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Mwebesa E, Awor S, Natuhamya C, Dricile R, Legason ID, Okimait D, Mangwi Ayiasi R, Tumwesigye NM. Impact of mass media campaigns on knowledge of malaria prevention measures among pregnant mothers in Uganda: a propensity score-matched analysis. Malar J 2024; 23:256. [PMID: 39182108 PMCID: PMC11344330 DOI: 10.1186/s12936-024-05083-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/17/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Uganda grapples with a considerable malaria burden, reporting prevalence rates of over 33% in some regions. To address this, the Uganda Ministry of Health employs audiovisual platforms for disseminating malaria prevention messages. However, the impact of these messages on pregnant women's knowledge of malaria prevention remains insufficiently explored. This paper therefore emphasizes the influence of audiovisual messages on the knowledge of malaria prevention measures among pregnant women in Uganda. METHODS Secondary data obtained from the Uganda Malaria Indicator Survey (MIS) 2018-2019 was used for this analysis. Women aged 15-49 were included in the study. A total of 8868 women were selected using a two-stage sample design. The two stages of selection included clusters and households. Women who were currently pregnant were included in the study, resulting in a weighted sample of 721 women. Propensity score-matched analysis was used to evaluate the impact of access to malaria messages on knowledge of prevention measures. RESULTS The study revealed that 39% [95% CI 34.0-44.2] of pregnant women were exposed to malaria messages before the survey. Those exposed had a 17.2% higher knowledge [ATT = 0.172; 95% CI 0.035-0.310] of using mosquito nets for prevention compared to those unexposed. Among women exposed, radios accounted for most form of access to mass media campaigns [64.8, 95% CI 57.0-71.8] followed by interpersonal communication [45.0, 95% CI 37.6-52.6], community health workers [38.8, 95% CI 29.6-48.8], community events [21.4, 95% CI 15.8-28.3], and social mobilization [18.3, 95% CI 12.7-25.8]. CONCLUSION Results highlight the importance of radios in spreading important malaria prevention messages to pregnant women. Being exposed to these messages is linked to increased awareness and knowledge about the proper use of insecticide-treated bed nets (ITNs) for preventing malaria. This finding underscores the importance of evaluating different channels for mass media campaigns to ensure the effective delivery of information about malaria prevention to the intended audiences.
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Affiliation(s)
- Edson Mwebesa
- Faculty of Science, Muni University, Arua, Uganda.
- School of Science and Aerospace Studies, Moi University, Eldoret, Kenya.
| | - Susan Awor
- School of Public Health, University of California Berkeley, Berkeley, USA
| | | | - Ratib Dricile
- Faculty of Health Sciences, Muni University, Arua, Uganda
| | - Ismail D Legason
- Faculty of Health Sciences, Muni University, Arua, Uganda
- Department of Oncology, Medical Sciences Division, University of Oxford, Oxford, UK
| | - David Okimait
- Faculty of Arts & Social Sciences, Africa Renewal University, Buloba, Uganda
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Miller L, Schmidt CN, Wanduru P, Wanyoro A, Santos N, Butrick E, Lester F, Otieno P, Walker D. Adapting the preterm birth phenotyping framework to a low-resource, rural setting and applying it to births from Migori County in western Kenya. BMC Pregnancy Childbirth 2023; 23:729. [PMID: 37845611 PMCID: PMC10577962 DOI: 10.1186/s12884-023-06012-7] [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: 03/28/2022] [Accepted: 09/19/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Preterm birth is the leading cause of neonatal and under-five mortality worldwide. It is a complex syndrome characterized by numerous etiologic pathways shaped by both maternal and fetal factors. To better understand preterm birth trends, the Global Alliance to Prevent Prematurity and Stillbirth published the preterm birth phenotyping framework in 2012 followed by an application of the model to a global dataset in 2015 by Barros, et al. Our objective was to adapt the preterm birth phenotyping framework to retrospective data from a low-resource, rural setting and then apply the adapted framework to a cohort of women from Migori, Kenya. METHODS