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Nawa M, Mupeyo-Mudala C, Banda-Tembo S, Adetokunboh O. The effects of modern housing on malaria transmission in different endemic zones: a systematic review and meta-analysis. Malar J 2024; 23:235. [PMID: 39113048 PMCID: PMC11308589 DOI: 10.1186/s12936-024-05059-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 07/27/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Modern housing has been shown to reduce the risk of malaria infections compared to traditional houses; however, it is unclear if the effects differ in different malaria transmission settings. This study evaluated the effects of modern housing on malaria among different endemic areas. METHODS Electronic databases, clinical trial registries and grey literature were searched for randomized controlled trials, cohort studies, case-control studies, and cross-sectional surveys on housing done between 1987 and 2022. Forest plots were done, and the quality of evidence was assessed using the Grading of Recommendations, Assessments, Development and Evaluation Framework. RESULTS Twenty-one studies were included; thirteen were cross-sectional, four were case-control and four were cohort studies. Cohort studies showed an adjusted risk ratio of 0.68 (95% CI 0.48-0.96), and cross-sectional studies indicated an adjusted odds ratio (aOR) of 0.79 (95%CI 0.75-0.83). By endemic transmission regions, the adjusted odds ratio in the high endemic settings was 0.80 (95%CI 0.76-085); in the moderate transmission regions, aOR = 0.76 (95%CI 0.67-0.85) and in the low transmission settings, aOR = 0.67 (95%CI 0.48-0.85). CONCLUSIONS The evidence from observational studies suggests that there are no differences in the protective effects of modern houses compared to traditional houses on malaria by endemicity level. This implies that good quality modern housing protects against malaria regardless of the malaria transmission settings.
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Affiliation(s)
- Mukumbuta Nawa
- Division of Epidemiology and Biostatistics, Stellenbosch University, Stellenbosch, Western Cape, South Africa.
- Department of Epidemiology and Biostatistics, Levy Mwanawasa Medical University, Lusaka, Zambia.
| | - Catherine Mupeyo-Mudala
- Department of Epidemiology and Biostatistics, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Sylvia Banda-Tembo
- Department of Epidemiology and Biostatistics, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Olatunji Adetokunboh
- Division of Epidemiology and Biostatistics, Stellenbosch University, Stellenbosch, Western Cape, South Africa
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, Western Cape, South Africa
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Mahendran R, Pathirana S, Weerasinghe MC. Living Conditions and Malaria: A Longitudinal Study in a Rural Malaria-Endemic Area of Sri Lanka. Am J Trop Med Hyg 2024; 111:317-323. [PMID: 38889733 PMCID: PMC11310603 DOI: 10.4269/ajtmh.22-0688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/25/2024] [Indexed: 06/20/2024] Open
Abstract
This study was conducted in a rural malaria-endemic community in Sri Lanka in 2014-2015 because malaria was no longer endemic in the area as of November 2012. Data on sociodemographic factors, living conditions, malaria infections, and use of mosquito protection methods during the period from 1990 to 2015 were collected through a household survey in a systematically selected sample of 724 households, covering >10% of the population in the area. Malaria incidence data were obtained from Anti-Malaria Campaign, and Malaria Research Unit of the University of Colombo. A total of 24,549 malaria cases were reported and a considerable improvement in living conditions was noted during the period covered. The association of malaria case incidence with living conditions of the community was evaluated using Spearman Rank Correlation at P <0.05. Sixty-six percent of households reported a history of malaria. The percentage of poorest type of houses (type 1) declined from 38.8% in the 1990-1994 period to 1.6% by 2015, whereas the best houses (type 5) doubled from 49.1% to 92.1% during the same period. Malaria case incidence was reported to be lowest in the best type houses (r = -0.933, P = 0.007), when pipe-borne water was available within the premises (for drinking: r = -0.846, P = 0.034; for personal hygiene: r = -0.859, P = 0.029), when water-sealed sanitary facilities were available (r = -0.956, P = 0.003), and when mosquito nets were used (r = -0.98, P = 0.001). This observed negative association may have been due to reduced human-mosquito contact.
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Affiliation(s)
| | - Sisira Pathirana
- Malaria Research Unit, Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Nankabirwa JI, Gonahasa S, Katureebe A, Mutungi P, Nassali M, Kamya MR, Westercamp N. The Uganda housing modification study - association between housing characteristics and malaria burden in a moderate to high transmission setting in Uganda. Malar J 2024; 23:223. [PMID: 39080697 PMCID: PMC11290271 DOI: 10.1186/s12936-024-05051-5] [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: 04/24/2024] [Accepted: 07/20/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Scale up of proven malaria control interventions has not been sufficient to control malaria in Uganda, emphasizing the need to explore innovative new approaches. Improved housing is one such promising strategy. This paper describes housing characteristics and their association with malaria burden in a moderate to high transmission setting in Uganda. METHODS Between October and November 2021, a household survey was conducted in 1500 randomly selected households in Jinja and Luuka districts. Information on demographics, housing characteristics, use of malaria prevention measures, and proxy indicators of wealth were collected for each household. A finger-prick blood sample was obtained for thick blood smears for malaria from all children aged 6 months to 14 years in the surveyed households. Febrile children had a malaria rapid diagnostics test (RDT) done; positive cases were managed according to national treatment guidelines. Haemoglobin was assessed in children aged < 5 years. Households were stratified as having modern houses (defined as having finished materials for roofs, walls, and floors and closed eaves) or traditional houses (those not meeting the definition of modern house). Associations between malaria burden and house type were estimated using mixed effects models and adjusted for age, wealth, and bed net use. RESULTS Most (65.5%) of the households surveyed lived in traditional houses. Most of the houses had closed eaves (85.5%), however, the use of other protective features like window/vent screens and installed ceilings was limited (0.4% had screened windows, 2.8% had screened air vents, and 5.2% had ceiling). Overall, 3,443 children were included in the clinical survey, of which 31.4% had a positive smear. RDT test positivity rate was 56.6% among children with fever. Participants living in modern houses had a significantly lower parasite prevalence by microscopy (adjusted prevalence ratio [aPR = 0.80]; 95% confidence interval [CI] 0.71 - 0.90), RDT test positivity rate (aPR = 0.90, 95%CI 0.81 - 0.99), and anaemia (aPR = 0.80, 95%CI 0.65 - 0.97) compared to those in traditional houses. CONCLUSION The study found that even after adjusting for wealth, higher quality housing had a moderate protective effect against malaria, on top of the protection already afforded by recently distributed nets.
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Affiliation(s)
- Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda.
- Department of Internal Medicine, Makerere University College of Health Science, Kampala, Uganda.
| | | | | | - Peter Mutungi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Martha Nassali
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Internal Medicine, Makerere University College of Health Science, Kampala, Uganda
| | - Nelli Westercamp
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Nguetsa GC, Elanga-Ndille E, Essangui Same EG, Nganso Keptchouang T, Mandeng SE, Ekoko Eyisap W, Binyang JA, Fogang B, Nouage L, Piameu M, Ayong L, Etang J, Wanji S, Eboumbou Moukoko CE. Utility of plasma anti-gSG6-P1 IgG levels in determining changes in Anopheles gambiae bite rates in a rural area of Cameroon. Sci Rep 2024; 14:14294. [PMID: 38906949 PMCID: PMC11192751 DOI: 10.1038/s41598-024-58337-8] [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: 11/16/2023] [Accepted: 03/27/2024] [Indexed: 06/23/2024] Open
Abstract
The applicability of the specific human IgG antibody response to Anopheles gambiae salivary Gland Protein-6 peptide 1 (gSG6-P1 salivary peptide) as a biomarker able to distinguish the level of exposure to mosquito bites according to seasonal variations has not yet been evaluated in Central African regions. The study aimed to provide the first reliable data on the IgG anti-gSG6-P1 response in rural area in Cameroon according to the dry- and rainy-season. Between May and December 2020, dry blood samples were collected from people living in the Bankeng village in the forest area of the Centre region of Cameroon. Malaria infection was determined by thick-blood smear microscopy and multiplex PCR. The level of IgG anti-gSG6-P1 response, was assessed by enzyme-linked immunosorbent assay. Anopheles density and aggressiveness were assessed using human landing catches. The prevalence of malaria infection remains significantly higher in the rainy season than in the dry season (77.57% vs 61.44%; p = 0.0001). The specific anti-gSG6-P1 IgG response could be detected in individuals exposed to few mosquito bites and showed inter-individual heterogeneity even when living in the same exposure area. In both seasons, the level of anti-gSG6-P1 IgG response was not significantly different between Plasmodium infected and non-infected individuals. Mosquito bites were more aggressive in the rainy season compared to the dry season (human biting rate-HBR of 15.05 b/p/n vs 1.5 b/p/n) where mosquito density was very low. Infected mosquitoes were found only during the rainy season (sporozoite rate = 10.63% and entomological inoculation rate-EIR = 1.42 ib/p/n). The level of IgG anti-gSG6-P1 response was significantly higher in the rainy season and correlated with HBR (p ˂ 0.0001). This study highlights the high heterogeneity of individual's exposure to the Anopheles gambiae s.l vector bites depending on the transmission season in the same area. These findings reinforce the usefulness of the anti-gSG6-P1 IgG response as an accurate immunological biomarker for detecting individual exposure to Anopheles gambiae s.l. bites during the low risk period of malaria transmission in rural areas and for the differentiating the level of exposure to mosquitoes.
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Affiliation(s)
- Glwadys Cheteug Nguetsa
- Malaria Research Unit, Centre Pasteur Cameroon, P.O. Box 1274, Yaoundé, Cameroon.
- Department of Microbiology and Parasitology, Faculty of Sciences, The University of Buea, P.O. Box 63, Buea, Cameroon.
| | - Emmanuel Elanga-Ndille
- Department of Animal Biology, Faculty of Sciences, The University of Dschang, P.O. Box 96, Dschang, Cameroon
- Department of Medical Entomology, Centre for Research in Infectious Diseases, P.O. Box 13591, Yaoundé, Cameroon
| | - Estelle Géraldine Essangui Same
- Malaria Research Unit, Centre Pasteur Cameroon, P.O. Box 1274, Yaoundé, Cameroon
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O. Box 2701, Douala, Cameroon
| | - Tatiana Nganso Keptchouang
- Malaria Research Unit, Centre Pasteur Cameroon, P.O. Box 1274, Yaoundé, Cameroon
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O. Box 2701, Douala, Cameroon
| | - Stanilas Elysée Mandeng
- Department of Animal Biology and Physiology, Faculty of Sciences, The University of Yaoundé, P.O. Box 337, Yaounde 1, Cameroon
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte Contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon
| | - Wolfgang Ekoko Eyisap
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte Contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon
| | - Jérome Achille Binyang
- Department of Medical Entomology, Centre for Research in Infectious Diseases, P.O. Box 13591, Yaoundé, Cameroon
- Department of Animal Biology and Physiology, Faculty of Sciences, The University of Yaoundé, P.O. Box 337, Yaounde 1, Cameroon
| | - Balotin Fogang
- Malaria Research Unit, Centre Pasteur Cameroon, P.O. Box 1274, Yaoundé, Cameroon
- Department of Animal Biology and Physiology, Faculty of Sciences, The University of Yaoundé, P.O. Box 337, Yaounde 1, Cameroon
| | - Lynda Nouage
- Department of Medical Entomology, Centre for Research in Infectious Diseases, P.O. Box 13591, Yaoundé, Cameroon
- Department of Animal Biology and Physiology, Faculty of Sciences, The University of Yaoundé, P.O. Box 337, Yaounde 1, Cameroon
| | - Micheal Piameu
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte Contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon
- Ecole des Sciences de La Santé, Université Catholique d'Afrique Centrale, P.O. Box 1110, Yaoundé, Cameroon
| | - Lawrence Ayong
- Malaria Research Unit, Centre Pasteur Cameroon, P.O. Box 1274, Yaoundé, Cameroon
| | - Josiane Etang
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O. Box 2701, Douala, Cameroon
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte Contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon
| | - Samuel Wanji
- Department of Microbiology and Parasitology, Faculty of Sciences, The University of Buea, P.O. Box 63, Buea, Cameroon
| | - Carole Else Eboumbou Moukoko
- Malaria Research Unit, Centre Pasteur Cameroon, P.O. Box 1274, Yaoundé, Cameroon.
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O. Box 2701, Douala, Cameroon.
- Laboratory of Parasitology, Mycology and Virology, Postgraduate Training Unit for Health Sciences, Postgraduate School for Pure and Applied Sciences, The University of Douala, P.O. Box 2701, Douala, Cameroon.
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Gonahasa S, Nassali M, Maiteki-Sebuguzi C, Namuganga JF, Opigo J, Nabende I, Okiring J, Epstein A, Snyman K, Nankabirwa JI, Kamya MR, Dorsey G, Staedke SG. LLIN evaluation in Uganda project (LLINEUP2): association between housing construction and malaria burden in 32 districts. Malar J 2024; 23:190. [PMID: 38886782 PMCID: PMC11181653 DOI: 10.1186/s12936-024-05012-y] [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: 02/21/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Well-built housing limits mosquito entry and can reduce malaria transmission. The association between community-level housing and malaria burden in Uganda was assessed using data from randomly selected households near 64 health facilities in 32 districts. METHODS Houses were classified as 'improved' (synthetic walls and roofs, eaves closed or absent) or 'less-improved' (all other construction). Associations between housing and parasitaemia were made using mixed effects logistic regression (individual-level) and multivariable fractional response logistic regression (community-level), and between housing and malaria incidence using multivariable Poisson regression. RESULTS Between November 2021 and March 2022, 4.893 children aged 2-10 years were enrolled from 3.518 houses; of these, 1.389 (39.5%) were classified as improved. Children living in improved houses had 58% lower odds (adjusted odds ratio = 0.42, 95% CI 0.33-0.53, p < 0.0001) of parasitaemia than children living in less-improved houses. Communities with > 67% of houses improved had a 63% lower parasite prevalence (adjusted prevalence ratio 0.37, 95% CI 0.19-0.70, p < 0.0021) and 60% lower malaria incidence (adjusted incidence rate ratio 0.40, 95% CI 0.36-0.44, p < 0.0001) compared to communities with < 39% of houses improved. CONCLUSIONS Improved housing was strongly associated with lower malaria burden across a range of settings in Uganda and should be utilized for malaria control.
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Affiliation(s)
- Samuel Gonahasa
- Infectious Diseases Research Collaboration, Kampala, Uganda.
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Martha Nassali
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Catherine Maiteki-Sebuguzi
- Infectious Diseases Research Collaboration, Kampala, Uganda
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | | | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Isaiah Nabende
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Adrienne Epstein
- Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Katherine Snyman
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Sarah G Staedke
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
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Xing SY, Zhang HT, Wang LM, Lu HZ, Peng ZY, Liu M, Li CX, Deng SQ. Examining the paradox: increased malaria risk in children under 5 in female-headed households in Nigeria. Malar J 2024; 23:171. [PMID: 38816783 PMCID: PMC11140880 DOI: 10.1186/s12936-024-04997-w] [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: 01/04/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Nigeria is facing a severe malaria crisis, accounting for a significant proportion of global cases and deaths of malaria. This study aimed to investigate the differences between female-headed households (FHHs) and male-headed households (MHHs) and their impact on malaria risk among children under five (U5) in Nigeria. METHODS Data from the 2021 Nigeria Malaria Indicator Survey (NMIS) were used for this cross-sectional study. A representative sample of 10,988 households was analysed, with key variables subjected to frequency calculations, descriptive statistics, and bivariate analyses using t-tests and chi-square analyses to compare the differences between FHHs and MHHs. RESULTS Among all participants, 92.1% (N = 10,126) reported residing in male-headed households, while 7.8% (N = 862) reported living in female-headed households. MHHs were significantly more likely to own insecticide-treated bed nets (ITNs) than FHHs (64.7% vs. 53.6%, P < 0.001). U5 children in MHHs had a greater likelihood of sleeping under a bed net the night before the survey than U5 children in FHHs (35.3% vs. 30.0%, P < 0.05). The prevalence of fever in the previous two weeks among U5 children was similar in MHHs and FHHs (35.4% vs. 31.4%), and the testing rates for malaria among U5 children who experienced febrile episodes were higher in MHHs than FHHs (22.4% vs. 15.4%, P < 0.05). Although not statistically significant, FHHs exhibited a higher percentage of U5 children testing positive for malaria compared to MHHs (87.8% vs. 78.9%). On the other hand, FHHs had higher education levels, overall wealth index scores, and a larger presence in urban areas compared to MHHs (P < 0.001). Moreover, FHHs reported higher adherence to malaria prevention awareness (P < 0.001). CONCLUSION In Nigeria, FHHs enjoy relatively better socioeconomic conditions and stronger awareness of malaria prevention compared to their male-headed counterparts. Contrary to expectations, FHHs are at an increased risk of malaria in children under 5 years old. This phenomenon is associated with entrenched gender inequality and the challenges women face in accessing critical assets. As women in FHHs bear the responsibility of income generation while caring for their children, it is crucial to prioritize interventions that address malaria management in FHHs to reduce both malaria incidence and mortality rates.
