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Casella A, Monroe A, Toso M, Hunter G, Underwood C, Pillai R, Hughes J, Van Lith LM, Cash S, Hwang J, Babalola S. Understanding psychosocial determinants of malaria behaviours in low-transmission settings: a scoping review. Malar J 2024; 23:15. [PMID: 38200574 PMCID: PMC10782749 DOI: 10.1186/s12936-023-04831-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Recent estimates show progress toward malaria elimination is slowing in many settings, underscoring the need for tailored approaches to fight the disease. In addition to essential structural changes, human behaviour plays an important role in elimination. Engagement in malaria behaviours depends in part on psychosocial determinants such as knowledge, perceived risk, and community norms. Understanding the state of research on psychosocial determinants in low malaria transmission settings is important to augment social and behaviour change practice. This review synthesizes research on psychosocial factors and malaria behaviours in low-transmission settings. METHODS A systematic search of peer-reviewed literature and supplemental manual search of grey literature was conducted using key terms and eligibility criteria defined a priori. Publications from 2000-2020 in the English language were identified, screened, and analysed using inductive methods to determine the relationship between the measured psychosocial factors and malaria behaviours. RESULTS Screening of 961 publications yielded 96 for inclusion. Nineteen articles collected data among subpopulations that are at increased risk of malaria exposure in low-transmission settings. Purposive and cluster randomized sampling were common sampling approaches. Quantitative, qualitative, and mixed-methods study designs were used. Knowledge, attitudes, and perceived risk were commonly measured psychosocial factors. Perceived response-efficacy, perceived self-efficacy, and community norms were rarely measured. Results indicate positive associations between malaria knowledge and attitudes, and preventive and care-seeking behaviour. Studies generally report high rates of correct knowledge, although it is comparatively lower among studies of high-risk groups. There does not appear to be sufficient extant evidence to determine the relationship between other psychosocial variables and behaviour. CONCLUSIONS The review highlights the need to deploy more consistent, comprehensive measures of psychosocial factors and the importance of reaching subpopulations at higher risk of transmission in low transmission contexts. Malaria-related knowledge is generally high, even in settings of low transmission. Programmes and research should work to better understand the psychosocial factors that have been positively associated with prevention and care-seeking behaviours, such as norms, perceived response efficacy, perceived self-efficacy, and interpersonal communication. These factors are not necessarily distinct from that which research has shown are important in settings of high malaria transmission. However, the importance of each factor and application to malaria behaviour change programming in low-transmission settings is an area in need of further research. Existing instruments and approaches are available to support more systematic collection of psychosocial determinants and improved sampling approaches and should be applied more widely. Finally, while human behaviour is critical, health systems strengthening, and structural interventions are essential to achieve malaria elimination goals.
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Affiliation(s)
- Albert Casella
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA.
| | - April Monroe
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Michael Toso
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Gabrielle Hunter
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Carol Underwood
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
- Department of Health, Behavior, & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ruchita Pillai
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Jayme Hughes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Lynn M Van Lith
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Shelby Cash
- U.S. President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jimee Hwang
- U.S. President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stella Babalola
- Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
- Department of Health, Behavior, & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Kawuki J, Donkor E, Gatasi G, Nuwabaine L. Mosquito bed net use and associated factors among pregnant women in Rwanda: a nationwide survey. BMC Pregnancy Childbirth 2023; 23:419. [PMID: 37280560 DOI: 10.1186/s12884-023-05583-9] [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: 10/24/2022] [Accepted: 04/07/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND In malaria-endemic countries such as Rwanda, the appropriate use of mosquito bed nets is an effective intervention for malaria prevention. Despite being one of the demographics most impacted by malaria, there is a dearth of literature on the usage of mosquito bed nets by pregnant women in Rwanda. The study aimed to assess the prevalence and associated factors for mosquito bed net use among pregnant women in Rwanda. METHODS We used weighted data from the 2020 Rwanda Demographic and Health Survey of 870 pregnant women, and multistage stratified sampling was used to select participants. Multivariable logistic regression was conducted to determine the factors associated with mosquito bed net use, using SPSS (version 26). RESULTS Of the 870 pregnant women, 57.9% (95%CI: 54.6-61.1) used mosquito bed nets. However, 16.7% did not use bed nets among those owning bed nets. On one hand, older age (AOR = 1.59, 95%CI: 1.04-2.44), primary education (AOR = 1.18, 95%CI: 1.07-2.23), being married (AOR = 2.17, 95%CI: 1.43-3.20), being from Kigali region (AOR = 1.97, 95%CI: 1.19-3.91), partner's education (AOR = 1.22, 95%CI: 1.13-3.41), having recently visited a health facility (AOR = 2.07, 95%CI: 1.35-3.18), and being in the third pregnancy trimester (AOR = 2.14, 95%CI: 1.44-3.18) were positively associated with mosquito bed net use. On the other hand, low wealth index (AOR = 0.13, 95%CI: 0.07-0.24), and being from Eastern region (AOR = 0.42, 95% CI: 0.26-0.66) had a negative association. CONCLUSIONS About half of the pregnant women in Rwanda used mosquito bed nets and the usage was associated with various socio-demographics. There is a need for appropriate risk communication and continuous sensitisation to improve mosquito net use among pregnant women. Early antenatal care attendance and partner engagement in malaria prevention and mosquito net use, as well as consideration of household dynamics, are also crucial in improving not only mosquito net coverage but also utilization.
