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Solanke BL, Soladoye DA, Birsirka IA, Abdurraheem A, Salau OR. Utilization of insecticide-treated nets and associated factors among childbearing women in Northern Nigeria. Malar J 2023; 22:184. [PMID: 37328856 DOI: 10.1186/s12936-023-04620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Studies have explored the correlates of insecticide-treated nets in Nigeria. The few studies that focused on Northern Nigeria mostly examined individual correlates, but largely ignored the community correlates. Also, the persistence of armed insurgencies in the region calls for more research attention. This study examines the utilization and the associated individual and community factors of insecticide-treated nets in Northern Nigeria. METHODS The study adopted a cross-sectional design. Data were extracted from the 2021 Nigeria Malaria Indicator Survey (NMIS). A weighted sample size of 6873 women was analysed. The outcome variable was the utilization of insecticide-treated nets. The explanatory variables selected at the individual/household level were maternal age, maternal education, parity, religion, sex of head of household, household wealth, and household size. The variables selected at the community level were the type of place of residence, geo-political zone of residence, the proportion of children under five who slept under a bed net, the proportion of women aged 15-49 who heard malaria media messages, and the community literacy level. Two variables, namely, the number of mosquito bed nets in the household, and the number of rooms used for sleeping were included for statistical control. Three multilevel mixed-effect regression models were fitted. RESULTS The majority of childbearing women (71.8%) utilized insecticide-treated nets. Parity and household size were the significant individual/household characteristics associated with the utilization of insecticide-treated nets. The proportion of under-five children in the community who slept under mosquito bed nets, and the geopolitical zone of residence were significant community correlates of the use of insecticide-treated nets. In addition, the number of rooms for sleeping, and the number of mosquito bed nets in the households were significantly associated with the utilization of insecticide-treated nets. CONCLUSION Parity, household size, number of sleeping rooms, number of treated bed nets, geo-political zone of residence, and proportion of under-five children sleeping under bed nets are important associated factors of the utilization of insecticide-treated nets in Northern Nigeria. Existing malaria preventive initiatives should be strengthened to target these characteristics.
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Affiliation(s)
- Bola Lukman Solanke
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Daniel Alabi Soladoye
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | - Omowumi Romoke Salau
- Department of Clinical Nursing Services, UHD Trust, Royal Bournemouth Dorset, Bournemouth, UK
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Fernández Montoya L, Alafo C, Martí-Soler H, Máquina M, Malheia A, Sacoor C, Abílio AP, Marrenjo D, Cuamba N, Galatas B, Aide P, Saúte F, Paaijmans KP. An evaluation of LLIN ownership, access, and use during the Magude project in southern Mozambique. PLoS One 2023; 18:e0282209. [PMID: 36972236 PMCID: PMC10042371 DOI: 10.1371/journal.pone.0282209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 02/07/2023] [Indexed: 03/29/2023] Open
Abstract
The Magude Project assessed the feasibly of eliminating malaria in a low transmission setting in southern Mozambique using a package of interventions. This study measured the ownership, access and use of long-lasting insecticide treated nets (LLINs) and inequalities in these indicators across household wealth, size and population subgroups, to understand the protection that LLINs provided during the project. Data were obtained from various household surveys. At least 31% of the nets distributed during the 2014 and 2017 campaigns were lost during the first year post-distribution. Most nets (77.1%) present in the district were Olyset Nets. LLIN access never exceeded 76.3% and use varied seasonally between 40% and 76.4%. LLIN access limited LLIN use during the project, especially during the high transmission season. LLIN ownership, access and use were lower in harder-to-reach localities, in poorer and larger households. Children and women below 30 had poorer access to LLINs than the overall population. Net use was lowest among school-aged children and young adults, especially among young males, and highest in children under 5, pregnant women, in older adults and in households that received indoor residual spraying (IRS). This study revealed that LLIN mass-distribution campaigns alone are not sufficient to achieve the high level of net protection needed during elimination programs and that reviewing the LLIN allocation scheme, top-up distributions and/or community engagement campaigns is needed, also to reduce inequalities in populations' access to LLINs.
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Affiliation(s)
- Lucia Fernández Montoya
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
- ISGlobal, Barcelona, Spain
| | - Celso Alafo
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
| | | | - Mara Máquina
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
| | - Arlindo Malheia
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
| | - Ana Paula Abílio
- Instituto Nacional da Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Dulcisaria Marrenjo
- Programa Nacional de Controlo da Malária, Ministério da Saúde, Maputo, Mozambique
| | - Nelson Cuamba
- Programa Nacional de Controlo da Malária, Ministério da Saúde, Maputo, Mozambique
- PMI VectorLink Project, Abt Associates Inc., Maputo, Mozambique
| | - Beatriz Galatas
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
- ISGlobal, Barcelona, Spain
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
- Instituto Nacional da Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
| | - Krijn P Paaijmans
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Manhiça, Manhiça Maputo, Mozambique
- ISGlobal, Barcelona, Spain
- Center for Evolution and Medicine, School of Life Sciences, Arizona State University, Tempe, AZ, United States of America
- The Biodesign Center for Immunotherapy, Vaccines and Virotherapy, Arizona State University, Tempe, AZ, United States of America
- Simon A. Levin Mathematical, Computational and Modeling Sciences Center, Arizona State University, Tempe, AZ, United States of America
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Barry I, Toure AA, Sangho O, Beavogui AH, Cisse D, Diallo A, Magassouba AS, Sylla Y, Doumbia L, Cherif MS, Camara AY, Diawara F, Tounkara M, Delamou A, Doumbia S. Variations in the use of malaria preventive measures among pregnant women in Guinea: a secondary analysis of the 2012 and 2018 demographic and health surveys. Malar J 2022; 21:309. [PMID: 36316702 PMCID: PMC9623996 DOI: 10.1186/s12936-022-04322-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 10/18/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Despite its effectiveness, the optimal use of the combination of insecticide-treated nets (ITN) and intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) remains low in malaria-endemic areas. Therefore, this study analyzed its variations and predictors in Guinea. METHODS This study was a secondary analysis of the 2012 and 2018 Guinea Demographic and Health Surveys (DHS). It included women who had given birth 3 years before each DHS, slept on ITN and took at least one dose of SP. Use was complete if a pregnant woman slept on ITNs and took SP (at least two doses in 2012; at least three doses in 2018). Moran indices were used to determine spatial autocorrelation and classification methods to identify malaria preventive measures (MPM) predictors. RESULTS In 2012, 60.88% of pregnant women had incomplete use of MPMs compared with 79.11% in 2018. Associated factors with incomplete MPMs in 2012 were as follows: having an indirect link with the head of household (AOR = 2.23, 95% CI 1.08-4.61) and performing at least 4 ANC visits (AOR = 0.66, 95% CI 0.44-0.99). In 2018: Living in households of 2 to 5 people (AOR = 0.54, 95% CI 0.36-0.80), have a man as the head of the household (AOR = 0.56, 95% CI 0.35-0.89), perform the first ANC in the second trimester of pregnancy (AOR = 0.74, 95% CI 0.54-0.99), perform at least 4 ANC visits (AOR = 0.47, 95% CI 0.36-0.62), have a job (AOR = 0. 67, 95% CI 0.50-0.88), give birth in a public health facility (AOR = 0.53, 95% CI 0.39-0.72) and the middle wealth quintile (AOR = 1.56, 95% CI 1.07-2.26). Analyses revealed a global autocorrelation (Moran index = 0.0009, p = 0.2349) and high-high clusters in Mamou in 2012. In 2018, autocorrelation was found (I Moran = 0.0169, p ≤ 0.05), with spatial clusters in 4 regions. CONCLUSION The link with the head of household and the number of ANC visits were the main factors in MPMs. It is essential to implement strategies at the household level and health system level and monitor them to reduce inequality across regions.
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Affiliation(s)
- Ibrahima Barry
- grid.461088.30000 0004 0567 336XDépartement d’Enseignement et de Recherche en Santé Publique et Spécialités (DERSP), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali ,National Centre for Training and Research in Rural Health of Mafèrinyah, Forécariah, Guinea
| | - Almamy Amara Toure
- National Centre for Training and Research in Rural Health of Mafèrinyah, Forécariah, Guinea ,Department of Public Health, Kofi Annan University of Guinea, Conakry, Guinea
| | - Oumar Sangho
- grid.461088.30000 0004 0567 336XDépartement d’Enseignement et de Recherche des Sciences Biologiques et Médicales (DERSBM), Faculté de Pharmacie (FAPH), USTTB, Bamako, Mali
| | - Abdoul Habib Beavogui
- National Centre for Training and Research in Rural Health of Mafèrinyah, Forécariah, Guinea
| | - Diao Cisse
- grid.442347.20000 0000 9268 8914Department of Public Health, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
| | - Abdourahamane Diallo
- Service de Gynécologie, Centre Hospitalo-Universitaire Ignace Deen, Conakry, Guinea
| | - Aboubacar Sidiki Magassouba
- grid.442347.20000 0000 9268 8914Department of Public Health, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
| | - Younoussa Sylla
- National Centre for Training and Research in Rural Health of Mafèrinyah, Forécariah, Guinea
| | - Lancina Doumbia
- grid.461088.30000 0004 0567 336XDépartement d’Enseignement et de Recherche en Santé Publique et Spécialités (DERSP), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
| | - Mahamoud Sama Cherif
- National Centre for Training and Research in Rural Health of Mafèrinyah, Forécariah, Guinea
| | - Alseny Yarie Camara
- National Centre for Training and Research in Rural Health of Mafèrinyah, Forécariah, Guinea
| | - Fatou Diawara
- Institut National de Santé Publique Mali, Bamako, Mali
| | - Moctar Tounkara
- grid.461088.30000 0004 0567 336XDépartement d’Enseignement et de Recherche en Santé Publique et Spécialités (DERSP), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
| | - Alexandre Delamou
- grid.442347.20000 0000 9268 8914Department of Public Health, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea ,African Centre of Excellence in the Prevention and Control of Communicable Diseases (CEA-PCMT), Conakry, Guinea
| | - Seydou Doumbia
- grid.461088.30000 0004 0567 336XDépartement d’Enseignement et de Recherche en Santé Publique et Spécialités (DERSP), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
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Mwamlima TG, Mwakasungula SM, Mkindi CG, Tambwe MM, Mswata SS, Mbwambo SG, Mboya MF, Draper SJ, Silk SE, Mpina MG, Vianney JM, Olotu AI. Understanding the role of serological and clinical data on assessing the dynamic of malaria transmission: a case study of Bagamoyo district, Tanzania. Pan Afr Med J 2022; 43:60. [PMID: 36578806 PMCID: PMC9755714 DOI: 10.11604/pamj.2022.43.60.35779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/01/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction naturally acquired blood-stage malaria antibodies and malaria clinical data have been reported to be useful in monitoring malaria change over time and as a marker of malaria exposure. This study assessed the total immunoglobulin G (IgG) levels to Plasmodium falciparum schizont among infants (5-17 months), estimated malaria incidence using routine health facility-based surveillance data and predicted trend relation between anti-schizont antibodies and malaria incidence in Bagamoyo. Methods 252 serum samples were used for assessment of total IgG by enzyme-linked immunosorbent assay and results were expressed in arbitrary units (AU). 147/252 samples were collected in 2021 during a blood-stage malaria vaccine trial [ClinicalTrials.gov NCT04318002], and 105/252 were archived samples of malaria vaccine trial conducted in 2012 [ClinicalTrials.gov NCT00866619]. Malaria incidence was calculated from outpatient clinic data of malaria rapid test or blood smear positive results retrieved from District-Health-Information-Software-2 (DHIS2) between 2013 and 2020. Cross-sectional data from both studies were analysed using STATA version 14. Results this study demonstrated a decline in total anti-schizont IgG levels from 490.21AU in 2012 to 97.07AU in 2021 which was related to a fall in incidence from 58.25 cases/1000 person-year in 2013 to 14.28 cases/1000 person-year in 2020. We also observed a significant difference in incidence when comparing high and low malaria transmission areas and by gender. However, we did not observe differences when comparing total anti-schizont antibodies by gender and study year. Conclusion total anti-schizont antibody levels appear to be an important serological marker of exposure for assessing the dynamic of malaria transmission in infants living in malaria-endemic regions.
