Bata District Research Articles

Knowledge, attitudes, and practices related to soil-transmitted helminth infections among residents of Bata district, Equatorial Guinea; a cross-sectional study

BackgroundSoil-transmitted helminth (STH) infection control remains a priority in endemic regions where local epidemiological data are needed for sustainable control strategies, particularly regarding population knowledge, attitudes, and practices (KAP). Our work assessed KAP toward STH infection and associated factors among residents of Bata district, Equatorial Guinea.MethodsA community-based cross-sectional study was conducted among 14 randomly selected communities in the Bata district. Eligible participants were interviewed face-to-face using a standardized questionnaire. Participants aged under 18 years were interviewed in the presence of their parents or legal guardians. For participants aged less than ten, a simplified version of the main questionnaire was developed focusing on children’s practices toward STH and was administered to their parents or legal guardians.ResultsA total of 399 participants were included in the present analysis. Among them, 58% responded to the main questionnaire. The mean (± SD) age of participants aged 10 and over was 37.5 (± 22.2) years, and 60% of them were females, while the mean (± SD) age of those aged less than ten was 5.0 (± 2.5) years. The respondents’ overall knowledge, attitudes, and practices to STH were rated as bad (33%), very good (77%), and good (55%), respectively. Knowledge was significantly associated with education level (p = 0.04) with the knowledge level lower for participants with no formal education than for those with secondary/university education (β = -0.56, 95% CI: -1.00 – -0.12, p = 0.01); Appropriate attitudes level was significantly associated with occupation (p = 0.02) and education levels (p = 0.049) with the appropriate attitude level lower for students than for farmers/fishers (β = -1.24, 95% CI: -2.17—-0.32, p = 0.01) and for primary-level participants than for those with secondary/university education (β = -0.68, 95% CI: -1.23—-0.13, p = 0.02); while appropriate practice level were significantly associated with age (p = 0.01), occupation (p = 0.01), and education (p = 0.02), with the appropriate practices level increasing with age (β = 0.03, 95% CI: 0.005 – 0.05, p = 0.01) and lower in participants with no formal education than in those with secondary/university education (β = -1.19, -2.05 – -0.32, p = 0.007).ConclusionThe present study revealed a lack of knowledge about STH in the study population, particularly regarding disease causes and transmission ways, highlighting the need for the implementation of integrated health education strategies, both at the community and school levels.

Pengaruh penyuluhan menggunakan media lembar balik tentang buah dan sayur pada siswa sekolah dasar

Background: The prevalence of fruit and vegetable consumption among school-aged children In Indonesia is approximately 96%. A lack of fruit and vegetable consumption can lead to a decreased immune system, increase the risk of constipation, cancer, and obesity, and reduce human resource productivity. Therefore, elementary school students' knowledge of nutrition, especially fruits and vegetables, needs to be improved by providing nutrition education on the importance of fruit and vegetable consumption.Objectives: To determine the effect of counseling using flip sheet media on increasing elementary school student’s knowledge of the importance of fruit and vegetable consumption in elementary school children.Methods: The research model used two stages. The first stage uses a media development design (R&D), and the second uses a quasi-experimental approach. The sample comprised of 44 participants. This research was conducted at SDN 62 in Banda Aceh, Lueng Bata District, Banda Aceh City. This study was conducted between April and May 2023. Data collection included primary and secondary data processed through editing, coding, processing, and cleaning. Data analysis was performed using a Dependent T-test at a 95% confidence interval (CI).Results: Counseling increased the children's knowledge of the importance of fruit and vegetable consumption (p= 0,006). The average knowledge of students before being given counseling using the flip sheet media was 64,55 + 8,19. Then, after being given counseling, the average value of knowledge increased to 96,02 + 4,39.Conclusion: Counseling using flip-sheet media affected children's knowledge of the importance of fruit and vegetable consumption.

Pelayanan Komprehensif pada Pasien Anak dengan Varicella Melalui Home Visit Menggunakan Family Folder

Home visit is one of the leading health service programs carried out by the health center. Various important information can be obtained from home visit activities, information on the health of family members, relationships between family members and illnesses suffered by each family member. One of the instruments that can be used in home visit activities is the family folder which also functions as a medical record. Community service activities carried out in the form of home visits to one patient with varicella in the working area of ​​the Batoh Health Center, Lueng Bata District, Banda Aceh City. Home visit activities to the preparation of reports are supervised by supervisors from the Family Medicine Section/Department of the Faculty of Medicine, Syiah Kuala University, Banda Aceh. Home visits were carried out twice in one family. The aim is to evaluate treatment and obtain more information about the patient's health condition, next of kin to the patient's and family's living conditions. Home visit activities are complemented by completing the Family Folder instrument which consists of a genogram, family life cycle, family map, family APGAR, family SCREEM and family life line.

