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Carrasco-Tenezaca M, Jawara M, Lee DSH, Holmes MS, Ceesay S, McCall P, Pinder M, D'Alessandro U, Knudsen JB, Lindsay SW, Wilson AL. Effect of passive and active ventilation on malaria mosquito house entry and human comfort: an experimental study in rural Gambia. J R Soc Interface 2023; 20:20220794. [PMID: 37015266 PMCID: PMC10072938 DOI: 10.1098/rsif.2022.0794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
Rural houses in sub-Saharan Africa are typically hot and allow malaria mosquitoes inside. We assessed whether passive or active ventilation can reduce house entry of malaria mosquitoes and cool a bedroom at night in rural Gambia. Two identical experimental houses were used: one ventilated and one unventilated (control). We evaluated the impact of (i) passive ventilation (solar chimney) and (ii) active ventilation (ceiling fan) on the number of mosquitoes collected indoors and environmental parameters (temperature, humidity, CO2, evaporation). Although the solar chimney did not reduce entry of Anopheles gambiae sensu lato, the ceiling fan reduced house entry by 91% compared with the control house. There were no differences in indoor nightly temperature, humidity or CO2 between intervention and control houses in either experiment. The solar chimney did not improve human comfort assessed using psychrometric analysis. While the ceiling fan improved human comfort pre-midnight, in the morning it was too cool compared with the control house, although this could be remedied through provision of blankets. Further improvements to the design of the solar chimney are needed. High air velocity in the ceiling fan house probably reduced mosquito house entry by preventing mosquito flight. Improved ventilation in houses may reduce malaria transmission.
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Affiliation(s)
| | - Musa Jawara
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Daniel Sang-Hoon Lee
- Architecture, Design and Conservation, The Royal Danish Academy, Philip De Langes Allé 10, Copenhagen 1435, Denmark
| | - Matthew S Holmes
- JDDK Architects, Millmount, Ponteland Rd, Cowgate, Newcastle upon Tyne NE5 3AL, England
| | - Sainey Ceesay
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Phillip McCall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Margaret Pinder
- Department of Biosciences, Durham University, Stockton Road, Durham, Durham DH1 3LE, UK
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Jakob B Knudsen
- Architecture, Design and Conservation, The Royal Danish Academy, Philip De Langes Allé 10, Copenhagen 1435, Denmark
| | - Steve W Lindsay
- Department of Biosciences, Durham University, Stockton Road, Durham, Durham DH1 3LE, UK
- London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Anne L Wilson
- Department of Biosciences, Durham University, Stockton Road, Durham, Durham DH1 3LE, UK
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Berkhout C, Berbra O, Favre J, Collins C, Calafiore M, Peremans L, Van Royen P. Defining and evaluating the Hawthorne effect in primary care, a systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:1033486. [PMID: 36425097 PMCID: PMC9679018 DOI: 10.3389/fmed.2022.1033486] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/18/2022] [Indexed: 10/31/2023] Open
Abstract
In 2015, we conducted a randomized controlled trial (RCT) in primary care to evaluate if posters and pamphlets dispensed in general practice waiting rooms enhanced vaccination uptake for seasonal influenza. Unexpectedly, vaccination uptake rose in both arms of the RCT whereas public health data indicated a decrease. We wondered if the design of the trial had led to a Hawthorne effect (HE). Searching the literature, we noticed that the definition of the HE was unclear if stated. Our objectives were to refine a definition of the HE for primary care, to evaluate its size, and to draw consequences for primary care research. We designed a Preferred Reporting Items for Systematic reviews and Meta-Analyses review and meta-analysis between January 2012 and March 2022. We included original reports defining the HE and reports measuring it without setting limitations. Definitions of the HE were collected and summarized. Main published outcomes were extracted and measures were analyzed to evaluate odds ratios (ORs) in primary care. The search led to 180 records, reduced on review to 74 for definition and 15 for quantification. Our definition of HE is "an aware or unconscious complex behavior change in a study environment, related to the complex interaction of four biases affecting the study subjects and investigators: selection bias, commitment and congruence bias, conformity and social desirability bias and observation and measurement bias." Its size varies in time and depends on the education and professional position of the investigators and subjects, the study environment, and the outcome. There are overlap areas between the HE, placebo effect, and regression to the mean. In binary outcomes, the overall OR of the HE computed in primary care was 1.41 (95% CI: [1.13; 1.75]; I 2 = 97%), but the significance of the HE disappears in well-designed studies. We conclude that the HE results from a complex system of interacting phenomena and appears to some degree in all experimental research, but its size can considerably be reduced by refining study designs.
