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Martin J, Lukole E, Messenger LA, Aziz T, Mallya E, Bernard E, Matowo NS, Mosha JF, Rowland M, Mosha FW, Manjurano A, Protopopoff N. Monitoring of Fabric Integrity and Attrition Rate of Dual-Active Ingredient Long-Lasting Insecticidal Nets in Tanzania: A Prospective Cohort Study Nested in a Cluster Randomized Controlled Trial. INSECTS 2024; 15:108. [PMID: 38392527 PMCID: PMC10889750 DOI: 10.3390/insects15020108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024]
Abstract
Pyrethroid-treated long-lasting insecticidal nets (LLINs) have been the main contributor to the reduction in malaria in the past two decades in sub-Saharan Africa. The development of pyrethroid insecticide resistance threatens the future of LLINs, especially when nets become holed and pyrethroid decays. In this study, three new classes of dual-active ingredient (AI) LLINs were evaluated for their physical durability: (1) Royal Guard, combining pyriproxyfen, which disrupts female fertility, and a pyrethroid, alpha-cypermethrin; (2) Interceptor G2, which combines the pyrrole chlorfenapyr and a pyrethroid (alpha-cypermethrin); (3) Olyset Plus, which incorporates the pyrethroid permethrin and the synergist piperonyl butoxide, to enhance the pyrethroid potency; and Interceptor, a reference net that contains alpha-cypermethrin as the sole active ingredient. About 40,000 nets of each type were distributed in February 2019 to different villages in Misungwi. A total of 3072 LLINs were followed up every 6-12 months up to 36 months to assess survivorship and fabric integrity. The median functional survival was less than three years with Interceptor, Interceptor G2, and Royal Guard showing 1.9 years each and Olyset Plus showing 0.9 years. After 36 months, 90% of Olyset Plus and Royal Guard and 87% of Interceptor G2 were no longer in use (discarded) due to wear and tear, compared to 79% for Interceptor. All dual-AI LLINs exhibited poor textile durability, with Olyset Plus being the worst.
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Affiliation(s)
- Jackline Martin
- Department of Parasitology, Pan-African Malaria Vector Research Consortium, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2240, Tanzania
- Department of Parasitology, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania
- Department of Disease Control, Faculty of Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Eliud Lukole
- Department of Parasitology, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania
| | - Louisa A Messenger
- Department of Disease Control, Faculty of Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
- Parasitology and Vector Biology Laboratory (UNLV PARAVEC Lab), School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
| | - Tatu Aziz
- Department of Parasitology, Pan-African Malaria Vector Research Consortium, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2240, Tanzania
| | - Elizabeth Mallya
- Department of Parasitology, Pan-African Malaria Vector Research Consortium, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2240, Tanzania
| | - Edmond Bernard
- Department of Parasitology, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania
| | - Nancy S Matowo
- Department of Disease Control, Faculty of Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Jacklin F Mosha
- Department of Parasitology, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania
| | - Mark Rowland
- Department of Disease Control, Faculty of Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Franklin W Mosha
- Department of Parasitology, Pan-African Malaria Vector Research Consortium, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2240, Tanzania
| | - Alphaxard Manjurano
- Department of Parasitology, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania
| | - Natacha Protopopoff
- Department of Disease Control, Faculty of Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Regional variations in child and mother's characteristics influencing the use of insecticide treated net in Nigeria. J Biosoc Sci 2023; 55:326-343. [PMID: 35164890 DOI: 10.1017/s0021932022000050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nigeria accounts for a quarter of malaria cases worldwide, which can be prevented with the use of insecticide treated nets (ITN). While studies have documented mother-related characteristics influencing use of ITN, regional variations in the influence of those factors are not well known. This study investigated nine factors (age, place of residence, education, religion, wealth, number of children in the household, sex of child, age of child and previous experience of child mortality) as possible predictors of use of ITN for children and how the associations vary across northern and southern parts of the country. The study utilised the 2015 Nigeria Malaria Indicator Survey, which comprised 6524 mothers (4009 from the north and 2151 from the south) aged 15-49. Bivariate and multivariate logistic regression models were fitted. It was found that, less than half (47.9%) of the respondents reported no access to a mosquito net in the north compared to 70.8% in the south. More than half (51.4%) of the northern respondents used insecticide treated net (ITN) for the child compared to 27.1% of southern mothers. When the variables are fitted together in the same model, place of residence, mother's age, mother's education, wealth, religion, number of children in the household and previous experience of child mortality were associated with the use of ITN. Regional variations exist in the influence of mother's age, number of children in the household and previous experience of child mortality. It was submitted that mother's characteristics are more important than the child's factors in the use of ITN, and that, contrary to the theory of poor utilisation of health-related facilities in the north compared to the south, residents in the former have access to and use ITN more than their counterparts from the latter.
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Mboma ZM, Festo C, Lorenz LM, Massue DJ, Kisinza WN, Bradley J, Moore JD, Mandike R, Akim I, Lines J, Overgaard HJ, Moore SJ. The consequences of declining population access to insecticide-treated nets (ITNs) on net use patterns and physical degradation of nets after 22 months of ownership. Malar J 2021; 20:171. [PMID: 33781261 PMCID: PMC8008556 DOI: 10.1186/s12936-021-03686-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background As insecticide-treated nets (ITNs) wear out and are disposed, some household members are prioritized to use remaining ITNs. This study assessed how nets are allocated within households to individuals of different age categories as ITNs are lost or damaged and as new ITNs are obtained. The study also explored how ITN allocation affects ITN durability. Methods A cross-sectional household survey and ITN durability study was conducted among 2,875 households across Tanzania to determine the proportion of nets that remain protective (serviceable) 22 months after net distribution aiming for universal coverage. Allocation of study nets within houses, and re-allocation of ITNs when new universal replacement campaign (URC) nets arrived in study households in Musoma District, was also assessed. Results Some 57.0% (95% CI 53.9–60.1%) of households had sufficient ITNs for every household member, while 84.4% (95% CI 82.4–86.4%) of the population had access to an ITN within their household (assuming 1 net covers every 2 members). In households with sufficient nets, 77.5% of members slept under ITNs. In households without sufficient nets, pregnant women (54.6%), children < 5 years (45.8%) and adults (42.1%) were prioritized, with fewer school-age children 5–14 years (35.9%), youths 15–24 years (28.1%) and seniors > 65 years (32.6%) sleeping under ITNs. Crowding (\documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ 3 people sleeping under nets) was twice as common among people residing in houses without sufficient nets for all age groups, apart from children < 5. Nets were less likely to be serviceable if: \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ 3 people slept under them (OR 0.50 (95% CI 0.40–0.63)), or if nets were used by school-age children (OR 0.72 (95% CI 0.56–0.93)), or if the net product was Olyset®. One month after the URC, only 23.6% (95% CI 16.7–30.6%) of the population had access to a URC ITN in Musoma district. Householders in Musoma district continued the use of old ITNs even with the arrival of new URC nets. Conclusion Users determined the useful life of ITNs and prioritized pregnant women and children < 5 to serviceable ITNs. When household net access declines, users adjust by crowding under remaining nets, which further reduces ITN lifespan. School-age children that commonly harbour gametocytes that mediate malaria transmission are compelled to sleep under unserviceable nets, crowd under nets or remain uncovered. However, they were accommodated by the arrival of new nets. More frequent ITN delivery through the school net programme in combination with mass distribution campaigns is essential to maximize ITN effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03686-2.
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Affiliation(s)
- Zawadi M Mboma
- Ifakara Health Institute, Dar es Salaam, Tanzania. .,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | | | - Lena M Lorenz
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.,College of Medicine and Veterinary Medicine, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Dennis J Massue
- Vector Control Product Testing Unit, Ifakara Health Institute, Ifakara, Tanzania.,Epidemiology and Public Health Department, Swiss Institute of Tropical and Public Health, Soccinstrase 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland.,University of Dar Es Salaam, Mbeya College of Health and Allied Sciences, Box 608, Mbeya, Tanzania
| | - William N Kisinza
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanga, Tanzania
| | - John Bradley
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Jason D Moore
- Vector Control Product Testing Unit, Ifakara Health Institute, Ifakara, Tanzania.,Epidemiology and Public Health Department, Swiss Institute of Tropical and Public Health, Soccinstrase 57, 4002, Basel, Switzerland
| | - Renata Mandike
- Ministry of Health and Social Welfare, National Malaria Control Programme, Dar-es-Salaam, Tanzania
| | - Ikupa Akim
- Epidemiology and Public Health Department, Swiss Institute of Tropical and Public Health, Soccinstrase 57, 4002, Basel, Switzerland
| | - Jo Lines
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Hans J Overgaard
- Faculty of Science and Technology, Norwegian University of Life Sciences, P.O. Box 5003, 1432, Ås, Norway.,Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sarah J Moore
- Vector Control Product Testing Unit, Ifakara Health Institute, Ifakara, Tanzania.,Epidemiology and Public Health Department, Swiss Institute of Tropical and Public Health, Soccinstrase 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
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Njatosoa AF, Mattern C, Pourette D, Kesteman T, Rakotomanana E, Rahaivondrafahitra B, Andriamananjara M, Harimanana A, Razafindrakoto J, Raboanary E, Andrianasolo A, Rogier C. Family, social and cultural determinants of long-lasting insecticidal net (LLIN) use in Madagascar: secondary analysis of three qualitative studies focused on children aged 5-15 years. Malar J 2021; 20:168. [PMID: 33771162 PMCID: PMC7995690 DOI: 10.1186/s12936-021-03705-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Although it is accepted that long-lasting insecticidal net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; the malaria prevalence is highest in this age group. The purpose of this research is to summarize recent qualitative studies describing LLIN use among the Malagasy people with a focus on children aged 5–15 years. Methods Qualitative data from three studies on malaria conducted between 2012 and 2016 in 10 districts of Madagascar were analysed. These studies cover all malaria epidemiological profiles and 10 of the 18 existing ethnic groups in Madagascar. A thematic analysis was conducted on the collected data from semi-structured interviews, direct observation data, and informal interviews. Results A total of 192 semi-structured interviews were conducted. LLINs are generally perceived positively because they protect the health and well-being of users. However, regional representations of mosquito nets may contribute to LLIN lower use by children over 5 years of age including the association between married status and LLIN use, which leads to the refusal of unmarried young men to sleep under LLINs; the custom of covering the dead with a mosquito net, which leads to fear of LLIN use; and taboos governing sleeping spaces for siblings of opposite sexes, which leads to LLIN shortages in households. Children under 5 years of age are known to be the most vulnerable age group for acquiring malaria and, therefore, are prioritized for LLIN use when there are limited supplies in households. In contrast, children over 5 years of age, who are perceived to be at less risk for malaria, often sleep without LLINs. Conclusions Perceptions, social practices and regional beliefs regarding LLINs and vulnerability to malaria contribute to the nonuse of LLINs among children over 5 years of age in Madagascar. Modifying LLIN policies to account for these factors may increase LLIN use in this age group and reduce disease burden.
