Socio-economic determinants of ownership and use of treated bed nets in Nigeria: results from a cross-sectional study in Cross River and Bauchi States in 2011

Regional variations in child and mother's characteristics influencing the use of insecticide treated net in Nigeria

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.

Inequalities in the use of insecticide-treated nets by pregnant women in Ghana, 2011 and 2017

BACKGROUND

Pregnant women and children are the most vulnerable group of people usually affected by malaria. The use of insecticide-treated nets is one of the proven interventions for mitigating malaria and its associated deaths in endemic regions, including Ghana. Meanwhile, there is limited evidence on the extent of inequality in insecticide-treated nets use by pregnant women in Ghana. This study assessed the inequalities in insecticide-treated nets use by pregnant women in Ghana.

METHODS

Data from the 2011 and 2017 versions of the Ghana Multiple Indicator Cluster Surveys were used. The 2019 updated World Health Organization (WHO) HEAT software (version 3.1) was used for all analyses. Four equity stratifiers were employed to disaggregate insecticide-treated nets use by pregnant women in Ghana. These are economic status, level of education, place of residence, and sub-national region. Four measures were used to compute inequality namely Difference (D), Population Attributable risk (PAR), Population Attributable Fraction (PAF) and Ratio (R).

RESULTS

The analyses indicated a rise in pregnant women's insecticide-treated nets use from 32.6% in 2011 to 49.7% in 2017. Except sub-national region, all the factors showed mild inequality in insecticide-treated nets use. For instance, with respect to the economic status of pregnant women, only a slight inequality was exhibited by one of the simple measures in both 2011 (R = 0.3; 95% UI = 0.2-0.6) and 2017 (R = 0.5; 95% UI = 0.3-0.7). Marginal inequality in insecticide-treated nets use was noted in 2011 (R = 0.6; 95% UI = 0.5-0.9) and 2017 (R = 0.8; 95% UI = 0.6-0.9) for level of education. In the same vein, slight inequality was realized with respect to place of residence in 2011 (R = 0.4; 95% UI = 0.3-0.6) and 2017 (R = 0.6; 95% UI = 0.5-0.7). For sub-national region, both simple (D = 50.5; 95% UI = 30.7-70.4) and complex (PAF = 91.3; 95% UI = 72.3-110.3) measures demonstrated substantial inequality in 2011. In the case of 2017, considerable inequality in insecticide-treated nets use occurred (D = 58; 95% UI = 42.2-73.8, PAF = 51.9; 95% UI = 36.2-67.6).

CONCLUSION

In conclusion, insecticide-treated nets utilization by pregnant Ghanaian women increased between 2011 and 2017. The findings show that Ghana's Ministry of Health in collaboration with anti-malarial non-governmental organizations must review patterns of insecticide-treated nets distribution and intensify advocacy among educated pregnant women, those in urban settings and the rich, to assuage the magnitude of inequality.

Ideational factors associated with consistent use of insecticide-treated nets: a multi-country, multilevel analysis

BACKGROUND

Malaria remains a major cause of morbidity and mortality in sub-Saharan Africa. Using insecticide-treated nets (ITNs) every night, year-round is critical to maximize protection against malaria. This study describes sociodemographic, psychosocial, and household factors associated with consistent ITN use in Cameroon, Côte d'Ivoire and Sierra Leone.

METHODS

Cross-sectional household surveys employed similar sampling procedures, data collection tools, and methods in three countries. The survey sample was nationally representative in Côte d'Ivoire, representative of the North and Far North regions in Cameroon, and representative of Bo and Port Loko districts in Sierra Leone. Analysis used multilevel logistic regression and sociodemographic, ideational, and household independent variables among households with at least one ITN to identify correlates of consistent ITN use, defined as sleeping under an ITN every night the preceding week.

