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Mhango P, Malata MP, Chipeta E, Sixpence A, Taylor TE, Wilson ML, Cohee LM, Mangani C, Mathanga DP. Barriers to accessing malaria treatment amongst school-age children in rural Malawi. Malar J 2023; 22:258. [PMID: 37674177 PMCID: PMC10481490 DOI: 10.1186/s12936-023-04695-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Over the last two decades, many countries have moved from malaria control toward malaria elimination. However, some sub-Saharan African countries, like Malawi, have recently seen a reversal in malaria control progress with reported increases in confirmed malaria cases. This may be the result of inadequate access to effective malaria control interventions by key population groups that perpetuate transmission. This study aimed to assess the barriers to accessing malaria treatment among school-aged children (SAC) in Malawi. METHODS A qualitative study was conducted between September and October 2020, where data were gathered in rural Malawi using free-listing interviews, key-informant interviews, semi-structured interviews and focus group discussions. Purposively sampled participants included SAC, parents of SAC, health workers and key stakeholders at community and district levels. Interviews were digitally recorded and transcribed verbatim. Data were organized using NVivo 12 software and analysed using the thematic method. RESULTS The study recruited 252 participants, with 156 being SAC, equally divided between boys and girls. Health system barriers to malaria treatment included long waiting hours and queues at clinics, frequent stock-outs of medical supplies, and travel time to the facility. Provider barriers included negative attitude and limited service hours. Individual and cultural barriers included fear of malaria tests and beliefs associating witchcraft as the best treatment for malaria. In addition, COVID-19-related barriers included the inability to follow preventive measures, a shift in focus from malaria to COVID-19, and fear of contracting COVID-19 and/or being tested for COVID-19 at the facility. CONCLUSIONS This study shows most of the barriers to accessing malaria treatment among SAC are similar to those experienced by other population groups. Furthermore, COVID-19 adversely affected SAC's access to treatment. Interventions that support SAC access to prompt diagnosis and treatment are urgently needed to improve the effective control of malaria.
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Affiliation(s)
- Patani Mhango
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Monica Patricia Malata
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Effie Chipeta
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Alick Sixpence
- Malaria Alert Centre (MAC), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Terrie E Taylor
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Mark L Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lauren M Cohee
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Don P Mathanga
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
- Malaria Alert Centre (MAC), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
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Ge Y, Liang D, Cao J, Gosling R, Mushi V, Huang J. How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years: findings from 19 sub-Saharan African countries. Infect Dis Poverty 2023; 12:29. [PMID: 37024969 PMCID: PMC10077698 DOI: 10.1186/s40249-023-01075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Prompt and appropriate clinical management of malaria is critical for reducing the continued high burden of malaria among children under five years in sub-Saharan countries. However, more remains to be known about how a patient's socioeconomic status (SES) would affect the access to diagnosis of malaria. METHODS In this cross-sectional study using the Demographic and Health Survey and Malaria Indicators Survey, we pooled the data of 38,567 febrile under-five children in 2016-2018 from 19 sub-Saharan countries. Multivariable logistic regression was used to assess the associations between SES and two binary outcomes: the visit to a health facility and a blood test for fever. Stratified analyses were further conducted by the type of health facilities (public hospitals/public primary healthcare facilities/private hospitals/private primary healthcare facilities) for the latter outcome. RESULTS Fifty-eight percent of the febrile children were taken to health facilities, among whom only 55% took blood tests. Compared to children from households in the highest wealth quintile, children in the lowest quintile were less likely to be taken to medical facilities [adjusted odds ratio (aOR) = 0.775, 95% confidence interval (CI): 0.675-0.889]. Parents with more than secondary education were more likely to seek care (aOR = 1.830, 95% CI: 1.561-2.145) and to have blood tests (aOR = 1.729, 95% CI: 1.436-2.082) for their febrile children than parents without formal education. The probabilities of receiving blood tests at public hospitals and public primary healthcare facilities stayed relatively high across parental education levels and wealth quintiles, while these probabilities remained the lowest at private primary healthcare facilities, ranging from 0.100 (95% CI: 0.074-0.127) to 0.139 (95% CI: 0.083-0.194) across parental education levels and from 0.104 (95% CI: 0.078-0.130) to 0.125 (95% CI: 0.090-0.160) across wealth quintiles. CONCLUSIONS Significant socioeconomic disparities existed both in the access to health facilities and laboratory diagnosis of malaria in children in sub-Saharan African countries. These disparities were particularly evident in the private sector. Universal health coverage needs to be further strengthened to make formal healthcare in general and the laboratory diagnosis of malaria more accessible and affordable.
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Affiliation(s)
- Yue Ge
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China
| | - Di Liang
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China
| | - Jun Cao
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China
- Key Laboratory of National Health Commission on Parasitic Disease Control and Prevention, Key Laboratory of Jiangsu Province on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Roland Gosling
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Vivian Mushi
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jiayan Huang
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China.
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MacPherson EE, Reynolds J, Sanudi E, Nkaombe A, Phiri C, Mankhomwa J, Dixon J, Chandler CIR. Understanding antimicrobial resistance through the lens of antibiotic vulnerabilities in primary health care in rural Malawi. Glob Public Health 2022; 17:2630-2646. [PMID: 34932915 DOI: 10.1080/17441692.2021.2015615] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The diminishing effectiveness of antimicrobials raises serious concerns for human health. While policy makers grapple to reduce the overuse of antimicrobial medicines to stem the rise of antimicrobial resistance, insufficient attention has been paid to how this applies to low-resource contexts. We provide an in-depth portrayal of antimicrobial prescribing at primary health care level in rural Chikwawa District, Malawi. Ethnographic fieldwork took place over 18 months (2018-2020). We surveyed 22 health facilities in the district, observed 1348 health worker-patient consultations, and carried out 49 in-depth interviews with staff and patients. Care was centred around provision of an antimicrobial. Amid chronic lack of essential medicines and other resources, clinic interactions were tightly scripted, providing patients little time to question or negotiate their treatment. We develop the concept of 'antibiotic vulnerabilities' to reveal multiple ways in which provision of antimicrobials in rural Malawi impacts care in conditions of extreme scarcity. Antibiotics are central and essential to primary care. As targets for optimal antimicrobial prescribing take a more central role in global policy, close attention is required of the ramifications for the delivery of care to ensure that efforts to stem resistance do not undermine the goal of improved health for all.