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Affiliation(s)
- Christophe Berkhout
- Department of General Practice/Family Medicine, Université de Lille, Lille, France
- Department of Family Medicine and Population Health, Universiteit Antwerpen, Antwerp, Belgium
| | - Ornella Berbra
- Department of General Practice/Family Medicine, Université de Lille, Lille, France
| | - Jonathan Favre
- Department of General Practice/Family Medicine, Université de Lille, Lille, France
| | | | - Matthieu Calafiore
- Department of General Practice/Family Medicine, Université de Lille, Lille, France
- ULR 2694 METRICS, Université de Lille, Lille, France
| | - Lieve Peremans
- Department of Family Medicine and Population Health, Universiteit Antwerpen, Antwerp, Belgium
- Department of Nursing and Midwifery, Universiteit Antwerpen, Antwerp, Belgium
| | - Paul Van Royen
- Department of Family Medicine and Population Health, Universiteit Antwerpen, Antwerp, Belgium
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Klu D, Aberese-Ako M, Manyeh AK, Immurana M, Doegah P, Dalaba M, Acquah E, Alhassan RK, Ansah EK. Mixed effect analysis of factors influencing the use of insecticides treated bed nets among pregnant women in Ghana: evidence from the 2019 Malaria Indicator Survey. BMC Pregnancy Childbirth 2022; 22:258. [PMID: 35346098 PMCID: PMC8958761 DOI: 10.1186/s12884-022-04586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Malaria during pregnancy is a major cause of maternal morbidity globally and leads to poor birth outcomes. The World Health Organization has recommended the use of insecticide treated bed nets (ITN) as one of the effective malaria preventive strategies among pregnant women in malaria endemic areas. This study, therefore, seeks to examine the individual and household factors associated with the use of ITNs among pregnant women in Ghana. Methods Data for this study was obtained from the 2019 Ghana Malaria Indicator Survey (GMIS) conducted between September 25 and November 24, 2019. The weighted sample comprised 353 pregnant women aged 15–49 years. Data was analyzed with SPSS version 22 using both descriptive and multilevel logistics regression modelling. Statistically significant level was set at p < 0.05. Results The study found that 49.2% of pregnant women in Ghana use ITN to prevent malaria. Pregnant women aged 35–49 years (AOR = 3.403, CI: 1.191–9.725), those with no formal education (AOR = 5.585, CI = 1.315–23.716), and those who had secondary education (AOR = 3.509, CI = 1.076–11.440) had higher odds of using ITN. Similarly, higher odds of ITN usage was found among who belonged to the Akan ethnic group (AOR = 7.234, CI = 1.497–34.955), dwell in male-headed households (AOR = 2.232, CI = 1.105–4.508) and those whose household heads are aged 60–69 years (AOR = 4.303, CI = 1.160–15.966). However, pregnant women who resided in urban areas (AOR = 0.355, CI = 0.216–0.582), those whose household heads aged 40–49 years (AOR = 0.175, CI = 0.066–0.467) and those who belonged to richer (AOR =0.184, CI = 0.050–0.679) and richest (AOR = 0.107, CI = 0.021–0.552) households had lower odds of using ITN for malaria prevention. Conclusions Individual socio-demographic and household factors such as pregnant women’s age, educational level, place of residence, ethnicity, sex and age of household head, and household wealth quintile are associated with the use of ITN for malaria prevention among pregnant women. These factors ought to be considered in strengthening malaria prevention campaigns and develop new interventions to help increase ITN utilization among vulnerable population living in malaria- endemic areas.
