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Cheng B, Htoo SN, Mhote NPP, Davison CM. Association between biological sex and insecticide-treated net use among household members in ethnic minority and internally displaced populations in eastern Myanmar. PLoS One 2021; 16:e0252896. [PMID: 34143807 PMCID: PMC8213136 DOI: 10.1371/journal.pone.0252896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/25/2021] [Indexed: 11/25/2022] Open
Abstract
Malaria prevalence in Myanmar is highest among remote and ethnic minority populations living near forest fringes along the country’s international borders. Insecticide-treated nets (ITNs) are a key intervention used to prevent malaria transmission, but insufficient ITN availability and low use can hinder effectiveness. This study assessed age and sex disparities in ITN possession, access, and use among household members of ethnic minority and internally displaced populations in eastern Myanmar. Cross-sectional data from the 2013 Eastern Burma Retrospective Mortality Survey were used to describe prevalence of ITN possession, access, and use. The association between a household member’s biological sex and their ITN use was assessed using multilevel log binomial regression. Age and household ITN supply were tested as potential effect modifiers. Of 37927 household members, 89.8% (95% CI: 89.5, 90.1) of people lived in households with at least one ITN. Approximately half belonged to households with sufficient ITN supply and used an ITN. Pregnant women and children under five had the highest proportion of ITN use regardless of sufficient household ITN status. Female adults aged 15 to 49 years old (Risk ratio or RR: 1.4, 95% CI: 1.29, 1.52) were more likely to use ITNs. This relationship did not differ by sufficient household ITN status. The findings suggest that among ethnic minority populations in areas where ITN use is indicated, many households do not have adequate ITN supply, and many individuals are not using ITNs. Children under five and pregnant women appear to be prioritized for ITN use and overall, women are slightly more likely to use ITNs than men. This study’s findings can support efforts ensuring that all household members belonging to ethnic minority and displaced populations in Eastern Myanmar benefit from sufficient ITN access and use for malaria prevention.
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Affiliation(s)
- Breagh Cheng
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | | | | | - Colleen M. Davison
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- * E-mail:
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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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Angesom T, Gebreyesus H, Gebremariam B. Long-Lasting Insecticidal Net Utilization and Associated Factors Among Pregnant Women in Asgede Tsimbla District, Northern Ethiopia, 2017. ENVIRONMENTAL HEALTH INSIGHTS 2020; 14:1178630220919393. [PMID: 32528222 PMCID: PMC7263101 DOI: 10.1177/1178630220919393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Malaria among pregnant women contributes to maternal anemia, low birth weight, spontaneous abortion, and infant deaths. In response to this serious health problem, regular use of the long-lasting insecticidal net is the most cost-effective method of preventing malaria. However, in most developing countries, including Ethiopia, long-lasting insecticidal net utilization by pregnant women is uncertain. OBJECTIVES This study was conducted to measure the utilization of insecticidal net and to identify the associated factors with its utilization among pregnant women in Asgede Tsimbla district in 2017. METHODS A community-based cross-sectional study was employed and data were collected using interviewer-administered questionnaire. Systematic random sampling method was used to select 550 pregnant women. Data were entered into a computer using Epi Info (version 7) and exported to Statistical Package for the Social Sciences (version 21) for further analysis. Variables with P-value less than 0.05 were used to declare statistical significance between the dependent and the independent variables in multivariable logistic regression. RESULTS Among 550 pregnant women surveyed, 347 (63.1%) of the pregnant women slept under a long-lasting insecticidal net the night before the survey. Urban residence (OR [95% CI] = 1.9 [1.22-3.01]), family size of 3-5 and >5 (2.8 [1.53-5.22] and 2.4 [1.20-5.03], respectively), and history of malaria during their current pregnancy (3.0 [1.95-4.86]) were found to be the factors associated with pregnant women's long-lasting insecticidal net utilization. CONCLUSION Utilization of long-lasting insecticidal net was low, and place of residence, exposure status to malaria during their current pregnancy, and family size were the factors associated with long-lasting insecticidal net utilization.
