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Paintsil EK, Boadi E, Dwamena A, Addo BH, Kumi A, Obiri-Danso K, Ofori LA. Demographic and socio-economic factors affecting bed net ownership, usage, and malaria transmission among adult patients seeking healthcare in two Ghanaian urban cities. BMC Public Health 2024; 24:106. [PMID: 38184552 PMCID: PMC10770894 DOI: 10.1186/s12889-023-17590-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/26/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The most cost-effective malaria prevention and control strategy is the use of a bed net. However, several factors affect the ownership and usage of bed nets among the adult population. Hence, this study aimed to examine socio-demographic factors affecting bed net ownership, usage and malaria transmission among adult patients seeking healthcare in two Ghanaian urban cities. METHODS This hospital-based cross-sectional study was conducted, between January and September 2021, at Bremang Seventh-Day Adventist Hospital, Suame Municipal, Ashanti Region and Sunyani Municipal Hospital, Sunyani, Bono Region, Ghana. Structured questionnaires were administered to a total of 550 participants to ascertain their ownership and usage of the bed nets. Afterwards, finger prick blood samples were collected for malaria microscopy. Crude and adjusted prevalence ratios (PR) and their respective 95% CIs were calculated, using Poisson regression with robust standard errors, to show associated variables in bivariate and multivariate analyses respectively. R software (version 4.1.1) was used to perform all statistical analyses. RESULTS About 53.3% (n = 293) of participants owned at least one-bed net but only 21.5% (n = 118) slept under it the previous night. Those married were 2.0 (95% CI: 1.6 - 2.5) and 2.4 (95% CI: 1.6 - 3.5) times more likely to own and use a bed net respectively than those who never married. Also, pregnant women were 1.3 (95% CI: 1.1 - 1.6) and 1.8 (95% CI: 1.3 - 2.5) times more likely to own and use a bed net respectively than non-pregnant. Even though income levels were not associated with bed net ownership and usage, students were 0.4 (95% CI: 0.2 - 0.6) and 0.2 (95% CI: 0.1 - 0.5) times less likely to own and use bed net respectively compared to formally employed persons. The overall malaria prevalence rate was 7.8%. Malaria-negative patients were 1.6 (95% CI: 1.2 - 2.0) and 2.4 (95% CI: 1.4 - 4.1) times more likely to own and use bed nets respectively than malaria positive. Patients with tertiary education recorded the lowest malaria prevalence (3.5%, n = 4). None of those with a monthly income > $300 recorded a case of malaria. On the contrary, majority 83%, n/N = 25/30) of the malaria-positive patients earned ≤ $150. CONCLUSION The National Malaria Control Program should conduct comprehensive mapping of all urban population segments before launching mass bed net distribution campaigns, taking into account demographic and socioeconomic factors to enhance bed net utilization and reduce malaria prevalence.
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Affiliation(s)
- Ellis Kobina Paintsil
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana.
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Enoch Boadi
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Bremang Seventh-Day Adventist Hospital, Suame Municipal, Ghana
| | - Anthony Dwamena
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Sunyani Municipal Hospital, Sunyani Municipal, Ghana
| | | | - Agyei Kumi
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - Kwasi Obiri-Danso
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Linda Aurelia Ofori
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Olivos N, Banta JE, Spencer-Hwang R, Ansong D, Beane Freeman LE, Clegg-Lamptey JN, Wiafe-Addai B, Edusei L, Adjei E, Titiloye N, Dedey F, Aitpillah F, Oppong J, Vanderpuye V, Osei-Bonsu E, Ahearn TU, Biritwum R, Yarney J, Awuah B, Nyarko K, Garcia-Closas M, Abubakar M, Brinton LA, Figueroa JD, Wiafe S. Mosquito control exposures and breast cancer risk: analysis of 1071 cases and 2096 controls from the Ghana Breast Health Study. Breast Cancer Res 2023; 25:150. [PMID: 38082317 PMCID: PMC10714652 DOI: 10.1186/s13058-023-01737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Epidemiologic data on insecticide exposures and breast cancer risk are inconclusive and mostly from high-income countries. Using data from 1071 invasive pathologically confirmed breast cancer cases and 2096 controls from the Ghana Breast Health Study conducted from 2013 to 2015, we investigated associations with mosquito control products to reduce the spread of mosquito-borne diseases, such as malaria. These mosquito control products were insecticide-treated nets, mosquito coils, repellent room sprays, and skin creams for personal protection against mosquitos. Multivariable and polytomous logistic regression models were used to estimate odds ratios (ORadj) and 95% confidence intervals (CI) with breast cancer risk-adjusted for potential confounders and known risk factors. Among controls, the reported use of mosquito control products were mosquito coils (65%), followed by insecticide-treated nets (56%), repellent room sprays (53%), and repellent skin creams (15%). Compared to a referent group of participants unexposed to mosquito control products, there was no significant association between breast cancer risk and mosquito coils. There was an association in breast cancer risk with reported use of insecticide-treated nets; however, that association was weak and not statistically significant. Participants who reported using repellent sprays were at elevated risks compared to women who did not use any mosquito control products, even after adjustment for all other mosquito control products (OR = 1.42, 95% CI=1.15-1.75). We had limited power to detect an association with repellent skin creams. Although only a few participants reported using repellent room sprays weekly/daily or < month-monthly, no trends were evident with increased frequency of use of repellent sprays, and there was no statistical evidence of heterogeneity by estrogen receptor (ER) status (p-het > 0.25). Our analysis was limited when determining if an association existed with repellent skin creams; therefore, we cannot conclude an association. We found limited evidence of risk associations with widely used mosquito coils and insecticide-treated nets, which are reassuring given their importance for malaria prevention. Our findings regarding specific breast cancer risk associations, specifically those observed between repellent sprays, require further study.
