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Jimeno-Maroto I, Galindo MS, Miller JB, Lambert Y, Carboni C, Bardon T, Plessis L, Vreden S, Suarez-Mutis M, Douine M, Sanna A. Community engagement in mobile and hard-to-reach populations: a community-based intervention for malaria elimination in a tri-national region of the Guiana Shield. Front Public Health 2024; 12:1377966. [PMID: 39319292 PMCID: PMC11420009 DOI: 10.3389/fpubh.2024.1377966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 08/20/2024] [Indexed: 09/26/2024] Open
Abstract
Several countries of the Guiana Shield are aiming at the control and elimination of malaria in areas where Artisanal and Small-scale Gold Mining (ASGM) activities predominate, raising questions about how to strengthen community engagement to improve the effectiveness of health programs. The Curema project focuses its intervention on the mobile and hard-to-reach ASGM population, complementing the efforts of national programs in the Guiana Shield. The Curema intervention combines targeted drug administration for suspected Plasmodium vivax asymptomatic carriers, the Malakit distribution, and health education activities. The primary goals of this manuscript are to outline a pathway to foster community participation in the Curema project aimed at eliminating malaria. Thus, it presents a vision of the challenges that the AGSM community poses in terms of community participation for an asymptomatic problem; and highlights the community-based model and the Information, Education and Communication (IEC) components as foundations for participation. In addition, it also presents culturally sensitive IEC strategies designed through iterative and collaborative consultative processes and other bottom-up outreach activities. The community engagement approach facilitates adaptability and responsiveness in a complex, evolving context increasing the effectiveness of interventions.
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Affiliation(s)
| | | | - Jane Bordalo Miller
- Development, Prevention, Monitoring and Border Cooperation (DPAC-Fronteira), Oiapoque, Brazil
| | - Yann Lambert
- CIC INSERM 1424, Cayenne Hospital, Cayenne, French Guiana
| | | | - Teddy Bardon
- CIC INSERM 1424, Cayenne Hospital, Cayenne, French Guiana
| | | | - Stephen Vreden
- Foundation for the Advancement of Scientific Research in Suriname (SWOS), Paramaribo, Suriname
| | - Martha Suarez-Mutis
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Maylis Douine
- CIC INSERM 1424, Cayenne Hospital, Cayenne, French Guiana
| | - Alice Sanna
- CIC INSERM 1424, Cayenne Hospital, Cayenne, French Guiana
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Obeagu EI, Obeagu GU. Adapting to the shifting landscape: Implications of climate change for malaria control: A review. Medicine (Baltimore) 2024; 103:e39010. [PMID: 39029063 PMCID: PMC11398779 DOI: 10.1097/md.0000000000039010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
Malaria, a global public health challenge, continues to affect millions of lives, particularly in regions where its transmission is endemic. The interplay between climate change and malaria dynamics has emerged as a critical concern, reshaping the landscape of this vector-borne disease. This review publication, titled "Adapting to the shifting landscape: Implications of climate change for malaria control," explores the multifaceted relationship between climate change and the control of malaria. The paper begins by dissecting the influence of climate change on malaria dynamics, including alterations in temperature, precipitation, and other climatic factors that impact the habitat and life cycle of malaria vectors. It delves into the evolving ecology and behavior of malaria vectors in response to changing climatic conditions, emphasizing the importance of understanding these adaptations. As a response to this shifting landscape, the review discusses adaptive strategies for malaria control, ranging from vector control measures to the utilization of climate data in early warning systems. Community engagement and education are highlighted as essential components of these strategies, recognizing the vital role of local communities in effective malaria control efforts. The paper also identifies future directions and research needs, underscoring the importance of staying ahead of the evolving climate-malaria relationship. This review underscores the urgency of adapting to the changing landscape of malaria transmission driven by climate change. It emphasizes the significance of proactively addressing climate-related challenges to enhance malaria control and protect the health and well-being of vulnerable populations.
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Cassidy-Seyoum SA, Chheng K, Chanpheakdey P, Meershoek A, Hsiang MS, von Seidlein L, Tripura R, Adhikari B, Ley B, Price RN, Lek D, Engel N, Thriemer K. Implementation of Glucose-6-Phosphate Dehydrogenase (G6PD) testing for Plasmodium vivax case management, a mixed method study from Cambodia. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003476. [PMID: 39028699 PMCID: PMC11259306 DOI: 10.1371/journal.pgph.0003476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/20/2024] [Indexed: 07/21/2024]
Abstract
Plasmodium vivax remains a challenge for malaria elimination since it forms dormant liver stages (hypnozoites) that can reactivate after initial infection. 8-aminoquinolone drugs kill hypnozoites but can cause severe hemolysis in individuals with Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency. The STANDARD G6PD test (Biosensor) is a novel point-of-care diagnostic capable of identifying G6PD deficiency prior to treatment. In 2021, Cambodia implemented the Biosensor to facilitate radical cure treatment for vivax malaria. To assess the Biosensor's implementation after its national rollout, a mixed-methods study was conducted in eight districts across three provinces in Cambodia. Interviews, focus group discussions, and observations explored stakeholders' experiences with G6PD testing and factors influencing its implementation. Quantitative data illustrative of test implementation were gathered from routine surveillance forms and key proportions derived. Qualitative data were analyzed thematically. The main challenge to implementing G6PD testing was that only 49.2% (437/888) of eligible patients reached health centers for G6PD testing following malaria diagnosis by community health workers. Factors influencing this included road conditions and long distances to the health center, compounded by the cost of seeking further care and patients' perceptions of vivax malaria and its treatment. 93.9% (790/841) of eligible vivax malaria patients who successfully completed referral (429/434) and directly presented to the health center (360/407) were G6PD tested. Key enabling factors included the test's acceptability among health workers and their understanding of the rationale for testing. Only 36.5% (443/1213) of eligible vivax episodes appropriately received primaquine. 70.5% (165/234) of female patients and all children under 20 kilograms never received primaquine. Our findings suggest that access to radical cure requires robust infrastructure and income security, which would likely improve referral rates to health centers enabling access. Bringing treatment closer to patients, through community health workers and nuanced community engagement, would improve access to curative treatment of vivax malaria.
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Affiliation(s)
- Sarah A. Cassidy-Seyoum
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Health Ethics and Society, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Keoratha Chheng
- Faculty of Tropical Medicine, Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
| | - Phal Chanpheakdey
- Faculty of Tropical Medicine, Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
| | - Agnes Meershoek
- Department of Health Ethics and Society, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Michelle S. Hsiang
- Institute for Global Health Sciences, Malaria Elimination Initiative, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of California San Francisco, San Francisco, California, United States of America
| | - Lorenz von Seidlein
- Faculty of Tropical Medicine, Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Rupam Tripura
- Faculty of Tropical Medicine, Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Bipin Adhikari
- Faculty of Tropical Medicine, Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Division of Education, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Faculty of Tropical Medicine, Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Dysoley Lek
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- National Institute of Public Health, School of Public Health, Phnom Penh, Cambodia
| | - Nora Engel
- Department of Health Ethics and Society, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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Bukhari T, Gichuhi J, Mbare O, Ochwal VA, Fillinger U, Herren JK. Willingness to accept and participate in a Microsporidia MB-based mosquito release strategy: a community-based rapid assessment in western Kenya. Malar J 2024; 23:113. [PMID: 38643165 PMCID: PMC11031974 DOI: 10.1186/s12936-024-04941-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Microsporidia MB, an endosymbiont naturally found in Anopheles mosquitoes inhibits transmission of Plasmodium and is a promising candidate for a transmission-blocking strategy that may involve mosquito release. A rapid assessment was carried out to develop insight into sociodemographic factors, public health concerns, and malaria awareness, management, and prevention practices with the willingness to accept and participate in Microsporidia MB-based transmission-blocking strategy to develop an informed stakeholder engagement process. METHODS The assessment consisted of a survey conducted in two communities in western Kenya that involved administering a questionnaire consisting of structured, semi-structured, and open questions to 8108 household heads. RESULTS There was an overall high level of willingness to accept (81%) and participate in the implementation of the strategy (96%). Although the willingness to accept was similar in both communities, Ombeyi community was more willing to participate (OR 22, 95% CI 13-36). Women were less willing to accept (OR 0.8, 95% CI 0.7-0.9) compared to men due to fear of increased mosquito bites near homes. Household heads with incomplete primary education were more willing to accept (OR 1.6, 95% CI 01.2-2.2) compared to those educated to primary level or higher. Perceiving malaria as a moderate or low public health issue was also associated with a lower willingness to accept and participate. Experience of > 3 malaria cases in the family over the last six months and knowledge that malaria is transmitted by only mosquito bites, increased the willingness to accept but reduced the willingness to participate. Awareness of malaria control methods based on mosquitoes that cannot transmit malaria increases the willingness to participate. CONCLUSION The study showed a high level of willingness to accept and participate in a Microsporidia MB-based strategy in the community, which is influenced by several factors such as community, disease risk perception, gender, education level, knowledge, and experience of malaria. Further research will need to focus on understanding the concerns of women, educated, and employed community members, and factors that contribute to the lower disease risk perception. This improved understanding will lead to the development of an effective communication strategy.
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Affiliation(s)
- Tullu Bukhari
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya.
| | - Joseph Gichuhi
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
| | - Oscar Mbare
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
| | - Victoria A Ochwal
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
| | - Ulrike Fillinger
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
| | - Jeremy K Herren
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
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Tanue EA, Omam LA, Ayuk GT, Noukeme BM, Metuge A, Nganmou I, Ebob MB, Donovan L, Stratil AS, Counihan H, Nkfusai CN, Hawkings H, Homolova B, Berryman E, Kolawole M, Zoungrana Y, Achu D, Wanji S, Omam EN. A formative cross-sectional study to assess caregiver's health-seeking behaviour and knowledge surrounding malaria, and understand the burden of malaria among children under-five in conflict-affected communities of Cameroon. Malar J 2024; 23:99. [PMID: 38589868 PMCID: PMC11003128 DOI: 10.1186/s12936-024-04902-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/05/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Malaria remains a major global health problem often worsened by political instability and armed conflict. The purpose of the study was to explore community knowledge, attitudes and practices on malaria prevention, and to understand the burden of malaria and health-seeking behaviours of caregivers of children under-five in conflict-affected communities of the South West and Littoral Regions of Cameroon. METHODS A cross-sectional survey involving internally displaced persons (IDPS), host population, and their children under-five was conducted across 80 communities. The survey was conducted from May to June 2021. Participants were interviewed using a structured questionnaire. Malaria prevalence for children under-five was determined using rapid diagnostic tests (RDT) on blood samples. Association between variables and displacement status was measured using chi square test and multivariate logistic regression model was fitted to identify factors associated with adequate knowledge on malaria prevention. RESULTS A total of 2386 adults participated in the study and 1543 RDTs were conducted for children under-five. Adequate levels of knowledge and attitudes on malaria prevention was recorded among 1258 (52.9%) of the participants, with very strong evidence to suggest the level to be higher among the host (59.5%) compared to the IDPs (49.5%) and returnees (39.7%) (p < 0.001). Good practices towards malaria prevention was 43.3%, with very strong evidence indicating lower levels among IDPs (42.8%) and returnees (28.5%) compared to the host (49.4%) (p < 0.001). Malaria prevalence for children under-five was 54.0% and adequate health-seeking for suspected episodes of malaria was 53.0%, without any difference among IDPs (51.78%) and returnees (48.7%) compared to host populations (55.4%) (p = 0.154). Multivariate logistic regression model showed that there was quite strong evidence to suggest primary and secondary levels of education have higher odds of having correct knowledge of malaria prevention (adjusted odds ratio (AOR) 1.71, 95% confidence interval (CI): 1.11-2.64, p = 0.015 and AOR 1.80, 95% CI 1.15-2.82, p = 0.010 respectively). There was very strong evidence to suggest that owning a radio or a television was associated with greater odds of having a higher knowledge on malaria prevention (AOR 1.49, 95% CI 1.233-1.81, p = 0.000 and AOR 1.47, 95% CI 1.18-1.84, p = 0.001). CONCLUSION Over half of the population have correct knowledge and attitudes towards malaria prevention but gaps in complete knowledge remained. Some of the caregivers know the correct malaria preventive practices coupled with largely unsatisfactory treatment approaches and reflected by the high prevalence of malaria among their children. In order to effectively treat malaria, innovative strategies should target community participation.
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Affiliation(s)
- Elvis Asangbeng Tanue
- Reach Out Cameroon, Small Soppo, P.O Box 88, Buea, Cameroon.
