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Sissoko B, Rafiq MY, Wang JR, Sissoko NDN. Social representations of malaria in a southern malian community: an ethnographic qualitative study. Malar J 2022; 21:276. [PMID: 36175914 PMCID: PMC9523929 DOI: 10.1186/s12936-022-04298-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 09/22/2022] [Indexed: 12/05/2022] Open
Abstract
Background Malaria is one of the prime reasons for medical consultation and the major cause of morbidity and mortality in Mali. To assess and understand the dynamics of social representations of malaria, the anthropological research was conducted in the Wayerema II neighbourhood of the health district of Sikasso, southern Mali. Methods This was an ethnographic study conducted qualitatively in 2011 and 2016 through informal conversations, 70 semi-structured interviews, and participant observations with key actors. The observations, conversations, and interviews investigated local people’s perceptions and knowledge about malaria, and how and to what extent the cultural and popular representations of the disease can have an impact on therapeutic routes. Results Mosquitoes are the principal agent of the transmission of malaria. However, the ubiquitous yet casually-claimed aetiological agents, causative, nosographic entities differ from—although sometimes integrated into—the biomedical dimension. For example, some communities perceive Kono, a complicated and pernicious form of malaria that often occurs among children, to originate from a supernatural force. “Bird disease” is another term used for Kono in Mali and other West African countries. Thus, overall, Kono is defined through the entanglements with cultural factors, namely the idiosyncratic habits, customs, and beliefs of the population of Wayerema II neighbourhood in the health district of Sikasso, Southern Mali. Wayerema II residents particularly tend to link therapeutic recourse amongst the afflicted not only to biomedical models but to sociocultural and popular perceptions and representations of malaria. Conclusion In the findings, self-medication through both traditional and modern medical techniques was the most frequent therapeutic modality. Hence, the integration of local popular knowledge with the biomedical register can contribute to a comprehensive understanding of social representations and perceptions of malaria, and qualitative improvements in the malaria control programme.
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Affiliation(s)
- Bourema Sissoko
- Institute of Anthropology, School of Social Development, East China Normal University, Minhang District, 500 Dongchuan Road, Shanghai, 200241, China. .,Faculty of Foreign Languages, Southwest Forestry University, 296 Bailongsi, Kunming, Yunnan, 650224, China.
| | - Mohamed Yunus Rafiq
- Department of Social Sciences, New York University Shanghai, 1555 Century Avenue, Pudong New District, Shanghai, 200122, China
| | - Jiaqi Rosemary Wang
- Department of Social Sciences, New York University Shanghai, 1555 Century Avenue, Pudong New District, Shanghai, 200122, China
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Gichuki PM, Kamau L, Njagi K, Karoki S, Muigai N, Matoke-Muhia D, Bayoh N, Mathenge E, Yadav RS. Bioefficacy and durability of Olyset ® Plus, a permethrin and piperonyl butoxide-treated insecticidal net in a 3-year long trial in Kenya. Infect Dis Poverty 2021; 10:135. [PMID: 34930459 PMCID: PMC8691082 DOI: 10.1186/s40249-021-00916-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-lasting insecticide nets (LLINs) are a core malaria intervention. LLINs should retain efficacy against mosquito vectors for a minimum of three years. Efficacy and durability of Olyset® Plus, a permethrin and piperonyl butoxide (PBO) treated LLIN, was evaluated versus permethrin treated Olyset® Net. In the absence of WHO guidelines of how to evaluate PBO nets, and considering the manufacturer's product claim, Olyset® Plus was evaluated as a pyrethroid LLIN. METHODS This was a household randomized controlled trial in a malaria endemic rice cultivation zone of Kirinyaga County, Kenya between 2014 and 2017. Cone bioassays and tunnel tests were done against Anopheles gambiae Kisumu. The chemical content, fabric integrity and LLIN survivorship were monitored. Comparisons between nets were tested for significance using the Chi-square test. Exact binomial distribution with 95% confidence intervals (95% CI) was used for percentages. The WHO efficacy criteria used were ≥ 95% knockdown and/or ≥ 80% mortality rate in cone bioassays and ≥ 80% mortality and/or ≥ 90% blood-feeding inhibition in tunnel tests. RESULTS At 36 months, Olyset® Plus lost 52% permethrin and 87% PBO content; Olyset® Net lost 24% permethrin. Over 80% of Olyset® Plus and Olyset® Net passed the WHO efficacy criteria for LLINs up to 18 and 12 months, respectively. At month 36, 91.2% Olyset® Plus and 86.4% Olyset® Net survived, while 72% and 63% developed at least one hole. The proportionate Hole Index (pHI) values representing nets in good, serviceable and torn condition were 49.6%, 27.1% and 23.2%, respectively for Olyset® Plus, and 44.9%, 32.8% and 22.2%, respectively for Olyset® Net but were not significantly different. CONCLUSIONS Olyset® Plus retained efficacy above or close to the WHO efficacy criteria for about 2 years than Olyset® Net (1-1.5 years). Both nets did not meet the 3-year WHO efficacy criteria, and showed little attrition, comparable physical durability and survivorship, with 50% of Olyset® Plus having good and serviceable condition after 3 years. Better community education on appropriate use and upkeep of LLINs is essential to ensure effectiveness of LLIN based malaria interventions.
