Use Of Bed Nets Research Articles

Wealth inequalities in reproductive and child health preventive care in Mozambique: a decomposition analysis

ABSTRACT Background Assessing the gap between rich and poor is important to monitor inequalities in health. Identifying the contribution to that gap can help policymakers to develop interventions towards decreasing that difference. Objective To quantify the wealth inequalities in health preventive measures (bed net use, vaccination, and contraceptive use) to determine the demographic and socioeconomic contribution factors to that inequality using a decomposition analysis. Methods Data from the 2015 Immunisation, Malaria and AIDs Indicators Survey were used. The total sample included 6946 women aged 15–49 years. Outcomes were use of insecticide-treated nets (ITN), child vaccination, and modern contraception use. Wealth Index was the exposure variable and age, marital status, place of residence, region, education, occupation, and household wealth index were the explanatory variables. Wealth inequalities were assessed using concentration indexes (Cindex). Wagstaff-decomposition analysis was conducted to assess the determinants of the wealth inequality. Results The Cindex was −0.081 for non-ITN, −0.189 for lack of vaccination coverage and −0.284 for non-contraceptive use, indicating a pro-poor inequality. The results revealed that 88.41% of wealth gap for ITN was explained by socioeconomic factors, with education and wealth playing the largest roles. Lack of full vaccination, socioeconomic factors made the largest contribution, through the wealth variable, whereas geographic factors came next. Finally, the lack of contraceptive use, socioeconomic factors were the main explanatory factors, but to a lesser degree than the other two outcomes, with wealth and education contributing most to explaining the gap. Conclusion There was a pro-poor inequality in reproductive and child preventive measures in Mozambique. The greater part of this inequality could be attributed to wealth, education, and residence in rural areas. Resources should be channeled into poor and non-educated rural communities to tackle these persistent inequities in preventive care.

Evaluation of an accelerometer-based monitor for detecting bed net use and human entry/exit using a machine learning algorithm

BackgroundDistribution of long-lasting insecticidal bed nets (LLINs) is one of the main control strategies for malaria. Improving malaria prevention programmes requires understanding usage patterns in households receiving LLINs, but there are limits to what standard cross-sectional surveys of self-reported LLIN use can provide. This study was designed to assess the performance of an accelerometer-based approach for measuring a range of LLIN use behaviours as a proof of concept for more granular LLIN-use monitoring over longer time periods.MethodsThis study was carried out under controlled conditions from May to July 2018 in Liverpool, UK. A single accelerometer was affixed to the side panel of an LLIN and participants carried out five LLIN use behaviours: (1) unfurling a net; (2) entering an unfurled net; (3) lying still as if sleeping; (4) exiting from under a net; and, (5) folding up a net. The randomForest package in R, a supervised non-linear classification algorithm, was used to train models on 20-s epochs of tagged accelerometer data. Models were compared in a validation dataset using overall accuracy, sensitivity and specificity, receiver operating curves and the area under the curve (AUC).ResultsThe five-category model had overall accuracy of 82.9% in the validation dataset, a sensitivity of 0.681 for entering a net, 0.632 for exiting, 0.733 for net down, and 0.800 for net up. A simplified four-category model, combining entering/exiting a net into one category had accuracy of 94.8%, and increased sensitivity for net down (0.756) and net up (0.829). A further simplified three-category model, identifying sleeping, net up, and a combined net down/enter/exit category had accuracy of 96.2% (483/502), with an AUC of 0.997 for net down and 0.987 for net up. Models for detecting entering/exiting by adults were significantly more accurate than for children (87.8% vs 70.0%; p < 0.001) and had a higher AUC (p = 0.03).ConclusionsUnderstanding how LLINs are used is crucial for planning malaria prevention programmes. Accelerometer-based systems provide a promising new methodology for studying LLIN use. Further work exploring accelerometer placement, frequency of measurements and other machine learning approaches could make these methods even more accurate in the future.

