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Ladu HI, Shuaibu U, Pulford J. Reasons for mosquito net non-use in malaria-endemic countries: A review of qualitative research published between 2011 and 2021. Trop Med Int Health 2024; 29:647-656. [PMID: 38796689 DOI: 10.1111/tmi.14006] [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] [Indexed: 05/28/2024]
Abstract
Mosquito nets, particularly insecticide-treated nets, are the most recommended method of malaria control in endemic countries. However, individuals do not always have access to insecticide-treated nets or use them as recommended. The current paper expands on a previous review published in 2011 which highlighted a need for more qualitative research on the reasons for mosquito net non-use. We present a systematic review of qualitative research published in the past decade to assess the growth and quality of qualitative papers about net non-use and examine and update the current understanding. A comprehensive literature search was carried out in MEDLINE, CINAHL, and Global Health, in addition to a citation search of the initial review. Relevant papers were screened and discussed. The critical appraisal assessment tool was used to ensure quality. Thematic synthesis was used to extract, synthesise, and analyse study findings. Compared with the initial review, the results showed a 10-fold increase in qualitative research on the reasons for mosquito net non-use between 2011 and 2021. In addition, the quality of the research has improved, with more than 90% of the papers receiving high scores, using the critical appraisal assessment tool. The reported reasons for non-use were categorised into four themes: human factors, net factors, housing structure, and net access. More than two thirds of the studies (25/39) were led by authors affiliated with institutions in malaria-endemic countries. Despite the distribution of free mosquito nets in malaria-endemic countries, earlier reported challenges remain pertinent. The most common reasons for net non-use across all regions of Malaria endemic countries pertained to human- and net-related factors. The research focus should shift towards intervention studies to address these issues.
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Affiliation(s)
- Hadiza Isa Ladu
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | | | - Justin Pulford
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Lukole EA, Cook J, Mosha JF, Mallya E, Aziz T, Kulkarni MA, Matowo NS, Martin J, Rowland M, Kleinschmidt I, Manjurano A, Mosha FW, Protopopoff N. Will a lack of fabric durability be their downfall? Impact of textile durability on the efficacy of three types of dual-active-ingredient long-lasting insecticidal nets: a secondary analysis on malaria prevalence and incidence from a cluster-randomized trial in north-west Tanzania. Malar J 2024; 23:199. [PMID: 38943155 PMCID: PMC11212245 DOI: 10.1186/s12936-024-05020-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND The Dual-Active Ingredient long-lasting insecticidal nets (Dual-AI LLIN) have been developed to counteract the reduced efficacy of pyrethroid (PY)-only nets due to widespread pyrethroid insecticide resistance in malaria vector mosquitoes. They constitute half of the nets distributed in sub-Saharan Africa between 2022 and 2024. However, their effectiveness once they develop holes is unclear, particularly in pyrethroid-resistant settings. This study evaluates the textile integrity of three dual- AI LLINs compared to standard PY LLN, over 3 years of use in a community in Tanzania and the associated impact on malaria prevalence and incidence. METHODS A secondary analysis of data from a randomized controlled trial (RCT) in North-western Tanzania was conducted to evaluate the effectiveness of α-cypermethrin only; pyriproxyfen and α-cypermethrin (PPF-PY); chlorfenapyr and α-cypermethrin (chlorfenapyr-PY); and the synergist piperonyl butoxide and permethrin (PBO-PY) LLINs on malaria infection prevalence and case incidence. The association between the net textile condition and 1/malaria prevalence over 3 years of use between 2019 and 2022, and 2/malaria case incidence in a cohort of children over 2 years of follow-up was assessed between 2019 and 2021. RESULTS There was no significant association between damaged (OR 0.98, 95% CI 0.71-1.37, p-value = 0.655) and too-torn (OR 1.07, 95% CI 0.77-1.47, p-value = 0.694) compared to intact nets on malaria prevalence for all net types. However, there were reduced rates of malaria case incidence in children sleeping under a net in good condition compared to too-torn nets (incidence rate ratio (IRR) 0.76 [95% CI 0.63-0.92], p = 0.005). Malaria incidence was also consistently lower in too-torn PBO-PY LLIN (IRR = 0.37 [95% CI 0.19-0.72], p = 0.003) and chlorfenapyr-PY LLIN (IRR = 0.45 [95% CI 0.33-0.97], p = 0.053) compared to an intact PY-only LLIN during the first year of follow up. In year 2, the incidence was only significantly lower in intact chlorfenapyr-PY LLIN (IRR = 0.49 [95% CI 0.29-0.81], p = 0.006) compared to intact PY LLIN. CONCLUSION The study confirmed that sleeping under a chlorfenapyr-PY LLIN or PBO-PY LLIN offered superior protection to pyrethroid-only nets even when torn. Preventing the development of holes is essential as they impact the level of protection offered against malaria infection. TRIAL REGISTRATION ClinicalTrials.gov, number (NCT03554616).
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Affiliation(s)
- Eliud Andrea Lukole
- Department of Parasitology, National Institute for Medical Research, Mwanza Medical Research Centre, Mwanza, Tanzania.
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | - Jackie Cook
- Department of Infectious Disease Epidemiology, MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacklin F Mosha
- Department of Parasitology, National Institute for Medical Research, Mwanza Medical Research Centre, Mwanza, Tanzania
| | - Elizabeth Mallya
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Tatu Aziz
- Department of Parasitology, National Institute for Medical Research, Mwanza Medical Research Centre, Mwanza, Tanzania
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Nancy S Matowo
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacklin Martin
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Mark Rowland
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Immo Kleinschmidt
- Department of Infectious Disease Epidemiology, MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Southern African Development Community Malaria Elimination Eight Secretariat, Windhoek, Namibia
| | - Alphaxard Manjurano
- Department of Parasitology, National Institute for Medical Research, Mwanza Medical Research Centre, Mwanza, Tanzania
| | - Franklin W Mosha
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Natacha Protopopoff
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Osborne A, Bangura C. Predictors of insecticide-treated bed nets use among pregnant women in Sierra Leone: evidence from the 2019 Sierra Leone Demographic Health Survey. Malar J 2024; 23:193. [PMID: 38898414 PMCID: PMC11188154 DOI: 10.1186/s12936-024-05018-6] [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: 02/24/2024] [Accepted: 06/16/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Malaria remains a significant public health threat in Sierra Leone, particularly for pregnant women and their unborn children. Infection during pregnancy can lead to severe consequences, including maternal anaemia, low birth weight, premature birth, and even death. Therefore, preventing malaria during pregnancy is crucial for improving maternal and child health outcomes. This study investigated the predictors of insecticide-treated bed net (ITN) use among pregnant women in Sierra Leone. METHODS The study analysed the 2019 Sierra Leone Demographic and Health Survey data (SLDHS). The study comprised a total of 900 pregnant women aged 15-49 years, representing the nationally representative sample. A multivariable binary regression analysis was used to explore the predictors of ITN use. The regression results were presented using an adjusted odds ratio (AOR) with 95% confidence intervals (CI). RESULTS The study found that the prevalence of ITN use among pregnant women was 64.2 [60.4, 67.9] in Sierra Leone. Pregnant women who were married [aOR = 2.02, 95% CI 1.32, 3.07] had higher odds of bed net use than those who were unmarried. Pregnant women with five or more children [aOR = 1.69, 95% CI 1.01, 2.84] had higher odds of mosquito bed net use than those with four and below children. Pregnant women living in the Northern, Northwestern, Southern and Western regions all had lower odds of bed net use than those in the Eastern region, with the lowest odds among those living in the western region [aOR = 0.19, 95% CI 0.09, 0.40]. Pregnant women who were Muslims [aOR = 0.63, 95% CI 0.41, 0.95] had lower odds of mosquito bed net use than Christians. Pregnant women with female household heads [aOR = 0.65, 95% CI 0.44, 0.95] had lower odds of mosquito bed net use than those with male household heads. CONCLUSION ITN use among pregnant women in Sierra Leone remains suboptimal. Marital status, parity, sex of household head, region and religion were associated with bed net use. The government and policymakers in Sierra Leone should integrate ITN education and distribution into prenatal care services, emphasizing the benefits for both mother and baby-partnering with healthcare providers to raise awareness and encourage consistent use. Involve local leaders, religious figures, and mothers' groups to promote the benefits of ITN during pregnancy. Educate husbands and partners on the importance of ITN use during pregnancy and encourage their support in its consistent use.