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Affiliation(s)
- Eleanor E MacPherson
- Malawi-Liverpool-Wellcome Trust and Liverpool School of Tropical Medicine, Blantyre, Malawi
| | | | | | | | | | | | - Justin Dixon
- London School of Hygiene and Tropical Medicine, London, UK
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Mwanga-Amumpaire J, Ndeezi G, Källander K, Obua C, Migisha R, Nkeramahame J, Stålsby Lundborg C, Kalyango JN, Alfvén T. Capacity to provide care for common childhood infections at low-level private health facilities in Western, Uganda. PLoS One 2021; 16:e0257851. [PMID: 34669729 PMCID: PMC8528317 DOI: 10.1371/journal.pone.0257851] [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: 06/04/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low-level private health facilities (LLPHFs) handle a considerable magnitude of sick children in low-resource countries. We assessed capacity of LLPHFs to manage malaria, pneumonia, diarrhea, and, possible severe bacterial infections (PSBIs) in under-five-year-olds. METHODS We conducted a cross-sectional survey in 110 LLPHFs and 129 health workers in Mbarara District, Uganda between May and December 2019. Structured questionnaires and observation forms were used to collect data on availability of treatment guidelines, vital medicines, diagnostics, and equipment; health worker qualifications; and knowledge of management of common childhood infections. RESULTS Amoxicillin was available in 97%, parental ampicillin and gentamicin in 77%, zinc tablets and oral rehydration salts in >90% while artemether-lumefantrine was available in 96% of LLPHF. About 66% of facilities stocked loperamide, a drug contraindicated in the management of diarrhoea in children. Malaria rapid diagnostic tests and microscopes were available in 86% of the facilities, timers/clocks in 57% but only 19% of the facilities had weighing scales and 6% stocked oxygen. Only 4% of the LLPHF had integrated management of childhood illness (IMCI) booklets and algorithm charts for management of common childhood illnesses. Of the 129 health workers, 52% were certificate nurses/midwives and (26% diploma nurses/clinical officers; 57% scored averagely for knowledge on management of common childhood illnesses. More than a quarter (38%) of nursing assistants had low knowledge scores. No notable significant differences existed between rural and urban LLPHFs in most parameters assessed. CONCLUSION Vital first-line medicines for treatment of common childhood illnesses were available in most of the LLPHFs but majority lacked clinical guidelines and very few had oxygen. Majority of health workers had low to average knowledge on management of the common childhood illnesses. There is need for innovative knowledge raising interventions in LLPHFs including refresher trainings, peer support supervision and provision of job aides.
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Affiliation(s)
- Juliet Mwanga-Amumpaire
- Mbarara University of Science and Technology, Mbarara, Uganda
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Grace Ndeezi
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Karin Källander
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Programme Division, Health Section, UNICEF, New York, New York, United States of America
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Richard Migisha
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Juvenal Nkeramahame
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Joan Nakayaga Kalyango
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Pharmacy, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Sachs’ Children and Youth Hospital, Stockholm, Sweden
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Appropriateness of Care for Common Childhood Infections at Low-Level Private Health Facilities in a Rural District in Western Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157742. [PMID: 34360041 PMCID: PMC8345429 DOI: 10.3390/ijerph18157742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022]
Abstract
In Uganda, >50% of sick children receive treatment from primary level-private health facilities (HF). We assessed the appropriateness of care for common infections in under-five-year-old children and explored perspectives of healthcare workers (HCW) and policymakers on the quality of healthcare at low-level private health facilities (LLPHF) in western Uganda. This was a mixed-methods parallel convergent study. Employing multistage consecutive sampling, we selected 110 HF and observed HCW conduct 777 consultations of children with pneumonia, malaria, diarrhea or neonatal infections. We purposively selected 30 HCW and 8 policymakers for in-depth interviews. Care was considered appropriate if assessment, diagnosis, and treatment were correct. We used univariable and multivariable logistic regression analyses for quantitative data and deductive thematic analysis for qualitative data. The proportion of appropriate care was 11% for pneumonia, 14% for malaria, 8% for diarrhea, and 0% for neonatal infections. Children with danger signs were more likely to receive appropriate care. Children with diarrhea or ability to feed orally were likely to receive inappropriate care. Qualitative data confirmed care given as often inappropriate, due to failure to follow guidelines. Overall, sick children with common infections were inappropriately managed at LLPHF. Technical support and provision of clinical guidelines should be increased to LLPHF.
