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Onyinyechi OM, Mohd Nazan AIN, Ismail S. Effectiveness of health education interventions to improve malaria knowledge and insecticide-treated nets usage among populations of sub-Saharan Africa: systematic review and meta-analysis. Front Public Health 2023; 11:1217052. [PMID: 37601202 PMCID: PMC10435857 DOI: 10.3389/fpubh.2023.1217052] [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: 05/04/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Malaria health education intervention is a community-directed approach that has long been considered important in preventing malaria in sub-Saharan Africa. However, its effectiveness is being questioned due to a lack of strong evidence. We aim to synthesize the evidence of the impact of health education on malaria knowledge and insecticide-treated nets (ITN) usage. Specifically, we analyzed the odds of correctly answering malaria-related questions and the odds of using ITN between the intervention and control groups. Methods Experimental and observational studies conducted in sub-Saharan Africa between 2000 and 2021 which had quantitatively evaluated the impact of health education interventions on malaria knowledge and ITN usage were included in the review. Results A total of 11 studies (20,523 participants) were included. Four studies used educational interventions to teach appropriate ITN strategies and promote ITN usage. Two others focused on improving knowledge of malaria transmission, prevention, treatment, and its signs and symptoms. The remaining five studies assessed both ITN use and malaria knowledge. Of these, 10 were eligible for meta-analysis. On average, the odds of a person in the intervention group reporting better malaria knowledge (odds ratio 1.30, 95% CI: 1.00 to 1.70, p = 0.05) and higher ITN usage (odds ratio 1.53, 95% CI: 1.02 to 2.29, p = 0.004) increased significantly after receiving health education interventions compared to those in the control group. The odds of ITN usage also substantially increased when the interventions were based on a theory or model (odds ratio 5.27, 95% CI: 3.24 to 8.58, p = 0.05). Discussion Our review highlights sub-Saharan Africa's various health education strategies to curb malaria over the past two decades. Meta-analysis findings show that health education interventions are moderately effective in improving malaria knowledge and ITN usage and have contributed to the effort of global malaria strategy.
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Utilization of Long-Lasting Insecticide Treated Nets and Parasitaemia at 6 Months after a Mass Distribution Exercise among Households in Mbarara Municipality, Uganda: A Cross-Sectional Community Based Study. Malar Res Treat 2018; 2018:4387506. [PMID: 30155242 PMCID: PMC6093084 DOI: 10.1155/2018/4387506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/24/2018] [Accepted: 06/27/2018] [Indexed: 11/18/2022] Open
Abstract
Background Utilization of long-lasting insecticide treated nets (LLINs) after free and mass distribution exercise has not been adequately studied. The objectives of this study were to assess ownership and utilization of LLINs following a mass distribution campaign in a Ugandan urban municipality. Methods We conducted a cross-sectional study in western Uganda among households with children under 5 years, at 6 months after a mass LLIN distribution exercise. We administered a questionnaire to measure LLIN ownership and utilization. We also measured parasitaemia among children under five years. Results Of the 346 households enrolled, 342 (98.8%) still owned all the LLINs. LLIN use was reported among 315 (91.1%) adult respondents and among 318 (91.9%) children under five. Parasitaemia was detected among 10 (2.9%) children under five. Males (OR=2.65, 95% CI 0.99-7.07), single respondents (OR=10.35, 95% CI 1.64-65.46), having a fitting bed net size (OR= 3.59, 95% CI 1.71-7.59), and no childhood malaria episode reported in the home in the last 12 months (OR=1.69, 95% CI 1.02-2.83) were all associated with LLIN use. Conclusions Ownership of LLIN is very high, and parasitaemia among the children was very low. Low parasitaemia may be attributed to high LLIN utilization. Long term follow-up should be done to determine durability of the ownership and utilization.
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de Beyl CZ, Kilian A, Brown A, Sy-Ar M, Selby RA, Randriamanantenasoa F, Ranaivosoa J, Zigirumugabe S, Gerberg L, Fotheringham M, Lynch M, Koenker H. Evaluation of community-based continuous distribution of long-lasting insecticide-treated nets in Toamasina II District, Madagascar. Malar J 2017; 16:327. [PMID: 28797252 PMCID: PMC5553758 DOI: 10.1186/s12936-017-1985-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/07/2017] [Indexed: 12/03/2022] Open
Abstract
Background Continuous distribution of insecticide-treated nets (ITNs) is thought to be an effective mechanism to maintain ITN ownership and access between or in the absence of mass campaigns, but evidence is limited. A community-based ITN distribution pilot was implemented and evaluated in Toamasina II District, Madagascar, to assess this new channel for continuous ITN distribution. Methods Beginning 9 months after the December 2012 mass campaign, a community-based distribution pilot ran for an additional 9 months, from September 2013 to June 2014. Households requested ITN coupons from community agents in their village. After verification by the agents, households exchanged the coupon for an ITN at a distribution point. The evaluation was a two-stage cluster survey with a sample size of 1125 households. Counterfactual ITN ownership and access were calculated by excluding ITNs received through the community pilot. Results At the end of the pilot, household ownership of any ITN was 96.5%, population access to ITN was 81.5 and 61.5% of households owned at least 1 ITN for every 2 people. Without the ITNs provided through the community channel, household ownership of any ITN was estimated at 74.6%, population access to an ITN at 55.5%, and households that owned at least 1 ITN for 2 people at only 34.7%, 18 months after the 2012 campaign. Ownership of community-distributed ITNs was higher among the poorest wealth quintiles. Over 80% of respondents felt the community scheme was fair and simple to use. Conclusions Household ITN ownership and population ITN access exceeded RBM targets after the 9-month community distribution pilot. The pilot successfully provided coupons and ITNs to households requesting them, particularly for the least poor wealth quintiles, and the scheme was well-perceived by communities. Further research is needed to determine whether community-based distribution can sustain ITN ownership and access over the long term, how continuous availability of ITNs affects household net replacement behaviour, and whether community-based distribution is cost-effective when combined with mass campaigns, or if used with other continuous channels instead of mass campaigns.
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Affiliation(s)
| | | | - Andrea Brown
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Mohamad Sy-Ar
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Richmond Ato Selby
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA.,Malaria Consortium, Kampala, Uganda
| | | | | | | | - Lilia Gerberg
- President's Malaria Initiative, US Agency for International Development, Washington, DC, USA
| | - Megan Fotheringham
- President's Malaria Initiative, US Agency for International Development, Washington, DC, USA
| | - Matthew Lynch
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Hannah Koenker
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA.
