Use Of Insecticide-treated Bed Nets Research Articles

Malaria-related knowledge and prevention practices in four neighbourhoods in and around Mumbai, India: a cross-sectional study.

BackgroundIndia accounts for the highest number of malaria cases outside of Africa. Eighty per cent of India’s population lives in malaria-risk areas, with cases increasing in urban areas. Mumbai, India, one of the most populous cities in the world, has experienced such an increase. To be successful, many malaria control efforts require community participation, which in turn depends on individuals’ knowledge and awareness of the disease. This study assessed the knowledge and prevention practices regarding malaria in residents of four different areas of Mumbai, India, around the time of a malaria outbreak and the start of a widespread awareness campaign.MethodsA cross-sectional comparative study assessed malaria-related knowledge and prevention practices in four geographically and socio-demographically distinct areas of Mumbai, India. A structured interviewer-administered questionnaire was administered to a stratified random sample of 119 households between 16 December 2010 and 30 January 2011. Participant socio-demographic characteristics, malaria knowledge, malaria prevention practices, and household environmental factors were examined overall and compared across the four areas of Mumbai.ResultsOverall, respondents had excellent knowledge of the mosquito as the means of transmission of malaria, mosquito biting times and breeding sites, and fever as a symptom of malaria. However, many respondents also held misconceptions about malaria transmission and symptoms. Respondents generally knew that bed nets are an effective prevention strategy, but only 30% used them, and only 4% used insecticide-treated bed nets. Knowledge and prevention practices varied across the four areas of Mumbai.ConclusionsAlthough most residents know that bed nets are effective in preventing malaria, usage of bed nets is very low, and almost no residents use insecticide-treated bed nets. As the four areas of Mumbai differed in knowledge, prevention practices, and primary sources of information, malaria control campaigns should be tailored according to the knowledge gaps, practices, environments, resources, and preferences in different areas of the city, using the interpersonal and media channels most likely to reach the target audiences. Malaria control efforts involving bed nets should emphasize use of insecticide-treated bed nets.

Persistent oscillations and backward bifurcation in a malaria model with varying human and mosquito populations: implications for control.

We derive and study a deterministic compartmental model for malaria transmission with varying human and mosquito populations. Our model considers disease-related deaths, asymptomatic immune humans who are also infectious, as well as mosquito demography, reproduction and feeding habits. Analysis of the model reveals the existence of a backward bifurcation and persistent limit cycles whose period and size is determined by two threshold parameters: the vectorial basic reproduction number Rm, and the disease basic reproduction number R0, whose size can be reduced by reducing Rm. We conclude that malaria dynamics are indeed oscillatory when the methodology of explicitly incorporating the mosquito's demography, feeding and reproductive patterns is considered in modeling the mosquito population dynamics. A sensitivity analysis reveals important control parameters that can affect the magnitudes of Rm and R0, threshold quantities to be taken into consideration when designing control strategies. Both Rm and the intrinsic period of oscillation are shown to be highly sensitive to the mosquito's birth constant λm and the mosquito's feeding success probability pw. Control of λm can be achieved by spraying, eliminating breeding sites or moving them away from human habitats, while pw can be controlled via the use of mosquito repellant and insecticide-treated bed-nets. The disease threshold parameter R0 is shown to be highly sensitive to pw, and the intrinsic period of oscillation is also sensitive to the rate at which reproducing mosquitoes return to breeding sites. A global sensitivity and uncertainty analysis reveals that the ability of the mosquito to reproduce and uncertainties in the estimations of the rates at which exposed humans become infectious and infectious humans recover from malaria are critical in generating uncertainties in the disease classes.

A Bayesian multinomial modeling of spatial pattern of co-morbidity of malaria and non-malarial febrile illness among young children in Nigeria.