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Affiliation(s)
- Tunu Guntram Mwamlima
- Ifakara Health Institute, Bagamoyo, Tanzania
- Department of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Corresponding author: Tunu Guntram Mwamlima, Ifakara Health Institute, Bagamoyo, Tanzania.
| | | | | | | | | | | | | | - Simon John Draper
- Department of Biochemistry, University of Oxford, Oxford OX1 3QU, United Kingdom
| | | | | | - John-Mary Vianney
- Department of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
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Ochwedo KO, Omondi CJ, Magomere EO, Olumeh JO, Debrah I, Onyango SA, Orondo PW, Ondeto BM, Atieli HE, Ogolla SO, Githure J, Otieno ACA, Githeko AK, Kazura JW, Mukabana WR, Guiyan Y. Hyper-prevalence of submicroscopic Plasmodium falciparum infections in a rural area of western Kenya with declining malaria cases. Malar J 2021; 20:472. [PMID: 34930283 PMCID: PMC8685826 DOI: 10.1186/s12936-021-04012-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The gold standard for diagnosing Plasmodium falciparum infection is microscopic examination of Giemsa-stained peripheral blood smears. The effectiveness of this procedure for infection surveillance and malaria control may be limited by a relatively high parasitaemia detection threshold. Persons with microscopically undetectable infections may go untreated, contributing to ongoing transmission to mosquito vectors. The purpose of this study was to determine the magnitude and determinants of undiagnosed submicroscopic P. falciparum infections in a rural area of western Kenya. METHODS A health facility-based survey was conducted, and 367 patients seeking treatment for symptoms consistent with uncomplicated malaria in Homa Bay County were enrolled. The frequency of submicroscopic P. falciparum infection was measured by comparing the prevalence of infection based on light microscopic inspection of thick blood smears versus real-time polymerase chain reaction (RT-PCR) targeting P. falciparum 18S rRNA gene. Long-lasting insecticidal net (LLIN) use, participation in nocturnal outdoor activities, and gender were considered as potential determinants of submicroscopic infections. RESULTS Microscopic inspection of blood smears was positive for asexual P. falciparum parasites in 14.7% (54/367) of cases. All of these samples were confirmed by RT-PCR. 35.8% (112/313) of blood smear negative cases were positive by RT-PCR, i.e., submicroscopic infection, resulting in an overall prevalence by RT-PCR alone of 45.2% compared to 14.7% for blood smear alone. Females had a higher prevalence of submicroscopic infections (35.6% or 72 out of 202 individuals, 95% CI 28.9-42.3) compared to males (24.2%, 40 of 165 individuals, 95% CI 17.6-30.8). The risk of submicroscopic infections in LLIN users was about half that of non-LLIN users (OR = 0.59). There was no difference in the prevalence of submicroscopic infections of study participants who were active in nocturnal outdoor activities versus those who were not active (OR = 0.91). Patients who participated in nocturnal outdoor activities and use LLINs while indoors had a slightly higher risk of submicroscopic infection than those who did not use LLINs (OR = 1.48). CONCLUSION Microscopic inspection of blood smears from persons with malaria symptoms for asexual stage P. falciparum should be supplemented by more sensitive diagnostic tests in order to reduce ongoing transmission of P. falciparum parasites to local mosquito vectors.
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Affiliation(s)
- Kevin O. Ochwedo
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Collince J. Omondi
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Edwin O. Magomere
- Department of Biochemistry and Molecular Biology, Egerton University, Njoro, Kenya
| | - Julius O. Olumeh
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Isaiah Debrah
- West Africa Centre for Cell Biology of Infectious Pathogen, Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | - Shirley A. Onyango
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Pauline W. Orondo
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Benyl M. Ondeto
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Harrysone E. Atieli
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Sidney O. Ogolla
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - John Githure
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Antony C. A. Otieno
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
| | - Andrew K. Githeko
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - James W. Kazura
- Centre for Global Health and Diseases, Case Western Reserve University, Cleveland, OH USA
| | - Wolfgang R. Mukabana
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Yan Guiyan
- Program in Public Health, College of Health Sciences, University of California, Irvine, USA
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Orish VN, Maalman RSE, Donkor OY, Ceruantes BYH, Osei E, Amu H, Appiah PK, Konlan KD, Mumuni H, Kim E, Kim S, Jung H, Ofori-Amoah J, Kofie P, Adjuik M, Alhassan RK, Donkor ES, Zottor FB, Kweku M, Amuna P, Kim SY, Gyapong JO. Assessing health-seeking behaviour and malaria prevention practices among communities in four districts of the Volta Region of Ghana. Malar J 2021; 20:450. [PMID: 34838027 PMCID: PMC8626995 DOI: 10.1186/s12936-021-03986-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background Malaria is a preventable disease that causes huge morbidity and mortality in malaria-endemic areas, especially among children and pregnant women. The malaria control programme focuses on the prevention of mosquito bites using insecticide-treated nets (ITNs) and mosquito aerosol sprays and coils, as well as prevention of severe disease among those infected through prompt and adequate treatment. The success of the malaria control programme in Ghana is dependent on the malaria prevention practices of people in the community. Therefore, this study evaluated the malaria prevention practices of participants in four districts of the Volta Region of Ghana. Methods This was a cross-sectional study conducted in Ketu South, Nkwanta South, Hohoe Municipality and Ho West districts of the Volta Region of Ghana. Questionnaire were administered to adults who consented to each household visited. Questions were asked on the socio-demographics and malaria prevention practices of the households. Data analysis was done using SPSS version 23 with frequency distribution done for all the variables. Pearson chi-square was used to determine the significant association between socio-demographics and malaria prevention practices, and Multivariate nominal logistic regression analysis was used to model the relationship between dichotomous dependent variables (ITN ownership and usage) and independent variables. Results Out of the 2493 participants; 2234 (89.6%) owned ITN and 1528 (68.4%) used ITN a night before this study, 768 (30.8%) used mosquito aerosol spray and 368 (15%) used mosquito coil. More females significantly owned ITN than males (1293, 92.4%, p ≤ 0.001). Participants from Ketu South had 1.5 times higher odds of owning an ITN compared to Ho West whose odds are not different from Nkwanta South or Hohoe (AOR, 1.56 [95% 1.09–2.22]; p = 0.01). In terms of ITN usage, participants in Nkwanta South were less likely to use ITN compared to the other districts; AOR, 0.434 [95% CI 0.31–0.62, p < 0.001]. Also, of the 668 participants that had a fever within the past 3 days, 268 (40.1%) visited a patent medicine store and 156 (23.4%) visited health facilities. Conclusion There is high ownership of ITNs, but relatively low utilization among the community members. Education on malaria prevention practices should be intensified and continuous among the population of the Volta Region to ensure the success of malaria control in the region.
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Affiliation(s)
- Verner N Orish
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | | | - Otchere Y Donkor
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | | | - Eric Osei
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.,Department of Public Health Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Hubert Amu
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Prince Kubi Appiah
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.,Department of Public Health Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Kennedy Diema Konlan
- Department of Public Health Graduate School, Yonsei University, Seoul, Republic of Korea.,School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Hadiru Mumuni
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Eunji Kim
- Korea Foundation for International Healthcare Ghana Office, Accra, Ghana
| | - Siwoo Kim
- Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hajun Jung
- Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jones Ofori-Amoah
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Philip Kofie
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Martin Adjuik
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Robert Kaba Alhassan
- Directorate of International Affairs, University of Health and Allied Sciences, Ho, Ghana
| | | | | | - Margaret Kweku
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Paul Amuna
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - So Yoo Kim
- Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - John Owusu Gyapong
- Office of the Vice-Chancellor, University of Health and Allied Sciences, Ho, Ghana
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Investigating differences in village-level heterogeneity of malaria infection and household risk factors in Papua New Guinea. Sci Rep 2021; 11:16540. [PMID: 34400687 PMCID: PMC8367982 DOI: 10.1038/s41598-021-95959-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Malaria risk is highly heterogeneous. Understanding village and household-level spatial heterogeneity of malaria risk can support a transition to spatially targeted interventions for malaria elimination. This analysis uses data from cross-sectional prevalence surveys conducted in 2014 and 2016 in two villages (Megiar and Mirap) in Papua New Guinea. Generalised additive modelling was used to characterise spatial heterogeneity of malaria risk and investigate the contribution of individual, household and environmental-level risk factors. Following a period of declining malaria prevalence, the prevalence of P. falciparum increased from 11.4 to 19.1% in Megiar and 12.3 to 28.3% in Mirap between 2014 and 2016, with focal hotspots observed in these villages in 2014 and expanding in 2016. Prevalence of P. vivax was similar in both years (20.6% and 18.3% in Megiar, 22.1% and 23.4% in Mirap) and spatial risk heterogeneity was less apparent compared to P. falciparum. Within-village hotspots varied by Plasmodium species across time and between villages. In Megiar, the adjusted odds ratio (AOR) of infection could be partially explained by household factors that increase risk of vector exposure, such as collecting outdoor surface water as a main source of water. In Mirap, increased AOR overlapped with proximity to densely vegetated areas of the village. The identification of household and environmental factors associated with increased spatial risk may serve as useful indicators of transmission hotspots and inform the development of tailored approaches for malaria control.
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8
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Chukwu C, Onuoha H, Okorafor KAK, Ojomo O, Mokuolu OA, Ekholuenetale M. Geopolitical zones differentials in intermittent preventive treatment in pregnancy (IPTp) and long lasting insecticidal nets (LLIN) utilization in Nigeria. PLoS One 2021; 16:e0254475. [PMID: 34270607 PMCID: PMC8284679 DOI: 10.1371/journal.pone.0254475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 06/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background The coverage of long lasting insecticidal nets (LLIN) and intermittent preventive treatment of malaria in pregnancy (IPTp) uptake for the prevention of malaria commonly vary by geography. Many sub-Saharan Africa (SSA) countries, including Nigeria are adopting the use of LLIN and IPTp to fight malaria. Albeit, the coverage of these interventions to prevent malaria across geographical divisions have been understudied in many countries. In this study, we aimed to explore the differentials in LLIN and IPTp uptake across Nigerian geopolitical zones. Methods We analyzed data from Nigeria Multiple Indicator Cluster Survey (MICS) 2016–17. The outcome variables were IPTp and LLIN uptake among women of childbearing age (15–49 years). A total sample of 24,344 women who had given birth were examined for IPTp use and 36,176 women for LLIN use. Percentages, Chi-square test and multivariable logit models plots were used to examine the geopolitical zones differentials in IPTp and LLIN utilization. Data was analyzed at 5% level of significance. Results The overall prevalence of IPTp was 76.0% in Nigeria. Moreover, there were differences across geopolitical zones: North Central (71.3%), North East (76.9%), North West (78.2%), South East (76.1%), South South (79.7%) and South West (72.4%) respectively. Furthermore, the prevalence of LLIN was 87.7%% in Nigeria. Also, there were differences across geopolitical zones: North Central (89.1%), North East (91.8%), North West (90.0%), South East (77.3%), South South (81.1%) and South West (69.8%) respectively. Women who have access to media use, married, educated and non-poor were more likely to uptake IPTp. On the other hand, rural dwellers and those with media use were more likely to use LLIN. Conversely, married, educated, non-poor and women aged 25–34 and 35+ were less likely to use LLIN. Conclusion Though the utilization of IPTp and LLIN was relatively high, full coverage are yet to be achieved. There was geopolitical zones differentials in the prevalence of IPTp and LLIN in Nigeria. Promoting the utilization of IPTp and LLINs across the six geopolitical zones through intensive health education and widespread mass media campaigns will help to achieve the full scale IPTp and LLIN utilization.
