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Lasmi K, Elimian K, Donovan L, Tounaikok N, Traoré A, Gils T, Rassi C, Marasciulo M, Richardson S, Tougri G, Diar MSI, Baker K. Barriers to the quality delivery of seasonal malaria chemoprevention in Chad and Burkina Faso: a qualitative exploration of caregivers and community distributors' perspectives. Malar J 2024; 23:216. [PMID: 39030554 PMCID: PMC11264698 DOI: 10.1186/s12936-024-05034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/01/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Recommended since 2012 by the World Health Organization (WHO), seasonal malaria chemoprevention (SMC) is a community-based intervention to prevent malaria in children in African regions where malaria transmission follows a seasonal pattern. Following the publication of consolidated WHO guidelines for malaria, SMC is expected to reach more children in new geographies in future years. Though SMC has been shown to reduce malaria-related morbidity and mortality, there is potential for quality improvement of the intervention implementation. Assisted by ten quality standards from a framework developed by Malaria Consortium, this paper aims to better understand the quality of SMC implementation and identify potential barriers to quality delivery of SMC. METHODS A qualitative thematic analysis on data collected after the annual SMC rounds implemented in Burkina Faso and Chad in 2019 was conducted. Sixteen focus group discussions conducted with caregivers and community distributors were analysed. Three selected quality standards for SMC delivery; planning and enumeration; community engagement; and administration of SMC medicines provided overarching quality themes under which subthemes were identified. RESULTS Eight subthemes relating to the three quality standards were identified. Although SMC was well accepted by communities in both settings, common barriers to the quality delivery of SMC were identified including difficulty ensuring adherence to the SMC administration protocol; difficulties reaching mobile populations; concerns around adverse drug reactions; rumours, and concerns about SMC safety; and community distributors' working conditions. Context-specific barriers included: the suboptimal timeliness of the SMC round in Burkina Faso, and the lack of involvement of female caregivers in mobilization activities in Chad. CONCLUSION In the context of increased adoption of SMC, this paper provides relevant insights and recommendations for the improved implementation of SMC programmes. These include the integration of strategies addressing communities' concerns around adverse drug reactions, gender-specific mobilization strategies, and attention to community distributors' working conditions. It also highlights the importance and utility of further, robust research on the quality of SMC delivery.
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Affiliation(s)
- Kévin Lasmi
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
| | - Kelly Elimian
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | | | - Adama Traoré
- Malaria Consortium, Burkina Faso Country Office, Ouagadougou, Burkina Faso
| | - Tinne Gils
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Global Health Institute, University of Antwerp, Wilrijk, Belgium
| | | | | | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Gauthier Tougri
- Programme national de lutte contre le paludisme, Ouagadougou, Burkina Faso
| | | | - Kevin Baker
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Malaria Consortium, London, UK
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Moukénet A, Moudiné K, Ngarasta N, Hinzoumbe CK, Seck I. Malaria infection and predictor factors among Chadian nomads' children. BMC Public Health 2024; 24:918. [PMID: 38549091 PMCID: PMC10979592 DOI: 10.1186/s12889-024-18454-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 03/26/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND In Chad, malaria remains a significant public health concern, particularly among nomadic populations. Geographical factors and the mobility of human populations have shown to be associated with the diversity of Plasmodium species. The study aims to describe the malaria prevalence among nomadic children and to investigate its associated factors. METHODS A cross-sectional study was conducted in February and October 2021 among nomadic communities in Chad. Blood sample were collected and tested from 187 Arab, Fulani and Dazagada