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Win KM, Show KL, Sattabongkot J, Aung PL. Ownership and use of insecticide-treated nets in Myanmar: insights from a nationally representative demographic and health survey. Malar J 2024; 23:167. [PMID: 38807175 PMCID: PMC11135007 DOI: 10.1186/s12936-024-04994-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Malaria poses a substantial public health threat in Myanmar, indicating the need for rigorous efforts to achieve elimination of the disease nationwide by 2030. The use of insecticide-treated nets (ITNs) forms part of a pivotal strategy for preventing transmission. This study explored the ownership and use of ITNs in Myanmar and identified factors associated with non-use of ITNs. METHODS Household datasets from the 2015-2016 Myanmar Demographic and Health Survey were utilised, which encompassed all household members except children under the age of five. Descriptive statistics and inferential tests, including simple and multiple logistics regression models and Pearson correlations, were employed for analysis. All analyses, taking the two-stage stratified cluster sampling design into account, used weighting factors and the "svyset" command in STATA. The ownership and use of bed nets were also visualised in QGIS maps. RESULTS Among the 46,507 participants, 22.3% (95% CI 20.0%, 24.5%) had access to ITNs, with only 15.3% (95% CI 13.7, 17.1%) sleeping under an ITN the night before the survey. Factors associated with the non-use of ITNs included age category (15-34 years-aOR: 1.17, 95% CI 1.01, 1.30; 50+ years-aOR: 1.19, 95% CI 1.06, 1.33), location (delta or lowland-aOR: 5.39, 95% CI 3.94, 7.38; hills-aOR: 1.80, 95% CI 1.20, 2.71; plains-aOR: 3.89, 95% CI 2.51, 6.03), urban residency (aOR: 1.63, 95% CI 1.22, 2.17), and wealth quintile (third-aOR: 1.38, 95% CI 1.08, 1.75; fourth-aOR: 1.65, 95% CI 1.23, 2.23; fifth-aOR: 1.47, 95% CI 1.02, 2.13). A coherent distribution of the ownership and use of ITNs was seen across all states/regions, and a strong correlation existed between the ownership and use of ITNs (r: 0.9795, 95% CI 0.9377, 0.9933, alpha < 0.001). CONCLUSIONS This study identified relatively low percentages of ITN ownership and use, indicating the need to increase the distribution of ITNs to achieve the target of at least one ITN per every two people. Strengthening the use of ITNs requires targeted health promotion interventions, especially among relatively affluent individuals residing in delta or lowland areas, hills, and plains.
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Affiliation(s)
- Kyawt Mon Win
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pyae Linn Aung
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Saili K, de Jager C, Masaninga F, Chisanga B, Sinyolo A, Chiwaula J, Chirwa J, Hamainza B, Chanda E, Bakyaita NN, Mutero CM. Community perceptions, acceptability, and the durability of house screening interventions against exposure to malaria vectors in Nyimba district, Zambia. BMC Public Health 2024; 24:285. [PMID: 38267927 PMCID: PMC10809574 DOI: 10.1186/s12889-024-17750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND House screening remains conspicuously absent in national malaria programs despite its recognition by the World Health Organization as a supplementary malaria vector-control intervention. This may be attributed, in part, to the knowledge gap in screen durability or longevity in local climatic conditions and community acceptance under specific cultural practices and socio-economic contexts. The objectives of this study were to assess the durability of window and door wire mesh screens a year after full house screening and to assess the acceptability of the house screening intervention to the participants involved. METHODS This study was conducted in Nyimba district, Zambia and used both quantitative and qualitative methods of data collection and analysis. Both direct observation and questionnaires were employed to assess the durability of the screens and the main reasons for damage. Findings on damage were summarized as percentages. Focus group discussions were used to assess people's knowledge, perceptions, and acceptability of the closing eaves and house screening intervention. Deductive coding and inductive coding were used to analyse the qualitative data. RESULTS A total of 321 out of 400 (80.3%) household owners of screened houses were interviewed. Many window screens (90.3%) were intact. In sharp contrast, most door screens were torn (n = 150; 46.7%) or entirely removed (n = 55; 17.1%). Most doors (n = 114; 76%) had their wire mesh damaged or removed on the bottom half. Goats (25.4%), rust (17.6%) and children (17.1%) were cited most as the cause of damage to door screens. The focus group discussion elicited positive experiences from the participants following the closing of eaves and screening of their windows and doors, ranging from sleeping peacefully due to reduced mosquito biting and/or nuisance and having fewer insects in the house. Participants linked house screening to reduced malaria in their households and community. CONCLUSION This study demonstrated that in rural south-east Zambia, closing eaves and screening windows and doors was widely accepted. Participants perceived that house screening reduced human-vector contact, reduced the malaria burden and nuisance biting from other potentially disease carrying insects. However, screened doors are prone to damage, mainly by children, domestic animals, rust, and termites.