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Taneja SB, Douglas GP, Cooper GF, Michaels MG, Druzdzel MJ, Visweswaran S. Bayesian network models with decision tree analysis for management of childhood malaria in Malawi. BMC Med Inform Decis Mak 2021; 21:158. [PMID: 34001100 PMCID: PMC8130361 DOI: 10.1186/s12911-021-01514-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is a major cause of death in children under five years old in low- and middle-income countries such as Malawi. Accurate diagnosis and management of malaria can help reduce the global burden of childhood morbidity and mortality. Trained healthcare workers in rural health centers manage malaria with limited supplies of malarial diagnostic tests and drugs for treatment. A clinical decision support system that integrates predictive models to provide an accurate prediction of malaria based on clinical features could aid healthcare workers in the judicious use of testing and treatment. We developed Bayesian network (BN) models to predict the probability of malaria from clinical features and an illustrative decision tree to model the decision to use or not use a malaria rapid diagnostic test (mRDT). METHODS We developed two BN models to predict malaria from a dataset of outpatient encounters of children in Malawi. The first BN model was created manually with expert knowledge, and the second model was derived using an automated method. The performance of the BN models was compared to other statistical models on a range of performance metrics at multiple thresholds. We developed a decision tree that integrates predictions with the costs of mRDT and a course of recommended treatment. RESULTS The manually created BN model achieved an area under the ROC curve (AUC) equal to 0.60 which was statistically significantly higher than the other models. At the optimal threshold for classification, the manual BN model had sensitivity and specificity of 0.74 and 0.42 respectively, and the automated BN model had sensitivity and specificity of 0.45 and 0.68 respectively. The balanced accuracy values were similar across all the models. Sensitivity analysis of the decision tree showed that for values of probability of malaria below 0.04 and above 0.40, the preferred decision that minimizes expected costs is not to perform mRDT. CONCLUSION In resource-constrained settings, judicious use of mRDT is important. Predictive models in combination with decision analysis can provide personalized guidance on when to use mRDT in the management of childhood malaria. BN models can be efficiently derived from data to support clinical decision making.
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Affiliation(s)
- Sanya B Taneja
- Intelligent Systems Program, University of Pittsburgh, 5108 Sennott Square, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA.
| | - Gerald P Douglas
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA.,Global Health Informatics Institute, Area 3, Lilongwe, Malawi
| | - Gregory F Cooper
- Intelligent Systems Program, University of Pittsburgh, 5108 Sennott Square, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marian G Michaels
- Division of Infectious Diseases, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Marek J Druzdzel
- Faculty of Computer Science, Bialystok University of Technology, Wiejska 45A, 15-351, Bialystok, Poland
| | - Shyam Visweswaran
- Intelligent Systems Program, University of Pittsburgh, 5108 Sennott Square, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
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Tizifa TA, Nkhono W, Mtengula S, van Vugt M, Munn Z, Kabaghe AN. Leveraging phone-based mobile technology to improve data quality at health facilities in rural Malawi: a best practice project. Malar J 2021; 20:203. [PMID: 33906650 PMCID: PMC8077781 DOI: 10.1186/s12936-021-03742-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To further reduce malaria burden, identification of areas with highest burden for targeted interventions needs to occur. Routine health information has the potential to indicate where and when clinical malaria occurs the most. Developing countries mostly use paper-based data systems however they are error-prone as they require manual aggregation, tallying and transferring of data. Piloting was done using electronic data capture (EDC) with a cheap and user friendly software in rural Malawian primary healthcare setting to improve the quality of health records. METHODS Audit and feedback tools from the Joanna Briggs Institute (Practical Application of Clinical Evidence System and Getting Research into Practice) were used in four primary healthcare facilities. Using this approach, the best available evidence for a malaria information system (MIS) was identified. Baseline audit of the existing MIS was conducted in the facilities based on available best practice for MIS; this included ensuring data consistency and completeness in MIS by sampling 25 random records of malaria positive cases. Implementation of an adapted evidence-based EDC system using tablets on an OpenDataKit platform was done. An end line audit following implementation was then conducted. Users had interviews on experiences and challenges concerning EDC at the beginning and end of the survey. RESULTS The existing MIS was paper-based, occupied huge storage space, had some data losses due to torn out papers and were illegible in some facilities. The existing MIS did not have documentation of necessary parameters, such as malaria deaths and treatment within 14 days. Training manuals and modules were absent. One health centre solely had data completeness and consistency at 100% of the malaria-positive sampled records. Data completeness and consistency rose to 100% with readily available records containing information on recent malaria treatment. Interview findings at the end of the survey showed that EDC was acceptable among users and they agreed that the tablets and the OpenDataKit were easy to use, improved productivity and quality of care. CONCLUSIONS Improvement of data quality and use in the Malawian rural facilities was achieved through the introduction of EDC using OpenDataKit. Health workers in the facilities showed satisfaction with the use of EDC.
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Affiliation(s)
- Tinashe A. Tizifa
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Training and Research Unit of Excellence (TRUE), School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - William Nkhono
- Training and Research Unit of Excellence (TRUE), School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Spencer Mtengula
- Training and Research Unit of Excellence (TRUE), School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Michele van Vugt
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Zachary Munn
- JBI, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Alinune N. Kabaghe
- Training and Research Unit of Excellence (TRUE), School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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Gachugia J, Chebore W, Otieno K, Ngugi CW, Godana A, Kariuki S. Evaluation of the colorimetric malachite green loop-mediated isothermal amplification (MG-LAMP) assay for the detection of malaria species at two different health facilities in a malaria endemic area of western Kenya. Malar J 2020; 19:329. [PMID: 32907582 PMCID: PMC7487890 DOI: 10.1186/s12936-020-03397-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/30/2020] [Indexed: 01/03/2023] Open
Abstract
Background Prompt diagnosis and effective malaria treatment is a key strategy in malaria control. However, the recommended diagnostic methods, microscopy and rapid diagnostic tests (RDTs), are not supported by robust quality assurance systems in endemic areas. This study compared the performance of routine RDTs and smear microscopy with a simple molecular-based colorimetric loop-mediated isothermal amplification (LAMP) at two different levels of the health care system in a malaria-endemic area of western Kenya. Methods Patients presenting with clinical symptoms of malaria at Rota Dispensary (level 2) and Siaya County Referral Hospital (level 4) were enrolled into the study after obtaining written informed consent. Capillary blood was collected to test for malaria by RDT and microscopy at the dispensary and county hospital, and for preparation of blood smears and dried blood spots (DBS) for expert microscopy and real-time polymerase chain reaction (RT-PCR). Results of the routine diagnostic tests were compared with those of malachite green loop-mediated isothermal amplification (MG-LAMP) performed at the two facilities. Results A total of 264 participants were enrolled into the study. At the dispensary level, the positivity rate by RDT, expert microscopy, MG-LAMP and RT-PCR was 37%, 30%, 44% and 42%, respectively, and 42%, 43%, 57% and 43% at the county hospital. Using RT-PCR as the reference test, the sensitivity of RDT and MG-LAMP was 78.1% (CI 67.5–86.4) and 82.9% (CI 73.0–90.3) at Rota dispensary. At Siaya hospital the sensitivity of routine microscopy and MG-LAMP was 83.3% (CI 65.3–94.4) and 93.3% (CI 77.9–99.2), respectively. Compared to MG-LAMP, there were 14 false positives and 29 false negatives by RDT at Rota dispensary and 3 false positives and 13 false negatives by routine microscopy at Siaya Hospital. Conclusion MG-LAMP is more sensitive than RDTs and microscopy in the detection of malaria parasites at public health facilities and might be a useful quality control tool in resource-limited settings.