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Affiliation(s)
- Chinedu Chukwu
- Monitoring and Evaluation Unit, Management Sciences for Health, Abuja, Nigeria
| | - Herbert Onuoha
- Department of Tropical Hygiene and Public Health, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Kwala Adline Katty Okorafor
- Department of Community Medicine, Faculty of Clinical Sciences, University of Abuja, Federal Capital Territory, Abuja, Nigeria
| | - Oluwaseun Ojomo
- Department of Psychology and Professional Development, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Olugbenga A. Mokuolu
- Department of Paediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- * E-mail:
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9
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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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10
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Hii J, Hustedt J, Bangs MJ. Residual Malaria Transmission in Select Countries of Asia-Pacific Region: Old Wine in a New Barrel. J Infect Dis 2021; 223:S111-S142. [PMID: 33906222 PMCID: PMC8079134 DOI: 10.1093/infdis/jiab004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Despite substantial reductions in malaria burden and improvement in case management, malaria remains a major public health challenge in the Asia-Pacific region. Residual malaria transmission (RMT) is the fraction of total transmission that persists after achievement of full operational coverage with effective insecticide-treated bed nets (ITNs)/long-lasting insecticidal nets (LLINs) and/or indoor residual spray interventions. There is a critical need to standardize and share best practices for entomological, anthropological, and product development investigative protocols to meet the challenges of RMT and elimination goals. Methods A systematic review was conducted to describe when and where RMT is occurring, while specifically targeting ownership and usage of ITN/LLINs, indoor residual spray application, insecticide susceptibility of vectors, and human and vector biting behavior, with a focus on nighttime activities. Results Sixty-six publications from 1995 to present met the inclusion criteria for closer review. Associations between local vector control coverage and use with behaviors of human and mosquito vectors varied by locality and circumstance. Consequently, the magnitude of RMT is insufficiently studied and analyzed with sparse estimates of individual exposure in communities, insufficient or incomplete observations of ITN/LLIN use, and the local human population movement into and from high-risk areas. Conclusions This review identified significant gaps or deficiencies that require urgent attention, namely, developing standardized procedures and methods to estimate risk exposure beyond the peridomestic setting, analytical approaches to measure key human-vector interactions, and seasonal location-specific agricultural or forest use calendars, and establishing the collection of longitudinal human and vector data close in time and location.
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Affiliation(s)
- Jeffrey Hii
- Malaria Consortium Asia, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | | | - Michael J Bangs
- Public Health and Malaria Control Department, PT Freeport Indonesia, International SOS, Jl. Kertajasa, Kuala Kencana, Papua, Indonesia.,Department of Entomology, Faculty of Agriculture, Kasertart University, Bangkok, Thailand
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11
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Kassam NA, Kaaya RD, Damian DJ, Schmiegelow C, Kavishe RA, Alifrangis M, Wang CW. Ten years of monitoring malaria trend and factors associated with malaria test positivity rates in Lower Moshi. Malar J 2021; 20:193. [PMID: 33879164 PMCID: PMC8056660 DOI: 10.1186/s12936-021-03730-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background High altitude settings in Eastern Africa have been reported to experience increased malaria burden due to vector habitat expansion. This study explored possible associations between malaria test positivity rates and its predictors including malaria control measures and meteorological factors at a high-altitude, low malaria transmission setting, south of Mount Kilimanjaro. Methods Malaria cases reported at the Tanganyika Plantation Company (TPC) hospital’s malaria registers, meteorological data recorded at TPC sugar factory and data on bed nets distributed in Lower Moshi from 2009 to 2018 were studied. Correlation between bed nets distributed and malaria test positivity rates were explored by using Pearson correlation analysis and the associations between malaria test positivity rates and demographic and meteorological variables were determined by logistic regression and negative binomial regression analyses, respectively. Results Malaria cases reported at TPC hospital ranged between 0.48 and 2.26% per year and increased slightly at the introduction of malaria rapid diagnostic tests. The risk of testing positive for malaria were significantly highest among individuals aged between 6 and 15 years (OR = 1.65; 1.65 CI = 1.28–2.13; p = 0.001) and 16–30 years (OR = 1.49; CI = 1.17–1.89; p = 0.001) and when adjusted for age, the risk were significantly higher among male individuals when compared to female individuals (OR = 1.54; 1.00–1.31; p = 0.044). Malaria test positivity rates were positively associated with average monthly minimum temperatures and negatively associated with average monthly maximum temperatures (incidence rate ratio (IRR) = 1.37, 95% confidence interval (CI) = 1.05–1.78, p = 0.019 and IRR = 0.72, 95% CI = 0.58–0.91, p = 0.005, respectively). When analysed with one month lag for predictor variables, malaria test positivity rates were still significantly associated with average monthly minimum and maximum temperatures (IRR = 1.67, 95% CI = 1.28–2.19, p = 0.001 and IRR = 0.68, 95% CI = 0.54–0.85, p = 0.001, respectively). Average monthly rainfall and relative humidity with or without a one month lag was not associated with malaria test positivity rates in the adjusted models. Explopring possible associations between distribution of long-lasting insecticidal nets, (LLINs) and malaria test positivity rates showed no apparent correlation between numbers of LLINs distributed in a particular year and malaria test positivity rates. Conclusion In Lower Moshi, the risk of being tested positive for malaria was highest for older children and male individuals. Higher minimum and lower maximum temperatures were the strongest climatic predictors for malaria test positivity rates. In areas with extensive irrigation activity as in Lower Moshi, vector abundance and thus malaria transmission may be less dependent on rainfall patterns and humidity. Mass distribution of LLINs did not have an effect in this area with already very low malaria transmission. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03730-1.
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Affiliation(s)
- Nancy A Kassam
- Kilimanjaro Christian Medical University College (KCMUCo), P.O. Box 2240, Moshi, Tanzania.
| | - Robert D Kaaya
- Kilimanjaro Christian Medical University College (KCMUCo), P.O. Box 2240, Moshi, Tanzania
| | - Damian J Damian
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Reginald A Kavishe
- Kilimanjaro Christian Medical University College (KCMUCo), P.O. Box 2240, Moshi, Tanzania
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Christian W Wang
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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12
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Minetti C, Tettevi EJ, Mechan F, Prada JM, Idun B, Biritwum NK, Osei-Atweneboana MY, Reimer LJ. Elimination within reach: A cross-sectional study highlighting the factors that contribute to persistent lymphatic filariasis in eight communities in rural Ghana. PLoS Negl Trop Dis 2019; 13:e0006994. [PMID: 30608931 PMCID: PMC6342320 DOI: 10.1371/journal.pntd.0006994] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 01/22/2019] [Accepted: 11/13/2018] [Indexed: 12/20/2022] Open
Abstract
Background Despite the progress achieved in scaling-up mass drug administration (MDA) for lymphatic filariasis (LF) in Ghana, communities with persistent LF still exist even after 10 years of community treatment. To understand the reasons for persistence, we conducted a study to assess the status of disease elimination and understand the adherence to interventions including MDA and insecticide treated nets. Methodology and principal findings We conducted a parasitological and epidemiological cross-sectional study in adults from eight villages still under MDA in the Northern Region savannah and the coastal Western Region of the country. Prevalence of filarial antigen ranged 0 to 32.4% and in five villages the prevalence of night blood microfilaria (mf) was above 1%, ranging from 0 to 5.7%. Median mf density was 67 mf/ml (range: 10–3,560). LF antigen positivity was positively associated with male sex but negatively associated with participating in MDA the previous year. Male sex was also associated with a decreased probability of participating in MDA. A stochastic model (TRANSFIL) was used to assess the expected microfilaria prevalence under different MDA coverage scenarios using historical data on one community in the Western Region. In this example, the model simulations suggested that the slow decline in mf prevalence is what we would expect given high baseline prevalence and a high correlation between MDA adherence from year to year, despite high MDA coverage. Conclusions There is a need for an integrated quantitative and qualitative research approach to identify the variations in prevalence, associated risk factors and intervention coverage and use levels between and within regions and districts. Such knowledge will help target resources and enhance surveillance to the communities most at risk and to reach the 2020 LF elimination goals in Ghana. Lymphatic filariasis (LF) is a mosquito-borne disease and a leading cause of disability and chronic morbidity worldwide. Despite the progress achieved so far in stopping LF transmission by treating the affected communities with specific drugs over several years, areas where lymphatic filariasis persists still exist. Understanding the reasons behind this is pivotal to both reach and sustain elimination. We investigated the factors associated with filariasis persistence in various communities still under drug treatment from two regions of Ghana. We reported high variability in disease burden, adherence to drug treatment and mosquito net use between regions and communities. LF infection was associated with men and not taking the drugs, and men were also less likely to take treatment. Using mathematical modelling, we showed that slight increases in treatment coverage will accelerate elimination. Our findings highlight the reasons for LF persistence and provide guidance on how to successfully achieve elimination by refining drug treatment distribution and mosquito control interventions more tailored to individuals and communities. We also demonstrated the value of using field-collected data in mathematical models to assess the current status of disease elimination and to identify the gaps in control interventions.
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Affiliation(s)
- Corrado Minetti
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Edward J. Tettevi
- Department of Environmental Biology and Health, Council for Scientific and Industrial Research Water Research Institute, Accra, Ghana
| | - Frank Mechan
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Joaquín M. Prada
- Mathematics Institute, University of Warwick, Coventry, United Kingdom
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Bright Idun
- Department of Environmental Biology and Health, Council for Scientific and Industrial Research Water Research Institute, Accra, Ghana
| | | | - Mike Yaw Osei-Atweneboana
- Department of Environmental Biology and Health, Council for Scientific and Industrial Research Water Research Institute, Accra, Ghana
| | - Lisa J. Reimer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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13
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Rangel G, Teerawattanapong N, Chamnanchanunt S, Umemura T, Pinyachat A, Wanram S. Candidate microRNAs as Biomarkers in Malaria Infection: A Systematic Review. Curr Mol Med 2019; 20:36-43. [PMID: 31429687 DOI: 10.2174/1566524019666190820124827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/15/2019] [Accepted: 07/30/2019] [Indexed: 01/15/2023]
Abstract
Malaria disease is a public health problem especially in tropical countries, 445.000 of malaria-related deaths have been reported in 2017. MicroRNAs (miRNAs) are small non-coding RNAs with 18-24 nucleotides in length, which have been demonstrated to regulate gene expression of several biological processes. The dysregulation of host immune-related gene expressions during the transcriptional process by microRNA has been extensively reported in malaria parasite invasion of erythrocytes infection. The candidate's miRNAs would be used as potential biomarkers in the future and perspective. A systematic review on miRNAs as candidate clinical biomarkers in malaria infection has been established in this study. Electronic databases (Medline, EMBASE, CINAHL and Cochrane data bases) were screened and articles were included as per established selection criteria. We comprehensively searched to identify publications related to malaria and miRNA. PRISMA guidelines were followed, 262 articles were searched, duplicates and unconnected papers were excluded. Nineteen articles were included in the study. It was found that malaria parasite infected liver or tissue produce tissue-specific miRNAs and release to the blood stream. The association of miRNAs including miR-16, miR-155, miR-150, miR-451 and miR-223 with the dysregulations of immune-related genes expression such as PfEMP-1, IFN-γ, AGO- 1 AGO-2; IL4, CD80, CD86, CD36, ANG-1 and ANG-2 during early, severe and/or cerebral malaria infections indicate the potential use of those miRNAs as biomarkers for malaria infection.