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Affiliation(s)
- Naomie Olivos
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Jim E Banta
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | | | | | - Laura E Beane Freeman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | | | | | | - Thomas U Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | - Mustapha Abubakar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
| | - Seth Wiafe
- School of Public Health, Loma Linda University, Loma Linda, CA, USA.
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Johnson EJ, McComic SE, Rault LC, Swale DR, Anderson TD. Bioinsecticidal activity of cajeput oil to pyrethroid-susceptible and -resistant mosquitoes. PESTICIDE BIOCHEMISTRY AND PHYSIOLOGY 2023; 193:105458. [PMID: 37248001 DOI: 10.1016/j.pestbp.2023.105458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/31/2023]
Abstract
Mosquito-borne diseases are a significant threat to human health. The frequent and repetitive application of insecticides can result in the selection of resistant mosquito populations leading to product failures for reducing community disease transmission. It is important that new interventions are discovered and developed for reducing mosquito populations and, in turn, protecting human health. Plant essential oils are promising chemical interventions for reducing mosquito populations. The myrtle family, Myrtaceae, has numerous species to be studied as potential bioinsecticides. Here, we combined toxicological, biochemical, and neurophysiological approaches to provide evidence for cajeput oil and terpene constituents to elicit bioinsecticidal activity to pyrethroid-susceptible and -resistant Aedes aegypti. We show cajeput oil terpenes to enhance cAMP production, increase ACh levels, inhibit in vivo and in vitro AChE activity, and disrupt spike discharge frequencies of the mosquito CNS. This study presents the first report on the bioinsecticidal activity of cajeput oil terpenes to pyrethroid-susceptible and -resistant mosquitoes and provides comparative data for the octopaminergic system as a putative molecular target for the bioinsecticides with implications for resistance management.
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Affiliation(s)
- Ellis J Johnson
- Department of Entomology, University of Nebraska, 103 Entomology Hall, 1700 East Campus Mall, Lincoln, NE 68583, USA
| | - Sarah E McComic
- Emerging Pathogens Institute, Department of Entomology and Nematology, University of Florida, 2055 Mowry Road, PO Box 100009, Gainesville, FL 32610, USA
| | - Leslie C Rault
- Department of Entomology, University of Nebraska, 103 Entomology Hall, 1700 East Campus Mall, Lincoln, NE 68583, USA
| | - Daniel R Swale
- Emerging Pathogens Institute, Department of Entomology and Nematology, University of Florida, 2055 Mowry Road, PO Box 100009, Gainesville, FL 32610, USA
| | - Troy D Anderson
- Department of Entomology, University of Nebraska, 103 Entomology Hall, 1700 East Campus Mall, Lincoln, NE 68583, USA.
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Miller JE, Malm K, Serge AA, Ateba MJ, Gitanya P, Sene D, Kooma EH, Kandeh B, Gerberg L, Nuñez L. Multi-country review of ITN routine distribution data: are ANC and EPI channels achieving their potential? Malar J 2022; 21:366. [PMID: 36461005 PMCID: PMC9719175 DOI: 10.1186/s12936-022-04373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/07/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Routine continuous distribution (CD) of insecticide-treated nets (ITNs) has been an important part of an overall ITN strategy to complement mass campaigns since the early 2000s. The backbone of CD implementation for many sub-Saharan African countries is distribution through antenatal care (ANC) and Expanded Programme for Immunizations (EPI) channels. Performance of these channels is often not monitored closely at the national level, nor is it reviewed globally, unlike the oversight provided to mass campaigns. The question as to why every eligible pregnant woman and child attending these services does not get an ITN remains important and yet, unanswered. METHODS ANC and EPI issuing rates from seven countries were reviewed with the aim of conducting a blinded multi-country analysis. Monthly data from January to December 2021 was extracted from each country's health management information system and analysed jointly with a National Malaria Control Programme (NMCP) focal point. VectorLink CD assessment reports were also reviewed to glean key findings. RESULTS ITN issuing rates varied across countries at ANC (31% to 93%) and EPI (39% to 92%). Across the seven countries, the median ITN issuing rate was 64% at ANC and 78% at EPI. Results varied greatly across months per country at both ANC and EPI. NMCP focal points are aware that mass campaigns often negatively affect implementation of ITN distribution through ANC and EPI, even though global and national guidelines emphasize sustaining CD during campaigns. Concerns were also raised about the standard ITN issuing rate indicator at ANC and even more so at EPI due to the denominator. Findings from CD assessments were similar across countries: ITN stock was inconsistent and sometimes inadequate, and updated guidelines on ITN distribution and utilization and funding for social behaviour change activities were lacking at the facility level. CONCLUSION The importance of optimizing ANC and EPI routine channels cannot be underscored enough. They are at the frontline to protect the most biologically vulnerable populations, i.e., pregnant women and unborn and young children. Although there are encouraging signs of improvement in issuing rates with some countries reaching optimal rates, further improvements are needed to ensure that every pregnant woman and young child receives the ITN to which they are entitled.