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, Cameroon.
| | - Lundi-Anne Omam
- Reach Out Cameroon, Small Soppo, P.O Box 88, Buea, Cameroon
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Glennis T Ayuk
- Reach Out Cameroon, Small Soppo, P.O Box 88, Buea, Cameroon
| | | | - Alain Metuge
- Reach Out Cameroon, Small Soppo, P.O Box 88, Buea, Cameroon
| | | | - Margaret Besem Ebob
- Reach Out Cameroon, Small Soppo, P.O Box 88, Buea, Cameroon
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Laura Donovan
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Ann-Sophie Stratil
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Helen Counihan
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Claude Ngwayu Nkfusai
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
- Department of Public Health, School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban, South Africa
| | - Helen Hawkings
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Blanka Homolova
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Elizabeth Berryman
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Maxwell Kolawole
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Yakouba Zoungrana
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Dorothy Achu
- National Malaria Control Programme, Ministry of Public Health, P.O Box 14386, Yaounde, Cameroon
| | - Samuel Wanji
- Department for Microbiology and Parasitology, University of Buea, P.O Box 12, Buea, Cameroon
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
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Abdissa D, Kebede Y, Sudhakar M, Abraham G, Bulcha G, Shiferaw T, Berhanu N, Teshome F, Miecha H, Birhanu Z. Community's knowledge, perceptions and preventive practices on Onchocerciasis in Jimma zone, Ethiopia, formative mixed study. PLoS Negl Trop Dis 2024; 18:e0011995. [PMID: 38478481 PMCID: PMC10936768 DOI: 10.1371/journal.pntd.0011995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND In Ethiopia, Onchocerciasis is a prevalent neglected tropical disease, currently targeted for elimination with mass drug administration and community behavioral changes towards sustained control and eventual elimination. This study aimed to elucidate the awareness, perceptions and practices of endemic communities in Jimma Zone, Ethiopia. METHODS AND MATERIALS Community-based cross-sectional study triangulated with qualitative method was conducted from October-November, 2021. A multistage sampling was employed and data were collected using a pre-tested interviewer-administered structured questionnaire. Logistic regression was used to identify the predictors of comprehensive knowledge and preventive practice. Adjusted odds ratios were calculated at 95% confidence interval (CI) and considered significant with a p-value of <0.05. Kruskal-Whallis and Mann-whitney tests were used to compare median risk perception score by socio-demographic factors. Qualitative data were collected through focus group discussions and key informant interviews and transcribed verbatim. Then the data were coded, categorized, and themes were developed. RESULT The overall prevalence of adequate comprehensive knowledge was 48.8% (95% CI: 44.9, 52.3), high risk perception was 18.7% (95%CI15.9, 21.4) and preventive practice was 46.9%(95%CI:(43.3,50.4). High risk perception[AOR = 1.95 95%CI: (1.32, 2.89] was statistically significant with comprehensive knowledge, likewise knowledge of mode of transmission [AOR = 2.64 95% CI: (1.44, 4.85)], knowledge of consequences [AOR = 2.12 95%CI: (1.21, 3.72)] and knowledge of preventive measures [AOR = 15.65,95%CI:(10.1, 24.2)] were statistically significant with preventive practice. The median risk perception was varied significantly between the groups by educational status, study district and age category. Qualitative evidence showed that there were great community knowledge gap about the disease. CONCLUSION Community knowledge, perceptions, and practices are unacceptably low. Risk perception was significantly associated with comprehensive knowledge, likewise knowledge of mode of transmission, consequences and preventive measures were significantly associated with preventive practice. This implies knowledge is a key component of effective prevention strategies as it is a necessary condition for the behavior change.
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Affiliation(s)
- Daba Abdissa
- Department of Biomedical Sciences, Jimma University, Jimma, Ethiopia
| | - Yohannes Kebede
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Morankar Sudhakar
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Gelila Abraham
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | | | | | | | - Firanbon Teshome
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Hirpa Miecha
- Oromia, regional health bureau, Oromia, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
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Naserrudin NA, Adhikari B, Culleton R, Hod R, Jeffree MS, Ahmed K, Hassan MR. Knowledge, compliance, and challenges in anti-malarial products usage: a systematic review of at-risk communities for zoonotic malaria. BMC Public Health 2024; 24:317. [PMID: 38287308 PMCID: PMC10823597 DOI: 10.1186/s12889-024-17792-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Zoonotic malaria is a growing public health threat in the WHO Southeast Asia (SEA) and Western Pacific (WP) regions. Despite vector-control measures, the distribution of Macaque fascicularis and M. nemestrina, and Anopheles mosquitoes carrying non-human simian malaria parasites poses challenges to malaria elimination. The systematic review assesses the literature on knowledge and malaria-preventive practices in zoonotic malaria-affected areas across the WHO SEA and WP, aiming to identify challenges for malaria control. METHODS Peer-reviewed articles published in English, Malay and Indonesian between January 2010 and December 2022 were searched in OVID Medline, Scopus, Web of Science, and Google Scholar. Studies of any design-excluding reviews, conference proceedings, and reports from all WHO SEA and WP countries vulnerable to zoonotic malaria-were included. Backwards-reference screening and thematic analysis were conducted. RESULTS Among 4,174 initially searched articles, 22 peer-reviewed articles met the inclusion criteria. An additional seven articles were identified through backwards-reference screening, resulting in a total of 29 articles for this review. Half of these studies were conducted in Cambodia, Myanmar, Malaysia, and Thailand, mainly in forests and remote communities. The review highlighted inconsistencies in the operationalization of knowledge, and five major themes were identified related to knowledge: causation and transmission, symptoms, treatment, severity and complications, and malaria prevention. While participants generally had some understanding of malaria causation/transmission, minority and indigenous ethnic groups demonstrated limited knowledge and held misconceptions, such as attributing malaria to drinking dirty water. Preventive practices included traditional and non-traditional or modern methods-with a preference for traditional approaches to avoid mosquito bites. Challenges to malaria control included feasibility, cost, and access to healthcare services. CONCLUSION This review provides insights into knowledge, local understandings, and preventive practices related to malaria in the WHO SEA and WP regions. The findings highlight the need for future research to explore the knowledge of at-risk communities regarding zoonotic malaria, their perceive threat of the disease and factors exposing them to zoonotic malaria. New strategies must be developed for zoonotic malaria programs tailored to local contexts, emphasizing the significance of community participation, health education, and socio-behavioural change initiatives. It is important to consider the interconnectedness of human health, environmental and non-human primates conservation. Socio-cultural nuances should also be carefully considered in the design and implementation of these programs to ensure their effect tailored to local contexts.
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Affiliation(s)
- Nurul Athirah Naserrudin
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Setia Alam, Shah alam, 40170, Malaysia
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
| | - Bipin Adhikari
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Richard Culleton
- Division of Molecular Parasitology, Proteo-Science Center, Ehime University, Toon, Ehime, 791-0295, Japan
| | - Rozita Hod
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
| | - Mohammad Saffree Jeffree
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia, Sabah, 88400, Kota Kinabalu, Malaysia
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, 88400, Malaysia
| | - Kamruddin Ahmed
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia, Sabah, 88400, Kota Kinabalu, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia.
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia, Sabah, 88400, Kota Kinabalu, Malaysia.
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Dicko B, Kodio S, Samoura H, Traoré F, Sykes N, Drabo M, Thizy D, Coche I, Robinson B, Sanogo K, Yagouré B, Diop S, Coulibaly MB. Stakeholder engagement in the development of genetically modified mosquitoes for malaria control in West Africa: lessons learned from 10 years of Target Malaria's work in Mali. Front Bioeng Biotechnol 2024; 11:1286694. [PMID: 38249804 PMCID: PMC10797414 DOI: 10.3389/fbioe.2023.1286694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
From 2012 to 2023, the Malaria Research and Training Center (MRTC), based out of the University of Sciences, Techniques and Technologies of Bamako (USTTB), was part of the Target Malaria research consortium working towards developing novel gene drive-based tools for controlling populations of malaria vector mosquitoes. As part of this work, Target Malaria Mali has undertaken a range of in-depth engagement activities with the communities where their research is conducted and with other stakeholders nationally. These activities were meant to ensure that the project's activities took place with the agreement of those communities, and that those communities were able to play a role in shaping the project's approach to ensure that its eventual outcomes were in line with their needs and concerns. This paper aims to conduct a critical assessment of those 10 years of stakeholder engagement in order to identify good practices which can inform future engagement work on gene drive research in West Africa. It sets out a range of approaches and practices that enabled the Target Malaria Mali team to engage a variety of stakeholders, to share information, collect feedback, and determine community agreement, in a manner that was inclusive, effective, and culturally appropriate. These can be useful tools for those working on gene drive research and other area-wide vector control methods in West African contexts to ensure that their research is aligned with the interests of the communities who are intended to be its ultimate beneficiaries, and to allow those communities to play a meaningful role in the research process.
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Affiliation(s)
- Bakara Dicko
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Souleymane Kodio
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Hatouma Samoura
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Fatoumata Traoré
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Naima Sykes
- Imperial College London, London, United Kingdom
| | | | | | | | | | - Kadiatou Sanogo
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bilkissou Yagouré
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Samba Diop
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mamadou B. Coulibaly
- Malaria Research and Training Center at the University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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9
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Lopez AR, Brown CA. Knowledge, attitudes and practices regarding malaria prevention and control in communities in the Eastern Region, Ghana, 2020. PLoS One 2023; 18:e0290822. [PMID: 37647322 PMCID: PMC10468076 DOI: 10.1371/journal.pone.0290822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa countries including Ghana, the malaria burden remains unacceptably high and still a serious health challenge. Evaluating a community's level of knowledge, attitude, and practice (KAP) regarding malaria is essential to enabling appropriate preventive and control measures. This study aimed to evaluate knowledge of malaria, attitudes toward the disease, and adoption of control and prevention practices in some communities across the Eastern Region of Ghana. METHODS A cross‑sectional based study was carried out in 13 communities across 8 districts from January -June, 2020. Complete data on socio-demographic characteristics and KAP were obtained from 316 randomly selected household respondents by a structured pre-tested questionnaire. Associations between KAP scores and socio-demographic profiles were tested by Chi-square and binary logistic regression. Data analysis was done with SPSS version 26.0. RESULTS Most respondents (85.4%) had good knowledge score about malaria. Preferred choice of treatment seeking place (50.6%) was the health center/clinic. All respondents indicated they would seek treatment within 24 hours. Mosquito coils were the preferred choice (58.9%) against mosquito bites. Majority of households (58.5%) had no bed nets and bed net usage was poor (10.1%). Nearly half of the respondents (49.4%) had a positive attitude toward malaria and 40.5% showed good practices. Chi-square analysis showed significant associations for gender and attitude scores (p = 0.033), and educational status and practice scores (p = 0.023). Binary logistic regression analysis showed that 51-60 year-olds were less likely to have good knowledge (OR = 0.20, p = 0.04) than 15-20 year-olds. Respondents with complete basic schooling were less likely to have good knowledge (OR = 0.33, p = 0.04) than those with no formal schooling. A positive attitude was less likely in men (OR = 0.61, p = 0.04). Good malaria prevention practice was lower (OR = 0.30, p = 0.01) in participants with incomplete basic school education compared to those with no formal schooling. CONCLUSION Overall scores for respondents' knowledge, though good, was not reflected in attitudes and levels of practice regarding malaria control and prevention. Behavioral change communication, preferably on radio, should be aimed at attitudes and practice toward the disease.
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Affiliation(s)
| | - Charles Addoquaye Brown
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Korle Bu, Accra, Ghana
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10
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Kayendeke M, Nabirye C, Nayiga S, Westercamp N, Gonahasa S, Katureebe A, Kamya MR, Staedke SG, Hutchinson E. House modifications as a malaria control tool: how does local context shape participants' experience and interpretation in Uganda? Malar J 2023; 22:244. [PMID: 37626312 PMCID: PMC10463640 DOI: 10.1186/s12936-023-04669-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Evidence that house design can provide protection from malaria is growing. Housing modifications such as screening windows, doors, and ceilings, and attaching insecticide-impregnated materials to the eaves (the gap between the top of the wall and bottom of the roof), can protect against malaria. To be effective at scale, however, these modifications must be adopted by household residents. There is evidence that housing modifications can be acceptable, but in-depth knowledge on the experiences and interpretation of modifications is lacking. This qualitative study was carried out to provide a holistic account of the relationship between experiences and interpretations of four types of piloted housing modifications and the local context in Jinja, Uganda. METHODS Qualitative research was conducted between January to June 2021, before and during the installation of four types of housing modifications. The methods included nine weeks of participant observations in two study villages, nine focus group discussions with primary caregivers and heads of households (11-12 participants each), and nine key informant interviews with stakeholders and study team members. RESULTS Most residents supported the modifications. Experiences and interpretation of the housing modifications were shaped by the different types of housing in the area and the processes through which residents finished their houses, local forms of land and property ownership, and cultural and spiritual beliefs about houses. CONCLUSIONS To maximize the uptake and benefit of housing modifications against malaria, programme development needs to take local context into account. Forms of local land and house ownership, preferences, the social significance of housing types, and religious and spiritual ideas shape the responses to housing modifications in Jinja. These factors may be important in other setting. Trial registration Trial registration number is NCT04622241. The first draft was posted on November 9th 2020.
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Affiliation(s)
| | - Christine Nabirye
- Infectious Diseases Research Collaboration, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Nelli Westercamp
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
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11
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Nadia J, Wang Y, Li G, Sun L, Mmadi SA, Abdallah KS, Abdallah AM, Shu L, Bacar A, Deng C, Huang X, Zhou X, Song J, Lu F. KNOWLEDGE, ATTITUDES, AND PRACTICES TOWARD MALARIA AND ANTIMALARIAL MASS DRUG ADMINISTRATION AMONG HEADS OF HOUSEHOLDS IN VILLAGES ON GRANDE COMORE ISLAND, THE COMOROS. J Parasitol 2023; 109:187-199. [PMID: 37270766 DOI: 10.1645/22-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Knowledge, attitudes, and practices (KAP) surveys on malaria and antimalarial mass drug administration (MDA) have not received much attention in the Union of the Comoros. This study is a household-based cross-sectional survey using a multi-stage sampling technique aiming at investigating KAP toward malaria and antimalarial MDA with artemisinin-piperaquine among heads of households on Grande Comore Island, the largest island of the Comoros. A predefined structured questionnaire containing socio-demographic characteristics and questions about malaria and antimalarial MDA was administered to 1,368 randomly selected heads of households from 10 malaria-endemic villages on Grande Comore Island. The results showed that 81.4% of the heads of households knew that malaria is a transmissible disease, 77.6% recognized mosquitoes as the vectors of malaria, and 70.8% recognized fever as one of the frequent symptoms of malaria; 40.8% of respondents remembered the name of the antimalarial drug used for MDA, and 62.1% remembered the color of the antimalarial tablets; and 65.1% chose to go to a public health center to seek treatment as their first option within 24 hr of the onset of initial malaria symptoms. This study found that most heads of households had a reasonable level of knowledge about malaria and antimalarial MDA. However, only 7.3% obtained full points on all knowledge-related questions. Misconceptions about malaria cause, transmission, diagnostic method, and antimalarial MDA exist in the community of Grande Comore Island. As the Comoros continues to put great efforts to go toward malaria elimination, the community's KAP on malaria and antimalarial MDA is crucial to guarantee the community's long-term adherence to malaria elimination interventions and could become key to guaranteeing malarial elimination in the Comoros. Therefore, there is a great need to improve malaria prevention awareness through strengthening malaria education and promoting behavioral change. Heads of households should be the core target of malaria education and behavioral change for malaria elimination.
