Increasing coverage of insecticide-treated nets in rural Nigeria: implications of consumer knowledge, preferences and expenditures for malaria prevention

Decomposition of changes in malaria prevalence amongst under-five children in Nigeria

BACKGROUND

Malaria remains a major public health problem in Nigeria. Changes in malaria prevalence can be attributed to three major control interventions: insecticide treated nets (ITNs), indoor residual spraying (IRS) and intermittent preventive treatment in pregnancy (IPTp). Use of ITNs has proven to be a practical, highly effective, and cost-effective intervention against malaria. Although, several studies have assessed the utilisation of ITNs, its impact on the prevalence of malaria over time is yet to be documented in Nigeria. Therefore, this study was conducted to decompose changes in malaria prevalence amongst under-five children between 2003 and 2013.

MATERIALS AND METHODS

A retrospective analysis of the 2003 and 2013 Nigeria Demographic Health Survey (NDHS) dataset was conducted. Occurrence of fever was used as a proxy for malaria. Percentage change in both outcome and explanatory variables between 2003 and 2013 was estimated. A multivariate decomposition technique was used to partition changes in malaria prevalence into two components: contribution of changes in determinants and changes in the effect of determinants.

RESULTS

A total of 5204 and 28634 records of children under-five were available in 2003 and 2013 respectively. Malaria prevalence declined from 31.8% to 13.1% between 2003 and 2013 (p<0.001). Changes in determinants contributed 4.7% and changes in the effect of determinants contributed 95.3% to the change in malaria prevalence.

CONCLUSIONS

There was a decline in the prevalence of malaria amongst children under five in Nigeria in the last ten years. Ownership of ITNs and their utilisation were the most contributing factors to the decline in malaria prevalence. Continued efforts should be made in promoting ITNs and their consistent and appropriate utilisation.

Knowledge of malaria prevention among pregnant women and female caregivers of under-five children in rural southwest Nigeria

Introduction. The morbidity and mortality from malaria are still unacceptably high in the developing countries, especially among the vulnerable groups like pregnant women and under-five children, despite all control efforts. The knowledge about the preventive measures of malaria is an important preceding factor for the acceptance and use of malaria preventive measures like Insecticide Treated Nets (ITN) by community members. Therefore, this study assessed the knowledge of malaria prevention among caregivers of under-five children and pregnant women in a rural community in Southwest Nigeria.

Methodology. This is part of a larger malaria prevention study in rural Southwest Nigeria. A descriptive cross-sectional survey was conducted among pregnant women and caregivers of under-five children in Igbo-Ora, a rural town in Southwest Nigeria using a semi-structured, interviewer-administered questionnaire. Information was obtained on knowledge of malaria prevention, and overall composite scores were computed for knowledge of malaria prevention and ITN use. Data were analyzed using SPSS version 16. Associations between variables were tested using a Chi-square with the level of statistical significance set at 5%.

Results. Of the 631 respondents, 84.9% were caregivers of under-five children and 67.7% were married. Mean age was 27.7 ± 6.3 years with 53.4% aged between 20 and 29 years. Majority (91.1%) had at least primary school education and 60.2% were traders. Overall, 57.7% had poor knowledge of malaria prevention. A good proportion (83.5%) were aware of the use of ITN for malaria prevention while 30.6% had poor knowledge of its use. Respondents who were younger (<30 years), had at least primary education and earn <10,000/per month had significantly poor knowledge of ITN use in malaria prevention. Majority (60.0%) respondents had poor attitude regarding use of ITNs.

Conclusion. This study showed that the knowledge of malaria prevention is still low among under-five caregivers and pregnant women in rural Southwest Nigeria despite current control measures. There is a need for concerted health education intervention to improve the knowledge of rural dwellers regarding malaria prevention, including the use of ITN. This will go a long way to improving the reported low level of ownership and utilization of ITN in the rural areas.

Malaria prevalence in north-eastern Nigeria: a cross-sectional study

OBJECTIVE

To assess the prevalence of malaria parasitemia in north-east Nigeria and to evaluate the measures for the prevention of malaria.

METHODS

A village in north-eastern Nigeria was selected for the cross sectional study at the height of the rainy season in October 2011. A total of 550 inhabitants of a hamlet were recruited for this study. After obtaining the consent individuals received a structured interview and were tested for malaria parasites in their blood films. Recruits testing positive for malaria were given a course of artemesinin-based combination therapy (ACT).

RESULTS

A total of 497 inhabitants representing approximately 90 percent of the population participated: a quarter of the study group carried malaria parasitesexclusively Plasmodium falciparum(P. falciparum)-representing a P. falciparum parasite rate (PfPR) of 24.5%. Besides, 53/138 in the age group of 2 to < 10 years old children tested positive for P. falciparum representing a PfPR2-10 value of 38.4%. Malaria control measures were used in just under a third (157/497) of this cohort. Despite these measures 28/157 (17.8%) still tested positive for P. falciparum.