Children in developing countries continue to suffer mortality and morbidity from a number of illnesses, among which are malaria and non-malarial febrile illnesses, which epidemiologically overlap. We examined the spatial pattern and risk factors of co-morbidity of malaria and non-malarial febrile illness among children aged 6-59 months in Nigeria. Using data from the 2010 Nigeria Malaria Indicator Survey, we considered the co-morbidity of malaria and non-malarial febrile illness among the children as multicategorical and selected a mixed multinomial logit model capable of incorporating covariates of different types. Inference was Bayesian, based on multicategorical linear mixed-model representation. We found that the risk of co-morbidity of malaria and non-malarial febrile illness increases as a child advances in age while the risk of non-malarial fever reduces after about 32 months of age. Area of residence (urban or rural), wealth index and type of roofing material used in the dwelling are other important risk factors for the co-morbidity found in this study. Further, children from four of Nigeria's 37 states are at high risk of malaria. Disease preventive measures need to be intensified, with more focus on rural areas and the poor. Campaigns for use of insecticide-treated bed nets need be more aggressive in all Nigerian states.

Long-lasting insecticide-treated bed net ownership and use among children under five years of age following a targeted distribution in central Uganda.

BackgroundUniversal coverage of long-lasting insecticide-treated bed nets (LLINs) for prevention of malaria was adopted by the Uganda National Malaria Control Programme in 2007. The first mass distribution of LLINs was implemented in 2010. Initially, a campaign targeted to households with pregnant women and children aged <five years was carried out, prior to a planned fill-in campaign to achieve universal LLIN coverage. This survey was conducted after the targeted distribution in central Uganda to assess progress in LLIN ownership and usage among children <five years.MethodsA two-stage, cluster-sample, cross-sectional household survey was carried out in early 2011 in Central region districts surveyed during the 2009 Malaria Indicator Survey (MIS). In the first sampling stage, 30 enumeration areas (EAs) were selected and all households were enumerated. Within each sampled EA, 20 households were randomly selected for interview using two questionnaires: a household questionnaire and a woman’s questionnaire for all women aged 15-49 years, both modified from the MIS.ResultsWhen compared to 2009 MIS results, household ownership of at least one LLIN increased by 47%, from 22 to 69% after the targeted campaign. LLIN use among children <five years increased by 40%, from 11 to 51%. Households with a child <six years old at the time of the survey, a proxy for those targeted, were significantly more likely to have received a campaign bed net (80.7 vs 35.2%, p < 0.001). LLIN ownership and use was equitable after the targeted campaign, with no significant differences by household wealth status.However, the proportion of households with at least one LLIN per two people was still low after the first campaign phase, increasing from 8.5 to 25.9%.ConclusionsThe first phase of the campaign led to substantial increases in both LLIN ownership and equitable use among children <five years in the Central region. However, access to an LLIN within the household was still low after the first phase of the campaign, indicating the need for the universal fill-in campaign.

The Effect of Mass Media Campaign on the Use of Insecticide-Treated Bed Nets among Pregnant Women in Nigeria.

Background. Malaria during pregnancy is a major public health problem in Nigeria especially in malaria-endemic areas. It increases the risk of low birth weight and child/maternal morbidity/mortality. This paper addresses the impact of radio campaigns on the use of insecticide-treated bed nets among pregnant women in Nigeria. Methods. A total of 2,348 pregnant women were interviewed during the survey across 21 of Nigeria's 36 states. Respondents were selected through a multistage sampling technique. Analysis was based on multivariate logistic regression. Results. Respondents who knew that sleeping under ITN prevents malaria were 3.2 times more likely to sleep under net (OR: 3.15; 95% CI: 2.28 to 4.33; P < 0.0001). Those who listened to radio are also about 1.6 times more likely to use ITN (OR: 1.56; 95% CI: 1.07 to 2.28; P = 0.020), while respondents who had heard of a specific sponsored radio campaign on ITN are 1.53 times more likely to use a bed net (P = 0.019). Conclusion. Pregnant women who listened to mass media campaigns were more likely to adopt strategies to protect themselves from malaria. Therefore, behavior change communication messages that are aimed at promoting net use and antenatal attendance are necessary in combating malaria.