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Affiliation(s)
- Si-Yu Xing
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, The Provincial Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Hai-Ting Zhang
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, The Provincial Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China
| | - Lin-Min Wang
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, The Provincial Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China
| | - Hong-Zheng Lu
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, The Provincial Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China
| | - Zhe-Yu Peng
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, The Provincial Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China
| | - Miao Liu
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, The Provincial Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China.
| | - Chun-Xiao Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China.
| | - Sheng-Qun Deng
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, The Provincial Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China.
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Engeda EH, Aldersey HM, Davison CM, Gelaye KA, Fayed N. Perceptions and behaviors of healthcare providers towards rehabilitation support to children with severe malaria-related disability in Ethiopia: A qualitative descriptive study using the Theoretical Domains Framework. PLoS One 2024; 19:e0298769. [PMID: 38696368 PMCID: PMC11065226 DOI: 10.1371/journal.pone.0298769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 01/31/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Severe malaria often results in childhood disability. The prevalence of disability related to severe malaria is significant and is estimated to affect up to 53% of severe malaria survivors. In contrast, information is sparse about how healthcare providers in Africa think about or provide rehabilitation support in acute and post-acute phases respectively. Understanding the perceptions and behaviors of healthcare providers treating malaria could help inform malaria-related disability research, policy, and practice, aimed at the providers themselves. This study explored the perceptions and behaviors of healthcare providers towards rehabilitation for children with severe malaria-related disability. The Theoretical Domains Framework was used to describe the findings relative to wider literature on health provider behavior change. METHODS A qualitative descriptive approach was used to interview thirteen healthcare providers recruited purposively based on their clinical professions, roles, and settings. Data were analyzed using directed content analysis. We decided on the most prominent theoretical domains considering the frequency of specific perceptions and behaviors across the participants, the frequency of perceptions and behaviors in each domain, and evidence of strong perceptions and behaviors. RESULTS Nine out of fourteen theoretical domains were identified. These domains were: Beliefs about consequences, environmental context and resources, goals, knowledge, skills, optimism, reinforcement, social influences, and social or professional role and identity. Healthcare providers' beliefs about their roles in screening for disability or referring to rehabilitation were less positive. CONCLUSIONS The findings of this study suggest the need for interventions to support healthcare providers in acute phases (prevention and control of severe malaria) and post-acute phases (disability screening, referral, and rehabilitation care). Recommended interventions should focus on developing clinical guidelines, training clinicians, addressing institutional factors, and modifying external social influences such as socio-cultural factors.
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Affiliation(s)
- Eshetu Haileselassie Engeda
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Heather M. Aldersey
- Queen’s University School of Rehabilitation Therapy, Kingston, Ontario, Canada
| | - Colleen M. Davison
- Department of Public Health Sciences, Queen’s University Kingston, Kingston, Ontario, Canada
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nora Fayed
- Queen’s University School of Rehabilitation Therapy, Kingston, Ontario, Canada
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Tizifa TA, Kabaghe AN, McCann RS, Gowelo S, Malenga T, Nkhata RM, Chapeta Y, Nkhono W, Kadama A, Takken W, Phiri KS, van Vugt M, van den Berg H, Manda-Taylor L. Assessing the implementation fidelity, feasibility, and sustainability of community-based house improvement for malaria control in southern Malawi: a mixed-methods study. BMC Public Health 2024; 24:951. [PMID: 38566043 PMCID: PMC10988826 DOI: 10.1186/s12889-024-18401-4] [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: 09/18/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Despite significant success in the fight against malaria over the past two decades, malaria control programmes rely on only two insecticidal methods: indoor residual spraying and insecticidal-treated nets. House improvement (HI) can complement these interventions by reducing human-mosquito contact, thereby reinforcing the gains in disease reduction. This study assessed the implementation fidelity, which is the assessment of how closely an intervention aligns with its intended design, feasibility, and sustainability of community-led HI in southern Malawi. METHODS The study, conducted in 22 villages (2730 households), employed a mixed-methods approach. Implementation fidelity was assessed using a modified framework, with longitudinal surveys collecting data on HI coverage indicators. Quantitative analysis, employing descriptive statistics, evaluated the adherence to HI implementation. Qualitative data came from in-depth interviews, key informant interviews, and focus groups involving project beneficiaries and implementers. Qualitative data were analysed using content analysis guided by the implementation fidelity model to explore facilitators, challenges, and factors affecting intervention feasibility. RESULTS The results show that HI was implemented as planned. There was good adherence to the intended community-led HI design; however, the adherence could have been higher but gradually declined over time. In terms of intervention implementation, 74% of houses had attempted to have eaves closed in 2016-17 and 2017-18, compared to 70% in 2018-19. In 2016-17, 42% of houses had all four sides of the eaves closed, compared to 33% in 2018-19. Approximately 72% of houses were screened with gauze wire in 2016-17, compared to 57% in 2018-19. High costs, supply shortages, labour demands, volunteers' poor living conditions and adverse weather were reported to hinder the ideal HI implementation. Overall, the community described community-led HI as feasible and could be sustained by addressing these socioeconomic and contextual challenges. CONCLUSION Our study found that although HI was initially implemented as planned, its fidelity declined over time. Using trained volunteers facilitated the fidelity and feasibility of implementing the intervention. A combination of rigorous community education, consistent training, information, education and communication, and intervention modifications may be necessary to address the challenges and enhance the intervention's fidelity, feasibility, and sustainability.
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Affiliation(s)
- Tinashe A Tizifa
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, University of Amsterdam, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands.
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
| | - Alinune N Kabaghe
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Robert S McCann
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
- Centre for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
| | - Steven Gowelo
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Tumaini Malenga
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- National TB and Leprosy Elimination Programme, Ministry of Health, Lilongwe, Malawi
| | - Richard M Nkhata
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Yankho Chapeta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Biological Sciences Department, Mzuzu University, Mzuzu, Malawi
| | - William Nkhono
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Asante Kadama
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Willem Takken
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Kamija S Phiri
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Michele van Vugt
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, University of Amsterdam, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Henk van den Berg
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Lucinda Manda-Taylor
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Kibondo UA, Renju J, Lukole E, Mosha JF, Mosha FW, Manjurano A, Rowland M, Protopopoff N. Factors associated with malaria infection among children after distribution of PBO-pyrethroid synergist-treated nets and indoor residual spraying in north-western Tanzania. PLoS One 2023; 18:e0295800. [PMID: 38127909 PMCID: PMC10734997 DOI: 10.1371/journal.pone.0295800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND After a decade of successful control, malaria is on the rise again. The prevalence of malaria in Tanzania has increased from 7% in 2017 to 8% in 2022 and reached 18% in Kagera region in the North West of Tanzania. Malaria vectors in Muleba district Kagera have high level of pyrethroid resistance. The aim of this paper is to explore factors associated with malaria infection prevalence in children aged 6 months to 14 years in Muleba, where Long Lasting Insecticidal Net (LLIN) combining a pyrethroid insecticide and synergist piperonyl butoxide (PBO) that counteract resistance in the mosquitoes, was first distributed under trial conditions in 2015. METHODS The trial was a community randomized control in which there were two malaria prevalence cross-sectional household surveys each year (June and December) from 2015 to 2017 in Muleba. In this study we conducted a secondary data analysis of the December surveys only. Multilevel Poisson regression analysis was used to assess factors associated with malaria infection. RESULTS A total of 10,941 children and 4,611 households were included in this study. Overall malaria prevalence was 35.8%, 53.3% and 54.4% in the year 2015, 2016 and 2017 respectively. Living in an area with standard LLIN as opposed to the novel PBO synergist LLIN, being a male child, above 5 years of age, living in a house with open eaves, living in house without IRS, having head of household with no formal education, lower socioeconomic status and survey year were associated with increased risk of malaria infection. CONCLUSIONS Using PBO LLIN reduced the risk of malaria infection. However, additional measures could further reduce malaria infection in areas of insecticide resistance such as housing improvement.
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Affiliation(s)
- Ummi Abdul Kibondo
- Vector Control Product Testing Unit (VCPTU) Ifakara Health Institute, Environmental Health, and Ecological Sciences, Bagamoyo, Tanzania
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Jenny Renju
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eliud Lukole
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jacklin F. Mosha
- National Institute for Medical Research, Mwanza Medical Research Centre, Mwanza, Tanzania
| | | | - Alphaxard Manjurano
- National Institute for Medical Research, Mwanza Medical Research Centre, Mwanza, Tanzania
| | - Mark Rowland
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
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Naserrudin NA, Lin PYP, Monroe A, Baumann SE, Adhikari B, Miller AC, Sato S, Fornace KM, Culleton R, Cheah PY, Hod R, Jeffree MS, Ahmed K, Hassan MR. Disentangling the intersection of inequities with health and malaria exposure: key lessons from rural communities in Northern Borneo. Malar J 2023; 22:343. [PMID: 37946259 PMCID: PMC10636872 DOI: 10.1186/s12936-023-04750-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The increasing incidence of Plasmodium knowlesi malaria poses a significant challenge to efforts to eliminate malaria from Malaysia. Macaque reservoirs, outdoors-biting mosquitoes, human activities, and agricultural work are key factors associated with the transmission of this zoonotic pathogen. However, gaps in knowledge regarding reasons that drive malaria persistence in rural Kudat, Sabah, Northern Borneo remain. This study was conducted to address this knowledge gap, to better understand the complexities of these entangled problems, and to initiate discussion regarding new countermeasures to address them. This study aims to highlight rural community members' perspectives regarding inequities to health relating to P. knowlesi malaria exposure. METHODS From January to October 2022, a study using qualitative methods was conducted in four rural villages in Kudat district of Sabah, Malaysia. A total of nine in-depth interviews were conducted with community and faith leaders, after the completion of twelve focus group discussions with 26 photovoice participants. The interviews were conducted using the Sabah Malay dialect, audio-recorded, transcribed, and translated into English. The research team led the discussion and analysis, which was approved by participants through member checking at the community level. RESULTS Participants identified disparity in health as a key issue affecting their health and livelihoods. Injustice in the social environment was also identified as a significant challenge, including the importance of listening to the voices of affected communities in disentangling the social and economic phenomena that can impact malaria control. Specific concerns included inadequate access to health-related resources and degradation of the environment. Participants recommended improving access to water and other necessities, increasing the availability of malaria control commodities in healthcare facilities, and developing sustainable programs to reduce socioeconomic disparities. CONCLUSION Inequities to health emerged as a key concern for malaria control in rural Kudat, Sabah. A locally targeted malaria programme cantered on improving the social and economic disparities associated with health outcomes, could be a potential strategy for malaria prevention in such areas. Community-level perspectives gathered from this study can be used as a foundation for future discussions and dialogues among policymakers and community members for achieving greater transparency, improving social equity, and interoperability in addressing P. knowlesi malaria control.
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Affiliation(s)
- Nurul Athirah Naserrudin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
- Sabah State Health Department, Ministry of Health, 88590, Kota Kinabalu, Malaysia
| | - Pauline Yong Pau Lin
- Faculty of Social Sciences and Humanities, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Malaysia
| | - April Monroe
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Sara Elizabeth Baumann
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA, 15261, USA
| | - 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
| | | | - Shigeharu Sato
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
- Department of Pathology and Microbiology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Malaysia
| | - Kimberly M Fornace
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Richard Culleton
- Division of Molecular Parasitology, Proteo-Science Center, Ehime University, Toon, Ehime, 791-0295, Japan
| | - Phaik Yeong Cheah
- 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
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rozita Hod
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Mohammad Saffree Jeffree
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Malaysia
| | - Kamruddin Ahmed
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
- Department of Pathology and Microbiology, 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, 56000, Kuala Lumpur, Malaysia.
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia.
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11
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Mponzi WP, Msaky DS, Binyaruka P, Kaindoa EW. Exploring the potential of village community banking as a community-based financing system for house improvements and malaria vector control in rural Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002395. [PMID: 37922222 PMCID: PMC10624283 DOI: 10.1371/journal.pgph.0002395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/09/2023] [Indexed: 11/05/2023]
Abstract
House improvement is associated with remarkable reductions in indoor mosquito bites and disease incidences, even in typical rural houses. However, its exploitation remains extremely poor in Tanzania and other endemic countries due to limited financial resources. Nevertheless, village community banks (VICOBA), practiced in Tanzania for nearly two decades, have proven to provide financial services to rural communities that would otherwise not be able to get them from formal financial institutions. This study explored the need, opinion, and willingness of VICOBA members to use VICOBA platforms as a source of finance for improving local houses and eventually controlling mosquito-borne diseases. A mixed-methods approach was used in this study, whereby a survey was administered to 150 participants and twelve focus group discussions were done in three villages in Ulanga district, rural Tanzania. The FGDs comprised eight participants each, with equal representation of males and females. The FGD guide was used to probe the opinions of study participants on malaria transmission, housing condition improvements, and financial resources. About 99% of all participants indicated the urgent need to improve their houses to prevent mosquito bites and were willing to utilize VICOBA for improving their houses. In the focus group discussion, the majority of people who participated were also in need of improving their houses. All participants confirmed that they were at the highest risk of getting mosquito-borne diseases, and they were willing to use money that was either saved or borrowed from their VICOBA for housing improvements and vector control. A self-sustaining financial system destined for house improvement and related interventions against malaria and other mosquito-borne diseases is crucial. The community members were willing to use VICOBA as a source of finance for house improvement and disease control; however, there was limited knowledge and sensitization on how they could utilize VICOBA for disease control.
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Affiliation(s)
- Winifrida P. Mponzi
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Dickson S. Msaky
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
- The Nelson Mandela, African Institution of Science and Technology, School of Life Sciences and Bio Engineering, Tengeru, Arusha, United Republic of Tanzania
| | - Peter Binyaruka
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Emmanuel W. Kaindoa
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
- The Nelson Mandela, African Institution of Science and Technology, School of Life Sciences and Bio Engineering, Tengeru, Arusha, United Republic of Tanzania
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa
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12
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Sun D, Jiang H, Wang G, Hu X, Wang S, Chen Y. Factors Contributing to the Pre-Elimination of Malaria from Hainan Island, China, 1986-2009. Am J Trop Med Hyg 2023; 109:1063-1071. [PMID: 37918006 PMCID: PMC10622475 DOI: 10.4269/ajtmh.23-0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/17/2023] [Indexed: 11/04/2023] Open
Abstract
Malaria was endemic in Hainan Island, China, for a lengthy period before its elimination. Here, we aim to gain a better understanding of malaria elimination by assessing and quantifying the relative effects of longitudinal changes in specific antimalarial interventions, socioeconomic development approaches, and malaria vectors on malaria prevalence in Hainan during the 1986-2009 pre-elimination period. Annual data were collected on the incidence of malaria, the number of residents protected by drugs (RPD), the number of residents protected by vector control, the presence of Anopheles minimus and Anopheles dirus, the annual per capita income of rural residents, major cash crop (rubber plantation) areas, the literacy rate of adult rural residents, and the rate of reinforced concrete house construction in rural areas. Backward stepwise multiple linear regression models were developed to identify the factors associated with the annual malaria incidence (AMI). The AMI declined from 20.3 to 0.8 per 10,000 population from 1986 to 2009; this decrease was significantly associated with an increase in the number of RPD and improved literacy rate among rural adults. The results of this study implied that the sustained distribution of antimalarial drugs and increase in education levels in risk areas significantly impacted the reduction and elimination of malaria infection in Hainan. We suggest that these findings could be applicable to malaria-endemic areas in Southeast Asia with similar natural and socioeconomic environments to Hainan and where malaria incidence has decreased to a low level.
