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García GA, Galick DS, Smith JM, Iyanga MM, Rivas MR, Mba Eyono JN, Phiri WP, Donfack OT, Smith DL, Guerra CA. The challenge of improving long-lasting insecticidal nets coverage on Bioko Island: using data to adapt distribution strategies. RESEARCH SQUARE 2024:rs.3.rs-4188387. [PMID: 38645156 PMCID: PMC11030524 DOI: 10.21203/rs.3.rs-4188387/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Since 2015, malaria vector control on Bioko Island has relied heavily upon long-lasting insecticidal nets (LLIN) to complement other interventions. Despite significant resources utilised, however, achieving and maintaining high coverage has been elusive. Here, core LLIN indicators were used to assess and redefine distribution strategies. Methods LLIN indicators were estimated for Bioko Island between 2015 and 2022 using a 1×1 km grid of areas. The way these indicators interacted was used to critically assess coverage targets. Particular attention was paid to spatial heterogeneity and to differences between urban Malabo, the capital, and the rural periphery. Results LLIN coverage according to all indicators varied substantially across areas, decreased significantly soon after mass distribution campaigns (MDC) and, with few exceptions, remained consistently below the recommended target. Use was strongly correlated with population access, particularly in Malabo. After a change in strategy in Malabo from MDC to fixed distribution points, use-to-access showed significant improvement, indicating those who obtained their nets from these sources were more likely to keep them and use them. Moreover, their use rates were significantly higher than those of whom sourced their nets elsewhere. Conclusions Striking a better balance between LLIN distribution efficiency and coverage represents a major challenge as LLIN retention and use rates remain low despite high access resulting from MDC. The cost benefit of fixed distribution points in Malabo was deemed significant, providing a viable alternative for guaranteeing access to LLINs to those who use them.
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Affiliation(s)
- Guillermo A. García
- MCD Global Health, 8403 Colesville Road, Suite 425, 20910 Silver Spring, USA
| | - David S. Galick
- MCD Global Health, Av. Parques de Africa, Malabo, Equatorial Guinea
| | - Jordan M. Smith
- MCD Global Health, 8403 Colesville Road, Suite 425, 20910 Silver Spring, USA
| | | | - Matilde Riloha Rivas
- National Malaria Control Program, Ministry of Health and Social Welfare of Equatorial Guinea, Malabo, Equatorial Guinea
| | | | - Wonder P. Phiri
- MCD Global Health, Av. Parques de Africa, Malabo, Equatorial Guinea
| | | | - David L. Smith
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, 98121 Seattle, USA
| | - Carlos A. Guerra
- MCD Global Health, 8403 Colesville Road, Suite 425, 20910 Silver Spring, USA
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Ochomo E, Rund SSC, Mthawanji RS, Antonio-Nkondjio C, Machani M, Samake S, Wolie RZ, Nsango S, Lown LA, Matoke-Muhia D, Kamau L, Lukyamuzi E, Njeri J, Chabi J, Akrofi OO, Ntege C, Mero V, Mwalimu C, Kiware S, Bilgo E, Traoré MM, Afrane Y, Hakizimana E, Muleba M, Orefuwa E, Chaki P, Juma EO. Mosquito control by abatement programmes in the United States: perspectives and lessons for countries in sub-Saharan Africa. Malar J 2024; 23:8. [PMID: 38178145 PMCID: PMC10768238 DOI: 10.1186/s12936-023-04829-3] [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: 08/10/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
Africa and the United States are both large, heterogeneous geographies with a diverse range of ecologies, climates and mosquito species diversity which contribute to disease transmission and nuisance biting. In the United States, mosquito control is nationally, and regionally coordinated and in so much as the Centers for Disease Control (CDC) provides guidance, the Environmental Protection Agency (EPA) provides pesticide registration, and the states provide legal authority and oversight, the implementation is usually decentralized to the state, county, or city level. Mosquito control operations are organized, in most instances, into fully independent mosquito abatement districts, public works departments, local health departments. In some cases, municipalities engage independent private contractors to undertake mosquito control within their jurisdictions. In sub-Saharan Africa (SSA), where most vector-borne disease endemic countries lie, mosquito control is organized centrally at the national level. In this model, the disease control programmes (national malaria control programmes or national malaria elimination programmes (NMCP/NMEP)) are embedded within the central governments' ministries of health (MoHs) and drive vector control policy development and implementation. Because of the high disease burden and limited resources, the primary endpoint of mosquito control in these settings is reduction of mosquito borne diseases, primarily, malaria. In the United States, however, the endpoint is mosquito control, therefore, significant (or even greater) emphasis is laid on nuisance mosquitoes as much as disease vectors. The authors detail experiences and learnings gathered by the delegation of African vector control professionals that participated in a formal exchange programme initiated by the Pan-African Mosquito Control Association (PAMCA), the University of Notre Dame, and members of the American Mosquito Control Association (AMCA), in the United States between the year 2021 and 2022. The authors highlight the key components of mosquito control operations in the United States and compare them to mosquito control programmes in SSA countries endemic for vector-borne diseases, deriving important lessons that could be useful for vector control in SSA.
