Distribution Of Insecticide-treated Bed Nets Research Articles

Predictors of insecticide-treated bed nets use among pregnant women in Sierra Leone: evidence from the 2019 Sierra Leone Demographic Health Survey

BackgroundMalaria remains a significant public health threat in Sierra Leone, particularly for pregnant women and their unborn children. Infection during pregnancy can lead to severe consequences, including maternal anaemia, low birth weight, premature birth, and even death. Therefore, preventing malaria during pregnancy is crucial for improving maternal and child health outcomes. This study investigated the predictors of insecticide-treated bed net (ITN) use among pregnant women in Sierra Leone.MethodsThe study analysed the 2019 Sierra Leone Demographic and Health Survey data (SLDHS). The study comprised a total of 900 pregnant women aged 15–49 years, representing the nationally representative sample. A multivariable binary regression analysis was used to explore the predictors of ITN use. The regression results were presented using an adjusted odds ratio (AOR) with 95% confidence intervals (CI).ResultsThe study found that the prevalence of ITN use among pregnant women was 64.2 [60.4, 67.9] in Sierra Leone. Pregnant women who were married [aOR = 2.02, 95% CI 1.32, 3.07] had higher odds of bed net use than those who were unmarried. Pregnant women with five or more children [aOR = 1.69, 95% CI 1.01, 2.84] had higher odds of mosquito bed net use than those with four and below children. Pregnant women living in the Northern, Northwestern, Southern and Western regions all had lower odds of bed net use than those in the Eastern region, with the lowest odds among those living in the western region [aOR = 0.19, 95% CI 0.09, 0.40]. Pregnant women who were Muslims [aOR = 0.63, 95% CI 0.41, 0.95] had lower odds of mosquito bed net use than Christians. Pregnant women with female household heads [aOR = 0.65, 95% CI 0.44, 0.95] had lower odds of mosquito bed net use than those with male household heads.ConclusionITN use among pregnant women in Sierra Leone remains suboptimal. Marital status, parity, sex of household head, region and religion were associated with bed net use. The government and policymakers in Sierra Leone should integrate ITN education and distribution into prenatal care services, emphasizing the benefits for both mother and baby—partnering with healthcare providers to raise awareness and encourage consistent use. Involve local leaders, religious figures, and mothers' groups to promote the benefits of ITN during pregnancy. Educate husbands and partners on the importance of ITN use during pregnancy and encourage their support in its consistent use.

Impact of targeted drug administration and intermittent preventive treatment for forest goers using artesunate–pyronaridine to control malaria outbreaks in Cambodia

IntroductionThe national malaria programme of Cambodia targets the rapid elimination of all human malaria by 2025. As clinical cases decline to near-elimination levels, a key strategy is the rapid identification of malaria outbreaks triggering effective action to interrupt local transmission. We report a comprehensive, multipronged management approach in response to a 2022 Plasmodium falciparum outbreak in Kravanh district, western Cambodia.MethodsThe provincial health department of Pursat in conjunction with the Center for Parasitology, Entomology and Malaria Control (CNM) identified villages where transmission was occurring using clinical records, and initiated various interventions, including the distribution of insecticide-treated bed nets, running awareness campaigns, and implementing fever screening with targeted drug administration. Health stations were set up at forest entry points, and later, targeted drug administrations with artesunate–pyronaridine (Pyramax) and intermittent preventive treatment for forest goers (IPTf) were implemented in specific village foci. Data related to adherence and adverse events from IPTf and TDA were collected. The coverage rates of interventions were calculated, and local malaria infections were monitored.ResultsA total of 942 individuals were screened through active fever surveillance in villages where IPTf and TDA were conducted. The study demonstrated high coverage and adherence rates in the targeted villages, with 92% (553/600) coverage in round one and 65% (387/600) in round two. Adherence rate was 99% (551/553) in round one and 98% (377/387) in round two. The study found that forest goers preferred taking Pyramax over repeated testing consistent with the coverage rates: 92% in round one compared to 65% in round two. All individuals reachable through health stations or mobile teams reported complete IPTf uptake. No severe adverse events were reported. Only six individuals reported mild adverse events, such as loss of energy, fever, abdominal pain, diarrhoea, and muscle aches. Two individuals attributed their symptoms to heavy alcohol intake following prophylaxis.ConclusionsThe targeted malaria outbreak response demonstrated high acceptability, safety, and feasibility of the selected interventions. Malaria transmission was rapidly controlled using the available community resources. This experience suggests the effectiveness of the programmatic response for future outbreaks.

