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García GA, Galick DS, Smith JM, Iyanga MM, Rivas MR, Mba Eyono JN, Phiri WP, Donfack OT, Smith DL, Guerra CA. The challenge of improving long-lasting insecticidal nets coverage on Bioko Island: using data to adapt distribution strategies. RESEARCH SQUARE 2024:rs.3.rs-4188387. [PMID: 38645156 PMCID: PMC11030524 DOI: 10.21203/rs.3.rs-4188387/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Since 2015, malaria vector control on Bioko Island has relied heavily upon long-lasting insecticidal nets (LLIN) to complement other interventions. Despite significant resources utilised, however, achieving and maintaining high coverage has been elusive. Here, core LLIN indicators were used to assess and redefine distribution strategies. Methods LLIN indicators were estimated for Bioko Island between 2015 and 2022 using a 1×1 km grid of areas. The way these indicators interacted was used to critically assess coverage targets. Particular attention was paid to spatial heterogeneity and to differences between urban Malabo, the capital, and the rural periphery. Results LLIN coverage according to all indicators varied substantially across areas, decreased significantly soon after mass distribution campaigns (MDC) and, with few exceptions, remained consistently below the recommended target. Use was strongly correlated with population access, particularly in Malabo. After a change in strategy in Malabo from MDC to fixed distribution points, use-to-access showed significant improvement, indicating those who obtained their nets from these sources were more likely to keep them and use them. Moreover, their use rates were significantly higher than those of whom sourced their nets elsewhere. Conclusions Striking a better balance between LLIN distribution efficiency and coverage represents a major challenge as LLIN retention and use rates remain low despite high access resulting from MDC. The cost benefit of fixed distribution points in Malabo was deemed significant, providing a viable alternative for guaranteeing access to LLINs to those who use them.
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Affiliation(s)
- Guillermo A. García
- MCD Global Health, 8403 Colesville Road, Suite 425, 20910 Silver Spring, USA
| | - David S. Galick
- MCD Global Health, Av. Parques de Africa, Malabo, Equatorial Guinea
| | - Jordan M. Smith
- MCD Global Health, 8403 Colesville Road, Suite 425, 20910 Silver Spring, USA
| | | | - Matilde Riloha Rivas
- National Malaria Control Program, Ministry of Health and Social Welfare of Equatorial Guinea, Malabo, Equatorial Guinea
| | | | - Wonder P. Phiri
- MCD Global Health, Av. Parques de Africa, Malabo, Equatorial Guinea
| | | | - David L. Smith
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, 98121 Seattle, USA
| | - Carlos A. Guerra
- MCD Global Health, 8403 Colesville Road, Suite 425, 20910 Silver Spring, USA
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Endriyas M, Kassa M, Chisha Y, Mekonnen E, Misganaw T, Loha E, Astatkie A. Low long-lasting insecticidal net use in malaria elimination areas in Southern Ethiopia: results from community based cross-sectional study. Malar J 2024; 23:94. [PMID: 38575937 PMCID: PMC10996104 DOI: 10.1186/s12936-024-04909-y] [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: 10/20/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Despite remarkable progress in malaria burden reduction, malaria continues to be a major public health problem globally. Ethiopia has been distributing long-lasting insecticidal nets (LLINs) for free and nationwide distribution was completed in 2016. However, evidence suggests that the utilization of LLINs varies from setting to setting and from time to time due to different factors, and up-to-date evidence is required for LLIN related decision-making. Hence, this study was designed to assess LLIN utilization and its determinants in the Southern Nations, Nationalities, and People's Region (SNNPR) of Ethiopia. METHODS A community-based cross-sectional study was conducted in Southern Ethiopia in 2019. Using multi-stage sampling, a total of 2466 households were included. The region was stratified based on the annual malaria index as high, moderate, low, and free strata. Cluster sampling was then applied to select households from high, moderate, and low strata. Data on LLIN ownership, utilization and different determinant factors were collected using household questionnaire. SurveyCTO was used to collect data and data was managed using Stata 15. Descriptive statistics and multilevel mixed-effects logistic regression were performed to identify the determinants of utilization of LLINs. Effect measures were reported using adjusted odds ratio (AOR) with 95% CI. RESULTS From a total of 2466 households, 48.7% of households had at least one LLIN. LLIN adequacy based on family size was 23% while it was15.7% based on universal access and 29.2% based on sleeping space. From 1202 households that possessed LLIN(s), 66.0% of households reported that they slept under LLIN the night preceding the survey. However, when the total population in all surveyed households were considered, only 22.9% of household members slept under LLIN the night preceding the survey. Malaria endemicity, educational status, wealth status, and knowledge about malaria were associated with LLINs utilization. In addition, reasons for non-use included perceived absence of malaria, side effects of LLIN, conditions of LLINs, inconvenient space and low awareness. CONCLUSION Low LLIN coverage and low utilization were noted. A low level of utilization was associated with malaria endemicity, wealth status and level of awareness. Distribution of LLIN and continuous follow-up with community awareness creation activities are vital to improve coverage and utilization of LLINs, and to ensure the country's malaria elimination goal.
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Affiliation(s)
| | - Mekidim Kassa
- College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
| | - Yilma Chisha
- College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
| | | | | | - Eskindir Loha
- Centre for International Health, University of Bergen, Bergen, Norway
- Chr. Michelsen Institute, Bergen, Norway
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Alafo C, Montoya LF, Martí-Soler H, Máquina M, Malheia A, Sacoor C, Abílio AP, Marrenjo D, Cuamba N, Galatas B, Aide P, Saúte F, Paaijmans KP. An evaluation of LLIN physical integrity and population attitudes towards net use, care and handling during the Magude project in southern Mozambique. Malar J 2024; 23:87. [PMID: 38532416 PMCID: PMC10967156 DOI: 10.1186/s12936-024-04910-5] [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: 12/20/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The Magude Project assessed the feasibility of eliminating malaria in Magude district, a low transmission setting in southern Mozambique, using a package of interventions, including long-lasting insecticidal nets (LLINs). As the efficacy of LLINs depends in part on their physical integrity, this metric was quantified for Olyset® Nets post mass-distribution, in addition to net use, care and handling practices and other risk factors associated with net physical integrity. METHODS Nets were collected during a cross-sectional net evaluation, nine months after the Magude project commenced, which was 2 years after the nets were distributed by the National Malaria Control Programme (NMCP). The physical integrity of the nets was assessed by counting and sizing the holes at different positions on each net. A structured questionnaire was administered to assess how the selected net was used and treated (care, wash and repair). Net bio-efficacy was assessed following the standard World Health Organization (WHO) cone bioassay procedures. RESULTS Out of the 170 Olyset® Nets included in the analysis, 63.5% had been used the night before. The main reason for not using a net was the notion that there were no mosquitoes present. The average number of people using each net was 1.79. Two thirds of the nets had only been washed once or twice since distribution. Most nets (80.9%) were holed and 18% were torn, but none of the risk factors were significantly associated with net integrity, except for presence of mice in the household. Less than half of the participants noticed holes in holed nets, and of those only 38.6% attempted to repair those. None of the six nets that were tested for bio-efficacy passed the WHO threshold of 80% mosquito mortality. CONCLUSION Overall the majority of Olyset® Nets were in serviceable condition two years post-distribution, but their insecticidal effect may have been lost. This study-together with previous evidence on suboptimal access to and use of LLINs in Magude district-highlights that LLINs as an intervention could have been optimized during the Magude project to achieve maximum intervention impact.
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Affiliation(s)
- Celso Alafo
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Maputo, Mozambique
| | - Lucia Fernandez Montoya
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona, Spain
| | | | - Mara Máquina
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Maputo, Mozambique
| | - Arlindo Malheia
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Maputo, Mozambique
| | - Ana Paula Abílio
- Instituto Nacional da Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Dulcisaria Marrenjo
- Programa Nacional de Controlo da Malária, Ministério da Saúde, Maputo, Mozambique
| | - Nelson Cuamba
- Programa Nacional de Controlo da Malária, Ministério da Saúde, Maputo, Mozambique
- PMI VectorLink Project, Abt Associates Inc., Maputo, Mozambique
| | - Beatriz Galatas
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona, Spain
- Global Malaria Program, World Health Organization, Geneva, Switzerland
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Maputo, Mozambique
- Instituto Nacional da Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Maputo, Mozambique
| | - Krijn P Paaijmans
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Maputo, Mozambique.
- ISGlobal, Barcelona, Spain.
- Center for Evolution and Medicine, School of Life Sciences, Arizona State University, Tempe, AZ, USA.
- Simon A. Levin Mathematical, Computational and Modeling Sciences Center, Arizona State University, Tempe, AZ, USA.
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Odero JI, Abong'o B, Moshi V, Ekodir S, Harvey SA, Ochomo E, Gimnig JE, Achee NL, Grieco JP, Oria PA, Monroe A. Early morning anopheline mosquito biting, a potential driver of malaria transmission in Busia County, western Kenya. Malar J 2024; 23:66. [PMID: 38438933 PMCID: PMC10910777 DOI: 10.1186/s12936-024-04893-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Insecticide-treated nets (ITNs) contributed significantly to the decline in malaria since 2000. Their protective efficacy depends not only on access, use, and net integrity, but also location of people within the home environment and mosquito biting profiles. Anopheline mosquito biting and human location data were integrated to identify potential gaps in protection and better understand malaria transmission dynamics in Busia County, western Kenya. METHODS Direct observation of human activities and human landing catches (HLC) were performed hourly between 1700 to 0700 h. Household members were recorded as home or away; and, if at home, as indoors/outdoors, awake/asleep, and under a net or not. Aggregated data was analysed by weighting hourly anopheline biting activity with human location. Standard indicators of human-vector interaction were calculated using a Microsoft Excel template. RESULTS There was no significant difference between indoor and outdoor biting for Anopheles gambiae sensu lato (s.l.) (RR = 0.82; 95% CI 0.65-1.03); significantly fewer Anopheles funestus were captured outdoors than indoors (RR = 0.41; 95% CI 0.25-0.66). Biting peaked before dawn and extended into early morning hours when people began to awake and perform routine activities, between 0400-0700 h for An. gambiae and 0300-0700 h for An. funestus. The study population away from home peaked at 1700-1800 h (58%), gradually decreased and remained constant at 10% throughout the night, before rising again to 40% by 0600-0700 h. When accounting for resident location, nearly all bites within the peri-domestic space (defined as inside household structures and surrounding outdoor spaces) occurred indoors for unprotected people (98%). Using an ITN while sleeping was estimated to prevent 79% and 82% of bites for An. gambiae and An. funestus, respectively. For an ITN user, most remaining exposure to bites occurred indoors in the hours before bed and early morning. CONCLUSION While use of an ITN was estimated to prevent most vector bites in this context, results suggest gaps in protection, particularly in the early hours of the morning when biting peaks and many people are awake and active. Assessment of additional human exposure points, including outside of the peri-domestic setting, are needed to guide supplementary interventions for transmission reduction.
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Affiliation(s)
- Julius I Odero
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Bernard Abong'o
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Vincent Moshi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Sheila Ekodir
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Steven A Harvey
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric Ochomo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - John E Gimnig
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Nicole L Achee
- Department of Biological Sciences, University of Notre Dame, Eck Institute for Global Health, Notre Dame, IN, USA
| | - John P Grieco
- Department of Biological Sciences, University of Notre Dame, Eck Institute for Global Health, Notre Dame, IN, USA
| | - Prisca A Oria
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - April Monroe
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
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Koenker H, Yukich J, Erskine M, Opoku R, Sternberg E, Kilian A. How many mosquito nets are needed to maintain universal coverage: an update. Malar J 2023; 22:200. [PMID: 37391703 DOI: 10.1186/s12936-023-04609-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/26/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Insecticide-treated nets (ITNs) have served as the cornerstone of malaria vector control in sub-Saharan Africa for the past two decades. Over 2.5 billion ITNs have been delivered since 2004 primarily through periodic mass distribution campaigns scheduled at approximately three-year intervals, aligning with the expected lifespan of nets. Recent work indicates that ITN retention times are less than two years in most countries, raising key questions for quantification approaches and delivery frequency for ITN distribution. This paper models several quantification approaches for five typical ITN distribution strategies, estimates the proportion of the population with access to an ITN, and presents recommended quantification approaches to meet global targets for ITN access and use. METHODS A stock and flow model with annual timesteps was used to model ITN distribution and resulting ITN access for 2020-2035 under five scenarios in 40 countries: (1) three-year mass campaigns, (2) full-scale annual continuous distribution, (3) three-year mass campaigns plus continuous distribution in the years between campaigns, (4) three-year mass campaigns at different quantification approaches, (5) two-year mass campaigns at different quantification approaches. All scenarios included ITN distribution to pregnant women at antenatal clinics and infants at immunization visits. RESULTS The current status quo of conducting mass campaigns every three years using a population/1.8 quantifier is insufficient to achieve or maintain targets of 80% population access to ITNs in most malaria-endemic countries, given most estimated retention times are less than three years. Tailored three- or two-year mass campaigns were less efficient than annual continuous distribution strategies in nearly all settings. For countries with at least 2.5 year median ITN retention times, full scale continuous distribution provided better ITN access while needing 20-23% fewer ITNs compared to current mass campaigns. CONCLUSION Given variation in ITN retention times across countries, tailored quantification approaches for mass campaigns and continuous distribution strategies are warranted. Continuous distribution strategies are likely to offer more efficient ways to maintain ITN coverage, with fewer nets, where ITN retention times are at least two and a half years. National malaria programmes and their funding partners should work to increase the number of ITNs available to those vulnerable to malaria, while at the same time working to extend the useful life of these critical commodities.
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Affiliation(s)
| | - Josh Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University, New Orleans, USA
| | - Marcy Erskine
- International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | - Robert Opoku
- International Federation of Red Cross and Red Crescent Societies, Nairobi, Kenya
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Afagbedzi SK, Alhassan Y, Kenu E, Malm K, Bandoh DAB, Peprah NY, Ansah OO, Guure C. Universal coverage and utilization of free long-lasting insecticidal nets for malaria prevention in Ghana: a cross-sectional study. Front Public Health 2023; 11:1140604. [PMID: 37304125 PMCID: PMC10248059 DOI: 10.3389/fpubh.2023.1140604] [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: 01/09/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Background Malaria continues to be one of the leading causes of mortality and morbidity, especially among children and pregnant women. The use of Long-Lasting Insecticide Nets (LLINs) has been recognized and prioritized as a major intervention for malaria prevention in Ghana. This study aims to establish the factors influencing the universal coverage and utilization of LLINs in Ghana. Methods The data used for this study was from a cross-sectional survey carried out to assess LLINs ownership and use in 9 out of the 10 old regions of Ghana from October 2018 to February 2019 where free LLIN distribution interventions were implemented. The EPI "30 × 7" cluster sampling method (three-stage sampling design) was modified to "15 × 14" and used for the study. A total of 9,977 households were interviewed from 42 districts. Descriptive statistics using percentages as well as tests of associations such as Pearson Chi-square and the magnitude of the associations using simple and multivariable logistic regression were implemented. Results Of the 9,977 households in the study, 88.0% of them owned at least one LLIN, universal coverage was 75.6%, while utilization was 65.6% among households with at least one LLIN. In the rural and urban areas, 90.8% and 83.2% of households, respectively, owned at least one LLIN. The was a 44% increase in universal coverage of LLINs in rural areas compared to urban areas (AOR: 1.44, 95% CI: 1.02-2.02). There were 29 higher odds of households being universally covered if they received LLIN from the PMD (AOR: 29.43, 95% CI: 24.21-35.79). Households with under-five children were 40% more likely to utilize LLIN (AOR: 1.40, 95% CI: 1.26-1.56). Respondents with universal coverage of LLIN had 25% increased odds of using nets (AOR: 1.25 95% CI: 1.06-1.48). Rural dwelling influences LLIN utilization, thus there was about 4-fold increase in household utilization of LLINs in rural areas compared to urban areas (AOR: 3.78, 95% CI: 2.73-5.24). Household size of more than 2 has high odds of LLINs utilization and awareness of the benefit of LLINs (AOR: 1.42, 95% CI: 1.18-1.71). Conclusion About nine in 10 households in Ghana have access at least to one LLIN, three-quarters had universal coverage, and over two-thirds of households with access used LLIN. The predictors of universal coverage included region of residence, rural dwellers, and PMD campaign, while households with child under-five, in rural areas, and with universal coverage were positively associated with utilization.
