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Zare M, Vatandoost H, Soleimani-Ahmadi M, Sanei-Dehkordi A, Jaberhashemi SA, Mohseni S. Knowledge and Practices of Women Regarding Malaria and Its Prevention: A Community-Based Study in an Area under Malaria Elimination Programme in Iran. J Arthropod Borne Dis 2023; 17:383-399. [PMID: 38868676 PMCID: PMC11164615 DOI: 10.18502/jad.v17i4.15301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/26/2023] [Indexed: 06/14/2024] Open
Abstract
Background Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are two core interventions for control and prevention of malaria infection. This descriptive cross-sectional study aimed to determine the knowledge and practices of women regarding malaria and its preventive measures in a malarious area in the Jask County, southeast of Iran. Methods Data was collected from 400 households through a two-stage random cluster sampling method in six villages. Pre-tested structured questionnaire was used to collect data. During the survey, visual observations were also made by the interviewers to check use of LLINs and IRS. The data were analyzed by SPSS software version 21. Results The majority of households had a high level of knowledge about symptoms (98%, n=392) and transmission (74.5%, n=298) of malaria. The main preventive measures against malaria were: LLINS (39.5%, n=158), IRS (32%, n=128), and screens on doors/windows (16.7%, n=67). In addition, participants with primary or higher educational level reported that they practice more malaria preventive measures, compared to those who were illiterate (OR=3.3, 95% CI= 1.6-6.6, p=0.0001, Table 6). In spite of positive perceptions about IRS and LLINs, only 35.5% (n=142) and 17% (n=68) of households used IRS and LLINs, respectively. Conclusion According to the results of this study, despite a high level of knowledge about malaria and its preventive measures, a small number of participants use LLINs and IRS for malaria prevention. Therefore, implementation of effective educational interventions is recommended to improve preventive practices against malaria in the study area.
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Affiliation(s)
- Mehdi Zare
- Department of Occupational Health Engineering, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hassan Vatandoost
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Chemical Pollutants and Pesticides, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Moussa Soleimani-Ahmadi
- Department of Medical Entomology and Vector Control, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Alireza Sanei-Dehkordi
- Department of Medical Entomology and Vector Control, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Shokrollah Mohseni
- Student Research Committee, Shiraz University of Medical Science, Shiraz, Iran
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Lippi CA, Mundis SJ, Sippy R, Flenniken JM, Chaudhary A, Hecht G, Carlson CJ, Ryan SJ. Trends in mosquito species distribution modeling: insights for vector surveillance and disease control. Parasit Vectors 2023; 16:302. [PMID: 37641089 PMCID: PMC10463544 DOI: 10.1186/s13071-023-05912-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: 03/17/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023] Open
Abstract
Species distribution modeling (SDM) has become an increasingly common approach to explore questions about ecology, geography, outbreak risk, and global change as they relate to infectious disease vectors. Here, we conducted a systematic review of the scientific literature, screening 563 abstracts and identifying 204 studies that used SDMs to produce distribution estimates for mosquito species. While the number of studies employing SDM methods has increased markedly over the past decade, the overwhelming majority used a single method (maximum entropy modeling; MaxEnt) and focused on human infectious disease vectors or their close relatives. The majority of regional models were developed for areas in Africa and Asia, while more localized modeling efforts were most common for North America and Europe. Findings from this study highlight gaps in taxonomic, geographic, and methodological foci of current SDM literature for mosquitoes that can guide future efforts to study the geography of mosquito-borne disease risk.
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Affiliation(s)
- Catherine A Lippi
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, FL, 32601, USA.
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32601, USA.
| | - Stephanie J Mundis
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, FL, 32601, USA
| | - Rachel Sippy
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, FL, 32601, USA
- School of Mathematics and Statistics, University of St Andrews, St Andrews, KY16 9SS, UK
| | - J Matthew Flenniken
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, FL, 32601, USA
| | - Anusha Chaudhary
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, FL, 32601, USA
| | - Gavriella Hecht
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, FL, 32601, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32601, USA
| | - Colin J Carlson
- Center for Global Health Science and Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Sadie J Ryan
- Quantitative Disease Ecology and Conservation (QDEC) Lab, Department of Geography, University of Florida, Gainesville, FL, 32601, USA.
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32601, USA.
