Insecticide-treated Bed Nets Coverage Research Articles

GIS-based spatiotemporal mapping of malaria prevalence and exploration of environmental inequalities

Malaria poses a significant threat to global health, with particular severity in Nigeria. Understanding key factors influencing health outcomes is crucial for addressing health disparities. Disease mapping plays a vital role in assessing the geographical distribution of diseases and has been instrumental in epidemiological research. By delving into the spatiotemporal dynamics of malaria trends, valuable insights can be gained into population dynamics, leading to more informed spatial management decisions. This study focused on examining the evolution of malaria in Nigeria over twenty years (2000–2020) and exploring the impact of environmental factors on this variation. A 5-year-period raster map was developed using malaria indicator survey data for Nigeria’s six geopolitical zones. Various spatial analysis techniques, such as point density, spatial autocorrelation, and hotspot analysis, were employed to analyze spatial patterns. Additionally, statistical methods, including Principal Component Analysis, Spearman correlation, and Ordinary Least Squares (OLS) regression, were used to investigate relationships between indicators and develop a predictive model. The study revealed regional variations in malaria prevalence over time, with the highest number of cases concentrated in northern Nigeria. The raster map illustrated a shift in the distribution of malaria cases over the five years. Environmental factors such as the Enhanced Vegetation Index, annual land surface temperature, and precipitation exhibited a strong positive association with malaria cases in the OLS model. Conversely, insecticide-treated bed net coverage and mean temperature negatively correlated with malaria cases in the same model. The findings from this research provide valuable insights into the spatiotemporal patterns of malaria in Nigeria and highlight the significant role of environmental drivers in influencing disease transmission. This scientific knowledge can inform policymakers and aid in developing targeted interventions to combat malaria effectively.

Bayesian spatio-temporal analysis of malaria prevalence in children between 2 and 10 years of age in Gabon

BackgroundGabon still bears significant malaria burden despite numerous efforts. To reduce this burden, policy-makers need strategies to design effective interventions. Besides, malaria distribution is well known to be related to the meteorological conditions. In Gabon, there is limited knowledge of the spatio-temporal effect or the environmental factors on this distribution. This study aimed to investigate on the spatio-temporal effects and environmental factors on the distribution of malaria prevalence among children 2–10 years of age in Gabon.MethodsThe study used cross-sectional data from the Demographic Health Survey (DHS) carried out in 2000, 2005, 2010, and 2015. The malaria prevalence was obtained by considering the weighting scheme and using the space–time smoothing model. Spatial autocorrelation was inferred using the Moran’s I index, and hotspots were identified with the local statistic Getis-Ord General Gi. For the effect of covariates on the prevalence, several spatial methods implemented in the Integrated Nested Laplace Approximation (INLA) approach using Stochastic Partial Differential Equations (SPDE) were compared.ResultsThe study considered 336 clusters, with 153 (46%) in rural and 183 (54%) in urban areas. The prevalence was highest in the Estuaire province in 2000, reaching 46%. It decreased until 2010, exhibiting strong spatial correlation (P < 0.001), decreasing slowly with distance. Hotspots were identified in north-western and western Gabon. Using the Spatial Durbin Error Model (SDEM), the relationship between the prevalence and insecticide-treated bed nets (ITNs) coverage was decreasing after 20% of coverage. The prevalence in a cluster decreased significantly with the increase per percentage of ITNs coverage in the nearby clusters, and per degree Celsius of day land surface temperature in the same cluster. It slightly increased with the number of wet days and mean temperature per month in neighbouring clusters.ConclusionsIn summary, this study showed evidence of strong spatial effect influencing malaria prevalence in household clusters. Increasing ITN coverage by 20% and prioritizing hotspots are essential policy recommendations. The effects of environmental factors should be considered, and collaboration with the national meteorological department (DGM) for early warning systems is needed.

