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Rufai T, Aninagyei E, Akuffo KO, Ayin CTM, Nortey P, Quansah R, Cudjoe FS, Tei-Maya E, Osei Duah Junior I, Danso-Appiah A. Malaria and typhoid fever among patients presenting with febrile illnesses in Ga West Municipality, Ghana. PLoS One 2023; 18:e0267528. [PMID: 37228010 DOI: 10.1371/journal.pone.0267528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Clinicians in areas where malaria and typhoid fever are co-endemic often treat infected patients irrationally, which may lead to the emergence of drug resistance and extra cost to patients. This study determined the proportion of febrile conditions attributable to either malaria and/or typhoid fever and the susceptibility patterns of Salmonella spp. isolates to commonly used antimicrobial agents in Ghana. METHODS One hundred and fifty-seven (157) febrile patients attending the Ga West Municipal Hospital, Ghana, from February to May 2017 were sampled. Blood samples were collected for cultivation of pathogenic bacteria and the susceptibility of the Salmonella isolates to antimicrobial agents was performed using the Kirby-Bauer disk diffusion method with antibiotic discs on Müller Hinton agar plates. For each sample, conventional Widal test for the detection of Salmonella spp was done as well as blood film preparation for detection of Plasmodium spp. Data on the socio-demographic and clinical characteristics of the study participants were collected using an android technology software kobo-collect by interview. RESULTS Of the total number of patients aged 2-37 years (median age = 6 years, IQR 3-11), 82 (52.2%) were females. The proportion of febrile patients with falciparum malaria was 57/157 (36.3%), while Salmonella typhi O and H antigens were detected in 23/157 (14.6%) of the samples. The detection rate of Salmonella spp in febrile patients was 10/157 (6.4%). Malaria and typhoid fever coinfection using Widal test and blood culture was 9 (5.7%) and 3 (1.9%), respectively. The isolates were highly susceptible to cefotaxime, ceftriaxone, ciprofloxacin, and amikacin but resistant to ampicillin, tetracycline, co-trimoxazole, gentamicin, cefuroxime, chloramphenicol, and meropenem. CONCLUSION Plasmodium falciparum and Salmonella spp coinfections were only up to 1.9%, while malaria and typhoid fever, individually, were responsible for 36.3% and 6.4%, respectively. Treatment of febrile conditions must be based on laboratory findings in order not to expose patients to unnecessary side effects of antibiotics and reduce the emergence and spread of drug resistance against antibiotics.
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Affiliation(s)
- Tanko Rufai
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Enoch Aninagyei
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Christian Teye-Muno Ayin
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Priscillia Nortey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Reginald Quansah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Francis Samuel Cudjoe
- School of Biomedical and Allied Health Science, University of Ghana, Korle-Bu, Accra
| | - Ernest Tei-Maya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Isaiah Osei Duah Junior
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Purdue University Biological Sciences, West-Lafayette, Indiana, United States of America
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
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Nlinwe NO, Nchefor FG, Takwi NB. Impact of long lasting insecticidal nets on asymptomatic malaria during pregnancy, in a rural and urban setting in Cameroon. Parasite Epidemiol Control 2022; 18:e00265. [PMID: 35992014 PMCID: PMC9375851 DOI: 10.1016/j.parepi.2022.e00265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/04/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
According to the world malaria report more malaria cases were reported in 2020 than in 2019, due to disruptions in the distribution of insecticide treated nets, caused by the COVID-19 pandemic. Consequently a projected 34.32% (11.6 million out of 33.8 million) pregnancies were exposed to malaria in the WHO African Region in 2020. This study was therefore designed to assess the impact of long lasting insecticidal nets (LLINs) on asymptomatic malaria in the pregnant women attending the Foumbot District Hospital (rural setting) and the Bamenda Regional Hospital (urban setting). This was a hospital based cross-sectional study done within three months from February to April 2021. A structured questionnaire and the CareStart™ Pf Malaria HRP2 qualitative rapid diagnostic test were used for data collection. Data were analysed using descriptive statistics, and Chi-square test. The relative risk, attributable risk, odds ratio, and likelihood ratio of malaria occurrence in exposed patients were determined by Chi-square (and Fisher's exact) test. The prevalence of asymptomatic malaria was 10.14% (63/621), with a higher prevalence among the pregnant women in the rural setting (12.21%; 37/303), than the urban setting (8.18%; 26/318). As indicated by the attributable risk, 21% of malaria incidence was attributed to absence of LLINs distribution in neighborhoods of the rural setting meanwhile 10% of malaria incidence is attributed to absence of LLINs distribution in neighborhoods of the urban setting. Regular screening for asymptomatic malaria in pregnancy and consistent free distribution of LLINs are recommended in endemic areas, especially in the rural settings.