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Mwema T, Lukubwe O, Joseph R, Maliti D, Iitula I, Katokele S, Uusiku P, Walusimbi D, Ogoma SB, Tambo M, Gueye CS, Williams YA, Vajda E, Tatarsky A, Eiseb SJ, Mumbengegwi DR, Lobo NF. Human and vector behaviors determine exposure to Anopheles in Namibia. Parasit Vectors 2022; 15:436. [PMID: 36397152 PMCID: PMC9673320 DOI: 10.1186/s13071-022-05563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/09/2022] [Indexed: 11/19/2022] Open
Abstract
Background Although the Republic of Namibia has significantly reduced malaria transmission, regular outbreaks and persistent transmission impede progress towards elimination. Towards an understanding of the protective efficacy, as well as gaps in protection, associated with long-lasting insecticidal nets (LLINs), human and Anopheles behaviors were evaluated in parallel in three malaria endemic regions, Kavango East, Ohangwena and Zambezi, using the Entomological Surveillance Planning Tool to answer the question: where and when are humans being exposed to bites of Anopheles mosquitoes? Methods Surveillance activities were conducted during the malaria transmission season in March 2018 for eight consecutive nights. Four sentinel structures per site were selected, and human landing catches and human behavior observations were consented to for a total of 32 collection nights per site. The selected structures were representative of local constructions (with respect to building materials and size) and were at least 100 m from each other. For each house where human landing catches were undertaken, a two-person team collected mosquitoes from 1800 to 0600 hours. Results Surveillance revealed the presence of the primary vectors Anopheles arabiensis, Anopheles gambiae sensu stricto (s.s.) and Anopheles funestus s.s., along with secondary vectors (Anopheles coustani sensu lato and Anopheles squamosus), with both indoor and outdoor biting behaviors based on the site. Site-specific human behaviors considerably increased human exposure to vector biting. The interaction between local human behaviors (spatial and temporal presence alongside LLIN use) and vector behaviors (spatial and temporal host seeking), and also species composition, dictated where and when exposure to infectious bites occurred, and showed that exposure was primarily indoors in Kavango East (78.6%) and outdoors in Ohangwena (66.7%) and Zambezi (81.4%). Human behavior-adjusted exposure was significantly different from raw vector biting rate. Conclusions Increased LLIN use may significantly increase protection and reduce exposure to malaria, but may not be enough to eliminate the disease, as gaps in protection will remain both indoors (when people are awake and not using LLINs) and outdoors. Alternative interventions are required to address these exposure gaps. Focused and question-based operational entomological surveillance together with human behavioral observations may considerably improve our understanding of transmission dynamics as well as intervention efficacy and gaps in protection. Graphical Abstract ![]()
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Chanda E, Arshad M, Khaloua A, Zhang W, Namboze J, Uusiku P, Angula AH, Gausi K, Tiruneh D, Islam QM, Kolivras K, Haque U. An investigation of the Plasmodium falciparum malaria epidemic in Kavango and Zambezi regions of Namibia in 2016. Trans R Soc Trop Med Hyg 2019; 112:546-554. [PMID: 30252108 DOI: 10.1093/trstmh/try097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/10/2018] [Indexed: 01/26/2023] Open
Abstract
Background Namibia is one of the countries among the eight that are targeting malaria elimination in southern Africa. However, the country has encountered malaria epidemics in recent years. The objective of this study was to investigate malaria epidemics and to contribute to strengthening malaria surveillance and control in an effort to move Namibia toward eliminating malaria. Method Malaria epidemiology data for 2014-2015 were collected from the weekly surveillance system. All consenting household members within a 100-m radius of index households were screened in 2016 using a Carestart malaria HRP2/pLDH combined rapid diagnostic test after epidemics. All houses within this radius were sprayed in 2016 with the pyrethroid deltamethrin and K-Othrine WG 250. Anopheles mosquito-positive breeding sites were identified and treated with the organophosphate larvicide temephos. Insecticide susceptibility and bioassay tests were conducted. Results During the epidemic response period in 2016, 56 parasitologically confirmed Plasmodium falciparum malaria cases in the Zambezi region were detected from active screening. The majority of those cases (83%) were asymptomatic infections. In the Kavango region, the malaria epidemic persisted, with 228 P. falciparum malaria cases recorded, but only 97 were investigated. In Namibia, malaria vector susceptibility was detected to 4% dichlorodiphenyltrichloroethane. Indoor residual spraying was conducted in 377 (90%) of the targeted households along with community awareness through health education of 1499 people and distribution of more than 2000 information, education and communication materials. The P. falciparum malaria cases in the Zambezi decreased from 122 in week 9 to 97 after week 15. Conclusions Malaria epidemics along with the persistence of asymptomatic reservoir infections pose a serious challenge in Namibia's elimination effort. The country needs to ensure sustainable interventions to target asymptomatic reservoir infections and prevent epidemics in order to successfully achieve its goal of eliminating malaria.
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Affiliation(s)
- Emmanuel Chanda
- World Health Organization, Regional Office for Africa, Cite du Djoue, Brazzaville, Republic of the Congo
| | - Mohd Arshad
- Department of Statistics and Operations Research, Aligarh Muslim University, Aligarh, India
| | - Asmaa Khaloua
- Department of Computer Science and Engineering, 1155 Union Circle #311366 Denton, Texas, USA
| | - Wenyi Zhang
- Institute of Disease Control and Prevention of PLA, NO. 20 Dong-Da-Jie Street, Fengtai District, Beijing, PR China
| | - Josephine Namboze
- World Health Organization, Country Office, Geza Banda-Adi Yacob St 178, Asmara 291-1, Eritrea
| | - Pentrina Uusiku
- Ministry of Health and Social Services, National Vector-borne Diseases Control Programme, Florence Nightingale Street, Windhoek, Namibia
| | - Andreas H Angula
- Ministry of Health and Social Services, National Vector-borne Diseases Control Programme, Florence Nightingale Street, Windhoek, Namibia
| | - Khoti Gausi
- World Health Organization, East and Southern Africa Inter-country Support Team, Causeway Harare, Zimbabwe