This was a single centre, observational, retrospective chart review of eligible births from November 2015 - March 2017 at Migori County Referral Hospital. Adaptations were made to accommodate limited diagnostic capabilities and data accuracy concerns. Prevalence of the phenotyping conditions were calculated as well as odds of adverse outcomes. RESULTS Three hundred eighty-seven eligible births were included in our study. The largest phenotype group was none (no phenotype could be identified; 41.1%), followed by extrauterine infection (25.1%), and antepartum stillbirth (16.7%). Extrauterine infections included HIV (75.3%), urinary tract infections (24.7%), malaria (4.1%), syphilis (3.1%), and general infection (3.1%). Severe maternal condition was ranked fourth (15.6%) and included anaemia (69.5%), chronic respiratory distress (22.0%), chronic hypertension prior to pregnancy (5.1%), diabetes (3.4%), epilepsy (3.4%), and sickle cell disease (1.7%). Fetal anaemia cases were the most likely to transfer to the newborn unit (OR 5.1, 95% CI 0.8, 30.9) and fetal anomaly cases were the most likely to result in a pre-discharge mortality (OR 3.9, 95% CI 0.8, 19.2). CONCLUSIONS Using routine data sources allowed for a retrospective analysis of an existing dataset, requiring less time and fewer resources than a prospective study and demonstrating a feasible approach to preterm phenotyping for use in low-resource settings to inform local prevention strategies.
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Affiliation(s)
- Lara Miller
- University of California San Francisco, Institute for Global Health Sciences, 550 16Th St, San Francisco, CA, 94158, USA.
| | - Christina N Schmidt
- University of California San Francisco, School of Medicine, 533 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Phillip Wanduru
- School of Public Health, Makerere University, New Mulago Gate Rd, Kampala, Uganda
| | - Anthony Wanyoro
- Department of Obstetrics and Gynaecology, Kenyatta University, Main Campus, Kenya Drive, Nairobi, Kenya
| | - Nicole Santos
- University of California San Francisco, Institute for Global Health Sciences, 550 16Th St, San Francisco, CA, 94158, USA
| | - Elizabeth Butrick
- University of California San Francisco, Institute for Global Health Sciences, 550 16Th St, San Francisco, CA, 94158, USA
| | - Felicia Lester
- Department of Obstetrics, University of California San Francisco, Gynaecology & Reproductive Sciences, 1825 Fourth St Third Floor, San Francisco, CA, 94158, USA
| | - Phelgona Otieno
- Kenya Medical Research Institute, 00200 Off Raila Odinga Way, Nairobi, Kenya
| | - Dilys Walker
- University of California San Francisco, Institute for Global Health Sciences, 550 16Th St, San Francisco, CA, 94158, USA
- Department of Obstetrics, University of California San Francisco, Gynaecology & Reproductive Sciences, 1825 Fourth St Third Floor, San Francisco, CA, 94158, USA
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Barry I, Toure AA, Sangho O, Beavogui AH, Cisse D, Diallo A, Magassouba AS, Sylla Y, Doumbia L, Cherif MS, Camara AY, Diawara F, Tounkara M, Delamou A, Doumbia S. Variations in the use of malaria preventive measures among pregnant women in Guinea: a secondary analysis of the 2012 and 2018 demographic and health surveys. Malar J 2022; 21:309. [PMID: 36316702 PMCID: PMC9623996 DOI: 10.1186/s12936-022-04322-3] [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: 03/20/2022] [Accepted: 10/18/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Despite its effectiveness, the optimal use of the combination of insecticide-treated nets (ITN) and intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) remains low in malaria-endemic areas. Therefore, this study analyzed its variations and predictors in Guinea. METHODS This study was a secondary analysis of the 2012 and 2018 Guinea Demographic and Health Surveys (DHS). It included women who had given birth 3 years before each DHS, slept on ITN and took at least one dose of SP. Use was complete if a pregnant woman slept on ITNs and took SP (at least two doses in 2012; at least three doses in 2018). Moran indices were used to determine spatial autocorrelation and classification methods to identify malaria preventive measures (MPM) predictors. RESULTS In 2012, 60.88% of pregnant women had incomplete use of MPMs compared with 79.11% in 2018. Associated factors with incomplete MPMs in 2012 were as follows: having an indirect link with the head of household (AOR = 2.23, 95% CI 1.08-4.61) and performing at least 4 ANC visits (AOR = 0.66, 95% CI 0.44-0.99). In 2018: Living in households of 2 to 5 people (AOR = 0.54, 95% CI 0.36-0.80), have a man as the head of the household (AOR = 0.56, 95% CI 0.35-0.89), perform the first ANC in the second trimester of pregnancy (AOR = 0.74, 95% CI 0.54-0.99), perform at least 4 ANC visits (AOR = 0.47, 95% CI 0.36-0.62), have a job (AOR = 0. 