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Affiliation(s)
- Ammy Fiadanana Njatosoa
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
| | - Chiarella Mattern
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,IRD, Ceped (Institut de Recherche Pour Le Développement, Université de Paris, INSERM), Paris, France
| | - Dolorès Pourette
- IRD, Ceped (Institut de Recherche Pour Le Développement, Université de Paris, INSERM), Paris, France
| | - Thomas Kesteman
- Unité de Recherche Sur Le Paludisme, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Elliot Rakotomanana
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Mauricette Andriamananjara
- Programme National de Lutte Contre Le Paludisme, Ministère de La Santé Publique, Antananarivo, Madagascar
| | - Aina Harimanana
- Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Emma Raboanary
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Andry Andrianasolo
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Institut International Des Sciences Sociales, Antananarivo, Madagascar
| | - Christophe Rogier
- Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Primum Vitare, Paris, France
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Malede A, Aemero M, Gari SR, Kloos H, Alemu K. Barriers of persistent long-lasting insecticidal nets utilization in villages around Lake Tana, Northwest Ethiopia: a qualitative study. BMC Public Health 2019; 19:1303. [PMID: 31619208 PMCID: PMC6796332 DOI: 10.1186/s12889-019-7692-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Malaria remains a major public health problem in Ethiopia. The use of LLINs is an effective approach to reducing transmission. Persistent use of LLINs is determined by numerous factors. Quantitative studies have assessed LLIN ownership and utilization, but the behavioral, socio-cultural, socioeconomic and net distribution contexts that impact their use have not been examined in depth. This study aimed to explore barriers of persistent LLIN use among communities around Lake Tana. Methods Twenty-three community residents who owned LLINs (15) or not (8) during the study period and 38 key informants were interviewed from April to June 2017. Phenomenological study was employed to explore the local contexts and factors that influence persistent use of LLINs. Individuals were purposefully selected to capture different views. Community residents were selected based on their permanent residence and LLIN use experience. Key informants were health extension workers, local leaders, students, and health professionals. The data were managed using QSR International NVivo Version 10 software and coded, and themes were identified. Results Killing ability of nets against arthropods other than mosquitoes reportedly made use of LLINs a favored malaria prevention method despite their ineffectiveness after 3 months. Conical nets were preferred due to their compatibility with varied sleeping structures. Numerous factors influenced persistent use, notably erroneous perceptions about LLINs, malaria and mosquitoes; bedbug infestation; inconvenience; unintended uses; distribution problem of nets; and socio-cultural and economic factors. Unintended uses were often associated with local needs and seldom linked with social issues and deficiencies in information about malaria and LLINs. Collateral benefits were considered important, principally in terms of disinfestation of bedbugs. Conclusions Non-persistent LLIN use was associated with inconvenient bed net design and early damage; non-potency of the insecticide against other arthropods; facilitation of bedbug infestation; unintended uses; wrong perceptions about malaria, mosquitoes, and LLINs; and inadequate follow-up regarding LLINs utilization. Distribution of conical nets and provision of adequate information on LLINs and malaria may promote persistent use. Using an insecticide that also kills arthropods other than mosquitoes may reduce unintended uses and increase persistent use.
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Affiliation(s)
- Asmamaw Malede
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Mulugeta Aemero
- Department of Medical Parasitology, School of Biomedical & Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Sirak Robele Gari
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Meless DG, Hounsa AE, Sangaré AD, Pongathié AS, Kouakou JS, Samba M, Kouadio L. [Evaluation of the operational capacity of first-line health facilities in the management of malaria in Ivory Coast]. Pan Afr Med J 2019; 34:16. [PMID: 31762885 PMCID: PMC6859026 DOI: 10.11604/pamj.2019.34.16.19932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/14/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Do health facilities (HF) have basic resources needed to manage malaria? The purpose of our study was to analyze the operational capacity (OC) of first-line health facilities in Ivory Coast in the management of malaria. METHODS SARA methodology was used to conduct a descriptive cross-sectional study from 10 to 30 July 2016. The operational capacity in the management showed an average availability of 9 identification tracers divided in 3 areas: (i) staff and guidelines; (ii) capacity of diagnosis; (iii) drugs and products. This operational capacity was assessed through the calculation of an index and then compared with the health facilities according to the management authority and the geographical area using Chi-square test with p-values α fixed at 0.05. RESULTS Out of 818 HFs, 651(79.6%) were in the public sector and 487(59.5%) were located in the rural area. The operational capacity of first line health facilities was 74.5%. This OC was higher in the public sector (81.3%) than in the private sector (48.8%) (p < 10-3) as well as in the rural area (82.7%) compared to the urban area (62.9%) (p < 10-3). CONCLUSION In 2016, first line health facilities in Ivory Coast had basic resources needed to manage malaria. It is necessary to focus on the need to strengthen health facility services in addition to prevention.
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Affiliation(s)
- David Guanga Meless
- Département de Santé Publique, UFR Odontostomatologie, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Annita Emeline Hounsa
- Département de Santé Publique, Hydrologie et Toxicologie, UFR des Sciences Pharmaceutiques et Biologiques, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Abou Dramane Sangaré
- Département de Santé Publique, UFR Odontostomatologie, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Adama Sanogo Pongathié
- Direction de l'Information et de l'Informatique Sanitaire, Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Julie Sackou Kouakou
- Département de Santé Publique, Hydrologie et Toxicologie, UFR des Sciences Pharmaceutiques et Biologiques, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Mamadou Samba
- Département de Santé Publique, UFR Odontostomatologie, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Luc Kouadio
- Département de Santé Publique, Hydrologie et Toxicologie, UFR des Sciences Pharmaceutiques et Biologiques, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
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Njumkeng C, Apinjoh TO, Anchang-Kimbi JK, Amin ET, Tanue EA, Njua-Yafi C, Achidi EA. Coverage and usage of insecticide treated nets (ITNs) within households: associated factors and effect on the prevalance of malaria parasitemia in the Mount Cameroon area. BMC Public Health 2019; 19:1216. [PMID: 31481054 PMCID: PMC6724238 DOI: 10.1186/s12889-019-7555-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 08/27/2019] [Indexed: 12/03/2022] Open
Abstract
Background Insecticide-treated nets (ITNs) are a widely used tool that has been proven to be effective in the prevention and control of malaria in malaria endemic countries. However, usage varies among households and can greatly affect the benefits of ITNs as a control tool for malaria transmission. This study determined the coverage and usage of ITNS as well as associated factors and the effect of coverage and usage on the prevalence of malaria parasitemia within households in the Mount Cameroon area. Methods A cross-sectional survey was conducted between August and September 2014 in six communities within the Mount Cameroon area. Households within the communities were enrolled through multistage sampling and household survey was done using a structured questionnaire. Capillary blood was collected for malaria parasite determination. Data was analysed using SPSS version 20 for windows. Differences in proportions were assessed using the Chi-square test while factors affecting ITNs usage were assessed in multivariate logistic regression at a statistical significance of P ≤ 0.05. Results A total of 504 households were surveyed, 1564 bed spaces reported while 915(58.5, 95% CI: 56.1–60.9) of the bed spaces had nets and 391(77.6, 95% CI, 74.0–80.2) of the households had at least one bed net. The odds of using ITNs was 2 folds higher (OR = 2.41; 95% CI 1.58–3.69 p = 0.001) and 3 folds higher (OR = 3.149, 95% CI 1.53–6.47 p = 0.002) among houses with 5 to 9 occupants and above 10 occupants respectively when compared to houses with less than 5 occupants. In addition, Individuals living in cement block houses were less likely to use ITNs. Compared to those living in wooden houses (OR = 0.488, 95% CI: 0.269–0.885; p = 0 .018). Rural communities had lower ITN coverage compared to semi-urban communities (p = 0.0001). Increase in ITNs coverage significantly reduces malaria prevalence (correlation − 0.899, p = 0.015). Conclusion Despite the efforts made to scale up ITN distribution so that universal coverage can be attained, coverage remains low. Increasing coverage and putting in place a mechanism to replace torn nets will go a long way reduce the prevalence of malaria parasitemia. Electronic supplementary material The online version of this article (10.1186/s12889-019-7555-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charles Njumkeng
- Global Research Education and health Foundation Buea, Molyko, P.O. BOX 356, Buea, South West Region, Cameroon. .,Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
| | - Tobias O Apinjoh
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon
| | | | - Elvis T Amin
- Global Research Education and health Foundation Buea, Molyko, P.O. BOX 356, Buea, South West Region, Cameroon
| | - Elvis A Tanue
- Global Research Education and health Foundation Buea, Molyko, P.O. BOX 356, Buea, South West Region, Cameroon.,Department of Public Health and Hygiene, University of Buea, Buea, Cameroon
| | - Clarisse Njua-Yafi
- Department of Animal Biology and Physiology, University of Yaounde I, Yaounde, Cameroon.,College of Technology, University of Bamenda, Bamenda, Cameroon
| | - Eric A Achidi
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon
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Loha E, Deressa W, Gari T, Balkew M, Kenea O, Solomon T, Hailu A, Robberstad B, Assegid M, Overgaard HJ, Lindtjørn B. Long-lasting insecticidal nets and indoor residual spraying may not be sufficient to eliminate malaria in a low malaria incidence area: results from a cluster randomized controlled trial in Ethiopia. Malar J 2019; 18:141. [PMID: 30999957 PMCID: PMC6471954 DOI: 10.1186/s12936-019-2775-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/11/2019] [Indexed: 12/22/2022] Open
Abstract
Background Conflicting results exist on the added benefit of combining long-lasting insecticidal nets (LLINs) with indoor residual spraying (IRS) to control malaria infection. The main study objective was to evaluate whether the combined use of LLINs and IRS with propoxur provides additional protection against Plasmodium falciparum and/or Plasmodium vivax among all age groups compared to LLINs or IRS alone. Methods This cluster-randomized, controlled trial was conducted in the Rift Valley area of Ethiopia from September 2014 to January 2017 (121 weeks); 44 villages were allocated to each of four study arms: LLIN + IRS, IRS, LLIN, and control. Each week, 6071 households with 34,548 persons were surveyed by active and passive case detection for clinical malaria. Primary endpoints were the incidence of clinical malaria and anaemia prevalence. Results During the study, 1183 malaria episodes were identified, of which 55.1% were P. falciparum and 25.3% were P. vivax, and 19.6% were mixed infections of P. falciparum and P. vivax. The overall malaria incidence was 16.5 per 1000 person-years of observation time (PYO), and similar in the four arms with 17.2 per 1000 PYO in the LLIN + IRS arm, 16.1 in LLIN, 17.0 in IRS, and 15.6 in the control arm. There was no significant difference in risk of anaemia among the trial arms. Conclusions The clinical malaria incidence and anaemia prevalence were similar in the four study groups. In areas with low malaria incidence, using LLINs and IRS in combination or alone may not eliminate malaria. Complementary interventions that reduce residual malaria transmission should be explored in addition to LLINs and IRS to further reduce malaria transmission in such settings. Trial registration PACTR201411000882128 (08 September 2014) Electronic supplementary material The online version of this article (10.1186/s12936-019-2775-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eskindir Loha
- School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Taye Gari
- School of Public Health, Hawassa University, Hawassa, Ethiopia.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Meshesha Balkew
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Oljira Kenea
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tarekegn Solomon
- School of Public Health, Hawassa University, Hawassa, Ethiopia.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Alemayehu Hailu
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Bjarne Robberstad
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Meselech Assegid
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for International Health, University of Bergen, Bergen, Norway
| | | | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway.