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Affiliation(s)
- Seth Kwaku Afagbedzi
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Yakubu Alhassan
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Ernest Kenu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Keziah Malm
- National Malaria Control Programme, Ghana Health Service, Accra, Ghana
| | | | - Nana Yaw Peprah
- National Malaria Control Programme, Ghana Health Service, Accra, Ghana
| | | | - Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Seyoum TF, Andualem Z, Yalew HF. Insecticide-treated bed net use and associated factors among households having under-five children in East Africa: a multilevel binary logistic regression analysis. Malar J 2023; 22:10. [PMID: 36611186 PMCID: PMC9826573 DOI: 10.1186/s12936-022-04416-y] [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: 04/08/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Even though malaria is preventable, it remains the leading cause of under-five morbidity and mortality in low-and middle-income countries. Despite the World Health Organization (WHO) recommendations, its advantage, and its free-of-cost access, the utilization of insecticide-treated nets (ITN) is still low in East Africa. Therefore, this study aimed to assess ITN use and associated factors among households having under-five children in East Africa. METHODS The most recent Demographic and Health Survey (DHS) datasets of East African countries were used. A total of 174,411 weighted samples was used for analysis. Given the hierarchical nature of DHS data, a multilevel binary logistic regression model was fitted to identify factors associated with ITN use. Four models were fitted and a model with the lowest deviance value was chosen as the best-fitted model for the data. Variables with a p-value < 0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel binary logistic regression analysis, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) was reported to declare the statistical significance and strength of association. RESULTS In this study, the proportion of ITN use among households having under-five children in East Africa was 46.32% (95% CI 46.08%, 46.55%), ranging from 11.8% in Zimbabwe to 70.03% in Rwanda. In the multivariable analysis, being in the age group 25-34 years, married, widowed, and divorced, primary and post-primary education, wealthy households, having a lower household size, many under-five children, having media exposure, and male-headed households were associated with higher odds of ITN use. Moreover, respondents from a rural place of residence, communities with a higher level of media exposure, communities with lower poverty levels, and communities with higher education levels had higher odds of ITN use. CONCLUSION In this study, the proportion of ITN use was relatively low. Both individual and community-level factors were associated with ITN use. Therefore, giving attention, especially to those who had no formal education, the poor, younger age groups, and households with the large family size is advisable to increase awareness about ITN use. Moreover, media campaigns regarding ITN use should be strengthened.
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Affiliation(s)
- Tigist Fekadu Seyoum
- grid.59547.3a0000 0000 8539 4635University of Gondar Comprehensive Specialized Hospital, P. O. Box 196, Gondar, Ethiopia
| | - Zewudu Andualem
- grid.59547.3a0000 0000 8539 4635Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Hailemariam Feleke Yalew
- grid.59547.3a0000 0000 8539 4635Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
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Fernández Montoya L, Alafo C, Martí-Soler H, Máquina M, Malheia A, Sacoor C, Abílio AP, Marrenjo D, Cuamba N, Galatas B, Aide P, Saúte F, Paaijmans KP. An evaluation of LLIN ownership, access, and use during the Magude project in southern Mozambique. PLoS One 2023; 18:e0282209. [PMID: 36972236 PMCID: PMC10042371 DOI: 10.1371/journal.pone.0282209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 02/07/2023] [Indexed: 03/29/2023] Open
Abstract
The Magude Project assessed the feasibly of eliminating malaria in a low transmission setting in southern Mozambique using a package of interventions. This study measured the ownership, access and use of long-lasting insecticide treated nets (LLINs) and inequalities in these indicators across household wealth, size and population subgroups, to understand the protection that LLINs provided during the project. Data were obtained from various household surveys. At least 31% of the nets distributed during the 2014 and 2017 campaigns were lost during the first year post-distribution. Most nets (77.1%) present in the district were Olyset Nets. LLIN access never exceeded 76.3% and use varied seasonally between 40% and 76.4%. LLIN access limited LLIN use during the project, especially during the high transmission season. LLIN ownership, access and use were lower in harder-to-reach localities, in poorer and larger households. Children and women below 30 had poorer access to LLINs than the overall population. Net use was lowest among school-aged children and young adults, especially among young males, and highest in children under 5, pregnant women, in older adults and in households that received indoor residual spraying (IRS). This study revealed that LLIN mass-distribution campaigns alone are not sufficient to achieve the high level of net protection needed during elimination programs and that reviewing the LLIN allocation scheme, top-up distributions and/or community engagement campaigns is needed, also to reduce inequalities in populations' access to LLINs.
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Affiliation(s)
- Lucia Fernández Montoya
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
- ISGlobal, Barcelona, Spain
| | - Celso Alafo
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
| | | | - Mara Máquina
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
| | - Arlindo Malheia
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
| | - Ana Paula Abílio
- Instituto Nacional da Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Dulcisaria Marrenjo
- Programa Nacional de Controlo da Malária, Ministério da Saúde, Maputo, Mozambique
| | - Nelson Cuamba
- Programa Nacional de Controlo da Malária, Ministério da Saúde, Maputo, Mozambique
- PMI VectorLink Project, Abt Associates Inc., Maputo, Mozambique
| | - Beatriz Galatas
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
- ISGlobal, Barcelona, Spain
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
- Instituto Nacional da Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
| | - Krijn P Paaijmans
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
- ISGlobal, Barcelona, Spain
- Center for Evolution and Medicine, School of Life Sciences, Arizona State University, Tempe, AZ, United States of America
- The Biodesign Center for Immunotherapy, Vaccines and Virotherapy, Arizona State University, Tempe, AZ, United States of America
- Simon A. Levin Mathematical, Computational and Modeling Sciences Center, Arizona State University, Tempe, AZ, United States of America
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Bamou R, Tchuinkam T, Kopya E, Awono-Ambene P, Njiokou F, Mwangangi J, Antonio-Nkondjio C. Knowledge, attitudes, and practices regarding malaria control among communities living in the south Cameroon forest region. IJID REGIONS 2022; 5:169-176. [PMID: 36467507 PMCID: PMC9713328 DOI: 10.1016/j.ijregi.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study assessed knowledge, attitudes, and practices (KAP) regarding malaria among communities living in the equatorial forest region of south Cameroon. METHODS The study was conducted in Olama and Nyabessan. Interviews were undertaken using a semi-structured questionnaire for data collection on KAP, while malaria rapid diagnostic testing, using SD BIOLINE kits, was employed for malaria parasite detection. RESULTS In total, 186 heads of households (HoH), comprising 105 (56.45%) males and 81 (43.45%) females, were interviewed. The majority of HoH demonstrated good knowledge of malaria (86.56%; n = 161) and control measures, with a high proportion of long-lasting insecticidal net (LLIN) ownership (96.8%; n = 180). More than two-thirds (81.1%; n = 151) of households owned at least one LLIN for two people. The majority of HoH (85.40%) declared visiting hospitals or clinics in cases of suspected malaria. Malaria parasite prevalence was high in the two study sites (63.9% in Nyabessan and 48.65% in Olama), and varied according to age, house type, and sleeping time. CONCLUSION The study indicated that despite good knowledge of malaria, high possession and utilization of control measures by population, transmission of malaria still persist in the area. The study stress the need for implementing additional control measures to improve the fight against malaria in the area.
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Key Words
- Cameroon
- HoH, head of household
- IRS, indoor residual spraying
- KAP
- KAP, knowledge, attitude, and practice
- LLIN, long-lasting insecticidal net
- MoH, Ministry of Health. PBO, piperonyl butoxide
- NMCP, National Malaria Control Program
- WHO, World Health Organization
- forested area
- mRDT, malaria rapid diagnostic test
- malaria determinants
- malaria prevalence
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Affiliation(s)
- Roland Bamou
- Vector Borne Diseases Laboratory of the Applied Biology and Ecology Research Unit (VBID-URBEA), Department of Animal Biology, Faculty of Science of the University of Dschang
- Organisation de Coordination pour la Lutte Contre les Endémies en Afrique Centrale (OCEAC), Yaounde, Cameroon
| | - Timoléon Tchuinkam
- Vector Borne Diseases Laboratory of the Applied Biology and Ecology Research Unit (VBID-URBEA), Department of Animal Biology, Faculty of Science of the University of Dschang
| | - Edmond Kopya
- Organisation de Coordination pour la Lutte Contre les Endémies en Afrique Centrale (OCEAC), Yaounde, Cameroon
- Laboratory of Parasitology and Ecology, Faculty of Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Parfait Awono-Ambene
- Organisation de Coordination pour la Lutte Contre les Endémies en Afrique Centrale (OCEAC), Yaounde, Cameroon
| | - Flobert Njiokou
- Laboratory of Parasitology and Ecology, Faculty of Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Joseph Mwangangi
- Center for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Centre for Vector Disease Control, Kenya Medical Research Institute (KEMRI), Kwale, Kenya
| | - Christophe Antonio-Nkondjio
- Organisation de Coordination pour la Lutte Contre les Endémies en Afrique Centrale (OCEAC), Yaounde, Cameroon
- Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Van Bortel W, Mariën J, Jacobs BKM, Sinzinkayo D, Sinarinzi P, Lampaert E, D’hondt R, Mafuko JM, De Weggheleire A, Vogt F, Alexander N, Wint W, Maes P, Vanlerberghe V, Leclair C. Long-lasting insecticidal nets provide protection against malaria for only a single year in Burundi, an African highland setting with marked malaria seasonality. BMJ Glob Health 2022; 7:bmjgh-2022-009674. [PMID: 36455989 PMCID: PMC9772646 DOI: 10.1136/bmjgh-2022-009674] [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: 05/20/2022] [Accepted: 10/08/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Long-lasting insecticidal nets (LLINs) are one of the key interventions in the global fight against malaria. Since 2014, mass distribution campaigns of LLINs aim for universal access by all citizens of Burundi. In this context, we assess the impact of LLINs mass distribution campaigns on malaria incidence, focusing on the endemic highland health districts. We also explored the possible correlation between observed trends in malaria incidence with any variations in climate conditions. METHODS Malaria cases for 2011-2019 were obtained from the National Health Information System. We developed a generalised additive model based on a time series of routinely collected data with malaria incidence as the response variable and timing of LLIN distribution as an explanatory variable to investigate the duration and magnitude of the LLIN effect on malaria incidence. We added a seasonal and continuous-time component as further explanatory variables, and health district as a random effect to account for random natural variation in malaria cases between districts. RESULTS Malaria transmission in Burundian highlands was clearly seasonal and increased non-linearly over the study period. Further, a fast and steep decline of malaria incidence was noted during the first year after mass LLIN distribution (p<0.0001). In years 2 and 3 after distribution, malaria cases started to rise again to levels higher than before the control intervention. CONCLUSION This study highlights that LLINs did reduce the incidence in the first year after a mass distribution campaign, but in the context of Burundi, LLINs lost their impact after only 1 year.
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Affiliation(s)
- Wim Van Bortel
- Outbreak Research Team, Institute of Tropical Medicine, Antwerpen, Belgium,Unit Entomology, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Joachim Mariën
- Outbreak Research Team, Institute of Tropical Medicine, Antwerpen, Belgium,Evolutionary Ecology Group, University of Antwerp, Antwerpen, Belgium
| | - Bart K M Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Denis Sinzinkayo
- National Malaria Control Programme, Bujumbura, Burundi,Doctoral School, University of Burundi, Bujumbura, Burundi
| | | | - Emmanuel Lampaert
- Department of Operations – Central African Regional Support Team, Médecins Sans Frontières, Kinshasa, Congo (the Democratic Republic of the)
| | - Rob D’hondt
- Medical Department, Environmental Health Unit, Médecins Sans Frontières, Brussels, Belgium
| | - Jean-Marie Mafuko
- Department of Operations, Médecins Sans Frontières, Bujumbura, Burundi
| | - Anja De Weggheleire
- Outbreak Research Team, Institute of Tropical Medicine, Antwerpen, Belgium,Unit of Mycobacterial Diseases and Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Florian Vogt
- Outbreak Research Team, Institute of Tropical Medicine, Antwerpen, Belgium,The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia,National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Neil Alexander
- Environmental Research Group Oxford Ltd, c/o Department of Biology, University of Oxford, Oxford, UK
| | - William Wint
- Environmental Research Group Oxford Ltd, c/o Department of Biology, University of Oxford, Oxford, UK
| | - Peter Maes
- Chief of WASH (Water, Sanitation and Hygiene), UNICEF, Kinshasa, Congo (the Democratic Republic of the)
| | - Veerle Vanlerberghe
- Tropical Infectious Diseases Group, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Corey Leclair
- Medical Department, Environmental Health Unit, Médecins Sans Frontières, Brussels, Belgium
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11
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Koenker H, Worges M, Kamala B, Gitanya P, Chacky F, Lazaro S, Mwalimu CD, Aaron S, Mwingizi D, Dadi D, Selby A, Serbantez N, Msangi L, Loll D, Yukich J. Annual distributions of insecticide-treated nets to schoolchildren and other key populations to maintain higher ITN access than with mass campaigns: a modelling study for mainland Tanzania. Malar J 2022; 21:246. [PMID: 36028866 PMCID: PMC9417077 DOI: 10.1186/s12936-022-04272-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/16/2022] [Indexed: 11/12/2022] Open
Abstract
Background Since 2013, the National Malaria Control Programme in mainland Tanzania has deployed annual distributions of insecticide-treated nets (ITNs) through primary schools to maintain ITN access and use. This School Net Programme (SNP) is slated to be used throughout mainland Tanzania by 2023. This modelling study projects ITN access under different ITN distribution strategies and quantification approaches. Methods A stock and flow model with a Tanzania-specific ITN decay rate was used to calculate annual net crops for four different ITN distribution strategies, varying quantification approaches within each strategy. Annual nets-per-capita (NPC) was derived from net crop and a standardized population projection. Nonparametric conditional quartile functions for the proportion of the population with access to an ITN (ITN access) as a function of NPC were used to predict ITN access and its variability. The number of ITNs required under the varying quantification approaches for the period 2022–2030 was calculated. Results Annual SNP quantified using a “population times 15%” approach maintained ITN access between 80 and 90%, when combined with reproductive and child health (RCH) ITN distribution, requiring 133.2 million ITNs. The same strategy quantified with “population times 22%” maintained ITN access at or above 90%, requiring 175.5 million ITNs. Under 5-year mass campaigns with RCH distribution for pregnant women and infants, ITN access reached 90% post-campaign and fell to 27–35% in the 4th year post-campaign, requiring 120.5 million ITNs over 8 years. 3-yearly mass campaigns with RCH reached 100% ITN access post-campaign and fell to 70% in the 3rd year post-campaign, requiring 154.4 million ITNs. Conclusion Given an ITN retention time in Tanzania of 2.15 years, the model predicts that mass campaigns conducted every 3 years in mainland Tanzania will not maintain ITN access at target levels of 80%, even with strong RCH channels. Mainland Tanzania can however expect to maintain ITN access at 80% or above by quantifying SNP using “population × 15%”, in addition to RCH ITN delivery. This strategy requires 14% fewer ITNs than a 3-year campaign strategy while providing more consistent ITN coverage. Meeting the targets of 80% ITN use would require maintaining 90% ITN access, achievable using a “population times 22%” quantification approach for SNP. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04272-w.
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Affiliation(s)
- Hannah Koenker
- USAID Tanzania Vector Control Activity, Tropical Health, Baltimore, MD, USA.
| | - Matt Worges
- USAID Tanzania Vector Control Activity, Tropical Health, New Orleans, LA, USA
| | - Benjamin Kamala
- USAID Tanzania Vector Control Activity, Johns Hopkins University School of Public Health Center for Communication Programmes, Dar es Salaam, Tanzania
| | - Peter Gitanya
- National Malaria Control Programme, Ministry of Health, Dodoma, Tanzania
| | - Frank Chacky
- National Malaria Control Programme, Ministry of Health, Dodoma, Tanzania
| | - Samwel Lazaro
- National Malaria Control Programme, Ministry of Health, Dodoma, Tanzania
| | | | - Sijenunu Aaron
- National Malaria Control Programme, Ministry of Health, Dodoma, Tanzania
| | - Deodatus Mwingizi
- USAID Tanzania Vector Control Activity, Johns Hopkins University School of Public Health Center for Communication Programmes, Dar es Salaam, Tanzania
| | - David Dadi
- USAID Tanzania Vector Control Activity, Johns Hopkins University School of Public Health Center for Communication Programmes, Dar es Salaam, Tanzania
| | - Ato Selby
- USAID Tanzania Vector Control Activity, Johns Hopkins University School of Public Health Center for Communication Programmes, Dar es Salaam, Tanzania
| | | | - Lulu Msangi
- US President's Malaria Initiative, Dar es Salaam, Tanzania
| | - Dana Loll
- USAID Tanzania Vector Control Activity, Johns Hopkins University School of Public Health Center for Communication Programs, Baltimore, MD, USA
| | - Joshua Yukich
- USAID Tanzania Vector Control Activity, Tropical Health, New Orleans, LA, USA
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12
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Inferring the epidemiological benefit of indoor vector control interventions against malaria from mosquito data. Nat Commun 2022; 13:3862. [PMID: 35790746 PMCID: PMC9256631 DOI: 10.1038/s41467-022-30700-1] [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: 03/03/2022] [Accepted: 05/11/2022] [Indexed: 12/03/2022] Open
Abstract
The cause of malaria transmission has been known for over a century but it is still unclear whether entomological measures are sufficiently reliable to inform policy decisions in human health. Decision-making on the effectiveness of new insecticide-treated nets (ITNs) and the indoor residual spraying of insecticide (IRS) have been based on epidemiological data, typically collected in cluster-randomised control trials. The number of these trials that can be conducted is limited. Here we use a systematic review to highlight that efficacy estimates of the same intervention may vary substantially between trials. Analyses indicate that mosquito data collected in experimental hut trials can be used to parameterize mechanistic models for Plasmodium falciparum malaria and reliably predict the epidemiological efficacy of quick-acting, neuro-acting ITNs and IRS. Results suggest that for certain types of ITNs and IRS using this framework instead of clinical endpoints could support policy and expedite the widespread use of novel technologies. Estimating the effectiveness of malaria vector control interventions has typically relied on resource-intensive cluster randomised trials. Here, the authors estimate changes in malaria prevalence using entomological data from experimental hut trials, which may provide an alternative route to approval of interventions in some situations.
