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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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Kuetche MTC, Tabue RN, Fokoua-Maxime CD, Evouna AM, Billong S, Kakesa O. Prevalence and risk factors determinants of the non-use of insecticide-treated nets in an endemic area for malaria: analysis of data from Cameroon. Malar J 2023; 22:205. [PMID: 37407962 DOI: 10.1186/s12936-023-04510-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/21/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Malaria is the main cause of morbidity and mortality in Cameroon. Insecticide-treated nets (ITNs) significantly reduce malaria transmission, but their use is not common in the population. This study aimed to estimate the nationwide prevalence of the non-use of ITNs and identify its major determinants. METHODS A cross-sectional study was conducted on interview data collected in households selected across all the regions of Cameroon through a non-probabilistic, random, 2-stage stratified sampling process. Descriptive statistics were used to describe the distribution of baseline characteristics across the households, and statistical tests assessed if the distribution of these characteristics differed significantly based on the non-use of ITNs, with 0.05 serving as a threshold of the p-value for statistical significance. The prevalence of the non-use of ITNs was estimated, and logistic regression models were used to tally the odds ratios of the associations between various factors and the non-use of ITNs, along with their 95% confidence intervals. The sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve (AUC) were determined, and the Hosmer Lemeshow test was used to measure the goodness of fit of each statistical model. RESULTS Of the 7593 households interviewed, 77% had at least one ITN and 59% of the population used ITNs. Only 72% of the population with at least one ITN used it. The logistic model of the multivariate analysis was significant at a 5% threshold. The AUC was 0.7087 and the error rate was 18.01%. The sensitivity and specificity of the model were 97.56% and 13.70%, respectively. The factors that were associated with ITN use were the presence of sufficient nets in the household (p < 0.0001), the region of residence (p < 0.0001), the level of education of the respondent (p < 0.0001), and the standard of living (p = 0.0286). Sex, age, colour preferences, as well as the shape and size of the nets were not associated with ITN use. CONCLUSIONS The use of ITNs in Cameroon was low and varied according to specific factors. These identified factors could be used as the foundations of effective sensitization campaigns on the importance of ITNs.
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Affiliation(s)
| | | | - C D Fokoua-Maxime
- School of Public Health, New York State University at Albany, Albany, NY, USA
| | - Armel M Evouna
- Cameroon Field Epidemiology Training Program, Yaoundé, Cameroon
| | - Serge Billong
- National Committee Against HIV-AIDS, Yaoundé, Cameroon
| | - Olivier Kakesa
- President's Malaria Initiative (PMI)-Measure Malaria Project, Yaoundé, Cameroon
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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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Aweis A, Salad AA, Araye FA, Ahmed AM, Wehlie OA, Osman AA, Akuku IG. Long-lasting insecticidal nets (LLINs) use among household members for protection against mosquito bite in Mogadishu districts. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000724. [PMID: 36962968 PMCID: PMC10019640 DOI: 10.1371/journal.pgph.0000724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 02/14/2023] [Indexed: 03/18/2023]
Abstract
Understanding long-lasting insecticidal nets (LLINs) utilization is important in monitoring and quantifying the impact of past and current prevention and control efforts of malaria. A cross-sectional study was carried out on a sample of 409 households in Mogadishu, to estimate the LLIN use and assess barriers to its utilization. A standardized questionnaire was used to collect data on demographics, malaria-related knowledge, and the use of preventive measures. LLINs use was assessed using multivariable generalized estimating equations with adjustment for clustering of study participants within the same household. Out of 409 households only 155 (37.9%) owned LLINs. Out of 237 owned LLINs, 199 (84.0%) were used. Median household size being 6.0 (3.0), intra-household net accessibility was low, with one net (42.6%) frequent. Most nets were from mass distribution (55.7%) and obtained '12 months ago'. Un-partnered respondents (unadjusted odds ratio [OR] 0.34, 95% CI 0.14, 0.82; p = 0.017) compared with partnered (married) respondents, large-sized household (adjusted OR 0.83, 96% CI 0.74-0.94; p = 0.002). There was marginal evidence of a greater odds of LLIN utilization among respondents knowledgeable of the correct cause of malaria, that is, mosquito bites (AOR 3.19, 95% CI 0.77, 13.2; p = 0.11) but was not statistically significant. Among households owning nets, most of the LLINs were hung the night prior to the survey (7.9% versus 98%) and was associated with greater marginal odds of utilization (p<0.001). Ownership of LLINs is insufficient in Mogadishu districts affecting household-level access and utilization. If this is not checked, this could weaken the progress made on malaria control efforts. LLIN utilization was modest and largely driven by recently acquired nets showing a desire to utilize them despite low coverage. These imply that mass and facility-based distribution, and awareness campaigns will remain relevant, but efforts for willingness-to-pay for LLINs should be strengthened to sustain coverage and replacements of worn-out nets.
