Use Of Insecticide-treated Bed Nets Research Articles

Comparative Study on Malaria Preventive Practices among Under-Five Children in Three States in South-South Nigeria

Background: Malaria has remained one of the leading causes of morbidity and mortality in children despite effective preventive and treatment modalities. This study is aimed at looking at the malaria preventive practices among under-five children in three Niger Delta states in Nigeria and comparing the differences among them if any. Methods: This was a cross sectional study carried out over six months from 1st January to 30th June 2019 in public health facilities among under-five children in three South-South states (Akwa Ibom, Delta and Rivers) of Nigeria. Using a stratified sampling method, children were recruited from 36 health facilities in the three states. A pretested interviewer administered questionnaire was used to harvest relevant information on socio-demographic characteristics of the subjects and informants and malaria preventive practices. Obtained data was analysed using SPSS version 22 and results are presented in prose and frequency tables. Chi-square and Fischer’s exact were used for comparison of categorical variables, while a p-value of ± 1.06 years. Mothers constituted over 80% of the informants in all the states. More of the informants had secondary education in Akwa Ibom and Delta states, while in Rivers state, more of them had tertiary education. Malaria prevention method practiced in the three states included; use of insecticide treated bed net (ITNs), insecticide spray, anti-malarial drugs, clearing of bushes and disposal of mosquito breeding cans and use of mosquito repellents. Indoor residual spraying (IRS) was not practiced in any of the states. Use of ITN was practiced more in Rivers state (53.2%) than in Delta (20.3%) and Akwa Ibom (8.2%) states, while use of insecticide spray was commoner in Akwa Ibom state (77.2%) than in Delta (56.3%) and Rivers (42.4%). This difference in the prevention techniques practiced among the states was statistically significant (Fischers exact −724.2, p-value = 0.0001). Conclusion: In conclusion, the practice of ITNs use is low in South-South Nigeria with IRS not being practiced at all. Introduction of IRS as a method of malaria vector control and public health education on ITNs ownership and use is advocated.

Trends in malaria prevalence and health related socioeconomic inequality in rural western Kenya: results from repeated household malaria cross-sectional surveys from 2006 to 2013

ObjectiveThe objective of this analysis was to examine trends in malaria parasite prevalence and related socioeconomic inequalities in malaria indicators from 2006 to 2013 during a period of intensification of...

Malaria Preventive Practices among Under-five Children in Rivers State, Nigeria

Background: Malaria is a life threatening protozoan infection and children under 5 years are one of the most vulnerable group. Good malaria preventive practices among these group is key to reducing malaria burden and its associated mortality.
 Objective: The aim of the study was to assess malaria preventive practices among under-five children in Rivers State, Nigeria.
 Materials and Methods: This was a cross sectional study carried out in public and private health facilities in Rivers state. Ethical approval for the study was obtained from the Research and Ethics committee of the University of Port Harcourt Teaching Hospital, while an informed written consent was obtained from the parents or caregivers of the participants. Stratified sampling method was used to select the health facilities and the subjects for the study. A pretested interviewer administered questionnaire was used to harvest relevant information on socio demographic characteristics of the subjects and informants and malaria preventive practices. Obtained data was analysed using SPSS version 22 and results are presented in prose and tables.
 Results: A total of 1138 children participated in the study constituting of 613 (53.9%) male and 525(46.1%) female giving a male: female ratio of 1.2:1. Mean age of participants was 1.74±1.08 years. Mothers, accounted for majority 1012 (88.9%) of the informants. Most of the informants had tertiary degree; 605 (53.4%) and 697 (61.8%) among mothers and fathers respectively. Among the occupations of fathers, public servants, civil servants and the self-employed were more represented, constituting 242 (21.4%), 200 (17.7%) and 149 (13.2%) respectively. Traders/ business women, the self-employed and civil servants were most represented among the occupations of mothers in the study and these accounted for 444 (39.7%), 181 (16.2%) and 137 (12.3%) respectively. Malaria preventive practices included use of Insecticide-treated bed nets (ITNs), Indoor spraying of insecticide (modified IRS), use of antimalarial drugs, clearing of bushes/ disposal of containers where mosquitoes breed and use of mosquito repellent creams which constituted 605 (53.2%), 483 (42.4%), 133 (11.7%), 4 (0.4%) and 2 (0.2%) respectively; there were 512 (45.0%) children who slept under ITNs the previous night. Also, 970 (85.2%) had window nets installed in their homes. Protective window nets was also in place in the homes of 970 (85.2%) of the study participants. Among families that practiced use of ITNs, 110 (61.8%) were from the middle social class and 62 (34.8%) were from the upper social class, while 316 (52.2%) and 276 (45.6%) were from the upper and middle social class respectively among those that practised Indoor spraying of insecticide (IRS). 
 Conclusion: Use of ITNs, modified IRS and use of anti malarials were the common malaria preventive practices among under-fives in Rivers state and these methods were more practiced among the middle and upper social class. Education on the integrated approach to malaria prevention which advocates the use of several malaria prevention methods in a holistic manner should be intensified.

