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Ladu HI, Shuaibu U, Pulford J. Reasons for mosquito net non-use in malaria-endemic countries: A review of qualitative research published between 2011 and 2021. Trop Med Int Health 2024. [PMID: 38796689 DOI: 10.1111/tmi.14006] [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: 05/28/2024]
Abstract
Mosquito nets, particularly insecticide-treated nets, are the most recommended method of malaria control in endemic countries. However, individuals do not always have access to insecticide-treated nets or use them as recommended. The current paper expands on a previous review published in 2011 which highlighted a need for more qualitative research on the reasons for mosquito net non-use. We present a systematic review of qualitative research published in the past decade to assess the growth and quality of qualitative papers about net non-use and examine and update the current understanding. A comprehensive literature search was carried out in MEDLINE, CINAHL, and Global Health, in addition to a citation search of the initial review. Relevant papers were screened and discussed. The critical appraisal assessment tool was used to ensure quality. Thematic synthesis was used to extract, synthesise, and analyse study findings. Compared with the initial review, the results showed a 10-fold increase in qualitative research on the reasons for mosquito net non-use between 2011 and 2021. In addition, the quality of the research has improved, with more than 90% of the papers receiving high scores, using the critical appraisal assessment tool. The reported reasons for non-use were categorised into four themes: human factors, net factors, housing structure, and net access. More than two thirds of the studies (25/39) were led by authors affiliated with institutions in malaria-endemic countries. Despite the distribution of free mosquito nets in malaria-endemic countries, earlier reported challenges remain pertinent. The most common reasons for net non-use across all regions of Malaria endemic countries pertained to human- and net-related factors. The research focus should shift towards intervention studies to address these issues.
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Affiliation(s)
- Hadiza Isa Ladu
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | | | - Justin Pulford
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Glozah FN, Tabong PTN, Bazant E, Asampong E, Hornuvo R, Nwameme A, Peprah NY, Chandi GM, Adongo PB, Dako-Gyeke P. Implementation and effectiveness outcomes of Community Health Advocacy Teams to improve long-lasting insecticide net distribution and use in six districts in Ghana: A one-group pre-post-test study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002123. [PMID: 38557578 PMCID: PMC10984411 DOI: 10.1371/journal.pgph.0002123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
Malaria remains a leading cause of illness and death especially among children and pregnant women in Ghana. Despite the efforts made by the National Malaria Elimination Programme (NMEP), including distribution of Long-Lasting Insecticide Nets (LLINs) to households through periodic Point Mass Distribution (PMD) campaigns and continuous channels (antenatal, schools and postnatal), there is a gap between access and use of LLINs in Ghana. An effective and functional community-based group that would seek to improve the effectiveness of LLIN distribution before, during, after PMD Campaigns and continuous distribution at the community level could help address this gap. This paper assesses the implementation outcomes and short-term effectiveness of the pilot implementation of co-created community health advocacy teams (CHAT) intervention in Ghanaian communities to plan and implement campaigns to increase LLIN use. The study employed a one-group pre-post study design and measured implementation outcomes (acceptability, appropriateness, and feasibility) and effectiveness outcomes (LLIN awareness, LLIN access, willingness to purchase LLIN, and LLIN use) among 800 community households. The CHAT intervention was implemented for four months across six districts in the Eastern and Volta regions of Ghana. The data were downloaded directly from REDCap and analyzed statistically (descriptive and McNemar test of association) using SPSS 22 software. After the implementation period, the majority of respondents in all six districts indicated that the CHAT intervention was acceptable (89.8%), appropriate (89.5%), and feasible (90%). Also, there was a significant association between baseline and end-line assessment on all four effectiveness outcome measures. Household members' awareness of, access to, willingness to purchase, and use of LLINs increased significantly over the four-month period that the CHAT intervention was implemented. The study concludes that CHAT is an acceptable, appropriate, and feasible intervention for supporting the National Malaria Programme in LLIN PMD and for engaging in Social and Behaviour Change Communication activities through the continuous channels of distribution. Additionally, the CHAT demonstrates short-term effectiveness outcomes in terms of creating LLIN awareness, providing access to LLIN, and encouraging Ghanaian community members to be willing to purchase and use LLINs. Although the activities of CHAT members were largely voluntary, integration into the existing primary health care system will make it sustainable.