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Affiliation(s)
- Augustus Osborne
- Department of Biological Sciences, School of Basic Sciences, Njala University, PMB, Freetown, Sierra Leone.
| | - Camilla Bangura
- Department of Biological Sciences, School of Basic Sciences, Njala University, PMB, Freetown, Sierra Leone
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Bukhari T, Gichuhi J, Mbare O, Ochwal VA, Fillinger U, Herren JK. Willingness to accept and participate in a Microsporidia MB-based mosquito release strategy: a community-based rapid assessment in western Kenya. Malar J 2024; 23:113. [PMID: 38643165 PMCID: PMC11031974 DOI: 10.1186/s12936-024-04941-y] [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: 01/31/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Microsporidia MB, an endosymbiont naturally found in Anopheles mosquitoes inhibits transmission of Plasmodium and is a promising candidate for a transmission-blocking strategy that may involve mosquito release. A rapid assessment was carried out to develop insight into sociodemographic factors, public health concerns, and malaria awareness, management, and prevention practices with the willingness to accept and participate in Microsporidia MB-based transmission-blocking strategy to develop an informed stakeholder engagement process. METHODS The assessment consisted of a survey conducted in two communities in western Kenya that involved administering a questionnaire consisting of structured, semi-structured, and open questions to 8108 household heads. RESULTS There was an overall high level of willingness to accept (81%) and participate in the implementation of the strategy (96%). Although the willingness to accept was similar in both communities, Ombeyi community was more willing to participate (OR 22, 95% CI 13-36). Women were less willing to accept (OR 0.8, 95% CI 0.7-0.9) compared to men due to fear of increased mosquito bites near homes. Household heads with incomplete primary education were more willing to accept (OR 1.6, 95% CI 01.2-2.2) compared to those educated to primary level or higher. Perceiving malaria as a moderate or low public health issue was also associated with a lower willingness to accept and participate. Experience of > 3 malaria cases in the family over the last six months and knowledge that malaria is transmitted by only mosquito bites, increased the willingness to accept but reduced the willingness to participate. Awareness of malaria control methods based on mosquitoes that cannot transmit malaria increases the willingness to participate. CONCLUSION The study showed a high level of willingness to accept and participate in a Microsporidia MB-based strategy in the community, which is influenced by several factors such as community, disease risk perception, gender, education level, knowledge, and experience of malaria. Further research will need to focus on understanding the concerns of women, educated, and employed community members, and factors that contribute to the lower disease risk perception. This improved understanding will lead to the development of an effective communication strategy.
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Affiliation(s)
- Tullu Bukhari
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya.
| | - Joseph Gichuhi
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
| | - Oscar Mbare
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
| | - Victoria A Ochwal
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
| | - Ulrike Fillinger
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
| | - Jeremy K Herren
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
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Martin J, Lukole E, Messenger LA, Aziz T, Mallya E, Bernard E, Matowo NS, Mosha JF, Rowland M, Mosha FW, Manjurano A, Protopopoff N. Monitoring of Fabric Integrity and Attrition Rate of Dual-Active Ingredient Long-Lasting Insecticidal Nets in Tanzania: A Prospective Cohort Study Nested in a Cluster Randomized Controlled Trial. INSECTS 2024; 15:108. [PMID: 38392527 PMCID: PMC10889750 DOI: 10.3390/insects15020108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024]
Abstract
Pyrethroid-treated long-lasting insecticidal nets (LLINs) have been the main contributor to the reduction in malaria in the past two decades in sub-Saharan Africa. The development of pyrethroid insecticide resistance threatens the future of LLINs, especially when nets become holed and pyrethroid decays. In this study, three new classes of dual-active ingredient (AI) LLINs were evaluated for their physical durability: (1) Royal Guard, combining pyriproxyfen, which disrupts female fertility, and a pyrethroid, alpha-cypermethrin; (2) Interceptor G2, which combines the pyrrole chlorfenapyr and a pyrethroid (alpha-cypermethrin); (3) Olyset Plus, which incorporates the pyrethroid permethrin and the synergist piperonyl butoxide, to enhance the pyrethroid potency; and Interceptor, a reference net that contains alpha-cypermethrin as the sole active ingredient. About 40,000 nets of each type were distributed in February 2019 to different villages in Misungwi. A total of 3072 LLINs were followed up every 6-12 months up to 36 months to assess survivorship and fabric integrity. The median functional survival was less than three years with Interceptor, Interceptor G2, and Royal Guard showing 1.9 years each and Olyset Plus showing 0.9 years. After 36 months, 90% of Olyset Plus and Royal Guard and 87% of Interceptor G2 were no longer in use (discarded) due to wear and tear, compared to 79% for Interceptor. All dual-AI LLINs exhibited poor textile durability, with Olyset Plus being the worst.
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Affiliation(s)
- Jackline Martin
- Department of Parasitology, Pan-African Malaria Vector Research Consortium, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2240, Tanzania
- Department of Parasitology, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania
- Department of Disease Control, Faculty of Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Eliud Lukole
- Department of Parasitology, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania
| | - Louisa A Messenger
- Department of Disease Control, Faculty of Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
- Parasitology and Vector Biology Laboratory (UNLV PARAVEC Lab), School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
| | - Tatu Aziz
- Department of Parasitology, Pan-African Malaria Vector Research Consortium, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2240, Tanzania
| | - Elizabeth Mallya
- Department of Parasitology, Pan-African Malaria Vector Research Consortium, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2240, Tanzania
| | - Edmond Bernard
- Department of Parasitology, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania
| | - Nancy S Matowo
- Department of Disease Control, Faculty of Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Jacklin F Mosha
- Department of Parasitology, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania
| | - Mark Rowland
- Department of Disease Control, Faculty of Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Franklin W Mosha
- Department of Parasitology, Pan-African Malaria Vector Research Consortium, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2240, Tanzania
| | - Alphaxard Manjurano
- Department of Parasitology, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania
| | - Natacha Protopopoff
- Department of Disease Control, Faculty of Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Kihwele F, Gavana T, Makungu C, Msuya HM, Mlacha YP, Govella NJ, Chaki PP, Sunguya BF. Exploring activities and behaviours potentially increases school-age children's vulnerability to malaria infections in south-eastern Tanzania. Malar J 2023; 22:293. [PMID: 37789435 PMCID: PMC10548596 DOI: 10.1186/s12936-023-04703-2] [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: 04/18/2023] [Accepted: 09/02/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Strengthening malaria control activities in Tanzania has dramatically declined human malaria infections. However, there is an increasing epidemiological shift in the burden on school-age children. The underlying causes for such an epidemiological shift remain unknown in this context. This study explored activities and behaviours that could increase the vulnerability of school-age children to transmission risk to provide insight into protection gap with existing interventions and opportunities for supplementary interventions. METHODS This cross-sectional study conducted twenty-four focus group discussions (FGDs) in three districts of Rufiji, Kibiti and Kilwa in south-eastern Tanzania. Sixteen FGDs worked with school-age children (13 to 18 years) separating girls and boys and eight FGDs with their parents in mixed-gender groups. A total of 205 community members participated in FGDs across the study area. Of them, 72 participants were parents, while 133 were school-age children (65 boys and 68 girls). RESULTS Routine domestic activities such as fetching water, washing kitchen utensils, cooking, and recreational activities such as playing and watching television and studying were the reported activities that kept school-age children outdoors early evening to night hours (between 18:00 and 23:00). Likewise, the social and cultural events including initiation ceremonies and livelihood activities also kept this age group outdoors from late evening to early night and sometimes past midnight hours. Parents migrating to farms from December to June, leaving behind school-age children unsupervised affecting their net use behaviour plus spending more time outdoors at night, and the behaviour of children sprawling legs and hands while sleeping inside treated bed nets were identified as potential risks to infectious mosquito bites. CONCLUSION The risky activities, behaviours, and social events mostly occurring outdoors might increase school-age children's vulnerability to malaria infections. The findings provide preliminary insight on potential risk factors for persisting transmission. Further studies to quantify the risk behaviour and activities are recommended to establish the magnitude and anticipated impact on supplementary control strategies to control infection in school-age children.
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Affiliation(s)
- Fadhila Kihwele
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania.
- Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, United Republic of Tanzania.
| | - Tegemeo Gavana
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania
- Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, United Republic of Tanzania
| | - Christina Makungu
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania
| | - Hajirani M Msuya
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania
| | - Yeromin P Mlacha
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania
| | - Nicodem James Govella
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania
- School of Life Sciences and Bioengineering (LISBE), Nelson Mandela African Institution of Science and Technology, P.O. BOX 447, Tengeru, Arusha, United Republic of Tanzania
| | - Prosper Pius Chaki
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania
- The Pan African Mosquito Control Association (PAMCA), KEMRI Headquarters, Mbagathi Road Nairobi, Nairobi, 54840-00200, Kenya
| | - Bruno Fokas Sunguya
- Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, United Republic of Tanzania
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Zerdo Z, Bastiaens H, Anthierens S, Massebo F, Masne M, Biresaw G, Shewangizaw M, Tunje A, Chisha Y, Yohannes T, Van Geertruyden JP. Effect of malaria prevention education on bed net utilization, incidence of malaria and treatment seeking among school-aged children in Southern Ethiopia; cluster randomized controlled trial. BMC Infect Dis 2023; 23:486. [PMID: 37474930 PMCID: PMC10360348 DOI: 10.1186/s12879-023-08464-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/15/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND School-aged children (SAC) have an increased risk to contract malaria and play a major role in its transmission dynamics. However, their malaria prevention experience is poor. Thus, the effect of malaria prevention education (MPE) on bed net utilization, treatment seeking from a health facility and cumulative incidence of malaria was evaluated in Southern Ethiopia. METHODS A two arm cluster randomized controlled trial was conducted by recruiting 2038 SAC from 32 schools. Structured questionnaire was used to collect data on socio-demographic, economic, bed net ownership, bed net utilization, whether the participated child suffered from malaria and has got treatment from a health facility. Generalized mixed effect logistic regression using school as random variable was used to assess the effect of the intervention on the outcome variables. RESULTS The ownership of bed net in households of the control and intervention schools was similar respectively with 84.6 and 88.6% (Crude Odds Ratio (COR): 1.5; 95%CI: 0.5-4.8). The percentage of SAC slept under the bed net the night before the survey was also similar (55.1% versus 54.0%); COR:1.04; 95%CI: 0.5-2.4). Bed net utilization was affected by household size to the bed net ratio ≤ 2 (Adjusted Odds Ratio (AOR) = 1.6; 95%CI:1.3-2.1), bed net utilization at baseline of the study (AOR = 2.3; 95%CI:1.5-3.6), and history of malaria attack in the last twelve months (AOR = 1.3; 95%CI:1.01-1.8). Reported cumulative incidence of malaria and treatment seeking from a health facility by SAC was similar between intervention and control arms: -2.1% (COR = 0.8; 95%CI: 0.5-1.5) and 9.6% (COR = 1.4; 95%CI: 0.4-4.3) respectively. The reported incidence of malaria was affected by altitude (AOR = 0.5; 95%CI: 0.3-0.8), low and medium wealth index (AOR = 0.7; 95%CI: 0.5-0.96 and AOR = 0.7; 95%CI: 0.5-0.98), adequate bed net number for household members (AOR = 0.7; 95%CI:0.5-0.9) and bed net utilization (AOR = 1.3; 95%CI:1.1-1.8). CONCLUSIONS MPE had no significant effect on the use of malaria prevention measures considered, treatment seeking from a health facility and reported cumulative incidence of malaria though bed net use was associated with malaria incidence. Before organizing any health education program, sustainable implementation efforts have to be warranted especially in SAC, a neglected but relevant vulnerable and reservoirs. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR202001837195738, registered 21/01/2020.
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Affiliation(s)
- Zerihun Zerdo
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
- Global Health Institute, Antwerp University, Antwerp, Belgium.
| | - Hilde Bastiaens
- Department of family medicine and population health, Antwerp University, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of family medicine and population health, Antwerp University, Antwerp, Belgium
| | - Fekadu Massebo
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Matewos Masne
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gelila Biresaw
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Misgun Shewangizaw
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abayneh Tunje
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Yilma Chisha
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tsegaye Yohannes
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Bamou R, Tchuinkam T, Kopya E, Awono-Ambene P, Njiokou F, Mwangangi J, Antonio-Nkondjio C. Knowledge, attitudes, and practices regarding malaria control among communities living in the south Cameroon forest region. IJID REGIONS 2022; 5:169-176. [PMID: 36467507 PMCID: PMC9713328 DOI: 10.1016/j.ijregi.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study assessed knowledge, attitudes, and practices (KAP) regarding malaria among communities living in the equatorial forest region of south Cameroon. METHODS The study was conducted in Olama and Nyabessan. Interviews were undertaken using a semi-structured questionnaire for data collection on KAP, while malaria rapid diagnostic testing, using SD BIOLINE kits, was employed for malaria parasite detection. RESULTS In total, 186 heads of households (HoH), comprising 105 (56.45%) males and 81 (43.45%) females, were interviewed. The majority of HoH demonstrated good knowledge of malaria (86.56%; n = 161) and control measures, with a high proportion of long-lasting insecticidal net (LLIN) ownership (96.8%; n = 180). More than two-thirds (81.1%; n = 151) of households owned at least one LLIN for two people. The majority of HoH (85.40%) declared visiting hospitals or clinics in cases of suspected malaria. Malaria parasite prevalence was high in the two study sites (63.9% in Nyabessan and 48.65% in Olama), and varied according to age, house type, and sleeping time. CONCLUSION The study indicated that despite good knowledge of malaria, high possession and utilization of control measures by population, transmission of malaria still persist in the area. The study stress the need for implementing additional control measures to improve the fight against malaria in the area.
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Key Words
- Cameroon
- HoH, head of household
- IRS, indoor residual spraying
- KAP
- KAP, knowledge, attitude, and practice
- LLIN, long-lasting insecticidal net
- MoH, Ministry of Health. PBO, piperonyl butoxide
- NMCP, National Malaria Control Program
- WHO, World Health Organization
- forested area
- mRDT, malaria rapid diagnostic test
- malaria determinants
- malaria prevalence
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Affiliation(s)
- Roland Bamou
- Vector Borne Diseases Laboratory of the Applied Biology and Ecology Research Unit (VBID-URBEA), Department of Animal Biology, Faculty of Science of the University of Dschang
- Organisation de Coordination pour la Lutte Contre les Endémies en Afrique Centrale (OCEAC), Yaounde, Cameroon
| | - Timoléon Tchuinkam
- Vector Borne Diseases Laboratory of the Applied Biology and Ecology Research Unit (VBID-URBEA), Department of Animal Biology, Faculty of Science of the University of Dschang
| | - Edmond Kopya
- Organisation de Coordination pour la Lutte Contre les Endémies en Afrique Centrale (OCEAC), Yaounde, Cameroon
- Laboratory of Parasitology and Ecology, Faculty of Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Parfait Awono-Ambene
- Organisation de Coordination pour la Lutte Contre les Endémies en Afrique Centrale (OCEAC), Yaounde, Cameroon
| | - Flobert Njiokou
- Laboratory of Parasitology and Ecology, Faculty of Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Joseph Mwangangi
- Center for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Centre for Vector Disease Control, Kenya Medical Research Institute (KEMRI), Kwale, Kenya
| | - Christophe Antonio-Nkondjio
- Organisation de Coordination pour la Lutte Contre les Endémies en Afrique Centrale (OCEAC), Yaounde, Cameroon
- Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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9
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Zerdo Z, Anthierens S, Van Geertruyden JP, Massebo F, Biresaw G, Shewangizaw M, Endashaw G, Tunje A, Masne M, Bastiaens H. Implementation of a malaria prevention education intervention in Southern Ethiopia: a qualitative evaluation. BMC Public Health 2022; 22:1811. [PMID: 36151537 PMCID: PMC9508754 DOI: 10.1186/s12889-022-14200-x] [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: 05/24/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though school-aged children (SAC) are at high risk of malaria, they are the ones that benefit the least from malaria prevention measures. A cluster randomized controlled trial was conducted to evaluate the effect of malaria prevention education (MPE) on insecticide-treated bed net (ITN) utilization and prompt diagnosis, reported incidence and treatment (PDAT) of malaria. Qualitative evaluation of the implementation of such interventions is vital to explain its effectiveness and will serve as guidance for future interventions. Therefore, this study aimed to evaluate the implementation of the MPE in southern Ethiopia. METHODS: The trial was registered in Pan African Clinical Trials Registry (PACTR202001837195738) on 21/01/2020. A descriptive qualitative study using semi-structured interview with participants of the MPE was conducted in January 2020 and January 2021. The collected data were transcribed verbatim and analyzed thematically. The analysis of the data was supported by NVivo. RESULTS The four themes identified after evaluation of MPE training were the setup of the training, challenges for the success of the training, anticipated challenges for practice as per the protocol and experienced immediate influences of the training. Participants appreciated the training: content covered, way of delivery and the mix of the participants. The context specific facilitators to bed net use were the collateral benefits of ITN and perceived at high risk of malaria while its barriers were quality and quantity of the bed nets, bed net associated discomforts, malaria health literacy and housing condition. Severeness of malaria symptoms and malaria health literacy were reported as both barriers and facilitators of the PDAT of malaria. The identified facilitators of PDAT of malaria were health professionals' attitude and exposure to MPE while its barriers were poverty, use of traditional medicine, health facility problems and Coronavirus Disease 2019 (COVID-19) pandemic. CONCLUSION Low attendance of parents in the training was the major challenge for the success of MPE. National malaria program should ensure the access to malaria prevention measures; and future studies using increased frequency of the intervention embedded with monitoring adherence to the intervention protocol shall be conducted to improve the gains from existing malaria interventions.