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Affiliation(s)
- Jane E. Miller
- grid.423224.10000 0001 0020 3631PMI VectorLink, PSI, Washington, DC USA
| | - Kezia Malm
- National Malaria Control Programme, Accra, Ghana
| | | | | | - Peter Gitanya
- grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, Tanzania
| | - Doudou Sene
- National Malaria Control Programme, Dakar, Senegal
| | | | - Balla Kandeh
- National Malaria Control Programme, Banjul, The Gambia
| | - Lilia Gerberg
- grid.507606.2U.S. President’s Malaria Initiative, USAID, Washington, DC USA
| | - Luigi Nuñez
- grid.423224.10000 0001 0020 3631PMI VectorLink, PSI, Washington, DC USA
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Hirai M, Umar U, Darikwa P, Osman AA, Mohamed A, Jama AM, Masheti C, Kader M. Exploring Potential Determinants of Mosquito Net Ownership and Use in Somalia: A Cross-Sectional Study. Diseases 2022; 10:diseases10040109. [PMID: 36412603 PMCID: PMC9680296 DOI: 10.3390/diseases10040109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/30/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
In Somalia, malaria remains a major public health threat. Understanding what influences the ownership and use of mosquito nets is of vital importance to accelerate malaria prevention efforts in the country. To explore the potential determinants of mosquito net ownership and use, this study conducted a secondary data analysis of the Somalia Micronutrient Survey 2019. Survey participants were identified through the multi-stage stratified cluster sampling, and logistic regression was performed for bivariate and multivariate analysis. The results suggested that household head’s age, educational attainment, household size, employment status of household members, socioeconomic status, geographic regions and type of residence are significantly associated with mosquito net ownership (p < 0.05). The analysis also highlighted household head’s age as an influential factor to mosquito net use. By further exploring and understanding the psychosocial determinants of mosquito net ownership and use, malaria prevention interventions can be made more effective in Somalia.
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Nadew J, Obsa MS, Alemayehu A, Haji Y. Utilization of insecticide treated nets among pregnant women in sodo zuria woreda Southern Ethiopia. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.926893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe malaria control strategy has shown an improvement in providing services and allocating resources to enhance malaria elimination. The world malaria report indicated that there was a marked increment of insecticide treated net (ITNs) utilization among pregnant women. However, in Ethiopia, the number of households with possession and utilization of ITNs is still far behind the WHO recommendations. Hence, this study was aimed to measure the magnitude of ITN utilization and to identify factors associated with its utilization among pregnant women from April 4, 2021 to April 15, 2021 in Sodo Zuria Woreda, in Wolaita Zone, Southern Ethiopia.MethodsA community based cross-sectional study was employed. Data were collected using interviewer administered pretested, structured questionnaires. Simple random sampling method was used to select 459 pregnant women. Data were entered into Epi Info version 7 and then exported to statistical package for the social sciences for further analysis. We used time period for data collection of current study. Binary’s logistic regression was used to determine factors affecting insecticides treated net (ITN) utilization. Adjusted Odd Ratios (OR) with 95% CI was used to measures the strengths of associations.ResultsOf 435 surveyed households with pregnant women, 341(78.39%) with 95% Confidence Interval (CI) (74.5%, 82.3%) possessed at least one insecticide treated net. Among them, 194(56.89%) with 95% CI (51.6%, 61.7%) interviewees had self-reported as they slept under insecticide treated net on the night preceding the data collection day. Utilization of insecticide treated nets by other family members, AOR: 6.615(95% CI: 3.358, 13.032), knowledge that the use of insecticide treated nets can prevent malaria, AOR: 3.221(95% CI: 1.737, 5.974), sleeping under insecticide treated nets, AOR: 3.726(95% CI: 1.974, 7.034), and attending ANC follow up visits, AOR: 1.956(95% CI: 1.097), were found to be significantly associated factors with pregnant women’s insecticide treated net utilization.ConclusionThe number of households with pregnant women who had possession and utilization of ITNs was much lower than the recommendations set by WHO. Therefore, information dissemination to malaria high risk groups about insecticide treated net utilization and replacement of worn-out insecticide treated nets should be emphasized.