CONCLUSIONS

The malaria burden is overestimated for this region in north-east Nigeria. The findings support an intermediate pattern of malaria endemicity. The 30% bed nets coverage for malaria control is well below the WHO estimates for 2011.

Lessons from the implementation of LLIN distribution campaign in Ilorin Kwara State, Nigeria

Background

Studies implemented to evaluate the success of Long-lasting insecticidal nets (LLIN) distribution campaigns are often limited to ownership and utilization rates, neglecting other factors that directly affect the efficacy of the tool in malaria control. This study investigates sleeping habits and net maintenance behaviour in addition to LLIN ownership, utilization and the challenges associated with LLIN use among residents in Ilorin City where the tool has been massively distributed.

Methods

A cross-sectional survey was conducted using pre-tested interviewer-administered questionnaire to obtain information from randomly selected household respondents in Ilorin, the Kwara State Capital. The study was conducted in July 2012, about sixteen months after the March 2011 distribution of LLIN in the locality. The results were analyzed using the EPI INFO 2007 version.

Results

LLIN ownership (85%) and utilization (37%) rates improved compared to earlier reports, though 29% of net users have noticed holes in the nets even as 26% claimed to have actually experienced mosquito bites under it. Most (92%) of the respondents who slept under LLIN the previous night before the study spent the first five hours of the night (19.00-23.00 hr) outdoors while 88% also engage in inappropriate net washing practices. All the LLIN users claimed to have experienced at least one malaria episode while 43% have had two or more episodes within the past twelve months.

Conclusion

The use of LLIN among the respondents in this study was accompanied by chancy sleeping habits, inappropriate net maintenance practices and repeated experience of mosquito bites under the nets. This shows the need to sustain the will and confidence of LLIN users in this area through frequent monitoring and surveillance visits targeted at enlightening the people on habits that increase malaria exposure risks as well as proper use and maintenance of LLIN for maximum malaria vector control benefits.

Towards making efficient use of household resources for appropriate prevention of malaria: investigating households' ownership, use and expenditures on ITNs and other preventive tools in Southeast Nigeria

BACKGROUND

Many households own, use and spend money on many malaria preventive tools, some of which are inappropriate and ineffective in preventing malaria. This is despite the promotion of use of effective preventive methods such as Insecticide treated nets (ITNs) and indoor residual house spraying (IRHS). The use of these ineffective methods imposes some economic burden on households with no resultant reduction in the risk of developing malaria. Hence, global and national targets in use of various effective malaria preventive toools are yet to be achieved in Nigeria. This paper presents new evidence on the differential use and expenditures on effective and non-effective malaria preventive methods in Nigeria.

METHODS

Semi-structured interviewer administered pre-tested questionnaire were used to collect data from 500 households from two communities in Enugu state, Nigeria. The two study communities were selected randomly while the households were selected systematically. Information was collected on demography, malaria status of children under 5 within the past month, types of malaria preventive tools used by households and how much was spent on these, the per capita household food expenditure and assets ownership of respondents to determine their socio-economic status.

RESULTS

There was high level of ownership of ITNs (73%) and utilization (71.2%), with 40% utilization by children under 5. There were also appreciable high levels of use of other malaria preventive tools such as window and door nets, indoor spray, aerosol spray and cleaning the environment. No significant inequity was found in ownership and utilization of ITNs and in use of other preventive methods across socioeconomic groups. However, households spent a lot of money on other preventive tools and average expenditures were between N0.83-N172 ($0.005-$1.2) The richest households spent the most on window and door nets (P = 0.04).

CONCLUSION

High levels of use and expenditure on ITNs and other malaria preventive tools exist. A programmatic challenge will involve designing ways and means of converting some of the inefficient and inappropriate expenditures on many ineffective malaria preventive tools to proven cost-effective methods such as ITNs and IRHS. This will help to achieve universal coverage with malaria preventive tools.

Adherence to intermittent preventive treatment for malaria with sulphadoxine-pyrimethamine and outcome of pregnancy among parturients in South East Nigeria

BACKGROUND

Intermittent preventive treatment of malaria for pregnant women (IPTp) is a very important strategy for the control of malaria in pregnancy in malaria-endemic tropical countries, where mosquito bites easily occur during evening outdoor activities. Issues related to provision, cost, and acceptability may affect the use of IPTp in some developing countries. The aim of the study was to assess the uptake and adherence to sulphadoxine-pyrimethamine-based intermittent preventive treatment of malaria during pregnancy and the relationship of IPTp use to pregnancy outcomes in two major obstetric centers in South East Nigeria.

METHODS

This was a prospective descriptive study involving women who received antenatal and delivery services. All recruited women were followed-up from booking until delivery, and statistical analysis was done with Epi Info version 7.