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Affiliation(s)
- Zerihun Zerdo
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia. .,Global Health Institute, Antwerp University, Antwerp, Belgium.
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | | | - Fekadu Massebo
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gelila Biresaw
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Misgun Shewangizaw
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gesila Endashaw
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abayneh Tunje
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Matewos Masne
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Hilde Bastiaens
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
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10
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Madumla EP, Moore SJ, Moore J, Mbuba E, Mbeyela EM, Kibondo UA, C S, Mmbaga, Kobe D, Baraka J, Msellemu D, Swai JK, Mboma ZM, Odufuwa OG. "In starvation, a bone can also be meat": a mixed methods evaluation of factors associated with discarding of long-lasting insecticidal nets in Bagamoyo, Tanzania. Malar J 2022; 21:101. [PMID: 35331242 PMCID: PMC8944021 DOI: 10.1186/s12936-022-04126-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Between 2000 and 2019, more than 1.8 billion long-lasting insecticidal nets (LLINs) were distributed in Africa. While the insecticidal durability of LLINs is around 3 years, nets are commonly discarded 2 years post distribution. This study investigated the factors associated with the decision of users to discard LLINs. METHODS A mixed-method sequential explanatory approach using a structured questionnaire followed by focus group discussions (FGDs) to collect information on experiences, views, reasons, how and when LLINs are discarded. Out of 6,526 households that responded to the questionnaire of LLINs durability trial, 160 households were randomly selected from the households in four villages in Bagamoyo Tanzania for FGDs but only 155 households participated in the FGDs. Five of the household representatives couldn't participate due to unexpected circumstances. A total of sixteen FGDs each comprising of 8-10 adults were conducted; older women (40-60 years), older men (40-60 years), younger women (18-39 years), younger men (18-39 years). During the FGDs, participants visually inspected seven samples of LLINs that were "too-torn" based on Proportionate Hole Index recommended by the World Health Organization (WHO) guidelines on LLIN testing, the nets were brought to the discussion and participants had to determine if such LLINs were to be kept or discarded. The study assessed responses from the same participants that attended FGD and also responded to the structured questionnaire, 117 participants fulfilled the criteria, thus data from only 117 participants are analysed in this study. RESULTS In FGDs, integrity of LLIN influenced the decision to discard or keep a net. Those of older age, women, and householders with lower income were more likely to classify a WHO "too-torn" net as "good". The common methods used to discard LLINs were burning and burying. The findings were seen in the quantitative analysis. For every additional hole, the odds of discarding a WHO "too-torn" LLIN increased [OR = 1.05 (95%CI (1.04-1.07)), p < 0.001]. Younger age group [OR = 4.97 (95%CI (3.25-7.32)), p < 0.001], male-headed households [OR = 6.85 (95%CI (4.44 -10.59)), p < 0.001], and wealthy households [OR = 3.88 (95%CI (2.33-6.46)), p < 0.001] were more likely to discard LLINs. CONCLUSION Integrity of LLIN was the main determinant for discarding or keeping LLINs and the decision to discard the net is associated with socioeconomic status of the household, and the age and gender of respondents. WHO "too torn" nets are encouraged to be used instead of none until replacement, and disposal of nets should be based on recommendation.
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Affiliation(s)
- Edith P Madumla
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania.
- Nelson Mandela African Institution of Science and Technology, Tengeru, Arusha, Tanzania.
| | - Sarah J Moore
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
- Nelson Mandela African Institution of Science and Technology, Tengeru, Arusha, Tanzania
- Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland
- University of Basel, St. Petersplatz 1, CH-4002, Basel, Switzerland
| | - Jason Moore
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
- Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland
| | - Emmanuel Mbuba
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
- Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland
- University of Basel, St. Petersplatz 1, CH-4002, Basel, Switzerland
| | - Edgar M Mbeyela
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Ummi A Kibondo
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | | | - Mmbaga
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Dickson Kobe
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Jitihada Baraka
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Daniel Msellemu
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
- Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland
- University of Basel, St. Petersplatz 1, CH-4002, Basel, Switzerland
| | - Johnson K Swai
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Zawadi M Mboma
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Olukayode G Odufuwa
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
- Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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11
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Pooseesod K, Parker DM, Meemon N, Lawpoolsri S, Singhasivanon P, Sattabongkot J, Cui L, Phuanukoonnon S. Ownership and utilization of bed nets and reasons for use or non-use of bed nets among community members at risk of malaria along the Thai-Myanmar border. Malar J 2021; 20:305. [PMID: 34229653 PMCID: PMC8259116 DOI: 10.1186/s12936-021-03837-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background With the goal for malaria elimination in Thailand set for 2024, increased coverage and utilization of bed net, especially insecticide-treated net (ITN) or long-lasting insecticidal net (LLIN) is a key strategy. This study aims to provide the necessary information about bed net ownership and utilization among the population at risk of malaria living along the Thai-Myanmar border in Tak province. Methods A cross-sectional study was conducted using a mixed-method approach in 331 households from 5 hamlets in the villages of the Thai-Myanmar border. The research tools included a questionnaire, bed net inspection, and semi-structured interviews. Logistic regression was used to explore the sociodemographic factors associated with bed net utilization. The qualitative analysis employed a thematic analysis approach. Results This survey found that 98.5% of households had at least one bed net per household, and 74.3% had at least one ITN/LLIN. However, only 30.8% of households reached the standard policy set by the Minister of Public Health of one ITN/LLINs per two persons. Most residents used bed net (92.1% used in the previous night and 80.9% used every day). For those using bed nets, however, 61.9% used ITNs or LLINs the night before and 53.1% used them every day. Nonetheless, the usage rates of bed nets (any type) in the previous night among children and pregnant women were high, reaching 95.3% and 90.0%, respectively. Seven explanatory variables showed statistically significant associations with bed net use every day, including: “not staying overnight in the forest or the field”, “sleeping pattern based on gender”, “sufficient numbers of bed nets to cover all sleeping spaces”, “preference for free bed nets”, “age”, “gender”, and “SES score” showed statistically significant association with bed net use every day. The major reasons for the regular use of bed nets in both household and the forest were to prevent mosquito biting. The reasons for not using bednets in the household were discomfort feelings from heat, perception of unnecessity due to low mosquito density, whereas the reason for not using bed nets in the forest was inconvenience. Conclusion Despite that overall coverage and usage of bed nets was high, only one third reached the standard level specified by the policy. Overnight in the forest, the dissatisfaction with the quality of free bed nets, insufficient number of bed nets, sleeping alone, male gender, age more than 10 years, low socioeconomic status, discomfort from heat, perception of no benefits of bed nets due to low mosquito density, and inconvenience were factors influencing bed net use. Maintaining high coverage and utility rate of bed nets should be a priority for the malaria high-risk population. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03837-5.
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Affiliation(s)
- Kasama Pooseesod
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand.,Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Daniel M Parker
- Department of Population Health & Disease Prevention, Program in Public Health Susan and Henry Samueli College of Health Sciences, University of California, Irvine, USA
| | - Natthani Meemon
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
| | - Pratap Singhasivanon
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand.,Faculty of Tropical Medicine, SEAMEO TROPMED Regional Centre for Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Suparat Phuanukoonnon
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand. .,Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand.