nomadic children aged 3-59 months using malaria rapid diagnostic test (RDT). A structured electronic questionnaire was administered to their parents to collect information about the socio‑economic data. Malaria testing results were categorized according to the SD BIOLINE Malaria Ag Pf/Pan RDT procedures. Logistic regression analysis was used to determine key risk factors explaining the prevalence of malaria. STATA version IC 13 was used for statistical analysis. RESULTS The overall malaria prevalence in nomadic children was 24.60%, with 65.20% being Plasmodium falciparum species and 34.8% mixed species. Boys were twice as likely (COR = 1.83; 95% CI, 0.92-3.62; p = 0.083) to have malaria than girls. Children whose parents used to seek traditional drugs were five times more likely (AOR = 5.59; 95% CI, 1.40-22.30, p = 0.015) to have malaria than children whose parents used to seek health facilities. Children whose parents reported spending the last night under a mosquito net were one-fifth as likely (AOR = 0.17; 95% CI, 0.03-0.90, p = 0.037) to have malaria compared to children whose parents did not used a mosquito net. Furthermore, Daza children were seventeen times (1/0.06) less likely (AOR = 0.06; 95% CI, 0.01-0.70, p = 0.024) to have malaria than Fulani children and children from households piped water as the main source were seven times more likely (AOR = 7.05; 95% CI, 1.69-29.45; p = 0.007) to have malaria than those using surface water. CONCLUSIONS Malaria remains a significant public health issue in the nomadic communities of Chad. Community education and sensitization programs within nomad communities are recommended to raise awareness about malaria transmission and control methods, particularly among those living in remote rural areas. The National Malaria Control Program (NMCP) should increase both the coverage and use of long-lasting insecticidal nets (LLINs) and seasonal malaria chemoprevention (SMC) in addition to promoting treatment-seeking behaviors in nomadic communities.
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Affiliation(s)
- Azoukalné Moukénet
- Cheikh Anta Diop University, Dakar, Senegal.
- University of Ndjamena, Ndjamena, Chad.
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Gatiba P, Laury J, Steinhardt L, Hwang J, Thwing JI, Zulliger R, Emerson C, Gutman JR. Contextual Factors to Improve Implementation of Malaria Chemoprevention in Children: A Systematic Review. Am J Trop Med Hyg 2024; 110:69-78. [PMID: 38081055 PMCID: PMC10793032 DOI: 10.4269/ajtmh.23-0478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/15/2023] [Indexed: 01/05/2024] Open
Abstract
Malaria remains a leading cause of childhood morbidity and mortality in sub-Saharan Africa, particularly among children under 5 years of age. To help address this challenge, the WHO recommends chemoprevention for certain populations. For children and infants, the WHO recommends seasonal malaria chemoprevention (SMC), perennial malaria chemoprevention (PMC; formerly intermittent preventive treatment in infants [IPTi]), and, more recently, intermittent preventive treatment in school children (IPTsc). This review describes the contextual factors, including feasibility, acceptability, health equity, financial considerations, and values and preferences, that impact implementation of these strategies. A systematic search was conducted on July 5, 2022, and repeated April 13, 2023, to identify relevant literature. Two reviewers independently screened titles for eligibility, extracted data from eligible articles, and identified and summarized themes. Of 6,295 unique titles identified, 65 were included. The most frequently evaluated strategy was SMC (n = 40), followed by IPTi (n = 18) and then IPTsc (n = 6). Overall, these strategies were highly acceptable, although with IPTsc, there were community concerns with providing drugs to girls of reproductive age and the use of nonmedical staff for drug distribution. For SMC, door-to-door delivery resulted in higher coverage, improved caregiver acceptance, and reduced cost. Lower adherence was noted when caregivers were charged with giving doses 2 and 3 unsupervised. For SMC and IPTi, travel distances and inclement weather limited accessibility. Sensitization and caregiver education efforts, retention of high-quality drug distributors, and improved transportation were key to improving coverage. Additional research is needed to understand the role of community values and preferences in chemoprevention implementation.
