Long-Lasting Insecticide Net Ownership, Access and Use in Southwest Ethiopia: A Community-Based Cross-Sectional Study

Efficacy of chlorfenapyr-pyrethroid and piperonyl butoxide-pyrethroid long-lasting insecticidal nets (LLINs) compared to pyrethroid-only LLINs for malaria control in Côte d'Ivoire: a three group, cluster randomised trial

BACKGROUND

The massive scale-up of long-lasting insecticidal nets (LLIN) has led to a major reduction in malaria burden in many sub-Saharan African (SSA) countries. The World Health Organization (WHO) has recently issued a strong recommendation for the use of chlorfenapyr-pyrethroid LLINs compared to standard pyrethroid-only LLINs in areas of high insecticide resistance intensity. However, there is still a lack of conclusive evidence on the efficacy of piperonyl butoxide-pyrethroid (PBO-py) LLINs, especially in West Africa, where vector composition and resistance mechanisms may be different from vectors in East Africa.

METHODS

This is a three-arm, superiority, triple-blinded, cluster randomised trial, with village as the unit of randomisation. This study conducted in Côte d'Ivoire will evaluate the efficacy on epidemiological and entomological outcomes of (1) the control arm: MAGNet® LN, which contains the pyrethroid, alpha-cypermethrin, (2) VEERALIN® LN, a net combining the synergist PBO and alpha-cypermethrin, and (3) Interceptor® G2 LN, which incorporates chlorfenapyr and alpha-cypermethrin, two adulticides with different mechanisms of action. A total of 33 villages with an average of 200 households per village will be identified, mapped, and randomised in a ratio of 1:1:1. Nets will be distributed at a central point following national guidelines with 1 net for every 2 people. The primary outcome of the trial will be incidence of malaria cases (confirmed by rapid diagnostic test (RDT)) in a cohort of 50 children aged 6 months to 10 years in each cluster, followed for 12 months (active case detection). Secondary outcomes are cross-sectional community prevalence of malaria infection (confirmed by RDT) in the study population at 6 and 12 months post-intervention (50 randomly selected persons per cluster), vector density, entomological inoculation rate (EIR), and phenotypic and genotypic insecticide resistance at baseline and 12 months post-intervention in 3 sentinel villages in each treatment arm.

DISCUSSION

In addition to generating further evidence for next-generation LLINs, this study will also provide the first evidence for pyrethroid-PBO nets in a West African setting. This could further inform WHO recommendations on the pragmatic use of pyrethroid-PBO nets.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05796193. Registered on April 3, 2023.

Utilization of long-lasting insecticide-treated net and its associated factors among pregnant women in Dawo district, Southwest Shoa Zone, Oromia, Ethiopia, 2023

Introduction

The use of long-lasting insecticide-treated net (LLIN) is one of the most effective malaria prevention strategies, particularly among pregnant women. It has mosquito-killing repellent and physical barrier properties. Pregnant women, children under 5 years of age, and patients with HIV/AIDS, as well as non-immune migrants, mobile populations, and travelers, are the most vulnerable groups to malaria. Even when pregnant women are given priority, not all nets owned by households are used by pregnant women. Therefore, the risk of the occurrence of malaria during pregnancy is also high.

Objective

This study aimed to assess the utilization of long-lasting insecticide-treated net and its associated factors among pregnant women in Dawo district, Southwest Shoa Zone, Oromia, Ethiopia, 2023.

Methods

A community-based analytical cross-sectional study was carried out in Dawo district, Southwest Shoa Zone, Oromia, Ethiopia, from 21 to 30 April 2023. A total of 353 pregnant women were chosen through simple random sampling and interviewed face-to-face using a structured and pre-tested questionnaire. Before being exported to the Statistical Package for Social Science (SPSS) version 23, the data were coded and entered into EPIDATA version 4.6. The study examined the prevalence of long-lasting insecticide-treated net use among pregnant women in the Dawo district using descriptive statistics. Analytical statistics, such as bivariable and multivariable logistic regression analyses, were used to determine the relationship between independent and dependent variables. Statistical significance was determined using a P-value of <0.05 and adjusted odd ratios with 95% confidence intervals.