FINDINGS

Consistent ITN use in Côte d'Ivoire was 65.4%, 72.6% in Cameroon, and 77.1% in Sierra Leone. While several sociodemographic and ideational variables were correlated with consistent ITN use, these varied across countries. Multilevel logistic regression results showed perceived self-efficacy to use ITNs and positive attitudes towards ITN use were variables associated with consistent use in all three countries. The perception of ITN use as a community norm was positively linked with consistent use in Cameroon and Côte d'Ivoire but was not significant in Sierra Leone. Perceived vulnerability to malaria was positively linked with consistent use in Cameroon and Sierra Leone but negatively correlated with the outcome in Côte d'Ivoire. Household net sufficiency was strongly and positively associated with consistent use in all three countries. Finally, the findings revealed strong clustering at the household and enumeration area (EA) levels, suggesting similarities in net use among respondents of the same EA and in the same household.

CONCLUSIONS

There are similarities and differences in the variables associated with consistent ITN use across the three countries and several ideational variables are significant. The findings suggest that a social and behaviour change strategy based on the ideation model is relevant for increasing consistent ITN use and can inform specific strategies for each context. Finally, ensuring household net sufficiency is essential.

OUP accepted manuscript

BACKGROUND

Insecticide-treated net (ITN) use is among the most recommended strategies to prevent malaria in pregnancy. We analysed the regional and socio-economic patterns of ITN use among pregnant women in Kenya using data from the 2003, 2008 and 2014 Kenyan Demographic and Health Surveys (KDHSs).

METHODS

Inequality was assessed using four dimensions: economic status, education, place of residence and region. Both relative and absolute summary measures were applied. In addition, simple and complex summary measures, i.e. difference, population attributable fraction, population attributable risk and ratio were considered based on the number of subgroups in each variable.

RESULTS

There was overt inequality in the use of ITNs among pregnant women, with greater use among the better-off group in 2003 and 2014. Greater ITN use was also observed among pregnant women with a higher level of education. Pregnant women from urban settings tended to use ITNs (slept under a net the night before the survey) more than their rural counterparts in the 2003 KDHS. There were significant regional variations across the three surveys in all inequality summary measures, except ratio in the 2014 survey.

CONCLUSIONS

Significant inequality in ITN use among pregnant women was observed at a macro scale.

Ownership and use of insecticide-treated nets under Ghana's National Malaria Control Program: What are the correlates?

OBJECTIVES

Ghana's National Malaria Control Program distributes free insecticide-treated nets (ITNs) as a malaria control measure. Some households with the ITN do not use it, however. This paper explores the socioeconomic and demographic determinants of ITN ownership and use among Ghanaian families.

METHODS

Data on 5741 households were obtained from the 2019 Ghana Malaria Indicator Survey. The survey is a nationally representative survey that obtains data on malaria-related issues. Negative binomial and Tobit regressions were applied to achieve the study's objectives.

RESULTS

Residence (rural-urban), wealth, and administrative region emerged as the most important predictors of ITN ownership and usage in Ghana. The results favoured rural and non-Greater Accra residents. However, wealth had a contrasting association with ITN ownership and use. Whereas affluent households owned more ITNs than the extremely poor, the latter used them more. Also, age and household size were significant for ITN ownership. Both variables had a nonlinear (inverted U-shaped) relationship with ITN ownership. In contrast, the proportion of household members under 5 and the bed net-to-household size ratio were positive and statistically significant determinants of ITN use.

CONCLUSION

The study highlights the need to effectively target the poor, especially in rural areas, for ITNs under the NMCP instead of universal distribution.

Rural-urban dimensions of the perception of malaria severity and practice of malaria preventive measures: insight from the 2018 Nigeria Demographic and Health Survey

Morbidities and mortalities caused by malaria are still a serious issue in Nigeria, with the country accounting for 25% of malaria morbidities and 24% of malaria mortalities globally in 2018. Treated bed nets reduce the incidence of malaria, but not all Nigerians use them. This study aimed to examine the factors associated with treated bed net usage, including perceived severity of malaria, and the rural-urban differences in the relationship between socio-demographic factors and use of treated bed nets in Nigeria. The analytic sample size comprised 40,693 women aged 15-49 years. Poisson regression and bivariable and multivariable analyses were used to test the study hypothesis that women who agreed that malaria could potentially lead to death would be more likely to adopt malaria preventive measures, including treated bed net use. About 48% of the women slept under a treated mosquito net the night before the survey. Those who perceived that malaria could lead to death had a higher likelihood of using a treated bed net in the urban, rural and combined samples. However, in the multivariable model, the association between perceived malaria severity and use of a treated bed net was only significant for rural women (APR=0.964, 95% CI: 0.933, 0.996). The results unexpectedly suggest that rural Nigerian women who perceive malaria to be severe have a lower likelihood of using treated bed nets. Also, rural-urban variations in the relationship between the socio-demographic variables and use of treated bed nets were observed. Policies should consider the observed rural-urban dichotomy in the influence of perceived severity of malaria and other socio-demographic factors on women's use of treated bed nets in Nigeria.