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Affiliation(s)
- Peris Gatiba
- Public Health Institute, Oakland, California
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica Laury
- Public Health Institute, Oakland, California
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jimee Hwang
- U.S. President’s Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julie I. Thwing
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rose Zulliger
- U.S. President’s Malaria Initiative, United States Agency for International Development, Washington, District of Columbia
| | - Courtney Emerson
- U.S. President’s Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julie R. Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Molina-de la Fuente I, Sagrado Benito MJ, Lasry E, Ousley J, García L, González V, Pasquale HA, Julla A, Uwiragiye P, Abdi AM, Chol BT, Abubakr B, Benito A, Casademont C, Berzosa P, Nanclares C. Seasonal malaria chemoprevention in a context of high presumed sulfadoxine-pyrimethamine resistance: malaria morbidity and molecular drug resistance profiles in South Sudan. Malar J 2023; 22:345. [PMID: 37950227 PMCID: PMC10637007 DOI: 10.1186/s12936-023-04740-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Seasonal malaria chemoprevention (SMC) using sulfadoxine-pyrimethamine plus amodiaquine (SP-AQ), is a community-based malaria preventive strategy commonly used in the Sahel region of sub-Saharan Africa. However, to date it has not been implemented in East Africa due to high SP resistance levels. This paper is a report on the implementation of SMC outside of the Sahel in an environment with a high level of presumed SP-resistance: five cycles of SMC using SPAQ were administered to children 3-59 months during a period of high malaria transmission (July-December 2019) in 21 villages in South Sudan. METHODS A population-based SMC coverage survey was combined with a longitudinal time series analysis of health facility and community health data measured after each SMC cycle. SMC campaign effectiveness was assessed by Poisson model. SPAQ molecular resistance markers were additionally analysed from dried blood spots from malaria confirmed patients. RESULTS Incidence of uncomplicated malaria was reduced from 6.6 per 100 to an average of 3.2 per 100 after SMC administration (mean reduction: 53%) and incidence of severe malaria showed a reduction from 21 per 10,000 before SMC campaign to a mean of 3.3 per 10,000 after each cycle (mean reduction: 84%) in the target group when compared to before the SMC campaign. The most prevalent molecular haplotype associated with SP resistance was the IRNGE haplotype (quintuple mutant, with 51I/59R/108N mutation in pfdhfr + 437G/540E in pfdhps). In contrast, there was a low frequency of AQ resistance markers and haplotypes resistant to both drugs combined (< 2%). CONCLUSIONS The SMC campaign was effective and could be used as an additional preventive tool in seasonal malaria settings outside of the Sahel, especially in areas where access to health care is unstable. Malaria case load reduction was observed despite the high level of resistance to SP.
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Affiliation(s)
| | | | - Estrella Lasry
- Médecins Sans Frontières, Carrer de Zamora, 54, 08005, Barcelona, Spain
| | | | - Luz García
- Institute of Health Carlos III, Madrid, Spain
| | | | | | - Ahmed Julla
- National Malaria Control Programme, Ministry of Health, Juba, South Sudan
| | | | | | | | | | - Agustín Benito
- Institute of Health Carlos III, Madrid, Spain
- Centro de Investigación Biomedica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | | | - Pedro Berzosa
- Institute of Health Carlos III, Madrid, Spain
- Centro de Investigación Biomedica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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Bakai TA, Thomas A, Iwaz J, Atcha-Oubou T, Tchadjobo T, Khanafer N, Rabilloud M, Voirin N. Effectiveness of seasonal malaria chemoprevention in three regions of Togo: a population-based longitudinal study from 2013 to 2020. Malar J 2022; 21:400. [PMID: 36587191 PMCID: PMC9804945 DOI: 10.1186/s12936-022-04434-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In 2012, the World Health Organization (WHO) recommended seasonal malaria chemoprevention (SMC) in areas of high seasonal transmission. Though implemented since 2013, the effectiveness of SMC in Togo was never evaluated. METHODS This study concerned routine data from 2013 to 2020 mass SMC campaigns for children under five in all health facilities of three Regions of Togo. Treatment coverage, reasons for non-treatment, and SMC-attributable adverse reactions were analysed per year and treatment round. Random effect logistic models estimated SMC effectiveness per health district, year, and treatment round. RESULTS The overall coverage was 98% (7,971,877 doses for 8,129,668 children). Contraindication was the main reason for non-administration. Over the study period, confirmed malaria cases decreased from 11,269 (1st round of 2016) to 1395 (4th round of 2020). Only 2,398 adverse reactions were reported (prevalence: 3/10,000), but no severe Lyell syndrome or Stevens-Johnson-type skin reaction. Compared to 2016, malaria prevalence decrease was estimated at 22.6% in 2017 (p < 0.001) and 75% in 2020 (p < 0.001). SMC effectiveness ranged from 76.6% (2nd round) to 96.2% (4th round) comparison with the 1st round. CONCLUSIONS SMC reduced significantly malaria cases among children under five. The results reassure all actors and call for effort intensification to reach the WHO goals for 2030.