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Affiliation(s)
- James Gachugia
- Department of Medical Microbiology, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, P. O. Box 62000-00200, Nairobi, Kenya
| | - Winnie Chebore
- Kenya Medical Research Institute, Centre for Global Health Research, P. O. Box 1578-40100, Kisumu, Kenya
| | - Kephas Otieno
- Kenya Medical Research Institute, Centre for Global Health Research, P. O. Box 1578-40100, Kisumu, Kenya
| | - Caroline Wangari Ngugi
- Department of Medical Microbiology, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, P. O. Box 62000-00200, Nairobi, Kenya
| | - Adano Godana
- National Malaria Control Programme, Ministry of Health, Kenyatta National Hospital, P. O. Box, Nairobi, 19982-00202, Kenya
| | - Simon Kariuki
- Kenya Medical Research Institute, Centre for Global Health Research, P. O. Box 1578-40100, Kisumu, Kenya.
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9
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Chilanga E, Collin-Vézina D, MacIntosh H, Mitchell C, Cherney K. Prevalence and determinants of malaria infection among children of local farmers in Central Malawi. Malar J 2020; 19:308. [PMID: 32854713 PMCID: PMC7457289 DOI: 10.1186/s12936-020-03382-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/19/2020] [Indexed: 01/22/2023] Open
Abstract
Background Malaria is a leading cause of morbidity and mortality among children under 5 years in Malawi, and especially among those from rural areas of central Malawi. The goal of this study was to examine the prevalence and determinants of malaria infection among children in rural areas of Dowa district in central Malawi. Methods A multistage, cross-sectional study design was used to systematically sample 523 child-mother dyads from postnatal clinics. A survey was administered to mothers and a rapid malaria infection diagnostic test was administered to children. The main outcome was positive malaria diagnostic tests in children. Logistic regressions were used to determine risk factors associated with malaria among children aged 2 to 59 months. Results The prevalence of malaria among children under 5 years was 35.4%. Results suggest that children of mothers who experienced recent intimate partner violence (IPV) were more likely to be diagnosed with malaria (AOR: 1.88, 95% CI 1.19–2.97; P = 0.007) than children of mothers who did not. Children of mothers who had no formal education were more likely to be diagnosed with malaria (AOR: 2.77, 95% CI 1.24–6.19; P = 0.013) than children of mothers who had received secondary education. Children aged 2 to 5 months and 6 to 11 months were less likely to be diagnosed with malaria (AOR: 0.21, 95% CI 0.10–0.46; P = 0.000 and AOR: 0.43; 95% CI 0.22–0.85; P = 0.016, respectively) than children aged 24 to 59 months. Conclusion The prevalence of malaria infection among children in the study area was comparable to the national level. In addition to available malaria control programmes, further attention should be paid to children whose mothers have no formal education, children aged 24 to 59 months, and children of mothers that are exposed to IPV in the area.
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Affiliation(s)
- Emmanuel Chilanga
- University of Livingstonia, Livingstonia, Malawi. .,School of Social Work, McGill University, Montreal, Canada.
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10
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Gaston RT, Ramroop S. Prevalence of and factors associated with malaria in children under five years of age in Malawi, using malaria indicator survey data. Heliyon 2020; 6:e03946. [PMID: 32426545 PMCID: PMC7226652 DOI: 10.1016/j.heliyon.2020.e03946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/10/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Malaria remains a public health problem in developing countries and Malawi is no different. Although there has been an improvement in reducing malaria in Malawi, it remains a problem, especially in children less than five years old. The primary objective of the study was to assess whether socio-economic, geographic and demographic factors are associated with malaria, using the generalized additive mixed model (GAMM). DATA AND METHODOLOGY The study used a 2017 dataset from the Malawi Malaria Indicator Survey (MMI) with a total number of 2724 children under five years old. The study also utilized the GAMM to analyze data. The outcome was that either the child had malaria or did not, as detected using the malaria Rapid Diagnostic Test (RDT) (Ayele et al., 2014a). RESULTS In this study, more than 37 % of the total number of children who were tested showed a positive malaria result. In addition, the results from this study using GAMM indicated that anaemia, mother's education level, wealth index, child's age, the altitude of the place of residence, region, place of residence, toilet facility and electricity were significantly associated with a positive malaria RDT. CONCLUSION The study revealed that socio-economic, geographical and demographic variables are the key factors in improving malaria vectors in children. Improving income levels and supporting the poorer rural community mostly from the Central Region would be a great achievement in reducing malaria vectors in Malawi. In addition, improving health care in rural areas, especially at higher altitudes, would contribute to controlling malaria and reducing anaemia.