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Doe MTT, Bajinka O, Barrow A. Antenatal care positive responses to pregnant women in preventing and controlling malaria in pregnancy: the sub-Saharan African perspective. World J Pediatr 2022; 18:453-462. [PMID: 35616810 DOI: 10.1007/s12519-022-00549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/27/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The response to antenatal care (ANC) for maternal and offspring outcomes, especially in pregnant women has been thoroughly studied. However, despite the number of interventional studies on the treatment of sulfadoxine-pyrimethamine combination (IPTp-SP) uptake, the point in point cases of the positive responses of ANC in improving health conditions of pregnant women are not found in the literature. DATA SOURCES This review collected ANC responses to the positive health outcomes for pregnant women with malaria, the challenges faced regarding IPTp-SP uptake during ANC visits and the role of ANC in preventing and controlling malaria in sub-Saharan Africa. It elucidated ANC and uptake of optimal intermittent preventive IPTp-SP and further described ANC as a tool for heterogeneity for malaria prevention. RESULTS ANC is seen as a microscope to malaria in pregnacy, maternal iron deficiency and anemia checkpoints, ANC and malaria treatment strategies, and ANC and the use of insecticide treated nets (ITN). The review further discussed ANC attendance influencing factors, limitations to ANC implications and the prospects in ANC visits on preventing malaria in pregnancy. CONCLUSIONS A declining trend of malaria transmission in Africa has been observed in recent years. However, the burden of malaria in pregnancy remains a health concern. The rate of SP resistance, low uptake of IPTp-SP, low LLINs distribution, late gestational ANC visits and low turnaround for optimal ANC visits for first time mothers' aggrevated the malaria-endemic settings among pregnant women in sub-Saharan Africa.
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Affiliation(s)
- Margaret Tete Telay Doe
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, People's Republic of China.
| | - Ousman Bajinka
- Department of Microbiology, Central South University, Changsha, Hunan Provinces, China.,China-Africa Research Centre of Infectious Diseases, School of Basic Medical Sciences, Central South University, Changsha, 410078, Hunan, China.,School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Amadou Barrow
- Heidelberg, Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany.,School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
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Cohen JM, Okumu F, Moonen B. The fight against malaria: Diminishing gains and growing challenges. Sci Transl Med 2022; 14:eabn3256. [PMID: 35767649 DOI: 10.1126/scitranslmed.abn3256] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Since the year 2000, historic reductions in malaria incidence and mortality have been driven by the widespread distribution of bed nets, drugs, and insecticides for the prevention and treatment of malaria. Scale-up of these tools has been enabled by an increase in malaria financing compounded by price reductions, yet these trends are unlikely to continue at the same rate. Rapid population growth in high-endemic areas requires procurement of more of these tools just to maintain current coverage, even as prices are likely to increase as resistance to drugs and insecticides forces shifts to newer products. Further progress toward the long-term goal of malaria eradication requires a combination of greater funding, more cost-effective resource allocation, and fundamental changes to the global malaria control strategy.
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Affiliation(s)
| | - Fredros Okumu
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK.,School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Bruno Moonen
- Bill & Melinda Gates Foundation, Seattle, WA, USA
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Alhassan Y, Dwomoh D, Amuasi SA, Nonvignon J, Bonful H, Tetteh M, Agyabeng K, Kotey M, Yawson AE, Bosomprah S. Impact of insecticide-treated nets and indoor residual spraying on self-reported malaria prevalence among women of reproductive age in Ghana: implication for malaria control and elimination. Malar J 2022; 21:120. [PMID: 35413832 PMCID: PMC9003985 DOI: 10.1186/s12936-022-04136-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Global Fund alone contributed 56% of all international financing for malaria and has invested more than US$13.5 billion in malaria treatment, prevention, and control programmes by June 2021. These investments include interventions such as mosquito nets, indoor residual spraying, and preventive treatment for children and pregnant women. However, there is paucity of studies for assessment of such investments to a reduction in malaria prevalence. This study was aimed at quantifying the impact of household access to insecticide-treated nets (ITNs) and the indoor residual spraying (IRS) on self-reported malaria prevalence among women of reproductive age in Ghana. Methods The study analysed the 2016 Ghana Malaria Indicator Survey (MIS) data. The MIS is a nationwide survey that included women aged 15–49 years. Poisson regression model with inverse probability to treatment weighting was used to determine average treatment effect estimate of the two malaria interventions on self-reported malaria prevalence among women of reproductive age in Ghana. Results A total sample of 4861 women interviewed from the 2016 Ghana MIS was used for analysis. The prevalence of self-reported malaria in 2016 was 34.4% (95% CI [32.4%, 36.4%]). Approximately 80.0% of women lived in households with access to ITNs [Percentage (Pr) = 79.9%, (95% CI [78.0%, 81.7%])], 12.4% (95% CI [7.5%, 19.8%]) of the households had access to IRS and 11.4% (95% CI [7.0%, 18.0%]) of the households had access to both ITNs and IRS. Household access to only ITN contributed to 7.1 percentage point (pt) reduction in the self-reported malaria among women (95% CI [− 12.0%, − 2.1%], p = 0.005) whilst IRS at the households contributed to 6.8pt reduction in malaria prevalence (95% CI [− 12.0%, − 2.1%], p = 0.005). Households with access to both ITNs and IRS contributed to a 27.1pt reduction in self-reported malaria prevalence among women (95% CI [− 12.0%, − 2.1%], p = 0.005). Conclusion Access to both ITNs and application of IRS at the household level contributed to a significant reduction in self-reported malaria prevalence among women of reproductive age in Ghana. This finding confirms the need for integration of malaria control interventions to facilitate attainment of malaria elimination in Ghana. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04136-3.