RESULTS

A total of 516 parturients were studied. The mean gestational age at booking was 21.8±6.9 weeks while the mean number of antenatal visits throughout the pregnancy was 5.5±3.1. The rate of uptake of at least one dose of prescribed IPTp was 72.1% (367/516). Of the 367 who took prescribed IPTp, adherence to second doses of IPTp was 59.7% (219/367), and only 4.9% (18/367) took a third dose. Clinical malaria occurred in 85% (127/149) of women who did not receive IPTp at all compared to 20.5% of those who received at least one dose of IPTp. All those who had clinical malaria despite IPTp had only one dose of IPTp despite booking in the second trimester. Malaria in pregnancy occurred significantly more in women who failed to adhere to subsequent doses of IPTp than in those who adhered (24.6% versus 14.3%, respectively; risk ratio =2.5; 95% confidence interval 2.1, 3.0; P<0.001). Similarly, neonatal malaria occurred significantly more in neonates whose mothers did not receive IPTp compared to those whose mothers received at least one dose of IPTp (7.4% versus 3.4%; risk ratio =1.4; 95% confidence interval 0.9, 2.1; P=0.003).

CONCLUSION

More than one half of parturients failed to adhere to prescribed intermittent preventive treatment for malaria in pregnancy in the major obstetric centers in Abakaliki, South East Nigeria. The very high prevalence of malaria among women who failed to adhere to IPTp and the associated adverse neonatal outcomes demands more pragmatic ways of improving access to, and acceptability of, malaria preventive measures in this area.

Impacts of agricultural practices on insecticide resistance in the malaria vector Anopheles arabiensis in Khartoum State, Sudan

Background

Agricultural pesticides may play a profound role in selection of resistance in field populations of mosquito vectors. The objective of this study is to investigate possible links between agricultural pesticide use and development of resistance to insecticides by the major malaria vector Anopheles arabiensis in northern Sudan.

Methodology/Principal Findings

Entomological surveys were conducted during two agricultural seasons in six urban and peri-urban sites in Khartoum state. Agro-sociological data were collected from 240 farmers subjected to semi-structured questionnaires based on knowledge attitude and practice (KAP) surveys. Susceptibility status of An. arabiensis (n=6000) was assessed in all sites and during each season using WHO bioassay tests to DDT, deltamethrin, permethrin, Malathion and bendiocarb. KAP analysis revealed that pesticide application was common practice among both urban and peri-urban farmers, with organophosphates and carbamates most commonly used. Selection for resistance is likely to be greater in peri-urban sites where farmers apply pesticide more frequently and are less likely to dispose of surpluses correctly. Though variable among insecticides and seasons, broad-spectrum mortality was slightly, but significantly higher in urban than peri-urban sites and most marked for bendiocarb, to which susceptibility was lowest. Anopheles arabiensis from all sites showed evidence of resistance or suspected resistance, especially pyrethroids. However, low-moderate frequencies of the L1014F kdr allele in all sites, which was very strongly associated with DDT, permethrin and deltamethrin survivorship (OR=6.14-14.67) suggests that resistance could increase rapidly.

Conclusions

Ubiquitous multiple-resistance coupled with presence of a clear mechanism for DDT and pyrethroids (kdr L1014F) in populations of An. arabiensis from Khartoum-Sudan suggests careful insecticide management is essential to prolong efficacy. Our findings are consistent with agricultural insecticide use as a source of selection for resistance and argue for coordination between the integrated vector control program and the Ministry of Agriculture to permit successful implementation of rational resistance management strategies.

Determinants of ownership and utilization of insecticide-treated bed nets for malaria control in eastern ethiopia

Background. Malaria remains a major cause of mortality and morbidity in the world, and particularly in sub-Saharan Africa. Objectives. The aim of this study was to determine ownership and utilization of ITNs among households with children under five in the previous night. Methods. A community based cross-sectional study was conducted in Gursum district in Eastern Ethiopia. A total of 335 households were surveyed using a pretested structured questionnaire administered though house-to-house interviews. Results. Household ownership for at least one mosquito net and use of nets were 62.4% (95% CI 57.2–67.6%) and 21.5% (95% CI 17.1–25.9%), respectively. Households who received or were told about ITN in the last 6 months were three times more likely to have used it than those who were not (OR 3.25; 95% CI 1.5–7.10). Households whose heads were engaged as a farmer (adjusted OR 0.137; 95% CI: 0.04–0.50) and housewife (OR 0.26; 95% CI: 0.08–0.82) were less likely to use ITN than those of other occupations. Conclusion. The findings indicate low ITN ownership and utilization among the households. Intensive health education and community mobilization effort should be employed to increase the possession and proper utilization of insecticide treated bed nets.

An investigation of the use of rectangular insecticide-treated nets for malaria control in Chipinge District, Zimbabwe: a descriptive study

INTRODUCTION

In 2007, Zimbabwe government distributed rectangular insecticide treated nets in Chipinge District, covering 100% of population at risk. However, malaria morbidity continued increasing from 492/1000 (49.2%) in 2007 to 667/1000 (66.7%) in 2008. A study was conducted in Chipinge District in May 2009 to investigate the use of rectangular insecticide treated nets and factors affecting their use in malaria prevention.