Prevalence, intensity and associated risk factors of soil-transmitted helminth infections among individuals living in Bata district, Equatorial Guinea.

Soil transmitted Helminths (STH) infections remain a public health concern worldwide, particularly in tropical and subtropical areas where these diseases are highly endemic. Knowing the prevalence and risk factors of the disease is crucial for efficient STH control strategies in endemic areas. The scarcity of epidemiological data on STH for Equatorial Guinea has motivated the decision to perform the present study. A cluster-based cross-sectional study was carried out in Bata district from November 2020 to January 2021. Stool samples were collected for the diagnostic of STH infections using Kato-Katz technique. Descriptive statistics was performed for determination of STH prevalence and intensity, while logistic regression models were used to assess the risk factors associated with STH infections. A total of 340 participants were included in the study with a mean age of 24 years (SD = 23.7) and 1.2 female-to-male sex-ratio. The overall prevalence of any STH was 60% (95%CI: 55-65). The most prevalent species were Ascaris lumbricoides (43%, 95%CI: 37-48) and Trichuris trichiura (40%, 95%CI: 35-46). Intensity of infection were mainly light to moderate. A trend of association was observed between age and any STH infection (overall p-value = 0.07), with a significant difference observed between children aged 5-14 years as compared to those aged 1-4 (aOR 2.12; 95%CI: 1.02-4.43, p-value = 0.04), while locality was significantly associated with STH infection (overall p-value<0.001) with a higher odds observed for peri-urban area as compared to urban area (aOR 4.57; 95%CI: 2.27-9.60, p-value<0.001). Bata district is a high STH transmission area, where school-aged children and peri-urban areas are associated with a higher risk of any STH infection. This situation calls for a full implementation of the WHO recommendations for STH control; mass drug administration of anthelminthic twice a year to the whole population with great attention to school age children, and prioritizing peri-urban areas where safe water, improve sanitation, and hygiene education should be implemented to achieve a better control.

Effects of Age, Gender and Soil-Transmitted Helminth Infection on Prevalence of Plasmodium Infection among Population Living in Bata District, Equatorial Guinea.

Malaria and soil-transmitted helminth (STH) co-infection is an important parasitic infection affecting populations in co-endemic countries including Equatorial Guinea. To date, the health impact of STH and malaria co-infection is inconclusive. The current study aimed to report the malaria and STH infection epidemiology in the continental region of Equatorial Guinea. We performed a cross-sectional study between October 2020 and January 2021 in the Bata district of Equatorial Guinea. Participants aged 1-9 years, 10-17 years and above 18 were recruited. Fresh venous blood was collected for malaria testing via mRDTs and light microscopy. Stool specimens were collected, and the Kato-Katz technique was used to detect the presence of Ascaris lumbricoides, Trichuris trichiura, hookworm spp. and intestinal Schistosoma eggs. A total of 402 participants were included in this study. An amount of 44.3% of them lived in urban areas, and only 51.9% of them reported having bed nets. Malaria infections were detected in 34.8% of the participants, while 50% of malaria infections were reported in children aged 10-17 years. Females had a lower prevalence of malaria (28.8%) compared with males (41.7%). Children of 1-9 years carried more gametocytes compared with other age groups. An amount of 49.3% of the participants infected with T. trichiura had malaria parasites compared with those infected with A. lumbricoides (39.6%) or both (46.8%). The overlapping problem of STH and malaria is neglected in Bata. The current study forces the government and other stakeholders involved in the fight against malaria and STH to consider a combined control program strategy for both parasitic infections in Equatorial Guinea.

Implementation of exclusive breastfeeding counseling for prospective brides in Lueng Bata District, Banda Aceh City

The importance of increasing knowledge about exclusive breastfeeding for expectant mothers in Aceh Province is an effort to achieve exclusive breastfeeding success above the national achievement of 69,7%. Optimal breastfeeding practices are one of the keys to success in reducing stunting. Counseling is essential in increasing the knowledge of prospective mothers or brides, supported by the use of media such as flyers that make it easier to understand the importance of exclusive breastfeeding for babies. This community service activity aims to increase the knowledge of prospective brides through counseling on exclusive breastfeeding using flyer media. Community service was carried out using a pretest-posttest non-equivalent group approach, namely providing exclusive breastfeeding counseling to prospective brides in Lueng Bata District. The number of participants was 20 people (10 couples), and activities were carried out in 2020. The counseling media is an exclusive breastfeeding flyer from the Indonesian Ministry of Health. Data collection was conducted through interviews using a questionnaire. The evaluation was carried out descriptively, consisting of a pretest and a posttest. The results showed an increase in average knowledge between before (26,3), and after (33,1) exclusive breastfeeding counseling was given using flyer media to prospective brides, or there was an increase in knowledge of 60,0%. In conclusion, through flyer media, exclusive breastfeeding counseling can improve the knowledge or understanding of prospective brides about exclusive breastfeeding.