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Affiliation(s)
- Teklit Angesom
- School of Public Health, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Hailay Gebreyesus
- School of Public Health, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Brhane Gebremariam
- School of Public Health, College of Health Science, Aksum University, Aksum, Ethiopia
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Balami AD, Said SM, Zulkefli NAM, Bachok N, Balami EL. An information-motivation-behavioural skills analysis of long-lasting insecticidal net use among pregnant women in a hospital in North-Eastern Nigeria. BMC Med Res Methodol 2019; 19:157. [PMID: 31319810 PMCID: PMC6637635 DOI: 10.1186/s12874-019-0803-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 07/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Sleeping under a long-lasting insecticidal net (LLIN) is recommended for all pregnant women in sub-Saharan Africa, due to the high prevalence of malaria infection and its associated complications in the region. Despite this, LLIN use has still remained sub-optimal among pregnant women in Maiduguri, Nigeria. Understanding the interplay of factors influencing this important health behaviour would guide the development of interventions to promote its adoption. Methods Data was collected from 380 randomly selected antenatal care attendees of a hospital in Maiduguri, using structured questionnaires. This data was then used to test the Information-Motivation-Behavioural Skills (IMB) model, for model fit, and interrelations among the constructs, using the structural equation modelling analysis with Smart-PLS. Results Information and motivation were significantly related to behavioural skills (r = 0.29, p < 0.001 and r = 0.37, p < 0.001, respectively); and also to behaviour (r = 0.22, p < 0.001 and r = 0.11, p = 0.033 respectively). Behavioural skills however, did not significantly relate to behaviour (r = 0.03, p = 0.278). Conclusion These findings highlight the potential usefulness of the IMB model in guiding interventions for promoting LLIN use among this group. More emphasis should also be laid on boosting levels of information and motivation among the target group. Electronic supplementary material The online version of this article (10.1186/s12874-019-0803-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ahmed Dahiru Balami
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia.
| | - Salmiah Md Said
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia
| | - Norsa'adah Bachok
- Unit of Biostatistics and Research Methodology, Universiti Sains Malaysia, Kelantan, Malaysia
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Storey JD, Babalola SO, Ricotta EE, Fox KA, Toso M, Lewicky N, Koenker H. Associations between ideational variables and bed net use in Madagascar, Mali, and Nigeria. BMC Public Health 2018; 18:484. [PMID: 29642883 PMCID: PMC5896159 DOI: 10.1186/s12889-018-5372-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background The use of insecticide-treated bed nets (ITNs) is crucial to the prevention, control, and elimination of malaria. Using household surveys conducted in 2014–2015 by the Health Communication Capacity Collaborative project in Madagascar, Mali, and Nigeria, we compared a model of psychosocial influence, called Ideation, to examine how malaria-related variables influence individual and household bed net use in each of these countries. Evaluations of non-malaria programs have confirmed the value of the ideational approach, but it is infrequently used to guide malaria interventions. The study objective was to examine how well this model could identify potentially effective malaria prevention approaches in different contexts. Methods Sampling and survey designs were similar across countries. A multi-stage random sampling process selected female caregivers with at least one child under 5 years of age for interviews. Additional data were collected from household heads about bed net use and other characteristics of household members. The caregiver survey measured psychosocial variables that were subjected to bivariate and multivariate analysis to identify significant ideational variables related to bed net use. Results In all three countries, children and adolescents over five were less likely to sleep under a net compared to children under five (OR = 0.441 in Madagascar, 0.332 in Mali, 0.502 in Nigeria). Adults were less likely to sleep under a net compared to children under five in Mali (OR = 0.374) and Nigeria (OR = 0.448), but not Madagascar. In all countries, the odds of bed net use were lower in larger compared to smaller households (OR = 0.452 in Madagascar and OR = 0.529 in Nigeria for households with 5 or 6 members compared to those with less than 5; and OR = 0.831 in Mali for larger compared to smaller households). Of 14 common ideational variables examined in this study, six were significant predictors in Madagascar (all positive), three in Mali (all positive), and two in Nigeria (both negative). Conclusion This research suggests that the systematic use of this model to identify relevant ideational variables in a particular setting can guide the development of communication strategies and messaging, thereby improving the effectiveness of malaria prevention and control.
