Household Coverage Research Articles

Preliminary studies on human lymphatic filariasis transmission control trials using Insecticide Treated Bednet (ITBN) in parts of Imo State, Nigeria

Human lymphatic filariasis (LF) is a significant public health problem in many tropical and sub tropical countries resulting in disfigurement and disability which warrants preventive action. The effectiveness of insecticide-treated bednet (ITBN) was compared in selected sentinel villages of Imo State, Nigeria, between February 2009 and December 2011, to evaluate their potential for LF control. Two cohorts were used; ITBN-full coverage/wide scale use and ITBN-vulnerable coverage/ selective use. Endophilic mosquitoes caught twice a month by pyrethrum spray catch (PSC) and day resting indoor collection (DRI) with aspirator were identified using standard morphological keys. Of 8,349 engorged female mosquitoes dissected/ examined for parity infection/infectivity status with Wuchereria bancrofti larvae, 60.88% (5,088/8,349) and 39.12% (3,266/8,349) represented ITBN-vulnerable and ITBN-full coverage catches respectively. Overall, ITBN-vulnerable cohorts collections were insignificantly higher than ITBN-full coverage cohorts (62.31% versus 37.69%, 59.22% versus 40.73%, 62.22% versus 37.78%) for 2009, 2010 and 2011 respectively. Five species present in both cohorts comprised Anopheles gambiae s.l., the most abundant (85.19% versus 74.04%), An. funestus s.l. (8.42% versus 12.19%) and Cx. quinquefasciatus (5.88% versus 3.83%) while Aedes aegypti and Mn. africana were rarely present. Village-specific vector densities/relative abundance from ITBN-vulnerable cohorts and ITBN-full cohorts showed no significant difference (p>0.05). Similarly, the physiological, infection (0.18% versus 0.49%) and infectivity status (0.00% versus 0.00%) were insignificant between the cohorts (p>0.05). The study highlights the importance of integrating vector borne disease interventions in the on-going plan to eliminate LF and the transmitting mosquito vectors in Nigeria.Keywords: Lymphatic filariasis; ITBN-full household coverage; ITBN-vulnerable household coverage; W. bancrofti; vectors

¿Cierran los números con la gente adentro?

Basado en la rama teórico-metodológica de la evaluación de datos demográficos, el artículo realiza una estimación de la cobertura de población del censo de población 2010 de Argentina. Complementando otras investigaciones, se integra esta indagación con una estimación sobre la cobertura de viviendas y hogares con base en la información publicada por el Instituto Nacional de Estadística y Censos. La omisión registrada muestra un bajo nivel con respecto al promedio general de América Latina, aunque alto comparado con las rondas censales de 1980 y 1991, y prevalece en distintos niveles la falta de transparencia en los procesos de construcción de resultados.

The effect of young children's faeces disposal practices on child growth: evidence from 34 countries.

To characterize the relationship between child faeces disposal and child growth in low- and middle-income countries. We analysed caregiver responses and anthropometric data from Demographic and Health Surveys (2005-2014) for 202614 children under five and 82949 children under two to examine the association between child faeces disposal and child growth. Child faeces disposal in an improved toilet was associated with reduced stunting for children under five [adjusted prevalence ratio (aPR)=0.90, 95% confidence interval (CI) 0.89-0.92] and a 0.12 increase in height-for-age z-score (HAZ; 95% CI: 0.10-0.15) among all households. Among households with improved sanitation access, practicing improved child faeces disposal was still associated with a decrease in stunting (aPR=0.94, 95% CI: 0.91-0.96) and a 0.09 increase in HAZ (95% CI: 0.06-0.13). Improved child faeces disposal was also associated with reductions in underweight and wasting, and an increase in weight-for-age z-score (WAZ), but not an increase in weight-for-height z-score (WHZ). Community coverage level of improved child faeces disposal was also associated with stunting, with 75-100% coverage associated with the greatest reduction in stunting. Child faeces disposal in an unimproved toilet was associated with reductions in underweight and wasting, but not stunting. Improved child faeces disposal practices could achieve greater reductions in child undernutrition than improving toilet access alone. Additionally, the common classification of child faeces disposal as 'safe' regardless of the type of toilet used for disposal may underestimate the benefits of disposal in an improved toilet and overestimate the benefits of disposal in an unimproved toilet.