MODEL KLASTERISASI WILAYAH KOTA BERDASARKAN INDEKS INFRASTRUKTUR UNTUK PERENCANAAN STRUKTUR RUANG BERKELANJUTAN

Banda Aceh has nine sub-districts. These sub-districts have different levels of infrastructure growth. This will make it difficult for the government to make policies or decisions to determine a good strategy for developing sub-districts in Banda Aceh City. To make it easier to make a policy in terms of infrastructure development for the sub-district, it is necessary to cluster the area in Banda Aceh City. Regional clustering will group regions with the same level of development. This will make it easier for the government to make a decision. In this study, there were eight infrastructure indices, roads, electricity, water, solid waste, telecommunications, wastewater, drainage, and green open spaces (RTH). From the results of the study, it was found that the discussion of Banda Aceh City can be divided into 3 clusters. The first clustering is a cluster that does not have a prominent advantage over the eight variables but has the lowest variable level in the fields of roads, garbage, and wastewater. The sub-districts included in the first clustering are Kuta Alam District and Syiah Kuala District. The second clustering is clustering which has the highest variables in the field of drainage and roads but has the lowest variables in the fields of green open space and drinking water. The sub-districts included in the second clustering are Baiturrahman District, Banda Raya District, Jaya Baru District, Leung Bata District, and Ulee Kareng District. The third clustering is the cluster that has the highest variables in the field of solid waste, drinking water, wastewater, and green open space but has the lowest variable in the drainage sector. From the results of the Analytical Hierarchy Process (AHP), it is found that development priorities are road construction, green open space, electricity, drinking water, telecommunications, wastewater, drainage, and finally solid waste. The results of the SWOT analysis show that the graph is located in the strength and opportunity sections. So the policy taken for the future is the main focus on the construction of infrastructure for solid waste, wastewater, green open space, and telecommunications.

The Effectiveness of Vegetable Starfruit Juice (Averrhoa bilimbi) and Rosella Tea (Hibiscus sabdariffa L) Against the Inhibition of Dental Plaque Formation

BACKGROUND: Dental disease is a significant public health problem. Various efforts have been made to maintain oral health by utilizing natural ingredients from plants. One of the natural ingredients often used among the community is Vegetable Starfruit Juice (Averrhoa bilimbi) and Rosella Tea. AIM: The purpose of this study was to analyze the effectiveness of Starfruit and rosella tea (Hibiscus sabdariffa L) on the Inhibition of Dental Plaque Formation. METHODS: Design this research is an experimental study with a post-test design only. The research was conducted in Gampong Batoh, Lueng Bata District, Banda Aceh City, from June 26 to October 04, 2021. The study population was the community of Gampong Batoh, Banda Aceh City. The sample in this study used a purposive sampling technique. The sample in this study met the criteria and was willing to assist in implementing the research by signing the informed consent. The number of research samples was 40 people. RESULTS: The results showed a significant difference in the effectiveness of Starfruit juice and rosella tea on the inhibition of plaque formation based on time duration (p &lt; 0.05). The group that rinsed with rosella tea solution had more effective inhibition than the group that rinsed with vegetable Starfruit juice solution (p &lt; 0.05). Vegetable Starfruit (A. bilimbi) and Rosella Tea contain bioactive compounds such as alkaloids, flavonoids, saponins, and tannins that can act as antibacterial agents in inhibiting the growth of Staphylococcus aureus. CONCLUSION: Vegetable Starfruit Juice (A. bilimbi) and Rosella Tea (H. sabdariffa L) effectively inhibit the formation of dental plaque.