Epidemiological risk factors for clinical malaria infection in the highlands of Western Kenya

BackgroundUnderstanding the complex heterogeneity of risk factors that can contribute to an increased risk of malaria at the individual and household level will enable more effective use of control measures. The objective of this study was to understand individual and household factors that influence clinical malaria infection among individuals in the highlands of Western Kenya.MethodsThis was a matched case–control study undertaken in the Western Kenya highlands. Clinical malaria cases were recruited from health facilities and matched to asymptomatic individuals from the community who served as controls. Each participant was screened for malaria using microscopy. Follow-up surveys were conducted with individual households to collect socio-economic data. The houses were also checked using pyrethrum spray catches to collect mosquitoes.ResultsA total of 302 malaria cases were matched to 604 controls during the surveillance period. Mosquito densities were similar in the houses of both groups. A greater percentage of people in the control group (64.6%) used insecticide-treated bed nets (ITNs) compared to the families of malaria cases (48.3%). Use of ITNs was associated with lower level of clinical malaria episodes (odds ratio 0.51; 95% CI 0.39–0.68; P < 0.0001). Low income was the most important factor associated with higher malaria infections (adj. OR 4.70). Use of malaria prophylaxis was the most important factor associated with less malaria infections (adj OR 0.36). Mother’s (not fathers) employment status (adj OR 0.48) and education level (adj OR 0.54) was important malaria risk factor. Houses with open eaves was an important malaria risk factor (adj OR 1.72).ConclusionThe identification of risk factors for clinical malaria infection provides information on the local malaria epidemiology and has the potential to lead to a more effective and targeted use of malaria control measures. These risk factors could be used to assess why some individuals acquire clinical malaria whilst others do not and to inform how intervention could be scaled at the local level.

Spatial Assessment of Contact Between Humans and Anopheles and Aedes Mosquitoes in a Medium-Sized African Urban Setting, Using Salivary Antibody-Based Biomarkers.

Anarchic and poorly controlled urbanization led to an increased risk of mosquito-borne diseases (MBD) in many African cities. Here, we evaluate the spatial heterogeneity of human exposure to malaria and arboviral disease vectors in an urban area of northern Senegal, using antibody-based biomarkers of exposure to Anopheles and Aedes mosquito bites. A cross-sectional study was undertaken during the rainy season of 2014 in 4 neighborhoods of Saint-Louis, a city in northern Senegal. Among children aged 6-59 months in each neighborhood, the dried blood spot technique was used to evaluate immunoglobulin G (IgG) responses to both gSG6-P1 (Anopheles) and Nterm-34-kDa (Aedes) salivary peptides as validated biomarkers of respective mosquito bite exposure. IgG response levels to gSG6-P1 and Nterm-34-kDa salivary peptides varied significantly between the 4 neighborhoods (P < .0001). The level of exposure to Aedes bites also varied according to household access to sanitation services (P = .027), whereas that of exposure to Anopheles bites varied according to insecticide-treated bed net use (P = .006). In addition, spatial clusters of high contact between humans and mosquitoes were identified inside 3 neighborhoods. Antibody-based biomarkers of exposure to Anopheles and Aedes mosquito bites could be helpful tools for evaluating the heterogeneity of exposure to malaria and arboviral disease vectors by national control programs.

