative method for the early and non-invasive detection and surveillance of various pathogens in human blood, including those not strictly mosquito-borne, in endemic settings.

OBJECTIVE: To analyze the environmental and socioeconomic risk factors of malaria transmission at municipality level, from 2010 to 2015, in the Brazilian Amazon. METHODS: The municipalities were stratified into high, moderate, and low transmission based on the annual parasite incidence. A multinomial logistic regression that compared low with medium transmission and low with high transmission was performed. For each category, three models were analyzed: one only with socioeconomic risk factors (Gini index, illiteracy, number of mines and indigenous areas); a second with the environmental factors (forest coverage and length of the wet season); and a third with all covariates (full model). RESULTS: The full model showed the best performance. The most important risks factors for high transmission were Gini index, length of the wet season and illiteracy, OR 2.06 (95%CI 1.19–3.56), 1.73 (95%CI 1.19–2.51) and 1.10 (95%CI 1.03–1.17), respectively. The medium transmission showed a weaker influence of the risk factors, being illiteracy, forest coverage and indigenous areas statistically significant but with marginal influence. CONCLUSIONS: As a disease of poverty, the reduction in wealth inequalities and, therefore, health inequalities, could reduce the transmission considerably. Besides, environmental risk factors as length of the wet season should be considered in the planning, prevention and control. Municipality-level and fine-scale analysis should be done together to improve the knowledge of the local dynamics of transmission.

Aedes ‐transmitted arboviruses have spread globally due to the spread of Aedes aegypti and Aedes albopictus . Its distribution is associated with human and physical geography. However, these factors have not been quantified in Cameroon. Therefore, the aim was to develop an Ae . albopictus geo‐referenced database to examine the risk factors associated with the vector distribution in Cameroon. Data on the Ae . albopictus presence and absence were collated and mapped from studies in published scientific literature between 2000 and 2020. Publicly available earth observation data were used to assess human geography, land use and climate risk factors related to the vector distribution. A logistic binomial regression was conducted to identify the significant risk factors associated with Ae . albopictus distribution. In total, 111 data points were collated (presence = 87; absence = 24). Different data collection methods and sites hindered the spatiotemporal analysis. An increase of one wet month in a year increased the odds of Ae . albopictus presence by 5.6 times. One unit of peri‐urban area increased the odds by 1.3 times. Using publicly available demographic and environmental data to better understand the key determinants of mosquito distributions may facilitate appropriately targeted public health messages and vector control strategies.

In response to innumerable global challenges in a world ever more complex and interconnected, including a number of public health challenges, the United Nations launched the 2030 Agenda for Sustainable Development; a guideline intended to deal with these issues. Foreseeing their huge complexity, the UNLEASH initiative was created with a vision to gather, on a yearly basis until 2030, 1.000 young talents from all over the world to co-create disruptive solutions for the 17 Sustainable Development Goals (SDGs). The School of Public Health of the University of São Paulo was selected as the only educational institution partner in South America and was invited to select and send students to the launching event in Denmark in August 2017. The aim of this study is to address and reflect on the seven SDGs (health, food, water, energy, urban sustainability, sustainable consumption and production and education) that were explored in this first event and relate the students’ experiences of this global innovation lab.

Introduction: Malaria still is a public health problem in the Americas. In 2015, Brazil accounted for 37% of all cases in the Americas, and of these cases, 99.5% were located in the Brazilian Amazon. Despite the mobilization of resources from the Brazilian National Plan for Malaria Control, too many municipalities have high transmission levels. The objective of this study is to evaluate the local epidemiological profile of malaria and its trend between 2010 and 2015 in the Brazilian Amazon. This study also aims to recognize the epidemiological differences in the local temporo-spatial dynamics of malaria. Methods: Malaria data were stratified by the annual parasite incidence (API) over the six-year period and by municipality. We used the method of seasonal decomposition by Loess smoothing to capture trend, seasonal and irregular components. A generalized linear model was applied to quantify trends, and the Kruskal-Wallis Rank Sum was applied to test for seasonality significance. Results: The malaria API declined by 61% from 2010 to 2015, and there was a 40% reduction of municipalities with high transmission (determined as an API higher than 50). In 2015, 9.4% of municipalities had high transmission and included 62.8% of the total cases. The time-series analyses showed different incidence patterns by region after 2012; several states have minimized the effect of the seasonality in their incidence rates, thus achieving low rates of incidence. There were 13 municipalities with sustained high transmission that have become the principal focus of malaria control; these municipalities contained 40% of the cases between 2013 and 2015. Discussion: Brazil has achieved advances, but more sustained efforts are necessary to contain malaria resurgence. The use of malaria stratification has been demonstrated as a relevant tool to plan malaria programs more efficiently, and spatiotemporal analysis corroborates the idea that implementing any intervention in malaria should be stratified by time to interpret tendencies and by space to understand the local dynamics of the disease.

Background: The healthcare system can be understood as the dynamic result of the interaction of hospitals, patients, providers, and government configuring a complex network of reciprocal influences. In order to better understand such a complex system, the analysis must include characteristics that are feasible to be studied in order to redesign its functioning. The analysis of the emergent patterns of pregnant women flows crossing municipal borders for birth-related hospitalizations in a region of São Paulo, Brazil, allowed to examine the functionality of the regional division in the state using a complex systems approach and to propose answers to the dilemma of concentration vs. distribution of maternal care regional services in the context of the Brazilian Unified Health System (SUS).Methods: Cross-sectional research of the areas of influence of hospitals using spatial interaction methods, recording the points of origin and destination of the patients and exploring the emergent patterns of displacement.Results: The resulting functional region is broader than the limits established in the legal provisions, verifying that 85% of patients move to hospitals with high technology to perform normal deliveries and cesarean sections. The region has high independence rates and behaves as a “service exporter.” Patients going to centrally located hospitals travel twice as long as patients who receive care in other municipalities even when the patients’ conditions do not demand technologically sophisticated services. The effects of regulation and the agents’ preferences reinforce the tendency to refer patients to centrally located hospitals.Conclusions: Displacement of patients during delivery may affect indicators of maternal and perinatal health. The emergent pattern of movements allowed examining the contradiction between wider deployments of services versus concentration of highly specialized resources in a few places. The study shows the potential of this type of analysis applied to other type of patients’ flows, such as cancer or specialized surgery, as tools to guide the regionalization of the Brazilian Health System.