Epidemiological behaviour and interventions of malaria in Niger, 2010–2019: a time-series analysis of national surveillance data

BackgroundMalaria remains a significant public health concern in Niger, with the number of cases increasing from 592,334 in 2000 to 3,138,696 in 2010. In response, a concerted campaign against the disease has been initiated. However, the implementation of these malaria interventions and their association with epidemiological behaviour remains unclear.MethodsA time-series study was conducted in Niger from 2010 to 2019. Multiple data sources concerning malaria were integrated, encompassing national surveillance data, Statistic Yearbook, targeted malaria control interventions, and meteorological data. Incidence rate, mortality rate, and case fatality ratio (CFR) by different regions and age groups were analysed. Joinpoint regression models were used to estimate annual changes in malaria. The changes in coverage of malaria interventions were evaluated.ResultsBetween 2010 to 2019, the incidence rate of malaria decreased from 249.43 to 187.00 cases per 1,000 population in Niger. Niamey had a high annual mean incidence rate and the lowest CFR, while Agadez was on the contrary. Joinpoint regression analysis revealed a declining trend in malaria incidence for all age groups except the 10–24 years group, and the mortality rate and the CFR initially decreased followed by an increase in all age groups. Niger has implemented a series of malaria interventions, with the major ones being scaled up to larger populations during the study period.ConclusionsThe scale-up of multi-interventions in Niger has significantly reduced malaria incidence, but the rise in mortality rate and CFR addresses the challenges in malaria control and elimination. Malaria endemic countries should enhance surveillance of malaria cases and drug resistance in Plasmodium, improve diagnosis and treatment, expand the population coverage of insecticide-treated bed nets and seasonal malaria chemoprevention, and strengthen the management of severe malaria cases.

Impacts of dual active-ingredient bed nets on the behavioural responses of pyrethroid resistant Anopheles gambiae determined by room-scale infrared video tracking

BackgroundThe success of insecticide treated bed nets (ITNs) for malaria vector control in Africa relies on the behaviour of various species of Anopheles. Previous research has described mosquito behavioural alterations resulting from widespread ITN coverage, which could result in a decrease in net efficacy. Here, behaviours were compared including timings of net contact, willingness to refeed and longevity post-exposure to two next-generation nets, PermaNet® 3.0 (P3 net) and Interceptor® G2 (IG2 net) in comparison with a standard pyrethroid-only net (Olyset Net™ (OL net)) and an untreated net.MethodsSusceptible and resistant Anopheles gambiae mosquitoes were exposed to the nets with a human volunteer host in a room-scale assay. Mosquito movements were tracked for 2 h using an infrared video system, collecting flight trajectory, spatial position and net contact data. Post-assay, mosquitoes were monitored for a range of sublethal insecticide effects.ResultsMosquito net contact was focused predominantly on the roof for all four bed nets. A steep decay in activity was observed for both susceptible strains when P3 net and OL net were present and with IG2 net for one of the two susceptible strains. Total mosquito activity was higher around untreated nets than ITNs. There was no difference in total activity, the number, or duration, of net contact, between any mosquito strain, with similar behaviours recorded in susceptible and resistant strains at all ITNs. OL net, P3 net and IG2 net all killed over 90% of susceptible mosquitoes 24 h after exposure, but this effect was not seen with resistant mosquitoes where mortality ranged from 16 to 72%. All treated nets reduced the willingness of resistant strains to re-feed when offered blood 1-h post-exposure, with a more pronounced effect seen with P3 net and OL net than IG2 net.ConclusionThese are the first results to provide an in-depth description of the behaviour of susceptible and resistant Anopheles gambiae strains around next-generation bed nets using a room-scale tracking system to capture multiple behaviours. These results indicate that there is no major difference in behavioural responses between mosquito strains of differing pyrethroid susceptibility when exposed to these new ITNs under the experimental conditions used.

Assessing Geographic Overlap between Zero-Dose Diphtheria-Tetanus-Pertussis Vaccination Prevalence and Other Health Indicators.

The integration of immunization with other essential health services is among the strategic priorities of the Immunization Agenda 2030 and has the potential to improve the effectiveness, efficiency, and equity of health service delivery. This study aims to evaluate the degree of spatial overlap between the prevalence of children who have never received a dose of the diphtheria-tetanus-pertussis-containing vaccine (no-DTP) and other health-related indicators, to provide insight into the potential for joint geographic targeting of integrated service delivery efforts. Using geospatially modeled estimates of vaccine coverage and comparator indicators, we develop a framework to delineate and compare areas of high overlap across indicators, both within and between countries, and based upon both counts and prevalence. We derive summary metrics of spatial overlap to facilitate comparison between countries and indicators and over time. As an example, we apply this suite of analyses to five countries-Nigeria, Democratic Republic of the Congo (DRC), Indonesia, Ethiopia, and Angola-and five comparator indicators-children with stunting, under-5 mortality, children missing doses of oral rehydration therapy, prevalence of lymphatic filariasis, and insecticide-treated bed net coverage. Our results demonstrate substantial heterogeneity in the geographic overlap both within and between countries. These results provide a framework to assess the potential for joint geographic targeting of interventions, supporting efforts to ensure that all people, regardless of location, can benefit from vaccines and other essential health services.

