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Alga A, Wasihun Y, Ayele T, Endawkie A, Feleke SF, Kebede N. Factors influencing delay in malaria treatment seeking at selected public health facilities in South Gonder, Ethiopia. Sci Rep 2024; 14:6648. [PMID: 38503838 PMCID: PMC10951229 DOI: 10.1038/s41598-024-56413-7] [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: 09/06/2023] [Accepted: 03/06/2024] [Indexed: 03/21/2024] Open
Abstract
Early and prompt treatment-seeking for malaria is necessary to reduce the progression of the disease to its severe forms and the associated mortality. Various studies have indicated that treatments sought for malaria were not always within the recommended timeframe. Therefore, this study aims to assess factors influencing delay in malaria treatment seeking at public health facilities in South Gonder, Ethiopia. An unmatched case-control study was conducted among 322 individuals, comprising 161 cases and 161 controls, who were randomly selected malaria patients visiting public health facilities in South Gonder District, Ethiopia, from May 20/2022 to June 25/2022. An interviewer-administered questionnaire was used to collect data, which were subsequently cleaned and entered into Epi data. Descriptive statistics were performed, and variables with a p-value of ≤ 0.25 from the bivariate analysis were included in a multivariable logistic regression model. Significant variables with a p-value of < 0.05 were retained in the multivariable model. Patients who were unable to read and write [AOR = 3.47 (1.01-11.9)], fear of side effects of malaria treatment drugs [AOR = 1.89 (1.04-3.42)], lack of access to health education malaria disease and its treatment [AOR = 1.93 (1.02-3.65)], lack of transportation access [AOR = 4.70 (1.73-12.7)], not membership of community-based health insurance [AOR = 2.5 (1.3-4.82)] and lack of confidence on malaria care health facility providing [AOR = 2.14 (1.06-4.29)], were found to be determinants of treatment-seeking delay among malaria patients. In Summary, this study revealed significant associations between delays in seeking malaria treatment and factors such as educational status (those who were unable to read and write), malaria drug side effects, health education on malaria, transportation access, CBHI membership, and confidence in health malaria care. it is recommended that targeted interventions and awareness campaigns be implemented to address these determinants, promoting prompt and effective malaria treatment-seeking behavior in the studied population.
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Affiliation(s)
- Adimasu Alga
- Department of Reproductive and Family Health, School of Public Health, College of Medicine Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitbarek Wasihun
- Department of Health Promotion, School of Public Health, College of Medicine Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tiruneh Ayele
- Department of Epidemiology and Biostatics, School of Public Health, College of Medicine Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abel Endawkie
- Department of Epidemiology and Biostatics, School of Public Health, College of Medicine Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine Health Sciences, Wollo University, Dessie, Ethiopia.
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Naserrudin NA, Adhikari B, Culleton R, Hod R, Jeffree MS, Ahmed K, Hassan MR. Knowledge, compliance, and challenges in anti-malarial products usage: a systematic review of at-risk communities for zoonotic malaria. BMC Public Health 2024; 24:317. [PMID: 38287308 PMCID: PMC10823597 DOI: 10.1186/s12889-024-17792-8] [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: 07/18/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Zoonotic malaria is a growing public health threat in the WHO Southeast Asia (SEA) and Western Pacific (WP) regions. Despite vector-control measures, the distribution of Macaque fascicularis and M. nemestrina, and Anopheles mosquitoes carrying non-human simian malaria parasites poses challenges to malaria elimination. The systematic review assesses the literature on knowledge and malaria-preventive practices in zoonotic malaria-affected areas across the WHO SEA and WP, aiming to identify challenges for malaria control. METHODS Peer-reviewed articles published in English, Malay and Indonesian between January 2010 and December 2022 were searched in OVID Medline, Scopus, Web of Science, and Google Scholar. Studies of any design-excluding reviews, conference proceedings, and reports from all WHO SEA and WP countries vulnerable to zoonotic malaria-were included. Backwards-reference screening and thematic analysis were conducted. RESULTS Among 4,174 initially searched articles, 22 peer-reviewed articles met the inclusion criteria. An additional seven articles were identified through backwards-reference screening, resulting in a total of 29 articles for this review. Half of these studies were conducted in Cambodia, Myanmar, Malaysia, and Thailand, mainly in forests and remote communities. The review highlighted inconsistencies in the operationalization of knowledge, and five major themes were identified related to knowledge: causation and transmission, symptoms, treatment, severity and complications, and malaria prevention. While participants generally had some understanding of malaria causation/transmission, minority and indigenous ethnic groups demonstrated limited knowledge and held misconceptions, such as attributing malaria to drinking dirty water. Preventive practices included traditional and non-traditional or modern methods-with a preference for traditional approaches to avoid mosquito bites. Challenges to malaria control included feasibility, cost, and access to healthcare services. CONCLUSION This review provides insights into knowledge, local understandings, and preventive practices related to malaria in the WHO SEA and WP regions. The findings highlight the need for future research to explore the knowledge of at-risk communities regarding zoonotic malaria, their perceive threat of the disease and factors exposing them to zoonotic malaria. New strategies must be developed for zoonotic malaria programs tailored to local contexts, emphasizing the significance of community participation, health education, and socio-behavioural change initiatives. It is important to consider the interconnectedness of human health, environmental and non-human primates conservation. Socio-cultural nuances should also be carefully considered in the design and implementation of these programs to ensure their effect tailored to local contexts.
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Affiliation(s)
- Nurul Athirah Naserrudin
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Setia Alam, Shah alam, 40170, Malaysia
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
| | - Bipin Adhikari
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Richard Culleton
- Division of Molecular Parasitology, Proteo-Science Center, Ehime University, Toon, Ehime, 791-0295, Japan
| | - Rozita Hod
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
| | - Mohammad Saffree Jeffree
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia, Sabah, 88400, Kota Kinabalu, Malaysia
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, 88400, Malaysia
| | - Kamruddin Ahmed
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia, Sabah, 88400, Kota Kinabalu, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia.
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia, Sabah, 88400, Kota Kinabalu, Malaysia.
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Xu JW, Deng DW, Wei C, Zhou XW, Li JX. Treatment-seeking behaviours of malaria patients versus non-malaria febrile patients along China-Myanmar border. Malar J 2023; 22:309. [PMID: 37833761 PMCID: PMC10576386 DOI: 10.1186/s12936-023-04747-4] [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: 03/14/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Appropriate malaria treatment-seeking behaviour (TSB) is critical for timely detecting malaria, prompt treatment, and prevention of onward transmission of the disease in a community. This study aimed to compare treatment-seeking behaviours between malaria patients and non-malaria febrile patients, and to analyse the factors associated with appropriate TSB along the China-Myanmar border. METHODS A cross-sectional study was carried out to investigate the appropriate TSB of microscopy-confirmed malaria patients versus non-malaria febrile (NMF) patients. An unconditional logistic regression analysis (LRA) was used to identify factors associated with appropriate TSB. RESULTS Among 223 malaria patients and 446 NMF patients, 129 (57.8%) of the malaria patients versus 163 (36.5%) of the NMF patients firstly sought treatment in health facilities without laboratory testing for malaria (P < 0.0001). A total of 85(38.1%) of the malaria patients versus 278 (62.3%) of the NMF patients had appropriate TSB, namely, seeking treatment in health facilities with laboratory testing for malaria within 48 h (P < 0.0001). Multivariate LRA identified that the malaria patients with Chinese nationality had less appropriate TSB compared to those with other nationalities (adjusted odds ratio [AOR]: 0.21, 95% confidence interval CI 0.07-0.68, P = 0.0097), and malaria patients residing in urban areas had more appropriate TSB compared to those living in rural areas (AOR: 2.16, 95%CI 1.06-4.39, P = 0.0337). CONCLUSIONS TSB was not appropriate in malaria patients. Chinese citizenship and rural residence were two independent factors associated with inappropriate malaria TSB. It is urgently necessary to improve appropriate malaria TSB through effective campaigns of information, education, and communication for malaria control in Myanmar and preventing reestablishment of malaria transmission in Yunnan, China.