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13
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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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Moukénet A, Richardson S, Moundiné K, Laoukolé J, Ngarasta N, Seck I. Knowledge and practices surrounding malaria and LLIN use among Arab, Dazagada and Fulani pastoral nomads in Chad. PLoS One 2022; 17:e0266900. [PMID: 35421160 PMCID: PMC9009653 DOI: 10.1371/journal.pone.0266900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background Chadian pastoral nomads are highly exposed to malaria due to their lifestyle and their mobility between various endemic areas. To inform strategies to reduce nomads’ risk of malaria and associated morbidity and mortality, it is important to understand the factors associated to their knowledge of malaria transmission and prevention practices. Methods A cross–sectional study among Arab, Dazagada and Fulani pastoral nomadic groups was conducted in February and October 2021. A validated structured electronic questionnaire was administered to assess knowledge of malaria. Attitudes and malaria prevention practices were assessed on the basis of perception of the causes of malaria and the use of a long-lasting insecticide-treated net (LLIN) the day before the survey. Data were analyzed using Chi—square tests and multivariate logistic regression with covariates adjustment. Results A total of 278 nomads aged 20 to 65 years were included in the study. Overall, 90.7% of participants surveyed had a good knowledge of malaria. Fulani respondents were more likely to have a good knowledge of malaria than Arab respondents (Adjusted Odd ratio (AOR): 5.00, 95% CI: 1.04–24.03) and households possessing a LLIN were more likely to have a good knowledge of malaria (AOR: 9.66, 95% CI: 1.24–75.36). Most nomad households surveyed reported sleeping under a mosquito net the night before the survey (87.1%) while 98.9% owned a LLIN. Daza respondents (AOR: 0.23, 95% CI: 0.09–0.56) were less likely to use LLINs than Arab respondents. The middle (AOR: 2.78, 95% CI: 1.17–6.62) and wealthier households (AOR: 6.68, 95% CI: 3.19–14.01) were more likely to use LLINs. Knowledge of malaria was associated with the use of LLIN (AOR: 12.77, 95% CI: 1.58–102.99). Conclusion There remains a need to improve nomads’ understanding of Plasmodium falciparum-carrying mosquitoes as the vector for malaria transmission and the quality of information provided. Knowledge of malaria and its prevention strategies in nomadic setting lead to the use of LLINs. Further reductions in malaria morbidity can be achieved by improving nomads’ access to LLINs. This study can inform on the design policies to improve nomadic communities’ knowledge of malaria prevention and promoting LLIN use as requested by the national policy against malaria.
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Affiliation(s)
- Azoukalné Moukénet
- Cheikh Anta Diop University, Dakar, Senegal
- University of Ndjamena, Ndjamena, Chad
- * E-mail:
| | - Sol Richardson
- Malaria Consortium, London, United Kingdom
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kebféné Moundiné
- StraDEC Training, Research & Innovation Department, Ndjamena, Chad
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15
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Afai G, Rossetto EV, Baltazar CS, Candrinho B, Saifodine A, Zulliger R. Factors associated with knowledge about malaria prevention among women of reproductive age, Tete Province, Mozambique, 2019–2020. Malar J 2022; 21:76. [PMID: 35248078 PMCID: PMC8897948 DOI: 10.1186/s12936-022-04090-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Mozambique is a malaria endemic country with an estimated prevalence of malaria in children 6–59 months old that is twice as high in rural areas (46.0%) as in urban areas (18.0%). However, only 46.0% of women aged 15–49 years had complete knowledge about malaria in 2018. This study aimed to identify the factors associated with malaria knowledge among women of reproductive age in a high malaria burden district. Methods Data from a cross-sectional study, using a population-based malaria research study in Mágoe District, 2019, were analysed. This analysis included women aged 15–49 years. A multivariate logistic regression model was developed to determine factors associated with complete knowledge of malaria that calculated adjusted odds ratio (aOR) and 95% confidence interval (CI) at a p < 0.05 significance level. Complete malaria knowledge was defined as when a woman correctly identified: fever as a malaria symptom, mosquito bites as the means of malaria transmission, mosquito nets as a tool for malaria prevention, malaria as curable, and were able to name an anti-malarial. Results A total of 1899 women were included in this analysis. There was complete malaria knowledge among 49% of the respondents. Seventy one percent mentioned fever as one of malaria symptoms, 92% mentioned mosquito bite as the cause of malaria infection, 94% identified that mosquito nets prevent malaria, 92% agreed that malaria has cure, and 76% were able to name at least one anti-malarial medicine. In the multivariate analysis, the following characteristics were associated with significantly higher odds of having complete malaria knowledge: having a secondary school or above education level (adjusted Odds Ratio, aOR = 2.5 CI [1.3–4.6] p = 0.005), being from the middle socioeconomic status group (aOR = 1.5 CI [1.1–2.1] p = 0.005), being from older age group of 35–39 (aOR = 1.9; CI [1.1–3.1] p < 0.001), having 1–2 children (aOR = 1.8; CI [1.2–2.6] p = 0.003), and having interviews completed in Portuguese or Cinyungwe (aOR = 2.3; CI [1.3–4.1] p = 0.004 and aOR = 2.1; CI [1.5–2.8] p < 0.001, respectively). Conclusion Most women in this study had some malaria knowledge, but gaps in complete knowledge remained. In order to broaden knowledge, educational messages about malaria prevention should be more effectively targeted to reach younger, less-educated women and in non-dominant languages.
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Okoh OM, Olapeju B, Oyedokun-Adebagbo F, Inyang U, McCartney-Melstad A, Tweedie I, Babalola S, Storey D. The role of ideation on the effect of an SBC intervention on consistent bed net use among caregivers of children under 5 years in Nigeria: a multilevel mediation analysis. BMC Public Health 2021; 21:1660. [PMID: 34517875 PMCID: PMC8436470 DOI: 10.1186/s12889-021-11709-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background Malaria remains a significant public health challenge in Nigeria. Consistent bed net use (sleeping under a treated net every night) has been identified as a key malaria prevention behavior. This paper explores the relationship between mass media social and behavior change interventions, psychosocial factors, and consistent bed net use. Methods Data is from the endline survey of a USAID-funded social and behavior change communication campaign conducted from 2012 to 2017 across five states in Nigeria. The outcome measure was consistent bed net use, and the mediator variable was a composite measure called ideation from a set of psychosocial factors believed to influence bed net use. The independent variable was recall of malaria specific media messages. Multilevel mediation analysis explored if recall of malaria specific media messages had any effect on bed net related ideation and if this ideation had any effect on consistent net use. Results Respondents included in this study were on average aged 31 years, mostly married or cohabiting (97.5%) and female 75%. Four in 10 (39.7%) respondents were able to recall malaria specific messages. Respondents with low, moderate and high recall were 23, 32 and 80% more likely to have a higher ideational score in the emotional domain compared to those not able to recall. Respondents were more likely to have higher ideational scores in the cognitive domain if they had low (AOR = 1.26, 95% CI 1.15–1.38), moderate (AOR = 1.16, 95% CI 1.00–1.34) or high recall (AOR = 1.55, 95% CI 1.16–2.06), respectively compared to those with no recall. Similarly, respondents with low (AOR = 1.03, 95% CI .99–1.08), moderate (AOR = 1.15, 95% CI 1.08–1.23) and high (AOR = 1.15, 95% CI 1.01–1.30) recall were more likely to have a higher ideational score in the social domain compared to those with no recall. After adjusting for recall of media messages and other potential covariates, all three ideational domains also had a significant positive effect on consistent bed net use. For every unit increase in ideational score, the likelihood of reporting consistent bed net use increased by 5 to 10%. There was a significant indirect effect of recalling malaria specific messages on consistent bed net use through each of the ideational domains. Conclusion Access to a bed net is a critical first step in the process of bed net utilization. However, psychosocial factors e.g., emotional, cognitive, and social domains of ideation also play a major role in bed net use. Mass media SBC interventions could potentially influence bed net related ideation and consequently improve net use behavior. Future Social and behavior change interventions should employ approaches that improve these domains of ideation within their audiences in order to increase bed net utilization. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11709-5.
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Affiliation(s)
- Osabohien Mathew Okoh
- Johns Hopkins University Center for Communication programs (JHUCCP), Baltimore, USA.
| | - Bolanle Olapeju
- Johns Hopkins University Center for Communication programs (JHUCCP), Baltimore, USA
| | - Foyeke Oyedokun-Adebagbo
- United States President's Malaria Initiative/United States Agency for International Development (PMI/USAID), Washington, D.C., USA
| | - Uwem Inyang
- United States President's Malaria Initiative/United States Agency for International Development (PMI/USAID), Washington, D.C., USA
| | | | - Ian Tweedie
- Johns Hopkins University Center for Communication programs (JHUCCP), Baltimore, USA
| | - Stella Babalola
- Johns Hopkins University Center for Communication programs (JHUCCP), Baltimore, USA
| | - Douglas Storey
- Johns Hopkins University Center for Communication programs (JHUCCP), Baltimore, USA
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Tungu PK, Sudi W, Kisinza W, Rowland M. Effectiveness of a long-lasting insecticide treatment kit (ICON® Maxx) for polyester nets over three years of household use: a WHO phase III trial in Tanzania. Malar J 2021; 20:345. [PMID: 34412651 PMCID: PMC8375204 DOI: 10.1186/s12936-021-03871-3] [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: 05/27/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background ICON® Maxx (Syngenta) is an insecticide treatment kit of pyrethroid and binding agent for long-lasting treatment of mosquito nets. Interim recommendation for use on nets was granted by the World Health Organization (WHO) after successful evaluation in experimental huts following multiple washes. A full WHO recommendation is contingent upon demonstration of continued bio-efficacy after 3 years of use. Methods A household-randomized prospective study design was used to assess ICON Maxx-treated nets over 3 years in north-eastern Tanzania. Conventional treated nets (with lambda-cyhalothrin, but without binder) served as a positive control. At 6-monthly intervals, cross-sectional household surveys monitored net use and physical integrity, while cone and tunnel tests assessed insecticidal efficacy. Pyrethroid content was determined after 12 and 36 months. A parallel cohort of nets was monitored annually for evidence of net deterioration and attrition. Results After 12 months’ use, 97% of ICON Maxx-treated nets but only 67% of CTN passed the WHO efficacy threshold for insecticidal durability (> 80% mortality in cone or tunnel or 90% feeding inhibition in tunnel). After 24- and 36-months use, 67% and 26% of ICON Maxx treated nets met the cone criteria, respectively, and over 90% met the combined cone and tunnel criteria. Lambda-cyhalothrin content after 36 months was 17% (15.8 ± 4.3 mg/m2) of initial content. ICON Maxx nets were used year-round and washed approximately 4 times per year. In cross-sectional survey after 36 months the average number of holes was 20 and hole index was 740 cm2 per net. Cohort nets had fewer holes and smaller hole index than cross-sectional nets. However, only 15% (40/264) of cohort nets were not lost to follow-up or not worn out after 36 months. Conclusions Because more than 80% of nets met the WHO efficacy criteria after 36 months use, ICON Maxx was granted WHO full recommendation. Cross-sectional and cohort surveys were complementary and gave a fuller understanding of net durability. To improve net usage and retention, stronger incentives and health messaging should be introduced in WHO LLIN longitudinal trials. Untreated polyester nets may be made long-lastingly insecticidal in Africa through simple household treatment using ICON Maxx pyrethroid-binder kits.
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Affiliation(s)
- Patrick K Tungu
- Amani Medical Research Centre, National Institute for Medical Research, Muheza, Tanzania. .,Pan-African Malaria Vector Research Consortium (PAMVERC), PO Box 81, Muheza, Tanga, Tanzania.
| | - Wema Sudi
- Amani Medical Research Centre, National Institute for Medical Research, Muheza, Tanzania.,Pan-African Malaria Vector Research Consortium (PAMVERC), PO Box 81, Muheza, Tanga, Tanzania
| | - William Kisinza
- Amani Medical Research Centre, National Institute for Medical Research, Muheza, Tanzania.,Pan-African Malaria Vector Research Consortium (PAMVERC), PO Box 81, Muheza, Tanga, Tanzania
| | - Mark Rowland
- Pan-African Malaria Vector Research Consortium (PAMVERC), PO Box 81, Muheza, Tanga, Tanzania.,London School of Hygiene and Tropical Medicine, London, UK
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18
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Pooseesod K, Parker DM, Meemon N, Lawpoolsri S, Singhasivanon P, Sattabongkot J, Cui L, Phuanukoonnon S. Ownership and utilization of bed nets and reasons for use or non-use of bed nets among community members at risk of malaria along the Thai-Myanmar border. Malar J 2021; 20:305. [PMID: 34229653 PMCID: PMC8259116 DOI: 10.1186/s12936-021-03837-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background With the goal for malaria elimination in Thailand set for 2024, increased coverage and utilization of bed net, especially insecticide-treated net (ITN) or long-lasting insecticidal net (LLIN) is a key strategy. This study aims to provide the necessary information about bed net ownership and utilization among the population at risk of malaria living along the Thai-Myanmar border in Tak province. Methods A cross-sectional study was conducted using a mixed-method approach in 331 households from 5 hamlets in the villages of the Thai-Myanmar border. The research tools included a questionnaire, bed net inspection, and semi-structured interviews. Logistic regression was used to explore the sociodemographic factors associated with bed net utilization. The qualitative analysis employed a thematic analysis approach. Results This survey found that 98.5% of households had at least one bed net per household, and 74.3% had at least one ITN/LLIN. However, only 30.8% of households reached the standard policy set by the Minister of Public Health of one ITN/LLINs per two persons. Most residents used bed net (92.1% used in the previous night and 80.9% used every day). For those using bed nets, however, 61.9% used ITNs or LLINs the night before and 53.1% used them every day. Nonetheless, the usage rates of bed nets (any type) in the previous night among children and pregnant women were high, reaching 95.3% and 90.0%, respectively. Seven explanatory variables showed statistically significant associations with bed net use every day, including: “not staying overnight in the forest or the field”, “sleeping pattern based on gender”, “sufficient numbers of bed nets to cover all sleeping spaces”, “preference for free bed nets”, “age”, “gender”, and “SES score” showed statistically significant association with bed net use every day. The major reasons for the regular use of bed nets in both household and the forest were to prevent mosquito biting. The reasons for not using bednets in the household were discomfort feelings from heat, perception of unnecessity due to low mosquito density, whereas the reason for not using bed nets in the forest was inconvenience. Conclusion Despite that overall coverage and usage of bed nets was high, only one third reached the standard level specified by the policy. Overnight in the forest, the dissatisfaction with the quality of free bed nets, insufficient number of bed nets, sleeping alone, male gender, age more than 10 years, low socioeconomic status, discomfort from heat, perception of no benefits of bed nets due to low mosquito density, and inconvenience were factors influencing bed net use. Maintaining high coverage and utility rate of bed nets should be a priority for the malaria high-risk population. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03837-5.
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Affiliation(s)
- Kasama Pooseesod
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand.,Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Daniel M Parker
- Department of Population Health & Disease Prevention, Program in Public Health Susan and Henry Samueli College of Health Sciences, University of California, Irvine, USA
| | - Natthani Meemon
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
| | - Pratap Singhasivanon
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand.,Faculty of Tropical Medicine, SEAMEO TROPMED Regional Centre for Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Suparat Phuanukoonnon
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand. .,Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand.