Results

Long-lasting insecticide-treated nets were utilized by 55.5% (95% CI: 50.4-60.7%) of all pregnant participants in the study, which was below the national target. Pregnant women who have antenatal care (ANC) contact for current pregnancy adjusted odds ratio (AOR = 4.66, 95% CI: 1.95, 11.10), community-based health insurance (CBHI) enrollment (AOR = 2.38, 95% confidence intervals, CI: 1.38, 4.11), children under 5 years of age (AOR = 2.68, 95% CI: 1.62, 4.43), understanding that malaria poses a risk to fetuses (AOR = 3.25, 95% CI: 1.26, 8.41), and LLINs access (AOR = 12.47, 95% CI: 3.98, 39.08), were factors that significantly associated with LLIN utilization.

Conclusion

In conclusion, the utilization of LLINs was relatively low. ANC contact for current pregnancy, CBHI enrollment, having children under the age of 5, having a high income, and understanding that malaria poses a risk to fetuses were factors significantly associated with LLIN utilization among pregnant women.

Universal coverage and utilization of free long-lasting insecticidal nets for malaria prevention in Ghana: a cross-sectional study

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.

Ideational factors associated with consistent use of insecticide-treated nets: a multi-country, multilevel analysis

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.

Malaria Burden and Associated Risk Factors in an Area of Pyrethroid-Resistant Vectors in Southern Benin

Malaria remains the main cause of morbidity and mortality in Benin despite the scale-up of long-lasting insecticidal nets (LLINs), indoor residual spraying, and malaria case management. This study aimed to determine the malaria burden and its associated risk factors in a rural area of Benin characterized by high net coverage and pyrethroid-resistant mosquito vectors. A community-based cross-sectional survey was conducted in three districts in southern Benin. Approximately 4,320 randomly selected participants of all ages were tested for malaria using rapid diagnostic tests within 60 clusters. Risk factors for malaria infection were evaluated using mixed-effect logistic regression models. Despite high population net use (96%), malaria infection prevalence was 43.5% (cluster range: 15.1-72.7%). Children (58.7%) were more likely to be infected than adults (31.2%), with a higher malaria prevalence among older children (5-10 years: 69.1%; 10-15 years: 67.9%) compared with young children (< 5 years: 42.1%); however, young children were more likely to be symptomatic. High household density, low socioeconomic status, young age (< 15 years), poor net conditions, and low net usage during the previous week were significantly associated with malaria infection. Malaria prevalence remains high in this area of intense pyrethroid resistance despite high net use. New classes of LLINs effective against resistant vectors are therefore crucial to further reduce malaria in this area.

Composition of mosquito fauna and insecticide resistance status of Anopheles gambiae sensu lato in Itang special district, Gambella, Southwestern Ethiopia

Background

Anopheles arabiensis, member species of the Anopheles gambiae complex, is the primary vector of malaria and is widely distributed in Ethiopia. Anopheles funestus, Anopheles pharoensis and Anopheles nili are secondary vectors occurring with limited distribution in the country. Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are pillars for the interventions against malaria control and elimination efforts in Ethiopia. However, the emergence and widespread of insecticide resistance in An. gambiae sensu lato (s.l.), might compromise the control efforts of the country. The aim of this study was to investigate composition of mosquito fauna and insecticide resistance status of An. gambiae s.l. in Itang special district ( woreda), Gambella, southwestern Ethiopia.

Methods

Adult mosquitoes were sampled from September 2020 to February 2021 using the CDC light trap and pyrethrum spray catch (PSC). CDC light traps were placed in three selected houses for two consecutive days per month to collect mosquitoes indoor and outdoor from 6:00 P.M. to 06:00 A.M. and PSC was used to collect indoor resting mosquitoes from ten selected houses once in a month from October 2020 to February 2021. Moreover, mosquito larvae were also collected from different breeding sites and reared to adults to assess susceptibility status of populations of An. gambiae s.l. in the study area. Susceptibility tests were conducted on two to three days old non blood fed female An. gambiae s.l. using insecticide impregnated papers with deltamethrin (0.05%), alpha-cypermethrin (0.05%), propoxur (0.1%), pirimiphos-methyl (0.25%) and bendiocarb (0.1%) following World Health Organization (WHO) standard susceptibility test procedure. Molecular diagnostics were done for the identification of member species of An. gambiae s.l. and detection of knockdown resistance (kdr) allele using species specific polymerase chain reaction (PCR) and allele specific PCR.

