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Casella A, Monroe A, Toso M, Hunter G, Underwood C, Pillai R, Hughes J, Van Lith LM, Cash S, Hwang J, Babalola S. Understanding psychosocial determinants of malaria behaviours in low-transmission settings: a scoping review. Malar J 2024; 23:15. [PMID: 38200574 PMCID: PMC10782749 DOI: 10.1186/s12936-023-04831-9] [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: 10/02/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Recent estimates show progress toward malaria elimination is slowing in many settings, underscoring the need for tailored approaches to fight the disease. In addition to essential structural changes, human behaviour plays an important role in elimination. Engagement in malaria behaviours depends in part on psychosocial determinants such as knowledge, perceived risk, and community norms. Understanding the state of research on psychosocial determinants in low malaria transmission settings is important to augment social and behaviour change practice. This review synthesizes research on psychosocial factors and malaria behaviours in low-transmission settings. METHODS A systematic search of peer-reviewed literature and supplemental manual search of grey literature was conducted using key terms and eligibility criteria defined a priori. Publications from 2000-2020 in the English language were identified, screened, and analysed using inductive methods to determine the relationship between the measured psychosocial factors and malaria behaviours. RESULTS Screening of 961 publications yielded 96 for inclusion. Nineteen articles collected data among subpopulations that are at increased risk of malaria exposure in low-transmission settings. Purposive and cluster randomized sampling were common sampling approaches. Quantitative, qualitative, and mixed-methods study designs were used. Knowledge, attitudes, and perceived risk were commonly measured psychosocial factors. Perceived response-efficacy, perceived self-efficacy, and community norms were rarely measured. Results indicate positive associations between malaria knowledge and attitudes, and preventive and care-seeking behaviour. Studies generally report high rates of correct knowledge, although it is comparatively lower among studies of high-risk groups. There does not appear to be sufficient extant evidence to determine the relationship between other psychosocial variables and behaviour. CONCLUSIONS The review highlights the need to deploy more consistent, comprehensive measures of psychosocial factors and the importance of reaching subpopulations at higher risk of transmission in low transmission contexts. Malaria-related knowledge is generally high, even in settings of low transmission. Programmes and research should work to better understand the psychosocial factors that have been positively associated with prevention and care-seeking behaviours, such as norms, perceived response efficacy, perceived self-efficacy, and interpersonal communication. These factors are not necessarily distinct from that which research has shown are important in settings of high malaria transmission. However, the importance of each factor and application to malaria behaviour change programming in low-transmission settings is an area in need of further research. Existing instruments and approaches are available to support more systematic collection of psychosocial determinants and improved sampling approaches and should be applied more widely. Finally, while human behaviour is critical, health systems strengthening, and structural interventions are essential to achieve malaria elimination goals.
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Affiliation(s)
- Albert Casella
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA.
| | - April Monroe
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Michael Toso
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Gabrielle Hunter
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Carol Underwood
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
- Department of Health, Behavior, & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ruchita Pillai
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Jayme Hughes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Lynn M Van Lith
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Shelby Cash
- U.S. President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jimee Hwang
- U.S. President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stella Babalola
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
- Department of Health, Behavior, & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Phok S, Tesfazghi K, Tompsett A, Thavrine B, Ly P, Hassan SED, Avrakotos A, Malster J, Felker-Kantor E. Behavioural determinants of malaria risk, prevention, and care-seeking behaviours among forest-goers in Cambodia. Malar J 2022; 21:362. [PMID: 36457085 PMCID: PMC9716661 DOI: 10.1186/s12936-022-04390-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cambodia has made significant progress towards achieving malaria elimination by 2025. Cases continue to decrease and are primarily concentrated in forested areas. Forest-goers are most at risk of malaria due to their proximity to the forest, poor sleeping conditions, frequent mobility, and distance from health services. Consistent use of long-lasting insecticidal nets or hammock nets (LLINs/LLIHNs), early diagnosis and treatment of cases are central to reducing disease burden. The aim of this study was to understand forest-goers' knowledge, attitudes, and practices related to malaria prevention and care-seeking, and to identify key behavioural determinants of LLIN/LLIHN use and prompt care-seeking within 24 h of developing a fever. METHODS A mixed-methods study design consisting of a cross-sectional survey and qualitative in-depth interviews was implemented in two Cambodian provinces. Survey participants (N = 654) were recruited using respondent driven sampling. Interview participants (N = 28) were selected using purposive sampling. Findings from the survey were analysed using univariate and bivariate analysis and multivariate weighted logistic regression. Interviews were coded and analysed using thematic content analysis. RESULTS All study participants had heard of malaria and 98% knew that malaria was transmitted by mosquitoes. LLIN/LLIHN ownership was high (94%). Although 99% of participants perceived LLIN/LLIHN use as an important malaria prevention measure, only 76% reported using one during their last visit to the forest. Only 39% of survey participants who reported seeking care did so within the recommended 24 h from fever onset during their last febrile illness. Among all study participants, 43% did not seek any healthcare during their last febrile episode. In controlled regression models, perceived community social norms were significantly associated with LLIN/LLIHN use (OR: 2.7, 96% CI 1.99-2.64) and care-seeking within 24 h of fever onset (OR: 1.7, 95% CI 1.00-2.88). Social support from other forest-goers was also significantly associated with LLIN/LLIHN use (OR: 4.9, 95% CI 1.32-18.12). CONCLUSIONS Study findings are consistent with other studies on LLIN/LLIHN use and care-seeking behaviours. While rates of LLIN/LLIHN ownership were high among the study population, rates of use were not as high. More concerning were the delayed care-seeking behaviours. Social behaviour change activities should incorporate social norms and social support as mechanisms for behaviour change given the identified positive correlations with LLIN/LLIHN use and prompt care-seeking.