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Sutcliffe JF, Yin S. Effects of indoor air movement and ambient temperature on mosquito (Anopheles gambiae) behaviour around bed nets: implications for malaria prevention initiatives. Malar J 2021; 20:427. [PMID: 34717652 PMCID: PMC8557611 DOI: 10.1186/s12936-021-03957-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background Until recently, relatively little research has been done on how mosquitoes behave around the occupied bed net in the indoor environment. This has been partly remedied in the last few years through laboratory and field studies, most of these using video methods and mosquito flight tracking. Despite these recent advances, understanding of the mosquito-bed net environment system, and the principles that underlie mosquito behaviour within it, is limited. This project aimed to further understand this system by studying the effects of gently moving air (such as might be introduced through room design to make the indoor environment more comfortable and conducive to ITN use) and warmer vs. cooler ambient conditions on mosquito activity around ITNs and other bed nets. Methods The activity of colonized female Anopheles gambiae around an occupied untreated bed net set up in a mosquito-proof tent in a large laboratory space was recorded under different ambient conditions using a laser detection-video recording system. Conditions tested were ‘cool’ (23–25 °C) and ‘warm’ (27–30 °C) air temperatures and the presence or absence of a cross-flow produced by a small central processing unit (CPU) fan pointed at the side of the net so that it produced a ‘low-’ or ‘high-’ speed cross-draught (approx. 0.1 and 0.4 m/s, respectively). Near-net activity in recordings was measured using video image analysis. Results In cool, still air conditions, more than 80% of near-net activity by An. gambiae occurred on the net roof. Introduction of the low-speed or high-speed cross-draught resulted in an almost total drop off in roof activity within 1 to 2 min and, in the case of the high-speed cross-draught, a complementary increase in activity on the net side. In warm, still conditions, near-net activity appeared to be lower overall than in cool, still air conditions and to be relatively less focussed on the roof. Introduction of the high-speed cross-draught in warm conditions resulted in a decrease in roof activity and increase in side activity though neither effect was statistically significant. Conclusions Results are interpreted in terms of the flow of the stimulatory odour plume produced by the net occupant which, consistent with established principles of fluid dynamics, appears to rise quickly and remain more intact above the net occupant in cool, still air than in warm, still air. Cross-draught effects are ascribed to the changes they cause in the flow of the host odour plume as opposed to mosquito flight directly. The implications of these results for house designs that promote indoor air movement, on bed net design, and on other vector control measures are discussed. How mosquitoes approach a net is influenced both by indoor temperature and ventilation and their interaction. This system is in need of further study. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03957-y.
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Affiliation(s)
- James F Sutcliffe
- Dept. Biology, Trent University, Peterborough, ON, Canada. .,Entomology Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Briet O, Koenker H, Norris L, Wiegand R, Vanden Eng J, Thackeray A, Williamson J, Gimnig JE, Fortes F, Akogbeto M, Yadouleton AW, Ombok M, Bayoh MN, Mzilahowa T, Abílio AP, Mabunda S, Cuamba N, Diouf E, Konaté L, Hamainza B, Katebe-Sakala C, Ponce de León G, Asamoa K, Wolkon A, Smith SC, Swamidoss I, Green M, Gueye S, Mihigo J, Morgan J, Dotson E, Craig AS, Tan KR, Wirtz RA, Smith T. Attrition, physical integrity and insecticidal activity of long-lasting insecticidal nets in sub-Saharan Africa and modelling of their impact on vectorial capacity. Malar J 2020; 19:310. [PMID: 32859210 PMCID: PMC7456088 DOI: 10.1186/s12936-020-03383-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Long-lasting insecticidal nets (LLINs) are the primary malaria prevention and control intervention in many parts of sub-Saharan Africa. While LLINs are expected to last at least 3 years under normal use conditions, they can lose effectiveness because they fall out of use, are discarded, repurposed, physically damaged, or lose insecticidal activity. The contributions of these different interrelated factors to durability of nets and their protection against malaria have been unclear. Methods Starting in 2009, LLIN durability studies were conducted in seven countries in Africa over 5 years. WHO-recommended measures of attrition, LLIN use, insecticidal activity, and physical integrity were recorded for eight different net brands. These data were combined with analyses of experimental hut data on feeding inhibition and killing effects of LLINs on both susceptible and pyrethroid resistant malaria vectors to estimate the protection against malaria transmission—in terms of vectorial capacity (VC)—provided by each net cohort over time. Impact on VC was then compared in hypothetical scenarios where one durability outcome measure was set at the best possible level while keeping the others at the observed levels. Results There was more variability in decay of protection over time by country than by net brand for three measures of durability (ratios of variance components 4.6, 4.4, and 1.8 times for LLIN survival, use, and integrity, respectively). In some countries, LLIN attrition was slow, but use declined rapidly. Non-use of LLINs generally had more effect on LLIN impact on VC than did attrition, hole formation, or insecticide loss. Conclusions There is much more variation in LLIN durability among countries than among net brands. Low levels of use may have a larger impact on effectiveness than does variation in attrition or LLIN degradation. The estimated entomological effects of chemical decay are relatively small, with physical decay probably more important as a driver of attrition and non-use than as a direct cause of loss of effect. Efforts to maximize LLIN impact in operational settings should focus on increasing LLIN usage, including through improvements in LLIN physical integrity. Further research is needed to understand household decisions related to LLIN use, including the influence of net durability and the presence of other nets in the household.