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Affiliation(s)
- Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China.
| | - Dao-Wei Deng
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China
| | - Chun Wei
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China
| | - Xing-Wu Zhou
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China
| | - Jian-Xiong Li
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China
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Rahmalia A, Poespoprodjo JR, Landuwulang CUR, Ronse M, Kenangalem E, Burdam FH, Thriemer K, Devine A, Price RN, Peeters Grietens K, Ley B, Gryseels C. Adherence to 14-day radical cure for Plasmodium vivax malaria in Papua, Indonesia: a mixed-methods study. Malar J 2023; 22:162. [PMID: 37210520 PMCID: PMC10199529 DOI: 10.1186/s12936-023-04578-3] [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: 06/15/2022] [Accepted: 04/25/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Reducing the risk of recurrent Plasmodium vivax malaria is critical for malaria control and elimination. Primaquine (PQ) is the only widely available drug against P. vivax dormant liver stages, but is recommended as a 14-day regimen, which can undermine adherence to a complete course of treatment. METHODS This is a mixed-methods study to assess socio-cultural factors influencing adherence to a 14-day PQ regimen in a 3-arm, treatment effectiveness trial in Papua, Indonesia. The qualitative strand, consisting of interviews and participant observation was triangulated with a quantitative strand in which trial participants were surveyed using a questionnaire. RESULTS Trial participants differentiated between two types of malaria: tersiana and tropika, equivalent to P. vivax and Plasmodium falciparum infection, respectively. The perceived severity of both types was similar with 44.0% (267/607) perceiving tersiana vs. 45.1% (274/607) perceiving tropika as more severe. There was no perceived differentiation whether malaria episodes were due to a new infection or relapse; and 71.3% (433/607) acknowledged the possibility of recurrence. Participants were familiar with malaria symptoms and delaying health facility visit by 1-2 days was perceived to increase the likelihood of a positive test. Prior to health facility visits, symptoms were treated with leftover drugs kept at home (40.4%; 245/607) or bought over the counter (17.0%; 103/607). Malaria was considered to be cured with 'blue drugs' (referring to dihydroartemisinin-piperaquine). Conversely, 'brown drugs,' referring to PQ, were not considered malaria medication and instead were perceived as supplements. Adherence to malaria treatment was 71.2% (131/184), in the supervised arm, 56.9% (91/160) in the unsupervised arm and 62.4% (164/263) in the control arm; p = 0.019. Adherence was 47.5% (47/99) among highland Papuans, 51.7% (76/147) among lowland Papuans, and 72.9% (263/361) among non-Papuans; p < 0.001. CONCLUSION Adherence to malaria treatment was a socio-culturally embedded process during which patients (re-)evaluated the characteristics of the medicines in relation to the course of the illness, their past experiences with illness, and the perceived benefits of the treatment. Structural barriers that hinder the process of patient adherence are crucial to consider in the development and rollout of effective malaria treatment policies.
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Affiliation(s)
- Annisa Rahmalia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia.
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
- Institute of Tropical Medicine, Antwerp, Belgium.
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika District Hospital, Timika, Indonesia
- Paediatric Research Office, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Chandra U R Landuwulang
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
| | - Maya Ronse
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Enny Kenangalem
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika Regency Health Authority, Timika, Papua, Indonesia
| | - Faustina H Burdam
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika Regency Health Authority, Timika, Papua, Indonesia
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Angela Devine
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Koen Peeters Grietens
- Institute of Tropical Medicine, Antwerp, Belgium
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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Nadia J, Wang Y, Li G, Sun L, Mmadi SA, Abdallah KS, Abdallah AM, Shu L, Bacar A, Deng C, Huang X, Zhou X, Song J, Lu F. KNOWLEDGE, ATTITUDES, AND PRACTICES TOWARD MALARIA AND ANTIMALARIAL MASS DRUG ADMINISTRATION AMONG HEADS OF HOUSEHOLDS IN VILLAGES ON GRANDE COMORE ISLAND, THE COMOROS. J Parasitol 2023; 109:187-199. [PMID: 37270766 DOI: 10.1645/22-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Knowledge, attitudes, and practices (KAP) surveys on malaria and antimalarial mass drug administration (MDA) have not received much attention in the Union of the Comoros. This study is a household-based cross-sectional survey using a multi-stage sampling technique aiming at investigating KAP toward malaria and antimalarial MDA with artemisinin-piperaquine among heads of households on Grande Comore Island, the largest island of the Comoros. A predefined structured questionnaire containing socio-demographic characteristics and questions about malaria and antimalarial MDA was administered to 1,368 randomly selected heads of households from 10 malaria-endemic villages on Grande Comore Island. The results showed that 81.4% of the heads of households knew that malaria is a transmissible disease, 77.6% recognized mosquitoes as the vectors of malaria, and 70.8% recognized fever as one of the frequent symptoms of malaria; 40.8% of respondents remembered the name of the antimalarial drug used for MDA, and 62.1% remembered the color of the antimalarial tablets; and 65.1% chose to go to a public health center to seek treatment as their first option within 24 hr of the onset of initial malaria symptoms. This study found that most heads of households had a reasonable level of knowledge about malaria and antimalarial MDA. However, only 7.3% obtained full points on all knowledge-related questions. Misconceptions about malaria cause, transmission, diagnostic method, and antimalarial MDA exist in the community of Grande Comore Island. As the Comoros continues to put great efforts to go toward malaria elimination, the community's KAP on malaria and antimalarial MDA is crucial to guarantee the community's long-term adherence to malaria elimination interventions and could become key to guaranteeing malarial elimination in the Comoros. Therefore, there is a great need to improve malaria prevention awareness through strengthening malaria education and promoting behavioral change. Heads of households should be the core target of malaria education and behavioral change for malaria elimination.
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Affiliation(s)
- Julie Nadia
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou 510440, China
| | - Yuxin Wang
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou 510440, China
| | - Guoming Li
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou 510440, China
| | - Liwei Sun
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou 510440, China
| | - Salim Abdoulkarim Mmadi
- Ministry of Health, Social Cohesion, Solidarity, and Gender Promotion, Bâtiment de la Fonction Publique, BP 1028, Moroni, the Union of the Comoros
| | - Kamal Said Abdallah
- National Malaria Control Program, Route de la Corniche, BP 5212, Moroni, the Union of the Comoros
| | - Ali Maoulida Abdallah
- Ministry of Health, Social Cohesion, Solidarity, and Gender Promotion, Bâtiment de la Fonction Publique, BP 1028, Moroni, the Union of the Comoros
| | - Lei Shu
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou 510440, China
| | - Affane Bacar
- National Malaria Control Program, Route de la Corniche, BP 5212, Moroni, the Union of the Comoros
| | - Changsheng Deng
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Xinan Huang
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Xian Zhou
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou 510440, China
| | - Jianping Song
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Fangli Lu
- Clinical Laboratory, the Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; Department of Parasitology, School of Medicine, Sun Yat-sen University, Shenzhen 518107, China; Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China; and Key Laboratory of Tropical Disease of the Ministry of Education, Sun Yat-sen University, Guangzhou 510080, China
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Rafati S, Baniasadi T, Dastyar N, Zoghi G, Ahmadidarrehsima S, Salari N, Rafati F. Prevalence of self-medication among the elderly: A systematic review and meta-analysis. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:67. [PMID: 37113410 PMCID: PMC10127510 DOI: 10.4103/jehp.jehp_630_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/14/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND Self-medication is the use of unprescribed drugs to treat a disease. Elderly self-medication can be more dangerous compared to other age groups because of changes in organ functions that occur due to senescence. This study aimed to estimate the prevalence of self-medication in the elderly, its related factors, and common drugs used in this regard. MATERIALS AND METHODS Electronic databases such as PubMed, Scopus, and Web of Science were searched between January 2016 and June 2021. The search strategy was built on two core concepts: "self-medication" and "aged". The search was limited to original articles in the English language. A random effect model was used to estimate the pooled prevalence of self-medication. Heterogeneity among studies was assessed using both the I2 statistic and the χ 2 test. Also, a meta-regression model was used to investigate the potential sources of heterogeneity of the studies. RESULTS Out of 520 non-duplicate studies, 38 were included in the meta-analysis. Self-medication in the elderly ranged from 0.3% to 82%. The pooled proportion of self-medication was 36% (95% CI: 27%-45%). The result of the χ 2 test and the I2 index (P < 0.001, I2= 99.90%) revealed notable heterogeneity among the included studies in the meta-analysis. The meta-regression showed a significant association between the sample size (adjusted β = -0.01; P = 0.043) and the pooled proportion of self-medication. CONCLUSION The prevalence of self-medication in the elderly is high. Education through mass media to raise awareness about the dangers of self-medication can help solve this problem.