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Affiliation(s)
- Sochea Phok
- Population Services International, Phnom Penh, Cambodia
| | - Kemi Tesfazghi
- grid.423224.10000 0001 0020 3631Population Services International, Washington, DC USA
| | - Andy Tompsett
- grid.423224.10000 0001 0020 3631Population Services International, Washington, DC USA
| | - Boukheng Thavrine
- grid.452707.3National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Po Ly
- grid.452707.3National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Saad El-Din Hassan
- US President’s Malaria Initiative, United States Agency for International Development, Phnom Penh, Cambodia
| | - Avery Avrakotos
- grid.420285.90000 0001 1955 0561US President’s Malaria Initiative, United States Agency for International Development, Washington, DC USA
| | - Jim Malster
- Population Services International, Phnom Penh, Cambodia
| | - Erica Felker-Kantor
- grid.423224.10000 0001 0020 3631Population Services International, Washington, DC USA
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Ahmed RA, Shankar H, Hussain SSA, Swargiary A, Kumar A, Tarique M, Prabhakar P, Suri HS, Singh K, Chakma JK, Singh J, Begum A. Moderate Rainfall and High Humidity During the Monsoon Season, Negligence in Using Malaria Protection Methods and High Proportion of Mild Symptomatic Patients Were the Driving Forces for Upsurge of Malaria Cases in 2018 Among Tea Tribe Populations in Endemic Dolonibasti Health Sub-center, Udalguri District, Assam State, North-East India. Front Med (Lausanne) 2022; 9:913848. [PMID: 35847777 PMCID: PMC9280886 DOI: 10.3389/fmed.2022.913848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/30/2022] [Indexed: 12/04/2022] Open
Abstract
Malaria elimination is a global priority, which India has also adopted as a target. Despite the malaria control efforts like long-lasting insecticidal nets distribution, rounds of indoor residual spray, the introduction of bi-valent rapid diagnostic tests and artemisinin combination therapy, malaria remained consistent in Dolonibasti sub-center of Orang block primary health center (BPHC) under the district Udalguri, Assam state followed by abrupt rise in cases in 2018. Therefore, we aimed to investigate the factors driving the malaria transmission in the outbreak area of Dolonibasti sub-center. Malaria epidemiological data (2008–2018) of Udalguri district and Orang BPHC was collected. The annual (2011-2018) and monthly (2013–2018) malaria and meteorological data of Dolonibasti sub-center was collected. An entomological survey, Knowledge, Attitude and Practices study among malaria cases (n = 120) from Dolonibasti was conducted. In 2018, 26.1 % (2136/ 8188) of the population of Dolonibasti were found to be malaria positive, of which 55% were adults (n = 1176). Majority of cases were from tea tribe populations (90%), either asymptomatic or with fever only, 67.5 % (81/120) had experienced malaria infection during past years. The outbreak was characterized by a strong increase in cases in June 2018, high proportion of slide falciparum rate of 26.1% (other years average, 15.8%) and high proportion of P. falciparum of 81.2 % (other years average, 84.3%). Anopheles minimus s.l. was the major vector with 28.6% positivity and high larval density in paddy fields/ drainage area. Annual relative humidity was associated with rise in malaria cases, annual parasite incidence (rs = 0.69, 90%CI; p = 0.06) and slide positivity rate (rs = 0.83, 95%CI; p = 0.01). Older people were less educated (rs = −0.66; p < 0.001), had lesser knowledge about malaria cause (rs = −0.42; χ2=21.80; p < 0.001) and prevention (rs = −0.18; p = 0.04). Malaria control practices were followed by those having knowledge about cause of malaria (rs = 0.36; χ2 = 13.50; p < 0.001) and prevention (rs = 0.40; χ2 = 17.71; p < 0.001). Altogether, 84.6% (44/52) of the respondents did not use protective measures. We described a sudden increase in malaria incidence in a rural, predominantly tea tribe population group with high illiteracy rate and ignorance on protective measures against malaria. More efforts that are concerted needed to educate the community about malaria control practices.