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Affiliation(s)
- Eric Ochomo
- Entomology Department, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
- Vector Control Products Unit, Researchworld Limited, Kisumu, Kenya.
| | | | - Rosheen S Mthawanji
- Vector Biology Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Christophe Antonio-Nkondjio
- Organisation de Coordination Pour la lutte contre les Endémies en Afrique centrale (OCEAC), Yaounde, Cameroon
| | - Maxwell Machani
- Entomology Department, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Rosine Z Wolie
- Vector Control Product Evaluation Centre - Institut Pierre Richet (VCPEC-IPR), Institut National de Santé Publique (INSP), Bouaké, Côte d'Ivoire
- Unité de Formation et de Recherche des Sciences de la Nature, Université Nangui Abrogoua, Abdijan, Côte d'Ivoire
| | - Sandrine Nsango
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Centre Pasteur in Cameroon, Yaounde, Cameroon
| | | | - Damaris Matoke-Muhia
- Pan-African Mosquito Control Association (PAMCA), KEMRI Headquarters, Nairobi, Kenya
- Centre for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Luna Kamau
- Centre for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edward Lukyamuzi
- Pan-African Mosquito Control Association (PAMCA), KEMRI Headquarters, Nairobi, Kenya
| | - Jane Njeri
- Pan-African Mosquito Control Association (PAMCA), KEMRI Headquarters, Nairobi, Kenya
| | | | | | - Charles Ntege
- National Malaria Control Division Ministry of Health, Kampala, Uganda
| | - Victor Mero
- Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | | | - Samson Kiware
- Pan-African Mosquito Control Association (PAMCA), KEMRI Headquarters, Nairobi, Kenya
- Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Etienne Bilgo
- Institut de Recherche en Sciences de la Sante (IRSS) Direction regionale de l'Ouest, Bobo Dioulasso, Burkina Faso
| | - Mohamed Moumine Traoré
- Malaria Research and Training Centre, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Sciences, Techniques and Technology of Bamako, BP 1805, Bamako, Mali
| | - Yaw Afrane
- Department of Medical Microbiology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Emmanuel Hakizimana
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre (RBC), Ministry of Health, Kigali, Rwanda
- Pan-African Mosquito Control Organization (PAMCO), Rwanda Chapter, Kigali, Rwanda
| | | | - Emma Orefuwa
- Pan-African Mosquito Control Association (PAMCA), KEMRI Headquarters, Nairobi, Kenya
| | - Prosper Chaki
- Pan-African Mosquito Control Association (PAMCA), KEMRI Headquarters, Nairobi, Kenya
| | - Elijah Omondi Juma
- Pan-African Mosquito Control Association (PAMCA), KEMRI Headquarters, Nairobi, Kenya
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Munsey A, Kinyina A, Assenga M, Almeida A, Kitojo C, Reaves E, Simeo J, Aron S, Chacky F, Nhiga SL, Drake M, Lemwayi R, Lash R, Walker PGT, Gutman JR. Assessing the utility of pregnant women as a sentinel surveillance population for malaria in Geita, Tanzania, 2019 - 2021. Int J Infect Dis 2023; 136:57-63. [PMID: 37567552 PMCID: PMC10870194 DOI: 10.1016/j.ijid.2023.08.007] [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: 05/19/2023] [Revised: 07/27/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES Estimates of malaria burden and intervention uptake in Africa are primarily based on household surveys. However, their expense and infrequency limit their utility. We investigated whether data collected during antenatal care (ANC) can provide relevant information for decision-makers. METHODS Malaria test positivity rates and questionnaire data from ANC attendees at 39 health facilities were compared to questionnaire data and positivity rates among children from two cross-sectional surveys in the facilities' corresponding catchment areas. RESULTS Trends in parasitemia among ANC attendees were predictive of trends in parasitemia among children at the council level (mean absolute error 6.0%). Primigravid ANC attendees had the lowest rates of net ownership (modeled odds ratio [OR] 0.28, 95% CI 0.19-0.40) and use (OR 0.58, 95% CI 0.42-0.79). ANC attendees reported higher levels of care-seeking (OR 1.78, 95% CI 1.48-2.14), malaria testing (OR 4.16, 95% CI 3.44-5.04), and treatment for children with fever (OR 7.66, 95% CI 4.89-11.98) compared to women surveyed in households, raising concerns about social desirability bias disproportionately impacting ANC surveys. CONCLUSION ANC surveillance is an effective strategy for tracking trends in malaria burden. More work is required to elucidate the value of administering questionnaires to ANC attendees.