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Affiliation(s)
- Joseph Kawuki
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Elorm Donkor
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ghislaine Gatasi
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Nanjing, Jiangsu Province, 210009, China
| | - Lilian Nuwabaine
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
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Regional variations in child and mother's characteristics influencing the use of insecticide treated net in Nigeria. J Biosoc Sci 2023; 55:326-343. [PMID: 35164890 DOI: 10.1017/s0021932022000050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nigeria accounts for a quarter of malaria cases worldwide, which can be prevented with the use of insecticide treated nets (ITN). While studies have documented mother-related characteristics influencing use of ITN, regional variations in the influence of those factors are not well known. This study investigated nine factors (age, place of residence, education, religion, wealth, number of children in the household, sex of child, age of child and previous experience of child mortality) as possible predictors of use of ITN for children and how the associations vary across northern and southern parts of the country. The study utilised the 2015 Nigeria Malaria Indicator Survey, which comprised 6524 mothers (4009 from the north and 2151 from the south) aged 15-49. Bivariate and multivariate logistic regression models were fitted. It was found that, less than half (47.9%) of the respondents reported no access to a mosquito net in the north compared to 70.8% in the south. More than half (51.4%) of the northern respondents used insecticide treated net (ITN) for the child compared to 27.1% of southern mothers. When the variables are fitted together in the same model, place of residence, mother's age, mother's education, wealth, religion, number of children in the household and previous experience of child mortality were associated with the use of ITN. Regional variations exist in the influence of mother's age, number of children in the household and previous experience of child mortality. It was submitted that mother's characteristics are more important than the child's factors in the use of ITN, and that, contrary to the theory of poor utilisation of health-related facilities in the north compared to the south, residents in the former have access to and use ITN more than their counterparts from the latter.
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Yeboah D, Boah M, Adokiya MN. Caregivers' use of insecticide-treated nets is associated with the use of ITNs by children under the age of five in Ghana. PLoS One 2023; 18:e0280065. [PMID: 36607997 PMCID: PMC9821783 DOI: 10.1371/journal.pone.0280065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Malaria poses a greater risk to children under the age of five years due to its high morbidity and mortality rates. The use of Insecticide-Treated Net (ITN) has been proven to be an effective preventive intervention in the control of malaria. However, its utilisation remains low. This study assessed the association of mother or caregiver's utilisation of ITN on its use by their children under five years of age in Ghana. METHODS This study used data from the 2019 Ghana Malaria Indicator Survey (GMIS). The study analysed a weighted sample of 1,876 women aged 15-49 years who had at least one child under the age of five. In this study, the outcome variable is mosquito bed net use in children under five years. We performed descriptive statistics, chi-square tests, and multinomial logistic regressions. RESULTS Of the women studied, 58.59% [95% CI: 55.39, 61.71] slept under mosquito bed nets the previous night. The utilisation of ITN in children under five was 61.88% [95% CI: 58.43, 65.2] on the night before the study. The adjusted logistic regression revealed that mothers/caregivers who slept under a mosquito bed net were more likely to have their children under five years of age sleeping under a mosquito bed net (RRR = 2.47, 95% CI: 1.48, 4.12; p <0.001). In addition, the use of ITN in children under five was also found to be predicted by the number of ANC visits, the number of children under five in the household, and wealth status. CONCLUSION The study found that the use of ITN by mothers/caregivers and their children remains low in Ghana. Nevertheless, we found that when a mother uses ITN, her children under the age of five are more likely to use it as well.