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Affiliation(s)
- Ahmed Aweis
- Benadir University, Mogadishu, Somalia
- * E-mail:
| | | | | | | | | | | | - Isaiah Gumbe Akuku
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
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Babalola S, Kumoji K, Awantang GN, Oyenubi OA, Toso M, Tsang S, Bleu T, Achu D, Hedge J, Schnabel DC, Cash S, Van Lith LM, McCartney-Melstad AC, Nkomou Y, Dosso A, Lahai W, Hunter GC. Ideational factors associated with consistent use of insecticide-treated nets: a multi-country, multilevel analysis. Malar J 2022; 21:374. [PMID: 36474206 PMCID: PMC9724329 DOI: 10.1186/s12936-022-04384-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Malaria remains a major cause of morbidity and mortality in sub-Saharan Africa. Using insecticide-treated nets (ITNs) every night, year-round is critical to maximize protection against malaria. This study describes sociodemographic, psychosocial, and household factors associated with consistent ITN use in Cameroon, Côte d'Ivoire and Sierra Leone. METHODS Cross-sectional household surveys employed similar sampling procedures, data collection tools, and methods in three countries. The survey sample was nationally representative in Côte d'Ivoire, representative of the North and Far North regions in Cameroon, and representative of Bo and Port Loko districts in Sierra Leone. Analysis used multilevel logistic regression and sociodemographic, ideational, and household independent variables among households with at least one ITN to identify correlates of consistent ITN use, defined as sleeping under an ITN every night the preceding week. FINDINGS Consistent ITN use in Côte d'Ivoire was 65.4%, 72.6% in Cameroon, and 77.1% in Sierra Leone. While several sociodemographic and ideational variables were correlated with consistent ITN use, these varied across countries. Multilevel logistic regression results showed perceived self-efficacy to use ITNs and positive attitudes towards ITN use were variables associated with consistent use in all three countries. The perception of ITN use as a community norm was positively linked with consistent use in Cameroon and Côte d'Ivoire but was not significant in Sierra Leone. Perceived vulnerability to malaria was positively linked with consistent use in Cameroon and Sierra Leone but negatively correlated with the outcome in Côte d'Ivoire. Household net sufficiency was strongly and positively associated with consistent use in all three countries. Finally, the findings revealed strong clustering at the household and enumeration area (EA) levels, suggesting similarities in net use among respondents of the same EA and in the same household. CONCLUSIONS There are similarities and differences in the variables associated with consistent ITN use across the three countries and several ideational variables are significant. The findings suggest that a social and behaviour change strategy based on the ideation model is relevant for increasing consistent ITN use and can inform specific strategies for each context. Finally, ensuring household net sufficiency is essential.
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Affiliation(s)
- Stella Babalola
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Kuor Kumoji
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Grace N. Awantang
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Olamide A. Oyenubi
- grid.416147.10000 0004 0455 9186Department of Internal Medicine, Montefiore New Rochelle Hospital, New Rochelle, USA
| | - Michael Toso
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Samantha Tsang
- grid.21107.350000 0001 2171 9311Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Therese Bleu
- National Malaria Control Programme, Abidjan, Côte d’Ivoire
| | - Dorothy Achu
- National Malaria Control Programme, Yaounde, Cameroon
| | - Judith Hedge
- U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Yaounde, Cameroon
| | - David C. Schnabel
- U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Shelby Cash
- grid.416738.f0000 0001 2163 0069U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, USA
| | - Lynn M. Van Lith
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Anna C. McCartney-Melstad
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Yannick Nkomou
- PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Yaounde, Cameroon
| | - Abdul Dosso
- PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Abidjan, Côte d’Ivoire
| | - Wani Lahai
- National Malaria Control Programme, Freetown, Sierra Leone
| | - Gabrielle C. Hunter
- grid.449467.c0000000122274844PMI Breakthrough ACTION Project, Johns Hopkins Center for Communication Programs, Baltimore, USA
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Tairou F, Nawaz S, Tahita MC, Herrera S, Faye B, Tine RCK. Malaria prevention knowledge, attitudes, and practices (KAP) among adolescents living in an area of persistent transmission in Senegal: Results from a cross-sectional study. PLoS One 2022; 17:e0274656. [PMID: 36454893 PMCID: PMC9714833 DOI: 10.1371/journal.pone.0274656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION While malaria morbidity has sharply declined in several areas in Senegal, it remains an important problem in the southern part of the country, particularly among adolescents. Understanding adolescents' knowledge, attitudes, prevention and care-seeking practices is important to inform more targeted interventions aimed at optimizing adolescents' uptake of malaria prevention and control measures. This study assessed malaria-related knowledge, attitudes, and practices (KAP) among adolescents living in a highly persistent transmission area in Senegal. METHODS A community-based cross-sectional survey was conducted among 391 adolescents living in the Saraya health district. A multistage random sampling technique was used to select households. An electronic questionnaire