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Affiliation(s)
- Julie Nadia
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou 510440, China
| | - Yuxin Wang
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou 510440, China
| | - Guoming Li
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou 510440, China
| | - Liwei Sun
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou 510440, China
| | - Salim Abdoulkarim Mmadi
- Ministry of Health, Social Cohesion, Solidarity, and Gender Promotion, Bâtiment de la Fonction Publique, BP 1028, Moroni, the Union of the Comoros
| | - Kamal Said Abdallah
- National Malaria Control Program, Route de la Corniche, BP 5212, Moroni, the Union of the Comoros
| | - Ali Maoulida Abdallah
- Ministry of Health, Social Cohesion, Solidarity, and Gender Promotion, Bâtiment de la Fonction Publique, BP 1028, Moroni, the Union of the Comoros
| | - Lei Shu
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou 510440, China
| | - Affane Bacar
- National Malaria Control Program, Route de la Corniche, BP 5212, Moroni, the Union of the Comoros
| | - Changsheng Deng
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Xinan Huang
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Xian Zhou
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou 510440, China
| | - Jianping Song
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Fangli Lu
- Clinical Laboratory, the Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; Department of Parasitology, School of Medicine, Sun Yat-sen University, Shenzhen 518107, China; Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China; and Key Laboratory of Tropical Disease of the Ministry of Education, Sun Yat-sen University, Guangzhou 510080, China
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12
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Bardosh K, Desir L, Jean L, Yoss S, Poovey B, Nute A, de Rochars MVB, Telfort MA, Benoit F, Chery G, Charlotin MC, Noland GS. Evaluating a community engagement model for malaria elimination in Haiti: lessons from the community health council project (2019-2021). Malar J 2023; 22:47. [PMID: 36759860 PMCID: PMC9910254 DOI: 10.1186/s12936-023-04471-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/29/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Community engagement (CE) plays a critical role in malaria control and elimination. CE approaches vary substantially, with more participatory programmes requiring higher levels of adaptive management. This study evaluates the effectiveness of a volunteer-based CE programme developed in Haiti in 2018. The approach was based on local leaders organizing and implementing monthly anti-malaria activities in their communities, and was implemented as part of Malaria Zero Consortium activities. METHODS This programme evaluation draws on quantitative and qualitative data collected from 23 Community Health Councils (CHCs) over a two-year period (2019-2021) in Grand'Anse department, a malaria hotspot region in Haiti. RESULTS Monthly monitoring data showed that 100% of the 23 CHCs remained functional over the two-year period, with an average of 0.90 monthly meetings held with an 85% attendance rate. A high degree of transparency and diversity in membership helped create strong planning and involvement from members. CHCs conducted an average of 1.6 community-based activities per month, directly engaging an average of 123 people per month. High levels of fluctuation in monthly activities were indicative of local ownership and self-organization. This included school and church sensitization, environmental sanitation campaigns, mass education, support for case referrals and community mobilization during mass drug administration (MDA) and indoor residual spraying (IRS) campaigns. Members drew on the tradition of konbit (mutual self-help), local histories of health and development campaigns and a lexicon of "solidarity" in difficult times as they negotiated their agency as community volunteers. Small incentives played both symbolic and supportive roles. Some level of politicization was viewed as inevitable, even beneficial. Rumours about financial and political profiteering of CHC volunteers took time to dispel while the tendency towards vertical planning in malaria control created conditions that excluded CHCs from some activities. This generated resentment from members who felt sidelined by the government malaria programme. CONCLUSION The CHC model was effective in promoting group solidarity and community-based anti-malaria activities over a two-year period in Haiti. With the end of the Malaria Zero Consortium in early 2021, there is now an opportunity to better integrate this programme into the primary healthcare system, evaluate the impact of the CHCs on malaria epidemiology, and promote the greater integration of CHCs with active surveillance and response activities.
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Affiliation(s)
- Kevin Bardosh
- School of Public Health, University of Washington, Seattle, WA, USA. .,The Carter Center, Atlanta, GA, USA.
| | - Luccene Desir
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
| | - Lorence Jean
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
| | - Sarah Yoss
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
| | - Brianna Poovey
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
| | - Andrew Nute
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
| | - Madsen Valerie Beau de Rochars
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA ,grid.15276.370000 0004 1936 8091Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL USA
| | - Marc-Aurèle Telfort
- grid.436183.bMinistère de la Sante Publique et de la Population, Jeremie and Port-au-Prince, Haiti
| | - Fabiola Benoit
- grid.436183.bMinistère de la Sante Publique et de la Population, Jeremie and Port-au-Prince, Haiti
| | - Ginette Chery
- grid.436183.bMinistère de la Sante Publique et de la Population, Jeremie and Port-au-Prince, Haiti
| | - Marie Carmelle Charlotin
- grid.436183.bMinistère de la Sante Publique et de la Population, Jeremie and Port-au-Prince, Haiti
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13
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Adhikari B, Tripura R, Peto TJ, Callery JJ, von Seidlein L, Dysoley L, Dondorp AM. Village malaria workers for the community-based management of vivax malaria. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 9:100128. [PMID: 37383038 PMCID: PMC10306055 DOI: 10.1016/j.lansea.2022.100128] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 06/30/2023]
Abstract
In Cambodia, malaria cases are on a trajectory towards the goal of malaria elimination by 2025. Vivax malaria is difficult to eliminate because of hypnozoites that can cause relapse. Primaquine, an 8-aminoquinoline, clears hypnozoites but requires testing for glucose-6-phosphate dehydrogenase (G6PD) deficiency. Routine primaquine treatment of vivax malaria has recently been implemented in Cambodia in which Village Malaria Workers (VMWs) diagnose vivax malaria by rapid diagnostic test and refer patients to health centres for G6PD testing and further treatment. Patients are referred back to the VMWs for monitoring adverse symptoms and treatment adherence. This article explores how VMWs' roles might be optimized for the community-based management of vivax malaria. With sufficient training and supervision, the role of VMWs might be expanded to include G6PD testing, making referral to the health centre superfluous. Community-based management of vivax malaria could increase the coverage of radical cure and accelerate vivax malaria elimination.
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Affiliation(s)
- Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Rupam Tripura
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Thomas J. Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - James J. Callery
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Lek Dysoley
- C.N.M National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Arjen M. Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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14
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Rulisa A, van Kempen L, Hakizimana E, Koenraadt CJM. Local resource mobilization for malaria vector control among Rwandan rice farmers: a pilot study into the role of community ownership. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:6. [PMID: 36691108 PMCID: PMC9872385 DOI: 10.1186/s41043-023-00345-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Evidence suggests a vicious cycle between rice cultivation and malaria control in Rwanda. Rice fields offer an attractive breeding ground for malaria vectors, which increases the disease burden in rice farming communities, and, consequently, reduces productivity in the rice sector. Community-based larval source management in rice fields is propagated as a sustainable solution to break this cycle. A sense of agency and ownership of malaria control interventions, as well as the mobilization of resources at the local level, are often considered preconditions for success. However, an evidence gap exists regarding the interaction between the agentive and financial dimension of local sustainability. METHODS We conduct a larviciding pilot involving three groups; one group where rice farmers sprayed their fields under expert supervision, one group where rice farmers organised the larviciding campaign themselves, and a (non-sprayed) control group. We test whether the difference in agency between the intervention groups affects farmers' willingness-to-pay for a larviciding campaign. Willingness-to-pay is elicited in a contingent valuation exercise, more specifically a bidding game, and is assessed both before and after the pilot (n = 288). Difference-in-difference estimates are computed, using a propensity score matching technique. Supplementary data were collected in a survey and two focus group discussions for triangulation. RESULTS The high-agency (self-organised) group significantly outperforms the low-agency (expert-supervised) group in terms of maintaining its willingness to contribute financially. However, higher willingness-to-pay in the high-agency group does not appear to be driven by a stronger sense of ownership per se. The supplementary data indicate high levels of ownership in both treatment groups compared to the control group. A tentative explanation lies in diverging perceptions concerning the effectiveness of the pilot. CONCLUSIONS The study supports the idea that community-led organization of larval source management can prove instrumental in mobilizing finance for malaria control in low-income settings where rice production interferes with the fight against malaria. However, the causality is complex. Feelings of ownership do not appear the main driver of willingness-to-pay, at least not directly, which opens up the possibility of initiating community-driven malaria control interventions that promote the agentive and financial dimension of local sustainability simultaneously.
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Affiliation(s)
- Alexis Rulisa
- grid.5590.90000000122931605Department of Cultural Anthropology and Development Studies, and Radboud Social Cultural Research, Radboud University, 6525 XZ Nijmegen, The Netherlands
| | - Luuk van Kempen
- grid.5590.90000000122931605Department of Cultural Anthropology and Development Studies, and Radboud Social Cultural Research, Radboud University, 6525 XZ Nijmegen, The Netherlands
| | - Emmanuel Hakizimana
- grid.452755.40000 0004 0563 1469Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Center, 7162 Kigali, Rwanda
| | - Constantianus J. M. Koenraadt
- grid.4818.50000 0001 0791 5666Laboratory of Entomology, Wageningen University & Research, 6708 Wageningen, The Netherlands
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15
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Gowelo S, Meijer P, Tizifa T, Malenga T, Mburu MM, Kabaghe AN, Terlouw DJ, van Vugt M, Phiri KS, Mzilahowa T, Koenraadt CJM, van den Berg H, Manda-Taylor L, McCann RS, Takken W. Community Participation in Habitat Management and Larviciding for the Control of Malaria Vectors in Southern Malawi. Am J Trop Med Hyg 2023; 108:51-60. [PMID: 36410320 PMCID: PMC9833073 DOI: 10.4269/ajtmh.21-1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Larval source management (LSM) could reduce malaria transmission when executed alongside core vector control strategies. Involving communities in LSM could increase intervention coverage, reduce operational costs, and promote sustainability via community buy-in. We assessed the effectiveness of community-led LSM to reduce anopheline larval densities in 26 villages along the perimeter of Majete Wildlife Reserve in southern Malawi. The communities formed LSM committees which coordinated LSM activities in their villages following specialized training. Effectiveness of larviciding by LSM committees was assessed via pre- and post-spray larval sampling. The effect of community-led LSM on anopheline larval densities in intervention villages was assessed via comparisons with densities in non-LSM villages over a period of 14 months. Surveys involving 502 respondents were undertaken in intervention villages to explore community motivation and participation, and factors influencing these outcomes. Larviciding by LSM committees reduced anopheline larval densities in post-spray sampling compared with pre-spray sampling (P < 0.0001). No differences were observed between anopheline larval densities during pre-spray sampling in LSM villages and those in non-LSM villages (P = 0.282). Knowledge about vector biology and control, and someone's role in LSM motivated community participation in the vector control program. Despite reducing anopheline larval densities in LSM villages, the impact of the community-led LSM could not be detected in our study setting because of low mosquito densities after scale-up of core malaria control interventions. Still, the contributions of the intervention in increasing a community's knowledge of malaria, its risk factors, and its control methods highlight potential benefits of the approach.
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Affiliation(s)
- Steven Gowelo
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.,Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands.,MAC Communicable Diseases Action Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Paola Meijer
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Tinashe Tizifa
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.,Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Tumaini Malenga
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.,African Institute for Development Policy, Lilongwe, Malawi
| | - Monicah M Mburu
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.,Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands.,Macha Research Trust, Choma, Zambia
| | - Alinune N Kabaghe
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.,Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Dianne J Terlouw
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Michèle van Vugt
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Kamija S Phiri
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Themba Mzilahowa
- MAC Communicable Diseases Action Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Henk van den Berg
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Lucinda Manda-Taylor
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Robert S McCann
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.,Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands.,Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Willem Takken
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
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16
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Naserrudin NA, Monroe A, Culleton R, Hod R, Jeffree MS, Ahmed K, Hassan MR. Reimagining zoonotic malaria control in communities exposed to Plasmodium knowlesi infection. J Physiol Anthropol 2022; 41:14. [PMID: 35413881 PMCID: PMC9004057 DOI: 10.1186/s40101-022-00288-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/31/2022] [Indexed: 12/21/2022] Open
Abstract
Plasmodium knowlesi malaria infection in humans has been reported throughout southeast Asia. The communities at risk are those living in areas where Macaque monkeys and Anopheles mosquito are present. Zoonotic malaria control is challenging due to the presence of the reservoir host and the possibility of human-vector-human transmission. Current control measures, including insecticide-treated nets (ITNs) and indoor residual spraying (IRS), are insufficient to address this threat due to gaps in protection associated with outdoor and early evening vector biting and social and economic activities, such as agricultural and forest work. Understanding the challenges faced by affected communities in preventing mosquito bites is important for reducing disease transmission. This opinion paper discusses opportunities to improve P. knowlesi malaria control through understanding the challenges faced by communities at risk and increasing community engagement and ownership of control measures. The paper highlights this issue by describing how the concept of reimagining malaria can be adapted to zoonotic malaria control measures including identifying current gaps in vector control, understanding interactions between environmental, economic, and human behavioral factors, and increasing community participation in and ownership of control measures.
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Affiliation(s)
- Nurul Athirah Naserrudin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.,Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia, Kota Kinabalu, Sabah, Malaysia.,Sabah State Health Department, Ministry of Health, Kota Kinabalu, Malaysia
| | - April Monroe
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Richard Culleton
- Department of Molecular Parasitology, Proteo-Science Centre, Ehime University, Matsuyama, Japan
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Muhammad Saffree Jeffree
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia, Kota Kinabalu, Sabah, Malaysia.,Department of Public Health, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Kamruddin Ahmed
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia, Kota Kinabalu, Sabah, Malaysia.,Department of Public Health, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
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17
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Kaehler N, Adhikari B, Cheah PY, von Seidlein L, Day NPJ, Dondorp AM, Pell C. Community engagement for malaria elimination in the Greater Mekong Sub-region: a qualitative study among malaria researchers and policymakers. Malar J 2022; 21:46. [PMID: 35164770 PMCID: PMC8845385 DOI: 10.1186/s12936-022-04069-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community engagement has increasingly received attention in malaria research and programme interventions, particularly as countries aim for malaria elimination. Although community engagement strategies and activities are constantly developing, little is known about how those who implement research or programmes view community engagement. This article explores the perspectives of researchers and policy makers in the Greater Mekong Sub-region (GMS) on community engagement for malaria control and elimination. METHODS Semi-structured interviews were conducted among 17 policymakers and 15 senior researchers working in the field of malaria. All interviews were audio-recorded and transcribed in English. Transcribed data were analysed using deductive and inductive approaches in QSR NVivo. Themes and sub-themes were generated. RESULTS Researchers and policymakers emphasized the importance of community engagement in promoting participation in malaria research and interventions. Building trust with the community was seen as crucial. Respondents emphasized involving authority/leadership structures and highlighted the need for intense and participatory engagement. Geographic remoteness, social, cultural, and linguistic diversity were identified as barriers to meaningful engagement. Local staff were described as an essential 'connect' between researchers or policymakers and prospective participants. Sharing information with community members, using various strategies including creative and participatory methods were highlighted. CONCLUSIONS Policymakers and researchers involved in malaria prevention and control in the GMS viewed community engagement as crucial for promoting participation in research or programmatic interventions. Given the difficulties of the 'last mile' to elimination, sustained investment in community engagement is needed in isolated areas of the GMS where malaria transmission continues. Involving community-based malaria workers is ever more critical to ensure the elimination efforts engage hard-to-reach populations in remote areas of GMS.