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Affiliation(s)
- Gregorio Rangel
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
- Centre for Excellence in Biomedical Science and Engineering, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
| | - Nattawat Teerawattanapong
- Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
| | - Supat Chamnanchanunt
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tsukuru Umemura
- Departments of Medical Technology and Sciences, International University of Health and Welfare, Ohkawa, Fukuoka 831-8501, Japan
| | - Anuwat Pinyachat
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
- Centre for Excellence in Biomedical Science and Engineering, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
| | - Surasak Wanram
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
- Centre for Excellence in Biomedical Science and Engineering, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
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14
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Buchwald AG, Sorkin JD, Sixpence A, Chimenya M, Damson M, Wilson ML, Seydel K, Hochman S, Mathanga D, Taylor TE, Laufer MK. Association Between Age and Plasmodium falciparum Infection Dynamics. Am J Epidemiol 2019; 188:169-176. [PMID: 30252032 DOI: 10.1093/aje/kwy213] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/12/2018] [Indexed: 11/12/2022] Open
Abstract
Few data exist on the incidence or duration of natural Plasmodium falciparum infections in high-transmission settings. School-aged children (SAC) carry a disproportionate burden of infections, suggesting either increased incidence or increased duration. We estimated the incidence and duration of unique infections according to age groups. The Mfera Cohort Study (2014-2017) in Malawi had 2 years of follow-up, with 120 participants tested monthly and during sick visits. Blood samples were collected to detect P. falciparum by microscopy and polymerase chain reaction. Positive samples underwent genotyping. Simulation was used to account for high rates of nondetection of infection among low-parasitemia infections, which increase in frequency with age. Adults had significantly fewer unique infections per person per year (median, 2.5) compared with SAC and children younger than 5 years of age (6.3 and 6.6, respectively). Over half of all genotypes were persistent. Infections lasted significantly longer in adults (median, 180 days) and SAC (median, 163 days) compared with children younger than 5 years of age (median, 97 days), after accounting for age-dependent nondetection of infection. SAC acquired new infections at the same rate as children younger than 5 years, but they maintained these infections for longer periods of time, similar to adults. This study provides new insights into P. falciparum infection dynamics that should be considered when designing malaria control strategies.
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Affiliation(s)
- Andrea G Buchwald
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - John D Sorkin
- Geriatrics Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
- Division of Geriatrics and Gerontology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alick Sixpence
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Mabvuto Chimenya
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Milius Damson
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Mark L Wilson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Karl Seydel
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Sarah Hochman
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Don Mathanga
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Terrie E Taylor
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Miriam K Laufer
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
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15
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Dillip A, Mboma ZM, Greer G, Lorenz LM. 'To be honest, women do everything': understanding roles of men and women in net care and repair in Southern Tanzania. Malar J 2018; 17:459. [PMID: 30526608 PMCID: PMC6286524 DOI: 10.1186/s12936-018-2608-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 12/01/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In Tanzania, the roles of men and women are classified based on the local cultural context. While men are usually the breadwinners, women are traditionally responsible for most domestic chores. Particularly for malaria prevention, studies in Africa have revealed women as being responsible for daily up-keep of the net. Using social role theory, this study explored the role of men and women in net care and repair and gender-related motivation and barriers to net care and repair in Tanzania. METHODS The study was conducted in the two villages of Ruangwa district in Lindi Region. The study applied qualitative approaches and carried out in-depth interviews and focus group discussions with men, women, women with children under the age of five, and village key informants. RESULTS Mosquito nets were valued by all participants as a protection measure against mosquitoes. Study findings indicate that net care and repair falls under a woman's daily household responsibilities. While men were said to assist in stitching damaged nets, washing dirty bed nets was regarded inappropriate for men and not traditionally accepted. Motivation for net care and repair was reported to come from both men and women; for a woman keeping the net clean defined a caring and responsible woman, while men indirectly promoted net washing when complaining about nets being dirty. Women reported that men could do everything that women do regarding net care and repair, but that it does not fit into societal norms. CONCLUSION With increased globalization in Tanzania, more women are becoming part of the workforce, which may limit their full commitment to net care and repair activities, leading to increased net damage, malaria incidences and higher costs for malaria treatment. The National Malaria Control Programme should consider incorporating research-informed gender-transformative messages into their behaviour change communication on mosquito nets and work closely with trusted Community Health Workers to inform communities about the importance of sharing responsibilities in net care and repair. It is acknowledged that changing people's behaviour and practices is a long process, which will require a deep cultural and political shift.
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Affiliation(s)
- Angel Dillip
- Ifakara Health Institute, Kiko Avenue, Mikocheni, P.O. Box 78373, Dar es Salaam, Tanzania.
| | - Zawadi Mageni Mboma
- Ifakara Health Institute, Kiko Avenue, Mikocheni, P.O. Box 78373, Dar es Salaam, Tanzania
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - George Greer
- USAID/US President's Malaria Initiative Tanzania, Old Bagamoyo Road, Msasani, Dar es Salaam, Tanzania
| | - Lena M Lorenz
- Ifakara Health Institute, Kiko Avenue, Mikocheni, P.O. Box 78373, Dar es Salaam, Tanzania
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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16
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Olapeju B, Choiriyyah I, Lynch M, Acosta A, Blaufuss S, Filemyr E, Harig H, Monroe A, Selby RA, Kilian A, Koenker H. Age and gender trends in insecticide-treated net use in sub-Saharan Africa: a multi-country analysis. Malar J 2018; 17:423. [PMID: 30428916 PMCID: PMC6234545 DOI: 10.1186/s12936-018-2575-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022] Open
Abstract
Background The degree to which insecticide-treated net (ITN) supply accounts for age and gender disparities in ITN use among household members is unknown. This study explores the role of household ITN supply in the variation in ITN use among household members in sub-Saharan Africa. Methods Data was from Malaria Indicator Surveys or Demographic and Health Surveys collected between 2011 and 2016 from 29 countries in sub-Saharan Africa. The main outcome was ITN use the previous night. Other key variables included ITN supply (nets/household members), age and gender of household members. Analytical methods included logistic regressions and meta-regression. Results Across countries, the median (range) of the percentage of households with enough ITNs was 30.7% (8.5–62.0%). Crude analysis showed a sinusoidal pattern in ITN use across age groups of household members, peaking at 0–4 years and again around 30–40 years and dipping among people between 5–14 and 50+ years. This sinusoidal pattern was more pronounced in households with not enough ITNs compared to those with enough ITNs. ITN use tended to be higher in females than males in households with not enough ITNs while use was comparable among females and males in households with enough ITNs. After adjusting for wealth quintile, residence and region, among households with not enough ITNs in all countries, the odds of ITN use were consistently higher among children under 5 years and non-pregnant women 15–49 years. Meta-regressions showed that across all countries, the mean adjusted odds ratio (aOR) of ITN use among children under 5 years, pregnant and non-pregnant women aged 15–49 years and people 50 years and above was significantly higher than among men aged 15–49 years. Among these household members, the relationship was attenuated when there were enough ITNs in the household (dropping 0.26–0.59 points) after adjusting for geographical zone, household ITN supply, population ITN access, and ITN use:access ratio. There was no significant difference in mean aOR of ITN use among school-aged children compared to men aged 15–49 years, regardless of household ITN supply. Conclusions This study demonstrated that having enough ITNs in the household increases level of use and decreases existing disparities between age and gender groups. ITN distribution via mass campaigns and continuous distribution channels should be enhanced as needed to ensure that households have enough ITNs for all members, including men and school-aged children.
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Affiliation(s)
- Bolanle Olapeju
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Ifta Choiriyyah
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Matthew Lynch
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Angela Acosta
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Sean Blaufuss
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Eric Filemyr
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Hunter Harig
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - April Monroe
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Richmond Ato Selby
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA
| | - Albert Kilian
- PMI VectorWorks Project, Tropical Health LLP, Montagut, Spain
| | - Hannah Koenker
- PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, School of Public Health, 111 Marketplace, Baltimore, MD, 21202, USA.
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Percival V, Dusabe-Richards E, Wurie H, Namakula J, Ssali S, Theobald S. Are health systems interventions gender blind? examining health system reconstruction in conflict affected states. Global Health 2018; 14:90. [PMID: 30157887 PMCID: PMC6116483 DOI: 10.1186/s12992-018-0401-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Global health policy prioritizes improving the health of women and girls, as evident in the Sustainable Development Goals (SDGs), multiple women's health initiatives, and the billions of dollars spent by international donors and national governments to improve health service delivery in low-income countries. Countries recovering from fragility and conflict often engage in wide-ranging institutional reforms, including within the health system, to address inequities. Research and policy do not sufficiently explore how health system interventions contribute to the broader goal of gender equity. METHODS This paper utilizes a framework synthesis approach to examine if and how rebuilding health systems affected gender equity in the post-conflict contexts of Mozambique, Timor Leste, Sierra Leone, and Northern Uganda. To undertake this analysis, we utilized the WHO health systems building blocks to establish benchmarks of gender equity. We then identified and evaluated a broad range of available evidence on these building blocks within these four contexts. We reviewed the evidence to assess if and how health interventions during the post-conflict reconstruction period met these gender equity benchmarks. FINDINGS Our analysis shows that the four countries did not meet gender equitable benchmarks in their health systems. Across all four contexts, health interventions did not adequately reflect on how gender norms are replicated by the health system, and conversely, how the health system can transform these gender norms and promote gender equity. Gender inequity undermined the ability of health systems to effectively improve health outcomes for women and girls. From our findings, we suggest the key attributes of gender equitable health systems to guide further research and policy. CONCLUSION The use of gender equitable benchmarks provides important insights into how health system interventions in the post-conflict period neglected the role of the health system in addressing or perpetuating gender inequities. Given the frequent contact made by individuals with health services, and the important role of the health system within societies, this gender blind nature of health system engagement missed an important opportunity to contribute to more equitable and peaceful societies.
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Affiliation(s)
- Valerie Percival
- International Affairs, Norman Paterson School of International Affairs, Carleton University, 5319 Richcraft Building, 1125 Colonel By Drive, Ottawa, ON K1S 5B6 Canada
| | | | - Haja Wurie
- ReBUILD Research Consortium, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Justine Namakula
- ReBUILD Consortium, School of Public Health, Makerere University, Kampala, Uganda
| | - Sarah Ssali
- School of Women and Gender Studies, ReBUILD consortium, Makerere University, Kampala, Uganda
| | - Sally Theobald
- Social Science and International Health, ReBUILD and RinGs Consortium, Liverpool School of Tropical Medicine, Liverpool, UK
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Raghavendra K, Chourasia MK, Swain DK, Bhatt RM, Uragayala S, Dutta GDP, Kleinschmidt I. Monitoring of long-lasting insecticidal nets (LLINs) coverage versus utilization: a community-based survey in malaria endemic villages of Central India. Malar J 2017; 16:467. [PMID: 29149892 PMCID: PMC5693530 DOI: 10.1186/s12936-017-2117-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Despite the known effectiveness of long-lasting insecticidal nets (LLINs) in providing protection against malaria, high level of ownership and use are very difficult to achieve and maintain. Nearly 40,000 LLINs were distributed in 2014 as an intervention tool against malaria transmission in 80 villages of Keshkal sub-district in Chhattisgarh, India. This study assessed LLIN coverage, access, utilization pattern, and key determinants for the net use 1 year after mass distribution. Methods In 2015, a cross-sectional household survey was carried out in 80 study clusters (whole village or part of village). From each cluster, 40 households were randomly selected and interviewed using a structured questionnaire adapted from the malaria indicator survey of Roll Back Malaria guidelines. Information on demographic characteristics, LLIN ownership, and its use on the night before the survey, and physical condition of LLINs were recorded. Results 2970 households were interviewed with a total of 15,003 individuals present in the households during the night before the survey. Nearly 98% of households had at least one LLIN and 59.4% of the surveyed population reportedly used an LLIN the previous night. LLIN use varied from 41 to 94% between the study clusters. Nearly 89% of the LLINs were found in good physical condition (without holes). However, proportion of household with at least one LLIN per two persons was only 39%. Conclusion Universal coverage of LLINs was inadequate in the study clusters making it difficult for all household members to use an LLIN. LLIN use varied between clusters and was highest in children under 5 years of age. Health education campaigns and creating awareness about the benefit of sleeping under the LLINs in providing protection against malaria is required not only to high risk groups of pregnant women and children below 5 years of age but all the members of the family to have an epidemiological impact of this intervention at the community level. Relatively high net use despite poor access to LLINs indicates an overall desire to use nets when they are available. The main barrier to increased use of nets is the low coverage at household level.
