Abstract
BackgroundThe burden of malaria in Uganda remains high, but has become increasingly heterogenous following intensified malaria control. Travel within Uganda is recognized as a risk factor for malaria, but behaviours associated with travel are not well-understood. To address this knowledge gap, malaria-relevant behaviours of cohort participants were assessed during travel and at home in Uganda.MethodsResidents from 80 randomly selected households in Nagongera sub-county, Tororo district were enrolled into a cohort to study malaria in rural Uganda. All participants were given long-lasting insecticidal nets (LLINs) at enrolment and were evaluated every 4 weeks at the study clinic. Participants were asked if they had travelled overnight from their home, and if so, a questionnaire was administered to capture information on travel details and behaviours. Behaviour while travelling was assessed within 4 weeks following travel during the study clinic visit. Behaviour while at home was assessed using a similar questionnaire during two-weekly home visits. Behaviours while travelling vs at home were compared using log binomial regression models with generalized estimating equations adjusting for repeated measures in the same individual. Analysis of factors associated with LLIN adherence, such as destination and duration of travel, time to bed during travel, gender and age at time of travel, were assessed using log binomial regression models with generalized estimating equations adjusting for repeated measures in the same individual.ResultsBetween October 2017 and October 2019, 527 participants were enrolled and assessed for travel. Of these, 123 (23.2%) reported taking 211 overnight trips; 149 (70.6%) trips were within Tororo. Participants were less likely to use LLINs when travelling than when at home (41.0% vs. 56.2%, relative risk [RR] 0.73, 95% CI 0.60–0.89, p = 0.002); this difference was noted for women (38.8% vs 59.2%, RR 0.66, 95% CI 0.52–0.83, p = 0.001) but not men (48.3% vs 46.6%, RR 0.96, 95% CI 0.67–1.40, p = 0.85). In an adjusted analysis, factors associated with LLIN use when travelling included destination (travelling to districts not receiving indoor residual spraying [IRS] 65.8% vs Tororo district 32.2%, RR 1.80, 95% CI 1.31–2.46, p < 0.001) and duration of travel (> 7 nights 60.3% vs one night 24.4%, RR 1.97, 95% CI 1.07–3.64, p = 0.03).ConclusionsTravellers, particularly women, were less likely to use LLINs when travelling than when at home. LLIN adherence was higher among those who travelled to non-IRS districts and for more than 1 week, suggesting that perceived malaria risk influences LLIN use. Strategies are needed to raise awareness of the importance of using LLINs while travelling.
Highlights
The burden of malaria in Uganda remains high, but has become increasingly heterogenous following intensified malaria control
In 2016, the insecticide was changed to the organophosphate pirimiphos-methyl (Actellic) and IRS with Actellic was delivered in June–July 2016, June–July 2017, June–July 2018, and March–April 2019
Factors associated with long-lasting insecticidal nets (LLINs) adherence during overnight travel Participants who travelled to districts without an IRS program were more likely to sleep under LLINs than those who travelled within Tororo district (65.8% vs 32.2%; relative risks (RR) 1.80, 95% CI 1.31–2.46, p < 0.001) (Table 3)
Summary
The burden of malaria in Uganda remains high, but has become increasingly heterogenous following intensified malaria control. Travel within Uganda is recognized as a risk factor for malaria, but behaviours associated with travel are not well-understood. Malaria control interventions have been scaled-up globally, resulting in significant declines in malaria burden [1,2,3]. Despite these achievements, malaria morbidity remains high worldwide; in 2018, 228 million malaria cases, 93% from Africa, were reported [1]. Factors contributing to the heterogeneity of malaria in Uganda include geographical variation in transmission intensity, increasing urbanization, and delivery of IRS to a limited number of districts [8, 9]
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