Caregiver exposure to malaria social and behaviour change messages can improve bed net use among children in an endemic country: secondary analysis of the 2015 Nigeria Malaria Indicator Survey

BackgroundTo reduce the malaria burden in Nigeria, the National Malaria Strategic Plan (NMSP) 2014‒2020 calls for the scale-up of prevention and treatment interventions, including social and behaviour change (SBC). SBC interventions can increase awareness and improve the demand for and uptake of malaria interventions. However, there is limited evidence supporting the implementation of SBC interventions to improve key malaria behaviours, such as insecticide-treated bed net (ITN) use, among children in Nigeria.MethodsUsing data from 2015 Nigeria Malaria Indicator Survey, this study used multiple logistic regression to assess the relationship between caregiver exposure to malaria messages and ITN use among children under five.ResultsCaregiver exposure to ITN-related messages was significantly associated with ITN use among children under five (odds ratio [OR] = 1.63, p < 0.001).ConclusionsThe results suggest that caregiver exposure to topic-specific SBC messages improves the use of ITNs among children. Given these results, Nigeria should strive to scale up SBC interventions to help increase ITN use among children in line with the objectives of the NMSP. Further evidence is needed to determine which SBC interventions are the most effective and scalable in Nigeria.

Global Sensitivity Analysis to Study the Impacts of Bed-Nets, Drug Treatment, and Their Efficacies on a Two-Strain Malaria Model

Malaria is a deadly infectious disease, which is transmitted to humans via the bites of infected female mosquitoes. Antimalarial drug resistance has been identified as one of the characteristics of malaria that complicates control efforts. Typically, the use of insecticide-treated bed-nets (ITNs) and drug treatment are some of the recommended control strategies against malaria. Here, the use of ITNs, drug treatment, and their efficacies and evolution of antimalarial drug resistance are considered to be the major driving forces in the dynamics of malaria transmissions. We formulate a mathematical model of two-strain malaria to assess the impacts of ITNs, drug treatment, and their efficacies on the transmission dynamics of the disease in a human population. We propose a simple mosquito biting rate function that depends on both the proportion of ITN usage and its efficacy. We show that both disease-free and co-existence equilibrium points are globally-asymptotically stable where they exist. The global uncertainty and sensitivity analysis conducted show that if about 95% of malaria cases can be treated with fewer than 5% treatment failure in a population with 95% ITN usage that remains 95% effective, malaria can be controlled. We find that the order in which numerous intervention measures are taken is important.

Socio-economic and demographic disparities in ownership and use of insecticide-treated bed nets for preventing malaria among rural reproductive-aged women in northern Ghana.

BackgroundMalaria continues to be a leading cause of morbidity and mortality in most countries in Sub-Saharan Africa. Insecticide-treated bed nets (ITNs) is one of the cost-effective interventions for preventing malaria in endemic settings. Ghana has made tremendous efforts to ensure widespread ownership and use of ITNs. However, national coverage statistics can mask important inequities that demand targeted attention. This study assesses the disparities in ownership and utilization of ITNs among reproductive-aged women in a rural impoverished setting of Ghana.MethodsPopulation-based cross-sectional data of 3,993 women between the age of 15 and 49 years were collected in seven districts of the Upper East region of Ghana using a two-stage cluster sampling approach. Bivariate and multivariate regression models were used to assess the social, economic and demographic disparities in ownership and utilization of ITN and to compare utilization rates among women in households owning at least one ITN.ResultsAs high as 79% of respondents were found to own ITN while 62% of ITN owners used them the night preceding the survey. We identified disparities in both ownership and utilization of ITNs in wealth index, occupational status, religion, and district of residence. Respondents in the relative richest wealth quintile were 74% more likely to own ITNs compared to those in the poorest quintile (p-value< 0.001, CI = 1.29–2.34) however, they were 33% less likely to use ITNs compared to the poorest (p-value = 0.01, CI = 0.50–0.91).ConclusionInterventions aimed at preventing and controlling malaria through the use of bed nets in rural Ghana and other similar settings should give more attention to disadvantage populations such as the poor and unemployed. Tailored massages and educational campaigns are required to ensure consistent use of treated bed nets.

