Appropriating "malaria": local responses to malaria treatment and prevention in Abidjan, Cote d'Ivoire

Predictors of delayed health seeking for febrile children: multi-level analysis of cross-sectional study data from southern Ethiopia

Background

Febrile illnesses are commonly reported as a primary reason for seeking healthcare in sub-Saharan Africa. Timely diagnosis and getting prompt treatment within 24 h of fever onset is crucial to avert the risk of developing severe complications and death. Understanding factors contributing to delayed health seeking is important for public health interventions. Hence, this study aimed to assess individual- and contextual-level factors associated with the delay in seeking prompt treatment for children with fever.

Method

A community-based cross-sectional study was conducted from September 2022 to June 2023 in Gamo zone, southern Ethiopia. Three districts were chosen, and then, from each district, six clusters or kebeles were chosen by simple random sampling. A total of 820 caregivers were randomly selected. A two-level mixed-effects logistic regression model was employed to identify factors associated with the delay in seeking prompt treatment. The associations were measured by an adjusted odds ratio (AOR), and statistical significance was declared at a 5% level of significance.

Result

The prevalence of the delay in seeking prompt care was 47.8%. Factors contributing to the delay were caregivers who were aged 30 years and above [AOR 0.23, 95% confidence interval (CI): 0.10-0.52], caregivers who followed the Protestant religion (AOR 3.67, 95% CI: 2.08-6.48), caregivers unable to read and write (AOR 5.32, 95% CI: 6.80-11.70), merchant caregivers (AOR 6.63, 95% CI: 2.75-15.97), caregivers who were exposed to only one media source (AOR 9.3, 95% CI: 8.43-15.60), caregivers with the experience of child death (AOR 0.05, 95% CI: 0.01-0.22), and caregivers seeking permission from their partners to access healthcare (AOR 12.64, 95% CI: 6.98-22.89).

Conclusion and recommendations

There was a high level of delay in seeking healthcare. Targeted community education through mass media, healthcare facilities, and community-level awareness campaigns should be strengthened to improve early treatment seeking and lessen the consequences of delayed treatment seeking.

Leveraging data science and machine learning for urban climate adaptation in two major African cities: a HE2AT Center study protocol

INTRODUCTION

African cities, particularly Abidjan and Johannesburg, face challenges of rapid urban growth, informality and strained health services, compounded by increasing temperatures due to climate change. This study aims to understand the complexities of heat-related health impacts in these cities. The objectives are: (1) mapping intraurban heat risk and exposure using health, socioeconomic, climate and satellite imagery data; (2) creating a stratified heat-health forecast model to predict adverse health outcomes; and (3) establishing an early warning system for timely heatwave alerts. The ultimate goal is to foster climate-resilient African cities, protecting disproportionately affected populations from heat hazards.

METHODS AND ANALYSIS

The research will acquire health-related datasets from eligible adult clinical trials or cohort studies conducted in Johannesburg and Abidjan between 2000 and 2022. Additional data will be collected, including socioeconomic, climate datasets and satellite imagery. These resources will aid in mapping heat hazards and quantifying heat-health exposure, the extent of elevated risk and morbidity. Outcomes will be determined using advanced data analysis methods, including statistical evaluation, machine learning and deep learning techniques.

ETHICS AND DISSEMINATION

The study has been approved by the Wits Human Research Ethics Committee (reference no: 220606). Data management will follow approved procedures. The results will be disseminated through workshops, community forums, conferences and publications. Data deposition and curation plans will be established in line with ethical and safety considerations.

Determinants of treatment-seeking behavior during self-reported febrile illness episodes using the socio-ecological model in Kilombero District, Tanzania

Background

Febrile diseases in Sub-Saharan Africa cause acute and chronic illness. Co-infections are common and these diseases have a complex etiology that includes zoonoses. For the implementation of appropriate treatment and control strategies, determinants of lay treatment-seeking behavior by the affected communities need to be understood. The objective of this study was to explore, using the socio-ecological model, the determinants of treatment-seeking actions among self-identified febrile illness cases in the Kilombero District of Tanzania.