Bed net use and malaria treatment-seeking behavior in artisanal gold mining and sugarcane growing areas of Western Kenya highlands

Provision of the bed net in Sub-Saharan Africa has substantially resulted in the decrease in malaria incidences in the region. However, malaria still ravages these regions causing significant deaths. This situation has been attributed to socio-economic inequalities that reduce access to the net, failure to seek treatment, and poor antimalarial drug use. Information about these factors in malaria control in Western Kenya highlands is not clearly documented. This study sought to find out bed net availability and use, treatment-seeking, and antimalarial drug use behavior in two rural communities. The study was a qualitative-quantitative baseline cross-sectional survey carried out in two rural villages in Western Kenya highlands in November – December 2018. Focus group discussion, a semi-structured questionnaire, and in-depth interviews were conducted in 736 households to determine: socio-demographic characteristics; bed net availability and use; action taken when sick with malaria, and antimalarial drug usage. Socio-demographic characteristics and the responses of the participants were expressed as percentages. Dependent and independent variables were cross-tabulated for calculation of OR and association was tested using Pearson Chi-square at 95% CI and a p ≤ 0.05 was considered significant. Ninety-three percent of the respondents had used the net the previous night, females (56.50%) constituted the majority of respondents, going to health facility (84.26%) was the preferred action taken when a person had malaria, Artemether Lumefantrine (90.19%), and a pain killer was the most cited drug, 22.96% of the responders reported to have failed to complete antimalarial dose saying that they had recovered from the malaria bout and 9.80% reported to re-use the remaining part of the dosage. This was the first study in mining and sugarcane growing communities in Western Kenya Highlands that has shown that there was no association between socio-demographic parameters and bed net use, action taken when having malaria, and adherence to drug use. The two rural communities have the bed net and know its use. They have good knowledge of malaria and seek treatment whenever they saw malaria signs. The study also reported that the action the sick person took when they had a malaria bout, the drug they got from the health facility, or failure to complete an AL dosage regimen was not associated with socio-demographic characteristics of the responder. These findings raise the need for further qualitative studies in other settings to accept or deny that there was no association between socio-demographics and action taken when hit with malaria bout, the drug used, and failure to complete drug dosage.

Malaria prevention practices and malaria prevalence among children living in a rural community in Southwest Nigeria.

Living conditions in most rural African communities favour malaria transmission and threaten global eradication. Prevention strategies and interventions such as the use of bed nets have reduced the prevalence of malaria. This study described the various methods employed to prevent malaria and their effects on malaria parasite prevalence among children living in a rural community in Nigeria. A community-based cross-sectional study conducted among 357 children aged 1-15 years, in a Nigerian rural community. Data was analyzed using SPSS version 25. Chi-squared test of association with a level of significance of p < 0.050 was used. Only 110 (30.8%) participants owned mosquito nets. Mostly those from the high social class (45; 40.9%) used the nets, and these were mostly 'under-five' children. Thirty-six (10.1%) were routinely given antimalarial drugs for malaria prophylaxis. Also, 102 (28.6%), 151 (42.3%), 278 (77.9%), 99 (27.7%) and 15 (5.0%) children used insecticides, local herbs, window nets, outlet door nets and mosquito repellent creams respectively. None of the methods employed to prevent malaria had statistically significant effect on malaria parasite prevalence among participants (p > 0.050). Malaria prevention methods were mostly practiced by participants of the high social class while children under-five considerably used mosquito nets. This study highlights the need to address the socio-demographic imbalance regarding malaria preventive measures in the community where the study was conducted. There is also a need to regulate the use of antimalarial drugs for malaria prophylaxis in the rural community. These suggest that the current malaria prevention methods in the community be reviewed.

Risk Factors Associated With Dengue in District Khyber, Khyber Pakhtunkhwa, Pakistan, From September 2 to November 24, 2019: Case-Control Study

