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Elemo N, Worko KT, Mama D, Guye AH. Long lasting insecticidal nets utilization and associated factors among households of West Arsi Zone, Oromia Region, Ethiopia. Sci Rep 2024; 14:17498. [PMID: 39080468 PMCID: PMC11289461 DOI: 10.1038/s41598-024-68703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 07/26/2024] [Indexed: 08/02/2024] Open
Abstract
Long-lasting insecticide nets are often used as a physical barrier to prevent infection of malaria. In sub-Saharan Africa, one of the most important ways of lowering the malaria burden is the utilization of long-lasting insecticide-treated nets. However, there is no sufficient information on long-lasting insecticide utilization in Ethiopia. Therefore, the study was aimed to assess long-lasting insecticide net utilization and associated factors among households of West Arsi Zone, Oromia, Southern Ethiopia, 2023. A community-based cross-sectional study design was conducted in West Arsi Zone with a sample of 2808 households from May 01 to 30, 2023. Data were collected from households by using interviewer-administered structured questionnaires. Data were checked, coded, and entered into Epinfo version 7, cleaned, and analyzed by SPSS version 25. Descriptive analysis was used to present frequencies, proportions, and graphs. Binary logistic regression analysis was computed and the variables with p-values less than 0.25 were selected to be included in the multivariable model. The final model was interpreted using an adjusted odd ratio with a 95% confidence interval and p-value < 0.05 to declare the statistical association between the outcome and independent variables. About 2389 (86.2%) of households have long-lasting insecticide nets that can be used while sleeping. But the overall prevalence of long-lasting insecticide nets utilization was 69.9% with (95% CI 68.1-71.8). Being female as household head (AOR 1.69, 95% CI 1.33-4.15), number of separate rooms in the living house (AOR 1.80, 95% CI 1.23-2.29), duration of long-lasting insecticide nets used to be replaced (AOR 2.81, 95% CI 2.18-5.35), knowledge status of the respondents (AOR 3.68; 95% CI 2.48-6.97) were significantly associated with long-lasting insecticide nets utilization. The overall Household's level of LLINs utilization was found to be low as compared to the national standard of Ethiopia, which is to be ≥ 85. The study identified that being female as household head, the number of separate rooms in the living house, the duration of long-lasting insecticide nets used to be replaced, knowledge status of the respondents were the predictors of long-lasting insecticide nets utilization among members of households. Thus, to improve the usage of LLINs, the West Arsi Zone Health Office and stakeholders should strengthen the long-term insecticide net utilization at the household level by educating the community with appropriate information.
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Affiliation(s)
- Nagesso Elemo
- Department of Disease Prevention and Control, West Arsi Zone Health Office, Shashemene, Ethiopia
| | - Kedir Tahir Worko
- Department of Disease Prevention and Control, West Arsi Zone Health Office, Shashemene, Ethiopia
| | - Dedafo Mama
- Department of Disease Prevention and Control, West Arsi Zone Health Office, Shashemene, Ethiopia
| | - Ararso Hordofa Guye
- Department of Public Health, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia.