METHODS

A descriptive cross-sectional study was conducted. Quantitative and qualitative methods were triangulated to assess utilisation of rectangular insecticide treated nets. Five interviewers administered 380 questionnaires to senior matriarchs selected from five wards, with 19,667 sampling frame (19,667/380 = 52). Five focus group discussions were conducted. Quantitative data were analysed using Statistical Package for the Social Sciences, while qualitative data were summarised into thematic areas.

RESULTS

Approximately, 95% of respondents knew that malaria was caused by mosquito bites. Perception of nets as malaria preventative measure was high (88%). Utilization of rectangular insecticide treated nets was low (33%) with 81% of those not using them expressed difficulty procedures of mounting them and unavailability of related accessories as main reasons. People preferred conical insecticide treated nets (84%) compared to rectangular insecticide treated nets (15%).

CONCLUSION

Although the Chipinge people accepted insecticide treated nets for malaria prevention, procedure of mounting rectangular insecticide treated nets and accessing related accessories prevented consistent use.In order for insecticide treated net project to have impact on malaria prevention, priority should be given to conical shape or rectangular shape with adequate accessories like wire nails and strings or twine.

Knowledge and practice of malaria prevention methods among residents of arba minch town and arba minch zuria district, southern ethiopia

BACKGROUND

To date, there is no effective vaccine or no effective drug for mass chemoprophylaxis against malaria. Thus, proper know-how and use of prevention methods is crucial. This study aims to assess the knowledge and practice of malaria prevention methods among the residents of Arba Minch area, Southern Ethiopia.

METHODS

A community-based cross-sectional study that utilized a two-stage sampling was conducted from January 22 to February 1, 2007 on a sample of 454 household heads or their deputies. SPSS 16 for windows was used for data analysis. Chi-square and Fisher's exact probability tests were used to assess the association of selected variables with place of residence.

RESULTS

Majority (86.8%) of the respondents mentioned fever as a symptom of malaria, and 98.2% of the respondents reported mosquito bite as the cause of malaria. Three hundred and eighty four (84.6%) of the respondents mentioned mosquito nets as protective measures against mosquito bites. The protective measure mostly used by the respondents or other household members in the last 12 months was mosquito net (73.3%) followed by aerosol insecticide (13%) with the former being used more in rural areas and the latter in urban areas.

CONCLUSION

The study subjects' awareness regarding the cause, symptoms and preventive measures of malaria was high. Use of mosquito net as protective measure against mosquito bites in the last 12 months was high. However, use of other preventive measures was low. Behavioral change communication is required to increase the use of other preventive measures along with mosquito nets.

Examining equity in access to long-lasting insecticide nets and artemisinin-based combination therapy in Anambra State, Nigeria

Background

In order to achieve universal health coverage, the government of Anambra State, southeast Nigeria has distributed free Long-lasting Insecticide treated Nets (LLINs) to the general population and delivered free Artemisinin-based Combination Therapy (ACT) to pregnant women and children less than 5 years. However, the levels of coverage with LLINS and ACTs is not clear, especially coverage of different socio-economic status (SES) population groups. This study was carried out to determine the level of coverage and access to LLINs and ACTs amongst different SES groups.

Methods

A questionnaire was used to collect data from randomly selected households in 19 local government areas of the State. Selected households had a pregnant woman and/or a child less than 5 years. The lot quality assurance sampling (LQAS) methodology was used in sampling. The questionnaire explored the availability and utilization of LLINs and ACTs from 2394 households. An asset-based SES index was used to examine the level of access of LLINS and ACTs to different SES quintiles.

Results

It was found that 80.5 % of the households had an LLIN and 64.4 % of the households stated that they actually used the nets the previous night. The findings showed that 42.3 % of pregnant women who had fever within the past month received ACTs, while 37.5 % of children ≪5 years old who had malaria in the past month had received ACTs. There was equity in ownership of nets for the range 1–5 nets per household. No significant SES difference was found in use of ACTs for treatment of malaria in children under five years old and in pregnant women.

Conclusions

The free distribution of LLINs and ACTs increased household coverage of both malaria control interventions and bridged the equity gap in access to them among the most vulnerable groups.

Determinants of insecticide-treated net ownership and utilization among pregnant women in Nigeria

Background

Malaria during pregnancy is a major public health problem in Nigeria leading to increase in the risk of maternal mortality, low birth weight and infant mortality. This paper is aimed at highlighting key predictors of the ownership of insecticide treated nets (ITNs) and its use among pregnant women in Nigeria.