| | - Desta Tiruneh
- World Health Organization, Country Office, Windhoek, Namibia
| | - Quazi M Islam
- World Health Organization, Country Office, Windhoek, Namibia
| | - Korine Kolivras
- Department of Geography, Virginia Tech, 220 Stanger St, 115 Major Williams Hall, Blacksburg, VA, USA
| | - Ubydul Haque
- Department of Geography, University of Florida, Gainesville, FL, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.,Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX
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Jacobson JO, Smith JL, Cueto C, Chisenga M, Roberts K, Hsiang M, Gosling R, Mumbengegwi D, Bennett A. Assessing malaria risk at night-time venues in a low-transmission setting: a time-location sampling study in Zambezi, Namibia. Malar J 2019; 18:179. [PMID: 31118028 PMCID: PMC6532237 DOI: 10.1186/s12936-019-2807-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/10/2019] [Indexed: 12/20/2022] Open
Abstract
Background Identifying efficient and effective strategies to reach and monitor populations at greatest risk of malaria in low-transmission settings is a key challenge for malaria elimination. In Namibia’s Zambezi Region, transmission is ongoing yet its drivers remain poorly understood. A growing literature suggests that night-time social activities may lead to malaria exposure that is beyond the reach of conventional preventive interventions, such as insecticide treated bed nets and indoor residual spraying. Methods Formative research was conducted with community members in March, 2015 in the catchment areas of six randomly selected health facilities in the western Zambezi Region to identify night-time locations where large numbers of individuals regularly congregate. Using time-location sampling, a survey was conducted between March and May, 2015 at community-identified venues (bars and evening church services) to develop representative estimates of the prevalence of parasite infection and risk factors among venue-goers. Results When compared to a contemporaneous household survey of the general population aged 15 and older (N = 1160), venue-goers (N = 480) were more likely to have spent the night away from their home recently (17.3% vs. 8.9%, P = 0.008), report recent fever (65.2% vs. 36.9%, P < 0.001), and were less likely to have sought care for fever (37.9% vs. 52.1%, P = 0.011). Venue-goers had higher, but not significantly different, rates of malaria infection (4.7% vs. 2.8%, P = 0.740). Risk factors for malaria infection among venue-goers could not be determined due to the small number of infections identified, however self-reported fever was positively associated with outdoor livelihood activities (adjusted odds ratio [AOR] = 1.9, 95% CI 1.0–3.3), not wearing protective measures at the time of the survey (AOR = 6.8, 9% CI 1.4–33.6) and having been bothered by mosquitos at the venue (AOR = 2.7, 95% CI 1.5–4). Conclusions Prevention measures and continued surveillance at night-time venues may be a useful complement to existing malaria elimination efforts.
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Affiliation(s)
- Jerry O Jacobson
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th St., San Francisco, CA, 94158, USA
| | - Jennifer L Smith
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th St., San Francisco, CA, 94158, USA
| | - Carmen Cueto
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th St., San Francisco, CA, 94158, USA
| | - Mukosha Chisenga
- Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia
| | - Kathryn Roberts
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th St., San Francisco, CA, 94158, USA
| | - Michelle Hsiang
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th St., San Francisco, CA, 94158, USA.,Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th St., San Francisco, CA, 94158, USA
| | - Davis Mumbengegwi
- Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th St., San Francisco, CA, 94158, USA.
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Herdiana H, Sari JFK, Whittaker M. Intersectoral collaboration for the prevention and control of vector borne diseases to support the implementation of a global strategy: A systematic review. PLoS One 2018; 13:e0204659. [PMID: 30303996 PMCID: PMC6179246 DOI: 10.1371/journal.pone.0204659] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction Vector Borne Diseases (VBDs) have a major impact on public health and socio-economic development. Inter-sectoral collaboration was recommended as one of the key elements of Integrated Vector Management (IVM), however limited evidence measures the effect and contribution of intersectoral approaches including but not only IVM. This systematic review aims to assess the existing evidence on all forms of inter-sectoral collaboration in VBD control and prevention, identify any gaps and develop a framework from a global perspective. Methods Articles were identified through a search of PUBMED, Science of Direct, Web of Knowledge, Google Scholar and WHO archives using key words and excluded duplications (n = 2,034). The exclusion of non-VBDs control and prevention interventions resulted in 194 eligible titles/abstract/keywords for full text assessment. Further exclusion of non-peer reviewed articles, non-declaration of ethical clearance, reviews and expert opinion articles resulted in 50 articles finally being included for analysis with the extraction of data on outcome, factor/s influencing the effectiveness, indicators of collaboration and sustainability. Results Of the 50 articles included in the analysis, 19 articles were categorized as of moderate-strong quality. All articles compared pre- and post-intervention outcomes against disease or vector variables. Three papers included outcome variables on intersectoral collaboration and participation indicator. However, no paper undertook component analysis by different sectors or different activities. Only one paper compared cost data for community-intersectoral intervention for IRS and traditional “vertical” IRS. Six factors were identified as influencing the effectiveness of inter-sectoral collaboration. Five of six factors are the main ones, namely the approach (37/47), resources (34/47), relationships (33/47), management (29/47) and shared vision (20/47) factors. A conceptual framework has been developed based on this review. Conclusion This review shows the importance of inter-sectoral collaboration to reduce VBDs or vector densities. However, very few studies measured how much inter-sectoral collaboration contributes to the impact. Further high-quality studies using inter-sectoral collaboration indicators are recommended to be undertaken.