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Nguetsa GC, Elanga-Ndille E, Essangui Same EG, Nganso Keptchouang T, Mandeng SE, Ekoko Eyisap W, Binyang JA, Fogang B, Nouage L, Piameu M, Ayong L, Etang J, Wanji S, Eboumbou Moukoko CE. Utility of plasma anti-gSG6-P1 IgG levels in determining changes in Anopheles gambiae bite rates in a rural area of Cameroon. Sci Rep 2024; 14:14294. [PMID: 38906949 PMCID: PMC11192751 DOI: 10.1038/s41598-024-58337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/27/2024] [Indexed: 06/23/2024] Open
Abstract
The applicability of the specific human IgG antibody response to Anopheles gambiae salivary Gland Protein-6 peptide 1 (gSG6-P1 salivary peptide) as a biomarker able to distinguish the level of exposure to mosquito bites according to seasonal variations has not yet been evaluated in Central African regions. The study aimed to provide the first reliable data on the IgG anti-gSG6-P1 response in rural area in Cameroon according to the dry- and rainy-season. Between May and December 2020, dry blood samples were collected from people living in the Bankeng village in the forest area of the Centre region of Cameroon. Malaria infection was determined by thick-blood smear microscopy and multiplex PCR. The level of IgG anti-gSG6-P1 response, was assessed by enzyme-linked immunosorbent assay. Anopheles density and aggressiveness were assessed using human landing catches. The prevalence of malaria infection remains significantly higher in the rainy season than in the dry season (77.57% vs 61.44%; p = 0.0001). The specific anti-gSG6-P1 IgG response could be detected in individuals exposed to few mosquito bites and showed inter-individual heterogeneity even when living in the same exposure area. In both seasons, the level of anti-gSG6-P1 IgG response was not significantly different between Plasmodium infected and non-infected individuals. Mosquito bites were more aggressive in the rainy season compared to the dry season (human biting rate-HBR of 15.05 b/p/n vs 1.5 b/p/n) where mosquito density was very low. Infected mosquitoes were found only during the rainy season (sporozoite rate = 10.63% and entomological inoculation rate-EIR = 1.42 ib/p/n). The level of IgG anti-gSG6-P1 response was significantly higher in the rainy season and correlated with HBR (p ˂ 0.0001). This study highlights the high heterogeneity of individual's exposure to the Anopheles gambiae s.l vector bites depending on the transmission season in the same area. These findings reinforce the usefulness of the anti-gSG6-P1 IgG response as an accurate immunological biomarker for detecting individual exposure to Anopheles gambiae s.l. bites during the low risk period of malaria transmission in rural areas and for the differentiating the level of exposure to mosquitoes.
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Affiliation(s)
- Glwadys Cheteug Nguetsa
- Malaria Research Unit, Centre Pasteur Cameroon, P.O. Box 1274, Yaoundé, Cameroon.
- Department of Microbiology and Parasitology, Faculty of Sciences, The University of Buea, P.O. Box 63, Buea, Cameroon.
| | - Emmanuel Elanga-Ndille
- Department of Animal Biology, Faculty of Sciences, The University of Dschang, P.O. Box 96, Dschang, Cameroon
- Department of Medical Entomology, Centre for Research in Infectious Diseases, P.O. Box 13591, Yaoundé, Cameroon
| | - Estelle Géraldine Essangui Same
- Malaria Research Unit, Centre Pasteur Cameroon, P.O. Box 1274, Yaoundé, Cameroon
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O. Box 2701, Douala, Cameroon
| | - Tatiana Nganso Keptchouang
- Malaria Research Unit, Centre Pasteur Cameroon, P.O. Box 1274, Yaoundé, Cameroon
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O. Box 2701, Douala, Cameroon
| | - Stanilas Elysée Mandeng
- Department of Animal Biology and Physiology, Faculty of Sciences, The University of Yaoundé, P.O. Box 337, Yaounde 1, Cameroon
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte Contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon
| | - Wolfgang Ekoko Eyisap
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte Contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon
| | - Jérome Achille Binyang
- Department of Medical Entomology, Centre for Research in Infectious Diseases, P.O. Box 13591, Yaoundé, Cameroon
- Department of Animal Biology and Physiology, Faculty of Sciences, The University of Yaoundé, P.O. Box 337, Yaounde 1, Cameroon
| | - Balotin Fogang
- Malaria Research Unit, Centre Pasteur Cameroon, P.O. Box 1274, Yaoundé, Cameroon
- Department of Animal Biology and Physiology, Faculty of Sciences, The University of Yaoundé, P.O. Box 337, Yaounde 1, Cameroon
| | - Lynda Nouage
- Department of Medical Entomology, Centre for Research in Infectious Diseases, P.O. Box 13591, Yaoundé, Cameroon
- Department of Animal Biology and Physiology, Faculty of Sciences, The University of Yaoundé, P.O. Box 337, Yaounde 1, Cameroon
| | - Micheal Piameu
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte Contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon
- Ecole des Sciences de La Santé, Université Catholique d'Afrique Centrale, P.O. Box 1110, Yaoundé, Cameroon
| | - Lawrence Ayong
- Malaria Research Unit, Centre Pasteur Cameroon, P.O. Box 1274, Yaoundé, Cameroon
| | - Josiane Etang
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O. Box 2701, Douala, Cameroon
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte Contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon
| | - Samuel Wanji
- Department of Microbiology and Parasitology, Faculty of Sciences, The University of Buea, P.O. Box 63, Buea, Cameroon
| | - Carole Else Eboumbou Moukoko
- Malaria Research Unit, Centre Pasteur Cameroon, P.O. Box 1274, Yaoundé, Cameroon.