Deteksi dini faktor resiko kanker payudara pada wanita di wilayah kerja Puskesmas Batoh Banda Aceh

Background: Breast cancer is an abnormal growth of cells that form in breast tissue. In Aceh, breast cancer is the third most non-communicable disease with most breast cancer patients having a period of late treatment. The results of research on women in Lueng Bata District Banda Aceh City in 2015 found data that the majority of respondents had never had regular breast examinations. This can result in breast cancer being detected at an advanced stage where the therapy often cannot make the patient recover and end up in pain and death. To prevent the occurrence of these problems, health promotion is held about breast cancer and breast self-examination (BSE).Objectives: This study aims to increase women's knowledge and understanding of breast cancer and increase awareness for early detection and appropriate treatment.Methods: was carried out for 3 days from 12 to 14 September 2018 to the community in the work area of the Batoh Health Center in Banda Aceh. The method used is filling out questionnaires, lectures accompanied by questions and answers to explain risk factors, early signs of breast cancer, as well as demonstrations of breast self-examination.Results: From the evaluation of the results obtained from the community service activities, among others, is to increase awareness and understanding of the community, especially women about breast cancer and breast self-examination. It is thus expected to continue on a will that is applied in daily behavioral changes to prevent and routinely examine breast cancer in order to prevent complications and improve quality of life.Conclusion: There is an increase in knowledge and understanding of the meaning, risk factors, early signs and symptoms of breast cancer, and how to detect breast cancer early.

Relationship between Diet Compliance and Blood Pressure of Hypertension Patients in Batoh Public Health Center, Lueng Bata District, Banda Aceh City

Hypertension is an abnormal increase in blood pressure in the arteries, and the increase continuously occurs over a period. People with hypertension must consider food factors (dietary compliance) because diet is one way to lower blood pressure. Patients with hypertension should adhere to a hypertension diet so that blood pressure becomes stable and further complications can be prevented. This study aims to determine the relationship between hypertension dietary compliance and blood pressure of hypertensive patients in Batoh Public Health Center, Lueng Bata District, Banda Aceh City. This descriptive-analytic research employed a cross-sectional design. The research sample was 37 women aged 45-60 years. They were selected using a non-probability technique with the purposive sampling technique. The research was conducted at the Batoh Public Health Center, Lueng Bata District, Banda Aceh City. The research data included hypertension diet compliance and blood pressure of hypertensive patients. The level of dietary compliance was determined using a questionnaire while the level of blood pressure was determined using a digital blood pressure measurement of Tensi One. The chi-square test was employed to analyze the relationship between diet compliance and blood pressure. This study has discovered that 64.9% of hypertensive patients have non-adherent diet compliance, and 78.4% of them have high blood pressure. These results denote a significant relationship between dietary compliance and blood pressure (p-value = 0.008).

Population genetic analysis of the Plasmodium falciparum erythrocyte binding antigen-175 (EBA-175) gene in Equatorial Guinea

BackgroundPlasmodium falciparum erythrocyte binding antigen-175 (PfEBA-175) is a candidate antigen for a blood-stage malaria vaccine, while various polymorphisms and dimorphism have prevented to development of effective vaccines based on this gene. This study aimed to investigate the dimorphism of PfEBA-175 on both the Bioko Island and continent of Equatorial Guinea, as well as the genetic polymorphism and natural selection of global PfEBA-175.MethodsThe allelic dimorphism of PfEBA-175 region II of 297 bloods samples from Equatorial Guinea in 2018 and 2019 were investigated by nested polymerase chain reaction and sequencing. Polymorphic characteristics and the effect of natural selection were analyzed using MEGA 7.0, DnaSP 6.0 and PopART programs. Protein function prediction of new amino acid mutation sites was performed using PolyPhen-2 and Foldx program.ResultsBoth Bioko Island and Bata district populations, the frequency of the F-fragment was higher than that of the C-fragment of PfEBA-175 gene. The PfEBA-175 of Bioko Island and Bata district isolates showed a high degree of genetic variability and heterogeneity, with π values of 0.00407 & 0.00411 and Hd values of 0.958 & 0.976 for nucleotide diversity, respectively. The values of Tajima's D of PfEBA-175 on Bata district and Bioko Island were 0.56395 and − 0.27018, respectively. Globally, PfEBA-175 isolates from Asia were more diverse than those from Africa and South America, and genetic differentiation quantified by the fixation index between Asian and South American countries populations was significant (FST > 0.15, P < 0.05). A total of 310 global isolates clustered in 92 haplotypes, and only one cluster contained isolates from three continents. The mutations A34T, K109E, D278Y, K301N, L305V and D329N were predicted as probably damaging.ConclusionsThis study demonstrated that the dimorphism of F-fragment PfEBA-175 was remarkably predominant in the study area. The distribution patterns and genetic diversity of PfEBA-175 in Equatorial Guinea isolates were similar another region isolates. And the levels of recombination events suggested that natural selection and intragenic recombination might be the main drivers of genetic diversity in global PfEBA-175. These results have important reference value for the development of blood-stage malaria vaccine based on this antigen.

