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Cakpo GE, Kombate G, Labité MA, Azianu KA, M'belou M. Parental behaviors regarding fever in young children in Benin: study of population survey data. Pan Afr Med J 2024; 47:125. [PMID: 38854865 PMCID: PMC11161694 DOI: 10.11604/pamj.2024.47.125.41320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/03/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction the search for care of parents in case of the febrile episode of children is not always systematic. This study aims to improve knowledge on health care research in cases of fever in children under five years of age in Benin. Methods this study used data from the Benin Demographic and Health Survey 2017-2018. Counselling or seeking care is defined as any child under 5 years of age who has a fever in the two weeks prior to the interview. Univariate and multivariate logistic regression analyses were performed using generalized linear model. Results a total of 2465 children were surveyed. The model predicting seeking appropriate advice or care in febrile children in Benin was distance from the nearest health center, region, maternal age, and socioeconomic status. Indeed, febrile children whose mothers perceived difficult geographical access to the health center were 30% less likely to seek care, compared to children whose geographical access to the health center was easy (aOR=0.70 (0.54-0.90)). In addition, mothers living in the Hill region were more likely (AOR=5.73 (3.53-9.45)) to seek appropriate advice or care compared to those living in Alibori. In terms of socioeconomic status, children whose mothers were very wealthy were more likely to have their mothers seek care (aOR=1.93 (1.33-2.81)). Conclusion interventions to improve universal primary health care coverage in terms of geographic accessibility, awareness and health literacy are the best allies for routine care.
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Affiliation(s)
- Gbènonminvo Enoch Cakpo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Centre de Recherche et d´Appui en Statistique, Parakou, Bénin
| | - Gountante Kombate
- Society for Study and Research in Public Health, Ouagadougou, Burkina Faso
| | - Matè Alonyenyo Labité
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Komi Ameko Azianu
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Mazimna M'belou
- Ecole Nationale des Auxilliaires Médicaux de Lomé, Lomé, Togo
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Xu JW, Deng DW, Wei C, Zhou XW, Li JX. Treatment-seeking behaviours of malaria patients versus non-malaria febrile patients along China-Myanmar border. Malar J 2023; 22:309. [PMID: 37833761 PMCID: PMC10576386 DOI: 10.1186/s12936-023-04747-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Appropriate malaria treatment-seeking behaviour (TSB) is critical for timely detecting malaria, prompt treatment, and prevention of onward transmission of the disease in a community. This study aimed to compare treatment-seeking behaviours between malaria patients and non-malaria febrile patients, and to analyse the factors associated with appropriate TSB along the China-Myanmar border. METHODS A cross-sectional study was carried out to investigate the appropriate TSB of microscopy-confirmed malaria patients versus non-malaria febrile (NMF) patients. An unconditional logistic regression analysis (LRA) was used to identify factors associated with appropriate TSB. RESULTS Among 223 malaria patients and 446 NMF patients, 129 (57.8%) of the malaria patients versus 163 (36.5%) of the NMF patients firstly sought treatment in health facilities without laboratory testing for malaria (P < 0.0001). A total of 85(38.1%) of the malaria patients versus 278 (62.3%) of the NMF patients had appropriate TSB, namely, seeking treatment in health facilities with laboratory testing for malaria within 48 h (P < 0.0001). Multivariate LRA identified that the malaria patients with Chinese nationality had less appropriate TSB compared to those with other nationalities (adjusted odds ratio [AOR]: 0.21, 95% confidence interval CI 0.07-0.68, P = 0.0097), and malaria patients residing in urban areas had more appropriate TSB compared to those living in rural areas (AOR: 2.16, 95%CI 1.06-4.39, P = 0.0337). CONCLUSIONS TSB was not appropriate in malaria patients. Chinese citizenship and rural residence were two independent factors associated with inappropriate malaria TSB. It is urgently necessary to improve appropriate malaria TSB through effective campaigns of information, education, and communication for malaria control in Myanmar and preventing reestablishment of malaria transmission in Yunnan, China.