Ownership and utilization of bed nets and reasons for use or non-use of bed nets among community members at risk of malaria along the Thai-Myanmar border

Background

With the goal for malaria elimination in Thailand set for 2024, increased coverage and utilization of bed net, especially insecticide-treated net (ITN) or long-lasting insecticidal net (LLIN) is a key strategy. This study aims to provide the necessary information about bed net ownership and utilization among the population at risk of malaria living along the Thai-Myanmar border in Tak province.

Methods

A cross-sectional study was conducted using a mixed-method approach in 331 households from 5 hamlets in the villages of the Thai-Myanmar border. The research tools included a questionnaire, bed net inspection, and semi-structured interviews. Logistic regression was used to explore the sociodemographic factors associated with bed net utilization. The qualitative analysis employed a thematic analysis approach.

Results

This survey found that 98.5% of households had at least one bed net per household, and 74.3% had at least one ITN/LLIN. However, only 30.8% of households reached the standard policy set by the Minister of Public Health of one ITN/LLINs per two persons. Most residents used bed net (92.1% used in the previous night and 80.9% used every day). For those using bed nets, however, 61.9% used ITNs or LLINs the night before and 53.1% used them every day. Nonetheless, the usage rates of bed nets (any type) in the previous night among children and pregnant women were high, reaching 95.3% and 90.0%, respectively. Seven explanatory variables showed statistically significant associations with bed net use every day, including: “not staying overnight in the forest or the field”, “sleeping pattern based on gender”, “sufficient numbers of bed nets to cover all sleeping spaces”, “preference for free bed nets”, “age”, “gender”, and “SES score” showed statistically significant association with bed net use every day. The major reasons for the regular use of bed nets in both household and the forest were to prevent mosquito biting. The reasons for not using bednets in the household were discomfort feelings from heat, perception of unnecessity due to low mosquito density, whereas the reason for not using bed nets in the forest was inconvenience.

Conclusion

Despite that overall coverage and usage of bed nets was high, only one third reached the standard level specified by the policy. Overnight in the forest, the dissatisfaction with the quality of free bed nets, insufficient number of bed nets, sleeping alone, male gender, age more than 10 years, low socioeconomic status, discomfort from heat, perception of no benefits of bed nets due to low mosquito density, and inconvenience were factors influencing bed net use. Maintaining high coverage and utility rate of bed nets should be a priority for the malaria high-risk population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-021-03837-5.

Long lasting insecticidal mosquito nets (LLINs) ownership, use and coverage following mass distribution campaign in Lake Victoria basin, Western Kenya

Background

Long-lasting insecticidal nets (LLINs) are the most widely used malaria prevention and control intervention in Africa. However, their effectiveness may vary depending on their local geographic coverage, ownership and use at household level. This study aimed at assessing LLINs ownership and use following mass distribution campaign in western Kenya.

Methods

A cross-sectional study was conducted in November 2017. A total of 160 households were randomly selected from 16 villages. Structured questionnaires were used to collect data on households’ knowledge on malaria, LLINs ownership, utilization and their perceived benefits. Data was analyzed using IBM Statistical Package for Social Sciences (SPSS) version 21 for windows. Variables were presented as proportions and associations between variables tested using Pearson’s chi-square test.