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Affiliation(s)
- Nils Kaehler
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, UK
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christopher Pell
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
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Guntur RD, Kingsley J, Islam FMA. Ethnic Variation and Its Association With Malaria Awareness: A Cross-sectional Study in East Nusa Tenggara Province, Indonesia. J Prev Med Public Health 2022; 55:68-79. [PMID: 35135050 PMCID: PMC8841199 DOI: 10.3961/jpmph.21.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives This study investigated associations between ethnicity and malaria awareness in East Nusa Tenggara Province (ENTP), Indonesia. Methods A community-based cross-sectional study was conducted upon 1503 adults recruited by multi-stage cluster random sampling. A malaria awareness questionnaire was used to collect data, according to which participants were classified as aware or unaware of malaria. Logistic regression was applied to quantify the strength of associations of factors with malaria awareness. Results The participation rate in this study was high (99.5%). The participants were distributed relatively evenly among the Manggarai, Atoni, and Sumba ethnicities (33.0, 32.3, and 30.2%, respectively). Malaria awareness was significantly different amongst these groups; it was most common in the Manggarai ethnicity (65.1%; 95% confidence interval [CI], 59.9 to 70.3) and least common in the Sumba ethnicity (35.0%; 95% CI, 27.6 to 42.4). The most prominent factor influencing the malaria awareness in the Sumba and Manggarai ethnicities was education level, whilst it was socioeconomic status (SES) in the Atoni ethnicity. The likelihood of malaria awareness was significantly higher in adults with an education level of diploma or above (adjusted odds ratio [aOR], 21.4; 95% CI, 3.59 to 127.7 for Manggarai; aOR, 6.94; 95% CI, 1.81 to 26.6 for Sumba). Malaria awareness was significantly more common amongst high-SES adults in the Atoni group (aOR, 24.48; 95% CI, 8.79 to 68.21). Conclusions Low education levels and low SES were prominent contributors to lower levels of malaria awareness in rural ENTP. Interventions should focus on improving malaria awareness to these groups to support the Indonesian government’s national commitment to achieve a malaria elimination zone by 2030.
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Affiliation(s)
- Robertus Dole Guntur
- Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
- Department of Mathematics, Faculty of Science and Engineering, University of Nusa Cendana, Kupang, Indonesia
- Corresponding author: Robertus Dole Guntur Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology, 453-457 Burwood Road, Hawthorn 3122, Australia E-mail:
| | - Jonathan Kingsley
- Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
- Centre of Urban Transitions, Swinburne University of Technology, Hawthorn, Australia
| | - Fakir M. Amirul Islam
- Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
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Engaging communities in planning and delivering eye care services. COMMUNITY EYE HEALTH 2022; 35:3-4. [PMID: 36425855 PMCID: PMC9680599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Paradkar PN, Sahasrabudhe PR, Ghag Sawant M, Mukherjee S, Blasdell KR. Towards Integrated Management of Dengue in Mumbai. Viruses 2021; 13:2436. [PMID: 34960705 PMCID: PMC8703503 DOI: 10.3390/v13122436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/15/2022] Open
Abstract
With increasing urbanisation, the dengue disease burden is on the rise in India, especially in large cities such as Mumbai. Current dengue surveillance in Mumbai includes municipal corporation carrying out specific activities to reduce mosquito breeding sites and the use of insecticides to suppress the adult mosquito populations. Clinical cases remain either underreported or misreported due to the restriction to government clinics, missing the large private health care sector. There is a need for an integrated approach to manage dengue outbreaks in Mumbai. There are various novel strategies available for use that can be utilised to improve disease detection, mosquito surveillance, and control of mosquito-borne diseases. These novel technologies are discussed in this manuscript. Given the complex ecosystem of mosquito-borne diseases in Mumbai, integrating data obtained from these technologies would support the ongoing mosquito control measures in Mumbai.
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Affiliation(s)
- Prasad N. Paradkar
- CSIRO Health & Biosecurity, Australian Centre for Disease Preparedness, 5 Portarlington Road, Geelong 3220, Australia;
| | | | - Mrunal Ghag Sawant
- Department of Zoonosis, Haffkine Institute for Training Research and Testing, Parel, Mumbai 400012, India;
| | - Sandeepan Mukherjee
- Department of Virology, Haffkine Institute for Training Research and Testing, Parel, Mumbai 400012, India;
| | - Kim R. Blasdell
- CSIRO Health & Biosecurity, Australian Centre for Disease Preparedness, 5 Portarlington Road, Geelong 3220, Australia;
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Guntur RD, Kingsley J, Islam FMA. Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia. PLoS One 2021; 16:e0259950. [PMID: 34780554 PMCID: PMC8592438 DOI: 10.1371/journal.pone.0259950] [Citation(s) in RCA: 4] [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: 10/30/2020] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The 2009 Indonesian roadmap to malaria elimination indicated that the nation had been progressing towards achieving malaria elimination by 2030. Currently, most of the districts in the western part of Indonesia have eliminated malaria; however, none of the districts in the East Nusa Tenggara Province (ENTP) have met these set targets. This study aimed to investigate the status of malaria awareness of rural adults in the ENTP. Methods A community-based cross-sectional study was conducted between October and December 2019 in high, moderate, and low malaria-endemic settings (MESs) in the ENTP. After obtaining informed consent, data were collected using an interviewer-administered structure questionnaire among 1503 participants recruited by a multi-stage cluster sampling method. A malaria awareness index was developed based on ten questions. A binary logistic regression method was applied to investigate the significance of any association between malaria awareness and the different MESs. Results The participation rate of the study was 99.5%. Of this number, 51.4% were female and 45.5% had completed primary education. The malaria awareness index was significantly low (48.8%, 95% confidence interval [CI]: 45.2–52.4). Malaria awareness of rural adults residing in low endemic settings was two times higher than for those living in high endemic settings (adjusted odds ratio [AOR]: 2.41, 95% CI: 1.81–3.21) and the basic malaria knowledge of participants living in low malaria-endemic settings was almost four times higher than that in high endemic settings (AOR: 3.75, 95% CI: 2.75–5.11). Of the total participants, 81.3% (95% CI: 79.1–83.5) were aware that malaria could be prevented and 75.1% (95% CI: 72.6–77.6) knew at least one prevention measure. Overall, the awareness of fever as the main symptom of malaria, mosquito bites as the transmission mode of malaria, and seeking treatment within 24 hours of suffering from malaria was poor at 37.9% (95% CI: 33.9–41.9), 59.1% (95% CI: 55.9–62.3), and 46.0% (95% CI: 42.3–49.7), respectively. The poor level of awareness was significantly different amongst the three MESs, with the lowest levels of awareness in the high endemic setting. Conclusion Malaria awareness of rural adults needs to be improved to address Indonesia’s national roadmap for malaria elimination. Results indicated that public health programs at a local government level should incorporate the malaria awareness index in their key strategic intervention to address malaria awareness.
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Affiliation(s)
- Robertus Dole Guntur
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Department of Mathematics, Faculty of Science and Engineering, Nusa Cendana University, Kupang, NTT, Indonesia
- * E-mail:
| | - Jonathan Kingsley
- Department of Health and Medical Science, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Centre of Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Fakir M. Amirul Islam
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Phiri MD, McCann RS, Kabaghe AN, van den Berg H, Malenga T, Gowelo S, Tizifa T, Takken W, van Vugt M, Phiri KS, Terlouw DJ, Worrall E. Cost of community-led larval source management and house improvement for malaria control: a cost analysis within a cluster-randomized trial in a rural district in Malawi. Malar J 2021; 20:268. [PMID: 34120608 PMCID: PMC8200285 DOI: 10.1186/s12936-021-03800-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/03/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND House improvement (HI) to prevent mosquito house entry, and larval source management (LSM) targeting aquatic mosquito stages to prevent development into adult forms, are promising complementary interventions to current malaria vector control strategies. Lack of evidence on costs and cost-effectiveness of community-led implementation of HI and LSM has hindered wide-scale adoption. This study presents an incremental cost analysis of community-led implementation of HI and LSM, in a cluster-randomized, factorial design trial, in addition to standard national malaria control interventions in a rural area (25,000 people), in southern Malawi. METHODS In the trial, LSM comprised draining, filling, and Bacillus thuringiensis israelensis-based larviciding, while house improvement (henceforth HI) involved closing of eaves and gaps on walls, screening windows/ventilation spaces with wire mesh, and doorway modifications. Communities implemented all interventions. Costs were estimated retrospectively using the 'ingredients approach', combining 'bottom-up' and 'top-down approaches', from the societal perspective. To estimate the cost of independently implementing each intervention arm, resources shared between trial arms (e.g. overheads) were allocated to each consuming arm using proxies developed based on share of resource input quantities consumed. Incremental implementation costs (in 2017 US$) are presented for HI-only, LSM-only and HI + LSM arms. In sensitivity analyses, the effect of varying costs of important inputs on estimated costs was explored. RESULTS The total economic programme costs of community-led HI and LSM implementation was $626,152. Incremental economic implementation costs of HI, LSM and HI + LSM were estimated as $27.04, $25.06 and $33.44, per person per year, respectively. Project staff, transport and labour costs, but not larvicide or screening material, were the major cost drivers across all interventions. Costs were sensitive to changes in staff costs and population covered. CONCLUSIONS In the trial, the incremental economic costs of community-led HI and LSM implementation were high compared to previous house improvement and LSM studies. Several factors, including intervention design, year-round LSM implementation and low human population density could explain the high costs. The factorial trial design necessitated use of proxies to allocate costs shared between trial arms, which limits generalizability where different designs are used. Nevertheless, costs may inform planners of similar intervention packages where cost-effectiveness is known. Trial registration Not applicable. The original trial was registered with The Pan African Clinical Trials Registry on 3 March 2016, trial number PACTR201604001501493.
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Affiliation(s)
- Mphatso Dennis Phiri
- Malaria Epidemiology Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
| | - Robert S McCann
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
| | - Alinune Nathanael Kabaghe
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Henk van den Berg
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Tumaini Malenga
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Steven Gowelo
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tinashe Tizifa
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Willem Takken
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Michèle van Vugt
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam-UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kamija S Phiri
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dianne J Terlouw
- Malaria Epidemiology Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Eve Worrall
- Liverpool School of Tropical Medicine, Liverpool, UK
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Fehr A, Nieto-Sanchez C, Muela J, Jaiteh F, Ceesay O, Maneh E, Baldeh D, Achan J, Dabira E, Conteh B, Bunders-Aelen J, Smekens T, Broekhuizen H, D'Alessandro U, Peeters Grietens K. From informed consent to adherence: factors influencing involvement in mass drug administration with ivermectin for malaria elimination in The Gambia. Malar J 2021; 20:198. [PMID: 33902611 PMCID: PMC8073909 DOI: 10.1186/s12936-021-03732-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background The World Health Organization (WHO) recommends consideration of mass drug administration (MDA) for malaria control in low-endemic settings approaching elimination. However, MDA remains a controversial strategy, as multiple individual, social, and operational factors have shown to affect its acceptability at local levels. This is further complicated by inconsistent definitions of key indicators derived from individual and community involvement—coverage, adherence, and compliance—that cast doubts about the actual and potential epidemiological impact of MDA on disease control and elimination. This study aimed to identify limitations and enabling factors impacting involvement at different stages of a large cluster-randomized trial assessing the effect of combining dihydroartemisinin-piperaquine (DP) and ivermectin (IVM) in malaria transmission in The Gambia. Methods This social science study used a mixed-methods approach. Qualitative data were collected in intervention and control villages through ethnographic methods, including in-depth interviews (IDIs), focus group discussions (FGDs), and participant observation conducted with trial participants and decliners, community leaders, and field staff. A cross-sectional survey was conducted in the intervention villages after the first year of MDA. Both strands of the study explored malaria knowledge and opinions, social dynamics influencing decision-making, as well as perceived risks, burdens, and benefits associated with this MDA. Results 157 IDIs and 11 FGDs were conducted, and 864 respondents were included in the survey. Barriers and enabling factors to involvement were differentially influential at the various stages of the MDA. Issues of social influence, concerns regarding secondary effects of the medication, costs associated with malaria, and acceptability of the implementing organization, among other factors, differently affected the decision-making processes throughout the trial. Rather than a linear trajectory, involvement in this MDA trial was subjected to multiple revaluations from enrolment and consent to medicine intake and adherence to treatment. Conclusions This study went beyond the individual factors often associated with coverage and adherence, and found that nuanced social dynamics greatly influence the decision-making process at all phases of the trial. These issues need to be consider for MDA implementation strategies and inform discussions about more accurate ways of reporting on critical effectiveness indicators. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03732-z.