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Firestone R, Rowe CJ, Modi SN, Sievers D. The effectiveness of social marketing in global health: a systematic review. Health Policy Plan 2016; 32:110-124. [DOI: 10.1093/heapol/czw088] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 12/30/2022] Open
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Montagu D, Goodman C, Berman P, Penn A, Visconti A. Recent trends in working with the private sector to improve basic healthcare: a review of evidence and interventions. Health Policy Plan 2016; 31:1117-32. [PMID: 27198979 DOI: 10.1093/heapol/czw018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2016] [Indexed: 11/14/2022] Open
Abstract
The private sector provides the majority of health care in Africa and Asia. A number of interventions have, for many years, applied different models of subsidy, support and engagement to address social and efficiency failures in private health care markets. We have conducted a review of these models, and the evidence in support of them, to better understand what interventions are currently common, and to what extent practice is based on evidence. Using established typologies, we examined five models of intervention with private markets for care: commodity social marketing, social franchising, contracting, accreditation and vouchers. We conducted a systematic review of both published and grey literature, identifying programmes large enough to be cited in publications, and studies of the listed intervention types. 343 studies were included in the review, including both published and grey literature. Three hundred and eighty programmes were identified, the earliest having begun operation in 1955. Commodity social marketing programmes were the most common intervention type, with 110 documented programmes operating for condoms alone at the highest period. Existing evidence shows that these models can improve access and utilization, and possibly quality, but for all programme types, the overall evidence base remains weak, with practice in private sector engagement consistently moving in advance of evidence. Future research should address key questions concerning the impact of interventions on the market as a whole, the distribution of benefits by socio-economic status, the potential for scale up and sustainability, cost-effectiveness compared to relevant alternatives and the risk of unintended consequences. Alongside better data, a stronger conceptual basis linking programme design and outcomes to context is also required.
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Affiliation(s)
| | | | | | - Amy Penn
- University of California, San Francisco, CA, USA
| | - Adam Visconti
- Georgetown University, Washington, DC, USA Providence Hospital, Mobile, AL, USA
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De Allegri M, Tiendrebéogo J, Müller O, Yé M, Jahn A, Ridde V. Understanding home delivery in a context of user fee reduction: a cross-sectional mixed methods study in rural Burkina Faso. BMC Pregnancy Childbirth 2015; 15:330. [PMID: 26653013 PMCID: PMC4676832 DOI: 10.1186/s12884-015-0764-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 11/25/2015] [Indexed: 11/25/2022] Open
Abstract
Background Several African countries have recently reduced/removed user fees for maternal care, producing considerable increases in the utilization of delivery services. Still, across settings, a conspicuous number of women continue to deliver at home. This study explores reasons for home delivery in rural Burkina Faso, where a successful user fee reduction policy is in place since 2007. Methods The study took place in the Nouna Health District and adopted a triangulation mixed methods design, combining quantitative and qualitative data collection and analysis methods. The quantitative component relied on use of data from the 2011 round of a panel household survey conducted on 1130 households. We collected data on utilization of delivery services from all women who had experienced a delivery in the previous twelve months and investigated factors associated with home delivery using multivariate logistic regression. The qualitative component relied on a series of open-ended interviews with 55 purposely selected households and 13 village leaders. We analyzed data using a mixture of inductive and deductive coding. Results Of the 420 women who reported a delivery, 47 (11 %) had delivered at home. Random effect multivariate logistic regression revealed a clear, albeit not significant trend for women from a lower socio-economic status and living outside an area to deliver at home. Distance to the health facility was found to be positively significantly associated with home delivery. Qualitative findings indicated that women and their households valued facility-based delivery above home delivery, suggesting that cultural factors do not shape the decision where to deliver. Qualitative findings confirmed that geographical access, defined in relation to the condition of the roads and the high transaction costs associated with travel, and the cost-sharing fees still applied at point of use represent two major barriers to access facility-based delivery. Conclusions Findings suggest that the current policy in Burkina Faso, as similar policies in the region, should be expanded to remove fees at point of use completely and to incorporate benefits/solutions to support the transport of women in labor to the health facility in due time.
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Affiliation(s)
- Manuela De Allegri
- Institute of Public Health, Medical Faculty, University of Heidelberg, Heidelberg, Germany.
| | | | - Olaf Müller
- Institute of Public Health, Medical Faculty, University of Heidelberg, Heidelberg, Germany.
| | - Maurice Yé
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
| | - Albrecht Jahn
- Institute of Public Health, Medical Faculty, University of Heidelberg, Heidelberg, Germany.
| | - Valéry Ridde
- University of Montreal School of Public Health (ESPUM), Montreal, Canada. .,Institut de recherche en santé publique de l'université de Montréal (IRSPUM), Montreal, Canada.
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Louis VR, Schoeps A, Tiendrebéogo J, Beiersmann C, Yé M, Damiba MR, Lu GY, Mbayiha AH, De Allegri M, Jahn A, Sié A, Becher H, Müller O. An insecticide-treated bed-net campaign and childhood malaria in Burkina Faso. Bull World Health Organ 2015; 93:750-8. [PMID: 26549902 PMCID: PMC4622154 DOI: 10.2471/blt.14.147702] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 05/22/2015] [Accepted: 05/29/2015] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To investigate if the first national insecticide-treated bed-net campaign in Burkina Faso, done in 2010, was followed by a decrease in childhood malaria in a district with high baseline transmission of the disease. METHODS We obtained data on the prevalence of Plasmodium falciparum parasitaemia in children aged 2 weeks to 36 months from malaria surveys in 2009 and 2011. We assessed morbidity in children younger than 5 years by comparing data from the Nouna health district's health management information system before and after the campaign in 2010. We analysed mortality data from 2008 to 2012 from Nouna's health and demographic surveillance system. FINDINGS The bed-net campaign was associated with an increase in the reported use of insecticide-treated nets. In 2009, 73% (630/869) of children reportedly slept under nets. In 2011, 92% (449/487) did. The campaign had no effect on the proportion of young children with P. falciparum parasitaemia after the rainy season; 52% (442/858) in 2009 and 53% (263/499) in 2011. Cases of malaria increased markedly after the campaign, as did the number of children presenting with other diseases. The campaign was not associated with any changes in child mortality. CONCLUSION The 2010 insecticide-treated net campaign in Burkina Faso was not associated with a decrease in care-seeking for malaria or all-cause mortality in children younger than 5 years. The most likely explanation is the high coverage of nets in the study area before the campaign which could have had an effect on mosquito vectors, limiting the campaign's impact.
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Affiliation(s)
- Valérie R Louis
- Institute of Public Health, Medical School, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Anja Schoeps
- Institute of Public Health, Medical School, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | | | - Claudia Beiersmann
- Institute of Public Health, Medical School, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Maurice Yé
- Centre de Recherche en Santé de Nouna (CRSN), BP02 Nouna, Burkina Faso
| | - Marie R Damiba
- Centre de Recherche en Santé de Nouna (CRSN), BP02 Nouna, Burkina Faso
| | - Guang Y Lu
- Institute of Public Health, Medical School, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - André H Mbayiha
- Institute of Public Health, Medical School, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Manuela De Allegri
- Institute of Public Health, Medical School, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Albrecht Jahn
- Institute of Public Health, Medical School, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Ali Sié
- Centre de Recherche en Santé de Nouna (CRSN), BP02 Nouna, Burkina Faso
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf Müller
- Institute of Public Health, Medical School, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
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De Allegri M, Agier I, Tiendrebeogo J, Louis VR, Yé M, Mueller O, Sarker M. Factors Affecting the Uptake of HIV Testing among Men: A Mixed-Methods Study in Rural Burkina Faso. PLoS One 2015; 10:e0130216. [PMID: 26132114 PMCID: PMC4488464 DOI: 10.1371/journal.pone.0130216] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 05/17/2015] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to explore factors shaping the decision to undergo Human Immunodeficiency Virus (HIV) testing among men in rural Burkina Faso. Methods The study took place in 2009 in the Nouna Health District and adopted a triangulation mixed methods design. The quantitative component relied on data collected through a structured survey on a representative sample of 1130 households. The qualitative component relied on 38 in-depth interviews, with men purposely selected to represent variation in testing decision, age, and place of residence. A two-part model was conducted, with two distinct outcome variables, i.e. “being offered an HIV test” and “having done an HIV test”. The qualitative data analysis relied on inductive coding conducted by three independent analysts. Result Of the 937 men, 357 had been offered an HIV test and 97 had taken the test. Younger age, household wealth, living in a village under demographic surveillance, and knowing that HIV testing is available at primary health facilities were all positively associated with the probability of being offered an HIV test. Household wealth and literacy were found to be positively associated, and distance was found to be negatively associated with the probability of having taken an HIV test. Qualitative findings indicated that the limited uptake of HIV testing was linked to poor knowledge on service availability and to low risk perceptions. Conclusion With only 10% of the total sample ever having tested for HIV, our study confirmed that male HIV testing remains unacceptably low in Sub-Saharan Africa. This results from a combination of health system factors, indicating general barriers to access, and motivational factors, such as one’s own knowledge of service availability and risk perceptions. Our findings suggested that using antenatal care and curative services as the exclusive entry points into HIV testing may not be sufficient to reach large portions of the male population. Thus, additional strategies are urgently needed to increase service uptake.