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Affiliation(s)
- Rahim Ali Ahmed
- National Vector Borne Disease Control Programme, Guwahati, India
- Parasite-Host Biology Group, ICMR – National Institute of Malaria Research, New Delhi, India
- Rahim Ali Ahmed
| | - Hari Shankar
- Indian Council of Medical Research, New Delhi, India
- *Correspondence: Hari Shankar
| | - Syed Shah Areeb Hussain
- Parasite-Host Biology Group, ICMR – National Institute of Malaria Research, New Delhi, India
| | | | - Avdhesh Kumar
- National Vector Borne Disease Control Programme, Ministry of Health & FW, Government of India, New Delhi, India
| | - Mohammad Tarique
- Department of Child Health, University of Missouri, Columbia, MO, United States
| | - Pankaj Prabhakar
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, India
| | | | - Kuldeep Singh
- Epidemiology & Environmental Biology Group, ICMR—National Institute of Malaria Research Field Station, Guwahati, India
- Kuldeep Singh
| | | | - Jyoti Singh
- Department of Zoology, Maitreyi College, University of Delhi, New Delhi, India
| | - Afluza Begum
- Department of Chemistry, Bhattadev University, Guwahati, India
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Olapeju B, Adams C, Wilson S, Simpson J, Hunter GC, Davis T, Mitchum L, Cox H, James K, Orkis J, Storey JD. Malaria care-seeking and treatment ideation among gold miners in Guyana. Malar J 2022; 21:29. [PMID: 35101036 PMCID: PMC8805325 DOI: 10.1186/s12936-022-04045-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/10/2022] [Indexed: 12/13/2022] Open
Abstract
Background Although miners are a priority population in malaria elimination in Guyana, scant literature exists on the drivers of malaria-related behaviour. This study explores the relationship between gold miners’ malaria-related ideation and the adoption of malaria care-seeking and treatment behaviours including prompt care-seeking, malaria testing, and self-medication. Methods Data are from a cross-sectional quantitative survey of 1685 adult miners between the ages of 18–59 years who live in mining camps in Regions 1, 7, and 8. The analysis focused on miners who reported an episode of fever in the past year (n = 745). Malaria care-seeking and treatment ideation was defined as a composite additive score consisting of the following variables: general malaria knowledge, perceived severity, perceived susceptibility, beliefs, perceived self-efficacy, perceived norms, interpersonal communication, and perceived response efficacy. Multivariable logistic regressions explored the relationship between ideation on care-seeking/treatment behaviours, controlling for confounding variables. Results Most miners with a recent episode of fever had perceived risk (92%), self-efficacy (67%), susceptibility (53%) and high malaria knowledge (53%). Overall, miners' care-seeking/treatment ideation score ranged from 0 to 8 with a mean of 4.1. Ideation scores were associated with higher odds of care-seeking for fever (aOR: 1.19; 95% CI 1.04–1.36), getting tested for malaria (aOR: 1.22; 95% CI 1.07–1.38) and lower odds of self-medication (aOR: 0.87; 95% CI 0.77–0.99). Conclusions A national community case management initiative is using study findings as part of its scale-up, using volunteers to make testing and treatment services more accessible to miners. This is complemented by a multi-channel mass media campaign to improve miners’ ideation. Communication messages focus on increasing miners’ knowledge of malaria transmission and symptoms, encourage positive beliefs about malaria testing and volunteer testers, promote evidence about the effectiveness of testing, and reminders of how quick and easy it is to get a malaria test with the community case management initiative. Study findings also have implications for efforts to eliminate malaria across the Guiana Shield.