Results

In total, 468 adult mosquitoes were collected from different houses. Culex mosquitoes were the most dominant (80.4%) followed by Anopheles mosquitoes. Three species of Anopheles (Anopheles coustani, An. pharoensis, and An. gambiae s.l.) were identified, of which An. coustani was the dominant (8.1%) species. Higher number of mosquitoes (231) were collected outdoor by CDC light traps. Out of 468 adult mosquitoes, 294 were blood fed, 46 were half-gravid and gravid whereas the remaining 128 were unfed. WHO bioassay tests revealed that the populations of An. gambiae s.l. in the study area are resistant against alpha-cypermethrin and deltamethrin, but susceptible to bendiocarb, pirimiphos-methyl and propoxur. Of the total 86 An. gambiae s.l. specimens assayed, 79 (92%) successfully amplified and identified as An. arabiensis. West African kdr (L1014F) mutation was detected with high kdr allele frequency ranging from 67 to 88%.

Conclusion

The detection of target site mutation, kdr L1014F allele, coupled with the phenotypic resistance against alpha-cypermethrin and deltamethrin call for continuous resistance monitoring.

Rural-Urban Differentials in Access to Behaviour Change Communication and Use of Long-Lasting Insecticide-Treated Nets and Artemisinin-Based Combination Therapy in Southeast Nigeria

BACKGROUND

As Malaria continues to take a heavy toll on the life and economy of Nigerians, The National Malaria Elimination Programme uses behaviour change communication (BCC) to promote the use of Long-Lasting Insecticide-treated Nets (LLIN) and Artemisinin-based Combination Therapy (ACT) to combat malaria. This study examined the impact of BCC on the use of LLIN and ACT in Southeast Nigeria.

METHODS

A structured questionnaire was used to gather data from 480 respondents in urban and rural communities across five states. Analysis of data was done using percentages, chi-square and logistic regression.

RESULTS

Findings showed weak effect of BCC on LLIN and ACT use despite achieving high (93.75%) exposure. Only 45.1% and 45.7% of the respondents used LLIN and ACT respectively. Urban residents were found to sleep under LLINs and use ACTs more than rural dwellers. Regression results showed that newspapers (OR=1.341) and the Internet (OR=3.216) increased the odds of LLIN use in the rural areas and magazines (OR=1.837) in the urban areas. Television (OR=2.375; P=0.002) and the Internet (OR=6.063; P=0.001) increased the odds of ACT use in the urban areas. Education was found to be a positive predictor of LLIN use in the rural (OR=4.645; P=0.011) and urban areas (OR=6.102) as well as ACT use in the rural (OR=7.268; p=0.002) and urban areas (0R=6.145; P=0.009).

CONCLUSION

Access to behaviour change communication though very high has not achieved the desired behaviour change. The National Malaria Elimination Programme should produce appropriate messages to address barriers to LLIN and ACT use.

Insecticide-treated net (ITN) use, factors associated with non-use of ITNs, and occurrence of sand flies in three communities with reported cases of cutaneous leishmaniasis in Ghana

Background

The insecticide treated bed net (ITN) has been proven for malaria control. Evidence from systematic review also suggests benefits of ITN roll out in reducing the incidence of cutaneous leishmaniasis (CL) and other vector borne diseases.

Methods

Using a community-based cross-sectional study design, ITN use, factors associated with non-use of ITNs, and occurrence of sand flies were investigated in three communities with reported cases of CL in the Oti region of Ghana.

