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Kabeya TK, Kasongo JCM, Matumba NB, Tshibangu DI, Garcia-Morzon LA, Burgueño E. Impact of mass distribution of long-lasting insecticide nets on the incidence of malaria in Lomami, Democratic Republic of Congo: a study based on electronic health record data (2018 - 2019). Pan Afr Med J 2023; 45:89. [PMID: 37663637 PMCID: PMC10474805 DOI: 10.11604/pamj.2023.45.89.33099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/16/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction holoendemic, malaria remains one of the major public health problems in Lomami Province in the Democratic Republic of Congo (DRC). To fight against it, a free mass distribution of long-lasting insecticide nets (LLINs) was organized in July 2019 throughout the province. The present study aimed to assess the incidence of malaria and its impact on anaemia of children from 0 to 59 months in this region before and after this intervention. Methods we had conducted a retrospective observational study from June to December 2018 and June to December 2019. The data were collected on District Health Information System version two (DHIS2) and analyzed with T-tests to compare the incidence rates before (second semester 2018) and after the distribution of LLINs (second semester 2019). Results the evolution of malaria cases immediately dropped after the distribution campaign. The incidence rates per 1,000 inhabitants in 2018 and 2019 were 106 and 107 respectively in the general population; 302 versus 305 in children aged 0 to 59 months and 219 versus 209 in pregnant women. The differences in incidence were not statistically significant with p values 0.497, 0.4602, and 0.3097 respectively. However, it was observed that the decrease in malaria cases led to a decrease in anaemia cases in general. Conclusion the LLIN distribution campaign did not decrease the incidence of malaria. The synergy of preventive interventions to reduce the incidence of malaria remains key.
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Affiliation(s)
- Theddy Kazadi Kabeya
- School of Public Health, University of Mwene Ditu, Lomami, Democratic Republic of Congo
- Health Regional Division, Kabinda, Lomami, Democratic Republic of Congo
| | - Jean Claude Musasa Kasongo
- School of Public Health, University of Mwene Ditu, Lomami, Democratic Republic of Congo
- Mwene-Ditu Health Zone, Lomami, Democratic Republic of Congo
| | | | | | | | - Eduardo Burgueño
- Centre Médical Vésale, Ngaliema, Kinshasa, Democratic Republic of Congo
- School of Medicine, Official University of Mbujimayi, Kasai-Oriental, Democratic Republic of Congo
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Onen H, Luzala MM, Kigozi S, Sikumbili RM, Muanga CJK, Zola EN, Wendji SN, Buya AB, Balciunaitiene A, Viškelis J, Kaddumukasa MA, Memvanga PB. Mosquito-Borne Diseases and Their Control Strategies: An Overview Focused on Green Synthesized Plant-Based Metallic Nanoparticles. INSECTS 2023; 14:221. [PMID: 36975906 PMCID: PMC10059804 DOI: 10.3390/insects14030221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
Mosquitoes act as vectors of pathogens that cause most life-threatening diseases, such as malaria, Dengue, Chikungunya, Yellow fever, Zika, West Nile, Lymphatic filariasis, etc. To reduce the transmission of these mosquito-borne diseases in humans, several chemical, biological, mechanical, and pharmaceutical methods of control are used. However, these different strategies are facing important and timely challenges that include the rapid spread of highly invasive mosquitoes worldwide, the development of resistance in several mosquito species, and the recent outbreaks of novel arthropod-borne viruses (e.g., Dengue, Rift Valley fever, tick-borne encephalitis, West Nile, yellow fever, etc.). Therefore, the development of novel and effective methods of control is urgently needed to manage mosquito vectors. Adapting the principles of nanobiotechnology to mosquito vector control is one of the current approaches. As a single-step, eco-friendly, and biodegradable method that does not require the use of toxic chemicals, the green synthesis of nanoparticles using active toxic agents from plant extracts available since ancient times exhibits antagonistic responses and broad-spectrum target-specific activities against different species of vector mosquitoes. In this article, the current state of knowledge on the different mosquito control strategies in general, and on repellent and mosquitocidal plant-mediated synthesis of nanoparticles in particular, has been reviewed. By doing so, this review may open new doors for research on mosquito-borne diseases.