“People will say that I am proud”: a qualitative study of barriers to bed net use away from home in four Ugandan districts

BackgroundDespite increased access and ownership, barriers to insecticide-treated bed net (ITN) use persist. While barriers within the home have been well documented, the challenges to net use when sleeping away from home remain relatively unexplored. This study examines common situations in which people sleep away from home and the barriers to ITN use in those situations.MethodsTo explore these issues, a group of researchers conducted 28 in-depth interviews and four focus groups amongst adults from net-owning households in four Ugandan districts.ResultsIn addition to sleeping outside during hot season, participants identified social events, livelihood activities, and times of difficulty as circumstances in which large numbers of people sleep away from home. Associated challenges to ITN use included social barriers such as fear of appearing proud, logistical barriers such as not having a place to hang a net, and resource limitations such as not having an extra net with which to travel. Social disapproval emerged as an important barrier to ITN use in public settings.ConclusionsUnique barriers to ITN use exist when people spend the night away from home. It is essential to identify and address these barriers in order to reduce malaria exposure in such situations. For events like funerals or religious “crusades” where large numbers of people sleep away from home, alternative approaches, such as spatial repellents may be more appropriate than ITNs. Additional research is required to identify the acceptability and feasibility of alternative prevention strategies in situations where ITNs are unlikely to be effective.

Analysis of the Cost of Malaria in Children and Use of Insecticide-treated Bednets in Africa

We examine the direct and indirect costs of malaria in children under five years and the benefit of investing in long lasting insecticide treated mosquito nets as a preventative policy strategy in 18 African countries. The results indicate that the use of mosquito treated nets can induce a 6.2 percent reduction in outpatient costs, a 6.6 percent reduction in inpatient treatment costs, a 6.3 percent reduction in productivity losses, and a 22.6 percent reduction in disability adjusted life years (DALY), all on an annual basis.

Push by a net, pull by a cow: can zooprophylaxis enhance the impact of insecticide treated bed nets on malaria control?

BackgroundMass insecticide treated bed net (ITN) deployment, and its associated coverage of populations at risk, had “pushed” a decline in malaria transmission. However, it is unknown whether malaria control is being enhanced by zooprophylaxis, i.e., mosquitoes diverted to feed on hosts different from humans, a phenomenon that could further reduce malaria entomological transmission risk in areas where livestock herding is common.MethodsBetween May and July 2009, we collected mosquitoes in 104 houses from three neighboring villages with high ITN coverage (over 80%), along Lake Victoria. We also performed a census of livestock in the area and georeferenced tethering points for all herds, as well as, mosquito larval habitats. Bloodmeal contents from sampled mosquitoes were analyzed, and each mosquito was individually tested for malaria sporozoite infections. We then evaluated the association of human density, ITN use, livestock abundance and larval habitats with mosquito abundance, bloodfeeding on humans and malaria sporozoite rate using generalized linear mixed effects models.ResultsWe collected a total of 8123 mosquitoes, of which 1664 were Anopheles spp. malaria vectors over 295 household spray catches. We found that vector household abundance was mainly driven by the number of householders (P < 0.05), goats/sheep tethered around the house (P < 0.05) and ITNs, which halved mosquito abundance (P < 0.05). In general, similar patterns were observed for Anopheles arabiensis, but not An. gambiae s.s. and An. funestus s.s., whose density did not increase with the presence of livestock animals. Feeding on humans significantly increased in all species with the number of householders (P < 0.05), and only significantly decreased for An. arabiensis in the presence of cattle (P < 0.05). Only 26 Anopheles spp. vectors had malaria sporozoites with the sporozoite rate significantly decreasing as the proportion of cattle feeding mosquitoes increased (P < 0.05).ConclusionOur data suggest that cattle, in settings with large ITN coverage, have the potential to drive an unexpected “push-pull” malaria control system, where An. arabiensis mosquitoes “pushed” out of human contact by ITNs are likely being further “pulled” by cattle.