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Affiliation(s)
- Manuela De Allegri
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Isabelle Agier
- University of Montreal School of Public Health (ESPUM), Montreal, Canada, Research Centre of the University of Montreal Hospital Centre (CRCHUM), Montreal, Canada
| | | | - Valerie Renée Louis
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Maurice Yé
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Olaf Mueller
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Malabika Sarker
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- * E-mail:
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Augustincic Polec L, Petkovic J, Welch V, Ueffing E, Tanjong Ghogomu E, Pardo Pardo J, Grabowsky M, Attaran A, Wells GA, Tugwell P. Strategies to increase the ownership and use of insecticide-treated bednets to prevent malaria. Cochrane Database Syst Rev 2015; 2015:CD009186. [PMID: 25822171 PMCID: PMC7025867 DOI: 10.1002/14651858.cd009186.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Malaria is a life-threatening parasitic disease and 40% of the world's population lives in areas affected by malaria. Insecticide-treated bednets (ITNs) effectively prevent malaria, however, barriers to their use have been identified. OBJECTIVES To assess the evidence on the effectiveness of available strategies that focus on delivery and appropriate use of ITNs. SEARCH METHODS We searched the EPOC Register of Studies, CENTRAL, MEDLINE, EMBASE, HealthStar, CINAHL, PubMed, Science Citation Index, ProQuest Dissertations and Theses, African Index Medicus (AIM), World Health Organization Library and Information Networks for Knowledge (WHOLIS), LILACS, Virtual Health Library (VHL), and the World Health Organization Library Information System (WHOLIS). Initial searches were conducted in May 2011, updated in March 2012 and February 2013. Authors contacted organizations and individuals involved in ITN distribution programs or research to identify current initiatives, studies or unpublished data, and searched reference lists of relevant reviews and studies. SELECTION CRITERIA Randomized controlled trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series evaluating interventions focused on increasing ITN ownership and use were considered. The populations of interest were individuals in malaria-endemic areas. DATA COLLECTION AND ANALYSIS Two authors independently screened studies to be included. They extracted data from the selected studies and assessed the risk of bias. When consensus was not reached, any disagreements were discussed with a third author. The magnitude of effect and quality of evidence for each outcome was assessed. MAIN RESULTS Of the 3032 records identified, 10 studies were included in this review. Effect of ITN cost on ownership:Four studies including 4566 households and another study comprising 424 participants evaluated the effect of ITN price on ownership. These studies suggest that providing free ITNs probably increases ITN ownership when compared to subsidized ITNs or ITNs offered at full market price. Effect of ITN Cost on appropriate use of ITNs:Three studies including 9968 households and another study comprising 259 individuals found that there is probably little or no difference in the use of ITNs when they are provided free, compared to providing subsidized ITNs or ITNs offered at full market price. Education:Five studies, including 12,637 households, assessed educational interventions regarding ITN use and concluded that education may increase the number of adults and children using ITNs (sleeping under ITNs) compared to no education.One study, including 519 households, assessed the effects of providing an incentive (an undisclosed prize) to promote ITN ownership and use, and found that incentives probably lead to little or no difference in ownership or use of ITNs, compared to not receiving an incentive.None of the included studies reported on adverse effects. AUTHORS' CONCLUSIONS Five studies examined the effect of price on ITN ownership and found moderate-certainty evidence that ownership was highest among the groups who received the ITN free versus those who purchased the ITN at any cost. In economic terms, this means that demand for ITNs is elastic with regard to price. However, once the ITN is supplied, the price paid for the ITN probably has little to no effect on its use; the four studies addressing this outcome failed to confirm the hypothesis that people who purchase nets will use them more than those who receive them at no cost. Educational interventions for promoting ITN use have an additional positive effect. However, the impact of different types or intensities of education is unknown.
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Affiliation(s)
- Lana Augustincic Polec
- University of OttawaCentre for Global Health, Institute of Population Health1 Stewart StreetOttawaONCanadaK1N 6N5
| | - Jennifer Petkovic
- University of OttawaBruyère Research Institute43 Bruyère StAnnex E, room 302OttawaONCanadaK1N 5C8
| | - Vivian Welch
- University of OttawaBruyère Research Institute43 Bruyère StAnnex E, room 302OttawaONCanadaK1N 5C8
| | - Erin Ueffing
- The Ottawa Hospital ‐ General CampusCanadian Cochrane Centre (formerly)OttawaONCanada
| | | | - Jordi Pardo Pardo
- Ottawa Hospital Research Institute, The Ottawa Hospital ‐ General CampusCentre for Practice‐Changing Research501 Smyth Road, Box 711Room L1258OttawaONCanadaK1H 8L6
| | - Mark Grabowsky
- National Vaccine Program OfficeHubert Humphrey Building, Room 715200 Independence Avenue, S.W.Washington, D.C.USA20201
| | - Amir Attaran
- University of OttawaCentre for Global Health, Institute of Population Health1 Stewart StreetOttawaONCanadaK1N 6N5
| | - George A Wells
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaONCanadaK1Y 4W7
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1H 8M5
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Bayesian variable selection in modelling geographical heterogeneity in malaria transmission from sparse data: an application to Nouna Health and Demographic Surveillance System (HDSS) data, Burkina Faso. Parasit Vectors 2015; 8:118. [PMID: 25888970 PMCID: PMC4365550 DOI: 10.1186/s13071-015-0679-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/21/2015] [Indexed: 12/02/2022] Open
Abstract
Background Quantification of malaria heterogeneity is very challenging, partly because of the underlying characteristics of mosquitoes and also because malaria is an environmentally driven disease. Furthermore, in order to assess the spatial and seasonal variability in malaria transmission, vector data need to be collected repeatedly over time (at fixed geographical locations). Measurements collected at locations close to each other and over time tend to be correlated because of common exposures such as environmental or climatic conditions. Non- spatial statistical methods, when applied to analyze such data, may lead to biased estimates. We developed rigorous methods for analyzing sparse and spatially correlated data. We applied Bayesian variable selection to identify the most important predictors as well as the elapsing time between climate suitability and changes in entomological indices. Methods Bayesian geostatistical zero-inflated binomial and negative binomial models including harmonic seasonal terms, temporal trends and climatic remotely sensed proxies were applied to assess spatio-temporal variation of sporozoite rate and mosquito density in the study area. Bayesian variable selection was employed to determine the most important climatic predictors and elapsing (lag) time between climatic suitability and malaria transmission. Bayesian kriging was used to predict mosquito density and sporozoite rate at unsampled locations. These estimates were converted to covariate and season-adjusted maps of entomological inoculation rates. Models were fitted using Markov chain Monte Carlo simulation. Results The results show that Anophele. gambiae is the most predominant vector (79.29%) and is more rain-dependant than its sibling Anophele. funestus (20.71%). Variable selection suggests that the two species react differently to different climatic conditions. Prediction maps of entomological inoculation rate (EIR) depict a strong spatial and temporal heterogeneity in malaria transmission risk despite the relatively small geographical extend of the study area. Conclusion Malaria transmission is very heterogeneous over the study area. The EIR maps clearly depict a strong spatial and temporal heterogeneity despite the relatively small geographical extend of the study area. Model based estimates of transmission can be used to identify high transmission areas in order to prioritise interventions and support research in malaria epidemiology. Electronic supplementary material The online version of this article (doi:10.1186/s13071-015-0679-7) contains supplementary material, which is available to authorized users.