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O. Box 2701, Douala, Cameroon.
- Laboratory of Parasitology, Mycology and Virology, Postgraduate Training Unit for Health Sciences, Postgraduate School for Pure and Applied Sciences, The University of Douala, P.O. Box 2701, Douala, Cameroon.
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Mboussou F, Ndoula ST, Nembot R, Baonga SF, Njinkeu A, Njoh AA, Biey JNM, Kaba MII, Amani A, Farham B, Habimana P, Impouma B. Setting up a data system for monitoring malaria vaccine introduction readiness and uptake in 42 health districts in Cameroon. BMJ Glob Health 2024; 9:e015312. [PMID: 38580377 PMCID: PMC11002407 DOI: 10.1136/bmjgh-2024-015312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/14/2024] [Indexed: 04/07/2024] Open
Abstract
Three months after the first shipment of RTS,S1/AS01 vaccines, Cameroon started, on 22 January 2024, to roll out malaria vaccines in 42 districts among the most at risk for malaria. Cameroon adopted and implemented the World Health Organization (WHO) malaria vaccine readiness assessment tool to monitor the implementation of preintroduction activities at the district and national levels. One week before the start of the vaccine rollout, overall readiness was estimated at 89% at a national level with two out of the five components of readiness assessment surpassing 95% of performance (vaccine, cold chain and logistics and training) and three components between 80% and 95% (planning, monitoring and supervision, and advocacy, social mobilisation and communication). 'Vaccine, cold chain and logistics' was the component with the highest number of districts recording below 80% readiness. The South-West and North-West, two regions with a high level of insecurity, were the regions with the highest number of districts that recorded a readiness performance below 80% in the five components. To monitor progress in vaccine rollout daily, Cameroon piloted a system for capturing immunisation data by vaccination session coupled with an interactive dashboard using the R Shiny platform. In addition to displaying data on vaccine uptake, this dashboard allows the generation of the monthly immunisation report for all antigens, ensuring linkage to the regular immunisation data system based on the end-of-month reporting through District Health Information Software 2. Such a hybrid system complies with the malaria vaccine rollout principle of full integration into routine immunisation coupled with strengthened management of operations.