Background Dengue is a vector-borne disease endemic to Pakistan as well as to Khyber Pakhtunkhwa. A total of 300 confirmed cases of dengue were reported in District Khyber in 2019, where a prompt response was initiated by the Disease Surveillance and Response Unit. Subsequently, a study was planned to identify the risk factors associated with dengue and to propose recommendations for containment of the disease. Objective This study aimed to assess the risk factors associated with dengue in District Khyber and to provide recommendations for improving the existing system and preventing dengue. Methods A case-control study was conducted in District Khyber from September 2 to November 24, 2019. Cases were enrolled from health care facilities based on predefined criteria, which included the presence of clinical signs and symptoms as well as laboratory confirmation of dengue NS1 antigen. Controls were enrolled from the community at a case-control ratio of 1:2. Data were collected using a pretested questionnaire in face-to-face interviews. Results A total of 300 cases were enrolled; 87% (263) of cases were men. This study found that 45% (269/601; odds ratio [OR] 15, 95% CI 9.9-24.07; P&lt;.001) of enrolled participants did not use bed nets and 39% (236/601; OR 1.7, 95% CI 1.1-2.4; P&lt;.001) did not use mosquito repellents. A total of 39% (233/601; OR 16.6, 95% CI 11.11-24.93; P&lt;.001) of enrolled participants who tested positive for dengue were neighbors, 35% (213/601; OR 1.47, 95% CI 1.04-2.0; P&lt;.001) lived in a joint family, and 40% (241/601; OR 3.32, 95% CI 2.3-4.7; P&lt;.001) slept outdoors; these factors were significantly associated with dengue. Conclusions Dengue is a preventable disease and can be controlled by the proper use of bed nets and mosquito repellents, modification of sleeping habits, and improvement in family structure. Dengue management training for health care personnel and community awareness are recommended.

Treatment-seeking and uptake of malaria prevention strategies among pregnant women and caregivers of children under-five years during COVID-19 pandemic in rural communities in South West Uganda: a qualitative study

BackgroundDespite efforts to avert the negative effects of malaria, there remain barriers to the uptake of prevention measures, and these have hindered its eradication. This study explored the factors that influence uptake of malaria prevention strategies among pregnant women and children under-five years and the impact of COVID-19 in a malaria endemic rural district in Uganda.MethodsThis was a qualitative case study that used focus group discussions, in-depth interviews, and key informant interviews involving pregnant women, caregivers of children under-five years, traditional birth attendants, village health teams, local leaders, and healthcare providers to explore malaria prevention uptake among pregnant women and children under-five years. The interviews were audio-recorded, transcribed and data were analyzed using thematic content approach.ResultsSeventy-two participants were enrolled in the Focus Group Discussions, 12 in the in-depth interviews, and 2 as key informants. Pregnant women and caregivers of children under-five years were able to recognize causes of malaria, transmission, and symptoms. All participants viewed malaria prevention as a high priority, and the use of insecticide-treated mosquito bed nets (ITNs) was upheld. Participants' own experiences indicated adverse effects of malaria to both pregnant women and children under-five. Home medication and the use of local herbs were a common practice. Some participants didn’t use any of the malaria prevention methods due to deliberate refusal, perceived negative effects of the ITNs, and family disparity. The Corona Virus Disease-2019 (COVID-19) control measures did not abate the risk of malaria infection but these were deleterious to healthcare access and the focus of malaria prevention.ConclusionsAlthough pregnant women and caregivers of children under-five years recognized symptoms of malaria infection, healthcare-seeking was not apt as some respondents used alternative approaches and delayed seeking formal healthcare. It is imperative to focus on the promotion of malaria prevention strategies and address drawbacks associated with misconceptions about these interventions, and promotion of health-seeking behaviors. As COVID-19 exacerbated the effect of malaria prevention uptake and healthcare seeking, it’s critical to recommit and integrate COVID-19 prevention measures in normative living and restrict future barriers to healthcare access.

Fractional mathematical modeling of malaria disease with treatment & insecticides

Many fatal diseases spread through vertical transmission while some of them spread through horizontal transmission and others transmit through both modes of transmission. Horizontal transmission illnesses are usually carried by a vector, which might be an animal, a bird, or an insect. Plasmodium parasites that dwell in red blood cells produce malaria, an infectious illness. This parasite is mostly transmitted to humans via mosquitoes. The dynamics of Malaria illness among human persons and vectors are examined in this study. The impact of the vector (mosquito) on disease transmission is also taken into account. The problem is described using nonlinear ODEs that are then generalized using the Atangana–Baleanu fractional derivative. Some theoretical analyses such as existence and uniqueness and stability via Ulam–Hyres stability analysis and optimal control strategies have been done. The numerical solution has been achieved via a numerical technique by implementing MATLAB software. Results of fractional, as well as classical order, are portrayed through different graphs while some figures are displayed for the global asymptotical stability of the model. From the graphical results, it can be noticed that the control parameters drastically decrease the number of infected human and vector population which will off course minimize the spread of infection among the human population. In addition to that, from the graphical results, it also be noticed that our model is globally asymptomatically stable as the solution converges to its equilibrium. Moreover, the use of bednets and insecticides can reduce the spread of infection dramatically while the impact of medication and treatment on the control of infection is comparatively less.