developed on Open Data Kit (ODK), was used to collect data on socio-demographic characteristics, household assets, adolescents' knowledge of malaria, as well as their attitudes with regards to malaria prevention, and care-seeking behaviors. Bivariate and multivariate analyses were performed to assess factors associated with adolescents' KAP towards malaria. RESULTS Nearly, one-third of the participants had good knowledge of malaria (34.4%) and good practice in regards to malaria preventive measures (32.8%) while 59.0% had a positive attitude and 73.8% had good care-seeking behavior regarding malaria. Multivariate analysis revealed that a primary (aOR = 5.43, p = 0.002) or secondary level of education (aOR = 10.41, p = 0.000) was associated with good knowledge of malaria transmission, signs, and prevention measures. Male individuals had lower knowledge compared to female ones (aOR = 0.40, p = 0.001). Individuals belonging to households from the highest wealth quintile were more likely to have a positive attitude towards malaria compared to those from households in the lowest wealth quintile (aOR = 3.49, p = 0.004). The odds of positive attitude towards malaria decreased among participants with koranic and primary education level, respectively (aOR = 0.14, p = 0.005) and (aOR = 0.24, p = 0.019). A positive attitude was 1.89 more likely to be (aOR = 1.89, p = 0.026) associated with good practice of prevention measures compared to adolescents who demonstrated negative attitudes. Individuals from households in the fourth (aOR = 0.42, p = 0.024), middle (aOR = 0.34, P = 0.005), and second (aOR = 0.42, p = 0.027) wealth quintiles were less likely to use malaria prevention measures compared to those from households in the highest wealth quintile. CONCLUSION The study revealed that adolescents, generally have poor levels of malaria knowledge and low uptake of malaria prevention and control interventions. Targeted interventions for high-risk adolescents are needed, that focus on improving their knowledge of the disease and effective preventive measures, and on increasing their access to health care services and LLINs.
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Affiliation(s)
- Fassiatou Tairou
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Saira Nawaz
- Primary Health Care, PATH, Seattle, Washington, United States of America
| | - Marc Christian Tahita
- Clinical Research Unit of Nanoro, Direction Régionale du Centre-Ouest de l’Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Samantha Herrera
- Malaria & Neglected Tropical Diseases Division, PATH, Washington, District of Columbia, United States of America
| | - Babacar Faye
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Roger C. K. Tine
- Department of Medical Parasitology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
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Okiring J, Gonahasa S, Nassali M, Namuganga JF, Bagala I, Maiteki-Sebuguzi C, Opigo J, Nabende I, Nangendo J, Kabami J, Ssewanyana I, Kiwuwa SM, Nankabirwa JI, Dorsey G, Briggs J, Kamya MR, Staedke SG. LLIN Evaluation in Uganda Project (LLINEUP2)-Factors associated with coverage and use of long‑lasting insecticidal nets following the 2020-21 national mass distribution campaign: a cross-sectional survey of 12 districts. Malar J 2022; 21:293. [PMID: 36261818 PMCID: PMC9580445 DOI: 10.1186/s12936-022-04302-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/26/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In 2020-2021, long-lasting insecticidal nets (LLINs) were distributed nationwide in Uganda during the COVID-19 pandemic. A cross-sectional survey was conducted in 12 districts to evaluate the impact of the campaign 1-5 months after LLIN distribution. METHODS During April-May 2021, households were randomly selected from target areas (1-7 villages) surrounding 12 government-run health facilities established as Malaria Reference Centres; at least 50 households were enrolled per cluster. Outcomes included household ownership of LLINs distributed through the universal coverage campaign (UCC) (at least one UCC LLIN), adequate coverage of UCC LLINs (at least one UCC LLIN per 2 residents), and use of LLINs (resident slept under a LLIN the previous night). Multivariate logistic regression models were used to identify household- and individual-level factors associated with outcomes, controlling for clustering around health facilities. RESULTS In total, 634 households, with 3342 residents and 1631 bed-nets, were included. Most households (93.4%) owned at least 1 UCC LLIN, but only 56.8% were adequately covered by UCC LLINs. In an adjusted analysis, the factor most strongly associated with adequate coverage by UCC LLINs was fewer household residents (1-4 vs 7-14; adjusted odds ratio [aOR] 12.96, 95% CI 4.76-35.26, p < 0.001; 5-6 vs 7-14 residents; aOR 2.99, 95% CI 1.21-7.42, p = 0.018). Of the 3166 residents of households that owned at least one UCC LLIN, only 1684 (53.2%) lived in adequately covered households; 89.9% of these used an LLIN the previous night, compared to 1034 (69.8%) of 1482 residents living in inadequately covered households. In an adjusted analysis, restricted to residents of inadequately covered households, LLIN use was higher in children under-five than those aged 5-15 years (aOR 3.04, 95% CI 2.08-4.46, p < 0.001), and higher in household heads than distantly-related residents (aOR 3.94, 95% CI 2.38-6.51, p < 0.001). CONCLUSIONS Uganda's 2021-21 campaign was successful, despite the COVID-19 pandemic. In future campaigns, strategies should be adopted to ensure high LLIN coverage, particularly for larger households. A better understanding of the drivers of LLIN use within households is needed to guide future interventions, educational messages, and behaviour change communication strategies; school-aged children and distantly-related residents appear vulnerable and could be targeted.