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Affiliation(s)
- Alexandra Fehr
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Claudia Nieto-Sanchez
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joan Muela
- Medical Anthropology Research Center, Universitat Rovira I Virgill, Tarragona, Spain
| | - Fatou Jaiteh
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Omar Ceesay
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ebrima Maneh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Dullo Baldeh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Jane Achan
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Edgard Dabira
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Bakary Conteh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Tom Smekens
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Umberto D'Alessandro
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Koen Peeters Grietens
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Roberts KW, Smith Gueye C, Baltzell K, Ntuku H, McCreesh P, Maglior A, Whittemore B, Uusiku P, Mumbengegwi D, Kleinschmidt I, Gosling R, Hsiang MS. Community acceptance of reactive focal mass drug administration and reactive focal vector control using indoor residual spraying, a mixed-methods study in Zambezi region, Namibia. Malar J 2021; 20:162. [PMID: 33752673 PMCID: PMC7986500 DOI: 10.1186/s12936-021-03679-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Namibia, as in many malaria elimination settings, reactive case detection (RACD), or malaria testing and treatment around index cases, is a standard intervention. Reactive focal mass drug administration (rfMDA), or treatment without testing, and reactive focal vector control (RAVC) in the form of indoor residual spraying, are alternative or adjunctive interventions, but there are limited data regarding their community acceptability. METHODS A parent trial aimed to compare the effectiveness of rfMDA versus RACD, RAVC versus no RAVC, and rfMDA + RAVC versus RACD only. To assess acceptability of these interventions, a mixed-methods study was conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in three rounds (pre-trial and in years 1 and 2 of the trial), and an endline survey. RESULTS In total, 17 KIIs, 49 FGDs were conducted with 449 people over three annual rounds of qualitative data collection. Pre-trial, community members more accurately predicted the level of community acceptability than key stakeholders. Throughout the trial, key participant motivators included: malaria risk perception, access to free community-based healthcare and IRS, and community education by respectful study teams. RACD or rfMDA were offered to 1372 and 8948 individuals in years 1 and 2, respectively, and refusal rates were low (< 2%). RAVC was offered to few households (n = 72) in year 1. In year 2, RAVC was offered to more households (n = 944) and refusals were < 1%. In the endline survey, 94.3% of 2147 respondents said they would participate in the same intervention again. CONCLUSIONS Communities found both reactive focal interventions and their combination highly acceptable. Engaging communities and centering and incorporating their perspectives and experiences during design, implementation, and evaluation of this community-based intervention was critical for optimizing study engagement.
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Affiliation(s)
- Kathryn W Roberts
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA.
- Global Programs for Research and Training, Malaria Elimination Initiative Namibia, Windhoek, Namibia.
| | - Cara Smith Gueye
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA
- Global Programs for Research and Training, Malaria Elimination Initiative Namibia, Windhoek, Namibia
| | - Kimberly Baltzell
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA
- Department of Family Health Care Nursing, School of Nursing, UCSF, San Francisco, USA
| | - Henry Ntuku
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA
- Global Programs for Research and Training, Malaria Elimination Initiative Namibia, Windhoek, Namibia
| | - Patrick McCreesh
- Department of Pediatrics, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, TX, Dallas, USA
| | - Alysse Maglior
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA
| | - Brooke Whittemore
- Department of Pediatrics, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, TX, Dallas, USA
| | - Petrina Uusiku
- National Vectorborne Diseases Control Programme, Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Davis Mumbengegwi
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Immo Kleinschmidt
- Wits Research Institute for Malaria, Wits/SAMRC Collaborating Centre for Multi-Disciplinary Research on Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Southern Africa Development Community Malaria Elimination Eight Secretariat, Windhoek, Namibia
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA
- Global Programs for Research and Training, Malaria Elimination Initiative Namibia, Windhoek, Namibia
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Michelle S Hsiang
- Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA.
- Department of Pediatrics, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, TX, Dallas, USA.
- Department of Pediatrics, UCSF, San Francisco, USA.
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de Sousa Pinto da Fonseca L, Arroz JAH, do Rosário O Martins M, Hartz Z. Are we interconnected? A qualitative study on the role and perception of different actors on malaria social behaviour change interventions in rural Mozambique. Malar J 2020; 19:420. [PMID: 33228658 PMCID: PMC7685607 DOI: 10.1186/s12936-020-03485-1] [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: 02/03/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interconnecting institutions (health and education sector) and community (through a network of community structures) in social and behaviour change (SBC) activities can add value in an effort for malaria prevention towards a long-term objective of elimination. This approach has been implemented since 2011 in some rural districts of Mozambique. The objective of this study is to describe the perceptions of community and institutional actors on malaria prevention interventions in rural Mozambique. METHODS A descriptive qualitative study with a constructivist research paradigm was conducted in October 2018 in two rural districts of Zambezia Province with high malaria burden in Mozambique. Key-informant sampling was used to select the study participants from different actors and layers: malaria community volunteers, health professionals, non-governmental actors, and education professionals. In-depth interviews (IDIs) and focus group discussions (FGDs) were used to explore the perceptions of these actors. Classic content analysis looking for themes and semantics was used, and saturation guided the sample size recruitment. RESULTS A total of 23 institutional actor IDIs took place, and 8 FGDs were held. Four themes emerged from the content analysis: (1) organizational and functional aspects; (2) knowledge about malaria; (3) perception of institutional actors on SBC and community involvement; and, (4) perception of institutional actors on the coordination and leadership on SBC malaria interventions. Community structures were well organized, linked to the health sector and operational, with good knowledge of malaria prevention. Education sector (school teachers) links with the health sector were in some cases good, and in other cases, non-existent. The importance of SBC interventions for malaria control was recognized by health actors, although the activities are delegated to non-governmental institutions. Domestic budgetary allocation constraints, quality of intervention and lack of SBC standard indicators were also identified by health actors as aspects for improvement. CONCLUSIONS Community structures, volunteers and primary school teachers have good knowledge on malaria prevention and regularly sensitize community members and students. Institutional health actors and partners recognize their role on malaria prevention activities, however, more interconnection is needed at different levels.
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Affiliation(s)
| | | | - Maria do Rosário O Martins
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisbon, Portugal
| | - Zulmira Hartz
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisbon, Portugal
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Matin MA, Sarkar NDP, Phru CS, Ley B, Thriemer K, Price RN, Peeters Grietens K, Ali Khan W, Alam MS, Gryseels C. Precarity at the Margins of Malaria Control in the Chittagong Hill Tracts in Bangladesh: A Mixed-Methods Study. Pathogens 2020; 9:pathogens9100840. [PMID: 33066621 PMCID: PMC7602388 DOI: 10.3390/pathogens9100840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 01/12/2023] Open
Abstract
Bangladesh has achieved significant progress towards malaria elimination, although health service delivery for malaria remains challenging in remote forested areas such as the Chittagong Hill Tracts (CHT). The aim of this study was to investigate perceptions of malaria and its treatment among the local population to inform contextualized strategies for rolling out radical cure for P. vivax in Bangladesh. The study comprised two sequential strands whereby the preliminary results of a qualitative strand informed the development of a structured survey questionnaire used in the quantitative strand. Results show that ethnic minority populations in the CHT live in precarious socio-economic conditions which increase their exposure to infectious diseases, and that febrile patients often self-treat, including home remedies and pharmaceuticals, before attending a healthcare facility. Perceived low quality of care and lack of communication between Bengali health providers and ethnic minority patients also affects access to public healthcare. Malaria is viewed as a condition that affects vulnerable people weakened by agricultural work and taking away blood is perceived to increase such vulnerability. Healthcare providers that initiate and sustain a dialogue about these issues with ethnic minority patients may foster the trust that is needed for local malaria elimination efforts.
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Affiliation(s)
- Mohammad Abdul Matin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka 1212, Bangladesh; (M.A.M.); (C.S.P.); (W.A.K.); (M.S.A.)
| | - Nandini D. P. Sarkar
- Department of Public Health, Institute of Tropical Medicine (ITM), Nationalestraat 155, 2000 Antwerp, Belgium; (N.D.P.S.); (K.P.G.)
| | - Ching Swe Phru
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka 1212, Bangladesh; (M.A.M.); (C.S.P.); (W.A.K.); (M.S.A.)
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Rocklands Drive Casuarina, Darwin Northern Territory 0810, Australia; (B.L.); (K.T.); (R.N.P.)
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Rocklands Drive Casuarina, Darwin Northern Territory 0810, Australia; (B.L.); (K.T.); (R.N.P.)
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Rocklands Drive Casuarina, Darwin Northern Territory 0810, Australia; (B.L.); (K.T.); (R.N.P.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7LG, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvith Road, Tungphyathai, Bangkok 10400, Thailand
| | - Koen Peeters Grietens
- Department of Public Health, Institute of Tropical Medicine (ITM), Nationalestraat 155, 2000 Antwerp, Belgium; (N.D.P.S.); (K.P.G.)
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka 1212, Bangladesh; (M.A.M.); (C.S.P.); (W.A.K.); (M.S.A.)
| | - Mohammad Shafiul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka 1212, Bangladesh; (M.A.M.); (C.S.P.); (W.A.K.); (M.S.A.)
| | - Charlotte Gryseels
- Department of Public Health, Institute of Tropical Medicine (ITM), Nationalestraat 155, 2000 Antwerp, Belgium; (N.D.P.S.); (K.P.G.)
- Correspondence: ; Tel.: +324-8561-8475
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Valdez D, Keys H, Ureña K, Cabral D, Camilo F, Ogando EC, Mercedes L, Noland GS, Blount SB, Lavery JV, Desir L, Puello J. Malaria outbreak response in urban Santo Domingo, Dominican Republic: lessons learned for community engagement. Rev Panam Salud Publica 2020; 44:e92. [PMID: 32774350 PMCID: PMC7406124 DOI: 10.26633/rpsp.2020.92] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/25/2020] [Indexed: 01/27/2023] Open
Abstract
Community engagement is crucial for public health initiatives, yet it remains an under-studied process within national disease elimination programs. This report shares key lessons learned for community engagement practices during a malaria outbreak response in the Los Tres Brazos neighborhood of urban Santo Domingo, Dominican Republic from 2015-2016. In this two-year period, 233 cases of malaria were reported—more than seven times the number of cases (31) reported in the previous two years. The initial outbreak response by the national malaria program emphasized “top-down” interventions such as active surveillance, vector control, and educative talks within the community. Despite a transient reduction in reported cases in mid-2015, transmission resurged at the end of 2015. The program responded by introducing active roles for trained community members that included door-to-door fever screening, testing with rapid diagnostic tests and treatment. Malaria cases declined significantly throughout 2016 and community-based active surveillance infrastructure helped to detect and limit a small episode of transmission in 2017. Results from qualitative research among community members revealed two key factors that facilitated their cooperation with community-based surveillance activities: motivation to help one’s community; and trust among stakeholders (community health workers, their neighbors and other key figures in the community, and malaria program staff and leadership). This experience suggests that community-led interventions and the program’s willingness to learn and adapt under changing circumstances can help control malaria transmission and pave the way for elimination.
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Affiliation(s)
- Dianelba Valdez
- Centro de Prevención y Control de Enfermedades Transmitidas por Vectores y Zoonosis Santo Domingo Dominican Republic Centro de Prevención y Control de Enfermedades Transmitidas por Vectores y Zoonosis, Santo Domingo, Dominican Republic
| | - Hunter Keys
- The Carter Center Atlanta United States of America The Carter Center, Atlanta, United States of America.,Department of Anthropology, University of Amsterdam Amsterdam the Netherlands Department of Anthropology, University of Amsterdam, Amsterdam, the Netherlands
| | - Keyla Ureña
- Centro de Prevención y Control de Enfermedades Transmitidas por Vectores y Zoonosis Santo Domingo Dominican Republic Centro de Prevención y Control de Enfermedades Transmitidas por Vectores y Zoonosis, Santo Domingo, Dominican Republic
| | - Domingo Cabral
- Centro de Prevención y Control de Enfermedades Transmitidas por Vectores y Zoonosis Santo Domingo Dominican Republic Centro de Prevención y Control de Enfermedades Transmitidas por Vectores y Zoonosis, Santo Domingo, Dominican Republic
| | - Francisco Camilo
- Centro de Prevención y Control de Enfermedades Transmitidas por Vectores y Zoonosis Santo Domingo Dominican Republic Centro de Prevención y Control de Enfermedades Transmitidas por Vectores y Zoonosis, Santo Domingo, Dominican Republic
| | - Eulalia C Ogando
- Junta de Vecinos, Los Tres Brazos Santo Domingo Dominican Republic Junta de Vecinos, Los Tres Brazos, Santo Domingo, Dominican Republic
| | - Luz Mercedes
- Centro Nacional para el Control de las Enfermedades Tropicales Santo Domingo Dominican Republic Centro Nacional para el Control de las Enfermedades Tropicales, Santo Domingo, Dominican Republic
| | - Gregory S Noland
- The Carter Center Atlanta United States of America The Carter Center, Atlanta, United States of America
| | - Stephen B Blount
- The Carter Center Atlanta United States of America The Carter Center, Atlanta, United States of America
| | - James V Lavery
- Hubert Department of Global Health, Rollins School of Public Health, and Center for Ethics, Emory University Atlanta United States of America Hubert Department of Global Health, Rollins School of Public Health, and Center for Ethics, Emory University, Atlanta, United States of America
| | - Luccene Desir
- The Carter Center Port-au-Prince Haiti The Carter Center, Port-au-Prince, Haiti
| | - Jose Puello
- Centro de Prevención y Control de Enfermedades Transmitidas por Vectores y Zoonosis Santo Domingo Dominican Republic Centro de Prevención y Control de Enfermedades Transmitidas por Vectores y Zoonosis, Santo Domingo, Dominican Republic
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Smith RA, Kim Y, Matthews SA, Sternberg ED, Doudou DT, Thomas MB. Communal Innovations: Inspiring Neighborhoods of Hope and Advocacy. JOURNAL OF HEALTH COMMUNICATION 2020; 25:444-453. [PMID: 32615884 PMCID: PMC7454529 DOI: 10.1080/10810730.2020.1785059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Innovations promise a better future, which may generate feelings of hope and inspire advocacy. Some innovations are more communal in nature: attempting to address a social problem, through community engagement and wide-spread adoption. For such innovations, the social processes that involve collective aspects of community life may play important roles in fostering hope and interpersonal advocacy. This study uses communication infrastructure theory and discrete emotions theory to investigate hope and advocacy within a field trial for a salient, visible, community-bound innovation to reduce transmission of malaria. Heads of households in one community (N = 119) in West Africa were interviewed. Results showed that innovation hope was predicted by appraisals of innovation attributes. Better appraisals of the innovation's attributes, greater perceived collective efficacy, and recent malaria illness predicted more innovation advocacy. The spatial analysis showed that innovation advocacy was geographically clustered within the community, but hope was not. The implications for theory and practice are discussed.