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Affiliation(s)
- J Douglas Storey
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA.
| | - Stella O Babalola
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Emily E Ricotta
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Kathleen A Fox
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Michael Toso
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Nan Lewicky
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Hannah Koenker
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
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A Meta-Regression Analysis of the Effectiveness of Mosquito Nets for Malaria Control: The Value of Long-Lasting Insecticide Nets. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030546. [PMID: 29562673 PMCID: PMC5877091 DOI: 10.3390/ijerph15030546] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 11/16/2022]
Abstract
Long-lasting insecticidal nets (LLINs) have been widely used as an effective alternative to conventional insecticide-treated nets (ITNs) for over a decade. Due to the growing number of field trials and interventions reporting the effectiveness of LLINs in controlling malaria, there is a need to systematically review the literature on LLINs and ITNs to examine the relative effectiveness and characteristics of both insecticide nettings. A systematic review of over 2000 scholarly articles published since the year 2000 was conducted. The odds ratios (ORs) of insecticidal net effectiveness in reducing malaria were recorded. The final dataset included 26 articles for meta-regression analysis, with a sample size of 154 subgroup observations. While there is substantial heterogeneity in study characteristics and effect size, we found that the overall OR for reducing malaria by LLIN use was 0.44 (95% CI = 0.41–0.48, p < 0.01) indicating a risk reduction of 56%, while ITNs were slightly less effective with an OR of 0.59 (95% CI = 0.57–0.61, p <0.01). A meta-regression model confirms that LLINs are significantly more effective than ITNs in the prevention of malaria, when controlling for other covariates. For both types of nets, protective efficacy was greater in high transmission areas when nets were used for an extended period. However, cross-sectional studies may overestimate the effect of the nets. The results surprisingly suggest that nets are less effective in protecting children under the age of five, which may be due to differences in child behavior or inadequate coverage. Compared to a previous meta-analysis, insecticide-treated nets appear to have improved their efficacy despite the risks of insecticide resistance. These findings have practical implications for policymakers seeking effective malaria control strategies.
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Low Utilization of Insecticide-Treated Bed Net among Pregnant Women in the Middle Belt of Ghana. Malar Res Treat 2017; 2017:7481210. [PMID: 28828192 PMCID: PMC5554553 DOI: 10.1155/2017/7481210] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/20/2017] [Accepted: 06/13/2017] [Indexed: 11/17/2022] Open
Abstract
Background Malaria in pregnancy leads to low birth weight, premature birth, anaemia, and maternal and neonatal mortality. Use of insecticide-treated nets (ITNs) during pregnancy is one of the proven interventions to reduce the malaria burden. However, Ghana has not achieved its target for ITN use among pregnant women. Methods A qualitative study was conducted in seven communities purposively selected from the middle belt of Ghana. Participants who had delivered in the six months prior to this study were selected. In all, seven focus group discussions and twenty-four in-depth interviews were conducted between June and August 2010. Results Respondents knew of the importance of ITNs and other malaria-preventive strategies. Factors such as financial access and missed opportunities of free distribution denied some pregnant women the opportunity to own or use an ITN. Reasons for not using ITNs during pregnancy included discomfort resulting from heat, smell of the net, and difficulty in hanging the net. Participants maintained their ITNs by preventing holes in the nets, retreatment, and infrequent washing. Conclusion Pregnant women know about the causes and prevention of malaria. However, this knowledge is not transformed into practice due to lack of access to ITNs and sleeping discomforts among other logistical constraints.