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Affiliation(s)
- Kamaraju Raghavendra
- National Institute of Malaria Research (ICMR), Sector-8, Dwarka, New Delhi, 110077, India.
| | - Mehul Kumar Chourasia
- National Institute of Malaria Research (ICMR) IIR-WHO Project, Field Unit, Kondagaon, Chhattisgarh, India
| | - Dipak Kumar Swain
- National Institute of Malaria Research (ICMR) IIR-WHO Project, Field Unit, Kondagaon, Chhattisgarh, India
| | - Rajendra M Bhatt
- National Institute of Malaria Research (ICMR), Field Unit, Lalpur, Raipur, Chhattisgarh, India
| | - Sreehari Uragayala
- National Institute of Malaria Research (ICMR), Field Unit, Bangalore, Karnataka, India
| | - G D P Dutta
- National Institute of Malaria Research (ICMR), Field Unit, Lalpur, Raipur, Chhattisgarh, India
| | - Immo Kleinschmidt
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Yekabong RC, Ebile WA, Fon PN, Asongalem EA. The impact of mass distribution of long lasting insecticide-treated bed-nets on the malaria parasite burden in the Buea Health District in South-West Cameroon: a hospital based chart review of patient's laboratory records. BMC Res Notes 2017; 10:534. [PMID: 29084600 PMCID: PMC5663123 DOI: 10.1186/s13104-017-2870-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/24/2017] [Indexed: 11/24/2022] Open
Abstract
Background Malaria remains a leading cause of illness and deaths in Cameroon. The use of long lasting insecticide treated bed nets (LLITN) is the most effective method to reduce the burden of malaria. The aim of this study was to determine the impact of the mass distribution of LLITN on the hospital prevalence of malaria (prevalence of malaria in patients with a presumptive diagnosis of malaria), in the Buea Health District in the South-West Region of Cameroon. Methods A hospital-based chart review of records of malaria confirmatory test results in health facilities of the Buea Health District from January 2011 through December 2013. Data were extracted with the help of a grid, then analyzed with EPIinfo version 6 and Microsoft Excel 2010. Chi square test was used to compare prevalence and ANOVA was used to compare mean parasitaemia. Results A total of 17,268 records were reviewed, 3545[20.5% (19.9–21.1)] confirmed malaria positive with mean trophozoite count of 2735.3 ± 23,323.5 trophozoite/µl of blood. Prevalence was higher in males 1497 [23.5% (22.4–24.5)] than females 2047 [18.8% (18.1–19.6)], p < 0.01. Significant evidence of a reduction in the prevalence of malaria was found in under-fives in 2012 (p = 0.03). Conclusions Universal coverage with LLITN failed to guarantee effective control of malaria in the Buea Health District, as expected. Continuous and appropriate use of LLITN is indispensable, in addition to periodic sensitization, booster campaigns of LLITN distribution and evaluation research for effective prevention and control of malaria.
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Affiliation(s)
- Renda Colins Yekabong
- Faculty of Health Sciences, University of Buea, Buea, Cameroon. .,Solidarity Health Foundation/Solidarity Hospital Molyko, Buea, Cameroon.
| | - Walter Akoh Ebile
- Department of Biomedical Sciences, Faculty of Sciences, University of Dschang, Dschang, Cameroon.,M.A SANTE (Meilleure Accès aux Soins de Santé), Yaoundé, Cameroon
| | - Peter Nde Fon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Solidarity Health Foundation/Solidarity Hospital Molyko, Buea, Cameroon
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Pam DD, de Souza DK, D'Souza S, Opoku M, Sanda S, Nazaradden I, Anagbogu IN, Okoronkwo C, Davies E, Elhassan E, Molyneux DH, Bockarie MJ, Koudou BG. Is mass drug administration against lymphatic filariasis required in urban settings? The experience in Kano, Nigeria. PLoS Negl Trop Dis 2017; 11:e0006004. [PMID: 29020042 PMCID: PMC5665554 DOI: 10.1371/journal.pntd.0006004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 11/01/2017] [Accepted: 10/02/2017] [Indexed: 11/23/2022] Open
Abstract
Background The Global Programme to Eliminate Lymphatic Filariasis (GPELF), launched in 2000, has the target of eliminating the disease as a public health problem by the year 2020. The strategy adopted is mass drug administration (MDA) to all eligible individuals in endemic communities and the implementation of measures to reduce the morbidity of those suffering from chronic disease. Success has been recorded in many rural endemic communities in which elimination efforts have centered. However, implementation has been challenging in several urban African cities. The large cities of West Africa, exemplified in Nigeria in Kano are challenging for LF elimination program because reaching 65% therapeutic coverage during MDA is difficult. There is therefore a need to define a strategy which could complement MDA. Thus, in Kano State, Nigeria, while LF MDA had reached 33 of the 44 Local Government Areas (LGAs) there remained eleven ‘urban’ LGAs which had not been covered by MDA. Given the challenges of achieving at least 65% coverage during MDA implementation over several years in order to achieve elimination, it may be challenging to eliminate LF in such settings. In order to plan the LF control activities, this study was undertaken to confirm the LF infection prevalence in the human and mosquito populations in three urban LGAs. Methods The prevalence of circulating filarial antigen (CFA) of Wuchereria bancrofti was assessed by an immuno-chromatography test (ICT) in 981 people in three urban LGAs of Kano state, Nigeria. Mosquitoes were collected over a period of 4 months from May to August 2015 using exit traps, gravid traps and pyrethrum knock-down spray sheet collections (PSC) in different households. A proportion of mosquitoes were analyzed for W. bancrofti, using dissection, loop-mediated isothermal amplification (LAMP) assay and conventional polymerase chain reaction (PCR). Results The results showed that none of the 981 subjects (constituted of <21% of children 5–10 years old) tested had detectable levels of CFA in their blood. Entomological results showed that An. gambiae s.l. had W. bancrofti DNA detectable in pools in Kano; W. bancrofti DNA was detected in between 0.96% and 6.78% and to a lesser extent in Culex mosquitoes where DNA was detected at rates of between 0.19% and 0.64%. DNA analysis showed that An. coluzzii constituted 9.9% of the collected mosquitoes and the remaining 90.1% of the mosquitoes were Culex mosquitoes. Conclusion Despite detection of W. bancrofti DNA within mosquito specimens collected in three Kano urban LGAs, we were not able to find a subject with detectable level of CFA. Together with other evidence suggesting that LF transmission in urban areas in West Africa may not be of significant importance, the Federal Ministry of Health advised that two rounds of MDA be undertaken in the urban areas of Kano. It is recommended that the prevalence of W. bancrofti infection in the human and mosquito populations be re-assessed after a couple of years. Mass drug administration (MDA) for the control of elephantiasis in the state of Kano in Nigeria, started in the year 2010. It was estimated that by 2015, the MDA programme will be extended to 11 remaining urban Local Government Areas (LGAs). However, MDA in urban areas faces specific challenges, the most prominent being the need to achieve coverage rates of 65% and above. As such MDA alone may not be sufficient to achieve the required programme impacts of reducing LF transmission to levels below which transmission cannot be sustained, and additional interventions may be required. This study set out to confirm the LF infection prevalence in the human and mosquito populations in three urban LGAs in Kano. Individuals were tested for signs of the disease, and mosquito samples were collected and also tested for the worms that cause the disease. The study revealed that of 981 people tested, none had circulating filarial antigen in the blood. However, the mosquitoes collected revealed the presence of the disease-causing worms, but the level of infection was low. The infection in the mosquitoes was also detected in two different types of mosquitoes. Based on the outcomes of this study, and evidence from other West African cities on the transmission of LF, the Federal Ministry of Health recommended that two rounds of MDA be undertaken in urban areas of Kano. A further reassessment after a couple of years is warranted.
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Affiliation(s)
- Dung D. Pam
- Applied Entomology and Parasitology Unit, Department of Zoology, University of Jos, Jos, Nigeria
| | - Dziedzom K. de Souza
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- * E-mail:
| | - Susan D'Souza
- Sightsavers International, UK Office, London, United Kingdom
| | - Millicent Opoku
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Safiya Sanda
- Sightsavers International, Nigeria Office, Kaduna, Nigeria
| | | | | | | | | | | | - David H. Molyneux
- Centre for Neglected Tropical Diseases and Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Moses J. Bockarie
- European and Developing Countries Clinical Trials Partnership, Africa Office, Cape Town, South Africa
| | - Benjamin G. Koudou
- Centre for Neglected Tropical Diseases and Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- UFR Science de la Nature, Université Nangui Abrogoua, Abidjan, Cote d’Ivoire
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Birhanu Z, Yihdego YYE, Yewhalaw D. Caretakers' understanding of malaria, use of insecticide treated net and care seeking-behavior for febrile illness of their children in Ethiopia. BMC Infect Dis 2017; 17:629. [PMID: 28923020 PMCID: PMC5604495 DOI: 10.1186/s12879-017-2731-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 09/12/2017] [Indexed: 11/19/2022] Open
Abstract
Background Local understandings of malaria and use of preventive measures-are critical factors in sustained control of malaria. This study assessed caretakers’ knowledge on malaria, use of Long Lasting Insecticide Treated Nets (LLINs) and care-seeking behavior for their children’s illness in different malaria transmission settings of Ethiopia. Methods Data were collected from 709 caretakers of children of 2–9 years of age during in 2016. A standard questionnaire was used to assess caretakers’ perceptions of malaria, use of LLIN and care seeking behavior for febrile illness of children aged 2–9 years. Results The caretakers recognized malaria mostly by chills (70.4%, 499/709), fever (45.7%, 324/709) and headache (39.8%, 282/709). Overall, only 66.4% (471) of the caretakers knew that mosquito bite caused malaria and that it was quite heterogeneous by localities (ranging from 26.1% to 89.4%) and altitude (p < 0.05). Majority, 72.2% (512), of the caretakers knew that sleeping under LLIN could prevent malaria. Overall knowledge on malaria (mean = 51.2%) was very low with significant variations by localities, altitude and levels of malaria transmission, being low in high altitude and low in transmission areas (p < 0.05). Four hundred ninety-one (69.3%, 491/709) of the children slept under LLIN in the previous night. Of malaria related knowledge items, only knowledge of LLIN was associated with net use; non-use of LLN was higher among caretakers who did not know the role of LLIN (AOR = 0.47, 95%CI: 0.28–0.77, p = 0.003). Of course, attributing causation of malaria to stagnant water discouraged use of net (p = 0.021). Of febrile children (n = 122), only 50 (41.0%) sought care with only 17 (34.0%) seeking the care promptly. There was no significant link between knowledge of malaria and care seeking behavior (p > 0.05). However, knowledge of malaria had some level of influence on treatment source preference where caretakers with greater knowledge preferred pharmacy as source of care. Conclusions The findings demonstrated that caretakers’ understanding of malaria was unsatisfactory with marked heterogeneity by localities. The present evidence suggests that knowledge is not sufficient enough to drive LLIN use and care seeking. Yet, context-specific health education interventions are important besides ensuring access to necessary preventive tools.