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Affiliation(s)
- Daudi Yeboah
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
- * E-mail: ,
| | - Michael Boah
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Martin Nyaaba Adokiya
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
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Babalola S, Kumoji K, Awantang GN, Oyenubi OA, Toso M, Tsang S, Bleu T, Achu D, Hedge J, Schnabel DC, Cash S, Van Lith LM, McCartney-Melstad AC, Nkomou Y, Dosso A, Lahai W, Hunter GC. Ideational factors associated with consistent use of insecticide-treated nets: a multi-country, multilevel analysis. Malar J 2022; 21:374. [PMID: 36474206 PMCID: PMC9724329 DOI: 10.1186/s12936-022-04384-3] [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: 05/20/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Malaria remains a major cause of morbidity and mortality in sub-Saharan Africa. Using insecticide-treated nets (ITNs) every night, year-round is critical to maximize protection against malaria. This study describes sociodemographic, psychosocial, and household factors associated with consistent ITN use in Cameroon, Côte d'Ivoire and Sierra Leone. METHODS Cross-sectional household surveys employed similar sampling procedures, data collection tools, and methods in three countries. The survey sample was nationally representative in Côte d'Ivoire, representative of the North and Far North regions in Cameroon, and representative of Bo and Port Loko districts in Sierra Leone. Analysis used multilevel logistic regression and sociodemographic, ideational, and household independent variables among households with at least one ITN to identify correlates of consistent ITN use, defined as sleeping under an ITN every night the preceding week. FINDINGS Consistent ITN use in Côte d'Ivoire was 65.4%, 72.6% in Cameroon, and 77.1% in Sierra Leone. While several sociodemographic and ideational variables were correlated with consistent ITN use, these varied across countries. Multilevel logistic regression results showed perceived self-efficacy to use ITNs and positive attitudes towards ITN use were variables associated with consistent use in all three countries. The perception of ITN use as a community norm was positively linked with consistent use in Cameroon and Côte d'Ivoire but was not significant in Sierra Leone. Perceived vulnerability to malaria was positively linked with consistent use in Cameroon and Sierra Leone but negatively correlated with the outcome in Côte d'Ivoire. Household net sufficiency was strongly and positively associated with consistent use in all three countries. Finally, the findings revealed strong clustering at the household and enumeration area (EA) levels, suggesting similarities in net use among respondents of the same EA and in the same household. CONCLUSIONS There are similarities and differences in the variables associated with consistent ITN use across the three countries and several ideational variables are significant. The findings suggest that a social and behaviour change strategy based on the ideation model is relevant for increasing consistent ITN use and can inform specific strategies for each context. Finally, ensuring household net sufficiency is essential.
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Affiliation(s)
- Stella Babalola
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Kuor Kumoji
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Grace N. Awantang
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Olamide A. Oyenubi
- grid.416147.10000 0004 0455 9186Department of Internal Medicine, Montefiore New Rochelle Hospital, New Rochelle, USA
| | - Michael Toso
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Samantha Tsang
- grid.21107.350000 0001 2171 9311Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Therese Bleu
- National Malaria Control Programme, Abidjan, Côte d’Ivoire
| | - Dorothy Achu
- National Malaria Control Programme, Yaounde, Cameroon
| | - Judith Hedge
- U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Yaounde, Cameroon
| | - David C. Schnabel
- U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Shelby Cash
- grid.416738.f0000 0001 2163 0069U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, USA
| | - Lynn M. Van Lith
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Anna C. McCartney-Melstad
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Yannick Nkomou
- PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Yaounde, Cameroon
| | - Abdul Dosso
- PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Abidjan, Côte d’Ivoire
| | - Wani Lahai
- National Malaria Control Programme, Freetown, Sierra Leone
| | - Gabrielle C. Hunter
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
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The Role of Human Behavior in Plasmodium knowlesi Malaria Infection: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063675. [PMID: 35329359 PMCID: PMC8953169 DOI: 10.3390/ijerph19063675] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 12/22/2022]
Abstract
Objectives: Plasmodium knowlesi is a non-human parasite that causes zoonotic disease in humans. This systematic review aims to highlight and summarize studies describing human behaviors and activities that expose humans to mosquito bites. Design: English entries in PubMed, Web of Science, and Science Direct from 2010 to 2020 were systematically perused, and the results were synthesized. Methodological quality was assessed using the Joanna Briggs Institute quality appraisal checklists. Setting: Studies that described malaria preventive measures were included. Laboratory, in vivo, in vitro, and animal studies were excluded. Primary and secondary outcome measures: The main outcome of the review was findings from studies describing the behavior that exposed a person or a group to P. knowlesi infection. Results: Twelve eligible studies were of good or medium quality. Attitude, disease misconceptions, perceived threat of disease, lack of motivation, and supernatural or traditional beliefs causing individuals to seek treatment from traditional healers influenced the exposure of individuals or communities to P. knowlesi malaria. Other factors were forestry activities (2.48, 1.45–4.23,95% CI, p = 0.0010) and sleeping outdoors (3.611, 1.48–8.85, 95% CI, p = 0.0049). Conclusions: Future studies must consider the importance of human behavior and community perspective on the infection to provide novel information to improve the current zoonotic malaria programs. Policymakers should concentrate on understanding human behavior and activities that expose individuals or communities to mosquito bites, in order to better design socially feasible interventions.