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Affiliation(s)
- Franklin N. Glozah
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Philip Teg-Nefaah Tabong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Eva Bazant
- Health Campaign Effectiveness Coalition, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Emmanuel Asampong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Ruby Hornuvo
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Adanna Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Gloria M. Chandi
- Ghana Health Service, Ga North Municipal Health Directorate, Greater Accra, Ghana
| | - Philip Baba Adongo
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Phyllis Dako-Gyeke
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
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Carrasco-Tenezaca M, Jawara M, Lee DSH, Holmes MS, Ceesay S, McCall P, Pinder M, D'Alessandro U, Knudsen JB, Lindsay SW, Wilson AL. Effect of passive and active ventilation on malaria mosquito house entry and human comfort: an experimental study in rural Gambia. J R Soc Interface 2023; 20:20220794. [PMID: 37015266 PMCID: PMC10072938 DOI: 10.1098/rsif.2022.0794] [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: 04/06/2023] Open
Abstract
Rural houses in sub-Saharan Africa are typically hot and allow malaria mosquitoes inside. We assessed whether passive or active ventilation can reduce house entry of malaria mosquitoes and cool a bedroom at night in rural Gambia. Two identical experimental houses were used: one ventilated and one unventilated (control). We evaluated the impact of (i) passive ventilation (solar chimney) and (ii) active ventilation (ceiling fan) on the number of mosquitoes collected indoors and environmental parameters (temperature, humidity, CO2, evaporation). Although the solar chimney did not reduce entry of Anopheles gambiae sensu lato, the ceiling fan reduced house entry by 91% compared with the control house. There were no differences in indoor nightly temperature, humidity or CO2 between intervention and control houses in either experiment. The solar chimney did not improve human comfort assessed using psychrometric analysis. While the ceiling fan improved human comfort pre-midnight, in the morning it was too cool compared with the control house, although this could be remedied through provision of blankets. Further improvements to the design of the solar chimney are needed. High air velocity in the ceiling fan house probably reduced mosquito house entry by preventing mosquito flight. Improved ventilation in houses may reduce malaria transmission.
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Affiliation(s)
| | - Musa Jawara
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Daniel Sang-Hoon Lee
- Architecture, Design and Conservation, The Royal Danish Academy, Philip De Langes Allé 10, Copenhagen 1435, Denmark
| | - Matthew S Holmes
- JDDK Architects, Millmount, Ponteland Rd, Cowgate, Newcastle upon Tyne NE5 3AL, England
| | - Sainey Ceesay
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Phillip McCall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Margaret Pinder
- Department of Biosciences, Durham University, Stockton Road, Durham, Durham DH1 3LE, UK
- 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
| | - Jakob B Knudsen
- Architecture, Design and Conservation, The Royal Danish Academy, Philip De Langes Allé 10, Copenhagen 1435, Denmark
| | - Steve W Lindsay
- Department of Biosciences, Durham University, Stockton Road, Durham, Durham DH1 3LE, UK
- London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Anne L Wilson
- Department of Biosciences, Durham University, Stockton Road, Durham, Durham DH1 3LE, UK
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Klu D, Aberese-Ako M, Manyeh AK, Immurana M, Doegah P, Dalaba M, Acquah E, Alhassan RK, Ansah EK. Mixed effect analysis of factors influencing the use of insecticides treated bed nets among pregnant women in Ghana: evidence from the 2019 Malaria Indicator Survey. BMC Pregnancy Childbirth 2022; 22:258. [PMID: 35346098 PMCID: PMC8958761 DOI: 10.1186/s12884-022-04586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Malaria during pregnancy is a major cause of maternal morbidity globally and leads to poor birth outcomes. The World Health Organization has recommended the use of insecticide treated bed nets (ITN) as one of the effective malaria preventive strategies among pregnant women in malaria endemic areas. This study, therefore, seeks to examine the individual and household factors associated with the use of ITNs among pregnant women in Ghana. Methods Data for this study was obtained from the 2019 Ghana Malaria Indicator Survey (GMIS) conducted between September 25 and November 24, 2019. The weighted sample comprised 353 pregnant women aged 15–49 years. Data was analyzed with SPSS version 22 using both descriptive and multilevel logistics regression modelling. Statistically significant level was set at p < 0.05. Results The study found that 49.2% of pregnant women in Ghana use ITN to prevent malaria. Pregnant women aged 35–49 years (AOR = 3.403, CI: 1.191–9.725), those with no formal education (AOR = 5.585, CI = 1.315–23.716), and those who had secondary education (AOR = 3.509, CI = 1.076–11.440) had higher odds of using ITN. Similarly, higher odds of ITN usage was found among who belonged to the Akan ethnic group (AOR = 7.234, CI = 1.497–34.955), dwell in male-headed households (AOR = 2.232, CI = 1.105–4.508) and those whose household heads are aged 60–69 years (AOR = 4.303, CI = 1.160–15.966). However, pregnant women who resided in urban areas (AOR = 0.355, CI = 0.216–0.582), those whose household heads aged 40–49 years (AOR = 0.175, CI = 0.066–0.467) and those who belonged to richer (AOR =0.184, CI = 0.050–0.679) and richest (AOR = 0.107, CI = 0.021–0.552) households had lower odds of using ITN for malaria prevention. Conclusions Individual socio-demographic and household factors such as pregnant women’s age, educational level, place of residence, ethnicity, sex and age of household head, and household wealth quintile are associated with the use of ITN for malaria prevention among pregnant women. These factors ought to be considered in strengthening malaria prevention campaigns and develop new interventions to help increase ITN utilization among vulnerable population living in malaria- endemic areas.