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Affiliation(s)
- Zewdie Birhanu
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
| | | | - Delenasaw Yewhalaw
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences, Jimma University, Jimma, Ethiopia.,Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia
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Finlay AM, Butts J, Ranaivoharimina H, Cotte AH, Ramarosandratana B, Rabarijaona H, Tuseo L, Chang M, Vanden Eng J. Free mass distribution of long lasting insecticidal nets lead to high levels of LLIN access and use in Madagascar, 2010: A cross-sectional observational study. PLoS One 2017; 12:e0183936. [PMID: 28850631 PMCID: PMC5574546 DOI: 10.1371/journal.pone.0183936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/14/2017] [Indexed: 11/11/2022] Open
Abstract
Background Madagascar conducted the first two phases of a national free mass distribution campaign of long-lasting insecticidal nets (LLINs) during a political crisis in 2009 aiming to achieve coverage of two LLINs per household as part of the National Malaria Control Strategy. The campaign targeted households in 19 out of 91 total health districts. Methods A community-based cross-sectional household survey using a three-stage cluster sample design was conducted four months post campaign to assess LLIN ownership, access and use. Multivariable logistic regression analysis was used to identify factors associated with household LLIN access and individual LLIN use. Results A total of 2211 households were surveyed representing 8867 people. At least one LLIN was present in 93.5% (95% confidence interval [CI], 91.6–95.5%) of households and 74.8% (95% CI, 71.0–78.6%) owned at least two LLINs. Access measured as the proportion of the population that could potentially be covered by household-owned LLINs was 77.2% (77.2% (95% CI, 72.9–81.3%) and LLIN use by all individuals was 84.2% (95% CI, 81.2–87.2%). LLIN use was associated with knowledge of insecticide treated net use to prevent malaria (OR = 3.58, 95% CI, 1.85–6.94), household ownership of more LLINs (OR 2.82, 95% CI 1.85–4.3), presence of children under five (OR = 2.05, 95% CI, 1.67–2.51), having traveled to the distribution point and receiving information about hanging a bednet (OR = 1.56, 95% CI, 1.41–1.74), and having received a post-campaign visit by a community mobilizer (OR = 1.75, 95% CI, 1.26–2.43). Lower LLIN use was associated with increasing household size (OR = 0.81 95% CI 0.77–0.85) and number of sleeping spaces (OR = 0.55, 95% CI, 0.44–0.68). Conclusions A large scale free mass LLIN distribution campaign was feasible and effective at achieving high LLIN access and use in Madagascar. Campaign process indicators highlighted potential areas for strengthening implementation to optimize access and equity.
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Affiliation(s)
- Alyssa M. Finlay
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, President’s Malaria Initiative, Antananarivo, Madagascar
- * E-mail:
| | - Jessica Butts
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, President’s Malaria Initiative, Atlanta, Georgia, United States of America
| | | | - Annett H. Cotte
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, President’s Malaria Initiative, Atlanta, Georgia, United States of America
| | | | | | | | - Michelle Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, President’s Malaria Initiative, Atlanta, Georgia, United States of America
| | - Jodi Vanden Eng
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, President’s Malaria Initiative, Atlanta, Georgia, United States of America
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Mazigo HD, Rumisha SF, Chiduo MG, Bwana VM, Mboera LEG. Malaria among rice farming communities in Kilangali village, Kilosa district, Central Tanzania: prevalence, intensity and associated factors. Infect Dis Poverty 2017; 6:101. [PMID: 28676077 PMCID: PMC5497374 DOI: 10.1186/s40249-017-0315-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria remains the most important cause of morbidity and mortality in Tanzania. However, its prevalence varies from area to area depending on various ecological, socio-economic and health system factors. This study was carried out to determine malaria prevalence and associated factors among rice farming communities in the Kilangali village of Kilosa District in Central Tanzania. METHODS A cross-sectional study was conducted in May 2015, involving randomly selected persons living in the six sub-villages of the Kilangali village, namely Mlegeni, Kisiwani, Makuruwili, Kwamtunga, Upogoroni and Chamwino. A finger prick blood sample was obtained for diagnosis of malaria infection using Giemsa-stained thick smears and a rapid malaria diagnostic test. Study participants were also screened for haemoglobin levels and a total of 570 children aged ≤ 12 years of age were examined for spleen enlargement using the palpation method. RESULTS A total of 1154 persons were examined for malaria infection with mean age of 21.9 ± 19.69 years. The overall malaria prevalence was 14.2% and 17.5% based on microscopic examination and rapid diagnostic test, respectively. Plasmodium falciparum accounted for the majority (89%) of the malaria infections. The overall geometrical mean parasite density was 20.5 parasites/μL (95% CI: 14.6-28.8). Malaria prevalence and parasitaemia was highest among individuals living in the Mlegeni (23.9%) and Makuruwili (24.4%) sub-villages. Among the children examined for splenomegaly, 2.98% (17/570) had it. The overall prevalence of anaemia was 34.6%. Malaria infection was associated with the age groups of 1-10 years (aOR = 4.41, 95% CI: 1.96-9.93, P < 0.001) and 11-20 years (aOR = 6.68, 95% CI: 2.91-15.37, P < 0.001); and mild anaemia (aOR = 1.71, 95% CI: 1.11-2.62, P < 0.014) and moderate anaemia (aOR = 1.55, 95% CI: 1.01-2.39, P < 0.045). CONCLUSIONS Malaria was found at the study setting and its prevalence varied according to the demographic characteristics of the study participants and between sub-villages that are closely located.
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Affiliation(s)
- Humphrey D Mazigo
- Department of Medical Parasitology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
| | - Susan F Rumisha
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Mercy G Chiduo
- National Institute for Medical Research, Dar es Salaam, Tanzania
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Kilian A, Lawford H, Ujuju CN, Abeku TA, Nwokolo E, Okoh F, Baba E. The impact of behaviour change communication on the use of insecticide treated nets: a secondary analysis of ten post-campaign surveys from Nigeria. Malar J 2016; 15:422. [PMID: 27542940 PMCID: PMC4992294 DOI: 10.1186/s12936-016-1463-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/29/2016] [Indexed: 11/11/2022] Open
Abstract
Background Mass distribution campaigns of insecticide-treated nets for malaria prevention are usually accompanied by intensive behaviour change communication (BCC) to encourage hanging and use of nets. However, data on the effectiveness of these communication efforts are scarce. In preparation for the next round of mass campaigns in Nigeria, a secondary analysis of existing data from post-campaign surveys was undertaken to investigate the influence of BCC on net hanging and use. Methods Surveys were undertaken between 2009 and 2012 in ten states in Nigeria using standardized questionnaires. Two-stage cluster sampling was used to select households in each study site. Outcomes were defined as the effects of BCC message exposure and recall on knowledge, attitudes, perception as well as intentions and actual use. From the univariable analysis, potential confounders and explanatory variables were identified and key effects explored in multivariable linear or logistic regression models; terms in the models were kept if they had a marginal significance with p < 0.2. To quantify the effects from BCC, a treatment effect model was used with an inverse-probability weight regression adjustment. Results More than half of the respondents (58.4 %; 95 % CI 56.0, 60.7) had heard a message about net use or hanging during or after the distribution campaign, with media cited as the most common source of information. Attitude towards net use was positively linked to the number of messages recalled and was overall better in the northern study sites. The number of messages recalled was also the strongest predictor of knowledge (p < 0.001). All BCC outcomes showed a significant increase in net use, which was strongest for the confidence to take action regarding nets with an overall effect of 17 %-point increase of net use comparing poor and excellent confidence levels. Intention to use every night increased net use by 15 %-points and discussing net use in the family by 8 % points. All these effects were statistically significant (p < 0.001). Conclusions Multichannel BCC
campaigns as well as other media were effective in contributing to an increase in net culture, hanging and use, particularly by vulnerable groups. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1463-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Festus Okoh
- National Malaria Elimination Programme, Abuja, Nigeria
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Babalola S, Ricotta E, Awantang G, Lewicky N, Koenker H, Toso M. Correlates of Intra-Household ITN Use in Liberia: A Multilevel Analysis of Household Survey Data. PLoS One 2016; 11:e0158331. [PMID: 27403877 PMCID: PMC4942134 DOI: 10.1371/journal.pone.0158331] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 06/14/2016] [Indexed: 11/02/2022] Open
Abstract
Malaria is a major cause of morbidity and mortality in Liberia. At the same time, insecticide-treated net (ITN) ownership and use remain low. Access is a key determinant of ITN use but it is not the only one; prior studies have identified factors that affect the use of ITNs in households with at least one ITN. These factors operate at the individual, household, and community levels. However, studies have generally not assessed the psychosocial or ideational determinants of ITN use. Using 2014 household survey data, this manuscript examines the socio-demographic, ideational, household, and community factors associated with household member use of ITNs in Liberia. Multilevel modeling was used to assess fixed effects at the individual, household, and community levels, and random effects at the household and cluster levels. The data showed significant residual clustering at the household level, indicating that there were unmeasured factors operating at this level that are associated with ITN use. The association of age with ITN use was moderated by sex such that men, older children, and teenagers were less likely to sleep under an ITN compared to women and children under five years old. Female caregivers' perceived severity of malaria, perceived self-efficacy to detect a complicated case of malaria, and exposure to the "Take Cover" communication campaign were positively associated with ITN use by members of her household. The association with household size was negative, while the relationship with the number of ITNs was positive. Programs should seek to achieve universal coverage (that is, one ITN for every two household members) and promote the notion that everyone needs to sleep under an ITN every night. Programs should also seek to strengthen perceived severity of malaria and educate intended audience groups on the signs of malaria complications. Given the significance of residual clustering at the household level, interventions that engage men as heads of household and key decision-makers are relevant.
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Affiliation(s)
- Stella Babalola
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
- * E-mail:
| | - Emily Ricotta
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
| | - Grace Awantang
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
| | - Nan Lewicky
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
| | - Hannah Koenker
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
| | - Michael Toso
- Health Communication Capacity Collaborative, Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States of America
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Dawaki S, Al-Mekhlafi HM, Ithoi I, Ibrahim J, Atroosh WM, Abdulsalam AM, Sady H, Elyana FN, Adamu AU, Yelwa SI, Ahmed A, Al-Areeqi MA, Subramaniam LR, Nasr NA, Lau YL. Is Nigeria winning the battle against malaria? Prevalence, risk factors and KAP assessment among Hausa communities in Kano State. Malar J 2016; 15:351. [PMID: 27392040 PMCID: PMC4938925 DOI: 10.1186/s12936-016-1394-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is one of the most severe global public health problems worldwide, particularly in Africa, where Nigeria has the greatest number of malaria cases. This community-based study was designed to investigate the prevalence and risk factors of malaria and to evaluate the knowledge, attitudes, and practices (KAP) regarding malaria among rural Hausa communities in Kano State, Nigeria. METHODS A cross-sectional community-based study was conducted on 551 participants from five local government areas in Kano State. Blood samples were collected and examined for the presence of Plasmodium species by rapid diagnostic test (RDT), Giemsa-stained thin and thick blood films, and PCR. Moreover, demographic, socioeconomic, and environmental information as well as KAP data were collected using a pre-tested questionnaire. RESULTS A total of 334 (60.6 %) participants were found positive for Plasmodium falciparum. The prevalence differed significantly by age group (p < 0.01), but not by gender or location. A multivariate analysis showed that malaria was associated significantly with being aged 12 years or older, having a low household family income, not using insecticide treated nets (ITNs), and having no toilets in the house. Overall, 95.6 % of the respondents had prior knowledge about malaria, and 79.7, 87.6 and 95.7 % of them knew about the transmission, symptoms, and prevention of malaria, respectively. The majority (93.4 %) of the respondents considered malaria a serious disease. Although 79.5 % of the respondents had at least one ITN in their household, utilization rate of ITNs was 49.5 %. Significant associations between the respondents' knowledge concerning malaria and their age, gender, education, and household monthly income were reported. CONCLUSIONS Malaria is still highly prevalent among rural Hausa communities in Nigeria. Despite high levels of knowledge and attitudes in the study area, significant gaps persist in appropriate preventive practices, particularly the use of ITNs. Innovative and Integrated control measures to reduce the burden of malaria should be identified and implemented in these communities. Community mobilization and health education regarding the importance of using ITNs to prevent malaria and save lives should be considered.