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Affiliation(s)
- Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China.
| | - Dao-Wei Deng
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China
| | - Chun Wei
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China
| | - Xing-Wu Zhou
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China
| | - Jian-Xiong Li
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China
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Win KM, Aung PL, Ring Z, Linn NYY, Kyaw MP, Nguitragool W, Cui L, Sattabongkot J, Lawpoolsri S. Interventions for promoting patients' adherence to 14-day primaquine treatment in a highly malaria-endemic township in Myanmar: a qualitative study among key stakeholders. Malar J 2023; 22:302. [PMID: 37814267 PMCID: PMC10563334 DOI: 10.1186/s12936-023-04743-8] [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: 08/31/2023] [Accepted: 10/04/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Plasmodium vivax malaria is considered a major threat to malaria eradication. The radical cure for P. vivax malaria normally requires a 14-day administration of primaquine (PQ) to clear hypnozoites. However, maintaining adherence to PQ treatment is a significant challenge, particularly in malaria-endemic rural areas. Hence, this study aimed to formulate interventions for promoting patients' commitment to PQ treatment in a highly malaria-endemic township in Myanmar. METHODS A qualitative study was conducted in Waingmaw Township in northern Myanmar, where P. vivax malaria is highly endemic. Key stakeholders including public health officers and community members participated in focus group discussions (FGDs) and in-depth interviews (IDIs) in September 2022. Data were collected using validated guidelines, translated into English, and visualized through thematic analysis. RESULTS Responsible individuals from different levels of the Myanmar National Malaria Control Programme participated in the IDIs. Most of them reported being aware of the markedly increasing trend of P. vivax and the possibility of relapse cases, especially among migrants who are lost to follow-up. Workload was a key concern surrounding intervention implementation. The respondents discussed possible interventions, such as implementing directly observed treatment (DOT) by family members, piloting a shorter PQ regimen, expanding the community's malaria volunteer network, and strengthening health education activities using local languages to promote reasonable drug adherence. FGDs among community members revealed that although people were knowledgeable about malaria symptoms, places to seek treatment, and the use of bed nets to prevent mosquito bites, most of them still preferred to be treated by quack doctors and rarely used insecticide-treated nets at worksites. Many often stopped taking the prescribed drugs once the symptoms disappeared. Nevertheless, some respondents requested more bed nets to be distributed and health promotion activities to be conducted. CONCLUSION In rural areas where human resources are limited, interventions such as implementing family member DOT or shortening PQ regimens should be introduced to enhance the radical cure for the P. vivax infection. Disseminating information about the importance of taking the entire treatment course and emphasizing the burden of relapse is also essential.
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Affiliation(s)
- Kyawt Mon Win
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Public Health, Ministry of Health, Naypyitaw, Myanmar
| | - Pyae Linn Aung
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Zau Ring
- State Public Health Department, Kachin State, Ministry of Health, Myitkyina, Myanmar
| | - Nay Yi Yi Linn
- Department of Public Health, Ministry of Health, Naypyitaw, Myanmar
| | | | - Wang Nguitragool
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Liwang Cui
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Win KM, Aung PL, Ring Z, Linn NYY, Kyaw MP, Nguitragool W, Cui L, Sattabongkot J, Lawpoolsri S. Interventions for promoting patients' adherence to 14-day primaquine treatment in a highly malaria-endemic township in Myanmar: A qualitative study among key stakeholders. RESEARCH SQUARE 2023:rs.3.rs-3312278. [PMID: 37720045 PMCID: PMC10503836 DOI: 10.21203/rs.3.rs-3312278/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background Plasmodium vivax malaria is considered a major threat to malaria eradication. The radical cure for P. vivax malaria normally requires a 14-day administration of primaquine (PQ) to clear hypnozoites. However, maintaining adherence to PQ treatment is a significant challenge, particularly in malaria-endemic rural areas. Hence, this study aimed to formulate interventions for promoting patients' commitment to PQ treatment in a highly malaria-endemic township in Myanmar. Methods A qualitative study was conducted in Waingmaw Township in northern Myanmar, where P. vivax malaria is highly endemic. Key stakeholders including public health officers and community members participated in focus group discussions (FGDs) and in-depth interviews (IDIs) in September 2022. Data were collected using validated guidelines, translated into English, and visualized through thematic analysis. Results Responsible individuals from different levels of the Myanmar National Malaria Control Program participated in the IDIs. Most of them reported being aware of the markedly increasing trend of P. vivax and the possibility of relapse cases, especially among migrants who are lost to follow-up. Workload was a key concern surrounding intervention implementation. The respondents discussed possible interventions, such as implementing directly observed treatment (DOT) by family members, piloting a shorter PQ regimen, expanding the community's malaria volunteer network, and strengthening health education activities using local languages to promote reasonable drug adherence. FGDs among community members revealed that although people were knowledgeable about malaria symptoms, places to seek treatment, and the use of bed nets to prevent mosquito bites, most of them still preferred to be treated by quack doctors and rarely used insecticide-treated nets at worksites. Many often stopped taking the prescribed drugs once the symptoms disappeared. Nevertheless, some respondents requested more bed nets to be distributed and health promotion activities to be conducted. Conclusion In rural areas where human resources are limited, interventions such as implementing family member DOT or shortening PQ regimens should be introduced to enhance the radical cure for the P. vivax infection. Disseminating information about the importance of taking the entire treatment course and emphasizing the burden of relapse is also essential.