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Affiliation(s)
- Jaffer Okiring
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda.
| | - Samuel Gonahasa
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Martha Nassali
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Jane F Namuganga
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Irene Bagala
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Catherine Maiteki-Sebuguzi
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Isaiah Nabende
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Joanita Nangendo
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jane Kabami
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Isaac Ssewanyana
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Steven M Kiwuwa
- Department of Child Health and Development Centre, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joaniter I Nankabirwa
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Jessica Briggs
- Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Sarah G Staedke
- Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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8
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Nlinwe NO, Nchefor FG, Takwi NB. Impact of long lasting insecticidal nets on asymptomatic malaria during pregnancy, in a rural and urban setting in Cameroon. Parasite Epidemiol Control 2022; 18:e00265. [PMID: 35992014 PMCID: PMC9375851 DOI: 10.1016/j.parepi.2022.e00265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/04/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
According to the world malaria report more malaria cases were reported in 2020 than in 2019, due to disruptions in the distribution of insecticide treated nets, caused by the COVID-19 pandemic. Consequently a projected 34.32% (11.6 million out of 33.8 million) pregnancies were exposed to malaria in the WHO African Region in 2020. This study was therefore designed to assess the impact of long lasting insecticidal nets (LLINs) on asymptomatic malaria in the pregnant women attending the Foumbot District Hospital (rural setting) and the Bamenda Regional Hospital (urban setting). This was a hospital based cross-sectional study done within three months from February to April 2021. A structured questionnaire and the CareStart™ Pf Malaria HRP2 qualitative rapid diagnostic test were used for data collection. Data were analysed using descriptive statistics, and Chi-square test. The relative risk, attributable risk, odds ratio, and likelihood ratio of malaria occurrence in exposed patients were determined by Chi-square (and Fisher's exact) test. The prevalence of asymptomatic malaria was 10.14% (63/621), with a higher prevalence among the pregnant women in the rural setting (12.21%; 37/303), than the urban setting (8.18%; 26/318). As indicated by the attributable risk, 21% of malaria incidence was attributed to absence of LLINs distribution in neighborhoods of the rural setting meanwhile 10% of malaria incidence is attributed to absence of LLINs distribution in neighborhoods of the urban setting. Regular screening for asymptomatic malaria in pregnancy and consistent free distribution of LLINs are recommended in endemic areas, especially in the rural settings.