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Affiliation(s)
- Olivier Briet
- Swiss Tropical and Public Health Institute, 4051, Basel, Switzerland.,University of Basel, 4001, Basel, Switzerland
| | - Hannah Koenker
- PMI VectorWorks, JHU Center for Communication Programs, Baltimore, MD, USA.,Tropical Health LLP, Baltimore, MD, USA
| | - Laura Norris
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Washington, DC, USA.,Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Ryan Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Jodi Vanden Eng
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | | | - John Williamson
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - John E Gimnig
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Filomeno Fortes
- National Malaria Control Program (NMCP), Ministry of Health, Luanda, Angola.,Institute of Hygiene and Tropical Medicine, NOVA University Lisbon, Lisbon, Portugal
| | - Martin Akogbeto
- Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Bénin
| | - Anges W Yadouleton
- Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Bénin.,Programme National de Lutte contre le Paludisme (PNLP), Ministry of Health, Cotonou, Bénin
| | - Maurice Ombok
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - M Nabie Bayoh
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.,PMI VectorLink Project, Abt Associates, Lusaka, Zambia
| | - Themba Mzilahowa
- College of Medicine, Malaria Alert Centre, P/Bag 360, Blantyre 3, Malawi
| | - Ana Paula Abílio
- Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique
| | - Samuel Mabunda
- Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique.,National Malaria Control Programme (NMCP), Ministry of Health, Maputo, Mozambique
| | - Nelson Cuamba
- Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique.,National Malaria Control Programme (NMCP), Ministry of Health, Maputo, Mozambique
| | - Elhadji Diouf
- Faculté des Sciences et Techniques (FST), Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Lassana Konaté
- Faculté des Sciences et Techniques (FST), Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | | | | | - Gabriel Ponce de León
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Kwame Asamoa
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Adam Wolkon
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Stephen C Smith
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Isabel Swamidoss
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Mike Green
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Salam Gueye
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Jules Mihigo
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Juliette Morgan
- U.S. President's Malaria Initiative, Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Ellen Dotson
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Allen S Craig
- U.S. President's Malaria Initiative, Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Kathrine R Tan
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Robert A Wirtz
- Division of Parasitic Diseases and Malaria, Centers for Disease Control (CDC) and Prevention, Atlanta, GA, USA
| | - Tom Smith
- Swiss Tropical and Public Health Institute, 4051, Basel, Switzerland. .,University of Basel, 4001, Basel, Switzerland.
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Kim S, Piccinini D, Mensah E, Lynch M. Using a Human-Centered Design Approach to Determine Consumer Preferences for Long-Lasting Insecticidal Nets in Ghana. GLOBAL HEALTH, SCIENCE AND PRACTICE 2019; 7:160-170. [PMID: 31249018 PMCID: PMC6641816 DOI: 10.9745/ghsp-d-18-00284] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 04/02/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND A human-centered design approach, paired with traditional research methods, was used to explore consumer preferences of middle-class Ghanaians for a long-lasting insecticidal net (LLIN) to be designed for the private-sector retail market. METHODS In March 2017, we conducted 9 focus groups with urban and rural middle-class Ghanaians across Ashanti, Greater Accra, and Western regions. A total of 78 participants (51 adults and 27 boarding school students) were involved in the focus groups. Participants were asked for their input on topics related to malaria prevention, LLIN perceptions and use behavior, as well as general consumer preferences related to the home and bedroom. They participated in a variety of exercises, such as rank ordering their preferences of various accessories that might be bundled with an LLIN and interacting with actual LLINs of different sizes and designs. The data were gathered and analyzed, using micro-interlocutor analysis framework to capture emergent themes. RESULTS LLINs are currently available through free distribution channels, but in most accounts, participants reported that the nets were inconvenient, uncomfortable, and not aesthetically pleasing, thus they were undesirable to use. For example, several participants described the process of hanging as well as entering and exiting the LLIN as challenging, stressful, and/or tedious. In addition, use of LLINs was considered to make people feel even hotter in an already warm climate as well as to leave users feeling confined within a small space. Finally, many participants discussed how to improve the look of LLINs including suggestions for additional colors, shapes, and hanging mechanisms to make the LLINs more compatible with their desired bedroom and home décor. Based on the participants' responses, we concluded that they would prefer LLINs that better reflect contemporary sensibilities. We devised and tested different LLIN attributes to address these points, focusing on a more convenient way to hang the net, a more attractive silhouette, and a zipper that allows the user to enter and exit with ease while still maintaining a sealed, mosquito-free space. A separate discrete choice experiment confirmed the attractiveness of these attributes by capturing the target population's willingness to pay for LLINs with said preference-congruent attributes. CONCLUSION Our human-centered design approach yielded consumer insights and preferences for novel LLIN designs for the private-sector retail market in Ghana. If this net design is successful, it could increase LLIN use among the middle class and catalyze the purchase of LLINs to support ongoing malaria control efforts.