Reemergence of Anopheles funestus as a Vector of Plasmodium falciparum in Western Kenya after Long-Term Implementation of Insecticide-Treated Bed Nets

Historically, the malaria vectors in western Kenya have been Anopheles funestus, Anopheles gambiae s.s., and Anopheles arabiensis. Of these species, An. funestus populations declined the most after the introduction of insecticide-treated bed nets (ITNs) in the 1990s in Asembo, and collections of An. funestus in the region remained low until at least 2008. Contrary to findings during the early years of ITN use in Asembo, the majority of the Anopheles collected here in 2010 and 2011 were An. funestus. Female An. funestus had characteristically high Plasmodium falciparum sporozoite rates and showed nearly 100% anthropophily. Female An. funestus were found more often indoors than outdoors and had relatively low mortality rates during insecticide bioassays. Together, these results are of serious concern for public health in the region, indicating that An. funestus may once again be contributing significantly to the transmission of malaria in this region despite the widespread use of ITNs/long-lasting insecticidal nets (LLINs).

Possession, Attitudes and Perceptions of Insecticide-treated Bed Nets among Pregnant Women in a Post Conflict District in Northern Uganda

Background: The use of insecticide-treated bed nets (ITNs) is one of the main strategies to control malaria in Uganda. The Uganda’s Ministry of Health had set a target of 50% of households to be covered with ITNs by the year 2007. This study aims at determining ITN possession, attitudes and perceptions among pregnant women who were living in internally displaced persons’ (IDP) Camps where buildings offered little or no protection against mosquitoes in Gulu district. Methods: A cross sectional study was conducted in 20 randomly selected IDP camps in Aswa and Omoro counties, Gulu district, Northern Uganda. Probability proportion to size cluster sampling technique was used to determine the numbers of expectant mothers in the selected camps. Consecutive sampling method was used by moving to the next nearest household until the required numbers of respondents were generated from each camp. Data was collected using well designed pretested questionnaires. The questionnaires were administered by trained research assistants who were fluent in the local language (Acholi). Results: ITN possession: 42% of respondents (95% CI 0.39 – 0.46) possessed ITN. 98% of the respondents reported that it was good to use ITN. 97% of the respondents perceive ITN as being effective at preventing mosquitoes bites which transmit malaria. 96% of the respondents who owned ITN were willing to continue using ITNs. Factors associated with ITN possession were; Having attended antenatal services (aOR 1.92, 95% CI 1.24 – 2.98, P-value 0.004); Having attained formal education (aOR 1.55, 95% CI 1.03 - 2.35, P-value 0.036); Willingness to buy ITN (aOR 1.98, 95% CI 1.22–3.21, P-value 0.006) and Willingness to recommend ITN use to others (aOR 3.77, 95% CI 1.12 – 12.77, P-value 0.033). Conclusion: Majority of the respondents had positive attitudes and perceptions towards ITN use. However, more than half of the respondents lacked ITN which was below the target set by Uganda Ministry of Health. Therefore government and other stakeholders should scale up free ITN distributions among the vulnerable groups if the Ministry of Health and the Roll Back Malaria Global Partnership Target is to be achieved.

A simple agent-based model of malaria transmission investigating intervention methods and acquired immunity

Malaria, an infectious disease prevalent in sub-Saharan Africa, is transmitted to humans through mosquito bites, and ordinary differential equation models have often been used to describe the spread of the disease. A basic agent-based model (ABM) of malaria transmission is established and compared to an ODE model of the disease in order to ascertain the similarity of the ABM to typical modeling approaches. Additionally, the ABM is described using protocol from current literature. In order to illustrate the flexibility of the ABM, the basic ABM is modified to incorporate the use of insecticide-treated bed nets (ITNs) and the effect of acquired immunity. The simulations incorporating acquired immunity and the use of ITNs show a decrease in the prevalence of the disease due to these factors. Additionally, the ABM can easily be modified to account for other complicated issues affecting malaria spread.

Falciparum malaria as an emerging cause of fever in adults living in Gabon, Central Africa.