Results

A total of 587 households comprising 189 (32.2%), 200 (34.1%), and 198 (33.7%) households from Ashiabre, Keri, and Sibi Hilltop communities with de facto population of 3639 participated in this study. The proportion of households that owned at least one ITN was 97.1%. The number of households having at least one ITN for every two members was 386 (65.8%) and 3159 (86.8%) household population had access to ITN. The household population that slept in ITN the night before this survey was 2370 (65.1%). Lack of household access to ITN (AOR = 1.80; CI: 1.31, 2.47), having a family size of more than 10 members (AOR = 2.53; CI: 1.20, 4.24), having more than 10 rooms for sleeping in a household (AOR = 10.18; CI: 1.28, 81.00), having 2–4 screened windows (AOR = 1.49; CI: 1.00, 2.20), and having 8–10 screened windows (AOR = 3.57; CI: 1.25, 10.17) were significantly associated with increased odds of not sleeping in ITN the night before the survey. A total of 193 female sand flies were trapped from various locations within the study communities.

Conclusions

Factors associated with ITN non-use such as lack of household access to ITN should be incorporated into future efforts to improve ITN use. Species of sand flies and their potential vectorial role in the study communities should also be investigated.

Role of health extension workers in the relationship between vector control interventions and malaria in Ethiopia

BACKGROUND

Despite a tremendous decline in the burden of malaria through public health interventions, it is yet remains a critical parasitic health problem in Ethiopia. Insecticide-treated nets and indoor residual spray are considered as the most effective preventive interventions against malaria. This study intended to determine the role of health extension workers in influencing the relationship between vector control strategies and malaria prevalence in Ethiopia.

METHODS

The study adopted a descriptive study based on panel data collected from 10 regions of Ethiopia from 2010 to 2018. The data collected were analyzed using STATA version 13.0. Structural equation modelling was used to assess the mediating effect of health extension workers in the relationship. Further, the random effect model was employed to investigate the direct relationship among the study variables.

RESULTS

We observed a strong mediating role of health extension workers to the relationship between strategic interventions and malaria prevalence, where the direct path is (β = 0.64, p < 0.05), and the indirect path (β = 0.72, p < 0.001) and (β = 0.98, p < 0.001) confirming the mediation condition to appear. Our analysis revealed that, insecticide-treated nets and indoor residual spray significantly impacts the malaria prevalence (β = 0.20, p < 0.05) and (β = 0.70, p < 0.001) respectively. Further, our analysis suggests that the cumulative effect of indoor residual spray and insecticide-treated mosquito nets have helped better avert malaria prevalence (β = 81.3%, P < 0.05). Moreover, the finding demonstrates the incremental rate of 30.2%, which is the indirect effect of the research [(β = 0.813) - (β1 = 0.511)].

CONCLUSION

The findings are potentially useful for the health sector in charge of infectious disease prevention and control, particularly in developing countries explaining how these group provided support to reduce malaria ensuring the provision of proper health message about the program.

Comparing insecticide-treated nets access-use based on universal household and population indicators vis-a-vis measures adapted to sleeping spaces in Ethiopia

Background

Insecticide-treated nets (ITNs) access-use has been pivotal monitoring indicator for malaria prevention and control, particularly in resource limited settings. The objective of the study was to compare ITN access-use based on universal household and population indicators and measures adapted to sleeping spaces.

Methods

A cross-sectional study was conducted in five districts of Jimma Zone, Ethiopia, March, 2019. 762 HHs were sampled for the survey. Multi-stage followed by simple random sampling used. Monitoring and evaluation reference group’s (MERG’s) indicators were used for measuring ITN access-use. MERG’s indicators are each adapted ITN access-use to sleeping spaces. Household (ownership, saturation and sufficiency) and population access and household members’ status of last night sleeping under ITN compared based on the two models. Differences of estimates of ITN access-use based on the two methods reported as magnitude of over/under estimations, at p-value < 0.05.

Results

Based on MERG’s approach, the study revealed household (HH) based indicators as such: HH ownership of at least 1 ITN (92.6%), sufficiency of ITN for every two people in HH (50.3%), and saturation of ITN for every 2 people in HHs with any ITN (54.6%). Moreover, population based indicators were: population with ITN access (P3 = 78.6%), people who slept under ITN previous night (63.0%), people who slept under ITN among who accessed it (73.1%), ITN use-gap (26.9%). Equivalent indicators of HH ownership, sufficiency, saturation, and people accessed at where they actually slept, and people slept under ITN among those accessed at where they slept estimated at 71.3%, 49.4%, 69.3%, 66.3%, and 92.1%, respectively. MERG’s approach over-estimated ownership, people’s access, and behaviour-failures by 21.3%, 12.3%, 19.0%, respectively. Over-estimation occurred for reasons such as many sleeping spaces lack ITN and > 2 people actually slept per sleeping space.

