Towards Safer and More Sustainable Systems for Monitoring Exophagic Vectors of Malaria in Western Kenya

Introduction. Longitudinal monitoring of outdoor-biting malaria vector populations is becoming increasingly important in understanding the dynamics of residual malaria transmission. However, the human landing catch (HLC), the gold standard for measuring human biting rates indoors and outdoors, is costly and raises ethical concerns related to increased risk of infective bites among collectors. Consequently, routine data on outdoor-feeding mosquito populations are usually limited due to the lack of a scalable tool with similar sensitivity to outdoor HLC. Methodology. The Anopheles trapping sensitivity of four baited proxy outdoor trapping methods—Furvela tent trap (FTT), host decoy trap (HDT), mosquito electrocuting traps (MET) and outdoor CDC light traps (OLT)—was assessed relative to HLC in a 5x5 replicated Latin square conducted over 25 nights in two villages of western Kenya. Indoor CDC light trap (ILT) was run in one house in each of the compounds with outdoor traps, while additional non-Latin square indoor and outdoor HLC collections were performed in one of the study villages. Results. The MET, FTT, HDT and OLT sampled approximately 4.67, 7.58, 5.69 and 1.98 times more An. arabiensis compared to HLC, respectively, in Kakola Ombaka. Only FTT was more sensitive relative to HLC in sampling of An. funestus in Kakola Ombaka (RR=5.59, 95%CI: 2.49-12.55, P < 0.001) and Masogo (RR=4.38, 95%CI: 1.62-11.80, P = 0.004) and in sampling An. arabiensis in Masogo (RR=5.37, 95%CI: 2.17-13.24, P < 0.001). OLT sampled signicantly higher numbers of An. coustani in Kakola Ombaka (RR=3.03, 95%CI: 1.65-5.56, P < 0.001) and Masogo (RR=2.88, 95%CI: 1.15-7.22, P=0.02) compared to HLC. OLT, HLC and MET sampled mostly An. coustani, FTT had similar proportions of An. funestus and An. arabiensis, while HDT sampled predominantly An. arabiensis in both villages. FTT showed close correlation with ILT in vector abundance for all three species at both collection sites. Conclusion. FTT and OLT are simple, easily scalable traps and are potential replacements for HLC in outdoor sampling of Anopheles mosquitoes. However, the FTT closely mirrored indoor CDC light trap in mosquito indices and therefore may be more of an indoor mimic than a true outdoor collection tool. HDT and MET show potential for sampling outdoor host seeking mosquitoes. However, the traps as currently designed may not be feasible for large scale, longitudinal entomological monitoring. Therefore, the baited outdoor CDC light trap may be the most appropriate tool currently available for assessment of outdoor-biting and malaria transmission risk. The study was conducted in May/June 2018 in two villages, Kakola Ombaka near the Ahero rice irrigation scheme, in Nyando sub-county and Masogo village in sub-county, Kisumu County, western Kenya The villages were selected to represent areas with high (Kakola Ombaka) and low (Masogo) mosquito densities. The study was conducted in the months of May and June coinciding with the end of the main rainy season and the period of peak mosquito numbers and malaria transmission. were collected by HLC outdoors compared to ILT in Kakola Ombaka. There was no signicant difference in the numbers of An. coustani collected by these two methods. In Masogo, there was no signicant difference in the catch sizes between the two HLC and ILT for all the three Anopheles species. There was no signicant difference in the numbers of An. arabiensis, An. funestus and An. coustani sampled outdoors by FTT compared to paired ILT collections in Kakola Ombaka or Masogo (P > 0.05).