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Affiliation(s)
- Dingwei Sun
- Hainan Provincial Center for Disease Control and Prevention, Haikou, China
| | - Hongwei Jiang
- Graduate School of Humanities, Osaka University, Toyonaka City, Japan
- Research Institute for Humanity and Nature, Kyoto, Japan
| | - Guangze Wang
- Hainan Provincial Center for Disease Control and Prevention, Haikou, China
| | - Ximin Hu
- Hainan Provincial Center for Disease Control and Prevention, Haikou, China
| | - Shanqing Wang
- Hainan Provincial Center for Disease Control and Prevention, Haikou, China
| | - Yan Chen
- Hainan Provincial Center for Disease Control and Prevention, Haikou, China
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Damien BG, Kesteman T, Dossou-Yovo GA, Dahounto A, Henry MC, Rogier C, Remoué F. Long-Lasting Insecticide-Treated Nets Combined or Not with Indoor Residual Spraying May Not Be Sufficient to Eliminate Malaria: A Case-Control Study, Benin, West Africa. Trop Med Infect Dis 2023; 8:475. [PMID: 37888603 PMCID: PMC10611126 DOI: 10.3390/tropicalmed8100475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
In sub-Saharan Africa, despite the implementation of multiple control interventions, the prevalence of malaria infection and clinical cases remains high. The primary tool for vector control against malaria in this region is the use of long-lasting insecticide-treated nets (LLINs) combined or not with indoor residual spraying (IRS) to achieve a synergistic effect in protection. The objective of this study was to assess the effectiveness of LLINs, with or without IRS, protected against Plasmodium falciparum infection and uncomplicated clinical cases (UCC) of malaria in Benin. A case-control study was conducted, encompassing all age groups, in the urban area of Djougou and the rural area of Cobly. A cross-sectional survey was conducted that included 2080 individuals in the urban area and 2770 individuals in the rural area. In the urban area, sleeping under LLINs did not confer significant protection against malaria infection and UCC when compared to no intervention. However, certain neighbourhoods benefited from a notable reduction in infection rates ranging from 65% to 85%. In the rural area, the use of LLINs alone, IRS alone, or their combination did not provide additional protection compared to no intervention. IRS alone and LLINs combined with IRS provided 61% and 65% protection against malaria infection, respectively, compared to LLINs alone. The effectiveness of IRS alone and LLINs combined with IRS against UCC was 52% and 54%, respectively, when compared to LLINs alone. In both urban and rural areas, the use of LLINs alone, IRS alone, and their combination did not demonstrate significant individual protection against malaria infection and clinical cases when compared to no intervention. In the conditions of this study, LLINs combined or not with IRS are not effective enough to eliminate malaria. In addition to the interventions, this study identified factors associated with malaria in Benin as housing design, neglected social groups like gender-marginalised individuals and adolescents, and socio-economic conditions acting as barriers to effective malaria prevention. Addressing these factors is crucial in order to facilitate malaria elimination efforts in sub-Saharan Africa.
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Affiliation(s)
- Barikissou G. Damien
- MIVEGEC (Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle), Université de Montpellier, CNRS, IRD, 911 Avenue Agropolis BP 64501, 34394 Montpellier, France; (G.A.D.-Y.); (A.D.); (M.-C.H.); (F.R.)
- Centre de Recherche Entomologique de Cotonou (CREC), Cotonou 06 BP 2604, Benin
| | - Thomas Kesteman
- Malaria Research Unit, Institute Pasteur de Madagascar, BP 1274 Avaradoha, Antananarivo 101, Madagascar; (T.K.); (C.R.)
| | - Gatien A. Dossou-Yovo
- MIVEGEC (Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle), Université de Montpellier, CNRS, IRD, 911 Avenue Agropolis BP 64501, 34394 Montpellier, France; (G.A.D.-Y.); (A.D.); (M.-C.H.); (F.R.)
- Centre de Recherche Entomologique de Cotonou (CREC), Cotonou 06 BP 2604, Benin
| | - Amal Dahounto
- MIVEGEC (Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle), Université de Montpellier, CNRS, IRD, 911 Avenue Agropolis BP 64501, 34394 Montpellier, France; (G.A.D.-Y.); (A.D.); (M.-C.H.); (F.R.)
- Centre de Recherche Entomologique de Cotonou (CREC), Cotonou 06 BP 2604, Benin
| | - Marie-Claire Henry
- MIVEGEC (Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle), Université de Montpellier, CNRS, IRD, 911 Avenue Agropolis BP 64501, 34394 Montpellier, France; (G.A.D.-Y.); (A.D.); (M.-C.H.); (F.R.)
- Centre de Recherche Entomologique de Cotonou (CREC), Cotonou 06 BP 2604, Benin
| | - Christophe Rogier
- Malaria Research Unit, Institute Pasteur de Madagascar, BP 1274 Avaradoha, Antananarivo 101, Madagascar; (T.K.); (C.R.)
- Primum Vitare, 118 Avenue Félix Faure, 75015 Paris, France
| | - Franck Remoué
- MIVEGEC (Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle), Université de Montpellier, CNRS, IRD, 911 Avenue Agropolis BP 64501, 34394 Montpellier, France; (G.A.D.-Y.); (A.D.); (M.-C.H.); (F.R.)
- Centre de Recherche Entomologique de Cotonou (CREC), Cotonou 06 BP 2604, Benin
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Semakula HM, Liang S, Mukwaya PI, Mugagga F, Nseka D, Wasswa H, Mwendwa P, Kayima P, Achuu SP, Nakato J. Bayesian belief network modelling approach for predicting and ranking risk factors for malaria infections among children under 5 years in refugee settlements in Uganda. Malar J 2023; 22:297. [PMID: 37794401 PMCID: PMC10552276 DOI: 10.1186/s12936-023-04735-8] [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: 06/03/2023] [Accepted: 09/29/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Malaria risk factors at household level are known to be complex, uncertain, stochastic, nonlinear, and multidimensional. The interplay among these factors, makes targeted interventions, and resource allocation for malaria control challenging. However, few studies have demonstrated malaria's transmission complexity, control, and integrated modelling, with no available evidence on Uganda's refugee settlements. Using the 2018-2019 Uganda's Malaria Indicator Survey (UMIS) data, an alternative Bayesian belief network (BBN) modelling approach was used to analyse, predict, rank and illustrate the conceptual reasoning, and complex causal relationships among the risk factors for malaria infections among children under-five in refugee settlements of Uganda. METHODS In the UMIS, household level information was obtained using standardized questionnaires, and a total of 675 children under 5 years were tested for malaria. From the dataset, a casefile containing malaria test results, demographic, social-economic and environmental information was created. The casefile was divided into a training (80%, n = 540) and testing (20%, n = 135) datasets. The training dataset was used to develop the BBN model following well established guidelines. The testing dataset was used to evaluate model performance. RESULTS Model accuracy was 91.11% with an area under the receiver-operating characteristic curve of 0.95. The model's spherical payoff was 0.91, with the logarithmic, and quadratic losses of 0.36, and 0.16 respectively, indicating a strong predictive, and classification ability of the model. The probability of refugee children testing positive, and negative for malaria was 48.1% and 51.9% respectively. The top ranked malaria risk factors based on the sensitivity analysis included: (1) age of child; (2) roof materials (i.e., thatch roofs); (3) wall materials (i.e., poles with mud and thatch walls); (4) whether children sleep under insecticide-treated nets; 5) type of toilet facility used (i.e., no toilet facility, and pit latrines with slabs); (6) walk time distance to water sources (between 0 and 10 min); (7) drinking water sources (i.e., open water sources, and piped water on premises). CONCLUSION Ranking, rather than the statistical significance of the malaria risk factors, is crucial as an approach to applied research, as it helps stakeholders determine how to allocate resources for targeted malaria interventions within the constraints of limited funding in the refugee settlements.
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Affiliation(s)
- Henry Musoke Semakula
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda.
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, 2055 Mowry Rd, Gainesville, FL, 32610, USA.
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts, Amherst, 01003, USA.
| | - Song Liang
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts, Amherst, 01003, USA
| | - Paul Isolo Mukwaya
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Frank Mugagga
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Denis Nseka
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Hannington Wasswa
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Patrick Mwendwa
- Department of Horticulture and Food Security, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200, Nairobi, Kenya
| | - Patrick Kayima
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Simon Peter Achuu
- National Environmental Management Authority (NEMA), Plot 17/19/21 Jinja Road, P.O. Box 22255, Kampala, Uganda
| | - Jovia Nakato
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
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Kihwele F, Gavana T, Makungu C, Msuya HM, Mlacha YP, Govella NJ, Chaki PP, Sunguya BF. Exploring activities and behaviours potentially increases school-age children's vulnerability to malaria infections in south-eastern Tanzania. Malar J 2023; 22:293. [PMID: 37789435 PMCID: PMC10548596 DOI: 10.1186/s12936-023-04703-2] [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: 04/18/2023] [Accepted: 09/02/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Strengthening malaria control activities in Tanzania has dramatically declined human malaria infections. However, there is an increasing epidemiological shift in the burden on school-age children. The underlying causes for such an epidemiological shift remain unknown in this context. This study explored activities and behaviours that could increase the vulnerability of school-age children to transmission risk to provide insight into protection gap with existing interventions and opportunities for supplementary interventions. METHODS This cross-sectional study conducted twenty-four focus group discussions (FGDs) in three districts of Rufiji, Kibiti and Kilwa in south-eastern Tanzania. Sixteen FGDs worked with school-age children (13 to 18 years) separating girls and boys and eight FGDs with their parents in mixed-gender groups. A total of 205 community members participated in FGDs across the study area. Of them, 72 participants were parents, while 133 were school-age children (65 boys and 68 girls). RESULTS Routine domestic activities such as fetching water, washing kitchen utensils, cooking, and recreational activities such as playing and watching television and studying were the reported activities that kept school-age children outdoors early evening to night hours (between 18:00 and 23:00). Likewise, the social and cultural events including initiation ceremonies and livelihood activities also kept this age group outdoors from late evening to early night and sometimes past midnight hours. Parents migrating to farms from December to June, leaving behind school-age children unsupervised affecting their net use behaviour plus spending more time outdoors at night, and the behaviour of children sprawling legs and hands while sleeping inside treated bed nets were identified as potential risks to infectious mosquito bites. CONCLUSION The risky activities, behaviours, and social events mostly occurring outdoors might increase school-age children's vulnerability to malaria infections. The findings provide preliminary insight on potential risk factors for persisting transmission. Further studies to quantify the risk behaviour and activities are recommended to establish the magnitude and anticipated impact on supplementary control strategies to control infection in school-age children.
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Affiliation(s)
- Fadhila Kihwele
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania.
- Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, United Republic of Tanzania.
| | - Tegemeo Gavana
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania
- Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, United Republic of Tanzania
| | - Christina Makungu
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania
| | - Hajirani M Msuya
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania
| | - Yeromin P Mlacha
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania
| | - Nicodem James Govella
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania
- School of Life Sciences and Bioengineering (LISBE), Nelson Mandela African Institution of Science and Technology, P.O. BOX 447, Tengeru, Arusha, United Republic of Tanzania
| | - Prosper Pius Chaki
- Environmental Health and Ecological Sciences Department, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78373, Dar Es Salaam, United Republic of Tanzania
- The Pan African Mosquito Control Association (PAMCA), KEMRI Headquarters, Mbagathi Road Nairobi, Nairobi, 54840-00200, Kenya
| | - Bruno Fokas Sunguya
- Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, United Republic of Tanzania
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Searle KM, Earland D, Francisco A, Muhiro V, Novela A, Ferrão J. Household structure is independently associated with malaria risk in rural Sussundenga, Mozambique. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1137040. [PMID: 38455901 PMCID: PMC10911029 DOI: 10.3389/fepid.2023.1137040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/26/2023] [Indexed: 03/09/2024]
Abstract
Introduction Mozambique has the fourth highest malaria cases and malaria mortality globally. Locally, malaria incidence increases from low in the southern region to high in the central and northern regions. Manica Province in central Mozambique has the fourth highest prevalence of malaria out of the 11 provinces, and the highest in the central region of the country. In this area where coverage of interventions has been limited, household level risk factors can be important for understanding the natural history of infection, as well as the implementation of current and future interventions. There has been indication that the relationship between household structure and malaria risk is actually a mediating one between the true relationship between household income and education and Plasmodium falciparum infection. The objective of this study was to determine and quantify these complex relationships. Methods We conducted a community-based cross-sectional study in Sussundenga village. Sussundenga is a rural village, located in Sussundenga District, Manica Province, Mozambique. We enrolled 303 participants from 83 randomly selected households. We collected information on demographics, household construction, and administered a P. falciparum rapid diagnostic test (RDT). We constructed several generalized estimating equations logistic regression models to determine the independent effects of housing construction on malaria risk. We also constructed models separate from generalized estimating equations logistic mediation models to determine the proportion of effects mediated by household construction material in the relationship between head of household occupation and education and malaria risk. Results The overall malaria prevalence among the study population by RDT was 30.8%. In the multivariable model adjusting for all individual and household factors as potential confounders, rudimentary roof structure was the only household structural variable that was statistically significantly associated with increased malaria risk [OR 2.41 (1.03-5.63)]. We found no evidence that household structure mediated the relationship between head of household education or employment and malaria risk in our study population. Discussion Household structure was a significant risk factor for malaria infection in our study population. These findings are consistent with malaria being a disease of poverty and an area that could be targeted for future interventions that could have long-term impacts.
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Affiliation(s)
- Kelly M. Searle
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | - Dominique Earland
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | | | - Valy Muhiro
- Sussundenge-Sede Centro de Saude Rural, Sussundenga, Mozambique
| | - Anisío Novela
- Sussundenge-Sede Centro de Saude Rural, Sussundenga, Mozambique
| | - João Ferrão
- UniSCED Aberta de Mozambique, Chimoio, Mozambique
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17
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Montenegro-Quiñonez CA, Louis VR, Horstick O, Velayudhan R, Dambach P, Runge-Ranzinger S. Interventions against Aedes/dengue at the household level: a systematic review and meta-analysis. EBioMedicine 2023; 93:104660. [PMID: 37352828 PMCID: PMC10333437 DOI: 10.1016/j.ebiom.2023.104660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Because the evidence for the role of structural housing and combinations of interventions (domestic or peri-domestic) against Aedes mosquitoes or dengue is still lacking, this systematic review and meta-analysis aimed to analyse and synthesize research focusing on the household as the unit of allocation. METHODS We searched MEDLINE, LILACS, and Web of Science databases until February 2023 using three general keyword categories: (1) "Aedes" or "dengue"; (2) structural housing interventions including "house", "water", or "drainage"; and (3) vector control interventions of potential relevance and their combinations. We performed a qualitative content analysis and a meta-analysis for 13 entries on dengue seroconversion data. FINDINGS 14,272 articles were screened by titles, 615 by abstracts, 79 by full-text. 61 were selected. Satisfactory data quality allowed for detailed content analysis. Interventions at the household level against the immature mosquito stages (21 studies, 34%) showed positive or mixed results in entomological and epidemiological outcomes (86% and 75% respectively). Combined interventions against immature and adult stages (11 studies, 18%) performed similarly (91% and 67%) while those against the adult mosquitoes (29 studies, 48%) performed less well (79%, 22%). A meta-analysis on seroconversion outcomes showed a not-statistically significant reduction for interventions (log odds-ratio: -0.18 [-0.51, 0.14 95% CI]). INTERPRETATION No basic research on housing structure or modification was eligible for this systematic review but many interventions with clear impact on vector indices and, to a lesser extent, on dengue were described. The small and not-statistically significant effect size of the meta-analysis highlights the difficulty of proving effectiveness against this highly-clustered disease and of overcoming practical implementation obstacles (e.g. efficacy loss, compliance). The long-term success of interventions depends on suitability, community commitment and official support and promotion. The choice of a specific vector control package needs to take all these context-specific aspects into consideration. FUNDING This work was funded by a grant from the World Health Organization (2021/1121668-0, PO 202678425, NTD/VVE).
