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Tesfaye GA, Wana EW, Workie MG. Critically High Burden of Acute Malnutrition and Its Associated Factors Among Children Under 5 Years in the Rural Settings of Southern Ethiopia. Food Nutr Bull 2024; 45:38-46. [PMID: 38439658 DOI: 10.1177/03795721241234087] [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] [Indexed: 03/06/2024]
Abstract
BACKGROUND Globally, acute malnutrition threatens the lives of several million children under 5 years of age. Malnutrition affects the social, economic, and medical aspects of all countries. In Ethiopia, acute malnutrition is not decreasing at the intended rate for unclear reasons. OBJECTIVE This study aimed to assess the burden of acute malnutrition and its associated factors among children under 5 years of age in a rural setting of southern Ethiopia. METHODS A community-based cross-sectional study was conducted from January to March 2022. A multistage sampling technique was used to select 421 children. Mothers/caretakers were interviewed using interviewer-administered questionnaire, while their children's height/length and weight were measured. Logistic regression analyses were used and presented as the crude odds ratio (COR) and adjusted odds ratio (AOR) with their 95% confidence intervals (CI). RESULTS The burden of acute malnutrition among children under 5 years of age in the study area was 22.6% (95% CI = 18.5-26.8). Fathers with primary education (AOR = 4.48; 95% CI = 1.93-10.39), households with improper solid waste disposal (AOR = 2.54; 95% CI = 1.11-5.82), not usually sleeping under insecticide-treated bed net (ITN) (AOR = 1.79; 95% CI = 1.01-3.19), unacceptable children dietary diversity score (DDS) (AOR = 2.56; 95% CI = 1.28-5.14), and unacceptable household DDS (AOR = 2.26; 95% CI = 1.02-5.00) were factors associated with acute malnutrition. CONCLUSIONS The prevalence of acute malnutrition among children was critically high. Upgrading paternal educational status, encouraging safe solid waste disposal, ensuring consistent use of ITN, and improving both child and household DDS should be stressed.
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Zerdo Z, Bastiaens H, Anthierens S, Massebo F, Masne M, Biresaw G, Shewangizaw M, Tunje A, Chisha Y, Yohannes T, Van Geertruyden JP. Effect of malaria prevention education on bed net utilization, incidence of malaria and treatment seeking among school-aged children in Southern Ethiopia; cluster randomized controlled trial. BMC Infect Dis 2023; 23:486. [PMID: 37474930 PMCID: PMC10360348 DOI: 10.1186/s12879-023-08464-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/15/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND School-aged children (SAC) have an increased risk to contract malaria and play a major role in its transmission dynamics. However, their malaria prevention experience is poor. Thus, the effect of malaria prevention education (MPE) on bed net utilization, treatment seeking from a health facility and cumulative incidence of malaria was evaluated in Southern Ethiopia. METHODS A two arm cluster randomized controlled trial was conducted by recruiting 2038 SAC from 32 schools. Structured questionnaire was used to collect data on socio-demographic, economic, bed net ownership, bed net utilization, whether the participated child suffered from malaria and has got treatment from a health facility. Generalized mixed effect logistic regression using school as random variable was used to assess the effect of the intervention on the outcome variables. RESULTS The ownership of bed net in households of the control and intervention schools was similar respectively with 84.6 and 88.6% (Crude Odds Ratio (COR): 1.5; 95%CI: 0.5-4.8). The percentage of SAC slept under the bed net the night before the survey was also similar (55.1% versus 54.0%); COR:1.04; 95%CI: 0.5-2.4). Bed net utilization was affected by household size to the bed net ratio ≤ 2 (Adjusted Odds Ratio (AOR) = 1.6; 95%CI:1.3-2.1), bed net utilization at baseline of the study (AOR = 2.3; 95%CI:1.5-3.6), and history of malaria attack in the last twelve months (AOR = 1.3; 95%CI:1.01-1.8). Reported cumulative incidence of malaria and treatment seeking from a health facility by SAC was similar between intervention and control arms: -2.1% (COR = 0.8; 95%CI: 0.5-1.5) and 9.6% (COR = 1.4; 95%CI: 0.4-4.3) respectively. The reported incidence of malaria was affected by altitude (AOR = 0.5; 95%CI: 0.3-0.8), low and medium wealth index (AOR = 0.7; 95%CI: 0.5-0.96 and AOR = 0.7; 95%CI: 0.5-0.98), adequate bed net number for household members (AOR = 0.7; 95%CI:0.5-0.9) and bed net utilization (AOR = 1.3; 95%CI:1.1-1.8). CONCLUSIONS MPE had no significant effect on the use of malaria prevention measures considered, treatment seeking from a health facility and reported cumulative incidence of malaria though bed net use was associated with malaria incidence. Before organizing any health education program, sustainable implementation efforts have to be warranted especially in SAC, a neglected but relevant vulnerable and reservoirs. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR202001837195738, registered 21/01/2020.