Determinants of successful vitamin A supplementation coverage among children aged 6-59 months in thirteen sub-Saharan African countries.

Vitamin A supplementation (VAS) for children aged 6-59 months occurs regularly in most sub-Saharan African countries. The present study aimed to explore child, household and delivery platform factors associated with VAS coverage and identify barriers to compliance in thirteen African countries. We pooled data (n ~60 000) from forty-four household coverage surveys and used bivariate and multivariable regression analyses to assess the effects of supplementation strategy, rural v. urban residence, child sex, child age, caregiver education and campaign awareness on child VAS status. Setting/Subjects Primary caregivers of children aged 6-59 months in thirteen countries. Door-to-door distribution resulted in higher VAS coverage than fixed-site plus outreach approaches (91 v. 63 %) and was a significant predictor of supplementation in the adjusted model (OR=19·0; 95 % CI 17·2, 21·1; P<0·001). Having been informed about the campaign was the main predictor of VAS in the door-to-door (OR=6·8; 95 % CI 5·8, 7·9; P<0·001) and fixed-site plus outreach (OR=72·5; 95 % CI 66·6, 78·8; P<0·001) groups. Door-to-door provision of VAS may achieve higher coverage than fixed-site models in the African context. However, the phase-out of door-to-door polio immunization campaigns in most sub-Saharan African countries threatens the main distribution vehicle for VAS. Our findings suggest well-informed communities are key to attaining higher coverage using fixed-site delivery alternatives.

Household Coverage with Adequately Iodized Salt Varies Greatly between Countries and by Residence Type and Socioeconomic Status within Countries: Results from 10 National Coverage Surveys

Background: Household coverage with iodized salt was assessed in 10 countries that implemented Universal Salt Iodization (USI).Objective: The objective of this paper was to summarize household coverage data for iodized salt, including the relation between coverage and residence type and socioeconomic status (SES).Methods: A review was conducted of results from cross-sectional multistage household cluster surveys with the use of stratified probability proportional to size design in Bangladesh, Ethiopia, Ghana, India, Indonesia, Niger, the Philippines, Senegal, Tanzania, and Uganda. Salt iodine content was assessed with quantitative methods in all cases. The primary indicator of coverage was percentage of households that used adequately iodized salt, with an additional indicator for salt with some added iodine. Indicators of risk were SES and residence type. We used 95% CIs to determine significant differences in coverage.Results: National household coverage of adequately iodized salt varied from 6.2% in Niger to 97.0% in Uganda. For salt with some added iodine, coverage varied from 52.4% in the Philippines to 99.5% in Uganda. Coverage with adequately iodized salt was significantly higher in urban than in rural households in Bangladesh (68.9% compared with 44.3%, respectively), India (86.4% compared with 69.8%, respectively), Indonesia (59.3% compared with 51.4%, respectively), the Philippines (31.5% compared with 20.2%, respectively), Senegal (53.3% compared with 19.0%, respectively), and Tanzania (89.2% compared with 57.6%, respectively). In 7 of 8 countries with data, household coverage of adequately iodized salt was significantly higher in high- than in low-SES households in Bangladesh (58.8% compared with 39.7%, respectively), Ghana (36.2% compared with 21.5%, respectively), India (80.6% compared with 70.5%, respectively), Indonesia (59.9% compared with 45.6%, respectively), the Philippines (39.4% compared with 17.3%, respectively), Senegal (50.7% compared with 27.6%, respectively) and Tanzania (80.9% compared with 51.3%, respectively).Conclusions: Uganda has achieved USI. In other countries, access to iodized salt is inequitable. Quality control and regulatory enforcement of salt iodization remain challenging. Notable progress toward USI has been made in Ethiopia and India. Assessing progress toward USI only through household salt does not account for potentially iodized salt consumed through processed foods.