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Affiliation(s)
- Carlos Alberto Montenegro-Quiñonez
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany; Instituto de Investigaciones, Centro Universitario de Zacapa, Universidad de San Carlos de Guatemala, Guatemala.
| | - Valérie R Louis
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany.
| | - Olaf Horstick
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany.
| | - Raman Velayudhan
- Department of Control of Neglected Tropical Diseases (NTD), World Health Organization, Switzerland.
| | - Peter Dambach
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany.
| | - Silvia Runge-Ranzinger
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany.
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18
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Armando CJ, Rocklöv J, Sidat M, Tozan Y, Mavume AF, Bunker A, Sewes MO. Climate variability, socio-economic conditions and vulnerability to malaria infections in Mozambique 2016-2018: a spatial temporal analysis. Front Public Health 2023; 11:1162535. [PMID: 37325319 PMCID: PMC10267345 DOI: 10.3389/fpubh.2023.1162535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/28/2023] [Indexed: 06/17/2023] Open
Abstract
Background Temperature, precipitation, relative humidity (RH), and Normalized Different Vegetation Index (NDVI), influence malaria transmission dynamics. However, an understanding of interactions between socioeconomic indicators, environmental factors and malaria incidence can help design interventions to alleviate the high burden of malaria infections on vulnerable populations. Our study thus aimed to investigate the socioeconomic and climatological factors influencing spatial and temporal variability of malaria infections in Mozambique. Methods We used monthly malaria cases from 2016 to 2018 at the district level. We developed an hierarchical spatial-temporal model in a Bayesian framework. Monthly malaria cases were assumed to follow a negative binomial distribution. We used integrated nested Laplace approximation (INLA) in R for Bayesian inference and distributed lag nonlinear modeling (DLNM) framework to explore exposure-response relationships between climate variables and risk of malaria infection in Mozambique, while adjusting for socioeconomic factors. Results A total of 19,948,295 malaria cases were reported between 2016 and 2018 in Mozambique. Malaria risk increased with higher monthly mean temperatures between 20 and 29°C, at mean temperature of 25°C, the risk of malaria was 3.45 times higher (RR 3.45 [95%CI: 2.37-5.03]). Malaria risk was greatest for NDVI above 0.22. The risk of malaria was 1.34 times higher (1.34 [1.01-1.79]) at monthly RH of 55%. Malaria risk reduced by 26.1%, for total monthly precipitation of 480 mm (0.739 [95%CI: 0.61-0.90]) at lag 2 months, while for lower total monthly precipitation of 10 mm, the risk of malaria was 1.87 times higher (1.87 [1.30-2.69]). After adjusting for climate variables, having lower level of education significantly increased malaria risk (1.034 [1.014-1.054]) and having electricity (0.979 [0.967-0.992]) and sharing toilet facilities (0.957 [0.924-0.991]) significantly reduced malaria risk. Conclusion Our current study identified lag patterns and association between climate variables and malaria incidence in Mozambique. Extremes in climate variables were associated with an increased risk of malaria transmission, peaks in transmission were varied. Our findings provide insights for designing early warning, prevention, and control strategies to minimize seasonal malaria surges and associated infections in Mozambique a region where Malaria causes substantial burden from illness and deaths.
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Affiliation(s)
- Chaibo Jose Armando
- Department of Public Health and Clinical Medicine, Sustainable Health Section, Umeå University, Umeå, Sweden
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Sustainable Health Section, Umeå University, Umeå, Sweden
- Heidelberg Institute of Global Health and Interdisciplinary Centre for Scientific Computing, Heidelberg University, Heidelberg, Germany
| | - Mohsin Sidat
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Yesim Tozan
- School of Global Public Health, New York University, New York, NY, United States
| | | | - Aditi Bunker
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Maquins Odhiambo Sewes
- Department of Public Health and Clinical Medicine, Sustainable Health Section, Umeå University, Umeå, Sweden
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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19
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Muindi K, Iddi S, Gitau H, Mberu B. Housing and health outcomes: evidence on child morbidities from six Sub-Saharan African countries. BMC Pediatr 2023; 23:219. [PMID: 37147616 PMCID: PMC10163804 DOI: 10.1186/s12887-023-03992-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/05/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND The connection between healthy housing status and health is well established. The quality of housing plays a significant role in infectious and non-communicable as well as vector-borne diseases. The global burden of disease attributable to housing is considerable with millions of deaths arising from diarrheal and respiratory diseases annually. In sub-Saharan Africa (SSA), the quality of housing remains poor although improvements have been documented. There is a general dearth of comparative analysis across several countries in the sub-region. We assess in this study, the association between healthy housing and child morbidity across six countries in SSA. METHODS We use the Demographic and Health Survey (DHS) data for six countries where the most recent survey collected health outcome data on child diarrhoea, acute respiratory illness, and fever. The total sample size of 91,096 is used in the analysis (representing 15, 044 for Burkina Faso, 11, 732 for Cameroon, 5, 884 for Ghana, 20, 964 for Kenya, 33, 924 for Nigeria, and 3,548 for South Africa). The key exposure variable is healthy housing status. We control for various factors associated with the three childhood health outcomes. These include quality housing status, residency (rural/urban), age of the head of the household, mother's education, mother's BMI status, marital status, mother's age, and religious status. Others include the child's gender, age, whether the child is from multiple or single births, and breastfeeding status. Inferential analysis using survey-weighted logistic regression is employed. RESULTS Our findings indicate that housing is an important determinant of the three outcomes investigated. Compared to unhealthier housing, healthy housing status was found to be associated with reduced odds of diarrhoea in Cameroon [Healthiest: aOR = 0.48, 95% CI, (0.32,0.71), healthier: aOR = 0.50, 95% CI,(0.35,0.70), Healthy: aOR = 0.60, 95% CI, (0.44,0.83), Unhealthy: aOR = 0.60, 95% CI, (0.44,0.81)], Kenya [Healthiest: aOR = 0.68, 95% CI, (0.52,0.87), Healtheir: aOR = 0.79, 95% CI, (0.63,0.98), Healthy: aOR = 0.76, 95% CI, (0.62,0.91)], South Africa[Healthy: aOR = 0.41, 95% CI, (0.18, 0.97)], and Nigeria [Healthiest: aOR = 0.48, 95% CI,(0.37,0.62), Healthier: aOR = 0.61, 95% CI,(0.50,0.74), Healthy: aOR = 0.71, 95%CI, (0.59,0.86), Unhealthy: aOR = 0.78, 95% CI, (0.67,0.91)], and reduced odds of Acute Respiratory Infection in Cameroon [Healthy: aOR = 0.72, 95% CI,(0.54,0.96)], Kenya [Healthiest: aOR = 0.66, 95% CI, (0.54,0.81), Healthier: aOR = 0.81, 95% CI, (0.69,0.95)], and Nigeria [Healthiest: aOR = 0.69, 95% CI, (0.56,0.85), Healthier: aOR = 0.72, 95% CI, (0.60,0.87), Healthy: aOR = 0.78, 95% CI, (0.66,0.92), Unhealthy: aOR = 0.80, 95% CI, (0.69,0.93)] while it was associated with increased odds in Burkina Faso [Healthiest: aOR = 2.45, 95% CI, (1.39,4.34), Healthy: aOR = 1.55, 95% CI, (1.09,2.20)] and South Africa [Healthy: aOR = 2.36 95% CI, (1.31, 4.25)]. In addition, healthy housing was significantly associated with reduced odds of fever among children in all countries except South Africa [Healthiest: aOR = 2.09, 95% CI, (1.02, 4.29)] where children living in the healthiest homes had more than double the odds of having fever. In addition, household-level factors such as the age of the household head, and place of residence were associated with the outcomes. Child-level factors such as breastfeeding status, age, and sex, and maternal-level factors such as education, age, marital status, body mass index (BMI), and religion were also associated with the outcomes. CONCLUSIONS The dissimilarity of findings across similar covariates and the multiple relations between healthy housing and under 5 morbidity patterns show unequivocally the heterogeneity that exists across African countries and the need to account for different contexts in efforts to seek an understanding of the role of healthy housing in child morbidity and general health outcomes.
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Affiliation(s)
- Kanyiva Muindi
- Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya.
| | - Samuel Iddi
- Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya.
- Department of Statistics and Actuarial Science, University of Ghana, Legon, Accra, Ghana.
| | - Hellen Gitau
- Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Blessing Mberu
- Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
- Demography and Population Studies, University of Witwatersrand, Johannesburg, South Africa
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20
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Baumgartner J, Rodriguez J, Berkhout F, Doyle Y, Ezzati M, Owusu G, Quayyum Z, Solomon B, Winters M, Adamkiewicz G, Robinson BE. Synthesizing the links between secure housing tenure and health for more equitable cities. Wellcome Open Res 2023; 7:18. [PMID: 37654603 PMCID: PMC10466000 DOI: 10.12688/wellcomeopenres.17244.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 09/02/2023] Open
Abstract
Millions of households in rich and poor countries alike are at risk of being unwilfully displaced from their homes or the land on which they live (i.e., lack secure tenure), and the urban poor are most vulnerable. Improving housing tenure security may be an intervention to improve housing and environmental conditions and reduce urban health inequalities. Building on stakeholder workshops and a narrative review of the literature, we developed a conceptual model that infers the mechanisms through which more secure housing tenure can improve housing, environmental quality, and health. Empirical studies show that more secure urban housing tenure can boost economic mobility, improve housing and environmental conditions including reduced exposure to pollution, create safer and more resourced communities, and improve physical and mental health. These links are shared across tenure renters and owners and different economic settings. Broader support is needed for context-appropriate policies and actions to improve tenure security as a catalyst for cultivating healthier homes and neighbourhoods and reducing urban health inequalities in cities.
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Affiliation(s)
- Jill Baumgartner
- Institute for Health and Social Policy, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Judith Rodriguez
- Graduate School of Design, Harvard University, Cambridge, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Frans Berkhout
- Department of Geography, Faculty of Social Science & Public Policy, King’s College London, London, UK
| | | | - Majid Ezzati
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - George Owusu
- Institute of Statistical, Social and Economic Research, University of Ghana, Accra, Ghana
- Centre for Urban Management Studies, University of Ghana, Accra, Ghana
| | - Zahidul Quayyum
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Bethlehem Solomon
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Meghan Winters
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Brian E. Robinson
- Department of Geography, Faculty of Social Science & Public Policy, King’s College London, London, UK
- Department of Geography, McGill University, Montreal, Canada
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21
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Musoke D, Atusingwize E, Namata C, Ndejjo R, Wanyenze RK, Kamya MR. Integrated malaria prevention in low- and middle-income countries: a systematic review. Malar J 2023; 22:79. [PMID: 36879237 PMCID: PMC9987134 DOI: 10.1186/s12936-023-04500-x] [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] [Accepted: 02/16/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND As many countries aim to eliminate malaria, use of comprehensive approaches targeting the mosquito vector and environment are needed. Integrated malaria prevention advocates the use of several malaria prevention measures holistically at households and in the community. The aim of this systematic review was to collate and summarize the impact of integrated malaria prevention in low- and middle-income countries on malaria burden. METHODS Literature on integrated malaria prevention, defined as the use of two or more malaria prevention methods holistically, was searched from 1st January 2001 to 31st July 2021. The primary outcome variables were malaria incidence and prevalence, while the secondary outcome measures were human biting and entomological inoculation rates, and mosquito mortality. RESULTS A total of 10,931 studies were identified by the search strategy. After screening, 57 articles were included in the review. Studies included cluster randomized controlled trials, longitudinal studies, programme evaluations, experimental hut/houses, and field trials. Various interventions were used, mainly combinations of two or three malaria prevention methods including insecticide-treated nets (ITNs), indoor residual spraying (IRS), topical repellents, insecticide sprays, microbial larvicides, and house improvements including screening, insecticide-treated wall hangings, and screening of eaves. The most common methods used in integrated malaria prevention were ITNs and IRS, followed by ITNs and topical repellents. There was reduced incidence and prevalence of malaria when multiple malaria prevention methods were used compared to single methods. Mosquito human biting and entomological inoculation rates were significantly reduced, and mosquito mortality increased in use of multiple methods compared to single interventions. However, a few studies showed mixed results or no benefits of using multiple methods to prevent malaria. CONCLUSION Use of multiple malaria prevention methods was effective in reducing malaria infection and mosquito density in comparison with single methods. Results from this systematic review can be used to inform future research, practice, policy and programming for malaria control in endemic countries.
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Affiliation(s)
- David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Edwinah Atusingwize
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Carol Namata
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses R Kamya
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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22
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Olagunju EA. Is the presence of mosquitoes an indicator of poor environmental sanitation? JOURNAL OF WATER AND HEALTH 2023; 21:385-401. [PMID: 37338318 PMCID: wh_2023_280 DOI: 10.2166/wh.2023.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The World Health Organization has designated mosquitoes as the most lethal animal since they are known to spread pathogen-transmitting organisms. Understanding the many environmental elements that contribute to the spread of these vectors is one of the many strategies used to stop them. If there are mosquitoes around people, it may indicate that there is not an appropriate environmental sanitation program in place in the community or region. Environmental sanitation involves improving any elements of the physical environment that could have a negative impact on a person's survival, health, or physical environment. Keywords containing 'Aedes,' 'Culex,' 'Anopheles,' 'dengue,' 'malaria,' 'yellow fever,' 'Zika,' 'West Nile,' 'chikungunya,' 'resident,' 'environment,' 'sanitation,' 'mosquito control,' and 'breeding sites' of published articles on PubMed, Google Scholar, and ResearchGate were reviewed. It was discovered that the general population should be involved in mosquito and mosquito-borne disease control. Collaboration between health professionals and the general population is essential. The purpose of this paper is to increase public awareness of environmental health issues related to diseases carried by mosquitoes.
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Affiliation(s)
- Emmanuel Ajibola Olagunju
- Department of Crop and Environmental Protection, Faculty of Agricultural Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria E-mail:
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23
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Bofu RM, Santos EM, Msugupakulya BJ, Kahamba NF, Swilla JD, Njalambaha R, Kelly AH, Lezaun J, Christofides N, Okumu FO, Finda MF. The needs and opportunities for housing improvement for malaria control in southern Tanzania. Malar J 2023; 22:69. [PMID: 36849883 PMCID: PMC9972788 DOI: 10.1186/s12936-023-04499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Malaria disproportionately affects low-income households in rural communities where poor housing is common. Despite evidence that well-constructed and mosquito-proofed houses can reduce malaria risk, housing improvement is rarely included in malaria control toolboxes. This study assessed the need, magnitude, and opportunities for housing improvement to control malaria in rural Tanzania. METHODS A mixed-methods study was conducted in 19 villages across four district councils in southern Tanzania. A structured survey was administered to 1292 community members to assess need, perceptions, and opportunities for housing improvement for malaria control. Direct observations of 802 houses and surrounding environments were done to identify the actual needs and opportunities, and to validate the survey findings. A market survey was done to assess availability and cost of resources and services necessary for mosquito-proofing homes. Focus group discussions were conducted with key stakeholders to explore insights on the potential and challenges of housing improvement as a malaria intervention. RESULTS Compared to other methods for malaria control, housing improvement was among the best understood and most preferred by community members. Of the 735 survey respondents who needed housing improvements, a majority needed window screening (91.1%), repairs of holes in walls (79.4%), door covers (41.6%), closing of eave spaces (31.2%) and better roofs (19.0%). Community members invested significant efforts to improve their own homes against malaria and other dangers, but these efforts were often slow and delayed due to high costs and limited household incomes. Study participants suggested several mechanisms of support to improve their homes, including government loans and subsidies. CONCLUSION Addressing the need for housing improvement is a critical component of malaria control efforts in southern Tanzania. In this study, a majority of the community members surveyed needed modest modifications and had plans to work on those modifications. Without additional support, their efforts were however generally slow; households would take years to sufficiently mosquito-proof their houses. It is, therefore, crucial to bring together the key players across sectors to reduce barriers in malaria-proofing housing in endemic settings. These may include government subsidies or partnerships with businesses to make housing improvement more accessible and affordable to residents.