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Ridde V, Agier I, Jahn A, Mueller O, Tiendrebéogo J, Yé M, De Allegri M. The impact of user fee removal policies on household out-of-pocket spending: evidence against the inverse equity hypothesis from a population based study in Burkina Faso. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2015; 16:55-64. [PMID: 24414280 DOI: 10.1007/s10198-013-0553-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 12/11/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND User fee removal policies have been extensively evaluated in relation to their impact on access to care, but rarely, and mostly poorly, in relation to their impact on household out-of-pocket (OOP) spending. This paucity of evidence is surprising given that reduction in household economic burden is an explicit aim for such policies. Our study assessed the equity impact on household OOP spending for facility-based delivery of the user fee reduction policy implemented in Burkina Faso since 2007 (i.e., subsidised price set at 900 Communauté Financière Africaine francs (CFA) for all, but free for the poorest). Taking into account the challenges linked to implementing exemption policies, we aimed to test the hypothesis that the user fee reduction policy had favoured the least poor more than the poor. METHODS We used data from six consecutive rounds (2006-2011) of a household survey conducted in the Nouna Health District. Primary outcomes are the proportion of households being fully exempted (the poorest 20% according to the policy) and the actual level of household OOP spending on facility-based delivery. The estimation of the effects relied on a Heckman selection model. This allowed us to estimate changes in OOP spending across socio-economic strata given changes in service utilisation produced by the policy. FINDINGS A total of 2,316 women reported a delivery between 2006 and 2011. Average household OOP spending decreased from 3,827 CFA in 2006 to 1,523 in 2011, without significant differences across socio-economic strata, neither in terms of households being fully exempted from payment nor in terms of the amount paid. Payment remained regressive and substantially higher than the stipulated 900 CFA. CONCLUSIONS The Burkinabè policy led to a significant and sustained reduction in household OOP health spending across all socio-economic groups, but failed to properly target the poorest by ensuring a progressive payment system.
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Affiliation(s)
- V Ridde
- Département de Médecine Sociale et Préventive, Montréal School of Public Health, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montréal, Canada,
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Rumisha SF, Smith TA, Masanja H, Abdulla S, Vounatsou P. Relationship between child survival and malaria transmission: an analysis of the malaria transmission intensity and mortality burden across Africa (MTIMBA) project data in Rufiji demographic surveillance system, Tanzania. Malar J 2014; 13:124. [PMID: 24679119 PMCID: PMC4021084 DOI: 10.1186/1475-2875-13-124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 02/19/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The precise nature of the relationship between malaria mortality and levels of transmission is unclear. Due to methodological limitations, earlier efforts to assess the linkage have lead to inconclusive results. The malaria transmission intensity and mortality burden across Africa (MTIMBA) project initiated by the INDEPTH Network collected longitudinally entomological data within a number of sites in sub-Saharan Africa to study this relationship. This work linked the MTIMBA entomology database with the routinely collected vital events within the Rufiji Demographic Surveillance System to analyse the transmission-mortality relation in the region. METHODS Bayesian Bernoulli spatio-temporal Cox proportional hazards models with village clustering, adjusted for age and insecticide-treated nets (ITNs), were fitted to assess the relation between mortality and malaria transmission measured by entomology inoculation rate (EIR). EIR was predicted at household locations using transmission models and it was incorporated in the model as a covariate with measure of uncertainty. Effects of covariates estimated by the model are reported as hazard ratios (HR) with 95% Bayesian confidence interval (BCI) and spatial and temporal parameters are presented. RESULTS Separate analysis was carried out for neonates, infants and children 1-4 years of age. No significant relation between all-cause mortality and intensity of malaria transmission was indicated at any age in childhood. However, a strong age effect was shown. Comparing effects of ITN and EIR on mortality at different age categories, a decrease in protective efficacy of ITN was observed (i.e. neonates: HR = 0.65; 95% BCI:0.39-1.05; infants: HR = 0.72; 95% BCI:0.48-1.07; children 1-4 years: HR = 0.88; 95% BCI:0.62-1.23) and reduction on the effect of malaria transmission exposure was detected (i.e. neonates: HR = 1.15; 95% BCI:0.95-1.36; infants: HR = 1.13; 95% BCI:0.98-1.25; children 1-4 years: HR = 1.04; 95% BCI:0.89-1.18). A very strong spatial correlation was also observed. CONCLUSION These results imply that assessing the malaria transmission-mortality relation involves more than the knowledge on the performance of interventions and control measures. This relation depends on the levels of malaria endemicity and transmission intensity, which varies significantly between different settings. Thus, sub-regions analyses are necessary to validate and assess reproducibility of findings.
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Affiliation(s)
- Susan F Rumisha
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4051 Basel, Switzerland
- National Institute for Medical Research, PO Box 9653, Dar es Salaam, Tanzania
| | - Thomas A Smith
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4051 Basel, Switzerland
| | | | - Salim Abdulla
- Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4051 Basel, Switzerland
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Zöllner C, De Allegri M, Louis VR, Yé M, Sié A, Tiendrebéogo J, Jahn A, Müller O. Insecticide-treated mosquito nets in rural Burkina Faso: assessment of coverage and equity in the wake of a universal distribution campaign. Health Policy Plan 2014; 30:171-80. [PMID: 24463333 DOI: 10.1093/heapol/czt108] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Insecticide-treated mosquito nets (ITNs) are an essential tool of the Roll Back Malaria strategy. An increasing number of African countries have embarked on mass distribution campaigns of long-lasting insecticide-treated nets (LLINs) with the ultimate goal of universal coverage. Such a national campaign with the goal of one ITN for every two people has been conducted in Burkina Faso in 2010. Our aim was to assess the coverage and equity effect of the universal distribution campaign of LLINs in Burkina Faso and to identify determinants of ITN ownership across households after the campaign. We evaluated its effects through comparison of data from two household surveys conducted in early 2010 (before the campaign) and early 2011 (after the campaign) on a representative rural district in north-western Burkina Faso. Data were collected on household characteristics (including socio-economic status) and ITN ownership. We used concentration curves and indices to compare ITN coverage indicators before and after the campaign and multilevel multivariate logistic regression to estimate factors associated with achievement of the universal coverage target in 2011. The survey included 1106 households in 2010 and 1094 in 2011. We found that the proportion of households with at least one ITN increased from 59% before the campaign to 99% afterwards, whereas the concentration index dropped from 0.087 (standard error (SE): 0.014) to 0.002 (SE: 0.002). Fifty-two per cent of households reached the target of one ITN for every two people per household, with the relevant concentration index at -0.031 (SE: 0.016). Eighty-six per cent of households owned at least one ITN for every three people. The main characteristics significantly associated with the targeted intra-household coverage were family size and distance to the health centre but not socio-economic status. In conclusion, despite not having fully met its target, the national LLIN campaign achieved a high level of coverage and fostered equity.