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Affiliation(s)
- Nfor Omarine Nlinwe
- The University of Bamenda, Faculty of Health Sciences, Department of Medical Laboratory Science. P.O Box 39, Bambili, Bamenda, North West Region, Cameroon
| | - Fundoh Golory Nchefor
- The University of Bamenda, Faculty of Health Sciences, Department of Medical Laboratory Science. P.O Box 39, Bambili, Bamenda, North West Region, Cameroon
| | - Negesa Bright Takwi
- The University of Bamenda, Faculty of Health Sciences, Department of Medical Laboratory Science. P.O Box 39, Bambili, Bamenda, North West Region, Cameroon
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Acheampong DO, Adu P, Ampomah P, Duedu KO, Aninagyei E. Immunological, haematological, and clinical attributes of rural and urban malaria: a case-control study in Ghana. J Parasit Dis 2021; 45:806-816. [PMID: 34475663 DOI: 10.1007/s12639-021-01363-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/10/2021] [Indexed: 10/22/2022] Open
Abstract
To compare clinical presentations, haematological and immunological parameters in urban and rural malaria patients. Clinically suspected malaria patients, resident in either rural or urban communities, were selected from seven health facilities in the Greater Accra region of Ghana. For each suspected malaria patient, parasites were detected microscopically and quantified subsequently. In each study site, an equal number of cases and age-matched controls were selected. In both cases and controls, clinical presentations, nutritional status, haematological, and immunological parameters were profiled. A total of 149 malaria patients and 149 nonmalaria controls were selected. Compared to rural dwellers with malaria, parasitaemia was significantly higher in both males and females and in the various age groups in urban dwellers with malaria. Additionally, mean lymphocytes, haemoglobin, haematocrit, mean cell haemoglobin, platelets, and mean platelet volume levels were significantly lower in urban dwellers with malaria. However, TNF-α, IL-6, and IL-12 levels in urban dwellers with malaria were significantly higher, while IL-10, CD4+, CD3+, CD8+ T-cells levels and CD4+/ CD3+ ratio were significantly lower in urban dwellers with malaria. Furthermore, chills, diarrhoea, fever, and pallor were significantly associated with urban dwellers with malaria. This study concluded that urban dwellers are more prone to severe malaria while rural dwellers tend to have more measured immune response against malaria infection, and therefore experienced better controlled inflammatory processes associated with mild form of the disease.