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Affiliation(s)
- Salwa Dawaki
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,School of Health Technology, Club Road, Nassarawa, Kano, Kano State, Nigeria
| | - Hesham M Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. .,Endemic and Tropical Diseases Unit, Medical Research Center, Jazan University, Jazan, Kingdom of Saudi Arabia. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Init Ithoi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Jamaiah Ibrahim
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wahib M Atroosh
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Awatif M Abdulsalam
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hany Sady
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Fatin Nur Elyana
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Ado U Adamu
- North West Zonal Tuberculosis Reference Laboratory, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Saadatu I Yelwa
- Rabi'u Musa Kwankwaso College of Advanced and Remedial Studies, Tudun Wada, Kano State, Nigeria
| | - Abdulhamid Ahmed
- Department of Biology, Faculty of Natural and Applied Sciences, Umaru Musa Yar'adua University, Katsina, Katsina State, Nigeria
| | - Mona A Al-Areeqi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Lahvanya R Subramaniam
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nabil A Nasr
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yee-Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Ingabire CM, Kateera F, Hakizimana E, Rulisa A, Muvunyi C, Mens P, Koenraadt CJM, Mutesa L, Van Vugt M, Van Den Borne B, Alaii J. Determinants of prompt and adequate care among presumed malaria cases in a community in eastern Rwanda: a cross sectional study. Malar J 2016; 15:227. [PMID: 27098976 PMCID: PMC4839127 DOI: 10.1186/s12936-016-1285-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/13/2016] [Indexed: 11/16/2022] Open
Abstract
Background In order to understand factors influencing fever/malaria management practices among community-based individuals, the study evaluated psychosocial, socio-demographic and environmental determinants of prompt and adequate healthcare-seeking behaviours. Methods A quantitative household (HH) survey was conducted from December 2014 to February 2015 in Ruhuha sector, Bugesera district in the Eastern province of Rwanda. HHs that reported having had at least one member who experienced a fever and/or malaria episode in the previous 3 months prior to the study were included in the analysis. Healthcare-seeking behaviours associated with the last episode of illness were analysed. Socio-demographic, health facility access, long-lasting insecticidal-treated nets (LLINs), data on malaria knowledge, data and theory of planned behaviour (TPB) related variables (attitudes, subjective norms, perceived behavioural control) with regard to fever/malaria healthcare seeking, were collected. The primary outcome was prompt and adequate care defined as: (1) seeking advice or treatment at a health facility (health centre or hospital) or from a community health worker (CHW); (2) advice or treatment seeking within same/next day of symptoms onset; (3) received a laboratory diagnosis; (4) received advice or treatment; and, (5) reported completing the prescribed dose of medication. Determinants of prompt and adequate care among presumed malaria cases were evaluated using a logistic regression analysis. Results Overall, 302 (21 %) of the 1410 interviewed HHs reported at least one member as having experienced a fever or malaria within the 3 months prior to the survey. The number of HHs (where at least one member reported fever/malaria) that reported seeking advice or treatment at a health facility (health centre or hospital) or from a CHW was 249 (82.4 %). Of those who sought advice or treatment, 87.3 % had done so on same/next day of symptoms developing, 82.8 % received a laboratory diagnosis, and more than 90 % who received treatment reported completing the prescribed dosage. Prompt and adequate care was reported from 162 of the 302 HHs (53.6 %) that experienced fever or malaria for one or more HH members. Bivariate analyses showed that head of household (HoH)-related characteristics including reported knowledge of three or more malaria symptoms, having health insurance, being able to pay for medical services, use of LLINs the night before the survey, having a positive attitude, perceiving social support, as well as a high-perceived behavioural control with regard to healthcare seeking, were all significantly associated with prompt and adequate care. In the final logistic regression model, a high-perceived behavioural control (odds ratio (OR) 5.068, p = 0.042), having a health insurance (OR 2.410, p = 0.044) and having knowledge of malaria symptoms (OR 1.654, p = 0.049) significantly predicted prompt and adequate care. Conclusions To promote prompt and adequate care seeking for malaria in the area, particular emphasis should be placed on community-focused strategies that promote early malaria symptom recognition, increased health insurance coverage and enhanced perceived behavioural control with regard to healthcare-seeking.
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Affiliation(s)
- Chantal Marie Ingabire
- Medical Research Center, Rwanda Biomedical Center, Kigali, Rwanda. .,Department of Health Promotion, Maastricht University, Maastricht, The Netherlands.
| | - Fredrick Kateera
- Medical Research Center, Rwanda Biomedical Center, Kigali, Rwanda.,Academic Medical Center, Amsterdam, The Netherlands
| | - Emmanuel Hakizimana
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda.,Laboratory of Entomology, Wageningen University, Wageningen, The Netherlands
| | - Alexis Rulisa
- Medical Research Center, Rwanda Biomedical Center, Kigali, Rwanda.,Department of Cultural Anthropology and Development Studies, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Claude Muvunyi
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Petra Mens
- Royal Tropical Institute/Koninklijk Instituut voor de Tropen, KIT Biomedical Research, Amsterdam, Netherlands
| | | | - Leon Mutesa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Bart Van Den Borne
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Jane Alaii
- Context Factor Solutions, Nairobi, Kenya
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Birhanu Z, Abebe L, Sudhakar M, Dissanayake G, Yihdego Y, Alemayehu G, Yewhalaw D. Access to and use gaps of insecticide-treated nets among communities in Jimma Zone, southwestern Ethiopia: baseline results from malaria education interventions. BMC Public Health 2015; 15:1304. [PMID: 26712366 PMCID: PMC4693421 DOI: 10.1186/s12889-015-2677-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 12/22/2015] [Indexed: 01/24/2023] Open
Abstract
Background Malaria remains one of the major public health concerns in Ethiopia. Use of long- lasting insecticidal nets (LLINs) is the country’s key malaria prevention and control strategy. This study intended to determine access to and usage gap of LLINs in malaria endemic settings in Southwestern Ethiopia. Methods Data were collected from 798 households in three districts (Mana, Kersa and Goma) of Jimma Zone, Southwestern Ethiopia, from December 2013 to January 2014. The data were analyzed using SPSS software package version 17.0. LLINs ownership, access and utilization gap were determined following the procedure developed by Survey and Indicator Task Force of the Roll Back Malaria Monitoring and Evaluation Reference Group. To complement the quantitative data, focus group discussions and interviews were conducted with community groups and key informants. Results In this study, 70.9 % (95 % CI: 67.8–74.1 %) of the surveyed households had at least one LLIN, and 63.0 % (95 % CI: 59.6–66.3 %) had sufficient LLINs for every member of the household. With respect to access, 51.9 % (95 % CI: 50.5–53.5 %) of the population had access to LLIN. Only, 38.4 % (95 % CI: 36.9–39.9 %) had slept under LLIN the previous night with females and children having priority to sleep under LLIN. This gave an overall use to access ratio of 70.2 % which resulted in behavior-driven failure of 29.8 %. Of the households with sufficient LLIN access, females (AOR = 1.52; 95 % CI:1.25–1.83; P = 0.001) and children aged 0–4 years (AOR = 2.28; 95 % CI:1.47–3.53;P = 0.001) were more likely to use LLINs than other household members. Shape of nets, sleeping arrangements, low risk perception, saving nets for future use, awareness and negligence, and perception of low efficacy of the LLINs contributed to behavioral failures. Conclusions LLIN use was hampered by lack of ownership and most importantly by behavioral driven gaps. This calls for designing and implementing appropriate behavioral change communication strategies to address behavioral failure. Improving access to LLINs also needs attention. Further, it requires moving beyond the traditional messaging approach for evidence based intervention to address specific needs and gaps.
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Affiliation(s)
- Zewdie Birhanu
- Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia.
| | - Lakew Abebe
- Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia.
| | - Morankar Sudhakar
- Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia.
| | - Gunawardena Dissanayake
- President's Malaria Initiative, United States Agency for International Development, Addis Ababa, Ethiopia.
| | - Yemane Yihdego
- Abt Associates African Indoor Residual Project, Addis Ababa, Ethiopia.
| | - Guda Alemayehu
- President's Malaria Initiative, United States Agency for International Development, Addis Ababa, Ethiopia.
| | - Delenasaw Yewhalaw
- Department of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia.
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Kateera F, Ingabire CM, Hakizimana E, Rulisa A, Karinda P, Grobusch MP, Mutesa L, van Vugt M, Mens PF. Long-lasting insecticidal net source, ownership and use in the context of universal coverage: a household survey in eastern Rwanda. Malar J 2015; 14:390. [PMID: 26445341 PMCID: PMC4596392 DOI: 10.1186/s12936-015-0915-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/25/2015] [Indexed: 12/02/2022] Open
Abstract
Background Universal long-lasting insecticidal net (LLIN) coverage (ULC) has reduced malaria morbidity and mortality across Africa. Although information is available on bed net use in specific groups, such as pregnant women and children under 5 years, there is paucity of data on their use among the general population. Bed net source, ownership and determinants of use among individuals from households in an eastern Rwanda community 8 months after a ULC were characterized. Methods Using household-based, interviewer-administered questionnaires and interviewer-direct observations, data on bed net source, ownership and key determinants of net use, including demographics, socio-economic status indicators, house structure characteristics, as well as of bed net quantity, type and integrity, were collected from 1400 randomly selected households. Univariate and mixed effects logistic regression modelling was done to assess for determinants of bed net use. Results A total of 1410 households and 6598 individuals were included in the study. Overall, the proportion of households with at least one net was 92 % while bed net usage was reported among 72 % of household members. Of the households surveyed, a total ownership of 2768 nets was reported, of which about 96 % were reportedly LLINs received from the ULC. By interviewer-physical observation, 88 % of the nets owned were of the LLIN type with the remaining 12 % did not carry any mark to enable type recognition. The odds of bed net use were significantly lower among males and individuals: from households of low socio-economic status, from households with <two bed nets, from households reporting use of ≥two sleeping spaces, and those reporting to have not slept on a bed. Conclusion In this study, despite high a bed net coverage, over 25 % of members reported not to have slept under a bed net the night before the survey. Males were particularly less likely to use bed nets even where nets were available. Household socio-economic status, number of bed nets and type and number of sleeping spaces were key determinants of bed net use. To maximize impact of ULC, strategies that target males as well as those that ensure ITN coverage for all, address barriers to feasible and convenient bed net use including covering over all sleeping space types, and provide net hanging supports, are needed.
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Affiliation(s)
- Fredrick Kateera
- Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda. .,Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands.
| | - Chantal M Ingabire
- Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda.
| | - Emmanuel Hakizimana
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda.
| | - Alexis Rulisa
- Department of Cultural Anthropology and Development Studies and Centre for International Development Issues, Radboud University, 6500 HE, Nijmegen, The Netherlands.
| | - Parfait Karinda
- Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda.
| | - Martin P Grobusch
- Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands.
| | - Leon Mutesa
- College of Medicine and Health Sciences, University of Rwanda, PO Box 3286, Kigali, Rwanda.
| | - Michèle van Vugt
- Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands.
| | - Petra F Mens
- Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands. .,Royal Tropical Institute/Koninklijk Instituut voor de Tropen, KIT Biomedical Research, Meibergdreef 39, 1105 AZ, Amsterdam, The Netherlands.