Forming Local Support System (LSS) Model as Agent of Change Behavior of Clean and Healthy Household in Riverbanks of Banjar Regency

PHBS is currently the theme of an important strategy in improving public health status. PHBS development program is a program that has been running since 1996. However, its success is still far from expectations. In South Kalimantan in 2015, the percentage of households with PHBS is 60.09%. The coverage of PHBS households in the work area of the District Health Office of Banjar in 2015 amounted to 52.1%.Based on the success of the previous cadre program, the alternative solution that can be done in the field is the formation of Local Support System (LSS) model as an agent of change of clean and healthy life behavior in the household order. This research uses analytic design, with Cross Sectional approach. Subjects were 90 peoples. Based on the results of the activity it was found that there was no significant correlation between knowledge, support of community leaders, and support of health officers and household PHBS strata shown with p-values of 0.337, 1, 000 and 0.059, respectively. However, there is a correlation between education level and household PHBS stratum with p-value= 0, 014, and there is significant difference before counseling and after counseling p-value equal to 0.0001. Suggestion from this research is LSS modeling is expected to become a model which can be one way to increase PHBS coverage of household order and to maintain positive behavior of community in applying PHBS of household order.

Application of psychosocial models to Home-Based Testing and Counseling (HBTC) for increased uptake and household coverage in a large informal urban settlement in Kenya.

IntroductionHome Based Testing and Counselling (HBTC) aims at reaching individuals who have low HIV risk perception and experience barriers which prevent them from seeking HIV testing and counseling (HTC) services. Saturating the community with HTC is needed to achieve the ambitious 90-90-90 targets of knowledge of HIV status, ARV treatment and viral suppression. This paper describes the use of health belief model and community participation principles in HBTC to achieve increased household coverage and HTC uptake.MethodsThis cross sectional survey was done between August 2009 and April 2011 in Kibera slums, Nairobi city. Using three community participation principles; defining and mobilizing the community, involving the community, overcoming barriers and respect to cultural differences and four constructs of the health belief model; risk perception, perceived severity, perceived benefits of changed behavior and perceived barriers; we offered HTC services to the participants. Descriptive statistics were used to describe socio-demographic characteristics, calculate uptake and HIV prevalence.ResultsThere were 72,577 individuals enumerated at the start of the program; 75,141 residents were found during service delivery. Of those, 71,925 (95.7%) consented to participate, out of which 71,720 (99.7%) took the HIV test. First time testers were (39%). The HIV prevalence was higher (6.4%) among repeat testers than first time testers (4.0%) with more women (7.4%) testing positive than men (3.6%) and an overall 5.5% slum prevalence.ConclusionThis methodology demonstrates that the use of community participation principles combined with a psychosocial model achieved high HTC uptake, coverage and diagnosed HIV in individuals who believed they are HIV free. This novel approach provides baseline for measuring HTC coverage in a community.

More than two-thirds of dietary iodine in children in northern Ghana is obtained from bouillon cubes containing iodized salt.

Bouillon cubes are widely consumed by poor households in sub-Saharan Africa. Because their main ingredient is salt, bouillon cubes could be a good source of iodine if iodized salt is used in their production and if their consumption by target groups is high. Our objective was to measure the iodine content of bouillon cubes, estimate their daily intake in school-aged children and evaluate their potential contribution to iodine intakes. In a cross-sectional study, we measured urinary iodine concentrations (UIC) and estimated total daily iodine intakes. We administered a questionnaire on usage of bouillon cubes. We measured the iodine content of bouillon cubes, household salt, drinking-water and milk products. Primary schools in northern Ghana. Schoolchildren aged 6-13 years. Among school-aged children (n 250), median (interquartile range) UIC and estimated iodine intake were 242 (163-365) µg/l and 129 (85-221) µg/d, indicating adequate iodine status. Median household salt iodine concentration (n 100) was only 2·0 (0·83-7·4) µg/g; 72 % of samples contained <5 µg iodine/g. Iodine concentrations in drinking-water and milk-based drinks were negligible. Median iodine content of bouillon cubes was 31·8 (26·8-43·7) µg/g, with large differences between brands. Estimated median per capita consumption of bouillon cubes was 2·4 (1·5-3·3) g/d and median iodine intake from bouillon cubes was 88 (51-110) µg/d. Despite low household coverage with iodized salt, iodine nutrition in school-aged children is adequate and an estimated two-thirds of their dietary iodine is obtained from bouillon cubes.