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Affiliation(s)
- Ramadhani M. Bofu
- grid.414543.30000 0000 9144 642XDepartment of Environmental Health and Ecological Sciences, Ifakara Health Institute, P. O. Box 53, Ifakara, Tanzania ,grid.451346.10000 0004 0468 1595School of Life Sciences and Bioengineering, The Nelson Mandela African Institution of Science and Technology, P. O. Box 447, Arusha, Tanzania ,Mpwapwa Institute of Health and Allied Sciences, The Ministry of Health, P.O. Box 743, Dodoma, Tanzania
| | - Ellen M. Santos
- grid.263857.d0000 0001 0816 4489Department of Applied Health, Southern Illinois University Edwardsville, Edwardsville, USA
| | - Betwel J. Msugupakulya
- grid.414543.30000 0000 9144 642XDepartment of Environmental Health and Ecological Sciences, Ifakara Health Institute, P. O. Box 53, Ifakara, Tanzania ,grid.48004.380000 0004 1936 9764Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Najat F. Kahamba
- grid.414543.30000 0000 9144 642XDepartment of Environmental Health and Ecological Sciences, Ifakara Health Institute, P. O. Box 53, Ifakara, Tanzania ,grid.8756.c0000 0001 2193 314XSchool of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G128QQ UK
| | - Joseph D. Swilla
- grid.451346.10000 0004 0468 1595School of Life Sciences and Bioengineering, The Nelson Mandela African Institution of Science and Technology, P. O. Box 447, Arusha, Tanzania ,grid.8193.30000 0004 0648 0244Department of Molecular Biology and Biotechnology, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Rukiyah Njalambaha
- grid.414543.30000 0000 9144 642XDepartment of Environmental Health and Ecological Sciences, Ifakara Health Institute, P. O. Box 53, Ifakara, Tanzania
| | - Ann H. Kelly
- grid.13097.3c0000 0001 2322 6764Department of Global Health and Social Medicine, King’s College London, London, UK
| | - Javier Lezaun
- grid.4991.50000 0004 1936 8948Institute for Science, Innovation, and Society, School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
| | - Nicola Christofides
- grid.11951.3d0000 0004 1937 1135School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 1 Smuts Avenue, Braamfontein, Johannesburg, 2000 South Africa
| | - Fredros O. Okumu
- grid.414543.30000 0000 9144 642XDepartment of Environmental Health and Ecological Sciences, Ifakara Health Institute, P. O. Box 53, Ifakara, Tanzania ,grid.451346.10000 0004 0468 1595School of Life Sciences and Bioengineering, The Nelson Mandela African Institution of Science and Technology, P. O. Box 447, Arusha, Tanzania ,grid.8756.c0000 0001 2193 314XSchool of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G128QQ UK ,grid.11951.3d0000 0004 1937 1135School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 1 Smuts Avenue, Braamfontein, Johannesburg, 2000 South Africa
| | - Marceline F. Finda
- grid.414543.30000 0000 9144 642XDepartment of Environmental Health and Ecological Sciences, Ifakara Health Institute, P. O. Box 53, Ifakara, Tanzania ,grid.451346.10000 0004 0468 1595School of Life Sciences and Bioengineering, The Nelson Mandela African Institution of Science and Technology, P. O. Box 447, Arusha, Tanzania
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Sarfo JO, Amoadu M, Kordorwu PY, Adams AK, Gyan TB, Osman AG, Asiedu I, Ansah EW. Malaria amongst children under five in sub-Saharan Africa: a scoping review of prevalence, risk factors and preventive interventions. Eur J Med Res 2023; 28:80. [PMID: 36800986 PMCID: PMC9936673 DOI: 10.1186/s40001-023-01046-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Africa has a higher burden of malaria-related cases and deaths globally. Children under five accounted for over two-thirds of all malaria deaths in sub-Saharan Africa (SSA). This scoping review aims to map evidence of the prevalence, contextual factors and health education interventions of malaria amongst children under 5 years (UN5) in SSA. METHOD Four main databases (PubMed, Central, Dimensions and JSTOR) produced 27,841 records of literature. Additional searches in Google, Google Scholar and institutional repositories produced 37 records. Finally, 255 full-text records were further screened, and 100 records were used for this review. RESULTS Low or no formal education, poverty or low income and rural areas are risk factors for malaria amongst UN5. Evidence on age and malnutrition as risk factors for malaria in UN5 is inconsistent and inconclusive. Furthermore, the poor housing system in SSA and the unavailability of electricity in rural areas and unclean water make UN5 more susceptible to malaria. Health education and promotion interventions have significantly reduced the malaria burden on UN5 in SSA. CONCLUSION Well-planned and resourced health education and promotion interventions that focus on prevention, testing and treatment of malaria could reduce malaria burden amongst UN5 in SSA.
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Affiliation(s)
- Jacob Owusu Sarfo
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | | | - Peace Yaa Kordorwu
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | - Abdul Karim Adams
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | | | - Abdul-Ganiyu Osman
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | - Immanuel Asiedu
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
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Sere IS, Bado AR. Individual and Contextual Factors Associated With Malaria Among Children 6-59 Months in Burkina Faso. Int J Public Health 2023; 68:1605347. [PMID: 36814437 PMCID: PMC9939434 DOI: 10.3389/ijph.2023.1605347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/09/2023] [Indexed: 02/07/2023] Open
Abstract
Objective: This study aims to understand the individual and contextual factors associated with malaria among children aged 6-59 months in Burkina Faso. Methods: This cross-sectional study used secondary data extracted from the Burkina Faso Malaria Indicator Survey 2017-2018. Descriptive analysis was used to analyse socio-demographic characteristics. We performed a multilevel logistic regression model to highlight individual and contextual factors of children's exposure to malaria. Results: Our analysis included 5,822 children aged 6-59 months. Of these, 15% had a positive rapid diagnostic test. Factors associated with malaria among children 6-59 months were age, maternal education, household wealth, rural residence, and region. The variability in malaria exposure was 16% attributable to the strata level and 23% to the primary sampling unit level. Some factors, such as the family's socio-economic status, access to hospital care, and place of living, were positively associated withs malaria cases in children. Conclusion: The study identified some individual and contextual determinants of malaria among children aged 6-59 months in Burkina Faso. Taking them into account for the design and implementation of policies will undeniably help in the fight against malaria in Burkina Faso.
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Affiliation(s)
- Ibrahima Stephane Sere
- Service De Neurologie, Centre Hopitalier Universitaire Sourou Sanou, Bobo-Dioulasso, Burkina Faso
| | - Aristide Romaric Bado
- Research Institute for Health Sciences (IRSS), Ouagadougou, Burkina Faso,West African Health Organisation (WAHO), Bobo Dioulasso, Burkina Faso,*Correspondence: Aristide Romaric Bado,
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Mmbando AS, Mponzi WP, Ngowo HS, Kifungo K, Kasubiri R, Njalambaha RM, Gavana T, Eiras AE, Batista EPA, Finda MF, Sangoro OP, Okumu FO. Small-scale field evaluation of transfluthrin-treated eave ribbons and sandals for the control of malaria vectors in rural Tanzania. Malar J 2023; 22:43. [PMID: 36739391 PMCID: PMC9898903 DOI: 10.1186/s12936-023-04476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 02/01/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early-evening and outdoor-biting mosquitoes may compromise the effectiveness of frontline malaria interventions, notably insecticide-treated nets (ITNs). This study aimed to evaluate the efficacy of low-cost insecticide-treated eave ribbons and sandals as supplementary interventions against indoor-biting and outdoor-biting mosquitoes in south-eastern Tanzania, where ITNs are already widely used. METHODS This study was conducted in three villages, with 72 households participating (24 households per village). The households were divided into four study arms and assigned: transfluthrin-treated sandals (TS), transfluthrin-treated eave ribbons (TER), a combination of TER and TS, or experimental controls. Each arm had 18 households, and all households received new ITNs. Mosquitoes were collected using double net traps (to assess outdoor biting), CDC light traps (to assess indoor biting), and Prokopack aspirators (to assess indoor resting). Protection provided by the interventions was evaluated by comparing mosquito densities between the treatment and control arms. Additional tests were done in experimental huts to assess the mortality of wild mosquitoes exposed to the treatments or controls. RESULTS TERs reduced indoor-biting, indoor-resting and outdoor-biting Anopheles arabiensis by 60%, 73% and 41%, respectively, while TS reduced the densities by 18%, 40% and 42%, respectively. When used together, TER & TS reduced indoor-biting, indoor-resting and outdoor-biting An. arabiensis by 53%, 67% and 57%, respectively. Protection against Anopheles funestus ranged from 42 to 69% with TER and from 57 to 74% with TER & TS combined. Mortality of field-collected mosquitoes exposed to TER, TS or both interventions was 56-78% for An. arabiensis and 47-74% for An. funestus. CONCLUSION Transfluthrin-treated eave ribbons and sandals or their combination can offer significant household-level protection against malaria vectors. Their efficacy is magnified by the transfluthrin-induced mortality, which was observed despite the prevailing pyrethroid resistance in the study area. These results suggest that TER and TS could be useful supplementary tools against residual malaria transmission in areas where ITN coverage is high but additional protection is needed against early-evening and outdoor-biting mosquitoes. Further research is needed to validate the performance of these tools in different settings, and assess their long-term effectiveness and feasibility for malaria control.
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Affiliation(s)
- Arnold S Mmbando
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara, Tanzania.
| | - Winifrida P Mponzi
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara, Tanzania
| | - Halfan S Ngowo
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara, Tanzania
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Khamis Kifungo
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara, Tanzania
| | - Robert Kasubiri
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara, Tanzania
| | - Rukiyah M Njalambaha
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara, Tanzania
| | - Tegemeo Gavana
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara, Tanzania
| | - Alvaro E Eiras
- Laboratory of Technological Innovation of Vector Control, Department of Parasitology, Biological Science Institute, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Elis P A Batista
- Laboratory of Technological Innovation of Vector Control, Department of Parasitology, Biological Science Institute, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marceline F Finda
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Republic of South Africa
| | - Onyango P Sangoro
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara, Tanzania
- Human Health Theme, International Centre of Insect Physiology and Ecology (ICIPE), Nairobi City, Kenya
| | - Fredros O Okumu
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara, Tanzania.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Republic of South Africa.
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK.
- School of Life Science and Bioengineering, Nelson Mandela African Institution of Science & Technology, Arusha, Tanzania.
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Burton TA, Kabinga LH, Simubali L, Hayre Q, Moore SJ, Stevenson JC, Lobo NF. Semi-field evaluation of a volatile transfluthrin-based intervention reveals efficacy as a spatial repellent and evidence of other modes of action. PLoS One 2023; 18:e0285501. [PMID: 37167335 PMCID: PMC10174509 DOI: 10.1371/journal.pone.0285501] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
Presently, the most common malaria control tools-i.e., long lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS)-are limited to targeting indoor biting and resting behaviors of Anopheles mosquito species. Few interventions are targeted towards malaria control in areas where transmission is driven or persists due to outdoor biting behaviors. This study investigated a volatile pyrethroid-based spatial repellent (VPSR) designed to bridge this gap and provide protection from mosquito bites in outdoor spaces. Southern Province, Zambia, is one such environment where outdoor biting is suspected to contribute to malaria transmission, where people are active in the evening in open-walled outdoor kitchens. This study assessed the VPSR in replica kitchens within a controlled semi-field environment. Endpoints included effects on mosquito host seeking, immediate and delayed mortality, deterrence, blood feeding inhibition, and fertility. Host-seeking was reduced by approximately 40% over the course of nightly releases in chambers containing VPSR devices. Mosquito behavior was not uniform throughout the night, and the modeled effect of the intervention was considerably higher when hourly catch rates were considered. These two observations highlight a limitation of this overnight semi-field design and consideration of mosquito circadian rhythms is recommended for future semi-field studies. Additionally, deterrence and immediate mortality were both observed in treatment chambers, with evidence of delayed mortality and a dose related response. These results demonstrate a primarily personal protective mode of action with possible positive and negative community effects. Further investigation into this primary mode of action will be conducted through a field trial of the same product in nearby communities.
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Affiliation(s)
- Timothy A Burton
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States of America
| | | | | | - Quinton Hayre
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States of America
| | - Sarah J Moore
- Vector Control Product Testing Unit (VCPTU), Ifakara Health Institute, Environmental Health, and Ecological Sciences, Bagamoyo, Tanzania
- Vector Biology Unit, Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, Basel, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
- The Nelson Mandela African Institution of Science and Technology (NM-AIST), Tengeru, Arusha, Tanzania
| | - Jennifer C Stevenson
- Macha Research Trust, Choma, Choma District, Zambia
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Neil F Lobo
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States of America
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Olufadewa I, Akinrinde D, Adesina M, Oladele R, Ayorinde T, Omo-Sowho U. The approval of the first malaria vaccine: The beginning of the end of the malaria epidemic. J Glob Health 2022; 12:03087. [PMID: 36560893 PMCID: PMC9780610 DOI: 10.7189/jogh.12.03087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Isaac Olufadewa
- Slum and Rural Health Initiative, Akobo, Nigeria,College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Deborah Akinrinde
- Slum and Rural Health Initiative, Akobo, Nigeria,College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Miracle Adesina
- Slum and Rural Health Initiative, Akobo, Nigeria,College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ruth Oladele
- Slum and Rural Health Initiative, Akobo, Nigeria,College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Toluwase Ayorinde
- Slum and Rural Health Initiative, Akobo, Nigeria,Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
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Awasthi KR, Jancey J, Clements ACA, Sah RK, Koirala MP, Chalise B, Leavy JE. Traditional Beliefs, Practices, and Migration: A Risk to Malaria Transmission in Rural Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16872. [PMID: 36554752 PMCID: PMC9779137 DOI: 10.3390/ijerph192416872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
The study aimed to explore sociocultural factors influencing the risk of malaria and practices and beliefs towards malaria prevention, transmission and treatment in a remote village in Khatyad Rural Municipality (KRM) of Nepal. A sequential exploratory mixed methods approach was used. Qualitative data were collected through 25 one-on-one, in-depth interviews followed by a face-to-face household survey (n = 218) among people from a village in KRM believed to have a high risk of malaria. Traditional practices such as Chhaupadi requiring the seclusion of women during menstruation and post-partum, transhumance, and reliance on traditional healers for the management of malaria were common practices in the village. The household survey found 98.1% of women faced menstrual exile either inside the house or in a separate hut, with 64.2% not having access to Long-lasting Insecticidal Nets (LLINs). Hardships and economic constraints compelled villagers to migrate seasonally for work to malaria-endemic areas in India, thereby exposing themselves to the risk of malaria. Persistent traditional beliefs and seasonal migration could threaten the elimination goals set by the national malaria program.
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Affiliation(s)
- Kiran Raj Awasthi
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Jonine Jancey
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Archie C. A. Clements
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
- Telethon Kids Institute, Perth, WA 6009, Australia
- Peninsula Medical School, University of Plymouth, Plymouth PL4 8AA, UK
| | - Rohit Kumar Sah
- National Malaria Program, Karnali Province Field Office, Nepalgunj 21900, Nepal
| | | | - Binaya Chalise
- Graduate School for International Development and Cooperation, Hiroshima University, Higasi-Hiroshima 739-8529, Japan
| | - Justine E. Leavy
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
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Abong’o B, Gimnig JE, Omoke D, Ochomo E, Walker ED. Screening eaves of houses reduces indoor mosquito density in rural, western Kenya. Malar J 2022; 21:377. [PMID: 36494664 PMCID: PMC9733111 DOI: 10.1186/s12936-022-04397-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite the scale-up of insecticide-treated nets and indoor residual spraying, the bulk of malaria transmission in western Kenya still occurs indoors, late at night. House improvement is a potential long-term solution to further reduce malaria transmission in the region. METHODS The impact of eave screening on mosquito densities was evaluated in two rural villages in western Kenya. One-hundred-and-twenty pairs of structurally similar, neighbouring houses were used in the study. In each pair, one house was randomly selected to receive eave screening at the beginning of the study while the other remained unscreened until the end of the sampling period. Mosquito sampling was performed monthly by motorized aspiration method for 4 months. The collected mosquitoes were analysed for species identification. RESULTS Compared to unscreened houses, significantly fewer female Anopheles funestus (RR = 0.40, 95% CI 0.29-0.55), Anopheles gambiae Complex (RR = 0.46, 95% CI 0.34-0.62) and Culex species (RR = 0.53, 95% CI 0.45-0.61) were collected in screened houses. No significant differences in the densities of the mosquitoes were detected in outdoor collections. Significantly fewer Anopheles funestus were collected indoors from houses with painted walls (RR = 0.05, 95% CI 0.01-0.38) while cooking in the house was associated with significantly lower numbers of Anopheles gambiae Complex indoors (RR = 0.60, 95% CI 0.45-0.79). Nearly all house owners (99.6%) wanted their houses permanently screened, including 97.7% that indicated a willingness to use their own resources. However, 99.2% required training on house screening. The cost of screening a single house was estimated at KES6,162.38 (US$61.62). CONCLUSION Simple house modification by eave screening has the potential to reduce the indoor occurrence of both Anopheles and Culex mosquito species. Community acceptance was very high although education and mobilization may be needed for community uptake of house modification for vector control. Intersectoral collaboration and favourable government policies on housing are important links towards the adoption of house improvements for malaria control.
