1
|
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.
Collapse
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
| |
Collapse
|
2
|
Leblanc C, Kassié D, Ranaivoharimina M, Rakotomanana EFN, Mangahasimbola RT, Randrianarijaona A, Ramiandrasoa R, Nely AJ, Razafindraibe NP, Andriamandimby SF, Ranoaritiana DB, Rajaonarivony V, Randrianasolo L, Baril L, Mattern C, Ratovoson R, Guis H. Mixed methods to evaluate knowledge, attitudes and practices (KAP) towards rabies in central and remote communities of Moramanga district, Madagascar. PLoS Negl Trop Dis 2024; 18:e0012064. [PMID: 38551968 PMCID: PMC11006160 DOI: 10.1371/journal.pntd.0012064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/10/2024] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
Control of dog-mediated rabies relies on raising awareness, access to post-exposure prophylaxis (PEP) and mass dog vaccination. To assess rabies awareness in Moramanga district, Madagascar, where rabies is endemic, two complementary quantitative and qualitative approaches were carried out in 2018. In the quantitative approach, a standardized questionnaire was administered to 334 randomized participants living in 170 households located less than 5 km from the anti-rabies treatment center (ARTC) located in Moramanga city (thereafter called the central area), and in 164 households located more than 15 km away from the ARTC in two rural communes (thereafter called the remote area). Logistic regression models were fitted to identify factors influencing knowledge and practice scores. The qualitative approach consisted in semi-structured interviews conducted with 28 bite victims who had consulted the ARTC, three owners of biting dogs, three ARTC staff and two local authorities. Overall, 15.6% (52/334) of households owned at least one dog. The dog-to-human ratio was 1:17.6. The central area had a significantly higher dog bite incidence (0.53 per 100 person-years, 95% CI: 0.31-0.85) compared to the remote area (0.22 per 100 person-years, 95% CI: 0.09-0.43) (p = 0.03). The care pathway following a bite depended on wound severity, how the dog was perceived and its owner's willingness to cover costs. Rabies vaccination coverage in dogs in the remote area was extremely low (2.4%). Respondents knew that vaccination prevented animal rabies but owners considered that their own dogs were harmless and cited access and cost of vaccine as main barriers. Most respondents were not aware of the existence of the ARTC (85.3%), did not know the importance of timely access to PEP (92.2%) or that biting dogs should be isolated (89.5%) and monitored. Good knowledge scores were significantly associated with having a higher socio-economic status (OR = 2.08, CI = 1.33-3.26) and living in central area (OR = 1.91, CI = 1.22-3.00). Good practice scores were significantly associated with living in central area (OR = 4.78, CI = 2.98-7.77) and being aware of the ARTC's existence (OR = 2.29, CI = 1.14-4.80). In Madagascar, knowledge on rabies was disparate with important gaps on PEP and animal management. Awareness campaigns should inform communities (i) on the importance of seeking PEP as soon as possible after an exposure, whatever the severity of the wound and the type of biting dog who caused it, and (ii) on the existence and location of ARTCs where free-of-charge PEP is available. They should also encourage owners to isolate and monitor the health of biting dogs. Above all, awareness and dog vaccination campaigns should be designed so as to reach the more vulnerable remote rural populations as knowledge, good practices and vaccination coverage were lower in these areas. They should also target households with a lower socio-economic status. If awareness campaigns are likely to succeed in improving access to ARTCs in Madagascar, their impact on prompting dog owners to vaccinate their own dogs seems more uncertain given the financial and access barriers. Therefore, to reach the 70% dog vaccination coverage goal targeted in rabies elimination programs, awareness campaigns must be combined with free-of-charge mass dog vaccination.
Collapse
Affiliation(s)
- Claire Leblanc
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- General Paediatrics and Paediatric Infectious Disease Unit, Nantes University Hospital, Nantes, France
| | - Daouda Kassié
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- CIRAD, UMR ASTRE, Antananarivo, Madagascar
- ASTRE, Univ Montpellier, CIRAD, INRAE, Montpellier, France
| | - Mendrika Ranaivoharimina
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | | | - Anjasoa Randrianarijaona
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Ravo Ramiandrasoa
- Vaccination Center, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Alphonse José Nely
- Service for the Fight against Plague, Emerging and Re-emerging Diseases and Neglected Tropical Endemo-Epidemic Diseases, Ministry of Public Health, Antananarivo, Madagascar
- WHO Madagascar, Antananarivo 101, Madagascar
| | | | - Soa Fy Andriamandimby
- National Laboratory of Rabies, Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Dany Bakoly Ranoaritiana
- Direction of Health Monitoring, Epidemiological Surveillance and Response (DVSSER), Ministry of Public Health, Antananarivo, Madagascar
| | - Virginie Rajaonarivony
- Service for the Fight against Plague, Emerging and Re-emerging Diseases and Neglected Tropical Endemo-Epidemic Diseases, Ministry of Public Health, Antananarivo, Madagascar
| | - Laurence Randrianasolo
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Chiarella Mattern
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Ceped (Institut de Recherche pour le Développement, Université de Paris, INSERM), Paris, France
| | - Rila Ratovoson
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Hélène Guis
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- CIRAD, UMR ASTRE, Antananarivo, Madagascar
- ASTRE, Univ Montpellier, CIRAD, INRAE, Montpellier, France
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| |
Collapse
|
3
|
Koenker H, Kumoji EK, Erskine M, Opoku R, Sternberg E, Taylor C. Reported reasons for non-use of insecticide-treated nets in large national household surveys, 2009-2021. Malar J 2023; 22:61. [PMID: 36810015 PMCID: PMC9942310 DOI: 10.1186/s12936-023-04490-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Insecticide-treated nets (ITN) are the cornerstone of modern malaria vector control, with nearly 3 billion ITNs delivered to households in endemic areas since 2000. ITN access, i.e. availability within the household, based on the number of ITNs and number of household members, is a pre-requisite for ITN use. Factors determining ITN use are frequently examined in published literature, but to date, large household survey data on reasons given for non-use of nets have not been explored. METHODS A total of 156 DHS, MIS, and MICS surveys conducted between 2003 and 2021 were reviewed for questions on reasons why nets were not used the previous night, identifying twenty-seven surveys. The percent of nets that were reported used the previous night was calculated for the 156 surveys, and frequencies and proportions of reasons for non-use were calculated within the twenty-seven surveys. Results were stratified by household supply of ITNs in three categories (not enough", "enough", and "more than enough") and by residence (urban/rural). RESULTS The proportion of nets used the previous night averaged over 70% between 2003 and 2021, with no discernible change over this period. Reported reasons for why a net goes unused fell largely into three categories-nets that are extra/being saved for future use; the perception that there is little risk of malaria (particularly in dry season); and "other" responses. Net attributes such as colour, size, shape, and texture, and concerns related to chemicals were the least frequent reasons given. Reasons for non-use of nets varied by household net supply, and in some surveys by residence. In Senegal's continuous DHS, the proportion of nets used peaked during high transmission season, and the proportion of nets that went unused due to "no/few mosquitoes" peaked during the dry season. CONCLUSIONS Unused nets were primarily those being saved for later use, or were not used due to perceived low risk of malaria. Classifying reasons for non-use into broader categories facilitates the design of appropriate social and behaviour change interventions to address the major underlying reasons for non-use, where this is feasible.
Collapse
Affiliation(s)
| | - E. Kuor Kumoji
- grid.449467.c0000000122274844Johns Hopkins Center for Communication Programs, Baltimore, USA
| | - Marcy Erskine
- grid.475581.a0000 0004 0411 9738International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | - Robert Opoku
- grid.475581.a0000 0004 0411 9738International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | | | - Cameron Taylor
- grid.431760.70000 0001 0940 5336The DHS Program, ICF, Rockville, USA ,grid.5284.b0000 0001 0790 3681University of Antwerp, Medicine and Health Sciences, Antwerp, Belgium
| |
Collapse
|
4
|
Malpass A, Hansen N, Dentinger CM, Youll S, Cotte A, Mattern C, Ravaoarinosy A. Status of malaria in pregnancy services in Madagascar 2010-2021: a scoping review. Malar J 2023; 22:59. [PMID: 36803987 PMCID: PMC9940392 DOI: 10.1186/s12936-023-04497-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Malaria in pregnancy (MIP) increases the risk of poor maternal and infant outcomes. To reduce these risks, WHO recommends insecticide-treated net (ITN) use, intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), and prompt case management. However, uptake of these interventions remains sub-optimal in Madagascar. A scoping review was conducted to determine the breadth and depth of information available during 2010-2021 about Madagascar's MIP activities and to identify barriers and facilitators to MIP interventions uptake. METHODS PubMed, Google Scholar, and USAID's files (Development Experience Catalog) were searched using the terms "Madagascar AND pregnancy AND malaria," and reports and materials from stakeholders were collected. Documents in English and French from 2010 to 2021 with data regarding MIP were included. Documents were systematically reviewed and summarized; results were captured in an Excel database. RESULTS Of 91 project reports, surveys and published articles, 23 (25%) fell within the stated time period and contained relevant data on MIP activities in Madagascar and were categorized accordingly: eight (35%) quality of care, including health facility readiness, provider knowledge and commodity availability; nine (39%) care-seeking behaviour; and, six (26%) prevention of MIP. Key barriers were identified: nine articles mentioned SP stockouts; seven found limitations of provider knowledge, attitudes, and behaviours (KAB) regarding MIP treatment and prevention; and, one reported limited supervision. MIP care seeking and prevention barriers and facilitators included women's KAB regarding MIP treatment and prevention, distance, wait times, poor service quality, cost, and/or unwelcoming providers. A 2015 survey of 52 health facilities revealed limited client access to antenatal care due to financial and geographic barriers; two 2018 surveys revealed similar findings. Self-treatment and care-seeking delays were reported even when distance was not a barrier. CONCLUSION Among the studies and reports on MIP in Madagascar, the scoping review frequently noted barriers that could be mitigated by reducing stockouts, improving provider knowledge and attitudes, refining MIP communication, and improving service access. There is a need for coordinated efforts to address the identified barriers is the key implication of the findings.