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Affiliation(s)
- Paul M Gichuki
- Eastern & Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya. .,School of Health Sciences, Meru University of Science and Technology, Meru, Kenya.
| | - Luna Kamau
- Centre for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kiambo Njagi
- Division of National Malaria Programme, Ministry of Health, Nairobi, Kenya
| | - Solomon Karoki
- Division of National Malaria Programme, Ministry of Health, Nairobi, Kenya
| | - Njoroge Muigai
- Department of Health, Kirinyaga County, Kirinyaga, Kenya
| | - Damaris Matoke-Muhia
- Centre for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nabie Bayoh
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Evan Mathenge
- Eastern & Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rajpal S Yadav
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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3
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Bannor R, Asare AK, Sackey SO, Osei-Yeboah R, Nortey PA, Bawole JN, Ansah V. Sleeping space matters: LLINs usage in Ghana. Pathog Glob Health 2020; 114:271-278. [PMID: 32530747 PMCID: PMC7480583 DOI: 10.1080/20477724.2020.1776920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Long Lasting Insecticidal Net (LLIN) is an effective malaria prevention mechanism. However, ownership of LLIN does not imply its use among households. The availability of enough sleeping space is a natural prerequisite to install and use LLINs. The objective of this study was to explore the effect of sleeping space and other socio-demographic factors of households' heads on LLINs usage among households. A cross-sectional household-based study was conducted using a quantitative approach. Data was collected exclusively from households that received LLINs at no direct financial cost to them in a mass malaria campaign conducted in the study area using a structured questionnaire. A total of 383 households sampled for the study received 1,181 LLINs with a range of 1 to 15 LLINs per household. Less than 16% of households that received more than 2 LLINs installed all the LLINs they received during the distribution. Among households that received LLINs, 45% of them did not use them at all and 36% of them used them every night including the night before data collection. The number of bedrooms, children and members per household, and the number of occupants per bedroom were also found statistically associated with the use of LLINs among households. The study used a quantitative approach to investigate sleeping space in relation to LLINs usage and malaria control, an area and topic that has not been adequately covered in the literature.
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Affiliation(s)
- Richard Bannor
- Department of Allied Health Sciences, UConn Center for
mHealth and Social Media, Institute for Collaboration on Health, Intervention and Policy, University
of Connecticut, Storrs, CT, USA
| | | | - Samuel Oko Sackey
- Department of Epidemiology and Disease Control, School of
Public Health, University of Ghana, Legon, Accra, Ghana
| | - Richard Osei-Yeboah
- Computational Biology Division, Institute of Infectious Disease and Molecular Medicine, University of Cape
Town, South Africa
| | - Priscillia Awo Nortey
- Department of Epidemiology and Disease Control, School of
Public Health, University of Ghana, Legon, Accra, Ghana
| | - Justice Nyigmah Bawole
- Department of Public Administration and Health Services
Management, University of Ghana Business School, Legon, Accra, Ghana
| | - Victoria Ansah
- Allied Health and Social Sciences, Institute of Health and Society, University of Worcester, UK
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4
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Santos EM, McClelland DJ, Shelly CE, Hansen L, Jacobs ET, Klimentidis YC, Ernst KC. Malaria education interventions addressing bed net care and repair practices: a systematic review. Pathog Glob Health 2020; 114:2-15. [PMID: 32000614 DOI: 10.1080/20477724.2020.1719727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Education intervention effectiveness to improve bed net care and repair knowledge or practices is unclear. To assess intervention effectiveness, we systematically reviewed eight peer-reviewed literature databases and 16 malaria organizations (PROSPERO protocol CRD42019123932) using pre-specified combinations of 'education intervention', 'mosquito net', and 'malaria' search terms. Data were abstracted for 29 of 43 studies meeting inclusion criteria, of which 16 studies included education as amain focus. Of these 16, there was evidence of intervention effectiveness among half of the studies, which reported improvements in knowledge or practices, while four had mixed results, and four had unclear results. Overall there is no clear conclusion regarding the effectiveness of education interventions to improve net care and repair, though some instructional methods suggest more success than others. Interventions used combinations of instructional methods; passive mass education (6), active mass education (12), and interpersonal methods (8). Interventions combining mass and interpersonal methods resulted in positive improvements (four positive, one mixed). We found no evidence that interventions grounded in health behavior theory achieved more positive results than those not grounded in theory, potentially because net care education was typically asecondary objective. Of 289 gray literature results, 286 (99%) were net distribution reports from Against Malaria Foundation describing 136 distributions; eighty of which (58.8%) mentioned no education related to net care and repair. We found lack of involvement of experts in education among included interventions. Involving trained instructors with expertise in education theory and instructional strategies may improve instruction quality to yield more effective interventions.