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Affiliation(s)
- Bernard Abong’o
- grid.33058.3d0000 0001 0155 5938Centre for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - John E. Gimnig
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, Division of Parasitic Diseases, Atlanta, GA 30341 USA
| | - Diana Omoke
- grid.33058.3d0000 0001 0155 5938Centre for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Eric Ochomo
- grid.33058.3d0000 0001 0155 5938Centre for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Edward D. Walker
- grid.17088.360000 0001 2150 1785Michigan State University, 6169 Biomedical Physical Sciences Building, East Lansing, MI 48824 USA
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Msoffe R, Hewitt M, Masalu JP, Finda M, Kavishe DR, Okumu FO, Mpolya EA, Kaindoa EW, Killeen GF. Participatory development of practical, affordable, insecticide-treated mosquito proofing for a range of housing designs in rural southern Tanzania. Malar J 2022; 21:318. [PMCID: PMC9636681 DOI: 10.1186/s12936-022-04333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 10/18/2022] [Indexed: 11/08/2022] Open
Abstract
Abstract
Background
Insecticidal mosquito-proof netting screens could combine the best features of insecticide-treated nets (ITNs) and indoor residual spraying (IRS), the two most important front line vector control interventions in Africa today, and also overcome the most important limitations of these methods. This study engaged members of a rural Tanzanian community in developing and evaluating simple, affordable and scalable procedures for installing readily available screening materials on eave gaps and windows of their own houses, and then treating those screens with a widely used IRS formulation of the organophosphate insecticide pirimiphos-methyl (PM).
Methods
A cohort of 54 households recruited upon consent, following which the structural features and occupant demographics of their houses were surveyed. Indoor mosquito densities were surveyed longitudinally, for approximately 3 months before and over 5 months after participatory house modification and screening using locally available materials. Each house was randomly assigned to one of three study arms: (1) No screens installed until the end of the study (negative control), (2) untreated screens installed, and (3) screened installed and then treated with PM, the insecticidal activity of which was subsequently assessed using standard cone assays.
Results
Almost all (52) recruited households participated until the end, at which point all houses had been successfully screened. In most cases, screening was only installed after making enabling structural modifications that were accepted by the enrolled households. Compared to unscreened houses, houses with either treated or untreated screens both almost entirely excluded Anopheles arabiensis (Relative reduction (RR) ≥ 98%, P < < 0.0001), the most abundant local malaria vector. However, screens were far less effective against Culex quinquefasciatus (RR ≤ 46%, P < < 0.0001), a non-malaria vector causing considerable biting nuisance, regardless of their treatment status. While PM did not augment household level protection by screens against either mosquito species (P = 0.676 and 0.831, respectively), 8 months after treatment it still caused 73% and 89% mortality among susceptible insectary-reared Anopheles gambiae following exposures of 3 and 30 min, respectively.
Conclusions
Participatory approaches to mosquito proofing houses may be acceptable and effective, and installed screens may be suitable targets for residual insecticide treatments.
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Okiring J, Gonahasa S, Nassali M, Namuganga JF, Bagala I, Maiteki-Sebuguzi C, Opigo J, Nabende I, Nangendo J, Kabami J, Ssewanyana I, Kiwuwa SM, Nankabirwa JI, Dorsey G, Briggs J, Kamya MR, Staedke SG. LLIN Evaluation in Uganda Project (LLINEUP2)-Factors associated with coverage and use of long‑lasting insecticidal nets following the 2020-21 national mass distribution campaign: a cross-sectional survey of 12 districts. Malar J 2022; 21:293. [PMID: 36261818 PMCID: PMC9580445 DOI: 10.1186/s12936-022-04302-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/26/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In 2020-2021, long-lasting insecticidal nets (LLINs) were distributed nationwide in Uganda during the COVID-19 pandemic. A cross-sectional survey was conducted in 12 districts to evaluate the impact of the campaign 1-5 months after LLIN distribution. METHODS During April-May 2021, households were randomly selected from target areas (1-7 villages) surrounding 12 government-run health facilities established as Malaria Reference Centres; at least 50 households were enrolled per cluster. Outcomes included household ownership of LLINs distributed through the universal coverage campaign (UCC) (at least one UCC LLIN), adequate coverage of UCC LLINs (at least one UCC LLIN per 2 residents), and use of LLINs (resident slept under a LLIN the previous night). Multivariate logistic regression models were used to identify household- and individual-level factors associated with outcomes, controlling for clustering around health facilities. RESULTS In total, 634 households, with 3342 residents and 1631 bed-nets, were included. Most households (93.4%) owned at least 1 UCC LLIN, but only 56.8% were adequately covered by UCC LLINs. In an adjusted analysis, the factor most strongly associated with adequate coverage by UCC LLINs was fewer household residents (1-4 vs 7-14; adjusted odds ratio [aOR] 12.96, 95% CI 4.76-35.26, p < 0.001; 5-6 vs 7-14 residents; aOR 2.99, 95% CI 1.21-7.42, p = 0.018). Of the 3166 residents of households that owned at least one UCC LLIN, only 1684 (53.2%) lived in adequately covered households; 89.9% of these used an LLIN the previous night, compared to 1034 (69.8%) of 1482 residents living in inadequately covered households. In an adjusted analysis, restricted to residents of inadequately covered households, LLIN use was higher in children under-five than those aged 5-15 years (aOR 3.04, 95% CI 2.08-4.46, p < 0.001), and higher in household heads than distantly-related residents (aOR 3.94, 95% CI 2.38-6.51, p < 0.001). CONCLUSIONS Uganda's 2021-21 campaign was successful, despite the COVID-19 pandemic. In future campaigns, strategies should be adopted to ensure high LLIN coverage, particularly for larger households. A better understanding of the drivers of LLIN use within households is needed to guide future interventions, educational messages, and behaviour change communication strategies; school-aged children and distantly-related residents appear vulnerable and could be targeted.
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Affiliation(s)
- Jaffer Okiring
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda.
| | - Samuel Gonahasa
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Martha Nassali
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Jane F Namuganga
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Irene Bagala
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Catherine Maiteki-Sebuguzi
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Isaiah Nabende
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Joanita Nangendo
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jane Kabami
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Isaac Ssewanyana
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Steven M Kiwuwa
- Department of Child Health and Development Centre, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joaniter I Nankabirwa
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Jessica Briggs
- Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Sarah G Staedke
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Abstract
BACKGROUND Malaria remains an important public health problem. Research in 1900 suggested house modifications may reduce malaria transmission. A previous version of this review concluded that house screening may be effective in reducing malaria. This update includes data from five new studies. OBJECTIVES To assess the effects of house modifications that aim to reduce exposure to mosquitoes on malaria disease and transmission. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register; Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE (PubMed); Embase (OVID); Centre for Agriculture and Bioscience International (CAB) Abstracts (Web of Science); and the Latin American and Caribbean Health Science Information database (LILACS) up to 25 May 2022. We also searched the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry to identify ongoing trials up to 25 May 2022. SELECTION CRITERIA Randomized controlled trials, including cluster-randomized controlled trials (cRCTs), cross-over studies, and stepped-wedge designs were eligible, as were quasi-experimental trials, including controlled before-and-after studies, controlled interrupted time series, and non-randomized cross-over studies. We sought studies investigating primary construction and house modifications to existing homes reporting epidemiological outcomes (malaria case incidence, malaria infection incidence or parasite prevalence). We extracted any entomological outcomes that were also reported in these studies. DATA COLLECTION AND ANALYSIS Two review authors independently selected eligible studies, extracted data, and assessed the risk of bias. We used risk ratios (RR) to compare the effect of the intervention with the control for dichotomous data. For continuous data, we presented the mean difference; and for count and rate data, we used rate ratios. We presented all results with 95% confidence intervals (CIs). We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS One RCT and six cRCTs met our inclusion criteria, with an additional six ongoing RCTs. We did not identify any eligible non-randomized studies. All included trials were conducted in sub-Saharan Africa since 2009; two randomized by household and four at the block or village level. All trials assessed screening of windows, doors, eaves, ceilings, or any combination of these; this was either alone, or in combination with roof modification or eave tube installation (an insecticidal "lure and kill" device that reduces mosquito entry whilst maintaining some airflow). In one trial, the screening material was treated with 2% permethrin insecticide. In five trials, the researchers implemented the interventions. A community-based approach was adopted in the other trial. Overall, the implementation of house modifications probably reduced malaria parasite prevalence (RR 0.68, 95% CI 0.57 to 0.82; 5 trials, 5183 participants; moderate-certainty evidence), although an inconsistent effect was observed in a subpopulation of children in one study. House modifications reduced moderate to severe anaemia prevalence (RR 0.70, 95% CI 0.55 to 0.89; 3 trials, 3643 participants; high-certainty evidence). There was no consistent effect on clinical malaria incidence, with rate ratios ranging from 0.38 to 1.62 (3 trials, 3365 participants, 4126.6 person-years). House modifications may reduce indoor mosquito density (rate ratio 0.63, 95% CI 0.30 to 1.30; 4 trials, 9894 household-nights; low-certainty evidence), although two studies showed little effect on this parameter. AUTHORS' CONCLUSIONS House modifications - largely screening, sometimes combined with insecticide and lure and kill devices - were associated with a reduction in malaria parasite prevalence and a reduction in people with anaemia. Findings on malaria incidence were mixed. Modifications were also associated with lower indoor adult mosquito density, but this effect was not present in some studies.
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Affiliation(s)
- Tilly Fox
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Marty Chaplin
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mark Napier
- Council for Scientific and Industrial Research, Pretoria, South Africa
- Centre for Development Support, University of the Free State, Bloemfontein, South Africa
| | - Evelyn A Olanga
- Malaria Alert Centre of the College of Medicine, Blantyre, Malawi
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Goshu EM, Zerefa MD, Tola HH. Occurrence of asymptomatic malaria infection and living conditions in the lowlands of Ethiopia: a community-based cross-sectional study. Infect Dis Poverty 2022; 11:94. [PMID: 36064653 PMCID: PMC9444277 DOI: 10.1186/s40249-022-01018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background A significant decline in malaria burden was documented in previously high burden African countries. Even though the global decline in malaria burden is significant, about 95% of it was typically found in 29 African countries and the decline was affected by COVID-19 in 2020. The considerable reduction in malaria incidence was noted due to effective prevention and treatment efforts, and rapid changes in living conditions. The relationship between the occurrence of asymptomatic malaria infection and household living conditions is well unstudied. This study aimed to determine the association between household living conditions and the occurrence of asymptomatic malaria in the lowlands of Ethiopia. Methods A community-based cross-sectional study was conducted from January to March 2021 in twelve villages of Gambella, Southern Nation Nationalities and People Region and Afar in Ethiopia. A total of 1366 households were randomly selected, interviewed, and tested for malaria by rapid diagnostic test and blood film microscopic examination. Multiple logistic regression model was used to determine the independent association between living conditions and asymptomatic malaria infection. Results The prevalence of asymptomatic malaria infection among individuals living in dwellings built with traditional floor/wall/roof ranges from 8.1% to 8.4% while it ranges from 2.0% to 4.6% among those living in modern floor/wall/roof houses. Dwellings built with traditional wall materials (P = 0.050), spending nights with cattle in the same house (P < 0.001), and availability of kitchen in the main house with no partition (P = 0.004) were significantly associated with asymptomatic malaria infection. Conclusions Asymptomatic malaria infection was 4.3 times higher among occupants residing in dwellings built with traditional wall materials; 5.6 times higher among households spending nights with cattle in the same house, and 2.3 times higher among households with kitchen in the main house with no partition. Therefore, policies and strategies on malaria elimination need to address or target improvements of the above listed living conditions for the community. A multi sectoral action is required to use these social determinants as a vector control strategic addition; and malaria elimination programs are expected to coordinate the implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s40249-022-01018-3.
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Affiliation(s)
- Endale Mengesha Goshu
- Water and Public Health Stream, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Meseret Dessalegne Zerefa
- Water and Public Health Stream, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Habteyes Hailu Tola
- Tuberculosis/HIV Research Directorate, Ethiopian Public Health Institute, P.O. Box 1242, Addis Ababa, Ethiopia
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Chastonay AHM, Chastonay OJ. Housing Risk Factors of Four Tropical Neglected Diseases: A Brief Review of the Recent Literature. Trop Med Infect Dis 2022; 7:tropicalmed7070143. [PMID: 35878154 PMCID: PMC9319438 DOI: 10.3390/tropicalmed7070143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 01/27/2023] Open
Abstract
Alongside peace, education, food, income, a stable ecosystem, sustainable resources and social justice, shelter is a prerequisite for health. According to international human rights law, everyone is entitled to an adequate standard of living, which includes adequate housing. Adequate housing, including access to water and sanitation, plays a critical role in the prevention and management of neglected tropical diseases, which affect over 1 billion people worldwide. Inadequate housing conditions represent a risk factor for many of them, e.g., Chagas disease that affects 6–8 million people worldwide, visceral leishmaniasis that kills 20,000–30,000 people/year, lymphatic filariasis which threatens 859 million people worldwide or dengue that has increased 8–10 fold over the last two decades. Vector control strategies for the above-mentioned diseases have shown their effectiveness and should include systematic and repetitive in-house spraying and individual protection (e.g., impregnated nets), as well as better-quality construction material and techniques and better sanitation infrastructures and practices. Access to adequate housing is a basic human right. The violation of the right to adequate housing may affect the enjoyment of other human rights. Access to adequate housing can strengthen (and facilitate access to) other basic human rights, such as the rights to work, health, security, and education.
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Affiliation(s)
| | - Oriane J. Chastonay
- Réseau Fribourgeois de Santé Mentale, 1700 Fribourg, Switzerland
- Correspondence:
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Njoroge MM, Hiscox A, Saddler A, Takken W, van Loon JJA, Fillinger U. Less is more: repellent-treated fabric strips as a substitute for full screening of open eave gaps for indoor and outdoor protection from malaria mosquito bites. Parasit Vectors 2022; 15:259. [PMID: 35858931 PMCID: PMC9297553 DOI: 10.1186/s13071-022-05384-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Providing protection from malaria vector bites, both indoors and outdoors, is crucial to curbing malaria parasite transmission. Screening of house entry points, especially with incorporated insecticides, confers significant protection but remains a costly and labour-intensive application. Use of spatial repellents has shown promise in creating areas of protection in peri-domestic areas. Methods This study aimed at comparing the protection provided by transfluthrin-treated and untreated complete screens over open eave gaps with incomplete transfluthrin-treated eave strips as a potential replacement for a full screen. Human landing catches were implemented independently inside and outside an experimental hut under controlled semi-field conditions, with insectary-reared Anopheles arabiensis mosquitoes. Results The odds of a female mosquito finding a human volunteer indoors and attempting to bite were similar whether the eaves were completely open or there was an untreated fabric strip fixed around the eaves. However, when the eave gap was completely screened without insecticide, the odds of receiving a bite indoors were reduced by 70% (OR 0.30, 95% CI 0.20–0.47). Adding transfluthrin to the full screen, further increased the protection indoors, with the odds of receiving a bite reduced by 92% (0.08, 95% CI 0.04–0.16) compared to the untreated screen. Importantly, the same protection was conferred when only a narrow transfluthrin-treated fabric strip was loosely fixed around the eave gap (OR 0.07, 95% CI 0.04–0.13). The impact of the transfluthrin treatment on outdoor biting was correlated with evening temperatures during the experiments. At lower evening temperatures, a transfluthrin-treated, complete screen provided moderate and variable protection from bites (OR 0.62, 95% CI 0.37–1.03), whilst at higher evening temperatures the odds of receiving a bite outdoors was over four times lower in the presence of transfluthrin, on either a full screen (OR 0.22 95% 0.12–0.38) or a fabric strip (OR 0.25, 95% 0.15–0.42), than when no treatment was present. Conclusion The findings suggest that transfluthrin-treated fabric strips can provide a substitute for complete eave screens. They are a simple, easy-to-handle tool for protecting people from malaria mosquito bites indoors and potentially around the house in climatic areas where evening and night-time temperatures are relatively high.