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Affiliation(s)
- Nfor Omarine Nlinwe
- The University of Bamenda, Faculty of Health Sciences, Department of Medical Laboratory Science. P.O Box 39, Bambili, Bamenda, North West Region, Cameroon
| | - Fundoh Golory Nchefor
- The University of Bamenda, Faculty of Health Sciences, Department of Medical Laboratory Science. P.O Box 39, Bambili, Bamenda, North West Region, Cameroon
| | - Negesa Bright Takwi
- The University of Bamenda, Faculty of Health Sciences, Department of Medical Laboratory Science. P.O Box 39, Bambili, Bamenda, North West Region, Cameroon
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Konlan KD, Kossi Vivor N, Gegefe I, Hayford L. Factors associated with ownership and utilization of insecticide treated nets among children under five years in sub-Saharan Africa. BMC Public Health 2022; 22:940. [PMID: 35538524 PMCID: PMC9092763 DOI: 10.1186/s12889-022-13347-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background Insecticide-treated net (ITN) is a cost-effective means to control malaria and morbidity in under-five children. This study synthesizes the factors associated with using the ITN as a malaria prevention tool in sub-Saharan Africa. Methods There was an advanced search of four electronic databases, including PubMed Central, CINAHL, EMBASE, and Google Scholar, and identified articles between 2016 to April 2021. Following the title, abstract and full-text reading, 13 articles were deemed appropriate for this review. All the researchers developed, discussed, and accepted a matrix to extract relevant information from the studies. A convergent synthesis was adopted and allowed for integrating qualitative, quantitative, and mixed-method studies and transforming them into qualitative findings. Results Household and caregiver related factors that influenced utilization of the ITN were, Household heads having two or more sleeping places, a knowledge that ITN prevents malaria, the presence of hanging ITNs, high literacy, living female-headed households, birth spacing, unmarried mothers, and antenatal clinic attendance promoted utilization. Perceived malaria risk was a critical determinant of ITN ownership and utilization. Some factors that hindered the use of the ITN included hotness of the weather, absence of visible mosquitoes, cost, inadequate number, rooms designs, unaffordability, insufficient knowledge on causes of malaria, and poor attitude to use. Specific ITN factors that hindered use were color, chemicals use, odor, and shape. Conclusion It is important to use integrated multi-sectoral and culturally appropriate interventions to encourage households to prioritize and utilize the ITN in under-5 children.
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Affiliation(s)
- Kennedy Diema Konlan
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana. .,College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | | | - Isaac Gegefe
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Linda Hayford
- General Nursing Unit, St. Anthony's Hospital, Dzodze, Ghana
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Njatosoa AF, Mattern C, Pourette D, Kesteman T, Rakotomanana E, Rahaivondrafahitra B, Andriamananjara M, Harimanana A, Razafindrakoto J, Raboanary E, Andrianasolo A, Rogier C. Family, social and cultural determinants of long-lasting insecticidal net (LLIN) use in Madagascar: secondary analysis of three qualitative studies focused on children aged 5-15 years. Malar J 2021; 20:168. [PMID: 33771162 PMCID: PMC7995690 DOI: 10.1186/s12936-021-03705-2] [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: 08/19/2020] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Although it is accepted that long-lasting insecticidal net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; the malaria prevalence is highest in this age group. The purpose of this research is to summarize recent qualitative studies describing LLIN use among the Malagasy people with a focus on children aged 5–15 years. Methods Qualitative data from three studies on malaria conducted between 2012 and 2016 in 10 districts of Madagascar were analysed. These studies cover all malaria epidemiological profiles and 10 of the 18 existing ethnic groups in Madagascar. A thematic analysis was conducted on the collected data from semi-structured interviews, direct observation data, and informal interviews. Results A total of 192 semi-structured interviews were conducted. LLINs are generally perceived positively because they protect the health and well-being of users. However, regional representations of mosquito nets may contribute to LLIN lower use by children over 5 years of age including the association between married status and LLIN use, which leads to the refusal of unmarried young men to sleep under LLINs; the custom of covering the dead with a mosquito net, which leads to fear of LLIN use; and taboos governing sleeping spaces for siblings of opposite sexes, which leads to LLIN shortages in households. Children under 5 years of age are known to be the most vulnerable age group for acquiring malaria and, therefore, are prioritized for LLIN use when there are limited supplies in households. In contrast, children over 5 years of age, who are perceived to be at less risk for malaria, often sleep without LLINs. Conclusions Perceptions, social practices and regional beliefs regarding LLINs and vulnerability to malaria contribute to the nonuse of LLINs among children over 5 years of age in Madagascar. Modifying LLIN policies to account for these factors may increase LLIN use in this age group and reduce disease burden.