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Affiliation(s)
- Shideh Rafati
- Social Factors in Health Promotion Research Center, Hormozgan Health Research Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Tayebeh Baniasadi
- Department of Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Neda Dastyar
- Department of Midwifery, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Ghazal Zoghi
- Endocrinology and Metabolism Research Center, Hormozgan Univesity of Medical Sciences, Bandar Abbas, Iran
| | - Sudabeh Ahmadidarrehsima
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Nasibeh Salari
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Foozieh Rafati
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
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Thet MM, Khaing MNT, Zin SS, Thein ST, Tesfazghi K. Choice of health providers and health-seeking behaviour among forest goer population in Myanmar: findings from a cross-sectional household survey. Malar J 2022; 21:382. [PMID: 36517905 PMCID: PMC9749299 DOI: 10.1186/s12936-022-04356-7] [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: 03/22/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In Myanmar, malaria still poses a significant burden for vulnerable populations particularly forest goers even though impressive progress has been made over the past decade. Limited evidence existed related to forest goers' health-seeking behaviour and factors that drive decision making for providers' choice to support national malaria programmes towards elimination. In response to that, this research is conducted to identify who they preferred and what are the factors associated with providers' choice in malaria febrile illness and Rapid Diagnostic Testing (RDT). METHODS A cross-sectional study applying quantitative household survey was completed with 479 forest goer households in 20 malaria endemic townships across Myanmar. The household data was collected with the types of providers that they consulted for recent and previous febrile episodes. To identify the factors associated with providers' choices, univariate and multivariate multinomial logistic regressions were done using Stata version 14.1. Statistical significance was set as p = 0.05. RESULTS A total of 307 individuals experienced fever within one month and 72.3% sought care from providers. Also, a total of 509 forest goers reported that they had a previous febrile episode and 62.6% received care from a provider. Furthermore, 56.2% said that they had RDT testing during these previous febrile illnesses. They consulted public facilities and public health staff, private facilities, private and semi-private providers, community health volunteers or workers in their residing village and those located outside their villages but majority preferred those within their villages. On multivariate analyses, second richest quintile (public, RRR = 12.9) (semi-private, RRR = 17.9), (outside, RRR = 8.4) and access to 4 and above nearby providers (public, RRR = 30.3) (semi-private, RRR = 1.5) (outside, RRR = 0.5) were found to be significantly associated with provider choice for recent fever episode. Similar findings were also found for previous febrile illness and RDT testing among forest goers. CONCLUSIONS It was highlighted in this study that in forest goer households, they preferred nearby providers and the decision to choose providers seemed to be influenced by their access to number of nearby providers and socio-economic status when they sought care from a provider regardless of fever occurrence location. It was important that the national programmes considere involving these nearby providers in elimination efforts.
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Affiliation(s)
- May Me Thet
- Population Services International Myanmar, No.16, West Shwe Gone Dine 4Th Street, Bahan Township, 11201 Yangon, Myanmar
| | - Myat Noe Thiri Khaing
- Population Services International Myanmar, No.16, West Shwe Gone Dine 4Th Street, Bahan Township, 11201 Yangon, Myanmar
| | - Su Su Zin
- Population Services International Myanmar, No.16, West Shwe Gone Dine 4Th Street, Bahan Township, 11201 Yangon, Myanmar
| | - Si Thu Thein
- Population Services International Myanmar, No.16, West Shwe Gone Dine 4Th Street, Bahan Township, 11201 Yangon, Myanmar
| | - Kemi Tesfazghi
- Greater Mekong Subregion Elimination of Malaria Through Surveillance (GEMS+), 1120 19Th St NW #600, Washington, DC 20036 USA
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Aung PL, Win KM, Pumpaibool T. Malaria Preventive Practices among People Residing in Different Malaria-Endemic Settings in a Township of Myanmar: A Mixed-Methods Study. Trop Med Infect Dis 2022; 7:tropicalmed7110353. [PMID: 36355895 PMCID: PMC9692550 DOI: 10.3390/tropicalmed7110353] [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: 09/24/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Different villages in a township or an area exhibit different malaria endemicities. This study aimed to investigate malaria preventive practices among people residing in different villages with stratified malaria endemicity in a township in Myanmar. Quantitative data were collected using standardized questionnaires by conducting face-to-face interviews, and qualitative data were obtained through in-depth interviews using a guideline. Quantitative data were analyzed using descriptive statistics and logistic regression models, whereas thematic analysis was used to visualize qualitative data. A total of 360 respondents with similar characteristics participated in the quantitative study. Knowledge regarding malaria and the availability of health information exhibited insignificant differences. Malaria preventive practices were considerably poor among people from moderate- and high-endemic villages (p < 0.05). Adult male farmers or gold miners with low annual family incomes reported poor preventive practices in both moderate- and high-endemic groups. People could not practice some malaria preventive measures because of a lack of resources, e.g., a lack of mosquito repellents. To eliminate the disparities of preventive practices in different malaria-endemic settings, heath-awareness-raising activities should be increased, especially in moderate- and high-endemic villages.
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Affiliation(s)
- Pyae Linn Aung
- College of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand
- Myanmar Health Network Organization, Yangon 11091, Myanmar
| | - Kyawt Mon Win
- Department of Public Health, Ministry of Health, NayPyiTaw 15011, Myanmar
| | - Tepanata Pumpaibool
- College of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand
- Correspondence:
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Guntur RD, Kingsley J, Islam FMA. Ethnic Variation and Its Association With Malaria Awareness: A Cross-sectional Study in East Nusa Tenggara Province, Indonesia. J Prev Med Public Health 2022; 55:68-79. [PMID: 35135050 PMCID: PMC8841199 DOI: 10.3961/jpmph.21.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives This study investigated associations between ethnicity and malaria awareness in East Nusa Tenggara Province (ENTP), Indonesia. Methods A community-based cross-sectional study was conducted upon 1503 adults recruited by multi-stage cluster random sampling. A malaria awareness questionnaire was used to collect data, according to which participants were classified as aware or unaware of malaria. Logistic regression was applied to quantify the strength of associations of factors with malaria awareness. Results The participation rate in this study was high (99.5%). The participants were distributed relatively evenly among the Manggarai, Atoni, and Sumba ethnicities (33.0, 32.3, and 30.2%, respectively). Malaria awareness was significantly different amongst these groups; it was most common in the Manggarai ethnicity (65.1%; 95% confidence interval [CI], 59.9 to 70.3) and least common in the Sumba ethnicity (35.0%; 95% CI, 27.6 to 42.4). The most prominent factor influencing the malaria awareness in the Sumba and Manggarai ethnicities was education level, whilst it was socioeconomic status (SES) in the Atoni ethnicity. The likelihood of malaria awareness was significantly higher in adults with an education level of diploma or above (adjusted odds ratio [aOR], 21.4; 95% CI, 3.59 to 127.7 for Manggarai; aOR, 6.94; 95% CI, 1.81 to 26.6 for Sumba). Malaria awareness was significantly more common amongst high-SES adults in the Atoni group (aOR, 24.48; 95% CI, 8.79 to 68.21). Conclusions Low education levels and low SES were prominent contributors to lower levels of malaria awareness in rural ENTP. Interventions should focus on improving malaria awareness to these groups to support the Indonesian government’s national commitment to achieve a malaria elimination zone by 2030.
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Affiliation(s)
- Robertus Dole Guntur
- Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
- Department of Mathematics, Faculty of Science and Engineering, University of Nusa Cendana, Kupang, Indonesia
- Corresponding author: Robertus Dole Guntur Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology, 453-457 Burwood Road, Hawthorn 3122, Australia E-mail:
| | - Jonathan Kingsley
- Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
- Centre of Urban Transitions, Swinburne University of Technology, Hawthorn, Australia
| | - Fakir M. Amirul Islam
- Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
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Guntur RD, Kingsley J, Islam FMA. Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia. PLoS One 2021; 16:e0259950. [PMID: 34780554 PMCID: PMC8592438 DOI: 10.1371/journal.pone.0259950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The 2009 Indonesian roadmap to malaria elimination indicated that the nation had been progressing towards achieving malaria elimination by 2030. Currently, most of the districts in the western part of Indonesia have eliminated malaria; however, none of the districts in the East Nusa Tenggara Province (ENTP) have met these set targets. This study aimed to investigate the status of malaria awareness of rural adults in the ENTP. Methods A community-based cross-sectional study was conducted between October and December 2019 in high, moderate, and low malaria-endemic settings (MESs) in the ENTP. After obtaining informed consent, data were collected using an interviewer-administered structure questionnaire among 1503 participants recruited by a multi-stage cluster sampling method. A malaria awareness index was developed based on ten questions. A binary logistic regression method was applied to investigate the significance of any association between malaria awareness and the different MESs. Results The participation rate of the study was 99.5%. Of this number, 51.4% were female and 45.5% had completed primary education. The malaria awareness index was significantly low (48.8%, 95% confidence interval [CI]: 45.2–52.4). Malaria awareness of rural adults residing in low endemic settings was two times higher than for those living in high endemic settings (adjusted odds ratio [AOR]: 2.41, 95% CI: 1.81–3.21) and the basic malaria knowledge of participants living in low malaria-endemic settings was almost four times higher than that in high endemic settings (AOR: 3.75, 95% CI: 2.75–5.11). Of the total participants, 81.3% (95% CI: 79.1–83.5) were aware that malaria could be prevented and 75.1% (95% CI: 72.6–77.6) knew at least one prevention measure. Overall, the awareness of fever as the main symptom of malaria, mosquito bites as the transmission mode of malaria, and seeking treatment within 24 hours of suffering from malaria was poor at 37.9% (95% CI: 33.9–41.9), 59.1% (95% CI: 55.9–62.3), and 46.0% (95% CI: 42.3–49.7), respectively. The poor level of awareness was significantly different amongst the three MESs, with the lowest levels of awareness in the high endemic setting. Conclusion Malaria awareness of rural adults needs to be improved to address Indonesia’s national roadmap for malaria elimination. Results indicated that public health programs at a local government level should incorporate the malaria awareness index in their key strategic intervention to address malaria awareness.