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Affiliation(s)
| | | | - Maxine Whittaker
- College of Public Health, Medical and Veterinary Sciences, The Australian Institute of Tropical Health and Medicine (AITHM) at James Cook University, Jakarta, Australia
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Experience and inspirations of the Mass Drug Administration Programme with artemisinin-piperaquine in Moheli Island of the Comoros assisted by China. GLOBAL HEALTH JOURNAL 2018. [DOI: 10.1016/s2414-6447(19)30156-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Khadka A, Perales NA, Wei DJ, Gage AD, Haber N, Verguet S, Patenaude B, Fink G. Malaria control across borders: quasi-experimental evidence from the Trans-Kunene malaria initiative (TKMI). Malar J 2018; 17:224. [PMID: 29866113 PMCID: PMC5987525 DOI: 10.1186/s12936-018-2368-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/25/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The transmission of malaria through population inflows from highly endemic areas with limited control efforts poses major challenges for national malaria control programmes. Several multilateral programmes have been launched in recent years to address cross-border transmission. This study assesses the potential impact of such a programme at the Angolan-Namibian border. METHODS Community-based malaria prevention programmes involving bed net distribution and behaviour change home visits were rolled-out using a controlled, staggered (stepped wedge) design between May 2014 and July 2016 in a 100 × 40 km corridor along the Angolan-Namibian border. Three rounds of survey data were collected. The primary outcome studied was fever among children under five in the 2 weeks prior to the survey. Multivariable linear and logistic regression models were used to assess overall programme impact and the relative impact of unilateral versus coordinated bilateral intervention programmes. RESULTS A total of 3844 child records were analysed. On average, programme rollout reduced the odds of child fever by 54% (aOR: 0.46, 95% CI 0.29 to 0.73) over the intervention period. In Namibia, the programme reduced the odds of fever by 30% in areas without simultaneous Angolan efforts (aOR: 0.70, 95% CI 0.34 to 1.44), and by an additional 62% in areas with simultaneous Angolan programmes. In Angola, the programme was highly effective in areas within 5 km of Namibian programmes (OR: 0.37, 95% CI 0.22 to 0.62), but mostly ineffective in areas closer to inland Angolan areas without concurrent anti-malarial efforts. CONCLUSIONS The impact of malaria programmes depends on programme efforts in surrounding areas with differential control efforts. Coordinated malaria programming within and across countries will be critical for achieving the vision of a malaria free world.
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Affiliation(s)
- Aayush Khadka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA.
| | | | - Dorothy J Wei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA
| | - Anna D Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA
| | - Noah Haber
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, 27516, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA
| | - Bryan Patenaude
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA
| | - Günther Fink
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA
- Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
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9
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Madani A, Soleimani-Ahmadi M, Davoodi SH, Sanei-Dehkordi A, Jaberhashemi SA, Zare M, Aghamolaei T. Household knowledge and practices concerning malaria and indoor residual spraying in an endemic area earmarked for malaria elimination in Iran. Parasit Vectors 2017; 10:600. [PMID: 29212553 PMCID: PMC5719751 DOI: 10.1186/s13071-017-2548-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/21/2017] [Indexed: 11/27/2022] Open
Abstract
Background Indoor residual spraying of insecticide (IRS) is a key intervention for reducing the burden of malaria infection. Effectiveness and success of this strategy are to a considerable extent dependent on knowledge and practice of the target community regarding the IRS. Iran has entered the malaria elimination phase, and IRS has been considered as the main strategy for malaria vector control. Therefore, this study was conducted to determine the household knowledge and practices about malaria and IRS in Bashagard County, one of the malaria-endemic areas in the southeast of Iran. Methods A community-based cross-sectional survey was conducted among 420 households in Bashagard County. The participants who were selected using a two-stage randomized cluster sampling procedure were subjected to a tested structured questionnaire. During the survey, direct observations were made concerning the use of IRS as well as housing conditions. The data were coded and analysed using SPSS version 19. Results Knowledge levels about malaria as a disease and the mosquito as its vector were high and of equal magnitude (85.5% and 85.4%, respectively), while knowledge levels of IRS were even higher (91.6%). The main source of households’ information about malaria and IRS was primarily community health workers (73.3%). Despite positive perceptions towards IRS only 26.7% of respondents had sprayed their houses which is lower than the WHO targeted coverage of 80%. Respiratory disorders and headache (33.3%), food contamination (24.9%), discolouring of inner house walls (17.7%), difficulty in furniture’s movement (13.8%), and unpleasant odour (10.4%) were the main reasons for IRS refusal. Conclusion There is a discrepancy between knowledge about symptoms and the transmission route of malaria and control practices related to IRS use. Therefore, IRS campaigns accompanied with education for behaviour change should be considered to ensure householders’ participation and cooperation in the IRS programme. Moreover, continuous evaluation and monitoring of IRS as well as conducting more surveys on knowledge, attitude, and practices are recommended to improve malaria control measures and to identify indicators for effective, successful, and sustainable malaria elimination programme.
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Affiliation(s)
- Abdoulhossain Madani
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Moussa Soleimani-Ahmadi
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. .,Department of Medical Entomology and Vector Control, Faculty of Health, Hormozgan University of Medical Sciences, P.O. Box: 79145-3838, Bandar Abbas, Iran.
| | - Sayed Hossein Davoodi
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Sanei-Dehkordi
- Department of Medical Entomology and Vector Control, Faculty of Health, Hormozgan University of Medical Sciences, P.O. Box: 79145-3838, Bandar Abbas, Iran
| | | | - Mehdi Zare
- Department of Occupational Health Engineering, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Teamur Aghamolaei
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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van den Berg H, Manuweera G, Konradsen F. Global trends in the production and use of DDT for control of malaria and other vector-borne diseases. Malar J 2017; 16:401. [PMID: 28982359 PMCID: PMC5629760 DOI: 10.1186/s12936-017-2050-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/30/2017] [Indexed: 11/30/2022] Open
Abstract
Background DDT was among the initial persistent organic pollutants listed under the Stockholm Convention and continues to be used for control of malaria and other vector-borne diseases in accordance with its provisions on acceptable purposes. Trends in the production and use of DDT were evaluated over the period 2001–2014. Results Available data on global production of DDT showed a 32% decline over the reporting period, from 5144 to 3491 metric tons of active ingredient p.a. Similarly, global use of DDT, for control of malaria and leishmaniasis, showed a 30% decline over the period 2001–2014, from 5388 metric tons p.a. to 3772 metric tons p.a. India has been by far the largest producer and user of DDT. In some countries, DDT is used in response to the development of resistance in malaria vectors against pyrethroid and carbamate insecticides. Some other countries have stopped using DDT, in compliance to the Convention, or in response to DDT resistance in malaria vectors. Progress has been made in establishing or amending national legal measures on DDT, with the majority of countries reportedly having measures in place that prohibit, or restrict, the production, import, export and use of DDT. Limitations in achieving the objectives of the Stockholm Convention with regard to DDT include major shortcomings in periodic reporting by Parties to the Stockholm Convention, and deficiencies in reporting to the DDT Register. Conclusion Global production and global use of DDT have shown a modest decline since the adoption of the Stockholm Convention.