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Solomon T, Loha E, Deressa W, Gari T, Overgaard HJ, Lindtjørn B. Low use of long-lasting insecticidal nets for malaria prevention in south-central Ethiopia: A community-based cohort study. PLoS One 2019; 14:e0210578. [PMID: 30629675 PMCID: PMC6328101 DOI: 10.1371/journal.pone.0210578] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction A decline in malaria morbidity and mortality has been documented in Ethiopia since 2005 following a scale-up of the distribution of long-lasting insecticidal nets (LLINs). However, universal access to LLINs ownership and use has not yet been achieved. This study aimed to determine ownership and use of LLINs over time in south-central Ethiopia. Methods A cohort of 17,142 individuals residing in 3,006 households was followed-up from October 2014 to January 2017 (121 weeks). New PermaNet2.0 LLINs were given to households in October 2014. Once per week, the LLIN use status was documented for each individual. A survey was conducted after 110 weeks of LLIN distribution to determine LLIN ownership. A multilevel negative binomial regression model was fitted to identify significant predictors of LLIN use. Results At baseline, the LLIN ownership was 100%. After 110 weeks only 233 (8%) of the households owned at least one LLIN. The median proportion of LLIN use per individuals during the study period was only 14%. During the first year (week 1–52) the average LLIN use per individuals was 36% and during the second year (week 53–104) it was 4.6%. More frequent LLIN use was reported among age group [5–14 years (adjusted IRR = 1.13, 95% CI 1.04–1.22), 15–24 years (adjusted IRR = 1.33, 95% CI 1.23–1.45), ≥25 years (adjusted IRR = 1.99, 95% CI 1.83–2.17)] compared to <5 years, and household head educational status [read and write (adjusted IRR = 1.17, 95% CI 1.09–1.26), primary (adjusted IRR = 1.20, 95% CI 1.12–1.27), secondary or above (adjusted IRR = 1.20, 95% CI (1.11–1.30)] compared to illiterate. Having a family size of over five persons (adjusted IRR = 0.78, 95% CI 0.73–0.84) was associated with less frequent use of LLINs compared to a family size of ≤5 persons. Conclusions The study showed a low LLIN ownership after 110 weeks and a low LLIN use during 121 weeks of follow-up, despite 100% LLIN coverage at baseline. The study highlights the need to design strategies to increase LLIN ownership and use for setting similar to those studied here.
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Affiliation(s)
- Tarekegn Solomon
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
- * E-mail:
| | - Eskindir Loha
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Taye Gari
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Hans J. Overgaard
- Faculty of Science and Technology, Norwegian University of Life Sciences, Akershus, Norway
| | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
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Olapeju B, Choiriyyah I, Lynch M, Acosta A, Blaufuss S, Filemyr E, Harig H, Monroe A, Selby RA, Kilian A, Koenker H. Age and gender trends in insecticide-treated net use in sub-Saharan Africa: a multi-country analysis. Malar J 2018; 17:423. [PMID: 30428916 PMCID: PMC6234545 DOI: 10.1186/s12936-018-2575-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022] Open
Abstract
Background The degree to which insecticide-treated net (ITN) supply accounts for age and gender disparities in ITN use among household members is unknown. This study explores the role of household ITN supply in the variation in ITN use among household members in sub-Saharan Africa. Methods Data was from Malaria Indicator Surveys or Demographic and Health Surveys collected between 2011 and 2016 from 29 countries in sub-Saharan Africa. The main outcome was ITN use the previous night. Other key variables included ITN supply (nets/household members), age and gender of household members. Analytical methods included logistic regressions and meta-regression. Results Across countries, the median (range) of the percentage of households with enough ITNs was 30.7% (8.5–62.0%). Crude analysis showed a sinusoidal pattern in ITN use across age groups of household members, peaking at 0–4 years and again around 30–40 years and dipping among people between 5–14 and 50+ years. This sinusoidal pattern was more pronounced in households with not enough ITNs compared to those with enough ITNs. ITN use tended to be higher in females than males in households with not enough ITNs while use was comparable among females and males in households with enough ITNs. After adjusting for wealth quintile, residence and region, among households with not enough ITNs in all countries, the odds of ITN use were consistently higher among children under 5 years and non-pregnant women 15–49 years. Meta-regressions showed that across all countries, the mean adjusted odds ratio (aOR) of ITN use among children under 5 years, pregnant and non-pregnant women aged 15–49 years and people 50 years and above was significantly higher than among men aged 15–49 years. Among these household members, the relationship was attenuated when there were enough ITNs in the household (dropping 0.26–0.59 points) after adjusting for geographical zone, household ITN supply, population ITN access, and ITN use:access ratio. There was no significant difference in mean aOR of ITN use among school-aged children compared to men aged 15–49 years, regardless of household ITN supply. Conclusions This study demonstrated that having enough ITNs in the household increases level of use and decreases existing disparities between age and gender groups. ITN distribution via mass campaigns and continuous distribution channels should be enhanced as needed to ensure that households have enough ITNs for all members, including men and school-aged children.
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Affiliation(s)
- Bolanle Olapeju
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Ifta Choiriyyah
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Matthew Lynch
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Angela Acosta
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Sean Blaufuss
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Eric Filemyr
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Hunter Harig
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - April Monroe
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Richmond Ato Selby
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Albert Kilian
- PMI VectorWorks Project, Tropical Health LLP, Montagut, Spain
| | - Hannah Koenker
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA.
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Doda Z, Solomon T, Loha E, Gari T, Lindtjørn B. A qualitative study of use of long-lasting insecticidal nets (LLINs) for intended and unintended purposes in Adami Tullu, East Shewa Zone, Ethiopia. Malar J 2018; 17:69. [PMID: 29409511 PMCID: PMC5801687 DOI: 10.1186/s12936-018-2209-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 01/27/2018] [Indexed: 11/22/2022] Open
Abstract
Background Malaria poses a significant public health threat globally, across Africa and in Ethiopia. The use of long-lasting insecticidal nets (LLINs) is currently a proven prevention mechanism. Evidence is building on what happens to LLINs following mass distribution campaigns, with mixed results from different studies, some reporting very low use for intended purposes, others an encouraging level of using for intended purposes. In Ethiopia, between 2005 and 2015, about 64 million LLINs were distributed through periodic mass campaigns with the aims to achieve 100% coverage and 80% utilization. However, studies from rural Ethiopia showed variable LLINs coverage and utilization rate. The MalTrial Project, a collaborative venture between Hawassa University, Ethiopia and NROAID, Norway, has started a trial project in 2014 in Adami Tullu District of central Ethiopia. Quantitative surveys have established evidence on LLINs ownership and utilization, but the behavioural, sociocultural and socioeconomic dynamics of why LLINs’ use for intended purposes is low or why they are employed for other purposes remained elusive. The present qualitative study, building on the quantitative findings and framework, therefore, attempted to fill gaps in these areas using qualitative methods in selected localities of the district. Methods The study employed 7 focus groups, 16 individual interviews and observation to undertake data collection in January 2017. The data were analysed using NVivo Version 11 (QSR International) to transcribe, code and identify themes using thematic analysis approach. Results The study found out that certain households were more likely to use nets for intended needs in proper ways; a range of factors, notably socio-cultural and poverty, highly influence users’ ideas about the right ways and decisions to use and care for the nets; knowledge gaps and wrong perception exist regarding the purposes and life cycle of the nets; LLINs are employed for repurposed uses once they are considered non-viable, old, or lose their physical integrity; existence of misuse was acknowledged and understood as wrong; and values about gender roles further shape uses, misuses and repurposed use of the nets. Conclusions Behavioural, socio-cultural, economic and ecological conditions coupled with deficiencies in perceived bed net design and distribution policies; weak education, communication and social support structures were important in understanding and accounting for why a low level of intended use and a rampant misuse and repurposed use in Adami Tullu community of Ethiopia. A major nexus to address in order to improve intended use of LLINs lies, first and foremost, in economic poverty and socio-cultural factors that underlie much of the misuse and repurposed use of the nets.