Knowledge and practices regarding malaria and the National Treatment Guidelines among public health workers in Equatorial Guinea

BackgroundIn 2018, an estimated 228 million cases of malaria occurred worldwide. Countries are far from having achieved reasonable levels of national protocol compliance among health workers. Lack of awareness of treatment protocols and treatment resistance by prescribers threatens to undermine progress when it comes to reducing the prevalence of this disease. This study sought to evaluate the degree of knowledge and practices regarding malaria diagnosis and treatment amongst prescribers working at the public health facilities of Bata, Equatorial Guinea.MethodsA cross-sectional survey was conducted in October-December 2017 amongst all public health professionals who attended patients under the age of 15 years, with suspected malaria in the Bata District of Equatorial Guinea. Practitioners were asked about their practices and knowledge of malaria and the National Malaria Treatment Guidelines. A bivariate analysis and a logistic regression model were used to determine factors associated with their knowledge.ResultsAmong the 44 practitioners interviewed, 59.1% worked at a Health Centre and 40.9% at the District Hospital of Bata. Important differences in knowledge and practices between hospital and health centre workers were found. Clinical diagnosis was more frequently by practitioners at the health centres (p = 0.059), while microscopy confirmation was more frequent at regional hospital (100%). Intramuscular artemether was the anti-malarial most administrated at the health centres (50.0%), while artemether-lumefantrine was the treatment most used at the regional hospital (66.7%). Most practitioners working at public health facilities (63.6%) have a low level of knowledge regarding the National Malaria Treatment Guidelines. While knowledge regarding malaria, the National Malaria Treatment Guidelines and treatment resistances is low, it was higher amongst hospital workers than amongst practitioners at health centres.ConclusionsIt is essential to reinforce practitioners’ knowledge, treatment and diagnosis practices and use of the National Malaria Treatment Guidelines in order to improve malaria case management and disease control in the region. A specific malaria training programme ensuring ongoing updates training is necessary in order to ensure that greater experience does not entail obsolete knowledge and, consequently, inadequate diagnosis and treatment practices.

Failures in the case management of children with uncomplicated malaria in Bata district of Equatorial Guinea and associated factors.

BackgroundIn Equatorial Guinea, malaria continues to be one of the main causes of morbidity and mortality among children. The National Therapeutic Guide established artesunate-amodiaquine (ASAQ) as first-line treatment for uncomplicated malaria, but compliance with this treatment is low. The aim of this study was to assess, for the first time, the performance of public healthcare workers in the diagnosis and treatment of uncomplicated malaria, their compliance with first-line Malaria National Therapeutic Guide and the associated factors.MethodsA cross-sectional survey was conducted at the nine public health facilities in the Bata District of Equatorial Guinea to assess the management of uncomplicated malaria in children < 15 years of age. Bivariate and multivariate statistical analyses were used to determine the recommended treatment compliance and related factors.ResultsA total of 227 children with uncomplicated malaria were recorded from 9 public health facilities. Most of the treatments prescribed (83.3%) did not follow the first-line treatment recommended for uncomplicated malaria. The diagnosis was established with parasite confirmation in 182 cases (80.2%). After adjustment for other variables, children under 2 months of age, the use of parasite confirmation to the diagnosis of malaria and being familiar with the national therapeutic guide were significantly associated with the prescription of the first-line recommended treatment. Cases attended at the hospital or in a health facility with ASAQ in the pharmacy at the time of the study were also more likely to be prescribed with the recommended treatment, but with non-significant association after adjustment for other variables.ConclusionsThis study identified the factors associated with the low compliance with the first-line treatment by the public healthcare facilities of Bata District of Equatorial Guinea. It seems necessary to improve case management of children with uncomplicated malaria; to reinforce the use of Malaria National Therapeutic Guide and to inform about the danger of using artemisinin monotherapy. Furthermore, it is crucial to provide recommended first-line treatment to the pharmacies of all public health facilities to ensure access to this treatment.