Following the observed increase of malaria prevalence among older children in Gabon, a descriptive observational study was carried out in 2012 to determine the prevalence of malaria in adults presenting with fever in two health centres of Libreville, the capital city of Gabon. Thick- and thin-blood smears for malaria diagnosis were performed in febrile individuals aged more than 15 years old. Age, use of bed nets, previous antimalarial drug treatment, clinical symptoms, chest radiography results, and available haemoglobin data were also recorded. Among the 304 patients screened, the global malaria frequency was of 42.1% (n = 128/34). Plasmodium (P). falciparum was the only species identified. The proportion of patients with a clinical malaria requiring parenteral treatment was 38.5%, whereas 47.5% of outpatients had uncomplicated malaria. According to WHO classification, 14 (19.7%) infected patients had severe malaria; neurological and respiratory symptoms tended to be more frequent in case of P. falciparum infection. Anaemia was found in 51.5% adults and none had severe anaemia. Almost half of adults consulting for fever in two health centres of the urban city of Libreville have malaria. The use of insecticide-treated bed nets, the screening, and the treatment of individuals with P. falciparum microscopic and submicroscopic asymptomatic infection or clinical malaria should be emphasized to reduce the transmission.

Biting patterns and seasonality of Anopheles gambiae sensu lato and Anopheles funestus mosquitoes in Kamuli District, Uganda.

BackgroundWe investigated the biting patterns and seasonal abundances of Anopheles gambiae s.l. and An. funestus mosquitoes in Kamuli District, Uganda.MethodsHourly indoor and outdoor catches of human biting mosquitoes were sampled from 19.00 to 07.00 hours for four consecutive nights each month using bed net traps in forty-eight houses randomly selected from Bugabula county where insecticide-treated bed nets (ITNs) had been used for at least five years and Budiope county where ITNs had not been used. The indoor and outdoor human-biting fractions, time of biting of the anophelines and climatic data were recorded from January to December 2010. Data were analysed using Multi-way analysis of variance, Kruskal-wallis rank sum test and Pearson correlation. The number of mosquitoes caught biting humans and resting indoors, the indoor and outdoor human biting densities and biting rates during different hours of the night, and mosquito abundances for a twelve-month sampling period in both zones are reported.ResultsApproximately four times more Anopheles mosquitoes were caught biting humans in Budiope County than in the Bugabula zone, with An. gambiae s. l. catches exceeding those of An. funestus. In both zones, peak night biting occurred between 23.00 and 05.00 hours. The majority of bites occurred between 03.00 and 06.00 hours for both Anopheles gambiae s. l. and funestus group. Outdoor biting densities of Anopheles gambiae s. l. exceeded the indoor biting densities throughout the night in both zones, while the indoor and outdoor human biting densities of An. funestus group were apparently equal. The outdoor and indoor human biting rates were similar in both zones. In Bugabula county, the abundance of An. gambiae s.l. was rainfall-dependent, while the An. funestus group could thrive with or without rain fall. In Budiope county, both An. gambiae s.l. and An. funestus mosquitoes thrived all year round regardless of the amount of rainfall.ConclusionConsidering the biting patterns, and seasonal abundances exhibited by Anopheles gambiae s.l. and An. funestus mosquitoes in Kamuli district, intensive use of ITNs combined with indoor residual spraying, environmental management and improved house designs in the context of integrated vector management may be the appropriate vector control strategy.

INFRAVEC: research capacity for the implementation of genetic control of mosquitoes