Methods

A total of 2348 pregnant women were selected by a multi-stage probability sampling technique. Structured interview schedule was used to elicit information on socio-demographic characteristics, ITN ownership, use, knowledge, behaviour and practices. Logistic regression was used to detect predictors of two indicators: ITN ownership, and ITN use in pregnancy among those who owned ITNs.

Results

ITN ownership was low; only 28.8% owned ITNs. Key predictors of ITN ownership included women who knew that ITNs prevent malaria (OR = 3.85; p < 0001); and registration at antenatal clinics (OR = 1.34; p = 0.003). The use of ITNs was equally low with only 7.5% of all pregnant women, and 25.7% of all pregnant women who owned ITNs sleeping under a net. The predictors of ITN use in pregnancy among women who owned ITNs (N = 677) identified by logistic regression were: urban residence (OR = 1.87; p = 0.001); knowledge that ITNs prevent malaria (OR = 2.93; p < 0001) and not holding misconceptions about malaria prevention (OR = 1.56; p = 0.036). Educational level was not significantly related to any of the two outcome variables. Although registration at ANC is significantly associated with ownership of a bednet (perhaps through free ITN distribution) this does not translate to significant use of ITNs.

Conclusions

ITN use lagged well behind ITN ownership. This seems to suggest that the current mass distribution of ITNs at antenatal facilities and community levels may not necessarily lead to use unless it is accompanied by behaviour change interventions that address the community level perceptions, misconceptions and positively position ITN as an effective prevention device to prevent malaria

Community-owned resource persons for malaria vector control: enabling factors and challenges in an operational programme in Dar es Salaam, United Republic of Tanzania

BACKGROUND

Community participation in vector control and health services in general is of great interest to public health practitioners in developing countries, but remains complex and poorly understood. The Urban Malaria Control Program (UMCP) in Dar es Salaam, United Republic of Tanzania, implements larval control of malaria vector mosquitoes. The UMCP delegates responsibility for routine mosquito control and surveillance to community-owned resource persons (CORPs), recruited from within local communities via the elected local government.

METHODS

A mixed method, cross-sectional survey assessed the ability of CORPs to detect mosquito breeding sites and larvae, and investigated demographic characteristics of the CORPs, their reasons for participating in the UMCP, and their work performance. Detection coverage was estimated as the proportion of wet habitats found by the investigator which had been reported by CORP. Detection sensitivity was estimated as the proportion of wet habitats found by the CORPS which the investigator found to contain Anopheles larvae that were also reported to be occupied by the CORP.

RESULTS

The CORPs themselves perceived their role as professional rather than voluntary, with participation being a de facto form of employment. Habitat detection coverage was lower among CORPs that were recruited through the program administrative staff, compared to CORPs recruited by local government officials or health committees (Odds Ratio = 0.660, 95% confidence interval = [0.438, 0.995], P = 0.047). Staff living within their areas of responsibility had > 70% higher detection sensitivity for both Anopheline (P = 0.016) and Culicine (P = 0.012): positive habitats compared to those living outside those same areas.

DISCUSSION AND CONCLUSIONS

Improved employment conditions as well as involving the local health committees in recruiting individual program staff, communication and community engagement skills are required to optimize achieving effective community participation, particularly to improve access to fenced compounds. A simpler, more direct, less extensive community-based surveillance system in the hands of a few, less burdened, better paid and maintained program personnel may improve performance and data quality.

Determinants of insecticide treated nets use among youth corp members in Edo State, Nigeria

Background

The Africa Malaria Report shows that many countries are quite far from reaching the universal coverage targets of 80% coverage by 2010 and maintain it at this level. This paper examines ITN use and the factors associated with its adoption among the youths in Nigeria. This information will help in the design of effective methods of providing and distributing the nets in order to enhance its adoption and maximize the public health benefits of ITNs.

Methods

This cross-sectional survey was carried out in 2006 among university leavers serving compulsory national service (youth corpers) using total sampling technique. The study was conducted using a self-administered questionnaire.

Results

A total of 656 youth corp members were interviewed. Only 23.8% of these youths ever use ITN while 4.3% currently use ITN before reporting in camp. A significant proportion of the youths acquired information on ITN from Mass Media (p = 0.0001). Other statistically significant factors that encourage the use of ITN include inexpensive market price of ITN (p = 0.0001), frequency of Malaria infestation (p = 0.019) and perceived malaria preventive action of ITN ( p = 0.000).

Following logistic regression analysis, perceived effective malaria preventive action of ITN [OR = 29.3, C.I = 17.17-50.0] and high frequency of Malaria infestation [OR = 1.55, C.I = 0.97-2.47] were predictors of ITN use.

Conclusion

The study shows that the use of ITN for the prevention of Malaria is low among these Nigerian youths. The major factors determining the adoption of ITN among the youths were perceived effective Malaria prevention action of ITN and high frequency of Malaria attack. These factors should be considered in the design of sustainable and effective locally relevant strategies for scale-up adoption of ITNs among a youthful African population.