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Affiliation(s)
- Rugiranka Tony Gaston
- School of Mathematics, Statistics and Computer Sciences, University of KwaZulu-Natal, Pietermaritzburg Campus, Private Bag X01, Scottsville, 3209, South Africa
| | - Shaun Ramroop
- School of Mathematics, Statistics and Computer Sciences, University of KwaZulu-Natal, Pietermaritzburg Campus, Private Bag X01, Scottsville, 3209, South Africa
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11
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Klootwijk L, Chirwa AE, Kabaghe AN, van Vugt M. Challenges affecting prompt access to adequate uncomplicated malaria case management in children in rural primary health facilities in Chikhwawa Malawi. BMC Health Serv Res 2019; 19:735. [PMID: 31640676 PMCID: PMC6805512 DOI: 10.1186/s12913-019-4544-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 09/20/2019] [Indexed: 01/09/2023] Open
Abstract
Background Reducing the burden of malaria highly depends on access to prompt and effective malaria diagnosis and treatment. The aim of this study was to identify challenges affecting prompt access to effective uncomplicated malaria case management in children below 10 years old in rural primary health care facilities in Malawi. Methods A cross sectional health facility survey was conducted in six primary health facilities in Chikhwawa district, Malawi. Officers-in-charge of health facilities were interviewed on availability of staff, supplies and drugs. All consecutive children presenting at the facility with fever or suspected malaria, aged 6 months to 10 years old, were eligible to participate in exit interviews. Exit interviews with participants’ guardians assessed duration of illness, demographic information and distance travelled. Adherence to recommended malaria case management guidelines included performing malaria rapid diagnostic tests (mRDTs) in children with fever or suspected malaria and prescribing recommended weight-based dose of artemether-lumefantrine (AL) when mRDT was positive. Multivariate logistic regression was used to determine factors associated with prompt care seeking within 24 h of onset of illness. Results Health facilities were staffed by at least two health workers. Of 265 children screened, nine were excluded due to severe illness. Twenty-one percent of children presenting at a health facility with fever were not tested for malaria. Adherence to positive and negative mRDT results for those tested was 99.4, 95% CI [98.1–100] and 97, 95% CI [88.9–100], respectively. AL was prescribed as recommended by weight in 152 children (92.2%). Temporary stock outs of AL occurred in five of six facilities. In total, 146 (57, 95% CI [52.7–64.1]) guardians of patients sought care within 24 h after fever onset. Children aged 5 to 10 years were less likely to present within 24 h of fever onset than children below 5 years of age (unadjusted odds ratio 0.40, 95% CI [0.2–0.7]). Conclusion Adherence to malaria diagnosis and treatment guidelines was high. However, delayed care seeking and stock outs may affect prompt and effective malaria case management. Further qualitative work is required to determine, and address factors associated with delay in care seeking for fever.
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Affiliation(s)
- Larissa Klootwijk
- Academic Medical Centre, University of Amsterdam, Redemptoristenpad 18, 5211XR, Den Bosch, Amsterdam, Netherlands.
| | - Anthony Emeritus Chirwa
- Training and Research Unit of Excellence, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Alinune Nathanael Kabaghe
- Training and Research Unit of Excellence, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Michele van Vugt
- Department of Internal Medicine and Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
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12
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Kaunda-Khangamwa BN, van den Berg H, McCann RS, Kabaghe A, Takken W, Phiri K, van Vugt M, Manda-Taylor L. The role of health animators in malaria control: a qualitative study of the health animator (HA) approach within the Majete malaria project (MMP) in Chikwawa District, Malawi. BMC Health Serv Res 2019; 19:478. [PMID: 31299974 PMCID: PMC6624973 DOI: 10.1186/s12913-019-4320-x] [Citation(s) in RCA: 10] [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: 01/25/2019] [Accepted: 07/02/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Malaria continues to place a high burden on communities due to challenges reaching intervention target levels in Chikwawa District, Malawi. The Hunger Project Malawi is using a health animator approach (HA) to address gaps in malaria control coverage. We explored the influence of community-based volunteers known as health animators (HAs) in malaria control. We assessed the impact of HAs on knowledge, attitudes, and practices towards malaria interventions. METHODS This paper draws on the qualitative data collected to explore the roles of communities, HAs and formal health workers attending and not attending malaria workshops for malaria control. Purposive sampling was used to select 78 respondents. We conducted 10 separate focus group discussions (FGDs)-(n = 6) with community members and (n = 4) key informants. Nine in-depth interviews (IDIs) were held with HAs and Health Surveillance Assistants (HSAs) in three focal areas near Majete Wildlife Reserve. Nvivo 11 was used for coding and analysis. We employed the framework analysis and social capital theory to determine how the intervention influenced health and social outcomes. RESULTS Using education, feedback sessions and advocacy in malaria workshop had mixed outcomes. There was a high awareness of community participation and comprehensive knowledge of the HA approach as key to malaria control. HAs were identified as playing a complementary role in malaria intervention. Community members' attitudes towards advocacy for better health services were poor. Attendance in malaria workshops was sporadic towards the final year of the intervention. Respondents mentioned positive attitudes and practices on net usage for prevention and prompt health-seeking behaviours. CONCLUSION The HA approach is a useful strategy for complementing malaria prevention strategies in rural communities and improving practices for health-seeking behaviour. Various factors influence HAs' motivation, retention, community engagement, and programme sustainability. However, little is known about how these factors interact to influence volunteers' motivation, community participation and sustainability over time. More research is needed to explore the acceptability of an HA approach and the impact on malaria control in other rural communities in Malawi.