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Affiliation(s)
- Yakubu Alhassan
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| | - Duah Dwomoh
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
| | - Susan Ama Amuasi
- Department of Physician Assistantship and Public Health, School of Medicine and Health Sciences, Central University College, Accra, Ghana
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| | - Harriet Bonful
- Department of Epidemiology, School of Public Health, University of Ghana, Accra, Ghana
| | - Mary Tetteh
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| | - Kofi Agyabeng
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Martha Kotey
- Department of Epidemiology, School of Public Health, University of Ghana, Accra, Ghana
| | - Alfred E Yawson
- Department of Community Health, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Samuel Bosomprah
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
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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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Sherrard-Smith E, Winskill P, Hamlet A, Ngufor C, N'Guessan R, Guelbeogo MW, Sanou A, Nash RK, Hill A, Russell EL, Woodbridge M, Tungu P, Kont MD, Mclean T, Fornadel C, Richardson JH, Donnelly MJ, Staedke SG, Gonahasa S, Protopopoff N, Rowland M, Churcher TS. Optimising the deployment of vector control tools against malaria: a data-informed modelling study. Lancet Planet Health 2022; 6:e100-e109. [PMID: 35065707 DOI: 10.1016/s2542-5196(21)00296-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND Concern that insecticide resistant mosquitoes are threatening malaria control has driven the development of new types of insecticide treated nets (ITNs) and indoor residual spraying (IRS) of insecticide. Malaria control programmes have a choice of vector control interventions although it is unclear which controls should be used to combat the disease. The study aimed at producing a framework to easily compare the public health impact and cost-effectiveness of different malaria prevention measures currently in widespread use. METHODS We used published data from experimental hut trials conducted across Africa to characterise the entomological effect of pyrethroid-only ITNs versus ITNs combining a pyrethroid insecticide with the synergist piperonyl butoxide (PBO). We use these estimates to parameterise a dynamic mathematical model of Plasmodium falciparum malaria which is validated for two sites by comparing simulated results to empirical data from randomised control trials (RCTs) in Tanzania and Uganda. We extrapolated model simulations for a series of potential scenarios likely across the sub-Saharan African region and include results in an online tool (Malaria INtervention Tool [MINT]) that aims to identify optimum vector control intervention packages for scenarios with varying budget, price, entomological and epidemiological factors. FINDINGS Our model indicates that switching from pyrethroid-only to pyrethroid-PBO ITNs could averted up to twice as many cases, although the additional benefit is highly variable and depends on the setting conditions. We project that annual delivery of long-lasting, non-pyrethroid IRS would prevent substantially more cases over 3-years, while pyrethroid-PBO ITNs tend to be the most cost-effective intervention per case averted. The model was able to predict prevalence and efficacy against prevalence in both RCTs for the intervention types tested. MINT is applicable to regions of sub-Saharan Africa with endemic malaria and provides users with a method of designing intervention packages given their setting and budget. INTERPRETATION The most cost-effective vector control package will vary locally. Models able to recreate results of RCTs can be used to extrapolate outcomes elsewhere to support evidence-based decision making for investment in vector control. FUNDING Medical Research Council, IVCC, Wellcome Trust. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Ellie Sherrard-Smith
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK.
