Knowledge and practice concerning malaria, insecticide-treated net (ITN) utilization and antimalarial treatment among pregnant women attending specialist antenatal clinics

Reproductive-Age Women's Knowledge and Care Seeking for Malaria Prevention and Control in Ghana: Analysis of the 2016 Malaria Indicator Survey

INTRODUCTION

Malaria is a major cause of morbidity and mortality worldwide, requiring individual and environmental level controls to prevent its adverse morbidity effects. This study examined reproductive-aged women's knowledge and care-seeking practices for malaria prevention and control in Ghana.

METHODS

The 2016 Ghana Malaria Indicator Survey data for reproductive-age women was analysed (n=5,150). Multilevel mixed-effects logistic regression model was used to determine factors associated with reproductive-aged women's knowledge and care-seeking practices for malaria.

RESULTS

62.3%, 81.3%, and 64.6% knowledge levels on causes, signs/symptoms, and prevention of malaria were found, respectively, among respondents. Age, wealth and educational status, religion, region, and place of residence (rural) were found to significantly influence respondents' knowledge of causes, signs/symptoms, and care-seeking practices for malaria. A 15% differential among Insecticide Treated Nets (ITNs) awareness and use was found. Increasing age (≥35 years) was associated with increasing knowledge of malaria. Regional variations were observed to significantly influence knowledge of malaria treatment.

CONCLUSION

Though ownership of ITNs and knowledge of malaria prevention were high, it did not necessarily translate into use of ITNs. Thus, there is a need to intensify education on the importance and the role of ITNs use in the prevention of malaria.

“When I am with my husband, I do not feel mosquito bite”

Purpose

The purpose of this paper is to explore how socio-cultural beliefs and practices could influence the knowledge, attitude and perception of insecticide-treated net (ITN) use in the control of malaria amongst pregnant women attending antenatal clinic.

Design/methodology/approach

Data were gathered using interviews and documentary review. Framework analysis was applied to classify emerging themes and the findings interpreted using the health belief model.

Findings

The findings showed that the pregnant women had appreciable knowledge, both the positive and negative attitudes and the perceptions of insecticide treated nets. To most of them, sleeping under an ITN would not affect pregnancy/cause abortion, but rather prevent mosquito bites and associated malaria.

Research limitations/implications

The limitations include the sample size of participants and health facilities used. Lack of application of a quantitative research method meant that the authors could not quantify the findings to ensure generalisation to the entire population.

Practical implications

The findings suggest that health policy makers, implementers and health professionals need to appreciate the perception and the attitude of pregnant women when designing policy guidelines for the malaria control programme.

Social implications

This paper helps to elucidate on how socio-cultural beliefs and practices could influence the knowledge, attitude and perception of ITN usage amongst both pregnant women and people in malaria endemic communities.

Originality/value

This paper suggests that health policy makers, implementers and health professionals have to devise strategies to address socio-cultural beliefs and practices in the scaling up of malaria control programmes.

Malaria and blood transfusion: major issues of blood safety in malaria-endemic countries and strategies for mitigating the risk of Plasmodium parasites

Malaria inflicts humankind over centuries, and it remains as a major threat to both clinical medicine and public health worldwide. Though hemotherapy is a life-sustaining modality, it continues to be a possible source of disease transmission. Hence, hemovigilance is a matter of grave concern in the malaria-prone third-world countries. In order to pursue an effective research on hemovigilance, a comprehensive search has been conducted by using the premier academic-scientific databases, WHO documents, and English-language search engines. One hundred two appropriate articles were chosen for data extraction, with a particular reference to emerging pathogens transmitted through blood transfusion, specifically malaria. Blood donation screening is done through microscopic examination and immunological assays to improve the safety of blood products by detection major blood-borne pathogens, viz., HIV, HBV, HCV, syphilis, and malarial parasites. Transfusion therapy significantly dwindles the preventable morbidity and mortality attributed to various illnesses and diseases, particularly AIDS, tuberculosis, and malaria. Examination of thick and thin blood smears are performed to detect positivity and to identify the Plasmodium species, respectively. However, all of these existing diagnostic tools have their own limitations in terms of sensitivity, specificity, cost-effectiveness, and lack of resources and skilled personnel. Globally, despite the mandate need of screening blood and its components according to the blood-establishment protocols, it is seldom practiced in the low-income/poverty-stricken settings. In addition, each and every single phase of transfusion chain carries sizable inherent risks from donors to recipients. Interestingly, opportunities also lie ahead to enhance the safety of blood-supply chain and patients. It can be achieved through sustainable blood-management strategies like (1) appropriate usage of precise diagnostic tools/techniques, (2) promoting hemovigilance system, and (3) adopting novel processes of inactivation technology. Furthermore, selection of the zero-risk donors could pave the way to build a transmissible malaria-free world in the near future.