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Affiliation(s)
- Sharon Kim
- Johns Hopkins Carey Business School, Baltimore, MD, USA.
| | | | | | - Matthew Lynch
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
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Ricotta E, Oppong S, Yukich JO, Briët OJT. Determinants of bed net use conditional on access in population surveys in Ghana. Malar J 2019; 18:63. [PMID: 30849976 PMCID: PMC6408824 DOI: 10.1186/s12936-019-2700-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/01/2019] [Indexed: 12/02/2022] Open
Abstract
Background Insecticide-treated nets (ITNs) are one of the most effective and widely available methods for preventing malaria, and there is interest in understanding the complexities of behavioural drivers of non-use among those with access. This analysis evaluated net use behaviour in Ghana by exploring how several household and environmental variables relate to use among Ghanaians with access to a net. Methods Survey data from the Ghana 2014 Demographic and Health Survey and the 2016 Malaria Indicator Survey were used to calculate household members’ access to space under a net as well as the proportion of net use conditional on access (NUCA). Geospatial information on cluster location was obtained, as well as average humidex, a measure of how hot it feels, for the month each cluster was surveyed. The relationship between independent variables and net use was assessed via beta-binomial regression models that controlled for spatially correlated random effects using non-Gaussian kriging. Results In both surveys, increasing wealth was associated with decreased net use among those with access in households when compared to the poorest category. In 2014, exposure to messages about bed net use for malaria prevention was associated with increased net use (OR 2.5, 95% CrI 1.5–4.2), as was living in a rural area in both 2014 (OR 2.5, 95% CrI 1.5–4.3) and 2016 (OR 1.6, 95% CrI 1.1–2.3). The number of nets per person was not associated with net use in either survey. Model fit was improved for both surveys by including a spatial random effect for cluster, demonstrating some spatial autocorrelation in the proportion of people using a net. Humidex, electricity in the household and IRS were not associated with NUCA. Conclusion Net use conditional on access is affected by household characteristics and is also spatially-dependent in Ghana. Setting (whether the household was urban or rural) plays a role, with wealthier and more urban households less likely to use nets when they are available. It will likely be necessary in the future to focus on rural settings, urban settings, and wealth status independently, both to better understand predictors of household net use in these areas and to design more targeted interventions to ensure consistent use of vector control interventions that meet specific needs of the population. Electronic supplementary material The online version of this article (10.1186/s12936-019-2700-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emily Ricotta
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, P.O. Box CH-4001, Basel, Switzerland.
| | - Samuel Oppong
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Korle-bu, P. O. Box KB 493, Accra, Ghana
| | - Joshua O Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St. #8317, New Orleans, LA, 70112, USA
| | - Olivier J T Briët
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland.,University of Basel, Petersplatz 1, P.O. Box CH-4001, Basel, Switzerland
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Knowledge, attitudes and practices regarding malaria in people living with HIV in rural and urban Ghana. Acta Trop 2018; 181:16-20. [PMID: 29391127 DOI: 10.1016/j.actatropica.2018.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/18/2018] [Accepted: 01/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND One of the malaria vulnerable groups is people living with HIV. This study investigated knowledge, attitude and practices (KAP) towards malaria in people living with HIV attending anti-retroviral therapy (ART) clinics in rural and urban Ghana. METHODS In this descriptive cross-sectional study patients attending the ART clinics in Atibie (rural area) and Accra (urban area) were interviewed on their knowledge, attitude and practices regarding malaria. Finger-prick capillary blood was tested for Plasmodium spp. with rapid diagnostic tests. Multivariate regression analysis was used to determine the influence of KAP on malaria prevalence. RESULTS Parasitemia was generally more frequent among HIV positive individuals in the rural area (29/116; 25%) in the rural area than in the urban area (35/350; 10%). Inaccurate knowledge of cause of malaria and prevention methods were associated with increased odds of malaria parasitemia; [OR = 1.51 (CI: 1.29-5.12); p < .05] and [OR = 2.59 (CI: 2.53-4.75); p < .05], respectively. There were disparities in socio-economic factors. For instance, low level of education was higher in the rural area (45/116; 38.8%) compared to the urban area (121/350; 34.6%). CONCLUSIONS Malaria control efforts may yield further results when the knowledge and socio-economic gap between rural and urban areas is closed.