Mosquitoes represent a major and global cause of human suffering due to the diseases they transmit. These include parasitic diseases, i.e. malaria and filariasis, and viral infections such as dengue, encephalitis, and yellow fever. The threat of mosquito-borne diseases is not limited to tropical and subtropical regions of the world. Trade and climate changes have opened new niches to tropical vectors in temperate areas of the world, thus putting previously unaffected regions at risk of disease transmission. The most notable example is the spread of Aedes species, particularly the Asian tiger mosquito Aedes albopictus to southern Europe (reviewed in Ref. 1). Endogenous cases of vector-borne diseases including West Nile fever, chikungunya, and dengue are frequently being reported, highlighting the increased risk of tropical diseases for the European population. Typically, vector control measures targetting mosquitoes are in most cases carried with the use of insecticides. This approach has a number of limitations that constrain their effectiveness. Lack of resources, inadequate logistics, and the insurgence of insecticide resistance are some of the problems encountered in disease-endemic countries (DECs). More recently in Africa, the widespread use of insecticide-treated bed nets has caused a dramatic reduction in malaria mortality and morbidity. Bed nets however are a temporary solution, a testimony of the failure to implement area-wide control measures aimed at eradicating malaria. US and Europe, with well-developed economies, have also failed to control the spread of mosquito vectors, particularly Aedes species. This alarming situation clearly speaks for the need to expand the knowledge on mosquito vectors and for the urgency of developing and validating novel biological and genetic control measures that overcome the limitations of current insecticide-based approaches. During the last 10 years, significant advances have been made in understanding the biology, the genetics, and the ecology of Anopheles and Aedes mosquitoes paralleled by the development of new molecular tools for investigating gene function and mosquito ability to transmit parasite and viral diseases. They offer a compelling opportunity to design and validate new genetic vector control measures. The size and the complexity of this undertaking require a high level of capacity, effort, and technological platforms. No laboratory--or even institution--has the resources, the infrastructure capacity, and the expertise to accomplish this task alone. INFRAVEC addresses the need of the scientific community to share facilities and integrate cutting-edge knowledge and technologies that are not readily accessible but nevertheless critical to exploit genetic and genomic information in the effort to control mosquito-borne diseases. Its objective is to provide laboratories that currently operate individually with limited coordination and little sharing of technologies, with the collective research capacity of the laboratories forming the core project infrastructure. INFRAVEC has provided resources to 31 institutions from European and African countries to enhance collaborative links, to execute joint research activity, and most importantly to enable individual researchers (from PhD students to established academics) to carry complex experimental activities by assigning research packages or ‘infrastructure access’ to be executed in the laboratory facilities and infrastructures of INFRAVEC. I report here on the overall activities of INFRAVEC and its impact on the scientific community with the purpose to initiate a dialogue with all stakeholders on its future evolution.

Comparison of the Laboratory Standard Washing Using CIPAC Washing Agent and the Domestic Washing on Three Recommended Types of Long-Lasting Insecticidal Mosquito Nets

BackgroundOne of the best ways to prevent malaria is the use of insecticide-treated bed nets. Manufacturers pursue easier, safer and more efficient nets. Hence, many studies on the efficacy and wash resistance using World Health Organization standards have been reported. The commonly used detergent is “Savon de Marseille”, because it closely resembles actually used soaps. At the 54th Collaborative International Pesticides Analytical Council (CIPAC) Technical Meeting in 2010, it was suggested to replace it by a standardized “CIPAC washing agent”. The aim of this study was to investigate the difference between a laboratory hand washing simulation using the CIPAC washing agent (method-1) and a domestic washing (method-2) on different bed nets, as well as the effect of the drying process on the release of active ingredient.MethodsInterceptor®, Permanet®2.0 and Netprotect® nets were used in three treatments, each repeated 20 times. The first treatment included method-1 washing and indoor drying. The second treatment included method-2 washing and indoor drying. The third treatment used method-2 washing and UV-drying. The residual insecticide contents were determined using gas chromatography.ResultsThe washing procedure and the number of washes have a significant effect on the release of active ingredient. Statistically, the two washing methods have the same effect on removing the active ingredient from the Interceptor® and Permanet®2.0 net, but a significantly different influence on the Netprotect® nets. The drying process has no significant effect on the insecticide.ConclusionBoth washing procedures affected the amount of insecticide remaining on nets independently of the impregnation technology. The active ingredient decreases with the number of washing cycles following an exponential or logarithmic model for coated nets. The laboratory hand washing simulation had more impact on the decrease of active ingredient content of the Netprotect® nets. All net types seemed to be effectively protected against UV-light.