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Affiliation(s)
- Ellen M Santos
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Deborah J McClelland
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Lindsay Hansen
- Office of Instruction & Assessment, Manuel Pacheco Integrated Learning Center, University of Arizona, Tucson, AZ, USA
| | - Elizabeth T Jacobs
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Yann C Klimentidis
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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5
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Santos EM, Coalson JE, Jacobs ET, Klimentidis YC, Munga S, Agawo M, Anderson E, Stroupe N, Ernst KC. Bed net care practices and associated factors in western Kenya. Malar J 2019; 18:274. [PMID: 31412865 PMCID: PMC6694604 DOI: 10.1186/s12936-019-2908-6] [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: 02/23/2019] [Accepted: 08/08/2019] [Indexed: 11/22/2022] Open
Abstract
Background Insecticide-treated nets (ITNs) and long-lasting insecticidal nets (LLINs) are effective for malaria prevention and are designed to provide nearly 5 years of mosquito protection. However, many ITNs and LLINs become damaged and ineffective for mosquito bite prevention within 1 to 2 years in field conditions. Non-adherence to recommended bed net care and repair practices may partially explain this shortened net longevity. Methods Using data from a cross-sectional study, a net care adherence score was developed and adherence to net care practices described from two regions of western Kenya. Relationships between attitudes and environmental factors that influence net longevity were measured with adherence to bed net care practices. Results While overall care practices are highly adherent particularly in the highlands, practices related to daily storage, washing frequency, and drying location need improvement in the lowlands. Seventy-seven percent of nets in the lowlands were washed < 3 months prior to the survey compared to 23% of nets in the highlands. More nets were dried in the sun in the lowlands (32% of nets) compared to the highlands (4% of nets). Different elements of care are influenced by various malaria attitudes and environmental factors, highlighting the complexity of factors associated with net care. For example, households that learned about net care from community events, that share a sleeping structure with animals, and that have nets used by adult males tend to adhere to washing frequency recommendations. Conclusions In western Kenya, many nets are cared for in accordance to recommended practices, particularly in the highlands sites. In the lowlands, demonstrating methods at community events to tie nets up during the day coupled with messaging to emphasize infrequent washing and drying nets in the shade may be an appropriate intervention. As illustrated by differences between the highlands and lowlands sites in the present study, should interventions to improve adherence to bed net care practices be necessary, they should be context-specific. Electronic supplementary material The online version of this article (10.1186/s12936-019-2908-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ellen M Santos
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA.
| | - Jenna E Coalson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA
| | - Elizabeth T Jacobs
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA
| | - Yann C Klimentidis
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA
| | - Stephen Munga
- Centre for Global Health Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Nyanza, 40100, Kenya
| | - Maurice Agawo
- Centre for Global Health Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Nyanza, 40100, Kenya
| | - Elizabeth Anderson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA
| | - Nancy Stroupe
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA
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Kibe LW, Kamau AW, Gachigi JK, Habluetzel A, Mbogo CM. A formative study of disposal and re-use of old mosquito nets by communities in Malindi, Kenya. MALARIAWORLD JOURNAL 2019; 6:9. [PMID: 31293898 PMCID: PMC11107875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND About 30 million insecticide treated mosquito nets have been distributed in Kenya since 2001 and ownership is approaching full coverage. As a consequence of this achievement, Kenya is faced with the challenge of disposing old mosquito nets that are no longer in use. The study aimed at investigating ways of disposal and re-use of old and torn nets by end users. MATERIALS AND METHODS A formative study was conducted in the former Malindi District, which is comprised of Malindi and Magarini sub-counties of Kilifi County in Coastal Kenya. A total of 6 Focus Group Discussions, 10 Key Informant Interviews and 9 transect walks/drives were undertaken. Data from the different sources were analysed separately and triangulated for similarities and differences. RESULTS There were variations in disposal and re-use of old nets between urban and rural or peri-urban residents. In all settings, people adopted innovative and beneficial ways of re-using old, expired nets, and those that were damaged beyond repair. Common causes of damage were fire, children, domestic animals sharing the sleeping room and friction from the bed poles while hanging or tacking it in under a sleeping mat. Re-use was most prominent in farming activities (78%) and less to for use in mosquito control, like window screening (15%). The remaining 8% was related to making ropes, swings, footballs, goal posts and fishing nets. Advantageous texture and nature of the netting material, perceived economic benefit and lack of guidelines for disposal were the main reasons cited by residents for re-using old nets. CONCLUSIONS It is important that re-use and disposal of old mosquito nets is distinguished from misuse of newly distributed mosquito nets. Alternative uses of old nets as opposed to misuse of new nets was found to be common in our study.