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Affiliation(s)
- Ammy Fiadanana Njatosoa
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
| | - Chiarella Mattern
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,IRD, Ceped (Institut de Recherche Pour Le Développement, Université de Paris, INSERM), Paris, France
| | - Dolorès Pourette
- IRD, Ceped (Institut de Recherche Pour Le Développement, Université de Paris, INSERM), Paris, France
| | - Thomas Kesteman
- Unité de Recherche Sur Le Paludisme, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Elliot Rakotomanana
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Mauricette Andriamananjara
- Programme National de Lutte Contre Le Paludisme, Ministère de La Santé Publique, Antananarivo, Madagascar
| | - Aina Harimanana
- Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Emma Raboanary
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Andry Andrianasolo
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Institut International Des Sciences Sociales, Antananarivo, Madagascar
| | - Christophe Rogier
- Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Primum Vitare, Paris, France
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Fru PN, Cho FN, Tassang AN, Fru CN, Fon PN, Ekobo AS. Ownership and Utilisation of Long-Lasting Insecticidal Nets in Tiko Health District, Southwest Region, Cameroon: A Cross-Sectional Study. J Parasitol Res 2021; 2021:8848091. [PMID: 33623716 PMCID: PMC7875632 DOI: 10.1155/2021/8848091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/06/2021] [Accepted: 01/18/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Malaria is and remains a serious health concern in Africa. In Cameroon, where malaria is endemic and a major public health problem, the major control measure put in place is the use of long-lasting insecticidal nets (LLINs). In the Tiko Health District (THD), the challenges have been to assess and to evaluate the ownership and utilisation of LLINs. This study sought to assess the ownership and utilisation rates of LLINs in the THD. Methodology. A cross-sectional survey involving 418 households was conducted in four health areas in the THD. A structured questionnaire was used to collect data on LLIN ownership and utilisation as well as sociodemographic characteristics. RESULTS The ownership of at least one LLIN per household, coverage, and accessibility were, respectively, 89%, 56.2%, and 66.3%, while installing LLINs on all beds in the household, sleeping under LLINs the previous night (SULPN), and universal utilisation were 72%, 24.9%, and 14.1%, respectively. Factors significantly associated with the ownership of at least one LLIN per household were respondent's age and gender. Heat (21.1%) and forgetfulness (6.5%) were the main reasons postulated for irregular utilisation of LLINs. CONCLUSION The ownership LLINs failed to guarantee utilisation and definitely effective control of malaria in the THD, as expected. Continuous and appropriate use of LLINs is indispensable, in addition to periodic sanitation, booster campaigns of LLIN distribution, and evaluation research for effective prevention and control of malaria.
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Affiliation(s)
- Paulette Ngum Fru
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 63 Buea, Cameroon
- District Health Service Tiko, South West Regional Delegation of Health, Ministry of Public Health, Cameroon
| | - Frederick Nchang Cho
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon
- Catholic School of Health Sciences, Saint Elizabeth Hospital Complex, P.O. Box 8 Shisong-Nso, Cameroon
- Central African Network for Tuberculosis, HIV/AIDS and Malaria (CANTAM), University of Buea, P.O. Box 63 Buea, Cameroon
- Global Health Systems Solutions, Cameroon
| | - Andrew N. Tassang
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon
- Buea Regional Hospital Annex, Buea, Cameroon
- Atlantic Medical Foundation, Mutengene, Cameroon
| | - Celestina Neh Fru
- Atlantic Medical Foundation, Mutengene, Cameroon
- Department of Sociology and Anthropology, Faculty of Social and Management Sciences, University of Buea, P.O. Box 63 Buea, Cameroon
| | - Peter Nde Fon
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 63 Buea, Cameroon
- Solidarity Hospital, Buea, Cameroon
| | - Albert Same Ekobo
- Faculty of Sciences, University of Yaoundé I, P.O. Box 337, Yaoundé, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon
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Zerdo Z, Bastiaens H, Anthierens S, Massebo F, Masne M, Biresaw G, Shewangizaw M, Tunje A, Chisha Y, Yohannes T, Van Geertruyden JP. Long-lasting insecticide-treated bed net ownership, utilization and associated factors among school-age children in Dara Mallo and Uba Debretsehay districts, Southern Ethiopia. Malar J 2020; 19:369. [PMID: 33059669 PMCID: PMC7559455 DOI: 10.1186/s12936-020-03437-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Malaria is one of the major causes of morbidity and mortality among school-age children (SAC) in sub-Saharan Africa. SAC account for more than 60% of the reservoir of malaria transmission, but they are given less emphasis in prioritizing malaria prevention interventions. This study was aimed at assessing the ownership of long-lasting insecticide treated bed nets (LLINs), its utilization and factors associated with ownership of LLINs by households and LLINs utilization among SAC in malaria-prone areas of Dara Mallo and Uba Debretsehay districts in Southern Ethiopia, October to December 2019. Methods This study is part of a baseline assessment in a cluster-randomized controlled trial. The data was collected through interview and observation, following a structured questionnaire, of 2261 SAC households. Univariable and multivariable multilevel logistic regressions were used to assess the association between LLINs ownership and utilization and potential predictor variables. Odds ratio (OR) and corresponding 95% confidence interval (CI) were used to determine the strength and statistical significance of association. Results The ownership of at least one LLIN by households of SAC was about 19.3% (95% CI 17.7–21.0%) but only 10.3% % (95% CI 7.7–13.7%) of these households had adequate access of bed nets to the household members. Ownership of bed net was marginally affected by living in semi-urban area (adjusted OR = 2.6; 95% CI 1.0–6.9) and occupational status of the household head being a civil servant (adjusted OR = 2.7; 95% CI 0.9–7.9). About 7.8% (95% CI 6.7–10.0%) of all SAC participated in the study and 40.4% (95% CI 57.4–66.7%) of children in households owning at least one LLIN passed the previous night under LLIN. LLIN utilization by SAC conditional to presence of at least one net in the household was significantly correlated with education level of mother above grade 6 (adjusted OR = 3.4; 95% CI 1.3–9.3) and the household size to bed net ratio less than or equal to 2 (adjusted OR = 20.7; 95% CI 4.7–132.5). Conclusion Ownership of bed net was lower than universal coverage of at least one bed net for two individuals. It is important to monitor replacement needs and educate mothers with low education level with their SAC on the benefit of consistent utilization of bed nets.