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Okunlola OA, Oyeyemi OT, Lukman AF. Modeling the relationship between malaria prevalence and insecticide-treated bed net coverage in Nigeria using a Bayesian spatial generalized linear mixed model with a Leroux prior. Epidemiol Health 2021; 43:e2021041. [PMID: 34098626 PMCID: PMC8510838 DOI: 10.4178/epih.e2021041] [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: 04/19/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate malaria transmission in relation to insecticide-treated net (ITN) coverage in Nigeria. METHODS We used an exploratory analysis approach to evaluate variation in malaria transmission in relation to ITN distribution in 1,325 Demographic and Health Survey clusters in Nigeria. A Bayesian spatial generalized linear mixed model with a Leroux conditional autoregressive prior for the random effects was used to model the spatial and contextual variation in malaria prevalence and ITN distribution after adjusting for environmental variables. RESULTS Spatial smoothed maps showed the nationwide distribution of malaria and ITN. The distribution of ITN varied significantly across the 6 geopolitical zones (p<0.05). The North-East had the least ITN distribution (0.196±0.071), while ITN distribution was highest in the South-South (0.309±0.075). ITN coverage was also higher in rural areas (0.281±0.074) than in urban areas (0.240±0.096, p<0.05). The Bayesian hierarchical regression results showed a non-significant negative relationship between malaria prevalence and ITN coverage, but a significant spatial structured random effect and unstructured random effect. The correlates of malaria transmission included rainfall, maximum temperature, and proximity to water. CONCLUSIONS Reduction in malaria transmission was not significantly related to ITN coverage, although much could be achieved in attempts to curtail malaria transmission through enhanced ITN coverage. A multifaceted and integrated approach to malaria control is strongly advocated.
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Affiliation(s)
- Oluyemi A Okunlola
- Department of Mathematics, University of Medical Sciences, Ondo, Nigeria
| | - Oyetunde T Oyeyemi
- Department of Biological Sciences, University of Medical Sciences, Ondo, Nigeria
| | - Adewale F Lukman
- Department of Physical Sciences, Landmark University, Omu-Aran, Nigeria
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Koenker H, Taylor C, Burgert-Brucker CR, Thwing J, Fish T, Kilian A. Quantifying Seasonal Variation in Insecticide-Treated Net Use among Those with Access. Am J Trop Med Hyg 2020; 101:371-382. [PMID: 31264562 PMCID: PMC6685578 DOI: 10.4269/ajtmh.19-0249] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Seasonal variation in the proportion of the population using an insecticide-treated net (ITN) is well documented and is widely believed to be dependent on mosquito abundance and heat, driven by rainfall and temperature. However, seasonal variation in ITN use has not been quantified controlling for ITN access. Demographic and Health Survey and Malaria Indicator Survey datasets, their georeferenced data, and public rainfall and climate layers were pooled for 21 countries. Nine rainfall typologies were developed from rainfall patterns in Köppen climate zones. For each typology, the odds of ITN use among individuals with access to an ITN within their households (“ITN use given access”) were estimated for each month of the year, controlling for region, wealth quintile, residence, year, temperature, and malaria parasitemia level. Seasonality of ITN use given access was observed over all nine rainfall typologies and was most pronounced in arid climates and less pronounced where rainfall was relatively constant throughout the year. Peak ITN use occurred 1–3 months after peak rainfall and corresponded with peak malaria incidence and average malaria transmission season. The observed lags between peak rainfall and peak ITN use given access suggest that net use is triggered by mosquito density. In equatorial areas, ITN use is likely to be high year-round, given the presence of mosquitoes and an associated year-round perceived malaria risk. These results can be used to inform behavior change interventions to improve ITN use in specific times of the year and to inform geospatial models of the impact of ITNs on transmission.