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Affiliation(s)
- Hudson Onen
- Department of Entomology, Uganda Virus Research Institute, Plot 51/59 Nakiwogo Road, Entebbe P.O. Box 49, Uganda
| | - Miryam M. Luzala
- Laboratory of Pharmaceutics and Phytopharmaceutical Drug Development, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa B.P. 212, Democratic Republic of the Congo
- Centre de Recherche et d’Innovation Technologique en Environnement et en Sciences de la Santé (CRITESS), University of Kinshasa, Kinshasa B.P. 212, Democratic Republic of the Congo
| | - Stephen Kigozi
- Department of Biological Sciences, Faculty of Science, Kyambogo University, Kampala P.O. Box 1, Uganda
| | - Rebecca M. Sikumbili
- Centre de Recherche et d’Innovation Technologique en Environnement et en Sciences de la Santé (CRITESS), University of Kinshasa, Kinshasa B.P. 212, Democratic Republic of the Congo
- Department of Chemistry, Faculty of Science, University of Kinshasa, Kinshasa B.P. 190, Democratic Republic of the Congo
| | - Claude-Josué K. Muanga
- Laboratory of Pharmaceutics and Phytopharmaceutical Drug Development, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa B.P. 212, Democratic Republic of the Congo
- Centre de Recherche et d’Innovation Technologique en Environnement et en Sciences de la Santé (CRITESS), University of Kinshasa, Kinshasa B.P. 212, Democratic Republic of the Congo
| | - Eunice N. Zola
- Laboratory of Pharmaceutics and Phytopharmaceutical Drug Development, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa B.P. 212, Democratic Republic of the Congo
- Centre de Recherche et d’Innovation Technologique en Environnement et en Sciences de la Santé (CRITESS), University of Kinshasa, Kinshasa B.P. 212, Democratic Republic of the Congo
| | - Sébastien N. Wendji
- Laboratory of Pharmaceutics and Phytopharmaceutical Drug Development, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa B.P. 212, Democratic Republic of the Congo
- Centre de Recherche et d’Innovation Technologique en Environnement et en Sciences de la Santé (CRITESS), University of Kinshasa, Kinshasa B.P. 212, Democratic Republic of the Congo
| | - Aristote B. Buya
- Laboratory of Pharmaceutics and Phytopharmaceutical Drug Development, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa B.P. 212, Democratic Republic of the Congo
- Centre de Recherche et d’Innovation Technologique en Environnement et en Sciences de la Santé (CRITESS), University of Kinshasa, Kinshasa B.P. 212, Democratic Republic of the Congo
| | - Aiste Balciunaitiene
- Institute of Horticulture, Lithuanian Research Centre for Agriculture and Forestry, 54333 Babtai, Lithuania
| | - Jonas Viškelis
- Institute of Horticulture, Lithuanian Research Centre for Agriculture and Forestry, 54333 Babtai, Lithuania
| | - Martha A. Kaddumukasa
- Department of Biological Sciences, Faculty of Science, Kyambogo University, Kampala P.O. Box 1, Uganda
| | - Patrick B. Memvanga
- Laboratory of Pharmaceutics and Phytopharmaceutical Drug Development, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa B.P. 212, Democratic Republic of the Congo
- Centre de Recherche et d’Innovation Technologique en Environnement et en Sciences de la Santé (CRITESS), University of Kinshasa, Kinshasa B.P. 212, Democratic Republic of the Congo
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Koenker H, Kumoji EK, Erskine M, Opoku R, Sternberg E, Taylor C. Reported reasons for non-use of insecticide-treated nets in large national household surveys, 2009-2021. Malar J 2023; 22:61. [PMID: 36810015 PMCID: PMC9942310 DOI: 10.1186/s12936-023-04490-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Insecticide-treated nets (ITN) are the cornerstone of modern malaria vector control, with nearly 3 billion ITNs delivered to households in endemic areas since 2000. ITN access, i.e. availability within the household, based on the number of ITNs and number of household members, is a pre-requisite for ITN use. Factors determining ITN use are frequently examined in published literature, but to date, large household survey data on reasons given for non-use of nets have not been explored. METHODS A total of 156 DHS, MIS, and MICS surveys conducted between 2003 and 2021 were reviewed for questions on reasons why nets were not used the previous night, identifying twenty-seven surveys. The percent of nets that were reported used the previous night was calculated for the 156 surveys, and frequencies and proportions of reasons for non-use were calculated within the twenty-seven surveys. Results were stratified by household supply of ITNs in three categories (not enough", "enough", and "more than enough") and by residence (urban/rural). RESULTS The proportion of nets used the previous night averaged over 70% between 2003 and 2021, with no discernible change over this period. Reported reasons for why a net goes unused fell largely into three categories-nets that are extra/being saved for future use; the perception that there is little risk of malaria (particularly in dry season); and "other" responses. Net attributes such as colour, size, shape, and texture, and concerns related to chemicals were the least frequent reasons given. Reasons for non-use of nets varied by household net supply, and in some surveys by residence. In Senegal's continuous DHS, the proportion of nets used peaked during high transmission season, and the proportion of nets that went unused due to "no/few mosquitoes" peaked during the dry season. CONCLUSIONS Unused nets were primarily those being saved for later use, or were not used due to perceived low risk of malaria. Classifying reasons for non-use into broader categories facilitates the design of appropriate social and behaviour change interventions to address the major underlying reasons for non-use, where this is feasible.