Conclusions

MERG’s universal indicators over estimated households and populations ITN access-use as a result of absence of measures capturing access-use values at spaces where people actually slept. Consequently, measures adapted to sleeping contexts revealed potential misdistributions practiced when the existing indicators are in use. Insertion of sleeping spaces into existing approach will be worthwhile and needs to be promoted as it improves curiosity in ITN distribution, produces closer estimates and prevents malaria prevention and control programmes from overlooking access-use challenges.

Malaria prevention and treatment in migrant agricultural workers in Dangur district, Benishangul-Gumuz, Ethiopia: social and behavioural aspects

BACKGROUND

Sixty percent of the Ethiopia population is at risk of malaria, with the highest prevalence reported in Gambella (6%) and Benishangul-Gumuz (3%) regions. Within these regions are large agricultural developments with high numbers of seasonal migrant workers. The migrant workers are believed to be at increased risk for malaria infection due to their poor living conditions and outdoor activities, but there is little information on their specific behaviours and health risks. This study was conducted to address this gap.

METHODS

Quantitative observations were conducted from September to December 2017 in the Benishangul-Gumuz Region. The nightly routines of mobile migrant workers were observed every month for 4 consecutive months. The study team collected quantitative data including nocturnal behavioural observations of worker living conditions, malaria prevention efforts, and work activities and surveys of worker representatives. Qualitative data was collected from migrant workers, farm managers and local health providers using focus group discussions and semi-structured interviews.

RESULTS

Migrant workers arrived in the study area during the peak malaria transmission season and the workers in focus groups reported repeated cases of malaria during their stay on the farms. Overall, less than a quarter of the migrant workers were sleeping under a mosquito net by midnight in all 4 observation months. Some work activities also took place outdoors at night. The study additionally found a lack of access to malaria prevention and treatment at the farms and challenges in utilizing local public health facilities.

CONCLUSIONS

There is a need to better address malaria prevention and treatment needs among migrant workers in Ethiopia through outreach from existing healthcare infrastructure and within the farms themselves. This will help prevent malaria transmission both within this population and prevent transmission of malaria back to home communities in lower burden areas in Ethiopia.

Assessing the efficacy of two dual-active ingredients long-lasting insecticidal nets for the control of malaria transmitted by pyrethroid-resistant vectors in Benin: study protocol for a three-arm, single-blinded, parallel, cluster-randomized controlled trial

BACKGROUND

Long-lasting insecticidal nets (LLINs) are currently the primary method of malaria control in sub-Saharan Africa and have contributed to a significant reduction in malaria burden over the past 15 years. However, this progress is threatened by the wide-scale selection of insecticide-resistant malaria vectors. It is, therefore, important to accelerate the generation of evidence for new classes of LLINs.

METHODS

This protocol presents a three-arm superiority, single-blinded, cluster randomized controlled trial to evaluate the impact of 2 novel dual-active ingredient LLINs on epidemiological and entomological outcomes in Benin, a malaria-endemic area with highly pyrethroid-resistant vector populations. The study arms consist of (i) Royal Guard® LLIN, a net combining a pyrethroid (alpha-cypermethrin) plus an insect growth regulator (pyriproxyfen), which in the adult female is known to disrupt reproduction and egg fertility; (ii) Interceptor G2® LLIN, a net incorporating two adulticides (alpha-cypermethrin and chlorfenapyr) with different modes of action; and (iii) the control arm, Interceptor® LLIN, a pyrethroid (alpha-cypermethrin) only LLIN. In all arms, one net for every 2 people will be distributed to each household. Sixty clusters were identified and randomised 1:1:1 to each study arm. The primary outcome is malaria case incidence measured over 24 months through active case detection in a cohort of 25 children aged 6 months to 10 years, randomly selected from each cluster. Secondary outcomes include 1) malaria infection prevalence (all ages) and prevalence of moderate to severe anaemia in children under 5 years old, measured at 6 and 18 months post-intervention; 2) entomological indices measured every 3 months using human landing catches over 24 months. Insecticide resistance intensity will also be monitored over the study period.