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Affiliation(s)
- Zerihun Doda
- College of Social Sciences & Humanities, Hawassa University, P.O. Box 005, Hawassa, Ethiopia.
| | - Tarekegn Solomon
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
| | - Eskindir Loha
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
| | - Taye Gari
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
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12
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Nissen A, Cook J, Loha E, Lindtjørn B. Proximity to vector breeding site and risk of Plasmodium vivax infection: a prospective cohort study in rural Ethiopia. Malar J 2017; 16:380. [PMID: 28927422 PMCID: PMC5605991 DOI: 10.1186/s12936-017-2031-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/14/2017] [Indexed: 11/15/2022] Open
Abstract
Background Despite falling incidence and mortality since the turn of the century, malaria remains an important global health challenge. In the future fight against malaria, greater emphasis will have to be placed on understanding and addressing malaria caused by the Plasmodium vivax parasite. Unfortunately, due to years of neglect and underfunding, there are currently many gaps in knowledge of P. vivax malaria. The aims of the present study were to explore the association between distance to vector breeding site and P. vivax infection in rural Ethiopia, and, secondarily, to test whether this association varies with age. Methods A prospective, cohort study of all residents in the Chano Mille Kebele in southern Ethiopia from April 2009 to March 2011 (n = 8121). Weekly household follow up visits included screening for febrile cases (active surveillance). Participants were also asked to contact the local health centre if they experienced subjective fever between visits (passive surveillance). Plasmodium vivax infection was confirmed using microscopy by two independent readers. Information was collected on demographics and household characteristics including GPS-determined distance to vector breeding site. Data was analysed using Cox regression modelling. Results Overall the P. vivax infection rate was 12.3/1000 person-years (95% CI 10.5–14.5). Mean household distance to breeding site was 2449 m (range 1646–3717 m). Fully adjusted results showed very strong evidence of an association between proximity to breeding site and P. vivax infection: rate ratio = 3.47 (95% CI 2.15–5.60; P < 0.001) comparing the group closest to the breeding site (distance < 2100 m; n = 1383) to the group furthest away (distance > 2700 m; n = 2460). There was no evidence that age was an effect modifier in the association. Conclusion Results showed strong evidence that household proximity to vector breeding site is positively associated with P. vivax infection in rural Ethiopia, and that this association is constant across age groups. The findings might influence how net-distribution and indoor residual spraying campaigns are planned, help guide strategies on water resource development by highlighting potential health effects of man-made dams near human habitats, and add to current educational information given to people living close to breeding sites.
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Affiliation(s)
- Alexander Nissen
- Norwegian Centre for Violence and Traumatic Stress Studies, Nydalen, P.O. Box 181, 0409, Oslo, Norway.
| | - Jackie Cook
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Eskindir Loha
- School of Public and Environmental Health, Hawassa University, Awassa, Ethiopia
| | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
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13
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Finlay AM, Butts J, Ranaivoharimina H, Cotte AH, Ramarosandratana B, Rabarijaona H, Tuseo L, Chang M, Vanden Eng J. Free mass distribution of long lasting insecticidal nets lead to high levels of LLIN access and use in Madagascar, 2010: A cross-sectional observational study. PLoS One 2017; 12:e0183936. [PMID: 28850631 PMCID: PMC5574546 DOI: 10.1371/journal.pone.0183936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/14/2017] [Indexed: 11/11/2022] Open
Abstract
Background Madagascar conducted the first two phases of a national free mass distribution campaign of long-lasting insecticidal nets (LLINs) during a political crisis in 2009 aiming to achieve coverage of two LLINs per household as part of the National Malaria Control Strategy. The campaign targeted households in 19 out of 91 total health districts. Methods A community-based cross-sectional household survey using a three-stage cluster sample design was conducted four months post campaign to assess LLIN ownership, access and use. Multivariable logistic regression analysis was used to identify factors associated with household LLIN access and individual LLIN use. Results A total of 2211 households were surveyed representing 8867 people. At least one LLIN was present in 93.5% (95% confidence interval [CI], 91.6–95.5%) of households and 74.8% (95% CI, 71.0–78.6%) owned at least two LLINs. Access measured as the proportion of the population that could potentially be covered by household-owned LLINs was 77.2% (77.2% (95% CI, 72.9–81.3%) and LLIN use by all individuals was 84.2% (95% CI, 81.2–87.2%). LLIN use was associated with knowledge of insecticide treated net use to prevent malaria (OR = 3.58, 95% CI, 1.85–6.94), household ownership of more LLINs (OR 2.82, 95% CI 1.85–4.3), presence of children under five (OR = 2.05, 95% CI, 1.67–2.51), having traveled to the distribution point and receiving information about hanging a bednet (OR = 1.56, 95% CI, 1.41–1.74), and having received a post-campaign visit by a community mobilizer (OR = 1.75, 95% CI, 1.26–2.43). Lower LLIN use was associated with increasing household size (OR = 0.81 95% CI 0.77–0.85) and number of sleeping spaces (OR = 0.55, 95% CI, 0.44–0.68). Conclusions A large scale free mass LLIN distribution campaign was feasible and effective at achieving high LLIN access and use in Madagascar. Campaign process indicators highlighted potential areas for strengthening implementation to optimize access and equity.
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Affiliation(s)
- Alyssa M. Finlay
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, President’s Malaria Initiative, Antananarivo, Madagascar
- * E-mail:
| | - Jessica Butts
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, President’s Malaria Initiative, Atlanta, Georgia, United States of America
| | | | - Annett H. Cotte
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, President’s Malaria Initiative, Atlanta, Georgia, United States of America
| | | | | | | | - Michelle Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, President’s Malaria Initiative, Atlanta, Georgia, United States of America
| | - Jodi Vanden Eng
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, President’s Malaria Initiative, Atlanta, Georgia, United States of America
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Low Utilization of Insecticide-Treated Bed Net among Pregnant Women in the Middle Belt of Ghana. Malar Res Treat 2017; 2017:7481210. [PMID: 28828192 PMCID: PMC5554553 DOI: 10.1155/2017/7481210] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/20/2017] [Accepted: 06/13/2017] [Indexed: 11/17/2022] Open
Abstract
Background Malaria in pregnancy leads to low birth weight, premature birth, anaemia, and maternal and neonatal mortality. Use of insecticide-treated nets (ITNs) during pregnancy is one of the proven interventions to reduce the malaria burden. However, Ghana has not achieved its target for ITN use among pregnant women. Methods A qualitative study was conducted in seven communities purposively selected from the middle belt of Ghana. Participants who had delivered in the six months prior to this study were selected. In all, seven focus group discussions and twenty-four in-depth interviews were conducted between June and August 2010. Results Respondents knew of the importance of ITNs and other malaria-preventive strategies. Factors such as financial access and missed opportunities of free distribution denied some pregnant women the opportunity to own or use an ITN. Reasons for not using ITNs during pregnancy included discomfort resulting from heat, smell of the net, and difficulty in hanging the net. Participants maintained their ITNs by preventing holes in the nets, retreatment, and infrequent washing. Conclusion Pregnant women know about the causes and prevention of malaria. However, this knowledge is not transformed into practice due to lack of access to ITNs and sleeping discomforts among other logistical constraints.
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Daygena TY, Massebo F, Lindtjørn B. Variation in species composition and infection rates of Anopheles mosquitoes at different altitudinal transects, and the risk of malaria in the highland of Dirashe Woreda, south Ethiopia. Parasit Vectors 2017; 10:343. [PMID: 28724450 PMCID: PMC5518156 DOI: 10.1186/s13071-017-2288-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 07/13/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The transmission of malaria is heterogeneous, and varies due to altitude. The information on whether the transmission of malaria is indigenous or imported to highland areas is scarce. Therefore, this study aimed to assess the species composition and infection rates of Anopheles at different altitudinal transects, and the risk of malaria if any in the highland of Dirashe Woreda, South Ethiopia. METHODS This study was conducted in Gato (low altitude; average elevation of 1273 m), Onota (mid-altitude; average elevation of 1707 m) and Layignaw-Arguba (high altitude; average elevation of 2337 m) from August 2015 to April 2016. Anopheles mosquitoes were sampled using Centers for Disease Control and Prevention (CDC) light traps from thirty houses (ten houses from each village). The circum-sporozoite proteins (CSPs) rate and entomological inoculation rate (EIR) of Anopheles mosquitoes were estimated. For the epidemiological survey, malaria cases were collected from laboratory registration books of selected health facilities from (August 2015-April 2016). A cross-sectional survey was done to collect data on malaria vector control activities in each village (August-September 2015). RESULTS One thousand two hundred sixty-eight Anopheles mosquitoes comprising Anopheles arabiensis, An. demeilloni, An. cinereus, An. pharoensis, An. funestus-group, An. pretoriensis, An. christyi, An. ardensis and An. tenebrosus were identified in the study area. Anopheles arabiensis was the dominant species in Gato, whereas An. demeilloni was the dominant species in Layignaw-Arguba. Five mosquitoes, three An. arabiensis from Gato and two An. demeilloni from Layignaw-Arguba, were positive for Plasmodium falciparum CSPs. Plasmodium falciparum CSP rate was 0.4% (95% CI: 0.08-1.15) for An. arabiensis in Gato, and it was 0.64% (95% CI: 0.08-2.3) for An. demeilloni from Layignaw-Arguba. The P. falciparum EIR of An. arabiensis was 8.6 (95% CI: 2.4-33.4) infectious bites/person/nine-months in Gato. Plasmodium falciparum parasite was dominant in Gato (88%) and Onota (57.5%), whereas in Layignaw-Arguba P. vivax (59.4%) occurred most frequently. Increased malaria cases were observed in children age 5-14 years in Gato (P < 0.05), whereas in Onota and Layignaw-Arguba there was no statistically significant difference in malaria cases among the age groups. Households owning at least one long lasting insecticidal net were 92.7% in the study area, and 77.6% slept under the net during the preceding night of the survey. About 64.4% of the households in Gato were protected by the indoor residual spray. However, the spraying was done when the density of local malaria vectors was low. CONCLUSION Incrimination of Plasmodium CSP positive Anopheles species and the presence of malaria in children under five years in high altitude Layignaw-Arguba may justify the existence of indigenous malaria transmission and the need for effective malaria control. Further investigation and confirmation using more sensitive molecular techniques are however needed to consider An. demeilloni as a proven vector of malaria in Ethiopia.