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Kombate G, Cakpo GE, Azianu KA, Labité MA, van der Sande MAB. Care-seeking behaviour among febrile children under five in Togo. BMC Public Health 2022; 22:2107. [PMCID: PMC9670432 DOI: 10.1186/s12889-022-14550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Fever is one of the warning signs of poor health in children. Care-seeking in febrile children is importance in reducing child deaths and morbidity. This care-seeking by parents in children with fever is however relatively low in sub-Sahara Africa. The aim of this study is to improve understanding of the behaviour of caregivers in seeking care for children under five with fever and to identify associated modifiable risk factors in Togo.
Methods
Data from a 2013–2014 cross-sectional nationally representative malaria indicator survey was used. Advice or care-seeking is defined as any child under 5 years of age with fever in the two weeks prior to the interview for whom advice or treatment was sought in a public medical area, private medical area, store, market, or from an itinerant medicine seller. Univariate and multivariate logistic regression analysis were performed using Generalized Linear Models.
Results
A total of 1359 febrile children out of 6529 children under five were enrolled. Care had been sought in 38.9% of cases. In multivariate analysis, independent risk factors associated with formal care seeking were accessibility to the nearest health center (aOR = 1.52, 95% CI [1.18–1.95], mother's education level secondary and above (aOR = 1.85, 95% [1.32–2.59]), mothers who identified as belonging to animist/traditionalist religions compared to mothers who belonged to a formal religion (catholic (aOR = 2. 28, 95% [1.55–3.37]), Muslim (aOR = 2.41, 95% [1.67–3.47]), and Protestant (aOR = 1.9, 95% [1.37–2.65]), Maritime region (aOR = 0.49, 95% [0.29–0.82]) compared to Lome commune.
Conclusion
Interventions should specifically target women with limited education, not identifying as part of an official church and at longer distance from health center.
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Rural-urban disparities and factors associated with delayed care-seeking and testing for malaria before medication use by mothers of under-five children, Igabi LGA, Kaduna Nigeria. Malar J 2020; 19:294. [PMID: 32811529 PMCID: PMC7436948 DOI: 10.1186/s12936-020-03371-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fever in under-five children (U5) is the commonest presenting complaint in general practice and mothers' recognition is an entry point for fever treatment, including malaria. This study describes rural-urban disparity in fever prevalence in U5, mothers' malaria knowledge, care-seeking, testing for malaria before anti-malarial medication and the associated factors. METHODS A cross-sectional survey was conducted among 630 mother-child pairs [rural (300) and urban (330)] selected randomly using a multi-stage sampling from 63 villages in Igabi LGA, Kaduna State, Nigeria. Trained female data collectors administered a pre-tested structured questionnaire to collect information on mother-child demographic profiles, malaria knowledge, fever episodes in birth order last child in two weeks prior to survey, blood testing before anti-malarial use, and delayed care-seeking defined as care sought for fever > 48 h of onset. Malaria knowledge was categorized into good, average, and poor if the final scores were ≥ 75th, 50th-74th, and < 50th percentiles, respectively. Frequency, proportions, and odds ratio were calculated. Statistically significant was set at p-value < 0.05. RESULTS The median age (interquartile range) of rural mothers was 30 (IQR, 10) years compared to 27 (IQR, 6) years in urban. Of the 70.0% (441/629) U5 children with fever, 58.5% (258/441) were in rural settlements. A third of the mothers whose child had fever sought care. Mothers in rural settlements were 2.8 (adjusted OR: 2.8, CI 1.8-4.2, p < 0.01) times more likely to delay care-seeking for fever. Other significant factors were poor or no knowledge of malaria transmission, poor perception of malaria as a major health problem, and household size > 5. Also, mothers who had no formal education were four times more likely to receive anti-malarial medications without testing for malaria compared to their educated counterpart (adjusted OR: 4.0, 95% CI 1.6-9.9, p < 0.000). CONCLUSIONS Rural-urban disparities existed between fever prevalence in U5 children, care-seeking practices by their mothers, and factors associated with delayed care-seeking and testing the fever for malaria before anti-malarial medication. Fever treatment for high impact malaria elimination in Nigeria needs a context-specific intervention rather than 'one-size-fits-all' approach.