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Ngo TD, Canavati SE, Dung DV, Vo TH, Tran DT, Tran LK, Whedbee RJ, Milgotina EI, Kelly GC, Edgel KA, Martin NJ. Results from a malaria indicator survey highlight the importance of routine data capture in high-risk forest and farm transmission sites in Vietnam to tailor location-specific malaria elimination interventions. PLoS One 2021; 16:e0250045. [PMID: 33861798 PMCID: PMC8051764 DOI: 10.1371/journal.pone.0250045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
In-line with the World Health Organization's (WHO) Global Technical Strategy for Malaria (2016-2030), Vietnam is striving to eliminate malaria by 2030. Targeting appropriate interventions in high-risk populations such as forest and forest-fringe communities is a critical component of malaria elimination efforts in Vietnam. In 2016, a household-level malaria indicator survey was conducted in Phu Yen Province, Vietnam with the aim of assessing the knowledge, behaviors and associated risks of malaria infection among priority mobile and migrant populations (MMPs) working and sleeping in forests and on farms. A total of 4211 people were included in the survey, comprised of 1074 heads of households and 3137 associated household members. Of the 1074 head-of-household respondents, 472 slept in a forest, 92 slept on a farm, 132 slept in both forests and farms, and 378 slept at their villages within the last 12 months. Age, literacy, and occupation were significantly different among those who slept in a forest versus on a farm. Of 301 respondents who answered questions about malaria risk factors at sleeping sites, 35% were somewhat aware of malaria prevention practices, but only 4% could recall at least four malaria prevention messages. Among the same group of 301 respondents, only 29% used nets and only 11% used treated nets. Ownership and use of nets among forest-goers was significantly lower than those who slept on a farm or in their village. Huts without walls were significantly prominent forest sleeping site locations (POR = 10.3; 95% CI 4.67-22.7). All respondents who slept in a forest requested standby malaria drugs and one-third of them self-treated without blood testing. Results from this study highlight the importance of capturing relevant location-specific data among priority populations such as remote forest and farm going mobile and migrant populations in Vietnam. Data regarding behavioral practices, knowledge, preventative measures, and intervention coverage at remote-area transmission sites must be routinely captured to effectively monitor progress and refine targeted intervention strategies accordingly.
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Affiliation(s)
- Thang Duc Ngo
- Department of Epidemiology, National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Sara E. Canavati
- Vysnova Partners, Inc., Landover, Maryland, United States of America
- Burnet Institute, Melbourne, Victoria, Australia
| | - Dang Viet Dung
- Department of Epidemiology, National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Thuan Huu Vo
- Vysnova Partners, Inc., Landover, Maryland, United States of America
| | - Duong Thanh Tran
- Department of Epidemiology, National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Long Khanh Tran
- Vysnova Partners, Inc., Landover, Maryland, United States of America
| | - Rosalie J. Whedbee
- Global Scientific Solutions for Health, Baltimore, Maryland, United States of America
| | | | - Gerard C. Kelly
- Vysnova Partners, Inc., Landover, Maryland, United States of America
- * E-mail:
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Olapeju B, Adams C, Hunter G, Wilson S, Simpson J, Mitchum L, Davis T, Orkis J, Cox H, Trotman N, Imhoff H, Storey D. Malaria prevention and care seeking among gold miners in Guyana. PLoS One 2020; 15:e0244454. [PMID: 33373407 PMCID: PMC7771697 DOI: 10.1371/journal.pone.0244454] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/09/2020] [Indexed: 11/19/2022] Open
Abstract
Despite being a priority population in malaria elimination, there is scant literature on malaria-related behavior among gold miners. This study explores the prevalence and factors influencing malaria prevention, care seeking and treatment behaviors in Guyana gold mining camps. A cross sectional survey was conducted among adult gold miners living in mining camps in the hinterland Regions 1 (Barima-Waini), 7 (Cuyuni-Mazaruni), and 8 (Potaro-Siparuni). Multivariable logistic regressions explored factors associated with miners’ self-report of mosquito net use, prompt care-seeking; self-medication; and testing for malaria. A third of miners used a mosquito net the night preceding the survey and net use was higher among those who believed that net use was the norm in their camp (aOR: 3.11; 95% CI:1.65, 5.88). Less than half (45%) of miners had a fever in the past 12 months, among whom 36% sought care promptly, 48% tested positive for malaria while 54% self-medicated before seeking care. Prompt care-seeking was higher among miners with high malaria knowledge (aOR: 1.44; 95% CI: 1.01, 2.05). Similarly, testing rates increased with secondary education (aOR: 1.71; 95% CI: (1.16, 2.51), high malaria knowledge (aOR: 1.45; 95% CI: 1.02, 2.05), positive beliefs regarding malaria transmission, threat, self-diagnosis, testing and treatment, and, trust in government services (aOR: 1.59; 95% CI (1.12, 2.27) and experience of a prior malaria episode (aOR: 2.62; 95% CI: 1.71, 4.00). Self-medication was lower among male miners (aOR: 0. 52; 95% CI: 0.32, 0.86). Malaria prevention and care seeking behaviors among miners are somewhat low and influenced by mosquito net usage, perceived norms, malaria knowledge and prior episode of confirmed malaria. Study findings have implications for malaria interventions in the hinterland regions of Guyana such as the mass and continuous distribution of insecticide treated nets as well as community case management initiatives using trained malaria testing and treatment volunteers to curb malaria transmission among remote gold mining populations. These include efforts to identify and address gaps in distributing mosquito nets to miners and address miners’ barriers to prompt care seeking, malaria testing and treatment adherence. Targeted social and behavior change messaging is needed on net acquisition, use and care, prompt care-seeking, malaria testing and treatment adherence. Additional efforts to ensure the overall sustainability of the community case management initiative include increased publicity of the community case management initiative among miners, use of incentives to promote retention rates among the community case management volunteer testers and public private partnerships between the Guyana Ministry of Health and relevant mining organizations.