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Affiliation(s)
- Rachel A. Smith
- Department of Communication Arts and Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Youllee Kim
- Department of Communication Arts and Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Stephen A. Matthews
- Department of Sociology and Criminology and the Department of Anthropology, The Pennsylvania State University, University Park, PA, USA
| | - Eleanore D. Sternberg
- Department of Entomology, The Pennsylvania State University, University Park, PA, USA
| | - Dimi Théodore Doudou
- Centre de recherche pour le Développement (CRD)/Laboratoire de Santé, Nutrition et Hygiène, Université Alassane Ouattara, Bouaké, Côte d’Ivoire
| | - Matthew B. Thomas
- Department of Entomology, The Pennsylvania State University, University Park, PA, USA
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Gordon A, Vander Meulen RJ, Maglior A. The 2019 Isdell:Flowers Cross Border Malaria Initiative Round Table: community engagement in the context of malaria elimination. Malar J 2019; 18:432. [PMID: 31856833 PMCID: PMC6924078 DOI: 10.1186/s12936-019-3054-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/07/2019] [Indexed: 11/10/2022] Open
Abstract
Government officials, representatives from malaria endemic communities, and nonprofit, academic, and private sector partners convened at the 2019 Isdell:Flowers Cross Border Malaria Initiative Round Table in Livingstone, Zambia from February 28-March 1, 2019 to discuss the necessity of community engagement and the involvement of those directly affected by malaria in malaria elimination efforts. Participants shared practical examples and principles of successful community engagement over the course of the Round Table. Three core principles of effective community engagement emerged: (1) there is no "one size fits all" community engagement strategy, (2) community engagement must be a bidirectional activity, and (3) community members must be at the heart of malaria elimination efforts.
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Affiliation(s)
- Alexandra Gordon
- Isdell:Flowers Cross Border Malaria Initiative, J.C. Flowers Foundation, New York, NY, USA.
| | | | - Alysse Maglior
- Isdell:Flowers Cross Border Malaria Initiative, J.C. Flowers Foundation, New York, NY, USA
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Li M, Zhou H, Yan H, Yin J, Feng X, Xia Z, Zhou S. Analysis on external competency assessment for malaria microscopists in China. Malar J 2019; 18:366. [PMID: 31727074 PMCID: PMC6857338 DOI: 10.1186/s12936-019-2996-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/04/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In order to meet the requirement of malaria elimination (ME), three courses of the External Competency Assessment of Malaria Microscopists (ECAMM) were conducted during 2017-2018 in China by facilitators designated by the World Health Organization (WHO-ECAMM). A training course with a model copied from the WHO-ECAMM course was also held a week ahead of ECAMM in March 2018. Thirty-six participants completed these courses and obtained different results. METHODS The slide structures, agendas, score calculations, and the levels of certifications of the four courses strictly adhered to the WHO guidelines. All the data were collected in Excel 2016 and analysed in Graphpad Prism5 or SPSS 23. Significant differences were evaluated in Graphpad Prism5 by two-tailed paired t tests between the pre-assessment and final-assessment for each of the four courses, as well as one-way ANOVAs with Kruskal-Wallis tests and Dunn's post hoc tests among the final assessments of the four courses. Correlations between participants' competency results and their ages, years working on malaria, and numbers of malaria cases reported in their provinces were evaluated by bivariate correlations (two-tailed) and linear regression (excluding cases pairwise) in SPSS 23. The Pearson correlation coefficients (r values), P values (two tailed), adjusted R square (Adjusted R2), standardized coefficients (β) and Sig. P values were recorded. The percentages of participants who gave the right answer to each slide (PPS) in the final assessments of the three WHO-ECAMM courses were calculated. Correlation analysis between PPS and parasitaemia (100-2000 parasites/μL) of Plasmodium falciparum slides used in species identification and parasite counting, were also evaluated via bivariate correlations (two-tailed) tests. RESULTS Among the 36 participants, 16 participants were certificated as Level 1 (two from NRL), 10 were certified as Level 2 (one from NRL). Within the same course, participants had improved their average scores from pre-assessments to final assessments. The numbers of malaria cases reported in participants' provinces were strongly correlated to their species identification (SI) scores; r = 0.45, P = 0.040, n = 21; r = 0.57, P = 0.001, n = 32; r = 0.56, P = 0.007). The parasitaemia of P. falciparum within 100-2000 parasites/μL was correlated significantly (r = 0.44, P = 0.008, n = 36) with the PPS of all counting slides but not with slides for identification (r = - 0.018, P = 0.93, n = 30). CONCLUSIONS The analysis and comparison of participants' competency results not only verified that the model of the WHO-ECAMM course had strong power in improving and assessing microscopists' competencies but also reflected the correlation between decreased numbers of indigenous malaria cases and microscopists' competencies in certain areas in China.
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Affiliation(s)
- Mei Li
- National Institute of Parasitic Diseases, Chinese Center for Diseases Control and Prevention, Shanghai, 200025, China
- Chinese Center for Tropical Diseases Research, Shanghai, 200025, China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025, China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, 200025, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Public Health, Shanghai, 200025, China
| | - Hejun Zhou
- National Institute of Parasitic Diseases, Chinese Center for Diseases Control and Prevention, Shanghai, 200025, China
- Chinese Center for Tropical Diseases Research, Shanghai, 200025, China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025, China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, 200025, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Public Health, Shanghai, 200025, China
| | - He Yan
- National Institute of Parasitic Diseases, Chinese Center for Diseases Control and Prevention, Shanghai, 200025, China
- Chinese Center for Tropical Diseases Research, Shanghai, 200025, China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025, China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, 200025, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Public Health, Shanghai, 200025, China
| | - Jianhai Yin
- National Institute of Parasitic Diseases, Chinese Center for Diseases Control and Prevention, Shanghai, 200025, China
- Chinese Center for Tropical Diseases Research, Shanghai, 200025, China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025, China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, 200025, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Public Health, Shanghai, 200025, China
| | - Xinyu Feng
- National Institute of Parasitic Diseases, Chinese Center for Diseases Control and Prevention, Shanghai, 200025, China
- Chinese Center for Tropical Diseases Research, Shanghai, 200025, China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025, China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, 200025, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Public Health, Shanghai, 200025, China
| | - Zhigui Xia
- National Institute of Parasitic Diseases, Chinese Center for Diseases Control and Prevention, Shanghai, 200025, China
- Chinese Center for Tropical Diseases Research, Shanghai, 200025, China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025, China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, 200025, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Public Health, Shanghai, 200025, China
| | - Shuisen Zhou
- National Institute of Parasitic Diseases, Chinese Center for Diseases Control and Prevention, Shanghai, 200025, China.
- Chinese Center for Tropical Diseases Research, Shanghai, 200025, China.
- WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025, China.
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, 200025, China.
- Key Laboratory of Parasite and Vector Biology, Ministry of Public Health, Shanghai, 200025, China.
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Keys HM, Noland GS, De Rochars MB, Taylor TH, Blount S, Gonzales M. Perceived discrimination in bateyes of the Dominican Republic: results from the Everyday Discrimination Scale and implications for public health programs. BMC Public Health 2019; 19:1513. [PMID: 31718594 PMCID: PMC6852895 DOI: 10.1186/s12889-019-7773-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/11/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Discrimination is a major driver of health disparities among minority groups and can impede the reach of public health programs. In the Dominican Republic, residents of bateyes, or agricultural 'company towns,' often face barriers to health care. This study examined the extent of perceived discrimination among batey populations and places the findings within the context of disease elimination efforts. METHODS In March-April 2016, a stratified, multi-stage cluster survey that included the 9-item Everyday Discrimination Scale (EDS) was conducted among residents (n = 768) of bateyes across the Dominican Republic. Exploratory factor analysis, differential item functioning, and linear and logistic regression were used to assess associations between EDS scores, ethnic group status, reasons for discrimination, and healthcare-seeking behavior. RESULTS Three ethnic groups were identified in the population: Haitian-born persons (42.5%), Dominican-born persons with Haitian descent (25.5%), and Dominican-born persons without Haitian descent (32.0%). Mean EDS scores (range 0-45) were highest among persons born in Haiti (18.2, 95% confidence interval [CI] = 16.4-20.1), followed by persons with Haitian descent (16.5, 95% CI = 14.9-18.0), and those without Haitian descent (13.3, 95% CI = 12.1-14.5). Higher EDS scores were significantly associated with Haitian birth (β = 6.8, 95% CI = 4.2-9.4; p < 0.001) and Haitian descent (β = 6.1, 95% CI = 3.2-9.0; p < 0.001). Most respondents (71.5%) had scores high enough to elicit reasons for their discrimination. Regardless of ethnic group, poverty was a common reason for discrimination, but Haitian-born and Haitian-descended people also attributed discrimination to their origin, documentation status, or skin color. EDS scores were not significantly associated with differences in reported care-seeking for recent fever (β = 1.7, 95% CI = - 1.4-4.9; p = 0.278). CONCLUSION Perceived discrimination is common among batey residents of all backgrounds but highest among Haitian-born people. Discrimination did not appear to be a primary barrier to care-seeking, suggesting other explanations for reduced care-seeking among Haitian populations. Public health community engagement strategies should avoid exacerbating stigma, build active participation in programs, and work towards community ownership of disease control and elimination goals.
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Affiliation(s)
- Hunter M. Keys
- Department of Anthropology, University of Amsterdam, Building B-REC B 8.01, Nieuwe Achtergracht 166, 1018 WV Amsterdam, The Netherlands
| | | | - Madsen Beau De Rochars
- Health Services Research, Management and Policy Department, University of Florida, 1225 Center Drive, HPNP 3101, Gainesville, FL 32611 USA
| | - Thomas H. Taylor
- Division of Laboratory Systems, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333 USA
| | - Stephen Blount
- The Carter Center, 453 Freedom Parkway, Atlanta, GA 30307 USA
| | - Manuel Gonzales
- Centro de Prevención y Control de Enfermedades transmitidas por Vectores y Zoonosis, Av. Juan Pablo Duarte No. 269, 10301 Santo Domingo, Dominican Republic
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Baltzell K, Harvard K, Hanley M, Gosling R, Chen I. What is community engagement and how can it drive malaria elimination? Case studies and stakeholder interviews. Malar J 2019; 18:245. [PMID: 31315631 PMCID: PMC6637529 DOI: 10.1186/s12936-019-2878-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/09/2019] [Indexed: 11/26/2022] Open
Abstract
Background In light of increasing complexity of identifying and treating malaria cases in low transmission settings, operational solutions are needed to increase effective delivery of interventions. Community engagement (CE) is at the forefront of this conversation given the shift toward creating local and site-specific solutions. Malaria programmes often confuse CE with providing information to the community or implementing community-based interventions. This study seeks to expand on CE approaches for malaria by looking to a variety of health and development programmes for lessons that can be applied to malaria elimination. Methods Qualitative data was collected from key informant interviews and community-based focus group discussions. Manual analysis was conducted with a focus on key principles, programme successes and challenges, the operational framework, and any applicable results. Results Ten programmes were included in the analysis: Ebola, HIV/Hepatitis C, Guinea worm, malaria, nutrition, and water, sanitation and hygiene. Seven focus group discussions (FGDs) with 69 participants, 49 key informant (KI) interviews with programme staff, and 7 KI interviews with thought leaders were conducted between October–April 2018. Participants discussed the critical role that village leaders and community health workers play in CE. Many programmes stated understanding community priorities is key for CE and that CE should be proactive and iterative. A major theme was prioritizing bi-directional interpersonal communication led by local community health workers. Programmes reported that measuring CE is difficult, particularly since CE is ongoing and fluid. Conclusions Results overwhelmingly suggest that CE must be an iterative process that relies on early involvement, frequent feedback and active community participation to be successful. Empowering districts and communities in planning and executing community-based interventions is necessary. Communities affected by the disease will ultimately achieve malaria elimination. For this to happen, the community itself must define, believe in, and commit to strategies to interrupt transmission. Electronic supplementary material The online version of this article (10.1186/s12936-019-2878-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kimberly Baltzell
- Department of Family Health Care Nursing, University of California San Francisco School of Nursing, San Francisco, USA. .,Institute for Global Health Sciences, University of California San Francisco, San Francisco, USA.
| | - Kelly Harvard
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, USA
| | - Marguerite Hanley
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, USA
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, USA.,Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Ingrid Chen
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, USA
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Keys HM, Noland GS, De Rochars MB, Blount S, Gonzales M. Prevalence of malaria and lymphatic filariasis in bateyes of the Dominican Republic. Infect Dis Poverty 2019; 8:39. [PMID: 31130142 PMCID: PMC6535845 DOI: 10.1186/s40249-019-0547-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/07/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The island of Hispaniola, shared by Haiti and the Dominican Republic (DR), is the only remaining malaria-endemic island in the Caribbean and accounts for 95% of the lymphatic filariasis (LF) burden in the Americas. Both countries aim to eliminate the diseases by 2020. Migration from Haiti, where both diseases are more prevalent, may promote transmission in the DR. Historically, Haitian migrant labourers live in rural Dominican agricultural 'company towns' called bateyes, many of which received mass drug administration (MDA) for LF elimination. This study sought to determine the prevalence of malaria and LF in bateyes of the DR and to describe related risk factors for disease. METHODS From March to April 2016, a cross-sectional, cluster survey was conducted across Dominican bateyes stratified into three regions: southwest, north and east. A household questionnaire (n = 776), captured demographics, ethnic origin, mobility patterns, malaria intervention coverage, and knowledge, and recent fever and treatment-seeking. Two individuals per household (n = 1418) were tested for malaria parasites by microscopy and rapid diagnostic test (RDT) and LF antigen by filariasis test strip (FTS). Population-level estimates and confidence intervals (CI) were computed adjusting for the survey design. Two-sided t-tests compared differences in knowledge scores. RESULTS No (0%) blood sample was Plasmodium-positive by microscopy or RDT. Six individuals were FTS-positive (0.5%; 95% CI: 0.2-1.5), but none (0%) of these were microfilariae-positive. Most batey residents were born in the DR (57.8%), documented (85.0%), and permanent residents (85.1%). Very few respondents (9.4%) reported travel to Haiti in the past year. Overall, half (53.8%) of respondents owned a bed net, and 82.3% of net owners reported using it the previous night. Indoor residual spraying (IRS) differed by region (range: 4.7%-61.2%). Most of those with recent fever sought care (56.0%), yet only 30.5% of those seeking care were tested for malaria. Compared to Dominican-born populations, Haitian-born respondents more frequently reported recent fever, did not seek care for the fever, had not heard of malaria, and could not name symptoms or prevention methods. CONCLUSIONS Malaria and LF transmission appear absent or extremely low in Dominican bateyes, which are a mixture of Haitian and Dominican residents. Travel to Haiti is rare, meaning risk of malaria and LF importation is low. Addressing identified gaps in intervention coverage, malaria knowledge, treatment seeking and service delivery will improve the quality of surveillance for these diseases, particularly among marginalized populations and promote island-wide elimination.
