Increased financial accessibility and targeted education messages could increase ownership and use of mosquito nets in Purulia District, West Bengal, India

Long-Lasting Insecticidal Net Coverage and Utilization in Burla Town of Sambalpur District: A Cross-Sectional Study

Background Vector-borne diseases continue to significantly contribute to mortality and morbidity, especially in developing nations. Vector management is a key pillar in combating these diseases, and long-lasting insecticidal nets (LLINs) are cost-effective tools. The Government of India, under the National Vector Borne Disease Control Programme (NVBDCP), has distributed LLINs for free to increase coverage and utilization. This study aims to estimate the coverage and utilization of LLINs in Burla town. Method This cross-sectional study was conducted from October to December 2022 in Burla town of Sambalpur in Odisha, India. The estimated sample size was 510 households, assuming 50% coverage. Multi-stage cluster sampling was adopted to select the Anganwadi centers and households. A pretested questionnaire was utilized for data collection by trained personnel through Epicollect5 (Centre for Genomic Pathogen Surveillance, Oxford, UK). Logistic regression was used to identify predictors for LLIN usage. Results The survey covered 516 households with 2,541 individuals and 1,165 nets. Household-level coverage was 94.2%, and regular utilization was 45.74%. Skin reactions (35.7%) were the most common reason for non-usage, followed by low mosquito density (12%). Logistic regression showed that the number of rooms (adjusted odds ratio (AOR) = 0.663, p = 0.012), number of bed nets (AOR = 2.757, p < 0.001), knowledge of malaria (AOR = 2.92, p = 0.04), adopting other measures for mosquito control (AOR = 0.295, p < 0.001), and washing the net (AOR = 1.92, p = 0.028) significantly predicted sleeping under mosquito net. Conclusion Our study has depicted high coverage of LLINs in Burla town, but utilization needs further improvement. Counseling regarding proper use can decrease the skin reactions responsible for non-usage. Regular health education programs are required to emphasize the benefits of LLIN use, along with regular monitoring and supervision.

Research on Digital Inclusive Finance Promoting the Integration of Rural Three-Industry

The development of digital financial inclusion helps create a healthy rural financial ecological environment and plays an important role in integrating rural tertiary industries. This paper incorporates digital financial inclusion into the rural tertiary industry integration research framework. Furthermore, it adopts the double-difference method to empirically analyze the impact of the development of digital financial inclusion on rural tertiary industry integration from the perspective of policy impact. In addition, it considers regional differences in the financial ecological environment; robustness tests were carried out using methods such as placebo tests and validated the conduction mechanism. The study through the double-difference model found that digital financial inclusion is very conducive to promoting rural tertiary industry integration; using the quantile DID (difference in differences) method to analyze the heterogeneity, it is concluded that there is a heterogeneous impact on rural tertiary industry integration. It exerts a more significant improvement in provinces and cities with higher rural tertiary industry integration levels. Constructing an intermediary effect model to verify the transmission mechanism concludes that the policy has promoted the improvement of rural tertiary industry integration efficiency by promoting technological innovation, improving agricultural modernization, and building a risk-sharing mechanism. Finally, it puts forward policy recommendations from optimizing the financial ecological environment, rationally allocating financial resources, and perfecting the transmission mechanism.

Effect of malaria preventive education on the use of long-lasting insecticidal nets among pregnant females in a Teaching Hospital in Osun state, south-west Nigeria

BACKGROUND

Malaria in pregnancy is a major public health problem in Nigeria. Long-Lasting Insecticidal Nets (LLINs) have been advocated as an effective tool against malaria transmission. However, success of this intervention largely depends on the knowledge and practices regarding malaria and its prevention. Unfortunately, few studies have been done on effect of malaria preventive education on use of LLIN in pregnancy.

OBJECTIVE

To assess the knowledge of malaria and determine the effect of malaria preventive education on the use of LLINs among pregnant females in a Teaching Hospital in Osun state.

METHOD

It was a one group pre-test post-test quasi - experimental hospital based study involving pregnant females attending Ante-Natal Clinic (ANC) of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). A total of 200 respondents were recruited for this study by 2-stage sampling technique. Data was collected using a pretested questionnaire to elicit information on socio-demographic characteristics, use of LLIN in pregnancy, knowledge of malaria and its preventive measures. The data collected was analysed using descriptive and inferential statistics. The descriptive statistics comprised frequency, percentage, means and standard deviations. Bivariate analysis comprised Chi-square test on knowledge of malaria before and after intervention while correlation test assessed strength of relationship between knowledge of malaria preventive education and use of LLINs before and after intervention. Multivariate analysis determined the predictors of LLINs use. Analytical statistics of cross tabulation was conducted considering a p < 0.05 to be statistically significant.