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Affiliation(s)
- Kochelani Saili
- International Centre of Insect Physiology and Ecology (icipe), Nairobi, P.O. Box 30772-00100, Kenya.
- School of Health Systems & Public Health, University of Pretoria Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa.
| | - Christiaan de Jager
- School of Health Systems & Public Health, University of Pretoria Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa
| | | | - Brian Chisanga
- International Centre of Insect Physiology and Ecology (icipe), Nairobi, P.O. Box 30772-00100, Kenya
- Development Economics Group, Wageningen University and Research, Wageningen, Netherlands
| | - Andy Sinyolo
- National Malaria Elimination Centre, Lusaka, Zambia
| | | | - Jacob Chirwa
- National Malaria Elimination Centre, Lusaka, Zambia
| | | | - Emmanuel Chanda
- World Health Organization, Regional Office, Brazzaville, Congo
| | | | - Clifford Maina Mutero
- International Centre of Insect Physiology and Ecology (icipe), Nairobi, P.O. Box 30772-00100, Kenya
- School of Health Systems & Public Health, University of Pretoria Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa
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Kakaire CN, Christofides N. The role of perceived threat and self-efficacy in the use of Insecticide Treated Bednets (ITNs) to prevent malaria among pregnant women in Tororo District, Uganda. PLoS One 2023; 18:e0289097. [PMID: 37494377 PMCID: PMC10370871 DOI: 10.1371/journal.pone.0289097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/11/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Despite increased coverage of Insecticide Treated Nets (ITNs) due to free distribution programs, ITN use in Uganda remains sub optimal among pregnant women. This study explored the relationship between constructs of a theoretical framework and Net use. OBJECTIVE The study examined the role of constructs from the Extended Parallel Process Model (EPPM) in determining ITN use amongst pregnant women 15-49 years in Tororo district, Uganda. METHODS A cross-sectional study using a systematic sample was conducted among 230 pregnant women attending antenatal care. The questionnaire was administered by trained research assistants. Analysis was conducted to establish the relationship between ITN use and perceived susceptibility, severity, self-efficacy and response efficacy. RESULTS Over three-quarters (78.6%) reported using ITNs the night before the study while 49.78% reported consistent Net use. High self-efficacy (AOR 9.48 95%CI 3.34-26.91) was associated with ITN use the previous night and consistent use. High perceived threat was associated with consistent ITN use (AOR 2.78, 95%CI 1.16-6.67) but not with Net use the previous night. CONCLUSION Self-efficacy was an important predictor of ITN use, as well as high levels of fear, as measured through perceived threat, which was associated with consistent ITN use, but not ITN use the previous night. Social and behavior change communication interventions should focus on improving self-efficacy to use ITNs.
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Affiliation(s)
- Charles Nelson Kakaire
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johanesburg, South Africa
| | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johanesburg, South Africa
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Babalola S, Kumoji K, Awantang GN, Oyenubi OA, Toso M, Tsang S, Bleu T, Achu D, Hedge J, Schnabel DC, Cash S, Van Lith LM, McCartney-Melstad AC, Nkomou Y, Dosso A, Lahai W, Hunter GC. Ideational factors associated with consistent use of insecticide-treated nets: a multi-country, multilevel analysis. Malar J 2022; 21:374. [PMID: 36474206 PMCID: PMC9724329 DOI: 10.1186/s12936-022-04384-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Stella Babalola
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Kuor Kumoji
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Grace N. Awantang
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Olamide A. Oyenubi
- grid.416147.10000 0004 0455 9186Department of Internal Medicine, Montefiore New Rochelle Hospital, New Rochelle, USA
| | - Michael Toso
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Samantha Tsang
- grid.21107.350000 0001 2171 9311Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Therese Bleu
- National Malaria Control Programme, Abidjan, Côte d’Ivoire
| | - Dorothy Achu
- National Malaria Control Programme, Yaounde, Cameroon
| | - Judith Hedge
- U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Yaounde, Cameroon
| | - David C. Schnabel
- U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Shelby Cash
- grid.416738.f0000 0001 2163 0069U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, USA
| | - Lynn M. Van Lith
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Anna C. McCartney-Melstad
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Yannick Nkomou
- PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Yaounde, Cameroon
| | - Abdul Dosso
- PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Abidjan, Côte d’Ivoire
| | - Wani Lahai
- National Malaria Control Programme, Freetown, Sierra Leone
| | - Gabrielle C. Hunter
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