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Affiliation(s)
- Henk van den Berg
- Laboratory of Entomology, Wageningen University, P.O. Box 8031, 6700EH, Wageningen, The Netherlands.
| | - Gamini Manuweera
- Secretariat of Basel, Rotterdam and Stockholm Conventions (BRS), United Nations Environment Programme, Geneva, Switzerland
| | - Flemming Konradsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Smith JL, Auala J, Haindongo E, Uusiku P, Gosling R, Kleinschmidt I, Mumbengegwi D, Sturrock HJW. Malaria risk in young male travellers but local transmission persists: a case-control study in low transmission Namibia. Malar J 2017; 16:70. [PMID: 28187770 PMCID: PMC5303241 DOI: 10.1186/s12936-017-1719-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/03/2017] [Indexed: 11/24/2022] Open
Abstract
Background A key component of malaria elimination campaigns is the identification and targeting of high risk populations. To characterize high risk populations in north central Namibia, a prospective health facility-based case–control study was conducted from December 2012–July 2014. Cases (n = 107) were all patients presenting to any of the 46 health clinics located in the study districts with a confirmed Plasmodium infection by multi-species rapid diagnostic test (RDT). Population controls (n = 679) for each district were RDT negative individuals residing within a household that was randomly selected from a census listing using a two-stage sampling procedure. Demographic, travel, socio-economic, behavioural, climate and vegetation data were also collected. Spatial patterns of malaria risk were analysed. Multivariate logistic regression was used to identify risk factors for malaria. Results Malaria risk was observed to cluster along the border with Angola, and travel patterns among cases were comparatively restricted to northern Namibia and Angola. Travel to Angola was associated with excessive risk of malaria in males (OR 43.58 95% CI 2.12–896), but there was no corresponding risk associated with travel by females. This is the first study to reveal that gender can modify the effect of travel on risk of malaria. Amongst non-travellers, male gender was also associated with a higher risk of malaria compared with females (OR 1.95 95% CI 1.25–3.04). Other strong risk factors were sleeping away from the household the previous night, lower socioeconomic status, living in an area with moderate vegetation around their house, experiencing moderate rainfall in the month prior to diagnosis and living <15 km from the Angolan border. Conclusions These findings highlight the critical need to target malaria interventions to young male travellers, who have a disproportionate risk of malaria in northern Namibia, to coordinate cross-border regional malaria prevention initiatives and to scale up coverage of prevention measures such as indoor residual spraying and long-lasting insecticide nets in high risk areas if malaria elimination is to be realized. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1719-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer L Smith
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, USA.
| | - Joyce Auala
- Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia
| | - Erastus Haindongo
- Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia
| | - Petrina Uusiku
- National Vector-Borne Disease Control Programme, Ministry of Health and Social Services, Windhoek, Namibia
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, USA
| | - Immo Kleinschmidt
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Davis Mumbengegwi
- Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia
| | - Hugh J W Sturrock
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, USA
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Larocca A, Moro Visconti R, Marconi M. Malaria diagnosis and mapping with m-Health and geographic information systems (GIS): evidence from Uganda. Malar J 2016; 15:520. [PMID: 27776516 PMCID: PMC5075756 DOI: 10.1186/s12936-016-1546-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 10/05/2016] [Indexed: 11/17/2022] Open
Abstract
Background Rural populations experience several barriers to accessing clinical facilities for malaria diagnosis. Increasing penetration of ICT and mobile-phones and subsequent m-Health applications can contribute overcoming such obstacles. Methods GIS is used to evaluate the feasibility of m-Health technologies as part of anti-malaria strategies. This study investigates where in Uganda: (1) malaria affects the largest number of people; (2) the application of m-Health protocol based on the mobile network has the highest potential impact. Results About 75% of the population affected by Plasmodium falciparum malaria have scarce access to healthcare facilities. The introduction of m-Health technologies should be based on the 2G protocol, as 3G mobile network coverage is still limited. The western border and the central-Southeast are the regions where m-Health could reach the largest percentage of the remote population. Six districts (Arua, Apac, Lira, Kamuli, Iganga, and Mubende) could have the largest benefit because they account for about 28% of the remote population affected by falciparum malaria with access to the 2G mobile network. Conclusions The application of m-Health technologies could improve access to medical services for distant populations. Affordable remote malaria diagnosis could help to decongest health facilities, reducing costs and contagion. The combination of m-Health and GIS could provide real-time and geo-localized data transmission, improving anti-malarial strategies in Uganda. Scalability to other countries and diseases looks promising.