Sensitivity and Bifurcation Analysis of Fuzzy SEIR‐SEI Dengue Disease Model

Dengue is one of the most serious mosquito‐borne infectious diseases in the world. The number of dengue cases is increasing every year worldwide. In this work, we discuss the fuzzy epidemic SEIR‐SEI compartmental model with the intervention of bed nets and fumigation to describe the transmission dynamics of dengue disease. We consider the biting rate, transmission rate, and recovery rate of the disease as fuzzy numbers. With different amounts of virus loads, we discuss the dynamical behavior of the system. The sensitivity analysis of the model is performed to compare the relative importance of the model parameters and to discuss the importance of fumigation, use of bed nets, and the effectiveness of bed nets. We demonstrate the bifurcation of the equilibrium point of the system with and without fumigation, with and without bed net user, and with different levels of effectiveness of bed nets. Numerical simulations are made to illustrate the mathematical results graphically. The infectivity of the disease depends on the amount of virus loads. The mathematical and simulated result shows that the intervention strategies, use of fumigation and bed nets, reduces the value of the basic reproduction number. Thus, this study suggests that the endemic situation of the disease can be brought under control by the effective use of the combination of fumigation and bed nets.

Sensitivity, Optimal Control, and Cost-Effectiveness Analysis of Intervention Strategies of Filariasis

In this work, sensitivity, optimal control, and cost-effectiveness of several intervention strategies of filariasis are discussed. We study the intervention strategies that are related to bednet use, insecticide, and the combination of bed-net use and insecticide. We use Pontryagin’s maximum principle to characterize the optimal controls. The Average Cost-Effectiveness Ratio (ACER) and Infection Averted Ratio (IAR) are used to identify the most cost-effective strategy. We also determine the basic reproduction number and investigate the sensitivity of the basic reproduction number on the parameters that are related to bed-net use and insecticide. Based on the ACER values, the most cost-effective strategy to control filariasis is insecticide intervention. On the other hand, the IAR values indicates that bed-net use intervention is the most cost-effective strategy. Furthermore, it is also the most effective strategy to eliminate filariasis. The sensitivity analysis results show that the control parameter related to bed net use and treatment have a central role in reducing the basic reproduction number and filariasis spread.

Laboratory Resistance Induction of Anopheles Minimus and Anopheles Dirus by the Exposure of Adult Females to Permethrin Treated Mosquito Nettings

A laboratory resistance induction study was conducted to determine the effects of permethrin impregnated nettings on the two major vectors of malaria in Thailand, Anopheles minimus and Anopheles dirus. To simulate the field use of bed nets, only females of the two species were exposed. An. minimus and An. dirus were selected using WHO bioassay tubes and cones, respectively, both using permethrin treated netting materials for three minutes. Changes in the phenotypic expression of resistance were monitored through the baseline and subsequent assessments of susceptibilities from the reference strains and within the generations of selected populations. The effects of permethrin selection on adult size were observed between the reference and last selected generation of both vectors. The activity of detoxifying enzymes (mixed function oxidases and non-specific esterases) were also compared between the reference and selected groups of both species for possible resistance mechanisms. Results showed a decrease in susceptibility level of 1.56 folds from the ninth selected generation (S9 ) of An. minimus. An. dirus developed low level resistance of 4.88 folds at S12. No significant effect was observed on adult sizes of the progenies of selected An. minimus and its reference strain. Varying results however were observed from An. dirus, with body weight significantly increased at S12 while no significant difference was observed between the wing lengths of the selected (S12) and reference strains. Significant increase in the levels of mixed function oxidases were detected from both selected generations of the two species. Further studies are needed to directly determine the presence of the resistance genes and the magnitude by which they are expressed in successive generations of vectors.

Clinically silent Plasmodium vivax infections in native Amazonians of northwestern Brazil: acquired immunity or low parasite virulence?