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19
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Maps and metrics of insecticide-treated net access, use, and nets-per-capita in Africa from 2000-2020. Nat Commun 2021; 12:3589. [PMID: 34117240 PMCID: PMC8196080 DOI: 10.1038/s41467-021-23707-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/12/2021] [Indexed: 02/05/2023] Open
Abstract
Insecticide-treated nets (ITNs) are one of the most widespread and impactful malaria interventions in Africa, yet a spatially-resolved time series of ITN coverage has never been published. Using data from multiple sources, we generate high-resolution maps of ITN access, use, and nets-per-capita annually from 2000 to 2020 across the 40 highest-burden African countries. Our findings support several existing hypotheses: that use is high among those with access, that nets are discarded more quickly than official policy presumes, and that effectively distributing nets grows more difficult as coverage increases. The primary driving factors behind these findings are most likely strong cultural and social messaging around the importance of net use, low physical net durability, and a mixture of inherent commodity distribution challenges and less-than-optimal net allocation policies, respectively. These results can inform both policy decisions and downstream malaria analyses.
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20
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Ng'ang'a PN, Aduogo P, Mutero CM. Long lasting insecticidal mosquito nets (LLINs) ownership, use and coverage following mass distribution campaign in Lake Victoria basin, Western Kenya. BMC Public Health 2021; 21:1046. [PMID: 34078333 PMCID: PMC8173981 DOI: 10.1186/s12889-021-11062-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 05/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background Long-lasting insecticidal nets (LLINs) are the most widely used malaria prevention and control intervention in Africa. However, their effectiveness may vary depending on their local geographic coverage, ownership and use at household level. This study aimed at assessing LLINs ownership and use following mass distribution campaign in western Kenya. Methods A cross-sectional study was conducted in November 2017. A total of 160 households were randomly selected from 16 villages. Structured questionnaires were used to collect data on households’ knowledge on malaria, LLINs ownership, utilization and their perceived benefits. Data was analyzed using IBM Statistical Package for Social Sciences (SPSS) version 21 for windows. Variables were presented as proportions and associations between variables tested using Pearson’s chi-square test. Results Malaria was reported to be the most frequently occurring disease (87.5%) in the area. Children under 5 years of age were reported to be at higher risks of malaria infection (28.6%). Around 31% of the respondents reported to have at least one member of the household sick with malaria a week before the interview. Commonly cited signs and symptoms of malaria were; fever (24.1%), headache (17.7%), vomiting (14.5%) feeling cold (12.6%) and loss of appetite (10%). There were 382 reported LLINs among 753 occupants in the 160 households surveyed. The average LLIN ownership was 2.4 nets per household and 1.97 persons per LLIN. Among the surveyed households, 96.9% owned at least one LLIN and 64.1% owned at least one LLIN for every two people. Among those who owned LLINs, 98.1% reported using them the previous night. Ownership per household ranged from 0 to 6 with a mean of 2.39. More than three quarter of the nets were acquired through free mass distribution campaigns and 80% were acquired less than 6 months prior to the survey. Conclusion Despite high net coverage and use, a number of households experienced malaria episodes in the study area. There is need to investigate the likelihood of outdoor malaria transmission and assess the physical integrity of the existing LLINs and their insecticidal effectiveness in protecting household members against malaria. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11062-7.
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Affiliation(s)
- Peter N Ng'ang'a
- International Centre of Insect Physiology and Ecology (ICIPE), PO Box 30772, Nairobi, Kenya. .,School of Public Health, Jomo Kenyatta University of Agriculture and Technology, PO Box 62000, Nairobi, Kenya.
| | - Polycarp Aduogo
- International Centre of Insect Physiology and Ecology (ICIPE), PO Box 30772, Nairobi, Kenya
| | - Clifford M Mutero
- International Centre of Insect Physiology and Ecology (ICIPE), PO Box 30772, Nairobi, Kenya.,School of Health Systems and Public Health, University of Pretoria, University of Pretoria Institute for Sustainable Malaria Control (UP ISMC),, Private Bag X363, Pretoria, 0001, South Africa
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21
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Tassembedo M, Coulibaly S, Ouedraogo B. Factors associated with the use of insecticide-treated nets: analysis of the 2018 Burkina Faso Malaria Indicator Survey. Malar J 2021; 20:220. [PMID: 34001104 PMCID: PMC8130301 DOI: 10.1186/s12936-021-03756-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 05/08/2021] [Indexed: 11/12/2022] Open
Abstract
Background Sleeping under an ITN reduces contact with mosquitoes through the combination of a physical barrier and an insecticidal effect, which reduces the incidence of malaria. The 2016–2020 Burkina Faso National Malaria Strategic Plan aims to have at least 90% of the population, 100% of children under age 5, and 100% of pregnant women sleep under an ITN. Methods The analysis examines individual, household, and community-level factors associated with ITN usage. According to the 2017–18 Burkina Faso MIS, 58% of individuals in households that own at least one ITN reported that they slept under an ITN on the night before the survey. Results The use of ITNs was significantly associated with individual, household, and community-level variables that included age, gender, age of household head, number of sleeping rooms, wealth, malaria prevalence, residence, and region. Conclusions The results highlight areas of intervention at the individual, household, and community levels that can increase ITN use.
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Affiliation(s)
- Mahamadi Tassembedo
- Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de l'Education (IFRISSE), Ouagadougou, Burkina Faso. .,Direction du Suivi, de l'évaluation et de la Capitalisation, Ministère de la santé, Ouagadougou, Burkina Faso.
| | - Soumaila Coulibaly
- Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de l'Education (IFRISSE), Ouagadougou, Burkina Faso.,Centre National de Recherche et de Formation sur le Paludisme (CNRFP)/Institut National de Santé Publique (INSP), Ministère de la santé, Ouagadougou, Burkina Faso
| | - Boukary Ouedraogo
- Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de l'Education (IFRISSE), Ouagadougou, Burkina Faso.,Direction des systèmes d'information en santé, Ministère de la santé, Ouagadougou, Burkina Faso
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22
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Hii J, Hustedt J, Bangs MJ. Residual Malaria Transmission in Select Countries of Asia-Pacific Region: Old Wine in a New Barrel. J Infect Dis 2021; 223:S111-S142. [PMID: 33906222 PMCID: PMC8079134 DOI: 10.1093/infdis/jiab004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Despite substantial reductions in malaria burden and improvement in case management, malaria remains a major public health challenge in the Asia-Pacific region. Residual malaria transmission (RMT) is the fraction of total transmission that persists after achievement of full operational coverage with effective insecticide-treated bed nets (ITNs)/long-lasting insecticidal nets (LLINs) and/or indoor residual spray interventions. There is a critical need to standardize and share best practices for entomological, anthropological, and product development investigative protocols to meet the challenges of RMT and elimination goals. Methods A systematic review was conducted to describe when and where RMT is occurring, while specifically targeting ownership and usage of ITN/LLINs, indoor residual spray application, insecticide susceptibility of vectors, and human and vector biting behavior, with a focus on nighttime activities. Results Sixty-six publications from 1995 to present met the inclusion criteria for closer review. Associations between local vector control coverage and use with behaviors of human and mosquito vectors varied by locality and circumstance. Consequently, the magnitude of RMT is insufficiently studied and analyzed with sparse estimates of individual exposure in communities, insufficient or incomplete observations of ITN/LLIN use, and the local human population movement into and from high-risk areas. Conclusions This review identified significant gaps or deficiencies that require urgent attention, namely, developing standardized procedures and methods to estimate risk exposure beyond the peridomestic setting, analytical approaches to measure key human-vector interactions, and seasonal location-specific agricultural or forest use calendars, and establishing the collection of longitudinal human and vector data close in time and location.
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Affiliation(s)
- Jeffrey Hii
- Malaria Consortium Asia, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | | | - Michael J Bangs
- Public Health and Malaria Control Department, PT Freeport Indonesia, International SOS, Jl. Kertajasa, Kuala Kencana, Papua, Indonesia.,Department of Entomology, Faculty of Agriculture, Kasertart University, Bangkok, Thailand
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23
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Scott J, Kanyangarara M, Nhama A, Macete E, Moss WJ, Saute F. Factors associated with use of insecticide-treated net for malaria prevention in Manica District, Mozambique: a community-based cross-sectional survey. Malar J 2021; 20:200. [PMID: 33906642 PMCID: PMC8077836 DOI: 10.1186/s12936-021-03738-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insecticide-treated net (ITN) use is crucial for preventing malaria infection. Despite significant improvements in ITN access and use over the past two decades, many malaria-endemic countries in sub-Saharan Africa have not yet reached global targets for universal coverage of ITNs. To reduce the gaps in ITN use, it is important to understand the factors associated with ITN use. The goal of this analysis was to determine the factors associated with ITN use in Manica District, Mozambique. METHODS A cross-sectional community-based survey was conducted from October to November 2019. Households were randomly selected, and all members of selected households were eligible to participate. Data on socio-demographic characteristics, housing construction and the ownership, use and characteristics of ITNs were collected using structured questionnaires. Factors independently associated with ITN use were identified using generalized estimating equations multivariate logistic regression. RESULTS Of the 302 households surveyed, 209 (69.2%) owned at least one ITN and 176 (58.3%) had one ITN for every two household members. The multivariate analysis indicated that the odds of ITN use was significantly lower among individuals in households with 3 or more members. However, the odds of ITN use was significantly higher among older age groups, poorer households, and as the number of ITNs in a household increased. CONCLUSIONS The findings of this analysis highlight the need for behaviour change communication strategies targeting young people and ITN distribution campaigns targeting larger households to increase ITN ownership, thereby improving ITN use in Manica District.
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Affiliation(s)
- Julia Scott
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29201, USA
| | - Mufaro Kanyangarara
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29201, USA.
| | - Abel Nhama
- Centro de Investigação Em Saúde de Manhiça (CISM), Maputo, Mozambique.,Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Eusebio Macete
- Centro de Investigação Em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - William John Moss
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Francisco Saute
- Centro de Investigação Em Saúde de Manhiça (CISM), Maputo, Mozambique
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24
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Mboma ZM, Festo C, Lorenz LM, Massue DJ, Kisinza WN, Bradley J, Moore JD, Mandike R, Akim I, Lines J, Overgaard HJ, Moore SJ. The consequences of declining population access to insecticide-treated nets (ITNs) on net use patterns and physical degradation of nets after 22 months of ownership. Malar J 2021; 20:171. [PMID: 33781261 PMCID: PMC8008556 DOI: 10.1186/s12936-021-03686-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background As insecticide-treated nets (ITNs) wear out and are disposed, some household members are prioritized to use remaining ITNs. This study assessed how nets are allocated within households to individuals of different age categories as ITNs are lost or damaged and as new ITNs are obtained. The study also explored how ITN allocation affects ITN durability. Methods A cross-sectional household survey and ITN durability study was conducted among 2,875 households across Tanzania to determine the proportion of nets that remain protective (serviceable) 22 months after net distribution aiming for universal coverage. Allocation of study nets within houses, and re-allocation of ITNs when new universal replacement campaign (URC) nets arrived in study households in Musoma District, was also assessed. Results Some 57.0% (95% CI 53.9–60.1%) of households had sufficient ITNs for every household member, while 84.4% (95% CI 82.4–86.4%) of the population had access to an ITN within their household (assuming 1 net covers every 2 members). In households with sufficient nets, 77.5% of members slept under ITNs. In households without sufficient nets, pregnant women (54.6%), children < 5 years (45.8%) and adults (42.1%) were prioritized, with fewer school-age children 5–14 years (35.9%), youths 15–24 years (28.1%) and seniors > 65 years (32.6%) sleeping under ITNs. Crowding (\documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ 3 people sleeping under nets) was twice as common among people residing in houses without sufficient nets for all age groups, apart from children < 5. Nets were less likely to be serviceable if: \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ 3 people slept under them (OR 0.50 (95% CI 0.40–0.63)), or if nets were used by school-age children (OR 0.72 (95% CI 0.56–0.93)), or if the net product was Olyset®. One month after the URC, only 23.6% (95% CI 16.7–30.6%) of the population had access to a URC ITN in Musoma district. Householders in Musoma district continued the use of old ITNs even with the arrival of new URC nets. Conclusion Users determined the useful life of ITNs and prioritized pregnant women and children < 5 to serviceable ITNs. When household net access declines, users adjust by crowding under remaining nets, which further reduces ITN lifespan. School-age children that commonly harbour gametocytes that mediate malaria transmission are compelled to sleep under unserviceable nets, crowd under nets or remain uncovered. However, they were accommodated by the arrival of new nets. More frequent ITN delivery through the school net programme in combination with mass distribution campaigns is essential to maximize ITN effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03686-2.
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Affiliation(s)
- Zawadi M Mboma
- Ifakara Health Institute, Dar es Salaam, Tanzania. .,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | | | - Lena M Lorenz
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.,College of Medicine and Veterinary Medicine, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Dennis J Massue
- Vector Control Product Testing Unit, Ifakara Health Institute, Ifakara, Tanzania.,Epidemiology and Public Health Department, Swiss Institute of Tropical and Public Health, Soccinstrase 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland.,University of Dar Es Salaam, Mbeya College of Health and Allied Sciences, Box 608, Mbeya, Tanzania
| | - William N Kisinza
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanga, Tanzania
| | - John Bradley
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Jason D Moore
- Vector Control Product Testing Unit, Ifakara Health Institute, Ifakara, Tanzania.,Epidemiology and Public Health Department, Swiss Institute of Tropical and Public Health, Soccinstrase 57, 4002, Basel, Switzerland
| | - Renata Mandike
- Ministry of Health and Social Welfare, National Malaria Control Programme, Dar-es-Salaam, Tanzania
| | - Ikupa Akim
- Epidemiology and Public Health Department, Swiss Institute of Tropical and Public Health, Soccinstrase 57, 4002, Basel, Switzerland
| | - Jo Lines
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Hans J Overgaard
- Faculty of Science and Technology, Norwegian University of Life Sciences, P.O. Box 5003, 1432, Ås, Norway.,Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sarah J Moore
- Vector Control Product Testing Unit, Ifakara Health Institute, Ifakara, Tanzania.,Epidemiology and Public Health Department, Swiss Institute of Tropical and Public Health, Soccinstrase 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
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Worrall E, Were V, Matope A, Gama E, Olewe J, Mwambi D, Desai M, Kariuki S, Buff AM, Niessen LW. Coverage outcomes (effects), costs, cost-effectiveness, and equity of two combinations of long-lasting insecticidal net (LLIN) distribution channels in Kenya: a two-arm study under operational conditions. BMC Public Health 2020; 20:1870. [PMID: 33287766 PMCID: PMC7720381 DOI: 10.1186/s12889-020-09846-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Malaria-endemic countries distribute long-lasting insecticidal nets (LLINs) through combined channels with ambitious, universal coverage (UC) targets. Kenya has used eight channels with variable results. To inform national decision-makers, this two-arm study compares coverage (effects), costs, cost-effectiveness, and equity of two combinations of LLIN distribution channels in Kenya. METHODS Two combinations of five delivery channels were compared as 'intervention' and 'control' arms. The intervention arm comprised four channels: community health volunteer (CHV), antenatal and child health clinics (ANCC), social marketing (SM) and commercial outlets (CO). The control arm consisted of the intervention arm channels except mass campaign (MC) replaced CHV. Primary analysis used random sample household survey data, service-provider costs, and voucher or LLIN distribution data to compare between-arm effects, costs, cost-effectiveness, and equity. Secondary analyses compared costs and equity by channel. RESULTS The multiple distribution channels used in both arms of the study achieved high LLIN ownership and use. The intervention arm had significantly lower reported LLIN use the night before the survey (84·8% [95% CI 83·0-86·4%] versus 89·2% [95% CI 87·8-90·5%], p < 0·0001), higher unit costs ($10·56 versus $7·17), was less cost-effective ($86·44, 95% range $75·77-$102·77 versus $69·20, 95% range $63·66-$77·23) and more inequitable (Concentration index [C.Ind] = 0·076 [95% CI 0·057 to 0·095 versus C.Ind = 0.049 [95% CI 0·030 to 0·067]) than the control arm. Unit cost per LLIN distributed was lowest for MC ($3·10) followed by CHV ($10·81) with both channels being moderately inequitable in favour of least-poor households. CONCLUSION In line with best practices, the multiple distribution channel model achieved high LLIN ownership and use in this Kenyan study setting. The control-arm combination, which included MC, was the most cost-effective way to increase UC at household level. Mass campaigns, combined with continuous distribution channels, are an effective and cost-effective way to achieve UC in Kenya. The findings are relevant to other countries and donors seeking to optimise LLIN distribution. TRIAL REGISTRATION The assignment of the intervention was not at the discretion of the investigators; therefore, this study did not require registration.