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12
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Hutchins H, Power G, Ant T, Teixeira da Silva E, Goncalves A, Rodrigues A, Logan J, Mabey D, Last A. A survey of knowledge, attitudes and practices regarding malaria and bed nets on Bubaque Island, Guinea-Bissau. Malar J 2020; 19:412. [PMID: 33203419 PMCID: PMC7670770 DOI: 10.1186/s12936-020-03469-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Malaria remains a significant public health problem in Guinea-Bissau, West Africa. Government control measures include bed net distribution campaigns, however, local knowledge, attitudes and practices towards bed nets and malaria are uncharacterized on the remote Bijagos Archipelago. METHODS Knowledge, attitude and practice questionnaires were conducted with household heads, aiming to explore the understanding of malaria and factors influencing bed net uptake and usage. Nets were observed in situ to appraise net quality and behaviour. All 14 villages and one semi-urban neighbourhood on Bubaque Island were included. One in 5 households containing school-aged children were randomly selected. RESULTS Of 100 participants, 94 were aware of malaria and 66 of those considered it a significant or severe problem, primarily because of its impact on health and income. Transmission, symptoms and risk factors were well known, however, 28.0% of participants felt under-informed. Some 80.0% reported contact with distribution campaigns, with inter-village variability. Campaign contact was associated with feeling well informed (OR 3.44; P = 0.024) and inversely with perceiving malaria a household (OR 0.18; P = 0.002) or regional problem (OR 0.25; P = 0.018). Every household contained nets; every identifiable example was a long-lasting insecticide-treated net (LLIN), however, 23.0% of households contained at least one expired net. Replacements were in demand; 89.0% of households reported that all residents used nets, and average occupancy was 2.07 people per net; 65.2% stated that the repurposing of bed nets was common. Correctly using bed nets, defined by age, integrity and demonstration, was 35.0% and strongly associated with completing intermittent preventative treatment in pregnancy (RR 3.63; P = 0.014). CONCLUSIONS Knowledge of malaria is good in these communities. Bed nets are used widely and are valued for their role in preventing malaria. However, their use is frequently sub-optimal and offers a target for improving malaria control by adapting popular distribution campaigns to provide more education alongside fresh LLINs. The impact of this could be significant as LLINs represent the mainstay of malaria prevention in Guinea-Bissau; however, the persistence of malaria despite the high uptake of LLINs seen in this study suggests that novel supplementary approaches must also be considered.
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Affiliation(s)
- Harry Hutchins
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Grace Power
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Thomas Ant
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | | | - Adriana Goncalves
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Amabelia Rodrigues
- Projecto de Saúde Bandim, Apartado, 8611004, Bissau Codex, Guinea-Bissau
| | - James Logan
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - David Mabey
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Anna Last
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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13
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Chan EYY, Sham TST, Shahzada TS, Dubois C, Huang Z, Liu S, Hung KK, Tse SL, Kwok KO, Chung PH, Kayano R, Shaw R. Narrative Review on Health-EDRM Primary Prevention Measures for Vector-Borne Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5981. [PMID: 32824754 PMCID: PMC7459832 DOI: 10.3390/ijerph17165981] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 01/01/2023]
Abstract
Climate change is expanding the global at-risk population for vector-borne diseases (VBDs). The World Health Organization (WHO) health emergency and disaster risk management (health-EDRM) framework emphasises the importance of primary prevention of biological hazards and its value in protecting against VBDs. The framework encourages stakeholder coordination and information sharing, though there is still a need to reinforce prevention and recovery within disaster management. This keyword-search based narrative literature review searched databases PubMed, Google Scholar, Embase and Medline between January 2000 and May 2020, and identified 134 publications. In total, 10 health-EDRM primary prevention measures are summarised at three levels (personal, environmental and household). Enabling factor, limiting factors, co-benefits and strength of evidence were identified. Current studies on primary prevention measures for VBDs focus on health risk-reduction, with minimal evaluation of actual disease reduction. Although prevention against mosquito-borne diseases, notably malaria, has been well-studied, research on other vectors and VBDs remains limited. Other gaps included the limited evidence pertaining to prevention in resource-poor settings and the efficacy of alternatives, discrepancies amongst agencies' recommendations, and limited studies on the impact of technological advancements and habitat change on VBD prevalence. Health-EDRM primary prevention measures for VBDs require high-priority research to facilitate multifaceted, multi-sectoral, coordinated responses that will enable effective risk mitigation.
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.H.); (S.L.); (K.K.C.H.)
- Nuffield Department of Medicine, University of Oxford, Oxford OX37BN, UK
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (T.S.T.S.); (T.S.S.); (S.L.A.T.); (K.O.K.); (P.-H.C.)
- GX Foundation, Hong Kong SAR, China;
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Tiffany Sze Tung Sham
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (T.S.T.S.); (T.S.S.); (S.L.A.T.); (K.O.K.); (P.-H.C.)
- GX Foundation, Hong Kong SAR, China;
| | - Tayyab Salim Shahzada
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (T.S.T.S.); (T.S.S.); (S.L.A.T.); (K.O.K.); (P.-H.C.)
- GX Foundation, Hong Kong SAR, China;
| | | | - Zhe Huang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.H.); (S.L.); (K.K.C.H.)
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (T.S.T.S.); (T.S.S.); (S.L.A.T.); (K.O.K.); (P.-H.C.)
| | - Sida Liu
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.H.); (S.L.); (K.K.C.H.)
- GX Foundation, Hong Kong SAR, China;
| | - Kevin K.C. Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.H.); (S.L.); (K.K.C.H.)
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (T.S.T.S.); (T.S.S.); (S.L.A.T.); (K.O.K.); (P.-H.C.)
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Shelly L.A. Tse
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (T.S.T.S.); (T.S.S.); (S.L.A.T.); (K.O.K.); (P.-H.C.)
| | - Kin On Kwok
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (T.S.T.S.); (T.S.S.); (S.L.A.T.); (K.O.K.); (P.-H.C.)
| | - Pui-Hong Chung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (T.S.T.S.); (T.S.S.); (S.L.A.T.); (K.O.K.); (P.-H.C.)
| | - Ryoma Kayano
- World Health Organization Centre for Health Development, Kobe 651-0073, Japan;
| | - Rajib Shaw
- Graduate School of Media and Governance, Keio University, Fujisawa 252-0882, Japan;
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14
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Odufuwa OG, Ross A, Mlacha YP, Juma O, Mmbaga S, Msellemu D, Moore S. Household factors associated with access to insecticide-treated nets and house modification in Bagamoyo and Ulanga districts, Tanzania. Malar J 2020; 19:220. [PMID: 32576180 PMCID: PMC7313165 DOI: 10.1186/s12936-020-03303-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/18/2020] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Insecticide-treated nets (ITNs) and house modifications are proven vector control tools, yet in most regions, full coverage has not been achieved. This study investigates household factors associated with access to ITNs and house modification in Tanzania. METHODS Baseline cross-sectional survey data from previous studies on spatial repellants and indoor residual spray evaluation was analysed from 6757 households in Bagamoyo (60 km north of Dar es Salaam) and 1241 households in Ulanga (a remote rural area in southeast Tanzania), respectively. Regression models were used to estimate the associations between the outcomes: population access to ITNs, access to ITN per sleeping spaces, window screens and closed eaves, and the covariates household size, age, gender, pregnancy, education, house size, house modification (window screens and closed eaves) and wealth. RESULTS Population access to ITNs (households with one ITN per two people that stayed in the house the previous night of the survey) was 69% (n = 4663) and access to ITNs per sleeping spaces (households with enough ITNs to cover all sleeping spaces used the previous night of the survey) was 45% (n = 3010) in Bagamoyo, 3 years after the last mass campaign. These findings are both lower than the least 80% coverage target of the Tanzania National Malaria Strategic Plan (Tanzania NMSP). In Ulanga, population access to ITNs was 92% (n = 1143) and ITNs per sleeping spaces was 88% (n = 1093), 1 year after the last Universal Coverage Campaign (UCC). Increased household size was significantly associated with lower access to ITNs even shortly after UCC. House modification was common in both areas but influenced by wealth. In Bagamoyo, screened windows were more common than closed eaves (65% vs 13%), whereas in Ulanga more houses had closed eaves than window screens (55% vs 12%). CONCLUSION Population access to ITNs was substantially lower than the targets of the Tanzania NMSP after 3 years and lower among larger households after 1 year following ITN campaign. House modification was common in both areas, associated with wealth. Improved access to ITNs and window screens through subsidies and Behaviour Change Communication (BCC) strategies, especially among large and poor households and those headed by people with a low level of education, could maximize the uptake of a combination of these two interventions.