Malaria Outbreak Investigation in Pastoral Communities of BenaTsemay District, Southern Ethiopia: A Case Control Study

Over 60% (60 million) of Ethiopian populations live in areas at risk for malaria. On June 17 /2017, surveillance data from BenaTsemay district showed that the district was experiencing an unusual high number of malaria cases in three kebeles (lowest administrative unit). We investigated the outbreak to describe malaria epidemiology in the district, identify population risk factors, and guide intervention measures for the community. Malaria case records from the District Health Office were reviewed to describe the outbreak. Unmatched case-control study was conducted with 60 randomly selected cases and 119 controls using a semi-structured questionnaire. Malaria cases were confirmed by either microscopy or malaria rapid diagnostic tests (RDTs) from June 5 to July 23/2017. Controls were persons with no diagnosis of malaria, and lives in similar kebele. Environmental assessment, observation of ownership and utilization of insecticide treated bed-nets (ITNs) were carried out. Multivariable regression model analysis was conducted to identify independent malaria risk factors. There were 648 malaria cases (50.3%-males) from three kebeles with no deaths recorded. The overall attack rate (AR) was 114/1000 populations, and it was highest in Sille kebele (167/1000 populations) and among 5-14 years old (179/1000 populations). Age <5 years (AOR=8.5; 95%CI: 1.2-59), living near mosquito breeding sites (AOR=6.5; 95%CI: 1.15-36.5), irregular use of ITNs (AOR=8.7; 95%CI: 1.5-49.6), inadequate ITNs per family size (AOR=13.4; 95%CI: 1.9-93) predicted having of malaria. Wearing long sleeved clothes was a protective factor (AOR=0.6; 95%C.I: 0.004-0.96). Several unmanaged stagnated water sources with Anopheles mosquito larvae, and the use of ITNs for other purposes were observed. The outbreak was associated with presence of nearby vector-breeding sites, and poor access and utilization of ITNs. Adequate information should be given along ITNs for the community in addition to early management of nearby vector-breeding sites to prevent similar outbreak in future.

Malaria prevention in the Buea health district in Cameroon: factors influencing Mosquito bed net use in households

Background : Insecticide treated bed nets (ITNs), though proven to be effective in preventing malaria will have little impact unless people sleep under them. Several studies have shown that owned ITNs are usually not used and that ITN use is influenced by several factors that vary between communities. Objective : To investigate the factors influencing the use of mosquito bed nets in households in the Buea Health District (BHD) in Cameroon. Material and Methods : A cross-sectional study with two-stage cluster sampling included 420 households from 35 sites. Questionnaires adapted from the Malaria Indicator Survey were used. CSPro 4.1 and Epi info 3.5.3 were used to create database and analyze respectively. Results : ITN ownership in the BHD was high (92.6%; 95% CI: 89.6%-94.9%) but ITN use was less than average (41.2%; 95% CI: 39.2%-43.3%). ITN use was least likely in the age group 5-15 years (P<0.01), in educated individuals (P<0.01) and in households with less than one ITN for two persons (P<0.01). White ITNs were less likely to be used (P<0.01). Conclusion : There is a gap between ITN ownership and use in the malaria holoendemic BHD and ITN use is associated with age of individual, level of education, colour of ITNs and household net density. Use of the highly owned ITNs could be increased by targeting the least protected 5-15 years age group and schooling individuals; by promoting school-based education on ITN use. Keywords : Insecticide-treated nets, malaria, Buea Health District

Does livestock protect from malaria or facilitate malaria prevalence? A cross-sectional study in endemic rural areas of Indonesia