Results

Malaria was reported to be the most frequently occurring disease (87.5%) in the area. Children under 5 years of age were reported to be at higher risks of malaria infection (28.6%). Around 31% of the respondents reported to have at least one member of the household sick with malaria a week before the interview. Commonly cited signs and symptoms of malaria were; fever (24.1%), headache (17.7%), vomiting (14.5%) feeling cold (12.6%) and loss of appetite (10%). There were 382 reported LLINs among 753 occupants in the 160 households surveyed. The average LLIN ownership was 2.4 nets per household and 1.97 persons per LLIN. Among the surveyed households, 96.9% owned at least one LLIN and 64.1% owned at least one LLIN for every two people. Among those who owned LLINs, 98.1% reported using them the previous night. Ownership per household ranged from 0 to 6 with a mean of 2.39. More than three quarter of the nets were acquired through free mass distribution campaigns and 80% were acquired less than 6 months prior to the survey.

Conclusion

Despite high net coverage and use, a number of households experienced malaria episodes in the study area. There is need to investigate the likelihood of outdoor malaria transmission and assess the physical integrity of the existing LLINs and their insecticidal effectiveness in protecting household members against malaria.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11062-7.

Patterns and correlates of ownership and utilization of insecticide-treated bed-nets for malaria control among women of reproductive age (15-49 years) in Malawi

Malaria is a major public health concern in Malawi. This study explored the patterns and correlates of ownership and utilization of ITNs for malaria control among women of reproductive age in Malawi. Data were derived from the multi-stage cross-sectional Malaria Indicator Survey (MIS) conducted in 2017, which followed ITN distribution in 2012 and 2015. Of the 3860 sampled women aged 15-49 years, 88% (3398/3860) and 64% (2473/3860) reported that they owned and utilized ITNs, respectively. Adjusted multivariate logistic regression analysis showed that the odds of ownership of ITNs were significantly low among women with no education (AOR = 0.36, CI = 0.18-0.72), those with primary education (AOR = 0.50, CI = 0.27-0.94) and poor women (AOR = 0.70, CI = 0.51-0.97). Similarly, the odds of utilization of ITNs were significantly low among women with no education, (AOR = 0.40, CI = 0.26-0.63), primary education (AOR = 0.53, CI = 0.36-0.78) and poor women (AOR = 0.70, CI = 0.51-0.97). Furthermore, the odds of utilization of ITNs were significantly low among women living in households without a radio (AOR = 0.79, CI = 0.67-0.93) and those who have not seen or heard a malaria message in the last 6 months (AOR = 0.74, CI = 0.64-0.87). In order to prevent malaria morbidity and mortality among women of reproductive age, especially those from poor households, the Malawi government and relevant stakeholders need to continue the free distribution of ITNs to the poor and encourage social behaviours that promote the ownership and utilization of ITNs.

A cross-sectional study of the prevalence, density, and risk factors associated with malaria transmission in urban communities of Ibadan, Southwestern Nigeria

Background

Malaria is a severe global public health challenge that causes significant morbidity and mortality worldwide, particularly in sub-Saharan Africa. This study was designed to determine the prevalence, parasite density, and risk factors associated with malaria infection transmission among residents of two urban communities of Ibadan, southwestern Nigeria.

Materials and methods

A cross-sectional hospital-based study was carried out on 300 participants. Blood samples were obtained. Thick and thin blood films were prepared and viewed using the standard parasitological technique of microscopy. Moreover, data on sociodemographic and environmental variables were obtained using a pre-tested standard questionnaire.

Results

Of the 300 participants examined, a total of 165 (55.0%) were found positive for Plasmodium falciparum with a mean (S.D) parasite density of 1814.70 (1829.117) parasite/μL of blood. The prevalence and parasite density of malaria infection vary significantly (P < 0.05) with age group. Children <5 years old were more likely to have malaria infection and high parasite densities than adults (p < 0.05). Similarly, in relation to gender, males significantly (P < 0.05) had a higher prevalence (60.2%) and mean (S.D) parasite density of malaria infection [2157.73 (1659.570) parasite/μL of blood] compared to females. Additionally, those without formal education had the highest prevalence (73.0%) and mean (S.D) parasite density of infection [2626.96 (2442.195) parasite/μL of blood]. The bivariate logistic regression analysis shows that age group 6–10 (Crude Odds Ratio, COR 0.066, 95% CI: 0.007–0.635), presence of streams/rivers (COR 0.225, 95% CI: 0.103–0.492), distance from streams/rivers within ≤1 km (COR 0.283, 95% CI: 0.122–0.654) and travel to rural area (COR 4.689, 95% CI: 2.430–9.049) were the significant risk factors.