Methods

Thirty-nine in-depth interviews were conducted with 28 men and 11 women in three villages in Kilombero district. These villages were purposively selected due to malaria endemicity in the area, animal husbandry practices, and proximity to livestock-wildlife interaction, all risk factors for contracting febrile zoonotic infections. Thematic analysis was conducted on the interviews to identify the key determinants of treatment-seeking actions.

Results

Study participants attributed febrile illnesses to malaria, typhoid and urinary tract infections. Treatment-seeking behavior was an iterative process, influenced by individual, socio-cultural, ecological and policy factors. Age, expendable income, previous history with a febrile illness, perceptions on disease severity, seasonal livelihood activities and access to timely healthcare were some of the determinants. Self-treatment with pharmaceutical drugs and herbs was usually the initial course of action. Formal healthcare was sought only when self-treatment failed and traditional healers were consulted after the perceived failure of conventional treatment. Delays in seeking appropriate health care and the consultation of medically unqualified individuals was very common.

Conclusion

The results imply that treatment-seeking behavior is shaped by multiple factors across all levels of the socio-ecological model. Public policy efforts need to focus on facilitating prompt health care seeking through community education on the complicated etiology of febrile illnesses. Improved access to timely treatment and better differential diagnostics by health professionals are essential to ensure correct and appropriate treatment and to reduce reliance of patients on unqualified persons.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11027-w.

Low rates of Plasmodium falciparum Pfcrt K76T mutation in three sentinel sites of malaria monitoring in Côte d'Ivoire

Despite efforts to eliminate it, malaria remains a major public health concern, particularly in Côte d'Ivoire. Chloroquine (CQ) was one of the first drugs used for its treatment, but was officially withdrawn from the market in 2007 following reports of high levels of chloroquine resistance. The present study was carried out after the withdrawal of CQ and provides an update on the rates of CQ resistance in Côte d'Ivoire. Samples were collected between September 2013 and March 2014 in Abidjan and from January to May 2016 in Abengourou and San Pedro through cross-sectional studies. Parasitemia was assessed by microscopy, and single nucleotide polymorphism in the Pfcrt (codon 76) gene was analyzed by nested PCR and restriction fragment length polymorphism. A total of 343 samples were analyzed: 119, 106 and 118 were from Abidjan, Abengourou, and San Pedro, respectively. The sex ratio of patients was 0.92. The mean age of patients enrolled was 9.6 years (SD = 10.8). The geometric mean of parasite density was 21,337 parasites/μL (SD = 49,508; range, 2,000-200,000). Molecular analysis revealed 57 K76T mutants (16.6%): 33, 9, and 15 in Abidjan, Abengourou and in San Pedro, respectively. Most of these were found in patients aged ≤15 years (42/57) who had parasitemia greater than 10,000 parasites/μL (40/57). This is the first study conducted in Côte d'Ivoire reporting a decline in Pfcrt K76T mutation rate. Thus, our results indicate the importance of following up on the observed trend also at a national level.

Fluid Drugs: Revisiting the Anthropology of Pharmaceuticals

This review discusses a growing body of scholarship at the intersection of anthropology and science and technology studies (STS) that examines how drugs are rendered efficacious in laboratories, therapeutic settings, and everyday lives. This literature foregrounds insights into how commercial interests and societal concerns shape the kinds of pharmaceutical effects that are actualized and how some efficacies are blocked in response to moral concerns. The work brought together here reveals how regulatory institutions and health policy makers seek to stabilize pharmaceutical actions while, on the front lines of care, pharmacists, health workers, and users tinker with dosages and indications to tailor pharmaceutical actions to specific circumstances. We show that there is no pure (pharmaceutical) object that precedes its socialization. Pharmaceuticals are not “discovered”; they are made and remade in relation to shifting contexts. This review outlines five key areas of ethnographic and STS research that examines such fluid drugs.

Malaria infection in children in tropical rainforest: assessments by women of Ugbowo Community in Benin City, Nigeria

OBJECTIVE

To examine how mothers recognize malaria infection in children aged less than five and five years, frequency and duration of the infection in these children as well as measures used to reduce exposure of children to mosquito bites, and to discuss the possibilities of designing a strategy that involves mothers in management and control of malaria infection.