BackgroundEver since it was discovered that zoophilic vectors can transmit malaria, zooprophylaxis has been used to prevent the disease. However, zoopotentiation has also been observed. Thus, the presence of livestock has been widely accepted as an important variable for the prevalence and risk of malaria, but the effectiveness of zooprophylaxis remained subject to debate. This study aims to critically analyse the effects of the presence of livestock on malaria prevalence using a large dataset from Indonesia.MethodsThis study is based on data from the Indonesia Basic Health Research (“Riskesdas”) cross-sectional survey of 2007 organized by the National Institute of Health Research and Development of Indonesia’s Ministry of Health. The subset of data used in the present study included 259,885 research participants who reside in the rural areas of 176 regencies throughout the 15 provinces of Indonesia where the prevalence of malaria is higher than the national average. The variable “existence of livestock” and other independent demographic, social and behavioural variables were tested as potential determinants for malaria prevalence by multivariate logistic regressions.ResultsRaising medium-sized animals in the house was a significant predictor of malaria prevalence (OR = 2.980; 95% CI 2.348–3.782, P < 0.001) when compared to keeping such animals outside of the house (OR = 1.713; 95% CI 1.515–1.937, P < 0.001). After adjusting for gender, age, access to community health facility, sewage canal condition, use of mosquito nets and insecticide-treated bed nets, the participants who raised medium-sized animals inside their homes were 2.8 times more likely to contract malaria than respondents who did not (adjusted odds ratio = 2.809; 95% CI 2.207–3.575; P < 0.001).ConclusionsThe results of this study highlight the importance of livestock for malaria transmission, suggesting that keeping livestock in the house contributes to malaria risk rather than prophylaxis in Indonesia. Livestock-based interventions should therefore play a significant role in the implementation of malaria control programmes, and focus on households with a high proportion of medium-sized animals in rural areas. The implementation of a “One Health” strategy to eliminate malaria in Indonesia by 2030 is strongly recommended.

Cost-Effectiveness of Indoor Residual Spraying of Households with Insecticide for Malaria Prevention and Control in Tanzania.

Using a decision-tree approach, we examined the cost-effectiveness of indoor residual spraying (IRS) of households with insecticide combined with insecticide-treated bed net (ITN) distribution (IRS + ITN), compared with ITN distribution alone in the programmatic context of mainland Tanzania. The primary outcome of our model was the expected economic cost to society per case of malaria averted in children ≤ 5 years of age. Indoor residual spraying of households with insecticide data came from a program implemented in northwest Tanzania from 2008 to 2012; all other data originated from the published literature. Through sensitivity and scenario analyses, the model also examined the effects of variations in insecticide resistance, malaria prevalence, and different IRS modalities. In the base case, IRS + ITN is expected to be more expensive and more effective than the ITN-only intervention (incremental cost-effectiveness ratio [ICER]: $152.36). The number of IRS rounds, IRS insecticide costs, ITN use, malaria prevalence, and the probability that a child develops symptoms following infection drove the interventions' cost-effectiveness. Compared with universal spraying, targeted spraying is expected to lead to a higher number of malaria cases per person targeted (0.211-0.256 versus 0.050-0.076), but the incremental cost per case of malaria averted is expected to be lower (ICER: $41.70). In a scenario of increasing pyrethroid resistance, the incremental expected cost per case of malaria averted is expected to increase compared with the base case (ICER: $192.12). Tanzania should pursue universal IRS only in those regions that report high malaria prevalence. If the cost per case of malaria averted of universal IRS exceeds the willingness to pay, targeted spraying could provide an alternative, but may result in higher malaria prevalence.

Quantifying bias in measuring insecticide-treated bednet use: meta-analysis of self-reported vs objectively measured adherence.