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Affiliation(s)
- Franck Mboussou
- Vaccine Preventable Diseases, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Raoul Nembot
- Ministry of Public Health, Yaounde, Centre, Cameroon
| | | | - Arnaud Njinkeu
- World Health Organization Country Office for Cameroon, Yaounde, Cameroon
| | - Andreas Ateke Njoh
- Ministry of Public Health, Yaounde, Centre, Cameroon
- 4School of Global Health and Bioethics, Euclid University, Bangui, Central African Republic
| | - Joseph Nsiari-Muzeyi Biey
- Vaccine Preventable Diseases, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Mohamed II Kaba
- World Health Organization Country Office for Cameroon, Yaounde, Cameroon
| | - Adidja Amani
- Vaccine Preventable Diseases, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Bridget Farham
- Communicable and Non Communicable Disease Cluster, World Health Organization Regional Office for Africa, Brazzaville, Brazzaville, Congo
| | - Phanuel Habimana
- World Health Organization Country Office for Cameroon, Yaounde, Cameroon
| | - Benido Impouma
- Communicable and Non Communicable Disease Cluster, World Health Organization Regional Office for Africa, Brazzaville, Brazzaville, Congo
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Bayou FD, Kebede N, Tsega Y, Nigussie S, Legassu TD, Muche A, Muluneh AA, Ayele FY. Under utilization of long-lasting insecticidal nets (LLINs) is challenging malaria elimination program in Ethiopia: a systematic review and meta-analysis. BMC Public Health 2024; 24:815. [PMID: 38491483 PMCID: PMC10941431 DOI: 10.1186/s12889-024-18344-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Malaria is one of the most common causes of morbidity and mortality in developing countries including Ethiopia. Mass distribution of insecticide-treated nets and indoor residual spray for high malaria risk groups are the major prevention measures in different countries. Achievement of the malaria elimination plan is highly determined by the level of effective utilization of intervention measures. However, there is scarce information showing the national level of insecticide-treated nets utilization. OBJECTIVE To estimate the pooled prevalence of insecticide-treated nets utilization in Ethiopia, 2023. METHOD A Systematic Review and Meta-analysis employed to assess the utilization of long-lasting insecticidal nets in Ethiopia. Published articles were searched from Google Scholar, PubMed, Web Sciences, CINAHIL, EMBASE, and Scopus. The collected articles were screened for data extraction and further analysis using preferred reporting items for systematic review and meta-analysis (PRISMA) flow chart. The quality of each study was assessed using the Jonna Briggs Institute (JBI) checklist. The data were extracted using Microsoft Excel and exported to STATA version 17.0 for analysis. The overall pooled prevalence of long-lasting insecticidal nets utilization was determined using a random effects model. RESULT Out of 1657 articles reviewed, only 21 of them were eligible for final analysis. All of the included studies were used to estimate the pooled prevalence of long-lasting insecticidal net utilization. The point prevalence of LLIN utilization ranged from 14.23 to 91.9%. The Meta-analysis estimated that the overall pooled prevalence of insecticidal nets utilization among all study participants in Ethiopia was 56.26% (95%CI: 44.04-68.48%). Subgroup analysis revealed that insecticidal nets utilization was relatively highest in the Amhara region [63.0, 95%CI (37.0-89.0%)] and during 2020-2023 [61, 95% CI (53.0-69.0%)]. CONCLUSION Long-lasting insecticidal nets utilization in Ethiopia is lower than the national target plan. Hence, it needs extra follow-up and intervention to enhance its utilization.
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Affiliation(s)
- Fekade Demeke Bayou
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia
| | - Yawkal Tsega
- Department of Health System and Project Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia
| | - Shambel Nigussie
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | | | - Amare Muche
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ayana Alebachew Muluneh
- Department of Health Informatics, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fanos Yeshanew Ayele
- Department of Public Health Nutrition, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia
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Njewa B, Eyong EEJ, Ebai CB. Malaria parasitaemia and its impact on biological parameters among children <16 years old attending the Nkwen District Hospital, Cameroon. MALARIAWORLD JOURNAL 2024; 15:3. [PMID: 38476708 PMCID: PMC10929319 DOI: 10.5281/zenodo.10731943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Introduction Malaria remains a major public health problem in children in endemic areas. This study aimed to determine its prevalence, intensity, and assess how biological parameters like RBC count, haemoglobin, haematocrit, glycaemia, platelet count and WBC count vary with respect to parasitaemia in children <16 years attending the Nkwen District Hospital, northwest Cameroon. Materials and Methods The study was a hospital-based cross-sectional study conducted between March-May 2023. Structured, closed-ended questionnaires were administered to obtain information. Patients' temperature was measured using an infrared forehead digital thermometer. Malaria was diagnosed by RDT and positive samples Giemsa-stained for parasitaemia. Full blood count was performed using a haemolyser and glycaemia measured using a glucometer. Results In total, 321 children were examined. Overall prevalence of malaria (all P. falciparum) was 22.7% (73/321), with 24.7% (18/73), 34.2% (25/73) and 41.1% (30/73) having low, moderate and high parasitaemias, respectively. Overall GMPD was 2.670.8±179.9/μL; children aged 6-10 years were hit hardest (5.377.7 ± 3.2/μL). Malaria-positive children had significantly lower RBC count, Hb concentration, Hct, blood sugar, WBC and platelet counts (p<0.05) compared to those that were negative. Among positive children, RBC count, Hct, Hb, lymphocyte and platelet count each showed a significant (p<0.05) decrease while total WBC and granulocyte count each showed a significant (p<0.05) increase with increasing levels of parasitaemia. Conclusions Changes in biological parameters during malaria are sensitive but poor specific indicators of malaria because they may overlap with symptoms of other infections. More attention should be given to children aged 6-10 years during strategic planning and design of malaria control programmes.
