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Faye SLB, Lugand MM, Offianan AT, Dossou-Yovo A, Kouadio DKM, Pinto F. Field testing of user-friendly perennial malaria chemoprevention packaging in Benin, Côte d'Ivoire and Mozambique. Malar J 2024; 23:157. [PMID: 38773567 PMCID: PMC11106929 DOI: 10.1186/s12936-024-04977-0] [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: 12/21/2023] [Accepted: 05/07/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Perennial malaria chemoprevention (PMC) aims to protect children at risk from severe malaria by the administration of anti-malarial drugs to children of defined ages throughout the year. Sulfadoxine-pyrimethamine (SP) has been widely used for chemoprevention in Africa and a child-friendly dispersible tablet formulation has recently become available. METHODS This qualitative non-interventional observational study was conducted in Benin, Côte d'Ivoire, and Mozambique between February and June 2022. Prototype blister packs, dispensing boxes and job aids designed to support dispersible SP deployment for PMC were evaluated using focus group discussions (FGD) and semi-structured in-depth individual interviews (IDI) with health authorities, health personnel, community health workers (CHWs) and caregivers. The aim was to evaluate knowledge and perceptions of malaria and chemoprevention, test understanding of the tools and identify gaps in understanding, satisfaction, user-friendliness and acceptability, and assess the potential role of CHWs in PMC implementation. Interviews were transcribed and imported to ATLAS.ti for encoding and categorization. Thematic content analysis used deductive and inductive coding with cross-referencing of findings between countries and participants to enrich data interpretation. Continuous comparison across the IDI and FGD permitted iterative, collaborative development of materials. RESULTS Overall, 106 participants completed IDIs and 70 contributed to FGDs. Malaria was widely recognised as the most common disease affecting children, and PMC was viewed as a positive intervention to support child health. The role of CHWs was perceived differently by the target groups, with caregivers appreciating their trusted status in the community, whereas health authorities preferred clinic-based deployment of PMC by health professionals. Empirical testing of the prototype blister packs, dispensing boxes and job aids highlighted the context-specific expectations of respondents, such as familiar situations and equipment, and identified areas of confusion or low acceptance. A key finding was the need for a clear product identity reflecting malaria. CONCLUSION Simple modifications profoundly affected the perception of PMC and influenced acceptability. Iterative quantitative investigation resulted in PMC-specific materials suited to the local context and socio-cultural norms of the target population with the aim of increasing access to chemoprevention in children most at risk of severe malaria.
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Affiliation(s)
- Sylvain Landry Birane Faye
- Laboratoire de Sociologie, Anthropologie, Psychologie (LASAP), Department of Sociology, Cheikh Anta DIOP University (UCAD), Dakar, Senegal
| | - Maud Majeres Lugand
- Medicines for Malaria Venture, 20 Route de Pré-Bois, PO Box 1826, 1215, Geneva 15, Switzerland.
| | - André Touré Offianan
- Department of Parasitology & Mycology, Institut Pasteur of Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Aurélie Dossou-Yovo
- Directorate of Health Training and Research, Ministry of Health, Cotonou, Benin
| | - Dieudonné Kouakou M'Bra Kouadio
- Département d'Anthropologie et de Sociologie/Centre de Recherche Pour le Développement, Université Alassane Ouattara, Bouaké, Côte d'Ivoire
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Mutoro J, Kafunjo JB, Eric-Kitutu F, Kalyango J, Mumbere I, Nshakira N. Level of and factors associated with optimal uptake of intermittent preventive treatment for malaria in pregnancy at private-not-for-profit health facilities in Kasese district. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002622. [PMID: 38569001 PMCID: PMC10990232 DOI: 10.1371/journal.pgph.0002622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/23/2024] [Indexed: 04/05/2024]
Abstract
Malaria in pregnancy poses a high risk of poor maternal and neonatal outcomes and WHO recommends IPTp. However, its uptake has remained sub-optimal among mothers who attend antenatal care at private-not-for-profit health facilities. This study determined the level of and factors associated with uptake Intermittent preventive treatment of malaria for pregnant women (IPTp) at private-not-for-profit (PNFP) health facilities in Kasese District, Uganda. This was a cross-sectional study involving 396 postpartum mothers in the postnatal wards of 8 PNFP health facilities in Kasese district was conducted in September 2022. One hospital and 2 Health Centre IVs were purposively selected and 5 Health Centre IIIs selected randomly. Mothers were consecutively selected and interviewer administered semi-structured questionnaires were used to collect the data. Data were entered in epi-data version 3.1, cleaned and analyzed using STATA version 14. Data were adjusted for clustering & modified poison regression was used to determine associations of the factors and the outcome. From the analysis, level of optimal uptake of IPTp was 51.5% CI = (46.6-56.4). Being married (aPR = 1.35, 95% CI = 1.06-1.7, p = 0.014), attending ANC more than 4 Visits (aPR = 1.29, 95%CI = 1.09-1.54, p<0.001) positively influence optimal uptake while not taking IPTp at recommended time intervals (aPR = 0.49, 95%CI = 0.39-0.62 p<0.001) and mothers paying for IPTp drugs themselves (aPR = 0.74, 95%CI = 0.57-0.97, p = 0.031) negatively influence optimal uptake. This moderate uptake of IPTp among pregnant mothers suggests insufficient protection of pregnant mothers against malaria. Efforts to improve Antenatal care attendance, taking IPTp at recommended time intervals, not paying for ITPp drugs and encouraging marriages should be intensified.