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Kumoji E'K, Awantang GN, Toso M, Kamara D, Bleu T, Lahai W, Sillah-Kanu M, Dosso A, Achu D, Babalola S. Ideational factors associated with net care behaviour: a multi-country analysis. Malar J 2022; 21:53. [PMID: 35177086 PMCID: PMC8851768 DOI: 10.1186/s12936-022-04053-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/17/2022] [Indexed: 11/12/2022] Open
Abstract
Background Malaria is endemic to sub-Saharan African countries. Mass and routine distribution, promotion, and use of ITNs are critical components of malaria prevention programmes. Correct and consistent use of insecticide-treated mosquito nets (ITN) is an effective strategy for malaria prevention. To extend bed-net lifespan, the World Health Organization recommends folding or tying up ITNs when they are not in use. This study analyses factors associated with net care practices in three African countries. Methods Researchers collected household data nationwide in Côte d’Ivoire, from the North and Far North regions of Cameroon, and from Port Loko and Bo districts in Sierra Leone, between 2018 and 2019. The dependent variable was respondents reporting that they fold or tie up their nets. The study adjusted for selected sociodemographic, ideational (psychosocial), and household variables using multilevel models. The analysis was limited to women of reproductive age and their male spouses/partners from households with at least one ITN: 2,940 respondents in Cameroon, 6,105 in Côte d’Ivoire, and 2,730 in Sierra Leone. Results Among respondents, 50.2% in Cameroon, 52.0% in Côte d’Ivoire and 75.6% in Sierra Leone reported folding or tying up their net when it was not in use. In all three countries, the data showed significant clustering at both household and community levels, indicating the influence of factors operating at these levels on net-care behaviour. The odds of reporting the behaviour varied significantly by geographic unit in each country. Consistent use of nets was strongly correlated with net-care behaviour. Furthermore, five ideational variables were positively associated with the outcome behaviour in all three countries: positive attitude towards net care, perceived susceptibility for malaria, response-efficacy of ITNs, perceived self-efficacy for net use, and the perception that net use was a community norm. Additional significant ideational variables included positive attitudes towards net use (Cameroon and Côte d’Ivoire), perceived severity of malaria (Côte d’Ivoire), and interpersonal communication about malaria (Côte d’Ivoire). Conclusions The study identified ideational variables associated with recommended net-care practice. Programme efforts designed to promote net-care practices and extend average lifespan of ITNs may be more effective if they emphasize positive attitudes towards net care, perceived susceptibility of malaria infection, response-efficacy of ITNs, perceived self-efficacy for net use, and promote net-care behaviour as a positive community norm. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04053-5.
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Affiliation(s)
- E 'Kuor Kumoji
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA.
| | - Grace N Awantang
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Michael Toso
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Diarra Kamara
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Thérèse Bleu
- Programme National de Lutte Contre Le Paludisme, Abidjan, Côte d'Ivoire
| | - Wani Lahai
- National Malaria Control Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Musa Sillah-Kanu
- National Malaria Control Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Abdul Dosso
- Programme National de Lutte Contre Le Paludisme, Abidjan, Côte d'Ivoire
| | - Dorothy Achu
- Programme National de Lutte Contre Le Paludisme Au Cameroun, Yaounde, Cameroon
| | - Stella Babalola
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Monroe A, Olapeju B, Moore S, Hunter G, Merritt AP, Okumu F, Babalola S. Improving malaria control by understanding human behaviour. Bull World Health Organ 2021; 99:837-839. [PMID: 34737477 PMCID: PMC8542269 DOI: 10.2471/blt.20.285369] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- April Monroe
- Johns Hopkins Center for Communication Programs, Suite 310, 111 Market Place, Baltimore, Maryland 21202, United States of America
| | - Bolanle Olapeju
- Johns Hopkins Center for Communication Programs, Suite 310, 111 Market Place, Baltimore, Maryland 21202, United States of America
| | - Sarah Moore
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Gabrielle Hunter
- Johns Hopkins Center for Communication Programs, Suite 310, 111 Market Place, Baltimore, Maryland 21202, United States of America
| | - Alice Payne Merritt
- Johns Hopkins Center for Communication Programs, Suite 310, 111 Market Place, Baltimore, Maryland 21202, United States of America
| | - Fredros Okumu
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Stella Babalola
- Johns Hopkins Center for Communication Programs, Suite 310, 111 Market Place, Baltimore, Maryland 21202, United States of America
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Efunshile AM, Ojide CK, Igwe D, Onyia B, Jokelainen P, Robertson LJ. Mosquito control at a tertiary teaching hospital in Nigeria. Infect Prev Pract 2021; 3:100172. [PMID: 34604733 PMCID: PMC8473772 DOI: 10.1016/j.infpip.2021.100172] [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: 07/13/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background Mosquitoes are vectors of numerous diseases, including malaria and yellow fever. Mosquito control is therefore a priority in many countries, especially in healthcare settings. Here we investigated the opinions of patients and staff regarding mosquito control at a hospital in Nigeria, and also gathered data on mosquito-control measures in this setting. Methods We conducted a cross-sectional questionnaire study of staff and patients and an observational approach to obtain data on mosquito-control measures used at a tertiary teaching hospital in Abakaliki, Nigeria. Discussion Both staff (N=517) and patients (N=302) reported experiencing more mosquito bites at the hospital than elsewhere. As well as contributing to discomfort, this exposure may put hospital staff and patients at risk of mosquito-borne infections. Complaints from patients about mosquitoes were reported by over 90% of staff, and over 50% of staff respondents were aware of patient discharge against medical advice due to mosquitoes. The most common control method was killing mosquitoes by hand. We observed a lack of door screens in all wards, window screens were absent or torn, and most beds did not have nets. In the children's wards none of the beds had nets. Conclusions Current measures against mosquitoes in this hospital appeared inadequate, and healthcare staff and hospital patients may be at increased risk of mosquito-borne infections. Mosquito control in the hospital requires attention, and the needs for improvement in mosquito control in the healthcare setting more widely should be evaluated and addressed.