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Affiliation(s)
- Lydiah W. Kibe
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- University of Camerino, Camerino, Italy
| | - Anne W. Kamau
- University of Nairobi, Institute for Development Studies, Nairobi, Kenya
| | - John K. Gachigi
- Ministry of Labour, Social Security and Services, Nairobi, Kenya
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Mboma ZM, Dillip A, Kramer K, Koenker H, Greer G, Lorenz LM. 'For the poor, sleep is leisure': understanding perceptions, barriers and motivators to mosquito net care and repair in southern Tanzania. Malar J 2018; 17:375. [PMID: 30348167 PMCID: PMC6196435 DOI: 10.1186/s12936-018-2528-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/15/2018] [Indexed: 01/08/2023] Open
Abstract
Background The rate of physical deterioration of long-lasting insecticidal nets (LLINs) varies by household practices, net brand and environment. One way to sustain the protection provided by LLINs against malaria is through day-to-day care, and repairing holes as and when they occur. To ensure LLIN coverage is high between mass campaigns and, as international donor funds decrease, personal responsibility to maintain nets in good condition is becoming more important. This study aimed to understand local barriers and motivators to net care and repair in southern Tanzania in a community that receives free LLINs through a school-based distribution mechanism. Methods Qualitative research methods were applied in a rural and peri-urban village in Ruangwa district. Focus group discussions (FGDs) were conducted for five groups of 8–12 participants; (1) key informants, (2) young men (18–24 years old), (3) women (> 18 years) with children under the age of five, (4) older men (> 25 years), and (5) older women with or without children (> 25 years). In each village, five men, five women with or without children, and five women with children under the age of five were recruited for in-depth interviews (IDIs). After each IDI and FGD with women with young children, participants were guided through a participatory activity. The study also counted the number and size of holes in nets currently used by IDI participants to determine their physical degradation status. Results A general willingness to care and repair mosquito nets was observed in Ruangwa district for the love of a good night’s sleep free of mosquito bites or noises. Net care was preferred over repair, especially among women who were the primary caretakers. The main motivation to look after nets was protection against mosquito bites and malaria. Washing nets occurred as frequently as every other week in some households to ensure cleanliness, which prevented other dirt-related problems such as sneezing and headaches. Barriers to net care included care not being a priority in the day-to-day activities and lack of net retreatment kits. Net repair was reported to be a temporary measure and necessary as soon as a hole was identified. However, during the net assessment and participatory activity, it became clear that people did not actually repair smaller holes. Protection against mosquitoes, malaria and cost saving from replacing nets were identified as motivators for net repair. Barriers to net repair included it not being a priority to repair holes that could be tucked under the mattress and lack of knowledge on when to repair nets. Conclusion In Ruangwa, net care was defined as overall net maintenance, such as cleanliness, and not directly associated with the prevention of damage as reported in other studies. Net repair was reported as a temporary measure before the acquisition of a new net, hence not a priority in a busy household. Inconsistencies were observed between reported intentions to repair mosquito nets and current net condition. Targeted education through health facilities and community change agents are potential means to overcome barriers to net care and repair.