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Alidosti M, Heidari Z, Shahnazi H, Zamani-Alavijeh F. Behaviors and Perceptions Related to Cutaneous Leishmaniasis in Endemic Areas of the World: A Review. Acta Trop 2021; 223:106090. [PMID: 34389332 DOI: 10.1016/j.actatropica.2021.106090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/18/2021] [Accepted: 08/01/2021] [Indexed: 12/13/2022]
Abstract
The investigation of perceptions and behaviors associated with cutaneous leishmaniasis (CL) in different societies has indicated that mere attention to biological and medical aspects is not enough to prevent and control diseases and it is necessary to know the disease-associated behaviors and beliefs. The present study aimed to answer a question: what are the behaviors and perceptions associated with cutaneous leishmaniasis in endemic regions of the world?. This study is a review of the articles published on CL from January 2010 to January 2021, on the International databases Science Direct, Scopus and PubMed. We utilized the terms cutaneous leishmaniasis, in combination with some keywords, including belief, perceptions, knowledge, attitude, practices, prevention, and behavior. Non-original studies, including editorials, reviews, prefaces, brief communications, and letters to the editor, CL epidemiological articles, pre-published articles that has not been peer reviewed, and articles that not provide complete findings on CL-related perceptions and behaviors were excluded from the present paper. After screening, 25 articles from 17 regions of the world were included in the study. The results depicted a novel classification of behaviors and perceptions related to CL prevention and control. Two positive and negative categories of perceptions and behaviors were discovered. Positive perceptions and behaviors were classified into five categories, including: 1- good awareness, 2- perceived susceptibility, 3- perceived severity, 4- perceived response efficiency, and 5- appropriate behaviors. Furthermore, negative perceptions and behaviors were classified into four categories: 1- poor awareness 2- misconceptions (A. About the disease vector B.about the cause of the disease, C. about the consequences of the disease and the treatment process), 3- perceived barriers (A. in prevention, B. in medical treatment), and 4- misbehaviors (A. negligence, B. local and traditional behavioral patterns). In most endemic parts of the world, misconceptions are probably the leading cause of several misbehaviors in dealing with CL. It seems that providing educational programs to strengthen positive beliefs and correct negative beliefs are rooted in the studies in different countries and could be useful for improving the relevant behaviors and ultimately, taking a step towards the prevention and control of CL.
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Affiliation(s)
- Masoumeh Alidosti
- Student Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Shahnazi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Rural-urban dimensions of the perception of malaria severity and practice of malaria preventive measures: insight from the 2018 Nigeria Demographic and Health Survey. J Biosoc Sci 2021; 54:858-875. [PMID: 34533116 DOI: 10.1017/s0021932021000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Nissan H, Ukawuba I, Thomson M. Climate-proofing a malaria eradication strategy. Malar J 2021; 20:190. [PMID: 33865383 PMCID: PMC8053291 DOI: 10.1186/s12936-021-03718-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
Two recent initiatives, the World Health Organization (WHO) Strategic Advisory Group on Malaria Eradication and the Lancet Commission on Malaria Eradication, have assessed the feasibility of achieving global malaria eradication and proposed strategies to achieve it. Both reports rely on a climate-driven model of malaria transmission to conclude that long-term trends in climate will assist eradication efforts overall and, consequently, neither prioritize strategies to manage the effects of climate variability and change on malaria programming. This review discusses the pathways via which climate affects malaria and reviews the suitability of climate-driven models of malaria transmission to inform long-term strategies such as an eradication programme. Climate can influence malaria directly, through transmission dynamics, or indirectly, through myriad pathways including the many socioeconomic factors that underpin malaria risk. These indirect effects are largely unpredictable and so are not included in climate-driven disease models. Such models have been effective at predicting transmission from weeks to months ahead. However, due to several well-documented limitations, climate projections cannot accurately predict the medium- or long-term effects of climate change on malaria, especially on local scales. Long-term climate trends are shifting disease patterns, but climate shocks (extreme weather and climate events) and variability from sub-seasonal to decadal timeframes have a much greater influence than trends and are also more easily integrated into control programmes. In light of these conclusions, a pragmatic approach is proposed to assessing and managing the effects of climate variability and change on long-term malaria risk and on programmes to control, eliminate and ultimately eradicate the disease. A range of practical measures are proposed to climate-proof a malaria eradication strategy, which can be implemented today and will ensure that climate variability and change do not derail progress towards eradication.