| | - Peter Winskill
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Arran Hamlet
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Corine Ngufor
- Centre de Recherches Entomologiques de Cotonou, Cotonou, Benin; London School of Hygiene and Tropical Medicine, London, UK
| | | | - Moussa W Guelbeogo
- Centre National de Recherche et de Formation sur le Paludisme, Burkina Faso
| | - Antoine Sanou
- Centre National de Recherche et de Formation sur le Paludisme, Burkina Faso
| | - Rebecca K Nash
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Alexander Hill
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Emma L Russell
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Mark Woodbridge
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Patrick Tungu
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Mara D Kont
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Tom Mclean
- Innovative Vector Control Consortium, Liverpool, UK
| | | | | | | | - Sarah G Staedke
- London School of Hygiene and Tropical Medicine, London, UK; Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | - Mark Rowland
- London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas S Churcher
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
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12
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Cote CM, Goel V, Muhindo R, Baguma E, Ntaro M, Shook-Sa BE, Reyes R, Staedke SG, Mulogo EM, Boyce RM. Malaria prevalence and long-lasting insecticidal net use in rural western Uganda: results of a cross-sectional survey conducted in an area of highly variable malaria transmission intensity. Malar J 2021; 20:304. [PMID: 34225756 PMCID: PMC8256478 DOI: 10.1186/s12936-021-03835-7] [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: 04/09/2021] [Accepted: 06/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background Long-lasting insecticidal nets (LLINs) remain a cornerstone of malaria control, but strategies to sustain universal coverage and high rates of use are not well-defined. A more complete understanding of context-specific factors, including transmission intensity and access to health facilities, may inform sub-district distribution approaches and tailored messaging campaigns. Methods A cross-sectional survey of 2190 households was conducted in a single sub-county of western Uganda that experiences highly variable malaria transmission intensity. The survey was carried out approximately 3 years after the most recent mass distribution campaign. At each household, study staff documented reported LLIN use and source among children 2 to 10 years of age and performed a malaria rapid diagnostic test. Elevation and distance to the nearest health facility was estimated for each household. Associations between parasite prevalence and LLIN use were estimated from log binomial regression models with elevation and distance to clinic being the primary variables of interest. Results Overall, 6.8% (148 of 2170) of children age 2–10 years of age had a positive RDT result, yielding a weighted estimate of 5.8% (95% confidence interval [CI] 5.4–6.2%). There was substantial variability in the positivity rates among villages, with the highest elevation villages having lower prevalence than lowest-elevation villages (p < .001). Only 64.7% (95% CI 64.0–65.5%) of children were reported to have slept under a LLIN the previous night. Compared to those living < 1 km from a health centre, households at ≥ 2 km were less likely to report the child sleeping under a LLIN (RR 0.86, 95% CI 0.83–0.89, p < .001). Households located farther from a health centre received a higher proportion of LLINs from government distributions compared to households living closer to health centres. Conclusions LLIN use and sourcing was correlated with household elevation and estimated distance to the nearest health facility. The findings suggest that current facility-based distribution strategies are limited in their reach. More frequent mass distribution campaigns and complementary approaches are likely required to maintain universal LLIN coverage and high rates of use among children in rural Uganda. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03835-7.
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Affiliation(s)
- Claire M Cote
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Varun Goel
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rabbison Muhindo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emmanuel Baguma
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Moses Ntaro
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bonnie E Shook-Sa
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Raquel Reyes
- Division of Hospital Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Edgar M Mulogo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ross M Boyce
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda. .,Institute of Global Health and Infectious Diseases, UNC School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Road, CB 7030, Chapel Hill, NC, 27599, USA.
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13
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Roux AT, Maharaj L, Oyegoke O, Akoniyon OP, Adeleke MA, Maharaj R, Okpeku M. Chloroquine and Sulfadoxine-Pyrimethamine Resistance in Sub-Saharan Africa-A Review. Front Genet 2021; 12:668574. [PMID: 34249090 PMCID: PMC8267899 DOI: 10.3389/fgene.2021.668574] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/20/2021] [Indexed: 12/20/2022] Open
Abstract
Malaria is a great concern for global health and accounts for a large amount of morbidity and mortality, particularly in Africa, with sub-Saharan Africa carrying the greatest burden of the disease. Malaria control tools such as insecticide-treated bed nets, indoor residual spraying, and antimalarial drugs have been relatively successful in reducing the burden of malaria; however, sub-Saharan African countries encounter great challenges, the greatest being antimalarial drug resistance. Chloroquine (CQ) was the first-line drug in the 20th century until it was replaced by sulfadoxine–pyrimethamine (SP) as a consequence of resistance. The extensive use of these antimalarials intensified the spread of resistance throughout sub-Saharan Africa, thus resulting in a loss of efficacy for the treatment of malaria. SP was replaced by artemisinin-based combination therapy (ACT) after the emergence of resistance toward SP; however, the use of ACTs is now threatened by the emergence of resistant parasites. The decreased selective pressure on CQ and SP allowed for the reintroduction of sensitivity toward those antimalarials in regions of sub-Saharan Africa where they were not the primary drug for treatment. Therefore, the emergence and spread of antimalarial drug resistance should be tracked to prevent further spread of the resistant parasites, and the re-emergence of sensitivity should be monitored to detect the possible reappearance of sensitivity in sub-Saharan Africa.