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Affiliation(s)
- Zerihun Zerdo
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
- Global Health Institute, Antwerp University, Antwerp, Belgium.
| | - Hilde Bastiaens
- Department of family medicine and population health, Antwerp University, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of family medicine and population health, Antwerp University, Antwerp, Belgium
| | - Fekadu Massebo
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Matewos Masne
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gelila Biresaw
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Misgun Shewangizaw
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abayneh Tunje
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Yilma Chisha
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tsegaye Yohannes
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Mrema S, Okumu F, Schellenberg J, Fink G. Associations between the use of insecticide-treated nets in early childhood and educational outcomes, marriage and child-bearing in early adulthood: evidence from a 22-year prospective cohort study in Tanzania. Malar J 2023; 22:134. [PMID: 37098566 PMCID: PMC10127494 DOI: 10.1186/s12936-023-04560-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/13/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The effectiveness of insecticide-treated nets (ITNs) in preventing malaria in young children is well established. However, the long-term effects of early childhood ITN use on educational outcomes, fertility, and marriage in early adulthood are not well understood. METHODS This study uses 22 years of longitudinal data from rural Tanzania to investigate the associations between early life ITN use and educational attainment, fertility and marriage in early adulthood. Unadjusted and adjusted logistic regression models were used to estimate the associations between early life ITN use and early adult outcomes (education, childbearing, and marriage), controlling for potential confounders, such as parental education, household asset quintiles, and year of birth. Analyses were conducted separately for men and women. RESULTS A total of 6706 participants born between 1998 and 2000 were enrolled in the study between 1998 and 2003. By 2019 a total of 604 had died and a further 723 could not be found, leaving 5379 participants who were interviewed, among whom complete data were available for 5216. Among women, sleeping under a treated net at least half of the time during early childhood ["high ITN use"] was associated with a 13% increase in the odds of completing primary school (adjusted odds ratio (aOR) 1.13 [0.85, 1.50]) and with a 40% increase in the odds of completing secondary school (aOR 1.40 [1.11, 1.76]) compared with women sleeping less frequently under ITNs in early life (< age 5 years). Among men, high ITN use was associated with a 50% increase in the odds of completing primary school (aOR 1.50 [1.18, 1.92]) and a 56% increase in the odds of completing secondary school (aOR 1.56 [1.16, 2.08]) compared to men with low ITN use in early life. Weaker associations were found between ITN use in early life and both adolescent childbearing (aOR 0.91 [0.75, 1.10]) and early marriage (aOR 0.86 [0.69, 1.05]). CONCLUSION This study found that early life use of ITNs was strongly associated with increased school completion in both men and women. More marginal associations were found between early-life ITN use and both marriage and child-bearing in early adulthood. ITN use during early childhood may have long-term positive effects on educational attainment in Tanzania. However, further research is needed to understand the mechanisms behind these associations and to explore the broader impacts of ITN use on other aspects of early adult life.
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Affiliation(s)
| | | | | | - Günther Fink
- Swiss Tropical and Public Health Institute and University of Basel, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland.