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Affiliation(s)
| | - Amanda Ross
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Yeromin P Mlacha
- Ifakara Health Institute, Bagamoyo, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Omary Juma
- Ifakara Health Institute, Bagamoyo, Tanzania
| | | | - Daniel Msellemu
- Ifakara Health Institute, Bagamoyo, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Sarah Moore
- Ifakara Health Institute, Bagamoyo, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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15
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Monroe A, Moore S, Okumu F, Kiware S, Lobo NF, Koenker H, Sherrard-Smith E, Gimnig J, Killeen GF. Methods and indicators for measuring patterns of human exposure to malaria vectors. Malar J 2020; 19:207. [PMID: 32546166 PMCID: PMC7296719 DOI: 10.1186/s12936-020-03271-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/29/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Effective targeting and evaluation of interventions that protect against adult malaria vectors requires an understanding of how gaps in personal protection arise. An improved understanding of human and mosquito behaviour, and how they overlap in time and space, is critical to estimating the impact of insecticide-treated nets (ITNs) and determining when and where supplemental personal protection tools are needed. Methods for weighting estimates of human exposure to biting Anopheles mosquitoes according to where people spend their time were first developed over half a century ago. However, crude indoor and outdoor biting rates are still commonly interpreted as indicative of human-vector contact patterns without any adjustment for human behaviour or the personal protection effects of ITNs. MAIN TEXT A small number of human behavioural variables capturing the distribution of human populations indoors and outdoors, whether they are awake or asleep, and if and when they use an ITN over the course of the night, can enable a more accurate representation of human biting exposure patterns. However, to date no clear guidance is available on what data should be collected, what indicators should be reported, or how they should be calculated. This article presents an integrated perspective on relevant indicators of human-vector interactions, the critical entomological and human behavioural data elements required to quantify human-vector interactions, and recommendations for collecting and analysing such data. CONCLUSIONS If collected and used consistently, this information can contribute to an improved understanding of how malaria transmission persists in the context of current intervention tools, how exposure patterns may change as new vector control tools are introduced, and the potential impact and limitations of these tools. This article is intended to consolidate understanding around work on this topic to date and provide a consistent framework for building upon it. Additional work is needed to address remaining questions, including further development and validation of methods for entomological and human behavioural data collection and analysis.
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Affiliation(s)
- April Monroe
- Johns Hopkins Center for Communication Programs, PMI VectorWorks Project, Baltimore, MD, USA.
- University of Basel, Basel, Switzerland.
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Sarah Moore
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Fredros Okumu
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Republic of South Africa
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Samson Kiware
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Neil F Lobo
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Hannah Koenker
- Johns Hopkins Center for Communication Programs, PMI VectorWorks Project, Baltimore, MD, USA
| | - Ellie Sherrard-Smith
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - John Gimnig
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gerry F Killeen
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
- School of Biological, Earth & Environmental Sciences and Environmental Research Institute, University College Cork, Cork, Republic of Ireland
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Mundagowa PT, Chimberengwa PT. Malaria outbreak investigation in a rural area south of Zimbabwe: a case-control study. Malar J 2020; 19:197. [PMID: 32487249 PMCID: PMC7268448 DOI: 10.1186/s12936-020-03270-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022] Open
Abstract
Background Ninety percent of the global annual malaria mortality cases emanate from the African region. About 80–90% of malaria transmissions in sub-Saharan Africa occur indoors during the night. In Zimbabwe, 79% of the population are at risk of contracting the disease. Although the country has made significant progress towards malaria elimination, isolated seasonal outbreaks persistently resurface. In 2017, Beitbridge District was experiencing a second malaria outbreak within 12 months prompting the need for investigating the outbreak. Methods An unmatched 1:1 case–control study was conducted to establish the risk factors associated with contracting malaria in Ward 6 of Beitbridge District from week 36 to week 44 of 2017. The sample size constituted of 75 randomly selected cases and 75 purposively selected controls. Data were collected using an interviewer-administered questionnaire and Epi Info version 7.2.1.0 was used to conduct descriptive, bivariate and multivariate analyses of the factors associated with contracting malaria. Results Fifty-two percent of the cases were females and the mean age of cases was 29 ± 13 years. Cases were diagnosed using rapid diagnostic tests. Sleeping in a house with open eaves (OR: 2.97; 95% CI 1.44–6.16; p < 0.01), spending the evenings outdoors (OR: 2.24; 95% CI 1.04–4.85; p = 0.037) and sleeping in a poorly constructed house (OR: 4.33; 95% CI 1.97–9.51; p < 0.01) were significantly associated with contracting malaria while closing eaves was protective (OR: 0.45; 95% CI 0.20–1.02; p = 0.055). After using backward stepwise logistic regression, sleeping in a poorly constructed house was associated with five-fold odds of getting sick from malaria (AOR: 8.40; 95% CI 1.69–41.66; p = 0.009). Those who had mosquito nets did not use them consistently. The district health team and the rural health centre were well prepared to response despite having limited human resources. Conclusion Health promotion messages should emphasize the importance of closing the entry points of the malaria vector, and the construction of better houses in the future. Residents had to be educated in the importance of consistent use of mosquito nets. The district had to improve malaria preventive measures like distribution of mosquito nets and lobby for more human resources to assist with malaria surveillance thus, curbing the recurrence of malaria outbreaks.
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Affiliation(s)
- Paddington T Mundagowa
- The Clinical Research Center, Africa University, 132 H. Chitepo Street, Mutare, Zimbabwe.
| | - Pugie T Chimberengwa
- Ministry of Health and Child Care, P.O Box 441, Bulawayo, Matabeleland North Province, Zimbabwe
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Malaria Outbreak Facilitated by Appearance of Vector-Breeding Sites after Heavy Rainfall and Inadequate Preventive Measures: Nwoya District, Northern Uganda, February-May 2018. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2020; 2020:5802401. [PMID: 32377206 PMCID: PMC7193302 DOI: 10.1155/2020/5802401] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/16/2020] [Accepted: 03/21/2020] [Indexed: 12/23/2022]
Abstract
Background Malaria is a leading cause of morbidity and mortality in Uganda. In April 2018, malaria cases surged in Nwoya District, Northern Uganda, exceeding expected limits and thereby requiring epidemic response. We investigated this outbreak to estimate its magnitude, identify exposure factors for transmission, and recommend evidence-based control measures. Methods We defined a malaria case as onset of fever in a resident of Anaka subcounty, Koch Goma subcounty, and Nwoya Town Council, Nwoya District, with a positive rapid diagnostic test or microscopy for malaria from 1 February to 25 May 2018. We reviewed medical records in all health facilities of affected subcounties to find cases. In a case-control study, we compared exposure factors between case-persons and asymptomatic controls matched by age and village. We also conducted entomological assessments on vector density and behavior. Results We identified 3,879 case-persons (attack rate [AR] = 6.5%) and two deaths (case-fatality rate = 5.2/10,000). Females (AR = 8.1%) were more affected than males (AR = 4.7%) (p < 0.0001). Of all age groups, 5–18 years (AR = 8.4%) were most affected. Heavy rain started in early March 2018, and a propagated outbreak followed in the first week of April 2018. In the case-control study, 55% (59/107) of case-persons and 18% (19/107) of controls had stagnant water around households for several days following rainfall (ORM-H = 5.6, 95% CI = 3.0–11); 25% (27/107) of case-persons and 51% (55/107) of controls wore full extremity covering clothes during evening hours (ORM-H = 0.30, 95% CI = 0.20–0.60); 71% (76/107) of case-persons and 85% (91/107) of controls slept under a long-lasting insecticide-treated net (LLIN) 14 days before symptom onset (ORM-H = 0.43, 95% CI = 0.22–0.85); 37% (40/107) of case-persons and 52% (56/107) of controls had access to at least one LLIN per 2 household members (ORM-H = 0.54, 95% CI = 0.30–0.97). Entomological assessment indicated active breeding sites in the entire study area; Anopheles gambiae sensu lato species were the predominant vector. Conclusion Increased vector-breeding sites after heavy rainfall and inadequate malaria preventive measures were found to have contributed to this outbreak. We recommended increasing coverage for LLINs and larviciding breeding sites in the area.