Investigating preferences for mosquito-control technologies in Mozambique with latent class analysis

Background

It is common practice to seek the opinions of future end-users during the development of innovations. Thus, the aim of this study is to investigate latent classes of users in Mozambique based on their preferences for mosquito-control technology attributes and covariates of these classes, as well as to explore which current technologies meet these preferences.

Methods

Surveys were administered in five rural villages in Mozambique. The data were analysed with latent class analysis.

Results

This study showed that users' preferences for malaria technologies varied, and people could be categorized into four latent classes based on shared preferences. The largest class, constituting almost half of the respondents, would not avoid a mosquito-control technology because of its cost, heat, odour, potential to make other health issues worse, ease of keeping clean, or inadequate mosquito control. The other three groups are characterized by the attributes which would make them avoid a technology; these groups are labelled as the bites class, by-products class, and multiple-concerns class. Statistically significant covariates included literacy, self-efficacy, willingness to try new technologies, and perceived seriousness of malaria for the household.

Conclusions

To become widely diffused, best practices suggest that end-users should be included in product development to ensure that preferred attributes or traits are considered. This study demonstrates that end-user preferences can be very different and that one malaria control technology will not satisfy everyone.

An exploratory qualitative study on perceptions about mosquito bed nets in the Niger Delta: what are the barriers to sustained use?

Background:

The effectiveness of malaria control programs is determined by an array of complex factors, including the acceptability and sustained use of preventative measures such as the bed net. A small-scale exploratory study was conducted in several locations in the Niger Delta region, Nigeria, to discover barriers against the use of bed nets, in the context of a current drive to scale up net use in Nigeria.

Methods:

A qualitative approach with a convenience sample was used. One to one interviews with mostly male adult volunteers were undertaken which explored typical living and sleeping arrangements, and perceptions about and barriers against the use of the mosquito prevention bed net.

Results:

Several key issues emerged from the qualitative data. Bed nets were not reported as widely used in this small sample. The reasons reported for lack of use included issues of convenience, especially net set up and dismantling; potential hazard and safety concerns; issues related to typical family composition and nature of accommodation; humid weather conditions; and perceptions of cost and effectiveness. Most barriers to net use concerned issues about everyday practical living and sleeping arrangements and perceptions about comfort. Interviewees identified were aware of malaria infection risks, but several also indicated certain beliefs that were barriers to net use.

Conclusions:

Successful control of malaria and scale up of insecticide-treated net coverage relies on community perceptions and practice. This small study has illuminated a number of important everyday life issues, which remain barriers to sustained net use, and has clarified further questions to be considered in net design and in future research studies. The study highlights the need for further research on the human concerns that contribute to sustained use of nets or, conversely, present significant barriers to their use.

Awareness and use of insecticide-treated bed nets among children attending outpatient clinic at UNTH, Enugu - the need for an effective mobilization process

BACKGROUND

The promotion of insecticide-treated net (ITN) can be a key approach towards the reduction of morbidity and mortality from malaria.

OBJECTIVE

To determine the proportion of mothers using insecticide treated nets for their children and reasons for nonuse.

STUDY DESIGN

Prospective hospital-based study.

METHOD

Consecutive mothers attending the children's out patient clinic of UNTH, Ituku-Ozalla, Enugu, whose children presented with fever without localizing focus were interviewed with the aid of an open-ended structured questionnaire.

RESULTS

Awareness of ITN was found in 184 (80%) of the 230 mothers interviewed, while only 48 (26.1%) use it for their children. There was statistically significant difference in terms of ITN awareness between the highly educated mothers and those with lower educational qualification (p = 0.000) but, in terms of ITN usage, there was no significant difference between the two groups (p = 0.40). Socio economic class did not influence the use of ITN (p = 0.153). A greater number; 56 (41.2%) have no reason for non-use. Reasons for nonuse include use of windows and door nets 22 (16.2%) and not convenient to spread 18 (13.2%).

CONCLUSION

There was a high awareness of ITN, which did not influence usage.

Malaria knowledge and agricultural practices that promote mosquito breeding in two rural farming communities in Oyo State, Nigeria

BACKGROUND

Agricultural practices such as the use of irrigation during rice cultivation, the use of ponds for fish farming and the storage of water in tanks for livestock provide suitable breeding grounds for anthropophylic mosquitoes. The most common anthropophylic mosquito in Nigeria which causes much of the morbidity and mortality associated with malaria is the anopheles mosquito. Farmers are therefore at high risk of malaria - a disease which seriously impacts on agricultural productivity. Unfortunately information relating to agricultural practices and farmers' behavioural antecedent factors that could assist malaria programmers plan and implement interventions to reduce risk of infections among farmers is scanty. Farmers' knowledge about malaria and agricultural practices which favour the breeding of mosquitoes in Fashola and Soku, two rural farming communities in Oyo State were therefore assessed in two rural farming communities in Oyo State.