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Affiliation(s)
- Tchaa A. Bakai
- grid.25697.3f0000 0001 2172 4233Université de Lyon, Lyon, France ,grid.7849.20000 0001 2150 7757Université Lyon 1, 69100 Villeurbanne, France ,grid.413852.90000 0001 2163 3825Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69003 Lyon, France ,grid.462854.90000 0004 0386 3493Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, 69100 Villeurbanne, France ,EPIMOD (Epidemiology and Modelling in Infectious Diseases), 01240 Lent, France ,Programme National de Lutte contre le Paludisme (PNLP), 01 BP 518, Lomé, Togo ,grid.412180.e0000 0001 2198 4166Service d’Hygiène, Épidémiologie et Prévention, Hôpital Édouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Anne Thomas
- grid.25697.3f0000 0001 2172 4233Université de Lyon, Lyon, France ,grid.7849.20000 0001 2150 7757Université Lyon 1, 69100 Villeurbanne, France ,grid.413852.90000 0001 2163 3825Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69003 Lyon, France ,grid.462854.90000 0004 0386 3493Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, 69100 Villeurbanne, France ,EPIMOD (Epidemiology and Modelling in Infectious Diseases), 01240 Lent, France
| | - Jean Iwaz
- grid.25697.3f0000 0001 2172 4233Université de Lyon, Lyon, France ,grid.7849.20000 0001 2150 7757Université Lyon 1, 69100 Villeurbanne, France ,grid.413852.90000 0001 2163 3825Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69003 Lyon, France ,grid.462854.90000 0004 0386 3493Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, 69100 Villeurbanne, France
| | - Tinah Atcha-Oubou
- Programme National de Lutte contre le Paludisme (PNLP), 01 BP 518, Lomé, Togo
| | - Tchassama Tchadjobo
- Programme National de Lutte contre le Paludisme (PNLP), 01 BP 518, Lomé, Togo
| | - Nagham Khanafer
- grid.412180.e0000 0001 2198 4166Service d’Hygiène, Épidémiologie et Prévention, Hôpital Édouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Muriel Rabilloud
- grid.25697.3f0000 0001 2172 4233Université de Lyon, Lyon, France ,grid.7849.20000 0001 2150 7757Université Lyon 1, 69100 Villeurbanne, France ,grid.413852.90000 0001 2163 3825Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69003 Lyon, France ,grid.462854.90000 0004 0386 3493Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, 69100 Villeurbanne, France
| | - Nicolas Voirin
- EPIMOD (Epidemiology and Modelling in Infectious Diseases), 01240 Lent, France
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Koko DC, Maazou A, Jackou H, Eddis C. Analysis of attitudes and practices influencing adherence to seasonal malaria chemoprevention in children under 5 years of age in the Dosso Region of Niger. Malar J 2022; 21:375. [PMID: 36474264 PMCID: PMC9727940 DOI: 10.1186/s12936-022-04407-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Seasonal malaria chemoprevention (SMC) consists of the intermittent administration of a 3 day course of anti-malarial medications during the months of highest malaria risk in the Sahel region, where malaria transmission is highly seasonal. SMC is an effective intervention to reduce episodes of uncomplicated and severe malaria in children. However, morbidity cannot be lowered without adherence to medications. The objective of this study was to examine SMC medication adherence and to identify the attitudes and practices of caregivers during the 2020 SMC campaign in the Dosso region. METHODS This study was conducted based on data from independent monitoring using random cluster sampling. Adherence levels and the attitudes and practices of caregivers were evaluated using data from caregivers' self-reports and analysed according