Level of awareness and utilization of insecticide-treated bed nets among medical students as measures for reducing malaria episodes

This study examined the level of awareness and utilization of insecticide-treated bed nets among medical students as measures for reducing malaria episodes in Delta State University, Abraka. It was a descriptive study with objectives and research questions formulated to achieve the study design. A sample size of 200 male and female students resident in the campus hostels were selected using random sampling technique. A self-structured questionnaire was designed and administered to the study participants, however, only 148 copies of the questionnaires were successfully retrieved and used for the study. Data generated were subjected to quantitative statistical analysis for frequencies, percentages, average mean and Chi-square testing. Findings revealed that the level of awareness was significantly associated with the role of health workers in the distribution of insecticide-treated bed nets in Delta State University, Abraka, although, factors hindering health workers from distributing insecticide-treated bed nets were identified. There was significant difference between perception of medical students and the utilization of insecticide-treated bed nets on risk of malaria spread. In addition, there was significant difference between the benefits of using insecticide-treated bed nets and the prevention and control of malaria. We therefore conclude that regular utilization of insecticide-treated bed nets due to adequate awareness eliminates contact with mosquitoes and prevents transmitting vectors of malaria from having contact with the users of insecticide-treated bed net. Massive health education campaign is recommended to further scale up the awareness and effective utilization of insecticide-treated bed nets towards prevention and control of malaria bites among students in Delta State University, Abraka.

Successful implementation of ITN distribution through health facilities in Ghana

BackgroundGlobal efforts to reduce malaria burden include distribution of insecticide-treated mosquito nets through mass campaigns and routine channels. Ghana’s National Malaria Elimination Programme (NMEP) distributes insecticide-treated bed nets (ITNs) through various channels, including to pregnant women at antenatal care (ANC) visits and children at vaccination visits through child welfare clinics (CWC). This study assessed historical ITN distribution throughout ANCs and CWCs across Ghana and the characteristics of high performing facilities.MethodsMonthly data on routine ITN distribution was provided from Ghana’s national health information management system for the years 2016–2021. Analyses were conducted to assess the performance of ITN distribution at ANC and CWC across time, ecological zone, regions, districts, facility ownership, and facility type. Univariate and multivariate logistic regressions were performed to predict the odds of ANC and CWC issuing rates greater or equal to 80% for a given facility type or ownership.ResultsIn 2021, 93% of women who attended their first antenatal care visit and 92% of children under five who received their second dose of the measles-rubella vaccine (MR2) had received an ITN. At the regional level, 94% of regions (n = 15/16) maintained the NSP target issuing rate of 80% throughout 2020 and 2021. While there were no clear differences in issuing rates between ecological zones, district-level differences were present across the six years. All health facility types performed at or above 80% in 2021 for both ANC and CWC. Odds ratios demonstrated differences in the likelihood of meeting the 80% issuing rate goal among different facility types as well as private versus public ownership when comparing ANC and CWC.ConclusionBy 2021, Ghana had improved its ITN issuing rates since the initial year of analysis, surpassing the 80% target by issuing nets to over 90% of pregnant women and young children attending ANC and CWC. Future work can explore the reasons for national and subnational differences in issuing rates as well as help understand additional characteristics of high performing facilities. Additionally, it is necessary to identify and expand on the drivers for improved performance over the time period.