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Brennan E, Abimbola S. Understanding and progressing health system decentralisation in Myanmar. GLOBAL SECURITY: HEALTH, SCIENCE AND POLICY 2020. [DOI: 10.1080/23779497.2020.1782247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Elliot Brennan
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Seye Abimbola
- Sydney School of Public Health, University of Sydney, Sydney, Australia
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Edwards HM, Sriwichai P, Kirabittir K, Prachumsri J, Chavez IF, Hii J. Transmission risk beyond the village: entomological and human factors contributing to residual malaria transmission in an area approaching malaria elimination on the Thailand-Myanmar border. Malar J 2019; 18:221. [PMID: 31262309 PMCID: PMC6604376 DOI: 10.1186/s12936-019-2852-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 06/19/2019] [Indexed: 11/12/2022] Open
Abstract
Background A mixed methods study was conducted to look at the
magnitude of residual malaria transmission (RMT) and factors contributing to low (< 1% prevalence), but sustained transmission in rural communities on the Thai–Myanmar border. Methods A cross-sectional behaviour and net survey, observational surveys and entomological collections in both villages and forested farm huts frequented by community members for subsistence farming practices were conducted. Results Community members frequently stayed overnight at subsistence farm huts or in the forest. Entomological collections showed higher biting rates of primary vectors in forested farm hut sites and in a more forested village setting compared to a village with clustered housing and better infrastructure. Despite high levels of outdoor biting, biting exposure occurred predominantly indoors, particularly for non-users of long-lasting insecticidal nets (LLINs). Risk of biting exposure was exacerbated by sub-optimal coverage of LLINs, particularly in subsistence farm huts and in the forest. Furthermore, early waking hours when people had left the safety of their nets coincided with peaks in biting in later morning hours. Conclusions Entomological and epidemiological findings suggest drivers and modulators of sustained infection prevalence in the area to be: higher mosquito abundance in forested areas where LLINs were used less frequently or could not be used; late sleeping and waking times coinciding with peak biting hours; feeding preferences of Anopheles taking them away from contact with LLIN and indoor residual spraying (IRS), e.g. exophagy and zoophagy; non-use of LLIN and use of damaged/torn LLIN; high population movement across the border and into forested areas thereby increasing risk of exposure, decreasing use of protection and limiting access to healthcare; and, Plasmodium vivax predominance resulting in relapse(s) of previous infection. The findings highlight gaps in current intervention coverage beyond the village setting. Electronic supplementary material The online version of this article (10.1186/s12936-019-2852-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hannah M Edwards
- Department of Disease Epidemiology, Imperial College London, London, UK. .,Malaria Consortium Asia, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand.