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Lessons from the implementation of LLIN distribution campaign in Ilorin Kwara State, Nigeria. BMC Public Health 2014; 14:514. [PMID: 24885737 PMCID: PMC4042003 DOI: 10.1186/1471-2458-14-514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 05/23/2014] [Indexed: 11/20/2022] Open
Abstract
Background Studies implemented to evaluate the success of Long-lasting insecticidal nets (LLIN) distribution campaigns are often limited to ownership and utilization rates, neglecting other factors that directly affect the efficacy of the tool in malaria control. This study investigates sleeping habits and net maintenance behaviour in addition to LLIN ownership, utilization and the challenges associated with LLIN use among residents in Ilorin City where the tool has been massively distributed. Methods A cross-sectional survey was conducted using pre-tested interviewer-administered questionnaire to obtain information from randomly selected household respondents in Ilorin, the Kwara State Capital. The study was conducted in July 2012, about sixteen months after the March 2011 distribution of LLIN in the locality. The results were analyzed using the EPI INFO 2007 version. Results LLIN ownership (85%) and utilization (37%) rates improved compared to earlier reports, though 29% of net users have noticed holes in the nets even as 26% claimed to have actually experienced mosquito bites under it. Most (92%) of the respondents who slept under LLIN the previous night before the study spent the first five hours of the night (19.00-23.00 hr) outdoors while 88% also engage in inappropriate net washing practices. All the LLIN users claimed to have experienced at least one malaria episode while 43% have had two or more episodes within the past twelve months. Conclusion The use of LLIN among the respondents in this study was accompanied by chancy sleeping habits, inappropriate net maintenance practices and repeated experience of mosquito bites under the nets. This shows the need to sustain the will and confidence of LLIN users in this area through frequent monitoring and surveillance visits targeted at enlightening the people on habits that increase malaria exposure risks as well as proper use and maintenance of LLIN for maximum malaria vector control benefits.
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Recalculating the net use gap: a multi-country comparison of ITN use versus ITN access. PLoS One 2014; 9:e97496. [PMID: 24848768 PMCID: PMC4030003 DOI: 10.1371/journal.pone.0097496] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 04/17/2014] [Indexed: 11/19/2022] Open
Abstract
Use of insecticide treated nets is widely recognized as one of the main interventions to prevent malaria and high use rates are a central goal of malaria programs. The gap between household ownership of at least one ITN and population use of ITN has in the past been seen as evidence for failure to achieve appropriate net use. However, past studies compared net use with ownership of at least one net, not access to sufficient nets within households. This study recalculates the net use gap in recent large household surveys using the comparison indicator of ‘access to nets within the household’ as now recommended by Roll Back Malaria and the World Health Organization. Data from 41 Demographic Health Surveys (DHS) and Malaria Indicator Surveys (MIS) (2005–2012) in sub-Saharan Africa were used. For each dataset three indicators were calculated: population access to ITN, population use of ITN, and household ownership of at least one ITN. The ITN use gap was expressed as the difference between one and the ratio of use to access. The median proportion of users compared to those with access was high, at 82.1%. Even at population access levels below 50%, a median 80.6% used an ITN given they had access, and this rate increased to 91.2% for access rates above 50%. Linear regression of use against access showed that 89.0% of household members with access to nets used them the night before. These results clearly show that previous interpretations of the net use gap as a failure of behavioral change communication interventions were not justified and that the gap was instead primarily driven by lack of intra-household access. They also demonstrate the usefulness of the newly recommended ITN indicators; access to an ITN within the household provides a much more accurate comparison of ITN use than ownership.
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Noland GS, Graves PM, Sallau A, Eigege A, Emukah E, Patterson AE, Ajiji J, Okorofor I, Oji OU, Umar M, Alphonsus K, Damen J, Ngondi J, Ozaki M, Cromwell E, Obiezu J, Eneiramo S, Okoro C, McClintic-Doyle R, Oresanya O, Miri E, Emerson PM, Richards FO. Malaria prevalence, anemia and baseline intervention coverage prior to mass net distributions in Abia and Plateau States, Nigeria. BMC Infect Dis 2014; 14:168. [PMID: 24669881 PMCID: PMC3994282 DOI: 10.1186/1471-2334-14-168] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 03/21/2014] [Indexed: 11/30/2022] Open
Abstract
Background Nigeria suffers the world’s largest malaria burden, with approximately 51 million cases and 207,000 deaths annually. As part of the country’s aim to reduce by 50% malaria-related morbidity and mortality by 2013, it embarked on mass distribution of free long-lasting insecticidal nets (LLINs). Methods Prior to net distribution campaigns in Abia and Plateau States, Nigeria, a modified malaria indicator survey was conducted in September 2010 to determine baseline state-level estimates of Plasmodium prevalence, childhood anemia, indoor residual spraying (IRS) coverage and bednet ownership and utilization. Results Overall age-adjusted prevalence of Plasmodium infection by microscopy was similar between Abia (36.1%, 95% CI: 32.3%–40.1%; n = 2,936) and Plateau (36.6%, 95% CI: 31.3%–42.3%; n = 4,209), with prevalence highest among children 5-9 years. P. malariae accounted for 32.0% of infections in Abia, but only 1.4% of infections in Plateau. More than half of children ≤10 years were anemic, with anemia significantly higher in Abia (76.9%, 95% CI: 72.1%–81.0%) versus Plateau (57.1%, 95% CI: 50.6%–63.4%). Less than 1% of households in Abia (n = 1,305) or Plateau (n = 1,335) received IRS in the 12 months prior to survey. Household ownership of at least one bednet of any type was 10.1% (95% CI: 7.5%–13.4%) in Abia and 35.1% (95% CI: 29.2%-41.5%) in Plateau. Ownership of two or more bednets was 2.1% (95% CI: 1.2%–3.7%) in Abia and 14.5% (95% CI: 10.2%–20.3%) in Plateau. Overall reported net use the night before the survey among all individuals, children <5 years, and pregnant women was 3.4%, 6.0% and 5.7%, respectively in Abia and 14.7%, 19.1% and 21.0%, respectively in Plateau. Among households owning nets, 34.4% of children <5 years and 31.6% of pregnant women in Abia used a net, compared to 52.6% of children and 62.7% of pregnant women in Plateau. Conclusions These results reveal high Plasmodium prevalence and childhood anemia in both states, low baseline coverage of IRS and LLINs, and sub-optimal net use—especially among age groups with highest observed malaria burden.
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Iliyasu Z, Babashani M, Abubakar IS, Salahudeen AA, Aliyu MH. Clinical burden and correlates of HIV and malaria co-infection, in northwest Nigeria. Acta Trop 2013; 128:630-5. [PMID: 24055714 DOI: 10.1016/j.actatropica.2013.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/26/2013] [Accepted: 09/09/2013] [Indexed: 11/18/2022]
Abstract
The clinical burden of malaria and HIV/AIDS in sub-Saharan Africa is well-described, but the dynamics of the interaction between the two diseases remain poorly understood. Using a cross-sectional study design, we assessed the prevalence and predictors of malaria infection among HIV-positive patients attending a referral center in urban Kano, northwest Nigeria. Structured questionnaires covering socio-demographic characteristics, HIV diagnosis and treatment, malaria preventive practices, clinical events and treatment were administered to HIV-infected adults (n=363). Information from questionnaires was supplemented with data from case notes. In the preceding year, nearly a third of respondents (32.2%; 95% CI=27.4-37.3) had at least one episode of fever, diagnosed as malaria on blood film examination. Half of all respondents (53.5%) admitted to using insecticide treated nets (ITN). One-third (35.8%) of participants were on malaria chemoprophylaxis at the time of the study. Female sex (adjusted Odds Ratio [aOR]=1.54, 95% confidence interval (CI): 1.32-2.73), immunosuppression (CD4+ cell count <350/μL vs. 600/μL, aOR=2.41, 95% CI 1.23-3.74) and non-use of ITN (aOR=1.97, 95% CI 1.17-2.85) predicted the occurrence of clinical malaria in patients. We report a high burden of malaria in HIV-infected patients attending a tertiary facility in urban Kano, Nigeria. Health communication, standardized protocols and ITN distribution should be integrated into comprehensive HIV programs in this setting.
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Affiliation(s)
- Zubairu Iliyasu
- Department of Community Medicine, Bayero University Kano, Nigeria; School of Health and Related Research, University of Sheffield, UK.
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Tokponnon FT, Aholoukpe B, Denon EY, Gnanguenon V, Bokossa A, N'guessan R, Oke M, Gazard DK, Akogbeto MC. Evaluation of the coverage and effective use rate of long-lasting insecticidal nets after nation-wide scale up of their distribution in Benin. Parasit Vectors 2013; 6:265. [PMID: 24499613 PMCID: PMC3848614 DOI: 10.1186/1756-3305-6-265] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/10/2013] [Indexed: 11/10/2022] Open
Abstract
Background In Benin, around four million Long-Lasting Insecticide-treated Nets were freely distributed to household to prevent malaria in 2011. In contrast to a previous campaign that targeted only children under 5 years and pregnant women, this distribution campaign was conducted in order to achieve universal coverage. This study presents the results of LLIN coverage and utilization after the distribution campaign. Methods The study was a cross-sectional household survey which utilized a stratified two-stage cluster sampling design. The strata represented the twelve departments covered by the national distribution campaign in 2011 and included a total of 4,800 households randomly selected in the country. A questionnaire adapted from the standard Malaria Indicator Survey (MIS) Household Questionnaire was used. Data were entered using QPS software and analyzed with R 2.14.1. Results LLIN ownership was 86.4% (74 – 94). On average, each household received 3 LLINs (2–4). The proportion of households that met the ratio one net for two persons was 77%. The proportions of individuals sleeping under LLINs were high (84.8%). LLIN use among urban residents was 10% lower than in effective users from rural areas (P = 0.00224). Conclusions The universal distribution campaign conducted in Benin has increased LLIN ownership and use in the community. But additional efforts are need to improve and maintain LLIN coverage.
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Kilian A, Koenker H, Baba E, Onyefunafoa EO, Selby RA, Lokko K, Lynch M. Universal coverage with insecticide-treated nets - applying the revised indicators for ownership and use to the Nigeria 2010 malaria indicator survey data. Malar J 2013; 12:314. [PMID: 24020332 PMCID: PMC3846735 DOI: 10.1186/1475-2875-12-314] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/09/2013] [Indexed: 11/17/2022] Open
Abstract
Background Until recently only two indicators were used to evaluate malaria prevention with insecticide-treated nets (ITN): “proportion of households with any ITN” and “proportion of the population using an ITN last night”. This study explores the potential of the expanded set of indicators recommended by the Roll Back Malaria Monitoring and Evaluation Reference Group (MERG) for comprehensive analysis of universal coverage with ITN by applying them to the Nigeria 2010 Malaria Indicator Survey data. Methods The two additional indicators of “proportion of households with at least one ITN for every two people” and “proportion of population with access to an ITN within the household” were calculated as recommended by MERG. Based on the estimates for each of the four ITN indicators three gaps were calculated: i) households with no ITN, ii) households with any but not enough ITN, iii) population with access to ITN not using it. In addition, coverage with at least one ITN at community level was explored by applying Lot Quality Assurance Sampling (LQAS) decision rules to the cluster level of the data. All outcomes were analysed by household background characteristics and whether an ITN campaign had recently been done. Results While the proportion of households with any ITN was only 42% overall, it was 75% in areas with a recent mass campaign and in these areas 66% of communities had coverage of 80% or better. However, the campaigns left a considerable intra-household ownership gap with 66% of households with any ITN not having enough for every family member. In contrast, the analysis comparing actual against potential use showed that ITN utilization was good overall with only 19% of people with access not using the ITN, but with a significant difference between the North, where use was excellent (use gap 11%), and the South (use gap 36%) indicating the need for enhanced behaviour change communication. Conclusions The expanded ITN indicators to assess universal coverage provide strong tools for a comprehensive system effectiveness analysis that produces clear, actionable evidence of progress as well as the need for specific additional interventions clearly differentiating between gaps in ownership and use.
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