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Affiliation(s)
| | - E. Kuor Kumoji
- grid.449467.c0000000122274844Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Marcy Erskine
- grid.475581.a0000 0004 0411 9738International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | - Robert Opoku
- grid.475581.a0000 0004 0411 9738International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | | | - Cameron Taylor
- grid.431760.70000 0001 0940 5336The DHS Program, ICF, Rockville, USA ,grid.5284.b0000 0001 0790 3681University of Antwerp, Medicine and Health Sciences, Antwerp, Belgium
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Van Bortel W, Mariën J, Jacobs BKM, Sinzinkayo D, Sinarinzi P, Lampaert E, D’hondt R, Mafuko JM, De Weggheleire A, Vogt F, Alexander N, Wint W, Maes P, Vanlerberghe V, Leclair C. Long-lasting insecticidal nets provide protection against malaria for only a single year in Burundi, an African highland setting with marked malaria seasonality. BMJ Glob Health 2022; 7:bmjgh-2022-009674. [PMID: 36455989 PMCID: PMC9772646 DOI: 10.1136/bmjgh-2022-009674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/08/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Long-lasting insecticidal nets (LLINs) are one of the key interventions in the global fight against malaria. Since 2014, mass distribution campaigns of LLINs aim for universal access by all citizens of Burundi. In this context, we assess the impact of LLINs mass distribution campaigns on malaria incidence, focusing on the endemic highland health districts. We also explored the possible correlation between observed trends in malaria incidence with any variations in climate conditions. METHODS Malaria cases for 2011-2019 were obtained from the National Health Information System. We developed a generalised additive model based on a time series of routinely collected data with malaria incidence as the response variable and timing of LLIN distribution as an explanatory variable to investigate the duration and magnitude of the LLIN effect on malaria incidence. We added a seasonal and continuous-time component as further explanatory variables, and health district as a random effect to account for random natural variation in malaria cases between districts. RESULTS Malaria transmission in Burundian highlands was clearly seasonal and increased non-linearly over the study period. Further, a fast and steep decline of malaria incidence was noted during the first year after mass LLIN distribution (p<0.0001). In years 2 and 3 after distribution, malaria cases started to rise again to levels higher than before the control intervention. CONCLUSION This study highlights that LLINs did reduce the incidence in the first year after a mass distribution campaign, but in the context of Burundi, LLINs lost their impact after only 1 year.
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Affiliation(s)
- Wim Van Bortel
- Outbreak Research Team, Institute of Tropical Medicine, Antwerpen, Belgium,Unit Entomology, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Joachim Mariën
- Outbreak Research Team, Institute of Tropical Medicine, Antwerpen, Belgium,Evolutionary Ecology Group, University of Antwerp, Antwerpen, Belgium
| | - Bart K M Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Denis Sinzinkayo
- National Malaria Control Programme, Bujumbura, Burundi,Doctoral School, University of Burundi, Bujumbura, Burundi
| | | | - Emmanuel Lampaert
- Department of Operations – Central African Regional Support Team, Médecins Sans Frontières, Kinshasa, Congo (the Democratic Republic of the)
| | - Rob D’hondt
- Medical Department, Environmental Health Unit, Médecins Sans Frontières, Brussels, Belgium
| | - Jean-Marie Mafuko
- Department of Operations, Médecins Sans Frontières, Bujumbura, Burundi
| | - Anja De Weggheleire
- Outbreak Research Team, Institute of Tropical Medicine, Antwerpen, Belgium,Unit of Mycobacterial Diseases and Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Florian Vogt
- Outbreak Research Team, Institute of Tropical Medicine, Antwerpen, Belgium,The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia,National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Neil Alexander
- Environmental Research Group Oxford Ltd, c/o Department of Biology, University of Oxford, Oxford, UK
| | - William Wint
- Environmental Research Group Oxford Ltd, c/o Department of Biology, University of Oxford, Oxford, UK
| | - Peter Maes
- Chief of WASH (Water, Sanitation and Hygiene), UNICEF, Kinshasa, Congo (the Democratic Republic of the)
| | - Veerle Vanlerberghe
- Tropical Infectious Diseases Group, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Corey Leclair
- Medical Department, Environmental Health Unit, Médecins Sans Frontières, Brussels, Belgium