Larvicidal efficacy of Ethiopian ethnomedicinal plant Juniperus procera essential oil against Afrotropical malaria vector Anopheles arabiensis (Diptera: Culicidae)

OBJECTIVE

To screen the essential oil of Juniperus procera (J. procera) (Cupressaceae) for larvicidal activity against late third instar larvae of Anopheles arabiensis (An. arabiensis) Patton, the principle malaria vector in Ethiopia.

METHODS

The essential oil of J. procera was evaluated against the larvae of An. arabiensis under the laboratory and semi-field conditions by adopting the World Health Organization standard protocols. The larval mortality was observed for 24 h of post exposure.

RESULTS

The essential oil of J. procera has demonstrated varying degrees of larvicidal activity against An. arabiensis. The LC50 and LC90 values of J. procera were 14.42 and 24.65 mg/L, respectively under the laboratory conditions, and from this data, a Chi-square value 6.662 was observed to be significant at the P=0.05 level. However, under the semi-field conditions the LC50 and LC90 values of J. procera were 24.51 and 34.21 mg/L, respectively and a Chi-square value 4.615 was significant at the P=0.05 level. The observations clearly showed that larval mortality rate is completely time and dose-dependent as compared with the control.

CONCLUSIONS

This investigation indicates that J. procera could serve as a potential larvicidal agent against insect vector of diseases, particularly An. arabiensis. However further studies are strongly recommended for the identification of the chemical constituents and the mode of action towards the rational design of alternative promising insecticidal agents in the near future.

Women's access and provider practices for the case management of malaria during pregnancy: a systematic review and meta-analysis

BACKGROUND

WHO recommends prompt diagnosis and quinine plus clindamycin for treatment of uncomplicated malaria in the first trimester and artemisinin-based combination therapies in subsequent trimesters. We undertook a systematic review of women's access to and healthcare provider adherence to WHO case management policy for malaria in pregnant women.

METHODS AND FINDINGS

We searched the Malaria in Pregnancy Library, the Global Health Database, and the International Network for the Rational Use of Drugs Bibliography from 1 January 2006 to 3 April 2014, without language restriction. Data were appraised for quality and content. Frequencies of women's and healthcare providers' practices were explored using narrative synthesis and random effect meta-analysis. Barriers to women's access and providers' adherence to policy were explored by content analysis using NVivo. Determinants of women's access and providers' case management practices were extracted and compared across studies. We did not perform a meta-ethnography. Thirty-seven studies were included, conducted in Africa (30), Asia (4), Yemen (1), and Brazil (2). One- to three-quarters of women reported malaria episodes during pregnancy, of whom treatment was sought by >85%. Barriers to access among women included poor knowledge of drug safety, prohibitive costs, and self-treatment practices, used by 5%-40% of women. Determinants of women's treatment-seeking behaviour were education and previous experience of miscarriage and antenatal care. Healthcare provider reliance on clinical diagnosis and poor adherence to treatment policy, especially in first versus other trimesters (28%, 95% CI 14%-47%, versus 72%, 95% CI 39%-91%, p = 0.02), was consistently reported. Prescribing practices were driven by concerns over side effects and drug safety, patient preference, drug availability, and cost. Determinants of provider practices were access to training and facility type (public versus private). Findings were limited by the availability, quality, scope, and methodological inconsistencies of the included studies.

CONCLUSIONS

A systematic assessment of the extent of substandard case management practices of malaria in pregnancy is required, as well as quality improvement interventions that reach all providers administering antimalarial drugs in the community. Pregnant women need access to information on which anti-malarial drugs are safe to use at different stages of pregnancy. Please see later in the article for the Editors' Summary.

The counterfeit anti-malarial is a crime against humanity: a systematic review of the scientific evidence

BACKGROUND

The counterfeiting of anti-malarials represents a form of attack on global public health in which fake and substandard anti-malarials serve as de facto weapons of mass destruction, particularly in resource-constrained endemic settings, where malaria causes nearly 660,000 preventable deaths and threatens millions of lives annually. It has been estimated that fake anti-malarials contribute to nearly 450,000 preventable deaths every year. This crime against humanity is often underestimated or ignored. This study attempts to describe and characterize the direct and indirect effects of counterfeit anti-malarials on public health, clinical care and socio-economic conditions.

METHODS

A search was performed using key databases, WHO documents, and English language search engines. Of 262 potential articles that were identified using a fixed set of criteria, a convenience sample of 105 appropriate articles was selected for this review.