Access and Adequate Utilization of Malaria Control Interventions among Women of Childbearing Age from 15 to 49 years in Badbaado IDPs Settlements, Mogadishu, Somalia

Background: Although there is limited national data and statistics on the burden of malaria in Somalia, it is considered a major public health problem in the country. children below 5 years, pregnant, lactating women and non-immune migrants carry most of the disease burden. the world malaria report 2020 estimated that there were around 759,000 cases and 1,942 deaths in Somalia in 2019.
 
 Aim of the study: The purpose of this study is to explore the results of a rapid assessment of the extent of current access and adequate utilization of malaria control interventions among women of childbearing age from 15 to 49 years in Badbaado IDPs Settlements, Dharkenley District, Mogadishu, Somalia. 
 
 Method: This study applied a non-probability purposive sampling strategy for recruiting study participants. A total of 150 women aged 15 to 49 years old were selected, and semi-structured questionnaires were the main data collection methods. The data was analyzed using SPSS version 23 and used a P-value of 95% to assess associations between variables with ≤0.05 regarded as a statistically significant.
 
 Results: The incidence of malaria among respondents was 59 cases (39.3%), of which 39 (66.1%) were mothers followed by 17 cases (28.8%) of children under the age of five years. The vast majority of 51 (63.0%) of the respondents who seek treatment confirmed that the distance from the health facility to their residence is about three kilometers or further. The majority of 39 (66.1%) of the respondents who were infected with malaria did not take the malaria medicine, while non-availability and/or non-affordability of the prescribed medicines in the clinics was the reason for not taking the medicine. Most of the respondents, 140 out of 150 of the study participants (93.3%), confirmed that they did not get any malarial services in their internally displaced persons IDPs settlements. Almost all of the respondents’ household members 147 (98%) did not own insecticide-treated bed nets (ITNs), reasoning that due to the lack of distribution of ITNs and the unaffordability of their costs. 
 
 Conclusion and Recommendation: The study revealed a high incidence of malaria cases. However, this study recommends the government and other stakeholders should provide funding to establish IDPs settlements clinics and increase mobile teams to provide adequate and accessible public health services to combat malaria in these vulnerable populations.

Implementation of insecticide-treated malaria bed nets in Tanzania: a systematic review

Background Malaria is a significant cause of morbidity, mortality, and economic burden among the Tanzanian population. An effective form of personal protection against malaria is the insecticide-treated bed net (ITN). Although Tanzania has made great efforts to implement ITNs in the general population, gaps in use, access, coverage, and ownership remain. We conducted a systematic review of the available data on the barriers and facilitators to the implementation of ITNs in Tanzania. Methods A comprehensive search was conducted in four databases: OVID Medline, OVID Embase, EBSCO CINAHL, and Web of Science. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to present the review and analysis. Eligible studies were appraised to determine the quality of evidence. Various content data were extracted, including study locations, years of publication, study objectives, and barriers and facilitators to ITNs. The Consolidated Framework for Implementation Research (CFIR) facilitated a thematic analysis of the barriers and facilitators. Results Seven mixed-methods and three qualitative studies met this review’s inclusion criteria. Seven regions and ten districts within Tanzania were represented in this review, most notably the Morogoro region and its respective districts, Kilombero and Ulanga. Study dates ranged from 1995 to 2020. Facilitators of ITN implementation included cost, voucher schemes, involving locals, planning for distribution, and social marketing and communication campaigns. Similarly, barriers to ITN implementation included cost, knowledge and beliefs, a poorly developed private sector, and inadequate distribution methods. Conclusions A systematic review of studies on the implementation of ITNs in Tanzania highlights vital areas in the development of successful implementation that include: (i) the cost of ITNs, (ii) knowledge and beliefs about ITNs among potential users, and (iii) planning for the execution of ITN distribution programs. ITN implementation can be enhanced if national stakeholders invest further in processes that promote ITN procurement, such as voucher schemes, providing education sessions, integrating distribution methods that cater to locals’ preferences, and initiating the promotion of ITN months in advance of their distribution. Registration PROSPERO (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=222128)