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Affiliation(s)
- Eve Worrall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Vincent Were
- Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, Liverpool, UK
- Kenya Medical Research Institute and Centre for Global Health Research, Kisumu, Kenya
| | - Agnes Matope
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Elvis Gama
- Directorate of Quality Management and Digital Health, Ministry of Health and Population, Lilongwe, Malawi
| | - Joseph Olewe
- Kenya Medical Research Institute and Centre for Global Health Research, Kisumu, Kenya
| | - Dennis Mwambi
- Population Services Kenya (PS Kenya), Nairobi, Kenya
- Population Reference Bureau, Nairobi, Kenya
| | - Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Simon Kariuki
- Kenya Medical Research Institute and Centre for Global Health Research, Kisumu, Kenya
| | - Ann M. Buff
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
- U.S. President’s Malaria Initiative, Nairobi, Kenya
| | - Louis W. Niessen
- Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, Liverpool, UK
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26
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Yaro JB, Ouedraogo A, Ouedraogo ZA, Diarra A, Lankouande M, Agboraw E, Worrall E, Toe KH, Sanou A, Guelbeogo WM, Sagnon N, Ranson H, Tiono AB, Lindsay SW, Wilson AL. A cohort study to identify risk factors for Plasmodium falciparum infection in Burkinabe children: implications for other high burden high impact countries. Malar J 2020; 19:371. [PMID: 33066799 PMCID: PMC7565747 DOI: 10.1186/s12936-020-03443-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Progress in controlling malaria has stalled in recent years. Today the malaria burden is increasingly concentrated in a few countries, including Burkina Faso, where malaria is not declining. A cohort study was conducted to identify risk factors for malaria infection in children in southwest Burkina Faso, an area with high insecticide-treated net (ITN) coverage and insecticide-resistant vectors. METHODS Incidence of Plasmodium falciparum infection was measured in 252 children aged 5 to 15 years, using active and passive detection, during the 2017 transmission season, following clearance of infection. Demographic, socio-economic, environmental, and entomological risk factors, including use of ITNs and insecticide resistance were monitored. RESULTS During the six-month follow-up period, the overall incidence of P. falciparum infection was 2.78 episodes per child (95% CI = 2.66-2.91) by microscopy, and 3.11 (95% CI = 2.95-3.28) by polymerase chain reaction (PCR). The entomological inoculation rate (EIR) was 80.4 infective bites per child over the six-month malaria transmission season. At baseline, 80.6% of children were reported as sleeping under an ITN the previous night, although at the last survey, 23.3% of nets were in poor condition and considered no longer protective. No association was found between the rate of P. falciparum infection and either EIR (incidence rate ratio (IRR): 1.00, 95% CI: 1.00-1.00, p = 0.08) or mortality in WHO tube tests when vectors were exposed to 0.05% deltamethrin (IRR: 1.05, 95% CI: 0.73-1.50, p = 0.79). Travel history (IRR: 1.52, 95% CI: 1.45-1.59, p < 0.001) and higher socio-economic status were associated with an increased risk of P. falciparum infection (IRR: 1.05, 95% CI: 1.00-1.11, p = 0.04). CONCLUSIONS Incidence of P. falciparum infection remains overwhelmingly high in the study area. The study findings suggest that because of the exceptionally high levels of malaria transmission in the study area, malaria elimination cannot be achieved solely by mass deployment of ITNs and additional control measures are needed.
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Affiliation(s)
- Jean Baptiste Yaro
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
- Department of Biosciences, Durham University, Durham, UK
| | - Alphonse Ouedraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Z Amidou Ouedraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Malik Lankouande
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Efundem Agboraw
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Eve Worrall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kobié Hyacinthe Toe
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Antoine Sanou
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
- Institute of Biodiversity Animal Health & Comparative Medicine, Glasgow University, Glasgow, UK
| | - W Moussa Guelbeogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - N'Fale Sagnon
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Hilary Ranson
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Alfred B Tiono
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | | | - Anne L Wilson
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK.
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Coalson JE, Santos EM, Little AC, Anderson EJ, Stroupe N, Agawo M, Hayden M, Munga S, Ernst KC. Insufficient Ratio of Long-Lasting Insecticidal Nets to Household Members Limited Universal Usage in Western Kenya: A 2015 Cross-Sectional Study. Am J Trop Med Hyg 2020; 102:1328-1342. [PMID: 32314696 PMCID: PMC7941599 DOI: 10.4269/ajtmh.19-0119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 01/22/2020] [Indexed: 11/07/2022] Open
Abstract
Universal "coverage" with long-lasting insecticidal nets (LLINs) is recommended for malaria control in endemic areas, but ownership does not ensure usage. We evaluated relationships between household-level ownership and individual-level usage in western Kenya in 2015. Low-prevalence highland (> 1,500 m) and highly endemic lowland (< 1,200 m) sites were surveyed from July to August 2015. Household members reported long-lasting insecticidal net ownership, use, and barriers to use. Net ownership was categorized as sufficient (≤ 2 people/net), insufficient (> 2 people/net), or none. Each LLIN was assumed to provide access to two people. We surveyed 574 lowland and 643 highland households, with 1,677 and 2,742 members, respectively. More than 98% of lowland households owned LLIN(s); 72.1% owned a sufficient number. Only 37.5% of highland households had sufficient nets. More people used LLINs than were estimated to have access in the lowlands (94.2% versus 85.3%), but proportions were similar in the highlands (54.3% versus 53.3%). Insufficient ownership was most common for larger households in both areas and strongly predicted LLIN usage. In households with insufficient nets, men, school-age children (aged 5-15 years), and nonnuclear family members were less likely to use LLINs; only relationship to the head of the household significantly predicted use in households with sufficient nets. Long-lasting insecticidal nets were widespread in western Kenya in 2015, but insufficient household ownership remained common in the epidemic highlands and in large households. Access seemed to be the primary driver of individual use. To interrupt transmission, LLIN campaigns should improve distribution to large households and promote use among men, school-age children, and nonnuclear family members.
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Affiliation(s)
- Jenna E. Coalson
- Center for Insect Science, University of Arizona, Tucson, Arizona
| | - Ellen M. Santos
- College of Public Health, University of Arizona, Tucson, Arizona
| | - Ashley C. Little
- College of Public Health, University of Arizona, Tucson, Arizona
| | | | - Nancy Stroupe
- College of Public Health, University of Arizona, Tucson, Arizona
| | | | - Mary Hayden
- Trauma, Health and Hazards Center, University of Colorado Colorado Springs, Colorado Springs, Colorado
| | | | - Kacey C. Ernst
- College of Public Health, University of Arizona, Tucson, Arizona
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Long-Lasting Insecticide-Treated Nets: Assessment of the Awareness and Utilization of Them among Antenatal Clinic Attendees in Abakaliki, Southeast Nigeria. J Trop Med 2020; 2020:2984867. [PMID: 32411254 PMCID: PMC7210555 DOI: 10.1155/2020/2984867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background The use of long-lasting insecticide-treated nets (LLITNs) is one of the effective strategies for the prevention of malaria, especially among pregnant women. Aim This study is aimed at assessing the awareness and utilization of LLITNs during pregnancy among antenatal clinic attendees at the Alex Ekwueme Federal University Teaching Hospital Abakaliki. Materials and Methods This was a cross-sectional study among antenatal attendees at the Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State. A semistructured questionnaire was used to obtain relevant information from the participants. Data analysis was done using SPSS version 20. Results The mean age of the women was 26.05 ± 5.76 years. About one-third (30%) of the respondents were nulliparous. Most of the respondents had at least a secondary education. More than ninety percent of the respondents had a good knowledge of malaria with 95.8% being aware of LLITNs. The main source of information was from hospitals (54.5%). The rate of utilization of LLITNs was 37.5%; however, consistent use was only reported by about a third of this proportion. The major reasons for not utilizing the nets include discomfort/heat and fear of the chemical content. Women with tertiary education were more likely to utilize mosquito nets during pregnancy compared with women with secondary or primary education. Women who live in rural areas (OR = 0.393 95% CI 0.602–0.073) were less likely to use LLITNs during pregnancy, while those who are aware of the aetiology of malaria (OR = 4.38 95% CI 0.983–19.591) were more likely to utilize LLITNs in pregnancy. Conclusion The level of awareness of LLITNs is high; however, its utilization was discouragingly low. Rural dwellers and those without appropriate knowledge of the aetiology of malaria were less likely to use LLITNs in pregnancy.
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Kim H, Miller FD, Hernandez A, Tanser F, Mogeni P, Cuadros DF. Spatiotemporal analysis of insecticide-treated net use for children under 5 in relation to socioeconomic gradients in Central and East Africa. Malar J 2020; 19:163. [PMID: 32321547 PMCID: PMC7178571 DOI: 10.1186/s12936-020-03236-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insecticide-treated net (ITN) use is the core intervention among the strategies against malaria in sub-Saharan Africa (SSA) and the percentage of ITN ownership has increased from 47% in 2010 to 72% in 2017 across countries in SSA. Regardless of this massive expansion of ITN distribution, considerable gap between ownership and use of ITNs has been reported. Using data from more than 100,000 households in Central and East Africa (CEA) countries, the main aim of this study was to identify barriers associated with low ITN use and conduct geospatial analyses to estimate numbers and locations of vulnerable children living in areas with high malaria and low ITN use. METHODS Main sources of data for this study were the Demographic and Health Surveys and Malaria Indicator Surveys conducted in 11 countries in CEA. Logistic regression models for each country were built to assess the association between ITN ownership or ITN use and several socioeconomic and demographic variables. A density map of children under 5 living in areas at high-risk of malaria and low ITN use was generated to estimate the number of children who are living in these high malaria burden areas. RESULTS Results obtained suggest that factors such as the number of members in the household, total number of children in the household, education and place of residence can be key factors linked to the use of ITN for protecting children against malaria in CEA. Results from the spatiotemporal analyses found that although total rates of ownership and use of ITNs across CEA have increased up to 70% and 48%, respectively, a large proportion of children under 5 (19,780,678; 23% of total number of children) still lives in high-risk malaria areas with low use of ITNs. CONCLUSION The results indicate that despite substantial progress in the distribution of ITNs in CEA, with about 70% of the households having an ITN, several socioeconomic factors have compromised the effectiveness of this control intervention against malaria, and only about 48% of the households protect their children under 5 with ITNs. Increasing the effective ITN use by targeting these factors and the areas where vulnerable children reside can be a core strategy meant to reducing malaria transmission.
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Affiliation(s)
- Hana Kim
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, OH, 45221, USA.,Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, USA
| | - F DeWolfe Miller
- Department of Tropical Medicine and Medical Microbiology and Pharmacology, University of Hawaii, Honolulu, HI, USA
| | - Andres Hernandez
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, OH, 45221, USA.,Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, USA
| | - Frank Tanser
- Research Department of Infection & Population Health, University College London, London, UK.,Africa Health Research Institute, Durban, Kwazulu-Natal, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, Kwazulu-Natal, South Africa
| | - Polycarp Mogeni
- Africa Health Research Institute, Durban, Kwazulu-Natal, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, Kwazulu-Natal, South Africa
| | - Diego F Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, OH, 45221, USA. .,Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, USA.
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30
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Koenker H, Taylor C, Burgert-Brucker CR, Thwing J, Fish T, Kilian A. Quantifying Seasonal Variation in Insecticide-Treated Net Use among Those with Access. Am J Trop Med Hyg 2020; 101:371-382. [PMID: 31264562 PMCID: PMC6685578 DOI: 10.4269/ajtmh.19-0249] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Seasonal variation in the proportion of the population using an insecticide-treated net (ITN) is well documented and is widely believed to be dependent on mosquito abundance and heat, driven by rainfall and temperature. However, seasonal variation in ITN use has not been quantified controlling for ITN access. Demographic and Health Survey and Malaria Indicator Survey datasets, their georeferenced data, and public rainfall and climate layers were pooled for 21 countries. Nine rainfall typologies were developed from rainfall patterns in Köppen climate zones. For each typology, the odds of ITN use among individuals with access to an ITN within their households (“ITN use given access”) were estimated for each month of the year, controlling for region, wealth quintile, residence, year, temperature, and malaria parasitemia level. Seasonality of ITN use given access was observed over all nine rainfall typologies and was most pronounced in arid climates and less pronounced where rainfall was relatively constant throughout the year. Peak ITN use occurred 1–3 months after peak rainfall and corresponded with peak malaria incidence and average malaria transmission season. The observed lags between peak rainfall and peak ITN use given access suggest that net use is triggered by mosquito density. In equatorial areas, ITN use is likely to be high year-round, given the presence of mosquitoes and an associated year-round perceived malaria risk. These results can be used to inform behavior change interventions to improve ITN use in specific times of the year and to inform geospatial models of the impact of ITNs on transmission.
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Affiliation(s)
- Hannah Koenker
- PMI VectorWorks Project, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, Maryland
| | - Cameron Taylor
- The Demographic and Health Surveys (DHS) Program, ICF, Rockville, Maryland
| | - Clara R Burgert-Brucker
- RTI International, Washington, District of Columbia.,The Demographic and Health Surveys (DHS) Program, ICF, Rockville, Maryland
| | - Julie Thwing
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tom Fish
- The Demographic and Health Surveys (DHS) Program, ICF, Rockville, Maryland
| | - Albert Kilian
- PMI VectorWorks Project, Tropical Health LLP, Montagut, Spain
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31
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Gryseels C, Bannister-Tyrrell M, Uk S, Set S, Suon S, Gerrets R, Peeters Grietens K. A Critical Enquiry into Variability of Insecticidal Net Use in Cambodia: Implications for Assessing Appropriateness of Malaria Elimination Interventions. Am J Trop Med Hyg 2020; 100:1424-1432. [PMID: 30994087 PMCID: PMC6553892 DOI: 10.4269/ajtmh.18-0730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Distributing long-lasting insecticidal nets (LLINs) to individuals living in malaria-endemic regions is a cornerstone of global malaria control. National malaria control programs aim to achieve "universal coverage" of at-risk populations to reach LLINs' full potential to reduce malaria, progress of which is then measured by indicators constructed from standardized questionnaires. Through an exploration of variability in LLIN use in Cambodia, we argue that indicators of universal coverage of LLINs are not sufficiently commensurate with the realities they are intended to measure, limiting the suitability of the data to serve program and policy purposes in a malaria elimination era. Reflecting on the various sources of variability in LLIN use, we apply and extend the concept of "appropriateness" as a third prong to the widely used "efficacy" and "effectiveness" criteria for evaluating LLINs as a tool for malaria prevention. Describing first the different dimensions of the intervention and the sociocultural context separately, we will further show how the variability underlying both is affected and induced by inappropriate aspects of the intervention and the measurements of its impact. We consider the gap between "net use" and the numerical representations of such local net use justifies further exploration of potential strategies to improve LLIN use in subgroups where persisting malaria transmission clusters.
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Affiliation(s)
| | | | - Sambunny Uk
- National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Srun Set
- National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Sokha Suon
- National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia
| | - René Gerrets
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
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32
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Olapeju B, Choiriyyah I, Bertram K, Piccinini D, Harig H, Selby RA, Lynch M, Koenker H. Who buys nets? Factors associated with ownership and use of purchased mosquito nets in sub-Saharan Africa. Malar J 2019; 18:401. [PMID: 31801579 PMCID: PMC6894199 DOI: 10.1186/s12936-019-3020-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public sector strategies to promote insecticide-treated net (ITN) access have resulted in increased ITN ownership across sub-Saharan Africa. However, the current status of the private sector distribution channel for nets has not been fully explored. This multi-country study explored the prevalence of net purchases and the characteristics of households that had purchased nets and used such nets in sub-Saharan Africa. METHODS Data from recent Malaria Indicator Survey (MIS) or Demographic and Health Survey (DHS) in 16 countries were analysed to explore the prevalence of purchased nets. Purchased nets were defined as nets obtained from shops/markets or pharmacies. Additional sub-analysis of factors associated with ownership and use of purchased nets was conducted in seven countries with over 10% of nets reported as purchased. Key outcomes included: prevalence of purchased nets out of all nets, household ownership of a purchased net, and whether a purchased net was used the previous night. Analytical methods included country level tests of association and multivariable logistic regressions. RESULTS Among all nets, the proportion of purchased nets in the study countries ranged from 0.8 to 32.7% and most (median = 77%) of these purchased nets were ITNs. Although the private nets are presumed to be from the retail, non-public sector, the prevalence of treated purchased nets suggests that some purchased nets may be "leaked" ITNs from public sector distributions, and thus, may be an informal sector rather than part of the formal "private sector". Urban, wealthier households as well as those with educated heads were more likely to own purchased nets. Use of such nets was, however, lower in wealthier households. In addition, net use was higher in households owning insufficient nets for their family size, and when the nets were newer than 24 months. CONCLUSION The formal and informal private sector have played a role in bolstering net access rates in some settings. Study findings can help relevant malaria control stakeholders gain insight on the contribution of purchased nets on their overall ITN strategy, identify potential target populations for private sector nets as well as inform the design and distribution of private sector insecticide-treated nets that appeal to their target groups.