RESULTS

Artemisinin-based combination therapy (ACT) is an important tool in the fight against malaria, but a sizable number of patients are unable to afford to this first-line treatment. Consequently, patients tend to procure cheaper anti-malarials, which may be fake or substandard. Forensic palynology reveals that counterfeits originate in Asia. Fragile drug regulations, ineffective law-enforcement agencies and corruption further burden ailing healthcare facilities. Substandard/fake anti-malarials can cause (a) economic sabotage; (b) therapeutic failure; (c) increased risk of the emergence and spread of resistant strains of Plasmodium falciparum and Plasmodium vivax; (d) an undermining of trust/confidence in healthcare stakeholders/systems; and, (e) serious side effects or death.

CONCLUSION

Combating counterfeit anti-malarials is a complex task due to limited resources and poor techniques for the detection and identification of fake anti-malarials. This situation calls for sustainable, global, scientific research and policy change. Further, responsible stakeholders in combination with the synthesis and supply of next generation malaria control tools, such as low-cost anti-malarials, must promote the development of a counterfeit-free and malaria-free future.

Insect repellent plants traditional usage practices in the Ethiopian malaria epidemic-prone setting: an ethnobotanical survey

BACKGROUND

The usage of insect repellent plants (IRPs) is one of the centuries-old practices in Africa. In Ethiopia, malaria remains a leading cause of morbidity and mortality, subsequently the majority of people have a tendency to apply various plants as repellents to reduce or interrupt the biting activity of insects. Accordingly, this survey was undertaken to document and evaluate knowledge and usage practices of the local inhabitants on IRPs in the malaria epidemic-prone setting of Ethiopia.

METHODS

Ethnobotanical survey was conducted between January and May 2013. Selected 309 household members were interviewed by administering pre-tested questionnaire on knowledge and usage practices of repellent plants, in Bechobore Kebele, Jimma Zone, Ethiopia.

RESULTS

Overall, 70.2% (217/309) and 91.8% (199/217) of the respondents have had ample awareness and usage practices of repellent plants, respectively. Informants cited about twenty-two plant species as repellents and also indicated that these plants are useful(85.5%), accessible(86.8%), and affordable(83.9%) too. Residents mainly applying dried leaves [93.9% (187/199)] by means of burning/smouldering [98.9% (197/199)] with the traditional charcoal stove to repel insects, primarily mosquitoes. About 52.8% (105/199) of the informants using approximately 15g of dried plant-materials every day. A Chi-square analysis shows statistically a significant link between the knowledge on repellent plants and gender as well as average monthly income although not with the age of the respondents. Nevertheless, the repellent plant usage custom was not significantly associated with gender, monthly income, and age of the informants.

CONCLUSION

Though most of the people have had an adequate awareness still a sizable faction of society suffers with deprivation of IRPs knowledge and usage practices. Therefore, this study calls for more surveys to conserve the existing indigenous knowledge and cultural practices. It could lay the first stone to develop the next generation cost-effective vector control tools in the near future.

Ownership and use of insecticide-treated nets during pregnancy in sub-Saharan Africa: a review

Over the past decade, significant gains have been made in the implementation of malaria prevention measures in pregnancy in sub-Saharan Africa, including the distribution of insecticide-treated nets (ITNs). These have been shown to cause a reduction in the incidence of malaria and its consequences such as maternal anaemia, stillbirths and intrauterine growth restriction. Currently most nations in Africa have policies for distributing ITNs to pregnant women through various mechanisms, however coverage remains well below the targets. This review summarizes recent evidence regarding the correlation between ownership and use of ITNs and the determinants of both, in pregnancy in sub-Saharan Africa, and reviews interventions directed at improving coverage. A review of the literature using Pubmed, CINAHL and scanning of reference lists was conducted in October 2012 and 59 articles were selected for final review. The research obtained was a mixture of national and district level surveys, and a narrative synthesis of the data was undertaken. Ownership of ITNs varied from as low as 3% to greater than 80%, and the main determinants were found to be education level, knowledge of malaria, community involvement, socio-economic status and parity, although the significance of each varied between the different settings and studies reviewed. In more than half the settings where data were available, the combination of lack of availability and lack of use of an available net meant that less than half of all pregnancies received the recommended intervention. Supply and cost remain major barriers to achieving optimal coverage, but the additional important contributor to reduced efficiency of intervention was the clear discrepancy between ownership and use, with available ITN use below 60% in several settings. Cited reasons for not using an ITN, where one was available, included discomfort, problems with hanging up nets and lack of space, low awareness of need, and seasonal variations in use. These findings highlight the need for context-specific approaches and educational components to be incorporated into ITN distribution programmes to address some of the reasons why some pregnant women do not use the ITNs they own.

Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-Saharan Africa: a systematic review and meta-analysis

BACKGROUND

Malaria in pregnancy has important consequences for mother and baby. Coverage with the World Health Organization-recommended prevention strategy for pregnant women in sub-Saharan Africa of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets (ITNs) is low. We conducted a systematic review to explore factors affecting delivery, access, and use of IPTp and ITNs among healthcare providers and women.

METHODS AND RESULTS

We searched the Malaria in Pregnancy Library and Global Health Database from 1 January 1990 to 23 April 2013, without language restriction. Data extraction was performed by two investigators independently, and data was appraised for quality and content. Data on barriers and facilitators, and the effect of interventions, were explored using content analysis and narrative synthesis. We conducted a meta-analysis of determinants of IPTp and ITN uptake using random effects models, and performed subgroup analysis to evaluate consistency across interventions and study populations, countries, and enrolment sites. We did not perform a meta-ethnography of qualitative data. Ninety-eight articles were included, of which 20 were intervention studies. Key barriers to the provision of IPTp and ITNs were unclear policy and guidance on IPTp; general healthcare system issues, such as stockouts and user fees; health facility issues stemming from poor organisation, leading to poor quality of care; poor healthcare provider performance, including confusion over the timing of each IPTp dose; and women's poor antenatal attendance, affecting IPTp uptake. Key determinants of IPTp coverage were education, knowledge about malaria/IPTp, socio-economic status, parity, and number and timing of antenatal clinic visits. Key determinants of ITN coverage were employment status, education, knowledge about malaria/ITNs, age, and marital status. Predictors showed regional variations.

CONCLUSIONS

Delivery of ITNs through antenatal clinics presents fewer problems than delivery of IPTp. Many obstacles to IPTp delivery are relatively simple barriers that could be resolved in the short term. Other barriers are more entrenched within the overall healthcare system or socio-economic/cultural contexts, and will require medium- to long-term strategies. Please see later in the article for the Editors' Summary.

Role of traditional antimalarial plants in the battle against the global malaria burden

Malaria continues to be a major global public health problem with 3.3 billion people at risk in 106 endemic countries. Globally, over 1000 plants have been used as potential antimalarials in resource-poor settings due to fragile health-care systems and lack of accessibility and affordability of artemisinin-based combination therapies (ACTs). Although many believe that the use of medicinal plants that have folklore reputations for antimalarial properties is relatively safe, many herbs may be potentially toxic due to their intrinsic adverse side effects. Therefore, herbal-derived remedies require powerful and deep assessment of their pharmacological qualities to establish their mode of action, safety, quality, and efficacy. In addition, the evolution of drug resistance also demands new antimalarial agents. This can be achieved by forming a vibrant antimalarial discovery pipeline among all stakeholders, including traditional healers, ethnobotanists, scientists, entomologists, pharmacists, and research institutions, for the isolation and characterization of the bioactive compounds with the ultimate objective of finding novel modes of action antimalarial compounds that can be used to fight against drug-resistant malarial parasites.

Predictors of malaria-association with rubber plantations in Thailand

Background

The national Global Fund-supported malaria (GFM) program in Thailand, which focuses on the household-level implementation of vector control via insecticide-treated nets (ITNs)/long-lasting insecticidal nets (LLINs) combined with indoor residual spraying (IRS), has been combating malaria risk situations in different provinces with complex epidemiological settings. By using the perception of malaria villagers (MVs), defined as villagers who recognized malaria burden and had local understanding of mosquitoes, malaria, and ITNs/LLINs and practiced preventive measures, this study investigated the predictors for malaria that are associated with rubber plantations in an area of high household-level implementation coverage of IRS (2007–2010) and ITNs/LLINs (2008–2010) in Prachuap Khiri Khan Province.

Methods

A structured questionnaire addressing socio-demographics, household characteristics and health behavioral factors (knowledge, perceptions and practices) regarding the performed interventions was administered to the 313 households (70 malaria-affected and 243 malaria-unaffected) that had respondents aged ≥18 years of both genders. In the univariate and multivariate analyses, only 246 (78.6%) MV respondents (62 malaria-affected and 184 malaria-unaffected) were analyzed to determine the predictors for risk (morbidity).