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Opiyo MA, Paaijmans KP. 'We spray and walk away': wall modifications decrease the impact of indoor residual spray campaigns through reductions in post-spray coverage. Malar J 2020; 19:30. [PMID: 31952538 PMCID: PMC6969461 DOI: 10.1186/s12936-020-3102-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022] Open
Abstract
Malaria prevalence has significantly reduced since 2000, largely due to the scale-up of vector control interventions, mainly indoor residual spraying (IRS) and long-lasting insecticide-treated nets (LLINs). Given their success, these tools remain the frontline interventions in the fight against malaria. Their effectiveness relies on three key ingredients: the intervention, the mosquito vector and the end-user. Regarding the intervention, factors such as the insecticide active ingredient(s) used and the durability and/or bio-efficacy of the tool over time are critical. For the vectors, these factors include biting and resting behaviours and the susceptibility to insecticides. Finally, the end-users need to accept and properly use the intervention. Whilst human attitude and behaviour towards LLINs are well-documented both during and after distribution, only initial coverage is monitored for IRS and in a few geographic settings the residual efficacy of the used product. Here, the historical evidence on end-users modifying their wall surfaces post-spraying is presented, a behaviour that has the potential to reduce actual IRS coverage, effectiveness and impact, as fewer people are truly protected. Therefore, clear guidelines on how to monitor IRS acceptability and/or coverage, both before, during and after spraying, are urgently needed as part of the Monitoring and Evaluation of malaria programmes.
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Affiliation(s)
- Mercy A Opiyo
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain. .,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
| | - Krijn P Paaijmans
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Center for Evolution and Medicine, School of Life Sciences, Arizona State University, Tempe, USA.,The Biodesign Center for Immunotherapy, Vaccines, and Virotherapy, Arizona State University, Tempe, AZ, USA
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19
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Andronescu LR, Buchwald AG, Coalson JE, Cohee L, Bauleni A, Walldorf JA, Kandangwe C, Mzilahowa T, Taylor TE, Mathanga DP, Laufer MK. Net age, but not integrity, may be associated with decreased protection against Plasmodium falciparum infection in southern Malawi. Malar J 2019; 18:329. [PMID: 31551076 PMCID: PMC6760057 DOI: 10.1186/s12936-019-2930-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/22/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Distribution campaigns for insecticide-treated nets (ITN) have increased the use of ITNs in Malawi, but malaria prevalence remains high even among those using the nets. Previous studies have addressed ITN ownership, insecticide resistance, and frequency of ITN use as possible contributing factors to the high prevalence of malaria infection despite high ITN coverage, but have rarely considered whether the condition of the ITN, or how many people use it, impacts efficacy. This study assessed how ITN integrity, ITN age, and the number of persons sharing a net might mitigate or reduce protective efficacy among self-identified ITN users in Malawi. METHODS From 2012 to 2014, six cross-sectional surveys were conducted in both the rainy and dry seasons in southern Malawi. Data were collected on ITN use, integrity (number and size of holes), and age. Blood samples for detecting Plasmodium falciparum infection were obtained from reported ITN users over 6 months of age. Generalized linear mixed models were used to account for clustering at the household and community level. The final model controlled for gender, household eaves, and community-level infection prevalence during the rainy season. RESULTS There were 9646 ITN users with blood samples across six surveys, 15% of whom tested positive for P. falciparum infection. Among children under 5 years old, there was a 50% increased odds of P. falciparum infection among those sleeping under an ITN older than two years, compared to those using an ITN less than 2 years old (OR = 1.50; 95% CI 1.07-2.08). ITN integrity and number of individuals sharing an ITN were not associated with P. falciparum infection. CONCLUSIONS Older ITNs were associated with higher rates of P. falciparum in young children, which may indicate that insecticide concentrations play a larger role in infection prevention than the physical barrier of an ITN. ITN use was self-reported and the integrity measures lacked the precision of newer methods, suggesting a need for objective measures of ITN use and more precise assessment of ITN integrity.
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Affiliation(s)
- Liana R. Andronescu
- 0000 0001 2175 4264grid.411024.2Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W, Baltimore Street, Baltimore, MD 21201 USA
| | - Andrea G. Buchwald
- 0000 0001 2175 4264grid.411024.2Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W, Baltimore Street, Baltimore, MD 21201 USA ,0000 0001 0703 675Xgrid.430503.1Present Address: University of Colorado School of Public Health, University of Colorado, 13001 E, 17th Place, Mail Stop B119, Aurora, CO 80045 USA
| | - Jenna E. Coalson
- 0000 0001 2168 186Xgrid.134563.6Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ 85724 USA
| | - Lauren Cohee
- 0000 0001 2175 4264grid.411024.2Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W, Baltimore Street, Baltimore, MD 21201 USA
| | - Andy Bauleni
- 0000 0001 2113 2211grid.10595.38Malaria Alert Centre, University of Malawi College of Medicine, Blantyre, Malawi
| | - Jenny A. Walldorf
- 0000 0001 2175 4264grid.411024.2Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W, Baltimore Street, Baltimore, MD 21201 USA ,0000 0001 2163 0069grid.416738.fPresent Address: Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Chifundo Kandangwe
- 0000 0001 2113 2211grid.10595.38Malaria Alert Centre, University of Malawi College of Medicine, Blantyre, Malawi
| | - Themba Mzilahowa
- 0000 0001 2113 2211grid.10595.38Malaria Alert Centre, University of Malawi College of Medicine, Blantyre, Malawi
| | - Terrie E. Taylor
- 0000 0001 2150 1785grid.17088.36Department of Osteopathic Medical Specialties, Michigan State University, 909 Fee Road, East Lansing, MI 48824 USA
| | - Don P. Mathanga
- 0000 0001 2113 2211grid.10595.38Malaria Alert Centre, University of Malawi College of Medicine, Blantyre, Malawi
| | - Miriam K. Laufer
- 0000 0001 2175 4264grid.411024.2Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W, Baltimore Street, Baltimore, MD 21201 USA
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20
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Asingizwe D, Poortvliet PM, Koenraadt CJM, van Vliet AJH, Ingabire CM, Mutesa L, Leeuwis C. Role of individual perceptions in the consistent use of malaria preventive measures: mixed methods evidence from rural Rwanda. Malar J 2019; 18:270. [PMID: 31395048 PMCID: PMC6686450 DOI: 10.1186/s12936-019-2904-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/05/2019] [Indexed: 12/03/2022] Open
Abstract
Background Malaria preventive measures, including long-lasting insecticide-treated bet nets (LLINs), indoor residual spraying (IRS), and controlling mosquito breeding sites, are key measures to achieve malaria elimination. Still, compliance with these recommended measures remains a major challenge. By applying a novel and comprehensive model for determinants of malaria prevention behaviour, this study tests how individual perceptions influence the intentions to use malaria preventive measures and explores strategies that stimulate their consistent use. Methods The study was carried out in the sectors of Ruhuha and Busoro, Rwanda during October and November 2017, and these were conducted into two phases. Phase one involved a questionnaire survey (N = 742), whereas Phase two employed a qualitative approach that included nine focus group discussions, seven key informant interviews, and three in-depth interviews. Results The findings of the quantitative study showed that participants very often use LLINs (66.6%), accept IRS (73.9%), and drain stagnant water in case of presence (62%). The intentions to use malaria preventive measures were consistently driven by perceived severity, perceived self-efficacy, perceived response efficacy, and subjective norms, and hindered by perceived barriers. The intentions were also positively associated with the actual use of LLINs, acceptance of IRS, and drainage of stagnant water. There is no evidence that either not having enough LLINs (ownership of at least one bed net in the household, here referred to as availability) or having sufficient LLINs (having one LLIN per two people in the household, here referred to as accessibility) moderated the relationship between behavioural intentions and actual use of LLINs. The qualitative study indicated that participants believed malaria risk to be high and perceived a high mosquito density. They also believed that repetitive malaria episodes are caused by the perceived low effectiveness of anti-malaria medications. Lack of LLINs increased the perceived added value of LLINs, and together with the increased malaria burden increased the perceived response efficacy. Participants highlighted the need to continuously mobilize and engage community members especially those who do not use LLINs when having one, and those who do not accept the spraying activities. Conclusion Malaria prevention interventions should target individual perceptions to enhance consistent use of malaria preventive measures. Three strategies to improve consistent use and acceptance of these measures are highlighted: (1) ensure access to LLINs and regular spraying activities, (2) community mobilization and (3) citizen engagement in malaria prevention activities.