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Affiliation(s)
- Bolanle Olapeju
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America
- * E-mail:
| | - Camille Adams
- Breakthrough ACTION Guyana, Georgetown, Demerara-Mahaica, Guyana
| | - Gabrielle Hunter
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America
| | - Sean Wilson
- Breakthrough ACTION Guyana, Georgetown, Demerara-Mahaica, Guyana
| | - Joann Simpson
- Breakthrough ACTION Guyana, Georgetown, Demerara-Mahaica, Guyana
| | - Lyndsey Mitchum
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America
| | - TrishAnn Davis
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America
| | - Jennifer Orkis
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America
| | - Horace Cox
- National Malaria Program, Ministry of Health, Georgetown, Demerara-Mahaica, Guyana
| | - Neil Trotman
- National Malaria Program, Ministry of Health, Georgetown, Demerara-Mahaica, Guyana
| | - Helen Imhoff
- National Malaria Program, Ministry of Health, Georgetown, Demerara-Mahaica, Guyana
| | - Douglas Storey
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America
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Association of information, education, and communication with enrolment in health insurance: a case of Nepal. Arch Public Health 2020; 78:135. [PMID: 33317622 PMCID: PMC7737309 DOI: 10.1186/s13690-020-00518-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many studies indicate that various health programmes have been failed because of the lack of appropriate information, education, and communication [IEC] for the target audiences. It is still unanswered which methods/means of communication could be the most powerful for changing behaviour or decision-making capacity. The paper aims to assess the effects of IEC on family enrolment in health insurance programme [HIP] in Nepal. METHODS We employed a household-based observational study with a control group. Altogether 810 household interviews were conducted in Baglung and Kailali districts of Nepal in 2018. The study used a validated structured interview schedule. Background characteristics of the family and respondents and their exposure to the means of communication were the independent variables while enrolment in health insurance [HI] was the dependent variable. RESULTS Data showed that 72% of the respondents heard about the HI and 66% knew the contribution amount for enrolment in HI. In the total enrolled households, 53% were household heads, 59% belonged to the age group 41-60 and 68% were above 60 years. More than half (56%) of rich compared to 46 and 49% of middle and poor (p < 0.05); 60% of the family member suffering from the chronic disease were enrolled in the HI. Similarly, 68% of those who heard about HI compared to 4 % who did not hear were enrolled (p < 0.001). A vast majority (69%) of those knowing contribution amount, 73% who interact with peer neighbour compared to 39% who did not, and 62% of those who listened to the radio and 63% of those who watched TV were enrolled in HI (p < 0.001). However, heard about HI (aOR = 21.18, 95%CI: 10.17-44.13, p < 0.001), knowledge about contribution amount (aOR = 5.13, 95%CI: 3.09-8.52, p < 0.001), having HI related books or guidelines (aOR = 4.84, 95%CI: 2.61-8.98, p < 0.001), and interact with peer or neighbours (aOR = 1.74, 95%CI: 1.34-2.65, p < 0.01) were appeared to be positive and significant predictors for enrolment in HI. CONCLUSION Knowledge about HI and interaction with peers and neighbours about the HI scheme of the government could lead to higher participation in the HIP. It would be better to incorporate this strategy while planning interventions for increasing enrolment in the HIP.