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Affiliation(s)
- Akinwale M Efunshile
- Department of Medical Microbiology, Ebonyi State University, Abakaliki, Nigeria.,Department of Medical Microbiology, Alex Ekweme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Chiedozie Kingsley Ojide
- Department of Medical Microbiology, Alex Ekweme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Daniel Igwe
- Department of Medical Microbiology, Alex Ekweme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Blessing Onyia
- Department of Medical Microbiology, Alex Ekweme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Pikka Jokelainen
- Laboratory of Parasitology, Department of Bacteria, Parasites & Fungi, Infectious Disease Preparedness, Statens Serum Institut, Artillerivej 5, Copenhagen S, 2300, Denmark
| | - Lucy J Robertson
- Parasitology, Department of Paraclinical Science, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, PO box 5003, Ås, 1432, Norway
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Okoh OM, Olapeju B, Oyedokun-Adebagbo F, Inyang U, McCartney-Melstad A, Tweedie I, Babalola S, Storey D. The role of ideation on the effect of an SBC intervention on consistent bed net use among caregivers of children under 5 years in Nigeria: a multilevel mediation analysis. BMC Public Health 2021; 21:1660. [PMID: 34517875 PMCID: PMC8436470 DOI: 10.1186/s12889-021-11709-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background Malaria remains a significant public health challenge in Nigeria. Consistent bed net use (sleeping under a treated net every night) has been identified as a key malaria prevention behavior. This paper explores the relationship between mass media social and behavior change interventions, psychosocial factors, and consistent bed net use. Methods Data is from the endline survey of a USAID-funded social and behavior change communication campaign conducted from 2012 to 2017 across five states in Nigeria. The outcome measure was consistent bed net use, and the mediator variable was a composite measure called ideation from a set of psychosocial factors believed to influence bed net use. The independent variable was recall of malaria specific media messages. Multilevel mediation analysis explored if recall of malaria specific media messages had any effect on bed net related ideation and if this ideation had any effect on consistent net use. Results Respondents included in this study were on average aged 31 years, mostly married or cohabiting (97.5%) and female 75%. Four in 10 (39.7%) respondents were able to recall malaria specific messages. Respondents with low, moderate and high recall were 23, 32 and 80% more likely to have a higher ideational score in the emotional domain compared to those not able to recall. Respondents were more likely to have higher ideational scores in the cognitive domain if they had low (AOR = 1.26, 95% CI 1.15–1.38), moderate (AOR = 1.16, 95% CI 1.00–1.34) or high recall (AOR = 1.55, 95% CI 1.16–2.06), respectively compared to those with no recall. Similarly, respondents with low (AOR = 1.03, 95% CI .99–1.08), moderate (AOR = 1.15, 95% CI 1.08–1.23) and high (AOR = 1.15, 95% CI 1.01–1.30) recall were more likely to have a higher ideational score in the social domain compared to those with no recall. After adjusting for recall of media messages and other potential covariates, all three ideational domains also had a significant positive effect on consistent bed net use. For every unit increase in ideational score, the likelihood of reporting consistent bed net use increased by 5 to 10%. There was a significant indirect effect of recalling malaria specific messages on consistent bed net use through each of the ideational domains. Conclusion Access to a bed net is a critical first step in the process of bed net utilization. However, psychosocial factors e.g., emotional, cognitive, and social domains of ideation also play a major role in bed net use. Mass media SBC interventions could potentially influence bed net related ideation and consequently improve net use behavior. Future Social and behavior change interventions should employ approaches that improve these domains of ideation within their audiences in order to increase bed net utilization. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11709-5.