BackgroundInsecticide-treated bednets (ITNs) are recommended for use by 3.4 billion people at risk of malaria world-wide. Policy makers rely on measurements of ITN use to optimize malaria prevention efforts. Self-reports are the most common means of assessing ITN use, but self-reports may be biased in a way that reduces their reliability as a proxy for ITN adherence. This meta-analysis compared self-reported and two methods which are more objective measures of ITN use to explore whether self-reports overestimate actual ITN adherence.MethodsA comprehensive search of electronic databases and hand searching reference lists resulted in screening 2885 records and 202 articles were read in full. Sixteen articles with comparable data were chosen for the meta-analysis. Comparable data was defined as self-reported and objectively measured ITN use (observation of a mounted ITN or surprise visits confirming use) at the same unit of analysis, covering the same time period and same population. A random effects model was used to determine a weighted average risk difference between self-reported and objectively measured ITN use. Additional stratified analyses were conducted to explore study heterogeneity.ResultsSelf-reported ITN use is 8 percentage points (95% confidence interval CI: 3 to 13) higher than objectively measured ITN use, representing a 13.6% overestimation relative to the proportion measured as adherent to ITN use by objective measures. Wide variations in the discrepancies between self-reports and objective measures were unable to be explained using stratified analyses of variables including location, year of publication, seasonality and others.ConclusionsSelf-reports overestimate ITN adherence relative to objectively measured ITN use by 13.6% and do so in an unpredictable manner that raises questions about the reliability of using self-reported ITN use alone as a surveillance tool and a guide for making policy decisions.

Malaria infection among children under-five: the use of large-scale interventions in Ghana

BackgroundDespite the significant investments to control malaria infection rates over the past years, infection rates remain significant in sub-Saharan Africa. This study investigates the association with use of large-scale malaria interventions such as: Indoor Residual Spraying (IRS), Insecticide Treated bed-Nets (ITN), and Behaviour Change Communication (BCC) strategies, and the prevalence of malaria among children under-five in Ghana.MethodsCross-sectional data on 2, 449 children aged 6 to 59 months who were tested for malaria, through Rapid Diagnostic Test (RDT), are drawn from the recent wave of the Ghana Demographic and Health Surveys (GDHS 2014). We use a logit model to analyse the heterogeneous association between control measures and malaria infection among under five children of different age cohorts and household poverty statuses.ResultsOur estimates suggest that IRS offers much more protection than ITN use. The odds of malaria infection among children who sleep in IRS is significantly lower (odds ratio [OR] = 0.312; 95% CI -1.47 -0.81; p = 0.00) compared to those who are not protected. This association is even high (odds ratio [OR] = 0.372; 95% CI -1.76 -1.02; p = 0.00) among children in poor households protected by IRS compared to those who have no IRS protection. ITN use did not have a significant association with malaria infection among children, except among children whose mothers have at least secondary education. For such children, the odds of malaria infection are significantly lower ([OR] =0.545; 95% CI = − 0.84 -0.11; p = 0.011) compared to those who are not protected. Regarding BCC strategies, we found that malaria education through television is the best strategy to covey malaria education as it significantly reduces the odds of malaria infection ([OR] =0.715; 95% CI = − 0.55 -0.10; p = 0.005) compared to those who do not received malaria education via television. BCC strategy via print media has a significant but limited protection for children of educated mothers.ConclusionPolicy makers should direct more resources to IRS, especially in communities where the use of ITN is less likely to be effective, such as poor and rural households. The distribution of ITNs needs to be accompanied with education programs to ensure its best protection.

Associations between ideational variables and bed net use in Madagascar, Mali, and Nigeria