Preventive Measures Against The Vectors Of Malaria In Akanda, Southwest Gabon: Knowledge, Attitudes, Practices, And Beliefs

Background: Reliable data on the Knowledge, Attitudes, Beliefs, and Practices (KABP) of the indigenes of Akanda and its environs on the different approaches to fight against vectors of malaria is lacking. Objective: To evaluate the KABP of the indigenes of Akanda and its environs on the different techniques used to fight against vectors of malaria. Materials and Methods: A cross sectional survey using semi-structured questionnaires was conducted on heads of randomly selected households at Akanda from April to June 2019. Results: We interviewed 369 heads of households and the population had a high literacy rate. It was noticed that 94% of respondents knew that mosquitoes could transmit malaria. More than 80% believed that Insecticide-Treated bed Nets (ITNs) could protect them from malaria infection. There was no preference in ITNs usage with age cohorts and seasons of the year. The ITNs owned by respondents were mostly purchased from shops. Respondents underlined that their reluctance to sleep under ITNs was because of their inability to breath under such conditions. Also, apart from the use of ITNs for malaria control, Indoor Residual Spraying (IRS) using insecticides (mostly Rambo®) purchased from shops and cleaning around house surroundings were practiced by &gt;50% of respondents. Conclusion: Despite respondent’s awareness of mosquitoes as vectors of malaria as well as the use of ITNs, IRS, and cleaning of home surroundings to reduce malaria vectors burden, the ITNs coverage rate is very weak and more sensitization is also required at Akanda in Gabon.

Modeling the relationship between malaria prevalence and insecticide-treated bed net coverage in Nigeria using a Bayesian spatial generalized linear mixed model with a Leroux prior

OBJECTIVESTo evaluate malaria transmission in relation to insecticide-treated net (ITN) coverage in Nigeria.METHODSWe used an exploratory analysis approach to evaluate variation in malaria transmission in relation to ITN distribution in 1,325 Demographic and Health Survey clusters in Nigeria. A Bayesian spatial generalized linear mixed model with a Leroux conditional autoregressive prior for the random effects was used to model the spatial and contextual variation in malaria prevalence and ITN distribution after adjusting for environmental variables.RESULTSSpatial smoothed maps showed the nationwide distribution of malaria and ITN. The distribution of ITN varied significantly across the 6 geopolitical zones (p<0.05). The North-East had the least ITN distribution (0.196±0.071), while ITN distribution was highest in the South-South (0.309±0.075). ITN coverage was also higher in rural areas (0.281±0.074) than in urban areas (0.240±0.096, p<0.05). The Bayesian hierarchical regression results showed a non-significant negative relationship between malaria prevalence and ITN coverage, but a significant spatial structured random effect and unstructured random effect. The correlates of malaria transmission included rainfall, maximum temperature, and proximity to water.CONCLUSIONSReduction in malaria transmission was not significantly related to ITN coverage, although much could be achieved in attempts to curtail malaria transmission through enhanced ITN coverage. A multifaceted and integrated approach to malaria control is strongly advocated.

Impact of increased ventilation on indoor temperature and malaria mosquito density: an experimental study in The Gambia.