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Affiliation(s)
- Osabohien Mathew Okoh
- Johns Hopkins University Center for Communication programs (JHUCCP), Baltimore, USA.
| | - Bolanle Olapeju
- Johns Hopkins University Center for Communication programs (JHUCCP), Baltimore, USA
| | - Foyeke Oyedokun-Adebagbo
- United States President's Malaria Initiative/United States Agency for International Development (PMI/USAID), Washington, D.C., USA
| | - Uwem Inyang
- United States President's Malaria Initiative/United States Agency for International Development (PMI/USAID), Washington, D.C., USA
| | | | - Ian Tweedie
- Johns Hopkins University Center for Communication programs (JHUCCP), Baltimore, USA
| | - Stella Babalola
- Johns Hopkins University Center for Communication programs (JHUCCP), Baltimore, USA
| | - Douglas Storey
- Johns Hopkins University Center for Communication programs (JHUCCP), Baltimore, USA
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Kebede Y, Sudhakar M, Alemayehu G, Abebe L, Birhanu Z. Comparing insecticide-treated nets access-use based on universal household and population indicators vis-a-vis measures adapted to sleeping spaces in Ethiopia. Malar J 2021; 20:355. [PMID: 34454501 PMCID: PMC8403356 DOI: 10.1186/s12936-021-03887-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/19/2021] [Indexed: 11/14/2022] Open
Abstract
Background Insecticide-treated nets (ITNs) access-use has been pivotal monitoring indicator for malaria prevention and control, particularly in resource limited settings. The objective of the study was to compare ITN access-use based on universal household and population indicators and measures adapted to sleeping spaces. Methods A cross-sectional study was conducted in five districts of Jimma Zone, Ethiopia, March, 2019. 762 HHs were sampled for the survey. Multi-stage followed by simple random sampling used. Monitoring and evaluation reference group’s (MERG’s) indicators were used for measuring ITN access-use. MERG’s indicators are each adapted ITN access-use to sleeping spaces. Household (ownership, saturation and sufficiency) and population access and household members’ status of last night sleeping under ITN compared based on the two models. Differences of estimates of ITN access-use based on the two methods reported as magnitude of over/under estimations, at p-value < 0.05. Results Based on MERG’s approach, the study revealed household (HH) based indicators as such: HH ownership of at least 1 ITN (92.6%), sufficiency of ITN for every two people in HH (50.3%), and saturation of ITN for every 2 people in HHs with any ITN (54.6%). Moreover, population based indicators were: population with ITN access (P3 = 78.6%), people who slept under ITN previous night (63.0%), people who slept under ITN among who accessed it (73.1%), ITN use-gap (26.9%). Equivalent indicators of HH ownership, sufficiency, saturation, and people accessed at where they actually slept, and people slept under ITN among those accessed at where they slept estimated at 71.3%, 49.4%, 69.3%, 66.3%, and 92.1%, respectively. MERG’s approach over-estimated ownership, people’s access, and behaviour-failures by 21.3%, 12.3%, 19.0%, respectively. Over-estimation occurred for reasons such as many sleeping spaces lack ITN and > 2 people actually slept per sleeping space. Conclusions MERG’s universal indicators over estimated households and populations ITN access-use as a result of absence of measures capturing access-use values at spaces where people actually slept. Consequently, measures adapted to sleeping contexts revealed potential misdistributions practiced when the existing indicators are in use. Insertion of sleeping spaces into existing approach will be worthwhile and needs to be promoted as it improves curiosity in ITN distribution, produces closer estimates and prevents malaria prevention and control programmes from overlooking access-use challenges.
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Affiliation(s)
- Yohannes Kebede
- Department of Health, Behavior, and Society, Jimma University, Jimma, Oromia, Ethiopia.