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Affiliation(s)
- Taye Yohannes Daygena
- Department of Biology, Arba Minch University, Arba Minch, Ethiopia
- Dirashe Woreda Health Office, Malaria and Other Vector-Borne Diseases Control Unit, Gidole, Ethiopia
| | - Fekadu Massebo
- Department of Biology, Arba Minch University, Arba Minch, Ethiopia
| | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
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Tassew A, Hopkins R, Deressa W. Factors influencing the ownership and utilization of long-lasting insecticidal nets for malaria prevention in Ethiopia. Malar J 2017; 16:262. [PMID: 28668084 PMCID: PMC5493859 DOI: 10.1186/s12936-017-1907-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 06/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Utilization of long-lasting insecticidal nets (LLINs) is regarded as key malaria prevention and control strategy. However, studies have reported a large gap in terms of both ownership and utilization particularly in the sub-Saharan Africa (SSA). With continual efforts to improve the use of LLIN and to progress malaria elimination, examining the factors influencing the ownership and usage of LLIN is of high importance. Therefore, the current study was conducted to examine the level of ownership and use of LLIN along with identification of associated factors at household level. METHODS A cross-sectional study was conducted in Mirab Abaya District, Southern Ethiopia in June and July 2014. A total of 540 households, with an estimated 2690 members, were selected in four kebeles of the district known to have high incidence of malaria. Trained data collectors interviewed household heads to collect information on the knowledge, ownership and utilization of LLINs, which was complemented by direct observation on the conditions and use of the nets through house-to-house visit. Bivariate and multivariable logistic regression analyses were used to determine factors associated to LLIN use. RESULTS Of 540 households intended to be included in the survey, 507 responded to the study (94.24% response rate), covering the homes of 2759 people. More than 58% of the households had family size >5 (the regional average), and 60.2% of them had at least one child below the age of 5 years. The ownership of at least one LLIN among households surveyed was 89.9%, and using at least one LLIN during the night prior to the survey among net owners was 85.1% (n = 456). Only 36.7% (186) mentioned at least as the mean of correct scores of all participants for 14 possible malaria symptoms and 32.7% (166) knew at least as the mean of correct scores of all participants for possible preventive methods. Over 30% of nets owned by the households were out of use. After controlling for confounding factors, having two or more sleeping places (adjusted odds ratio [aOR] = 2.58, 95% CI 1.17, 5.73), knowledge that LLIN prevents malaria (aOR = 2.51, 95% CI 1.17, 5.37), the presence of hanging bed nets (aOR = 19.24, 95% CI 9.24, 40.07) and walls of the house plastered or painted >12 months ago (aOR = 0.09, 95% CI 0.01, 0.71) were important predictors of LLIN utilization. CONCLUSIONS This study found a higher proportion of LLIN ownership and utilization by households than had previously been found in similar studies in Ethiopia, and in many studies in SSA. However, poor knowledge of the transmission mechanisms and the symptoms of malaria, and vector control measures to prevent malaria were evident. Moderate proportions of nets were found to be out of use or in poor repair. Efforts should be in place to maintain the current rate of utilization of LLIN in the district and improve on the identified gaps in order to support the elimination of malaria.
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Affiliation(s)
- Admasu Tassew
- Ethiopian Institute of Water Resources, Addis Ababa University, Akaki Campus, P. O. Box 150461, Addis Ababa, Ethiopia. .,Department of Biology, Arba Minch University, Arba Minch, Ethiopia.
| | - Richard Hopkins
- Natural Resources Institute, University of Greenwich, Chatham Maritime, UK
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Ntuku HM, Ruckstuhl L, Julo-Réminiac JE, Umesumbu SE, Bokota A, Tshefu AK, Lengeler C. Long-lasting insecticidal net (LLIN) ownership, use and cost of implementation after a mass distribution campaign in Kasaï Occidental Province, Democratic Republic of Congo. Malar J 2017; 16:22. [PMID: 28068989 PMCID: PMC5223346 DOI: 10.1186/s12936-016-1671-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Long-lasting insecticidal nets (LLIN) are a highly effective means for preventing malaria infection and reducing associated morbidity and mortality. Mass free distribution campaigns have been shown to rapidly increase LLIN ownership and use. Around 3.5 million LLINs were distributed free of charge in the Kasaï Occidental Province in the Democratic Republic of Congo (DRC) in September–October 2014, using two different approaches, a fixed delivery strategy and a door-to-door strategy including hang-up activities. Methods Repeated community-based cross-sectional surveys were conducted 2 months before and six months after the mass distribution. Descriptive statistics were used to measure changes in key malaria household indicators. LLIN ownership and use were compared between delivery strategies. Univariate and multivariate logistic regression analyses were used to identify factors associated with LLIN use before and after the mass distribution. A comparative financial cost analysis between the fixed delivery and door-to-door distribution strategies was carried out from the provider’s perspective. Results Household ownership of at least one LLIN increased from 39.4% pre-campaign to 91.4% post-campaign and LLIN universal coverage, measured as the proportion of households with at least one LLIN for every two people increased from 4.1 to 41.1%. Population access to LLIN within the household increased from 22.2 to 80.7%, while overall LLIN use increased from 18.0 to 68.3%. Higher LLIN ownership was achieved with the fixed delivery strategy compared with the door-to-door (92.5% [95% CI 90.2–94.4%] versus 85.2% [95% CI 78.5–90.0%]), while distribution strategy did not have a significant impact on LLIN use (69.6% [95% CI 63.1–75.5%] versus 65.7% [95% CI 52.7–76.7%]). Malaria prevalence among children aged 6–59 months was 44.8% post-campaign. Living in a household with sufficient numbers of LLIN to cover all members was the strongest determinant of LLIN use. The total financial cost per LLIN distributed was 6.58 USD for the fixed distribution strategy and 6.61 USD for the door-to-door strategy. Conclusions The mass distribution campaign was effective for rapidly increasing LLIN ownership and use. These gains need to be sustained for long-term reduction in malaria burden. The fixed delivery strategy achieved a higher LLIN coverage at lower delivery cost compared with the door-to-door strategy and seems to be a better distribution strategy in the context of the present study setting.
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Affiliation(s)
- Henry Maggi Ntuku
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Laura Ruckstuhl
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Solange E Umesumbu
- National Malaria Control Programme, Kinshasa, Democratic Republic of Congo
| | - Alain Bokota
- National Malaria Control Programme, Kinshasa, Democratic Republic of Congo
| | | | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Odhiambo MT, Vulule JM, Afrane YA, Ombok M, Bosselmann R, Skovmand O. Supplementary effect and durability of prototype insecticide-treated eave curtains on indoor resting mosquitoes in Kadibo division, Western Kenya. MALARIAWORLD JOURNAL 2016; 7:11. [PMID: 38601356 PMCID: PMC11003215 DOI: 10.5281/zenodo.10818166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Background Use of insecticide treated bednets (ITNs) was a breakthrough in the fight against malaria. However, ITNs are only effective when properly used. Recent reports indicate low compliance in ITN usage and changes in biting times of malaria vectors with early and late biting cases recorded when people are not sleeping under their nets. Hence, there is a need to develop methods to supplement or replace the use of ITNs for malaria vector control. A field trial was conducted to investigate the effect and longevity of prototypes of long lasting impregnated UV protected eave nets, curtains and door hangers (fully screened houses), compared to houses with bednets only, in traditional East African houses. Materials and methods A randomised controlled trial was carried out in the Ahero rice irrigation scheme in Nyando district, Western Kenya. Eighty houses with open eaves were randomly selected. Forty of these houses were fully screened (FSH+LLINs) with long lasting insecticide-treated nets/curtains used to screen the eaves, windows and doors. The FSH materials were produced with anti-UV additives. The other 40 houses served as controls. Long lasting insecticide-treated bednets (LLINs) were suspended over all sleeping areas in the control and intervention houses. Indoor resting Anopheles mosquitoes were collected using pyrethrum spray catches (PSC) during both dry and wet seasons. Indoor population densities of anophelines were compared between intervention (FSH+LLINs) and control (LLINs) houses. Loss of insecticide (deltamethrin) was compared after 12 and 24 months for both the FSH materials and LLINs through bioassays and chemical analyses. Results In the FSH+LLINs houses densities of indoor resting Anopheles funestus and An. arabiensis were reduced by 82% (RR=0.18, 95% CI 0.09-0.36, P<0.0001) and 70% (RR=0.30, 95% CI 0.15-0.58, P<0.0001), respectively. No significant difference was recorded for indoor resting Culex spp. (RR=0.95, 95% CI 0.48-1.86, P=0.8). The population of indoor resting bloodfed An. arabiensis and An. funestus was reduced by 72% (RR=0.22, 95% CI 0.09-0.51, P<0.0001) and 84% (RR=0.16, 95% CI 0.07-0.33, P<0.0001) in the FSH+LLINs houses and LLIN houses, respectively. Insecticide loss in eave nets did not depend on the side of the house where the nets were placed. The eave nets showed little loss of bio efficacy over the 12-24 months period. Conclusions The study revealed that the use of insecticide-treated nets on the eaves and windows combined with door hangers largely impeded entrance of anopheline mosquitoes into houses and can be used to compliment LLINs for household protection. The eave nets were suspended from wood structures near the eave and remained in place when walls were re-plastered. The nets are therefore not depending on daily compliance behaviour and provide protection for the entire household.