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Affiliation(s)
- Hannah Koenker
- PMI VectorWorks Project, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, Maryland
| | - Cameron Taylor
- The Demographic and Health Surveys (DHS) Program, ICF, Rockville, Maryland
| | - Clara R Burgert-Brucker
- RTI International, Washington, District of Columbia.,The Demographic and Health Surveys (DHS) Program, ICF, Rockville, Maryland
| | - Julie Thwing
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tom Fish
- The Demographic and Health Surveys (DHS) Program, ICF, Rockville, Maryland
| | - Albert Kilian
- PMI VectorWorks Project, Tropical Health LLP, Montagut, Spain
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Taking the 'I' out of LLINs: using insecticides in vector control tools other than long-lasting nets to fight malaria. Malar J 2020; 19:73. [PMID: 32059675 PMCID: PMC7023706 DOI: 10.1186/s12936-020-3151-x] [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: 09/23/2019] [Accepted: 02/05/2020] [Indexed: 11/23/2022] Open
Abstract
Long-lasting insecticidal nets, or LLINs, have significantly reduced malaria morbidity and mortality over the past two decades. The net provides a physical barrier that decreases human-mosquito contact and the impregnated insecticide kills susceptible mosquito vectors upon contact and may repel them. However, the future of LLINs is threatened as resistance to pyrethroids is now widespread, the chemical arsenal for LLINs is very limited, time from discovery of next-generation insecticides to market is long, and persistent transmission is frequently caused by vector populations avoiding contact with LLINs. Here we ask the question whether, given these challenges, insecticides should be incorporated in nets at all. We argue that developing long-lasting nets without insecticide(s) can still reduce vector populations and provide both personal and community protection, if combined with other approaches or technologies. Taking the insecticide out of the equation (i) allows for a faster response to the current pyrethroid resistance crisis, (ii) avoids an LLIN-treadmill aimed at replacing failing bed nets due to insecticide resistance, and (iii) permits the utilization of our current and future insecticidal arsenal for other vector control tools to target persistent malaria transmission.
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Macdonald M, Putzer T. Human-Centered Design and Sustainable Malaria Interventions. GLOBAL HEALTH, SCIENCE AND PRACTICE 2019; 7:148-149. [PMID: 31249016 PMCID: PMC6641806 DOI: 10.9745/ghsp-d-19-00189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Human-centered design provides a method to adapt malaria control interventions to be more closely aligned with a family's convenience, comfort, and personal lifestyle, enabling a broader and more sustained culture of access and use.
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Affiliation(s)
- Michael Macdonald
- Associate Editor, Global Health: Science and Practice Journal, and Consultant, Catonsville, MD, USA.
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Ricotta E, Oppong S, Yukich JO, Briët OJT. Determinants of bed net use conditional on access in population surveys in Ghana. Malar J 2019; 18:63. [PMID: 30849976 PMCID: PMC6408824 DOI: 10.1186/s12936-019-2700-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/01/2019] [Indexed: 12/02/2022] Open
Abstract
Background Insecticide-treated nets (ITNs) are one of the most effective and widely available methods for preventing malaria, and there is interest in understanding the complexities of behavioural drivers of non-use among those with access. This analysis evaluated net use behaviour in Ghana by exploring how several household and environmental variables relate to use among Ghanaians with access to a net. Methods Survey data from the Ghana 2014 Demographic and Health Survey and the 2016 Malaria Indicator Survey were used to calculate household members’ access to space under a net as well as the proportion of net use conditional on access (NUCA). Geospatial information on cluster location was obtained, as well as average humidex, a measure of how hot it feels, for the month each cluster was surveyed. The relationship between independent variables and net use was assessed via beta-binomial regression models that controlled for spatially correlated random effects using non-Gaussian kriging. Results In both surveys, increasing wealth was associated with decreased net use among those with access in households when compared to the poorest category. In 2014, exposure to messages about bed net use for malaria prevention was associated with increased net use (OR 2.5, 95% CrI 1.5–4.2), as was living in a rural area in both 2014 (OR 2.5, 95% CrI 1.5–4.3) and 2016 (OR 1.6, 95% CrI 1.1–2.3). The number of nets per person was not associated with net use in either survey. Model fit was improved for both surveys by including a spatial random effect for cluster, demonstrating some spatial autocorrelation in the proportion of people using a net. Humidex, electricity in the household and IRS were not associated with NUCA. Conclusion Net use conditional on access is affected by household characteristics and is also spatially-dependent in Ghana. Setting (whether the household was urban or rural) plays a role, with wealthier and more urban households less likely to use nets when they are available. It will likely be necessary in the future to focus on rural settings, urban settings, and wealth status independently, both to better understand predictors of household net use in these areas and to design more targeted interventions to ensure consistent use of vector control interventions that meet specific needs of the population. Electronic supplementary material The online version of this article (10.1186/s12936-019-2700-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emily Ricotta
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, P.O. Box CH-4001, Basel, Switzerland.