ANALYSIS OF PERFORMANCE OF PUBLIC HEALTH CENTER HEALTH PROMOTION OFFICER IN INCREASING THE COVERAGE OF PHBS HOUSEHOLD IN THE WORK AREA OF HEALTH OFFICER KOTA PALEMBANG

Background : The coverage of PHBS household Palembang in 2014 is 64.36%, this has not been able to meet the performance targets set by health promotion and community empowerment of Palembang City in 2014 that was 70% of household using PHBS). Percentage of Public Health Center in the Palembang which not able to meet the target of PHBs Household coverage in 2014 reached 56.41% (22 Public Health Center).The main factor that affect the success of health promotion activities is PHBS household coverage in Public Health Center level, one of which relates to the performance of health promotion officer. Therefore, this study aims to determine the performance of health promotion officer and determinan factors that influence it such as knowledge, motivation, compensation and organizational circumstances. Method: This research was quantitative research with cross sectional design. Respondents are 38 health promotion officer from 38 public health center in Palembang. Analysis was used Chi-square test. Result: Univariate analysis showed that 57.9% of the officers had a good performance. Bivariate test results showed that knowledge (p=0.027), motivation (p=0.010), compensation (p=0.021), and organizational circumstances (p=0.015) had an influence on the performance of health promotion officer in increasing the coverage of PHBS household. Conclusion: The performance of health promotion officer in increasing coverage of PHBS household influenced by the knowledge, motivation, compensation and organizational circumstances . Keywords: Performance, health promotion officer, public health center

Household Coverage of Fortified Staple Food Commodities in Rajasthan, India.

A spatially representative statewide survey was conducted in Rajasthan, India to assess household coverage of atta wheat flour, edible oil, and salt. An even distribution of primary sampling units were selected based on their proximity to centroids on a hexagonal grid laid over the survey area. A sample of n = 18 households from each of m = 252 primary sampling units PSUs was taken. Demographic data on all members of these households were collected, and a broader dataset was collected about a single caregiver and a child in the first 2 years of life. Data were collected on demographic and socioeconomic status; education; housing conditions; recent infant and child mortality; water, sanitation, and hygiene practices; food security; child health; infant and young child feeding practices; maternal dietary diversity; coverage of fortified staples; and maternal and child anthropometry. Data were collected from 4,627 households and the same number of caregiver/child pairs. Atta wheat flour was widely consumed across the state (83%); however, only about 7% of the atta wheat flour was classified as fortifiable, and only about 6% was actually fortified (mostly inadequately). For oil, almost 90% of edible oil consumed by households in the survey was classified as fortifiable, but only about 24% was fortified. For salt, coverage was high, with almost 85% of households using fortified salt and 66% of households using adequately fortified salt. Iodized salt coverage was also high; however, rural and poor population groups were less likely to be reached by the intervention. Voluntary fortification of atta wheat flour and edible oil lacked sufficient industry consolidation to cover significant portions of the population. It is crucial that appropriate delivery channels are utilized to effectively deliver essential micronutrients to at-risk population groups. Government distribution systems are likely the best means to accomplish this goal.