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Affiliation(s)
- Martin T.O. Odhiambo
- Centre for Global Health Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya
- Jaramogi Oginga Odinga University of Science and Technology, PO Box 210-40601, Bondo, Kenya
| | - John M. Vulule
- Centre for Global Health Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya
| | - Yaw A. Afrane
- Centre for Global Health Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya
- Jaramogi Oginga Odinga University of Science and Technology, PO Box 210-40601, Bondo, Kenya
| | - Maurice Ombok
- Centre for Global Health Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya
| | - Rune Bosselmann
- Intelligent Insect Control (IIC), 118 Chemin des Alouettes, Castelnau-le-Lez, France
| | - Ole Skovmand
- Intelligent Insect Control (IIC), 118 Chemin des Alouettes, Castelnau-le-Lez, France
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Tang S, Ji L, Hu T, Bishwajit G, Da Feng, Ming H, Xian Y, Fu Q, He Z, Fu H, Wang R, Feng Z. Determinants of public malaria awareness during the national malaria elimination programme: a cross-sectional study in rural China. Malar J 2016; 15:372. [PMID: 27430322 PMCID: PMC4950815 DOI: 10.1186/s12936-016-1427-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/05/2016] [Indexed: 12/12/2022] Open
Abstract
Background Public malaria health promotion is an integral part of the national malaria elimination programme, which was launched by the Chinese government in 2010. However, the public awareness of malaria needs to improve. This study aims to explore the determinants of public awareness of malaria. Methods A cross-sectional survey was conducted using stratified sampling method from June 2015 to March 2016. Bivariate logistic regression was performed to explore the association between predictors and malaria awareness in the sample population. The homogeneity of the interaction between group assignment and the degree of knowledge related to malaria among the subgroups was calculated by Cochran–Mantel–Haenszel test. Results Community media (including bulletin boards of village clinics or township hospitals, newspapers, exercise books, shopping bags, aprons, disposable cups, leaflets and banner advertisements) was the most prominent determinant influencing public awareness of malaria. The probability of having high-degree of knowledge about malaria among participants who received malaria-related information from community media were 3.99 times greater than those who did not (odds ratio 3.99, 95 % confidence interval 3.04–5.25, p < 0.001). Moreover, socio-demographic predictors including age, distance to township hospital, endemic county type, history of suffering from malaria, electronic media, self-assessed household income level, educational attainment and the knowledge about malaria were clearly associated with public awareness of malaria. Conclusions Community media played the most important role in public awareness of malaria. However, only a few participants have received malaria knowledge through this media. It suggests that community media was an effective publicity material, which should expand its coverage. Malaria health promotion campaign needs to be aligned with target populations, in particular, people who are under 45 years old and residents (especially in type-3 counties) in remote areas.
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Affiliation(s)
- Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Lu Ji
- Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Tao Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China.,Bureau of Disease Prevention and Control, National Health and Family, Beijing, China
| | - Ghose Bishwajit
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Da Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Hui Ming
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Yue Xian
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Qian Fu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Zhifei He
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Hang Fu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Ruoxi Wang
- University of Nottingham, Nottingham, UK
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China.
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20
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Hailu A, Lindtjørn B, Deressa W, Gari T, Loha E, Robberstad B. Equity in long-lasting insecticidal nets and indoor residual spraying for malaria prevention in a rural South Central Ethiopia. Malar J 2016; 15:366. [PMID: 27422024 PMCID: PMC4947266 DOI: 10.1186/s12936-016-1425-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 07/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background While recognizing the recent achievement in the global fight against malaria, the disease remains a challenge to health systems in low-income countries. Beyond widespread consensuses about prioritizing malaria prevention, little is known about the prevailing status of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) across different levels of wealth strata. The aim of this study was to evaluate the socioeconomic related dimension of inequalities in malaria prevention interventions. Methods This study was conducted in July–August 2014 in Adami Tullu district in the South-central Ethiopia, among 6069 households. A cross-sectional data were collected on household characteristics, LLIN ownership and IRS coverage. Principal component analysis technique was used for ranking households based on socioeconomic position. The inequality was measured using concentration indices and concentration curve. Decomposition method was employed in order to quantify the percentage contribution of each socioeconomic related variable on the overall inequality. Results The proportion of households with at least one LLIN was 11.6 % and IRS coverage was 72.5 %. The Erreygers normalized concentration index was 0.0627 for LLIN and 0.0383 for IRS. Inequality in LLIN ownership was mainly associated with difference in housing situation, household size and access to mass-media and telecommunication service. Conclusion Coverage of LLIN was low and significant more likely to be owned by the rich households, whereas houses were sprayed equitably. The current mass free distribution of LLINs should be followed by periodic refill based on continuous monitoring data.
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Affiliation(s)
- Alemayehu Hailu
- Center for International Health, University of Bergen, Bergen, Norway. .,Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
| | - Bernt Lindtjørn
- Center for International Health, University of Bergen, Bergen, Norway
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Taye Gari
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
| | - Eskindir Loha
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
| | - Bjarne Robberstad
- Center for International Health, University of Bergen, Bergen, Norway.,Center for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
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Babalola S, Ricotta E, Awantang G, Lewicky N, Koenker H, Toso M. Correlates of Intra-Household ITN Use in Liberia: A Multilevel Analysis of Household Survey Data. PLoS One 2016; 11:e0158331. [PMID: 27403877 PMCID: PMC4942134 DOI: 10.1371/journal.pone.0158331] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 06/14/2016] [Indexed: 11/02/2022] Open
Abstract
Malaria is a major cause of morbidity and mortality in Liberia. At the same time, insecticide-treated net (ITN) ownership and use remain low. Access is a key determinant of ITN use but it is not the only one; prior studies have identified factors that affect the use of ITNs in households with at least one ITN. These factors operate at the individual, household, and community levels. However, studies have generally not assessed the psychosocial or ideational determinants of ITN use. Using 2014 household survey data, this manuscript examines the socio-demographic, ideational, household, and community factors associated with household member use of ITNs in Liberia. Multilevel modeling was used to assess fixed effects at the individual, household, and community levels, and random effects at the household and cluster levels. The data showed significant residual clustering at the household level, indicating that there were unmeasured factors operating at this level that are associated with ITN use. The association of age with ITN use was moderated by sex such that men, older children, and teenagers were less likely to sleep under an ITN compared to women and children under five years old. Female caregivers' perceived severity of malaria, perceived self-efficacy to detect a complicated case of malaria, and exposure to the "Take Cover" communication campaign were positively associated with ITN use by members of her household. The association with household size was negative, while the relationship with the number of ITNs was positive. Programs should seek to achieve universal coverage (that is, one ITN for every two household members) and promote the notion that everyone needs to sleep under an ITN every night. Programs should also seek to strengthen perceived severity of malaria and educate intended audience groups on the signs of malaria complications. Given the significance of residual clustering at the household level, interventions that engage men as heads of household and key decision-makers are relevant.
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Affiliation(s)
- Stella Babalola
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
- * E-mail:
| | - Emily Ricotta
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
| | - Grace Awantang
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
| | - Nan Lewicky
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
| | - Hannah Koenker
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
| | - Michael Toso
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
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Regmi K, Kunwar A, Ortega L. A systematic review of knowledge, attitudes and beliefs about malaria among the South Asian population. Infect Ecol Epidemiol 2016; 6:30822. [PMID: 27141987 PMCID: PMC4854845 DOI: 10.3402/iee.v6.30822] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/02/2016] [Accepted: 04/06/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Malaria is one of the deadliest mosquito-borne diseases in the world. More than 80% of the total populations are at risk of malaria in the 22 countries in Asia and the Pacific. South Asia alone is home to an estimated 1.4 billion people at risk of contracting malaria. Despite the remarkable progress in reducing the burden of malaria, evidence of the disease based on knowledge of the social and cultural contexts from a South Asian perspective is limited. Our objective was to understand the knowledge, attitudes and beliefs about malaria in South Asian communities. METHODOLOGY We conducted a systematic literature review, searching six databases, between 1990 and 2015, focusing on knowledge, attitudes and beliefs about malaria in South Asia. Databases were searched using both 'free terms' and 'index terms' funnelled using Boolean operators and truncations. Inclusion and exclusion criteria were set, and included papers were scrutinised, employing a critical appraisal tool to find the best available evidences to support the study purpose. RESULTS AND DISCUSSION Evidence from 32 articles (26 quantitative, four qualitative and two mixed methods). General knowledge and awareness of the disease, its transmission, and control and preventative measures were generally found to be lacking amongst both the general public and healthcare professionals. In addition, the study shows that poor socio-economic factors - including limited access to services due to poor/limited availability - and issues of affordability are considered as major risk factors. CONCLUSION This review suggests the importance of increasing health awareness, mobilising the local or community healthcare professionals, for prevention as well as early detection and effective treatment of malaria among people who are at risk. Malaria is also a disease associated with poverty and socio-cultural factors; therefore, strong political will, wider partnerships between health and non-health sectors, and strengthening health systems' technical and managerial capabilities at all level of primary healthcare systems, is inevitable.
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Affiliation(s)
- Krishna Regmi
- Faculty of Health and Social Sciences, Institute for Health Research, University of Bedfordshire, Luton, UK;
| | - Anju Kunwar
- Faculty of Health and Social Sciences, Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Leonard Ortega
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
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Mattern C, Pourette D, Raboanary E, Kesteman T, Piola P, Randrianarivelojosia M, Rogier C. "Tazomoka Is Not a Problem". Local Perspectives on Malaria, Fever Case Management and Bed Net Use in Madagascar. PLoS One 2016; 11:e0151068. [PMID: 26943672 PMCID: PMC4778873 DOI: 10.1371/journal.pone.0151068] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/23/2016] [Indexed: 11/19/2022] Open
Abstract
Background Although its incidence has been decreasing during the last decade, malaria is still a major public health issue in Madagascar. The use of Long Lasting Insecticidal Nets (LLIN) remains a key malaria control intervention strategy in Madagascar, however, it encounters some obstacles. The present study aimed to explore the local terminology related to malaria, information channels about malaria, attitude towards bed nets, and health care seeking practices in case of fever. This article presents novel qualitative findings about malaria. Until now, no such data has been published for Madagascar. Methods A comparative qualitative study was carried out at four sites in Madagascar, each differing by malaria epidemiology and socio-cultural background of the populations. Seventy-one semi-structured interviews were conducted with biomedical and traditional caregivers, and members of the local population. In addition, observations of the living conditions and the uses of bed net were conducted. Results Due to the differences between local and biomedical perspectives on malaria, official messages did not have the expected impact on population in terms of prevention and care seeking behaviors. Rather, most information retained about malaria was spread through informal information circulation channels. Most interviewees perceived malaria as a disease that is simple to treat. Tazomoka (“mosquito fever”), the Malagasy biomedical word for malaria, was not used by populations. Tazo (“fever”) and tazomahery (“strong fever”) were the terms more commonly used by members of the local population to refer to malaria related symptoms. According to local perceptions in all areas, tazo and tazomahery were not caused by mosquitos. Each of these symptoms required specific health recourse. The usual fever management strategies consisted of self-medication or recourse to traditional and biomedical caregivers. Usage of bed nets was intermittent and was not directly linked to protection against malaria in the eyes of most Malagasy people. Conclusions This article highlights the conflicting understanding of malaria between local perceptions and the biomedical establishment in Madagascar. Local perceptions of malaria present a holistic vision of the disease that includes various social and cultural dimensions, rather than reflecting one universal understanding, as in the biomedical image. The consideration of this “holistic vision” and other socio-cultural aspects surrounding the understanding of malaria is essential in implementing successful control intervention strategies.