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Affiliation(s)
- Bertrand Njewa
- Department of Microbiology and Parasitology, Faculty of Science, The University of Bamenda, P.O. Box 39, Bambili, North West Region, Cameroon
| | - Ebanga Echi Joan Eyong
- Department of Microbiology and Parasitology, Faculty of Science, The University of Bamenda, P.O. Box 39, Bambili, North West Region, Cameroon
| | - Calvin Bissong Ebai
- Department of Microbiology and Parasitology, Faculty of Science, The University of Bamenda, P.O. Box 39, Bambili, North West Region, Cameroon
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Solanke BL, Soladoye DA, Birsirka IA, Abdurraheem A, Salau OR. Utilization of insecticide-treated nets and associated factors among childbearing women in Northern Nigeria. Malar J 2023; 22:184. [PMID: 37328856 DOI: 10.1186/s12936-023-04620-4] [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: 02/08/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Studies have explored the correlates of insecticide-treated nets in Nigeria. The few studies that focused on Northern Nigeria mostly examined individual correlates, but largely ignored the community correlates. Also, the persistence of armed insurgencies in the region calls for more research attention. This study examines the utilization and the associated individual and community factors of insecticide-treated nets in Northern Nigeria. METHODS The study adopted a cross-sectional design. Data were extracted from the 2021 Nigeria Malaria Indicator Survey (NMIS). A weighted sample size of 6873 women was analysed. The outcome variable was the utilization of insecticide-treated nets. The explanatory variables selected at the individual/household level were maternal age, maternal education, parity, religion, sex of head of household, household wealth, and household size. The variables selected at the community level were the type of place of residence, geo-political zone of residence, the proportion of children under five who slept under a bed net, the proportion of women aged 15-49 who heard malaria media messages, and the community literacy level. Two variables, namely, the number of mosquito bed nets in the household, and the number of rooms used for sleeping were included for statistical control. Three multilevel mixed-effect regression models were fitted. RESULTS The majority of childbearing women (71.8%) utilized insecticide-treated nets. Parity and household size were the significant individual/household characteristics associated with the utilization of insecticide-treated nets. The proportion of under-five children in the community who slept under mosquito bed nets, and the geopolitical zone of residence were significant community correlates of the use of insecticide-treated nets. In addition, the number of rooms for sleeping, and the number of mosquito bed nets in the households were significantly associated with the utilization of insecticide-treated nets. CONCLUSION Parity, household size, number of sleeping rooms, number of treated bed nets, geo-political zone of residence, and proportion of under-five children sleeping under bed nets are important associated factors of the utilization of insecticide-treated nets in Northern Nigeria. Existing malaria preventive initiatives should be strengthened to target these characteristics.
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Affiliation(s)
- Bola Lukman Solanke
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Daniel Alabi Soladoye
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | - Omowumi Romoke Salau
- Department of Clinical Nursing Services, UHD Trust, Royal Bournemouth Dorset, Bournemouth, UK
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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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