| | - Patchara Sriwichai
- Department of Entomology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Kirakorn Kirabittir
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Jetsumon Prachumsri
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Irwin F Chavez
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Jeffrey Hii
- Department of Disease Epidemiology, Imperial College London, London, UK
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Linn NYY, Tripathy JP, Maung TM, Saw KK, Maw LYW, Thapa B, Lin Z, Thi A. How are the village health volunteers deliver malaria testing and treatment services and what are the challenges they are facing? A mixed methods study in Myanmar. Trop Med Health 2018; 46:28. [PMID: 30123042 PMCID: PMC6090948 DOI: 10.1186/s41182-018-0110-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022] Open
Abstract
Background Village health volunteers (VHVs) play a key role in delivering community-based malaria care especially in the hard-to-reach areas in Myanmar. It is necessary to assess their performance and understand the challenges encountered by them for effective community management of malaria. This mixed methods study was conducted to (i) understand the cascade of malaria services (testing, diagnosis, referral, and treatment of malaria) provided by the VHVs under the National Malaria Control Programme (NMCP) in Myanmar in 2016 and compare with other health care providers and (ii) explore the challenges in the delivery of malaria services by VHVs. Methods A sequential mixed methods study was designed with a quantitative followed by a descriptive qualitative component. The quantitative study was a cohort design involving analysis of secondary data available from NMCP database whereas the qualitative part involved 16 focus group discussions (eight each with community and VHVs) and 14 key informant interviews with program stakeholders in four selected townships. Results Among 444,268 cases of undifferentiated fever identified by VHVs in 2016, 444,190 were tested using a rapid diagnostic test. Among those tested, 20,375 (4.6%) cases of malaria were diagnosed, of whom 16,910 (83.0%) received appropriate treatment, with 7323 (35.9%) receiving treatment within 24 h. Of all malaria cases, 296 (1.5%) were complicated, of whom 79 (26.7%) were referred to the higher facility. More than two thirds of all cases were falciparum malaria (13,970, 68.6%) followed by vivax (5619, 27.6%). Primaquine was given to 83.6% of all cases. VHVs managed 34.0% of all undifferentiated fever cases, 35.9% of all malaria cases, and identified 38.0% of all Plasmodium falciparum cases reported under NMCP. The key barriers identified are work-related (challenges in reporting, referral, management of malaria especially primaquine therapy, and lack of community support) and logistics related (challenges in transportation, financial constraints, time and shortage of drugs, and test kits). On the other hand, they also enjoy good community support and acceptance in most areas. Conclusion VHVs play an important role in malaria care in Myanmar, especially in the hard-to-reach areas. More programmatic support is needed in terms of logistics, transportation allowance, and supervision to improve their performance.
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Affiliation(s)
- Nay Yi Yi Linn
- Vector Borne Disease Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Jaya Prasad Tripathy
- 2International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India.,3International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Thae Maung Maung
- 4Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Khine Khine Saw
- Vector Borne Disease Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | | | - Badri Thapa
- Malaria Unit, World Health Organization Country Office, Yangon, Myanmar
| | - Zaw Lin
- Vector Borne Disease Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aung Thi
- Vector Borne Disease Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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Naing PA, Maung TM, Tripathy JP, Oo T, Wai KT, Thi A. Awareness of malaria and treatment-seeking behaviour among persons with acute undifferentiated fever in the endemic regions of Myanmar. Trop Med Health 2017; 45:31. [PMID: 29213208 PMCID: PMC5713003 DOI: 10.1186/s41182-017-0070-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 09/28/2017] [Indexed: 12/02/2022] Open
Abstract
Background Myanmar has a high burden of malaria with two-third of the population at risk of malaria. One of the basic elements of the Roll Back Malaria Initiative to fight against malaria is early diagnosis and treatment within 24 h of fever. Public awareness about malaria is a key factor in malaria prevention and control and in improving treatment-seeking behaviour. Methods A large community-based survey was carried out in 27 townships of malaria endemic regions in Myanmar in 2015 which reported on the knowledge, behaviour and practices around malaria in the general population. We used the data already collected in this survey to assess (i) general public awareness of malaria and (ii) treatment-seeking behaviour and associated factors among persons with acute undifferentiated fever. Results A total of 6597 respondents from 6625 households were interviewed (response rate of 99.5%). About 85% of the respondents were aware that mosquito bite was the mode of transmission of malaria and 90% mentioned that malaria was preventable. However, only 16% of the respondents knew about anti-malaria drug resistance. There were certain misconceptions about the transmission of malaria such as dirty water, same blood group, sharing shelter, sleeping/eating together and poor hygiene. Health facility staff were the most common source of information about malaria (80%). Nearly one-fourth (23%) of the respondents with fever resorted to self-medication. Around 28% of the respondents with fever underwent blood testing, less than half of whom (44%) were tested within 24 h. Elderly age group, females, those with poor knowledge about malaria and those residing in non-Regional Artemisinin Resistance Initiative townships were associated with poor treatment-seeking behaviour in case of fever. Conclusion Although there is fair knowledge on mosquito bite as a mode of transmission and prevention of malaria, there are some misconceptions about transmission of malaria. Those having poor knowledge about malaria have poor treatment-seeking behaviour. A considerable number of respondents seek care from informal care providers and seek care late. Thus, there is a need to promote awareness about the role of early diagnosis and appropriate treatment and address misconceptions about transmission of malaria.