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Affiliation(s)
- Blessings N. Kaunda-Khangamwa
- The School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
- The Malaria Alert Centre, University of Malawi, College of Medicine, Blantyre, Malawi
- The University of Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Henk van den Berg
- Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert S. McCann
- Wageningen University and Research Centre, Wageningen, The Netherlands
- Training and Research Unit of Excellence, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Alinune Kabaghe
- The School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
- Training and Research Unit of Excellence, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Willem Takken
- Wageningen University and Research Centre, Wageningen, The Netherlands
| | - Kamija Phiri
- The School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
- Training and Research Unit of Excellence, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Michele van Vugt
- Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Lucinda Manda-Taylor
- The School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
- Training and Research Unit of Excellence, University of Malawi, College of Medicine, Blantyre, Malawi
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13
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Mpimbaza A, Nayiga S, Ndeezi G, Rosenthal PJ, Karamagi C, Katahoire A. Understanding the context of delays in seeking appropriate care for children with symptoms of severe malaria in Uganda. PLoS One 2019; 14:e0217262. [PMID: 31166968 PMCID: PMC6550380 DOI: 10.1371/journal.pone.0217262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/08/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction A large proportion of children with uncomplicated malaria receive appropriate treatment late, contributing to progression of illness to severe disease. We explored contexts of caregiver delays in seeking appropriate care for children with severe malaria. Methods This qualitative study was conducted at the Children’s Ward of Jinja Hospital, where children with severe malaria were hospitalized. A total of 22in-depth interviews were conducted with caregivers of children hospitalized with severe malaria. Issues explored were formulated based on the Partners for Applied Social Sciences (PASS) model, focusing on facilitators and barriersto caregivers’promptseeking and accessing ofappropriate care. The data were coded deductively using ATLAS.ti (version 7.5). Codes were then grouped into families based on emerging themes. Results Caregivers’ rating of initial symptoms as mild illness lead to delays in response. Use of home initiated interventions with presumably ineffective herbs or medicines was common, leading to further delay. When care was sought outside the home, drug shops were preferred over public health facilities for reasons of convenience. Drug shops often provided sub-optimal care, and thus contributed to delays in access to appropriate care. Public facilities were often a last resort when illness was perceived to be progressing to severe disease. Further delays occurred at health facilities due to inadequate referral systems. Conclusion Communities living in endemic areas need to be sensitized about the significance of fever, even if mild, as an indicator of malaria. Additionally, amidst ongoing efforts at bringing antimalarial treatment services closer to communities, the value of drug shops as providers ofrationalantimalarialtreatment needs to be reviewed.
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Affiliation(s)
- Arthur Mpimbaza
- Child Health & Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Grace Ndeezi
- Department of Pediatrics & Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Philip J. Rosenthal
- Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Charles Karamagi
- Department of Pediatrics & Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
- Clinical Epidemiology Unit, Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Anne Katahoire
- Child Health & Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
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14
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Ewing AC, Davis NL, Kayira D, Hosseinipour MC, van der Horst C, Jamieson DJ, Kourtis AP. Prescription of Antibacterial Drugs for HIV-Exposed, Uninfected Infants, Malawi, 2004-2010. Emerg Infect Dis 2018; 25. [PMID: 30561313 PMCID: PMC6302572 DOI: 10.3201/eid2501.180782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Antimicrobial drug resistance is a serious health hazard driven by overuse. Administration of antimicrobial drugs to HIV-exposed, uninfected infants, a population that is growing and at high risk for infection, is poorly studied. We therefore analyzed factors associated with antibacterial drug administration to HIV-exposed, uninfected infants during their first year of life. Our study population was 2,152 HIV-exposed, uninfected infants enrolled in the Breastfeeding, Antiretrovirals and Nutrition study in Lilongwe, Malawi, during 2004-2010. All infants were breastfed through 28 weeks of age. Antibacterial drugs were prescribed frequently (to 80% of infants), and most (67%) of the 5,329 prescriptions were for respiratory indications. Most commonly prescribed were penicillins (43%) and sulfonamides (23%). Factors associated with lower hazard for antibacterial drug prescription included receipt of cotrimoxazole preventive therapy, receipt of antiretroviral drugs, and increased age. Thus, cotrimoxazole preventive therapy may lead to fewer prescriptions for antibacterial drugs for these infants.
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15
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van den Berg H, van Vugt M, Kabaghe AN, Nkalapa M, Kaotcha R, Truwah Z, Malenga T, Kadama A, Banda S, Tizifa T, Gowelo S, Mburu MM, Phiri KS, Takken W, McCann RS. Community-based malaria control in southern Malawi: a description of experimental interventions of community workshops, house improvement and larval source management. Malar J 2018; 17:266. [PMID: 30012147 PMCID: PMC6048888 DOI: 10.1186/s12936-018-2415-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/10/2018] [Indexed: 12/22/2022] Open
Abstract
Background Increased engagement of communities has been emphasized in global plans for malaria control and elimination. Three interventions to reinforce and complement national malaria control recommendations were developed and applied within the context of a broad-based development initiative, targeting a rural population surrounding a wildlife reserve. The interventions, which were part of a 2-year research trial, and assigned to the village level, were implemented through trained local volunteers, or ‘health animators’, who educated the community and facilitated collective action. Results Community workshops on malaria were designed to increase uptake of national recommendations; a manual was developed, and training of health animators conducted, with educational content and analytical tools for a series of fortnightly community workshops in annual cycles at village level. The roll-back malaria principle of diagnosis, treatment and use of long-lasting insecticidal nets was a central component of the workshops. Structural house improvement to reduce entry of malaria vectors consisted of targeted activities in selected villages to mobilize the community into voluntarily closing the eaves and screening the windows of their houses; the project provided wire mesh for screening. Corrective measures were introduced to respond to field challenges. Committees were established at village level to coordinate the house improvement activities. Larval source management (LSM) in selected villages consisted of two parts: one on removal of standing water bodies by the community at large; and one on larviciding with bacterial insecticide Bacillus thuringiensis israelensis by trained village committees. Community workshops on malaria were implemented as ‘core intervention’ in all villages. House improvement and LSM were implemented in addition to community workshops on malaria in selected villages. Conclusions Three novel interventions for community mobilization on malaria prevention and control were described. The interventions comprised local organizational structure, education and collective action, and incorporated elements of problem identification, planning and evaluation. These methods could be applicable to other countries and settings. Electronic supplementary material The online version of this article (10.1186/s12936-018-2415-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Henk van den Berg
- Laboratory of Entomology, Wageningen University, PO Box 16, 6700AA, Wageningen, The Netherlands.