Introduction
Anopheles funestus and An. gambiae/An. coluzzii are considered to be the most e cient malaria vectors in sub-Saharan Africa, largely due to their high levels of anthropophagy [1]. The endophagic and endophilic nature of these primary malaria vector species has led to the use of widespread indoor focused interventions including insecticide treated nets (ITNs) and indoor residual spraying (IRS). The implementation of these measures has contributed to substantial reductions in the malaria burden in sub-Saharan Africa since 2000 [2,3]. However, sustained indoor targeted control measures have been associated with changes in malaria vector species composition [4][5][6] and possibly behaviour [7][8][9]. In some settings, these changes have been associated with increased proportions of more exophilic vector species such as An. arabiensis or changes in the biting and resting behavior of An. gambiae or An. funestus, leading to relative increases in outdoor transmission [10][11][12][13]. Sustained indoor vector control through ITNs and IRS in western Kenya has resulted in changes in species composition, with the more generalist species An. arabiensis becoming the predominant species in some locations [4,7] and changes in An. gambiae s.s. behaviour resulting in earlier biting [9] with a high frequency of animal and mixed human-animal blood meals [8]. Longitudinal monitoring of vector species composition, biting rates, physiological status, biting and resting behaviour, and ecology are fundamental to understanding the risk of malaria transmission in an area, identifying future threats and formulating methods of control and monitoring [14]. However, outdoor biting mosquitoes pose new challenges in sub-Saharan Africa as they cannot be reliably monitored using many of the current collection methods and tools to control them effectively are lacking.
When conducted under close supervision, the human landing catch (HLC) is generally considered the gold standard for indoor and outdoor collections which can provide critical information on malaria vector species composition, biting densities and time of biting [15]. However, HLC is a labour-intensive and costly procedure requiring trained collectors and extensive supervision [16,17] and is unsustainable for large-scale operational sampling of malaria vectors. There are also ethical questions regarding the use of human collectors to attract pathogen transmitting mosquitoes [18,19]. While provision of malaria chemoprophylaxis has been demonstrated to be protective to HLC collectors [20], there is still potential for transmission of arboviruses and other mosquitotransmitted pathogens [18]. Due to these ethical concerns coupled with logistical challenges in HLC implementation, the technique is rarely used for routine monitoring of mosquito populations.

Routine monitoring of indoor mosquito populations in western Kenya has been conducted using indoor Centers for Disease
Control and Prevention light trap (ILT) and pyrethrum spray catch (PSC). The ILT has been observed by some studies to be an effective alternative to indoor HLC [21][22][23][24], whereas other studies have reported the trap to collect fewer Anopheles than HLC [25]. Mathenge et al (2005) showed that ILT collected 60% of An. arabiensis and 120% of An. funestus compared to indoor HLC [24]. Pyrethrum spray catch (PSC) and ILT have become standard trapping methods to monitor indoor populations, but no reliable method has emerged to replace HLC outdoors. As a result, longitudinal entomological monitoring conducted by the President's Malaria Initiative (PMI) VectorLink Project from 2017 to 2018 consisted only of indoor trapping using ILT, PSC, and use of window exit traps, with no routine outdoor trapping taking place.
Scalable traps designed speci cally for monitoring outdoor biting and resting malaria vectors are urgently needed [12]. The choice of collection method for operational surveillance should be driven by trap e cacy and scalability, rather than ne-scale precision with respect to human landing catches (HLC) [26]. This study compared four outdoor traps with HLC as a positive control to identify a suitable replacement for the HLC for longitudinal surveillance of outdoor biting malaria vectors. The primary objective was to determine outdoor trap e cacy for estimating Anopheles numbers per trapping night in comparison with the 'gold standard' HLC. Secondary objectives were to determine the outdoor biting mosquito species composition and to determine endophily proportion by comparing each outdoor trap with indoor CDC light trap (ILT).

Study sites
The study was conducted in May/June 2018 in two villages, Kakola Ombaka near the Ahero rice irrigation scheme, in Nyando subcounty and Masogo village in Mhoroni sub-county, Kisumu County, western Kenya ( Figure 1). The villages were selected to represent areas with high (Kakola Ombaka) and low (Masogo) mosquito densities. The study was conducted in the months of May and June coinciding with the end of the main rainy season and the period of peak mosquito numbers and malaria transmission.  Table 1). The study was conducted for 25 nights with each outdoor trap being set in one of ve house compounds per night. Traps were rotated between the housing compounds nightly, so that over ve trapping nights each trap was rotated between all ve house compounds. Collectors worked in two shifts each night and were rotated weekly between collection locations each night. Housing compounds where outdoor traps were set were at least 100 m from each other to minimize the risk of host-odour interference. The location for each outdoor collection method was marked in each compound to ensure consistency throughout the study. Outdoor collections were made approximately 8-22m away from the house in a cleared space. In each housing compound where outdoor trapping was conducted, an indoor CDC light trap (ILT) was set inside the house each night for comparison with the outdoor catch. The ILT was installed in a bedroom at approximately 1.5 m above the oor next to an occupied in-situ ITN. All collections were performed from 18:00 to 07:00 the following morning. Figure 2 shows photographs of the ve outdoor trapping methods. These are described in more detail below:

Furvela Tent Trap
The Furvela tent trap was developed and tested in the village of Furvela, Mozambique and has been utilized in several locations including Tanzania, Ghana and Cambodia [27][28][29]. The basic principle of the Furvela tent trap is that host odor and exhaled gases emanating from a gap, the diameter of a CDC trap, in the predominantly closed door of the tent, attract mosquitoes to the gap on the tent-door. Close to the gap, the fan and collection bag of a CDC trap (without the light, lid or grid) is placed horizontally outside the tent, 2 to 3 cm from the opening in the door. On approach to the opening, the insects are sucked into the trap and held in the trap collection bag (Figure 2, panels B1-2). The suction from the fan effectively prevents any mosquitoes from entering the tent, even at high densities, so that the sleeper is not exposed to biting risk.

Host Decoy Trap
The Host Decoy Trap (HDT) was rst evaluated in the eld in 2015 in Burkina Faso. The HDT exploits the blood-seeking behavior of mosquitoes by mimicking the sensory stimuli that a mosquito follows when searching for a person to bite. These include host odor, a visual stimulus, and body temperature of warm-blooded hosts. These stimuli are incorporated into a trap that lures mosquitoes towards it and then captures them when they land. The trap was set as described by Hawkes et al. [30]. Brie y, the host decoy trap is a cylindrical container lled with warm water, insulated with Styrofoam to prevent heat loss and regulate the surface temperature. The container is covered with a black jacket to provide visual contrast and transparent sticky tape to which mosquitoes get stuck on landing. Host odor from a nearby occupied tent is exhausted using a fan, pushed through a pipe and vented close to the trap ( Figure 2, panels C1-2). Mosquitoes attracted to an odor source are induced to land upon the visually conspicuous, warm trap, where upon they get stuck. The mosquitoes are recovered from the trap by dissolving the glue upon which they are stuck [30].

Electrocuting Grids
These devices were originally developed to quantify the numbers of tsetse ies attracted to humans and wildlife hosts by placing electrocuting nets in an incomplete ring around the host species [31]. The electrocuting grid is effectively invisible to ying insects which, as they approach a stimulus such as a vertebrate host, inadvertently collide with it and are either killed or stunned.
Electrocuting grids (0.5 m high; 1 m wide) consisted of vertical copper wires, 0.2 mm in diameter, 5 mm apart and spray painted black to reduce their visibility to ying insects. Alternate wires were earthed or charged by a transformer with a direct current (DC) input (12 V: 3 A) and an output of 50 kV, pulsing at ~70 Hz. Insects killed or stunned after colliding with the grids were collected on a sticky panel placed under the electrocuting grid. A simple shelter was erected over the collector to protect them from the rain. The collector sat on a stool and four panels of electrocuting grids were arranged around the legs up to the knee level. The rest of the body was covered with an untreated bed net attached to the top frame of the electrocuting grid. Mosquitoes attempting to access the collector were electrocuted and dropped on the sticky panel under the grid from where they were collected and recovered by dissolving the glue ( Figure 2, panels D1-2).

CDC-Light Trap (Outdoors)
CDC light traps are battery powered with a motorized fan, light bulb, and a mosquito collection cup. The trap can be used with CO 2 to mimic breath exhalation. Mosquitoes attracted to the traps by either light and/or CO 2 , are drawn in at the top and forced downward by the fan into the collection cup, from which cannot escape. Malaria transmitting mosquitoes are nocturnal, therefore, traps are typically deployed at dusk and collected at dawn the following day. When deployed indoors, the optimum location for sampling house-visiting mosquitoes has been reported to be as close as possible to the host, with improved catching e ciency when the trap is installed at the foot of an occupied untreated bednet [32,33]. From an epidemiological point of view, the use of light-trap next to an occupied bednet is more meaningful than using an unbaited light trap [34] as it provides a good measure of host-seeking mosquito densities. Outdoor deployment of light traps is not commonly used in surveillance particularly in regions where people are mostly indoors at night. The CDC-LT was hung outdoors at 1.5m above the ground next to an occupied, untreated bed net ( Figure 2, panel E). The bed and light trap were protected from rainfall by a tarpaulin.