Malaria in Pregnancy Amidst Possession of Insecticide Treated Bed Nets (ITNs) in Orlu L.G.A. of Imo State, Nigeria

Malaria is one of the most dreadful diseases in pregnancy due because it affects not only the pregnant mother, but also the foetus especially in the Tropical African countries. Most endemic nations have embarked on free or affordable distribution of insecticide treated bed net as an alternative to drug interventions, yet many people, especially children and pregnant women stand the risk of malaria attack annually. Hence the study on the malaria status and possession of insecticide treated bed net (ITN) among pregnant women in Orlu LGA in 2019.A total of 600 pregnant women were encountered in health care service centersin the area, out of which 514 gave their consent and participated in the study. Blood samples were collected using finger pricking method, stains made directly on slides allowed to dry and then taken to diagnostic laboratory for parasitological analysis. The slides were stained with Giemsa stain and examined using X100 oil immersion objective lens. Biodata and other relevant information on the use/ non use of ITN were obtained using well- structured questionnaire and focus group discussions. The results obtained revealed that out of 514 participants examined,318(61.9%) had malaria parasites while 196(38.1%) had no malaria. Gravid related prevalence showed primed of having the highest prevalence of 69.1%, while the least infected were those of thirdgravidae, (44.3%). Trimester related prevalence also had the first trimester group of having the highest prevalence of 71.5%, while the least was observed among the second trimesters, 55.5%. Of 217 (42.2%) who use ITN,129 (59.4%) were infected while 63.6% of those who do not use had a malaria infection as well. Generally, this study revealed that it is not only the distribution or possession of ITN that reduces or prevents malaria infection, but the zeal and enabling environment to use the nets appropriately. A lot more is needed to really prevent malaria infection among the most vulnerable and indeed the entire populace through improved education strategy. Better enlightenment of the public as well as availability of coping strategies to really ameliorate the effect of extra heat and rashes from the bed nets are paramount.

Out-of-pocket costs and time spent attending antenatal care services: a case study of pregnant women in selected rural communities in Zinder, Niger

BackgroundDespite an official policy of exemption from health care costs, pregnant women in Niger still face some out-of-pocket costs (OPC) in addition to time costs when they attend antenatal care (ANC) services. We aimed to: 1) assess the OPC for pregnant woman attending ANC, 2) estimate the time spent to attend ANC and the opportunity cost of that time, and 3) assess how OPC and time spent to attend ANC affected ANC attendance.MethodsData were obtained from a quasi-experimental descriptive study carried out in the region of Zinder, Niger, which compared pre- and post-intervention cohorts of pregnant women (n = 1736 women who reported attending ANC during their current pregnancy). An ANC attendance score was developed to describe the timing of ANC attendance in regard to the WHO recommendation of attending 4 ANC sessions. OPC and time spent were evaluated separately for associations with ANC attendance using Spearman correlations.ResultsThe mean (±SD) age of pregnant women was 25.0 ± 6.4 yr, 19.0% were ≤ 19 yr and 99.7% were in their second or third trimester of gestation at the time of the interview. Among those who were > 13 weeks and > 27 weeks of gestation, 4.0 and 74.4% had attended ANC during their first and second trimesters, respectively. The median (1st quartile (Q1), 3rd quartile (Q3)) ANC score was 0 (− 1, 0), reflecting that the majority of women failed to follow the WHO recommendation. More than half of the women (72.5%) experienced OPC related to ANC. The majority of women (> 80%) reported spending ~ 3 h for an ANC visit, including travel and waiting time. Time spent to attend ANC was not associated with ANC attendance score. Women who experienced OPC, and those who received iron folic acid (IFA) or long-lasting insecticide-treated bednets during an ANC visit, were more likely to have a higher ANC attendance score compared to those who did not.ConclusionOPC and time spent were not identified as barriers to ANC visits, and IFA and long-lasting insecticide-treated bednets distribution could be used to motivate pregnant women to attend ANC.Trial registrationThe NiMaNu project was registered at www.clinicaltrials.gov as NCT01832688. Registered 16 April 2013.