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Affiliation(s)
- Alexandra T Roux
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Leah Maharaj
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Olukunle Oyegoke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Oluwasegun P Akoniyon
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Matthew Adekunle Adeleke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Rajendra Maharaj
- Office of Malaria Research, South African Medical Research Council, Cape Town, South Africa
| | - Moses Okpeku
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
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14
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Kua KP, Lee SWH. Randomized trials of housing interventions to prevent malaria and Aedes-transmitted diseases: A systematic review and meta-analysis. PLoS One 2021; 16:e0244284. [PMID: 33417600 PMCID: PMC7793286 DOI: 10.1371/journal.pone.0244284] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/08/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Mosquito-borne diseases remain a significant public health problem in tropical regions. Housing improvements such as screening of doors and windows may be effective in reducing disease transmission, but the impact remains unclear. OBJECTIVES To examine whether housing interventions were effective in reducing mosquito densities in homes and the impact on the incidence of mosquito-borne diseases. METHODS In this systematic review and meta-analysis, we searched 16 online databases, including NIH PubMed, CINAHL Complete, LILACS, Ovid MEDLINE, and Cochrane Central Register of Controlled Trials for randomized trials published from database inception to June 30, 2020. The primary outcome was the incidence of any mosquito-borne diseases. Secondary outcomes encompassed entomological indicators of the disease transmission. I2 values were used to explore heterogeneity between studies. A random-effects meta-analysis was used to assess the primary and secondary outcomes, with sub-group analyses for type of interventions on home environment, study settings (rural, urban, or mixed), and overall house type (traditional or modern housing). RESULTS The literature search yielded 4,869 articles. After screening, 18 studies were included in the qualitative review, of which nine were included in the meta-analysis. The studies enrolled 7,200 households in Africa and South America, reporting on malaria or dengue only. The type of home environmental interventions included modification to ceilings and ribbons to close eaves, screening doors and windows with nets, insecticide-treated wall linings in homes, nettings over gables and eaves openings, mosquito trapping systems, metal-roofed houses with mosquito screening, gable windows and closed eaves, and prototype houses using southeast Asian designs. Pooled analysis depicted a lower risk of mosquito-borne diseases in the housing intervention group (OR = 0.68; 95% CI = 0.48 to 0.95; P = 0.03). Subgroup analysis depicted housing intervention reduced the risk of malaria in all settings (OR = 0.63; 95% CI = 0.39 to 1.01; P = 0.05). In urban environment, housing intervention was found to decrease the risk of both malaria and dengue infections (OR = 0.52; 95% CI = 0.27 to 0.99; P = 0.05).Meta-analysis of pooled odds ratio showed a significant benefit of improved housing in reducing indoor vector densities of both Aedes and Anopheles (OR = 0.35; 95% CI = 0.23 to 0.54; P<0.001). CONCLUSIONS Housing intervention could reduce transmission of malaria and dengue among people living in the homes. Future research should evaluate the protective effect of specific house features and housing improvements associated with urban development.
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Affiliation(s)
- Kok Pim Kua
- Puchong Health Clinic, Petaling District Health Office, Ministry of Health Malaysia, Petaling, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Sunway City, Malaysia
- Asian Center for Evidence Synthesis in Population, Implementation, and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Sunway City, Malaysia
- Gerontechnology Laboratory, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Sunway City, Malaysia
- Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
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15
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Worrall E, Were V, Matope A, Gama E, Olewe J, Mwambi D, Desai M, Kariuki S, Buff AM, Niessen LW. Coverage outcomes (effects), costs, cost-effectiveness, and equity of two combinations of long-lasting insecticidal net (LLIN) distribution channels in Kenya: a two-arm study under operational conditions. BMC Public Health 2020; 20:1870. [PMID: 33287766 PMCID: PMC7720381 DOI: 10.1186/s12889-020-09846-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Malaria-endemic countries distribute long-lasting insecticidal nets (LLINs) through combined channels with ambitious, universal coverage (UC) targets. Kenya has used eight channels with variable results. To inform national decision-makers, this two-arm study compares coverage (effects), costs, cost-effectiveness, and equity of two combinations of LLIN distribution channels in Kenya. METHODS Two combinations of five delivery channels were compared as 'intervention' and 'control' arms. The intervention arm comprised four channels: community health volunteer (CHV), antenatal and child health clinics (ANCC), social marketing (SM) and commercial outlets (CO). The control arm consisted of the intervention arm channels except mass campaign (MC) replaced CHV. Primary analysis used random sample household survey data, service-provider costs, and voucher or LLIN distribution data to compare between-arm effects, costs, cost-effectiveness, and equity. Secondary analyses compared costs and equity by channel. RESULTS The multiple distribution channels used in both arms of the study achieved high LLIN ownership and use. The intervention arm had significantly lower reported LLIN use the night before the survey (84·8% [95% CI 83·0-86·4%] versus 89·2% [95% CI 87·8-90·5%], p < 0·0001), higher unit costs ($10·56 versus $7·17), was less cost-effective ($86·44, 95% range $75·77-$102·77 versus $69·20, 95% range $63·66-$77·23) and more inequitable (Concentration index [C.Ind] = 0·076 [95% CI 0·057 to 0·095 versus C.Ind = 0.049 [95% CI 0·030 to 0·067]) than the control arm. Unit cost per LLIN distributed was lowest for MC ($3·10) followed by CHV ($10·81) with both channels being moderately inequitable in favour of least-poor households. CONCLUSION In line with best practices, the multiple distribution channel model achieved high LLIN ownership and use in this Kenyan study setting. The control-arm combination, which included MC, was the most cost-effective way to increase UC at household level. Mass campaigns, combined with continuous distribution channels, are an effective and cost-effective way to achieve UC in Kenya. The findings are relevant to other countries and donors seeking to optimise LLIN distribution. TRIAL REGISTRATION The assignment of the intervention was not at the discretion of the investigators; therefore, this study did not require registration.