Conclusions

Malaria infection is prevalent in the study area and was greatly influenced by traveling activities from the rural areas to urban centers and vice versa. Multifaceted and integrated control strategy should be adopted. Health education on mosquito prevention and chemoprophylaxis before and during travel to rural areas are essential.

Socio-economic and demographic disparities in ownership and use of insecticide-treated bed nets for preventing malaria among rural reproductive-aged women in northern Ghana

Background

Malaria continues to be a leading cause of morbidity and mortality in most countries in Sub-Saharan Africa. Insecticide-treated bed nets (ITNs) is one of the cost-effective interventions for preventing malaria in endemic settings. Ghana has made tremendous efforts to ensure widespread ownership and use of ITNs. However, national coverage statistics can mask important inequities that demand targeted attention. This study assesses the disparities in ownership and utilization of ITNs among reproductive-aged women in a rural impoverished setting of Ghana.

Methods

Population-based cross-sectional data of 3,993 women between the age of 15 and 49 years were collected in seven districts of the Upper East region of Ghana using a two-stage cluster sampling approach. Bivariate and multivariate regression models were used to assess the social, economic and demographic disparities in ownership and utilization of ITN and to compare utilization rates among women in households owning at least one ITN.

Results

As high as 79% of respondents were found to own ITN while 62% of ITN owners used them the night preceding the survey. We identified disparities in both ownership and utilization of ITNs in wealth index, occupational status, religion, and district of residence. Respondents in the relative richest wealth quintile were 74% more likely to own ITNs compared to those in the poorest quintile (p-value< 0.001, CI = 1.29–2.34) however, they were 33% less likely to use ITNs compared to the poorest (p-value = 0.01, CI = 0.50–0.91).

Conclusion

Interventions aimed at preventing and controlling malaria through the use of bed nets in rural Ghana and other similar settings should give more attention to disadvantage populations such as the poor and unemployed. Tailored massages and educational campaigns are required to ensure consistent use of treated bed nets.

Determination of the predictive factors of long-lasting insecticide-treated net ownership and utilisation in the Bamenda Health District of Cameroon

Background

Malaria is a serious health concern in Africa. In Cameroon, an endemic country where malaria remains a major public health problem, several control measures have been put in place among which the use of insecticide-treated bednets (LLINs/ITNs) is considered one of the core vector control strategies. However, the greatest challenges include ownership and utilisation by individuals and households. Factors such as age, marital status, gender, education and occupation of the household head, household size, knowledge of bednets, socioeconomic status, and environmental factors have been suggested to have an impact on bednet ownership and utilisation in different settings. The present study sought to determine bednet ownership and utilisation rates and to assess the impact of predictive factors on bednet ownership and use in the Bamenda Health District (BHD) of Cameroon.

Methods

A cross-sectional study involving 384 households was conducted in six health areas in the BHD. A structured and semi-structured questionnaire was used to collect data on demographic and household characteristics as well as information on their bednet ownership and utilisation. Descriptive statistics, bivariate and multivariate logistic regression analysis were performed.

Results

Frequency of bednet ownership was relatively high (63.5%) with LLINs being most abundant (91.9%); the majority of households (87.7%) obtained their bednets during the 2011 free distribution campaign. Utilisation was relatively high (69.3%), with negligence (29.3%) and heat discomfort (26.7%) accounting most for non-usage of bednets. Children less than 5 years (63%) and pregnant women (60%) most often used these nets. Households headed by a married couple, those with older household heads, household with smaller size (5–12 persons), and knowledge of bednets (good knowledge) had positive impacts on bednet ownership (p < 0.05). The gender of the household head (males), their educational level, environmental conditions (presence of suitable mosquito breeding sites), bednet number in households (greater number of bednets) and the prioritised groups (children < 5 and pregnant women) had positive impacts on bednet utilisation in households (p < 0.05). There was a negative association between bednet ownership and utilisation by households as bednet ownership was high and utilisation of these nets was low. Marital status and age of household head, household size, and knowledge of bednets had impacts on bednet ownership while gender and educational level of the household head, environmental suitability, the number of bednets and the two prioritised groups had an impact on bednet usage.