A Mass Insecticide-Treated Bed Net Distribution Campaign Reduced Malaria Risk on an Individual but Not Population Level in a Highland Epidemic-Prone Area of Kenya.

In epidemic-prone areas of the western highlands, the Kenya Ministry of Health conducted campaigns of indoor residual spraying (IRS) of households, followed by mass distribution of insecticide-treated bed nets (ITNs), as part of the National Malaria Strategy. We previously reported that in the highland areas of Kipsamoite and Kapsisiywa, widespread IRS coverage in 2007, after lower but substantial coverage in 2005 and 2006, contributed to possible local interruption of malaria transmission between 2007 and 2008. Indoor residual spraying campaigns in the area ended in 2010, succeeded by a mass ITN distribution campaign in 2011 and 2012 targeting universal coverage. Insecticide-treated bed net use in the area increased from 17.1% pre-campaign in 2011 to 51.7% post-campaign in 2012, but decreased to 35.8% in 2013. The ITN campaign did not reduce malaria incidence in the population as a whole (odds ratio [OR] after ITN distribution versus before, 1.29, 95% CI: 1.00-1.66, P = 0.049). However, in 2011-2013, individuals who stated that they slept under ITNs as compared with those who did not had a decrease in malaria incidence that approached statistical significance (OR 0.74, 95% CI: 0.52-1.04, P = 0.08). Mass ITN distribution after previous annual IRS campaigns was insufficient to further reduce malaria transmission in this area of low and highly seasonal transmission possibly because of low ITN use despite the mass campaign.

Pausing the Fight Against Malaria to Combat the COVID-19 Pandemic in Africa: Is the Future of Malaria Bleak?

Malaria remains a major global health burden, killing hundreds of thousands annually, especially in sub-Saharan Africa. In 2019, a Phase IV Expanded Programme on Immunization (EPI)-linked malaria vaccine implementation was underway. However, in December 2019, a novel pneumonia condition termed coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with many clinical, epidemiological, and biological parallels to malaria, was reported in Wuhan, China. COVID-19 is spreading rapidly, and, as of the 3rd of June, 2020, more than 382,507 persons had died from COVID-19. Children under 5 years who suffer high malaria-attributable mortalities are largely asymptomatic for COVID-19. Considering that the malaria burden is highest in low-income tropical countries with little capacity to fund malaria control and eradication programs, the fight against malaria in these regions is likely to be hampered. Access to healthcare has generally been limited, while malaria interventions, such as seasonal malaria chemotherapy and distribution of insecticide-treated bed nets, have been suspended due to lockdowns. Likewise, the repurposing of antimalarials for treatment of COVID-19 shared symptoms and the shift in focus from the production of malaria rapid diagnostic tests (RDTs) to COVID-19 RDTs is a cause for concern in malaria-endemic regions. Children are less affected by the COVID-19 pandemic compared to the elderly. However, due to the fears of contracting SARS-CoV-2, the elderly who are worst affected by COVID-19 may not take children for malaria medication, resulting in high malaria-related mortalities among children. COVID-19 has disproportionately affected developed countries, threatening their donation capacity. These are likely to thwart malaria control efforts in low-income regions. Here, we present perspectives on the collateral impact of COVID-19 on malaria, especially in Africa.

Exploring the Mechanisms of Multiple Insecticide Resistance in a Highly Plasmodium-Infected Malaria Vector Anopheles funestus Sensu Stricto from Sahel of Northern Nigeria.