| | - Morankar Sudhakar
- Department of Health, Behavior, and Society, Jimma University, Jimma, Oromia, Ethiopia
| | - Guda Alemayehu
- President's Malaria Initiative, United States Agency for International Development, Addis Ababa, Ethiopia
| | - Lakew Abebe
- Department of Health, Behavior, and Society, Jimma University, Jimma, Oromia, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behavior, and Society, Jimma University, Jimma, Oromia, Ethiopia
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Carrel M, Kim S, Mwandagalirwa MK, Mvuama N, Bala JA, Nkalani M, Kihuma G, Atibu J, Diallo AO, Goel V, Thwai KL, Juliano JJ, Emch M, Tshefu A, Parr JB. Individual, household and neighborhood risk factors for malaria in the Democratic Republic of the Congo support new approaches to programmatic intervention. Health Place 2021; 70:102581. [PMID: 34020231 PMCID: PMC8328915 DOI: 10.1016/j.healthplace.2021.102581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Democratic Republic of the Congo (DRC) remains one of the countries most impacted by malaria despite decades of control efforts, including multiple mass insecticide treated net (ITN) distribution campaigns. The multi-scalar and complex nature of malaria necessitates an understanding of malaria risk factors over time and at multiple levels (e.g., individual, household, community). Surveillance of households in both rural and urban settings over time, coupled with detailed behavioral and geographic data, enables the detection of seasonal trends in malaria prevalence and malaria-associated behaviors as well as the assessment of how the local environments within and surrounding an individual's household impact malaria outcomes. METHODS Participants from seven sites in Kinshasa Province, DRC were followed for over two years. Demographic, behavioral, and spatial information was gathered from enrolled households. Malaria was assessed using both rapid diagnostic tests (RDT) and polymerase chain reaction (PCR) and seasonal trends were assessed. Hierarchical regression modeling tested associations between behavioral and environmental factors and positive RDT and PCR outcomes at individual, household and neighborhood scales. RESULTS Among 1591 enrolled participants, malaria prevalence did not consistently vary seasonally across the sites but did vary by age and ITN usage. Malaria was highest and ITN usage lowest in children ages 6-15 years across study visits and seasons. Having another member of the household test positive for malaria significantly increased the risk of an individual having malaria [RDT: OR = 4.158 (2.86-6.05); PCR: OR = 3.37 (2.41-4.71)], as did higher malaria prevalence in the 250 m neighborhood around the household [RDT: OR = 2.711 (1.42-5.17); PCR: OR = 4.056 (2.3-7.16)]. Presence of water within close proximity to the household was also associated with malaria outcomes. CONCLUSIONS Taken together, these findings suggest that targeting non-traditional age groups, children >5 years old and teenagers, and deploying household- and neighborhood-focused interventions may be effective strategies for improving malaria outcomes in high-burden countries like the DRC.
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Affiliation(s)
- Margaret Carrel
- Department of Geographical & Sustainability Sciences, 305 Jessup Hall, University of Iowa, Iowa City, IA, 52245, USA.
| | - Seungwon Kim
- Department of Geographical & Sustainability Sciences, 305 Jessup Hall, University of Iowa, Iowa City, IA, 52245, USA.
| | - Melchior Kashamuka Mwandagalirwa
- Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA; Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Nono Mvuama
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Joseph A Bala
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Marthe Nkalani
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Georges Kihuma
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Joseph Atibu
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Alpha Oumar Diallo
- Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Varun Goel
- Department of Geography, CB3220, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Kyaw L Thwai
- Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Jonathan J Juliano
- Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA; Division of Infectious Diseases, School of Medicine, CB#7030, 130 Mason Farm Road, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Michael Emch
- Department of Geography, CB3220, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Antoinette Tshefu
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Jonathan B Parr
- Division of Infectious Diseases, School of Medicine, CB#7030, 130 Mason Farm Road, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
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Okagbue HI, Oguntunde PE, Obasi ECM, Adamu PI, Opanuga AA. Diagnosing malaria from some symptoms: a machine learning approach and public health implications. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-020-00488-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Anaba U, Hutchinson PL, Abegunde D, White Johansson E. Pneumonia-related ideations, care-seeking, and treatment behaviors among children under 2 years with pneumonia symptoms in northwestern Nigeria. Pediatr Pulmonol 2020; 55 Suppl 1:S91-S103. [PMID: 31990144 DOI: 10.1002/ppul.24644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prompt treatment of pediatric pneumonia symptoms is a cornerstone of child survival programs but remains a challenge in Nigeria. Psychosocial influences, or ideations, directly influence pathways to care but have not been previously measured or examined for pediatric pneumonia. METHODS A two-stage cluster-sample cross-sectional population-based survey was conducted in Kebbi, Sokoto, and Zamfara States in September 2019. Across 108 enumeration areas, all households were enumerated to census pregnant women and randomly sample women with children under 2 years ("under-twos") for inclusion. Respondents were asked about pediatric pneumonia and other health-related behaviors and ideations developed using the Ideation Model of Strategic Communication and Behavior Change. Prevalence ratios for predictors of care-seeking from formal medical sources and antibiotic treatment for pneumonia symptoms among under-twos were calculated using mixed-effects Poisson regression models with robust error variance. RESULTS Among 350 under-twos with pneumonia symptoms, 33.8% were taken to formal medical care and 38.0% used antibiotics. Women who positively viewed treatment efficacy and those who positively viewed health services quality had 1.35 (95% CI: 1.00-1.82; P = .050) and 2.13 (95% CI: 1.35-3.35; P = .001) times higher likelihood of attending formal medical sources, while women viewing peers as mostly attending drug shops had 29% lower likelihood. Perceived treatment efficacy and illness susceptibility were also significant predictors for antibiotic use. CONCLUSIONS Program interventions focusing on increasing pneumonia knowledge alone may not be sufficient to improve care-seeking and treatment rates and should expand to address perceived and actual poor-quality health services and maternal beliefs about treatment efficacy, social norms, illness severity, and susceptibility.