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Affiliation(s)
- Caroline Zöllner
- Institute of Public Health, University of Heidelberg, INF 324, 69120 Heidelberg, Germany and Centre de Recherche en Santé de Nouna, BP 02, Nouna, Burkina Faso
| | - Manuela De Allegri
- Institute of Public Health, University of Heidelberg, INF 324, 69120 Heidelberg, Germany and Centre de Recherche en Santé de Nouna, BP 02, Nouna, Burkina Faso
| | - Valérie R Louis
- Institute of Public Health, University of Heidelberg, INF 324, 69120 Heidelberg, Germany and Centre de Recherche en Santé de Nouna, BP 02, Nouna, Burkina Faso
| | - Maurice Yé
- Institute of Public Health, University of Heidelberg, INF 324, 69120 Heidelberg, Germany and Centre de Recherche en Santé de Nouna, BP 02, Nouna, Burkina Faso
| | - Ali Sié
- Institute of Public Health, University of Heidelberg, INF 324, 69120 Heidelberg, Germany and Centre de Recherche en Santé de Nouna, BP 02, Nouna, Burkina Faso
| | - Justin Tiendrebéogo
- Institute of Public Health, University of Heidelberg, INF 324, 69120 Heidelberg, Germany and Centre de Recherche en Santé de Nouna, BP 02, Nouna, Burkina Faso
| | - Albrecht Jahn
- Institute of Public Health, University of Heidelberg, INF 324, 69120 Heidelberg, Germany and Centre de Recherche en Santé de Nouna, BP 02, Nouna, Burkina Faso
| | - Olaf Müller
- Institute of Public Health, University of Heidelberg, INF 324, 69120 Heidelberg, Germany and Centre de Recherche en Santé de Nouna, BP 02, Nouna, Burkina Faso
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Singh M, Brown G, Rogerson SJ. Ownership and use of insecticide-treated nets during pregnancy in sub-Saharan Africa: a review. Malar J 2013; 12:268. [PMID: 23914731 PMCID: PMC3734149 DOI: 10.1186/1475-2875-12-268] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/30/2013] [Indexed: 11/25/2022] Open
Abstract
Over the past decade, significant gains have been made in the implementation of malaria prevention measures in pregnancy in sub-Saharan Africa, including the distribution of insecticide-treated nets (ITNs). These have been shown to cause a reduction in the incidence of malaria and its consequences such as maternal anaemia, stillbirths and intrauterine growth restriction. Currently most nations in Africa have policies for distributing ITNs to pregnant women through various mechanisms, however coverage remains well below the targets. This review summarizes recent evidence regarding the correlation between ownership and use of ITNs and the determinants of both, in pregnancy in sub-Saharan Africa, and reviews interventions directed at improving coverage. A review of the literature using Pubmed, CINAHL and scanning of reference lists was conducted in October 2012 and 59 articles were selected for final review. The research obtained was a mixture of national and district level surveys, and a narrative synthesis of the data was undertaken. Ownership of ITNs varied from as low as 3% to greater than 80%, and the main determinants were found to be education level, knowledge of malaria, community involvement, socio-economic status and parity, although the significance of each varied between the different settings and studies reviewed. In more than half the settings where data were available, the combination of lack of availability and lack of use of an available net meant that less than half of all pregnancies received the recommended intervention. Supply and cost remain major barriers to achieving optimal coverage, but the additional important contributor to reduced efficiency of intervention was the clear discrepancy between ownership and use, with available ITN use below 60% in several settings. Cited reasons for not using an ITN, where one was available, included discomfort, problems with hanging up nets and lack of space, low awareness of need, and seasonal variations in use. These findings highlight the need for context-specific approaches and educational components to be incorporated into ITN distribution programmes to address some of the reasons why some pregnant women do not use the ITNs they own.
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Affiliation(s)
- Megha Singh
- Nossal Institute for Global Health, University of Melbourne, Carlton, VIC, Australia.
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Hill J, Hoyt J, van Eijk AM, D'Mello-Guyett L, Ter Kuile FO, Steketee R, Smith H, Webster J. Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-Saharan Africa: a systematic review and meta-analysis. PLoS Med 2013; 10:e1001488. [PMID: 23935459 PMCID: PMC3720261 DOI: 10.1371/journal.pmed.1001488] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/13/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Malaria in pregnancy has important consequences for mother and baby. Coverage with the World Health Organization-recommended prevention strategy for pregnant women in sub-Saharan Africa of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets (ITNs) is low. We conducted a systematic review to explore factors affecting delivery, access, and use of IPTp and ITNs among healthcare providers and women. METHODS AND RESULTS We searched the Malaria in Pregnancy Library and Global Health Database from 1 January 1990 to 23 April 2013, without language restriction. Data extraction was performed by two investigators independently, and data was appraised for quality and content. Data on barriers and facilitators, and the effect of interventions, were explored using content analysis and narrative synthesis. We conducted a meta-analysis of determinants of IPTp and ITN uptake using random effects models, and performed subgroup analysis to evaluate consistency across interventions and study populations, countries, and enrolment sites. We did not perform a meta-ethnography of qualitative data. Ninety-eight articles were included, of which 20 were intervention studies. Key barriers to the provision of IPTp and ITNs were unclear policy and guidance on IPTp; general healthcare system issues, such as stockouts and user fees; health facility issues stemming from poor organisation, leading to poor quality of care; poor healthcare provider performance, including confusion over the timing of each IPTp dose; and women's poor antenatal attendance, affecting IPTp uptake. Key determinants of IPTp coverage were education, knowledge about malaria/IPTp, socio-economic status, parity, and number and timing of antenatal clinic visits. Key determinants of ITN coverage were employment status, education, knowledge about malaria/ITNs, age, and marital status. Predictors showed regional variations. CONCLUSIONS Delivery of ITNs through antenatal clinics presents fewer problems than delivery of IPTp. Many obstacles to IPTp delivery are relatively simple barriers that could be resolved in the short term. Other barriers are more entrenched within the overall healthcare system or socio-economic/cultural contexts, and will require medium- to long-term strategies. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
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The impact of targeted subsidies for facility-based delivery on access to care and equity - evidence from a population-based study in rural Burkina Faso. J Public Health Policy 2012; 33:439-53. [PMID: 22932023 DOI: 10.1057/jphp.2012.27] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We conducted the first population-based impact assessment of a financing policy introduced in Burkina Faso in 2007 on women's access to delivery services. The policy offers an 80 per cent subsidy for facility-based delivery. We collected information on delivery in five repeated cross-sectional surveys carried out from 2006 to 2010 on a representative sample of 1050 households in rural Nouna Health District. Over the 5 years, the proportion of facility-based deliveries increased from 49 to 84 per cent (P<0.001). The utilization gap across socio-economic quintiles, however, remained unchanged. The amount received for all services associated with births decreased by 67 per cent (P<0.001), but women continued to pay on average 1423 CFA (\[euro]1=655 CFA), about 500 CFA more than the set tariff of 900 CFA. Our findings indicate the operational effectiveness of the policy in increasing the use of facility-based delivery services for women. The potential to reduce maternal mortality substantially has not yet been assessed by health outcome measures of neonatal and maternal mortality.