The Nigerian Government is scaling up the distribution of insecticide-treated bed nets for malaria control, but the lack of surveillance data, especially in the Sudan/Sahel region of the country, may hinder targeting priority populations. Here, the vectorial role and insecticide resistance profile of a population of a major malaria vector Anopheles funestus sensu stricto from Sahel of Nigeria was characterised. An. funestus s.s. was the only vector found, with a high human blood index (100%) and a biting rate of 5.3/person/night. High Plasmodium falciparum infection was discovered (sporozoite rate = 54.55%). The population is resistant to permethrin (mortality = 48.30%, LT50 = 65.76 min), deltamethrin, DDT (dichlorodiphenyltrichloroethane) and bendiocarb, with mortalities of 29.44%, 56.34% and 54.05%, respectively. Cone-bioassays established loss of efficacy of the pyrethroid-only long-lasting insecticidal nets (LLINs); but 100% recovery of susceptibility was obtained for piperonylbutoxide (PBO)-containing PermaNet®3.0. Synergist bioassays with PBO and diethyl maleate recovered susceptibility, implicating CYP450s (permethrin mortality = 78.73%, χ2 = 22.33, P < 0.0001) and GSTs (DDT mortality = 81.44%, χ2 = 19.12, P < 0.0001). A high frequency of 119F GSTe2 mutation (0.84) was observed (OR = 16, χ2 = 3.40, P = 0.05), suggesting the preeminent role of metabolic resistance. These findings highlight challenges associated with deployment of LLINs and indoor residual spraying (IRS) in Nigeria.

Preparedness is essential for malaria-endemic regions during the COVID-19 pandemic

Preparedness is essential for malaria-endemic regions during the COVID-19 pandemic

Costs of insecticide-treated bed net distribution systems in sub-Saharan Africa

BackgroundInsecticide-treated nets (ITNs) are one of the most cost-effective measures for preventing malaria. The World Health Organization recommends both large-scale mass distribution campaigns and continuous distributions (CD) as part of a multifaceted strategy to achieve and sustain universal access to ITNs. A combination of these strategies has been effective for scaling up ITN access. For policy makers to make informed decisions on how to efficiently implement CD or combined strategies, information on the costs and cost-effectiveness of these delivery systems is necessary, but relatively few published studies of the cost continuous distribution systems exist.MethodsTo address the gap in continuous distribution cost data, four types of delivery systems—CD through antenatal care services (ANC) and the expanded programme on immunization (EPI) (Ghana, Mali, and mainland Tanzania), CD through schools (Ghana and mainland Tanzania), and a combined community/health facility-based distribution (Zanzibar, Tanzania), as well as mass distributions (Mali)—were costed. Data on costs were collected retrospectively from financial and operational records, stakeholder interviews, and resource use surveys.ResultsOverall, from a full provider perspective, mass distributions and continuous systems delivered ITNs at overlapping economic costs per net distributed (mass distributions: 4.37–4.61 USD, CD channels: 3.56–9.90 USD), with two of the school-based systems and the mass distributions at the lower end of this range. From the perspective of international donors, the costs of the CD systems were, for the most part, less costly than the mass distributions (mass distributions: 4.34–4.55 USD, Ghana and Tanzania 2017 school-based: 3.30–3.69 USD, health facility-based: 3.90–4.55 USD, combined community/health facility 4.55 USD). The 2015 school-based distribution (7.30 USD) and 2016 health facility-based distribution (6.52 USD) programmes in Tanzania were an exception. Mass distributions were more heavily financed by donors, while CD relied more extensively on domestic resource contributions.ConclusionsThese results suggest that CD strategies can continue to deliver nets at a comparable cost to mass distributions, especially from the perspective of the donor.

The effectiveness of older insecticide-treated bed nets (ITNs) to prevent malaria infection in an area of moderate pyrethroid resistance: results from a cohort study in Malawi