| | - Samuel Oppong
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Korle-bu, P. O. Box KB 493, Accra, Ghana
| | - Joshua O Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St. #8317, New Orleans, LA, 70112, USA
| | - Olivier J T Briët
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland.,University of Basel, Petersplatz 1, P.O. Box CH-4001, Basel, Switzerland
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Israel OK, Fawole OI, Adebowale AS, Ajayi IO, Yusuf OB, Oladimeji A, Ajumobi O. Caregivers' knowledge and utilization of long-lasting insecticidal nets among under-five children in Osun State, Southwest, Nigeria. Malar J 2018; 17:231. [PMID: 29914488 PMCID: PMC6006692 DOI: 10.1186/s12936-018-2383-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 06/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Utilization of long-lasting insecticidal nets (LLIN) has been associated with reduction of malaria incidence, especially among children. The 2013 Nigeria Demographic and Health Survey revealed Osun State had the least proportion (5.7%) of under-five children (U5) who slept under LLIN the night before the survey. A study was conducted to assess caregivers' knowledge about LLIN, utilization of LLIN and factors influencing LLIN use among U5 in Osun State, Nigeria. METHODS A cross-sectional study was carried out among 1020 mothers/caregivers of U5 selected from six communities in Osun State using a multistage sampling technique. A pre-tested interviewer administered questionnaire was used to collect information on socio-demographic characteristics, mothers' knowledge about LLIN, ownership and utilization of LLIN and factors influencing use of LLIN in U5. Questions on knowledge about LLIN were scored and categorized into good (scored ≥ 5) and poor (score < 5) knowledge out of a maximum obtainable score of seven. Utilization of LLIN was defined as the proportion of U5 who slept under net the night before the survey. Data were analysed using descriptive statistics, Chi square test and logistic regression at α < 0.05. Transcripts from focus group discussions (FGD) were analysed for emerging themes related to caregivers' perspectives on utilization and factors affecting use of LLIN among U5. RESULTS Majority of the respondents 588 (58.3%) fall between age 25-34 years, with a mean age of 30.0 ± 6.3 years. All were aware of LLIN but only 76.1% had good knowledge and 59.0% reported use of LLIN among their U5. Reported barriers to utilizing LLIN were; heat (96.4%), reactions to the chemical (75.5%) and unpleasant odour (41.3%). These were corroborated at FGD. Those with formal education [adjusted odds ratio (aOR) = 1.4; 95% CI 1.0-2.1] and those with good knowledge of LLIN (aOR = 1.8; 95% CI 1.4-2.5) were more likely to use LLIN than their counterparts without formal education and those with poor knowledge of LLIN respectively. CONCLUSIONS The level of knowledge of respondents about LLIN was high and the utilization of LLIN among U5 was above average, however, it is still far below the 80% target. Efforts should be made to further improve utilization of LLIN through intensified promotion and health education.