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Yukich JO, Briët OJT, Ahorlu CK, Nardini P, Keating J. Willingness to pay for small solar powered bed net fans: results of a Becker-DeGroot-Marschak auction in Ghana. Malar J 2017; 16:316. [PMID: 28784127 PMCID: PMC5547488 DOI: 10.1186/s12936-017-1965-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND METHODS Long-lasting insecticidal nets (LLINs) are one of the main interventions recommended by the World Health Organization for malaria vector control. LLINs are ineffective if they are not being used. Subsequent to the completion of a cluster randomized cross over trial conducted in rural Greater Accra where participants were provided with the 'Bɔkɔɔ System'-a set of solar powered net fan and light consoles with a solar panel and battery-or alternative household water filters, all trial participants were invited to participate in a Becker-DeGroot-Marschak auction to determine the mean willingness to pay (WTP) for the fan and light consoles and to estimate the demand curve for the units. RESULTS, DISCUSSION AND CONCLUSIONS Results demonstraed a mean WTP of approximately 55 Cedis (~13 USD). Demand results suggested that at a price which would support full manufacturing cost recovery, a majority of households in the area would be willing to purchase at least one such unit.
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Affiliation(s)
- Joshua O. Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St. #8317, New Orleans, LA 70112 USA
| | - Olivier J. T. Briët
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Collins K. Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Joseph Keating
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St. #8317, New Orleans, LA 70112 USA
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Jaeger MS, Briët OJT, Keating J, Ahorlu CK, Yukich JO, Oppong S, Nardini P, Pfeiffer C. Perceptions on the effect of small electric fans on comfort inside bed nets in southern Ghana: a qualitative study. Malar J 2016; 15:580. [PMID: 27905928 PMCID: PMC5134074 DOI: 10.1186/s12936-016-1614-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/15/2016] [Indexed: 11/14/2022] Open
Abstract
Background Long-lasting insecticidal nets (LLINs) are known to be highly effective in reducing malaria transmission, morbidity and mortality. However, among those owning an LLIN, use rates are often suboptimal. A reported barrier to bed net use is discomfort due to heat. This qualitative study was part of a larger evaluation conducted in communities without electricity in rural Ghana to assess whether 0.8 W solar powered net fans can increase net use. Methods Twenty-three key informant interviews with household heads in the study communities in Shai-Osudoku District, southern Ghana, were conducted from July to August 2015. The purpose of the interviews was to obtain insight into perceptions of participants about the net fan system in relation to LLIN use. Results While all study participants reported using LLINs, with mosquito nuisance prevention as the prime motivation, heat was also mentioned as a key barrier to net use. Respondents appreciated the net fans because they improved comfort inside bed nets. The LED light on the fan stand became the main source of light at night and positively influenced the perception of the intervention as a whole. Conclusion The general acceptance of the net fan system by the study participants highlights the potential of the intervention to improve comfort inside mosquito nets. This, therefore, has a potential to increase bed net use in areas with low access to electricity.
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Affiliation(s)
- Mulako S Jaeger
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Olivier J T Briët
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Joseph Keating
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 2301, New Orleans, LA, 70112, USA
| | - Collins K Ahorlu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P.O. Box LG581, Legon, Ghana
| | - Joshua O Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 2301, New Orleans, LA, 70112, USA
| | - Samuel Oppong
- National Malaria Control Programme, P.O. Box KB 493, Korle-bu, Accra, Ghana
| | - Peter Nardini
- Green World Health Net, 307 Amherst Dr. SE, Albuquerque, NM, 87106, USA
| | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
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