BackgroundA previous cohort study in Malawi showed that users of new insecticide-treated bed nets (ITNs) were significantly protected against malaria compared to non-users, despite moderate levels of pyrethroid resistance among the primary mosquito vectors. The present study investigated whether ITNs that were 1–2 years old continued to protect users in the same area with moderate pyrethroid resistance.MethodsOne year following a baseline cross-sectional malaria parasitaemia prevalence survey and universal distribution of deltamethrin ITNs (May 2012), a fixed cohort of 1223 children aged 6–59 months was enrolled (April 2013). Children were tested for parasitaemia at monthly scheduled visits and at unscheduled sick visits from May to December 2013 using rapid diagnostic tests. ITN use the prior night and the condition of ITNs (based on presence of holes) was assessed by caregiver self-report. The incidence rate ratio (RR) comparing malaria infection among users and non-users of ITNs was modelled using generalized estimating equations adjusting for potential confounders and accounting for repeated measures on each child. The protective efficacy (PE) of ITN use was calculated as 1 − RR.ResultsIn this cohort, self-reported ITN use remained consistently high (> 95%) over the study period. Although users of ITNs were slightly more protected compared to non-users of ITNs, the difference in incidence of infection was not statistically significant (RR 0.83, 95% confidence interval [CI] 0.54–1.27). Among ITN users, malaria incidence was significantly lower in users of ITNs with no holes (of any size) compared to users of ITNs with ≥ 1 hole (RR 0.82, 95% CI 0.69–0.98).ConclusionsThere was no significant PE of using 1–2 year-old ITNs on the incidence of malaria in children in an area of moderate pyrethroid resistance, but among ITN users, the authors found increased protection by ITNs with no holes compared to ITNs with holes. Given the moderate levels of pyrethroid resistance in the primary malaria vector and recent evidence of added benefits of ITNs with synergists or non-pyrethroid insecticides, next-generation ITNs may be a useful strategy to address pyrethroid resistance and should be further explored in Malawi.

The Effect of Antimalarial Campaigns on Child Mortality and Fertility in Sub-Saharan Africa

We examine the extent to which recent declines in child mortality and fertility in Sub-Saharan Africa can be attributed to insecticide-treated bed nets (ITNs). Exploiting the rapid increase in ITNs since the mid-2000s, we employ a difference-in-differences estimation strategy to identify the causal effect of ITNs on mortality and fertility. We show that the ITN distribution campaigns reduced all-cause child mortality, but surprisingly increased total fertility rates in the short run in spite of reduced desire for children and increased contraceptive use. We explain this paradox in two ways. First, we show evidence for an unexpected increase in fecundity and sexual activity due to the better health environment after the ITN distribution. Second, we show evidence that the effect on fertility is positive only temporarily – lasting only 1-3 years after the beginning of the ITN distribution programs – and then becomes negative. Taken together, these results suggest the ITN distribution campaigns may have caused fertility to increase unexpectedly and temporarily, or that these increases may just be a tempo effect -- changes in fertility timing which do not lead to increased completed fertility.

Why It Is Difficult to Eradicate Malaria in Sub-Sahara Africa

Abstract Malaria is a major public health problem in Sub-Sahara Africa (SSA). First-time pregnant mothers and children below the age of five are the most vulnerable. Governments of the region have relied on both local and international donor agencies to fight against malaria where emphasis has been on financial interventions, provision and distribution of insecticide-treated bed nets (ITNs), provision of rapid-test apparatus, and drugs for first line treatment. However, the impacts of local and global efforts have been minimally felt as the burden of malaria continues unabated. The rate of malaria infections is still apocalyptically alarming. This article argues that the reason why cases and deaths attributable to malaria continue to rise is because wrong approaches are used in the so-called broad fight against malaria. Based on the assumptions of the epidemiological triangle model, the web of causation and social determinants of health, the article argues that for countries in SSA to effectively fight malaria, the nexus between the agent, host, and environment must be acknowledged. It is constructively argued that efforts to tame the scourge of malaria in SSA would be in futility where the environmental factors that produce the breeding ground for malaria are not adequately addressed. European and American experiences are compared to sufficiently substantiate this line of argument.

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.