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Affiliation(s)
- Hunter M. Keys
- Department of Anthropology, University of Amsterdam, Building B-REC B 8.01, Nieuwe Achtergracht 166, 1018 WV Amsterdam, The Netherlands
| | | | - Madsen Beau De Rochars
- Health Services Research, Management and Policy Department, University of Florida, 1225 Center Drive, HPNP 3101, Gainesville, FL 32611 USA
| | - Stephen Blount
- The Carter Center, 453 Freedom Parkway, Atlanta, GA 30307 USA
| | - Manuel Gonzales
- Center for Prevention and Control of Vector-borne and Zoonotic Diseases, Av. Juan Pablo Duarte No. 269, 10301 Santo Domingo, Dominican Republic
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Jaiteh F, Masunaga Y, Okebe J, D'Alessandro U, Balen J, Bradley J, Gryseels C, Ribera JM, Grietens KP. Community perspectives on treating asymptomatic infections for malaria elimination in The Gambia. Malar J 2019; 18:39. [PMID: 30777112 PMCID: PMC6378745 DOI: 10.1186/s12936-019-2672-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Innovative and cost-effective strategies that clear asymptomatic malaria infections are required to reach malaria elimination goals, but remain a challenge. This mixed methods study explored people's attitudes towards the reactive treatment of compound contacts of malaria cases with a 3-day course of dihydroartemisinin-piperaquine (DHAP), the socio-cultural representations of asymptomatic infections, and more specifically their treatment. METHODS Prior to the start of the intervention, a sequential mixed method study was carried out. Qualitative data collection involved in-depth interviews and participant observations (including informal conversations) with key informants from the trial communities and the trial staff. Quantitative data were derived from a pre-trial cross-sectional survey on health literacy and health-seeking behaviour among randomly selected members of the study communities. RESULTS In the pre-trial cross-sectional survey, 73% of respondents reported that malaria could be hidden in the body without symptoms. Whilst this may be interpreted as people's comprehension of asymptomatic malaria, qualitative data indicated that informants had different interpretations of asymptomatic disease than the biomedical model. It was described as: (i) a minor illness that does not prevent people carrying out daily activities; (ii) an illness that oscillates between symptomatic and asymptomatic phases; and, (iii) a condition where disease agents are present in the body but remain hidden, without signs and symptoms, until something triggers their manifestation. Furthermore, this form of hidden malaria was reported to be most present in those living in the same compound with a malaria case (71%). CONCLUSION Treating asymptomatic malaria with pharmaceuticals was considered acceptable. However, people felt uncertain to take treatment without screening for malaria first, largely due to the lack of symptoms. Knowledge of asymptomatic malaria was not a strong re-inforcement for treatment adherence. In this study, the pre-intervention active engagement of communities existed of having people co-design accurate information messages about their personal risk of malaria, which increased their trust in expert knowledge and thus proved essential for the successful implementation of the community-based intervention.
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Affiliation(s)
- Fatou Jaiteh
- Medical Anthropology Unit, Institute of Tropical Medicine, Antwerp, Belgium.
- Medical Research Council Unit the Gambia at the London, School of Hygiene and Tropical Medicine, Fajara, The Gambia.
- Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Yoriko Masunaga
- Medical Anthropology Unit, Institute of Tropical Medicine, Antwerp, Belgium
- Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Joseph Okebe
- Medical Research Council Unit the Gambia at the London, School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit the Gambia at the London, School of Hygiene and Tropical Medicine, Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Julie Balen
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - John Bradley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Gryseels
- Medical Anthropology Unit, Institute of Tropical Medicine, Antwerp, Belgium
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"Wherever doctors cannot reach, the sunshine can": overcoming potential barriers to malaria elimination interventions in Haiti. Malar J 2018; 17:393. [PMID: 30373575 PMCID: PMC6206681 DOI: 10.1186/s12936-018-2553-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Haiti and the Dominican Republic, the only two Caribbean countries with endemic malaria transmission, are committed to eliminating malaria. With a Plasmodium falciparum prevalence under 1% and a highly focal transmission, the efforts towards elimination in Haiti will include several community-based interventions that must be tailored to the local sociocultural context to increase their uptake. However, little is known about local community perceptions regarding malaria and the planned elimination interventions. The aim of this study is to develop a robust understanding of how to tailor, implement and promote malaria elimination strategies in Haiti. METHODS A cross-sectional qualitative study was conducted December 2015-August 2016 in Grande-Anse and the North Department in Haiti. Data collection included key informant interviews (n = 51), in-depth interviews (n = 15) and focus group discussions (n = 14) with health workers, traditional healers, teachers, priests or pastors, informal community leaders, public officials, and community members. Following a grounded theory approach, transcripts were coded and analysed using content analysis. Coded text was sorted by the types of interventions under consideration by the malaria elimination programme. RESULTS The level of knowledge about malaria was low. Many participants noted community beliefs about malaria being caused by magical phenomena in addition to vector-borne transmission. Participants described malaria as a problem rooted in the environment, with vector control the most noted method of prevention. Though participants noted malaria a severe disease, it ranked lower than other health problems perceived as more acute. Access barriers to healthcare were described including a lack of bed nets. Some distrust about pills, tests, and foreigners in general was expressed, and in few cases linked to previous experience with malaria campaigns under dictatorial regimes. CONCLUSIONS There are several potential barriers and opportunities to implement community-based malaria elimination interventions in rural Haiti. Elimination efforts should include the collaboration of voodoo priests and other traditional healers, be coupled with solutions to wider community concerns or other health interventions, and learn from previous or similar programmes, such as the campaign to eliminate lymphatic filariasis. It is essential to engage with communities and gain their trust to successfully implement targeted aggressive elimination activities.
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Yasuoka J, Kikuchi K, Nanishi K, Ly P, Thavrin B, Omatsu T, Mizutani T. Malaria knowledge, preventive actions, and treatment-seeking behavior among ethnic minorities in Ratanakiri Province, Cambodia: a community-based cross-sectional survey. BMC Public Health 2018; 18:1206. [PMID: 30367615 PMCID: PMC6203989 DOI: 10.1186/s12889-018-6123-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022] Open
Abstract
Background Malaria incidence has been steadily declining in Cambodia, where the government is aiming to eliminate malaria by 2025. Successful malaria elimination requires active engagement and participation of communities to recognize malaria symptoms and the development of prompt treatment-seeking behavior for early diagnosis and appropriate treatment. This study examined malaria knowledge, preventive actions, and treatment-seeking behavior among different groups of ethnic minorities and Khmer in Ratanakiri Province, Cambodia. Methods Face-to-face interviews were conducted in December 2015, targeting 388 mothers with children under 2 years old, who belonged to ten ethnic minority groups or the Khmer group living in 62 rural villages in Ratanakiri. In addition to describing mothers’ knowledge and actions for malaria prevention, logistic regression analysis was performed to identify determinants of fever during the most recent pregnancy and among children under two. Results Overall 388 mothers were identified for enrollment into the study of which 377 (97.2%) were included in analyses. The majority of mothers slept under bed nets at home (95.8%) and wore long-sleeved clothes (83.8%) for malaria prevention. However, knowledge of malaria was limited: 44.6% were aware of malaria symptoms, 40.6% knew the malaria transmission route precisely, and 29.2% knew of mosquito breeding places. Staying overnight at a farm hut was significantly associated with having fever during the most recent pregnancy (adjusted odds ratio [AOR] 2.008, 95% confidence interval [CI]: 1.215–3.321) and a child having fever (AOR 3.681, 95% CI 1.943–6.972). Mothers’ partaking in a variety of malaria preventive actions was protective against fever in children (AOR 0.292, 95% CI: 0.136–0.650). Among those who had fever during pregnancy, 39.4% did not seek treatment. Conclusion Although the majority of mothers took malaria preventive actions, knowledge of malaria epidemiology and vector ecology and treatment-seeking behavior for fever were limited. Staying overnight at farm huts, regardless of the differences in socio-demographic and socio-cultural characteristics, was strongly associated with fever episodes during pregnancy and childhood. This study indicates the necessity of spreading accurate malaria knowledge, raising awareness of health risks related to agricultural practices, and promoting treatment-seeking behavior among ethnic minorities to strengthen their engagement in malaria elimination.
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Affiliation(s)
- Junko Yasuoka
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo, 183-8508, Japan.
| | - Kimiyo Kikuchi
- Graduate Education and Research Training Program in Decision Science for Sustainable Society, Kyushu University, Motooka 744, Nishi-ku, Fukuoka-shi, Fukuoka, 819-0395, Japan
| | - Keiko Nanishi
- Office of International Academic Affairs, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Po Ly
- National center for Parasitology, Entomology & Malaria Control (CNM), Ministry of Health, #477 Betong Street (Corner St.92), Village Trapangsvay, Sanakat Phnom Penh Thmey, Khan Sen Sok, Phnom Penh, Cambodia
| | - Boukheng Thavrin
- National center for Parasitology, Entomology & Malaria Control (CNM), Ministry of Health, #477 Betong Street (Corner St.92), Village Trapangsvay, Sanakat Phnom Penh Thmey, Khan Sen Sok, Phnom Penh, Cambodia
| | - Tsutomu Omatsu
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo, 183-8508, Japan
| | - Tetsuya Mizutani
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo, 183-8508, Japan
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Armstrong-Mensah EA, Ndiaye SM. Global Health Security Agenda Implementation: A Case for Community Engagement. Health Secur 2018; 16:217-223. [PMID: 30096251 DOI: 10.1089/hs.2017.0097] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In today's interconnected world, infectious diseases can spread rapidly within and between countries. The 2014-2016 Ebola epidemic in Guinea, Liberia, and Sierra Leone underscored the inability of countries with limited capacities and weak public health systems to respond effectively to outbreaks. To mitigate future health threats, nations and international organizations launched the Global Health Security Agenda (GHSA) to accelerate compliance with the WHO's International Health Regulations, so as to enhance global protection from infectious disease threats. To advance GHSA's mandate to build capacity to prevent, detect, and respond to infectious diseases, and thereby contain threats at their source, community engagement is needed. This article advocates for community engagement in GHSA implementation, using examples from 3 GHSA action packages. A country's ability to prevent a local disease outbreak from becoming an epidemic often rests with the level of knowledge about the situation and the actions taken at the community level.
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van den Berg H, van Vugt M, Kabaghe AN, Nkalapa M, Kaotcha R, Truwah Z, Malenga T, Kadama A, Banda S, Tizifa T, Gowelo S, Mburu MM, Phiri KS, Takken W, McCann RS. Community-based malaria control in southern Malawi: a description of experimental interventions of community workshops, house improvement and larval source management. Malar J 2018; 17:266. [PMID: 30012147 PMCID: PMC6048888 DOI: 10.1186/s12936-018-2415-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/10/2018] [Indexed: 12/22/2022] Open
Abstract
Background Increased engagement of communities has been emphasized in global plans for malaria control and elimination. Three interventions to reinforce and complement national malaria control recommendations were developed and applied within the context of a broad-based development initiative, targeting a rural population surrounding a wildlife reserve. The interventions, which were part of a 2-year research trial, and assigned to the village level, were implemented through trained local volunteers, or ‘health animators’, who educated the community and facilitated collective action. Results Community workshops on malaria were designed to increase uptake of national recommendations; a manual was developed, and training of health animators conducted, with educational content and analytical tools for a series of fortnightly community workshops in annual cycles at village level. The roll-back malaria principle of diagnosis, treatment and use of long-lasting insecticidal nets was a central component of the workshops. Structural house improvement to reduce entry of malaria vectors consisted of targeted activities in selected villages to mobilize the community into voluntarily closing the eaves and screening the windows of their houses; the project provided wire mesh for screening. Corrective measures were introduced to respond to field challenges. Committees were established at village level to coordinate the house improvement activities. Larval source management (LSM) in selected villages consisted of two parts: one on removal of standing water bodies by the community at large; and one on larviciding with bacterial insecticide Bacillus thuringiensis israelensis by trained village committees. Community workshops on malaria were implemented as ‘core intervention’ in all villages. House improvement and LSM were implemented in addition to community workshops on malaria in selected villages. Conclusions Three novel interventions for community mobilization on malaria prevention and control were described. The interventions comprised local organizational structure, education and collective action, and incorporated elements of problem identification, planning and evaluation. These methods could be applicable to other countries and settings. Electronic supplementary material The online version of this article (10.1186/s12936-018-2415-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Henk van den Berg
- Laboratory of Entomology, Wageningen University, PO Box 16, 6700AA, Wageningen, The Netherlands.
| | - Michèle van Vugt
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Alinune N Kabaghe
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | | | | | - Asante Kadama
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Saidon Banda
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tinashe Tizifa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Steven Gowelo
- Laboratory of Entomology, Wageningen University, PO Box 16, 6700AA, Wageningen, The Netherlands.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Monicah M Mburu
- Laboratory of Entomology, Wageningen University, PO Box 16, 6700AA, Wageningen, The Netherlands.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kamija S Phiri
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Willem Takken
- Laboratory of Entomology, Wageningen University, PO Box 16, 6700AA, Wageningen, The Netherlands
| | - Robert S McCann
- Laboratory of Entomology, Wageningen University, PO Box 16, 6700AA, Wageningen, The Netherlands.,College of Medicine, University of Malawi, Blantyre, Malawi
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Taffon P, Rossi G, Kindermans JM, Van den Bergh R, Nguon C, Debackere M, Vernaeve L, De Smet M, Venables E. 'I could not join because I had to work for pay.': A qualitative evaluation of falciparum malaria pro-active case detection in three rural Cambodian villages. PLoS One 2018; 13:e0195809. [PMID: 29649317 PMCID: PMC5897025 DOI: 10.1371/journal.pone.0195809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/29/2018] [Indexed: 11/19/2022] Open
Abstract
Background Pro-active case detection (Pro-ACD), in the form of voluntary screening and treatment (VSAT) following community mobilisation about ‘asymptomatic malaria’, is currently being evaluated as a tool for Plasmodium falciparum elimination in Preah Vihear Province, Cambodia. Methods A qualitative study was conducted to explore community understanding, perceptions, expectations and acceptability of the Pro-ACD intervention in order to identify aspects that could be improved in future Pro-ACD activities. This was ancillary to a three-round VSAT campaign, carried out in three villages between December 2015 and March 2016. Qualitative data collection began shortly after the end of the three rounds of screening. Purposive sampling was used to select participants. Nine focus group discussions with participants (n = 46) and non-participants (n = 40) in the Pro-ACD screening were conducted, in addition to in-depth interviews with key village figures (n = 9). Results Health promotion messages were well delivered and received, but it was difficult for many villagers to understand the messages around ‘asymptomatic malaria’. Overall, villagers and village leaders had a positive opinion about the VSAT intervention. Acceptability was high, as a direct consequence of favourable perceptions towards the screening activity: the Pro-ACD intervention was seen by the local population as an effective, inexpensive, reliable and readily available tool to protect individuals and the community from the insurgence of malaria. Physical absence and lack of time (both linked to work-related activities) were the main reasons for non-participation. Conclusions Although VSAT was generally well perceived and accepted, the ‘time factor’ related to the need to satisfy essential daily subsistence requirements played a significant role in determining participation in the screening. More well-adapted and meaningful Pro-ACD approaches could be implemented by improving the timing of the testing activites, and strengthening community participation and engagement to increase acceptability.