Collapse
Affiliation(s)
- Ashley Malpass
- US President's Malaria Initiative, USAID, Washington, DC, USA.
| | - Natasha Hansen
- grid.507606.2US President’s Malaria Initiative, USAID, Washington, DC USA
| | - Catherine M. Dentinger
- grid.416738.f0000 0001 2163 0069Malaria Branch, US President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Susan Youll
- grid.507606.2US President’s Malaria Initiative, USAID, Washington, DC USA
| | - Annett Cotte
- grid.416738.f0000 0001 2163 0069Malaria Branch, US President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Chiarella Mattern
- grid.418511.80000 0004 0552 7303Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Aimée Ravaoarinosy
- grid.490713.8National Malaria Control Programme, Ministry of Health, Antananarivo, Madagascar
| |
Collapse
|
5
|
Favero R, Dentinger CM, Rakotovao JP, Kapesa L, Andriamiharisoa H, Steinhardt LC, Randrianarisoa B, Sethi R, Gomez P, Razafindrakoto J, Razafimandimby E, Andrianandraina R, Andriamananjara MN, Ravaoarinosy A, Mioramalala SA, Rawlins B. Experiences and perceptions of care-seeking for febrile illness among caregivers, pregnant women, and health providers in eight districts of Madagascar. Malar J 2022; 21:212. [PMID: 35799168 PMCID: PMC9261007 DOI: 10.1186/s12936-022-04190-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Prompt diagnosis and treatment of malaria contributes to reduced morbidity, particularly among children and pregnant women; however, in Madagascar, care-seeking for febrile illness is often delayed. To describe factors influencing decisions for prompt care-seeking among caregivers of children aged < 15 years and pregnant women, a mixed-methods assessment was conducted with providers (HP), community health volunteers (CHV) and community members. Methods One health district from each of eight malaria-endemic zones of Madagascar were purposefully selected based on reported higher malaria transmission. Within districts, one urban and one rural community were randomly selected for participation. In-depth interviews (IDI) and focus group discussions (FGD) were conducted with caregivers, pregnant women, CHVs and HPs in these 16 communities to describe practices and, for HPs, system characteristics that support or inhibit care-seeking. Knowledge tests on malaria case management guidelines were administered to HPs, and logistics management systems were reviewed. Results Participants from eight rural and eight urban communities included 31 HPs from 10 public and 8 private Health Facilities (HF), five CHVs, 102 caregivers and 90 pregnant women. All participants in FGDs and IDIs reported that care-seeking for fever is frequently delayed until the ill person does not respond to home treatment or symptoms become more severe. Key care-seeking determinants for caregivers and pregnant women included cost, travel time and distance, and perception that the quality of care in HFs was poor. HPs felt that lack of commodities and heavy workloads hindered their ability to provide quality malaria care services. Malaria commodities were generally more available in public versus private HFs. CHVs were generally not consulted for malaria care and had limited commodities. Conclusions Reducing cost and travel time to care and improving the quality of care may increase prompt care-seeking among vulnerable populations experiencing febrile illness. For patients, perceptions and quality of care could be improved with more reliable supplies, extended HF operating hours and staffing, supportive demeanors of HPs and seeking care with CHVs. For providers, malaria services could be improved by increasing the reliability of supply chains and providing additional staffing. CHVs may be an under-utilized resource for sick children.
Collapse
Affiliation(s)
- Rachel Favero
- Maternal and Child Survival Program, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA.
| | - Catherine M Dentinger
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.,US President's Malaria Initiative, US Centers for Disease Control and Prevention, Antananarivo, Madagascar
| | - Jean Pierre Rakotovao
- Maternal and Child Survival Programme, Antanaimena Immeuble Santa, Lot II 3ème étage 101, Antananarivo, Madagascar
| | - Laurent Kapesa
- US President's Malaria Initiative, US Centers for Disease Control and Prevention, Antananarivo, Madagascar
| | - Haja Andriamiharisoa
- Maternal and Child Survival Programme, Antanaimena Immeuble Santa, Lot II 3ème étage 101, Antananarivo, Madagascar
| | - Laura C Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bakoly Randrianarisoa
- Maternal and Child Survival Programme, Antanaimena Immeuble Santa, Lot II 3ème étage 101, Antananarivo, Madagascar
| | - Reena Sethi
- Maternal and Child Survival Program, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Patricia Gomez
- Maternal and Child Survival Program, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Jocelyn Razafindrakoto
- US President's Malaria Initiative, US Centers for Disease Control and Prevention, Antananarivo, Madagascar
| | - Eliane Razafimandimby
- Maternal and Child Survival Programme, Antanaimena Immeuble Santa, Lot II 3ème étage 101, Antananarivo, Madagascar
| | - Ralaivaomisa Andrianandraina
- Maternal and Child Survival Programme, Antanaimena Immeuble Santa, Lot II 3ème étage 101, Antananarivo, Madagascar
| | | | - Aimée Ravaoarinosy
- National Malaria Control Programme, Ministry of Health, Antananarivo, Madagascar
| | | | - Barbara Rawlins
- Maternal and Child Survival Program, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| |
Collapse
|
6
|
Madumla EP, Moore SJ, Moore J, Mbuba E, Mbeyela EM, Kibondo UA, C S, Mmbaga, Kobe D, Baraka J, Msellemu D, Swai JK, Mboma ZM, Odufuwa OG. "In starvation, a bone can also be meat": a mixed methods evaluation of factors associated with discarding of long-lasting insecticidal nets in Bagamoyo, Tanzania. Malar J 2022; 21:101. [PMID: 35331242 PMCID: PMC8944021 DOI: 10.1186/s12936-022-04126-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/17/2022] [Indexed: 11/27/2022] Open
Abstract
Background Between 2000 and 2019, more than 1.8 billion long-lasting insecticidal nets (LLINs) were distributed in Africa. While the insecticidal durability of LLINs is around 3 years, nets are commonly discarded 2 years post distribution. This study investigated the factors associated with the decision of users to discard LLINs. Methods A mixed-method sequential explanatory approach using a structured questionnaire followed by focus group discussions (FGDs) to collect information on experiences, views, reasons, how and when LLINs are discarded. Out of 6,526 households that responded to the questionnaire of LLINs durability trial, 160 households were randomly selected from the households in four villages in Bagamoyo Tanzania for FGDs but only 155 households participated in the FGDs. Five of the household representatives couldn’t participate due to unexpected circumstances. A total of sixteen FGDs each comprising of 8–10 adults were conducted; older women (40–60 years), older men (40–60 years), younger women (18–39 years), younger men (18–39 years). During the FGDs, participants visually inspected seven samples of LLINs that were “too-torn” based on Proportionate Hole Index recommended by the World Health Organization (WHO) guidelines on LLIN testing, the nets were brought to the discussion and participants had to determine if such LLINs were to be kept or discarded. The study assessed responses from the same participants that attended FGD and also responded to the structured questionnaire, 117 participants fulfilled the criteria, thus data from only 117 participants are analysed in this study. Results In FGDs, integrity of LLIN influenced the decision to discard or keep a net. Those of older age, women, and householders with lower income were more likely to classify a WHO “too-torn” net as “good”. The common methods used to discard LLINs were burning and burying. The findings were seen in the quantitative analysis. For every additional hole, the odds of discarding a WHO “too-torn” LLIN increased [OR = 1.05 (95%CI (1.04–1.07)), p < 0.001]. Younger age group [OR = 4.97 (95%CI (3.25–7.32)), p < 0.001], male-headed households [OR = 6.85 (95%CI (4.44 –10.59)), p < 0.001], and wealthy households [OR = 3.88 (95%CI (2.33–6.46)), p < 0.001] were more likely to discard LLINs. Conclusion Integrity of LLIN was the main determinant for discarding or keeping LLINs and the decision to discard the net is associated with socioeconomic status of the household, and the age and gender of respondents. WHO “too torn” nets are encouraged to be used instead of none until replacement, and disposal of nets should be based on recommendation. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04126-5.