Malaria remains common among native Amazonians, challenging Brazil's elimination efforts. We examined the epidemiology of malaria in riverine populations of the country's main hotspot - the upper Juruá Valley in Acre state, close to the Brazil-Peru border, where Plasmodium vivax accounts for > 80% of cases. Participants (n = 262) from 10 villages along the Azul River were screened for malaria parasites by microscopy and genus-specific, cytochrome b (cytb) gene-based polymerase chain reaction. Positive samples were further tested with quantitative TaqMan assays targeting P. vivax- and P. falciparum-specific cytb domains. We used multiple logistic regression analysis to identify independent correlates of P. vivax infection. Microscopy detected only one P. vivax and two P. falciparum infections. TaqMan assays detected 33 P. vivax infections (prevalence, 11.1%), 78.1% of which asymptomatic, with a median parasitaemia of 34/mL. Increasing age, male sex and use of insecticide-treated bed nets were significant predictors of elevated P. vivax malaria risk. Children and adults were similarly likely to remain asymptomatic once infected. Our findings are at odds with the hypothesis of age-related clinical immunity in native Amazonians. The low virulence of local parasites is suggested as an alternative explanation for subclinical infections in isolated populations.

Risk Factors Associated with a Dengue Fever Outbreak in Islamabad, Pakistan: Case-Control Study.

BackgroundOn October 23, 2016, 79 dengue fever cases were reported from the Union Council Tarlai to Federal Disease Surveillance and Response Unit Islamabad. A team was established to investigate the suspected dengue outbreak.ObjectiveThe aim of this study was to determine the extent of the outbreak and identify the possible risk factors.MethodsActive case finding was performed through a house-to-house survey. A case was defined as an acute onset of fever ≥38℃ in a resident of Tarlai from October 2 to November 11, 2016, with a positive dengue virus (nonstructural protein, NS-1) test and any of the two of following signs and symptoms: retroorbital/ocular pain, headache, rash, myalgia, arthralgia, and hemorrhagic manifestations. A structured questionnaire was used to collect data. Age- and sex-matched controls (1:1) were identified from residents in the same area as cases. Blood samples were taken and sent to the National Institute of Health for genotype identification.ResultsDuring the active case search, 145 cases of dengue fever were identified by surveying 928 houses from October 23 to November 11, 2016. The attack rate (AR) was 17.0/10,000. The mean age was 34.4 (SD 14.4) years. More than half of the cases were male (80/145, 55.2%). Among all cases, 29% belonged to the 25-34 years age group and the highest AR was found in the 35-44 years age group (35.6/10,000), followed by the 55-64 years age group (35.5/10,000). All five blood samples tested positive for NS-1 (genotype DENV-2). The most frequent presenting signs/symptoms were fever and headache (both 100%). Stagnant water around houses (odds ratio [OR] 4.86, 95% CI 2.94-8.01; P<.001), presence of flower pots in the home (OR 2.73, 95% CI 1.67-4.45; P<.001), and open water containers (OR 2.24, 95% CI 1.36-3.60; P<.001) showed higher odds among cases. Conversely, use of bed nets (OR 0.44, 95% CI 0.25-0.77; P=.003), insecticidal spray (OR 0.33, 95% CI 0.22-0.55; P<.001), door screens (OR 0.27, 95% CI 0.15-0.46; P<.001), mosquito coil/mat (OR 0.26, 95% CI 0.16-0.44; P<.001), and cleanliness of the house (OR 0.12, 95% CI 0.05-0.26; P<.001) showed significant protective effects.ConclusionsStagnant water acting as breeding grounds for vectors was identified as the probable cause of spread of the dengue outbreak. Establishment of surveillance and an early reporting system along with use of protective measures against the vector are strongly recommended.