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Access to and use of long-lasting insecticidal nets and factors associated with non-use among communities in malaria-endemic areas of Al Hudaydah governorate in the Tihama region, west of Yemen. Malar J 2017; 16:244. [PMID: 28599666 PMCID: PMC5466721 DOI: 10.1186/s12936-017-1894-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Universal coverage of the targeted malaria-endemic areas with long-lasting insecticidal nets (LLINs) is implemented as one of the key interventions for malaria control and elimination in Yemen. In 2013, through a mass campaign, LLINs were distributed to the targeted communities in Al Hudaydah governorate. This study aimed to assess the ownership of, access to, and use of LLINs. It also aimed to identify factors associated with not using LLINs in malaria-endemic areas of Al Hudaydah in the Tihama region, west of Yemen. Methods A cross-sectional survey was conducted in four districts (Ad Durayhimi, Al Marawi’ah, Al Mansuriyah and Bayt Al Faqiah) in Al Hudaydah during February 2016. A total of 701 households were included in this study. Data on socio-demographic characteristics and availability of LLINs were collected by interview and observation. Four indicators for malaria prevention using LLINs; proportion of households with at least one LLIN, proportion of households with at least one LLIN for every two people, proportion of population with access to LLINs in the surveyed households and proportion of population who slept under LLINs the previous night of the survey were calculated as indicated by Roll Back Malaria Monitoring and Evaluation Reference Group. Use to access ratio was assessed. Factors associated with not using LLINs among people with access were also investigated. Results Of 701 households with 4900 de facto population, ownership of at least one LLIN was 90.6%, while 24.1% owned at least one for every two people during the survey in 2016. The overall proportion of people with access to LLINs was 51.5% (95% CI 50.1–52.9). Only 19.0% (95% CI 17.9–20.1) slept under LLINs the night before the survey and the overall use to access ratio was 0.37. The proportions of children under 5 years of age with access to and use of LLINs were 13.7 and 42.5%, respectively. On the other hand, the proportions of pregnant women with access to and use of LLINs were 16.4 and 20.0%, respectively. Multivariable analysis identified that people living in Al Mansuriyah district [adjusted odds ratio (AOR) = 3.29, 95% confidence interval (CI) 1.35–8.01; P = 0.009)], having three or more damaged LLINs in the house (AOR = 2.76, 95% CI 1.79–4.25; P < 0.001), aged between 16 and 45 years old (AOR = 2.17, 95% CI 1.26–3.75; P = 0.005) or older (AOR = 2.17, 95% CI 1.09–4.29; P = 0.026) and living in huts (AOR = 1.59, 95% CI 1.09–2.32; P = 0.015) were significantly less likely to use LLINs. Conclusions This study shows a low LLIN access rate among local communities targeted for universal LLIN coverage in Al Hudaydah, a malaria-endemic area of high transmission. This finding necessitates additional distribution channels following mass campaigns to maintain the universal coverage. Reduced use of LLINs among people with access in these communities together with the identified risks of non-use highlight the importance of conducting behaviour change communication campaigns to enhance using LLINs in areas with universal coverage.
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Koenker H, Yukich JO. Effect of user preferences on ITN use: a review of literature and data. Malar J 2017; 16:233. [PMID: 28571583 PMCID: PMC5455118 DOI: 10.1186/s12936-017-1879-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/26/2017] [Indexed: 11/14/2022] Open
Abstract
Background Insecticide-treated bed nets (ITNs) are the primary tool for vector control, and optimizing ITN use is a key concern of national programmes. Available evidence indicates that bed net users often have preferences for shape, colour, size, and other attributes, but it is unclear whether these preferences are strong enough to have any significant effect on bed net use, and whether countries and donors should invest in more expensive attributes in order to maximize ITN use. The link between bed net attributes, preferences, and use was investigated using a literature review and review of publicly available, nationally representative household surveys from sub-Saharan Africa. Methods A literature search was conducted to identify publications with data on preferences for net attributes and on associations between net attributes and use. Publicly available DHS and MIS datasets were screened for variables on net preferences and net attributes. Wald tests were run to obtain odds ratios and confidence intervals for the use of nets of various attributes in univariate analysis. A multilevel logistic regression was constructed to assess the odds of a net’s use, controlling for background variables and adding random effects variables at the household and cluster level. Results Preferences for certain net attributes exist, but do not impede high rates of net use in countries where data were available. Stated preferences for shape and colour do not significantly influence net use to degrees that would require action by programme planners. By and large, people are using the nets they receive, and when they do not, it is for reasons unrelated to shape and size (primarily perceived mosquito density, heat or an excess of nets). Households in higher wealth quintiles tend to own greater numbers of conical nets, indicating that they have the ability to obtain or purchase these nets on their own, and individuals resident in higher wealth quintile households also use conical nets preferentially. Conclusions The increased manufacturing costs for conical nets are not outweighed by the very small, often non-existent, increases in use rates in sub-Saharan Africa. Programmes that wish to explore the relationship between net attributes, preferences and use rates should include these questions in nationally representative household surveys to be able to capture trends across geographic and socio-economic groups. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1879-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hannah Koenker
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA.