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Affiliation(s)
- Julius Mutoro
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Justus Barageine Kafunjo
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Freddy Eric-Kitutu
- Department of Pharmacy, School of Health Sciences, Makerere University, Kampala, Uganda
| | - Joan Kalyango
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Iving Mumbere
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nathan Nshakira
- Department of Community Health, School of Medicine, Kabale University, Kampala, Uganda
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Zare M, Vatandoost H, Soleimani-Ahmadi M, Sanei-Dehkordi A, Jaberhashemi SA, Mohseni S. Knowledge and Practices of Women Regarding Malaria and Its Prevention: A Community-Based Study in an Area under Malaria Elimination Programme in Iran. J Arthropod Borne Dis 2023; 17:383-399. [PMID: 38868676 PMCID: PMC11164615 DOI: 10.18502/jad.v17i4.15301] [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: 10/20/2021] [Accepted: 11/26/2023] [Indexed: 06/14/2024] Open
Abstract
Background Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are two core interventions for control and prevention of malaria infection. This descriptive cross-sectional study aimed to determine the knowledge and practices of women regarding malaria and its preventive measures in a malarious area in the Jask County, southeast of Iran. Methods Data was collected from 400 households through a two-stage random cluster sampling method in six villages. Pre-tested structured questionnaire was used to collect data. During the survey, visual observations were also made by the interviewers to check use of LLINs and IRS. The data were analyzed by SPSS software version 21. Results The majority of households had a high level of knowledge about symptoms (98%, n=392) and transmission (74.5%, n=298) of malaria. The main preventive measures against malaria were: LLINS (39.5%, n=158), IRS (32%, n=128), and screens on doors/windows (16.7%, n=67). In addition, participants with primary or higher educational level reported that they practice more malaria preventive measures, compared to those who were illiterate (OR=3.3, 95% CI= 1.6-6.6, p=0.0001, Table 6). In spite of positive perceptions about IRS and LLINs, only 35.5% (n=142) and 17% (n=68) of households used IRS and LLINs, respectively. Conclusion According to the results of this study, despite a high level of knowledge about malaria and its preventive measures, a small number of participants use LLINs and IRS for malaria prevention. Therefore, implementation of effective educational interventions is recommended to improve preventive practices against malaria in the study area.