| | - Michèle van Vugt
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Alinune N Kabaghe
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | | | | | - Asante Kadama
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Saidon Banda
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tinashe Tizifa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Steven Gowelo
- Laboratory of Entomology, Wageningen University, PO Box 16, 6700AA, Wageningen, The Netherlands.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Monicah M Mburu
- Laboratory of Entomology, Wageningen University, PO Box 16, 6700AA, Wageningen, The Netherlands.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kamija S Phiri
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Willem Takken
- Laboratory of Entomology, Wageningen University, PO Box 16, 6700AA, Wageningen, The Netherlands
| | - Robert S McCann
- Laboratory of Entomology, Wageningen University, PO Box 16, 6700AA, Wageningen, The Netherlands.,College of Medicine, University of Malawi, Blantyre, Malawi
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16
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Kabaghe AN, Chipeta MG, McCann RS, Terlouw DJ, Tizifa T, Truwah Z, Phiri KS, van Vugt M. Access and adequate utilization of malaria control interventions in rural Malawi: a descriptive quantitative study. Malar J 2018; 17:104. [PMID: 29510701 PMCID: PMC5838945 DOI: 10.1186/s12936-018-2253-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 03/02/2018] [Indexed: 11/23/2022] Open
Abstract
Background Despite the availability of cost effective malaria control interventions, such as insecticide-treated bed nets (ITN), diagnosis and effective treatment of malaria, and intermittent preventive treatment during pregnancy (IPTp), the lack of equitable access and coverage affect utilization of these interventions in rural communities. Aggregated rates of access and utilization of malaria interventions in national surveys mask substantial variations in intervention coverage. Utilization of interventions and factors affecting utilization need investigation in rural communities. Methods One year of quantitative data collected from a rolling Malaria Indicator Survey (April 2015–April 2016) in Chikhwawa District, Malawi, before the ITN distribution campaign, were analysed. Univariate analyses were used to quantify rates of ITN usage, care-seeking for fever in children aged 6–59 months and women aged 15–49 years and IPTp uptake (for women aged 15–49 years with a recent delivery). Results were compared to national survey estimates; factors associated with these outcomes were determined using multivariate regression models. Results A total of 2046 participants were included from 1328 households; 56.6% were women aged 15–49 years and 43.4% were children aged 6–59 months. Reported ownership of at least one ITN per household and under-five children ITN use the previous night were 35.3 and 33.5% compared to 70.2 and 67.1%, respectively, in the national survey; ITN use was higher in high wealth quintile households than low quintile ones. For participants with recent fever, 37.6 and 19.5% sought care and sought care within 24 h, respectively. Care-seeking was lower for febrile women than febrile children [aOR, 95% CI 0.53 (0.35–0.81)]. Uptake of two and three or more doses of IPTp were 40.6 and 15.0%, respectively, among women with a pregnancy in the last 2 years. Conclusion To achieve effective malaria control, fine-scale or district-based surveillance should be used to identify and target communities requiring scaling up of interventions. Qualitative research and a participatory community approach should be used to address behavioural factors affecting how people make use of interventions.
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Affiliation(s)
- Alinune Nathanael Kabaghe
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands. .,School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre 3, Malawi.
| | - Michael Give Chipeta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre 3, Malawi.,Lancaster Medical School, Lancaster University, Lancaster, LA1 4YG, UK.,Malawi-Liverpool Wellcome Trust Clinical Research Program, Queen Elizabeth Central Hospital, College of Medicine, Blantyre, Malawi
| | - Robert Sean McCann
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre 3, Malawi.,Laboratory of Entomology, Wageningen University and Research Centre, 6708 PB, Wageningen, The Netherlands
| | - Dianne Jean Terlouw
- Malawi-Liverpool Wellcome Trust Clinical Research Program, Queen Elizabeth Central Hospital, College of Medicine, Blantyre, Malawi
| | - Tinashe Tizifa
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre 3, Malawi
| | - Zinenani Truwah
- Management Sciences for Health-Malawi Program, EBC Building, Off Paul Kagame Road, Private Bag 398, Lilongwe 3, Malawi
| | - Kamija Samuel Phiri
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre 3, Malawi
| | - Michèle van Vugt
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands.