METHODS

The data were originated from personal interviews which involved mothers in the Ugbowo Community in Benin City, Nigeria who were selected using multi-stage systemic random sampling technique. The data were analyzed qualitatively and by use of percentages, arithmetic mean and bar chart.

RESULTS

The results showed that all the interviewees believed that children got malaria infection along with fever or fever and other symptoms. Approximately 30% of interviewee recognized malaria infection through fever and cough while 1% by fever and vomiting. Approximately 72% of the interviewees claimed that their children had malaria infection every three months and 16% claimed that their children had the infection every month. Most of the interviewees reported that the length of time from recognition of malaria symptoms on their children to treatment was between one and three days. Most of the interviewees used insecticide treated bed nets to reduce their children's exposure to mosquito bites and few used mosquito repellent ointment.

CONCLUSIONS

For malaria management strategy to be effective and sustainable, it is important to empower women with more knowledge on detection of malaria symptoms and they should be involved in planning and designing the strategy.

Transmission of malaria in relation to distribution and coverage of long-lasting insecticidal nets in central Côte d'Ivoire

Background

The use of long-lasting insecticidal nets (LLINs) is an effective malaria control strategy. However, there are challenges to achieve high coverage, such as distribution sustainability, and coverage keep-up. This study assessed the effect of LLINs coverage and contextual factors on entomological indicators of malaria in rural Côte d’Ivoire.

Methods

The study was carried out between July 2009 and May 2012 in three villages (Bozi, N’Dakonankro and Yoho) of central Côte d’Ivoire. In Bozi and Yoho, LLINs were distributed free of charge by the national malaria control programme in 2008. In Bozi, an additional distribution was carried out in May 2011. No specific interventions were done in N’Dakonankro. Entomological surveys were conducted in July 2009 and July 2010 (baseline), and in August and November 2011 and in February 2012. Frequency of circumsporozoite protein was determined using an enzyme-linked immunosorbent assay. Regression models were employed to assess the impact of LLINs and changing patterns of irrigated rice farming on entomological parameters, and to determine associations with LLINs coverage and other contextual factors.

Results

In Bozi, high proportion of LLIN usage was observed (95-100%). After six months, 95% of LLINs were washed at least once and 79% were washed up to three times within one year. Anopheles gambiae was the predominant malaria vector (66.6% of all mosquitoes caught). From 2009 to 2012, in N’Dakonankro, the mean annual entomological inoculation rate (EIR) increased significantly from 116.8 infectious bites/human/year (ib/h/y) to 408.8 ib/h/y, while in the intervention villages, the EIR decreased significantly from 514.6 ib/h/y to 62.0 ib/h/y (Bozi) and from 83.9 ib/h/y to 25.5 ib/h/y (Yoho). The risk of an infectious bite over the three-year period was significantly lower in the intervention villages compared to the control village (p <0.001).

Conclusion

High coverage and sensitization of households to use LLINs through regular visits (particularly in Bozi) and abandoning irrigated rice farming (in Yoho) resulted in highly significant reductions of EIR. The national malaria control programme should consider household sensitization and education campaigns and other contextual factors to maximize the benefit of LLINs.

Local concepts of anemia-related illnesses and public health implications in the Taabo health demographic surveillance system, Côte d'Ivoire

BACKGROUND

A 14-month prospective longitudinal study conducted in the Taabo health demographic surveillance system (HDSS), south-central Côte d'Ivoire, revealed high prevalence of anemia in different population groups in three types of settings (i.e., small town, village, and hamlet). Demographic parameters and several variables related to parasitic infections, micronutrient status, and inflammation were significantly associated with higher odds of anemia. However, cultural concepts and knowledge of various anemia-related illnesses and their relation with people's behaviors have not been investigated.

METHODS

Sixteen focus group discussions and six key informant interviews were performed with village authorities, health workers, and traditional healers. Questionnaires were administrated to 200 school-aged children and 115 young women. Of these individuals, 206 participated in the preceding longitudinal study, whereas the remaining 109 people were not exposed to prior research, but had similar age and sex profiles. Mean prominence of participants' responses was compared between groups of participants and across study settings.