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Affiliation(s)
- Mehdi Zare
- Department of Occupational Health Engineering, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hassan Vatandoost
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Chemical Pollutants and Pesticides, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Moussa Soleimani-Ahmadi
- Department of Medical Entomology and Vector Control, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Alireza Sanei-Dehkordi
- Department of Medical Entomology and Vector Control, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Shokrollah Mohseni
- Student Research Committee, Shiraz University of Medical Science, Shiraz, Iran
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Hutchinson P, Zulliger R, Butts JK, Candrinho B, Saifodine A, Eisele TP, Yukich J. Interpersonal communication, cultural norms, and community perceptions associated with care-seeking for fever among children under age five in Magoé district, Mozambique. Malar J 2023; 22:279. [PMID: 37735394 PMCID: PMC10515048 DOI: 10.1186/s12936-023-04689-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: 06/30/2022] [Accepted: 08/26/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Malaria is endemic throughout Mozambique, contributing significantly to the country's burden of disease. Prompt and effective treatment for fevers in children can limit the mortality and morbidity impacts of the disease but many children in the country are not taken for formal care when ill. Using an ideational model of behaviour, this study assesses the magnitude of the relationships for potential drivers of care-seeking, including interpersonal communication, malaria messaging, and knowledge and attitudes about malaria, with actual care-seeking behaviours for under-five children with fever in Magoé district, Mozambique. METHODS Data on the care-seeking behaviours for fever come from a 2019 household malaria survey in Magoé district. Households were randomly selected for interview from among those with at least one child under age five and one net for every two household members. From 1621 mother-child dyads, the analytical sample consists of 300 children under age five with a fever in the 2 weeks prior to the survey. Multilevel random effects logistic regression models are estimated to test for associations between care-seeking behaviours and hypothesized behavioural determinants, including interpersonal communication (IPC), malaria messaging, ideational factors (e.g., norms, attitudes, beliefs, risk perceptions), and community characteristics. RESULTS Overall, 18.5% of children under age five (N = 300) were reported to have fever in the previous 2 weeks and, of these, 68.5% were taken to a formal sector health care provider. Multivariate models highlight significant roles for interpersonal communication; care-seeking was highest among mothers who spoke only with friends/community members about malaria (94.0%, p < 0.001), followed by those who spoke only with their husband (78.6%, p = 0.015), relative to 63.3% who spoke with no one. Care-seeking decisions made by a child's grandmother were associated with a 25.0% point (p = 0.001) greater likelihood of seeking care relative to decisions made by the mother alone. Exposure to any malaria messaging was also positively associated with care-seeking (90.5% versus 62.7%, p < 0.001). In contrast, among all individual- and community-level ideational factors, only perceptions of self-efficacy to seek care were related to care-seeking behaviours. CONCLUSIONS These results suggest that social and behaviour change interventions that focus on encouraging families and community members to talk about malaria and the need to promptly seek treatment for fevers in children may be particularly effective at increasing this behaviour in this and similar settings. Such messaging and IPC should consider grandmothers as a target audience, as they appear to be perceived as highly influential in care-seeking decision-making in this community.
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Affiliation(s)
- Paul Hutchinson
- Department of International Health and Sustainable Development, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Rose Zulliger
- U.S. President's Malaria Initiative, U.S. Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Jessica K Butts
- U.S. President's Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Abu Saifodine
- U.S. President's Malaria Initiative, United States Agency for International Development, Maputo, Mozambique
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Josh Yukich
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Malaria Knowledge-Base and Prevalence of Parasitaemia in Asymptomatic Adults in the Forest Zone of Ghana. Acta Parasitol 2022; 67:1719-1731. [PMID: 36261782 DOI: 10.1007/s11686-022-00629-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/05/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To determine the levels of knowledge, awareness and perception of malaria, and to determine the infection status among asymptomatic adults in selected districts. METHODS This descriptive, cross-sectional study recruited 849 participants from seven districts in the malaria meso-endemic forest zone of Ghana. Questionnaires were administered to elicit responses from asymptomatic adults on malaria awareness, knowledge and insecticide-treated net (ITN) usage. Capillary blood samples were taken from study subjects for malaria Rapid Diagnostic Test (RDT) and microscopy. Descriptive statistics was used to analyse quantitative and qualitative data. RESULTS Ninety-eight percent of participants were aware of malaria, 94.0% owned ITNs but only 35.5% consistently used them. Also, 56.7% correctly associated malaria with mosquitoes and 54.5% identified stagnant water as the breeding site. Twelve percent (12.2%) and 13.1% of the subjects tested positive for malaria via RDT and microscopy, respectively. Of the 111 confirmed malaria cases, 107 had Plasmodium falciparum infections, two had Plasmodium ovale infections and there were two Plasmodium falciparum-Plasmodium ovale mixed infections. CONCLUSION Awareness and knowledge of malaria was satisfactory but this did not translate into mosquito avoidance behaviour due to deep-seated perceptions and myths. With the prevalence of asymptomatic parasitaemia observed, this reservoir of infection could be dislodged with appropriate health education targeted at women in the rural communities.
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