DISCUSSION

This study is the second cluster randomised controlled trial to evaluate the efficacy of these next-generation LLINs to control malaria transmitted by insecticide-resistant mosquitoes. The results of this study will form part of the WHO evidence-based review to support potential public health recommendations of these nets and shape malaria control strategies of sub-Saharan Africa for the next decade.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03931473 , registered on 30 April 2019.

Effectiveness of peer-learning assisted primary school students educating the rural community on insecticide-treated nets utilization in Jimma-zone Ethiopia

Background

Making insecticide-treated nets (ITNs) utilization a social norm would support the global goal of malaria eradication and Ethiopian national aim of its elimination by 2030. Jimma zone is one of the endemic settings in Ethiopia. This study aimed to report effects of malaria education, delivered by students, on community behaviours; particularly ITNs.

Methods

In pre-posttest, cross-sectional household surveys conducted in rural villages of 5 districts in Jimma Zone, Ethiopia, 762 households were sampled. The intervention engaged students from primary schools in participatory peer education within small groups, followed by exposing parents with malaria messages aimed at influencing perceptions and practices. The data were analysed using SPSS version 20.0. Proportions/means differences were computed to compare changes in exposure, knowledge, perceptions, and practices using 95% CI at p < 0.05. Regression analyses were conducted to assess exposures to school-based education, content intensity, perception, and access related predictors of ITN utilization over the intervention periods.

Results

Over the intervention periods, the findings showed significant improvement in exposure to and content intensity of malaria messages delivered by students, effect size (ES) = 44.5% and 19.3%, p < 0.001, respectively. ITN utilization (ES = 25.8%), and the reported behaviour of giving ITN priority to children under 5 years old and pregnant women increased by ES = 16.3% and  24.8%, respectively. The exposure status or content intensity of malaria education, in turn, significantly improved comprehensive knowledge about malaria (β = +1.82), misconceptions about causes (β = − 11.46), awareness of caring for ITN (β = +24.79), identifying ITN as effective preventive methods (OR = 1.93), attitude towards ITN (β = +0.20), perceived efficacy of ITN (OR = 1.04), acceptance of ITN as a means to control the danger of malaria (β = +8.08%), and ITN utilization (OR = 1.85). Nonetheless, perceived threat (β = − 0.19) significantly negatively correlated with exposure to students’ messages. Socio-demography, access, exposures to messages, and parental perception that students were good reminders predicted ITN utilization over the intervention periods with some changing patterns.

Conclusions

Exposing the community to malaria education through students effectively supports behaviour change, particularly ITN usage, to be more positive towards desired malaria control practices. A school-based strategy is recommended to the national effort to combat malaria.

School-based social and behavior change communication (SBCC) advances community exposure to malaria messages, acceptance, and preventive practices in Ethiopia: A pre-posttest study

Background

Ethiopia has shown incredible success in malaria morbidity, mortality, and control. Community empowerment is a milestone to meet the ambitious plans of eliminating malaria by 2030.

Objectives

This study aimed to evaluate school-based malaria social behavior change communication (SBCC) in terms of community message exposure, acceptance, knowledge, and practices.

Methods

A community-based pre-posttest study was conducted in five districts of the Jimma Zone, Ethiopia. 762 and 759 households were sampled for baseline and end-line, respectively. The intervention engaged students from primary schools on participatory peer education within small groups, followed by exposing parents with malaria messages aimed to influencing ideation and preventive practices. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. Proportion/mean differences were computed to compare both surveys on exposure, knowledge, perceptions, and practices at p <0.05. Finally, a regression analysis was conducted between key changes and school-based exposure.