Collapse
Affiliation(s)
- Edith P Madumla
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania. .,Nelson Mandela African Institution of Science and Technology, Tengeru, Arusha, Tanzania.
| | - Sarah J Moore
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania.,Nelson Mandela African Institution of Science and Technology, Tengeru, Arusha, Tanzania.,Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland.,University of Basel, St. Petersplatz 1, CH-4002, Basel, Switzerland
| | - Jason Moore
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania.,Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland
| | - Emmanuel Mbuba
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania.,Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland.,University of Basel, St. Petersplatz 1, CH-4002, Basel, Switzerland
| | - Edgar M Mbeyela
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Ummi A Kibondo
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | | | - Mmbaga
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Dickson Kobe
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Jitihada Baraka
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Daniel Msellemu
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania.,Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland.,University of Basel, St. Petersplatz 1, CH-4002, Basel, Switzerland
| | - Johnson K Swai
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Zawadi M Mboma
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Olukayode G Odufuwa
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania.,Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland.,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
7
|
Sayre D, Steinhardt LC, Irinantenaina J, Dentinger C, Rasoanaivo TF, Kapesa L, Razafindrakoto J, Legrand A, Prada N, Gutman J, Lewis L, Mangahasimbola RT, Andriamananjara M, Ravaoarinosy AV, Ralemary N, Garchitorena A, Harimanana A. Baseline malaria prevalence and care-seeking behaviours in rural Madagascar prior to a trial to expand malaria community case management to all ages. Malar J 2021; 20:422. [PMID: 34702255 PMCID: PMC8549293 DOI: 10.1186/s12936-021-03956-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrated community case management of malaria, pneumonia, and diarrhoea can reduce mortality in children under five years (CU5) in resource-poor countries. There is growing interest in expanding malaria community case management (mCCM) to older individuals, but limited empirical evidence exists to guide this expansion. As part of a two-year cluster-randomized trial of mCCM expansion to all ages in southeastern Madagascar, a cross-sectional survey was conducted to assess baseline malaria prevalence and healthcare-seeking behaviours. METHODS Two enumeration areas (EAs) were randomly chosen from each catchment area of the 30 health facilities (HFs) in Farafangana district designated for the mCCM age expansion trial; 28 households were randomly selected from each EA for the survey. All household members were asked about recent illness and care-seeking, and malaria prevalence was assessed by rapid diagnostic test (RDT) among children < 15 years of age. Weighted population estimates and Rao-Scott chi-squared tests were used to examine illness, care-seeking, malaria case management, and malaria prevalence patterns. RESULTS Illness in the two weeks prior to the survey was reported by 459 (6.7%) of 8050 respondents in 334 of 1458 households surveyed. Most individuals noting illness (375/459; 82.3%) reported fever. Of those reporting fever, 28.7% (112/375) sought care; this did not vary by participant age (p = 0.66). Most participants seeking care for fever visited public HFs (48/112, 46.8%), or community healthcare volunteers (CHVs) (40/112, 31.0%). Of those presenting with fever at HFs or to CHVs, 87.0% and 71.0%, respectively, reported being tested for malaria. RDT positivity among 3,316 tested children < 15 years was 25.4% (CI: 21.5-29.4%) and increased with age: 16.9% in CU5 versus 31.8% in 5-14-year-olds (p < 0.0001). Among RDT-positive individuals, 28.4% of CU5 and 18.5% of 5-14-year-olds reported fever in the two weeks prior to survey (p = 0.044). CONCLUSIONS The higher prevalence of malaria among older individuals coupled with high rates of malaria testing for those who sought care at CHVs suggest that expanding mCCM to older individuals may substantially increase the number of infected individuals with improved access to care, which could have additional favorable effects on malaria transmission.
Collapse
Affiliation(s)
- Dean Sayre
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA. .,Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC Atlanta, 1600 Clifton Rd, Atlanta, GA, USA.
| | - Laura C Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC Atlanta, 1600 Clifton Rd, Atlanta, GA, USA
| | | | - Catherine Dentinger
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC Atlanta, 1600 Clifton Rd, Atlanta, GA, USA.,U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, Lot 207A, Point Liberty, Andranoro, Antehiroka, 105, Antananarivo, Madagascar
| | | | - Laurent Kapesa
- U.S. President's Malaria Initiative, USAID, Lot 207A, Point Liberty, Andranoro, Antehiroka, 105, Antananarivo, Madagascar
| | - Jocelyn Razafindrakoto
- U.S. President's Malaria Initiative, USAID, Lot 207A, Point Liberty, Andranoro, Antehiroka, 105, Antananarivo, Madagascar
| | - Agathe Legrand
- Institut Pasteur de Madagascar , BP 1274 Ambatofotsikely, 101, Antananarivo, Madagascar
| | - Nicole Prada
- Institut Pasteur de Madagascar , BP 1274 Ambatofotsikely, 101, Antananarivo, Madagascar
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC Atlanta, 1600 Clifton Rd, Atlanta, GA, USA
| | - Lauren Lewis
- U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA.,Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC Atlanta, 1600 Clifton Rd, Atlanta, GA, USA
| | | | | | | | - Nicolas Ralemary
- Ministry of Public Health, Farafangana District Office, Farafangana, Madagascar
| | - Andres Garchitorena
- Institut Pasteur de Madagascar , BP 1274 Ambatofotsikely, 101, Antananarivo, Madagascar.,MIVEGEC, Univ. Montpellier, CNRS, IRD, 911 Av Agropolis, Montpellier, France
| | - Aina Harimanana
- Institut Pasteur de Madagascar , BP 1274 Ambatofotsikely, 101, Antananarivo, Madagascar
| |
Collapse
|
8
|
Carrel M, Kim S, Mwandagalirwa MK, Mvuama N, Bala JA, Nkalani M, Kihuma G, Atibu J, Diallo AO, Goel V, Thwai KL, Juliano JJ, Emch M, Tshefu A, Parr JB. Individual, household and neighborhood risk factors for malaria in the Democratic Republic of the Congo support new approaches to programmatic intervention. Health Place 2021; 70:102581. [PMID: 34020231 PMCID: PMC8328915 DOI: 10.1016/j.healthplace.2021.102581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Democratic Republic of the Congo (DRC) remains one of the countries most impacted by malaria despite decades of control efforts, including multiple mass insecticide treated net (ITN) distribution campaigns. The multi-scalar and complex nature of malaria necessitates an understanding of malaria risk factors over time and at multiple levels (e.g., individual, household, community). Surveillance of households in both rural and urban settings over time, coupled with detailed behavioral and geographic data, enables the detection of seasonal trends in malaria prevalence and malaria-associated behaviors as well as the assessment of how the local environments within and surrounding an individual's household impact malaria outcomes. METHODS Participants from seven sites in Kinshasa Province, DRC were followed for over two years. Demographic, behavioral, and spatial information was gathered from enrolled households. Malaria was assessed using both rapid diagnostic tests (RDT) and polymerase chain reaction (PCR) and seasonal trends were assessed. Hierarchical regression modeling tested associations between behavioral and environmental factors and positive RDT and PCR outcomes at individual, household and neighborhood scales. RESULTS Among 1591 enrolled participants, malaria prevalence did not consistently vary seasonally across the sites but did vary by age and ITN usage. Malaria was highest and ITN usage lowest in children ages 6-15 years across study visits and seasons. Having another member of the household test positive for malaria significantly increased the risk of an individual having malaria [RDT: OR = 4.158 (2.86-6.05); PCR: OR = 3.37 (2.41-4.71)], as did higher malaria prevalence in the 250 m neighborhood around the household [RDT: OR = 2.711 (1.42-5.17); PCR: OR = 4.056 (2.3-7.16)]. Presence of water within close proximity to the household was also associated with malaria outcomes. CONCLUSIONS Taken together, these findings suggest that targeting non-traditional age groups, children >5 years old and teenagers, and deploying household- and neighborhood-focused interventions may be effective strategies for improving malaria outcomes in high-burden countries like the DRC.
