Insecticide-treated Bed Nets Research Articles

Knowledge, Attitudes and Practices Among Adult Malaria Patients Co-Infected with Opportunistic Intestinal Coccidian Parasites in Fundong Health District, Northwest, Cameroon: A Cross Section Study Design

Introduction: Malaria and intestinal coccidian parasitic co-infections, are becoming a public health emergency affecting millions of people around the world. They are among the leading cause of socio-economic problems, long suffering and death especially in developing countries like Cameroon. Introducing new appropriate preventive and control measures to the population requires thorough assessment of community and patient-based knowledge, attitude and preventive practices towards malaria and pathogenic intestinal coccidian parasites is crucial. Our study aimed to describe knowledge, attitudes, and practices and the risk factors among adult malaria patients co-infected with intestinal parasitic infections in the Fundong Health District, a locality in the Northwest Region of Cameroon. Methods: This was a cross-sectional study carried out between February and December, 2022 involving sixteen (16) health facilities in Fundong Health district. A total number of 330 patients participated in the study. Normal saline wet mount and formol-ether concentration techniques were employed in coccidian parasitic detection. Blood samples were subjected to Giemsa stained and viewed microscopically to detect the Plasmodium parasites. Pretested structured questionnaires were administered to collect information on patient’s socio-demographic factors and determine patients’ knowledge, attitudes and practices towards malaria and intestinal coccidian parasites, as well as their prevention and control. The Pearson’s Chi-Square (χ2) and Student T-test were performed a part of the statistical analysis to check for associations between malaria, infection and between malaria-coccidian co-infection and demographic factors. Statistical significance was set a P-value<0.05. Results: Participants main sources of information on malaria were: Television (TV) and radio 111/330 (34%), community health workers 109/330 (33%), and Hospitals (37%). Participants had good knowledge of mosquito bite as the malaria transmission route, 296/330 (90%), night time is the frequent biting time for the mosquito 296/330(90%), dark corners 229 (69%) and dirty areas 175(53%) as mosquito resting places. Knowledge score was also good on cleaning of the house surroundings, 281/330(85%), clearing the bushes 180/330(55%), poor knowledge score on drainage of stagnant water113/330 (34%) as ways to prevent the mosquito from multiplying. Participants had good knowledge of insecticide treated bed nets 295/330 (89%) as the best way to prevent mosquito bites. However, participants also expressed poor knowledge on edges of the river or streams 7(20%), and animal shed 20/330 (6%) as mosquito hiding places, and Plasmodium specie as malaria causative agent 8/330 (2%) (P-value=0.011). Poor scores were recorded on knowledge of opportunistic intestinal coccidian parasites (19.4%) (P=0.427), and was significantly low on unsafe water (47.2%) (P-value=0.036) as possible transmission routes for coccidian parasites. The knowledge score was also low on the at-risk population for malaria and intestinal coccidian infection (31.9%) P-value=0.009. Participants who had poor knowledge about coccidian transmission routes were less likely to drink from protected water source with an odds of 0.713(95% CI: 0.297-1.711) P value=0.449, compared to those who were more knowledgeable and who were 2.981(95% CI: 1.367-6.115) P value=0.005, more likely to use protected source of drinking water. Participants who had hand washing facility in the household were 3.488 (1.760-6.912) value=0.001 times more likely have better knowledge of coccidian transmission routes compared to those who did not have 0.748 (95% CI: 0.406-1.376) P value=0.350. Poor knowledge score of poor hygiene as major cause of coccidian infection significantly associated with poor practice score of sometime or not at all disinfecting animal shed to prevent coccidian infection among study participants (P =0.039). Conclusion: The overall knowledge scores, attitude and practices level of participants towards malaria and opportunistic intestinal coccidian parasites were relatively good. A significant proportion of the participants still have misconceptions about cause, modes of transmission and practices towards malaria and coccidian prevention methods. A combined health education programmes for malaria and intestinal coccidian parasites aimed at raising community awareness needs to be evidence based and requires innovative approaches, to address the gaps identified in the study.

Generalized Linear Models to Forecast Malaria Incidence in Three Endemic Regions of Senegal.