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Affiliation(s)
- Bolanle Olapeju
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA.
| | - Ifta Choiriyyah
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Kathryn Bertram
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Danielle Piccinini
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Hunter Harig
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Richmond Ato Selby
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Matthew Lynch
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Hannah Koenker
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
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Asingizwe D, Poortvliet PM, Koenraadt CJM, van Vliet AJH, Ingabire CM, Mutesa L, Leeuwis C. Role of individual perceptions in the consistent use of malaria preventive measures: mixed methods evidence from rural Rwanda. Malar J 2019; 18:270. [PMID: 31395048 PMCID: PMC6686450 DOI: 10.1186/s12936-019-2904-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/05/2019] [Indexed: 12/03/2022] Open
Abstract
Background Malaria preventive measures, including long-lasting insecticide-treated bet nets (LLINs), indoor residual spraying (IRS), and controlling mosquito breeding sites, are key measures to achieve malaria elimination. Still, compliance with these recommended measures remains a major challenge. By applying a novel and comprehensive model for determinants of malaria prevention behaviour, this study tests how individual perceptions influence the intentions to use malaria preventive measures and explores strategies that stimulate their consistent use. Methods The study was carried out in the sectors of Ruhuha and Busoro, Rwanda during October and November 2017, and these were conducted into two phases. Phase one involved a questionnaire survey (N = 742), whereas Phase two employed a qualitative approach that included nine focus group discussions, seven key informant interviews, and three in-depth interviews. Results The findings of the quantitative study showed that participants very often use LLINs (66.6%), accept IRS (73.9%), and drain stagnant water in case of presence (62%). The intentions to use malaria preventive measures were consistently driven by perceived severity, perceived self-efficacy, perceived response efficacy, and subjective norms, and hindered by perceived barriers. The intentions were also positively associated with the actual use of LLINs, acceptance of IRS, and drainage of stagnant water. There is no evidence that either not having enough LLINs (ownership of at least one bed net in the household, here referred to as availability) or having sufficient LLINs (having one LLIN per two people in the household, here referred to as accessibility) moderated the relationship between behavioural intentions and actual use of LLINs. The qualitative study indicated that participants believed malaria risk to be high and perceived a high mosquito density. They also believed that repetitive malaria episodes are caused by the perceived low effectiveness of anti-malaria medications. Lack of LLINs increased the perceived added value of LLINs, and together with the increased malaria burden increased the perceived response efficacy. Participants highlighted the need to continuously mobilize and engage community members especially those who do not use LLINs when having one, and those who do not accept the spraying activities. Conclusion Malaria prevention interventions should target individual perceptions to enhance consistent use of malaria preventive measures. Three strategies to improve consistent use and acceptance of these measures are highlighted: (1) ensure access to LLINs and regular spraying activities, (2) community mobilization and (3) citizen engagement in malaria prevention activities.
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Affiliation(s)
- Domina Asingizwe
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. .,Strategic Communication Group, Wageningen University and Research, Wageningen, The Netherlands.
| | - P Marijn Poortvliet
- Strategic Communication Group, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Arnold J H van Vliet
- Environmental Systems Analysis Group, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Leon Mutesa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Cees Leeuwis
- Knowledge, Technology and Innovation Group, Wageningen University and Research, Wageningen, The Netherlands
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Andrada A, Herrera S, Yé Y. Are new national malaria strategic plans informed by the previous ones? A comprehensive assessment of sub-Saharan African countries from 2001 to present. Malar J 2019; 18:253. [PMID: 31358012 PMCID: PMC6664540 DOI: 10.1186/s12936-019-2898-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New national malaria strategic plans (NMSPs) should build upon the achievements and challenges identified during the implementation of previous plans, but there is limited research on the transition process between NMSPs. This study aims to fill this gap through an assessment of NMSPs across sub-Saharan Africa. METHODS The study reviewed the two most recent NMSPs for selected sub-Saharan African countries. Targets for six core malaria indicators were extracted from each NMSP and compared to the coverage achieved according to corresponding population-based surveys completed near the end of the NMSP term. Implementation challenges and proposed solutions identified through the NMSP analysis were documented. The current NMSP was reviewed to determine whether proposed solutions had been integrated into the strategy. RESULTS Twenty-two countries in sub-Saharan Africa were included in the assessment. Of the 135 verified targets, only 4 were achieved. No country reached more than one of the six targets assessed in each NMSP. Despite this low success rate, only four of the 22 countries lowered a subsequent target, with most setting the next target at an equal or greater level. Most NMSPs identified solutions to address implementation challenges faced, but the solutions were not always fully incorporated in the new strategy. CONCLUSIONS The results show a disconnect between NMSPs. Most targets were set according to global goals rather than the individual country's previous achievements and limitations. This indicates a need to revise the NMSP development process to guide programmes in defining targets based on their country context and incorporate strategies to address challenges identified in the previous NMSP. This will allow countries to set and meet achievable targets as they work toward global goals.
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Affiliation(s)
- Andrew Andrada
- ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
| | - Samantha Herrera
- ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.,Save the Children, 899 North Capitol Street NE, #900, Washington, DC, 20002, USA
| | - Yazoumé Yé
- ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA
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Theiss-Nyland K, Lines J, Fine P. Can ITN distribution policies increase children's ITN use? A DHS analysis. Malar J 2019; 18:191. [PMID: 31176365 PMCID: PMC6555912 DOI: 10.1186/s12936-019-2824-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/29/2019] [Indexed: 01/25/2023] Open
Abstract
Background Insecticide-treated nets (ITN) have largely been distributed via mass distribution campaigns. Since 2011, however, the World Health Organization (WHO) has recommended additional ITN distribution via routine antenatal care (ANC) and expanded programme on immunization (EPI) services. Countries have begun to implement these routine facility-based distribution strategies, but inconsistently, and there is little research on outcomes of these new programmes. This paper investigates the impact of ITN distribution policies on children’s net use, comparing countries with different policies in place. Methods Demographic Health Surveys from 25 countries in Africa were used to analyse household ITN ownership, and ITN use among children under 5 years of age. Countries were categorized in terms of the ITN facility-based distribution policies in place, based on nationally reported policies and distribution data provided to the WHO. The analysis was conducted for individual countries and then pooled with all countries in each category weighted equally to present the average country experience, by ITN distribution policy. Results Household ITN ownership, children’s ITN use, and children’s ITN use in households with at least one ITN increase with each additional routine facility-based distribution policy. An average of 54.0% of children slept under an ITN in countries with ITN distribution via ANC and EPI, compared to 34.3% and 24.7% in countries with ITN distribution via ANC only, or no facility-based distribution, respectively. Linear regression found a 13% increase in net use among children under 5, on average, with each additional ITN distribution policy. Conclusion ITN distribution via ANC and EPI can not only assist countries in maintaining ITN ownership and use, but may be extremely effective at increasing ITN ownership and use. There is also an additional benefit associated with combined ANC and EPI-based ITN distribution, compared to ANC distribution alone.
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Affiliation(s)
- Katherine Theiss-Nyland
- Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Jo Lines
- Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Paul Fine
- Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Talipouo A, Ngadjeu CS, Doumbe-Belisse P, Djamouko-Djonkam L, Sonhafouo-Chiana N, Kopya E, Bamou R, Awono-Ambene P, Woromogo S, Kekeunou S, Wondji CS, Antonio-Nkondjio C. Malaria prevention in the city of Yaoundé: knowledge and practices of urban dwellers. Malar J 2019; 18:167. [PMID: 31072344 PMCID: PMC6509831 DOI: 10.1186/s12936-019-2799-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/03/2019] [Indexed: 01/26/2023] Open
Abstract
Background Malaria prevention in Cameroon mainly relies on the use of ITNs. Although several free distribution campaigns of treated nets have been conducted across the country, bed net usage remains very low. A household survey was conducted to assess knowledge of the population and practices affecting treated net usage in the city of Yaoundé. Methods A community-based descriptive cross-sectional survey was conducted in January 2017 in 32 districts of the city of Yaoundé. Parents (household head, spouse or an elder representative) who consented to the study, were interviewed using a structured pre-tested questionnaire. Interviews were conducted in French or English. A questionnaire consisting of 22 questions was administered to know (i) people’s knowledge and attitude on preventive measures; and, (ii) attitudes concerning the treatment of malaria and estimated amount spent for malaria prevention and treatment. Results A total of 1643 household heads were interviewed. Over 94% of people interviewed associated malaria transmission to mosquito bites. The main methods used against mosquito bites were: treated bed nets (94%; n = 1526) and insecticide spray or coils (32.2%; n = 523). The majority of people interviewed reported using bed nets mainly to prevent from mosquito bites (84.4%, n = 1257), rather than for malaria prevention (47.3%). Knowledge and attitude analysis revealed that people with university or secondary level of education have better knowledge of malaria, prevention and treatment measures compared to those with the primary level (OR = 7.03; P < 0.001). Also, wealthy households were more aware of good practices concerning malaria prevention and treatment compared to poor ones. In the majority of districts of Yaoundé, over 50% of people interviewed per district, had good knowledge of malaria and prevention measures but less than 50% applied good practices concerning malaria treatment and prevention. The amount spent annually by a household for vector control was CFAF 11,589 ± 1133 (US$21.87 ± 2.14) and CFAF 66,403 ± 4012 (US$125.29 ± 7.57) for malaria treatment. Conclusion The study indicated that, despite good knowledge of malaria and prevention measures, few people apply good practices. More sensitization needs to be done to improve adherence to good practices concerning malaria prevention and treatment. Electronic supplementary material The online version of this article (10.1186/s12936-019-2799-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abdou Talipouo
- Institut de Recherche de Yaoundé (IRY), Organisation de Coordination pour la Lutte contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon.,Faculty of Sciences, University of Yaoundé 1, P.O. Box 337, Yaoundé, Cameroon
| | - Carmene S Ngadjeu
- Institut de Recherche de Yaoundé (IRY), Organisation de Coordination pour la Lutte contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon.,Faculty of Sciences, University of Yaoundé 1, P.O. Box 337, Yaoundé, Cameroon
| | - Patricia Doumbe-Belisse
- Institut de Recherche de Yaoundé (IRY), Organisation de Coordination pour la Lutte contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon.,Faculty of Sciences, University of Yaoundé 1, P.O. Box 337, Yaoundé, Cameroon
| | - Landre Djamouko-Djonkam
- Institut de Recherche de Yaoundé (IRY), Organisation de Coordination pour la Lutte contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon.,Faculty of Sciences, University of Dschang, P.O. Box 337, Dschang, Cameroon
| | - Nadege Sonhafouo-Chiana
- Institut de Recherche de Yaoundé (IRY), Organisation de Coordination pour la Lutte contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon.,Faculty of Health Sciences, University of Buea, P.O. Box 456, Buea, Cameroon
| | - Edmond Kopya
- Institut de Recherche de Yaoundé (IRY), Organisation de Coordination pour la Lutte contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon.,Faculty of Sciences, University of Yaoundé 1, P.O. Box 337, Yaoundé, Cameroon
| | - Roland Bamou
- Institut de Recherche de Yaoundé (IRY), Organisation de Coordination pour la Lutte contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon.,Faculty of Sciences, University of Dschang, P.O. Box 337, Dschang, Cameroon
| | - Parfait Awono-Ambene
- Institut de Recherche de Yaoundé (IRY), Organisation de Coordination pour la Lutte contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon
| | - Sylvain Woromogo
- Centre Inter Etats d'Enseignement Supérieur en Santé Publique d'Afrique Centrale (CIESPAC), P.O. Box 1536, Brazzaville, Congo
| | - Sevilor Kekeunou
- Faculty of Sciences, University of Yaoundé 1, P.O. Box 337, Yaoundé, Cameroon
| | - Charles S Wondji
- Vector Biology Liverpool School of Tropical Medicine Pembroke Place, Liverpool, L3 5QA, UK
| | - Christophe Antonio-Nkondjio
- Institut de Recherche de Yaoundé (IRY), Organisation de Coordination pour la Lutte contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon. .,Vector Biology Liverpool School of Tropical Medicine Pembroke Place, Liverpool, L3 5QA, UK.
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Ricotta E, Oppong S, Yukich JO, Briët OJT. Determinants of bed net use conditional on access in population surveys in Ghana. Malar J 2019; 18:63. [PMID: 30849976 PMCID: PMC6408824 DOI: 10.1186/s12936-019-2700-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/01/2019] [Indexed: 12/02/2022] Open
Abstract
Background Insecticide-treated nets (ITNs) are one of the most effective and widely available methods for preventing malaria, and there is interest in understanding the complexities of behavioural drivers of non-use among those with access. This analysis evaluated net use behaviour in Ghana by exploring how several household and environmental variables relate to use among Ghanaians with access to a net. Methods Survey data from the Ghana 2014 Demographic and Health Survey and the 2016 Malaria Indicator Survey were used to calculate household members’ access to space under a net as well as the proportion of net use conditional on access (NUCA). Geospatial information on cluster location was obtained, as well as average humidex, a measure of how hot it feels, for the month each cluster was surveyed. The relationship between independent variables and net use was assessed via beta-binomial regression models that controlled for spatially correlated random effects using non-Gaussian kriging. Results In both surveys, increasing wealth was associated with decreased net use among those with access in households when compared to the poorest category. In 2014, exposure to messages about bed net use for malaria prevention was associated with increased net use (OR 2.5, 95% CrI 1.5–4.2), as was living in a rural area in both 2014 (OR 2.5, 95% CrI 1.5–4.3) and 2016 (OR 1.6, 95% CrI 1.1–2.3). The number of nets per person was not associated with net use in either survey. Model fit was improved for both surveys by including a spatial random effect for cluster, demonstrating some spatial autocorrelation in the proportion of people using a net. Humidex, electricity in the household and IRS were not associated with NUCA. Conclusion Net use conditional on access is affected by household characteristics and is also spatially-dependent in Ghana. Setting (whether the household was urban or rural) plays a role, with wealthier and more urban households less likely to use nets when they are available. It will likely be necessary in the future to focus on rural settings, urban settings, and wealth status independently, both to better understand predictors of household net use in these areas and to design more targeted interventions to ensure consistent use of vector control interventions that meet specific needs of the population. Electronic supplementary material The online version of this article (10.1186/s12936-019-2700-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emily Ricotta
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, P.O. Box CH-4001, Basel, Switzerland.
| | - Samuel Oppong
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Korle-bu, P. O. Box KB 493, Accra, Ghana
| | - Joshua O Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St. #8317, New Orleans, LA, 70112, USA
| | - Olivier J T Briët
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland.,University of Basel, Petersplatz 1, P.O. Box CH-4001, Basel, Switzerland
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Olapeju B, Choiriyyah I, Lynch M, Acosta A, Blaufuss S, Filemyr E, Harig H, Monroe A, Selby RA, Kilian A, Koenker H. Age and gender trends in insecticide-treated net use in sub-Saharan Africa: a multi-country analysis. Malar J 2018; 17:423. [PMID: 30428916 PMCID: PMC6234545 DOI: 10.1186/s12936-018-2575-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022] Open
Abstract
Background The degree to which insecticide-treated net (ITN) supply accounts for age and gender disparities in ITN use among household members is unknown. This study explores the role of household ITN supply in the variation in ITN use among household members in sub-Saharan Africa. Methods Data was from Malaria Indicator Surveys or Demographic and Health Surveys collected between 2011 and 2016 from 29 countries in sub-Saharan Africa. The main outcome was ITN use the previous night. Other key variables included ITN supply (nets/household members), age and gender of household members. Analytical methods included logistic regressions and meta-regression. Results Across countries, the median (range) of the percentage of households with enough ITNs was 30.7% (8.5–62.0%). Crude analysis showed a sinusoidal pattern in ITN use across age groups of household members, peaking at 0–4 years and again around 30–40 years and dipping among people between 5–14 and 50+ years. This sinusoidal pattern was more pronounced in households with not enough ITNs compared to those with enough ITNs. ITN use tended to be higher in females than males in households with not enough ITNs while use was comparable among females and males in households with enough ITNs. After adjusting for wealth quintile, residence and region, among households with not enough ITNs in all countries, the odds of ITN use were consistently higher among children under 5 years and non-pregnant women 15–49 years. Meta-regressions showed that across all countries, the mean adjusted odds ratio (aOR) of ITN use among children under 5 years, pregnant and non-pregnant women aged 15–49 years and people 50 years and above was significantly higher than among men aged 15–49 years. Among these household members, the relationship was attenuated when there were enough ITNs in the household (dropping 0.26–0.59 points) after adjusting for geographical zone, household ITN supply, population ITN access, and ITN use:access ratio. There was no significant difference in mean aOR of ITN use among school-aged children compared to men aged 15–49 years, regardless of household ITN supply. Conclusions This study demonstrated that having enough ITNs in the household increases level of use and decreases existing disparities between age and gender groups. ITN distribution via mass campaigns and continuous distribution channels should be enhanced as needed to ensure that households have enough ITNs for all members, including men and school-aged children.