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Affiliation(s)
- Robertus Dole Guntur
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Department of Mathematics, Faculty of Science and Engineering, Nusa Cendana University, Kupang, NTT, Indonesia
- * E-mail:
| | - Jonathan Kingsley
- Department of Health and Medical Science, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Centre of Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Fakir M. Amirul Islam
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
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11
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Thet MM, Khaing MNT, Zin SS, Oo S, Aung YK, Thein ST. Role of small private drug shops in malaria and tuberculosis programs in Myanmar: a cross-sectional study. J Pharm Policy Pract 2021; 14:89. [PMID: 34784970 PMCID: PMC8594090 DOI: 10.1186/s40545-021-00335-6] [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: 03/15/2021] [Accepted: 06/07/2021] [Indexed: 12/04/2022] Open
Abstract
Background The role of community drug shops in providing primary care has been recognized as important in Myanmar as in other countries. The contribution by private community drug shops to National Tuberculosis case notifications and National Malaria testing and positive cases is significant. Population Services International Myanmar (PSI/Myanmar) has been successfully training and engaging community drug shops to screen presumptive Tuberculosis to make referrals to public health clinics and perform malaria rapid diagnostic tests (mRDT) to malaria fever cases and provide management accordingly. Objectives The study aims to identify barriers to service provision of the trained providers at the drug shops that are currently engaged in PSI/Myanmar Tuberculosis and malaria programs. Exploring their needs enabled us to identify and address barriers, to provide evidence for better linkage with the primary care system. Method A mixed method study was conducted with the service providers at the drug shops. A quantitative follow up survey was done with 177 trained Tuberculosis service providers and 65 trained malaria service providers. A total of 32 qualitative in-depth interviews were completed. Seventeen Tuberculosis trained providers and 15 malaria trained providers participated in individual interviews. Content analysis approach was used to generate themes for the data analysis. Results From the survey, the majority of drug shops reported that they performed appropriate first steps, particularly referring symptomatic Tuberculosis cases and offering mRDT testing to fever cases. Nevertheless, in-depth interviews with them revealed they did not adhere to the national guidelines for every client. There was a need to emphasize the importance of following the national guidelines for referring patients with prolonged cough and fever cases management. For those who were trained in Tuberculosis case referral, support from program staff was needed to make smooth referrals. Those who were trained in malaria often considered differential diagnosis of fever other than malaria and did not test with malaria rapid diagnostic test due to declining numbers of malaria cases. Conclusion The study findings highlighted that the drug shops trained in Tuberculosis referral seemed to have the potential to fully engage into the primary care health system if provided with suitable support and supervision. On the other hand, those trained in malaria case management might be less motivated to engage in the era of declining malaria endemicity. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-021-00335-6.
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Affiliation(s)
- May Me Thet
- Strategic Information Division, Population Services International Myanmar, No. 16, West Shwe Gone Dine 4th Street, Bahan Township, 11201, Yangon, Myanmar.
| | - Myat Noe Thiri Khaing
- Strategic Information Division, Population Services International Myanmar, No. 16, West Shwe Gone Dine 4th Street, Bahan Township, 11201, Yangon, Myanmar
| | - Su Su Zin
- Strategic Information Division, Population Services International Myanmar, No. 16, West Shwe Gone Dine 4th Street, Bahan Township, 11201, Yangon, Myanmar
| | - Sandar Oo
- Strategic Information Division, Population Services International Myanmar, No. 16, West Shwe Gone Dine 4th Street, Bahan Township, 11201, Yangon, Myanmar
| | - Ye Kyaw Aung
- Strategic Information Division, Population Services International Myanmar, No. 16, West Shwe Gone Dine 4th Street, Bahan Township, 11201, Yangon, Myanmar
| | - Si Thu Thein
- Strategic Information Division, Population Services International Myanmar, No. 16, West Shwe Gone Dine 4th Street, Bahan Township, 11201, Yangon, Myanmar
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The acceptability of targeted mass treatment with primaquine for local elimination of vivax malaria in a northern Myanmar township: a mixed-methods study. Parasit Vectors 2021; 14:549. [PMID: 34689796 PMCID: PMC8543804 DOI: 10.1186/s13071-021-05064-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Radical cure of the Plasmodium vivax latent liver stage is required to effectively manage vivax malaria. Targeted mass treatment with primaquine may be an effective mechanism for reducing reservoirs of the disease. Since community engagement and high coverage are essential for mass treatment programs, this study aimed to determine the acceptability of mass primaquine treatment in a targeted community in a northern Myanmar township. Methods A cross-sectional mixed-methods study was deployed among household leaders in July 2019. Face-to-face interviews using structured questionnaires and standardized qualitative guidelines were conducted to gather information. Descriptive and inferential statistics, including logistic regression models, were applied. Results Among 609 study respondents, > 90% agreed to participate in an upcoming targeted mass primaquine treatment (TPT) program. Factors contributing to higher odds of acceptability of the program were older age [adjusted odds ratios (aOR): 2.38, 95% confidence intervals (CI) 1.08–8.96], secondary education level (aOR: 3.99, 95% CI 1.12–20.01), having good knowledge of malaria (aOR: 2.12, 95% CI 1.04–4.76), experiencing malaria within the family (aOR: 1.92, 95% CI 1.14–5.13), and believing eliminating malaria from the village is possible (aOR: 2.83, 95% CI 1.07–4.07). Furthermore, 50 community respondents, 6 midwives, and 4 public health staff (grade II) participated in the qualitative component of the study. Many thought that TPT seemed feasible and stressed that high coverage of underserved groups and health education are needed before commencing the activity. Conclusions Most respondents agreed to participate in the proposed mass treatment campaign. Older people with secondary education level and those who had experienced malaria within their families were most likely to report willingness to participate. These same individuals may be important in the community engagement process to increase community acceptance of the program. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-05064-y.
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Guntur RD, Kingsley J, Islam FMA. Epidemiology of Malaria in East Nusa Tenggara Province in Indonesia: Protocol for a Cross-sectional Study. JMIR Res Protoc 2021; 10:e23545. [PMID: 33835037 PMCID: PMC8075045 DOI: 10.2196/23545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 01/08/2021] [Accepted: 03/04/2021] [Indexed: 02/01/2023] Open
Abstract
Background Malaria is a global pandemic that results in approximately 228 million cases globally; 3.5% of these cases are in Southeast Asian countries, including Indonesia. Following the World Health Organization (WHO) initiative, Indonesia is in the process of achieving malaria-free zone status by 2030. However, the eastern part of Indonesia, including the East Nusa Tenggara Province (ENTP), still has a disproportionately high rate of malaria. Objective The aims of this cross-sectional study are to determine the awareness and knowledge, attitude, and practice toward various aspects of malaria among rural adults and their associated factors, including sociodemographic factors and ethnicities; assess the gap between coverage of, access to, and use of long-lasting insecticide-treated nets (LLINs) among the households; estimate the prevalence of and factors associated with malaria in rural adults; and develop a risk prediction model for malaria. Methods A multistage cluster sampling procedure with a systematic random sampling procedure at cluster level 4 was applied to recruit 1503 adults aged 18 years or older from the ENTP. Each participant participated in a face-to-face interview to assess their awareness and knowledge, attitude, and practice toward aspects of malaria, practices of sleeping under LLINs, and history of malaria. Information on sociodemographic, environmental, and lifestyle factors was also documented. The proportion of knowledge, attitude, and practice toward aspects of malaria and their variations across different sociodemographic and ethnic groups will be analyzed using descriptive statistics and chi-square tests. Coverage and access to LLINs will be evaluated based on the WHO recommendations. Malaria risk factors will be analyzed using logistic regression. Multilevel logistic regression will be applied to estimate the risk score for malaria. Results Of the total participants, 99.46% (1495/1503) of rural adults from 49 villages in the ENTP participated in a face-to-face interview from October to December 2019. The study results are expected to be published in peer-reviewed journals. Conclusions The best malaria risk prediction model will be developed in this study. In this protocol, we developed a methodology to provide new evidence to guide health policy in supporting the ENTP government’s expectation to achieve the malaria-free rating by 2030. International Registered Report Identifier (IRRID) DERR1-10.2196/23545
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Affiliation(s)
- Robertus Dole Guntur
- Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia.,Department of Mathematics, Faculty of Science and Engineering, Nusa Cendana University, Kupang NTT, Indonesia
| | - Jonathan Kingsley
- Department of Health and Medical Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia.,Centre of Urban Transitions, Swinburne University of Technology, Hawthorn, Melbourne, Australia
| | - Fakir M Amirul Islam
- Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
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Wang L, Yin J, Zheng C, Smith SJ, Ngegba E, Huang X, Kamara A, Chen X, Wang X, Luo W, Kan B. A Household-Based Cross-Sectional Survey of Knowledge, Awareness and Practice Regarding Malaria in Western Area Rural District, Sierra Leone. Front Public Health 2021; 9:664971. [PMID: 33816430 PMCID: PMC8012796 DOI: 10.3389/fpubh.2021.664971] [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: 02/06/2021] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Sierra Leone is a highly endemic area for malaria, and the implementation of the National Malaria Strategic Plan (2016-2020) has reached its midpoint in 2018. To provide more specific guidance for interventions in the future, a household-based cross-sectional survey was conducted to elucidate the knowledge, awareness and practices regarding malaria and malarial control measures among the general public. Three communities (Grafton, Jui, and Kossoh) in the Western Area Rural District that were in close proximity to Sierra Leone's capital city of Freetown were included. Households were randomly selected and interviewed with a structured questionnaire covering malaria infection, diagnosis, treatment and prevention, as well as knowledge of malaria prevention. As a result, a total of 262 qualified questionnaires were included. The average cost for meals per day is ~30,000 Leones in each household. The rate of awareness, indicated by reporting having heard of malaria, was 98.1% (257/262), and 86.6% (227/262) of the respondents knew that mosquito bites are the main route of transmission. In addition, 80.9% (212/262) of the respondents sought health advice or treatment for the illness, and a similar percentage of respondents had been tested for malaria, mostly with rapid diagnostic tests (RDTs). A high demand for long-lasting insecticidal nets (72.1%) matched the serious shortage (61.8%, 162/262), and of the households that reported a lack of nets, 66 had children younger than 5 years old. In conclusion, public awareness of malaria prevention is high, based on this survey, although there was a limited use of preventive measures in these three communities and the malaria burden was still high. Therefore, the public's knowledge of malaria should be sustained and reinforced, and the distribution and use of malaria prevention measures should be promoted to supprt the achievement of the planned objectives.