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Affiliation(s)
- Desmond Omane Acheampong
- Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Patrick Adu
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Paulina Ampomah
- Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Kwabena Obeng Duedu
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Volta Region, PMB 31, Ho, Ghana
| | - Enoch Aninagyei
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Volta Region, PMB 31, Ho, Ghana
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Dasgupta S. Burden of climate change on malaria mortality. Int J Hyg Environ Health 2018; 221:782-791. [DOI: 10.1016/j.ijheh.2018.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/06/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
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Mangeni JN, Menya D, Obala A, Platt A, O'Meara WP. Development and validation of a rapid assessment tool for malaria prevention. Malar J 2016; 15:544. [PMID: 27825350 PMCID: PMC5101824 DOI: 10.1186/s12936-016-1575-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insecticide-treated bed nets (ITN) have been shown to be efficacious in reducing malaria morbidity and mortality in many regions. Unfortunately in some areas, malaria has persisted despite the scale up of ITNs. Recent reports indicate that human behaviour and mosquito behaviour are potential threats to the efficacy of ITNs. However, these concerns are likely highly heterogeneous even at very small scales. This study aimed at developing, testing and validating a rapid assessment tool to collect actionable information at local levels for a quick evaluation of potential barriers to malaria prevention. METHODS The study was conducted at the Webuye Health and Demographic Surveillance Site in Bungoma East Sub-County, Kenya. Based on the findings from the case-control study, 12 primary surveillance components that encompass the major impediments to successful prevention were identified and used to develop a rapid assessment tool. Twenty community health volunteers were trained to identify patients with laboratory-confirmed malaria in six peripheral health facilities located within six sub locations and subsequently followed them up to their homes to conduct a rapid assessment. Sampling and analysis of the results of the survey are based on Lot Quality Assurance. RESULTS The tool was able to detect local heterogeneity in bed net coverage, bed net use and larval site abundance in the six health facility catchment areas. Nearly all the catchment areas met the action threshold for incomplete household coverage (i.e. not all household members not using a net the previous night) except the peri-urban area. Although the threshold for nets not in good condition was set very high (≥50%), only two catchment areas failed to meet the action threshold. On the indicator for "Net not used every day last week", half of the areas failed, while for net ownership, only two areas met the action threshold. CONCLUSION The rapid assessment tool was able to detect marked heterogeneity in key indicators for malaria prevention between patients attending health facilities, and can distinguish between priority areas for intervention. There is need to validate it for use in other contexts.
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Affiliation(s)
| | - Diana Menya
- College of Health Sciences, Moi University, Eldoret, Kenya
| | - Andrew Obala
- College of Health Sciences, Moi University, Eldoret, Kenya
| | | | - Wendy Prudhomme O'Meara
- Duke Global Health Institute, Durham, NC, USA.,Academic Model Providing Access to Healthcare, Eldoret, Kenya.,Department of Medicine, Duke University, Durham, NC, USA
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Differences in the malariometric indices of asymptomatic carriers in three communities in ibadan, Nigeria. Adv Prev Med 2014; 2014:509236. [PMID: 25587454 PMCID: PMC4284954 DOI: 10.1155/2014/509236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 12/09/2014] [Indexed: 11/17/2022] Open
Abstract
This study was conducted to determine the malariometric indices of children in three different settings in Ibadan, Nigeria. Children were recruited from an urban slum (Oloomi) and a periurban (Sasa) and a rural community (Igbanda) in Ibadan. Children aged between 2 and 10 years were randomly selected from primary schools in the urban and periurban areas. In the rural community, children were recruited from the centre of the village. A total of 670 (55.0%) out of 1218 children recruited were positive for malaria parasitaemia. The urban population had the highest proportion of children with malaria parasitaemia. Splenomegaly was present in 31.5%, hepatomegaly in 41.5%, hepatosplenomegaly in 27.5%, and anaemia in 25.2% of the children. The parasite density was not significantly different among children in the three communities. Children in the rural community had the highest mean PCV of 34.2% and the lowest rates of splenomegaly (6.1%), hepatomegaly (7.6%), and hepatosplenomegaly (4.6%). The spleen rates, liver rates, and presence of hepatosplenomegaly and anaemia were similar in the urban and periurban communities. The malariometric indices among the asymptomatic carriers were high, especially in the urban slum. This stresses the need for intensified efforts at controlling the disease in the study area.