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Willey BA, Paintain LS, Mangham L, Car J, Schellenberg JA. Strategies for delivering insecticide-treated nets at scale for malaria control: a systematic review. Bull World Health Organ 2012; 90:672-684E. [PMID: 22984312 DOI: 10.2471/blt.11.094771] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 01/31/2012] [Accepted: 02/02/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To synthesize findings from recent studies of strategies to deliver insecticide-treated nets (ITNs) at scale in malaria-endemic areas. METHODS Databases were searched for studies published between January 2000 and December 2010 in which: subjects resided in areas with endemicity for Plasmodium falciparum and Plasmodium vivax malaria; ITN delivery at scale was evaluated; ITN ownership among households, receipt by pregnant women and/or use among children aged < 5 years was evaluated; and the study design was an individual or cluster-randomized controlled design, nonrandomized, quasi-experimental, before-and-after, interrupted time series or cross-sectional without temporal or geographical controls. Papers describing qualitative studies, case studies, process evaluations and cost-effectiveness studies linked to an eligible paper were also included. Study quality was assessed using the Cochrane risk of bias checklist and GRADE criteria. Important influences on scaling up were identified and assessed across delivery strategies. FINDINGS A total of 32 papers describing 20 African studies were reviewed. Many delivery strategies involved health sectors and retail outlets (partial subsidy), antenatal care clinics (full subsidy) and campaigns (full subsidy). Strategies achieving high ownership among households and use among children < 5 delivered ITNs free through campaigns. Costs were largely comparable across strategies; ITNs were the main cost. Cost-effectiveness estimates were most sensitive to the assumed net lifespan and leakage. Common barriers to delivery included cost, stock-outs and poor logistics. Common facilitators were staff training and supervision, cooperation across departments or ministries and stakeholder involvement. CONCLUSION There is a broad taxonomy of strategies for delivering ITNs at scale.
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Affiliation(s)
- Barbara A Willey
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England.
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De Allegri M, Louis VR, Tiendrébeogo J, Souares A, Yé M, Tozan Y, Jahn A, Mueller O. Moving towards universal coverage with malaria control interventions: achievements and challenges in rural Burkina Faso. Int J Health Plann Manage 2012; 28:102-21. [DOI: 10.1002/hpm.2116] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 04/19/2012] [Accepted: 05/10/2012] [Indexed: 11/10/2022] Open
Affiliation(s)
- Manuela De Allegri
- Institute of Public Health; University of Heidelberg; Heidelberg; Germany
| | - Valérie R Louis
- Institute of Public Health; University of Heidelberg; Heidelberg; Germany
| | | | - Aurelia Souares
- Institute of Public Health; University of Heidelberg; Heidelberg; Germany
| | - Maurice Yé
- Centre de Recherche en Santé de Nouna; Nouna; Burkina Faso
| | | | - Albrecht Jahn
- Institute of Public Health; University of Heidelberg; Heidelberg; Germany
| | - Olaf Mueller
- Institute of Public Health; University of Heidelberg; Heidelberg; Germany
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Louis VR, Bals J, Tiendrebéogo J, Bountogo M, Ramroth H, De Allegri M, Traoré C, Beiersmann C, Coulibaly B, Yé M, Jahn A, Becher H, Müller O. Long-term effects of malaria prevention with insecticide-treated mosquito nets on morbidity and mortality in African children: randomised controlled trial. Trop Med Int Health 2012; 17:733-41. [PMID: 22519853 DOI: 10.1111/j.1365-3156.2012.02990.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective is to investigate the effect of malaria control with insecticide-treated mosquito nets (ITNs) regarding possible higher mortality in children protected during early infancy, due to interference with immunity development, and to assess long-term effects on malaria prevalence and morbidity. METHODS Between 2000 and 2002, a birth cohort was enrolled in 41 villages of a malaria holoendemic area in north-western Burkina Faso. All neonates (n = 3387) were individually randomised to ITN protection from birth (group A) vs. ITN protection from age 6 months (group B). Primary outcome was all-cause mortality. In 2009, a survey took place in six sentinel villages, and in 2010, a census was conducted in all study villages. RESULTS After a median follow-up time of 8.3 years, 443/3387 (13.1%) children had migrated out of the area and 484/2944 (16.4%) had died, mostly at home. Long-term compliance with ITN protection was good. There were no differences in mortality between study groups (248 deaths in group A, 236 deaths in group B; rate ratio 1.05, 95% CI: 0.889-1.237, P = 0.574). The survey conducted briefly after the rainy season in 2009 showed that more than 80% of study children carried asexual malaria parasites and up to 20% had clinical malaria. CONCLUSION Insecticide-treated mosquito net protection in early infancy is not a risk factor for mortality. Individual ITN protection does not sufficiently reduce malaria prevalence in high-transmission areas. Achieving universal ITN coverage remains a major challenge for malaria prevention in Africa.
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Affiliation(s)
- Valérie R Louis
- Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
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Beiersmann C, Bountogo M, Tiendrébeogo J, Louis VR, Gabrysch S, Yé M, Jahn A, Müller O. Malnutrition in young children of rural Burkina Faso: comparison of survey data from 1999 with 2009. Trop Med Int Health 2012; 17:715-21. [PMID: 22519807 DOI: 10.1111/j.1365-3156.2012.02985.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE For measurement of progress towards the Millennium Development Goal (MDG) 1, reliable data on nutrition indicators of specific countries are essential. Malnutrition is also the main determinant for childhood mortality, which is addressed in MDG 4. METHODS In the health and demographic surveillance area of Kossi Province in north-western Burkina Faso, nutritional parameters were compared in two cohorts of young children of the same age range from eight villages. Surveys took place in June and December of the year 1999 and 2009. A multivariate model was used to control for confounding variables. RESULTS For the 1999 study, data were analysed for 179 and 197 children who took part in the June and December survey respectively. In 2009, corresponding data were analysed for 460 and 409 children. Prevalence of underweight was highest in December 1999 (42.6%) and lowest in December 2009 (34.1%). After adjustment for age, sex and village, there was a slight but not always significant improvement in the z-scores of weight-for-age, weight-for-length, length-for-age, and mid-arm circumference over time. CONCLUSIONS The findings from this study confirm the still unacceptable high prevalence of malnutrition in young children of rural sub-Saharan Africa (SSA). Progress in the reduction of malnutrition remains slow on this continent making it rather unlikely that the corresponding MDGs will be achieved. Large-scale multi-sectoral community-based interventions are urgently needed for a sustainable improvement of child health in SSA.