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Affiliation(s)
- Chiarella Mattern
- Epidemiology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Dolorès Pourette
- Centre Population et Développement (CEPED), Institut de Recherche pour le Développement, Paris, France
- Université Catholique de Madagascar, Antananarivo, Madagascar
| | - Emma Raboanary
- Epidemiology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Thomas Kesteman
- Malaria research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Patrice Piola
- Epidemiology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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Berkessa T, Oljira D, Tesfa B. Insecticide treated nets use and its determinants among settlers of Southwest Ethiopia. BMC Public Health 2016; 16:106. [PMID: 26830027 PMCID: PMC4736163 DOI: 10.1186/s12889-016-2768-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 01/22/2016] [Indexed: 11/15/2022] Open
Abstract
Background Ethiopia is rapidly increasing insecticide-treated nets (ITNs) coverage to combat malaria, but adequate follow-up and factors affecting use of ITNs is lacking. The aim of this study was to assess determinants of the use of ITNs in a southwest area of Ethiopia. Methods This cross-sectional survey was conducted in the Chewaka district settlement area of southwest Oromia from March to May, 2013. Kebeles were stratified by degree of urbanization (rural, peri-urban, or urban). Randomly selected households, which had been freely supplied with at least one ITN, were surveyed using a pre-tested, structured questionnaire administered through household interviews. Logistic regression analysis was used to examine the association between use of ITNs and determinant factors. Results Of 574 households surveyed, 72.6 % possessed ITNs and 80 % of these had been used the night before the survey. The most common reasons for the absence ITNs in the household identified in this study were ITNs were old and therefore discarded and that households use ITNs for purposes other than their intended use. The multivariate analysis found that knowledge of malaria transmission by mosquito bites (Adjusted OR = 3.44, 95 % CI: 1.80–6.59), and washing of ITNs at least once by households (Adjusted OR = 2.66, 95 % CI: 1.35–5.26) were significantly associated with an ITN being used by households. The mean possession was 1.59 ITN per household (3.57 persons per an ITN). One hundred fifty four (36.9 %) of ITNs had at least one hole/tear. Among these, 108 (70.1 %) ITNs had at least one hole/tear with greater than 2 cm and 29 (18.8 %) had greater than seven holes/tears. Conclusions This study in Southwest Ethiopia showed a high proportion of net ownership compared to a household survey from Ethiopia which included in the World Malaria Report. Despite somewhat high percentages ITN ownership, the study demonstrated there was still a gap between ownership and use of ITNs. Use of ITNs was affected by knowledge of malaria transmission by mosquito bite and washing of ITNs at least once by households. Intensive health education and community mobilization efforts should be employed to attempt to influence these factors that significantly affect ITN use.
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Affiliation(s)
- Tsegaye Berkessa
- Department of Public Health, Faculty of Public Health and Medical Sciences, Mettu University, Mettu, PO Box 318, Ilu Ababor, Ethiopia.
| | - D Oljira
- Department of Public Health, Faculty of Public Health and Medical Sciences, Mettu University, Mettu, PO Box 318, Ilu Ababor, Ethiopia
| | - B Tesfa
- Department of Midwifery, Faculty of Public Health and Medical Sciences, Mettu University, Mettu, PO Box 318, Ilu Ababor, Ethiopia
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Pinchoff J, Hamapumbu H, Kobayashi T, Simubali L, Stevenson JC, Norris DE, Colantuoni E, Thuma PE, Moss WJ. Factors Associated with Sustained Use of Long-Lasting Insecticide-Treated Nets Following a Reduction in Malaria Transmission in Southern Zambia. Am J Trop Med Hyg 2015; 93:954-60. [PMID: 26324729 DOI: 10.4269/ajtmh.15-0093] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 06/19/2015] [Indexed: 11/07/2022] Open
Abstract
Understanding factors influencing sustained use of long-lasting insecticide-treated nets (LLIN) in areas of declining malaria transmission is critical to sustaining control and may facilitate elimination. From 2008 to 2013, 655 households in Choma District, Zambia, were randomly selected and residents were administered a questionnaire and malaria rapid diagnostic test. Mosquitoes were collected concurrently by light trap. In a multilevel model, children and adolescents of 5-17 years of age were 55% less likely to sleep under LLIN than adults (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.35, 0.58). LLIN use was 80% higher during the rainy season (OR = 1.8; CI = 1.5, 2.2) and residents of households with three or more nets were over twice as likely to use a LLIN (OR = 2.1; CI = 1.4, 3.1). For every increase in 0.5 km from the nearest health center, the odds of LLIN use decreased 9% (OR = 0.9; CI = 0.88, 0.98). In a second multilevel model, the odds of LLIN use were more than twice high if more than five mosquitoes (anopheline and culicine) were captured in the house compared with households with no mosquitoes captured (OR = 2.1; CI = 1.1, 3.9). LLIN use can be sustained in low-transmission settings with continued education and distributions, and may be partially driven by the presence of nuisance mosquitoes.
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Affiliation(s)
- Jessie Pinchoff
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Harry Hamapumbu
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Tamaki Kobayashi
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Limonty Simubali
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer C Stevenson
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Douglas E Norris
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth Colantuoni
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Philip E Thuma
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Kilian A, Koenker H, Obi E, Selby RA, Fotheringham M, Lynch M. Field durability of the same type of long-lasting insecticidal net varies between regions in Nigeria due to differences in household behaviour and living conditions. Malar J 2015; 14:123. [PMID: 25890233 PMCID: PMC4376338 DOI: 10.1186/s12936-015-0640-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/04/2015] [Indexed: 11/10/2022] Open
Abstract
Background With the recent publication of WHO-recommended methods to estimate net survival, comparative analyses from different areas have now become possible. With this in mind, a study was undertaken in Nigeria to compare the performance of a specific long-lasting insecticidal net (LLIN) product in three socio-ecologically different areas. In addition, the objective was to assess the feasibility of a retrospective study design for durability. Methods In three states, Zamfara in the north, Nasarawa in the centre and Cross River in the south, four local government areas were selected one year after mass distribution of 100-denier polyester LLINs. From a representative sample of 300 households per site that had received campaign nets, an assessment of net survival was made based on rate of loss of nets and the physical condition of surviving nets measured by the proportionate hole index (pHI). Surveys were repeated after two and three years. Results Over the three-year period 98% of the targeted sample size of 3,720 households was obtained and 94% of the 5,669 campaign nets found were assessed for damage. With increasing time since distribution, recall of having received campaign nets dropped by 11-22% and only 31-87% of nets actually lost were reported. Using a recall bias adjustment, attrition rates were fairly similar in all three sites. The proportion of surviving nets in serviceable condition differed dramatically, however, resulting in an estimated median net survival of 3.0 years in Nasarawa, 4.5 years in Cross River and 4.7 years in Zamfara. Although repairs on damaged nets increased from around 10% at baseline to 21-38% after three years, the average pHI value for each of the four hole size categories did not differ between repaired and unrepaired nets. Conclusions First, the differences observed in net survival are driven by living conditions and household behaviours and not the LLIN material. Second, recall bias in a retrospective durability study can be significant and while adjustments can be made, enough uncertainty remains that prospective studies on durability are preferable wherever possible. Third, repair does not seem to measurably improve net condition and focus should, therefore, be on improving preventive behaviour. Electronic supplementary material The online version of this article (doi:10.1186/s12936-015-0640-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Albert Kilian
- Tropical Health LLP, Montagut, Spain. .,Malaria Consortium, London, UK.
| | - Hannah Koenker
- Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, USA.
| | - Emmanuel Obi
- Malaria Consortium Nigeria Office, Abuja, Nigeria.
| | | | - Megan Fotheringham
- United States Agency for International Development, President's Malaria Initiative, Washington, DC, USA.
| | - Matthew Lynch
- Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, USA.