BackgroundThe use of insecticide-treated bed nets (ITNs) is crucial to the prevention, control, and elimination of malaria. Using household surveys conducted in 2014–2015 by the Health Communication Capacity Collaborative project in Madagascar, Mali, and Nigeria, we compared a model of psychosocial influence, called Ideation, to examine how malaria-related variables influence individual and household bed net use in each of these countries. Evaluations of non-malaria programs have confirmed the value of the ideational approach, but it is infrequently used to guide malaria interventions. The study objective was to examine how well this model could identify potentially effective malaria prevention approaches in different contexts.MethodsSampling and survey designs were similar across countries. A multi-stage random sampling process selected female caregivers with at least one child under 5 years of age for interviews. Additional data were collected from household heads about bed net use and other characteristics of household members. The caregiver survey measured psychosocial variables that were subjected to bivariate and multivariate analysis to identify significant ideational variables related to bed net use.ResultsIn all three countries, children and adolescents over five were less likely to sleep under a net compared to children under five (OR = 0.441 in Madagascar, 0.332 in Mali, 0.502 in Nigeria). Adults were less likely to sleep under a net compared to children under five in Mali (OR = 0.374) and Nigeria (OR = 0.448), but not Madagascar. In all countries, the odds of bed net use were lower in larger compared to smaller households (OR = 0.452 in Madagascar and OR = 0.529 in Nigeria for households with 5 or 6 members compared to those with less than 5; and OR = 0.831 in Mali for larger compared to smaller households). Of 14 common ideational variables examined in this study, six were significant predictors in Madagascar (all positive), three in Mali (all positive), and two in Nigeria (both negative).ConclusionThis research suggests that the systematic use of this model to identify relevant ideational variables in a particular setting can guide the development of communication strategies and messaging, thereby improving the effectiveness of malaria prevention and control.

Access and adequate utilization of malaria control interventions in rural Malawi: a descriptive quantitative study

BackgroundDespite the availability of cost effective malaria control interventions, such as insecticide-treated bed nets (ITN), diagnosis and effective treatment of malaria, and intermittent preventive treatment during pregnancy (IPTp), the lack of equitable access and coverage affect utilization of these interventions in rural communities. Aggregated rates of access and utilization of malaria interventions in national surveys mask substantial variations in intervention coverage. Utilization of interventions and factors affecting utilization need investigation in rural communities.MethodsOne year of quantitative data collected from a rolling Malaria Indicator Survey (April 2015–April 2016) in Chikhwawa District, Malawi, before the ITN distribution campaign, were analysed. Univariate analyses were used to quantify rates of ITN usage, care-seeking for fever in children aged 6–59 months and women aged 15–49 years and IPTp uptake (for women aged 15–49 years with a recent delivery). Results were compared to national survey estimates; factors associated with these outcomes were determined using multivariate regression models.ResultsA total of 2046 participants were included from 1328 households; 56.6% were women aged 15–49 years and 43.4% were children aged 6–59 months. Reported ownership of at least one ITN per household and under-five children ITN use the previous night were 35.3 and 33.5% compared to 70.2 and 67.1%, respectively, in the national survey; ITN use was higher in high wealth quintile households than low quintile ones. For participants with recent fever, 37.6 and 19.5% sought care and sought care within 24 h, respectively. Care-seeking was lower for febrile women than febrile children [aOR, 95% CI 0.53 (0.35–0.81)]. Uptake of two and three or more doses of IPTp were 40.6 and 15.0%, respectively, among women with a pregnancy in the last 2 years.ConclusionTo achieve effective malaria control, fine-scale or district-based surveillance should be used to identify and target communities requiring scaling up of interventions. Qualitative research and a participatory community approach should be used to address behavioural factors affecting how people make use of interventions.

Mathematical assessment of the role of vector insecticide resistance and feeding/resting behavior on malaria transmission dynamics: Optimal control analysis.