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Affiliation(s)
- Lili Wang
- Center for Global Public Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianhai Yin
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Shanghai, China
| | - Canjun Zheng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Samuel Juana Smith
- National Malaria Control Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Esther Ngegba
- Center for Global Public Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoxia Huang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Anitta Kamara
- National Malaria Control Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Xia Chen
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xu Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Shanghai, China
| | - Wei Luo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Biao Kan
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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15
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Linn NN, Kyaw KWY, Shewade HD, Kyaw AMM, Tun MM, Khine SK, Linn NYY, Thi A, Lin Z. Notified dengue deaths in Myanmar (2017-18): profile and diagnosis delays. F1000Res 2020; 9:579. [PMID: 32724563 PMCID: PMC7336047 DOI: 10.12688/f1000research.23699.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Complications in dengue usually occur between day four and day six after fever onset. Hence, early diagnosis and haematological monitoring are vital. Among all hospital reported dengue deaths in Myanmar in 2017-18, we assessed the i) patient profile, ii) proportion of patients who arrived with a dengue diagnosis at admission and iii) delays in diagnosis after fever onset. Methods: This was a descriptive study involving secondary data. For all the notified deaths, death investigation forms were not available in prescribed format and therefore, data were extracted from hospital case records. Results: Of 304 deaths, 184 (60.5%) were female and 233 (76.6%) were less than 10 years old. Township level hospitals or below reported 36 deaths (11.8%) and the remaining deaths were from higher level facilities. Dengue was diagnosed before admission in 26 (8.5%) people and 169 (55.6%) were in shock at admission. Of 208 with date of fever onset recorded, the median diagnosis delay was four (interquartile range-IQR: 3, 5) days. Patient level delay (median three days) was a major contributor to the diagnosis delay. Conclusions: Most of the patients who died did not have a diagnosis of dengue before admission. This calls for an urgent review of health system preparedness in peripheral health facilities to suspect, diagnose, monitor, refer and treat dengue in children and patient level factors for better understanding of the reasons of delay. Timely filling of death investigation forms in a prescribed format and quarterly death reviews based on these is recommended.
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Affiliation(s)
- Nwe Ni Linn
- Vector Borne Disease Control Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Khine Wut Yee Kyaw
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar.,Center for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Hemant Deepak Shewade
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Department of Operational Research, The Union South East Asia, New Delhi, India
| | - Aye Mon Mon Kyaw
- Vector Borne Disease Control Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Myat Min Tun
- Vector Borne Disease Control Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - San Kyawt Khine
- Vector Borne Disease Control Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Nay Yi Yi Linn
- Vector Borne Disease Control Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aung Thi
- Vector Borne Disease Control Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Zaw Lin
- Vector Borne Disease Control Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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16
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Identification and strengthening of positive deviance: An efforts to reduce the incidence of malaria in Selayar islands. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.07.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Min KT, Maung TM, Oo MM, Oo T, Lin Z, Thi A, Tripathy JP. Utilization of insecticide-treated bed nets and care-seeking for fever and its associated socio-demographic and geographical factors among under-five children in different regions: evidence from the Myanmar Demographic and Health Survey, 2015-2016. Malar J 2020; 19:7. [PMID: 31906965 PMCID: PMC6945537 DOI: 10.1186/s12936-019-3088-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/25/2019] [Indexed: 12/22/2022] Open
Abstract
Background Malaria is one of the top-five contributors to under-5 deaths in Myanmar. Use of insecticide-treated nets (ITN) and receiving early appropriate care in case of fever are the core interventions to prevent malaria and its complications and thereby deaths. This study aimed to assess among the under-five children, (a) utilization of ITNs and its associated factors, (b) care-seeking behaviour among their caregivers and its associated factors and uptake of malaria testing among those with fever in the last 2 weeks. Methods This was a cross sectional study using secondary analysis of Myanmar Demographic and Health Survey (MDHS) conducted in 2015–2016. Multivariable logistic regression was used to explore the factors associated with non-utilization of ITNs and not seeking care for fever. Effect sizes have been presented using odds ratios with 95% confidence intervals. Data analysis was done using svyset command in STATA to account for the multi-stage sampling design of the survey. Results Of 4597 alive under-five children, 80.5% did not sleep under an ITN last night. The factors significantly associated with non-utilization of ITNs were residing in malaria elimination regions (aOR = 2.0, 1.3–3.2), urban residence (aOR = 1.8, 1.2–2.9), staying in delta region (aOR = 8.7, 4.7–12.2), hilly region (aOR = 3.0, 2.0–4.6, and having highest wealth quintile (aOR = 1.8, 1.1–3.0). Around 16% had fever in the last 2 weeks, of whom 66.7% sought care for fever and 3% got tested for malaria. Nearly half (50.9%) of the caregivers sought care from a government health facility, followed by private hospital/doctor (27.8%), shop (8.0%), village health worker (4.4%) and pharmacy (3.1%). The factors associated with not seeking care for fever were residing in specific geographical locations (hilly, delta and central plains compared to coastal region) and having lowest wealth quintile (aOR = 2.3, 1.1–5.7). Conclusions This study highlighted that ownership and utilization of ITNs was very poor among under-5children. Care-seeking behaviour of the caregivers of under-5 children in case of fever was dismal with two-thirds not seeking care. The programme should seriously consider addressing these barriers if Myanmar is to achieve zero malaria deaths by 2030.
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Affiliation(s)
- Kyi Thar Min
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar.
| | - Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Myo Minn Oo
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Tin Oo
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Zaw Lin
- Vector Borne Disease Control Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aung Thi
- National Malaria Control Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India.,International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,All India Institute of Medical Sciences, Nagpur, India
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18
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Khine SK, Kyaw NTT, Thekkur P, Lin Z, Thi A. Malaria hot spot along the foothills of Rakhine state, Myanmar: geospatial distribution of malaria cases in townships targeted for malaria elimination. Trop Med Health 2019; 47:60. [PMID: 31889888 PMCID: PMC6921393 DOI: 10.1186/s41182-019-0184-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Myanmar has targeted elimination of malaria by 2030. In three targeted townships of Rakhine state of Myanmar, a project is being piloted to eliminate malaria by 2025. The comprehensive case investigation (CCI) and geotagging of cases by health workers is a core activity under the project. However, the CCI data is not analyzed for obtaining information on geospatial distribution of cases and timeliness of diagnosis. In this regard, we aimed to depict geospatial distribution and assess the proportion with delayed diagnosis among diagnosed malaria cases residing in three targeted townships during April 2018 to March 2019. Methods This was a cross sectional analysis of CCI data routinely collected by national malaria control programme. The geocode (latitude and longitude) of the address was analysed using Quantum Geographic Information System software to deduce spot maps and hotspots of cases. The EpiData analysis software was used to summarize the proportion with delay in diagnosis (diagnosed ≥24 hours after the fever onset). Results Of the 171 malaria cases diagnosed during study period, the CCI was conducted in 157 (92%) cases. Of them, 127 (81%) cases reported delay in diagnosis, 138 (88%) cases were indigenous who got infection within the township and 13 (8%) were imported from outside the township. Malaria hotspots were found along the foothills with increase in cases during the rainy season. The indigenous cases were concentrated over the foothills in the northern and southern borders of Toungup township. Conclusion In the targeted townships for malaria elimination, the high proportion of the cases was indigenous and clustered at the foothill areas during rainy season. The programme should strengthen case surveillance and healthcare services in the areas with aggregation of cases to eliminate the malaria in the township. As high majority of patients have delayed diagnosis, the reasons for delay has to be explored and corrective measures needs to be taken.