Efektivitas Program Kelambunisasi di Puskesmas Oesapa Kecamatan Kelapa Lima Kota Kupang

The program for routine insecticide-treated bed nets is one of the government's efforts to reduce malaria morbidity. The research objective was to describe the effectiveness of the routine insecticide-treated bednet distribution program in the context of reducing malaria morbidity in Oesapa Health Center, Kelapa Lima District, Kupang City in 2018. Descriptive survey research with a qualitative approach. Informants in this study amounted to 3 people and 65 families as observation samples. The research instrument uses interview guidelines. The results of the study show 1) Input; health workers and facilities were limited (cars and motorbikes), particularly in distributing the nets to pregnant women, infants, children under five, and children. 2) Process; The program was planned by The Health Office of Kupang City while implementation and evaluation was taken by health workers from Oesapa Health Center. Barriers were related to low accessibility in reaching the targeted house in need, inadequate number of health staff, and unavailability of special facility needed to distribute the nets 3) Output; A total of 188 nets was distributed to the target according to the program goal. Based on observations from 65 households that became the study sample, 63 households used and treated kalambu with insecticides until 2019. The distribution of insecticide-treated bed nets was considered ineffective. Health workers and facilities need to be provided adequately to distribute the nets and monitoring is necessary to guarantee the distribution reaching the target.

Exposing Anopheles mosquitoes to antimalarials blocks Plasmodium parasite transmission.

Every year the bites of Anopheles mosquitoes kill hundreds of thousands of people, mostly young African children, by transmitting deadly Plasmodium falciparum malaria parasites. Since the turn of the century, efforts to prevent transmission of these parasites via the mass distribution of insecticide-treated bed nets have been extremely successful, causing an unprecedented reduction in malaria deaths1. However, resistance to insecticides has become widespread in Anopheles populations2–4, threatening a global resurgence of the disease and making the generation of effective new malaria control tools an urgent public health priority. Here, we show that development of P. falciparum can be rapidly and completely blocked when Anopheles gambiae females uptake low concentrations of specific antimalarials from treated surfaces, simulating contact with a bed net. Mosquito exposure to atovaquone prior to or shortly after P. falciparum infection causes full parasite arrest in the female midgut, preventing transmission of infection. Similar transmission-blocking effects are achieved with other cytochrome B inhibitors, demonstrating that parasite mitochondrial function is a good target for parasite killing. Incorporating these effects into a model of malaria transmission dynamics predicts that the inclusion of Plasmodium inhibitors on mosquito nets would significantly mitigate the global health impact of insecticide resistance. This study identifies a powerful new strategy for blocking Plasmodium transmission by Anopheles females, with promising implications for malaria eradication efforts.

Robust optimization of the insecticide-treated bed nets procurement and distribution planning under uncertainty for malaria prevention and control

Vector control, particularly distribution of insecticide-treated bed nets (ITNs), constitutes one of the major pathways to prevent and reduce malaria transmission. ITN distribution campaigns face several challenges, such as inadequate funding, budgetary constraints, hard-to-reach areas, limited transportation, and market and price volatility. While long-term agreements and proper planning can effectively overcome such challenges, those options may not be available for all humanitarian organizations and governments. To gain a better understanding of such tradeoffs we develop a robust optimization model that minimize ITN distribution costs while taking into consideration protection against financial, market and logistical uncertainties. The simultaneous account of such uncertainties is rarely seen on the humanitarian supply chain design literature. The proposed robust model explores data-driven adaptive uncertainty sets that capture the dependence structure among procurement and distribution costs, leading to plausible uncertain scenarios. In addition, we develop a hierarchical optimization approach to ease the burden of setting a specific robustness level for each constraint, when uncertainties are related to the independent terms. We study a United Nations Children’s Fund ITN distribution campaign in Ivory Coast, observing that (1) total costs increase with campaign robustness, as expected, and (2) campaign robustness comprises of improved supply chain flexibility, which might minimize efforts if it becomes necessary to adjust procurement and transportation plans when uncertainty arises. In addition, assessing robust solutions through Monte Carlo simulations against several realizations of uncertain parameter values indicates that, as desired, robust plan feasibility increases with the specified level of conservatism.