In sub-Saharan Africa, cooler houses would increase the coverage of insecticide-treated bednets, the primary malaria control tool. We examined whether improved ventilation, using windows screened with netting, cools houses at night and reduces malaria mosquito house entry in The Gambia. Identical houses were constructed, with badly fitting doors the only mosquito entry points. Two men slept in each house and mosquitoes captured using light traps. First, temperature and mosquito density were compared in four houses with 0, 1, 2 and 3 screened windows. Second, carbon dioxide (CO2), a major mosquito attractant, was measured in houses with (i) no windows, (ii) screened windows and (iii) screened windows and screened doors. Computational fluid dynamic modelling captured the spatial movement of CO2. Increasing ventilation made houses cooler, more comfortable and reduced malaria mosquito house entry; with three windows reducing mosquito densities by 95% (95%CI = 90–98%). Screened windows and doors reduced the indoor temperature by 0.6°C (95%CI = 0.5–0.7°C), indoor CO2 concentrations by 31% between 21.00 and 00.00 h and malaria mosquito entry by 76% (95%CI = 69–82%). Modelling shows screening reduces CO2 plumes from houses. Under our experimental conditions, cross-ventilation not only reduced indoor temperature, but reduced the density of house-entering malaria mosquitoes, by weakening CO2 plumes emanating from houses.

Host-feeding Preference of Anopheles Species under Prolonged Use of Insecticide-treated Bed Nets in Kamuli District, Uganda: Implications for Vector Control

Background: The blood-feeding patterns are crucial in incriminating disease vectors as well as facilitating the design and consolidation of effective vector control interventions in an area. &#x0D; Objective: This study aimed to establish if prolonged use of insecticide-treated bed nets (ITNs) caused a shift in the preferred hosts of the common malaria vectors as the hosts were under the bed net. Such a shift would render ITNs less effective and would probably explain the continued morbidity and mortality due to malaria in the highly endemic Kamuli district.&#x0D; Methods: A total of 3,519 indoor and outdoor human biting female Anopheles gambiae sensu lato and An. funestus mosquitoes were collected from 48 households using human-baited bed net traps. All 187 indoor resting blood-fed anophelines collected were tested by direct enzyme-linked immunosorbent assay (ELISA) for blood meal host identification. Of these, 73 mid guts came from 24 households in villages with a 69% ITNs coverage, while 114 mid guts were from 24 households in non-ITN villages.&#x0D; Results: Blood meal hosts were identified in only 10.96% (n = 8) and 14.91% (n = 17) of the Anopheles blood meals from the intervention and non-intervention zones, respectively. Other blood meals could not be clearly identified. Eight (100%) blood meals in the intervention zone were from humans, while in the non-intervention zone, 15 (88.24%), one (5.88%) and one (5.88%) came from humans, cattle and goat, respectively. These findings demonstrated that the malaria vectors in Kamuli district are anthropophilic, with nearly all the mosquitoes collected from both zones feeding on humans during every blood meal (p = 0.82). This indicated high vector-human contacts, and thus implicating these species as important in the transmission of Plasmodium species and probably other infections.&#x0D; Conclusion: The use of insecticide-treated bed nets is effective for controlling malaria vectors inside houses, evoking universal coverage of houses in the area.

Predictors of Malaria Prevalence and Coverage of Insecticide-Treated Bednets among Under-Five Children in the Buea Health District, South West Region, Cameroon

Introduction: Cameroon is a hyperendemic country to malaria where it remains a major public health concern, especially amongst children under-five. Insecticide-treated bednets (ITBNs) is the main control strategies. This study aimed at determining the predictors of malaria prevalence and coverage of ITBNs among under-five children in the Buea Health District (BHD), South West Region of Cameroon in other to reduce the morbidity and mortality of malaria. Methods: A cross-sectional study was carried out in the BHD which is a malaria-hyperendemic area. Every head (female/male) of the household who was present at home at the time of data collection was randomly interviewed using a structured questionnaire. Under-five children were ascertained for malaria using microscopy, with a temperature of ≥37.50°C. Results: Out of 391 children (mean age = 19.7 month, SD = 2.5) who were selected and ascertained for malaria, the overall malaria prevalence was 13.04% (95% CI: 10.04 - 16.78). In a multivariate analysis after adjusting for confounders, female parents/guardians (AOR = 0.53, 95% CI: 0.29 - 0.91) was associated with low risk of malaria while parents/guardians with no formal/primary educational (AOR = 3.3, 95% CI: 1.76 - 4.04) and children who did not use ITBN (AOR = 1.40, 95% CI: 1.08 - 2.51) were associated with an increased risk of malaria. Out of the selected children, 84.4% possessed ITBN (95% CI: 80.4 - 87.7) while 72.6% (95% CI: 67.9 - 76.8) used ITBN. In a multivariate after adjusting for confounders, Bova health area showed a significantly lower usage of ITBNs (χ 2 = 14.053, p = 0.003). Conclusion: The findings indicate that increased ITBN usage, increased parents/guardians’ educational level and good knowledge of ITBN is required to lower the risk of under-five children being infected with malaria. Health area of residence greatly influences the direct relationship between bednets possession and usage. These, therefore, indicates the possession of ITBN doesn’t mean their usage. The Cameroon National malaria control programs should consider the realities of the living conditions of the population for the implementation of better policies.