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Larson PS, Minakawa N, Dida GO, Njenga SM, Ionides EL, Wilson ML. Insecticide-treated net use before and after mass distribution in a fishing community along Lake Victoria, Kenya: successes and unavoidable pitfalls. Malar J 2014; 13:466. [PMID: 25431086 PMCID: PMC4289357 DOI: 10.1186/1475-2875-13-466] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Insecticide-treated nets (ITNs) have proven instrumental in the successful reduction of malaria incidence in holoendemic regions during the past decade. As distribution of ITNs throughout sub-Saharan Africa (SSA) is being scaled up, maintaining maximal levels of coverage will be necessary to sustain current gains. The effectiveness of mass distribution of ITNs, requires careful analysis of successes and failures if impacts are to be sustained over the long term. Methods Mass distribution of ITNs to a rural Kenyan community along Lake Victoria was performed in early 2011. Surveyors collected data on ITN use both before and one year following this distribution. At both times, household representatives were asked to provide a complete accounting of ITNs within the dwelling, the location of each net, and the ages and genders of each person who slept under that net the previous night. Other data on household material possessions, education levels and occupations were recorded. Information on malaria preventative factors such as ceiling nets and indoor residual spraying was noted. Basic information on malaria knowledge and health-seeking behaviours was also collected. Patterns of ITN use before and one year following net distribution were compared using spatial and multi-variable statistical methods. Associations of ITN use with various individual, household, demographic and malaria related factors were tested using logistic regression. Results After infancy (<1 year), ITN use sharply declined until the late teenage years then began to rise again, plateauing at 30 years of age. Males were less likely to use ITNs than females. Prior to distribution, socio-economic factors such as parental education and occupation were associated with ITN use. Following distribution, ITN use was similar across social groups. Household factors such as availability of nets and sleeping arrangements still reduced consistent net use, however. Conclusions Comprehensive, direct-to-household, mass distribution of ITNs was effective in rapidly scaling up coverage, with use being maintained at a high level at least one year following the intervention. Free distribution of ITNs through direct-to-household distribution method can eliminate important constraints in determining consistent ITN use, thus enhancing the sustainability of effective intervention campaigns. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-466) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter S Larson
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
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Boulay M, Lynch M, Koenker H. Comparing two approaches for estimating the causal effect of behaviour-change communication messages promoting insecticide-treated bed nets: an analysis of the 2010 Zambia malaria indicator survey. Malar J 2014; 13:342. [PMID: 25174278 PMCID: PMC4161873 DOI: 10.1186/1475-2875-13-342] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/26/2014] [Indexed: 11/17/2022] Open
Abstract
Over the past decade, efforts to increase the use of insecticide-treated bed nets (ITNs) have relied primarily on the routine distribution of bed nets to pregnant women attending antenatal services or on the mass distribution of bed nets to households. While these distributions have increased the proportion of households owning ITNs and the proportion of people sleeping under an ITN the night prior to the survey, the role that behaviour-change communication (BCC) plays in the use of ITNs remains unquantified. This paper uses two analytic approaches, propensity score matching and treatment effect modelling, to examine the relationship between exposure to the BCC messages and the use of a bed net the previous night, using the 2010 Zambia Malaria Indicator Survey (MIS). When matched on similar propensity scores, a statistically significant 29.5 percentage point difference in ITN use is observed between exposed and unexposed respondents. Fifty-nine per cent of unexposed respondents reported sleeping under an ITN the previous night, compared to 88% of the exposed respondents. A smaller but similarly significant difference between exposed and unexposed groups, 12.7 percentage points, is observed in the treatment effect model, which also controls for the number of bed nets owned by the household and exposure to malaria information from health workers. Using either approach, a statistically significant effect of exposure to BCC messages on a woman’s use of an ITN was found. Propensity score matching has the advantage of using statistically-matched pairs and relying on the assumption that given the measured covariates, outcome is independent of treatment assignment (conditional independence assumption), thereby allowing us to mimic a randomized control trial. Results from propensity score matching indicate that BCC messages account for a 29-percentage point increase in the use of ITNs among Zambian households that already own at least one ITN. These analyses serve to illustrate that BCC programmes can contribute to national programmes seeking to increase the use of ITNs inside the home. They also offer a viable approach for evaluating the effectiveness of other BCC programmes promoting behaviour that will reduce malaria transmission or mitigate the consequences of infection.
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Affiliation(s)
- Marc Boulay
- Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA.
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Chourasia MK, Abraham VJ, John J. Household training vs. mass campaigns: a better method of health communication for preventing malaria. Trop Doct 2014; 44:196-200. [PMID: 25161177 DOI: 10.1177/0049475514545201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Malaria is endemic in several states of India with high tribal population. Effective use of long-lasting insecticide treated bed nets (LLITNs) can reduce the burden of malaria in these settings. This study assessed the knowledge and behaviour regarding malaria in a tribal population and compared two health education strategies for enhancing effective utilisation of bed nets. A community-based intervention study was carried out among 218 households in two villages. One community received household level training on effective utilisation of LLITNs while the others received training in a mass campaign and outcomes were measured after 2 months. The study showed that the proportion utilising LLITNs was significantly higher among those receiving household level training as compared to those who received the mass campaign. Household level training appears to be a more effective form of health education for improving knowledge and promoting use of LLITNs in these isolated community groups.
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Affiliation(s)
| | - Vinod J Abraham
- Professor of Community Medicine, Department of Community Health, Christian Medical College, India
| | - Jacob John
- Associate Professor, Department of Community Health, Christian Medical College, India
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Deressa W, Yihdego YY, Kebede Z, Batisso E, Tekalegne A. Individual and household factors associated with use of insecticide treated nets in southern Ethiopia. Trans R Soc Trop Med Hyg 2014; 108:616-24. [PMID: 25170029 DOI: 10.1093/trstmh/tru129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although mass distribution has been considered as the best method to rapidly scale up the coverage of long-lasting insecticidal nets (LLINs) for malaria prevention, little information is available on determinants associated with net utilization at local settings. We studied individual and household factors associated with LLIN use in Halaba district in southern Ethiopia. METHODS This is a population-based survey conducted in October 2008 in 16 randomly selected villages. Data on individual and household characteristics, LLIN ownership and use were collected through house-to-house visits. Univariate and multiple logistic regression models were used to examine the effect of each independent variable on LLIN use by respondents. RESULTS A total of 1235 households participated in the study, and 755/1235 (61.1%) had owned at least one LLIN. Among LLIN-owning households, 419/629 (66.6%) children under the age of five years and 33/55 (60.0%) pregnant women slept under an LLIN the night before the survey. The number of LLINs hung in the household (adjusted OR [aOR] 13.2, 95% CI: 3.7-47.5) and knowledge about malaria (aOR 2.3, 95% CI: 1.2-4.5) were the two important predictors associated with LLINs use. CONCLUSIONS A substantial gap between net ownership and use was identified. Hanging nets and knowledge of malaria predict higher odds of sleeping under an LLIN the previous night. More intensive research on factors that contribute to low LLIN usage is needed.
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Affiliation(s)
- Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yemane Y Yihdego
- Centre for National Health Development in Ethiopia, Addis Ababa, Ethiopia
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Nyunt MH, Aye KM, Kyaw MP, Kyaw TT, Hlaing T, Oo K, Zaw NN, Aye TT, San NA. Challenges in universal coverage and utilization of insecticide-treated bed nets in migrant plantation workers in Myanmar. Malar J 2014; 13:211. [PMID: 24888548 PMCID: PMC4058704 DOI: 10.1186/1475-2875-13-211] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/25/2014] [Indexed: 11/10/2022] Open
Abstract
Background High coverage of the bed nets can reduce mortality and morbidity of mosquito-borne diseases including malaria. Although the migrant workers are at high risk of malaria, there are many hidden challenges in universal coverage and utilization of the insecticide-treated nets (ITNs) in this populations. Methods Cross sectional study was conducted in 170 migrant workers in palm oil plantation sites in Tanintharyi Region and 175 in rubber plantation sites in Mon State. A multistage stratified cluster sampling was applied to select the participants. During household visit, face-to-face interviews using structured pre-coded, pre tested questionnaires and direct observation on installation of the bed nets was conducted. Two focus group discussions in each site were done by sample stratified purposive sampling method mainly focused on effective utilization of bed nets. Results Among them, 332 (96.2%) had a bed net and 284 (82.3%) had an ITN, while 204 (59.1%) had unused extranets. Among the ITNs users, 28.9% reported problems including insecticide smell (56.9%), dizziness (20.2%), headache (12.8%) and itchiness (9.2%). More than 75% received ITNs from health authorities and NGOs free-of-charge. More than 70% wanted to buy a net but they were unaffordable for 64% of them. On observation, only five families could show no bed net, but 80% showed 1–3 ITNs. Consistent utilization in all seasons was noted in 189 (53.1%), that was higher in palm oil plantation than rubber plantation workers (p = 0.0001) due to the nature of the work at night. Perceived malaria risk was also significantly higher ITNs consistent users than non-users (p = 0.0004) and better willingness to buy an ITN by themselves (p = 0.0005). They said that effectiveness of the ITNs was reduced after 6 months and 2–3 times washing. They wished to receive more durable smooth nets with small holes in lace. Misuses of the ITNs such as use the nets for animals and fishing, were also noted. Conclusion There should be efforts to improve effective utilization of ITNs by continuous mass free distribution, durability monitoring, surveillance of insecticide resistance of the vector and behaviour change interventions in migrant plantation workers.
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Affiliation(s)
- Myat H Nyunt
- Department of Medical Research (Lower Myanmar), Yangon, Republic of the Union of Myanmar.
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Recalculating the net use gap: a multi-country comparison of ITN use versus ITN access. PLoS One 2014; 9:e97496. [PMID: 24848768 PMCID: PMC4030003 DOI: 10.1371/journal.pone.0097496] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 04/17/2014] [Indexed: 11/19/2022] Open
Abstract
Use of insecticide treated nets is widely recognized as one of the main interventions to prevent malaria and high use rates are a central goal of malaria programs. The gap between household ownership of at least one ITN and population use of ITN has in the past been seen as evidence for failure to achieve appropriate net use. However, past studies compared net use with ownership of at least one net, not access to sufficient nets within households. This study recalculates the net use gap in recent large household surveys using the comparison indicator of ‘access to nets within the household’ as now recommended by Roll Back Malaria and the World Health Organization. Data from 41 Demographic Health Surveys (DHS) and Malaria Indicator Surveys (MIS) (2005–2012) in sub-Saharan Africa were used. For each dataset three indicators were calculated: population access to ITN, population use of ITN, and household ownership of at least one ITN. The ITN use gap was expressed as the difference between one and the ratio of use to access. The median proportion of users compared to those with access was high, at 82.1%. Even at population access levels below 50%, a median 80.6% used an ITN given they had access, and this rate increased to 91.2% for access rates above 50%. Linear regression of use against access showed that 89.0% of household members with access to nets used them the night before. These results clearly show that previous interpretations of the net use gap as a failure of behavioral change communication interventions were not justified and that the gap was instead primarily driven by lack of intra-household access. They also demonstrate the usefulness of the newly recommended ITN indicators; access to an ITN within the household provides a much more accurate comparison of ITN use than ownership.
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