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Mawejje HD, Weetman D, Epstein A, Lynd A, Opigo J, Maiteki-Sebuguzi C, Lines J, Kamya MR, Rosenthal PJ, Donnelly MJ, Dorsey G, Staedke SG. Characterizing pyrethroid resistance and mechanisms in Anopheles gambiae ( s.s.) and Anopheles arabiensis from 11 districts in Uganda. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2023; 3:100106. [PMID: 36590346 PMCID: PMC9798136 DOI: 10.1016/j.crpvbd.2022.100106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/09/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
Insecticide resistance threatens recent progress on malaria control in Africa. To characterize pyrethroid resistance in Uganda, Anopheles gambiae (s.s.) and Anopheles arabiensis were analyzed from 11 sites with varied vector control strategies. Mosquito larvae were collected between May 2018 and December 2020. Sites were categorized as receiving no indoor-residual spraying ('no IRS', n = 3); where IRS was delivered from 2009 to 2014 and in 2017 and then discontinued ('IRS stopped', n = 4); and where IRS had been sustained since 2014 ('IRS active', n = 4). IRS included bendiocarb, pirimiphos methyl and clothianidin. All sites received long-lasting insecticidal nets (LLINs) in 2017. Adult mosquitoes were exposed to pyrethroids; with or without piperonyl butoxide (PBO). Anopheles gambiae (s.s.) and An. arabiensis were identified using PCR. Anopheles gambiae (s.s.) were genotyped for Vgsc-995S/F, Cyp6aa1, Cyp6p4-I236M, ZZB-TE, Cyp4j5-L43F and Coeae1d, while An. arabiensis were examined for Vgsc-1014S/F. Overall, 2753 An. gambiae (s.l.), including 1105 An. gambiae (s.s.) and 1648 An. arabiensis were evaluated. Species composition varied by site; only nine An. gambiae (s.s.) were collected from 'IRS active' sites, precluding species-specific comparisons. Overall, mortality following exposure to permethrin and deltamethrin was 18.8% (148/788) in An. gambiae (s.s.) and 74.6% (912/1222) in An. arabiensis. Mortality was significantly lower in An. gambiae (s.s.) than in An. arabiensis in 'no IRS' sites (permethrin: 16.1 vs 67.7%, P < 0.001; deltamethrin: 24.6 vs 83.7%, P < 0.001) and in 'IRS stopped' sites (permethrin: 11.3 vs 63.6%, P < 0.001; deltamethrin: 25.6 vs 88.9%, P < 0.001). When PBO was added, mortality increased for An. gambiae (s.s.) and An. arabiensis. Most An. gambiae (s.s.) had the Vgsc-995S/F mutation (95% frequency) and the Cyp6p4-I236M resistance allele (87%), while the frequency of Cyp4j5 and Coeae1d were lower (52% and 55%, respectively). Resistance to pyrethroids was widespread and higher in An. gambiae (s.s.). Where IRS was active, An. arabiensis dominated. Addition of PBO to pyrethroids increased mortality, supporting deployment of PBO LLINs. Further surveillance of insecticide resistance and assessment of associations between genotypic markers and phenotypic outcomes are needed to better understand mechanisms of pyrethroid resistance and to guide vector control.
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Affiliation(s)
- Henry Ddumba Mawejje
- Infectious Diseases Research Collaboration, Kampala, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - David Weetman
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Adrienne Epstein
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Amy Lynd
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jimmy Opigo
- National Malaria Control Division, Uganda Ministry of Health, Kampala, Uganda
| | - Catherine Maiteki-Sebuguzi
- Infectious Diseases Research Collaboration, Kampala, Uganda.,National Malaria Control Division, Uganda Ministry of Health, Kampala, Uganda
| | - Jo Lines
- London School of Hygiene and Tropical Medicine, London, UK
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Martin J Donnelly
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, USA
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Bukhari T, Pevsner R, Herren JK. Microsporidia: a promising vector control tool for residual malaria transmission. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.957109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) have resulted in a major decrease in malaria transmission. However, it has become apparent that malaria can be effectively transmitted despite high coverage of LLINs/IRS. Residual transmission can occur due to Plasmodium-carrying Anopheles mosquitoes that are insecticide resistant and have feeding and resting behavior that reduces their chance of encountering the currently deployed indoor malaria control tools. Residual malaria transmission is likely to be the most significant hurdle to achieving the goal of malaria eradication and research and development towards new tools and strategies that can control residual malaria transmission is therefore critical. One of the most promising strategies involves biological agents that are part of the mosquito microbiome and influence the ability of Anopheles to transmit Plasmodium. These differ from biological agents previously used for vector control in that their primary effect is on vectoral capacity rather than the longevity and fitness of Anopheles (which may or may not be affected). An example of this type of biological agent is Microsporidia MB, which was identified in field collected Anopheles arabiensis and caused complete inhibition of Plasmodium falciparum transmission without effecting the longevity and fitness of the host. Microsporidia MB belongs to a unique group of rapidly adapting and evolving intracellular parasites and symbionts called microsporidia. In this review we discuss the general biology of microsporidians and the inherent characteristics that make some of them particularly suitable for malaria control. We then discuss the research priorities for developing a transmission blocking strategy for the currently leading microsporidian candidate Microsporidia MB for malaria control.