Collapse
Affiliation(s)
- Margaret Carrel
- Department of Geographical & Sustainability Sciences, 305 Jessup Hall, University of Iowa, Iowa City, IA, 52245, USA.
| | - Seungwon Kim
- Department of Geographical & Sustainability Sciences, 305 Jessup Hall, University of Iowa, Iowa City, IA, 52245, USA.
| | - Melchior Kashamuka Mwandagalirwa
- Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA; Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Nono Mvuama
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Joseph A Bala
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Marthe Nkalani
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Georges Kihuma
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Joseph Atibu
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Alpha Oumar Diallo
- Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Varun Goel
- Department of Geography, CB3220, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Kyaw L Thwai
- Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Jonathan J Juliano
- Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA; Division of Infectious Diseases, School of Medicine, CB#7030, 130 Mason Farm Road, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Michael Emch
- Department of Geography, CB3220, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Antoinette Tshefu
- Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
| | - Jonathan B Parr
- Division of Infectious Diseases, School of Medicine, CB#7030, 130 Mason Farm Road, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA.
| |
Collapse
|
9
|
Andrianantoandro VT, Pourette D, Rakotomalala O, Ramaroson HJV, Ratovoson R, Rakotoarimanana FMJ. Factors influencing maternal healthcare seeking in a highland region of Madagascar: a mixed methods analysis. BMC Pregnancy Childbirth 2021; 21:428. [PMID: 34134653 PMCID: PMC8210351 DOI: 10.1186/s12884-021-03930-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Madagascar, maternal mortality remains stable and high (426 deaths per 100,000 live births). This situation is mainly due to a delay or lack of use of maternal healthcare services. Problems related to maternal healthcare services are well documented in Madagascar, but little information related to maternal healthcare seeking is known. Thus, this paper aims to identify and analyze the factors that influence the utilization of maternal services, specifically, the use of antenatal care (ANC) during pregnancy and the use of skilled birth attendants (SBAs) at delivery. METHOD We used quantitative and qualitative approaches in the study. Two communes of the Vakinankaratra region, which are located in the highlands, were the settings. Data collection occurred from October 2016 to July 2017. A total of 245 pregnant women were included and followed up in the quantitative survey, and among them, 35 participated in in-depth interviews(IDIs). Logistic regressions were applied to explore the influencing factors of antenatal and delivery healthcare seeking practices through thematic qualitative analysis. RESULTS Among the 245 women surveyed, 13.9% did not attend any ANC visits. School level, occupation and gravidity positively influenced the likelihood of attending one or more ANC visits. The additional use of traditional caregivers remained predominant and was perceived as potentially complementary to medical care. Nine in ten (91%) women expressed a preference for delivery at healthcare facilities (HFs), but 61% of births were assisted by a skilled birth attendant (SBA).The school level; the frequency of ANCs; the origin region; and the preference between modern or traditional care influenced the use of SBAs at delivery. A lack of preparation (financial and logistics problems) and women's low involvement in decision making at delivery were the main barriers to giving birth at HFs. CONCLUSION The use of maternal healthcare services is starting to gain ground, although many women and their relatives still use traditional caregivers at the same time. Relatives play a crucial role in maternal healthcare seeking. It would be necessary to target women's relatives for awareness-raising messages about ANC and childbirth in healthcare facilities and to support and formalize collaborations between traditional healers and biomedical caregivers.
Collapse
Affiliation(s)
- Voahirana Tantely Andrianantoandro
- Unité Mixte Internationale-Résiliences (Université Catholique de Madagascar, Institut de Recherche pour le Développement), Université Catholique de Madagascar, BP 6059, 101, Antananarivo, Madagascar.
| | - Dolorès Pourette
- IRD, Ceped (IRD, Université Paris Descartes, INSERM), équipe SAGESUD, Paris, France
| | - Olivier Rakotomalala
- Centre de recherche pour le développement (Université Catholique de Madagascar), Antananarivo, Madagascar
| | | | - Rila Ratovoson
- Unité d'Epidémiologie et de Recherche Clinique, Institut Pasteur, Antananarivo, Madagascar
| | | |
Collapse
|
10
|
Steinhardt LC, Ravaoarisoa E, Wiegand R, Harimanana A, Hedje J, Cotte AH, Zigirumugabe S, Kesteman T, Rasoloharimanana TL, Rakotomalala E, Randriamoramanana AM, Rakotondramanga JM, Razanatsiorimalala S, Mercereau-Puijalon O, Perraut R, Ratsimbasoa A, Butts J, Rogier C, Piola P, Randrianarivelojosia M, Vigan-Womas I. School-Based Serosurveys to Assess the Validity of Using Routine Health Facility Data to Target Malaria Interventions in the Central Highlands of Madagascar. J Infect Dis 2021; 223:995-1004. [PMID: 32761176 PMCID: PMC10940115 DOI: 10.1093/infdis/jiaa476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In low-malaria-transmission areas of Madagascar, annual parasite incidence (API) from routine data has been used to target indoor residual spraying at subdistrict commune level. To assess validity of this approach, we conducted school-based serological surveys and health facility (HF) data quality assessments in 7 districts to compare API to gold-standard commune-level serological measures. METHODS At 2 primary schools in each of 93 communes, 60 students were randomly selected with parents and teachers. Capillary blood was drawn for rapid diagnostic tests (RDTs) and serology. Multiplex bead-based immunoassays to detect antibodies to 5 Plasmodium falciparum antigens were conducted, and finite mixture models used to characterize seronegative and seropositive populations. Reversible catalytic models generated commune-level annual seroconversion rates (SCRs). HF register data were abstracted to assess completeness and accuracy. RESULTS RDT positivity from 12 770 samples was 0.5%. Seroprevalence to tested antigens ranged from 17.9% (MSP-1) to 59.7% (PF13). Median commune-level SCR was 0.0108 (range, 0.001-0.075). Compared to SCRs, API identified 71% (95% confidence interval, 51%-87%) of the 30% highest-transmission communes; sensitivity declined at lower levels. Routine data accuracy did not substantially affect API performance. CONCLUSIONS API performs reasonably well at identifying higher-transmission communes but sensitivity declined at lower transmission levels.
Collapse
Affiliation(s)
- Laura C Steinhardt
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elisabeth Ravaoarisoa
- Malaria Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Faculty of Sciences, University of Antananarivo, Antananarivo, Madagascar
| | - Ryan Wiegand
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aina Harimanana
- Epidemiology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Judith Hedje
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- US President's Malaria Initiative, Antananarivo, Madagascar
| | - Annett H Cotte
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sixte Zigirumugabe
- US President's Malaria Initiative, Antananarivo, Madagascar
- United States Agency for International Development, Washington, District of Columbia, USA
| | - Thomas Kesteman
- Malaria Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Fondation Merieux, Lyon, France
| | | | - Emma Rakotomalala
- Immunology of Infectious Diseases Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | | | | | | | - Ronald Perraut
- Immunology Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - Arsène Ratsimbasoa
- National Malaria Control Program of Madagascar, Ministry of Public Health, Antananarivo, Madagascar
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
- L'Institut Hospitalo-Universitaire en Maladies Infectieuses de Marseille, Marseille, France
| | - Jessica Butts
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christophe Rogier
- L'Institut Hospitalo-Universitaire en Maladies Infectieuses de Marseille, Marseille, France
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Patrice Piola
- Epidemiology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Inès Vigan-Womas
- Immunology of Infectious Diseases Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| |
Collapse
|
11
|
Njatosoa AF, Mattern C, Pourette D, Kesteman T, Rakotomanana E, Rahaivondrafahitra B, Andriamananjara M, Harimanana A, Razafindrakoto J, Raboanary E, Andrianasolo A, Rogier C. Family, social and cultural determinants of long-lasting insecticidal net (LLIN) use in Madagascar: secondary analysis of three qualitative studies focused on children aged 5-15 years. Malar J 2021; 20:168. [PMID: 33771162 PMCID: PMC7995690 DOI: 10.1186/s12936-021-03705-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Although it is accepted that long-lasting insecticidal net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; the malaria prevalence is highest in this age group. The purpose of this research is to summarize recent qualitative studies describing LLIN use among the Malagasy people with a focus on children aged 5–15 years. Methods Qualitative data from three studies on malaria conducted between 2012 and 2016 in 10 districts of Madagascar were analysed. These studies cover all malaria epidemiological profiles and 10 of the 18 existing ethnic groups in Madagascar. A thematic analysis was conducted on the collected data from semi-structured interviews, direct observation data, and informal interviews. Results A total of 192 semi-structured interviews were conducted. LLINs are generally perceived positively because they protect the health and well-being of users. However, regional representations of mosquito nets may contribute to LLIN lower use by children over 5 years of age including the association between married status and LLIN use, which leads to the refusal of unmarried young men to sleep under LLINs; the custom of covering the dead with a mosquito net, which leads to fear of LLIN use; and taboos governing sleeping spaces for siblings of opposite sexes, which leads to LLIN shortages in households. Children under 5 years of age are known to be the most vulnerable age group for acquiring malaria and, therefore, are prioritized for LLIN use when there are limited supplies in households. In contrast, children over 5 years of age, who are perceived to be at less risk for malaria, often sleep without LLINs. Conclusions Perceptions, social practices and regional beliefs regarding LLINs and vulnerability to malaria contribute to the nonuse of LLINs among children over 5 years of age in Madagascar. Modifying LLIN policies to account for these factors may increase LLIN use in this age group and reduce disease burden.