Utilization of Insecticide Treated Bed Nets (ITNs) among Caregivers of Children under Five Years in the Ho Municipality.

Background In Ghana, attempts to control malaria through antimalarial medications are currently threatened by the emergence and spread of drug resistant malaria parasites. This, together with the increasing incidence of malaria, has heightened the need for a more effective method of controlling the spread. The use of Insecticide Treated Bed Net (ITN) has been recognised as an effective measure in the prevention of malaria. Objective/Purpose In this study, we examined the utilisation of ITN among caregivers of children under five years in Ho municipality of Ghana. Methods This descriptive cross-sectional study recruited 283 household representatives through a multistage sampling method. A questionnaire was used to collect the data and was analyzed using STATA version 14. Descriptive and inferential statistics were adopted in presenting the data. Results Ownership of ITN was higher (80.7%) than its utilisation (41.7%). The age of caregiver was strongly associated with the utilisation of ITN (AOR=2.00, 95% CI=0.00, 0.02, p<0.001) among children less than five years. Caregivers aged 26-35 were 49% times less likely to use an ITN as compared to those aged between 17 and 25 and the difference was statistically significant. Conclusion In order to ensure a high ITN coverage and utilisation, there is the need for continuous distribution of ITNs to households. Households should be sensitized to use the nets to prevent the continuous spread of malaria.

A Review of the Literature on Insecticide Treated Bed Net Use, Anaemia and Malaria Parasitaemia in Under Five Children

Insecticide Treated bed Net (ITN) is considered to be the most efficacious of all currently feasible interventions for malaria control in Africa. However, lack of data on its use in under five children has made it difficult to keep tract of its efficacy in this population. This study was aimed at pooling published data from parts of Africa and Asia with the hope of providing an overview of the use of ITNs and its efficacy in children under five years of age. Literature search was carried out Pubmed, Pubmedcentral, MEDLINE, and Cochrane library for all published articles between 1991 and 2015 using search strings such as under five children, ITN, malaria parasitaemia, anaemia, protective efficacy, ownership and use, pattern of deployment and types of ITN. Based on specific criteria, 30 studies were included. Few countries have met the ITN coverage target of 80% including Nigeria, with coverage rates ranging from about 69% to 75%. ITN use in under five children has been shown to reduce the prevalence of malaria and anaemia in areas unstable malaria transmission to a variable degree. ITN possession does not always translate to usage and consistent use is required for effective malaria control.

Modelling the impact of the long-term use of insecticide-treated bed nets on Anopheles mosquito biting time

BackgroundEvidence of changing in biting and resting behaviour of the main malaria vectors has been mounting up in recent years as a result of selective pressure by the widespread and long-term use of insecticide-treated bed nets (ITNs), and indoor residual spraying. The impact of resistance behaviour on malaria intervention efficacy has important implications for the epidemiology and malaria control programmes. In this context, a theoretical framework is presented to understand the mechanisms determining the evolution of feeding behaviour under the pressure of use of ITNs.MethodsAn agent-based stochastic model simulates the impact of insecticide-treated bed nets on mosquito fitness by reducing the biting rates, as well as increasing mortality rates. The model also incorporates a heritability function that provides the necessary genetic plasticity upon which natural selection would act to maximize the fitness under the pressure of the control strategy.ResultsThe asymptotic equilibrium distribution of mosquito population versus biting time is shown for several daily uses of ITNs, and the expected disruptive selection on this mosquito trait is observed in the simulations. The relative fitness of strains that bite at much earlier time with respect to the wild strains, when a threshold of about 50% of ITNs coverage highlights the hypothesis of a behaviour selection. A sensitivity analysis has shown that the top three parameters that play a dominant role on the mosquito fitness are the proportion of individuals using bed nets and its effectiveness, the impact of bed nets on mosquito oviposition, and the mosquito genetic plasticity related to changing in biting time.ConclusionBy taking the evolutionary aspect into account, the model was able to show that the long-term use of ITNs, although representing an undisputed success in reducing malaria incidence and mortality in many affected areas, is not free of undesirable side effects. From the evolutionary point of view of the parasite virulence, it should be expected that plasmodium parasites would be under pressure to reduce their virulence. This speculative hypothesis can eventually be demonstrated in the medium to long-term use of ITNs.