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Affiliation(s)
- Phyo Aung Naing
- Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka Road Dagon Township, Yangon, 11191 Myanmar
| | - Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka Road Dagon Township, Yangon, 11191 Myanmar
| | - Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Regional Office, New Delhi, India
| | - Tin Oo
- Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka Road Dagon Township, Yangon, 11191 Myanmar
| | - Khin Thet Wai
- Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka Road Dagon Township, Yangon, 11191 Myanmar
| | - Aung Thi
- National Malaria Control Program, Ministry of Health and Sports, Naypyitaw, Myanmar
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Thein ST, Khin HSS, Thi A. Insights into the availability and distribution of oral artemisinin monotherapy in Myanmar: evidence from a nationally representative outlet survey. Malar J 2017; 16:170. [PMID: 28438145 PMCID: PMC5404336 DOI: 10.1186/s12936-017-1793-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/31/2017] [Indexed: 12/31/2022] Open
Abstract
Background The containment of artemisinin resistance in Myanmar, historically an important probable origin and route of anti-malarial resistance to the India sub-continent and beyond, is crucial to global malaria control and elimination. This paper describes what is currently known about the sale and distribution of oral artemisinin monotherapy (AMT) across Myanmar, where this medicine is commonly found. Methods A nationally representative 2015 outlet survey was conducted in the private sector, and among community health workers across four geographical domains. A national sample of outlets was screened for availability of malaria testing and treatment, and an audit was completed for all anti-malarials. Results A total of 3859 outlets across Myanmar had an anti-malarial in stock on the day of survey. Of the 3859 anti-malarial stocking outlets, 988 outlets stocked oral AMT. Availability of oral AMT was highest among outlets in the Western border (36.8%) versus other domains (Eastern, 15.0%; Central, 19.3% Coastal, 10.7%). Over 90% of the oral AMT service delivery points were private sector outlets: general retailers (49.4%), pharmacies (23.5%), and itinerant drug vendors (14.2%). Eleven unique oral AMT products were audited. The most common product audited was Artesunate®, manufactured by Mediplantex in Vietnam, which accounted for 79.9% of the oral AMT market share. Other oral AMT products were manufactured in China and in Myanmar. Over 60% of oral AMT products had a shelf life at purchase of greater than 2 years and only 14.7% were expired. The median number of oral AMT tablets typically dispensed to treat malaria was two tablets, approximately one tenth of a full adult course. The median price of a 50 mg tablet was $0.16. Conclusions Given the high availability and distribution of oral AMT, it is possible that Myanmar has become the last remaining viable market for any oral AMT in the region for manufacturers. National and international organizations need to act quickly and effectively to stop the production and distribution to both improve malaria control within Myanmar and reduce risk of artemisinin resistance spreading to India and Africa. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1793-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Si Thu Thein
- Population Services International Myanmar, No. 16, West Shwe Gone Dine 4th Street, Yangon, Myanmar.
| | - Hnin Su Su Khin
- Population Services International Myanmar, No. 16, West Shwe Gone Dine 4th Street, Yangon, Myanmar
| | - Aung Thi
- National Malaria Control Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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Alegana VA, Wright J, Pezzulo C, Tatem AJ, Atkinson PM. Treatment-seeking behaviour in low- and middle-income countries estimated using a Bayesian model. BMC Med Res Methodol 2017; 17:67. [PMID: 28427337 PMCID: PMC5397699 DOI: 10.1186/s12874-017-0346-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Seeking treatment in formal healthcare for uncomplicated infections is vital to combating disease in low- and middle-income countries (LMICs). Healthcare treatment-seeking behaviour varies within and between communities and is modified by socio-economic, demographic, and physical factors. As a result, it remains a challenge to quantify healthcare treatment-seeking behaviour using a metric that is comparable across communities. Here, we present an application for transforming individual categorical responses (actions related to fever) to a continuous probabilistic estimate of fever treatment for one country in Sub-Saharan Africa (SSA). METHODS Using nationally representative household survey data from the 2013 Demographic and Health Survey (DHS) in Namibia, individual-level responses (n = 1138) were linked to theoretical estimates of travel time to the nearest public or private health facility. Bayesian Item Response Theory (IRT) models were fitted via Markov Chain Monte Carlo (MCMC) simulation to estimate parameters related to fever treatment and estimate probability of treatment for children under five years. Different models were implemented to evaluate computational needs and the effect of including predictor variables such as rurality. The mean treatment rates were then estimated at regional level. RESULTS Modelling results suggested probability of fever treatment was highest in regions with relatively high incidence of malaria historically. The minimum predicted threshold probability of seeking treatment was 0.3 (model 1: 0.340; 95% CI 0.155-0.597), suggesting that even in populations at large distances from facilities, there was still a 30% chance of an individual seeking treatment for fever. The agreement between correctly predicted probability of treatment at individual level based on a subset of data (n = 247) was high (AUC = 0.978), with a sensitivity of 96.7% and a specificity of 75.3%. CONCLUSION We have shown how individual responses in national surveys can be transformed to probabilistic measures comparable at population level. Our analysis of household survey data on fever suggested a 30% baseline threshold for fever treatment in Namibia. However, this threshold level is likely to vary by country or endemicity. Although our focus was on fever treatment, the methodology outlined can be extended to multiple health seeking behaviours captured in routine national survey data and to other infectious diseases.