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Affiliation(s)
- Hannah Nissan
- Grantham Research Institute for Climate Change and the Environment, London School of Economics and Political Science, London, UK.
- International Research Institute for Climate and Society, Columbia University, Palisades, NY, USA.
| | - Israel Ukawuba
- Mailman School for Public Health, Columbia University, New York, NY, USA
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Yirsaw AN, Gebremariam RB, Getnet WA, Mihret MS. Insecticide-treated net utilization and associated factors among pregnant women and under-five children in East Belessa District, Northwest Ethiopia: using the Health Belief model. Malar J 2021; 20:130. [PMID: 33663516 PMCID: PMC7971121 DOI: 10.1186/s12936-021-03666-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria during pregnancy and childhood is one of the major public health challenges globally. Its prevalence is huge in Africa, especially in sub-Saharan countries and Ethiopia. Insecticide-treated mosquito net (ITN) use is one of the primary malaria preventive strategies. Previous studies did not adequately address the health belief and behaviour-related correlates of ITN using health belief model (HBM), although a number of studies were conducted in this theme. Therefore, this study was aimed at assessing the prevalence and associated factors of ITN utilization among pregnant women and under five children in east Belessa district, northwest Ethiopia, 2020. METHODS A community-based cross-sectional mixed study was conducted in east Belessa district from February 01-30/2020. A total of 724 eligible participants were included in the quantitative study. A multistage cluster sampling technique was used. The quantitative data were collected using an interviewer-administered structured questionnaire. Data were entered into Epi data version 4.6.0.2 and then exported to SPSS version 16 for analysis. The binary logistic regression model was fitted and the level of significance was declared based on AOR with its 95% CI and p-value ≤ 0.05. Meanwhile, the qualitative data were collected using focus group discussions and key informant interviews, and analysed using a thematic analysis approach. RESULTS The prevalence of ITN utilization was 56.5% (95% CI 53.0, 60.2) and independently predicted by a corrugated iron roof of the house (AOR = 1.53; 95% CI 1.15, 2.22), rural residence (AOR = 1.59; 95% CI 1.11,2.28), ≥ 2 number of rooms in the house (AOR = 1.56; 95% CI 1.06, 2.30) and high level of perceived barrier (AOR = 0.53; 95% CI 0.38,0.74). In the qualitative findings, the main barrier was connected to misconceptions and misperception towards malaria and ITN. CONCLUSION The prevalence of ITN utilization in the study area was lower than the national target (100%). It was significantly associated with household characteristics, residence, and level of a perceived barrier. Reversing the community's misconceptions through information, education and communication (IEC), and behavioural change communication (BCC) would enhance ITN utilization.
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Affiliation(s)
- Amlaku Nigusie Yirsaw
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia.
| | - Resom Berhe Gebremariam
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Wallelign Alemnew Getnet
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tapera O. Determinants of long-lasting insecticidal net ownership and utilization in malaria transmission regions: evidence from Zimbabwe Demographic and Health Surveys. Malar J 2019; 18:278. [PMID: 31429761 PMCID: PMC6701104 DOI: 10.1186/s12936-019-2912-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/13/2019] [Indexed: 12/04/2022] Open
Abstract
Background Long-lasting insecticidal nets (LLINs) were first introduced in 2010 as a vector control intervention, to complement indoor residual spraying, to reduce malaria transmission in Zimbabwe. The objective of this study was to investigate factors that were associated with LLIN ownership and utilization among households in malaria transmission regions of Zimbabwe. Methods A secondary analysis of cross sectional data from the Zimbabwe demographic and health survey (ZDHS) conducted in 2010 and 2015 surveys round was conducted. The analysis used household-level datasets from across the country to generate evidence for the study. Univariate analysis was used to yield descriptive statistics. Principal component analysis (PCA) was used to calculate wealth quintiles. Binary logistic regression approach was used to identify determinants of LLIN ownership and utilization after controlling for other factors. Data analyses were conducted using STATA version 14 software. Results There were no major changes in demographic characteristics of households sampled between 2010 and 2015 survey cycles. LLIN ownership increased significantly by 42 percentage points from 2010 to 2015. There was a tremendous increase in universal coverage of LLINs between 2010 and 2015. The overall utilization levels of LLINs among children under-5 years decreased by 11 percentage points between 2010 and 2015. LLIN usage amongst households followed the same trend with that of the under-fives. Using logistic regression model for 2015 data, region/province, type of place of residence, availability of electricity, radio, roof type, gender of head of household, having telephone, type of cooking fuel, presence of mobile phone, owning a bank account, IRS spraying in the previous 12 months, wealth index, and satellite television decorder were independently associated with net ownership among households. Type of place of residence, age of household head, type of cooking fuel, IRS in previous 12 months, and pregnancy were associated with LLIN utilization. Conclusion This study revealed increasing LLIN coverage and low usage in malaria-transmission regions of Zimbabwe. Strengthening of LLIN campaigns, social behaviour change communication (SBCC) interventions and programme routine monitoring are recommended.