Progress in coverage of bed net ownership and use in Burkina Faso 2003\u20132014: evidence from population-based surveys

BackgroundUse of insecticide-treated bed nets (ITNs) is the cornerstone of malaria prevention. In 2010 and 2013, the Burkina Faso Government launched mass distribution campaigns of ITNs to increase coverage of ownership and use in the country. This study assessed the progress towards universal bed net coverage in Burkina Faso.MethodsThe authors used data from the Burkina Faso 2003 and 2010 Demographic and Health Surveys (DHS), the 2006 Multiple Indicator Cluster Surveys (MICS) and the 2014 Malaria Indicator Survey (MIS). For each survey, the authors computed key malaria prevention indicators in line with recommendations from the Survey and Indicator Task Force of the Roll Back Malaria Monitoring and Evaluation Reference Group. The trends over a decade was assessed by calculating percentage point change between 2003 and 2014.ResultsAt national level, the proportion of households owning at least one ITN increased substantially from 5.6, 95% CI (4.7, 6.5%) in 2003 to 89.9% (88.5, 91.2%) in 2014, with low heterogeneity between regions. The proportion of households owning at least one ITN per two people increased significantly from 1.8% (1.4, 2.3%) in 2003 to 49.2% (47.3, 51.0%) in 2014. ITN use in the general population increased from 2.0% (1.6, 2.3%) in 2003, to 67.0% (65.3, 68.7%) in 2014. A similar trend was observed among children under the age of five years, increasing from 1.9% (1.5, 2.4%) in 2003 to 75.2% (73.2, 77.3%) in 2014, and among pregnant women, increasing from 3.0% (1.9, 4.2%) in 2003 to 77.1% (72.9, 81.3%) in 2014. The intra-household ownership gap was 67.0% (61.5, 72.4%) in 2003, but decreased significantly to 45.3% (43.6, 47.1%) in 2014. The behavioural gap, which was relatively low in 2013 with only 20.0% of people who had access to an ITN but were not using it, further decreased to 5.9% in 2014.ConclusionBurkina Faso made considerable progress in coverage of ITN ownership, access and use between 2003 and 2014, as a result of the two free mass distribution campaigns in 2010 and 2013. However, ITN coverage remains below the national targets of 100% for ownership and 80% for use. The results of 90% of ownership and 67% of use confirm that free mass distribution campaigns of ITNs are effective; however, there is room for improvement to reach and maintain optimal coverage of ITN ownership and use.

The effect of price on demand for and use of bednets: evidence from a randomized experiment in Madagascar.

There is an on-going debate about whether health products, such as insecticide-treated bednets (ITNs) for protection against malaria, should be distributed for free or at a positive price to maximize ownership and use. One argument in favour of free distribution is related to positive externalities. Like vaccines, individual use of ITNs provides a community-wide protective effect against malaria even for non-users. In addition, price may act as a barrier to ownership particularly among those most at-risk who are frequently poor. Alternatively, charging a positive price may reduce donor dependence, more efficiently allocate nets to those most at risk of malaria, and encourage use through a hypothesized sunk cost effect, where individuals are more likely to use goods they pay for. Using a randomized experiment in Madagascar, we evaluate the impact of price on demand for and use of ITNs. We find that price negatively affects both demand and use of ITNs. When price increases by $0.55, demand falls by 23.1% points (CI 19.6–26.6; P < 0.01) and effective coverage falls by 23.1% points (CI 19.6–26.6; P < 0.01). We fail to find evidence of a screening effect for prices greater than zero, but households eligible for free ITNs are more likely to use them if they have more self-reported fevers in the household at baseline. We also fail to find evidence of a sunk cost effect, meaning that households are not more likely to use nets that they pay for. Our results suggest that: (1) only partially subsidizing ITNs significantly limits ownership and (2) distributing ITNs for free or at a small nominal price will maximize demand and effective coverage. Alternative sources of financing should be identified to completely (or almost completely) subsidize the cost of ITNs in order to maximize coverage of ITNs among poor populations at risk of malaria.