Collapse
Affiliation(s)
- Ammy Fiadanana Njatosoa
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
| | - Chiarella Mattern
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,IRD, Ceped (Institut de Recherche Pour Le Développement, Université de Paris, INSERM), Paris, France
| | - Dolorès Pourette
- IRD, Ceped (Institut de Recherche Pour Le Développement, Université de Paris, INSERM), Paris, France
| | - Thomas Kesteman
- Unité de Recherche Sur Le Paludisme, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Elliot Rakotomanana
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Mauricette Andriamananjara
- Programme National de Lutte Contre Le Paludisme, Ministère de La Santé Publique, Antananarivo, Madagascar
| | - Aina Harimanana
- Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Emma Raboanary
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Andry Andrianasolo
- Groupe Santé & Sciences Sociales, Unité Épidémiologie Et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Institut International Des Sciences Sociales, Antananarivo, Madagascar
| | - Christophe Rogier
- Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Primum Vitare, Paris, France
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Ratovoson R, Randremanana R, Rakotomanana F, Andriamandimby SF, Mangahasimbola R, Masquelier B, Richard V, Piola P, Pison G, Baril L. Cohort Profile: Moramanga health survey in urban and rural areas in Madagascar (MHURAM project). Int J Epidemiol 2019; 48:1754-1755i. [PMID: 31665291 DOI: 10.1093/ije/dyz215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rila Ratovoson
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,DemoSud Research Unit, Institut National d'Etudes Démographiques, Paris, France
| | - Rindra Randremanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Fanjasoa Rakotomanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Reziky Mangahasimbola
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Bruno Masquelier
- DemoSud Research Unit, Institut National d'Etudes Démographiques, Paris, France.,Center for Demographic Research, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Vincent Richard
- Direction of International Affairs, Institut Pasteur, Paris, France
| | - Patrice Piola
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Gilles Pison
- DemoSud Research Unit, Institut National d'Etudes Démographiques, Paris, France.,Eco-Anthropology Research Unit, National Museum of Natural History, Paris, France
| | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| |
Collapse
|
14
|
Indriambelo A, Rakotomamonjy MA, Andriamalala R, Rabarison H, Ratsimbason M, Knoblauch A, Randrianarivelojosia M. Herbal Remedies to Treat Malaria in Madagascar: Hype and Hope. Methods Mol Biol 2019; 2013:307-321. [PMID: 31267508 DOI: 10.1007/978-1-4939-9550-9_19] [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] [Indexed: 06/09/2023]
Abstract
On the island of Madagascar, prior to the arrival of the Europeans, some pathologies including malaria, locally known as tazo (fever), were already described. As part of the Malagasy traditional knowledge, traditional medicine mainly based on the use of herbal remedies is part of the malaria treatment still today. Across the country, hundreds of plants are identified as antimalarial, and some compounds from plants show interesting in vitro activities against human Plasmodium. However, it has become clear that most of the antimalarial herbal remedies traditionally used are not efficient antimalarials. In order to identify authentic antimalarial herbal remedies, methodical approaches should range from plant selection to biological screening. In this paper, we share our point of view based on our experience on antimalarial plants in Madagascar.
Collapse
Affiliation(s)
- Arsène Indriambelo
- Faculté des Sciences, Université de Toliara, Toliara, Madagascar
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Rakotondrafara Andriamalala
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Centre National d'Application de Recherche Pharmaceutique, Antananarivo, Madagascar
| | - Harison Rabarison
- Faculté des Sciences, Université d'Antananarivo, Antananarivo, Madagascar
| | - Michel Ratsimbason
- Centre National d'Application de Recherche Pharmaceutique, Antananarivo, Madagascar
| | - Astrid Knoblauch
- Faculté des Sciences, Université de Toliara, Toliara, Madagascar
- Global Health Institute, Stony Brook University, Stony Brook, NY, USA
| | - Milijaona Randrianarivelojosia
- Faculté des Sciences, Université de Toliara, Toliara, Madagascar.
- Institut Pasteur de Madagascar, Antananarivo, Madagascar.
| |
Collapse
|
15
|
Testing bio-efficacy of insecticide-treated nets with fewer mosquitoes for enhanced malaria control. Sci Rep 2018; 8:16769. [PMID: 30425283 PMCID: PMC6233220 DOI: 10.1038/s41598-018-34979-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/07/2018] [Indexed: 11/29/2022] Open
Abstract
Malaria control programs implementing Long-Lasting Insecticidal Nets (LLINs) are encouraged to conduct field monitoring of nets’ survival, fabric integrity and insecticidal bio-efficacy. The reference method for testing the insecticide activity of LLINs needs 100 two-to-five-day-old female mosquitoes per net, which is highly resource-intensive. We aimed at identifying an alternative protocol, using fewer mosquitos, while ensuring a precision in the main indicator of ±5 percentage points (pp). We compared different laboratory methods against the probability of the LLIN to fail the test as determined by a hierarchical Bayesian model. When using 50 mosquitoes per LLIN and considering mortality only instead of mortality or knock-down as validity criteria, the average error in the measure of the proportion of nets considered as valid was 0.40 pp. The 95% confidence interval of this value never exceed 5 pp when the number of LLIN tested was ≥40. This method slightly outperforms the current recommendations. As a conclusion, testing the bio-efficacy of LLINs with half as many mosquitoes provides a valid evaluation of the proportion of valid LLINs. This approach could increase entomology labs’ testing capacity and decrease costs, with no impact in the decision process for public health purposes.
Collapse
|
16
|
|
17
|
Girond F, Madec Y, Kesteman T, Randrianarivelojosia M, Randremanana R, Randriamampionona L, Randrianasolo L, Ratsitorahina M, Herbreteau V, Hedje J, Rogier C, Piola P. Evaluating Effectiveness of Mass and Continuous Long-lasting Insecticidal Net Distributions Over Time in Madagascar: A Sentinel Surveillance Based Epidemiological Study. EClinicalMedicine 2018; 1:62-69. [PMID: 30294720 PMCID: PMC6169794 DOI: 10.1016/j.eclinm.2018.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The reduction of global malaria burden over the past 15 years is much attributed to the expansion of mass distribution campaigns (MDCs) of long-lasting insecticidal nets (LLIN). In Madagascar, two LUN MDCs were implemented and one district also benefited from a community-based continuous distribution (CB-CD). Malaria incidence dropped but eventually rebounded after a decade. METHODS Data from a sentinel surveillance network over the 2009-2015 period was analyzed. Alerts were defined as w eekly number o f malaria cases exceeding the 90th percentile value for three consecutive weeks. Statistical analyses assessed the temporal relationship between LLIN MDCs and (i) number of malaria cases and (ii) malaria alerts detected, and (iii) the effect of a combination of MDCs and a CB-CD in Toamasina District. FINDINGS Analyses showed an increase of 13.6 points and 21.4 points in the percentile value of weekly malaria cases during the second and the third year following the MDC of LLINs respectively. The percentage of alert-free sentinel sites was 98.2% during the first year after LLIN MDC, 56.7% during the second year and 31.5% during the third year. The number of weekly malaria cases decreased by 14% during the CB-CD in Toamasina District. In contrast, sites without continuous distribution had a 12% increase of malaria cases. INTERPRETATION These findings support the malaria-preventive effectiveness of MDCs in Madagascar but highlight their limited duration when not followed by continuous distribution. The resulting policy implications are crucial to sustain reductions in malaria burden in high transmission settings.