Conclusion

These factors may be relevant for policy makers and in decision making for the intensification of campaign strategies to ensure more effective subsequent distribution campaigns in the BHD and beyond.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4155-5) contains supplementary material, which is available to authorized users.

Prevalence and determinants of malaria among children in Zambézia Province, Mozambique

Background

Malaria is the leading cause of death among children in Mozambique. Prevalence and factors associated with malaria are not well studied among children in rural Zambézia Province. Whether prevalence of malaria varies across diverse districts within the province is unknown.

Methods

A cross-sectional survey of female heads of household was conducted during April and May 2014, a period of peak malaria transmission. Data were collected on up to two randomly selected children aged 6–59 months per household. The outcome of interest was self-report of symptomatic malaria confirmed by diagnostic test in the past 30 days. Analyses accounted for the two-stage cluster sample design. Prevalence of symptomatic malaria was calculated for the province and three over-sampled focus districts—Alto Molócuè, Morrumbala, and Namacurra. Multivariable logistic regression of symptomatic malaria diagnosis included: district, age, sex, education, bed net use, urban setting, distance to health facility, income, roofing material, and pig farming.

Results

Data were collected on 2540 children. Fifty percent were female, and the median age was 24 months. Sixty percent of children slept under bed nets the night prior to the survey, but utilization varied between districts (range 49–89%; p < 0.001). Forty-three percent of children reported fever in the past 30 days, 91% of those sought care at a health facility, 67% of those had either a malaria rapid diagnostic test or blood smear, and 67% of those had a positive test result and therefore met our case definition of self-reported symptomatic malaria. There were significant differences in prevalence of fever (p < 0.001), health-seeking (p < 0.001), and diagnostic testing (p = 0.003) between focus districts. Province-wide prevalence of symptomatic malaria was 13% and among focus districts ranged from 14% in Morrumbala to 17% in Namacurra (p < 0.001). Higher female caregiver education (OR 1.88; 95% CI 1.31–2.70), having fewer young children in the household (OR 1.25; 95% CI 1.01–1.56), and higher income (OR 1.56; 95% CI 1.11–2.22) were independently associated with having a child with symptomatic malaria.

Conclusions

Self-reported symptomatic malaria is highly prevalent among children in Zambézia Province, Mozambique and varies significantly between diverse districts. Factors facilitating access to health services are associated with symptomatic malaria diagnosis. These findings should inform resource allocation in the fight against malaria in Mozambique.

Zika and chikungunya: mosquito-borne viruses in a changing world

The reemergence and growing burden of mosquito-borne virus infections have incited public fear and growing research efforts to understand the mechanisms of infection-associated health outcomes and to provide better approaches for mosquito vector control. While efforts to develop therapeutics, vaccines, and novel genetic mosquito-control technologies are underway, many important underlying ecological questions remain that could significantly enhance our understanding and ability to predict and prevent transmission. Here, we review the current knowledge about the transmission ecology of two recent arbovirus invaders, the chikungunya and Zika viruses. We introduce the viruses and mosquito vectors, highlighting viral biology, historical routes of transmission, and viral mechanisms facilitating rapid global invasion. In addition, we review factors contributing to vector global invasiveness and transmission efficiency. We conclude with a discussion of how human-induced biotic and abiotic environmental changes facilitate mosquito-borne virus transmission, emphasizing critical gaps in understanding. These knowledge gaps are tremendous; much of our data on basic mosquito ecology in the field predate 1960, and the mosquitoes themselves, as well as the world they live in, have substantially changed. A concerted investment in understanding the basic ecology of these vectors, which serve as the main drivers of pathogen transmission in both wildlife and human populations, is now more important than ever.

Is Nigeria winning the battle against malaria? Prevalence, risk factors and KAP assessment among Hausa communities in Kano State

BACKGROUND

Malaria is one of the most severe global public health problems worldwide, particularly in Africa, where Nigeria has the greatest number of malaria cases. This community-based study was designed to investigate the prevalence and risk factors of malaria and to evaluate the knowledge, attitudes, and practices (KAP) regarding malaria among rural Hausa communities in Kano State, Nigeria.