Human Landing Catch (Outdoors)
One collector sat outside on a chair with lower limbs exposed and a dimly lit kerosene lamp nearby to provide some light. A torch ( ashlight) was used to spot the mosquitoes landing on the exposed lower limbs of the HLC collector. Mosquitoes landing on the exposed limbs were aspirated and transferred into paper cups labelled with the hour of collection ( Figure 3, panel A1). Within each collection hour, the collectors worked for 45 minutes with 15 minutes breaks between the hours and switched shifts at midnight.
Collectors provided written consent to participate in the study. They were tested for malaria infection using a malaria rapid diagnostic test seven days before collections began and all tested negative. The collectors were placed on weekly malaria prophylaxis beginning seven days before collections began and continuing up to four weeks after the end of collections. Over the same period, the collectors were monitored for malaria infection. None were tested positive during and up to four weeks after HLCs were conducted. Each collector was compensated for time spent in mosquito collection.

Additional Non-Latin Square Human Landing Catch
To assess malaria vector biting behavior, Plasmodium falciparum infection rates and risk of human to exposure to mosquito bites, an additional ve nights of HLCs were conducted indoors and outdoors in ve houses in Kakola Ombaka. The collections were performed in the last of week of the Latin square outdoor trap comparison study. In each collection house, four collectors worked in pairs in two shifts over the collection period. In each shift, one of the collectors performed worked outdoors within ve meters from the house while the other was indoors in the unoccupied living room. The collectors were rotated between the collection shifts and location. The HLC collectors also recorded the location of household members (indoors or outdoors) every hour to assess their risk of exposure to mosquito bites.
Laboratory Analysis. All collected Anopheles were identi ed morphologically using the keys of Gillies and Coetzee, 1987 [35]. Further species discrimination was performed only for An. gambiae s.l. and An. funestus groups while all females were analyzed for sporozoite infection. Female mosquitoes were dissected into parts for various procedures: heads and thoraces were used for determination of P. falciparum sporozoite infection by enzyme-linked immunosorbent assay (ELISA) using standard operating procedures as described in the MR4 Methods in Anopheles Research [36], adapted from Wirtz et al. [37]. The legs and wings were used in PCR analyses to identify to species level members of the An. gambiae species complex and Anopheles funestus group [36]. The protocol of Scott et al. [38] as described in standard operating procedures in the MR4 Methods in Anopheles Research [36] was used for distinguishing between different species of An. gambiae while the protocol of Koekemoer et al. [39] was used to identify members of the An. funestus species group.
Data Analysis. Analysis was done using R statistical software version 4.0.2. Data were tted using Generalized Linear Mixed Effects Models (GLMMs) to describe how well the other traps proportionately sample the same composition and species as HLC.
Since the data were over-dispersed, the package glmmADMB [40] was used to t negative binomial distribution models for the analysis of mosquito numbers in the outdoor traps for the Latin Square study. The numbers of female Anopheles mosquitoes were assessed as a function of collection method as a xed effect while collection compounds and days were treated as random factors. The same statistical package was used to assess catch sizes in indoor CDC light trap and each of the paired outdoor traps, the numbers of female Anopheles mosquitoes were assessed as a function of collection method as a xed effect, and collection compound as a random factor. Pairwise comparisons of the mean numbers of each Anopheles species collected by the different trapping methods were done by Tukey's test. To analyze Anopheles species proportions for each trapping method, a binomial GLM model was used.