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Nosten F, Richard-Lenoble D, Danis M. A Brief History of Malaria. Presse Med 2022; 51:104130. [PMID: 35667599 DOI: 10.1016/j.lpm.2022.104130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022] Open
Abstract
For millions of years, invertebrates and malaria parasites have coexisted and to date, malaria remains the most important human parasitic disease. This co-evolution had profound impacts on the movements of early hominids and on the genome of modern humans. Over the past two centuries, progress has been made with the discovery of the parasite, its transmission, and medicines, paving the way to the control of the disease and its elimination in some countries. However, the Plasmodium parasite is a formidable foe capable of developing resistance to drugs, and the mosquito vector has adapted to insecticides, foiling all attempts to eradicate the disease. Over recent years the economic and social costs of malaria have been recognized and more funds have been mobilized than ever before, however further efforts are needed. National programs, international institutions and researchers will need to do better if the preventable deaths of hundreds of thousands of mostly African children are to be averted.
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Affiliation(s)
- François Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research building, University of Oxford Old Road campus, Oxford, UK; Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - Dominique Richard-Lenoble
- Professeur émérite des Universités - CHR de Tours, Parasitologie-Médecine tropicale. Membre de l'Académie Nationale de Médecine
| | - Martin Danis
- Professeur émérite, Parasitologie, Médecine Tropicale, Centre Hospitalier Universitaire Pitié-Salpêtrière, Sorbonne Université Paris Médecine, Académie Nationale de Médecine
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Greenwood B, Zongo I, Dicko A, Chandramohan D, Snow RW, Ockenhouse C. Resurgent and delayed malaria. Malar J 2022; 21:77. [PMID: 35264158 PMCID: PMC8905818 DOI: 10.1186/s12936-022-04098-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/22/2022] [Indexed: 11/19/2022] Open
Abstract
The populations of moderate or highly malaria endemic areas gradually acquire some immunity to malaria as a result of repeated exposure to the infection. When this exposure is reduced as a result of effective malaria control measures, subjects who benefitted from the intervention may consequently be at increased risk of malaria if the intervention is withdrawn, especially if this is done abruptly, and an effective malaria vector remains. There have been many examples of this occurring in the past, a phenomenon often termed ‘rebound malaria’, with the incidence of malaria rebounding to the level present before the intervention was introduced. Because the main clinical burden of malaria in areas with a high level of malaria transmission is in young children, malaria control efforts have, in recent decades, focussed on this group, with substantial success being obtained with interventions such as insecticide treated mosquito nets, chemoprevention and, most recently, malaria vaccines. These are interventions whose administration may not be sustained. This has led to concerns that in these circumstances, the overall burden of malaria in children may not be reduced but just delayed, with the main period of risk being in the period shortly after the intervention is no longer given. Although dependent on the same underlying process as classical ‘resurgent’ malaria, it may be helpful to differentiate the two conditions, describing the later as ‘delayed malaria’. In this paper, some of the evidence that delayed malaria occurs is discussed and potential measures for reducing its impact are suggested.
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Affiliation(s)
- Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
| | - Issaka Zongo
- Institut de Recherche en Science de La Santé, Bobo-Dioulasso, Burkina Faso
| | - Alassane Dicko
- Malaria Research and Training Centre, University of Sciences Techniques and Technologies, Bamako, Mali
| | - Daniel Chandramohan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Robert W Snow
- Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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