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Taffon P, Rossi G, Kindermans JM, Van den Bergh R, Nguon C, Debackere M, Vernaeve L, De Smet M, Venables E. 'I could not join because I had to work for pay.': A qualitative evaluation of falciparum malaria pro-active case detection in three rural Cambodian villages. PLoS One 2018; 13:e0195809. [PMID: 29649317 PMCID: PMC5897025 DOI: 10.1371/journal.pone.0195809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/29/2018] [Indexed: 11/19/2022] Open
Abstract
Background Pro-active case detection (Pro-ACD), in the form of voluntary screening and treatment (VSAT) following community mobilisation about ‘asymptomatic malaria’, is currently being evaluated as a tool for Plasmodium falciparum elimination in Preah Vihear Province, Cambodia. Methods A qualitative study was conducted to explore community understanding, perceptions, expectations and acceptability of the Pro-ACD intervention in order to identify aspects that could be improved in future Pro-ACD activities. This was ancillary to a three-round VSAT campaign, carried out in three villages between December 2015 and March 2016. Qualitative data collection began shortly after the end of the three rounds of screening. Purposive sampling was used to select participants. Nine focus group discussions with participants (n = 46) and non-participants (n = 40) in the Pro-ACD screening were conducted, in addition to in-depth interviews with key village figures (n = 9). Results Health promotion messages were well delivered and received, but it was difficult for many villagers to understand the messages around ‘asymptomatic malaria’. Overall, villagers and village leaders had a positive opinion about the VSAT intervention. Acceptability was high, as a direct consequence of favourable perceptions towards the screening activity: the Pro-ACD intervention was seen by the local population as an effective, inexpensive, reliable and readily available tool to protect individuals and the community from the insurgence of malaria. Physical absence and lack of time (both linked to work-related activities) were the main reasons for non-participation. Conclusions Although VSAT was generally well perceived and accepted, the ‘time factor’ related to the need to satisfy essential daily subsistence requirements played a significant role in determining participation in the screening. More well-adapted and meaningful Pro-ACD approaches could be implemented by improving the timing of the testing activites, and strengthening community participation and engagement to increase acceptability.
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Affiliation(s)
| | | | | | | | - Chea Nguon
- Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | | | - Martin De Smet
- Médecins Sans Frontières, Operational Centre Belgium, Brussels, Belgium
| | - Emilie Venables
- Médecins Sans Frontières, Operational Centre Belgium, Brussels, Belgium
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Kumar D, Singh SB, Kumar A, Kishore A, Kashyap V. A comparative study of epidemiological investigations of malaria outbreaks and related deaths in two districts of Jharkhand during the same prewinter season using shoe-leather epidemiology. J Family Med Prim Care 2018; 6:744-749. [PMID: 29564256 PMCID: PMC5848391 DOI: 10.4103/jfmpc.jfmpc_55_17] [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] [Indexed: 11/16/2022] Open
Abstract
Background: Following news of deaths in two districts of Jharkhand (West Singhbum and Garhwa) in November 2016, epidemiological investigations were contemplated to investigate any current outbreak of falciparum malaria and deaths attributed to it. Methodology: The epidemiological investigations, verbal autopsy of suspected deaths attributed to malaria and keys interviews were conducted in the 2nd and 4th week of November 2016 in Khuntpani and Dhurki block of West Singhbum and Garhwa districts, respectively, following a strict protocol. Results: The affected villages were Argundi and Korba-Pahariya and their adjacent tolas in Khuntpani and Dhurki block. Undoubtedly, there was the continuous transmission of falciparum malaria in both the regions in October and November 2016. The total cases (according to case definitions) were 1002, of them, 338 and 12 patients were positive for Plasmodium falciparum positive (Pf +ve) and Plasmodium vivax positive (Pv +ve), respectively, in the affected areas of Khuntpani block. In Dhurki block, out of the total of 631 patients fulfilling the case definition, 65 patients were PF +ve and 23 Pv +ve. Comparing to the last year, there is remarkably high number of falciparum cases. Verbal autopsy of deceased individuals showed that malaria might be one of the strongly probable diagnoses, but not conclusively. Conclusion: According to epidemiological investigation, verbal autopsy and key interviews conducted, it may be concluded that there is a definite outbreak of falciparum malaria in the area and environment is congenial for malaria and other tropical diseases.