METHODS

This descriptive cross-sectional study involved the collection of data through the use of eight Focus Group Discussions (FGDs) and the interview of 403 randomly selected farmers using semi-structured questionnaires. These sets of information were supplemented with observations of agricultural practices made in 40 randomly selected farms. The FGD data were recorded on audio-tapes, transcribed and subjected to content analysis while the quantitative data were analyzed using descriptive and inferential statistics.

RESULTS

Most respondents in the two communities had low level of knowledge of malaria causation as only 12.4% stated that mosquito bite could transmit the disease. Less than half (46.7%) correctly mentioned the signs and symptoms of malaria as high body temperature, body pains, headache, body weakness and cold/fever. The reported main methods for preventing mosquito bites in the farming communities included removal of heaps of cassava tuber peelings (62.3%), bush burning/clearing (54.6%) and clearing of ditches (33.7%). The dumping of cassava tuber peelings which allows the collection of pools of water in the farms storage of peeled cassava tubers soaked in water in uncovered plastic containers, digging of trenches, irrigation of farms and the presence of fish ponds were the observed major agricultural practices that favoured mosquito breeding on the farms. A significant association was observed between respondents' knowledge about malaria and agricultural practices which promote mosquito breeding. Respondents' wealth quintile level was also seen to be associated with respondents' knowledge about malaria and agricultural practices which promote mosquito breeding.

CONCLUSION

Farmers' knowledge of malaria causation and signs and symptoms was low, while agricultural practices which favour mosquito breeding in the farming communities were common. There is an urgent need to engage farmers in meaningful dialogue on malaria reduction initiatives including the modification of agricultural practices which favour mosquito breeding. Multiple intervention strategies are needed to tackle the factors related to malaria prevalence and mosquito abundance in the communities.

Malaria control under the Taliban regime: insecticide-treated net purchasing, coverage, and usage among men and women in eastern Afghanistan

Background

Scaling up insecticide-treated mosquito net (ITN) coverage is a key malaria control strategy even in conflict-affected countries [1,2]. Socio-economic factors influence access to ITNs whether subsidized or provided free to users. This study examines reported ITN purchasing, coverage, and usage in eastern Afghanistan and explores women's access to health information during the Taliban regime (1996-2001). This strengthens the knowledge base on household-level health choices in complex-emergency settings.

Methods

Fifteen focus group discussions (FGDs) and thirty in-depth interviews were conducted with men and women from ITN-owning and non-owning households. FGDs included rank ordering, pile sorting and focused discussion of malaria knowledge and ITN purchasing. Interviews explored general health issues, prevention and treatment practices, and women's malaria knowledge and concerns. Seven key informant interviews with health-related workers and a concurrent survey of 200 ITN-owning and 214 non-owning households were used to clarify or quantify findings.

Results

Malaria knowledge was similar among men and women and ITN owners and non-owners. Women reported obtaining health information through a variety of sources including clinic staff, their husbands who had easier access to information, and particularly female peers. Most participants considered ITNs very desirable, though not usually household necessities. ITN owners reported more household assets than non-owners. Male ITN owners and non-owners ranked rugs and ITNs as most desired, while women ranked personal assets such as jewellery highest. While men were primarily responsible for household decision-making and purchasing, older women exerted considerable influence. Widow-led and landless households reported most difficulties purchasing ITNs. Most participants wanted to buy ITNs only if they could cover all household members. When not possible, preferential usage was given to women and children.

Conclusions

Despite restricted access to health facilities and formal education, Afghan women were surprisingly knowledgeable about the causes of malaria and the value of ITNs in prevention. Inequities in ITN usage were noted between rather than within households, with some unable to afford even one ITN and others not wanting ITNs unless all household members could be protected. Malaria knowledge thus appears a lesser barrier to ITN purchasing and coverage in eastern Afghanistan than are pricing and distribution strategies.

A qualitative study on the acceptability and preference of three types of long-lasting insecticide-treated bed nets in Solomon Islands: implications for malaria elimination

Background

In March 2008, the Solomon Islands and Vanuatu governments raised the goal of their National Malaria Programmes from control to elimination. Vector control measures, such as indoor residual spraying (IRS) and long-lasting insecticidal bed nets (LLINs) are key integral components of this programme. Compliance with these interventions is dependent on their acceptability and on the socio-cultural context of the local population. These factors need to be investigated locally prior to programme implementation.

Method

Twelve focus group discussions (FGDs) were carried out in Malaita and Temotu Provinces, Solomon Islands in 2008. These discussions explored user perceptions of acceptability and preference for three brands of long-lasting insecticide-treated bed nets (LLINs) and identified a number of barriers to their proper and consistent use.