Kajian Kepuasan Pengguna Rumah Bantuan Cinta Kasih Panteriek Banda Aceh

Post-disaster earthquake and tsunami December 26, 2004 Aceh region suffered a devastation in the field of infrastructure is quite wide, especially housing that amounted to ± 123,000 units. The construction of relief housing for disaster victims by relocating one of them is located in the village of Panteriek Lueng Bata district of Banda Aceh under the name of Cinta Kasih Housing built by Tzu Chi volunteers (Yayasan Budha Tzu Chi Indonesia) of 716 houses. This study aims to determine the level of satisfaction of the people who use Rumah Cinta Kasih Panteriek assistance and analyze the dominant factors of satisfaction level from the location, building design, product quality, facilities and infrastructure. Determination of this research sample using slovin formula obtained 83 house units as a sample of 486 housing units that have not changed shape. Methods used mix methods between qualitative and quantitative where in the primary data collection using cluster sampling technique, then the data is analyzed by index frequency. This research begins with a pre-survey process where tested the questionnaire to determine the level of validity and reliability on each item question tested to 10 respondents. Pre-survey results show that the validity value of 0,31 – 0,70greater than 0.3 while the reliability value 0,86 greater than 0,6 with the sense that the questionnaire is feasible used in this study. The results showed that as many as 16% of respondents answered very satisfied and 28% answered satisfied; 21% answered quite satisfied; 15% answered not satisfied; and 20% of respondents answered very dissatisfied with the Cinta Kasih Panteriek. The dominant factor causing dissatisfaction of the householder is clean water (PDAM or drilled well) with value FI = 0,28; (FI = 0,36), land area (FI = 0,38), and house size (FI = 0,38). While the most dominant factor of the satisfaction of home users is access to the highway with the value of FI = 0,80. From the results of this study it can be concluded that the main cause of dissatisfaction of people in Cinta Kasih Panteriek caused by inadequate network of water supply as basic human needs in carrying out its activities.

The use and preference of artemether as a first-choice treatment for malaria: results from a cross-sectional survey in the Bata district, Equatorial Guinea

BackgroundMalaria is endemic in Equatorial Guinea with stable transmission, and it remains a major cause of morbidity and mortality in children under 5 years of age. Adherence to artemisinin-based combination therapy (ACT) as a first-line treatment for uncomplicated malaria is critical to malaria control. Six years after the introduction of artesunate-amodiaquine (AS/AQ) therapy in Equatorial Guinea, adherence to the first-line treatment seems to be low in the Bata district. The factors associated with the choice of malaria treatment have not been studied previously in this area; therefore, this study aimed to analyse the preference and use of artemether as malaria treatment and its related factors in the Bata district of Equatorial Guinea.MethodsIn 2013, a cross-sectional study was conducted in the Bata district, which involved 428 households. Bivariate and multivariate statistical analyses were conducted to determine the relevance of socio-economic, geographical, and behavioural factors that played a role in the preference and use of artemether as malaria treatment.ResultsArtemether was considered the best treatment for malaria by 110 caregivers (26%), and was the antimalarial most administrated in the Bata district. It was prescribed to 117 children (27.34%); while, only 6.78% were administered AS/AQ. Caregivers living ≤ 3 km from the nearest health facility were almost two times more likely to consider artemether as the best treatment than those living farther away (95% CI 0.31–0.86). Caregivers with at least a secondary school education were 2.7 times more likely to consider artemether as the best treatment than those less educated. Children whose caregivers considered artemether the best treatment against malaria were five times more likely to be treated with artemether than children with caregivers who did not consider it the best (OR 5.07, 95% CI 2.93–8.78). In contrast, children that reported weakness as a symptom were less likely to be treated with artemether than those with other symptoms (OR 0.47, 95% CI 0.28–0.78).ConclusionCaregivers, public and private health staff, and drug sellers need to understand the importance of using ACT to treat uncomplicated malaria and the dangers of using artemisinin monotherapy.

Prevalence of anemia and associated factors in children living in urban and rural settings from Bata District, Equatorial Guinea, 2013.