Children Living With Uninsured Family Members: Differences by Family Structure

Despite increased access to insurance through the Patient Protection and Affordable Care Act of 2010, uninsurance rates are expected to remain relatively high. Having uninsured family members may expose children to financial hardships. Eligibility rules governing both private and public health insurance are based on outdated expectations about family structure. Using 2009–2011 data from the National Health Interview Survey (N = 65,038), the authors investigated family structure differences in family‐level insurance coverage of households with children. Children living with married biological parents were the least likely to have uninsured family members and most likely to have all family members covered by private insurance. Controlling for demographic characteristics and income, children in single‐mother families had the same risk of having an uninsured family member as children in married‐parent families. Children with cohabiting biological parents had higher rates of family uninsurance than children with married biological parents, even accounting for other characteristics.

Performance of rapid test kits to assess household coverage of iodized salt.

The main indicator adopted to track universal salt iodization has been the coverage of adequately iodized salt in households. Rapid test kits (RTK) have been included in household surveys to test the iodine content in salt. However, laboratory studies of their performance have concluded that RTK are reliable only to distinguish between the presence and absence of iodine in salt, but not to determine whether salt is adequately iodized. The aim of the current paper was to examine the performance of RTK under field conditions and to recommend their most appropriate use in household surveys. Standard performance characteristics of the ability of RTK to detect the iodine content in salt at 0 mg/kg (salt with no iodine), 5 mg/kg (salt with any added iodine) and 15 mg/kg ('adequately' iodized salt) were calculated. Our analysis employed the agreement rate (AR) as a preferred metric of RTK performance. Setting/Subjects Twenty-five data sets from eighteen population surveys which assessed household iodized salt by both the RTK and a quantitative method (i.e. titration or WYD Checker) were obtained from Asian (nineteen data sets), African (five) and European (one) countries. In detecting iodine in salt at 0 mg/kg, the RTK had an AR>90 % in eight of twenty-three surveys, while eight surveys had an AR90 %. The RTK is not suited for assessment of adequately iodized salt coverage. Quantitative assessment, such as by titration or WYD Checker, is necessary for estimates of adequately iodized salt coverage.

Iodine Status of Women of Reproductive Age in Sierra Leone and Its Association with Household Coverage with Adequately Iodized Salt.

Salt iodization programs are a public health success in tackling iodine deficiency. Yet, a large proportion of the world’s population remains at risk for iodine deficiency. In a nationally representative cross-sectional survey in Sierra Leone, household salt samples and women’s urine samples were quantitatively analyzed for iodine content. Salt was collected from 1123 households, and urine samples from 817 non-pregnant and 154 pregnant women. Household coverage with adequately iodized salt (≥15 mg/kg iodine) was 80.7%. The median urinary iodine concentration (UIC) of pregnant women was 175.8 µg/L and of non-pregnant women 190.8 µg/L. Women living in households with adequately iodized salt had higher median UIC (for pregnant women: 180.6 µg/L vs. 100.8 µg/L, respectively, p < 0.05; and for non-pregnant women: 211.3 µg/L vs. 97.8 µg/L, p < 0.001). Differences in UIC by residence, region, household wealth, and women’s education were much smaller in women living in households with adequately iodized salt than in households without. Despite the high household coverage of iodized salt in Sierra Leone, it is important to reach the 20% of households not consuming adequately iodized salt. Salt iodization has the potential for increasing equity in iodine status even with the persistence of other risk factors for deficiency.

Multi-country comparison of delivery strategies for mass campaigns to achieve universal coverage with insecticide-treated nets: what works best?