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Affiliation(s)
- Zawadi M Mboma
- Ifakara Health Institute, Dar-es-Salaam, Tanzania. .,London School of Hygiene and Tropical Medicine, London, UK.
| | - Angel Dillip
- Ifakara Health Institute, Dar-es-Salaam, Tanzania
| | - Karen Kramer
- National Malaria Control Programme, Dar-es-Salaam, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Hannah Koenker
- PMI VectorWorks, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - George Greer
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Dar es Salaam, Tanzania
| | - Lena M Lorenz
- Ifakara Health Institute, Dar-es-Salaam, Tanzania.,London School of Hygiene and Tropical Medicine, London, UK
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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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9
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Cisse MBM, Sangare D, Oxborough RM, Dicko A, Dengela D, Sadou A, Mihigo J, George K, Norris L, Fornadel C. A village level cluster-randomized entomological evaluation of combination long-lasting insecticidal nets containing pyrethroid plus PBO synergist in Southern Mali. Malar J 2017; 16:477. [PMID: 29162120 PMCID: PMC5698970 DOI: 10.1186/s12936-017-2124-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is growing concern that malaria vector resistance to pyrethroid insecticides may reduce the effectiveness of long-lasting insecticidal nets (LLINs). Combination LLINs are designed to control susceptible and pyrethroid-resistant mosquito populations through a mixture of pyrethroid with piperonyl butoxide (PBO) synergist. A cluster randomized trial with entomology outcome measures was conducted in Mali to determine the added benefit over mono-treated pyrethroid predecessors. Four LLIN treatments; permethrin + PBO, permethrin, deltamethrin + PBO, and deltamethrin, were randomly allocated to four villages each (16 villages total) and distributed to cover every sleeping place. Entomological monitoring of indoor Anopheles resting densities, host preference, vector longevity, and sporozoite rates were monitored every 2 months over 2 years in 2014 and 2015. RESULTS Bottle bioassays confirmed permethrin and deltamethrin resistance in Anopheles gambiae sensu lato (s.l.), (the predominant species throughout the study) with pre-exposure to PBO indicating partial involvement of oxidases. Between 2014 and 2015 the mean indoor resting density was greater in the deltamethrin + PBO LLIN arm than the deltamethrin LLIN arm at 3.05 (95% CI 3.00-3.10) An. gambiae s.l. per room per day compared with 1.9 (95% CI 1.87-1.97). There was no significant difference in sporozoite rate at 3.97% (95% CI 2.91-5.02) for the deltamethrin LLIN arm and 3.04% (95% CI 2.21-3.87) for deltamethrin + PBO LLIN arm (P = 0.17). However, when analysed by season there was some evidence that the sporozoite rate was lower in the deltamethrin + PBO LLIN arm than deltamethrin LLIN arm during the rainy/high malaria transmission seasons at 1.95% (95% CI 1.18-2.72) and 3.70% (95% CI 2.56-4.84) respectively (P = 0.01). CONCLUSIONS While there was some evidence that An. gambiae s.l. sporozoite rates were lower in villages with deltamethrin + PBO LLINs during the high malaria transmission seasons of 2014-2015, there was no reduction in parity rates or indoor resting densities. There was also no evidence that permethrin + PBO LLINs provided any improved control when compared with permethrin LLINs. Combination nets may have a greater impact in areas where mixed function oxidases play a more important role in pyrethroid resistance.
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Affiliation(s)
- Moussa B M Cisse
- Université des Sciences Techniques et Technologiques de Bamako (USTTB), Bamako, Mali
| | - Djibril Sangare
- Université des Sciences Techniques et Technologiques de Bamako (USTTB), Bamako, Mali.,Malaria Research and Training Center (MRTC), University of Bamako, Bamako, Mali
| | - Richard M Oxborough
- PMI Africa Indoor Residual Spraying Project, Abt Associates 4550 Montgomery Ave, Suite 800 North, Bethesda, MD, 20814, USA.