Deteksi Gen Kdr pada Nyamuk Anopheles di Kabupaten Maluku Tenggara Barat

Malaria is still a health problem in Indonesia, particularly in Eastern part of Indonesia. The use of LLIN insecticide bed nets is one of the efforts to reduce the malaria morbidity rate by protecting human from malaria vector bites. The Anopheles flavirostris, Anopheles barbirostris, and Anopheles subpictus mosquitoes are three of the species reported as malaria vectors in West-Southeast Maluku Regency. The aim of this research was to detect the kdr gene in An. flavirostris, An. barbirostris, and An.subpictus mosquitoes collected from Alusi Kelaan village, West-Southeast Maluku Regency. The research was conducted at the Papua Biomedical Research and Development Center, in June 2016. A total of six An. flavirostris, 42 An. barbirostris, and 24 An. subpictus were pooled separately for genomic DNA extraction. The sample used was the An. flavirostris, An. barbirostris, and An. subpictus that survived after the impregnated paper test. The kdr gene detection was carried out using quantitative PCR (qPCR) focused on points V1010 and L1014. The results showed that there were no kdr mutant strains in the An. flavirostris, An. barbirostris, and An. subpictus. These results indicated that the sensitivity of pyrethroid insecticides contained in LLIN mosquito nets to An. flavirostris, An. barbirostris, and An. subpictus mosquitoes was not decreased in West Southeast Maluku Regency.

Low Malaria Transmission in Rosso, an Irrigated Rice-Growing Area in Mauritania

The construction of dams along the Senegal River resulted in an increase in irrigated land areas and changes in the epidemiology and transmission of water-related diseases. The objective of this study was to update epidemiological data on malaria in Rosso, one of the major Mauritanian cities along the Senegal River. Febrile patients (n = 318) were screened for malaria using a rapid diagnostic test (RDT) for malaria and microscopic examination of blood smears. Diagnosis was later confirmed by polymerase chain reaction (PCR). The mean age of 318 febrile patients was 25.1 (range 1–80 years). Only 7 (2.2%) and 2 (0.6%) had a positive RDT and thick smear, respectively. PCR confirmed the diagnosis in two Plasmodium vivax-infected patients. Most participants (198/318, 62.3%) had no recent travel history outside Rosso. The majority of the febrile patients (90%, 284/311) owned at least one insecticide-treated net (ITN). The frequency of the use of ITNs was not significantly associated with season (rainy vs. dry seasons; p = 0.9) or with the number of ITNs per household (rs = 0.07; n = 285; p = 0.19). Of 285 individuals with ITNs, only two (0.7%) with no travel history were PCR-positive for malaria. Despite the presence of mosquito breeding sites related to rice irrigation, malaria transmission in Rosso remained very low, possibly due to the high coverage and frequent use of bed nets. Regular entomological surveillance for possible changes in the prevalence of Anopheles mosquito species and their behavioural aspects should be implemented.

Seasonal malaria chemoprevention in older children: magnitude, consequences and opportunities

Seasonal malaria chemoprevention is tailored for children 3 to 59 months in areas of high transmission of malaria between July and October. However, SMC was administrated to children outside the pre-defined age range. This study aims to evaluate to which extent the treatment was given to these children. The authors carried out a cross sectional survey in November 2018 in eight (8) health regions. Sampled of 944 household where mothers of children under the age of 10 were interviewed about SMC coverage. They used a structured questionnaire to mothers/tutors including child’s age, the history of SMC administration including the adherence to the three daily doses, the possession or not of SMC cards, use of bed nets, and finally episodes of illnesses during the SMC period. Proportion of treated children included proportions captured both during mother/tutor’s interview or card inspection. A total of 1191 children between the age of 5 years and over were identified. According to mother’s declaration, 19.65% (234/1191) children received at least one dose of SMC; only 150 children had SMC card, of whom 146 (97.33%) have received at least one dose of SMC. Despite the well-known age target of SMC, older children were treated; however reduced, this deserves further attention. Key words: SMC coverage, children over 59 months, Burkina Faso.

Hepatitis B and Asymptomatic Malaria Infection among Pregnant Women in a Semiurban Community of North-Central Nigeria.