BackgroundThe use of insecticide-treated nets (ITNs) is widely recognized as one of the main interventions to prevent malaria. High ITN coverage is needed to reduce transmission. Mass distribution campaigns are the fastest way to rapidly scale up ITN coverage. However, the best strategy to distribute ITNs to ensure household coverage targets are met is still under debate. This paper presents results from 14 post-campaign surveys in five African countries to assess whether the campaign strategy used had any effect on distribution outcome.MethodsData from 13,901 households and 14 campaigns from Ghana, Nigeria, Senegal, South Sudan and Uganda, were obtained through representative cross-sectional questionnaire surveys, conducted three to 16 months after ITN distribution. All evaluations used a multi-stage sampling approach and similar methods for data collection. Key outcomes examined were the proportion of households having received a net from the campaign and the proportion of households with one net for every two people.ResultsHousehold registration rates proved to be the most important determinant of a household receiving any net from the campaign (adjusted odds ratio [OR] 74.8; 95 % confidence interval [CI]: 55.3–101.1) or had enough ITNs for all household members (adjusted OR 19.1; 95 % CI: 55.34–101.05). Factors that positively influenced registration were larger household size (adjusted OR 1.7; 95 % CI: 1.5–2.1) and families with children under five (adjusted OR 1.4; 95 % CI: 1.2–1.6). Urban residence was negatively associated with receipt of a net from the campaign (adjusted OR 0.73; 95 % CI: 0.58–0.92). Registration was equitable in most campaigns except for Uganda and South Sudan, where the poorest wealth quintiles were less likely to have been reached. After adjusting for other factors, delivery strategy (house-to-house vs. fixed point) and distribution approach (integrated versus stand-alone) did not show a systematic impact on registration or owning any ITN. Campaigns that used a universal coverage allocation strategy were more effective in increasing the proportion of households with enough ITNs than campaigns that used a fixed number of ITNs. Registering based on counting usual sleeping spaces resulted in higher levels of households with one net per two people among those receiving any campaign net (adjusted OR 1.6; 95 % CI: 1.07–2.48) than campaigns that registered based on the number of household members.ConclusionAll of the campaigns, irrespective of strategy, successfully increased ownership of at least one ITN. Delivery method and distribution approach were not associated with receipt of at least one ITN from the campaign. Rather, the key determining factor for receipt of at least one ITN from the campaign was a successful registration process, which depends on the ability of community volunteers to reach households during the exercise. Universal coverage campaigns, especially those that used a sleeping space allocation strategy, were more effective in increasing the proportion of households with enough ITNs. Maximizing registration completeness and using a universal coverage allocation strategy are therefore likely to improve campaign outcomes.

Accuracy of Coverage Survey Recall following an Integrated Mass Drug Administration for Lymphatic Filariasis, Schistosomiasis, and Soil-Transmitted Helminthiasis.

BackgroundAchieving target coverage levels for mass drug administration (MDA) is essential to elimination and control efforts for several neglected tropical diseases (NTD). To ensure program goals are met, coverage reported by drug distributors may be validated through household coverage surveys that rely on respondent recall. This is the first study to assess accuracy in such surveys.Methodology/Principal FindingsRecall accuracy was tested in a series of coverage surveys conducted at 1, 6, and 12 months after an integrated MDA in Togo during which three drugs (albendazole, ivermectin, and praziquantel) were distributed. Drug distribution was observed during the MDA to ensure accurate recording of persons treated during the MDA. Information was obtained for 506, 1131, and 947 persons surveyed at 1, 6, and 12 months, respectively. Coverage (defined as the percentage of persons taking at least one of the MDA medications) within these groups was respectively 88.3%, 87.4%, and 80.0%, according to the treatment registers; it was 87.9%, 91.4% and 89.4%, according to survey responses. Concordance between respondents and registers on swallowing at least one pill was >95% at 1 month and >86% at 12 months; the lower concordance at 12 months was more likely due to difficulty matching survey respondents with the year-old treatment register rather than inaccurate responses. Respondents generally distinguished between pills similar in appearance; concordance for recall of which pills were taken was over 80% in each survey.SignificanceIn this population, coverage surveys provided remarkably consistent coverage estimates for up to one year following an integrated MDA. It is not clear if similar consistency will be seen in other settings, however, these data suggest that in some settings coverage surveys might be conducted as much as one year following an MDA without compromising results. This might enable integration of post-MDA coverage measurement into large, multipurpose, periodic surveys, thereby conserving resources.