Species Identi cation
From the Latin square comparison of outdoor traps, a total of 2,849 female Anopheles mosquitoes and 20,093 Culex species were collected outdoors at ve sampling locations in each of the two sites over 25 trapping nights outdoors. The most abundant of the Anopheles species based on morphological identi cation was An. coustani (1,339,47.0% of all Anopheles mosquitoes) followed by An. gambiae s.l. (1,066, 37.4%), An. funestus (435, 15.3%) and An. pharoensis (9, 0.3%). Only 11 male Anopheles mosquitoes were sampled over the collection period (Table 1). Of the female An. gambiae s.l. from outdoor traps, 563 samples were analyzed by PCR for species identi cation, and of these, 557 (98.9%) were An. arabiensis and 6 (1.1%) An. gambiae s.s. Of 212 samples morphologically identi ed as An. funestus s.l., all were identi ed by PCR as An. funestus s.s.   Tables 2 and 3 respectively.
Comparison of outdoor traps with indoor CDC light trap.
We compared each of the outdoor traps with the paired indoor light trap data to assess catch size ratios of An. arabiensis, An. funestus and An. coustani indoor and outdoor in the same house compound (Tables 3 and 4). This comparison is useful in determining the endophilic/exophilic nature of each species in the area and determining the relative performance of each outdoor trap.   29.3% and other Anopheles 2.6% (Fig. 5).
We estimated the risk of human exposure to mosquito bites at one of the study villages, Kakola Ombaka. Figure 6 shows the number of bites per person per hour by An. funestus and An. arabiensis, adjusted by location of members of the household over the collection period to demonstrate the risk of exposure to mosquito bites. The risk of exposure to bites by An. funestus was highest indoors with peak at approximately 9 bites per person occurring between 5:00am and 6:00am, corresponding to the time when most people left their bedrooms (Supplemental Fig. 1) and were no longer protected by ITNs. Outdoor exposure to bites by An. funestus was mostly low with a peak of approximately 2 bites per person per night occurring between 6:00am and 7:00am. Exposure occurring indoors in the living room while unprotected by ITNs was estimated to be less than a single bite per person per hour for most of the collection period with a peak risk of exposure occurring between 6:00am and 8:00am. Extended exposure to An. funestus bites, albeit at low rates, was observed indoors until 11:00 am when collections ceased (Fig. 6A).
The risk of exposure to bites by An. arabiensis was low compared to that of An. funestus, with a peak of less than a single bite per person per hour. Like biting by An. funestus, the peak biting by An. arabiensis occurred between 5:00am and 6:00am corresponding to the time when most people left their bedroom. Risk of exposure to bites by An. arabiensis outdoors was negligible (Fig. 6B).
An assessment of the location of members of the households showed, on average, 78% of individuals were outdoors between 5:00 pm and 8:00 pm. The proportion of people outdoors decreased steadily with a proportionate increase in numbers indoor over time. The proportion of people indoors, in the bedroom area was on average 83% between 8:00 pm and 6:00 am and this decreased steadily between 6:00 am and 7:00 am with an increase in the numbers outdoors over the same time. On average, 69% of the people were outdoors between 6:00am and 11:00am when collection ceased (Supplemental Fig. 1).

Plasmodium falciparum sporozoite rates
A sub-sample of 1,253 Anopheles from outdoor traps and 1,989 from indoor CDC light traps were analyzed for sporozoite infection. From outdoor collections, the overall sporozoite infection rate was 0.4% (5/1,253) with infection rates of