Anemia in children under 5 years of age is a global public health problem. According to the World Health Organization the current rate of anemia among preschool aged children in Equatorial Guinea is 66%. No information is available above this age. The cross-sectional Prevamal Survey was conducted in 2013 aimed at providing baseline data on malaria prevalence in children aged 2 months-15 years old. Sampling was carried out with the use of a multistage, stratified cluster strategy in the district of Bata, Equatorial Guinea. The χ2 test and adjusted Poisson regression models were applied to assess the association between social-demographic and economic factors, malaria and anemia. A total of 1436 children were tested, out of which 1,421 children (99%) were tested for anemia. Over 85% were anemic; out of them, 284 (24%), 815 (67%) and 111 (9%) children had mild, moderate and severe anemia, respectively. Severe anemia was more frequent among children aged 2–12 months old and those living in rural sites. About 47% tested positive for malaria via a rapid diagnostic test (RDT). This rate was significantly higher in rural villages (66%; p<0.001). The prevalence of anemia and malaria was higher in rural settings (p<0.001). On the other hand, anemia in urban areas displayed a heterogeneity and complexity that differed from the rural environment: in urban neighbourhoods, children with concomitant malaria infection were more likely to be anemic (adjusted prevalence rate (aPR):1.19; CI 95%: 1.12–1.28). Moreover, the prevalence of anemia was higher in children aged above 13 months compared to younger children (p<0.005). Belonging to the poorest wealth tertile were positively (aPR: 1.14, 95% CI: 1.05–1.24) and children’ parents being employees (aPR: 0.86, 95% CI: 0.76–0.96) or self-employed (aPR: 0.86, 95% CI: 0.76–0.97) vs. working in agriculture and/or fishing negatively associated with anemia among urban children. This marked urban-rural variation indicates the importance of targeting specific areas or districts. Strategies aimed at reducing malaria are clearly paramount in this country. Prevention and treatment of other factors associated with the etiology of anemia (e.g., iron deficiency) are also likely necessary to combat the burden of anemia in Equatorial Guinea.

Spatial clustering and risk factors of malaria infections in Bata district, Equatorial Guinea

BackgroundThe transmission of malaria is intense in the majority of the countries of sub-Saharan Africa, particularly in those that are located along the Equatorial strip. The present study aimed to describe the current distribution of malaria prevalence among children and its environment-related factors as well as to detect malaria spatial clusters in the district of Bata, in Equatorial Guinea.MethodsFrom June to August 2013 a representative cross-sectional survey using a multistage, stratified, cluster-selected sample was carried out of children in urban and rural areas of Bata District. All children were tested for malaria using rapid diagnostic tests (RDTs). Results were linked to each household by global position system data. Two cluster analysis methods were used: hot spot analysis using the Getis-Ord Gi statistic, and the SaTScan™ spatial statistic estimates, based on the assumption of a Poisson distribution to detect spatial clusters. In addition, univariate associations and Poisson regression model were used to explore the association between malaria prevalence at household level with different environmental factors.ResultsA total of 1416 children aged 2 months to 15 years living in 417 households were included in this study. Malaria prevalence by RDTs was 47.53%, being highest in the age group 6–15 years (63.24%, p < 0.001). Those children living in rural areas were there malaria risk is greater (65.81%) (p < 0.001). Malaria prevalence was higher in those houses located <1 km from a river and <3 km to a forest (IRR: 1.31; 95% CI 1.13–1.51 and IRR: 1.44; 95% CI 1.25–1.66, respectively). Poisson regression analysis also showed a decrease in malaria prevalence with altitude (IRR: 0.73; 95% CI 0.62–0.86). A significant cluster inland of the district, in rural areas has been found.ConclusionsThis study reveals a high prevalence of RDT-based malaria among children in Bata district. Those households situated in inland rural areas, near to a river, a green area and/or at low altitude were a risk factor for malaria. Spatial tools can help policy makers to promote new recommendations for malaria control.

Profile of molecular mutations in pfdhfr, pfdhps, pfmdr1, and pfcrt genes of Plasmodium falciparum related to resistance to different anti-malarial drugs in the Bata District (Equatorial Guinea)

BackgroundThe emergence of drug resistance in Plasmodium falciparum has been a major contributor to the global burden of malaria. Drug resistance complicates treatment, and it is one of the most important problems in malaria control. This study assessed the level of mutations in P. falciparum genes, pfdhfr, pfdhps, pfmdr1, and pfcrt, related to resistance to different anti-malarial drugs, in the Continental Region of Equatorial Guinea, after 8 years of implementing artesunate combination therapies as the first-line treatment.ResultsA triple mutant of pfdhfr (51I/59R/108N), which conferred resistance to sulfadoxine/pyrimethamine (SP), was found in 78% of samples from rural settings; its frequency was significantly different between urban and rural settings (p = 0.007). The 164L mutation was detected for the first time in this area, in rural settings (1.4%). We also identified three classes of previously described mutants and their frequencies: the partially resistant (pfdhfr 51I/59R/108N + pfdhps 437G), found at 54% (95% CI 47.75–60.25); the fully resistant (pfdhfr 51I/59R/108N + pfdhps 437G/540E), found at 28% (95% CI 7.07–14.93); and the super resistant (pfdhfr 51I/59R/108N + pfdhps 437G/540E/581G), found at 6% (95% CI 0.48–4.32). A double mutation in pfmdr1 (86Y + 1246Y) was detected at 2% (95% CI 0.24–3.76) frequency, distributed in both urban and rural samples. A combination of single mutations in the pfmdr1 and pfcrt genes (86Y + 76T), which was related to resistance to chloroquine and amodiaquine, was detected in 22% (95% CI 16.8–27.2) of samples from the area.ConclusionsThe high level of mutations detected in P. falciparum genes related to SP resistance could be linked to the unsuccessful withdrawal of SP treatment in this area. Drug resistance can reduce the efficacy of intermittent prophylactic treatment with SP for children under 5 years old and for pregnant women. Although a high number of mutations was detected, the efficacy of the first-line treatment, artemisinin/amodiaquine, was not affected. To avoid increases in the numbers, occurrence, and spread of mutations, and to protect the population, the Ministry of Health should ensure that health centres and hospitals are supplied with appropriate first-line treatments for malaria.