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Jo Y, Barthel N, Stierman E, Clifton K, Pak ES, Ezeiru S, Ekweremadu D, Onugu N, Ali Z, Egwu E, Akoh O, Uzunyayla O, Van Hulle S. The Potential of Digital Data Collection Tools for Long-lasting Insecticide-Treated Net Mass Campaigns in Nigeria: Formative Study. JMIR Form Res 2021; 5:e23648. [PMID: 34623310 PMCID: PMC8538022 DOI: 10.2196/23648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 06/29/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Nigeria has the world’s largest malaria burden, accounting for 27% of the world’s malaria cases and 23% of malaria mortality globally. This formative study describes the operational process of the mass distribution of long-lasting insecticide-treated nets (LLINs) during a campaign program in Nigeria. Objective This study aims to assess whether and how digital data collection and management tools can change current practices and help resolve major implementation issues. Methods Qualitative data on the technical features and operational processes of paper-based and information and communication technology (ICT)–based systems in the Edo and Kwara states from June 2 to 30, 2017, were collected on the basis of documented operation manuals, field observations, and informant interviews. During the LLIN campaign in Edo State, we recruited 6 local government area focal persons and monitors and documented daily review meetings during household mobilization (9 days) and net distribution (5 days) to understand the major program implementation issues associated with the following three aspects: logistic issues, technical issues, and demand creation. Each issue was categorized according to the expected degree (low, mid, and high) of change by the ICT system. Results The net campaign started with microplanning and training, followed by a month-long implementation process, which included household mobilization, net movement, net distribution, and end process monitoring. The ICT system can improve management and oversight issues related to data reporting and processes through user-centered interface design, built-in data quality control logic flow or algorithms, and workflow automation. These often require more than 50% of staff time and effort in the current paper-based practice. Compared with the current paper-based system, the real-time system is expected to reduce the time to payment compensation for health workers by about 20 days and produce summary campaign statistics for at least 20 to 30 days. Conclusions The ICT system can facilitate the measurement of population coverage beyond program coverage during an LLIN campaign with greater data reliability and timeliness, which are often compromised due to the limited workforce capacity in a paper-based system.
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Affiliation(s)
- Youngji Jo
- Boston Medical Center, Boston, MA, United States
| | | | | | | | - Esther Semee Pak
- Graduate Institute of International Development Studies, Geneva, Switzerland
| | | | | | | | - Zainab Ali
- Catholic Relief Services, Abuja, Nigeria
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Cote CM, Goel V, Muhindo R, Baguma E, Ntaro M, Shook-Sa BE, Reyes R, Staedke SG, Mulogo EM, Boyce RM. Malaria prevalence and long-lasting insecticidal net use in rural western Uganda: results of a cross-sectional survey conducted in an area of highly variable malaria transmission intensity. Malar J 2021; 20:304. [PMID: 34225756 PMCID: PMC8256478 DOI: 10.1186/s12936-021-03835-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background Long-lasting insecticidal nets (LLINs) remain a cornerstone of malaria control, but strategies to sustain universal coverage and high rates of use are not well-defined. A more complete understanding of context-specific factors, including transmission intensity and access to health facilities, may inform sub-district distribution approaches and tailored messaging campaigns. Methods A cross-sectional survey of 2190 households was conducted in a single sub-county of western Uganda that experiences highly variable malaria transmission intensity. The survey was carried out approximately 3 years after the most recent mass distribution campaign. At each household, study staff documented reported LLIN use and source among children 2 to 10 years of age and performed a malaria rapid diagnostic test. Elevation and distance to the nearest health facility was estimated for each household. Associations between parasite prevalence and LLIN use were estimated from log binomial regression models with elevation and distance to clinic being the primary variables of interest. Results Overall, 6.8% (148 of 2170) of children age 2–10 years of age had a positive RDT result, yielding a weighted estimate of 5.8% (95% confidence interval [CI] 5.4–6.2%). There was substantial variability in the positivity rates among villages, with the highest elevation villages having lower prevalence than lowest-elevation villages (p < .001). Only 64.7% (95% CI 64.0–65.5%) of children were reported to have slept under a LLIN the previous night. Compared to those living < 1 km from a health centre, households at ≥ 2 km were less likely to report the child sleeping under a LLIN (RR 0.86, 95% CI 0.83–0.89, p < .001). Households located farther from a health centre received a higher proportion of LLINs from government distributions compared to households living closer to health centres. Conclusions LLIN use and sourcing was correlated with household elevation and estimated distance to the nearest health facility. The findings suggest that current facility-based distribution strategies are limited in their reach. More frequent mass distribution campaigns and complementary approaches are likely required to maintain universal LLIN coverage and high rates of use among children in rural Uganda. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03835-7.