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Affiliation(s)
- C Beiersmann
- Institute of Public Health, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
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Spatial distribution of bednet coverage under routine distribution through the public health sector in a rural district in Kenya. PLoS One 2011; 6:e25949. [PMID: 22022481 PMCID: PMC3192112 DOI: 10.1371/journal.pone.0025949] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 09/14/2011] [Indexed: 11/19/2022] Open
Abstract
Insecticide-treated nets (ITNs) are one of the most important and cost-effective tools for malaria control. Maximizing individual and community benefit from ITNs requires high population-based coverage. Several mechanisms are used to distribute ITNs, including health facility-based targeted distribution to high-risk groups; community-based mass distribution; social marketing with or without private sector subsidies; and integrating ITN delivery with other public health interventions. The objective of this analysis is to describe bednet coverage in a district in western Kenya where the primary mechanism for distribution is to pregnant women and infants who attend antenatal and immunization clinics. We use data from a population-based census to examine the extent of, and factors correlated with, ownership of bednets. We use both multivariable logistic regression and spatial techniques to explore the relationship between household bednet ownership and sociodemographic and geographic variables. We show that only 21% of households own any bednets, far lower than the national average, and that ownership is not significantly higher amongst pregnant women attending antenatal clinic. We also show that coverage is spatially heterogeneous with less than 2% of the population residing in zones with adequate coverage to experience indirect effects of ITN protection.
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Beiersmann C, Bountogo M, Tiendrébeogo J, De Allegri M, Louis VR, Coulibaly B, Yé M, Mueller O. Falciparum malaria in young children of rural Burkina Faso: comparison of survey data in 1999 with 2009. Malar J 2011; 10:296. [PMID: 21989335 PMCID: PMC3200185 DOI: 10.1186/1475-2875-10-296] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/11/2011] [Indexed: 11/24/2022] Open
Abstract
Background Roll Back Malaria (RBM) interventions such as insecticide-treated mosquito nets (ITN) and artemisinin-based combination therapy (ACT) have become implemented with different velocities in the endemic countries of sub-Saharan Africa (SSA) in recent years. There is conflicting evidence on how much can be achieved under real life conditions with the current interventions in the highly endemic savannah areas of SSA. Methods The study took place in a rural area of north-western Burkina Faso, which was defined as holoendemic in 1999. Clinical and parasitological data were compared in two cohorts of young children of the same age range from eight villages. Surveys took place in June and December of the year 1999 and 2009 respectively. Results Prevalence of mosquito net use increased from 22% in 1999 to 73% in 2009, with the majority of nets being ITNs in 2009. In 2009, P. falciparum prevalence was significantly lower compared to 1999 (overall reduction of 22.8%). Conclusions The reduction in malaria prevalence in young children observed between 1999 and 2009 in a rural and formerly malaria holoendemic area of Burkina Faso is likely attributable to the increase in ITN availability and utilization over time.
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Affiliation(s)
- Claudia Beiersmann
- Institute of Public Health, Ruprecht-Karls-University Heidelberg, INF 324, 69124 Heidelberg, Germany.
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Beiersmann C, De Allegri M, Tiendrebéogo J, Yé M, Jahn A, Mueller O. Different delivery mechanisms for insecticide-treated nets in rural Burkina Faso: a provider's perspective. Malar J 2010; 9:352. [PMID: 21129224 PMCID: PMC3003674 DOI: 10.1186/1475-2875-9-352] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 12/04/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insecticide-treated nets (ITNs) have been confirmed to be a very effective tool in malaria control. Two different delivery strategies for roll-out of ITN programmes have been the focus of debate in the last years: free distribution and distribution through commercial marketing systems. They are now seen as complementary rather than opponent. Acceptance of these programmes by the community and involved providers is an important aspect influencing their sustainability. This paper looks at how providers perceived, understood and accepted two interventions involving two different delivery strategies (subsidized sales supported by social marketing and free distribution to pregnant women attending antenatal care services). METHODS The interventions took place in one province of north-western Burkina Faso in 2006 in the frame of a large randomized controlled ITN intervention study. For this descriptive qualitative study data were collected through focus group discussions and individual interviews. A total of four focus group discussions and eleven individual interviews have been conducted with the providers of the study interventions. RESULTS The free distribution intervention was well accepted and perceived as running well. The health care staff had a positive and beneficial view of the intervention and did not feel overwhelmed by the additional workload. The social marketing intervention was also seen as positive by the rural shopkeepers. However, working in market economy, shopkeepers feared the risk of unsold ITNs, due to the low demand and capacity to pay for the product in the community. CONCLUSION The combination of ITN free distribution and social marketing was in general well accepted by the different providers. However, low purchasing power of clients and the resulting financial insecurities of shopkeepers remain a challenge to ITN social marketing in rural SSA.
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Affiliation(s)
- Claudia Beiersmann
- Institute of Public Health, Ruprecht-Karls-University Heidelberg, INF 324, 69124 Heidelberg, Germany
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De Allegri M, Ridde V, Louis VR, Sarker M, Tiendrebéogo J, Yé M, Müller O, Jahn A. Determinants of utilisation of maternal care services after the reduction of user fees: a case study from rural Burkina Faso. Health Policy 2010; 99:210-8. [PMID: 21056505 DOI: 10.1016/j.healthpol.2010.10.010] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/04/2010] [Accepted: 10/09/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify determinants of utilisation for antenatal care (ANC) and skilled attendance at birth after a substantial reduction in user fees. METHODS The study was conducted in the Nouna Health District in north-western Burkina Faso in early 2009. Data was collected by means of a representative survey on a sample of 435 women who reported a pregnancy in the prior 12 months. Two independent logit models were used to assess the determinants of (a) ANC utilisation (defined as having attended at least 3 visits) and (b) skilled assistance at birth (defined as having delivered in a health facility). RESULTS 76% of women had attended at least 3 ANC visits and 72% had delivered in a facility. Living within 5 km from a facility was positively associated, while animist religion, some ethnicities, and household wealth were negatively associated with ANC utilisation. Some ethnicities, living within 5 km from a health facility, and having attended at least 3 ANC visits were positively associated with delivering in a facility. CONCLUSIONS User fee alleviation secured equitable access to care across socio-economic groups, but alone did not ensure that all women benefited from ANC and from skilled attendance at birth. Investments in policies to address barriers beyond financial ones are urgently needed.
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Affiliation(s)
- Manuela De Allegri
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, INF 324, Heidelberg, Germany.