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Affiliation(s)
- Margaret Mendi Njoroge
- International Centre of Insect Physiology and Ecology (icipe), Human Health Theme, P.O. Box 30772-00100, Nairobi, Kenya. .,Wageningen University & Research, Laboratory of Entomology, P.O. Box 16, 6700 AA, Wageningen, The Netherlands.
| | - Alexandra Hiscox
- Wageningen University & Research, Laboratory of Entomology, P.O. Box 16, 6700 AA, Wageningen, The Netherlands.,ARCTEC, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Adam Saddler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 833, Basel, Switzerland.,Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania.,Malaria Atlas Project, Telethon Kids Institute, 15 Hospital Ave, Nedlands, Perth, WA, 6009, Australia
| | - Willem Takken
- Wageningen University & Research, Laboratory of Entomology, P.O. Box 16, 6700 AA, Wageningen, The Netherlands
| | - Joop J A van Loon
- Wageningen University & Research, Laboratory of Entomology, P.O. Box 16, 6700 AA, Wageningen, The Netherlands
| | - Ulrike Fillinger
- International Centre of Insect Physiology and Ecology (icipe), Human Health Theme, P.O. Box 30772-00100, Nairobi, Kenya
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Cohen JM, Okumu F, Moonen B. The fight against malaria: Diminishing gains and growing challenges. Sci Transl Med 2022; 14:eabn3256. [PMID: 35767649 DOI: 10.1126/scitranslmed.abn3256] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Since the year 2000, historic reductions in malaria incidence and mortality have been driven by the widespread distribution of bed nets, drugs, and insecticides for the prevention and treatment of malaria. Scale-up of these tools has been enabled by an increase in malaria financing compounded by price reductions, yet these trends are unlikely to continue at the same rate. Rapid population growth in high-endemic areas requires procurement of more of these tools just to maintain current coverage, even as prices are likely to increase as resistance to drugs and insecticides forces shifts to newer products. Further progress toward the long-term goal of malaria eradication requires a combination of greater funding, more cost-effective resource allocation, and fundamental changes to the global malaria control strategy.
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Affiliation(s)
| | - Fredros Okumu
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK.,School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Bruno Moonen
- Bill & Melinda Gates Foundation, Seattle, WA, USA
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Okumu F, Gyapong M, Casamitjana N, Castro MC, Itoe MA, Okonofua F, Tanner M. What Africa can do to accelerate and sustain progress against malaria. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000262. [PMID: 36962314 PMCID: PMC10021840 DOI: 10.1371/journal.pgph.0000262] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
After a longstanding global presence, malaria is now largely non-existent or suppressed in most parts of the world. Today, cases and deaths are primarily concentrated in sub-Saharan Africa. According to many experts, this persistence on the African continent reflects factors such as resistance to insecticides and drugs as well as insufficient access to essential commodities such as insecticide-treated nets and effective drugs. Crucially, however, this narrative ignores many central weaknesses in the fight against malaria and instead reinforces a narrow, commodity-driven vision of disease control. This paper therefore describes the core challenges hindering malaria programs in Africa and highlights key opportunities to rethink current strategies for sustainable control and elimination. The epidemiology of malaria in Africa presents far greater challenges than elsewhere and requires context-specific initiatives tailored to national and sub-national targets. To sustain progress, African countries must systematically address key weaknesses in its health systems, improve the quality and use of data for surveillance-responses, improve both technical and leadership competencies for malaria control, and gradually reduce overreliance on commodities while expanding multisectoral initiatives such as improved housing and environmental sanitation. They must also leverage increased funding from both domestic and international sources, and support pivotal research and development efforts locally. Effective vaccines and drugs, or other potentially transformative technologies such as genedrive modified mosquitoes, could further accelerate malaria control by complementing current tools. However, our underlying strategies remain insufficient and must be expanded to include more holistic and context-specific approaches critical to achieve and sustain effective malaria control.
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Affiliation(s)
| | - Margaret Gyapong
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Núria Casamitjana
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic–University of Barcelona, Barcelona, Spain
| | - Marcia C. Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Maurice A. Itoe
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Friday Okonofua
- Department of Obstetrics and Gynaecology, School of Medicine, University of Benin, Benin City, Nigeria
| | - Marcel Tanner
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Tairou F, Diallo A, Sy O, Kone A, Manga IA, Sylla K, Lelo S, Fall CB, Sow D, Ndiaye M, Faye B, Tine RCK. Malaria-associated risk factors among adolescents living in areas with persistent transmission in Senegal: a case-control study. Malar J 2022; 21:193. [PMID: 35725475 PMCID: PMC9208171 DOI: 10.1186/s12936-022-04212-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Senegal, malaria morbidity has sharply decreased over these past years. However, malaria epidemiology remains heterogeneous with persistent transmission in the southeastern part of the country and many cases among older children and adolescents. Little is known about factors associated with clinical malaria among this group. A better understanding of malaria transmission among this newly emerging vulnerable group will guide future interventions targeting this population group. This study aimed to identify factors associated with clinical malaria among adolescents in Senegal. METHODS A case-control study was conducted from November to December 2020 in four health posts located in the Saraya district. Cases were defined as adolescents (10-19 years) with an uncomplicated malaria episode with fever (temperature > 37.5°) or a history of fever and positive malaria rapid diagnostic test (RDT). Controls were from the same age group, living in the neighbourhood of the case, presenting a negative RDT. A standardized, pre-tested questionnaire was administered to each study participant followed by a home visit to assess the participant's living conditions. Factors associated with clinical malaria were assessed using stepwise logistic regression analysis. RESULTS In total, 492 individuals were recruited (246 cases and 246 controls). In a multivariate analysis, factors associated with clinical malaria included non-use of long-lasting insecticidal net (LLIN) (aOR = 2.65; 95% CI 1.58-4.45), non-use of other preventive measures (aOR = 2.51; 95% CI 1.53-4.11) and indoor sleeping (aOR = 3.22; 95% CI 1.66-6.23). Protective factors included 15-19 years of age (aOR = 0.38; 95% CI 0.23-0.62), absence of stagnant water around the house (aOR = 0.27; 95% CI 0.16-0.44), having a female as head of household (aOR = 0.47; 95% CI 0.25-0.90), occupation such as apprentice (OR = 0.24; 95% CI 0.11-0.52). CONCLUSIONS The study revealed that environmental factors and non-use of malaria preventive measures are the main determinants of malaria transmission among adolescents living in areas with persistent malaria transmission in Senegal. Strategies aimed at improving disease awareness and access to healthcare interventions, such as LLINs, are needed to improve malaria control and prevention among these vulnerable groups.
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Affiliation(s)
- Fassiatou Tairou
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal.
| | | | - Ousmane Sy
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Aminatou Kone
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal.,Malaria Research and Training Center, University of Bamako, Bamako, Mali
| | - Isaac Akhenaton Manga
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Khadim Sylla
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Souleye Lelo
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Cheikh Binetou Fall
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Doudou Sow
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Magatte Ndiaye
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Babacar Faye
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Roger C K Tine
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
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Mshamu S, Mmbando A, Meta J, Bradley J, Bøjstrup TC, Day NPJ, Mukaka M, Okumu F, Olotu A, Pell C, Deen J, Knudsen J, Lindsay SW, von Seidlein L. Assessing the impact of a novel house design on the incidence of malaria in children in rural Africa: study protocol for a household-cluster randomized controlled superiority trial. Trials 2022; 23:519. [PMID: 35725486 PMCID: PMC9207857 DOI: 10.1186/s13063-022-06461-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Traditional rural housing in hot, humid regions of sub-Saharan Africa usually consists of single-level, poorly ventilated dwellings. Houses are mostly poorly screened against malaria mosquitoes and limited airflow discourages the use of bednets resulting in high indoor transmission. This study aims to determine whether living in a novel design house with elevated bedrooms and permeable screened walls reduces malaria, respiratory tract infections, and diarrhoea among children in rural Tanzania. Methods/study design This is a household-randomized, controlled study in 60 villages in Mtwara, Tanzania. A total of 550 households are randomly selected, 110 of which are allocated a novel design house and 440 households continue to reside in traditional houses. A dynamic cohort of about 1650 children under 13 years will be enrolled and followed for 3 years, approximately 330 living in novel design houses and 1320 in traditional rural houses. The primary endpoint is the incidence of malaria; secondary endpoints are incidences of acute respiratory tract infections and diarrhoea diseases detected by passive and active surveillance. Exposure to malaria vectors will be assessed using light traps in all study houses. Structural, economic, and social science studies will assess the durability, cost-effectiveness, and acceptability of the new houses compared with traditional housing. Environmental data will be collected indoors and outdoors in study homes to assess the differences between house typologies. Discussion This is the first randomized controlled trial to assess the protective efficacy of a new house design targeting malaria in sub-Saharan Africa. The findings of this study could influence the future construction of homes in hot and humid zones of Africa. Trial registration ClinicalTrials.govNCT04529434. Registered on August 27, 2020
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Affiliation(s)
- Salum Mshamu
- CSK Research Solutions, Mtwara, Tanzania.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Arnold Mmbando
- Ifakara Health Institute, Ifakara, Tanzania.,Department of Biosciences, Durham University, Durham, UK
| | - Judith Meta
- University of Amsterdam, Amsterdam, Netherlands
| | - John Bradley
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Nicholas P J Day
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
| | - Mavuto Mukaka
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
| | | | - Ally Olotu
- Ifakara Health Institute, Ifakara, Tanzania
| | | | | | - Jakob Knudsen
- The Royal Danish Academy of Fine Arts, Copenhagen, Denmark
| | | | - Lorenz von Seidlein
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. .,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand.
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Woolley KE, Bartington SE, Pope FD, Greenfield SM, Tusting LS, Price MJ, Thomas GN. Cooking outdoors or with cleaner fuels does not increase malarial risk in children under 5 years: a cross-sectional study of 17 sub-Saharan African countries. Malar J 2022; 21:133. [PMID: 35477567 PMCID: PMC9044678 DOI: 10.1186/s12936-022-04152-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Smoke from solid biomass cooking is often stated to reduce household mosquito levels and, therefore, malarial transmission. However, household air pollution (HAP) from solid biomass cooking is estimated to be responsible for 1.67 times more deaths in children aged under 5 years compared to malaria globally. This cross-sectional study investigates the association between malaria and (i) cleaner fuel usage; (ii) wood compared to charcoal fuel; and, (iii) household cooking location, among children aged under 5 years in sub-Saharan Africa (SSA). Methods Population-based data was obtained from Demographic and Health Surveys (DHS) for 85,263 children within 17 malaria-endemic sub-Saharan countries who were who were tested for malaria with a malarial rapid diagnostic test (RDT) or microscopy. To assess the independent association between malarial diagnosis (positive, negative), fuel type and cooking location (outdoor, indoor, attached to house), multivariable logistic regression was used, controlling for individual, household and contextual confounding factors. Results Household use of solid biomass fuels and kerosene cooking fuels was associated with a 57% increase in the odds ratio of malarial infection after adjusting for confounding factors (RDT adjusted odds ratio (AOR):1.57 [1.30–1.91]; Microscopy AOR: 1.58 [1.23–2.04]) compared to cooking with cleaner fuels. A similar effect was observed when comparing wood to charcoal among solid biomass fuel users (RDT AOR: 1.77 [1.54–2.04]; Microscopy AOR: 1.21 [1.08–1.37]). Cooking in a separate building was associated with a 26% reduction in the odds of malarial infection (RDT AOR: 0.74 [0.66–0.83]; Microscopy AOR: 0.75 [0.67–0.84]) compared to indoor cooking; however no association was observed with outdoor cooking. Similar effects were observed within a sub-analysis of malarial mesoendemic areas only. Conclusion Cleaner fuels and outdoor cooking practices associated with reduced smoke exposure were not observed to have an adverse effect upon malarial infection among children under 5 years in SSA. Further mixed-methods research will be required to further strengthen the evidence base concerning this risk paradigm and to support appropriate public health messaging in this context. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04152-3.
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Affiliation(s)
- Katherine E Woolley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Suzanne E Bartington
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Francis D Pope
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sheila M Greenfield
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Lucy S Tusting
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Malcolm J Price
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
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Epuitai J, Woolley KE, Bartington SE, Thomas GN. Association between Wood and Other Biomass Fuels and Risk of Low Birthweight in Uganda: A Cross-Sectional Analysis of 2016 Uganda Demographic and Health Survey Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074377. [PMID: 35410058 PMCID: PMC8999071 DOI: 10.3390/ijerph19074377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/29/2022]
Abstract
In utero exposure to household air pollution (HAP) from polluting cooking fuels has been linked to adverse pregnancy outcomes including low birthweight (LBW). No previous study in Uganda has attempted to investigate the association between the different types of biomass cooking fuels and LBW. This study was conducted to investigate the association between wood and other biomass cooking fuel use with increased risk of LBW, using the 2016 Uganda Demographic and Health Survey for 15,270 live births within five years prior to interview. LBW, defined as birthweight of <2500 g, was estimated from maternal recall and health cards. Association between household exposure to the different solid biomass cooking fuels and LBW was determined using multivariable logistic regression. Biomass cooking fuels were used in 99.6% of the households, with few (0.3%) using cleaner fuels and 0.1% with no cooking, while the prevalence of LBW was 9.6% of all live-births. Although the crude analysis suggested an association between wood fuel use and LBW compared to other biomass and kerosene fuel use (AOR: 0.82; 95% CI: 0.67−1.00), after adjusting for socio-demographic and obstetric factors, no association was observed (AOR: 0.94; 95% CI: 0.72−1.22). LBW was significantly more likely among female neonates (AOR: 1.32 (95% CI: 1.13−1.55) and neonates born to mothers living in larger households (AOR: 1.03; 95% CI: 1.00−1.07). LBW was significantly less likely among neonates delivered at term (AOR: 0.39; 95% CI: 0.31−0.49), born to women with secondary or tertiary level of education (AOR: 0.80; 95% CI: 0.64−1.00), living in households with a higher wealth index (AOR: 0.69; 95% CI: 0.50−0.96), Eastern (AOR: 0.76; 95% CI:0.59−0.98) and Northern (AOR: 0.75; 95% CI: 0.57−0.99) regions. The study findings suggest inconclusive evidence regarding the association between the use of wood compared to other biomass and kerosene cooking fuels and risk of LBW. Given the close observed association between socioeconomic status and LBW, the Ugandan government should prioritize public health actions which support female education and broader sustainable development to improve household living standards in this setting.
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Affiliation(s)
- Joshua Epuitai
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (J.E.); (K.E.W.); (S.E.B.)
- Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Katherine E. Woolley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (J.E.); (K.E.W.); (S.E.B.)
| | - Suzanne E. Bartington
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (J.E.); (K.E.W.); (S.E.B.)
| | - G. Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (J.E.); (K.E.W.); (S.E.B.)