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Affiliation(s)
- Eve Worrall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Vincent Were
- Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, Liverpool, UK
- Kenya Medical Research Institute and Centre for Global Health Research, Kisumu, Kenya
| | - Agnes Matope
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Elvis Gama
- Directorate of Quality Management and Digital Health, Ministry of Health and Population, Lilongwe, Malawi
| | - Joseph Olewe
- Kenya Medical Research Institute and Centre for Global Health Research, Kisumu, Kenya
| | - Dennis Mwambi
- Population Services Kenya (PS Kenya), Nairobi, Kenya
- Population Reference Bureau, Nairobi, Kenya
| | - Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Simon Kariuki
- Kenya Medical Research Institute and Centre for Global Health Research, Kisumu, Kenya
| | - Ann M. Buff
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
- U.S. President’s Malaria Initiative, Nairobi, Kenya
| | - Louis W. Niessen
- Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, Liverpool, UK
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16
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Yukich J, Stuck L, Scates S, Wisniewski J, Chacky F, Festo C, Kabulika G, Dimoso K, Mandike R, Greer G, Serbantez N, Elisaria E, Nyoni W, Dadi D, Akim I, Lengeler C, Brown N, Koenker H. Sustaining LLIN coverage with continuous distribution: the school net programme in Tanzania. Malar J 2020; 19:158. [PMID: 32303240 PMCID: PMC7164342 DOI: 10.1186/s12936-020-03222-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/03/2020] [Indexed: 12/18/2022] Open
Abstract
Most malaria-endemic countries have struggled in the past decade to establish effective national-scale continuous distribution mechanisms for long-lasting insecticidal nets (LLINs). Since the implementation of the Tanzania National Voucher Scheme in 2004 and mass-distribution campaigns in 2009–2011 and 2015–2016, Tanzania has been committed to finding new and innovative ways of achieving and maintaining universal bed net coverage. Planning for the School Net Programme (SNP) began in 2011 and in 2013, the country piloted a SNP in three regions. Nets were distributed annually to children attending schools in selected primary and secondary grades. Intra-family re-distribution was assumed, and hence the family as a whole, rather than just the children themselves, were the targeted beneficiaries. The programme has since expanded to 14 regions and has seen six rounds of annual distribution. In its fifth year, 3 million nets were distributed at a cost of USD 3.64 per net and USD 0.60 per person-year of protection (including the net). ITN access and use were maintained at a high level (~ 50–75%) over the first 4 years of distribution within selected evaluation areas, even in the absence of a mass distribution event. Net distribution through primary schools has proven to be a feasible and effective strategy for maintaining consistently high coverage in Tanzania.
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Affiliation(s)
- Joshua Yukich
- PMI VectorWorks, Center for Applied Malaria Research and Evaluation Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Logan Stuck
- PMI VectorWorks, Center for Applied Malaria Research and Evaluation Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Sara Scates
- PMI VectorWorks, Center for Applied Malaria Research and Evaluation Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Janna Wisniewski
- Department of Health Policy and Management, Tulane University of School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Frank Chacky
- National Malaria Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | | | - George Kabulika
- PMI VectorWorks, Johns Hopkins Center for Communication Programs, Dar es Salaam, Tanzania
| | - Kanuth Dimoso
- PMI VectorWorks, Johns Hopkins Center for Communication Programs, Dar es Salaam, Tanzania
| | - Renata Mandike
- National Malaria Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - George Greer
- U. S. President's Malaria Initiative, United States Agency for International Development, Dar es Salaam, Tanzania
| | - Naomi Serbantez
- U. S. President's Malaria Initiative, United States Agency for International Development, Dar es Salaam, Tanzania
| | | | - Waziri Nyoni
- PMI VectorWorks, Johns Hopkins Center for Communication Programs, Dar es Salaam, Tanzania
| | - David Dadi
- PMI VectorWorks, Johns Hopkins Center for Communication Programs, Dar es Salaam, Tanzania
| | - Ikupa Akim
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Nick Brown
- A to Z Textile Mills Ltd, Arusha, Tanzania.,Nicholas Brown Consulting Ltd., Cardiff, Wales, UK
| | - Hannah Koenker
- PMI VectorWorks, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
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