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Affiliation(s)
- Victor A Alegana
- Geography and Environment, University of Southampton, Southampton, UK.
- Flowminder Foundation, Stockholm, Sweden.
| | - Jim Wright
- Geography and Environment, University of Southampton, Southampton, UK
| | - Carla Pezzulo
- Geography and Environment, University of Southampton, Southampton, UK
- Flowminder Foundation, Stockholm, Sweden
| | - Andrew J Tatem
- Geography and Environment, University of Southampton, Southampton, UK
- Flowminder Foundation, Stockholm, Sweden
| | - Peter M Atkinson
- Geography and Environment, University of Southampton, Southampton, UK
- Faculty of Science and Technology, Lancaster University, Lancaster, UK
- School of Geography, Archaeology and Palaeoecology, Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland, UK
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Mu TT, Sein AA, Kyi TT, Min M, Aung NM, Anstey NM, Kyaw MP, Soe C, Kyi MM, Hanson J. Malaria incidence in Myanmar 2005-2014: steady but fragile progress towards elimination. Malar J 2016; 15:503. [PMID: 27756394 PMCID: PMC5069869 DOI: 10.1186/s12936-016-1567-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 10/07/2016] [Indexed: 01/20/2023] Open
Abstract
Background There has been an impressive recent reduction in the global incidence of malaria, but the development of artemisinin resistance in the Greater Mekong Region threatens this progress. Increasing artemisinin resistance is particularly important in Myanmar, as it is the country in the Greater Mekong Region with the greatest malaria burden. If malaria is to be eliminated in the region, it is essential to define the spatial and temporal epidemiology of the disease in Myanmar to inform control strategies optimally. Results Between the years 2005 and 2014 there was an 81.1 % decline in the reported annual incidence of malaria in Myanmar (1341.8 cases per 100,000 population to 253.3 cases per 100,000 population). In the same period, there was a 93.5 % decline in reported annual mortality from malaria (3.79 deaths per 100,000 population to 0.25 deaths per 100,000 population) and a 87.2 % decline in the proportion of hospitalizations due to malaria (7.8 to 1.0 %). Chin State had the highest reported malaria incidence and mortality at the end of the study period, although socio-economic and geographical factors appear a more likely explanation for this finding than artemisinin resistance. The reduced malaria burden coincided with significant upscaling of disease control measures by the national government with support from international partners. These programmes included the training and deployment of over 40,000 community health care workers, the coverage of over 60 % of the at-risk population with insecticide-treated bed nets and significant efforts to improve access to artemesinin-based combination treatment. Beyond these malaria-specific programmes, increased general investment in the health sector, changing population demographics and deforestation are also likely to have contributed to the decline in malaria incidence seen over this time. Conclusions There has been a dramatic fall in the burden of malaria in Myanmar since 2005. However, with the rise of artemisinin resistance, continued political, financial and scientific commitment is required if the ambitious goal of malaria elimination in the country is to be realized.
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Affiliation(s)
- Thet Thet Mu
- Department of Public Health, Ministry of Health, Nay Pyi Taw, Myanmar
| | - Aye Aye Sein
- Department of Public Health, Ministry of Health, Nay Pyi Taw, Myanmar
| | - Tint Tint Kyi
- Department of Medical Care, Ministry of Health, Nay Pyi Taw, Myanmar
| | - Myo Min
- Myanmar Medical Association, Yangon, Myanmar
| | | | | | | | - Chit Soe
- University of Medicine 1, Yangon, Myanmar
| | | | - Josh Hanson
- University of Medicine 2, Yangon, Myanmar. .,Menzies School of Health Research, Darwin, Australia. .,The Kirby Institute, Sydney, Australia.
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