67, 95% CI 0.50-0.88), give birth in a public health facility (AOR = 0.53, 95% CI 0.39-0.72) and the middle wealth quintile (AOR = 1.56, 95% CI 1.07-2.26). Analyses revealed a global autocorrelation (Moran index = 0.0009, p = 0.2349) and high-high clusters in Mamou in 2012. In 2018, autocorrelation was found (I Moran = 0.0169, p ≤ 0.05), with spatial clusters in 4 regions. CONCLUSION The link with the head of household and the number of ANC visits were the main factors in MPMs. It is essential to implement strategies at the household level and health system level and monitor them to reduce inequality across regions.
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Affiliation(s)
- Ibrahima Barry
- grid.461088.30000 0004 0567 336XDépartement d’Enseignement et de Recherche en Santé Publique et Spécialités (DERSP), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali ,National Centre for Training and Research in Rural Health of Mafèrinyah, Forécariah, Guinea
| | - Almamy Amara Toure
- National Centre for Training and Research in Rural Health of Mafèrinyah, Forécariah, Guinea ,Department of Public Health, Kofi Annan University of Guinea, Conakry, Guinea
| | - Oumar Sangho
- grid.461088.30000 0004 0567 336XDépartement d’Enseignement et de Recherche des Sciences Biologiques et Médicales (DERSBM), Faculté de Pharmacie (FAPH), USTTB, Bamako, Mali
| | - Abdoul Habib Beavogui
- National Centre for Training and Research in Rural Health of Mafèrinyah, Forécariah, Guinea
| | - Diao Cisse
- grid.442347.20000 0000 9268 8914Department of Public Health, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
| | - Abdourahamane Diallo
- Service de Gynécologie, Centre Hospitalo-Universitaire Ignace Deen, Conakry, Guinea
| | - Aboubacar Sidiki Magassouba
- grid.442347.20000 0000 9268 8914Department of Public Health, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
| | - Younoussa Sylla
- National Centre for Training and Research in Rural Health of Mafèrinyah, Forécariah, Guinea
| | - Lancina Doumbia
- grid.461088.30000 0004 0567 336XDépartement d’Enseignement et de Recherche en Santé Publique et Spécialités (DERSP), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
| | - Mahamoud Sama Cherif
- National Centre for Training and Research in Rural Health of Mafèrinyah, Forécariah, Guinea
| | - Alseny Yarie Camara
- National Centre for Training and Research in Rural Health of Mafèrinyah, Forécariah, Guinea
| | - Fatou Diawara
- Institut National de Santé Publique Mali, Bamako, Mali
| | - Moctar Tounkara
- grid.461088.30000 0004 0567 336XDépartement d’Enseignement et de Recherche en Santé Publique et Spécialités (DERSP), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
| | - Alexandre Delamou
- grid.442347.20000 0000 9268 8914Department of Public Health, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea ,African Centre of Excellence in the Prevention and Control of Communicable Diseases (CEA-PCMT), Conakry, Guinea
| | - Seydou Doumbia
- grid.461088.30000 0004 0567 336XDépartement d’Enseignement et de Recherche en Santé Publique et Spécialités (DERSP), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
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Mohammed AG, Duah D, Kenu E, Nonvignon J, Manu A, Bonful HA. Factors influencing health workers' compliance with the WHO intermittent preventive treatment for malaria in pregnancy recommendations in the Northern Region, Ghana. Malar J 2022; 21:273. [PMID: 36153616 PMCID: PMC9509592 DOI: 10.1186/s12936-022-04286-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although IPTp-SP is a lifesaving World Health Organization (WHO) recommended preventive intervention for pregnant women in malaria-endemic regions, IPTp-SP uptake in the Northern region of Ghana is much lower than the sub-optimal national coverage level. Assessing the extent of health workers' compliance and its associated factors will generate valuable pointers to be targeted at the program