Feasibility and implementation of community-based malaria case management with integrated vector control in the Democratic Republic of Congo.

BackgroundMalaria prevalence in the Mulumbu Health Area in Lualaba Province, Democratic Republic of the Congo has remained high (>70 %) despite repeated vector control (indoor residual spray) and mass insecticide-treated bed net coverage. Therefore, a pilot study was implemented to attack the parasite directly and demonstrate the feasibility and acceptability of community case management of malaria (CCMm) using trained community health workers (CHWs).MethodsA 13 month prospective evaluation of CCMm was undertaken in 14 rural villages. Focus group discussions and structured interviews were conducted in pre- and post-intervention periods to assess community acceptability of CCMm. Weekly data collected by CHWs assessed program impact over time, matched with malaria school-based prevalence surveys (MSPS) in the Mulumbu Health Area (CCMm study arm) compared to a comparison (non-CCMm) arm in the Mpala Health Area approximately 25 km apart.ResultsOverall population perception of the CCMm was highly positive. 6619 community contacts were managed by CHWs from which 1433 (21.6 %) were malaria positive by rapid detection tests during the 10 month intervention. Among the malaria infected, 94.7 % (1358) were recorded as ‘uncomplicated’ infections with 99.7 % provided full course of treatment. CHWs referred 278 (4.2 %) patients deemed ‘complicated’ to a designated primary health center for advanced care. While pre-intervention MSPS data revealed significantly higher (p = 0.0135) malaria in the CCMm area compared to the non-CCMm area, at post-intervention there was no statistical difference (p = 0.562) between the two areas. Notably, for the first time, no malaria-related deaths were recorded in the 14 CCMm intervention villages during observation.ConclusionCommunity case management of malaria was shown to be an effective and promising strategy for prompt and effective management of malaria. It was well accepted by the community and showed evidence of a reduction in malaria morbidity and mortality. Further refinement of CCMm implementation, cost implications and sustainability is advised before expanding the programme.

Factors associated with the non-use of insecticide-treated nets in Rwandan children.

BackgroundInsecticide-treated bed nets (ITNs) are highly effective in reducing malaria burden when used properly. However, factors related to individuals, households and community may influence how ITNs are used for malaria control. The study examined influences exerted at these levels to determine if they are associated with ITN non-use among children under 5 years of age in Rwanda.MethodsUsing data from the 2010 Rwanda Demographic Health Survey, the investigation was done on the factors associated with ITN non-use among children under 5 years. Descriptive statistics as well as univariate and multilevel logistic regression analyses were used to identify factors associated with ITN non-use.ResultsResponses from a total of 6173 women aged 15–49 years living in 492 villages were included in the analysis. Risk factors for children not utilizing ITNs (25 %) included: (Odds ratio [95 % confidence interval]) households with more than five members (1.42 [1.23–1.63]), employed mother (1.33 [1.06–1.66]), and lower household altitude (1.36 [1.14–1.61]). Protective risk factors for ITN use included households with more than three nets (0.39 [0.33–0.47]), mothers who attended one to four visits at antenatal clinics during pregnancy (0.45 [0.29–0.69]), more than four antenatal clinic visits during pregnancy (0.39 [0.21–0.70]), mothers married or living with partner (0.43 [0.36–0.52]), mothers with any education level (0.77 [0.65–0.91]), and households with higher community wealth quintile (0.71 [0.59–0.84]).ConclusionsRwanda has achieved high coverage of ITN use and proper use has contributed to a decline in malaria in Rwanda; however, maintaining universal ITN coverage is not enough to protect citizens from this disease. Risk factors related to ITN non-use at individual, household and community level include poverty, education, birth spacing, and antenatal clinic attendance. There is a need to address findings with strategies to mitigate the non-use of ITNs for effective malaria prevention in Rwanda.

Factors associated with use of malaria control interventions by pregnant women in Buwunga subcounty, Bugiri District.