Caregivers’ Malaria Knowledge, Beliefs and Attitudes, and Related Factors in the Bata District, Equatorial Guinea

ObjectivesAdequate community knowledge about malaria is crucial in order to improve prevention by reducing exposure to the disease. Malaria is a major cause of morbidity and mortality among children of less than five years of age in Equatorial Guinea. However, information concerning the accuracy of community knowledge is insufficient. This study aimed at assessing the depth of caregivers’ knowledge of malaria, their beliefs and attitudes about this disease, and their socioeconomic determinants in the Bata district of Equatorial Guinea.MethodologyA cross-sectional study was conducted in the district of Bata, involving 440 houses selected from 18 rural villages and 26 urban neighbourhoods. A combined "Malaria Knowledge Score" was generated based on caregivers’ knowledge about transmission, symptoms, prevention, the treatment of children, and best place to seek treatment. Multivariate logistic regressions analyses were performed to assess those factors that are associated with knowledge about malaria.ResultsA total of 428 caregivers were interviewed; 255 (59.6%) and 173 (40.4%) lived in urban and rural areas respectively. Significant differences between rural and urban households were observed in caregivers’ malaria knowledges and beliefs. Almost 42% of urban and 65% of rural caregivers were unaware as to how malaria is transmitted (OR = 2.69; 95% CI: 1.78–4.05). Together with rurality, the factors most significantly associated with the Malaria Knowledge were the level of education of the caregiver and the socioeconomic status of the household.ConclusionsImprovements in educational programs are needed to empower the most vulnerable households such that they can pro-actively implement malaria control measures. This could be achieved by a comprehensive communication strategy aimed at changing individual and community behaviours, and delivered by suitably trained community health workers and indoor residual spraying personnel.

Determinants of delay in malaria care-seeking behaviour for children 15 years and under in Bata district, Equatorial Guinea.

BackgroundMalaria remains a major cause of morbidity and mortality in children under 5 years of age in Equatorial Guinea. Early appropriate treatment can reduce progression of the illness to severe stages, thus reducing of mortality, morbidity and onward transmission. The factors that contribute to malaria treatment delay have not been studied previously in Equatorial Guinea. The objective of this study was to assess the determinants of delay in seeking malaria treatment for children in the Bata district, in mainland Equatorial Guinea.MethodologyA cross-sectional study was conducted in Bata district, in 2013, which involved 428 houses in 18 rural villages and 26 urban neighbourhoods. Household caregivers were identified in each house and asked about their knowledge of malaria and about the management of the last reported malaria episode in a child 15 years and younger under their care. Bivariate and multivariate statistical analyses were conducted to determine the relevance of socio-economic, geographical and behavioural factors on delays in care-seeking behaviour.ResultsNearly half of the children sought treatment at least 24 h after the onset of the symptoms. The median delay in seeking care was 2.8 days. Children from households with the highest socio-economic status were less likely to be delayed in seeking care than those from households with the lowest socio-economic status (OR 0.37, 95 % CI 0.19–0.72). Children that first received treatment at home, mainly paracetamol, were more than twice more likely to be delayed for seeking care, than children who did not first receive treatment at home (OR 2.36, 95 % CI 1.45–3.83). Children living in a distance >3 km from the nearest health facility were almost two times more likely to be delayed in seeking care than those living closer to a facility but with non significant association once adjusted for other variables (OR 1.75, 95 % CI 0.88–3.47).ConclusionTo decrease malaria morbidity and mortality in Bata district, efforts should be addressed to reduce household delays in seeking care. It is necessary to provide free access to effective malaria diagnosis and treatment, to reinforce malaria management at community level through community health workers and drug sellers and to increase awareness on the severity of malaria, the importance of early diagnosis and appropriate treatment.