RESULTS

There was an increase in the scores of knowledge on malaria transmission after the intervention and this was statistically significant (χ² = 8.862, p < 0.01). Similarly, the scores of knowledge on malaria prevention increased after the intervention and this was statistically significant (χ² = 10.023, p < 0.01). Respondents' age, marital status and gravidity were predictors of LLINs use. Biserial correlation showed a statistically positive relationship between knowledge of malaria preventive education and use of LLINs after intervention (r = 0.036, p < 0.01).

CONCLUSION

The use of malaria preventive education was found to be effective in increasing the use of LLIN in this study. These findings highlight a need for educational intervention in implementation of LLINs. There is therefore a need to strengthen the policy of malaria prevention education as an integral component with distribution of free LLIN in health care setting to enhance its utilization.

Assessment of the Status of Awareness, Ownership, and Usage of Long-Lasting Insecticide Treated Nets after Mass Distribution in Ekiti State, Nigeria

Vector control with long-lasting insecticide treated nets (LLINs) has been identified as a major component of malaria prevention and control. The study examined present status of awareness, ownership, and utilization of LLINs in malaria high-risk areas of Ekiti State, Nigeria. Data were obtained from 352 copies of semistructured interviewer-guided questionnaire distributed to participants of each household in the four Local Government Areas (LGAs) of Ekiti State, where malaria is endemic after mass distribution of LLINs. Findings in this study showed that awareness was high (91.8%) in the Local Government Areas (LGAs) with mass media contributing largely (44.3%) to awareness. Also, LLINs ownership was found to be high (71.3%) with 72.9% of the nets being supplied by the government. Of the owners of LLINs, usage rate was observed to be 67.6%. Multivariate analysis result showed that statistically significant sociodemographic characteristics of respondents predicting the usage of LLINs included age greater than 50 years (p value = 0.008), female gender (χ² = 8.2014, p value = 0.004), being married (χ² = 24.721, p value <0.001), civil servants (χ² = 12.739, p value = 0.005), and average income above poverty line (χ² = 13.576, p value = 0.004). The study concluded that although not all households surveyed owned LLINs, nevertheless, the level of usage of LLINs among net-owning households was high. The study recommended continuous free distribution, periodic household survey, and expanding public knowledge on the benefits of LLINs usage especially through social media.

Multi-dimensional knowledge of malaria among Nigerian caregivers: implications for insecticide-treated net use by children

Background

Poor malaria knowledge can negatively impact malaria control programmes. This study evaluates knowledge distribution in the domains of causation, transmission, vulnerability, symptoms, and treatment of malaria. It assesses the association between a caregiver’s knowledge about malaria and ownership and use of insecticide-treated nets (ITNs) by children.

Methods

Some 1939 caregivers of young children were recruited through a school-based survey in two Nigerian states. A 20-item, multi-dimensional survey instrument was developed and used to rank each caregiver’s knowledge in five dimensions (cause, transmission, vulnerability, symptoms, treatment of malaria). Scores for each domain were used to create an aggregate knowledge score for each caregiver. The outcome measures were ITN ownership, and ITN use the night and week before the study. Regression models were used to evaluate the relationship between caregiver’s knowledge (individual domains and aggregate score) and ownership and use of ITN after controlling for likely confounders.

Results

The main predictor of ITN use was ITN ownership (r = 0.653; p < 0.001); however, ownership only explains 43 % of variance in net use. Total knowledge index for the study population was significantly associated with both ITN ownership (r = 0.122; p = 0.001) and use (r = 0.095; p = 0.014). The spectrum of caregiver’s knowledge of malaria and its causes captured in the various domains was, however, found to be poor. Fifty percent of the respondents knew that malaria is transmitted by female mosquitoes and 65 % still believe that too much exposure to the sun is a risk factor for malaria. Knowledge of populations most vulnerable to malaria (83 %) and knowledge of malaria transmission (32 %) were the domains with the highest and lowest average correct answers.

Conclusions

There is a need to improve ITN coverage in Nigeria as ITN ownership was associated with ITN use. Additionally, treating knowledge as a multi-dimensional phenomenon revealed that a lot of misperceptions about malaria still exist. Distribution of ITNs through the public/private sector may need to be augmented with tailored behavioural change communication to dispel myths and improve the multi-dimensional knowledge of malaria in the local population.

Malaria elimination in India and regional implications

The malaria situation in India is complex as a result of diverse socio-environmental conditions. India contributes a substantial burden of malaria outside sub-Saharan Africa, with the third highest Plasmodium vivax prevalence in the world. Successful malaria control in India is likely to enhance malaria elimination efforts in the region. Despite modest gains, there are many challenges for malaria elimination in India, including: varied patterns of malaria transmission in different parts of the country demanding area-specific control measures; intense malaria transmission fuelled by favourable climatic and environment factors; varying degrees of insecticide resistance of vectors; antimalarial drug resistance; a weak surveillance system; and poor national coordination of state programmes. Prevention and protection against malaria are low as a result of a weak health-care system, as well as financial and socioeconomic constraints. Additionally, the open borders of India provide a potential route of entry for artesunate-resistant parasites from southeast Asia. This situation calls for urgent dialogue around tackling malaria across borders-between India's states and neighbouring countries-through sharing of information and coordinated control and preventive measures, if we are to achieve the aim of malaria elimination in the region.