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Affiliation(s)
- Bolanle Olapeju
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Ifta Choiriyyah
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Matthew Lynch
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Angela Acosta
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Sean Blaufuss
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Eric Filemyr
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Hunter Harig
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - April Monroe
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Richmond Ato Selby
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Albert Kilian
- PMI VectorWorks Project, Tropical Health LLP, Montagut, Spain
| | - Hannah Koenker
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA.
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Koenker H, Arnold F, Ba F, Cisse M, Diouf L, Eckert E, Erskine M, Florey L, Fotheringham M, Gerberg L, Lengeler C, Lynch M, Mnzava A, Nasr S, Ndiop M, Poyer S, Renshaw M, Shargie E, Taylor C, Thwing J, Van Hulle S, Ye Y, Yukich J, Kilian A. Assessing whether universal coverage with insecticide-treated nets has been achieved: is the right indicator being used? Malar J 2018; 17:355. [PMID: 30305127 PMCID: PMC6180430 DOI: 10.1186/s12936-018-2505-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/03/2018] [Indexed: 12/20/2022] Open
Abstract
Background/methods Insecticide-treated nets (ITNs) are the primary tool for malaria vector control in sub-Saharan Africa, and have been responsible for an estimated two-thirds of the reduction in the global burden of malaria in recent years. While the ultimate goal is high levels of ITN use to confer protection against infected mosquitoes, it is widely accepted that ITN use must be understood in the context of ITN availability. However, despite nearly a decade of universal coverage campaigns, no country has achieved a measured level of 80% of households owning 1 ITN for 2 people in a national survey. Eighty-six public datasets from 33 countries in sub-Saharan Africa (2005–2017) were used to explore the causes of failure to achieve universal coverage at the household level, understand the relationships between the various ITN indicators, and further define their respective programmatic utility. Results The proportion of households owning 1 ITN for 2 people did not exceed 60% at the national level in any survey, except in Uganda’s 2014 Malaria Indicator Survey (MIS). At 80% population ITN access, the expected proportion of households with 1 ITN for 2 people is only 60% (p = 0.003 R2 = 0.92), because individuals in households with some but not enough ITNs are captured as having access, but the household does not qualify as having 1 ITN for 2 people. Among households with 7–9 people, mean population ITN access was 41.0% (95% CI 36.5–45.6), whereas only 6.2% (95% CI 4.0–8.3) of these same households owned at least 1 ITN for 2 people. On average, 60% of the individual protection measured by the population access indicator is obscured when focus is put on the household “universal coverage” indicator. The practice of limiting households to a maximum number of ITNs in mass campaigns severely restricts the ability of large households to obtain enough ITNs for their entire family. Conclusions The two household-level indicators—one representing minimal coverage, the other only ‘universal’ coverage—provide an incomplete and potentially misleading picture of personal protection and the success of an ITN distribution programme. Under current ITN distribution strategies, the global malaria community cannot expect countries to reach 80% of households owning 1 ITN for 2 people at a national level. When programmes assess the success of ITN distribution activities, population access to ITNs should be considered as the better indicator of “universal coverage,” because it is based on people as the unit of analysis. Electronic supplementary material The online version of this article (10.1186/s12936-018-2505-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hannah Koenker
- PMI Vectorworks Project, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, USA.
| | | | - Fatou Ba
- National Malaria Control Programme, Ministry of Health, Dakar, Senegal
| | - Moustapha Cisse
- National Malaria Control Programme, Ministry of Health, Dakar, Senegal
| | - Lamine Diouf
- National Malaria Control Programme, Ministry of Health, Dakar, Senegal
| | - Erin Eckert
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Washington, DC, USA
| | - Marcy Erskine
- International Federation of the Red Cross and Red Crescent Societies, Geneva, Switzerland
| | - Lia Florey
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Washington, DC, USA
| | - Megan Fotheringham
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Washington, DC, USA
| | - Lilia Gerberg
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Washington, DC, USA
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Matthew Lynch
- PMI Vectorworks Project, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, USA
| | | | - Susann Nasr
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Médoune Ndiop
- National Malaria Control Programme, Ministry of Health, Dakar, Senegal
| | - Stephen Poyer
- Population Services International, Washington, DC, USA
| | | | - Estifanos Shargie
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | | | - Julie Thwing
- U.S. President's Malaria Initiative, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Josh Yukich
- PMI VectorWorks Project, Centre for Applied Malaria Research, Tulane University School of Public Health, New Orleans, LA, USA
| | - Albert Kilian
- PMI VectorWorks Project, Tropical Health LLP, Montagut, Spain
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Babalola S, Adedokun ST, McCartney-Melstad A, Okoh M, Asa S, Tweedie I, Tompsett A. Factors associated with caregivers' consistency of use of bed nets in Nigeria: a multilevel multinomial analysis of survey data. Malar J 2018; 17:280. [PMID: 30071875 PMCID: PMC6071383 DOI: 10.1186/s12936-018-2427-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/24/2018] [Indexed: 11/12/2022] Open
Abstract
Background Malaria remains endemic in Nigeria despite programmes and policies put in place toward malaria elimination. Long-lasting insecticidal nets have been documented to offer protection from malaria by preventing mosquito bites. While many studies have examined the factors associated with the use of bed nets in Nigeria and across Africa, little information is available on the factors associated with consistency of use of bed nets. Methods The data for this study were derived from a household survey conducted in three states in Nigeria (Akwa Ibom, Kebbi and Nasarawa) between July and September 2015 by the Health Communication Capacity Collaborative, a 5-year cooperative agreement supported by the United States Agency for International Development and the US President’s Malaria initiative and led by the Johns Hopkins Center for Communication Programs. The analysis was limited to a total of 3884 men and women selected from 2863 households with at least one bed net. Multilevel multinomial logistic regression was used to assess the factors associated with consistency of use of bed nets. Results The findings revealed 43.2% of the respondents use bed nets every night, while 38.4% use bed nets most nights. The factors associated with using a bed net every night rather than rarely or never using a bed net included sociodemographic and household variables (age, gender, religion, household size, net density, and household wealth), ideational variables (perceptions about severity, susceptibility, self-efficacy to use nets, and response-efficacy of bed net; awareness of place of purchase; willingness to pay for bed nets; attitudes towards net use; and descriptive norm about nets), and state of residence. The three study states differ significantly in terms of most of the independent variables included in the estimated model. Conclusions The study recommends that efforts designed to promote consistent use of bed nets should be state-specific and include strategies targeting ideational variables. Furthermore, given the significance of unmeasured heterogeneity at the cluster level, strategies to engage and mobilize the community, such as community dialogue, home visits and engaging community leadership, are relevant.
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Affiliation(s)
- Stella Babalola
- Breakthrough Action/Johns Hopkins Center for Communication Programs, Johns Hopkins University, 111 Market Place - Suite 310, Baltimore, MD, 21202, USA.
| | - Sulaimon T Adedokun
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Anna McCartney-Melstad
- Breakthrough Action/Johns Hopkins Center for Communication Programs, Johns Hopkins University, 111 Market Place - Suite 310, Baltimore, MD, 21202, USA
| | - Mathew Okoh
- Breakthrough Action/Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Sola Asa
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Ian Tweedie
- Breakthrough Action/Johns Hopkins Center for Communication Programs, Johns Hopkins University, 111 Market Place - Suite 310, Baltimore, MD, 21202, USA
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Storey JD, Babalola SO, Ricotta EE, Fox KA, Toso M, Lewicky N, Koenker H. Associations between ideational variables and bed net use in Madagascar, Mali, and Nigeria. BMC Public Health 2018; 18:484. [PMID: 29642883 PMCID: PMC5896159 DOI: 10.1186/s12889-018-5372-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background The use of insecticide-treated bed nets (ITNs) is crucial to the prevention, control, and elimination of malaria. Using household surveys conducted in 2014–2015 by the Health Communication Capacity Collaborative project in Madagascar, Mali, and Nigeria, we compared a model of psychosocial influence, called Ideation, to examine how malaria-related variables influence individual and household bed net use in each of these countries. Evaluations of non-malaria programs have confirmed the value of the ideational approach, but it is infrequently used to guide malaria interventions. The study objective was to examine how well this model could identify potentially effective malaria prevention approaches in different contexts. Methods Sampling and survey designs were similar across countries. A multi-stage random sampling process selected female caregivers with at least one child under 5 years of age for interviews. Additional data were collected from household heads about bed net use and other characteristics of household members. The caregiver survey measured psychosocial variables that were subjected to bivariate and multivariate analysis to identify significant ideational variables related to bed net use. Results In all three countries, children and adolescents over five were less likely to sleep under a net compared to children under five (OR = 0.441 in Madagascar, 0.332 in Mali, 0.502 in Nigeria). Adults were less likely to sleep under a net compared to children under five in Mali (OR = 0.374) and Nigeria (OR = 0.448), but not Madagascar. In all countries, the odds of bed net use were lower in larger compared to smaller households (OR = 0.452 in Madagascar and OR = 0.529 in Nigeria for households with 5 or 6 members compared to those with less than 5; and OR = 0.831 in Mali for larger compared to smaller households). Of 14 common ideational variables examined in this study, six were significant predictors in Madagascar (all positive), three in Mali (all positive), and two in Nigeria (both negative). Conclusion This research suggests that the systematic use of this model to identify relevant ideational variables in a particular setting can guide the development of communication strategies and messaging, thereby improving the effectiveness of malaria prevention and control.
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Affiliation(s)
- J Douglas Storey
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA.
| | - Stella O Babalola
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Emily E Ricotta
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Kathleen A Fox
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Michael Toso
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Nan Lewicky
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Hannah Koenker
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
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A Meta-Regression Analysis of the Effectiveness of Mosquito Nets for Malaria Control: The Value of Long-Lasting Insecticide Nets. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030546. [PMID: 29562673 PMCID: PMC5877091 DOI: 10.3390/ijerph15030546] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 11/16/2022]
Abstract
Long-lasting insecticidal nets (LLINs) have been widely used as an effective alternative to conventional insecticide-treated nets (ITNs) for over a decade. Due to the growing number of field trials and interventions reporting the effectiveness of LLINs in controlling malaria, there is a need to systematically review the literature on LLINs and ITNs to examine the relative effectiveness and characteristics of both insecticide nettings. A systematic review of over 2000 scholarly articles published since the year 2000 was conducted. The odds ratios (ORs) of insecticidal net effectiveness in reducing malaria were recorded. The final dataset included 26 articles for meta-regression analysis, with a sample size of 154 subgroup observations. While there is substantial heterogeneity in study characteristics and effect size, we found that the overall OR for reducing malaria by LLIN use was 0.44 (95% CI = 0.41–0.48, p < 0.01) indicating a risk reduction of 56%, while ITNs were slightly less effective with an OR of 0.59 (95% CI = 0.57–0.61, p <0.01). A meta-regression model confirms that LLINs are significantly more effective than ITNs in the prevention of malaria, when controlling for other covariates. For both types of nets, protective efficacy was greater in high transmission areas when nets were used for an extended period. However, cross-sectional studies may overestimate the effect of the nets. The results surprisingly suggest that nets are less effective in protecting children under the age of five, which may be due to differences in child behavior or inadequate coverage. Compared to a previous meta-analysis, insecticide-treated nets appear to have improved their efficacy despite the risks of insecticide resistance. These findings have practical implications for policymakers seeking effective malaria control strategies.
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Mboma ZM, Overgaard HJ, Moore S, Bradley J, Moore J, Massue DJ, Kramer K, Lines J, Lorenz LM. Mosquito net coverage in years between mass distributions: a case study of Tanzania, 2013. Malar J 2018; 17:100. [PMID: 29490649 PMCID: PMC5831856 DOI: 10.1186/s12936-018-2247-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 02/22/2018] [Indexed: 11/13/2022] Open
Abstract
Background The Government of Tanzania is the main source of long-lasting insecticidal nets (LLINs) for its population. Mosquito nets (treated and untreated) are also available in the commercial market. To sustain investments and health gains in the fight against malaria, it is important for the National Malaria Control Programme to monitor LLIN coverage especially in the years between mass distributions and to understand what households do if their free nets are deemed unusable. The aim of this paper was to assess standard LLIN indicators by wealth status in Tanzania in 2013, 2 years after the last mass campaign in 2011, and extend the analysis to untreated nets (UTNs) to investigate how households adapt when nets are not continuously distributed. Methods Between October–December 2013, a household survey was conducted in 3398 households in eight districts in Tanzania. Using the Roll Back Malaria indicators, the study analysed: (1) household net ownership; (2) access to nets; (3) population net use and (4) net use:access ratio. Outcomes were calculated for LLINs and UTNs. Results were analysed by socio-economic quintiles and by district. Results Only three of the eight districts had household LLIN ownership of more than 80%. In 2013, less than a quarter of the households had one LLIN for every two people and only half of the population had access to an LLIN. Only the wealthier quintiles increased their net ownership and access to levels above 80% through the addition of UTNs. Overall net use of the population was low (LLINs: 32.8%; UTNs: 9.5%) and net use:access ratio was below target level (LLINs: 0.66; UTN: 0.50). Both measures varied significantly by district. Conclusions Two years after the last mass campaign, the percentage of households or population with access to LLINs was low. These findings indicate the average rate at which households in Tanzania lose their nets is higher than the rate at which they acquire new nets. The wealthiest households topped up their household net ownership with UTNs. Efforts to make LLINs available through commercial markets should be promoted, so those who can afford to buy nets purchase LLINs rather than UTNs. Net use was low around 40% and mostly explained by lack of access to nets. However, the use:access ratio was poor in Mbozi and Kahama districts warranting further investigations to understand other barriers to net use. Electronic supplementary material The online version of this article (10.1186/s12936-018-2247-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zawadi M Mboma
- Ifakara Health Institute, Bagamoyo, Tanzania.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Hans J Overgaard
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway.
| | - Sarah Moore
- Ifakara Health Institute, Bagamoyo, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - John Bradley
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Jason Moore
- Ifakara Health Institute, Bagamoyo, Tanzania.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Dennis J Massue
- Ifakara Health Institute, Bagamoyo, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland.,National Institute for Medical Research, Muheza, Tanzania
| | - Karen Kramer
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Jo Lines
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Lena M Lorenz
- Ifakara Health Institute, Bagamoyo, Tanzania.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Kanyangarara M, Hamapumbu H, Mamini E, Lupiya J, Stevenson JC, Mharakurwa S, Chaponda M, Thuma PE, Gwanzura L, Munyati S, Mulenga M, Norris DE, Moss WJ. Malaria knowledge and bed net use in three transmission settings in southern Africa. Malar J 2018; 17:41. [PMID: 29351795 PMCID: PMC5775538 DOI: 10.1186/s12936-018-2178-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/09/2018] [Indexed: 12/03/2022] Open
Abstract
Background Insecticide-treated nets (ITNs) reduce malaria morbidity and mortality in endemic areas. Despite increasing availability, the use of ITNs remains limited in some settings. Poor malaria knowledge is a barrier to the widespread use of ITNs. The goal of this study was to assess the levels of malaria knowledge and evaluate factors associated with bed net use among individuals residing in three regions of southern Africa with different levels of malaria transmission and control. Methods A cross-sectional study was conducted on a sample of 7535 residents recruited from 2066 households in Mutasa District, Zimbabwe (seasonal malaria transmission), Choma District, Zambia (low transmission) and Nchelenge District, Zambia (high transmission), between March 2012 and March 2017. A standardized questionnaire was used to collect data on demographics, malaria-related knowledge and use of preventive measures. Multivariate logistic regression analyses were used to assess determinants of bed net use. Results Most of the 3836 adult participants correctly linked mosquito bites to malaria (85.0%), mentioned at least one malaria symptom (95.5%) and knew of the benefit of sleeping under an ITN. Bed net ownership and use were highest in Choma and Nchelenge Districts and lowest in Mutasa District. In multivariate analyses, knowledge of ITNs was associated with a 30–40% increased likelihood of bed net use after adjusting for potential confounders across all sites. Other factors significantly associated with bed net use were age, household size and socioeconomic status, although the direction, strength and size of association varied by study site. Importantly, participants aged 5–14 years had reduced odds of sleeping under a bed net compared to children younger than 5 years. Conclusion Relevant knowledge of ITNs translated into the expected preventive behaviour of sleeping under a bed net, underscoring the need for continued health messaging on malaria prevention. The implementation and delivery of malaria control and elimination interventions needs to consider socioeconomic equity gaps, and target school-age children to ensure access to and improve utilization of ITNs.