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Affiliation(s)
- Udochisom Anaba
- Breakthrough RESEARCH/Nigeria, Abuja, Nigeria.,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans
| | - Paul L Hutchinson
- Breakthrough RESEARCH/Nigeria, Abuja, Nigeria.,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans
| | - Dele Abegunde
- Breakthrough RESEARCH/Nigeria, Abuja, Nigeria.,Population Council, Washington, District of Columbia
| | - Emily White Johansson
- Breakthrough RESEARCH/Nigeria, Abuja, Nigeria.,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans
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15
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Adedokun ST, Uthman OA. Individual and contextual correlates of mosquito net use among women in Nigeria. Malar J 2020; 19:138. [PMID: 32264875 PMCID: PMC7137195 DOI: 10.1186/s12936-020-03219-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/01/2020] [Indexed: 11/26/2022] Open
Abstract
Background Malaria has been described as an urgent public health priority with almost half of the world’s population being at risk. Use of insecticide-treated nets is considered one of the effective ways of preventing malaria. Nigeria, which is ranked among the five countries that are responsible for almost half of the global malaria cases, has less than half of its women population using mosquito nets. This study examined the effects of individual and contextual factors on the use of mosquito nets among women of reproductive age in Nigeria. Methods This study used data obtained from 2015 Nigeria Malaria Indicator Survey (NMIS) which involved 6048 women aged 15–49 who possessed at least one mosquito net. Multilevel binary logistic regression models were applied in the multivariable analysis. Results About 53% of the women used mosquito nets with more than 60% of uneducated and poor women in this category. The use of mosquito nets was significantly associated with being from poor households, having knowledge about the cause of malaria, having access to malaria messages, possessing knowledge about the efficacy of malaria prevention drugs during pregnancy, having knowledge about the importance of tests to detect malaria, maintaining small household size and living in the most socioeconomically disadvantaged communities and states. Conclusions The study revealed that mosquito net use among women in Nigeria is affected by individual and contextual factors. It is important for policy makers to design a mosquito-net-use model which would take individual and contextual factors into consideration.
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Affiliation(s)
- Sulaimon T Adedokun
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Olalekan A Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK.,Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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16
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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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Ricotta E, Oppong S, Yukich JO, Briët OJT. Determinants of bed net use conditional on access in population surveys in Ghana. Malar J 2019; 18:63. [PMID: 30849976 PMCID: PMC6408824 DOI: 10.1186/s12936-019-2700-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/01/2019] [Indexed: 12/02/2022] Open
Abstract
Background Insecticide-treated nets (ITNs) are one of the most effective and widely available methods for preventing malaria, and there is interest in understanding the complexities of behavioural drivers of non-use among those with access. This analysis evaluated net use behaviour in Ghana by exploring how several household and environmental variables relate to use among Ghanaians with access to a net. Methods Survey data from the Ghana 2014 Demographic and Health Survey and the 2016 Malaria Indicator Survey were used to calculate household members’ access to space under a net as well as the proportion of net use conditional on access (NUCA). Geospatial information on cluster location was obtained, as well as average humidex, a measure of how hot it feels, for the month each cluster was surveyed. The relationship between independent variables and net use was assessed via beta-binomial regression models that controlled for spatially correlated random effects using non-Gaussian kriging. Results In both surveys, increasing wealth was associated with decreased net use among those with access in households when compared to the poorest category. In 2014, exposure to messages about bed net use for malaria prevention was associated with increased net use (OR 2.5, 95% CrI 1.5–4.2), as was living in a rural area in both 2014 (OR 2.5, 95% CrI 1.5–4.3) and 2016 (OR 1.6, 95% CrI 1.1–2.3). The number of nets per person was not associated with net use in either survey. Model fit was improved for both surveys by including a spatial random effect for cluster, demonstrating some spatial autocorrelation in the proportion of people using a net. Humidex, electricity in the household and IRS were not associated with NUCA. Conclusion Net use conditional on access is affected by household characteristics and is also spatially-dependent in Ghana. Setting (whether the household was urban or rural) plays a role, with wealthier and more urban households less likely to use nets when they are available. It will likely be necessary in the future to focus on rural settings, urban settings, and wealth status independently, both to better understand predictors of household net use in these areas and to design more targeted interventions to ensure consistent use of vector control interventions that meet specific needs of the population. Electronic supplementary material The online version of this article (10.1186/s12936-019-2700-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emily Ricotta
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, P.O. Box CH-4001, Basel, Switzerland.
| | - Samuel Oppong
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Korle-bu, P. O. Box KB 493, Accra, Ghana
| | - Joshua O Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St. #8317, New Orleans, LA, 70112, USA
| | - Olivier J T Briët
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland.,University of Basel, Petersplatz 1, P.O. Box CH-4001, Basel, Switzerland
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