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Affiliation(s)
- Dewesh Kumar
- Department of PSM, RIMS, Ranchi, Jharkhand, India
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Liverani M, Charlwood JD, Lawford H, Yeung S. Field assessment of a novel spatial repellent for malaria control: a feasibility and acceptability study in Mondulkiri, Cambodia. Malar J 2017; 16:412. [PMID: 29029614 PMCID: PMC5640900 DOI: 10.1186/s12936-017-2059-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large-scale use of insecticide-treated nets and indoor residual spraying have contributed to a significant decrease in malaria transmission worldwide. Further reduction and progress towards elimination, however, require complementary control measures which can address the remaining gaps in protection from mosquito bites. Following the development of novel pyrethroids with high knockdown effects on malaria vectors, programmatic use of spatial repellents has been suggested as one potential strategy to fill the gaps. This report explores social and contextual factors that may influence the relevance, uptake and sustainable use of a spatial repellent in two remote villages in Mondulkiri province, Cambodia, with endemic malaria transmission. The repellent consisted of polyethylene emanators, held in an open plastic frame and impregnated with 10% metofluthrin. RESULTS In a baseline survey, 90.9% of households in Ou Chra (n = 30/33) and 96.6% in Pu Cha (n = 57/59) were interviewed. Behavioural data were collected for all household occupants (n = 448). In both villages, there were times and places in which people remained exposed to mosquito bites. Prior to the installation of the repellent, 50.6 and 59.5% of respondents noted that bites occurred "very often" inside the house and in the outdoor area surrounding the house, respectively. Indoor biting was reported to occur more frequently in the evening, followed by at night, while outdoor biting occurred more frequently in the early morning. In a follow-up survey, spatial repellents were well received in both villages, although 63.2% of respondents would not replace bed nets with repellents. Most participants (96.6%) were willing to use the product again; the mean willingness to pay was US$ 0.3 per unit. A preference for local procurement methods emerged. CONCLUSION Widespread use of spatial repellents would not fill all protective gaps, but, if their entomological efficacy can be ascertained, outdoor application has the potential to enhance vector control strategies in Cambodia. Successful implementation would require subsidisation and integration with the existing national malaria control strategy. It is hoped that this study, while contributing to a better understanding of the social contexts of residual malaria transmission, will generate further interest in the evaluation of spatial repellents for malaria control.
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Affiliation(s)
- Marco Liverani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Harriet Lawford
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Shunmay Yeung
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Romay-Barja M, Ncogo P, Nseng G, Santana-Morales MA, Herrador Z, Berzosa P, Valladares B, Riloha M, Benito A. Caregivers' Malaria Knowledge, Beliefs and Attitudes, and Related Factors in the Bata District, Equatorial Guinea. PLoS One 2016; 11:e0168668. [PMID: 28036341 PMCID: PMC5201263 DOI: 10.1371/journal.pone.0168668] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/04/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives Adequate community knowledge about malaria is crucial in order to improve prevention by reducing exposure to the disease. Malaria is a major cause of morbidity and mortality among children of less than five years of age in Equatorial Guinea. However, information concerning the accuracy of community knowledge is insufficient. This study aimed at assessing the depth of caregivers’ knowledge of malaria, their beliefs and attitudes about this disease, and their socioeconomic determinants in the Bata district of Equatorial Guinea. Methodology A cross-sectional study was conducted in the district of Bata, involving 440 houses selected from 18 rural villages and 26 urban neighbourhoods. A combined "Malaria Knowledge Score" was generated based on caregivers’ knowledge about transmission, symptoms, prevention, the treatment of children, and best place to seek treatment. Multivariate logistic regressions analyses were performed to assess those factors that are associated with knowledge about malaria. Results A total of 428 caregivers were interviewed; 255 (59.6%) and 173 (40.4%) lived in urban and rural areas respectively. Significant differences between rural and urban households were observed in caregivers’ malaria knowledges and beliefs. Almost 42% of urban and 65% of rural caregivers were unaware as to how malaria is transmitted (OR = 2.69; 95% CI: 1.78–4.05). Together with rurality, the factors most significantly associated with the Malaria Knowledge were the level of education of the caregiver and the socioeconomic status of the household. Conclusions Improvements in educational programs are needed to empower the most vulnerable households such that they can pro-actively implement malaria control measures. This could be achieved by a comprehensive communication strategy aimed at changing individual and community behaviours, and delivered by suitably trained community health workers and indoor residual spraying personnel.