RESULTS

Local concepts of anemia-related illnesses referred to its perceived causes based on two logical frameworks - biomedical and sociocultural - although a clear distinction was often blurred. We found few differences in knowledge, beliefs, and behaviors across study settings and between participants who were exposed to prior research and newly recruited ones. Malaria und nutritional issues as understood and managed by the population differed from definitions and recommendations provided by the health system. Malaria was not acknowledged as an exclusive mosquito-transmitted disease and participants referred to the quantity, rather than the quality, of food when talking about nutritional issues.

CONCLUSIONS

Local concepts and ideas about anemia have public health implications, inasmuch as they are related to people's attitudes, risk-related and help-seeking behaviors, which in turn might affect their health status. Local terminology and beliefs about anemia and malaria should be carefully considered when developing health intervention and education programs. The similarity in knowledge about anemia-related illnesses and associated behaviors, regardless of study setting and prior exposure to research, suggests that a uniform communication strategy may be used to develop education programs and awareness campaigns aimed at the prevention and control of anemia in south-central Côte d'Ivoire.

Community perceptions on malaria and care-seeking practices in endemic Indian settings: policy implications for the malaria control programme

BACKGROUND

The focus of India's National Malaria Programme witnessed a paradigm shift recently from health facility to community-based approaches. The current thrust is on diagnosing and treating malaria by community health workers and prevention through free provision of long-lasting insecticidal nets. However, appropriate community awareness and practice are inevitable for the effectiveness of such efforts. In this context, the study assessed community perceptions and practice on malaria and similar febrile illnesses. This evidence base is intended to direct the roll-out of the new strategies and improve community acceptance and utilization of services.

METHODS

A qualitative study involving 26 focus group discussions and 40 key informant interviews was conducted in two districts of Odisha State in India. The key points of discussion were centred on community perceptions and practice regarding malaria prevention and treatment. Thematic analysis of data was performed.

RESULTS

The 272 respondents consisted of 50% females, three-quarter scheduled tribe community and 30% students. A half of them were literates. Malaria was reported to be the most common disease in their settings with multiple modes of transmission by the FGD participants. Adoption of prevention methods was seasonal with perceived mosquito density. The reported use of bed nets was low and the utilization was determined by seasonality, affordability, intoxication and alternate uses of nets. Although respondents were aware of malaria-related symptoms, care-seeking from traditional healers and unqualified providers was prevalent. The respondents expressed lack of trust in the community health workers due to frequent drug stock-outs. The major determinants of health care seeking were socio-cultural beliefs, age, gender, faith in the service provider, proximity, poverty, and perceived effectiveness of available services.

CONCLUSION

Apart from the socio-cultural and behavioural factors, the availability of acceptable care can modulate the community perceptions and practices on malaria management. The current community awareness on symptoms of malaria and prevention is fair, yet the prevention and treatment practices are not optimal. Promoting active community involvement and ownership in malaria control and management through strengthening community based organizations would be relevant. Further, timely availability of drugs and commodities at the community level can improve their confidence in the public health system.

Molecular analysis of markers associated with chloroquine and sulfadoxine/pyrimethamine resistance in Plasmodium falciparum malaria parasites from southeastern Côte-d'Ivoire by the time of Artemisinin-based Combination Therapy adoption in 2005

PURPOSE

Artemisin-based combination therapies became the recommended therapy in Côte-d'Ivoire in 2005, but both chloroquine (CQ) and sulfadoxine/pyrimethamine (SP) have been heavily used for many decades. Despite this long history, little is known about the geographical distribution of drug resistance-conferring genotypes outside the capital city of Abidjan. In this work, we compared the prevalence of drug-resistant genotypes in Bonoua, an urban area, and Samo, a rural agricultural area, in southeastern Côte-d'Ivoire, about 59 km from Abidjan.

PATIENTS AND METHODS

Samples were collected from symptomatic patients in both sites during the rainy season in 2005. Genomic DNA was isolated and codons associated with resistance to CQ and SP were analyzed: pfcrt codons Cys-72-Ser, Val-73-Val, Met-74-Ile, Arg-75-Glu, Lys-76-Thr; pfdhfr codons Ala-16-Val, Arg-51-Ile, Cys-59-Arg, Ser-108-Arg/Thr, and Ile-164-Leu; pfdhps codons Ser-436-Ala, Ala-437-Gly, Lys-540-Glu, Ala-581-Gly, and Ala-613-Thr/Ser.