to Bernard Vrijens' taxonomy. RESULTS At the initiation of treatment phase, 99% of children (N = 2296) received their first administration of medication, with 90% of caregivers (N = 1436) knowing that the medications help prevent malaria. However, only 56% of caregivers (N = 1856) reported that treatment initiation took place under direct observation by the distributor. At the implementation of treatment phase, 90% of children (N = 2132) took their medication on the second day and 84% (N = 1068) took it the third day. "Forgetting," "not having time," and "the mother's absence" were the main reasons caregivers gave to explain discontinuation of the 3 day course of medication. CONCLUSION This simple, low-cost survey demonstrated that coverage of SMC and adherence by caregivers to completing the full 3 day medication course was high. The survey also showed that knowledge, attitudes, and practices of some caregivers regarding adherence to medications during the SMC campaign could be improved. Expanding distributors' training, developing and providing them with tools for interpersonal communication, and strengthening supervision could lead to even higher adherence.
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Affiliation(s)
| | - Aminata Maazou
- U.S. PMI Impact Malaria Project, Population Services International, Niamey, Niger
| | - Hadiza Jackou
- Programme National de Lutte Contre le Paludisme, Niamey, Niger
| | - Charlotte Eddis
- grid.507606.2U.S. PMI Impact Malaria Project, Population Service International, Washington, DC USA
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Adjei MR, Kubio C, Buamah M, Sarfo A, Suuri T, Ibrahim S, Sadiq A, Abubakari II, Baafi JV. Effectiveness of seasonal malaria chemoprevention in reducing under-five malaria morbidity and mortality in the Savannah Region, Ghana. Ghana Med J 2022; 56:64-70. [PMID: 37449257 PMCID: PMC10336463 DOI: 10.4314/gmj.v56i2.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE To assess the effectiveness of seasonal malaria chemoprevention (SMC) in reducing under-five malaria morbidity and mortality. DESIGN Under-five malaria data for confirmed episodes, deaths, and number of children dosed per cycle of SMC campaign were extracted from the District Health Information Management System (DHIMS-2) for 2018-2019. Data verification was done to compare extracted data with the source for completeness and consistency. Association between SMC and the main outcome variables (malaria cases and mortality) was computed from 2X2 tables and reported as rate ratios at a 95% confidence level. SETTING All seven (7) districts in Savannah Region, Ghana. PARTICIPANTS Children under five years. INTERVENTION Sulphadoxine-Pyrimethamine and Amodiaquine (SPAQ) prophylaxis given monthly, four times, durng the rainy season (July to October). MAIN OUTCOME MEASURES SMC coverage per cycle and under-five malaria morbidity and mortality ratios. RESULTS Over 370,000 dose packs of SPAQ were administered with an average cycle coverage of 93%. There was approximately 17% (p<0.01) and 67% (p=0.047) reduction in malaria-related morbidity and mortality, respectively, in the implementation year compared with the baseline. This translated into nearly 9,300 episodes of all forms of malaria and nine malaria-attributable deaths averted by the intervention. CONCLUSION SMC (combined with existing control measures) wields prospects of accelerating the regional/national malaria elimination efforts if the implementation is optimised. Expansion of the intervention to other high-prevalence regions with seasonal variation in disease burden may be worthwhile. FUNDING None declared.