In Search of Structured Business Model for Renewable Energy Expansion in India

While overall power generation in India has been increasing over the years, the coverage of households in the energy access net (with 38% of total households or over 500 million people having no energy access) and availability of supply (at only 5-6 hours/day) are still prime concerns for the Government. In such a scenario, is renewable energy an alternative given the shortage of supply from conventional sources, with over 30,000 MW stranded power plants, commitment of the Government to set up 100 Smart Cities, High-speed/Semi-speed Rails, Industrial Corridors and more beyond that ‘power to all’ by 2022’ Through this study, an attempt has been made to understand the socio-economic-environmental impact of renewable energy expansion and examined the factors that govern the feasibility and/or viability in meeting the ambitious clean energy target of 175 GW set out by the Government. The key determinants of renewable energy are found to be functionality variation, pattern of household’s energy consumption, willingness-to-pay, behavioral change in tariff and cost, grid integration, energy efficiency and access to cheap green finance. Selective implementation of a combination of On-Grid, Off-Grid and localized Mini-Grids application and flexible revenue modality such as ‘Pay as-you-go’ in off-grid areas and ‘Net-metering’ or ‘Feed-in-tariff’ concept in grid-connected areas are best suited. Further, enforceable renewable purchase obligation, renewable generation obligation, faster and efficient implementation of renewable energy certificates as tradable commodity, carbon trading as a source of revenue, green marketing, mobilization of funds under corporate social responsibility and single procurement of all renewable energy by a centralized unit would go a long way in achieving the renewable targets.

Access to iodized salt in 11 low- and lower-middle-income countries: 2000 and 2010.

ObjectiveTo describe changes in household access to iodized salt in relation to socioeconomic factors.MethodsWe extracted data on iodized household salt from Multiple Indicator Cluster Surveys conducted in 2000 and 2010. As part of the surveys, household salt samples were tested for iodization by standardized rapid-test kits that yield results to indicate whether salt is not iodized, inadequately iodized, (less than 15 parts per million, ppm), or adequately iodized (more than 15 ppm). We calculated indices of household salt iodization in 2000 and 2010, taking into account survey sampling weights. We explored associations between these indices and socioeconomic variables, both within and between countries.FindingsWe analysed data from 105 162 households in 2000 and 144 018 households in 2010. Between 2000 and 2010, household coverage of adequately iodized salt increased by 6.1% (from 46.3% to 52.4%) on average, but with regional differences: coverage fell by 13.0% (from 77.5% to 64.5%) in the Central African Republic but improved by 40.4% (from 22.2% to 62.6%) in Sierra Leone. Improvements in coverage were higher in rural areas and among the poorest households, but within-country socioeconomic disparities remained. There were weak associations between changes in salt iodization and national level socioeconomic indicators.ConclusionOverall, the coverage of adequately iodized household salt increased over the last decade. However, the changes varied widely among countries. The goal of universal salt iodization is still distant for many countries and requires renewed efforts by governments, bilateral and multilateral agencies and civil society.

Combination of Insecticide Treated Nets and Indoor Residual Spraying in Northern Tanzania Provides Additional Reduction in Vector Population Density and Malaria Transmission Rates Compared to Insecticide Treated Nets Alone: A Randomised Control Trial.