| | - Joshua O Yukich
- Center for Applied Malaria Research, Tulane University School of Public Health, New Orleans, LA, USA
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Clark S, Berrang-Ford L, Lwasa S, Namanya D, Twesigomwe S, Kulkarni M. A Longitudinal Analysis of Mosquito Net Ownership and Use in an Indigenous Batwa Population after a Targeted Distribution. PLoS One 2016; 11:e0154808. [PMID: 27145034 PMCID: PMC4856310 DOI: 10.1371/journal.pone.0154808] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 04/19/2016] [Indexed: 11/18/2022] Open
Abstract
Major efforts for malaria prevention programs have gone into scaling up ownership and use of insecticidal mosquito nets, particularly in sub-Saharan Africa where the malaria burden is high. Socioeconomic inequities in access to long lasting insecticidal nets (LLINs) are reduced with free distributions of nets. However, the relationship between social factors and retention of nets after a free distribution has been less studied, particularly using a longitudinal approach. Our research aimed to estimate the ownership and use of LLINs, and examine the determinants of LLIN retention, within an Indigenous Batwa population after a free LLIN distribution. Two LLINs were given free of charge to each Batwa household in Kanungu District, Uganda in November 2012. Surveyors collected data on LLIN ownership and use through six cross-sectional surveys pre- and post-distribution. Household retention, within household access, and individual use of LLINs were assessed over an 18-month period. Socioeconomic determinants of household retention of LLINs post-distribution were modelled longitudinally using logistic regression with random effects. Direct house-to-house distribution of free LLINs did not result in sustainable increases in the ownership and use of LLINs. Three months post-distribution, only 73% of households owned at least one LLIN and this period also saw the greatest reduction in ownership compared to other study periods. Eighteen-months post distribution, only a third of households still owned a LLIN. Self-reported age-specific use of LLINs was generally higher for children under five, declined for children aged 6–12, and was highest for older adults aged over 35. In the model, household wealth was a significant predictor of LLIN retention, controlling for time and other variables. This research highlights on-going socioeconomic inequities in access to malaria prevention measures among the Batwa in southwestern Uganda, even after free distribution of LLINs, and provides critical information to inform local malaria programs on possible intervention entry-points to increase access and use among this marginalized population.
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Affiliation(s)
- Sierra Clark
- Dept of Epidemiology, McGill University, Montreal, Quebec, Canada
- * E-mail: (LBF); (SC)
| | - Lea Berrang-Ford
- Dept of Geography, McGill University, Montreal, Quebec, Canada
- * E-mail: (LBF); (SC)
| | - Shuaib Lwasa
- Dept of Geography, Makerere University, Kampala, Uganda
| | | | | | - IHACC Research Team
- Indigenous Health Adaptation to Climate Change Research Team, McGill University, Montreal, Canada
| | - Manisha Kulkarni
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Song JS, Paul MM, Dhakal S, Smith MK, Michel MK, Cha E, Nam EW. Analysis of Insecticide-Treated Net Use by Pregnant Women: Implications for Donor Organizations. J Lifestyle Med 2016; 6:36-42. [PMID: 27358838 PMCID: PMC4915765 DOI: 10.15280/jlm.2016.6.1.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/08/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends the use of insecticide-treated nets (ITNs) for the prevention of malaria and reduction of mortality and morbidity from mosquito-borne diseases. Although many countries, including the Democratic Republic of Congo, have adopted this recommendation and distributed bed nets to their inhabitants, the percentage of the population using ITNs remains low. METHODS This study was conducted with 400 mothers with at least one child under 5 years of age in health zones in the Bandundu province. Face-to-face interviews were conducted using structured pre-coded questionnaires. Chi-square tests and logistic regressions were calculated using the SPSS Version 21.0 software. RESULTS Among the studied variables, education status (p = 0.013), marital status (p = 0.004), ANC utilization (p = 0.13), suffering from malaria during pregnancy (p = 0.019), and knowledge of the seriousness of malaria (p = 0.013) were significant determinants of the use of ITNs in logistic regression analyses. CONCLUSION The results of this study indicate that the regular use of ITNs by women during pregnancy is associated with marital status, attending ANC services, and awareness of the serious nature of malaria. Therefore, education about the risk factors among populations is needed.