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Affiliation(s)
- Michael R Adjei
- Regional Health Directorate, Ghana Health Service, Damongo, Savannah Region, Ghana
| | - Chrysantus Kubio
- Regional Health Directorate, Ghana Health Service, Damongo, Savannah Region, Ghana
| | - Marcel Buamah
- Regional Health Directorate, Ghana Health Service, Damongo, Savannah Region, Ghana
| | - Adjei Sarfo
- Regional Health Directorate, Ghana Health Service, Damongo, Savannah Region, Ghana
| | - Thomas Suuri
- Regional Health Directorate, Ghana Health Service, Damongo, Savannah Region, Ghana
| | - Saeed Ibrahim
- Regional Health Directorate, Ghana Health Service, Damongo, Savannah Region, Ghana
| | - Abubakari Sadiq
- Regional Health Directorate, Ghana Health Service, Damongo, Savannah Region, Ghana
| | | | - Janet V Baafi
- Sunyani West District Health Directorate, Ghana Health Service, Fiapre, Bono Region, Ghana
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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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Moukénet A, Honoré B, Smith H, Moundiné K, Djonkamla WM, Richardson S, Dormbaye M, Ngarasta N, Seck I. Knowledge and social beliefs of malaria and prevention strategies among itinerant Nomadic Arabs, Fulanis and Dagazada groups in Chad: a mixed method study. Malar J 2022; 21:56. [PMID: 35183185 PMCID: PMC8858476 DOI: 10.1186/s12936-022-04074-0] [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: 09/11/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nomadic populations in Chad are at increased risk of contracting malaria because of their lifestyle. Being highly mobile they are often excluded from disease control programmes, and access to preventive measures and treatment is more difficult. Effective malaria control interventions take account of local modes of transmission, patterns of care-seeking behaviour and community perceptions of cause and prevention practices. There is currently little information about malaria knowledge and perceptions among nomadic groups in Chad, or their awareness of malaria control interventions and this study sought to address this knowledge gap.
Methods
A mixed methods study, including a cross-sectional survey with men and women (n = 78) to determine the level of knowledge and use of malaria prevention strategies among Arabs, Peuls and Dagazada nomadic groups. Three focus group discussions were conducted with women to explore their representation of malaria and knowledge of preventive methods. Key informant interviews were held with leaders of nomadic groups (n = 6) to understand perception of malaria risk among itinerant communities.
Results
Nomads are aware of the risk of malaria, recognize the symptoms and have local explanations for the disease. Reported use of preventive interventions such as Seasonal Malaria Chemoprevention (SMC) for children and Intermittent Preventive Treatment (IPT) of malaria in pregnancy was very low. However, 42.3% of respondents reported owning at least one LLIN and 60% said they slept under an LLIN the night before the survey. In case of a malaria episode, nomads seek clinicians, informal drug sellers in the street or market for self-medication, or traditional medicine depending on their financial means. Interviews with nomad leaders and discussions with women provide key themes on: (i) social representation of malaria risk and (ii) social representation of malaria and (iii) perspectives on malaria prevention and (iv) malaria treatment practices.
Conclusion
The nomadic groups included in this study are aware of risk of malaria and their level of exposure. Local interpretations of the cause of malaria could be addressed through tailored and appropriate health education. Except for LLINs, malaria prevention interventions are not well known or used. Financial barriers lowered access to both mosquito nets and malaria treatment. Reducing the barriers highlighted in this study will improve access to the healthcare system for nomadic groups, and increase the opportunity to create awareness of and improve uptake of SMC and IPT among women and children.