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Larsen DA, Hutchinson P, Bennett A, Yukich J, Anglewicz P, Keating J, Eisele TP. Community coverage with insecticide-treated mosquito nets and observed associations with all-cause child mortality and malaria parasite infections. Am J Trop Med Hyg 2014; 91:950-8. [PMID: 25200267 DOI: 10.4269/ajtmh.14-0318] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Randomized trials and mathematical modeling suggest that insecticide-treated mosquito nets (ITNs) provide community-level protection to both those using ITNs and those without individual access. Using nationally representative household survey datasets from 17 African countries, we examined whether community ITN coverage is associated with malaria infections in children < 5 years old and all-cause child mortality (ACCM) among children < 5 years old in households with one or more ITNs versus without any type of mosquito net (treated or untreated). Increasing ITN coverage (> 50%) was protective against malaria infections and ACCM for children in households with an ITN, although this protection was not conferred to children in households without ITNs in these data. Children in households with ITNs were protected against malaria infections and ACCM with ITN coverage > 30%, but this protection was not significant with ITN coverage < 30%. Results suggest that ITNs are more effective with higher ITN coverage.
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Affiliation(s)
- David A Larsen
- Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York; Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California; Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Global Health Group, University of California, San Francisco, California
| | - Paul Hutchinson
- Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York; Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California; Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Global Health Group, University of California, San Francisco, California
| | - Adam Bennett
- Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York; Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California; Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Global Health Group, University of California, San Francisco, California
| | - Joshua Yukich
- Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York; Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California; Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Global Health Group, University of California, San Francisco, California
| | - Philip Anglewicz
- Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York; Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California; Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Global Health Group, University of California, San Francisco, California
| | - Joseph Keating
- Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York; Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California; Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Global Health Group, University of California, San Francisco, California
| | - Thomas P Eisele
- Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York; Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California; Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Global Health Group, University of California, San Francisco, California
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Perkins TA, Scott TW, Le Menach A, Smith DL. Heterogeneity, mixing, and the spatial scales of mosquito-borne pathogen transmission. PLoS Comput Biol 2013; 9:e1003327. [PMID: 24348223 PMCID: PMC3861021 DOI: 10.1371/journal.pcbi.1003327] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/24/2013] [Indexed: 11/18/2022] Open
Abstract
The Ross-Macdonald model has dominated theory for mosquito-borne pathogen transmission dynamics and control for over a century. The model, like many other basic population models, makes the mathematically convenient assumption that populations are well mixed; i.e., that each mosquito is equally likely to bite any vertebrate host. This assumption raises questions about the validity and utility of current theory because it is in conflict with preponderant empirical evidence that transmission is heterogeneous. Here, we propose a new dynamic framework that is realistic enough to describe biological causes of heterogeneous transmission of mosquito-borne pathogens of humans, yet tractable enough to provide a basis for developing and improving general theory. The framework is based on the ecological context of mosquito blood meals and the fine-scale movements of individual mosquitoes and human hosts that give rise to heterogeneous transmission. Using this framework, we describe pathogen dispersion in terms of individual-level analogues of two classical quantities: vectorial capacity and the basic reproductive number, . Importantly, this framework explicitly accounts for three key components of overall heterogeneity in transmission: heterogeneous exposure, poor mixing, and finite host numbers. Using these tools, we propose two ways of characterizing the spatial scales of transmission—pathogen dispersion kernels and the evenness of mixing across scales of aggregation—and demonstrate the consequences of a model's choice of spatial scale for epidemic dynamics and for estimation of , both by a priori model formulas and by inference of the force of infection from time-series data. Pathogens transmitted by mosquitoes, such as malaria and dengue, are notorious for the biological complexity associated with how they are transmitted within local communities. Yet mathematical models for these pathogens, which are critical tools for making recommendations for control policy, are based around concepts originally designed to describe how molecules interact in chemical systems. To provide those interested in mosquito-borne diseases a more appropriate tool for modeling their transmission, we introduce a mathematical framework that is based on the spatial locations where mosquitoes lay eggs and feed on blood and how mosquitoes and hosts move about those locations. Analysis of this framework shows that the transmission contributions of different hosts and locations can be calculated, and that overall potential for transmission in a community depends on three concepts: heterogeneous exposure (some people bitten by mosquitoes more than others), poor mixing (non-random contacts between hosts and mosquitoes), and finite population sizes (each host can contribute at most one new infection towards the population total). Together, these factors determine critical levels of vaccination coverage to eliminate a pathogen and the spatial areas over which transmission should be modeled and studied in the field.