Collapse
Affiliation(s)
- Florian Girond
- Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274 Avaradoha, Antananarivo 101, Madagascar
- UMR 228 ESPACE-DEV (IRD, UAG, UM, UR), Station SEAS-OI, 40 avenue de Soweto, 97410 Saint Pierre, France
- Elimination 8 (E8), Windhoek, Namibia
- Corresponding author at: 175 CD 26, L'Entre-Deux 97414, Ile de la Réunion, France.
| | - Yoann Madec
- Emerging Diseases Epidemiology Unit, Institut Pasteur, 25-28, rue du Docteur Roux, 75015 Paris, France
| | - Thomas Kesteman
- Unité de Recherche sur le Paludisme, Institut Pasteur de Madagascar, BP 1274, Avaradoha, Antananarivo 101, Madagascar
- Fondation Mérieux, 17 rue Bourgelat, 69002 Lyon, France
| | | | - Rindra Randremanana
- Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274 Avaradoha, Antananarivo 101, Madagascar
| | - Lea Randriamampionona
- Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274 Avaradoha, Antananarivo 101, Madagascar
- Direction de Veille Sanitaire et de Surveillance Epidémiologique, Ministry of Health, Madagascar
| | - Laurence Randrianasolo
- Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274 Avaradoha, Antananarivo 101, Madagascar
| | - Maherisoa Ratsitorahina
- Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274 Avaradoha, Antananarivo 101, Madagascar
- Direction de Veille Sanitaire et de Surveillance Epidémiologique, Ministry of Health, Madagascar
| | - Vincent Herbreteau
- UMR 228 ESPACE-DEV (IRD, UAG, UM, UR), Station SEAS-OI, 40 avenue de Soweto, 97410 Saint Pierre, France
| | - Judith Hedje
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
- U.S. President's Malaria Initiative, Antananarivo 101, Madagascar
| | - Christophe Rogier
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE) - UMR 6236, 27 boulevard Jean Moulin, 13385 Marseille Cedex 05, France
- Institute for Biomedical Research of the French Armed Forces (IRBA), BP 73, 91223 Brétigny Sur Orge Cedex, France
| | - Patrice Piola
- Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274 Avaradoha, Antananarivo 101, Madagascar
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh
| |
Collapse
|
18
|
|
19
|
Complications with use of misoprostol for abortion in Madagascar: between ease of access and lack of information. Contraception 2017; 97:116-121. [PMID: 29242087 DOI: 10.1016/j.contraception.2017.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 11/25/2017] [Accepted: 12/04/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective was to learn what complications some women experienced in Madagascar following use of misoprostol for abortion and what treatment they received post misoprostol use. STUDY DESIGN This was a qualitative study in 2015-2016 among women who had experienced complications after use of misoprostol, with or without additional methods, for abortion; what information they received before use; what dosage and regimens they used; what complications they experienced; and what treatment they received postuse. We initially conducted in-depth, semistructured interviews with 60 women who had undergone an abortion that resulted in complications. The results presented here are based on interviews with the subset of 19 women who had used misoprostol. RESULTS The 19 women were aged 16-40, with an average age of 21-26 at interview and average age of 18-21 at abortion. To obtain an abortion, they sought advice from partners, friends, family members, and/or traditional practitioners and health care providers. Misoprostol was easily accessible through the formal and informal sectors, but the dosages and regimens the women used on the advice of others were extremely variable, did not match WHO guidelines and were apparently ineffective, resulting in failed abortion, incomplete abortion, heavy bleeding/hemorrhage, strong pain and/or infection. CONCLUSIONS This study provides data on complications from the use of misoprostol as an abortifacient in Madagascar. Health care providers need training in correct misoprostol use and how to treat complications. Law and policy reforms are needed to support such training and to ensure the provision of safe abortion services in the public health system. IMPLICATIONS Health care providers who provide abortion care and treatment of abortion complications need training in correct misoprostol use and treatment of complications. Women and pharmacy workers also need this information. Law and policy reforms are needed to allow training and provision of safe services. Further research is needed on the extent and impact of incorrect misoprostol administration.
Collapse
|
20
|
Randriamaherijaona S, Raharinjatovo J, Boyer S. Durability monitoring of long-lasting insecticidal (mosquito) nets (LLINs) in Madagascar: physical integrity and insecticidal activity. Parasit Vectors 2017; 10:564. [PMID: 29132421 PMCID: PMC5683549 DOI: 10.1186/s13071-017-2419-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 10/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Long-lasting insecticidal mosquito nets (LLINs) are highly effective for malaria prevention. However, it is also clear that durability monitoring is essential to predict when, post-distribution, a net population, no longer meets minimum WHO standards and needs to be replaced. Following a national distribution campaign in 2013, we tracked two durability indicators, physical integrity and bio-efficacy at six and 12 months post-distribution. While the loss of net integrity during this period was in line with expectations for a one-year net life, bio-efficacy results suggested that nets were losing insecticidal effect faster than expected. The rate of bio-efficacy loss varied significantly between different net brands. Methods We tested 600 randomly selected LLINs, 200 from each of three net brands. Each brand came from different eco-epidemiological zones reflecting the original distribution scheme. Fabric integrity (size and number of holes) was quantified using the proportional hole index (pHI). A subsample of the nets, 134 new nets, 150 at six months and 124 at 12 months, were then tested for bio-efficacy using the World Health Organization (WHO) recommended method. Results Three net types, Netprotect®, Royalsentry® and Yorkool®, were followed. After six months, 54%, 39% and 45%, respectively, showed visible loss of integrity. The median pHI by type was estimated to be one, zero and one respectively. The percentage of damaged nets increased after 12 months such that 83.5%, 74% and 68.5%, had holes. The median pHI for each brand of nets was 47.5, 47 and 23. No significant difference in the estimated pHI at either six or 12 months was observed. There was a statistically significant difference in the proportion of hole size category between the three brands (χ2 = 15.761, df = 4, P = 0.003). In cone bio-assays, mortality of new Yorkool® nets was surprisingly low (48.6%), mortality was 90.2% and 91.3% for Netprotect® and Royalsentry® (F(2, 131) = 81.59, P < 0.0001), respectively. At 12 month use, all tested nets were below the WHO threshold for replacement. Conclusion These findings suggest that there is a need for better net quality control before distribution. More frequent replacement of LLINs is probably not an option programmatically. Regardless of prior approval, LLIN durability monitoring for quality assessment as well as net loss following distribution is necessary to improve malaria control efforts. Electronic supplementary material The online version of this article (10.1186/s13071-017-2419-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sanjiarizaha Randriamaherijaona
- Unité d'Entomologie Médicale, Institut Pasteur de Madagascar, 1274 Avaradoha, 101, Antananarivo, BP, Madagascar. .,Ecole doctorale Sciences de la vie et de l'environnement, Université d'Antananarivo, 101, Antananarivo, Madagascar.
| | - Jacky Raharinjatovo
- Population Services International Madagascar, 7748 Ampefiloha, 101, Antananarivo, BP, Madagascar
| | - Sébastien Boyer
- Medical Entomology Platform, Institute Pasteur of Cambodia, 5 Preah Monivong Blvd (93), Phnom Penh, Cambodia
| |
Collapse
|
21
|
Nkamedjie PP, Dongho GB, Mabvouna RB, Russo G, Sobze MS. Long lasting impregnated mosquito net (LLIN) utilisation, incidence of fever and therapeutic itineraries: the case of Mifi health district in western Cameroon. MALARIAWORLD JOURNAL 2017; 8:19. [PMID: 34532242 PMCID: PMC8415069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Long Lasting Impregnated mosquito Net (LLIN) use is effective against malaria in endemic tropical areas. However, its utilisation remains limited. Among the most common clinical signs of malaria is fever and many studies have reported the existence of different local ways of handling fever; amongst which uncontrolled used of antimalarial drugs. We investigated LLINs use and its impact on fever outcomes and the various therapeutic measures used to deal with fever episodes. MATERIALS AND METHODS Data was extracted from a cross sectional descriptive and analytic study performed between January and April 2014 in Mifi health district. Data was collected in households through a face to face interview with standard household questionnaires, treated and analysed using Epi Info statistical software version 3.5.3. RESULTS A total of 317 participants were interviewed with average age 33.2 years (SD = 10.8). Female respondents were predominant (85.2%; n=270). Most participants attended secondary education (53.6%; n= 170). Married marital status was most represented (58.1%; n= 185). 75.4% (n=239) of households owned at least 1 LLIN against an estimated average district coverage of 1 LLIN for 3.3 persons. Average bednet usage for households owning at least 1 LLIN was 57.9%. Utilisation of LLINs in households reduced fever episodes by 5.3%, (p=0.36). To handle fever episodes, road side medicines represented priority therapeutic itinerary for most of our respondents (95.0%; n=301). CONCLUSIONS Although LLINs are effective in reducing fever episodes, their utilisation remains low. Self-medication to treat fever seems to be prominent. There is a need to optimise communication for behavioural change strategies to promote consistent LLIN use and anti-malarial therapy, assisted by qualified health personnel.