Discussion
This study demonstrated marked differences in Anopheles catch sizes by species in outdoor traps in comparison to HLC. HLC was considered the gold standard for this study and the prediction was that all other outdoor traps would collect fewer Anopheles than HLC as has been reported in several studies comparing CDC LT indoors with HLC [25]. However, in Kakola Ombaka, HLC captured the fewest An. arabiensis, with all other outdoor traps catching greater densities. The ideal alternative to the HLC either indoors or outdoors should collect mosquitoes in densities that are consistently proportional to the HLC through a range of transmission intensities with similar species compositions. In addition, factors such as cost, feasibility and scalability should be considered in selecting a collection method for operational surveillance [26].
The Furvela tent trap has been described as a simple and effective way of collecting outdoor host seeking mosquitoes [27].
Similarly, we observed the trap to be a simple tool for sampling mosquitoes that is easy to set up while being comfortable and safe from biting for the person occupying the tent. If the objective is to catch the greatest number of malaria vectors outdoors, the FTT was the most effective in sampling both An. funestus and An. arabiensis outdoors in the two villages. The trap sampled approximately 6 times more An. funestus compared to HLC in Kakola Ombaka and 2 times more in Masogo. While the catch size for An. arabiensis was approximately 8 and 5 times more than HLC in the two sites respectively. Both An. funestus and An. arabiensis occurred in the FTT at nearly equal proportions, with relatively low numbers of An. coustani collected in the trap. An important consideration is whether the FTT is truly collecting outdoor host-seeking mosquitoes or is merely a scale model of an indoor environment that traps mosquitoes attempting to enter the tent as they would enter a house. Charlwood et al concluded that the FTT was truly collecting outdoor biting species in Tanzania and Mozambique, based on the greater diversity of species (such as Mansonia and Coquillettidia spp) by FTT compared to ILT and the greater densities of endophilic species such as An. funestus by ILT [27]. In this study we observed FTT outdoors closely mirrored ILT in both abundance and Anopheles species composition, with no signi cant difference in An. funestus, An. arabiensis or An. coustani densities between FTT and ILT. In contrast the ILT densities of An. funestus were greater than all other outdoor trapping methods, including HLC. From this we conclude that An. funestus in the study site were predominantly endophilic, but the FTT mimicked indoor collections, capturing otherwise endophilic mosquitoes as they attempted to enter the tent. In an earlier trap comparison study in western Kenya, the Ifakara tent trap (another tent trap not used in the current investigation) was observed to be the only trap with the numbers of An. funestus captured not signi cantly different from HLC indoor [26]. These observations suggest that tent traps such as FTT are not truly outdoor trapping tools but mimics of an indoor environment where the trapped mosquito species exhibit house entry traits.
CDC light traps are commonly installed indoors adjacent to an occupied bed net [32,33]. Outdoor implementation is more challenging, especially in regions where people do not routinely sleep outdoors, including the current study site. Collectors were reluctant to sleep outdoors due to possible security risks from humans and nocturnal animals and the relatively cold weather. OLT was the only trap that sampled more An. coustani in both villages when compared to HLC. We conclude that the high densities of An. coustani were partly due to the exophilic nature of this species based on higher densities compared to ILT and partly due to attraction to the light bulb based on the higher densities compared to other outdoor traps. When compared with ILT, the OLT was superior in sampling more exophilic and exophagic An. arabiensis and An. coustani whilst the converse was true for An. funestus. Therefore, we conclude that the outdoor CDC light trap was the most useful outdoor trap tested in terms of determining outdoor host-seeking preferences and densities of Anopheles species. The CDC light traps have been reported to be the most effective alternative to HLC [21][22][23] when implemented indoors. Our results demonstrate that implementation of CDC light traps outdoor is similarly an effective alternative to HLC outdoors. However, further investigation is needed to generate data on hourly biting rates compared between CDC light traps and HLC to effectively demonstrate peaks of mosquito biting and exposure.
The host decoy trap was effective in sampling An. arabiensis compared to both HLC and ILT. We have previously demonstrated HDT with cattle odour to be effective for collecting An. arabiensis outdoors in western Kenya, whereas using human odour was not particularly effective [41]. However, in the current study, the HDT trap baited with a human sampled 6 times more An. arabiensis compared to HLC. The HDT combines host odours, heat and visual stimuli to simulate a host [30,41] which provides the basis of sampling outdoor host seeking mosquitoes with a potential of replacing HLC [30]. The trap however requires optimization of the heating system and odour source to ensure consistency and enable scalability and ease of application.
The MET showed promise as an outdoor mosquito trap, with comparable sampling sensitivity to HLC for An. funestus and An. coustani and higher sensitivity in sampling of An. arabiensis at relatively high mosquito densities in Kakola Ombaka. A study in the Kilombero Valley, southern Tanzania observed the MET to achieve over 50% sampling sensitivity relative to HLC [42]. A separate study in Dar es Salaam, investigating an improved prototype of MET observed the trap to be a highly sensitive tool that accurately quanti es epidemiologically relevant metrics of mosquito biting densities, behaviours and human exposure distribution [43]. Elsewhere in Burkina Faso, MET was observed to be less sensitive relative to HLC, however, the density of An. gambiae s.l. in MET were highly correlated with HLC [44]. We observed MET to correlate well with HLC at relatively high vector numbers but poorly at low mosquito numbers. While a number of studies have reported MET as a safer alternative to HLC for surveillance of mosquitoes outdoors [42][43][44][45], we observed the trap to pose an unacceptable level of discomfort to the collectors who were required to sit with minimal body movement, as the trap is located around their legs throughout the collection period.
The poor performance of HLC relative to other trapping methods in sampling outdoor biting mosquitoes may re ect its well-known limitation that accuracy and catch size is reliant on the performance of collectors and performance is di cult to measure. Every effort was made to ensure the quality of HLC collections, by working with trained collectors, providing asks of coffee, and conducting nightly supervision. We hypothesize that the numbers of Anopheles mosquitoes collected were lower in HLC due to the large densities of Culex in the area, which may have led to HLC collectors to focus on the larger Culex mosquitoes but miss some of the Anopheles. The standardization of other trapping methods is a potential advantage over HLC, which is prone to unknown levels of variation. However, HLC remains the most suitable method for assessing hourly biting behavior of mosquitoes.
There is a risk of malaria transmission and other infections from both indoor and outdoor mosquito bites. Even though sporozoite infections were highest in indoor collections by CDC light traps, sporozoite infected mosquitoes were observed outdoors albeit at low proportions. These results con rm the possibility of malaria transmission outdoors away from the protection of indoor based vector control tools. While it is important to monitor outdoor biting of malaria vectors, the level of risk is dependent on human behavior and the amount of time spent outdoors. In Bioko, despite sustained indoor interventions through LLINs and IRS, fears of high outdoor malaria risk in children proved unfounded as only 4% of children spent time outside between 22:00 and 05:00 [46].
The risk of Anopheles mosquito bites was estimated based on the location of the study population during HLCs. Human activity outdoors steadily increased from 05:00am corresponding to the period of increased mosquito biting by both An. funestus and An. arabiensis. These observations indicated that in western Kenya the greatest risk of exposure was indoors late at night but with some outdoor exposure to both species, particularly in the early morning. Consequently, monitoring of outdoor mosquito populations as vector interventions such as ITNs or IRS reduce indoor transmission is critical in understanding the dynamics in malaria transmission.