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Affiliation(s)
- Zerihun Zerdo
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia. .,Global Health Institute, Antwerp University, Antwerp, Belgium.
| | - Hilde Bastiaens
- Department of Family Medicine and Population Health, Antwerp University, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, Antwerp University, Antwerp, Belgium
| | - Fekadu Massebo
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Matewos Masne
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gelila Biresaw
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Misgun Shewangizaw
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abayneh Tunje
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Yilma Chisha
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tsegaye Yohannes
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Getting the message across: Characterizing a need to bridge public health messaging for tuberculosis across a rural/urban and CHW/traditional healer divide in Madagascar (A review). SCIENTIFIC AFRICAN 2020. [DOI: 10.1016/j.sciaf.2020.e00321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Babalola OJ, Sambo MN, Idris SH, Ajayi IOO, Ajumobi O, Nguku P. Factors associated with utilization of LLINs among women of child-bearing age in Igabi, Kaduna State, Nigeria. Malar J 2019; 18:412. [PMID: 31823793 PMCID: PMC6902412 DOI: 10.1186/s12936-019-3046-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The long-lasting insecticidal nets (LLIN) are effective against prevention of malaria and its utilization has been proven to save lives. Despite the mass distribution of LLIN, Nigeria remains the country with the highest malaria burden in Africa. The awareness of LLIN in Nigeria is high, but the utilization is low. The aim of this work is to describe factors associated with the utilization of LLIN among women of child-bearing age (WCBA) in Igabi, Kaduna, Nigeria. METHODS A cross-sectional survey was conducted among 630 WCBA selected using a multi-stage sampling at 63 randomly selected villages in Igabi Local Government Area of Kaduna State. Trained female data collectors administered pre-tested structured questionnaires adapted from the Malaria Indicator Survey. Information collected were demographic profile, knowledge of LLIN as a preventive strategy for malaria, and LLIN ownership and utilization. LLIN utilization was assessed by identifying household members that slept under the hanged LLIN the night before the survey. Questions on the awareness of LLIN, ability to define what it is, use of LLIN, what differentiates LLIN from other bed nets, and duration of use before replacement, were scored and categorized as good, average and poor knowledge of LLIN. RESULTS A total of 629 WCBA was sampled, their mean age (± SD) was 29.3 (± 6.2) years, 22.0% were pregnant, 40.5% had no formal education, 41.1% were employed, and 47.7% lived in rural communities. Awareness and good knowledge about LLINs for the prevention of malaria was 96.0% and 24.0%, respectively. The proportion of women who slept under a LLIN the night before the survey (utilization) was 70.0% and slightly higher (74.0%) among pregnant WCBA. Women who lived in rural communities were more likely to utilize LLINs compared to their urban counterparts (OR 3.4; 95% CI 2.3-4.9). Younger women (aged < 30 years) were less likely to utilize LLINs compared to the older women (OR 0.7; 95% CI 0.5-0.9). CONCLUSIONS The knowledge of LLIN among WCBA was poor, but LLIN utilization was moderate. Living in rural communities and older WCBA were significant characteristics associated with LLIN utilization. Strategies that will improve the utilization of LLIN among the young and urban WCBA should be the focus of the Malaria Elimination Programme (MEP).