RESULTS

A limited number of genotypes were found in Bonoua compared with Samo. In both sites, the triple-mutant allele CVIET of pfcrt predominated: 100% in Bonoua and 86.2% in Samo. The wild-type allele, NCSI of pfdhfr, was common - 50% in Bonoua and 38.7% in Samo - but the triple-mutant IRNI and double-mutant NRNI were also frequent (IRNI, 32.6% in Bonoua and 19.4% in Samo; NRNI, 15.2% in Bonoua and 9.7% in Samo). In Samo, a wide range of different genotypes of Pfdhps was observed, with alleles carrying the Gly-437 codon fixed in Bonoua and comprising 73% of the isolates in Samo.

CONCLUSION

Although these two sites are only 8 km apart, they belonged to very different ecological environments. The overall prevalence of alleles of single-nucleotide polymorphisms associated with resistance to CQ and SP in both locations was among the highest of the region by 2005, although the more rural site showed a more diverse set of alleles and mixed infections. Continued surveillance of these markers will be a useful tool for drug policy, as both CQ and SP are still frequently used years after withdrawal, and SP is recommended by the World Health Organization for intermittent preventive therapy for pregnant women and infants. Data analyzed herein are among the first to be generated during the year of artemisin-based combination-therapy introduction in Côte-d'Ivoire and could be of some interest for malaria policy-makers.

Biomedical techniques in context: on the appropriation of biomedical procedures and artifacts

On the assumption that technical practices and artifacts are fundamental constituents of individual and collective attempts to order lives and bodies in health and sickness, in this introduction, we set out three central propositions. First, medical techniques have to take center stage in research on biomedicine. Second, as medical artifacts travel worldwide, they become part of the processes of sociocultural appropriation. Third, anthropologists have to consider how to study the transformations associated with such appropriation and how much they need to know about the technical aspects of their objects of study. The mutual transformative potential of both biomedical artifacts and practices and the new contexts of application have so far been undertheorized in medical anthropology--a gap that we aim to close with our reflections and the collection of empirical studies of various biomedical techniques in this issue.

Appropriation and dementia in India

Biomedical technologies like MRI scans offer a way for carers and people with dementia to 'see' pathology, as a means to reorient their perceptions of the body and functionality. Through interpretive and syncretic processes, the MRI and the diagnosis of dementia facilitate the incorporation of the clinical category 'dementia' into social understandings of illness and care in India. Complex shifts occur as families and providers move from socio-cultural explanations of disruption to bio-social etiologies of the disease 'dementia' and then to socio-ecological frameworks of causality. Both the biomedicalisation of illness and the localisation of illness occur as the clinical category 'dementia' is folded into local understandings of illness and care. Through elucidating how the dialectic between biomedical and local knowledge is operationalized, we offer insights into how dementia is absorbed and appropriated into Indian cultural contexts.

Peer education: the effects on knowledge of pregnancy related malaria and preventive practices in women of reproductive age in Edo State, Nigeria

Background

There is limited uptake of measures to prevent malaria by pregnant women in Nigeria which is often related to the lack of knowledge on Malaria in Pregnancy (MIP) and its effects on mother and foetus. This study, explored peer to peer education as a tool in raising knowledge of MIP among women of child bearing age.

Methods

1105 women of child bearing age were interviewed in their households using a structured questionnaire about their knowledge of malaria in general, MIP and use of preventive measures. Thereafter, a peer education campaign was launched to raise the level of knowledge in the community. The interviews were repeated after the campaign and the responses between the pre- and post-intervention were compared.

Results

In the pre-assessment women on average answered 64.8% of the question on malaria and its possibility to prevent malaria correctly. The peer education campaign had a significant impact in raising the level of knowledge among the women; after the campaign the respondents answered on average 73.8% of the questions correctly. Stratified analysis on pre and post assessment scores for malaria in general (68.8 & 72.9%) and MIP (61.7 & 76.3%) showed also significant increase. Uptake of bed nets was reported to be low: 11.6%

Conclusion

Peer education led to a significant increase in knowledge of malaria and its prevention but we could not asses its influence on the use of preventive measures.