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Affiliation(s)
- Claire M Cote
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Varun Goel
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rabbison Muhindo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emmanuel Baguma
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Moses Ntaro
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bonnie E Shook-Sa
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Raquel Reyes
- Division of Hospital Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Edgar M Mulogo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ross M Boyce
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda. .,Institute of Global Health and Infectious Diseases, UNC School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Road, CB 7030, Chapel Hill, NC, 27599, USA.
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Topazian HM, Gumbo A, Brandt K, Kayange M, Smith JS, Edwards JK, Goel V, Mvalo T, Emch M, Pettifor AE, Juliano JJ, Hoffman I. Effectiveness of a national mass distribution campaign of long-lasting insecticide-treated nets and indoor residual spraying on clinical malaria in Malawi, 2018-2020. BMJ Glob Health 2021; 6:bmjgh-2021-005447. [PMID: 33947708 PMCID: PMC8098915 DOI: 10.1136/bmjgh-2021-005447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/06/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Malawi’s malaria burden is primarily assessed via cross-sectional national household surveys. However, malaria is spatially and temporally heterogenous and no analyses have been performed at a subdistrict level throughout the course of a year. The WHO recommends mass distribution of long-lasting insecticide-treated bed nets (LLINs) every 3 years, but a national longitudinal evaluation has never been conducted in Malawi to determine LLIN effectiveness lifespans. Methods Using District Health Information Software 2 (DHIS2) health facility data, available from January 2018 to June 2020, we assessed malaria risk before and after a mass distribution campaign, stratifying by age group and comparing risk differences (RDs) by LLIN type or annual application of indoor residual spraying (IRS). Results 711 health facilities contributed 20 962 facility reports over 30 months. After national distribution of 10.7 million LLINs and IRS in limited settings, malaria risk decreased from 25.6 to 16.7 cases per 100 people from 2018 to 2019 high transmission seasons, and rebounded to 23.2 in 2020, resulting in significant RDs of −8.9 in 2019 and −2.4 in 2020 as compared with 2018. Piperonyl butoxide (PBO)-treated LLINs were more effective than pyrethroid-treated LLINs, with adjusted RDs of −2.3 (95% CI −2.7 to −1.9) and −1.5 (95% CI −2.0 to −1.0) comparing 2019 and 2020 high transmission seasons to 2018. Use of IRS sustained protection with adjusted RDs of −1.4 (95% CI −2.0 to −0.9) and −2.8% (95% CI −3.5 to −2.2) relative to pyrethroid-treated LLINs. Overall, 12 of 28 districts (42.9%) experienced increases in malaria risk in from 2018 to 2020. Conclusion LLINs in Malawi have a limited effectiveness lifespan and IRS and PBO-treated LLINs perform better than pyrethroid-treated LLINs, perhaps due to net repurposing and insecticide-resistance. DHIS2 provides a compelling framework in which to examine localised malaria trends and evaluate ongoing interventions.
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Affiliation(s)
- Hillary M Topazian
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Austin Gumbo
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | - Katerina Brandt
- Department of Geography, University of North Carolina at Chapel Hill Graduate School, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Kayange
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Varun Goel
- Department of Geography, University of North Carolina at Chapel Hill Graduate School, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tisungane Mvalo
- University of North Carolina Project-Malawi, Lilongwe, Malawi.,Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael Emch
- Department of Geography, University of North Carolina at Chapel Hill Graduate School, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Audrey E Pettifor
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan J Juliano
- Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Irving Hoffman
- University of North Carolina Project-Malawi, Lilongwe, Malawi.,Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Tetteh EK. Assuring health commodity security in resource-poor settings. Res Social Adm Pharm 2021; 18:2538-2546. [PMID: 33865713 DOI: 10.1016/j.sapharm.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022]
Abstract
Health planners charged with the task of building or at least maintaining the health of populations within low- and middle-income countries (LMICs) have to find ways of providing steady, predictable supplies of health commodities for unpredictable demands for healthcare and health. To address this issue, this paper emphasizes a focus on aggregate commodity security defined as the continuous interrupted supply of health commodities belonging to all therapeutic categories and not just a selected subset. Given this focus, the paper identifies logistics systems comprising of a set of logistics activities as the machinery for assuring aggregate commodity security. Steady reliable supplies of health commodities, whenever and wherever they are needed, however, means looking beyond logistics systems. Health planners must ask whether there is a healthy supplier base for the commodities needed. The paper notes that a secure supply of health commodities in any LMIC, will remain an illusion without functional logistics systems supported by a healthy supplier base.