Collapse
Affiliation(s)
- Patrick P. Nkamedjie
- Institute for Research, Socio-economic Development and Communication (IRESCO), Yaoundé, Cameroon,*
| | - Ghyslaine B. Dongho
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Italy
| | - Rodrigue B. Mabvouna
- Department of Biology, Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Gianluca Russo
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Italy
| | - Martin S. Sobze
- Department of Biomedical Sciences, University of Dschang, Cameroon
| |
Collapse
|
22
|
Brooks HM, Jean Paul MK, Claude KM, Mocanu V, Hawkes MT. Use and disuse of malaria bed nets in an internally displaced persons camp in the Democratic Republic of the Congo: A mixed-methods study. PLoS One 2017; 12:e0185290. [PMID: 28950001 PMCID: PMC5614551 DOI: 10.1371/journal.pone.0185290] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/08/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Malaria is a major cause of morbidity and mortality among displaced populations in tropical zones. Bed nets are widely used to prevent malaria; however, few data are available on bed net distribution within displaced populations. Methods Mixed methods study in a single internally displaced persons (IDP) camp and neighboring community in Eastern Democratic Republic of the Congo (DRC). Qualitative data (focus group discussions, FGDs) and quantitative data (door-to-door survey and individual testing using malaria rapid diagnostic test, RDT) were collected. Results Ten FGDs were conducted with 55 individuals. Although malaria was widely recognized as a significant threat and bed nets were freely distributed in the camp, many households did not own or use them. IDPs converged on the following reasons for low bed net ownership and use: inconvenience of net installation and sale of nets to meet immediate needs such as food. One hundred households, comprised of 411 individuals, were surveyed in Birambizo. The burden of malaria was high (45/78 (58%) of children <5 were positive for malaria by RDT) and bed net utilization was low (29/100 (29%) households owned a bed net, and 85/411 (20%) individuals slept under a bed net the previous night). Children <5 were more likely to use a bed net than older children or adults (OR 3.4 (95%CI 2.0–5.8), p<0.0001). Compared to 29 bed nets currently in use by study participants, 146 bed nets had been sold (82%) or exchanged (18%) either in the camp (27%) or in the neighbouring village market (73%). Conclusions Qualitative descriptions and quantitative analysis revealed pragmatic barriers to bed net usage and widespread sale of freely distributed bed nets within IDP camps, despite a high burden of malaria. Additional strategies, beyond bed net distribution, are warranted to combat malaria in vulnerable and hard-to-reach population.
Collapse
Affiliation(s)
| | | | | | - Victor Mocanu
- Department of Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Michael T. Hawkes
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
| |
Collapse
|
23
|
Koenker H, Yukich JO. Effect of user preferences on ITN use: a review of literature and data. Malar J 2017; 16:233. [PMID: 28571583 PMCID: PMC5455118 DOI: 10.1186/s12936-017-1879-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/26/2017] [Indexed: 11/14/2022] Open
Abstract
Background Insecticide-treated bed nets (ITNs) are the primary tool for vector control, and optimizing ITN use is a key concern of national programmes. Available evidence indicates that bed net users often have preferences for shape, colour, size, and other attributes, but it is unclear whether these preferences are strong enough to have any significant effect on bed net use, and whether countries and donors should invest in more expensive attributes in order to maximize ITN use. The link between bed net attributes, preferences, and use was investigated using a literature review and review of publicly available, nationally representative household surveys from sub-Saharan Africa. Methods A literature search was conducted to identify publications with data on preferences for net attributes and on associations between net attributes and use. Publicly available DHS and MIS datasets were screened for variables on net preferences and net attributes. Wald tests were run to obtain odds ratios and confidence intervals for the use of nets of various attributes in univariate analysis. A multilevel logistic regression was constructed to assess the odds of a net’s use, controlling for background variables and adding random effects variables at the household and cluster level. Results Preferences for certain net attributes exist, but do not impede high rates of net use in countries where data were available. Stated preferences for shape and colour do not significantly influence net use to degrees that would require action by programme planners. By and large, people are using the nets they receive, and when they do not, it is for reasons unrelated to shape and size (primarily perceived mosquito density, heat or an excess of nets). Households in higher wealth quintiles tend to own greater numbers of conical nets, indicating that they have the ability to obtain or purchase these nets on their own, and individuals resident in higher wealth quintile households also use conical nets preferentially. Conclusions The increased manufacturing costs for conical nets are not outweighed by the very small, often non-existent, increases in use rates in sub-Saharan Africa. Programmes that wish to explore the relationship between net attributes, preferences and use rates should include these questions in nationally representative household surveys to be able to capture trends across geographic and socio-economic groups. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1879-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hannah Koenker
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA.
| | - Joshua O Yukich
- Center for Applied Malaria Research, Tulane University School of Public Health, New Orleans, LA, USA
| |
Collapse
|
24
|
Olive MM, Grosbois V, Tran A, Nomenjanahary LA, Rakotoarinoro M, Andriamandimby SF, Rogier C, Heraud JM, Chevalier V. Reconstruction of Rift Valley fever transmission dynamics in Madagascar: estimation of force of infection from seroprevalence surveys using Bayesian modelling. Sci Rep 2017; 7:39870. [PMID: 28051125 PMCID: PMC5209714 DOI: 10.1038/srep39870] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/29/2016] [Indexed: 11/09/2022] Open
Abstract
The force of infection (FOI) is one of the key parameters describing the dynamics of transmission of vector-borne diseases. Following the occurrence of two major outbreaks of Rift Valley fever (RVF) in Madagascar in 1990-91 and 2008-09, recent studies suggest that the pattern of RVF virus (RVFV) transmission differed among the four main eco-regions (East, Highlands, North-West and South-West). Using Bayesian hierarchical models fitted to serological data from cattle of known age collected during two surveys (2008 and 2014), we estimated RVF FOI and described its variations over time and space in Madagascar. We show that the patterns of RVFV transmission strongly differed among the eco-regions. In the North-West and Highlands regions, these patterns were synchronous with a high intensity in mid-2007/mid-2008. In the East and South-West, the peaks of transmission were later, between mid-2008 and mid-2010. In the warm and humid northwestern eco-region favorable to mosquito populations, RVFV is probably transmitted all year-long at low-level during inter-epizootic period allowing its maintenance and being regularly introduced in the Highlands through ruminant trade. The RVF surveillance of animals of the northwestern region could be used as an early warning indicator of an increased risk of RVF outbreak in Madagascar.
Collapse
Affiliation(s)
- Marie-Marie Olive
- CIRAD, Animal and Integrated Risk Management (AGIRs) Unit, Montpellier, France
- Institut Pasteur de Madagascar, Virology Unit, Antananarivo, Madagascar
| | - Vladimir Grosbois
- CIRAD, Animal and Integrated Risk Management (AGIRs) Unit, Montpellier, France
| | - Annelise Tran
- CIRAD, Animal and Integrated Risk Management (AGIRs) Unit, Montpellier, France
| | | | | | | | - Christophe Rogier
- Institut Pasteur de Madagascar, Direction, Madagascar
- Institute for Biomedical Research of the French Armed Forces (IRBA), Brétigny-Sur-Orge, France
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), Marseille, France
| | | | - Veronique Chevalier
- CIRAD, Animal and Integrated Risk Management (AGIRs) Unit, Montpellier, France
| |
Collapse
|
25
|
Contemporary epidemiological overview of malaria in Madagascar: operational utility of reported routine case data for malaria control planning. Malar J 2016; 15:502. [PMID: 27756389 PMCID: PMC5070222 DOI: 10.1186/s12936-016-1556-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria remains a major public health problem in Madagascar. Widespread scale-up of intervention coverage has led to substantial reductions in case numbers since 2000. However, political instability since 2009 has disrupted these efforts, and a resurgence of malaria has since followed. This paper re-visits the sub-national stratification of malaria transmission across Madagascar to propose a contemporary update, and evaluates the reported routine case data reported at this sub-national scale. METHODS Two independent malariometrics were evaluated to re-examine the status of malaria across Madagascar. First, modelled maps of Plasmodium falciparum infection prevalence (PfPR) from the Malaria Atlas Project were used to update the sub-national stratification into 'ecozones' based on transmission intensity. Second, routine reports of case data from health facilities were synthesized from 2010 to 2015 to compare the sub-national epidemiology across the updated ecozones over time. Proxy indicators of data completeness are investigated. RESULTS The epidemiology of malaria is highly diverse across the island's ecological regions, with eight contiguous ecozones emerging from the transmission intensity PfPR map. East and west coastal areas have highest transmission year-round, contrasting with the central highlands and desert south where trends appear more closely associated with epidemic outbreak events. Ecozones have shown steady increases in reported malaria cases since 2010, with a near doubling of raw reported case numbers from 2014 to 2015. Gauges of data completeness suggest that interpretation of raw reported case numbers will underestimate true caseload as only approximately 60-75 % of health facility data are reported to the central level each month. DISCUSSION A sub-national perspective is essential when monitoring the epidemiology of malaria in Madagascar and assessing local control needs. A robust assessment of the status of malaria at a time when intervention coverage efforts are being scaled up provides a platform from which to guide intervention preparedness and assess change in future periods of transmission.