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Oguoma VM, Anyasodor AE, Adeleye AO, Eneanya OA, Mbanefo EC. Multilevel modelling of the risk of malaria among children aged under five years in Nigeria. Trans R Soc Trop Med Hyg 2021; 115:482-494. [PMID: 32945885 DOI: 10.1093/trstmh/traa092] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/11/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malaria is still a major cause of morbidity and mortality among children aged <5 y (U5s). This study assessed individual, household and community risk factors for malaria in Nigerian U5s. METHODS Data from the Nigerian Malaria Health Indicator Survey 2015 were pooled for analyses. This comprised a national survey of 329 clusters. Children aged 6-59 mo who were tested for malaria using microscopy were retained. Multilevel logit model accounting for sampling design was used to assess individual, household and community factors associated with malaria parasitaemia. RESULTS A total of 5742 children were assessed for malaria parasitaemia with an overall prevalence of 27% (95% CI 26 to 28%). Plasmodium falciparum constituted 98% of the Plasmodium species. There was no significant difference in parasitaemia between older children and those aged ≤12 mo. In adjusted analyses, rural living, northwest region, a household size of >7, dependence on river and rainwater as primary water source were associated with higher odds of parasitaemia, while higher wealth index, all U5s who slept under a bed net and dependence on packaged water were associated with lower odds of parasitaemia. CONCLUSION Despite sustained investment in malaria control and prevention, a quarter of the overall study population of U5s have malaria. Across the six geopolitical zones, the highest burden was in children living in the poorest rural households.
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Affiliation(s)
- Victor M Oguoma
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | | | - Adeniyi O Adeleye
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Mackay, QLD, Australia
| | - Obiora A Eneanya
- Washington University School of Medicine, Department of Medicine, Infectious Diseases Division, St. Louis, MO, USA
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Audibert C, Tchouatieu AM. Perception of Malaria Chemoprevention Interventions in Infants and Children in Eight Sub-Saharan African Countries: An End User Perspective Study. Trop Med Infect Dis 2021; 6:tropicalmed6020075. [PMID: 34064620 PMCID: PMC8163176 DOI: 10.3390/tropicalmed6020075] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
Preventive chemotherapy interventions have been identified as key tools for malaria prevention and control. Although a large number of publications have reported on the efficacy and safety profile of these interventions, little literature exists on end-user experience. The objective of this study was to provide insights on the perceptions and attitudes towards seasonal malaria chemoprevention (SMC) and intermittent preventive treatment of infants (IPTi) to identify drivers of and barriers to acceptance. A total of 179 in-depth qualitative interviews were conducted with community health workers (CHWs), health center managers, parents of children receiving chemoprevention, and national decision makers across eight countries in sub-Saharan Africa. The transcribed verbatim responses were coded and analyzed using a thematic approach. Findings indicate that, although SMC is largely accepted by end users, coverage remained below 100%. The main causes mentioned were children's absenteeism, children being sick, parents' reluctance, and lack of staff. Regarding IPTi, results from participants based in Sierra Leone showed that the intervention was generally accepted and perceived as efficacious. The main challenges were access to water, crushing the tablets, and high staff turnover. SMC and IPTi are perceived as valuable interventions. Our study identified the key elements that need to be considered to facilitate the expansion of these two interventions to different geographies or age groups.