Results

The study revealed a sharp increase in exposure to malaria messages with effect size (ES) of 65.7%, p <0.001. School specific exposure has grown to 57.8% (ES = 44.5%). Comprehensive knowledge about malaria increased to 39.1% (ES = 14.8%). Identifying mosquito bites as a cause of malaria was increased by ES = 20.8%. A slight reduction in risk perception (ES = 3.3%) and attitude (ES = 3.8%) and a higher rise in self-efficacy (ES = 8.5%) were observed. Community message acceptance in favor of malaria danger control was significantly improved by 10% i.e. an increase in rational decision making to uptake preventive practices. Consistently, insecticide-treated nets (ITNs) usage was improved to 63.0% (ES = 25.8%). Giving priority to use ITNs for under five years old children and pregnant women grew by 16.3% and 24.8%, respectively. Significant improvements were observed in treatment-seeking for fever (ES = 16.3%) and early treatment-seeking (ES = 15.5%). Not painting or plastering walls 6 months within spraying changed by ES = 61%. No significant change was observed in drug adherence. The school-based content intensity of exposure had effects on comprehensive knowledge, message acceptance, and ITN utilization.

Conclusions

Engaging school-aged children effectively advances community exposure, perception, and behaviors. We recommend the inclusion of school-based SBCC in the national malaria control programs.

Insufficient Ratio of Long-Lasting Insecticidal Nets to Household Members Limited Universal Usage in Western Kenya: A 2015 Cross-Sectional Study

Universal "coverage" with long-lasting insecticidal nets (LLINs) is recommended for malaria control in endemic areas, but ownership does not ensure usage. We evaluated relationships between household-level ownership and individual-level usage in western Kenya in 2015. Low-prevalence highland (> 1,500 m) and highly endemic lowland (< 1,200 m) sites were surveyed from July to August 2015. Household members reported long-lasting insecticidal net ownership, use, and barriers to use. Net ownership was categorized as sufficient (≤ 2 people/net), insufficient (> 2 people/net), or none. Each LLIN was assumed to provide access to two people. We surveyed 574 lowland and 643 highland households, with 1,677 and 2,742 members, respectively. More than 98% of lowland households owned LLIN(s); 72.1% owned a sufficient number. Only 37.5% of highland households had sufficient nets. More people used LLINs than were estimated to have access in the lowlands (94.2% versus 85.3%), but proportions were similar in the highlands (54.3% versus 53.3%). Insufficient ownership was most common for larger households in both areas and strongly predicted LLIN usage. In households with insufficient nets, men, school-age children (aged 5-15 years), and nonnuclear family members were less likely to use LLINs; only relationship to the head of the household significantly predicted use in households with sufficient nets. Long-lasting insecticidal nets were widespread in western Kenya in 2015, but insufficient household ownership remained common in the epidemic highlands and in large households. Access seemed to be the primary driver of individual use. To interrupt transmission, LLIN campaigns should improve distribution to large households and promote use among men, school-age children, and nonnuclear family members.

Individual and contextual correlates of mosquito net use among women in Nigeria

Background

Malaria has been described as an urgent public health priority with almost half of the world’s population being at risk. Use of insecticide-treated nets is considered one of the effective ways of preventing malaria. Nigeria, which is ranked among the five countries that are responsible for almost half of the global malaria cases, has less than half of its women population using mosquito nets. This study examined the effects of individual and contextual factors on the use of mosquito nets among women of reproductive age in Nigeria.

Methods

This study used data obtained from 2015 Nigeria Malaria Indicator Survey (NMIS) which involved 6048 women aged 15–49 who possessed at least one mosquito net. Multilevel binary logistic regression models were applied in the multivariable analysis.

Results

About 53% of the women used mosquito nets with more than 60% of uneducated and poor women in this category. The use of mosquito nets was significantly associated with being from poor households, having knowledge about the cause of malaria, having access to malaria messages, possessing knowledge about the efficacy of malaria prevention drugs during pregnancy, having knowledge about the importance of tests to detect malaria, maintaining small household size and living in the most socioeconomically disadvantaged communities and states.

Conclusions

The study revealed that mosquito net use among women in Nigeria is affected by individual and contextual factors. It is important for policy makers to design a mosquito-net-use model which would take individual and contextual factors into consideration.