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Affiliation(s)
| | | | - Michele Marconi
- Research and Consulting GIS, Natural Resources Management, Marine Ecology, Disaster Risk Reduction, Hue, Vietnam
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Chanda E, Ameneshewa B, Bagayoko M, Govere JM, Macdonald MB. Harnessing Integrated Vector Management for Enhanced Disease Prevention. Trends Parasitol 2016; 33:30-41. [PMID: 27720141 DOI: 10.1016/j.pt.2016.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/11/2016] [Accepted: 09/15/2016] [Indexed: 11/16/2022]
Abstract
The increasing global threat of emerging and re-emerging vector-borne diseases (VBDs) poses a serious health problem. The World Health Organization (WHO) recommends integrated vector management (IVM) strategy for combating VBD transmission. An IVM approach requires entomological knowledge, technical and infrastructure capacity, and systems facilitating stakeholder collaboration. In sub-Saharan Africa, successful operational IVM experience comes from relatively few countries. This article provides an update on the extent to which IVM is official national policy, the degree of IVM implementation, the level of compliance with WHO guidelines, and concordance in the understanding of IVM, and it assesses the operational impact of IVM. The future outlook encompasses rational and sustainable use of effective vector control tools and inherent improved return for investment for disease vector control.
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Affiliation(s)
- Emmanuel Chanda
- Vector Control Specialist/Consultant, Kamwala South, Lusaka, Zambia.
| | | | - Magaran Bagayoko
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - John M Govere
- Vector Control Specialist/Consultant, Nelspruit, Mpumalanga, South Africa
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Advances in mapping malaria for elimination: fine resolution modelling of Plasmodium falciparum incidence. Sci Rep 2016; 6:29628. [PMID: 27405532 PMCID: PMC4942778 DOI: 10.1038/srep29628] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/22/2016] [Indexed: 10/31/2022] Open
Abstract
The long-term goal of the global effort to tackle malaria is national and regional elimination and eventually eradication. Fine scale multi-temporal mapping in low malaria transmission settings remains a challenge and the World Health Organisation propose use of surveillance in elimination settings. Here, we show how malaria incidence can be modelled at a fine spatial and temporal resolution from health facility data to help focus surveillance and control to population not attending health facilities. Using Namibia as a case study, we predicted the incidence of malaria, via a Bayesian spatio-temporal model, at a fine spatial resolution from parasitologically confirmed malaria cases and incorporated metrics on healthcare use as well as measures of uncertainty associated with incidence predictions. We then combined the incidence estimates with population maps to estimate clinical burdens and show the benefits of such mapping to identifying areas and seasons that can be targeted for improved surveillance and interventions. Fine spatial resolution maps produced using this approach were then used to target resources to specific local populations, and to specific months of the season. This remote targeting can be especially effective where the population distribution is sparse and further surveillance can be limited to specific local areas.
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Okia M, Okui P, Lugemwa M, Govere JM, Katamba V, Rwakimari JB, Mpeka B, Chanda E. Consolidating tactical planning and implementation frameworks for integrated vector management in Uganda. Malar J 2016; 15:214. [PMID: 27074809 PMCID: PMC4831111 DOI: 10.1186/s12936-016-1269-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/01/2016] [Indexed: 12/03/2022] Open
Abstract
Background Integrated vector management (IVM) is the recommended approach for controlling some vector-borne diseases (VBD). In the face of current challenges to disease vector control, IVM is vital to achieve national targets set for VBD control. Though global efforts, especially for combating malaria, now focus on elimination and eradication, IVM remains useful for Uganda which is principally still in the control phase of the malaria continuum. This paper outlines the processes undertaken to consolidate tactical planning and implementation frameworks for IVM in Uganda. Case description The Uganda National Malaria Control Programme with its efforts to implement an IVM approach to vector control was the ‘case’ for this study. Integrated management of malaria vectors in Uganda remained an underdeveloped component of malaria control policy. In 2012, knowledge and perceptions of malaria vector control policy and IVM were assessed, and recommendations for a specific IVM policy were made. In 2014, a thorough vector control needs assessment (VCNA) was conducted according to WHO recommendations. The findings of the VCNA informed the development of the national IVM strategic guidelines. Information sources for this study included all available data and accessible archived documentary records on VBD control in Uganda. The literature was reviewed and adapted to the local context and translated into the consolidated tactical framework. Discussion WHO recommends implementation of IVM as the main strategy to vector control and has encouraged member states to adopt the approach. However, many VBD-endemic countries lack IVM policy frameworks to guide implementation of the approach. In Uganda most VBD coexists and could be managed more effectively if done in tandem. In order to successfully control malaria and other VBD and move towards their elimination, the country needs to scale up proven and effective vector control interventions and also learn from the experience of other countries. The IVM strategy is important in consolidating inter-sectoral collaboration and coordination and providing the tactical direction for effective deployment of vector control interventions along the five key elements of the approach and to align them with contemporary epidemiology of VBD in the country. Conclusions Uganda has successfully established an evidence-based IVM approach and consolidated strategic planning and operational frameworks for VBD control. However, operating implementation arrangements as outlined in the national strategic guidelines for IVM and managing insecticide resistance, as well as improving vector surveillance, are imperative. In addition, strengthened information, education and communication/behaviour change and communication, collaboration and coordination will be crucial in scaling up and using vector control interventions.