Level of awareness and use of insecticide treated bed nets among pregnant women attending antenatal clinics in Anambra State, South Eastern Nigeria

This was a cross sectional study designed to assess the level of awareness, ownership and use of insecticide treated bed nets (ITNs) by pregnant women attending antenatal clinics in Anambra state, South Eastern Nigeria. A structured questionnaire was self administered to 700 volunteer pregnant women aged 17 to 45 years recruited during routine antenatal care in selected hospitals in the study area to capture information on use of ITNs. The information obtained was analyzed using simple ratios, percentages and charts. The result showed that 651 (93%) of the women were fully aware of the use of ITNs during pregnancy, 420 (60%) owned ITNs in their homes while only 308 (46%) used the nets partially or wholly, and 392 (56%) never used the nets. The level of awareness of pregnant women concerning the use of ITNs was high while actual ownership and use was low. Public health education needs to be intensified to create more awareness and increase ownership and use. Key words: Insecticide treated nets, pregnant women, Anambra State, South Eastern Nigeria.

Integrated approach to malaria prevention at household level in rural communities in Uganda: experiences from a pilot project

BackgroundMalaria is a major public health challenge in sub-Saharan Africa. In Uganda, malaria is the leading cause of morbidity and mortality especially among children under five years of age. This pilot project promoted prevention of malaria at household level using an integrated approach in two rural communities in Wakiso District, Uganda. This involved advocating and implementing several strategies in a holistic manner geared towards reduction in the occurrence of malaria. The specific strategies involved can be classified as: 1) personal protection – use of insecticide-treated bed nets and insecticide sprays; 2) reducing mosquito breeding sites – draining pools of water, larviciding and clearing unnecessary vegetation around homes; and 3) reducing entry of mosquitoes into houses – installing mosquito proofing in windows, ventilators and open eaves, and closing windows and doors early in the evenings.Case descriptionThe objectives of the project were to: carry out a baseline survey on malaria prevention; train community health workers and increase awareness among the community on the integrated approach to malaria prevention; and, establish demonstration sites using the integrated approach. A baseline survey among 376 households was conducted which generated information on the knowledge, attitudes and practices of the community in relation to malaria prevention. The project trained 25 community health workers and over 200 community members were sensitized on the integrated approach to malaria prevention. In addition, 40 demonstration households using the integrated approach were established.Discussion and evaluationThe use of multiple methods in the prevention of malaria was appreciated by the community particularly the demonstration households using the integrated approach. Initial project evaluation showed that the community had become more knowledgeable about the various malaria prevention methods that were advocated in the integrated approach. In addition, some of the methods that were not being used before project implementation, such as early closing of windows, had been adopted. The presence of mosquitoes in the demonstration households had also reduced.ConclusionThe integrated approach to malaria prevention at household level was well perceived by the project community, which could be scaled up to other areas. More rigorous studies such as randomized controlled trials are also recommended to further explore the public health impact of the integrated approach to malaria prevention.

Sleeping under insecticide-treated nets to prevent malaria in Nigeria: what do we know?

Malaria remains a public-health concern in Nigeria despite huge global investments in the production and distribution of insecticide-treated bednets (ITNs) to protect people from Plasmodium falciparum parasite. Information on the use of ITNs is needed for designing strategies for its effective use. Focus group discussions (FGDs) were conducted in communities from 3 geopolitical zones of Nigeria. The people had poor knowledge of malaria and mosquito bites, which resulted in wrong perception and misuse of the nets as door and window blinds to "protect entire household" since only two nets were given per household. The use of community structures (traditional leaders/village heads, youths, churches, and mosques) was suggested to ensure effective distribution of nets, sensitize, and monitor net-use in the communities. Health education would dispel misconceptions that ITNs could kill, curtail human fertility, and that local gin (Kai-Kai) would induce sleep and make one oblivious of mosquito nuisance.