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Affiliation(s)
- San Kyawt Khine
- 1Vector Borne Diseases Control Programme, Ministry of Health and Sports, Main Road, Sittwe, Rakhine State Myanmar
| | - Nang Thu Thu Kyaw
- International Union against Tuberculosis and Lung disease, Centre for Operational Research, Mandalay, Myanmar
| | - Pruthu Thekkur
- 3Centre for Operational Research, The Union South-East Asia Office, New Delhi, India
| | - Zaw Lin
- 4Vector Borne Diseases Control Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aung Thi
- 4Vector Borne Diseases Control Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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Minn PW, Shewade HD, Kyaw NTT, Phyo KH, Linn NYY, Min MS, Aung YN, Myint ZT, Thi A. Quality of Malaria Treatment Provided under 'Better Health Together' Project in Ethnic Communities of Myanmar: How Are We Performing? Trop Med Infect Dis 2019; 4:tropicalmed4040140. [PMID: 31817078 PMCID: PMC6958459 DOI: 10.3390/tropicalmed4040140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 11/24/2022] Open
Abstract
Malaria accounted for 18% of all deaths in the ethnic communities of Myanmar. In this cross-sectional study, we assessed the extent of and factors associated with receipt of quality malaria treatment services provided by integrated community malaria volunteer (ICMV) under six ethnic health organisations. Data of people with malaria diagnosed by rapid diagnostic tests during 2017–2018 were extracted from the ICMV registers. Documentation of prescribing a complete course of drugs was used to assess quality. Of 2881 people with malaria, village-based ICMV diagnosed and treated 2279 (79%) people. Overall, 2726 (95%) people received correct drugs in the correct dose and adequate duration appropriate to malaria species, age and pregnancy status while 1285 (45%) people received ‘correct and timely (within 24 h of fever)’ treatment. Children under five years, those with severe malaria, mixed infection and falciparum malaria were less likely to receive the correct treatment. When compared to health posts, village-based ICMVs and mobile teams performed better in providing correct treatment and mobile teams in providing ‘correct and timely’ treatment. This calls for ensuring the early presentation of people to health workers within 24 h of undifferentiated fever through health promotion initiatives. Future studies should assess adherence to medication and clinical improvement.
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Affiliation(s)
- Phyo Wai Minn
- Community Partners International, Yangon 11201, Myanmar; (M.S.M.); (Y.N.A.); (Z.T.M.)
- Correspondence: or ; Tel.: +95-9797657288
| | - Hemant Deepak Shewade
- International Union against Tuberculosis and Lung Disease (The Union), 75006 Paris, France;
- The Union South East Asia Office, New Delhi 110016, India
- Karuna Trust, Bengaluru 560041, India
| | - Nang Thu Thu Kyaw
- The Union Myanmar Country Office, Mandalay 05021, Myanmar; (N.T.T.K.); (K.H.P.)
| | - Khaing Hnin Phyo
- The Union Myanmar Country Office, Mandalay 05021, Myanmar; (N.T.T.K.); (K.H.P.)
| | - Nay Yi Yi Linn
- Vector Borne Disease Control Program, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw 15011, Myanmar; (N.Y.Y.L.); (A.T.)
| | - Myat Sandi Min
- Community Partners International, Yangon 11201, Myanmar; (M.S.M.); (Y.N.A.); (Z.T.M.)
| | - Yan Naing Aung
- Community Partners International, Yangon 11201, Myanmar; (M.S.M.); (Y.N.A.); (Z.T.M.)
| | - Zaw Toe Myint
- Community Partners International, Yangon 11201, Myanmar; (M.S.M.); (Y.N.A.); (Z.T.M.)
| | - Aung Thi
- Vector Borne Disease Control Program, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw 15011, Myanmar; (N.Y.Y.L.); (A.T.)
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Aung PL, Pumpaibool T, Soe TN, Burgess J, Menezes LJ, Kyaw MP, Cui L. Health education through mass media announcements by loudspeakers about malaria care: prevention and practice among people living in a malaria endemic area of northern Myanmar. Malar J 2019; 18:362. [PMID: 31718628 PMCID: PMC6852921 DOI: 10.1186/s12936-019-2985-6] [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: 04/19/2019] [Accepted: 10/24/2019] [Indexed: 11/30/2022] Open
Abstract
Background Interventions to raise community awareness about malaria prevention and treatment have used various approaches with little evidence on their efficacy. This study aimed to determine the effectiveness of loudspeaker announcements regarding malaria care and prevention practices among people living in the malaria endemic villages of Banmauk Township, Sagaing Region, Myanmar. Methods Four villages among the most malaria-burdened areas were randomly selected: two villages were assigned as the intervention group, and two as the control. Prior to the peak transmission season of malaria in June 2018, a baseline questionnaire was administered to 270 participants from randomly selected households in the control and intervention villages. The loudspeaker announcements broadcasted health messages on malaria care and prevention practices regularly at 7:00 pm every other day. The same questionnaire was administered at 6-month post intervention to both groups. Descriptive statistics, Chi-square, and the t-test were utilized to assess differences between and within groups. Results Participants across the control and intervention groups showed similar socio-economic characteristics; the baseline knowledge, attitude and practice mean scores were not significantly different between the groups. Six months after the intervention, improvements in scores were observed at p-value < 0.001 in both groups, however; the increase was greater among the intervention group. The declining trend of malaria was also noticed during the study period. In addition, more than 75% of people expressed positive opinions of the intervention. Conclusions The loudspeaker intervention was found to be feasible and effective, as shown by the significant improvement in scores related to prevention and care-seeking practices for malaria as well as reduced malaria morbidity. Expanding the intervention to a larger population in this endemic region and evaluating its long-term effectiveness are essential in addition to replicating this in other low-resource malaria endemic regions.
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Affiliation(s)
- Pyae Linn Aung
- College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Tepanata Pumpaibool
- College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Than Naing Soe
- Department of Public Health, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Jessica Burgess
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA
| | - Lynette J Menezes
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA
| | | | - Liwang Cui
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA.
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Aung PL, Pumpaibool T, Soe TN, Kyaw MP. Knowledge, attitude and practice levels regarding malaria among people living in the malaria endemic area of Myanmar. JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.1108/jhr-01-2019-0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
Malaria still remains a significant public health problem in Myanmar and it has a complex epidemiology. Evidence-based community awareness raising interventions are also particularly needed. This cross-sectional study was organized to explore the basic characteristics associated with knowledge, attitude and practice (KAP) regarding malaria among people living in the most malaria-endemic villages of the Banmauk Township, Sagaing Region, Myanmar. The paper aims to discuss these issues.
Design/methodology/approach
The Banmauk, one of the most malaria-endemic townships, was selected purposively in order to represent the survey results for people living in malaria hotspots. During the peak malaria season (July 2018), 250 household leaders were invited to be interviewed with structured questionnaires. In addition to descriptive data, the associations were determined by χ2-test and correlation.
Findings
Overall KAP indicated considerably low percentages of good levels, especially in practice, only 21.6 percent showed good practice, 38.4 percent had good knowledge and 56.8 percent had good attitude. Age (p=0.022) and annual family income (p<0.001) were significantly associated with the knowledge level, whereas having fever attacks among family members in the last two weeks (p=0.023) showed statistical association with attitude at a p-value <0.05. Surprisingly, there were no associated variables with malaria practice. In addition, there were negative correlations between knowledge with attitude and knowledge with practice; however, the results were not significant.
Originality/value
The overall KAP regarding malaria was at relatively poor levels among people living in malaria transmission areas. Therefore, new approaches to improve malaria KAP are promptly needed in this community.