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Affiliation(s)
- Ebenezer Kwabena Tetteh
- Department of Pharmacy Practice & Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
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Topazian HM, Gumbo A, Puerto-Meredith S, Njiko R, Mwanza A, Kayange M, Mwalilino D, Mvula B, Tegha G, Mvalo T, Edwards JK, Emch M, Pettifor A, Smith JS, Hoffman I, Meshnick SR, Juliano JJ. Asymptomatic Plasmodium falciparum malaria prevalence among adolescents and adults in Malawi, 2015-2016. Sci Rep 2020; 10:18740. [PMID: 33127922 PMCID: PMC7603306 DOI: 10.1038/s41598-020-75261-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022] Open
Abstract
Malaria remains a significant cause of morbidity and mortality in Malawi, with an estimated 18–19% prevalence of Plasmodium falciparum in children 2–10 years in 2015–2016. While children report the highest rates of clinical disease, adults are thought to be an important reservoir to sustained transmission due to persistent asymptomatic infection. The 2015–2016 Malawi Demographic and Health Survey was a nationally representative household survey which collected dried blood spots from 15,125 asymptomatic individuals ages 15–54 between October 2015 and February 2016. We performed quantitative polymerase chain reaction on 7,393 samples, detecting an overall P. falciparum prevalence of 31.1% (SE = 1.1). Most infections (55.6%) had parasitemias ≤ 10 parasites/µL. While 66.2% of individuals lived in a household that owned a bed net, only 36.6% reported sleeping under a long-lasting insecticide-treated net (LLIN) the previous night. Protective factors included urbanicity, greater wealth, higher education, and lower environmental temperatures. Living in a household with a bed net (prevalence difference 0.02, 95% CI − 0.02 to 0.05) and sleeping under an LLIN (0.01; − 0.02 to 0.04) were not protective against infection. Our findings demonstrate a higher parasite prevalence in adults than published estimates among children. Understanding the prevalence and distribution of asymptomatic infection is essential for targeted interventions.
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Affiliation(s)
- Hillary M Topazian
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, 27510, USA.
| | - Austin Gumbo
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | | | - Ruth Njiko
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Alexis Mwanza
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, 27510, USA
| | - Michael Kayange
- National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | - David Mwalilino
- National HIV Reference Laboratory, Malawi Ministry of Health, Lilongwe, Malawi
| | - Bernard Mvula
- National HIV Reference Laboratory, Malawi Ministry of Health, Lilongwe, Malawi
| | - Gerald Tegha
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Tisungane Mvalo
- University of North Carolina Project-Malawi, Lilongwe, Malawi.,Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, 27510, USA
| | - Michael Emch
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, 27510, USA.,Department of Geography, University of North Carolina, Chapel Hill, NC, USA
| | - Audrey Pettifor
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, 27510, USA.,Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, 27510, USA
| | - Irving Hoffman
- University of North Carolina Project-Malawi, Lilongwe, Malawi.,Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Steven R Meshnick
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, 27510, USA
| | - Jonathan J Juliano
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Dahmana H, Mediannikov O. Mosquito-Borne Diseases Emergence/Resurgence and How to Effectively Control It Biologically. Pathogens 2020; 9:E310. [PMID: 32340230 PMCID: PMC7238209 DOI: 10.3390/pathogens9040310] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/28/2022] Open
Abstract
Deadly pathogens and parasites are transmitted by vectors and the mosquito is considered the most threatening vector in public health, transmitting these pathogens to humans and animals. We are currently witnessing the emergence/resurgence in new regions/populations of the most important mosquito-borne diseases, such as arboviruses and malaria. This resurgence may be the consequence of numerous complex parameters, but the major cause remains the mismanagement of insecticide use and the emergence of resistance. Biological control programmes have rendered promising results but several highly effective techniques, such as genetic manipulation, remain insufficiently considered as a control mechanism. Currently, new strategies based on attractive toxic sugar baits and new agents, such as Wolbachia and Asaia, are being intensively studied for potential use as alternatives to chemicals. Research into new insecticides, Insect Growth Regulators, and repellent compounds is pressing, and the improvement of biological strategies may provide key solutions to prevent outbreaks, decrease the danger to at-risk populations, and mitigate resistance.