METHODS

A cross-sectional community-based study was conducted on 551 participants from five local government areas in Kano State. Blood samples were collected and examined for the presence of Plasmodium species by rapid diagnostic test (RDT), Giemsa-stained thin and thick blood films, and PCR. Moreover, demographic, socioeconomic, and environmental information as well as KAP data were collected using a pre-tested questionnaire.

RESULTS

A total of 334 (60.6 %) participants were found positive for Plasmodium falciparum. The prevalence differed significantly by age group (p < 0.01), but not by gender or location. A multivariate analysis showed that malaria was associated significantly with being aged 12 years or older, having a low household family income, not using insecticide treated nets (ITNs), and having no toilets in the house. Overall, 95.6 % of the respondents had prior knowledge about malaria, and 79.7, 87.6 and 95.7 % of them knew about the transmission, symptoms, and prevention of malaria, respectively. The majority (93.4 %) of the respondents considered malaria a serious disease. Although 79.5 % of the respondents had at least one ITN in their household, utilization rate of ITNs was 49.5 %. Significant associations between the respondents' knowledge concerning malaria and their age, gender, education, and household monthly income were reported.

CONCLUSIONS

Malaria is still highly prevalent among rural Hausa communities in Nigeria. Despite high levels of knowledge and attitudes in the study area, significant gaps persist in appropriate preventive practices, particularly the use of ITNs. Innovative and Integrated control measures to reduce the burden of malaria should be identified and implemented in these communities. Community mobilization and health education regarding the importance of using ITNs to prevent malaria and save lives should be considered.

Traditional medicine used in childbirth and for childhood diarrhoea in Nigeria's Cross River State: interviews with traditional practitioners and a statewide cross-sectional study

OBJECTIVES

Examine factors associated with use of traditional medicine during childbirth and in management of childhood diarrhoea.

DESIGN

Cross-sectional cluster survey, household interviews in a stratified last stage random sample of 90 census enumeration areas; unstructured interviews with traditional doctors.

SETTING

Oil-rich Cross River State in south-eastern Nigeria has 3.5 million residents, most of whom depend on a subsistence agriculture economy.

PARTICIPANTS

8089 women aged 15-49 years in 7685 households reported on the health of 11,305 children aged 0-36 months in July-August 2011.

PRIMARY AND SECONDARY OUTCOME MEASURES

Traditional medicine used at childbirth and for management of childhood diarrhoea; covariates included access to Western medicine and education, economic conditions, engagement with the modern state and family relations. Cluster-adjusted analysis relied on the Mantel-Haenszel procedure and Mantel extension.

RESULTS

24.1% (1371/5686) of women reported using traditional medicine at childbirth; these women had less education, accessed antenatal care less, experienced more family violence and were less likely to have birth certificates for their children. 11.3% (615/5425) of young children with diarrhoea were taken to traditional medical practitioners; these children were less likely to receive BCG, to have birth certificates, to live in households with a more educated head, or to use fuel other than charcoal for cooking. Education showed a gradient with decreasing use of traditional medicine for childbirth (χ(2) 135.2) and for childhood diarrhoea (χ(2) 77.2).

CONCLUSIONS

Use of traditional medicine is associated with several factors related to cultural transition and to health status, with formal education playing a prominent role. Any assessment of the effectiveness of traditional medicine should anticipate confounding by these factors, which are widely recognised to affect health in their own right.

Factors associated with the use of mosquito bed nets: results from two cross-sectional household surveys in Zambézia Province, Mozambique

Background

Malaria remains a major threat to some 3.2 billion persons globally. Malaria contributes heavily to the overall disease burden in Mozambique and is considered endemic. A cornerstone of Mozambique’s vector control strategy has been to strive for universal coverage of insecticide-treated nets (ITN).

Methods

The study is a population-based cross-sectional survey of female heads-of-household in Zambézia Province, Mozambique conducted during August–September, 2010 and April–May, 2014. Analyses accounted for a stratified two-stage cluster sample design. Outcomes of interest included sleeping under a mosquito net during the previous night. Descriptive statistics were calculated for three oversampled districts and for the entire province. Multivariable logistic regression analysis was used to estimate factors associated with both changes over time and increased mosquito bed net usage.