The large-scale use of insecticide-treated bednets (ITNs) and indoor residual spraying (IRS), over the last two decades, has resulted in a dramatic reduction of malaria incidence globally. However, the effectiveness of these interventions is now being threatened by numerous factors, such as resistance to insecticide in the mosquito vector and their preference to feed and rest outdoors or early in the evening (when humans are not protected by the bednets). This study presents a new deterministic model for assessing the population-level impact of mosquito insecticide resistance on malaria transmission dynamics. A notable feature of the model is that it stratifies the mosquito population in terms of type (wild or resistant to insecticides) and feeding preference (indoor or outdoor). The model is rigorously analysed to gain insight into the existence and asymptotic stability properties of the various disease-free equilibria of the model namely the trivial disease-free equilibrium, the non-trivial resistant-only boundary disease-free equilibrium and a non-trivial disease-free equlibrium where both the wild and resistant mosquito geneotypes co-exist). Simulations of the model, using data relevant to malaria transmission dynamics in Ethiopia (a malaria-endemic nation), show that the use of optimal ITNs alone, or in combination with optimal IRS, is more effective than the singular implementation of an optimal IRS-only strategy. Further, when the effect of the fitness cost of insecticide resistance with respect to fecundity (i.e., assuming a decrease in the baseline birth rate of new resistant-type adult female mosquitoes) is accounted for, numerical simulations of the model show that the combined optimal ITNs-IRS strategy could lead to the effective control of the disease, and insecticide resistance effectively managed during the first 8 years of the 15-year implementation period of the insecticides-based anti-malaria control measures in the community.

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.

Factors affecting the uptake of malaria prevention strategies among pregnant women in Nigeria: evidence from 2013 Nigeria demographic and health survey

This study aims to examine the factors affecting the uptake of malaria prevention strategies among pregnant women in Nigeria. Secondary data from the 2013 Nigeria Demographic and Health Survey were used to examine the factors affecting the uptake of malaria prevention strategies among pregnant women (n = 4493) in Nigeria. Variables on demographic and socio-economic characteristics of pregnant women were analysed. Data analysis was carried out using STATA version 12 software and univariate, bivariate and multivariate analyses were conducted. We found that only 10.3% of pregnant women received intermittent preventive treatment of malaria in pregnancy, while 17.4% used insecticide-treated bed nets. Multivariate analysis indicated that maternal age (p < 0.05), geo-political zone (p < 0.05), socio-economic status (p < 0.05), religion (p < 0.05), women’s autonomy (p < 0.05) and number of antenatal care visits (p < 0.05) were significant predictors of the uptake of intermittent preventive treatment of malaria in pregnancy. The use of insecticide-treated bed nets was influenced by socio-economic status (p < 0.05) and women’s occupation (p < 0.05). Our study shows that there is poor uptake of malaria prevention strategies among pregnant women in Nigeria. In addition, demographic and socio-economic factors affect the uptake of malaria prevention strategies. The design of new policies and improvement in the current malaria prevention programs should target demographic and socio-economic factors which are important in increasing the uptake of malaria prevention strategies among pregnant women. We also recommend economic empowerment of women.

Malaria prevalence metrics in low- and middle-income countries: an assessment of precision in nationally-representative surveys

BackgroundOne pillar to monitoring progress towards the Sustainable Development Goals is the investment in high quality data to strengthen the scientific basis for decision-making. At present, nationally-representative surveys are the main source of data for establishing a scientific evidence base, monitoring, and evaluation of health metrics. However, little is known about the optimal precisions of various population-level health and development indicators that remains unquantified in nationally-representative household surveys. Here, a retrospective analysis of the precision of prevalence from these surveys was conducted.MethodsUsing malaria indicators, data were assembled in nine sub-Saharan African countries with at least two nationally-representative surveys. A Bayesian statistical model was used to estimate between- and within-cluster variability for fever and malaria prevalence, and insecticide-treated bed nets (ITNs) use in children under the age of 5 years. The intra-class correlation coefficient was estimated along with the optimal sample size for each indicator with associated uncertainty.FindingsResults suggest that the estimated sample sizes for the current nationally-representative surveys increases with declining malaria prevalence. Comparison between the actual sample size and the modelled estimate showed a requirement to increase the sample size for parasite prevalence by up to 77.7% (95% Bayesian credible intervals 74.7–79.4) for the 2015 Kenya MIS (estimated sample size of children 0–4 years 7218 [7099–7288]), and 54.1% [50.1–56.5] for the 2014–2015 Rwanda DHS (12,220 [11,950–12,410]).ConclusionThis study highlights the importance of defining indicator-relevant sample sizes to achieve the required precision in the current national surveys. While expanding the current surveys would need additional investment, the study highlights the need for improved approaches to cost effective sampling.