Malaria knowledge, attitudes and practices among migrants from malaria-endemic countries in Evrotas, Laconia, Greece, 2013

Following re-emergence of malaria in Evrotas, Laconia, in 2009–12, a malaria-control programme was implemented in 2011–12 targeting migrants from malaria-endemic countries, including house-to-house active case detection, health education and distribution of mosquito protection items. In June 2013, we surveyed migrants in Evrotas to assess their malaria knowledge, attitudes and practices to guide prevention activities. We selected participants using simple random sampling and interviewed them, using structured questionnaires. We defined mosquito protection practices (MPPs) as the use of full-length clothes/topical repellent, mosquito screens, fans or air-conditioning, and insecticides. We calculated prevalence ratios (PRs) using Poisson regression and we allowed for clustering of participants in a residence. Of 654 migrants, we invited 132 and 130 participated (all men; 120 (92%) from Pakistan). Of the 130, 56 (43%) identified fever as a malaria symptom; those who were aware of this had higher level of education (PR: 3.2; 95% confidence interval (CI): 1.2–9.0). A total of 111 (85%) used insecticide-treated bednets and 95 (73%) used more than two MPPs. Poor housing conditions (warehouses/shacks: PR: 0.8; 95% CI: 0.6–0.9), were associated with use of up to two MPPs. Despite extensive interventions in Evrotas, the level of malaria awareness among migrants remained suboptimal and poor housing conditions hindered effective mosquito protection. We recommend culturally adapted health education and improvement of housing conditions to minimise the risk of new cases and re-establishment of malaria in Greece.

Knowledge and practices on malaria prevention in two rural communities in Wakiso District, Uganda

BACKGROUND

Malaria is the leading cause of morbidity and mortality in Uganda particularly among children under 5 years of age.

OBJECTIVES

The study assessed the knowledge and practices on malaria prevention in 2 rural communities in Wakiso District, Uganda with emphasis on the various prevention methods.

METHODS

The study was a cross-sectional survey carried out among 376 households using both quantitative and qualitative methods. Log-binomial regression, chi square and Spearman's rank order correlation were used to test for associations.

RESULTS

The majority of participants (64.6%) had low knowledge on malaria prevention methods, with untreated mosquito nets (81.7%), mosquito coils (36.9%) and insecticide treated nets (29.6%) being the most known methods. Knowledge on malaria prevention methods was associated with age (χ2 = 32.1; p < 0.01), employment status (χ2 = 18.1; p < 0.01), education (χ2 = 20.3; p = 0.01), income (χ2 = 14.5; p = 0.01) and having heard a malaria message in the previous 12 months (χ2 = 92.3; p < 0.01). Households that had at least one mosquito net were 45.5% and net ownership increased with household income. Only 0.5% of the houses had undergone indoor residual spraying in the previous 12 months, while 2.1% had complete mosquito proofing in windows and ventilators to prevent mosquito entry.

CONCLUSION

There is potential to improve practices on malaria prevention by targeting other methods beyond mosquito nets such as installing proofing in windows and ventilators. The integrated approach to malaria prevention which advocates the use of several malaria prevention methods in a holistic manner should be explored for this purpose.

Content analysis of primary and secondary school textbooks regarding malaria control: a multi-country study

BACKGROUND

In tropical settings, malaria education at school is potentially useful, but textbook content related to malaria education has so far received little attention. This study aimed to examine whether school textbooks contain sufficient knowledge and skills to help children in primary and lower secondary schools and their family members to cope with malaria.

METHODOLOGY/PRINCIPAL FINDINGS

This was a descriptive, cross-country study. We collected textbooks that were used by children in grades one to nine from nine countries endemic for malaria: Laos, Cambodia, Nepal, Bangladesh, Sri Lanka, Zambia, Niger, Benin, and Ghana. Two reviewers per country identified descriptions about malaria by seeking the term "malaria" or a local word that corresponds to malaria in languages other than English. The authors categorized the identified descriptions according to the content of the descriptions. Additionally, the authors examined whether the identified contents addressed life skill messages. Of a total of 474 textbooks collected, 35 contained descriptions about malaria. The most commonly included content was transmission mode/vector (77.1%), followed by preventive measures (60.0%), epidemiology (57.1%), cause/agent (54.3%), signs/symptoms (37.1%) and treatment (22.9%). Treatment-related content was not included in any textbooks from four countries and textbooks failed to recommend the use of insecticide-treated bed nets in five countries. Very few textbooks included content that facilitated prompt treatment, protection of risk groups, and use of recommended therapy.

CONCLUSION/SIGNIFICANCE

Textbooks rarely included knowledge and skills that are crucial to protect schoolchildren and their families from malaria. This study identified the need for improvement to textbook contents regarding malaria.