Conclusion
Sampling of outdoor mosquito population is important in understanding changes in the risk of malaria transmission with increased indoor mosquito control efforts. However, data on longitudinal outdoor mosquito monitoring is usually limited due lack of a safe, e cient, easily deployed outdoor sampling tool. The Furvela tent trap is simple and effective tool for sampling mosquitoes, easy to set and exposure free. We observed higher sensitivity relative to HLC in sampling major Anopheles species in western Kenya, however, the trap closely mirrored indoor CDC light trap in mosquito indices and therefore may be more of an indoor mimic than a true outdoor collection tool. Outdoor human baited CDC light trap is relatively simple to use and easily scalable and a suitable alternative to HLC with potential for collection of hourly mosquito data. The host decoy trap also has potential for sampling outdoor host seeking mosquitoes with a possibility of replacing HLC. However, the trap needs improvement with regards to heating and odour sources and mosquito trapping mechanism to enable scalability. Finally, the MET, showed variability in sensitivity relative to HLC at high and low vector densities and may not be easily scalable for routine mosquito collections. Based on these observations, outdoor light trap is the most appropriate tool currently available for routine assessment of outdoor biting and malaria transmission risk in this setting.

Declarations
Ethics approval and consent to participate The study was approved by the Kenya Medical Research Institute/ Scienti c and Ethics Review Unit (KEMRI/SERU), number 2776 and by CDC through a reliance agreement with KEMRI/SERU (CDC IRB 6728). Individuals participating in outdoor trapping gave informed consent. Those conducting HLC were screened for malaria before the start of the study and treated if positive. Collectors were placed on me oquine malaria prophylaxis, (Mephaquin, Acino Pharma AG, Switzerland) one week before collections began, with repeat doses once every week through the collection period, until four weeks after collections ended. Verbal consent was sought from the household head to use CDC-LT indoors and outdoor traps in their compound. All methods were performed in accordance with relevant guidelines and regulations.

Consent for publication
Not applicable.