Background The overlap of malaria and Hepatitis B Virus (HBV) infections present a major threat to public health throughout endemic countries of tropical and sub-Saharan Africa. There is a paucity of data on the prevalence and associated factors of malaria and HBV infections among pregnant women in Ejule, a semiurban area of Nigeria. Therefore, the current study was designed to assess the seroprevalence of malaria and HBV among pregnant women attending antenatal clinics in Ejule Metropolis. Materials and Methods In a hospital-based cross-sectional study, blood samples collected from 200 apparently healthy pregnant women at the Ilemona Clinic were screened for Plasmodium falciparum (P. falciparum) and HBsAg using histidine-rich protein 2 (HRP2) and hepatitis B surface antigen (HBsAg) rapid diagnostic tests (RDTs), respectively. Relevant sociodemographic and putative risk factor information was obtained with structured questionnaires. Results The prevalence of the infections was 44 (22%), 5 (2.5%), and 1 (0.5%) for P. falciparum monoinfection and HBV monoinfection and coinfection, respectively. Single and concurrent infections peaked at ages 31–40 years but decreased with older ages. High P. falciparum, 31 (59.62%), and HBV 2 (3.85%) infection were observed among those without formal education. Contrary to ages, occupation, and knowledge of infection, malaria parasitemia differed significantly with lower educational qualification (p ≤ 0.001), being single (p=0.001), and inconsistent use of insecticide-treated bed nets (ITNs) (p=0.04, OR = 5, CI: 0.10–0.47). History of blood donation (OR = 5, p=0.04, CI: 1.10–32.80) and multiple sex partners (OR = 11.9, p=0.01, CI: 0.01–0.93) were found to be significantly associated with hepatitis B surface antigenemia rate during pregnancy. No evidence of HBV infection was observed in women with a history of HBV vaccination. Conclusions Malaria is still highly prevalent among pregnant women due to high illiteracy and noncompliance to using ITNs. Therefore, routine screening and educating pregnant mothers are crucial in eliminating malaria in endemic settings. The low rate of hepatitis B and coinfection with malaria shows that further improvement in HBV vaccination could considerably reduce the disease burden among pregnant women.

Knowledge, attitudes and control practices regarding venomous arthropods among staff and students in a Nigerian public university campus.

The objectives of this study were to assess the knowledge, attitudes and control practices among the staff and students of Nnamdi Azikiwe University (NAU), Awka, Anambra State, Nigeria, regarding venomous arthropods. The knowledge, attitudes and control practices regarding venomous arthropods were assessed in 350 participants. The respondents were aware of the presence of venomous arthropods at NAU and they had seen them on campus, with spiders (40.44%) being the most common and electric ants (1.39%) being the least common. The control practices applied to limit the activities of these arthropods included keeping the environment clean (40.80%), the use of insecticides (37.33%), the use of repellents (8.68%), spraying houses with kerosene (7.81%), spraying of fuel on the arthropods (3.47%), screening of houses (1.39%) and the use of bed nets (0.52%). An assessment and determination of knowledge, attitudes and control practices regarding venomous arthropods among the staff and students of NAU is necessary in order to improve the preventive measures to reduce injuries caused by venomous arthropod encounters, which are some of the most underestimated health hazards in tropical regions, including southeastern Nigeria, affecting primarily rural communities. According to the findings of our study, students and staff at NAU are rarely involved in life-threatening incidents as a result of their encounters with venomous arthropods and most apply several globally accepted standard practices for the control of venomous arthropods.

Magnitude of low birthweight in malaria endemic settings of Nanoro, rural Burkina Faso: a secondary data analysis

Low birthweight (LBW) is a worldwide problem that particularly affects developing countries. However, limited information is available on its magnitude in rural area of Burkina Faso. This study aimed to estimate the prevalence of low birthweight and to identify its associated factors in Nanoro health district. A secondary analysis of data collected during a cross-sectional survey was conducted to assess the prevalence of low birthweight in Nanoro health and demographic surveillance system area (HDSS). Maternal characteristics extracted from antenatal care books or by interview, completed by malaria diagnosis were examined through a multi-level logistic regression to estimate odd-ratios of association with low birthweight. Significance level was set at 5%. Of the 291 neonates examined, the prevalence of low birthweight was 12%. After adjustment for socio-demographic, obstetric and malaria prevention variables, being primigravid (OR = 8.84, [95% CI: 3.72–21.01]), or multigravid with history of stillbirth (OR = 5.03, [95% CI: 1.54–16.40]), as well as the lack of long-lasting insecticide treated bed net use by the mother the night preceding the admission for delivery (OR = 2.5, [95% CI: 1.1–5.9]) were significantly associated with neonate low birthweight. The number of antenatal visits however did not confer any direct benefit on birthweight status within this study area. The prevalence of low birthweight was high in the study area and represents an important public health problem in Burkina Faso. In light of these results, a redefinition of the content of the antenatal care package is needed.