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Affiliation(s)
- Obafemi J Babalola
- Liberia Field Epidemiology and Laboratory Training Programme, National Public Health Institute, Congo Town, Montserrado, Liberia. .,Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), Asokoro District, Abuja, Nigeria.
| | - Mohammed N Sambo
- Department of Community Medicine, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Suleiman H Idris
- Department of Community Medicine, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Ike-Oluwapo O Ajayi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Olufemi Ajumobi
- Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), Asokoro District, Abuja, Nigeria.,National Malaria Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), Asokoro District, Abuja, Nigeria
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Solomon T, Loha E, Deressa W, Gari T, Overgaard HJ, Lindtjørn B. Low use of long-lasting insecticidal nets for malaria prevention in south-central Ethiopia: A community-based cohort study. PLoS One 2019; 14:e0210578. [PMID: 30629675 PMCID: PMC6328101 DOI: 10.1371/journal.pone.0210578] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction A decline in malaria morbidity and mortality has been documented in Ethiopia since 2005 following a scale-up of the distribution of long-lasting insecticidal nets (LLINs). However, universal access to LLINs ownership and use has not yet been achieved. This study aimed to determine ownership and use of LLINs over time in south-central Ethiopia. Methods A cohort of 17,142 individuals residing in 3,006 households was followed-up from October 2014 to January 2017 (121 weeks). New PermaNet2.0 LLINs were given to households in October 2014. Once per week, the LLIN use status was documented for each individual. A survey was conducted after 110 weeks of LLIN distribution to determine LLIN ownership. A multilevel negative binomial regression model was fitted to identify significant predictors of LLIN use. Results At baseline, the LLIN ownership was 100%. After 110 weeks only 233 (8%) of the households owned at least one LLIN. The median proportion of LLIN use per individuals during the study period was only 14%. During the first year (week 1–52) the average LLIN use per individuals was 36% and during the second year (week 53–104) it was 4.6%. More frequent LLIN use was reported among age group [5–14 years (adjusted IRR = 1.13, 95% CI 1.04–1.22), 15–24 years (adjusted IRR = 1.33, 95% CI 1.23–1.45), ≥25 years (adjusted IRR = 1.99, 95% CI 1.83–2.17)] compared to <5 years, and household head educational status [read and write (adjusted IRR = 1.17, 95% CI 1.09–1.26), primary (adjusted IRR = 1.20, 95% CI 1.12–1.27), secondary or above (adjusted IRR = 1.20, 95% CI (1.11–1.30)] compared to illiterate. Having a family size of over five persons (adjusted IRR = 0.78, 95% CI 0.73–0.84) was associated with less frequent use of LLINs compared to a family size of ≤5 persons. Conclusions The study showed a low LLIN ownership after 110 weeks and a low LLIN use during 121 weeks of follow-up, despite 100% LLIN coverage at baseline. The study highlights the need to design strategies to increase LLIN ownership and use for setting similar to those studied here.
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Affiliation(s)
- Tarekegn Solomon
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
- * E-mail:
| | - Eskindir Loha
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Taye Gari
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Hans J. Overgaard
- Faculty of Science and Technology, Norwegian University of Life Sciences, Akershus, Norway
| | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
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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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Utilization of Long-Lasting Insecticide Treated Nets and Parasitaemia at 6 Months after a Mass Distribution Exercise among Households in Mbarara Municipality, Uganda: A Cross-Sectional Community Based Study. Malar Res Treat 2018; 2018:4387506. [PMID: 30155242 PMCID: PMC6093084 DOI: 10.1155/2018/4387506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/24/2018] [Accepted: 06/27/2018] [Indexed: 11/18/2022] Open
Abstract
Background Utilization of long-lasting insecticide treated nets (LLINs) after free and mass distribution exercise has not been adequately studied. The objectives of this study were to assess ownership and utilization of LLINs following a mass distribution campaign in a Ugandan urban municipality. Methods We conducted a cross-sectional study in western Uganda among households with children under 5 years, at 6 months after a mass LLIN distribution exercise. We administered a questionnaire to measure LLIN ownership and utilization. We also measured parasitaemia among children under five years. Results Of the 346 households enrolled, 342 (98.8%) still owned all the LLINs. LLIN use was reported among 315 (91.1%) adult respondents and among 318 (91.9%) children under five. Parasitaemia was detected among 10 (2.9%) children under five. Males (OR=2.65, 95% CI 0.99-7.07), single respondents (OR=10.35, 95% CI 1.64-65.46), having a fitting bed net size (OR= 3.59, 95% CI 1.71-7.59), and no childhood malaria episode reported in the home in the last 12 months (OR=1.69, 95% CI 1.02-2.83) were all associated with LLIN use. Conclusions Ownership of LLIN is very high, and parasitaemia among the children was very low. Low parasitaemia may be attributed to high LLIN utilization. Long term follow-up should be done to determine durability of the ownership and utilization.
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