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Sié A, Louis VR, Gbangou A, Müller O, Niamba L, Stieglbauer G, Yé M, Kouyaté B, Sauerborn R, Becher H. The Health and Demographic Surveillance System (HDSS) in Nouna, Burkina Faso, 1993-2007. Glob Health Action 2010; 3. [PMID: 20847837 PMCID: PMC2940452 DOI: 10.3402/gha.v3i0.5284] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 08/19/2010] [Accepted: 08/20/2010] [Indexed: 11/16/2022] Open
Abstract
The Nouna Health and Demographic Surveillance System (HDSS) is located in rural Burkina Faso and has existed since 1992. Currently, it has about 78,000 inhabitants. It is a member of the International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), a global network of members who conducts longitudinal health and demographic evaluation of populations in low- and middle-income countries. The health facilities consist of one hospital and 13 basic health centres (locally known as CSPS). The Nouna HDSS has been used as a sampling frame for numerous studies in the fields of clinical research, epidemiology, health economics, and health systems research. In this paper we review some of the main findings, and we describe the effects that almost 20 years of health research activities have shown in the population in general and in terms of the perception, economic implications, and other indicators. Longitudinal data analyses show that childhood, as well as overall mortality, has significantly decreased over the observation period 1993–2007. The under-five mortality rate dropped from about 40 per 1,000 person-years in the mid-1990s to below 30 per 1,000 in 2007. Further efforts are needed to meet goal four of the Millennium Development Goals, which is to reduce the under-five mortality rate by two-thirds between 1990 and 2015.
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Affiliation(s)
- Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
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Webster J, Chandramohan D, Hanson K. Methods for evaluating delivery systems for scaling-up malaria control intervention. BMC Health Serv Res 2010; 10 Suppl 1:S8. [PMID: 20594374 PMCID: PMC2895752 DOI: 10.1186/1472-6963-10-s1-s8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Despite increased resources over the past few years the coverage of malaria control interventions is still inadequate to reach national and international targets and achieve the full potential of the interventions to improve population health. One of the reasons for this inadequate coverage of efficacious interventions is the limited understanding of the optimum delivery systems of the interventions in different contexts. Although there have been debates about how to deliver interventions, the methods for evaluating the effectiveness of different delivery systems have rarely been discussed. Delivery of interventions is relatively complex and a thorough evaluation would need to look holistically at multiple steps in the delivery process and at multiple factors influencing the process. A better understanding of the strength of the evidence on delivery system effectiveness is needed in order to optimise delivery of efficacious interventions. Methods A literature review was conducted of methods used to evaluate delivery systems for insecticide treated nets, intermittent preventive treatment in pregnant women, and treatment for malaria in children. Results The methodology of delivery system evaluations varied. There were inconsistencies between objectives and methods of the evaluations including inappropriate outcome measures and unnecessary controls. There were few examples where the delivery processes were adequately described, or measured. We propose a cross sectional observational study design with attribution of the outcomes to a specific delivery system as an appropriate method for evaluating delivery systems at scale. Conclusions The proposed evaluation framework is adaptable to natural experiments at scale, and can be applied using data from routine surveys such as the Demographic and Health Surveys, modified by the addition of one to two questions for each intervention. This framework has the potential to enable wider application of rigorous evaluations and thereby improve the evidence base on which decisions about delivery systems for malaria control and other public health interventions are taken.
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Affiliation(s)
- Jayne Webster
- Disease Control and Vector Biology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Tipke M, Louis VR, Yé M, De Allegri M, Beiersmann C, Sié A, Mueller O, Jahn A. Access to malaria treatment in young children of rural Burkina Faso. Malar J 2009; 8:266. [PMID: 19930680 PMCID: PMC2790466 DOI: 10.1186/1475-2875-8-266] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 11/24/2009] [Indexed: 11/25/2022] Open
Abstract
Background Effective and timely treatment is an essential aspect of malaria control, but remains a challenge in many parts of sub-Saharan Africa. The objective of this study was to describe young children's access to malaria treatment in Nouna Health District, Burkina Faso. Methods In February/March 2006, a survey was conducted in a representative sample of 1,052 households. Results Overall 149/1052 (14%) households reported the current possession of anti-malarial medicine, which was significantly associated with urban area, literacy of household head, having young children, and high socio-economic status. Out of a total of 802 children under five years, at least one malaria episode was reported for 239 (30%) within the last month. Overall 95% of children received treatment, either modern (72%), traditional (18%) or mixed (5%). Most of the medicines were provided as home treatment by the caregiver and half of children received some type of modern treatment within 24 hours of the occurrence of first symptoms. Despite a recent policy change to artemisinin-based combination therapy, modern anti-malarials consisted mainly of chloroquine (93%). Modern drugs were obtained more often from a health facility in localities with a health facility compared to those without (60% vs. 25.6%, p < 0.001). In contrast, beside informal providers, volunteer community health workers (CHW) were the main source of modern medicine in localities without a health centre (28% vs. 3%, p < 0.001). Conclusion Access to modern health services providing quality controlled effective combination therapies against malaria needs to be strengthened in rural Africa, which should include a re-investigation of the role of CHW 30 years after Alma Ata.
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Affiliation(s)
- Maike Tipke
- Institute for Public Health, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
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De Allegri M, Marschall P, Flessa S, Tiendrebeogo J, Kouyate B, Jahn A, Muller O. Comparative cost analysis of insecticide-treated net delivery strategies: sales supported by social marketing and free distribution through antenatal care. Health Policy Plan 2009; 25:28-38. [DOI: 10.1093/heapol/czp031] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ramroth H, Ndugwa RP, Müller O, Yé Y, Sié A, Kouyaté B, Becher H. Decreasing childhood mortality and increasing proportion of malaria deaths in rural Burkina Faso. Glob Health Action 2009; 2. [PMID: 20027271 PMCID: PMC2779934 DOI: 10.3402/gha.v2i0.1909] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 03/18/2009] [Accepted: 03/19/2009] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Malaria is the leading cause of death among children less than five years of age in sub-Saharan Africa (SSA), however, precise estimates on the burden of malaria are lacking. The aim of this study was to describe temporal trends for malaria and all-cause mortality by combining a series of clinical and intervention studies conducted in Burkina Faso. METHODS Data from a demographic surveillance system was used to follow-up children under five years who participated in five observational and intervention studies between June 1999 and December 2004 in rural north-western Burkina Faso. Mortality data was analyzed with cause-specific mortality ascertained using the verbal autopsy method. Person-years (PY) of observations were computed and age-standardized mortality rates (MR) for all-causes and malaria (adjusted for missing causes of death) were calculated. Rate ratios to investigate mortality variations over years were calculated using multivariate Poisson regression. RESULTS The study followed 6,387 children aged less than five years (mean follow-up: 2.8 years; 16,099 PY). During the study period, 443 deaths were registered with malaria accounting for 49% of all deaths. All-cause and malaria-specific MR were 26.7 (95% CI: 24.2-29.2) and 15.8 (95% CI: 14.217.7) per 1,000 PY. All-cause MR declined over years of follow-up (from 31.2 to 16.3 per 1,000 PY in 1999/2000 to 2004, respectively) but malaria MR remained relatively stable (from 15.8 to 12.1 per 1,000 PY in 1999/2000 to 2004, respectively) resulting in an increasing relative effect of malaria on all-cause mortality. Variations in all-cause and malaria-specific mortality were observed with increasing age and across village town clusters. CONCLUSION The findings of this study support the continuously decreasing trend of all-cause mortality in most of SSA, but call for more efforts to comprehensively address malaria with existing control tools such as insecticide-treated bed nets and effective first-line combination therapies.
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Affiliation(s)
- Heribert Ramroth
- Department of Tropical Hygiene and Public Health, University of Heidelberg, Heidelberg, Germany
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