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Affiliation(s)
- Oluwaseyi K Israel
- Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), Abuja, Nigeria. .,Department of Community Medicine, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria.
| | - Olufunmilayo I Fawole
- Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), Abuja, Nigeria.,Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Ayo S Adebowale
- Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), Abuja, Nigeria.,Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - IkeOluwapo O Ajayi
- Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), Abuja, Nigeria.,Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Oyindamola B Yusuf
- Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), Abuja, Nigeria.,Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Abisola Oladimeji
- Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), Abuja, Nigeria
| | - Olufemi Ajumobi
- Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), Abuja, Nigeria.,National Malaria Programme, Federal Ministry of Health, Abuja, Nigeria
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Yukich JO, Briët OJT, Ahorlu CK, Nardini P, Keating J. Willingness to pay for small solar powered bed net fans: results of a Becker-DeGroot-Marschak auction in Ghana. Malar J 2017; 16:316. [PMID: 28784127 PMCID: PMC5547488 DOI: 10.1186/s12936-017-1965-y] [Citation(s) in RCA: 4] [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: 03/28/2017] [Accepted: 07/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND METHODS Long-lasting insecticidal nets (LLINs) are one of the main interventions recommended by the World Health Organization for malaria vector control. LLINs are ineffective if they are not being used. Subsequent to the completion of a cluster randomized cross over trial conducted in rural Greater Accra where participants were provided with the 'Bɔkɔɔ System'-a set of solar powered net fan and light consoles with a solar panel and battery-or alternative household water filters, all trial participants were invited to participate in a Becker-DeGroot-Marschak auction to determine the mean willingness to pay (WTP) for the fan and light consoles and to estimate the demand curve for the units. RESULTS, DISCUSSION AND CONCLUSIONS Results demonstraed a mean WTP of approximately 55 Cedis (~13 USD). Demand results suggested that at a price which would support full manufacturing cost recovery, a majority of households in the area would be willing to purchase at least one such unit.
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Affiliation(s)
- Joshua O. Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St. #8317, New Orleans, LA 70112 USA
| | - Olivier J. T. Briët
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Collins K. Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Joseph Keating
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St. #8317, New Orleans, LA 70112 USA
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Briët OJT, Yukich JO, Pfeiffer C, Miller W, Jaeger MS, Khanna N, Oppong S, Nardini P, Ahorlu CK, Keating J. The effect of small solar powered 'Bͻkͻͻ' net fans on mosquito net use: results from a randomized controlled cross-over trial in southern Ghana. Malar J 2017; 16:12. [PMID: 28049477 PMCID: PMC5209841 DOI: 10.1186/s12936-016-1654-2] [Citation(s) in RCA: 10] [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: 08/03/2016] [Accepted: 12/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-lasting insecticidal nets (LLINs) are ineffective malaria transmission prevention tools if they are unused. Discomfort due to heat is the most commonly reported reason for not using nets, but this problem is largely unaddressed. With increasing rural electrification and the dropping price of solar power, fans could improve comfort inside nets and be affordable to populations in malaria endemic areas. Here, results are presented from a pilot randomized controlled cross-over study testing the effect of fans on LLIN use. METHODS Eighty-three households from two rural communities in Greater Accra, Ghana, randomized into three groups, participated in a 10-month cross-over trial. After a screening survey to identify eligible households, all households received new LLINs. Bͻkͻͻ net fan systems (one fan per member) were given to households in Group 1 and water filters were given to households in Group 2. At mid-point, Group 1 and 2 crossed over interventions. Households in Group 1 and 2 participated in fortnightly surveys on households' practices related to nets, fans and water filters, while households in Group 3 were surveyed only at screening, mid-point and study end. Entomological and weather data were collected throughout the study. Analysis took both 'per protocol' (PP) and 'intention to treat' (ITT) approaches. The mid- and end-point survey data from Group 1 and 2 were analysed using Firth logistic regressions. Fortnightly survey data from all groups were analysed using logistic regressions with random effects. RESULTS Provision of fans to households appeared to increase net use in this study. Although the increase in net use explained by fans was not significant in the primary analyses (ITT odds ratio 3.24, p > 0.01; PP odds ratio = 1.17, p > 0.01), it was significant in secondary PP analysis (odds ratio = 1.95, p < 0.01). Net use was high at screening and even higher after provision of new LLINs and with follow up. Fan use was 90-100% depending on the fortnightly visit. CONCLUSIONS This pilot study could not provide definitive evidence that fans increase net use. A larger study with additional statistical power is needed to assess this association across communities with diverse environmental and socio-demographic characteristics.
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Affiliation(s)
- Olivier J. T. Briët
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Joshua O. Yukich
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
- Center for Applied Malaria Research and Evaluation, Tulane University, New Orleans, USA
| | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Mulako S. Jaeger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nitin Khanna
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Collins K. Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joseph Keating
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
- Center for Applied Malaria Research and Evaluation, Tulane University, New Orleans, USA
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