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Affiliation(s)
- T. Alex Perkins
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
- Department of Entomology, University of California, Davis, California, United States of America
- * E-mail:
| | - Thomas W. Scott
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
- Department of Entomology, University of California, Davis, California, United States of America
| | - Arnaud Le Menach
- Center for Disease Dynamics, Economics and Policy, Washington, D.C., United States of America
| | - David L. Smith
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
- Center for Disease Dynamics, Economics and Policy, Washington, D.C., United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Yukich J, Bennett A, Keating J, Yukich RK, Lynch M, Eisele TP, Kolaczinski K. Planning long lasting insecticide treated net campaigns: should households' existing nets be taken into account? Parasit Vectors 2013; 6:174. [PMID: 23763773 PMCID: PMC3689647 DOI: 10.1186/1756-3305-6-174] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/22/2013] [Indexed: 11/18/2022] Open
Abstract
Background Mass distribution of long-lasting insecticide treated bed nets (LLINs) has led to large increases in LLIN coverage in many African countries. As LLIN ownership levels increase, planners of future mass distributions face the challenge of deciding whether to ignore the nets already owned by households or to take these into account and attempt to target individuals or households without nets. Taking existing nets into account would reduce commodity costs but require more sophisticated, and potentially more costly, distribution procedures. The decision may also have implications for the average age of nets in use and therefore on the maintenance of universal LLIN coverage over time. Methods A stochastic simulation model based on the NetCALC algorithm was used to determine the scenarios under which it would be cost saving to take existing nets into account, and the potential effects of doing so on the age profile of LLINs owned. The model accounted for variability in timing of distributions, concomitant use of continuous distribution systems, population growth, sampling error in pre-campaign coverage surveys, variable net ‘decay’ parameters and other factors including the feasibility and accuracy of identifying existing nets in the field. Results Results indicate that (i) where pre-campaign coverage is around 40% (of households owning at least 1 LLIN), accounting for existing nets in the campaign will have little effect on the mean age of the net population and (ii) even at pre-campaign coverage levels above 40%, an approach that reduces LLIN distribution requirements by taking existing nets into account may have only a small chance of being cost-saving overall, depending largely on the feasibility of identifying nets in the field. Based on existing literature the epidemiological implications of such a strategy is likely to vary by transmission setting, and the risks of leaving older nets in the field when accounting for existing nets must be considered. Conclusions Where pre-campaign coverage levels established by a household survey are below 40% we recommend that planners do not take such LLINs into account and instead plan a blanket mass distribution. At pre-campaign coverage levels above 40%, campaign planners should make explicit consideration of the cost and feasibility of accounting for existing LLINs before planning blanket mass distributions. Planners should also consider restricting the coverage estimates used for this decision to only include nets under two years of age in order to ensure that old and damaged nets do not compose too large a fraction of existing net coverage.
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Affiliation(s)
- Joshua Yukich
- Center for Applied Malaria Research and Evaluation, Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA.
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Febir LG, Asante KP, Dzorgbo DBS, Senah KA, Letsa TS, Owusu-Agyei S. Community perceptions of a malaria vaccine in the Kintampo districts of Ghana. Malar J 2013; 12:156. [PMID: 23651533 PMCID: PMC3656774 DOI: 10.1186/1475-2875-12-156] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/06/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Malaria remains the leading cause of morbidity and mortality in sub-Saharan Africa despite tools currently available for its control. Making malaria vaccine available for routine use will be a major hallmark, but its acceptance by community members and health professionals within the health system could pose considerable challenge as has been found with the introduction of polio vaccinations in parts of West Africa. Some of these challenges may not be expected since decisions people make are many a time driven by a complex myriad of perceptions. This paper reports knowledge and perceptions of community members in the Kintampo area of Ghana where malaria vaccine trials have been ongoing as part of the drive for the first-ever licensed malaria vaccine in the near future. METHODS Both qualitative and quantitative methods were used in the data collection processes. Women and men whose children were or were not involved in the malaria vaccine trial were invited to participate in focus group discussions (FGDs). Respondents, made up of heads of religious groupings in the study area, health care providers, traditional healers and traditional birth attendants, were also invited to participate in in-depth interviews (IDIs). A cross-sectional survey was conducted in communities where the malaria vaccine trial (Mal 047RTS,S) was carried out. In total, 12 FGDs, 15 IDIs and 466 household head interviews were conducted. RESULTS Knowledge about vaccines was widespread among participants. Respondents would like their children to be vaccinated against all childhood illnesses including malaria. Knowledge of the long existing routine vaccines was relatively high among respondents compared to hepatitis B and Haemophilus influenza type B vaccines that were introduced more recently in 2002. There was no clear religious belief or sociocultural practice that will serve as a possible barrier to the acceptance of a malaria vaccine. CONCLUSION With the assumption that a malaria vaccine will be as efficacious as other EPI vaccines, community members in Central Ghana will accept and prefer malaria vaccine to malaria drugs as a malaria control tool. Beliefs and cultural practices as barriers to the acceptance of malaria vaccine were virtually unknown in the communities surveyed.