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Roberts KW, Smith Gueye C, Baltzell K, Ntuku H, McCreesh P, Maglior A, Whittemore B, Uusiku P, Mumbengegwi D, Kleinschmidt I, Gosling R, Hsiang MS. Community acceptance of reactive focal mass drug administration and reactive focal vector control using indoor residual spraying, a mixed-methods study in Zambezi region, Namibia. Malar J 2021; 20:162. [PMID: 33752673 PMCID: PMC7986500 DOI: 10.1186/s12936-021-03679-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Namibia, as in many malaria elimination settings, reactive case detection (RACD), or malaria testing and treatment around index cases, is a standard intervention. Reactive focal mass drug administration (rfMDA), or treatment without testing, and reactive focal vector control (RAVC) in the form of indoor residual spraying, are alternative or adjunctive interventions, but there are limited data regarding their community acceptability. METHODS A parent trial aimed to compare the effectiveness of rfMDA versus RACD, RAVC versus no RAVC, and rfMDA + RAVC versus RACD only. To assess acceptability of these interventions, a mixed-methods study was conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in three rounds (pre-trial and in years 1 and 2 of the trial), and an endline survey. RESULTS In total, 17 KIIs, 49 FGDs were conducted with 449 people over three annual rounds of qualitative data collection. Pre-trial, community members more accurately predicted the level of community acceptability than key stakeholders. Throughout the trial, key participant motivators included: malaria risk perception, access to free community-based healthcare and IRS, and community education by respectful study teams. RACD or rfMDA were offered to 1372 and 8948 individuals in years 1 and 2, respectively, and refusal rates were low (< 2%). RAVC was offered to few households (n = 72) in year 1. In year 2, RAVC was offered to more households (n = 944) and refusals were < 1%. In the endline survey, 94.3% of 2147 respondents said they would participate in the same intervention again. CONCLUSIONS Communities found both reactive focal interventions and their combination highly acceptable. Engaging communities and centering and incorporating their perspectives and experiences during design, implementation, and evaluation of this community-based intervention was critical for optimizing study engagement.
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Affiliation(s)
- Kathryn W Roberts
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA.
- Global Programs for Research and Training, Malaria Elimination Initiative Namibia, Windhoek, Namibia.
| | - Cara Smith Gueye
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA
- Global Programs for Research and Training, Malaria Elimination Initiative Namibia, Windhoek, Namibia
| | - Kimberly Baltzell
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA
- Department of Family Health Care Nursing, School of Nursing, UCSF, San Francisco, USA
| | - Henry Ntuku
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA
- Global Programs for Research and Training, Malaria Elimination Initiative Namibia, Windhoek, Namibia
| | - Patrick McCreesh
- Department of Pediatrics, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, TX, Dallas, USA
| | - Alysse Maglior
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA
| | - Brooke Whittemore
- Department of Pediatrics, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, TX, Dallas, USA
| | - Petrina Uusiku
- National Vectorborne Diseases Control Programme, Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Davis Mumbengegwi
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Immo Kleinschmidt
- Wits Research Institute for Malaria, Wits/SAMRC Collaborating Centre for Multi-Disciplinary Research on Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Southern Africa Development Community Malaria Elimination Eight Secretariat, Windhoek, Namibia
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA
- Global Programs for Research and Training, Malaria Elimination Initiative Namibia, Windhoek, Namibia
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Michelle S Hsiang
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA.
- Department of Pediatrics, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, TX, Dallas, USA.
- Department of Pediatrics, UCSF, San Francisco, USA.
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Looman L, Pell C. End-user perspectives on preventive antimalarials: A review of qualitative research. Glob Public Health 2021; 17:753-767. [PMID: 33617406 DOI: 10.1080/17441692.2021.1888388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Antimalarials have been administered widely to prevent clinical malaria and researchers have explored how end-users' perspectives influence uptake and adherence. Drawing on a systematic search, this review aims to synthesise qualitative research on end-user perceptions of antimalarials for disease prevention. Searches were undertaken in PubMed and ISI Web of Knowledge. After applying exclusion criteria, identified sources underwent thematic analysis. Identified sources were published between 2000 and 2020 and drew on studies undertaken across Africa, Asia, Europe, Oceania and America. The sources revealed end-user concerns about the potential benefits and harms of preventive treatment that are entwined with broader understandings of the disease, the intervention, its implementation, accompanying information, and how it is embedded in wider healthcare and social relationships. The implications for antimalarials as preventive therapy encompass the need to build trust, including interpersonal trust, engage diverse stakeholders and to address broader health and wellbeing concerns during implementation.
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Affiliation(s)
- Lisanne Looman
- Department of Global Health Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Christopher Pell
- Department of Global Health Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands.,Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
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