- Correspondence:
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Nguyen TT, Nguyen XX, Wilson-Barthes M, Sawada I, Muela J, Hausmann-Muela S, Pham TV, Van Nguyen H, Van Nguyen V, Tran DT, Gryseels C, D'Alessandro U, Grietens KP, Erhart A. Why using bed nets is a challenge among minority populations in Central Vietnam. Malar J 2022; 21:87. [PMID: 35292018 PMCID: PMC8922825 DOI: 10.1186/s12936-022-04114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite freely distributed insecticide-treated nets (ITNs) and health information campaigns to increase their use among populations at risk, malaria transmission persists in forested areas in Vietnam, especially among ethnic minority communities. A mixed-methods study was conducted in four villages of Ca Dong and M'nong ethnicity in Central Vietnam between 2009 and 2011 to assess factors limiting the uptake of ITNs. METHODS The mixed-methods research design consisted of a qualitative study to explore the context and barriers to ITN use, and a cross-sectional household survey (n = 141) to quantify factors for limited and appropriate net use. RESULTS The Ca Dong and M'nong's livelihood was dependent on swidden farming in the forest. Poverty-related factors, including the lack of beds, blankets, the practice of sleeping around the kitchen fire and deteriorated ITNs due to open housing structures, were reasons for alternative and non-use of ITNs. When household members stayed overnight in plot huts at fields, ITNs were even more unavailable and easily deteriorated. 72.5% of households reported having received one net for every two persons, and 82.2% of participants reported to have used ITNs the night before the survey. However, only 18.4% of participants were estimated to be effectively protected by ITNs after accounting for the availability of torn ITNs and the way ITNs were used, for example as blankets, at both village and fields. Multi-variable logistic regression showed the effect of four significant factors for appropriate ITN use: i) being female (AOR = 8.08; p = 0.009); ii) aware of mosquito bites as the sole cause of malaria (AOR = 7.43; p = 0.008); iii) not sleeping around the kitchen fire (AOR = 24.57; p = 0.001); and iv) having sufficient number of ITNs in the household (AOR = 21.69; p = 0.001). CONCLUSION This study showed how social factors rooted in poverty and swidden agriculture limited the effective use of ITNs, despite high coverage, among ethnic minority populations in Central Vietnam. An in-depth understanding of the local context is essential to develop specific indicators for measuring ITN use.
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Affiliation(s)
- Thuan Thi Nguyen
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. .,National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam.
| | - Xa Xuan Nguyen
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Marta Wilson-Barthes
- International Health Institute, Brown University School of Public Health, Providence, USA
| | - Ikumi Sawada
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Joan Muela
- University Ramon I Virgili, Tarragona, Spain.,Partners for Applied Social Sciences, PASS International, Tessenderlo, Belgium
| | | | - Thanh Vinh Pham
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Hong Van Nguyen
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | | | - Duong Thanh Tran
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Charlotte Gryseels
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Koen Peeters Grietens
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Partners for Applied Social Sciences, PASS International, Tessenderlo, Belgium.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Annette Erhart
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
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Mitchell CL, Ngasala B, Janko MM, Chacky F, Edwards JK, Pence BW, Mohamed A, Mhamilawa LE, Makene T, Kyaw T, Molteni F, Mkali H, Nyinondi S, Kabula B, Serbantez N, Eckert EL, Kitojo C, Reaves E, Emch M, Juliano JJ. Evaluating malaria prevalence and land cover across varying transmission intensity in Tanzania using a cross-sectional survey of school-aged children. Malar J 2022; 21:80. [PMID: 35264152 PMCID: PMC8905829 DOI: 10.1186/s12936-022-04107-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/24/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Transmission of malaria in sub-Saharan Africa has become increasingly stratified following decades of malaria control interventions. The extent to which environmental and land cover risk factors for malaria may differ across distinct strata of transmission intensity is not well known and could provide actionable targets to maximize the success of malaria control efforts. METHODS This study used cross-sectional malaria survey data from a nationally representative cohort of school-aged children in Tanzania, and satellite-derived measures for environmental features and land cover. Hierarchical logistic regression models were applied to evaluate associations between land cover and malaria prevalence within three distinct strata of transmission intensity: low and unstable, moderate and seasonal, and high and perennial. RESULTS In areas with low malaria transmission, each 10-percentage point increase in cropland cover was associated with an increase in malaria prevalence odds of 2.44 (95% UI: 1.27, 5.11). However, at moderate and higher levels of transmission intensity, no association between cropland cover and malaria prevalence was detected. Small associations were observed between greater grassland cover and greater malaria prevalence in high intensity settings (prevalence odds ratio (POR): 1.10, 95% UI: 1.00, 1.21), and between greater forest cover and reduced malaria prevalence in low transmission areas (POR: 0.74, 95% UI: 0.51, 1.03), however the uncertainty intervals of both estimates included the null. CONCLUSIONS The intensity of malaria transmission appears to modify relationships between land cover and malaria prevalence among school-aged children in Tanzania. In particular, greater cropland cover was positively associated with increased malaria prevalence in areas with low transmission intensity and presents an actionable target for environmental vector control interventions to complement current malaria control activities. As areas are nearing malaria elimination, it is important to re-evaluate environmental risk factors and employ appropriate interventions to effectively address low-level malaria transmission.
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Affiliation(s)
- Cedar L. Mitchell
- grid.410711.20000 0001 1034 1720Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Billy Ngasala
- grid.25867.3e0000 0001 1481 7466Muhimbili University of Health and Allied Sciences, Dar es Salam, Tanzania
| | - Mark M. Janko
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, Washington, USA
| | - Frank Chacky
- grid.490706.cGender, Elderly and Children, Ministry of Health, Community Development, Dodoma, Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, Tanzania
| | - Jessie K. Edwards
- grid.410711.20000 0001 1034 1720Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Brian W. Pence
- grid.410711.20000 0001 1034 1720Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Ally Mohamed
- grid.490706.cGender, Elderly and Children, Ministry of Health, Community Development, Dodoma, Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, Tanzania
| | - Lwidiko E. Mhamilawa
- grid.25867.3e0000 0001 1481 7466Muhimbili University of Health and Allied Sciences, Dar es Salam, Tanzania
| | - Twilumba Makene
- grid.25867.3e0000 0001 1481 7466Muhimbili University of Health and Allied Sciences, Dar es Salam, Tanzania
| | - Thwai Kyaw
- grid.10698.360000000122483208Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Fabrizio Molteni
- grid.490706.cGender, Elderly and Children, Ministry of Health, Community Development, Dodoma, Tanzania ,Tropical and Public Health Institute, Basel, Switzerland
| | | | | | | | - Naomi Serbantez
- US President’s Malaria Initiative (PMI), United States Agency for International Development, Dar es Salaam, Tanzania
| | - Erin L. Eckert
- grid.62562.350000000100301493RTI International, Washington, DC USA
| | - Chonge Kitojo
- US President’s Malaria Initiative (PMI), United States Agency for International Development, Dar es Salaam, Tanzania
| | - Erik Reaves
- President’s Malaria Initiative, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Michael Emch
- grid.410711.20000 0001 1034 1720Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA ,grid.410711.20000 0001 1034 1720Department of Geography, University of North Carolina, Chapel Hill, NC USA
| | - Jonathan J. Juliano
- grid.10698.360000000122483208Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
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Shah HA, Carrasco LR, Hamlet A, Murray KA. Exploring agricultural land-use and childhood malaria associations in sub-Saharan Africa. Sci Rep 2022; 12:4124. [PMID: 35260722 PMCID: PMC8904834 DOI: 10.1038/s41598-022-07837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/24/2022] [Indexed: 11/09/2022] Open
Abstract
Agriculture in Africa is rapidly expanding but with this comes potential disbenefits for the environment and human health. Here, we retrospectively assess whether childhood malaria in sub-Saharan Africa varies across differing agricultural land uses after controlling for socio-economic and environmental confounders. Using a multi-model inference hierarchical modelling framework, we found that rainfed cropland was associated with increased malaria in rural (OR 1.10, CI 1.03-1.18) but not urban areas, while irrigated or post flooding cropland was associated with malaria in urban (OR 1.09, CI 1.00-1.18) but not rural areas. In contrast, although malaria was associated with complete forest cover (OR 1.35, CI 1.24-1.47), the presence of natural vegetation in agricultural lands potentially reduces the odds of malaria depending on rural-urban context. In contrast, no associations with malaria were observed for natural vegetation interspersed with cropland (veg-dominant mosaic). Agricultural expansion through rainfed or irrigated cropland may increase childhood malaria in rural or urban contexts in sub-Saharan Africa but retaining some natural vegetation within croplands could help mitigate this risk and provide environmental co-benefits.
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Affiliation(s)
- Hiral Anil Shah
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK. .,Grantham Institute - Climate Change and the Environment - Imperial College London, London, UK.
| | - Luis Roman Carrasco
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Arran Hamlet
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Kris A Murray
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.,MRC Unit The Gambia at London, School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia.,Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
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When Local Trade-Offs between SDGs Turn Out to Be Wealth-Dependent: Interaction between Expanding Rice Cultivation and Eradicating Malaria in Rwanda. SUSTAINABILITY 2022. [DOI: 10.3390/su14042100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Interactions between SDGs are increasingly mapped and mediating factors that determine whether existing synergies or trade-offs can be identified. However, if and how the wealth status of the concerned population shapes whether SDG interaction constitutes a vicious or virtuous circle is largely overlooked. This article focuses on interaction between SDG2 (nutrition) and SDG3 (health), in particular, the relationship between rice production intensification and the fight against malaria, and thus the role of wealth in explaining the trade-off. This study employed a large-scale survey of rural households (n = 3968) in eastern Rwanda, conducted at a time when a rapid expansion of rice fields co-existed with a strong resurgence of malaria. Logistic regression shows that rice-cultivating households faced significant higher malaria risk, as proxied by fever incidence, confirming the negative externality of agricultural intensification on public health through offering a habitat for vector-borne diseases. Even though rice-cultivating households tend to be higher up the local wealth distribution than those outside the rice sector, its distributional effects are generally biased against the poor. Poorer households outside the rice sector hardly share in the benefits from increased rice production but suffer the consequences in terms of increased malaria risk. The case thus draws attention to the importance of using a distributional lens when analyzing interaction between SDGs locally.
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Malaria prevention interventions beyond long-lasting insecticidal nets and indoor residual spraying in low- and middle-income countries: a scoping review. Malar J 2022; 21:31. [PMID: 35109848 PMCID: PMC8812253 DOI: 10.1186/s12936-022-04052-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Significant progress in malaria prevention during the past two decades has prompted increasing global dialogue on malaria elimination. Recent reviews on malaria strategies have focused mainly on long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), with little emphasis on other prevention methods. This article is a scoping review of literature on malaria prevention methods beyond LLINs and IRS in low- and middle-income countries (LMICs). Methods This scoping review found articles published between from 1994 to 2020. Studies were obtained from a search of the PubMed, the Cochrane Library and Social Science abstracts. Grey literature and manual search of secondary references was also done. The search strategy included all study designs but limited only to English. Three independent reviewers performed the selection and characterization of articles, and the data collected were synthesized qualitatively. Results A total of 10,112 studies were identified among which 31 met the inclusion criteria. The results were grouped by the 3 emerging themes of: housing design; mosquito repellents; and integrated vector control. Housing design strategies included closing eves, screening of houses including windows, doors and ceilings, while mosquito repellents were mainly spatial repellents, use of repellent plants, and use of plant-based oils. Integrated vector control included larvae source management. Evidence consistently shows that improving housing design reduced mosquito entry and malaria prevalence. Spatial repellents also showed promising results in field experiments, while evidence on repellent plants is limited and still emerging. Recent literature shows that IVM has been largely ignored in recent years in many LMICs. Some malaria prevention methods such as spatial repellents and IVM are shown to have the potential to target both indoor and outdoor transmission of malaria, which are both important aspects to consider to achieve malaria elimination in LMICs. Conclusion The scoping review shows that other malaria prevention strategies beyond LLINs and IRS have increasingly become important in LMICs. These methods have a significant role in contributing to malaria elimination in endemic countries if they are adequately promoted alongside other conventional approaches. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04052-6.
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Characterization of Healthy Housing in Africa: Method, Profiles, and Determinants. J Urban Health 2022; 99:146-163. [PMID: 35079945 PMCID: PMC8788402 DOI: 10.1007/s11524-021-00603-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/02/2022]
Abstract
Housing is a key social determinant of health with implications for both physical and mental health. The measurement of healthy housing and studies characterizing the same in sub-Saharan Africa (SSA) are uncommon. This study described a methodological approach employed in the assessment and characterization of healthy housing in SSA using the Demographic and Health Survey (DHS) data for 15 countries and explored healthy housing determinants using a multiple survey-weighted logistic regression analysis. For all countries, we demonstrated that the healthy housing index developed using factor analysis reasonably satisfies both reliability and validity tests and can therefore be used to describe the distribution of healthy housing across different groups and in understanding the linkage with individual health outcomes. We infer from the results that unhealthy housing remains quite high in most SSA countries. Having a male head of the household was associated with decreased odds of healthy housing in Burkina Faso (OR = 0.80, CI = 0.68-0.95), Cameroon (OR = 0.65, CI = 0.57, 0.76), Malawi (OR = 0.70, CI = 0.64-0.78), and Senegal (OR = 0.62, CI = 0.51-0.74). Further, increasing household size was associated with reducing odds of healthy housing in Kenya (OR = 0.53, CI = 0.44-0.65), Namibia (OR = 0.34, CI = 0.24-0.48), Nigeria (OR = 0.57, CI = 0.46-0.71), and Uganda (OR = 0.79, CI = 0.67-0.94). Across all countries, household wealth was a strong determinant of healthy housing, with middle and rich households having higher odds of residing in healthy homes compared to poor households. Odds ratios ranged from 3.63 (CI = 2.96-4.44) for households in the middle wealth group in the DRC to 2812.2 (CI = 1634.8-4837.7) in Namibia's wealthiest households. For other factors, the analysis also showed variation across countries. Our findings provide timely insights for the implementation of housing policies across SSA countries, drawing attention to aspects of housing that would promote occupant health and wellbeing. Beyond the contribution to the measurement of healthy housing in SSA, our paper highlights key policy and program issues that need further interrogation in the search for pathways to addressing the healthy housing deficit across most SSA countries. This has become critical amid the COVID-19 pandemic, where access to healthy housing is pivotal in its control.
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Baumgartner J, Rodriguez J, Berkhout F, Doyle Y, Ezzati M, Owuso G, Quayyum Z, Solomon B, Winters M, Adamkiewicz G, Robinson BE. Synthesizing the links between secure housing tenure and health for more equitable cities. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17244.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Millions of households in rich and poor countries alike are at risk of being unwilfully displaced from their homes or the land on which they live (i.e., lack secure tenure), and the urban poor are most vulnerable. Improving housing tenure security may be an intervention to improve housing and environmental conditions and reduce urban health inequalities. Building on stakeholder workshops and a narrative review of the literature, we developed a conceptual model that infers the mechanisms through which more secure housing tenure can improve housing, environmental quality, and health. Empirical studies show that more secure urban housing tenure can boost economic mobility, improve housing and environmental conditions including reduced exposure to pollution, create safer and more resourced communities, and improve physical and mental health. These links are shared across tenure renters and owners and different economic settings. Broader support is needed for context-appropriate policies and actions to improve tenure security as a catalyst for cultivating healthier homes and neighbourhoods and reducing urban health inequalities in cities.
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Examining the paradox of urban disease ecology by linking the perspectives of Urban One Health and Ecology with Cities. Urban Ecosyst 2022; 25:1735-1744. [PMID: 35855439 PMCID: PMC9283848 DOI: 10.1007/s11252-022-01260-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 12/14/2022]
Abstract
The ecology of zoonotic, including vector-borne, diseases in urban social-ecological systems is influenced by complex interactions among human and environmental factors. Several characteristics contribute to the emergence and spread of infectious diseases in urban places, such as high human population densities, favorable habitat for vectors, and humans' close proximity to animals and their pathogens. On the other hand, urban living can contribute to the improvement of public health through better access to health services and creation of ecological and technological infrastructure that reduces disease burdens. Therefore, urbanization creates a disease ecology paradox through the interplay of urban health penalties and advantages for individual and community outcomes. To address this contradiction, we advocate a holistic Urban One Health perspective for managing urban systems, especially their green spaces and animal populations, in ways that more effectively control the spread of zoonotic diseases. This view should be coupled with an Ecology with Cities approach which emphasizes actionable science needed for urban planning, management and policymaking; developing disease and vector surveillance programs using citizen and community science methods; and improving education and communication actions that help diverse stakeholders understand the complexities of urban disease ecology. Such measures will enable scholars from many disciplines to collaborate with professionals, government officials, and others to tackle challenges of the urban disease paradox and create more sustainable, health-promoting environments.
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