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Affiliation(s)
- Oscar Tapera
- Department of Mathematics, Faculty of Science, Midlands State University, Gweru, Zimbabwe.
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Asingizwe D, Poortvliet PM, Koenraadt CJM, van Vliet AJH, Ingabire CM, Mutesa L, Leeuwis C. Role of individual perceptions in the consistent use of malaria preventive measures: mixed methods evidence from rural Rwanda. Malar J 2019; 18:270. [PMID: 31395048 PMCID: PMC6686450 DOI: 10.1186/s12936-019-2904-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/05/2019] [Indexed: 12/03/2022] Open
Abstract
Background Malaria preventive measures, including long-lasting insecticide-treated bet nets (LLINs), indoor residual spraying (IRS), and controlling mosquito breeding sites, are key measures to achieve malaria elimination. Still, compliance with these recommended measures remains a major challenge. By applying a novel and comprehensive model for determinants of malaria prevention behaviour, this study tests how individual perceptions influence the intentions to use malaria preventive measures and explores strategies that stimulate their consistent use. Methods The study was carried out in the sectors of Ruhuha and Busoro, Rwanda during October and November 2017, and these were conducted into two phases. Phase one involved a questionnaire survey (N = 742), whereas Phase two employed a qualitative approach that included nine focus group discussions, seven key informant interviews, and three in-depth interviews. Results The findings of the quantitative study showed that participants very often use LLINs (66.6%), accept IRS (73.9%), and drain stagnant water in case of presence (62%). The intentions to use malaria preventive measures were consistently driven by perceived severity, perceived self-efficacy, perceived response efficacy, and subjective norms, and hindered by perceived barriers. The intentions were also positively associated with the actual use of LLINs, acceptance of IRS, and drainage of stagnant water. There is no evidence that either not having enough LLINs (ownership of at least one bed net in the household, here referred to as availability) or having sufficient LLINs (having one LLIN per two people in the household, here referred to as accessibility) moderated the relationship between behavioural intentions and actual use of LLINs. The qualitative study indicated that participants believed malaria risk to be high and perceived a high mosquito density. They also believed that repetitive malaria episodes are caused by the perceived low effectiveness of anti-malaria medications. Lack of LLINs increased the perceived added value of LLINs, and together with the increased malaria burden increased the perceived response efficacy. Participants highlighted the need to continuously mobilize and engage community members especially those who do not use LLINs when having one, and those who do not accept the spraying activities. Conclusion Malaria prevention interventions should target individual perceptions to enhance consistent use of malaria preventive measures. Three strategies to improve consistent use and acceptance of these measures are highlighted: (1) ensure access to LLINs and regular spraying activities, (2) community mobilization and (3) citizen engagement in malaria prevention activities.
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Affiliation(s)
- Domina Asingizwe
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. .,Strategic Communication Group, Wageningen University and Research, Wageningen, The Netherlands.
| | - P Marijn Poortvliet
- Strategic Communication Group, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Arnold J H van Vliet
- Environmental Systems Analysis Group, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Leon Mutesa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Cees Leeuwis
- Knowledge, Technology and Innovation Group, Wageningen University and Research, Wageningen, The Netherlands
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11
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Ricotta E, Oppong S, Yukich JO, Briët OJT. Determinants of bed net use conditional on access in population surveys in Ghana. Malar J 2019; 18:63. [PMID: 30849976 PMCID: PMC6408824 DOI: 10.1186/s12936-019-2700-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/01/2019] [Indexed: 12/02/2022] Open
Abstract
Background Insecticide-treated nets (ITNs) are one of the most effective and widely available methods for preventing malaria, and there is interest in understanding the complexities of behavioural drivers of non-use among those with access. This analysis evaluated net use behaviour in Ghana by exploring how several household and environmental variables relate to use among Ghanaians with access to a net. Methods Survey data from the Ghana 2014 Demographic and Health Survey and the 2016 Malaria Indicator Survey were used to calculate household members’ access to space under a net as well as the proportion of net use conditional on access (NUCA). Geospatial information on cluster location was obtained, as well as average humidex, a measure of how hot it feels, for the month each cluster was surveyed. The relationship between independent variables and net use was assessed via beta-binomial regression models that controlled for spatially correlated random effects using non-Gaussian kriging. Results In both surveys, increasing wealth was associated with decreased net use among those with access in households when compared to the poorest category. In 2014, exposure to messages about bed net use for malaria prevention was associated with increased net use (OR 2.5, 95% CrI 1.5–4.2), as was living in a rural area in both 2014 (OR 2.5, 95% CrI 1.5–4.3) and 2016 (OR 1.6, 95% CrI 1.1–2.3). The number of nets per person was not associated with net use in either survey. Model fit was improved for both surveys by including a spatial random effect for cluster, demonstrating some spatial autocorrelation in the proportion of people using a net. Humidex, electricity in the household and IRS were not associated with NUCA. Conclusion Net use conditional on access is affected by household characteristics and is also spatially-dependent in Ghana. Setting (whether the household was urban or rural) plays a role, with wealthier and more urban households less likely to use nets when they are available. It will likely be necessary in the future to focus on rural settings, urban settings, and wealth status independently, both to better understand predictors of household net use in these areas and to design more targeted interventions to ensure consistent use of vector control interventions that meet specific needs of the population. Electronic supplementary material The online version of this article (10.1186/s12936-019-2700-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emily Ricotta
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, P.O. Box CH-4001, Basel, Switzerland.