Results

Mosquito nuisance and perceived threat of malaria were the main determinants of bed net use. Knowledge of malaria and the means to prevent it were not sufficient to guarantee compliance with LLIN use. Factors such as climate, work and evening social activities impact on the use of bed nets, particularly in men. LLIN acceptability plays a varying role in compliance with their use in villages involved in this study. Participants in areas of reported high and year round mosquito nuisance and perceived threat of malaria reported LLIN use regardless of any reported unfavourable characteristics. Those in areas of low or seasonal mosquito nuisance were more likely to describe the unfavourable characteristics of LLINs as reasons for their intermittent or non-compliance. The main criterion for LLIN brand acceptability was effectiveness in preventing mosquito bites and malaria. Discussions highlighted considerable confusion around LLIN care and washing which may be impacting on their effectiveness and reducing their acceptability in Solomon Islands.

Conclusion

Providing LLINs that are acceptable will be more important for improving compliance in areas of low or seasonal mosquito nuisance and malaria transmission. The implications of these findings on malaria elimination in Solomon Islands are discussed.

Quantifying the economic burden of malaria in Nigeria using the willingness to pay approach

Background

Malaria illness imposes great burden on the society as it has adverse effects on the physical, mental and social well being of the people as well as on the economic development of the nation.

Methods

The study uses the Willingness To Pay (WTP) approach to evaluate the burden of malaria in Nigeria.

Results

The results indicate that households would be prepared to pay an average of about Naira 1,112 (USD 9.3) per month for the treatment of malaria. This is about Naira 427 (USD 3.6) in excess of the average expenditure they currently make on malaria treatment per month. Similarly, households are willing to pay on the average a sum of Naira 7,324 (USD 61) per month for the control of malaria. Again, this is an excess of about Naira 2,715 (USD 22.6) over the cost they currently bear (protection, treatment and indirect costs), and it represents households' average valuation of their intangible costs of malaria illness. This amount represents about Naira 611.7 (USD 5.1) per head per month and Naira 7,340 (USD 61.2) per year. For a country with a population of about 120 million this translates to about Naira 880,801 million per annum representing about 12.0 per cent of Gross Domestic Product. Hence, the malaria burden in Nigeria is enormous and has a devastating impact on economic growth.

Conclusion

In the long term, it is important to recognize that health and poverty are closely linked. Reducing the burden of malaria in Nigeria will help to contribute to the economic well-being of communities; and poverty-reduction will be an essential input into improving health. National malaria control programme in Nigeria and their partners need to recognize these links, and identify mechanisms for ensuring that the poorest have access to essential health interventions.

Investigating mosquito-net coverage in Nigeria. How useful are consumer marketing surveys?

A marketing company conducting a consumer omnibus survey (COS) in April 2000 was paid to include questions about household ownership of mosquito nets. At the time of the survey, which involved 5018 respondents, most and perhaps all of the nets owned by the respondents would have been untreated, as a product for net treatment was then virtually unavailable. Sampling was conducted in all 36 states and the Federal Capital Territory, Abuja. Core questions were asked about socio-demographic and socio-economic characteristics, and commissioned questions were asked about household net ownership, the source of the household's newest net, if any, and the price paid for that net. The data were analysed using bivariate and multivariate methods. Socio-economic status was measured using an asset index. The estimated number of nets was adjusted using information on asset ownership from the national Demographic and Health Survey of 1999. After this adjustment for sampling bias, net coverage and the total number of nets in Nigerian households were estimated to be approximately 9% and 3 million, respectively. The single most important association with net ownership was access to a flit-gun. It appears that COS are a potentially useful source of information for assessing mosquito-net coverage at household level and monitoring changes over time. They have the advantage of being administered frequently, and they are relatively low cost. The present results were comparable with those from other studies conducted at a similar time. The main disadvantage of COS is sampling bias but, as shown here, it is often possible to adjust for this.

Compliance of young children with ITN protection in rural Burkina Faso

BACKGROUND

Insecticide-treated bed nets (ITNs) are known to be highly effective in reducing malaria morbidity and mortality. The effectiveness of ITNs is largely influenced by behavioural factors and not much is known regarding such factors under programme conditions.

METHODS

This descriptive study was nested into a large ITN effectiveness study in rural Burkina Faso. During two cross-sectional surveys in the dry and rainy season of 2003, random samples of young children from nine representative villages (n = 180 per survey) were investigated for compliance with ITN protection and related behaviour. Data were collected through direct observations and through interviews with mothers.

RESULTS

ITNs were perceived as very important for protection against mosquitoes and malaria particularly during the rainy season, but there were problems with their use during the dry season. Young children usually slept with their mother under the ITN and self-reported compliance was 66% and 98% during dry and rainy season, respectively (confirmed by direct observation in 34% and 79%, respectively). Important reasons for low compliance during the dry season were high temperatures inside houses and problems related to changing sleeping places during the night.

CONCLUSION

Under programme conditions, compliance with ITN protection in young children is sufficient during the rainy season, but is rather low during the hot and dry season. Greater emphasis needs to be placed on information/education efforts to make people aware of the fact that the risk of contracting malaria may persist throughout the year.