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Affiliation(s)
- Handi Dahmana
- Aix Marseille Univ, IRD, AP-HM, MEPHI, 13005 Marseille, France;
- IHU-Méditerranée Infection, 13005 Marseille, France
| | - Oleg Mediannikov
- Aix Marseille Univ, IRD, AP-HM, MEPHI, 13005 Marseille, France;
- IHU-Méditerranée Infection, 13005 Marseille, France
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Scates SS, Finn TP, Wisniewski J, Dadi D, Mandike R, Khamis M, Greer G, Serbantez N, Segbaya S, Owusu P, Mihigo J, Gerberg L, Acosta A, Koenker H, Yukich J. Costs of insecticide-treated bed net distribution systems in sub-Saharan Africa. Malar J 2020; 19:105. [PMID: 32131834 PMCID: PMC7055111 DOI: 10.1186/s12936-020-03164-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/13/2020] [Indexed: 12/01/2022] Open
Abstract
Background Insecticide-treated nets (ITNs) are one of the most cost-effective measures for preventing malaria. The World Health Organization recommends both large-scale mass distribution campaigns and continuous distributions (CD) as part of a multifaceted strategy to achieve and sustain universal access to ITNs. A combination of these strategies has been effective for scaling up ITN access. For policy makers to make informed decisions on how to efficiently implement CD or combined strategies, information on the costs and cost-effectiveness of these delivery systems is necessary, but relatively few published studies of the cost continuous distribution systems exist. Methods To address the gap in continuous distribution cost data, four types of delivery systems—CD through antenatal care services (ANC) and the expanded programme on immunization (EPI) (Ghana, Mali, and mainland Tanzania), CD through schools (Ghana and mainland Tanzania), and a combined community/health facility-based distribution (Zanzibar, Tanzania), as well as mass distributions (Mali)—were costed. Data on costs were collected retrospectively from financial and operational records, stakeholder interviews, and resource use surveys. Results Overall, from a full provider perspective, mass distributions and continuous systems delivered ITNs at overlapping economic costs per net distributed (mass distributions: 4.37–4.61 USD, CD channels: 3.56–9.90 USD), with two of the school-based systems and the mass distributions at the lower end of this range. From the perspective of international donors, the costs of the CD systems were, for the most part, less costly than the mass distributions (mass distributions: 4.34–4.55 USD, Ghana and Tanzania 2017 school-based: 3.30–3.69 USD, health facility-based: 3.90–4.55 USD, combined community/health facility 4.55 USD). The 2015 school-based distribution (7.30 USD) and 2016 health facility-based distribution (6.52 USD) programmes in Tanzania were an exception. Mass distributions were more heavily financed by donors, while CD relied more extensively on domestic resource contributions. Conclusions These results suggest that CD strategies can continue to deliver nets at a comparable cost to mass distributions, especially from the perspective of the donor.
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Affiliation(s)
- Sara S Scates
- PMI VectorWorks Project, Department of Tropical Medicine and the Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Timothy P Finn
- PMI VectorWorks Project, Department of Tropical Medicine and the Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Janna Wisniewski
- PMI VectorWorks Project, Department of Tropical Medicine and the Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - David Dadi
- PMI VectorWorks Project, Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA
| | - Renata Mandike
- Tanzania National Malaria Control Programme, Dodoma, Tanzania
| | - Mwinyi Khamis
- Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania
| | - George Greer
- U.S. President's Malaria Initiative, US Agency for International Development, Dar es Salaam, Tanzania
| | - Naomi Serbantez
- U.S. President's Malaria Initiative, US Agency for International Development, Dar es Salaam, Tanzania
| | - Sylvester Segbaya
- PMI VectorWorks Project, Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA
| | - Prince Owusu
- PMI VectorWorks Project, Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA
| | - Jules Mihigo
- U.S. President's Malaria Initiative, US Agency for International Development, Bamako, Mali
| | - Lilia Gerberg
- U.S President's Malaria Initiative, U.S. Agency for International Development, Washington, D.C., USA
| | - Angela Acosta
- PMI VectorWorks Project, Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA
| | - Hannah Koenker
- PMI VectorWorks Project, Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA
| | - Joshua Yukich
- PMI VectorWorks Project, Department of Tropical Medicine and the Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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LLIN Evaluation in Uganda Project (LLINEUP): factors associated with childhood parasitaemia and anaemia 3 years after a national long-lasting insecticidal net distribution campaign: a cross-sectional survey. Malar J 2019; 18:207. [PMID: 31234882 PMCID: PMC6591906 DOI: 10.1186/s12936-019-2838-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/14/2019] [Indexed: 12/31/2022] Open
Abstract