| | - Samuel Oppong
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Korle-bu, P. O. Box KB 493, Accra, Ghana
| | - Joshua O Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St. #8317, New Orleans, LA, 70112, USA
| | - Olivier J T Briët
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland.,University of Basel, Petersplatz 1, P.O. Box CH-4001, Basel, Switzerland
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12
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Babalola S, Adedokun ST, McCartney-Melstad A, Okoh M, Asa S, Tweedie I, Tompsett A. Factors associated with caregivers' consistency of use of bed nets in Nigeria: a multilevel multinomial analysis of survey data. Malar J 2018; 17:280. [PMID: 30071875 PMCID: PMC6071383 DOI: 10.1186/s12936-018-2427-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/24/2018] [Indexed: 11/12/2022] Open
Abstract
Background Malaria remains endemic in Nigeria despite programmes and policies put in place toward malaria elimination. Long-lasting insecticidal nets have been documented to offer protection from malaria by preventing mosquito bites. While many studies have examined the factors associated with the use of bed nets in Nigeria and across Africa, little information is available on the factors associated with consistency of use of bed nets. Methods The data for this study were derived from a household survey conducted in three states in Nigeria (Akwa Ibom, Kebbi and Nasarawa) between July and September 2015 by the Health Communication Capacity Collaborative, a 5-year cooperative agreement supported by the United States Agency for International Development and the US President’s Malaria initiative and led by the Johns Hopkins Center for Communication Programs. The analysis was limited to a total of 3884 men and women selected from 2863 households with at least one bed net. Multilevel multinomial logistic regression was used to assess the factors associated with consistency of use of bed nets. Results The findings revealed 43.2% of the respondents use bed nets every night, while 38.4% use bed nets most nights. The factors associated with using a bed net every night rather than rarely or never using a bed net included sociodemographic and household variables (age, gender, religion, household size, net density, and household wealth), ideational variables (perceptions about severity, susceptibility, self-efficacy to use nets, and response-efficacy of bed net; awareness of place of purchase; willingness to pay for bed nets; attitudes towards net use; and descriptive norm about nets), and state of residence. The three study states differ significantly in terms of most of the independent variables included in the estimated model. Conclusions The study recommends that efforts designed to promote consistent use of bed nets should be state-specific and include strategies targeting ideational variables. Furthermore, given the significance of unmeasured heterogeneity at the cluster level, strategies to engage and mobilize the community, such as community dialogue, home visits and engaging community leadership, are relevant.
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Affiliation(s)
- Stella Babalola
- Breakthrough Action/Johns Hopkins Center for Communication Programs, Johns Hopkins University, 111 Market Place - Suite 310, Baltimore, MD, 21202, USA.