Results

Of the 3916 households interviewed in 2010 and 3906 households in 2014, 64.3 % were in possession of at least one mosquito bed net. A higher proportion of households in Namacurra (90 %) reported possession of a mosquito net, compared to Alto Molócuè (77 %) and Morrumbala (34 %), respectively in 2014. Of pregnant respondents, 58.6 % reported sleeping under a mosquito net the previous night in 2010 compared to 68.4 % in 2014. Fifty percent of children 0–59 months slept under a mosquito net the previous night in 2010 compared to 60 % in 2014. Factors associated with use of a mosquito net for female head-of-household respondents were higher education, understanding Portuguese, larger household size, having electricity in the household, and larger household monthly income. As travel time to a health facility increased (per 1 h), respondents had 13 % lower odds of sleeping under a mosquito net (OR 0.87; 95 % CI 0.74–1.01, p = 0.07). Pregnant women in 2014 had a 2.4 times higher odds of sleeping under a bed net if they lived in Namacurra compared to Alto Molócuè (95 % CI 0.91–6.32, p = 0.002 for district). Higher maternal education, living in Namacurra, and acquisition of mosquito bed nets were associated with a child 0–59 months reporting sleeping under the net in the previous night in 2014.

Conclusions

Intensified focus on the poorest, least educated, and most distant from health services is needed to improve equity of ITN availability and usage. Additionally, while some districts have already surpassed goals in terms of coverage and utilization of ITN, renewed emphasis should be placed on bringing all geographic regions of the province closer to meeting these targets.

The Impact of Integrated Community Case Management of Childhood Diseases Interventions to Prevent Malaria Fever in Children Less than Five Years Old in Bauchi State of Nigeria

BACKGROUND

Malaria accounts for about 300,000 childhood deaths and 30% of under-five year old mortality in Nigeria annually. We assessed the impact of intervention strategies that integrated Patent Medicines Vendors into community case management of childhood-diseases, improved access to artemisinin combination therapy (ACT) and distributed bed nets to households. We explored the influence of household socioeconomic characteristics on the impact of the interventions on fever in the under-five year olds in Bauchi State Nigeria.

METHODS

A cross-sectional case-controlled, interventional study, which sampled 3077 and 2737 under-5 year olds from 1,588 and 1601 households in pre- and post-intervention periods respectively, was conducted from 2013 to 2015. Difference-in-differences and logistic regression analyses were performed to estimate the impact attributable to the interventions: integrated community case management of childhood illness which introduced trained public and private sector health providers and the possession of nets on the prevalence of fever.

RESULTS

Two-week prevalence of fever among under-fives declined from 56.6% at pre-intervention to 42.5% at post-intervention. Fever-prevention fraction attributable to nets was statistically significant (OR = 0.217, 95% CI: 0.08-0.33). Children in the intervention group had significantly fewer incidence of fever than children in the control group had (OR = 0.765, 95% CI: 0.67-0.87). Although being in the intervention group significantly provided 23.5% protection against fever (95% CI: 0.13-0.33), the post-intervention likelihood of fever was also significantly less than at pre-intervention (OR = 0.57, 95% CI: 0.50-0.65). The intervention protection fraction against fever was statistically significant at 43.4% (OR = 0.434, 95% CI: 0.36-0.50). Logistic regression showed that the odds of fever were lower in households with nets (OR = 0.72, 95% CI: 0.60-0.88), among children whose mothers had higher education, in the post-intervention period (OR = 0.39, 95% CI: 0.33-0.46) and in the intervention group (OR = 0.52, 95% CI: 0.48-0.66). The odds of fever increased with higher socio-economic status of households (17.9%-19.5%). Difference-in-differences showed that the interventions significantly reduced occurrence of fever in the intervention group (OR = 1.70, 95% CI: 1.36-2.14).

CONCLUSION

The interventions were effective in reducing the prevalence and the likelihood of childhood malaria fever. Taken to scale, these can significantly reduce the burden of malaria fever in the under-five year old children.