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Komazawa O, Kaneko S, K’Opiyo J, Kiche I, Wanyua S, Shimada M, Karama M. Are long-lasting insecticidal nets effective for preventing childhood deaths among non-net users? A community-based cohort study in western Kenya. PLoS One 2012; 7:e49604. [PMID: 23185378 PMCID: PMC3501471 DOI: 10.1371/journal.pone.0049604] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 10/11/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Increasing the distribution and use of insecticide-treated nets (ITNs) in Sub-Saharan Africa has made controlling malaria with ITNs more practical. We evaluated community effects induced by ITNs, specifically long-lasting insecticidal nets (LLINs), under ordinary conditions in an endemic malaria area of Western Kenya. METHODS Using the database from Mbita Health and Demographic Surveillance System (HDSS), children younger than 5 years old were assessed over four survey periods. We analyzed the effect of bed net usage, LLIN density and population density of young people around a child on all-cause child mortality (ACCM) rates using Cox PH models. RESULTS During the study, 14,554 children were followed and 250 deaths were recorded. The adjusted hazard ratios (HRs) for LLIN usage compared with no net usage were not significant among the models: 1.08 (95%CI 0.76-1.52), 1.19 (95%CI 0.69-2.08) and 0.92 (95%CI 0.42-2.02) for LLIN users, untreated net users, and any net users, respectively. A significant increasing linear trend in risk across LLIN density quartiles (HR=1.25; 95%CI 1.03-1.51) and a decreasing linear trend in risk across young population density quartiles among non-net user children (HR=0.77; 95%CI 0.63-0.94) were observed. CONCLUSIONS Although our data showed that current LLIN coverage level (about 35%) could induce a community effect to protect children sleeping without bed nets even in a malaria-endemic area, it appears that a better system is needed to monitor the current malaria situation globally in order to optimize malaria control programs with limited resources.