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Affiliation(s)
| | - Peter Okui
- National Malaria Control Programme, Ministry of Health, Kampala, Uganda
| | - Myers Lugemwa
- National Malaria Control Programme, Ministry of Health, Kampala, Uganda
| | | | - Vincent Katamba
- National Malaria Control Programme, Ministry of Health, Kampala, Uganda
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Oxborough RM. Trends in US President's Malaria Initiative-funded indoor residual spray coverage and insecticide choice in sub-Saharan Africa (2008-2015): urgent need for affordable, long-lasting insecticides. Malar J 2016; 15:146. [PMID: 26957210 PMCID: PMC4784374 DOI: 10.1186/s12936-016-1201-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/01/2016] [Indexed: 11/30/2022] Open
Abstract
This article reports the changing pattern of US President’s Malaria Initiative-funded IRS in sub-Saharan Africa between 2008 and 2015. IRS coverage in sub-Saharan Africa increased from <2 % of the at-risk population in 2005, to 11 % or 78 million people in 2010, mainly as a result of increased funding from PMI. The scaling up of IRS coverage in sub-Saharan Africa has been successful in several epidemiological settings and contributed to reduced malaria transmission rates. However, the spread and intensification of pyrethroid resistance in malaria vectors led many control programmes to spray alternative insecticides. Between 2009 and 2013, pyrethroid spraying decreased from 87 % (13/15) of PMI-funded countries conducting IRS to 44 % (7/16), while bendiocarb use increased from 7 % (1/15) to 56 % (9/16). Long-lasting pirimiphos-methyl CS received WHOPES recommendation in 2013 and was scheduled to be sprayed in 85 % (11/13) of PMI-funded countries conducting IRS in 2015. The gradual replacement of relatively inexpensive pyrethroids, firstly with bendiocarb (carbamate) and subsequently with pirimiphos methyl CS (organophosphate), has contributed to the downscaling of most PMI-funded IRS programmes. Overall, there was a 53 % decrease in the number of structures sprayed between years of peak coverage and 2015, down from 9.04 million to 4.26 million structures. Sizeable reductions in the number of structures sprayed were reported in Madagascar (56 %, 576,320–254,986), Senegal (64 %, 306,916–111,201), Tanzania (68 %, 1,224,095–389,714) and Zambia (63 %, 1,300,000–482,077), while in Angola, Liberia and Malawi PMI-funded spraying was suspended. The most commonly cited reason was increased cost of pesticides, as vector resistance necessitated switching from pyrethroids to organophosphates. There are worrying preliminary reports of malaria resurgence following IRS withdrawal in parts of Benin, Tanzania and Uganda. The increase in malaria cases following the end of the Global Malaria Eradication Programme in 1969 highlights the fragility of such gains when control efforts are weakened. At present there are several countries reliant on organophosphates and carbamates for IRS, and increasing incipient resistance is a serious threat that could result in IRS no longer being viable. A portfolio of new cost-effective insecticides with different modes of action is urgently needed.
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Chanda E, Ameneshewa B, Mihreteab S, Berhane A, Zehaie A, Ghebrat Y, Usman A. Consolidating strategic planning and operational frameworks for integrated vector management in Eritrea. Malar J 2015; 14:488. [PMID: 26630934 PMCID: PMC4668606 DOI: 10.1186/s12936-015-1022-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contemporary malaria vector control relies on the use of insecticide-based, indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs). However, malaria-endemic countries, including Eritrea, have struggled to effectively deploy these tools due technical and operational challenges, including the selection of insecticide resistance in malaria vectors. This manuscript outlines the processes undertaken in consolidating strategic planning and operational frameworks for vector control to expedite malaria elimination in Eritrea. CASE DESCRIPTION The effort to strengthen strategic frameworks for vector control in Eritrea was the 'case' for this study. The integrated vector management (IVM) strategy was developed in 2010 but was not well executed, resulting in a rise in malaria transmission, prompting a process to redefine and relaunch the IVM strategy with integration of other vector borne diseases (VBDs) as the focus. The information sources for this study included all available data and accessible archived documentary records on malaria vector control in Eritrea. Structured literature searches of published, peer-reviewed sources using online, scientific, bibliographic databases, Google Scholar, PubMed and WHO, and a combination of search terms were utilized to gather data. The literature was reviewed and adapted to the local context and translated into the consolidated strategic framework. DISCUSSION In Eritrea, communities are grappling with the challenge of VBDs posing public health concerns, including malaria. The global fund financed the scale-up of IRS and LLIN programmes in 2014. Eritrea is transitioning towards malaria elimination and strategic frameworks for vector control have been consolidated by: developing an integrated vector management (IVM) strategy (2015-2019); updating IRS and larval source management (LSM) guidelines; developing training manuals for IRS and LSM; training of national staff in malaria entomology and vector control, including insecticide resistance monitoring techniques; initiating the global plan for insecticide resistance management; conducting needs' assessments and developing standard operating procedure for insectaries; developing a guidance document on malaria vector control based on eco-epidemiological strata, a vector surveillance plan and harmonized mapping, data collection and reporting tools. CONCLUSION Eritrea has successfully consolidated strategic frameworks for vector control. Rational decision-making remains critical to ensure that the interventions are effective and their choice is evidence-based, and to optimize the use of resources for vector control. Implementation of effective IVM requires proper collaboration and coordination, consistent technical and financial capacity and support to offer greater benefits.
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Affiliation(s)
- Emmanuel Chanda
- Vector Control Specialist/Consultant, Kamwala South, Lusaka, Zambia.
| | | | - Selam Mihreteab
- National Malaria Control Programme, Ministry of Health, Asmara, Eritrea.
| | - Araia Berhane
- Communicable Diseases and Control Division, Ministry of Health, Asmara, Eritrea.
| | - Assefash Zehaie
- World Health Organization, Eritrea Country Office, Asmara, Eritrea.
| | - Yohannes Ghebrat
- World Health Organization, Eritrea Country Office, Asmara, Eritrea.