| | - Sulaimon T Adedokun
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Anna McCartney-Melstad
- Breakthrough Action/Johns Hopkins Center for Communication Programs, Johns Hopkins University, 111 Market Place - Suite 310, Baltimore, MD, 21202, USA
| | - Mathew Okoh
- Breakthrough Action/Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Sola Asa
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Ian Tweedie
- Breakthrough Action/Johns Hopkins Center for Communication Programs, Johns Hopkins University, 111 Market Place - Suite 310, Baltimore, MD, 21202, USA
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13
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Idris ZM, Chan CW, Mohammed M, Kalkoa M, Taleo G, Junker K, Arcà B, Drakeley C, Kaneko A. Serological measures to assess the efficacy of malaria control programme on Ambae Island, Vanuatu. Parasit Vectors 2017; 10:204. [PMID: 28441959 PMCID: PMC5405492 DOI: 10.1186/s13071-017-2139-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/13/2017] [Indexed: 01/10/2023] Open
Abstract
Background Seroepidemiology can provide evidence for temporal changes in malaria transmission and is an important tool to evaluate the effectiveness of control interventions. During the early 2000s, Vanuatu experienced an acute increase in malaria incidence due to a lapse in funding for vector control. After the distribution of subsidised insecticide-treated nets (ITNs) resumed in 2003, malaria incidence decreased in the subsequent years. This study was conducted to find the serological evidence supporting the impact of ITN on exposure to Anopheles vector bites and parasite prevalence. Methods On Ambae Island, blood samples were collected from 231 and 282 individuals in 2003 and 2007, respectively. Parasite prevalence was determined by microscopy. Antibodies to three Plasmodium falciparum (PfSE, PfMSP-119, and PfAMA-1) and three Plasmodium vivax (PvSE, PvMSP-119, and PvAMA-1) antigens, as well as the Anopheles-specific salivary antigen gSG6, were detected by ELISA. Age-specific seroprevalence was analysed using a reverse catalytic modelling approach to estimate seroconversion rates (SCRs). Results Parasite rate decreased significantly (P < 0.001) from 19.0% in 2003 to 3.2% in 2007, with a shift from P. falciparum predominance to P. falciparum-P. vivax co-dominance. Significant (P < 0.001) decreases were observed in seroprevalence to all three P. falciparum antigens but only two of three P. vivax antigens (except PvAMA-1; P = 0.153), consistent with the more pronounced decrease in P. falciparum prevalence. Seroprevalence to gSG6 also decreased significantly (P < 0.001), suggesting that reduced exposure to vector bites was important to the decrease in parasite prevalence between 2003 and 2007. Analyses of age-specific seroprevalence showed a three-fold decrease in P. falciparum transmission, but the evidence for the decrease in P. vivax transmission was less clear. Conclusions Serological markers pointed to the effectiveness of ITNs in reducing malaria prevalence on Ambae Island between 2003 and 2007. The recombinant gSG6 antigen originally developed to indicate exposure to the Afrotropical vector An. gambiae may be used in the Pacific to complement the traditional measure of entomological inoculation rate (EIR).
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Affiliation(s)
- Zulkarnain Md Idris
- Island Malaria Group, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden. .,Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Chim W Chan
- Island Malaria Group, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Mubasher Mohammed
- Island Malaria Group, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Klara Junker
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK.,Yeast and Fermentation, Carlsberg Research Laboratory, Copenhagen, Denmark
| | - Bruno Arcà
- Department of Public Health and Infectious Diseases, Parasitology Section, Sapienza University of Rome, Rome, Italy
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - Akira Kaneko
- Island Malaria Group, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Parasitology and Research Centre for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan.,Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
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14
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Arroz JAH. Social and behavior change communication in the fight against malaria in Mozambique. Rev Saude Publica 2017; 51:18. [PMID: 28355338 PMCID: PMC5342323 DOI: 10.1590/s1518-8787.2017051006360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/12/2015] [Indexed: 11/21/2022] Open
Abstract
Long-lasting insecticide-treated nets and/or indoor residual spraying, associated with case management, are key interventions in the control of malaria in Africa. The objective of this study is to comment on the role of social and behavior change communication as a potential key intervention in the control of malaria in Mozambique.
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15
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Surveillance for malaria outbreak on malaria-eliminating islands in Tafea Province, Vanuatu after Tropical Cyclone Pam in 2015. Epidemiol Infect 2016; 145:41-45. [PMID: 27609054 DOI: 10.1017/s0950268816002041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The risk of malaria outbreak surfaced in Vanuatu after Tropical Cyclone (TC) Pam in March 2015. In June and July 2015 we conducted malariometric surveys on the islands of Tanna, Aneityum, and Erromango in Tafea Province, where malaria elimination had been targeted, to determine if malaria incidence had increased after TC Pam. No Plasmodium infection was detected by microscopy and PCR in 3009 survey participants. Only 6·3% (190/3007) of participants had fever. Spleen rates in children aged ⩽12 years from Aneityum and Tanna were low, at 3·6% (14/387) and 5·3% (27/510), respectively. Overall bed net use was high at 72·8% (2175/2986); however, a significantly higher (P < 0·001) proportion of participants from Aneityum (85·9%, 796/927) reported net use than those from Tanna (67·1%, 751/1119) and Erromango (66·8%, 628/940). A recent decrease in malaria incidence in Tafea Province through comprehensive intervention measures had reduced the indigenous parasite reservoir and limited the latter's potential to spur an outbreak after TC Pam. The path towards malaria elimination in Tafea Province was not adversely affected by TC Pam.