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Affiliation(s)
- Anna Munsey
- U.S. President's Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA.
| | | | | | | | - Chonge Kitojo
- U.S. President's Malaria Initiative, U.S. Agency for International Development (USAID), Dar es Salaam, Tanzania
| | - Erik Reaves
- U.S. President's Malaria Initiative, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | | | | | | | | | | | | | - Ryan Lash
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Patrick G T Walker
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College, London, UK
| | - Julie R Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
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Koenker H, Yukich J, Erskine M, Opoku R, Sternberg E, Kilian A. How many mosquito nets are needed to maintain universal coverage: an update. Malar J 2023; 22:200. [PMID: 37391703 DOI: 10.1186/s12936-023-04609-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/26/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Insecticide-treated nets (ITNs) have served as the cornerstone of malaria vector control in sub-Saharan Africa for the past two decades. Over 2.5 billion ITNs have been delivered since 2004 primarily through periodic mass distribution campaigns scheduled at approximately three-year intervals, aligning with the expected lifespan of nets. Recent work indicates that ITN retention times are less than two years in most countries, raising key questions for quantification approaches and delivery frequency for ITN distribution. This paper models several quantification approaches for five typical ITN distribution strategies, estimates the proportion of the population with access to an ITN, and presents recommended quantification approaches to meet global targets for ITN access and use. METHODS A stock and flow model with annual timesteps was used to model ITN distribution and resulting ITN access for 2020-2035 under five scenarios in 40 countries: (1) three-year mass campaigns, (2) full-scale annual continuous distribution, (3) three-year mass campaigns plus continuous distribution in the years between campaigns, (4) three-year mass campaigns at different quantification approaches, (5) two-year mass campaigns at different quantification approaches. All scenarios included ITN distribution to pregnant women at antenatal clinics and infants at immunization visits. RESULTS The current status quo of conducting mass campaigns every three years using a population/1.8 quantifier is insufficient to achieve or maintain targets of 80% population access to ITNs in most malaria-endemic countries, given most estimated retention times are less than three years. Tailored three- or two-year mass campaigns were less efficient than annual continuous distribution strategies in nearly all settings. For countries with at least 2.5 year median ITN retention times, full scale continuous distribution provided better ITN access while needing 20-23% fewer ITNs compared to current mass campaigns. CONCLUSION Given variation in ITN retention times across countries, tailored quantification approaches for mass campaigns and continuous distribution strategies are warranted. Continuous distribution strategies are likely to offer more efficient ways to maintain ITN coverage, with fewer nets, where ITN retention times are at least two and a half years. National malaria programmes and their funding partners should work to increase the number of ITNs available to those vulnerable to malaria, while at the same time working to extend the useful life of these critical commodities.
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Affiliation(s)
| | - Josh Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University, New Orleans, USA
| | - Marcy Erskine
- International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | - Robert Opoku
- International Federation of Red Cross and Red Crescent Societies, Nairobi, Kenya
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