| | - Abdourhamane Dicko
- Programme National de Lutte Contre le Paludisme (PNLP), Ministère de la Santé, Bamako, Mali
| | - Dereje Dengela
- PMI Africa Indoor Residual Spraying Project, Abt Associates 4550 Montgomery Ave, Suite 800 North, Bethesda, MD, 20814, USA
| | - Aboubacar Sadou
- President's Malaria Initiative USAID, ACI2000; Rue 243, Porte 297, BP 34, Bamako, Mali
| | - Jules Mihigo
- President's Malaria Initiative USAID, ACI2000; Rue 243, Porte 297, BP 34, Bamako, Mali
| | - Kristen George
- President's Malaria Initiative USAID, 1300 Pennsylvania Avenue NW, Washington, DC, USA
| | - Laura Norris
- President's Malaria Initiative USAID, 1300 Pennsylvania Avenue NW, Washington, DC, USA
| | - Christen Fornadel
- President's Malaria Initiative USAID, 1300 Pennsylvania Avenue NW, Washington, DC, USA
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10
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Zewde A, Irish S, Woyessa A, Wuletaw Y, Nahusenay H, Abdelmenan S, Demissie M, Gulema H, Dissanayake G, Chibsa S, Solomon H, Yenehun MA, Kebede A, Lorenz LM, Ponce-de-Leon G, Keating J, Worku A, Berhane Y. Knowledge and perception towards net care and repair practice in Ethiopia. Malar J 2017; 16:396. [PMID: 28969636 PMCID: PMC5625612 DOI: 10.1186/s12936-017-2043-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 09/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-lasting insecticidal nets (LLINs) are a key malaria control intervention. Although LLINs are presumed to be effective for 3 years under field or programmatic conditions, net care and repair approaches by users influence the physical and chemical durability. Understanding how knowledge, perception and practices influence net care and repair practices could guide the development of targeted behavioural change communication interventions related to net care and repair in Ethiopia and elsewhere. METHODS This population-based, household survey was conducted in four regions of Ethiopia [Amhara, Oromia, Tigray, Southern Nations Nationalities Peoples Region (SNNPR)] in June 2015. A total of 1839 households were selected using multi-stage sampling procedures. The household respondents were the heads of households. A questionnaire was administered and the data were captured electronically. STATA software version 12 was used to analyse the data. Survey commands were used to account for the multi-stage sampling approach. Household descriptive statistics related to characteristics and levels of knowledge and perception on net care and repair are presented. Ordinal logistic regression was used to identify factors associated with net care and repair perceptions. RESULTS Less than a quarter of the respondents (22.3%: 95% CI 20.4-24.3%) reported adequate knowledge of net care and repair; 24.6% (95% CI 22.7-26.5%) of the respondents reported receiving information on net care and repair in the previous 6 months. Thirty-five per cent of the respondents (35.1%: 95% CI 32.9-37.4%) reported positive perceptions towards net care and repair. Respondents with adequate knowledge on net care and repair (AOR 1.58: 95% CI 1.2-2.02), and those who discussed net care and repair with their family (AOR 1.47: 95% CI 1.14-1.89) had higher odds of having positive perceptions towards net care and repair. CONCLUSIONS The low level of reported knowledge on net care and repair, as well as the low level of reported positive perception towards net repair need to be addressed. Targeted behavioural change communication campaigns could be used to target specific groups; increased net care and repair would lead to longer lasting nets.
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Affiliation(s)
- Ayele Zewde
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Seth Irish
- Entomology Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention and U.S. President's Malaria Initiative, Atlanta, USA
| | - Adugna Woyessa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yonas Wuletaw
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Honelgn Nahusenay
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
| | | | - Meaza Demissie
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Hanna Gulema
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | | | - Sheleme Chibsa
- President Malaria Initiative (PMI-USAID), Addis Ababa, Ethiopia
| | - Hiwot Solomon
- Ethiopian National Malaria Prevention, Control and Elimination Program, Addis Ababa, Ethiopia
| | - Meseret A Yenehun
- Ethiopian National Malaria Prevention, Control and Elimination Program, Addis Ababa, Ethiopia
| | - Amha Kebede
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Lena M Lorenz
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Joseph Keating
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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11
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The US President's Malaria Initiative and under-5 child mortality in sub-Saharan Africa: A difference-in-differences analysis. PLoS Med 2017; 14:e1002319. [PMID: 28609442 PMCID: PMC5469567 DOI: 10.1371/journal.pmed.1002319] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 05/09/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Despite substantial financial contributions by the United States President's Malaria Initiative (PMI) since 2006, no studies have carefully assessed how this program may have affected important population-level health outcomes. We utilized multiple publicly available data sources to evaluate the association between introduction of PMI and child mortality rates in sub-Saharan Africa (SSA). METHODS AND FINDINGS We used difference-in-differences analyses to compare trends in the primary outcome of under-5 mortality rates and secondary outcomes reflecting population coverage of malaria interventions in 19 PMI-recipient and 13 non-recipient countries between 1995 and 2014. The analyses controlled for presence and intensity of other large funding sources, individual and household characteristics, and country and year fixed effects. PMI program implementation was associated with a significant reduction in the annual risk of under-5 child mortality (adjusted risk ratio [RR] 0.84, 95% CI 0.74-0.96). Each dollar of per-capita PMI expenditures in a country, a measure of PMI intensity, was also associated with a reduction in child mortality (RR 0.86, 95% CI 0.78-0.93). We estimated that the under-5 mortality rate in PMI countries was reduced from 28.9 to 24.3 per 1,000 person-years. Population coverage of insecticide-treated nets increased by 8.34 percentage points (95% CI 0.86-15.83) and coverage of indoor residual spraying increased by 6.63 percentage points (95% CI 0.79-12.47) after PMI implementation. Per-capita PMI spending was also associated with a modest increase in artemisinin-based combination therapy coverage (3.56 percentage point increase, 95% CI -0.07-7.19), though this association was only marginally significant (p = 0.054). Our results were robust to several sensitivity analyses. Because our study design leaves open the possibility of unmeasured confounding, we cannot definitively interpret these results as causal. CONCLUSIONS PMI may have significantly contributed to reducing the burden of malaria in SSA and reducing the number of child deaths in the region. Introduction of PMI was associated with increased coverage of malaria prevention technologies, which are important mechanisms through which child mortality can be reduced. To our knowledge, this study is the first to assess the association between PMI and all-cause child mortality in SSA with the use of appropriate comparison groups and adjustments for regional trends in child mortality.