Effect of malaria transmission reduction by insecticide-treated bed nets (ITNs) on the genetic diversity of Plasmodium falciparum merozoite surface protein (MSP-1) and circumsporozoite (CSP) in western Kenya

BackgroundAlthough several studies have investigated the impact of reduced malaria transmission due to insecticide-treated bed nets (ITNs) on the patterns of morbidity and mortality, there is limited information on their effect on parasite diversity.MethodsSequencing was used to investigate the effect of ITNs on polymorphisms in two genes encoding leading Plasmodium falciparum vaccine candidate antigens, the 19 kilodalton blood stage merozoite surface protein-1 (MSP-119kDa) and the Th2R and Th3R T-cell epitopes of the pre-erythrocytic stage circumsporozoite protein (CSP) in a large community-based ITN trial site in western Kenya. The number and frequency of haplotypes as well as nucleotide and haplotype diversity were compared among parasites obtained from children <5 years old prior to the introduction of ITNs (1996) and after 5 years of high coverage ITN use (2001).ResultsA total of 12 MSP-119kDa haplotypes were detected in 1996 and 2001. The Q-KSNG-L and E-KSNG-L haplotypes corresponding to the FVO and FUP strains of P. falciparum were the most prevalent (range 32–37%), with an overall haplotype diversity of > 0.7. No MSP-119kDa 3D7 sequence-types were detected in 1996 and the frequency was less than 4% in 2001. The CSP Th2R and Th3R domains were highly polymorphic with a total of 26 and 14 haplotypes, respectively detected in 1996 and 34 and 13 haplotypes in 2001, with an overall haplotype diversity of > 0.9 and 0.75 respectively. The frequency of the most predominant Th2R and Th3R haplotypes was 14 and 36%, respectively. The frequency of Th2R and Th3R haplotypes corresponding to the 3D7 parasite strain was less than 4% at both time points. There was no significant difference in nucleotide and haplotype diversity in parasite isolates collected at both time points.ConclusionHigh diversity in these two genes has been maintained overtime despite marked reductions in malaria transmission due to ITNs use. The frequency of 3D7 sequence-types was very low in this area. These findings provide information that could be useful in the design of future malaria vaccines for deployment in endemic areas with high ITN coverage and in interpretation of efficacy data for malaria vaccines based on 3D7 parasite strains.

Antenatal Care Attendance, a Surrogate for Pregnancy Outcome? The Case of Kumasi, Ghana

Antenatal care (ANC) has been shown to influence infant and maternal outcomes. WHO recommends 4 ANC visits for uncomplicated pregnancies. However, pregnant women in Ghana are required to attend 8-13 antenatal visits. We investigated the association of ANC attendance with adverse pregnancy outcomes (defined as low infant birth weight, stillbirth, preterm delivery or small for gestational age). A quantitative cross-sectional study was conducted on 629 women, age 19-48 years who presented for delivery at two selected public hospitals and 16 traditional birth attendants from July to November 2011. Socio-demographic and antenatal information were collected using a structured questionnaire. ANC attendance, medical and obstetric/gynecological history were abstracted from maternal antenatal records. Data were analyzed using Chi square and logistic regression. Twenty-two percent of the women experienced an adverse outcome. Eleven percent of the women attended <4 ANC visits. In an unadjusted model, these women had an increased likelihood of experiencing an adverse outcome (OR 2.27; 95% CI 1.30-3.94; p = 0.0038). High parity (>5 children) was also associated with adverse birth outcomes. Women screened for syphilis or use of insecticide-treated bed nets had a 40 and 36% (p = 0.0447 and p = 0.0293) reduced likelihood of experiencing an adverse pregnancy outcome respectively. After adjusting for confounders, attending <4 antenatal visits was associated with adverse pregnancy outcome compared with ≥4 ANC visits (Adjusted OR 2.55; 95% CI 1.16-5.63; p = 0.0202). Attending <4 antenatal visits and high parity were associated with adverse pregnancy outcomes for uncomplicated pregnancies.