Results

The majority (70%) of households were covered by IRS. For a combination of ITNs/LLINs, there were 74% of malaria-affected households covered and 46% of malaria-unaffected households. In a logistic regression analysis using odds ratios (aORs) adjusted on the variables and a 95% confidence interval (CI), malaria affecting MVs was associated with daily worker (i.e., earning daily income by normally practicing laborious activities mostly in agriculture such as rubber tapping and rubber sheet processing at the smallholdings of rubber plantations) (aOR = 2.9, 95% CI: 1.1-7.4), low-moderate level of malaria knowledge (aOR = 2.4, 95% CI: 1.1-5.0) and sleeping under mosquito-nets (nets/ITNs/LLINs intermittently and ITNs/LLINs only) (aOR = 2.0, 95% CI: 1.0-3.7).

Conclusions

The MV predictors for malaria-association with rubber plantations included occupation (daily worker), misconceptions about malaria (mosquito and prevention) and the use of mosquito-nets. Human practices such as revisiting rubber plantations while exposed to multiple bites at multiple locations are more likely to apply to daily workers than to rubber farmers/tappers and others. The promotion and use of ITNs/LLINs depends substantially on cultural factors and defensive behaviors relevant to their occupational risk despite the perceived threats of malaria and the perceived benefits of ITNs/LLINs. This information supports the conclusion that GFM program implementation in Thailand or elsewhere for malaria-associated with rubber plantations would benefit from the potential use of ITNs/LLINs and changes in personal protection behaviors.

Knowledge and self-reported practice of the local inhabitants on traditional insect repellent plants in Western Hararghe zone, Ethiopia

ETHNOPHARMACOLOGICAL RELEVANCE

This paper reveals the trend of knowledge and self-reported practice of traditional insect repellent plants (TIRPs) and could serve as a baseline data to identify/formulate novel plant-based insect repellents in the near future.

AIM OF THE STUDY

Insect repellent plants usage is a long-standing and age old tradition. Thus, the major objective of this survey was to assess the knowledge and self-reported practice of the local inhabitants on TIRPs in Western Hararghe zone, Ethiopia.

MATERIALS AND METHODS

The ethnobotanical survey was conducted between January and March 2011 via administering pre-tested questionnaire by involving the selected 150 household members in the study area.

RESULTS

The survey results clearly reveal that nearly 92.1% [90.1% (99/110) of female and 97.5% (39/40) of male] of the respondents have had adequate awareness on TIRPs. Leaves were the most widely applied plant parts and burning/smoldering the plant materials in order to generate smoke was the most common practice. Chi-square statistical analysis shows that there was no significant difference observed in the knowledge of the repellent plants between the gender (P-value=0.134), average monthly income (P-value=0.529) and educational status (P-value=0.107) but there was a significant association with the age (P-value=0.012) of respondents. However, repellent plants usage custom is significantly associated with gender (P-value=0.021) and educational status (P-value=0.003) of the respondents but, there was such no significant relationship between the age (P-value=0.312) average monthly income (P-value=0.111) and repellent plants usage custom.

CONCLUSION

Conducting more ethnobotanical survey on TIRPs is extremely important in order to generate and maintain the data-base. Besides, identifying the bio-active molecules, which are responsible for the repellent activity and eventually conducting laboratory and field based studies to evaluate their efficacy and safety are extremely imperative to formulate new classes of plant-based insect repellents/insecticides in the near future.

Ethnomedicinal knowledge, belief and self-reported practice of local inhabitants on traditional antimalarial plants and phytotherapy

ETHNOPHARMACOLOGICAL RELEVANCE

This paper reveals the trend of knowledge and practice of traditional antimalarial plants (TAPs) to prevent/treat malaria.

MATERIALS AND METHODS

Stratified, systematic random sampling was adopted. The ethnomedicinal survey was conducted between January and March 2011 by involving the selected 371 household members on knowledge and practice of TAPs by administering a pre-tested questionnaire.

RESULTS

Overall, 54.4% respondents had adequate awareness and usage custom of TAPs and 16 types of plant have been most commonly known and employed by the respondents to prevent/treat malaria. Leaves (57.2%) were most commonly used plant part to prepare traditional antimalarial phytotherapy remedies. Decoction was one of the most commonly used methods to administer TAPs. The chi-square test result revealed that a significant association is found between the usage custom of traditional antimalarial plants and gender (P-value=0.0282), age (P-value=0.0024), educational status (P-value=0.0295), and monthly income (P-value=0.0001), although not with the ethnicity (P-value=0.7933) of the respondents.

CONCLUSION

TAPs usage is an integral part of the tradition and custom of the Ethiopians. However, nearly half of the respondents have had lack of awareness about TAPs and majority of them are reluctant in exercising either due to its ineffectiveness or its bitter taste. Therefore, further laboratory-based research is extremely imperative to identify their antiplasmodial activity and bioactive molecules which could pave the way to formulate the novel affordable as well as accessible potent antimalarials in the near future.