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12
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Taylor C, Florey L, Ye Y. Equity trends in ownership of insecticide-treated nets in 19 sub-Saharan African countries. Bull World Health Organ 2017; 95:322-332. [PMID: 28479633 DOI: 10.2471/blt.16.172924] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 01/06/2017] [Accepted: 01/13/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the change in equity of insecticide-treated net (ITN) ownership among 19 malaria-endemic countries in sub-Saharan Africa before and after the launch of the Cover The Bed Net Gap initiative. METHODS To assess change in equity in ownership of at least one ITN by households from different wealth quintiles, we used data from Demographic and Health Surveys and Malaria Indicator Surveys. We assigned surveys conducted before the launch (2003-2008) as baseline surveys and surveys conducted between 2009-2014 as endpoint surveys. We did country-level and pooled multicountry analyses. Pooled analyses based on malaria transmission risk, were done by dividing geographical zones into either low- and intermediate-risk or high-risk. To assess changes in equity, we calculated the Lorenz concentration curve and concentration index (C-index). FINDINGS Out of the 19 countries we assessed, 13 countries showed improved equity between baseline and endpoint surveys and two countries showed no changes. Four countries displayed worsened equity, two favouring the poorer households and two favouring the richer. The multicountry pooled analysis showed an improvement in equity (baseline survey C-index: 0.11; 95% confidence interval, CI: 0.10 to 0.11; and endpoint survey C-index: 0.00; 95% CI: -0.01 to 0.00). Similar trends were seen in both low- and intermediate-risk and high-risk zones. CONCLUSION The mass ITN distribution campaigns to increase coverage, linked to the launch of the Cover The Bed Net Gap initiative, have led to improvement in coverage of ITN ownership across sub-Saharan Africa with significant reduction in inequity among wealth quintiles.
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Affiliation(s)
- Cameron Taylor
- The DHS Program, ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, United States of America (USA)
| | - Lia Florey
- The DHS Program, ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, United States of America (USA)
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13
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Jaeger MS, Briët OJT, Keating J, Ahorlu CK, Yukich JO, Oppong S, Nardini P, Pfeiffer C. Perceptions on the effect of small electric fans on comfort inside bed nets in southern Ghana: a qualitative study. Malar J 2016; 15:580. [PMID: 27905928 PMCID: PMC5134074 DOI: 10.1186/s12936-016-1614-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/15/2016] [Indexed: 11/14/2022] Open
Abstract
Background Long-lasting insecticidal nets (LLINs) are known to be highly effective in reducing malaria transmission, morbidity and mortality. However, among those owning an LLIN, use rates are often suboptimal. A reported barrier to bed net use is discomfort due to heat. This qualitative study was part of a larger evaluation conducted in communities without electricity in rural Ghana to assess whether 0.8 W solar powered net fans can increase net use. Methods Twenty-three key informant interviews with household heads in the study communities in Shai-Osudoku District, southern Ghana, were conducted from July to August 2015. The purpose of the interviews was to obtain insight into perceptions of participants about the net fan system in relation to LLIN use. Results While all study participants reported using LLINs, with mosquito nuisance prevention as the prime motivation, heat was also mentioned as a key barrier to net use. Respondents appreciated the net fans because they improved comfort inside bed nets. The LED light on the fan stand became the main source of light at night and positively influenced the perception of the intervention as a whole. Conclusion The general acceptance of the net fan system by the study participants highlights the potential of the intervention to improve comfort inside mosquito nets. This, therefore, has a potential to increase bed net use in areas with low access to electricity.