Effect of roof colour on indoor temperature and human comfort levels, with implications for malaria control: a pilot study using experimental houses in rural Gambia

BackgroundIn rural sub-Saharan Africa, thatch roofs are being replaced by metal roofs. Metal roofing, however, increases indoor temperatures above human comfort levels, and thus makes it more likely that residents will not use an insecticide-treated bed net (ITN) at night. Whether the colour of a metal roof affects indoor temperature and human comfort was assessed.MethodsTwo identical, experimental houses were constructed with metal roofs in rural Gambia. Roof types were: (1) original bare-metal, (2) painted with red oxide primer or (3) white gloss, to reflect solar radiation. Pairwise comparisons were run in six, five-night blocks during the malaria season 2018. Indoor climate was measured in each house and multivariate analysis used to compare indoor temperatures during the day and night.ResultsFrom 21.00 to 23.59 h, when most residents decide whether to use an ITN or not, the indoor temperature of a house with a bare metal roof was 31.5 °C (95% CI 31.2–31.8 °C), a red roof, 30.3 °C (95% CI 30.0–30.6) and a white roof, 29.8 °C (95% CI 29.4–30.1). During the same period, red-roofed houses were 1.23 °C cooler (95% CI 1.22–1.23) and white roofs 1.74 °C cooler (95% CI 1.70–1.79) than bare-metal roofed houses (p < 0.001). Similar results were found from 00.00 to 06.00 h. Maximum daily temperatures were 0.93 °C lower in a white-roofed house (95% CI 0.10–0.30, p < 0.001), but not a red roof (mean maximum temperature difference = 0.44 °C warmer, 95% CI 0.43–0.45, p = 0.081), compared with the bare-metal roofed houses. Human comfort analysis showed that from 21.00 to 23.59 h houses with white roofs (comfortable for 87% time) were more comfortable than bare-metal roofed houses (comfortable for 13% time; odds ratio = 43.7, 95% CI 27.5–69.5, p < 0.001). The cost of painting a metal roof white is approximately 31–68 USD.ConclusionsHouses with a white roof were consistently cooler and more comfortable than those with a bare metal roof. Painting the roofs of houses white is a cheap way of making a dwelling more comfortable for the occupants and could potentially increase bed net use in hot humid countries.

Proximity of Residence to Irrigation Determines Malaria Risk and Anopheles Abundance at an Irrigated Agroecosystem in Malawi.

ABSTRACT.As countries of sub-Saharan Africa expand irrigation to improve food security and foster economic growth, it is important to quantify the malaria risk associated with this process. Irrigated ecosystems can be associated with increased malaria risk, but this relationship is not fully understood. We studied this relationship at the Bwanje Valley Irrigation Scheme (800 hectares) in Malawi. Household prevalence of malaria and indoor Anopheles density were quantified in two cross-sectional studies in 2016 and 2017 (5,829 residents of 1,091 households). Multilevel logistic regression was used to estimate the association between distance to the irrigation scheme and malaria infection and mosquito density. The prevalence of malaria infection was 50.2% (2,765/5,511) by histidine-rich protein 2–based malaria rapid diagnostic tests and 30.1% (1,626/5,403) by microscopy. Individuals residing in households within 3 km of the scheme had significantly higher prevalence of infection (adjusted odds ratio [aOR] = 1.41; 95% confidence interval [CI] 1.18, 1.68); school-aged children had the highest prevalence among age groups (aOR = 1.34; 95% CI 1.11, 1.63). Individuals who reported bed net use, and households with higher socioeconomic status and higher level of education for household head or spouse, had lower odds of malaria infection. Female Anopheles mosquitoes (2,215 total; Anopheles arabiensis, 90.5%, Anopheles funestus, 9.5%) were significantly more abundant in houses located within 1.5 km of the scheme. Proximity of human dwellings to the irrigation scheme increased malaria risk, but higher household wealth index reduced risk. Therefore, multisectoral approaches that spur economic growth while mitigating increased malaria transmission are needed for people living close to irrigated sites.