level. The study examined the factors influencing health workers' compliance with the WHO recommended guidelines for IPTp-SP in the Northern Region. METHODS A cross-sectional study among 315 health workers in the Northern region was conducted. Semi-structured questionnaires were used to collect data on health workers' sociodemographic characteristics, facility-based factors and knowledge level. Data were collected on health workers' compliance with the recommended practices through covert observations using a checklist. Facility observations were carried out using a checklist. Crude and adjusted logistic regression were used to determine predictors of health workers' compliance, at a 5% significance level adjusting for clustering. RESULTS Of the 315 health workers studied, the median age was 29 years (26-34 years). Females constituted (80.5%; 252) of the 313 workers. The majority (47.4%;148) of the 312 health workers were midwives. Overall, 56.2% (CI 51.0 - 62.0) were adequately complying with the recommended guidelines. Lower levels of compliance were recorded in health centres 15.6% (5.0 - 33.0) and CHPS compounds 21.2% (11.0 - 35.0). The factors associated with compliance included health workers' knowledge (aOR = 7.64, 95% CI 4.21 - 13.87, p < 0.001), job satisfaction (aOR 10.87, 95% CI 7.04 - 16.79, p < 0.001), in-service training (aOR 10.11, 95% CI 4.53 - 22.56, p < 0.001), supervision (aOR 4.01, 95% CI 2.09 - 7.68, p < 0.001), availability of job aids (aOR 3.61, 95% CI 2.44 - 5.35, p < 0.001), health workers experience (aOR = 10.64, 95% CI 5.99 - 18.91, p < 0.001) and facility type (aOR 0.03, 95% CI 0.01-0.07, p < 0.001). CONCLUSION Compliance with the recommended IPTp-SP guidelines is suboptimal in the region, with lower-level health facilities recording the least compliance levels. Health centres and CHPS facilities should be prioritized in distributing limited resources to improve health worker quality of care for antenatal care clients.
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Affiliation(s)
- Abdul Gafaru Mohammed
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Dwomoh Duah
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Ghana
| | - Ernest Kenu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
| | - Alex Manu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Harriet Affran Bonful
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana.
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Vincenz C, Dolo Z, Saye S, Lovett JL, Strassmann BI. Risk factors for placental malaria, sulfadoxine-pyrimethamine doses, and birth outcomes in a rural to urban prospective cohort study on the Bandiagara Escarpment and Bamako, Mali. Malar J 2022; 21:110. [PMID: 35361195 PMCID: PMC8974163 DOI: 10.1186/s12936-022-04125-6] [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: 12/24/2021] [Accepted: 03/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria in Mali remains a primary cause of morbidity and mortality, with women at high risk during pregnancy for placental malaria (PM). Risk for PM and its association with birth outcomes was evaluated in a rural to urban longitudinal cohort on the Bandiagara Escarpment and the District of Bamako. METHODS Placental samples (N = 317) were collected from 249 mothers who were participants in a prospective cohort study directed by BIS in the years 2011 to 2019. A placental pathologist and research assistant evaluated the samples by histology in blinded fashion to assess PM infection stage and parasite density. Generalized estimating equations (GEE) were used to model the odds of PM infection. RESULTS In a multivariable model, pregnancies in Bamako, beyond secondary education, births in the rainy season (instead of the hot dry season), and births to women who had ≥ 3 doses of sulfadoxine-pyrimethamine (SP) instead of no doses were associated with reduced odds of experiencing PM (active and past infections combined). Births in later years of the study were strongly associated with reduced odds of PM. Maternal age, which was positively associated with offspring year of birth, was significant as a predictor of PM only if offspring year of birth was omitted from the model. Gravidity was positively associated with both maternal age and offspring year of birth such that if either variable was included in the model, then gravidity was no longer significant. However, if maternal age or year of offspring birth were