BackgroundIn Uganda, the Government has promoted the use of intermittent preventive treatment of malaria in pregnancy (IPTp) and insecticide-treated bed nets (ITNs) as malaria control strategies for pregnant women. However, their utilization among pregnant women is low. This study aimed at assessing factors associated with use of IPTp for malaria and ITNs by pregnant women in Buwunga sub-county, Bugiri District.MethodsThis was a cross-sectional study, conducted in Buwunga sub-county, Bugiri District, employing quantitative data collection tools. A total of 350 household members were randomly selected to participate in the study. Data were entered and analysed using Epi info version 3.5.1; bivariable and multivariable analysis was done to assess the factors associated with use of IPTp and ITNs among pregnant women.ResultsThe level of uptake of IPTp1 (at least one dose) was 63.7 % while IPTp2 (at least two doses) was 42.0 %. More than half (58.6 %) of the mothers had slept under an ITN the night before the survey. Slightly more than half (51.9 %) of the mothers mentioned stock outs as the major reason for not accessing IPTp and ITNs. The main factors that were statistically significant for IPTp2 uptake were the knowledge of mothers on IPTp2 (AOR 2.48 95 % CI 1.53–4.02) and providing women with free clean water at the antenatal care (ANC) clinic (AOR 3.63 95 % CI 2.06–6.39). Factors that were significant for ITN utilization included education level of mothers (AOR 2.03 95 % CI 1.09–3.78), ease of access (AOR 2.74 95 % CI 1.65–4.52), and parity (AOR 1.71 95 % CI 1.01–1.29).ConclusionThe level of uptake of the two recommended doses of sulfadoxine–pyrimethamine (SP) tablets for malaria prevention (IPTp2) was low, slightly more than half of the mothers slept under an ITN the night before the survey. Appropriate measures to increase the level of uptake of IPTp2 and coverage of ITNs among pregnant women should be implemented, and these include providing health education about IPTp and ITNs, and ensuring that mothers are provided with free safe clean water at ANC clinic.

Optimal insecticide-treated bed-net coverage and malaria treatment in a malaria-HIV co-infection model

ABSTRACTWe propose and study a mathematical model for malaria-HIV co-infection transmission and control, in which malaria treatment and insecticide-treated nets are incorporated. The existence of a backward bifurcation is established analytically, and the occurrence of such backward bifurcation is influenced by disease-induced mortality, insecticide-treated bed-net coverage and malaria treatment parameters. To further assess the impact of malaria treatment and insecticide-treated bed-net coverage, we formulate an optimal control problem with malaria treatment and insecticide-treated nets as control functions. Using reasonable parameter values, numerical simulations of the optimal control suggest the possibility of eliminating malaria and reducing HIV prevalence significantly, within a short time horizon.

Assessing the effects of malaria interventions on the geographical distribution of parasitaemia risk in Burkina Faso.

BackgroundBurkina Faso conducted its first nationally representative household malaria survey in 2010/2011. The survey collected among others, information on malaria interventions, treatment choices and malaria parasite prevalence in children aged 6–59 months.MethodsIn this study, Bayesian geostatistical models were employed to assess the effects of health interventions related to insecticide-treated bed nets (ITN), indoor residual spray (IRS), artemisinin-based combination therapy (ACT) coverage associated with childhood malaria parasite risk at national and sub-national level, after taking into account geographical disparities of climatic/environmental and socio-economic factors. Several ITN coverage measures were calculated and Bayesian variable selection was used to identify the most important ones. Parasitaemia risk depicting spatial patterns of infections were estimated.ResultsThe results show that the predicted population-adjusted parasitaemia risk ranges from 4.04 % in Kadiogo province to 82 % in Kompienga province. The effect of ITN coverage was not important at national level; however ITNs have an important protective effect in Ouagadougou as well as in three districts in the western part of the country with high parasitaemia prevalence and low to moderate coverage. There is a large variation in ACT coverage between the districts. Although at national level the ACT effects on parasitaemia risk was not important, at sub-national level 18 districts around Ouagadougou deliver effective treatment.ConclusionThe produced maps show great variations in parasitaemia risk across the country and identify the districts where interventions are being effective. These outputs are valuable tools that can help improve malaria control in Burkina Faso.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1282-x) contains supplementary material, which is available to authorized users.