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Affiliation(s)
- Mufaro Kanyangarara
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Edmore Mamini
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - James Lupiya
- Tropical Disease Research Centre, Ndola Central Hospital, Ndola, Zambia
| | - Jennifer C Stevenson
- Macha Research Trust, Macha, Choma District, Zambia.,Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Mike Chaponda
- Tropical Disease Research Centre, Ndola Central Hospital, Ndola, Zambia
| | - Philip E Thuma
- Macha Research Trust, Macha, Choma District, Zambia.,Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lovemore Gwanzura
- Department of Medical Laboratory Sciences, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Modest Mulenga
- Tropical Disease Research Centre, Ndola Central Hospital, Ndola, Zambia
| | - Douglas E Norris
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William J Moss
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Seyoum D, Speybroeck N, Duchateau L, Brandt P, Rosas-Aguirre A. Long-Lasting Insecticide Net Ownership, Access and Use in Southwest Ethiopia: A Community-Based Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111312. [PMID: 29077052 PMCID: PMC5707951 DOI: 10.3390/ijerph14111312] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 01/05/2023]
Abstract
Introduction: A large proportion of the Ethiopian population (approximately 68%) lives in malaria risk areas. Millions of long-lasting insecticide treated nets (LLINs) have been distributed as part of the malaria prevention and control strategy in the country. This study assessed the ownership, access and use of LLNs in the malaria endemic southwest Ethiopia. Methods: A community-based cross-sectional study was conducted in southwest Ethiopia during October–November 2015, including 836 households from sixteen villages around Gilgel-Gibe dam area. Indicators of ownership, access and use of LLINs were derived following the Roll Back Malaria (RBM) guidelines. Factors associated with failure for both LLIN access and use were analysed at household level using a multivariate logistic regression model. Results: The proportion of households with at least one LLIN was 82.7% (95% CI: 80.0, 85.1). However, only 68.9% (95% CI: 65.6, 71.9) had enough LLINs to cover all family members (with ≥one LLIN for every two persons). While 75.3% (95% CI: 68.4, 83.0) of the population was estimated to have accessed to LLINs, only 63.8% (95% CI: 62.3, 65.2) reported to have used a LLIN the previous night. The intra-household gap (i.e., households owning at least one LLIN, but unable to cover all family members) and the behavioral gap (i.e., household members who did not sleep under a LLIN despite having access to one) were 16.8% and 10.5%, respectively. Age, marital status and education of household heads, as well as household size and cooking using firewood were associated with the access to enough LLINs within households. Decreased access to LLINs at households was the main determinant for not achieving ≥80% household members sleeping under a LLIN the previous night. Other associated factors were household size and education level of household head. Conclusions: LLIN coverage levels in study villages remain below national targets of 100% for ownership and 80% for use. The access to enough LLINs within the households is the main restriction of LLIN use in the study area.
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Affiliation(s)
- Dinberu Seyoum
- Institute of Health and Society (IRSS), Université Catholique de Louvain, 1200 Brussels, Belgium.
- Department of Statistics, Natural Science College, Jimma University, Jimma 378, Ethiopia.
| | - Niko Speybroeck
- Institute of Health and Society (IRSS), Université Catholique de Louvain, 1200 Brussels, Belgium.
| | - Luc Duchateau
- Biometrics Research Group, Faculty of Veterinary Medicine, Ghent University, 9000 Ghent, Belgium.
| | - Patrick Brandt
- School of Economic, Political and Policy Sciences, The University of Texas, Dallas, TX 75080, USA.
| | - Angel Rosas-Aguirre
- Institute of Health and Society (IRSS), Université Catholique de Louvain, 1200 Brussels, Belgium.
- Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima 31, Peru.
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46
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Florey LS, Bennett A, Hershey CL, Bhattarai A, Nielsen CF, Ali D, Luhanga M, Taylor C, Eisele TP, Yé Y. Impact of Insecticide-Treated Net Ownership on All-Cause Child Mortality in Malawi, 2006-2010. Am J Trop Med Hyg 2017; 97:65-75. [PMID: 28990922 PMCID: PMC5619930 DOI: 10.4269/ajtmh.15-0929] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Insecticide-treated nets (ITNs) have been shown to be highly effective at reducing malaria morbidity and mortality in children. However, there are limited studies that assess the association between increasing ITN coverage and child mortality over time, at the national level, and under programmatic conditions. Two analytic approaches were used to examine this association: a retrospective cohort analysis of individual children and a district-level ecologic analysis. To evaluate the association between household ITN ownership and all-cause child mortality (ACCM) at the individual level, data from the 2010 Demographic and Health Survey (DHS) were modeled in a Cox proportional hazards framework while controlling for numerous environmental, household, and individual confounders through the use of exact matching. To evaluate population-level association between ITN ownership and ACCM between 2006 and 2010, program ITN distribution data and mortality data from the 2006 Multiple Indicator Cluster Survey and the 2010 DHS were aggregated at the district level and modeled using negative binomial regression. In the Cox model controlling for household, child and maternal health factors, children between 1 and 59 months in households owning an ITN had significantly lower mortality compared with those without an ITN (hazard ratio = 0.75, 95% confidence interval [CI] = 0.62–90). In the district-level model, higher ITN ownership was significantly associated with lower ACCM (incidence rate ratio = 0.77; 95% CI = 0.60–0.98). These findings suggest that increasing ITN ownership may have contributed to the decline in ACCM during 2006–2010 in Malawi and represent a novel use of district-level data from nationally representative surveys.
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Affiliation(s)
| | - Adam Bennett
- Malaria Elimination Initiative, University of California, San Francisco, California
| | - Christine L Hershey
- President's Malaria Initiative, United States Agency for International Development, Arlington, Virginia
| | - Achuyt Bhattarai
- President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carrie F Nielsen
- President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Doreen Ali
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Misheck Luhanga
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | | | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Yazoume Yé
- ICF, MEASURE Evaluation, Rockville, Maryland
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47
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Brooks HM, Jean Paul MK, Claude KM, Mocanu V, Hawkes MT. Use and disuse of malaria bed nets in an internally displaced persons camp in the Democratic Republic of the Congo: A mixed-methods study. PLoS One 2017; 12:e0185290. [PMID: 28950001 PMCID: PMC5614551 DOI: 10.1371/journal.pone.0185290] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/08/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Malaria is a major cause of morbidity and mortality among displaced populations in tropical zones. Bed nets are widely used to prevent malaria; however, few data are available on bed net distribution within displaced populations. Methods Mixed methods study in a single internally displaced persons (IDP) camp and neighboring community in Eastern Democratic Republic of the Congo (DRC). Qualitative data (focus group discussions, FGDs) and quantitative data (door-to-door survey and individual testing using malaria rapid diagnostic test, RDT) were collected. Results Ten FGDs were conducted with 55 individuals. Although malaria was widely recognized as a significant threat and bed nets were freely distributed in the camp, many households did not own or use them. IDPs converged on the following reasons for low bed net ownership and use: inconvenience of net installation and sale of nets to meet immediate needs such as food. One hundred households, comprised of 411 individuals, were surveyed in Birambizo. The burden of malaria was high (45/78 (58%) of children <5 were positive for malaria by RDT) and bed net utilization was low (29/100 (29%) households owned a bed net, and 85/411 (20%) individuals slept under a bed net the previous night). Children <5 were more likely to use a bed net than older children or adults (OR 3.4 (95%CI 2.0–5.8), p<0.0001). Compared to 29 bed nets currently in use by study participants, 146 bed nets had been sold (82%) or exchanged (18%) either in the camp (27%) or in the neighbouring village market (73%). Conclusions Qualitative descriptions and quantitative analysis revealed pragmatic barriers to bed net usage and widespread sale of freely distributed bed nets within IDP camps, despite a high burden of malaria. Additional strategies, beyond bed net distribution, are warranted to combat malaria in vulnerable and hard-to-reach population.
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Affiliation(s)
| | | | | | - Victor Mocanu
- Department of Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Michael T. Hawkes
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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48
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McCann RS, van den Berg H, Diggle PJ, van Vugt M, Terlouw DJ, Phiri KS, Di Pasquale A, Maire N, Gowelo S, Mburu MM, Kabaghe AN, Mzilahowa T, Chipeta MG, Takken W. Assessment of the effect of larval source management and house improvement on malaria transmission when added to standard malaria control strategies in southern Malawi: study protocol for a cluster-randomised controlled trial. BMC Infect Dis 2017; 17:639. [PMID: 28938876 PMCID: PMC5610449 DOI: 10.1186/s12879-017-2749-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 09/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to outdoor and residual transmission and insecticide resistance, long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) will be insufficient as stand-alone malaria vector control interventions in many settings as programmes shift toward malaria elimination. Combining additional vector control interventions as part of an integrated strategy would potentially overcome these challenges. Larval source management (LSM) and structural house improvements (HI) are appealing as additional components of an integrated vector management plan because of their long histories of use, evidence on effectiveness in appropriate settings, and unique modes of action compared to LLINs and IRS. Implementation of LSM and HI through a community-based approach could provide a path for rolling-out these interventions sustainably and on a large scale. METHODS/DESIGN We will implement community-based LSM and HI, as additional interventions to the current national malaria control strategies, using a randomised block, 2 × 2 factorial, cluster-randomised design in rural, southern Malawi. These interventions will be continued for two years. The trial catchment area covers about 25,000 people living in 65 villages. Community participation is encouraged by training community volunteers as health animators, and supporting the organisation of village-level committees in collaboration with The Hunger Project, a non-governmental organisation. Household-level cross-sectional surveys, including parasitological and entomological sampling, will be conducted on a rolling, 2-monthly schedule to measure outcomes over two years (2016 to 2018). Coverage of LSM and HI will also be assessed throughout the trial area. DISCUSSION Combining LSM and/or HI together with the interventions currently implemented by the Malawi National Malaria Control Programme is anticipated to reduce malaria transmission below the level reached by current interventions alone. Implementation of LSM and HI through a community-based approach provides an opportunity for optimum adaptation to the local ecological and social setting, and enhances the potential for sustainability. TRIAL REGISTRATION Registered with The Pan African Clinical Trials Registry on 3 March 2016, trial number PACTR201604001501493.
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Affiliation(s)
- Robert S McCann
- Wageningen University and Research, Wageningen, The Netherlands. .,College of Medicine, University of Malawi, Blantyre, Malawi. .,Laboratory of Entomology, Wageningen University and Research, PO Box 16, 6700, AA, Wageningen, The Netherlands.
| | | | | | - Michèle van Vugt
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Dianne J Terlouw
- Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi-Liverpool Wellcome Trust, Blantyre, Malawi
| | - Kamija S Phiri
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Aurelio Di Pasquale
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Nicolas Maire
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Steven Gowelo
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Monicah M Mburu
- Wageningen University and Research, Wageningen, The Netherlands.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Alinune N Kabaghe
- College of Medicine, University of Malawi, Blantyre, Malawi.,Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Michael G Chipeta
- College of Medicine, University of Malawi, Blantyre, Malawi.,Lancaster University, Lancaster, UK.,Malawi-Liverpool Wellcome Trust, Blantyre, Malawi
| | - Willem Takken
- Wageningen University and Research, Wageningen, The Netherlands
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Access to and use of long-lasting insecticidal nets and factors associated with non-use among communities in malaria-endemic areas of Al Hudaydah governorate in the Tihama region, west of Yemen. Malar J 2017; 16:244. [PMID: 28599666 PMCID: PMC5466721 DOI: 10.1186/s12936-017-1894-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Universal coverage of the targeted malaria-endemic areas with long-lasting insecticidal nets (LLINs) is implemented as one of the key interventions for malaria control and elimination in Yemen. In 2013, through a mass campaign, LLINs were distributed to the targeted communities in Al Hudaydah governorate. This study aimed to assess the ownership of, access to, and use of LLINs. It also aimed to identify factors associated with not using LLINs in malaria-endemic areas of Al Hudaydah in the Tihama region, west of Yemen. Methods A cross-sectional survey was conducted in four districts (Ad Durayhimi, Al Marawi’ah, Al Mansuriyah and Bayt Al Faqiah) in Al Hudaydah during February 2016. A total of 701 households were included in this study. Data on socio-demographic characteristics and availability of LLINs were collected by interview and observation. Four indicators for malaria prevention using LLINs; proportion of households with at least one LLIN, proportion of households with at least one LLIN for every two people, proportion of population with access to LLINs in the surveyed households and proportion of population who slept under LLINs the previous night of the survey were calculated as indicated by Roll Back Malaria Monitoring and Evaluation Reference Group. Use to access ratio was assessed. Factors associated with not using LLINs among people with access were also investigated. Results Of 701 households with 4900 de facto population, ownership of at least one LLIN was 90.6%, while 24.1% owned at least one for every two people during the survey in 2016. The overall proportion of people with access to LLINs was 51.5% (95% CI 50.1–52.9). Only 19.0% (95% CI 17.9–20.1) slept under LLINs the night before the survey and the overall use to access ratio was 0.37. The proportions of children under 5 years of age with access to and use of LLINs were 13.7 and 42.5%, respectively. On the other hand, the proportions of pregnant women with access to and use of LLINs were 16.4 and 20.0%, respectively. Multivariable analysis identified that people living in Al Mansuriyah district [adjusted odds ratio (AOR) = 3.29, 95% confidence interval (CI) 1.35–8.01; P = 0.009)], having three or more damaged LLINs in the house (AOR = 2.76, 95% CI 1.79–4.25; P < 0.001), aged between 16 and 45 years old (AOR = 2.17, 95% CI 1.26–3.75; P = 0.005) or older (AOR = 2.17, 95% CI 1.09–4.29; P = 0.026) and living in huts (AOR = 1.59, 95% CI 1.09–2.32; P = 0.015) were significantly less likely to use LLINs. Conclusions This study shows a low LLIN access rate among local communities targeted for universal LLIN coverage in Al Hudaydah, a malaria-endemic area of high transmission. This finding necessitates additional distribution channels following mass campaigns to maintain the universal coverage. Reduced use of LLINs among people with access in these communities together with the identified risks of non-use highlight the importance of conducting behaviour change communication campaigns to enhance using LLINs in areas with universal coverage.
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50
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Koenker H, Yukich JO. Effect of user preferences on ITN use: a review of literature and data. Malar J 2017; 16:233. [PMID: 28571583 PMCID: PMC5455118 DOI: 10.1186/s12936-017-1879-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/26/2017] [Indexed: 11/14/2022] Open
Abstract
Background Insecticide-treated bed nets (ITNs) are the primary tool for vector control, and optimizing ITN use is a key concern of national programmes. Available evidence indicates that bed net users often have preferences for shape, colour, size, and other attributes, but it is unclear whether these preferences are strong enough to have any significant effect on bed net use, and whether countries and donors should invest in more expensive attributes in order to maximize ITN use. The link between bed net attributes, preferences, and use was investigated using a literature review and review of publicly available, nationally representative household surveys from sub-Saharan Africa. Methods A literature search was conducted to identify publications with data on preferences for net attributes and on associations between net attributes and use. Publicly available DHS and MIS datasets were screened for variables on net preferences and net attributes. Wald tests were run to obtain odds ratios and confidence intervals for the use of nets of various attributes in univariate analysis. A multilevel logistic regression was constructed to assess the odds of a net’s use, controlling for background variables and adding random effects variables at the household and cluster level. Results Preferences for certain net attributes exist, but do not impede high rates of net use in countries where data were available. Stated preferences for shape and colour do not significantly influence net use to degrees that would require action by programme planners. By and large, people are using the nets they receive, and when they do not, it is for reasons unrelated to shape and size (primarily perceived mosquito density, heat or an excess of nets). Households in higher wealth quintiles tend to own greater numbers of conical nets, indicating that they have the ability to obtain or purchase these nets on their own, and individuals resident in higher wealth quintile households also use conical nets preferentially. Conclusions The increased manufacturing costs for conical nets are not outweighed by the very small, often non-existent, increases in use rates in sub-Saharan Africa. Programmes that wish to explore the relationship between net attributes, preferences and use rates should include these questions in nationally representative household surveys to be able to capture trends across geographic and socio-economic groups. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1879-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hannah Koenker
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA.
| | - Joshua O Yukich
- Center for Applied Malaria Research, Tulane University School of Public Health, New Orleans, LA, USA
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