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Affiliation(s)
- Jin Sung Song
- Department of Health Administration, Graduate School, Yonsei University, Wonju, Korea; Yonsei Global Health Center, Yonsei University, Wonju, Korea; Socio-Economic Development Department, Korea International Cooperation Agency, Seongnam, Korea
| | - Mansiangi Mankadi Paul
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Sarita Dhakal
- Department of Health Administration, Graduate School, Yonsei University, Wonju, Korea; Yonsei Global Health Center, Yonsei University, Wonju, Korea
| | - Mpaka Kiansiku Smith
- Public Health Research and Action Centre (CRASP), Kongo University, Mbanza-Ngungu, Democratic Republic of the Congo
| | | | - Eunju Cha
- Socio-Economic Development Department, Korea International Cooperation Agency, Seongnam, Korea
| | - Eun Woo Nam
- Department of Health Administration, Graduate School, Yonsei University, Wonju, Korea; Yonsei Global Health Center, Yonsei University, Wonju, Korea
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Mwandama D, Gutman J, Wolkon A, Luka M, Jafali J, Ali D, Mathanga DP, Skarbinski J. The use of intermittent preventive treatment in pregnancy and insecticide-treated bed nets for malaria prevention by women of child-bearing age in eight districts in Malawi. Malar J 2015; 14:316. [PMID: 26272067 PMCID: PMC4536790 DOI: 10.1186/s12936-015-0840-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 08/06/2015] [Indexed: 11/10/2022] Open
Abstract
Background Intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated bed nets (ITNs) can reduce the morbidity and mortality associated with malaria in pregnancy. Although the coverage for both IPTp and ITN use have been described in Malawi, the analysis of factors associated with IPTp receipt and ITN use is lacking. This analysis was conducted to assess IPTp and ITN use and predictors of use by women of child-bearing age (WOCBA). Methods A two-stage cluster-sample cross-sectional survey was conducted April 16–30, 2009 in eight districts across Malawi. Information on receipt of two or more doses of IPTp, ITN ownership, and ITN use the night before the survey was collected. Multivariate logistic regression was used to assess predictors of IPTp and ITN use. Results Data were collected from 7407 households containing 6985 WOCBA and 3213 recently pregnant women (women who reported a completed pregnancy in the 2 years before the survey). Most recently pregnant women (96 %) had at least one antenatal care (ANC) clinic visit; 91 % reported receiving at least one dose of IPTp, and 72 % reported receiving two or more doses of IPTp. Women in Phalombe, Rumphi, and Lilongwe were more likely to receive two doses of IPTp than those in Blantyre [adjusted odds ratio (aOR) 2.5 (95 % CI 1.5–4.5), 2.5 (95 % CI 1.5–4.3), and 2.0 (95 % CI 1.2–3.1), respectively]. Educated women were more likely to have received IPTp compared to women with no education [aOR 1.6 (95 % CI 1.0–2.6) for those who completed primary school, aOR1.9 (95 % CI 1.1–3.3) for some secondary school, and aOR 4.1 (95 % CI 1.9–8.7) for completed secondary school or above], and women in the poorest socioeconomic status quintile were less likely to receive IPTp than those in the least poor quintile [aOR 0.68 (95 % CI 0.48–0.97)]. In all, 53 % of WOCBA used an ITN the previous night. Women in Nkhotkhota and Phalombe were less likely to have slept under an ITN the previous night compared to those in Blantyre [aOR 0.52 (95 % CI 0.39–0.69) and aOR 0.67 (95 % CI 0.47–0.95), respectively]. In addition, age [aOR 0.61 (95 % CI 0.45–0.83) for women 15–19 years old], and either being currently pregnant [aOR 1.5 (95 % CI 1.2–2.0)] or having been pregnant in the previous 2 years [aOR 2.4, (95 % CI 2.1–2.8)] were associated with ITN use. Conclusion In Malawi in 2009, IPTp and ITN use in WOCBA fell short of national and international goals. Adoption of new guidelines encouraging administration of IPTp at every scheduled ANC visit might increase IPTp use. Increasing health promotion activities to encourage earlier attendance at ANC clinics and create demand for IPTp and ITNs might improve overall IPTp and ITN use.