Indoor residual spraying (IRS) combined with insecticide treated nets (ITN) has been implemented together in several sub-Saharan countries with inconclusive evidence that the combined intervention provides added benefit. The impact on malaria transmission was evaluated in a cluster randomised trial comparing two rounds of IRS with bendiocarb plus universal coverage ITNs, with ITNs alone in northern Tanzania. From April 2011 to December 2012, eight houses in 20 clusters per study arm were sampled monthly for one night with CDC light trap collections. Anopheles gambiae s.l. were identified to species using real time PCR Taq Man and tested for the presence of Plasmodium falciparum circumsporozoite protein. ITN and IRS coverage was estimated from household surveys. IRS coverage was more than 85% in two rounds of spraying in January and April 2012. Household coverage with at least one ITN per house was 94.7% after the universal coverage net campaign in the baseline year and the proportion of household with all sleeping places covered by LLIN was 50.1% decreasing to 39.1% by the end of the intervention year. An.gambiae s.s. comprised 80% and An.arabiensis 18.3% of the anopheline collection in the baseline year. Mean An.gambiae s.l. density in the ITN+IRS arm was reduced by 84% (95%CI: 56%-94%, p = 0.001) relative to the ITN arm. In the stratum of clusters categorised as high anopheline density at baseline EIR was lower in the ITN+IRS arm compared to the ITN arm (0.5 versus 5.4 per house per month, Incidence Rate Ratio: 0.10, 95%CI: 0.01–0.66, p-value for interaction <0.001). This trial provides conclusive evidence that combining carbamate IRS and ITNs produces major reduction in Anopheles density and entomological inoculation rate compared to ITN alone in an area of moderate coverage of LLIN and high pyrethroid resistance in An.gambiae s.s.

The Rise and Fall of Universal Salt Iodization in Vietnam: Lessons Learned for Designing Sustainable Food Fortification Programs With a Public Health Impact.

In 2005, more than 90% of Vietnamese households were using adequately iodized salt, and urinary iodine concentration among women of reproductive age was in the optimal range. However, household coverage declined thereafter to 45% in 2011, and urinary iodine concentration levels indicated inadequate iodine intake. To review the strengths and weaknesses of the Vietnamese universal salt iodization program from its inception to the current day and to discuss why achievements made by 2005 were not sustained. Qualitative review of program documents and semistructured interviews with national stakeholders. National legislation for mandatory salt iodization was revoked in 2005, and the political importance of the program was downgraded with consequential effects on budget, staff, and authority. The Vietnamese salt iodization program, as it was initially designed and implemented, was unsustainable, as salt iodization was not practiced as an industry norm but as a government-funded activity. An effective and sustainable salt iodization program needs to be reestablished for the long-term elimination of iodine deficiency, building upon lessons learned from the past and programs in neighboring countries. The new program will need to include mandatory legislation, including salt for food processing; industry responsibility for the cost of fortificant; government commitment for enforcement through routine food control systems and monitoring of iodine status through existing health/nutrition assessments; and intersectoral collaboration and management of the program. Many of the lessons would apply equally to universal salt iodization programs in other countries and indeed to food fortification programs in general.

Individual and contextual factors associated with community health workers' performance in Nyanza Province, Kenya: a multilevel analysis.

BackgroundSeveral African and South Asian countries are currently investing in new cadres of community health workers (CHWs) as a major part of strategies aimed at reaching the Millennium Development Goals. However, one review concluded that community health workers did not consistently provide services likely to have substantial effects on health and that quality was usually poor. The objective of this research was to assess the CHWs’ performance in Western Kenya and describe determinants of that performance using a multilevel analysis of the two levels, individual and supervisor/community.MethodsThis study conducted three surveys between August and September 2011 in Nyanza Province, Kenya. The participants of the three surveys were all 1,788 active CHWs, all their supervisors, and 2,560 randomly selected mothers who had children aged 12 to 23 months. CHW performance was generated by three indicators: reporting rate, health knowledge and household coverage. Multilevel analysis was performed to describe the determinants of that performance.ResultsThe significant factors associated with the CHWs’ performance were their marital status, educational level, the size of their household, their work experience, personal sanitation practice, number of supervisions received and the interaction between their supervisors’ better health knowledge and the number of supervisions.ConclusionA high quality of routine supervisions is one of the key interventions in sustaining a CHW’s performance. In addition, decreasing the dropout rate of CHWs is important both for sustaining their performance and for avoiding the additional cost of replacing them. As for the selection criteria of new CHWs, good educational status, availability of supporters for household chores and good sanitation practices are all important in selecting CHWs who can maintain their high performance level.