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16
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Tang S, Ji L, Hu T, Wang R, Fu H, Shao T, Liu C, Shao P, He Z, Li G, Feng Z. Public awareness of malaria in the middle stage of national malaria elimination programme. A cross-sectional survey in rural areas of malaria-endemic counties, China. Malar J 2016; 15:373. [PMID: 27436087 PMCID: PMC4949874 DOI: 10.1186/s12936-016-1428-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Remarkable progress in the elimination of malaria has been achieved by the Chinese government in the past 5 years. However, imported cases have increased rapidly, and it is a critical threat to the national malaria elimination programme. This study aims to investigate the current status of the public awareness of malaria in the middle stage of the national malaria elimination progress. METHODS A cross-sectional survey with multi-stage stratified randomized sampling was undertaken between June 2015 and March 2016. A total of 1321 residents from nine malaria-endemic counties, 27 townships and 81 villages were interviewed using a structured questionnaire. RESULTS The results showed 51.6 % of the respondents had sufficient malaria knowledge. The malaria awareness of the public in type I counties was better than that in type II, whereas that in type III was the lowest. Approximately 74.9 % of the respondents were aware of at least one form of prevention of malaria, and 85.2 % of them would seek treatment when suffering from malaria. However, the awareness of fever, chills, sweating as common symptoms of malaria were 53.4, 56.2 and 31.6 %, respectively. The level of malaria awareness of the at-risk population was similar to that of the general population, it seemingly increased along with age and declined with the distance away from township hospitals. CONCLUSION The public awareness of malaria needs to improve continuously. Health education campaigns should focus on basic malaria knowledge and cover target populations. The multi-sectoral or even international collaboration should be further intensified. Careful planning is required to ensure that scattered villages are incorporated into the malaria health promotion system to sustain elimination.
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Affiliation(s)
- Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Lu Ji
- Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Tao Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China.,Bureau of Disease Prevention and Control, National Health and Family, Beijing, China
| | - Ruoxi Wang
- University of Nottingham, Nottingham, UK
| | - Hang Fu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Tian Shao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Chunyan Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Piaopiao Shao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Zhe He
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Gang Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China.
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Babalola S, Ricotta E, Awantang G, Lewicky N, Koenker H, Toso M. Correlates of Intra-Household ITN Use in Liberia: A Multilevel Analysis of Household Survey Data. PLoS One 2016; 11:e0158331. [PMID: 27403877 PMCID: PMC4942134 DOI: 10.1371/journal.pone.0158331] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 06/14/2016] [Indexed: 11/02/2022] Open
Abstract
Malaria is a major cause of morbidity and mortality in Liberia. At the same time, insecticide-treated net (ITN) ownership and use remain low. Access is a key determinant of ITN use but it is not the only one; prior studies have identified factors that affect the use of ITNs in households with at least one ITN. These factors operate at the individual, household, and community levels. However, studies have generally not assessed the psychosocial or ideational determinants of ITN use. Using 2014 household survey data, this manuscript examines the socio-demographic, ideational, household, and community factors associated with household member use of ITNs in Liberia. Multilevel modeling was used to assess fixed effects at the individual, household, and community levels, and random effects at the household and cluster levels. The data showed significant residual clustering at the household level, indicating that there were unmeasured factors operating at this level that are associated with ITN use. The association of age with ITN use was moderated by sex such that men, older children, and teenagers were less likely to sleep under an ITN compared to women and children under five years old. Female caregivers' perceived severity of malaria, perceived self-efficacy to detect a complicated case of malaria, and exposure to the "Take Cover" communication campaign were positively associated with ITN use by members of her household. The association with household size was negative, while the relationship with the number of ITNs was positive. Programs should seek to achieve universal coverage (that is, one ITN for every two household members) and promote the notion that everyone needs to sleep under an ITN every night. Programs should also seek to strengthen perceived severity of malaria and educate intended audience groups on the signs of malaria complications. Given the significance of residual clustering at the household level, interventions that engage men as heads of household and key decision-makers are relevant.
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Affiliation(s)
- Stella Babalola
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
- * E-mail:
| | - Emily Ricotta
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
| | - Grace Awantang
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
| | - Nan Lewicky
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
| | - Hannah Koenker
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
| | - Michael Toso
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
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