Background Recent reductions in malaria burden have been attributed largely to long-lasting insecticidal nets (LLINs). In March–June 2017, approximately 3 years after a national LLIN distribution campaign, a cross-sectional community survey was conducted to investigate factors associated with malaria parasitaemia and anaemia, in advance of Uganda’s 2017–2018 LLIN campaign. Methods Households from 104 clusters in 48 districts were randomly selected using two-staged cluster sampling; 50 households were enrolled per cluster. Eligible children aged 2–10 years had blood obtained for a thick blood smear and those aged 2–4 years had haemoglobin measured. Associations between outcomes and variables of interest were assessed using log-binomial regression with generalized estimating equations to adjust for household clustering. Results In total, 5196 households, 8834 children with blood smear results, and 3753 with haemoglobin results were included. Only 16% of children lived in households with adequate LLIN coverage. Overall, parasite prevalence was 26.0%, ranging from 8.0% in the South West to 53.1% in East Central. Limiting data to children 2–4 years of age, parasite prevalence was 21.4%, up from 16.9% in 2014–2015 following the national LLIN campaign. In a multivariate analysis, factors associated with parasitaemia included region (East-Central vs South-Western; adjusted prevalence ratio [aPR] 6.45, 95% CI 5.55–7.50; p < 0.001), older age (8–10 vs 2–3 years; aPR 1.57, 95% CI 1.43–1.72; p < 0.001), living in a poorer household (poorest vs least poor tercile; aPR 2.32, 95% CI 2.05–2.63; p < 0.001), one constructed of traditional materials (aPR 1.13, 95% CI 1.03–1.24; p = 0.008), or without adequate LLIN coverage (aPR 1.30, 95% CI 1.14–1.48; p < 0.001). Overall, the prevalence of anaemia (haemoglobin < 10 g/dL) was 15.1% and varied geographically. In a multivariate analysis, factors associated with anaemia included region, younger age, living in a traditional house, and parasitaemia, which was the strongest predictor (aPR 2.50, 95% CI 2.12–2.95; p < 0.001). Conclusions Three years after a national LLIN campaign, LLIN coverage was low and parasite prevalence had increased. Parasite prevalence varied widely across Uganda; older children, those living in poorer households, and those with inadequate LLIN coverage, were at highest risk of parasitaemia. LLINs may need to be distributed more frequently through mass campaigns or continuously through sustainable mechanisms. Targeting interventions to geographic areas and populations at highest risk should also be considered.
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13
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Dolan CB, BenYishay A, Grépin KA, Tanner JC, Kimmel AD, Wheeler DC, McCord GC. The impact of an insecticide treated bednet campaign on all-cause child mortality: A geospatial impact evaluation from the Democratic Republic of Congo. PLoS One 2019; 14:e0212890. [PMID: 30794694 PMCID: PMC6386397 DOI: 10.1371/journal.pone.0212890] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/11/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To test the impact of a nationwide Long-Lasting Insecticidal Nets [LLINs] distribution program in the Democratic Republic of Congo [DRC] on all-cause under-five child mortality exploiting subnational variation in malaria endemicity and the timing in the scale-up of the program across provinces. DESIGN Geospatial Impact Evaluation using a difference-in-differences approach. SETTING Democratic Republic of the Congo. PARTICIPANTS 52,656 children sampled in the 2007 and 2013/2014 DRC Demographic and Health Surveys. INTERVENTIONS The analysis provides plausibly causal estimates of both average treatment effects of the LLIN distribution campaign and geospatial heterogeneity in these effects based on malaria endemicity. It compares the under-five, all-cause mortality for children pre- and post-LLIN campaign relative to children in those areas that had not yet been exposed to the campaign using a difference-in-differences model and controlling for year- and province-fixed effects, and province-level trends in mortality. RESULTS We find that the campaign led to a 41% decline [3.7 percentage points, 95% CI 1.3 to 6.0] in under-5 mortality risk among children living in rural areas with malaria ecology above the sample median. Results were robust to controlling for household assets and the presence of other health aid programs. No effect was detected in children living in areas with malaria ecology below the median. CONCLUSION The findings of this paper make important contributions to the evidence base for the effectiveness of large scale-national LLIN campaigns against malaria. We found that the program was effective in areas of the DRC with the highest underlying risk of malaria. Targeting bednets to areas with greatest underlying risk for malaria may help to increase the efficiency of increasingly limited malaria resources but should be balanced against other malaria control concerns.
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Affiliation(s)
- Carrie B. Dolan
- Department of Kinesiology and Health Sciences, William and Mary, Williamsburg, Virginia, United States of America
| | - Ariel BenYishay
- Department of Economics, William and Mary, Williamsburg, Virginia, United States of America
| | - Karen A. Grépin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Jeffery C. Tanner
- Independent Evaluation Group, World Bank, Washington, DC, United States of America
| | - April D. Kimmel
- Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - David C. Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Gordon C. McCord
- School of Global Policy and Strategy, University of California San Diego, San Diego, California, United States of America
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