not adjusted for, then the odds of PM were nearly two-fold higher in primigravida compared to multigravida. Birth outcomes improved (+ 285 g birth weight, + 2 cm birth length, + 75 g placental weight) for women who had ≥ 3 doses of SP compared to no doses, but no difference was detected in birth weight or length for women who had 2 instead of ≥ 3 SP doses. However, at 2 instead of ≥ 3 doses placentas were 36 g lighter and the odds of low birth weight (< 2500 g) were 14% higher. Severe parasite densities (> 10% erythrocytes infected) were significantly associated with decreases in birth weight, birth length, and placental weight, as were chronic PM infections. The women who received no SP during pregnancy (7% of the study total) were younger and lacked primary school education. The women who received ≥ 3 doses of SP came from more affluent families. CONCLUSIONS Women who received no doses of SP during pregnancy experienced the most disadvantageous birth outcomes in both Bamako and on the Bandiagara Escarpment. Such women tended to be younger and to have had no primary school education. Targeting such women for antenatal care, which is the setting in which SP is most commonly administered in Mali, will have a more positive impact on public health than focusing on the increment from two to three doses of SP, although that increment is also desirable.
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Affiliation(s)
- Claudius Vincenz
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Zachary Dolo
- Independent Investigator, Bandiagara Cercle, Mali
| | - Serou Saye
- Independent Investigator, Bandiagara Cercle, Mali
| | - Jennie L Lovett
- Department of Anthropology, University of Michigan, Ann Arbor, MI, USA
| | - Beverly I Strassmann
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA. .,Department of Anthropology, University of Michigan, Ann Arbor, MI, USA.
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Roux AT, Maharaj L, Oyegoke O, Akoniyon OP, Adeleke MA, Maharaj R, Okpeku M. Chloroquine and Sulfadoxine-Pyrimethamine Resistance in Sub-Saharan Africa-A Review. Front Genet 2021; 12:668574. [PMID: 34249090 PMCID: PMC8267899 DOI: 10.3389/fgene.2021.668574] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/20/2021] [Indexed: 12/20/2022] Open
Abstract
Malaria is a great concern for global health and accounts for a large amount of morbidity and mortality, particularly in Africa, with sub-Saharan Africa carrying the greatest burden of the disease. Malaria control tools such as insecticide-treated bed nets, indoor residual spraying, and antimalarial drugs have been relatively successful in reducing the burden of malaria; however, sub-Saharan African countries encounter great challenges, the greatest being antimalarial drug resistance. Chloroquine (CQ) was the first-line drug in the 20th century until it was replaced by sulfadoxine-pyrimethamine (SP) as a consequence of resistance. The extensive use of these antimalarials intensified the spread of resistance throughout sub-Saharan Africa, thus resulting in a loss of efficacy for the treatment of malaria. SP was replaced by artemisinin-based combination therapy (ACT) after the emergence of resistance toward SP; however, the use of ACTs is now threatened by the emergence of resistant parasites. The decreased selective pressure on CQ and SP allowed for the reintroduction of sensitivity toward those antimalarials in regions of sub-Saharan Africa where they were not the primary drug for treatment. Therefore, the emergence and spread of antimalarial drug resistance should be tracked to prevent further spread of the resistant parasites, and the re-emergence of sensitivity should be monitored to detect the possible reappearance of sensitivity in sub-Saharan Africa.
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Affiliation(s)
- Alexandra T. Roux
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Leah Maharaj
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Olukunle Oyegoke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Oluwasegun P. Akoniyon
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Matthew Adekunle Adeleke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Rajendra Maharaj
- Office of Malaria Research, South African Medical Research Council, Cape Town, South Africa
| | - Moses Okpeku
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
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