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Gains attained in malaria control coverage within settings earmarked for pre-elimination: malaria indicator and prevalence surveys 2012, Eritrea. Malar J 2015; 14:467. [PMID: 26589786 PMCID: PMC4654824 DOI: 10.1186/s12936-015-0992-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eritrea, like most countries in sub-Saharan Africa, has expended much effort towards malaria control with the view of transitioning from reduction of the disease burden to elimination. This paper reports on the level of achievement as highlighted by the follow-on, malaria-endemic area representative, survey that aimed to provide data and to assess progress on malaria indicators and parasite prevalence at household level across the country. METHODS In 2012, data were collected using a two-stage stratified cluster random sample of 1887 households in 96 clusters (villages in rural areas and census enumeration areas in urban centers) during a malaria indicator and prevalence survey in Eritrea. The survey determined parasite prevalence in vulnerable population groups and evaluated coverage, use and access to malaria control services. Standardized Roll-Back Malaria Monitoring and Evaluation Reference Group household and women's questionnaires were adapted to the local situation and used for collection of data that were analysed and summarized using descriptive statistics. RESULTS The results of the survey showed that 90% (95% CI 89-91) of households owned at least one mosquito net. The proportion of the population with access to an insecticide-treated net (ITN) in their household was 55% (95% CI 54-56). The utilization of ITNs was 67% (95% CI 65-70) for children under 5 years and 60% (95% CI 58-63) for pregnant women (OR: 0. 73(95% CI 0.62-0.85); P = 0.52). Only 28% (95% CI 26-30) of households were covered by indoor residual spraying (IRS) the previous year with significant heterogeneity by zoba (Debub 50 % (95% CI 45-54) vs Gash Barka 32 % (95% CI 28-36); OR = 0. 47 (95% CI 0.36-0.61), P = 0.05). Malaria parasite prevalence was low; 1.1% (95% CI 0.9-1.3) in the general population and 1.4% (95% CI 1.0-2.0) in children under five and 0.7% (95% CI 0.4-1.1) among women aged 15-49 years. Only 19% (95% CI 15-26) of children under five had fever in the 2 weeks preceding the survey, with 61% (95% CI 54.1-67.1) seeking treatment from a health facility. Data on knowledge levels show that 92% reported that malaria is transmitted by mosquitoes, 92% mentioned that the use of mosquito nets could prevent malaria, 47% knew malaria prevention medication, 83% cited fever as a sign and symptom of malaria, and 35% had heard or seen malaria awareness messages. CONCLUSION Notwithstanding confounders, the observed low malaria parasite prevalence could be associated with malaria intervention coverage, access and utilization as well as high and equitable knowledge levels in the population. This indicates that Eritrea is on the right track towards pre-elimination. However, technical and infrastructure capacity should be strengthened to facilitate implementation, surveillance, monitoring, and evaluation.
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Chanda E, Mzilahowa T, Chipwanya J, Mulenga S, Ali D, Troell P, Dodoli W, Govere JM, Gimnig J. Preventing malaria transmission by indoor residual spraying in Malawi: grappling with the challenge of uncertain sustainability. Malar J 2015; 14:254. [PMID: 26104657 PMCID: PMC4477419 DOI: 10.1186/s12936-015-0759-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/03/2015] [Indexed: 12/03/2022] Open
Abstract
Background In the past decade, there has been rapid scale-up of insecticide-based malaria vector control in the context of integrated vector management (IVM) according to World Health Organization recommendations. Endemic countries have deployed indoor residual spraying (IRS) and long-lasting insecticidal nets as hallmark vector control interventions. This paper discusses the successes and continued challenges and the way forward for the IRS programme in Malawi. Case description The National Malaria Control Programme in Malawi, with its efforts to implement an integrated approach to malaria vector control, was the ‘case’ for this study. Information sources included all available data and accessible archived documentary records on IRS in Malawi. A methodical assessment of published and unpublished documents was conducted via a literature search of online electronic databases. Discussion Malawi has implemented IRS as the main malaria transmission-reducing intervention. However, pyrethroid and carbamate resistance in malaria vectors has been detected extensively across the country and has adversely affected the IRS programme. Additionally, IRS activities have been characterized by substantial inherent logistical and technical challenges culminating into missed targets. As a consequence, programmatic IRS operations have been scaled down from seven districts in 2010 to only one district in 2014. The future of the IRS programme in Malawi is uncertain due to limited funding, high cost of alternative insecticides and technical resource challenges being experienced in the country. Conclusions The availability of a long-lasting formulation of the organophosphate pirimiphos-methyl makes the re-introduction of IRS a possibility and may be a useful approach for the management of pyrethroid resistance. Implementing the IVM strategy, advocating for sustainable domestic funding, including developing an insecticide resistance monitoring and management plan and vector surveillance guidelines will be pivotal in steering entomologic monitoring and future vector control activities in Malawi.
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Affiliation(s)
| | | | - John Chipwanya
- Ministry of Health, National Malaria Control Programme, Lilongwe, Malawi.
| | - Shadreck Mulenga
- Ministry of Health, National Malaria Control Programme, Lilongwe, Malawi.
| | - Doreen Ali
- Ministry of Health, National Malaria Control Programme, Lilongwe, Malawi.
| | | | - Wilfred Dodoli
- World Health Organization, Country Office, Lilongwe, Malawi.
| | - John M Govere
- Malaria Vector Control Consultant, Nelspruit, Mpumalanga, South Africa.
| | - John Gimnig
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
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