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Portugaliza HP, Galatas B, Nhantumbo H, Djive H, Murato I, Saúte F, Aide P, Pell C, Munguambe K. Examining community perceptions of malaria to inform elimination efforts in Southern Mozambique: a qualitative study. Malar J 2019; 18:232. [PMID: 31296238 PMCID: PMC6625114 DOI: 10.1186/s12936-019-2867-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 07/03/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In a background of renewed calls for malaria eradication, several endemic countries in sub-Saharan Africa are contemplating malaria elimination nationally or sub-nationally. In Mozambique, a strategy to eliminate malaria in the south is underway in the context of low endemicity levels and cross-border initiatives to eliminate malaria in South Africa and Eswatini. In this context, a demonstration project aiming to interrupt malaria transmission through mass antimalarial drug administrations and intensified vector control programmes accompanied by community engagement and standard case management was implemented in the Magude District. To ensure the necessary uptake of these interventions, formative qualitative research explored the perceptions, beliefs, attitudes, and practices related to malaria, its prevention and control. The current article describes the results of this study. METHODS Seventeen focus group discussions were conducted between September and October of 2015 with the community leaders (6), adult men (5), women of reproductive age (5), and traditional healers (1) in Magude prior to the implementation of the project interventions. Respondents discussed perceptions around malaria symptoms, causes, preventions, and treatments. RESULTS Knowledge of malaria was linked to awareness of its clinical presentation, and on-going vector control programmes. Perceptions of malaria aetiology were fragmented but related mainly to mosquito-mediated transmission. Reported preventive measures mostly involved mosquito control although participants were aware of the protective limitations of vector control tools. Awareness of asymptomatic carriers and the risk of outdoor malaria transmission were varied. Fever and malaria-like symptoms triggered immediate care-seeking community at health facilities. The identified barriers to malaria treatment included fear/mistrust in Western medicine, distance to health facilities, and lack of transportation. CONCLUSIONS Several constraints and opportunities will potentially influence malaria elimination in Magude. Malaria awareness, trust in health institutions, and the demand for chemoprophylaxis could facilitate new interventions, such as mass drug administration. A lack of awareness of asymptomatic carriers, inadequate understanding of residual transmission, and barriers to care seeking could jeopardize uptake. Hence, elimination campaigns require strong community engagement and grassroots mobilization.
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Affiliation(s)
- Harvie P Portugaliza
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036, Barcelona, Catalonia, Spain.
- Department of Global Health, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands.
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, 2000, Belgium.
| | - Beatriz Galatas
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036, Barcelona, Catalonia, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Hoticha Nhantumbo
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Helder Djive
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Ilda Murato
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Francisco Saúte
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Christopher Pell
- Department of Global Health, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development AHTC, Tower C4, Paasheuvelweg 25, 1105 BP, Amsterdam, The Netherlands
- Centre for Social Science and Global Health, University of Amsterdam, Nieuwe Achtergracht 166, 1001 NA, Amsterdam, The Netherlands
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Universidade Eduardo Mondlane, Maputo, Mozambique
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Cassy A, Saifodine A, Candrinho B, Martins MDR, da Cunha S, Pereira FM, Samo Gudo E. Care-seeking behaviour and treatment practices for malaria in children under 5 years in Mozambique: a secondary analysis of 2011 DHS and 2015 IMASIDA datasets. Malar J 2019; 18:115. [PMID: 30940127 PMCID: PMC6444821 DOI: 10.1186/s12936-019-2751-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/28/2019] [Indexed: 11/23/2022] Open
Abstract
Background In Mozambique, the prevalence of malaria in children under 5 years of age is among the highest in the world, but limited data exist on determinants of care-seeking behaviour for malaria. This study aimed at determining the trends and factors associated with care-seeking behaviour for fever among children under 5 years of age and to assess the treatment practices for malaria. Methods Secondary data analysis of two cross-sectional studies. Descriptive statistics were used to summarize socio-economic and demographic characteristics of participants, using data from the 2011 Demographic and Health Survey and 2015 Indicators of Immunization, Malaria and HIV/AIDS Survey. Complex sampling logistic regression model was used to identify factors associated with care-seeking behaviour, with estimated adjusted odds ratio and respective 95% confidence intervals, only for 2015 IMASIDA data. Results A total of 10,452 and 5168 children under 5 years of age were enrolled in the 2011 DHS and 2015 IMASIDA, respectively. Care-seeking for fever in public and private sectors remained stable during this period (62.6%; 835/1432 in 2011 and 63.7%; 974/1529 in 2015). The main place where care was sought in both surveys was public hospitals (86.2%; 773/897 in 2011 and 86.7%; 844/974 in 2015). Prescription of anti-malarial drugs increased from 42.9% (385/897) in 2011 to 53.8% (524/974) in 2015. Artemether–lumefantrine was the most used anti-malarial drug for febrile children in both surveys and its use increased from 59.0% (219/373) in 2011 to 89.3% (457/512) in 2015. Data from 2015 elucidated that care-seeking was more common in children whose mothers had a secondary level of education (AOR = 2.27 [95% CI 1.15–4.49]) and among those in poorer quintile (AOR = 1.46 [95% CI 0.83–1.90]). Mothers with higher education level (AOR = 0.16 [95% CI 0.34–0.78]) were less likely to seek out care. People from Manica (AOR = 2.49 [1.03–6.01]), Sofala ([AOR = 2.91 [1.03–8.24]), Inhambane (AOR = 3.95 [1.25–12.45]), Gaza (AOR = 3.25 [1.22–8.65]) and Maputo Province (AOR = 2.65 [1.10–6.41]) were more likely to seek care than people from Maputo City. Conclusion Data from this study showed that care-seeking in Mozambique remained suboptimal. Interventions to raise the awareness for early care-seeking during episodes of fever should be urgently reinforced and intensified.
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Affiliation(s)
- Annette Cassy
- Program of Endemic Diseases of Large Impact, Instituto Nacional de Saúde, Maputo, Mozambique. .,Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal.
| | | | - Baltazar Candrinho
- National Malaria Control Program, National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | - Maria do Rosário Martins
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Filomena Martins Pereira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Eduardo Samo Gudo
- Program of Endemic Diseases of Large Impact, Instituto Nacional de Saúde, Maputo, Mozambique
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Buh A, Kota K, Bishwajit G, Yaya S. Prevalence and Associated Factors of Taking Intermittent Preventive Treatment in Pregnancy in Sierra Leone. Trop Med Infect Dis 2019; 4:tropicalmed4010032. [PMID: 30736456 PMCID: PMC6473366 DOI: 10.3390/tropicalmed4010032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/02/2019] [Accepted: 02/04/2019] [Indexed: 11/16/2022] Open
Abstract
Malaria infection during pregnancy is a major public health problem in sub-Saharan Africa. The World Health Organization (WHO) recommends that gestational and congenital malaria can be prevented by using intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). IPTp-SP is a full therapeutic course of antimalarial medicine administered during pregnancy as a component of antenatal care. This study's objective was to assess the prevalence and predictors of IPTp-SP uptake in pregnancy in Sierra Leone. This study was based on the fifth round of the Multiple Indicator Cluster Survey (MICS 5) conducted in Sierra Leone in 2016. Participants were 8526 women aged between 15⁻49 years. Outcome variables were uptake of IPTp-SP during the last pregnancy. Data were analysed using cross-tabulation and logistic regression methods. Results showed that the prevalence of taking IPTp-SP was 94.81% (92.40, 96.14), and that the prevalence of taking at least three doses was 93.24% (92.50, 94.81). In the multivariate logistic regression, education, parity, and antenatal care (ANC) use were significant predictors of IPTp-SP uptake. Women with higher education had lower odds of taking IPTp-SP (Odds Ratio = 0.647, 95%CI = 0.444, 0.943); having higher parity (>4) was associated with lower odds of taking IPTp-SP (OR = 0.663; 95%CI = 0.442, 0.994) and adequate ANC use increased the odds of taking IPTp-SP in both urban (OR = 1.450, 95%CI = 1.158, 3.128) and rural areas (OR = 1.903, 95%CI = 1.069, 1.966). In contrast, the positive association between ANC visits and adequate doses of taking IPTp-SP was true for rural women only (OR = 1.408, 95%CI = 1.174, 1.689). In conclusion, the use of IPTp-SP is close to being universal, with the prevalence being relatively higher in the rural areas. Based on our findings, promoting adequate antenatal care visits should be regarded as a key strategy to improve the use of IPTp-SP in Sierra Leone. Further studies could focus on exploring other predictors of IPTp-SP uptake that are not captured by MICS in Sierra Leone.
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Affiliation(s)
- Amos Buh
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N6N5, Canada.
| | - Komlan Kota
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N6N5, Canada.