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Affiliation(s)
| | | | | | | | - Chea Nguon
- Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | | | - Martin De Smet
- Médecins Sans Frontières, Operational Centre Belgium, Brussels, Belgium
| | - Emilie Venables
- Médecins Sans Frontières, Operational Centre Belgium, Brussels, Belgium
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Birhanu Z, Yihdego YYE, Yewhalaw D. Quantifying malaria endemicity in Ethiopia through combined application of classical methods and enzyme-linked immunosorbent assay: an initial step for countries with low transmission initiating elimination programme. Malar J 2018; 17:152. [PMID: 29618357 PMCID: PMC5885372 DOI: 10.1186/s12936-018-2282-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/21/2018] [Indexed: 01/09/2023] Open
Abstract
Background In the context of reduced transmission of malaria, it is essential to re-evaluate and determine the level of transmission as it guides re-orientation of control measures which is appropriate to local disease epidemiology. However, little is known about level of malaria transmission in Ethiopia. The present study aimed to investigate the level of malaria transmission through combined application of classical methods and enzyme-linked immunosorbent assay (EIA) in low transmission settings of Ethiopia. Methods This study was conducted in June 2016 on 763 apparently healthy children 2–9 years of age. Children were recruited from ten sites representing different malaria transmission settings in Ethiopia. Splenomegaly rate, infection rate and EIA antibody test were used to determine endemicity. The data were analysed using SPSS 21.0 and Stata 12.0. Results The overall prevalence of malaria parasitaemia was 2.49% (95% CI 1.38–3.59) and 2.36% (95% CI 1.28–3.44) as detected using rapid diagnostic test and microscopy, respectively. Plasmodium falciparum accounted for 62.63% of the infections. The prevalence of parasitaemia significantly varied by altitude and localities; the highest (5.8%) in areas below 1500 m above sea level. Overall, splenomegaly rate was 1.70% (95% CI 0.78–0.2.66%), making the overall malaria transmission hypoendemic. Infection rate was higher among males (2.7%), but rate of splenomegaly was higher in females. Incongruent with spleen rate and parasitaemia, EIA showed a higher level of cumulative exposure to malaria with spatially localized and highly heterogeneous transmission. Overall, 126 (18.75%, 95% CI 15.79–21.71) of the children were positive for total malaria antibodies with significant variations with altitude, age and sex; the higher in areas of < 1500 m asl (25.8%), children ≥ 5 years (22.1%) and among males (20.9%). Conclusions Splenomegaly and parasitaemia are not good measures to show variations in the levels of malaria transmission in reduced and/or low endemic settings. The malaria antibody (i.e. serological) test seems to be a good measure of malaria endemicity showing greater degree of heterogeneity and localized risk of transmission. Thus, malaria elimination efforts need to be supported with serological indicators to identify patterns of foci of transmission to set priorities for interventions.
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Affiliation(s)
- Zewdie Birhanu
- Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia.
| | | | - Delenasaw Yewhalaw
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.,Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia
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Abstract
Global health security is increasingly reliant on vigilance to provide early warning of transnational health threats. In theory, this approach requires that sentinels, based in communities most affected by new or reemerging infectious diseases, deliver timely alerts of incipient risk. Medicalizing global safety also implies there are particular forms of insecurity that must be remedied to preempt disease spread. I examine vigilance in the context of spreading drug-resistant malaria in Southeast Asian border zones and argue that to act as sentinels, marginal groups vulnerable to infection must be able to articulate what social and behavioral factors prompt proliferating disease risks.
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Affiliation(s)
- Chris Lyttleton
- a Department of Anthropology , Macquarie University , Sydney , NSW , Australia
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Hlongwana KW, Sartorius B, Tsoka-Gwegweni J. Malaria programme personnel's experiences, perceived barriers and facilitators to implementing malaria elimination strategy in South Africa. Malar J 2018; 17:21. [PMID: 29316916 PMCID: PMC5761101 DOI: 10.1186/s12936-017-2154-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Africa has set an ambitious goal targeting to eliminate malaria by 2018, which is consistent with the United Nations Sustainable Development Goals' call to end the epidemic of malaria by 2030 across the globe. There are conflicting views regarding the feasibility of malaria elimination, and furthermore studies investigating malaria programme personnel's perspectives on strategy implementation are lacking. METHODS The study was a cross-sectional survey conducted in 2014 through a face-to-face investigator-administered semi-structured questionnaire to all eligible and consenting malaria programme personnel (team leader to senior manager levels) in three malaria endemic provinces (KwaZulu-Natal, Mpumalanga, and Limpopo) of South Africa. RESULTS The overall response rate was 88.6% (148/167) among all eligible malaria personnel. The mean age of participants was 47 years (SD 9.7, range 27-70), and the mean work experience of 19.4 years (SD 11.1, range 0-42). The majority were male (78.4%), and 66.9% had secondary level education. Awareness of the malaria elimination policy was high (99.3%), but 89% contended that they were never consulted when the policy was formulated and few had either seen (29.9%) or read (23%) the policy, either in full or in part. Having read the policy was positively associated with professional job designations (managers, EHPs and entomologists) (p = 0.010) and tertiary level education (p = 0.042). There was a sentiment that the policy was neither sufficiently disseminated to all key healthcare workers (76.4%) nor properly adapted (68.9%) for the local operational context in the elimination strategy. Most (89.1%) participants were not optimistic about eliminating malaria by 2018, as they viewed the elimination strategy in South Africa as too theoretical with unrealistic targets. Other identified barriers included inadequate resources (53.5%) and high cross-border movements (19.8%). CONCLUSIONS Most participants were not positive that South Africa could achieve the malaria elimination goal by 2018, citing the high cross-border movements and lack of resources as key barriers. The National and relevant Provincial Departments of Health should consider investing more time and resources in further stakeholder engagement for more effective implementation of malaria elimination strategy in South Africa.
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Affiliation(s)
- Khumbulani Welcome Hlongwana
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, King George Avenue, Durban, South Africa.
| | - Benn Sartorius
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, King George Avenue, Durban, South Africa
| | - Joyce Tsoka-Gwegweni
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, King George Avenue, Durban, South Africa
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McCann RS, van den Berg H, Diggle PJ, van Vugt M, Terlouw DJ, Phiri KS, Di Pasquale A, Maire N, Gowelo S, Mburu MM, Kabaghe AN, Mzilahowa T, Chipeta MG, Takken W. Assessment of the effect of larval source management and house improvement on malaria transmission when added to standard malaria control strategies in southern Malawi: study protocol for a cluster-randomised controlled trial. BMC Infect Dis 2017; 17:639. [PMID: 28938876 PMCID: PMC5610449 DOI: 10.1186/s12879-017-2749-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 09/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to outdoor and residual transmission and insecticide resistance, long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) will be insufficient as stand-alone malaria vector control interventions in many settings as programmes shift toward malaria elimination. Combining additional vector control interventions as part of an integrated strategy would potentially overcome these challenges. Larval source management (LSM) and structural house improvements (HI) are appealing as additional components of an integrated vector management plan because of their long histories of use, evidence on effectiveness in appropriate settings, and unique modes of action compared to LLINs and IRS. Implementation of LSM and HI through a community-based approach could provide a path for rolling-out these interventions sustainably and on a large scale. METHODS/DESIGN We will implement community-based LSM and HI, as additional interventions to the current national malaria control strategies, using a randomised block, 2 × 2 factorial, cluster-randomised design in rural, southern Malawi. These interventions will be continued for two years. The trial catchment area covers about 25,000 people living in 65 villages. Community participation is encouraged by training community volunteers as health animators, and supporting the organisation of village-level committees in collaboration with The Hunger Project, a non-governmental organisation. Household-level cross-sectional surveys, including parasitological and entomological sampling, will be conducted on a rolling, 2-monthly schedule to measure outcomes over two years (2016 to 2018). Coverage of LSM and HI will also be assessed throughout the trial area. DISCUSSION Combining LSM and/or HI together with the interventions currently implemented by the Malawi National Malaria Control Programme is anticipated to reduce malaria transmission below the level reached by current interventions alone. Implementation of LSM and HI through a community-based approach provides an opportunity for optimum adaptation to the local ecological and social setting, and enhances the potential for sustainability. TRIAL REGISTRATION Registered with The Pan African Clinical Trials Registry on 3 March 2016, trial number PACTR201604001501493.
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Affiliation(s)
- Robert S McCann
- Wageningen University and Research, Wageningen, The Netherlands. .,College of Medicine, University of Malawi, Blantyre, Malawi. .,Laboratory of Entomology, Wageningen University and Research, PO Box 16, 6700, AA, Wageningen, The Netherlands.
| | | | | | - Michèle van Vugt
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Dianne J Terlouw
- Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi-Liverpool Wellcome Trust, Blantyre, Malawi
| | - Kamija S Phiri
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Aurelio Di Pasquale
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Nicolas Maire
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Steven Gowelo
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Monicah M Mburu
- Wageningen University and Research, Wageningen, The Netherlands.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Alinune N Kabaghe
- College of Medicine, University of Malawi, Blantyre, Malawi.,Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Michael G Chipeta
- College of Medicine, University of Malawi, Blantyre, Malawi.,Lancaster University, Lancaster, UK.,Malawi-Liverpool Wellcome Trust, Blantyre, Malawi
| | - Willem Takken
- Wageningen University and Research, Wageningen, The Netherlands
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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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Polisye Kont Moustik: A Culturally Competent Approach to Larval Source Reduction in the Context of Lymphatic Filariasis and Malaria Elimination in Haiti. Trop Med Infect Dis 2017; 2:tropicalmed2030039. [PMID: 30270896 PMCID: PMC6082096 DOI: 10.3390/tropicalmed2030039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/12/2017] [Accepted: 08/13/2017] [Indexed: 11/17/2022] Open
Abstract
Community engagement has become an increasingly important focus of global health programs. Arbovirus emergence in the Americas (Zika and chikungunya virues), and global goals for malaria and lymphatic filariasis elimination, mean that community-based mosquito control has taken on a new salience. But how should mosquito control initiatives be designed and implemented in ways that best engage local people? What are the challenges and trade-offs of different strategies, not only for effectiveness but also for scale-up? In this paper, we describe the social and political dynamics of a pilot study in a small town in northern Haiti. With the aim of developing a culturally-competent approach to larval source management (LSM), our pilot project combined larval surveillance with environmental management, social engagement, community education, and larvicide application. Orientated around a network of 'Mosquito Police' (Polisye Kont Moustik, in Haitian Creole), our approach integrated elements of formative research, social learning, and community participation. Here, we reflect on the challenges we encountered in the field, from larval mapping, staff management, education and behavior change, engagement with formal and informal leaders, and community-based environmental cleanup. We discuss how these programmatic efforts were influenced and shaped by a complex range of social, cultural, political, and economic realities, and conclude by discussing the implications of our community-based approach for the elimination of lymphatic filariasis and malaria, and other vector-borne diseases, in Haiti.
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Yanow SK, Gavina K, Gnidehou S, Maestre A. Impact of Malaria in Pregnancy as Latin America Approaches Elimination. Trends Parasitol 2016; 32:416-427. [PMID: 26875608 DOI: 10.1016/j.pt.2016.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/14/2016] [Accepted: 01/19/2016] [Indexed: 11/29/2022]
Abstract
In Latin America, four million pregnancies are at risk of malaria annually, but malaria in pregnancy is largely overlooked. As countries progress toward malaria elimination, targeting reservoirs of transmission is a priority. Pregnant women are an important risk group because they harbor asymptomatic infections and dormant liver stages of Plasmodium vivax that cause relapses. Of significant concern is the discovery that most infections in pregnant women fail to be detected by routine diagnostics. We review here recent findings on malaria in pregnancy within Latin America. We focus on the Amazon basin and Northwest Colombia, areas that harbor the greatest burden of malaria, and propose that more sensitive diagnostics and active surveillance at antenatal clinics will be necessary to eliminate malaria from these final frontiers.
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Affiliation(s)
- Stephanie K Yanow
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada.
| | - Kenneth Gavina
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Sedami Gnidehou
- Department of Biology, Campus Saint-Jean, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda Maestre
- Grupo Salud y Comunidad, Universidad de Antioquia, Medellín, Colombia
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