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Affiliation(s)
- Mulako S Jaeger
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Olivier J T Briët
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Joseph Keating
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 2301, New Orleans, LA, 70112, USA
| | - Collins K Ahorlu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P.O. Box LG581, Legon, Ghana
| | - Joshua O Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 2301, New Orleans, LA, 70112, USA
| | - Samuel Oppong
- National Malaria Control Programme, P.O. Box KB 493, Korle-bu, Accra, Ghana
| | - Peter Nardini
- Green World Health Net, 307 Amherst Dr. SE, Albuquerque, NM, 87106, USA
| | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
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Koenker H, Kilian A, Hunter G, Acosta A, Scandurra L, Fagbemi B, Onyefunafoa EO, Fotheringham M, Lynch M. Impact of a behaviour change intervention on long-lasting insecticidal net care and repair behaviour and net condition in Nasarawa State, Nigeria. Malar J 2015; 14:18. [PMID: 25604427 PMCID: PMC4308907 DOI: 10.1186/s12936-014-0538-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While some data on net durability have been accumulating in recent years, including formative qualitative research on attitudes towards net care and repair, no data are available on how the durability of a net is influenced by behaviour of net maintenance, care and repair, and whether behavioural change interventions (BCC) could substantially impact on the average useful life of the net. METHODS The study used an intervention-control design with before-after assessment through repeated cross-sectional household surveys with two-stage cluster sampling following Nasarawa State's December 2010 mass campaign. All campaign nets were 100-denier polyester, long-lasting insecticidal nets (LLIN). Baseline, midline, and endline surveys occurred at one-year intervals, in March 2012, March 2013, and April 2014, respectively. Outcome measures were the proportion of confirmed campaign nets with observed repairs, and the proportion in serviceable condition, measured with proportionate hole index (pHI) and according to WHO guidelines. RESULTS For all respondents, exposure to BCC messages was strongly correlated with increased positive attitude towards care and repair, and increases in attitude were positively correlated with observed net repairs, and with the proportion of nets in serviceable condition. In a multivariate regression model, positive care and repair attitude (OR 6.17 p = 0.001) and level of exposure (1 source: OR 4.00 p = 0.000; 3 sources: OR 9.34 p = 0.000) remained the most significant predictors of net condition, controlling for background and environmental factors. Nets that were tied up had 2.70 higher odds of being in serviceable condition (p = 0.001), while repairs made to nets were not sufficient to improve their pHI category. Estimated median net lifespan was approximately one full year longer for nets in households with a positive compared to a negative attitude. CONCLUSION Exposure to multiple channels of a comprehensive BCC intervention was associated with improved attitude scores, and with improved net condition at endline. It is possible for BCC interventions to change both attitudes and behaviours, and to have an important effect on overall median net lifespan. Care and repair messages are easily incorporated into existing malaria BCC platforms, and will help contribute to improved net condition, providing, in principle, more protection from malaria.
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Affiliation(s)
- Hannah Koenker
- Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, USA.
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Scandurra L, Acosta A, Koenker H, Kibuuka DM, Harvey S. "It is about how the net looks": a qualitative study of perceptions and practices related to mosquito net care and repair in two districts in eastern Uganda. Malar J 2014; 13:504. [PMID: 25519882 PMCID: PMC4301822 DOI: 10.1186/1475-2875-13-504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/14/2014] [Indexed: 11/30/2022] Open
Abstract
Background Prolonging net durability has important implications for reducing both malaria transmission and the frequency of net replacement. Protective behaviour, such as net care and repair, offers promise for improving net integrity and durability. Given the potential cost-savings and public health benefit associated with extending the useful life of long-lasting insecticidal nets (LLINs), prevention and mitigation of damage will become ever more critical to ensuring adequate net coverage at the population level. Methods A qualitative assessment was conducted in two districts in central eastern Uganda in September 2013. Data on household net care and repair behaviour, attitudes and practices were collected from 30 respondents through in-depth interviews (IDIs), observations, photos, and video to gather an in-depth understanding of these behaviours. Results Net damage was common and the most cited causes were children and rodents. Responses revealed strong social norms about net cleanliness and aesthetics, and strong expectations that others should care for and repair their own nets. Respondents were receptive and able to repair nets, though longer-term repair methods, such as sewing and patching, were not as commonly reported or observed. Self-reported behaviour was not always consistent with observed or demonstrated behaviour, revealing potential misconceptions and the need for clear and consistent net care and repair messaging. Conclusions Respondents considered both aesthetics and malaria protection important when deciding whether, when, and how to care for and repair nets. BCC should continue to emphasize the importance of maintaining net integrity for malaria prevention purposes as well as for maintaining aesthetic appeal. Additional research is needed, particularly surrounding washing, drying, daily storage routines, and gender roles in care and repair, in order to understand the complexity of these behaviours, and refine existing or develop new behaviour change communication (BCC) messages for net care and repair.
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Affiliation(s)
- Leah Scandurra
- Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA.
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