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17
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Kabaghe AN, Chipeta MG, Gowelo S, Mburu M, Truwah Z, McCann RS, van Vugt M, Grobusch MP, Phiri KS. Fine-scale spatial and temporal variation of clinical malaria incidence and associated factors in children in rural Malawi: a longitudinal study. Parasit Vectors 2018; 11:129. [PMID: 29506570 PMCID: PMC5839004 DOI: 10.1186/s13071-018-2730-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/19/2018] [Indexed: 11/25/2022] Open
Abstract
Background Spatio-temporal variations in malaria burden are currently complex and costly to measure, but are important for decision-making. We measured the spatio-temporal variation of clinical malaria incidence at a fine scale in a cohort of children under five in an endemic area in rural Chikhwawa, Malawi, determined associated factors, and monitored adult mosquito abundance. Methods We followed-up 285 children aged 6–48 months with recorded geolocations, who were sampled in a rolling malaria indicator survey, for one year (2015–2016). Guardians were requested to take the children to a nearby health facility whenever ill, where health facility personnel were trained to record malaria test results and temperature on the child’s sick-visit card; artemisinin-based combination therapy was provided if indicated. The cards were collected and replaced 2-monthly. Adult mosquitoes were collected from 2-monthly household surveys using a Suna trap. The head/thorax of adult Anopheles females were tested for presence of Plasmodium DNA. Binomial logistic regression and geospatial modelling were performed to determine predictors of and to spatially predict clinical malaria incidence, respectively. Results Two hundred eighty two children, with complete results, and 267.8 child-years follow-up time were included in the analysis. The incidence rate of clinical malaria was 1.2 cases per child-year at risk; 57.1% of the children had at least one clinical malaria case during follow-up. Geographical groups of households where children experienced repeated malaria infections overlapped with high mosquito densities and high entomological inoculation rate locations. Conclusions Repeated malaria infections within household groups account for the majority of cases and signify uneven distribution of malaria risk within a small geographical area. Electronic supplementary material The online version of this article (10.1186/s13071-018-2730-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alinune N Kabaghe
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, Netherlands. .,School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre 3, Malawi.
| | - Michael G Chipeta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre 3, Malawi.,Lancaster University, Lancaster Medical School, Lancaster, LA1 4YG, UK.,Malawi-Liverpool Wellcome Trust, P O Box 30096, Blantyre 3, Malawi
| | - Steve Gowelo
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre 3, Malawi.,Laboratory of Entomology, Wageningen University and Research, 6708 PB, Wageningen, Netherlands
| | - Monicah Mburu
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre 3, Malawi.,Laboratory of Entomology, Wageningen University and Research, 6708 PB, Wageningen, Netherlands
| | - Zinenani Truwah
- Management Sciences for Health - Malawi Program, EBC Building, Off Paul Kagame Road, Private Bag 398, Lilongwe 3, Malawi
| | - Robert S McCann
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre 3, Malawi.,Laboratory of Entomology, Wageningen University and Research, 6708 PB, Wageningen, Netherlands
| | - Michèle van Vugt
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, Netherlands
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, Netherlands
| | - Kamija S Phiri
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre 3, Malawi
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18
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Malenga T, Kabaghe AN, Manda-Taylor L, Kadama A, McCann RS, Phiri KS, van Vugt M, van den Berg H. Malaria control in rural Malawi: implementing peer health education for behaviour change. Global Health 2017; 13:84. [PMID: 29157284 PMCID: PMC5694909 DOI: 10.1186/s12992-017-0309-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/03/2017] [Indexed: 12/02/2022] Open
Abstract
Background Interventions to reduce malaria burden are effective if communities use them appropriately and consistently. Several tools have been suggested to promote uptake and use of malaria control interventions. Community workshops on malaria, using the ‘Health Animator’ approach, are a potential behaviour change strategy for malaria control. The strategy aims to influence a change in mind-set of vulnerable populations to encourage self-reliance, using community volunteers known as Health Animators. The aim of the paper is to describe the process of implementing community workshops on malaria by Health Animators to improve uptake and use of malaria control interventions in rural Malawi. Methods This is a descriptive study reporting feasibility, acceptability, appropriateness and fidelity of using Health Animator-led community workshops for malaria control. Quantitative data were collected from self-reporting and researcher evaluation forms. Qualitative assessments were done with Health Animators, using three focus groups (October–December 2015) and seven in-depth interviews (October 2016–February 2017). Results Seventy seven health Animators were trained from 62 villages. A total of 2704 workshops were conducted, with consistent attendance from January 2015 to June 2017, representing 10–17% of the population. Attendance was affected by social responsibilities and activities, relationship of the village leaders and their community and involvement of Community Health Workers. Active discussion and participation were reported as main strengths of the workshops. Health Animators personally benefited from the mind-set change and were proactive peer influencers in the community. Although the information was comprehended and accepted, availability of adequate health services was a challenge for maintenance of behaviour change. Conclusion Community workshops on malaria are a potential tool for influencing a positive change in behaviour towards malaria, and applicable for other health problems in rural African communities. Social structures of influence and power dynamics affect community response. There is need for systematic monitoring of community workshops to ensure implementation fidelity and strengthening health systems to ensure sustainability of health behaviour change.
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Affiliation(s)
- Tumaini Malenga
- Department of Health Systems and Policy Development, University of Malawi College of Medicine, Blantyre, Malawi.,Training and Research Unit of Excellence, University of Malawi College of Medicine, Blantyre, Malawi
| | - Alinune Nathanael Kabaghe
- Training and Research Unit of Excellence, University of Malawi College of Medicine, Blantyre, Malawi. .,Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. .,School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi.
| | - Lucinda Manda-Taylor
- Department of Health Systems and Policy Development, University of Malawi College of Medicine, Blantyre, Malawi.,School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Asante Kadama
- Training and Research Unit of Excellence, University of Malawi College of Medicine, Blantyre, Malawi
| | - Robert S McCann
- Training and Research Unit of Excellence, University of Malawi College of Medicine, Blantyre, Malawi.,School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi.,Wageningen University and Research, Wageningen, The Netherlands
| | - Kamija Samuel Phiri
- Training and Research Unit of Excellence, University of Malawi College of Medicine, Blantyre, Malawi.,School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Michèle van Vugt
- Training and Research Unit of Excellence, University of Malawi College of Medicine, Blantyre, Malawi.,Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk van den Berg
- Training and Research Unit of Excellence, University of Malawi College of Medicine, Blantyre, Malawi.,Wageningen University and Research, Wageningen, The Netherlands
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