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Affiliation(s)
- Dyson Mwandama
- Malaria Alert Centre, University of Malawi College of Medicine, Blantyre, Malawi.
| | - Julie Gutman
- Division of Parasitic Diseases and Malaria, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Adam Wolkon
- Division of Parasitic Diseases and Malaria, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Madalitso Luka
- Malaria Alert Centre, University of Malawi College of Medicine, Blantyre, Malawi.
| | - James Jafali
- Malaria Alert Centre, University of Malawi College of Medicine, Blantyre, Malawi.
| | - Doreen Ali
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi.
| | - Don P Mathanga
- Malaria Alert Centre, University of Malawi College of Medicine, Blantyre, Malawi. .,Malawi and Department of Community Health, College of Medicine, Lilongwe, Malawi.
| | - Jacek Skarbinski
- Division of Parasitic Diseases and Malaria, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Leonard L, Diop S, Doumbia S, Sadou A, Mihigo J, Koenker H, Berthe S, Monroe A, Bertram K, Weber R. Net use, care and repair practices following a universal distribution campaign in Mali. Malar J 2014; 13:435. [PMID: 25408158 PMCID: PMC4242490 DOI: 10.1186/1475-2875-13-435] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Government of Mali and the President's Malaria Initiative conducted a long-lasting, insecticidal net (LLIN) distribution campaign in April 2011 in the Sikasso region of Mali, with the aim of universal coverage, defined as one insecticide-treated net for every two persons. This study examines how households in post- and pre-campaign regions value and care for nets. METHODS The study was conducted in October 2012 in Sikasso and Kayes in the southeast and western regions of Mali, respectively. The regions were purposively selected to allow for comparison between areas that had already had a mass distribution campaign (Sikasso) and areas that had not yet had a mass distribution campaign (Kayes). Study sites and households were randomly selected. Sleeping space questionnaires and structured interviews with household heads were conducted to obtain information on net use, perceived value of free nets in relation to other malaria prevention activities, and net care and repair practices. RESULTS The study included 40 households, split evenly across the two regions. Forty interviews were conducted with household heads and 151 sleeping spaces were inventoried using the sleeping space questionnaire. Nets obtained through the free distribution were reported to be highly valued in comparison to other malaria prevention strategies. Overall, net ownership and use were higher among households in areas that had already experienced a mass distribution. While participants reported using and valuing these nets, care and repair practices varied. CONCLUSION National net use is high in Mali, and comparatively higher in the region covered by the universal distribution campaign than in the region not yet covered. While the Government of Mali and implementing partners have made strides to ensure high net coverage, some gaps remain related to communication messaging of correct and consistent net use throughout the year, and on improving net care and repair behaviour. By focusing on these areas as well as improved access to nets, coverage and use rates should continue to increase, contributing to improvements in malaria control.
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Affiliation(s)
- Lori Leonard
- Department of Development Sociology, Cornell University, Ithaca, NY 14853, USA.
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