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Affiliation(s)
- Maria Romay-Barja
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
- * E-mail:
| | - Policarpo Ncogo
- Centro de Referencia de Control de Endemias, Malabo, Equatorial Guinea
| | - Gloria Nseng
- Ministerio de Salud y Bienestar Social, Malabo, Equatorial Guinea
| | - Maria A. Santana-Morales
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Zaida Herrador
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Pedro Berzosa
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Basilio Valladares
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Matilde Riloha
- Ministerio de Salud y Bienestar Social, Malabo, Equatorial Guinea
| | - Agustin Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
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Canavati SE, Quintero CE, Lawford HLS, Yok S, Lek D, Richards JS, Whittaker MA. High mobility, low access thwarts interventions among seasonal workers in the Greater Mekong Sub-region: lessons from the malaria containment project. Malar J 2016; 15:434. [PMID: 27562347 PMCID: PMC5000443 DOI: 10.1186/s12936-016-1491-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the process of malaria elimination in the Greater Mekong Sub-region, mobile and migrant populations (MMPs) have been identified as the most at-risk demographic. An important sub-group of MMPs are seasonal workers, and this paper presents an evaluation of the reach and effectiveness of interventions tailored towards this group and was carried out as part of the Containment Project from 2009-11. METHODS A mixed-methods study was conducted in Pailin Province in Western Cambodia. Three-hundred-and-four seasonal workers were surveyed using a structured questionnaire. Qualitative data were gathered through a total of eight focus group discussions and 14 in-depth interviews. Data triangulation of the qualitative and quantitative data was used during analysis. RESULTS High mobility and low access of the target population to the interventions, as well as lack of social and anthropological research that led to implementation oversights, resulted in under-exposure of seasonal workers to interventions. Consequently, their reach and impact were severely limited. Some services, particularly Mobile Malaria Workers, had the ability to significantly impact key factors, such as risky behaviours among those they did reach. Others, like Listening and Viewing Clubs and mass media campaigns, showed little impact. CONCLUSIONS There is potential in two of the interventions assessed, but high mobility and inadequate exposure of seasonal workers to these interventions must be considered in the development and planning of future interventions to avoid investing in low-impact activities and ensure that all interventions perform according to their maximum potential. This will be critical in order for Cambodia to achieve its aim of malaria elimination. The lessons learned from this study can be extrapolated to other areas of health care in Cambodia and other countries in order to reduce the gap between healthcare provided to MMPs, especially seasonal workers, and to the general population.
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Affiliation(s)
- Sara E. Canavati
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400 Thailand
| | - Cesia E. Quintero
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
| | - Harriet L. S. Lawford
- The National Centre For Parasitology, Entomology and Malaria Control, Ministry of Health, Corner Street 92, Trapaing Svay Village, Sankat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia
| | - Sovann Yok
- Provincial Health Department, Pailin City, Pailin Province Cambodia
- National Institute of Public Health, #2, St. 289, Toul Kork District, Phnom Penh, Cambodia
| | - Dysoley Lek
- The National Centre For Parasitology, Entomology and Malaria Control, Ministry of Health, Corner Street 92, Trapaing Svay Village, Sankat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia
- National Institute of Public Health, #2, St. 289, Toul Kork District, Phnom Penh, Cambodia
| | - Jack S. Richards
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Microbiology, Monash University, Melbourne, Australia
| | - Maxine Anne Whittaker
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811 Australia
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Tang S, Ji L, Hu T, Wang R, Fu H, Shao T, Liu C, Shao P, He Z, Li G, Feng Z. Public awareness of malaria in the middle stage of national malaria elimination programme. A cross-sectional survey in rural areas of malaria-endemic counties, China. Malar J 2016; 15:373. [PMID: 27436087 PMCID: PMC4949874 DOI: 10.1186/s12936-016-1428-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Remarkable progress in the elimination of malaria has been achieved by the Chinese government in the past 5 years. However, imported cases have increased rapidly, and it is a critical threat to the national malaria elimination programme. This study aims to investigate the current status of the public awareness of malaria in the middle stage of the national malaria elimination progress. METHODS A cross-sectional survey with multi-stage stratified randomized sampling was undertaken between June 2015 and March 2016. A total of 1321 residents from nine malaria-endemic counties, 27 townships and 81 villages were interviewed using a structured questionnaire. RESULTS The results showed 51.6 % of the respondents had sufficient malaria knowledge. The malaria awareness of the public in type I counties was better than that in type II, whereas that in type III was the lowest. Approximately 74.9 % of the respondents were aware of at least one form of prevention of malaria, and 85.2 % of them would seek treatment when suffering from malaria. However, the awareness of fever, chills, sweating as common symptoms of malaria were 53.4, 56.2 and 31.6 %, respectively. The level of malaria awareness of the at-risk population was similar to that of the general population, it seemingly increased along with age and declined with the distance away from township hospitals. CONCLUSION The public awareness of malaria needs to improve continuously. Health education campaigns should focus on basic malaria knowledge and cover target populations. The multi-sectoral or even international collaboration should be further intensified. Careful planning is required to ensure that scattered villages are incorporated into the malaria health promotion system to sustain elimination.
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Affiliation(s)
- Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Lu Ji
- Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Tao Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China.,Bureau of Disease Prevention and Control, National Health and Family, Beijing, China
| | - Ruoxi Wang
- University of Nottingham, Nottingham, UK
| | - Hang Fu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Tian Shao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Chunyan Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Piaopiao Shao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Zhe He
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Gang Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China.
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