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Affiliation(s)
- Osuke Komazawa
- Department of Eco-Epidemiology, Institute of Tropical Medicine, Nagasaki University (NUITM), Nagasaki, Japan
| | - Satoshi Kaneko
- Department of Eco-Epidemiology, Institute of Tropical Medicine, Nagasaki University (NUITM), Nagasaki, Japan
- Graduate School of International Health Development, Nagasaki University, Nagasaki, Japan
- NUITM-KEMRI Project, Nairobi, Kenya
| | | | - Ibrahim Kiche
- NUITM-KEMRI Project, Nairobi, Kenya
- Thomas Odhiambo Campus, Mbita, International Center of Insect Physiology and Ecology (ICIPE), Mbita, Kenya
| | | | - Masaaki Shimada
- Department of Eco-Epidemiology, Institute of Tropical Medicine, Nagasaki University (NUITM), Nagasaki, Japan
- NUITM-KEMRI Project, Nairobi, Kenya
| | - Mohamed Karama
- Graduate School of International Health Development, Nagasaki University, Nagasaki, Japan
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- NUITM-KEMRI Project, Nairobi, Kenya
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Factors contributing to urban malaria transmission in sub-saharan Africa: a systematic review. J Trop Med 2012; 2012:819563. [PMID: 23125863 PMCID: PMC3483782 DOI: 10.1155/2012/819563] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/17/2012] [Accepted: 09/17/2012] [Indexed: 12/04/2022] Open
Abstract
Sub-Saharan Africa suffers by far the greatest malaria burden worldwide and is currently undergoing a profound demographic change, with a growing proportion of its population moving to urban areas. Urbanisation is generally expected to reduce malaria transmission; however the disease still persists in African cities, in some cases at higher levels than in nearby rural areas. Objective. This paper aims to collate and analyse risk factors for urban malaria transmission throughout sub-Saharan Africa and to discuss their implications for control. Methods. A systematic search on malaria and urbanisation was carried out focusing on sub-Saharan Africa. Particular interest was taken in vector breeding sites in urban and periurban areas. Results. A variety of urban vector breeding sites were catalogued, the majority of which were artificial, including urban agriculture, tyre tracks, and ditches. Natural breeding sites varied according to location. Low socioeconomic status was a significant risk factor for malaria, often present in peri-urban areas. A worrying trend was seen in the adaptation of malaria vector species to the urban environment. Urban malaria is highly focused and control programs should reflect this. Conclusion. As urbanisation continues and vector species adapt, continued monitoring and control of urban malaria in sub-Saharan Africa is essential.
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Govella NJ, Ferguson H. Why Use of Interventions Targeting Outdoor Biting Mosquitoes will be Necessary to Achieve Malaria Elimination. Front Physiol 2012; 3:199. [PMID: 22701435 PMCID: PMC3372949 DOI: 10.3389/fphys.2012.00199] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 05/22/2012] [Indexed: 12/22/2022] Open
Affiliation(s)
- Nicodem James Govella
- Biomedical and Environmental Thematic Group, Ifakara Health InstituteDar es Salaam, United Republic of Tanzania
| | - Heather Ferguson
- College of Medical, Veterinary and Life Sciences, Boyd Orr Centre for Population and Ecosystem Health, University of GlasgowGlasgow, UK
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14
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Lim SS, Fullman N, Stokes A, Ravishankar N, Masiye F, Murray CJL, Gakidou E. Net benefits: a multicountry analysis of observational data examining associations between insecticide-treated mosquito nets and health outcomes. PLoS Med 2011; 8:e1001091. [PMID: 21909249 PMCID: PMC3167799 DOI: 10.1371/journal.pmed.1001091] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 07/21/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Several sub-Saharan African countries have rapidly scaled up the number of households that own insecticide-treated mosquito nets (ITNs). Although the efficacy of ITNs in trials has been shown, evidence on their impact under routine conditions is limited to a few countries and the extent to which the scale-up of ITNs has improved population health remains uncertain. METHODS AND FINDINGS We used matched logistic regression to assess the individual-level association between household ITN ownership or use in children under 5 years of age and the prevalence of parasitemia among children using six malaria indicator surveys (MIS) and one demographic and health survey. We used Cox proportional hazards models to assess the relationship between ITN household ownership and child mortality using 29 demographic and health surveys. The pooled relative reduction in parasitemia prevalence from random effects meta-analysis associated with household ownership of at least one ITN was 20% (95% confidence interval [CI] 3%-35%; I² = 73.5%, p<0.01 for I² value). Sleeping under an ITN was associated with a pooled relative reduction in parasitemia prevalence in children of 24% (95% CI 1%-42%; I² = 79.5%, p<0.001 for I² value). Ownership of at least one ITN was associated with a pooled relative reduction in mortality between 1 month and 5 years of age of 23% (95% CI 13-31%; I² = 25.6%, p>0.05 for I² value). CONCLUSIONS Our findings across a number of sub-Saharan African countries were highly consistent with results from previous clinical trials. These findings suggest that the recent scale-up in ITN coverage has likely been accompanied by significant reductions in child mortality and that additional health gains could be achieved with further increases in ITN coverage in populations at risk of malaria. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
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