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Affiliation(s)
- Domina Asingizwe
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. .,Strategic Communication Group, Wageningen University and Research, Wageningen, The Netherlands.
| | - P Marijn Poortvliet
- Strategic Communication Group, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Arnold J H van Vliet
- Environmental Systems Analysis Group, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Leon Mutesa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Cees Leeuwis
- Knowledge, Technology and Innovation Group, Wageningen University and Research, Wageningen, The Netherlands
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Linn SY, Maung TM, Tripathy JP, Shewade HD, Oo SM, Linn Z, Thi A. Barriers in distribution, ownership and utilization of insecticide-treated mosquito nets among migrant population in Myanmar, 2016: a mixed methods study. Malar J 2019; 18:172. [PMID: 31088451 PMCID: PMC6518764 DOI: 10.1186/s12936-019-2800-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 05/04/2019] [Indexed: 01/09/2023] Open
Abstract
Background Sleeping under insecticide-treated mosquito nets/long-lasting insecticidal nets (ITNs/LLINs henceforth referred to as ITNs) is one of the core interventions recommended by the World Health Organization to reduce malaria transmission and prevent malaria in high-risk communities, such as migrants, by preventing mosquito bites. The malaria burden among the migrant population is a big challenge for malaria elimination in Myanmar. In this context, this study aimed to assess the ownership and utilization of ITNs and to understand the barriers to distribution and utilization of ITNs among the high-risk migrant communities in the Regional Artemisinin Resistance Initiative (RAI) project areas of Myanmar. Methods A sequential mixed methods study (quantitative component: cross-sectional study involving analysis of secondary data available from a survey conducted among migrant households in the RAI project areas of Myanmar in 2016 followed by a descriptive qualitative component in 2018). A total of 17 focus group discussions (involving 121 participants) with different groups of migrants and 17 key-informant interviews with key programme stakeholders were conducted in 4 selected townships of RAI project areas. Results Of 3230 migrant households, 63.3% had at least one ITN while 36% had sufficient ITNs (i.e., 1 ITN per 2 persons). Regarding ITN utilization, about 52% of household members reported sleeping under an ITN the previous night, which is similar among under-fives and pregnant women. Over half of all bed nets were ITNs, with nearly one-third having holes or already undergone repairs. The qualitative findings revealed that the key challenges for ITN utilization were insufficient ITNs in households and dislike of ITNs. The barriers to ITN distribution were incomplete migrant mapping due to resource constraints (time, money, manpower) and difficulties in transportation and carrying ITNs. Conclusion This study highlights poor ownership and utilization of ITNs among migrants in the RAI project areas of Myanmar and barriers to their ownership and utilization. To achieve universal coverage and utilization, more programmatic support by the programme is needed to carry out complete migrant mapping and continuous ITN distribution in remote locations.
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Affiliation(s)
- Shwe Yi Linn
- Vector Borne Disease Control, Naypyi Taw, Southern Shan State, Myanmar.
| | - Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India.,International Union Against Tuberculosis and Lung Disease, Paris, France.,All India Institute of Medical Sciences, Nagpur, India
| | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Swai Mon Oo
- Population Services International, Yangon, Myanmar
| | - Zaw Linn
- Vector Borne Disease Control Programme, Ministry of Health and Sports, Naypyi Taw, Myanmar
| | - Aung Thi
- Vector Borne Disease Control Programme, Ministry of Health and Sports, Naypyi Taw, Myanmar
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Peprah S, Dhudha H, Ally H, Masalu N, Kawira E, Chao CN, Genga IO, Mumia M, Were PA, Kinyera T, Otim I, Legason ID, Biggar RJ, Bhatia K, Goedert JJ, Pfeiffer RM, Mbulaiteye SM. A population-based study of the prevalence and risk factors of low-grade Plasmodium falciparum malaria infection in children aged 0-15 years old in northern Tanzania. Trop Med Int Health 2019; 24:571-585. [PMID: 30843638 PMCID: PMC6499672 DOI: 10.1111/tmi.13225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Northern Tanzania experiences significant malaria-related morbidity and mortality, but accurate data are scarce. We update the data on patterns of low-grade Plasmodium falciparum malaria infection among children in northern Tanzania. METHODS Plasmodium falciparum malaria prevalence (pfPR) was assessed in a representative sample of 819 children enrolled in 94 villages in northern Tanzania between October 2015 and August 2016, using a complex survey design. Individual- and household-level risk factors for pfPR were elicited using structured questionnaires. pfPR was assessed using rapid diagnostic tests (RDTs) and thick film microscopy (TFM). Associations with pfPR, based on RDT, were assessed using adjusted odds ratios (aOR) and confidence intervals (CI) from weighted survey logistic regression models. RESULTS Plasmodium falciparum malaria prevalence (pfPR) was 39.5% (95% CI: 31.5, 47.5) by RDT and 33.4% (26.0, 40.6) by TFM. pfPR by RDT was inversely associated with higher-education parents, especially mothers (5-7 years of education: aOR 0.55; 95% CI: 0.31, 0.96, senior secondary education: aOR 0.10; 95% CI: 0.02, 0.55), living in a house near the main road (aOR 0.34; 95% CI: 0.15, 0.76), in a larger household (two rooms: aOR 0.40; 95% CI: 0.21, 0.79, more than two rooms OR 0.35; 95% CI: 0.20, 0.62). Keeping a dog near or inside the house was positively associated with pfPR (aOR 2.01; 95% CI: 1.26, 3.21). pfPR was not associated with bed-net use or indoor residual spraying. CONCLUSIONS Nearly 40% of children in northern Tanzania had low-grade malaria antigenaemia. Higher parental education and household metrics but not mosquito bed-net use were inversely associated with pfPR.
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Affiliation(s)
- Sally Peprah
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Herry Dhudha
- EpideMiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) Study, Bugando Medical Center, Mwanza, Tanzania
| | - Hillary Ally
- EpideMiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) Study, Bugando Medical Center, Mwanza, Tanzania
| | - Nestory Masalu
- EpideMiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) Study, Bugando Medical Center, Mwanza, Tanzania
| | - Esther Kawira
- EMBLEM Study, Shirati Health and Educational Foundation, Shirati, Tanzania
| | - Colin N Chao
- EpideMiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) Study, Bugando Medical Center, Mwanza, Tanzania
| | - Isaiah O. Genga
- EMBLEM Study, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Mediatrix Mumia
- EMBLEM Study, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Pamela A. Were
- EMBLEM Study, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Tobias Kinyera
- EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda
| | - Isaac Otim
- EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda
| | | | - Robert J. Biggar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Kishor Bhatia
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - James J. Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Sam M. Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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Antimalarial bednet protection of children disappears when shared by three or more people in a high transmission setting of western Kenya. Parasitology 2018; 146:363-371. [PMID: 30198452 DOI: 10.1017/s003118201800149x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A sizeable proportion of households is forced to share single long-lasting insecticide treated net (LLIN). However, the relationship between increasing numbers of people sharing a net and the risk for Plasmodium infection is unclear. This study revealed whether risk for Plasmodium falciparum infection is associated with the number of people sharing a LLIN in a holoendemic area of Kenya. Children ⩽5 years of age were tested for P. falciparum infection using polymerase chain reaction. Of 558 children surveyed, 293 (52.5%) tested positive for parasitaemia. Four hundred and fifty-eight (82.1%) reported sleeping under a LLIN. Of those, the number of people sharing a net with the sampled child ranged from 1 to 5 (median = 2). Children using a net alone or with one other person were at lower risk than non-users (OR = 0.29, 95% CI 0.10-0.82 and OR = 0.47, 95% CI 0.22-0.97, respectively). On the other hand, there was no significant difference between non-users and children sharing a net with two (OR = 0.88, 95% CI 0.44-1.77) or more other persons (OR = 0.75, 95% CI 0.32-1.72). LLINs are effective in protecting against Plasmodium infection in children when used alone or with one other person compared with not using them. Public health professionals should inform caretakers of the risks of too many people sharing a net.
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