Collapse
|
26
|
Randriamaherijaona S, Velonirina HJ, Boyer S. Susceptibility status of Anopheles arabiensis (Diptera: Culicidae) commonly used as biological materials for evaluations of malaria vector control tools in Madagascar. Malar J 2016; 15:338. [PMID: 27364163 PMCID: PMC4929764 DOI: 10.1186/s12936-016-1406-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Madagascar is a malaria-endemic country with an increase in cases in recent years. In vector control using insecticide, a susceptible strain is necessary to evaluate insecticide efficacy, either for spraying or on nets. The susceptibility of Anopheles arabiensis from Antananarivo, Madagascar to two organophosphate, three pyrethroid, two carbamate, and one organochlorine insecticides was investigated. Since 2010, An. arabiensis strain has been maintained away from insecticide source during 110 generations with optimal insectarium conditions. Methods Bioassay were performed on adult mosquitoes to assess the susceptibility of An. arabiensis to insecticide-impregnated papers (malathion 5 %, fenitrothion 1 %, deltamethrin 0.05 %, permethrin 0.75 %, alphacypermethrin 0.05 %, bendiocarb 0.1 %, propoxur 0.01 %, and DDT 4 %) following World Health Organization Pesticide Evaluation Scheme guidelines. Bioassay using Center for Disease Control bottle tests were also used to detect mortality. Molecular assay were carried out to detect the presence of knock down resistance (kdr) mutation using PCR techniques. Results Anopheles arabiensis is fully susceptible with 100 % mortality to malathion, fenitrothion, deltamethrin, permethrin, alphacypermethrin, bendiocarb, propoxur, and DDT. No kdr gene was detected using PCR method. Conclusion The strain An. arabiensis maintained in the insectarium of Institut Pasteur de Madagascar is a fully susceptible strain and can be used for insecticide evaluation.
Collapse
Affiliation(s)
- Sanjiarizaha Randriamaherijaona
- Unité d'Entomologie Médicale, Institut Pasteur de Madagascar, Antananarivo, Madagascar. .,Ecole Doctorale Science de la vie et de l'environnement, Faculté des Sciences, Université d'Antananarivo, Antananarivo, Madagascar.
| | | | - Sébastien Boyer
- Unité d'Entomologie Médicale, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| |
Collapse
|
27
|
Kesteman T, Randrianarivelojosia M, Piola P, Rogier C. Post-deployment effectiveness of malaria control interventions on Plasmodium infections in Madagascar: a comprehensive phase IV assessment. Malar J 2016; 15:322. [PMID: 27306378 PMCID: PMC4910239 DOI: 10.1186/s12936-016-1376-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/08/2016] [Indexed: 11/24/2022] Open
Abstract
Background Because international funding for malaria control is plateauing, affected countries that receive foreign funding are expected to maintain a constant budget while continuing to reduce Plasmodium transmission. To investigate the appropriateness of a malaria control policy in Madagascar, the effectiveness of all currently deployed malaria control interventions (MCIs) was measured. Methods A nationwide cross-sectional survey was conducted in 2012–2013 at 62 sites throughout Madagascar. A total of 15,746 individuals of all ages were tested for Plasmodium infection using rapid diagnostic tests and were interviewed about their use of long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS), intermittent preventive treatment of pregnant women (IPTp), and exposure to information, education and communication (IEC) campaigns. The association between Plasmodium infection and MCI exposure was calculated using multivariate multilevel models, and the protective effectiveness (PE) of an intervention was defined as one minus the odds ratio of this association. Results The individual PE of regular LLIN use was high and significant (41 %, 95 % confidence interval [CI] 23–54), whereas its community PE was not. The PE of IRS at the household level was significant in one transmission pattern only (44 %, 95 % CI 11–65), and the community PE with high IRS coverage (>75 %) was high and significant overall (78 %, 95 % CI 44–91). Using LLINs after IRS increased the PE, and the reciprocal was also true. The maternal PE of IPTp was high but non-significant (65 %, 95 % CI −32 to 91). The PE of IEC was low, non-significant and restricted to certain areas (24 %, 95 % CI −34 to 57). Conclusions This snapshot of the effectiveness of MCIs confirms that integrated vector control is required in malaria control policies in Madagascar and suggests combining MCIs when one is questionable. Policymakers should consider the local effectiveness of all deployed MCIs through a similar phase IV assessment. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1376-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Thomas Kesteman
- Malaria Research Unit, Institut Pasteur de Madagascar, BP 1274, 101, Avaradoha, Antananarivo, Madagascar. .,Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE)-UMR 6236, 27 boulevard Jean Moulin, 13385, Marseille, Cedex 05, France. .,Fondation Mérieux, 17 rue Bourgelat, 69002, Lyon, France.
| | | | - Patrice Piola
- Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, 101 Avaradoha, Antananarivo, Madagascar
| | - Christophe Rogier
- Malaria Research Unit, Institut Pasteur de Madagascar, BP 1274, 101, Avaradoha, Antananarivo, Madagascar.,Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE)-UMR 6236, 27 boulevard Jean Moulin, 13385, Marseille, Cedex 05, France.,Institute for Biomedical Research of the French Armed Forces (IRBA), BP 73, 91223, Brétigny-Sur-Orge Cedex, France
| |
Collapse
|
28
|
Kesteman T, Randrianarivelojosia M, Raharimanga V, Randrianasolo L, Piola P, Rogier C. Effectiveness of malaria control interventions in Madagascar: a nationwide case-control survey. Malar J 2016; 15:83. [PMID: 26867661 PMCID: PMC4751752 DOI: 10.1186/s12936-016-1132-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 01/27/2016] [Indexed: 11/10/2022] Open
Abstract
Background Madagascar, as other malaria endemic countries, depends mainly on international funding for the implementation of malaria control interventions (MCI). As these funds no longer increase, policy makers need to know whether these MCI actually provide the expected protection. This study aimed at measuring the effectiveness of MCI deployed in all transmission patterns of Madagascar in 2012–2013 against the occurrence of clinical malaria cases. Methods From September 2012 to August 2013, patients consulting for non-complicated malaria in 31 sentinel health centres (SHC) were asked to answer a short questionnaire about long-lasting insecticidal nets (LLIN) use, indoor residual spraying (IRS) in the household and intermittent preventive treatment of pregnant women (IPTp) intake. Controls were healthy all-ages individuals sampled from a concurrent cross-sectional survey conducted in areas surrounding the SHC. Cases and controls were retained in the database if they were resident of the same communes. The association between Plasmodium infection and exposure to MCI was calculated by multivariate multilevel models, and the protective effectiveness (PE) of an intervention was defined as 1 minus the odds ratio of this association. Results Data about 841 cases (out of 6760 cases observed in SHC) and 8284 controls was collected. The regular use of LLIN provided a significant 51 % PE (95 % CI [16–71]) in multivariate analysis, excluding in one transmission pattern where PE was −11 % (95 % CI [−251 to 65]) in univariate analysis. The PE of IRS was 51 % (95 % CI [31–65]), and the PE of exposure to both regular use of LLIN and IRS was 72 % (95 % CI [28–89]) in multivariate analyses. Vector control interventions avoided yearly over 100,000 clinical cases of malaria in Madagascar. The maternal PE of IPTp was 73 %. Conclusions In Madagascar, LLIN and IRS had good PE against clinical malaria. These results may apply to other countries with similar transmission profiles, but such case–control surveys could be recommended to identify local failures in the effectiveness of MCI. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1132-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Thomas Kesteman
- Malaria Research Unit, Institut Pasteur de Madagascar, BP 1274, 101, Avaradoha, Antananarivo, Madagascar. .,Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE) - UMR 6236, 27 boulevard Jean Moulin, 13385, Marseille Cedex 05, France. .,Fondation Mérieux, 17 rue Bourgelat, 69002, Lyon, France.
| | | | - Vaomalala Raharimanga
- Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, 101, Avaradoha, Antananarivo, Madagascar.
| | - Laurence Randrianasolo
- Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, 101, Avaradoha, Antananarivo, Madagascar.
| | - Patrice Piola
- Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, 101, Avaradoha, Antananarivo, Madagascar.
| | - Christophe Rogier
- Malaria Research Unit, Institut Pasteur de Madagascar, BP 1274, 101, Avaradoha, Antananarivo, Madagascar. .,Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE) - UMR 6236, 27 boulevard Jean Moulin, 13385, Marseille Cedex 05, France. .,Institute for Biomedical Research of the French Armed Forces (IRBA), BP 73, 91223, Brétigny-Sur-Orge Cedex, France.
| |
Collapse
|