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
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Vilay P, Nonaka D, Senamonty P, Lao M, Iwagami M, Kobayashi J, Hernandez PM, Phrasisombath K, Kounnavong S, Hongvanthong B, Brey PT, Kano S. Malaria prevalence, knowledge, perception, preventive and treatment behavior among military in Champasak and Attapeu provinces, Lao PDR: a mixed methods study. Trop Med Health 2019; 47:11. [PMID: 30700970 PMCID: PMC6347756 DOI: 10.1186/s41182-019-0138-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Malaria is a major health problem in Lao People's Democratic Republic (Lao PDR) with high transmission in remote and forest areas, particularly in the South. The military is at risk of malaria infection especially those deployed in forest areas. This study determined the prevalence of malaria infection and assessed knowledge, perception, and preventive and treatment behavior regarding malaria among military personnel in two southern provinces in Lao PDR. Methods Quantitative and qualitative approaches were undertaken in Champasak and Attapeu provinces in 2017. From 313 military personnel, quantitative data were collected through questionnaire-based interviews and blood samples used for parasite detection by polymerase chain reaction (PCR). Qualitative data were collected through 7 focus group discussions and 17 in-depth interviews among 49 military personnel. Fisher's exact test and Mann-Whitney U test were used to assess the association between malaria infection and participant characteristics. Content analysis for qualitative data was performed to explore perception and treatment behaviors regarding malaria. Results The prevalence of malaria infection was 11.2% (Plasmodium falciparum: 1.3%, Plasmodium vivax: 9.3% and mixed infections: 0.6%). Many participants understood that malaria is transmitted through mosquito bites, although they did not necessarily know the name of vector mosquitoes (Anopheles). Surprisingly, more than a half also believed that malaria is transmitted through drinking stream water. One-third of the participants used long-lasting insecticidal nets. Due to limited supply, participants were often unable to use mosquito repellent and coils when necessary. Because participants were unable to receive timely diagnosis and appropriate treatment for malaria in their camps, they commonly practiced self-treatment using antibiotics, painkillers, and/or traditional medicines. They only go to a healthcare facility through their supervisor if their conditions worsen. Conclusions The prevalence of symptomatic and asymptomatic malaria was conspicuous among military in forest areas. Many participants believed that malaria is transmitted not only by mosquito bites but also from drinking stream water. Preventive equipment was often insufficient. Self-treatment was practiced before referring to healthcare facility. To further prevent military from contracting malaria, the National Malaria Control Program and military body should provide adequate and suitable health education, protective equipment, and on-site malaria case management.
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Affiliation(s)
- Phoutnalong Vilay
- 1Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara-cho, Okinawa, 903-0215 Japan.,2Center of Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Lao PDR.,SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR
| | - Daisuke Nonaka
- 1Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara-cho, Okinawa, 903-0215 Japan.,SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR
| | - Phosadeth Senamonty
- Military Institute of Diseases Prevention, Department of Military Medical, Ministry of Defense, Vientiane, Lao PDR
| | - Malayvanh Lao
- Military Institute of Diseases Prevention, Department of Military Medical, Ministry of Defense, Vientiane, Lao PDR
| | - Moritoshi Iwagami
- SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR.,5Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan.,6Institut Pasteur du Laos, Ministry of Health, Vientiane, Lao PDR
| | - Jun Kobayashi
- 1Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara-cho, Okinawa, 903-0215 Japan.,SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR
| | - Paul Michael Hernandez
- 1Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara-cho, Okinawa, 903-0215 Japan.,7Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila, 625 Pedro Gil Street, Ermita, 1000 Manila, Philippines
| | | | - Sengchanh Kounnavong
- SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR.,9Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR
| | - Bouasy Hongvanthong
- 2Center of Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Lao PDR.,SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR
| | - Paul T Brey
- SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR.,6Institut Pasteur du Laos, Ministry of Health, Vientiane, Lao PDR
| | - Shigeyuki Kano
- SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR.,5Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
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Low uptake of malaria testing within 24 h of fever despite appropriate health-seeking among migrants in Myanmar: a mixed-methods study. Malar J 2018; 17:396. [PMID: 30373591 PMCID: PMC6206677 DOI: 10.1186/s12936-018-2546-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is limited information on uptake of malaria testing among migrants who are a ‘high-risk’ population for malaria. This was an explanatory mixed-methods study. The quantitative component (a cross sectional analytical study-nation-wide migrant malaria survey in 2016) assessed the knowledge; health-seeking; and testing within 24 h of fever and its associated factors. The qualitative component (descriptive design) explored the perspectives of migrants and health care providers [including village health volunteers (VHV)] into the barriers and suggested solutions to increase testing within 24 h. Quantitative data analysis was weighted for the three-stage sampling design of the survey. Qualitative data analysis involved manual descriptive thematic analysis. Results A total of 3230 households were included in the survey. The mean knowledge score (maximum score 11) for malaria was 5.2 (0.95 CI 5.1, 5.3). The source of information about malaria was 80% from public health facility staff and 21% from VHV. Among 11 193 household members, 964 (8.6%) had fever in last 3 months. Health-seeking was appropriate for fever in 76% (0.95 CI 73, 79); however, only 7% (0.95 CI 5, 9) first visited a VHV while 19% (0.95 CI 16, 22) had self-medication. Of 964, 220 (23%, 0.95 CI 20, 26) underwent malaria blood testing within 24 h. Stable migrants, high knowledge score and appropriate health-seeking were associated with testing within 24 h. Qualitative findings showed that low testing within 24 h despite appropriate health-seeking was due to lack of awareness among migrants regarding diagnosis services offered by VHV, delayed health-seeking at public health facilities and not all cases of fever being tested by VHV and health staff. Providing appropriate behaviour change communication for migrants related to malaria, provider’s acceptance for malaria testing for all fever cases and mobile peer volunteer under supervision were suggested to overcome above barriers. Conclusions Providers were not testing all migrant patients with fever for malaria. Low uptake within 24 h was also due to poor utilization of services offered by VHV. The programme should seriously consider addressing these barriers and implementing the recommendations if Myanmar is to eliminate malaria by 2030. Electronic supplementary material The online version of this article (10.1186/s12936-018-2546-4) contains supplementary material, which is available to authorized users.
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Linn NYY, Tripathy JP, Maung TM, Saw KK, Maw LYW, Thapa B, Lin Z, Thi A. How are the village health volunteers deliver malaria testing and treatment services and what are the challenges they are facing? A mixed methods study in Myanmar. Trop Med Health 2018; 46:28. [PMID: 30123042 PMCID: PMC6090948 DOI: 10.1186/s41182-018-0110-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022] Open
Abstract
Background Village health volunteers (VHVs) play a key role in delivering community-based malaria care especially in the hard-to-reach areas in Myanmar. It is necessary to assess their performance and understand the challenges encountered by them for effective community management of malaria. This mixed methods study was conducted to (i) understand the cascade of malaria services (testing, diagnosis, referral, and treatment of malaria) provided by the VHVs under the National Malaria Control Programme (NMCP) in Myanmar in 2016 and compare with other health care providers and (ii) explore the challenges in the delivery of malaria services by VHVs. Methods A sequential mixed methods study was designed with a quantitative followed by a descriptive qualitative component. The quantitative study was a cohort design involving analysis of secondary data available from NMCP database whereas the qualitative part involved 16 focus group discussions (eight each with community and VHVs) and 14 key informant interviews with program stakeholders in four selected townships. Results Among 444,268 cases of undifferentiated fever identified by VHVs in 2016, 444,190 were tested using a rapid diagnostic test. Among those tested, 20,375 (4.6%) cases of malaria were diagnosed, of whom 16,910 (83.0%) received appropriate treatment, with 7323 (35.9%) receiving treatment within 24 h. Of all malaria cases, 296 (1.5%) were complicated, of whom 79 (26.7%) were referred to the higher facility. More than two thirds of all cases were falciparum malaria (13,970, 68.6%) followed by vivax (5619, 27.6%). Primaquine was given to 83.6% of all cases. VHVs managed 34.0% of all undifferentiated fever cases, 35.9% of all malaria cases, and identified 38.0% of all Plasmodium falciparum cases reported under NMCP. The key barriers identified are work-related (challenges in reporting, referral, management of malaria especially primaquine therapy, and lack of community support) and logistics related (challenges in transportation, financial constraints, time and shortage of drugs, and test kits). On the other hand, they also enjoy good community support and acceptance in most areas. Conclusion VHVs play an important role in malaria care in Myanmar, especially in the hard-to-reach areas. More programmatic support is needed in terms of logistics, transportation allowance, and supervision to improve their performance.
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Affiliation(s)
- Nay Yi Yi Linn
- Vector Borne Disease Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Jaya Prasad Tripathy
- 2International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India.,3International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Thae Maung Maung
- 4Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Khine Khine Saw
- Vector Borne Disease Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | | | - Badri Thapa
- Malaria Unit, World Health Organization Country Office, Yangon, Myanmar
| | - Zaw Lin
- Vector Borne Disease Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aung Thi
- Vector Borne Disease Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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