Affecting millions of individuals yearly, malaria is one of the most dangerous and deadly tropical diseases. It is a major global public health problem, with an alarming spread of parasite transmitted by mosquito (Anophele). Various studies have emerged that construct a mathematical and statistical model for malaria incidence forecasting. In this study, we formulate a generalized linear model based on Poisson and negative binomial regression models for forecasting malaria incidence, taking into account climatic variables (such as the monthly rainfall, average temperature, relative humidity), other predictor variables (the insecticide-treated bed-nets (ITNs) distribution and Artemisinin-based combination therapy (ACT)) and the history of malaria incidence in Dakar, Fatick and Kedougou, three different endemic regions of Senegal. A forecasting algorithm is developed by taking the meteorological explanatory variable Xj at time t-𝓁j, where t is the observation time and 𝓁j is the lag in Xj that maximizes its correlation with the malaria incidence. We saturated the rainfall in order to reduce over-forecasting. The results of this study show that the Poisson regression model is more adequate than the negative binomial regression model to forecast accurately the malaria incidence taking into account some explanatory variables. The application of the saturation where the over-forecasting was observed noticeably increases the quality of the forecasts.

Using routine health data to evaluate the impact of indoor residual spraying on malaria transmission in Madagascar

IntroductionIndoor residual spraying (IRS) and insecticide-treated bed nets (ITNs) are cornerstone malaria prevention methods in Madagascar. This retrospective observational study uses routine data to evaluate the impacts of IRS overall,...

Predictors of mosquito bed net use among children under-fives in Ghana: a multilevel analysis of the 2019 malaria indicator survey

BackgroundMorbidities and mortalities due to malaria can be prevented by the use of insecticide-treated mosquito bed nets (ITN), which has been proven for malaria control and elimination. The purpose of this study was to assess the critical factors that predict the use of ITN among children under-fives in Ghana.MethodsThe study utilized data from the 2019 Ghana Malaria Indicator Survey (GMIS). The outcome variable was mosquito bed net use among children under-fives. To determine critical factors that independently predict ITN use, multilevel multivariable logistic regression was employed using Stata version 16. Odds ratios and associated 95% confidence intervals and p-values were reported. A p < 0.05 was used to declare statistical significance.ResultsThe overall prevalence of ITN usage was 57.4%. Utilization of bed nets was 66.6% in the rural areas and 43.5% in the urban areas, was highest in the Upper West region (80.6%) even when stratified to rural (82.9%) and urban areas (70.3%) whilst Greater Accra region (30.5%, rural = 41.7%, urban = 28.9%) had the least. The community level multilevel analysis showed that bed net utilization was higher among children in rural areas [AOR = 1.99, 95% CI 1.32–3.01, p = 0.001] and in household with wooden wall materials [AOR = 3.29, 95% CI 1.15–9.40, p = 0.027]. Bed net utilization was however, less for households with 3 + children under-five [AOR = 0.29, 95% CI 0.19–0.46, p < 0.001), 4 years old (AOR = 0.66, 95% CI 00.48–00.92, p = 0.014], without universal access to bed net [AOR = 0.52, 95% CI 0.37–0.73, p < 0.001], those in the Greater Accra [AOR = 0.26, 95% CI 0.13–0.51, p < 0.001], Eastern [AOR = 0.47, 95% CI 0.23–0.95, p = 0.036], Northern [AOR = 0.42, 95% CI 0.20–0.88, p = 0.022], middle [AOR = 0.57, 95% CI 0.35–0.94, p = 0.026] and rich/richest [AOR = 0.51, 95% CI 0.29–0.92, p = 0.025] household wealth quintile. Substantial unobserved household and community level differences in bed net use were found.ConclusionThis study demonstrates the need to intensify promotion of ITN use to those in urban areas, Greater Accra, Eastern and Northern regions, houses without wooden wall materials, middle and rich/richest households. Interventions should be targeted at older children and households with more under-five children and to ensure full access and use of ITNs among all children under-fives in each household as part of the overall goal of achieving the health-related SDGs.

Two decades of malaria control in Malawi: Geostatistical Analysis of the changing malaria prevalence from 2000-2022

Background Malaria remains a public health problem in Malawi and has a serious socio-economic impact on the population. In the past two decades, available malaria control measures have been substantially scaled up, such as insecticide-treated bed nets, artemisinin-based combination therapies, and, more recently, the introduction of the malaria vaccine, the RTS,S/AS01. In this paper, we describe the epidemiology of malaria for the last two decades to understand the past transmission and set the scene for the elimination agenda. Methods A collation of parasite prevalence surveys conducted between the years 2000 and 2022 was done. A spatio-temporal geostatistical model was fitted to predict the yearly malaria risk for children aged 2–10 years (PfPR 2–10) at 1×1 km spatial resolutions. Parameter estimation was done using the Monte Carlo maximum likelihood methods. District level prevalence estimates adjusted for population are calculated for the years 2000 to 2022. Results A total of 2,595 sampled unique locations from 2000 to 2022 were identified through the data collation exercise. This represents 70,565 individuals that were sampled in the period. In general, the PfPR2_10 declined over the 22 years. The mean modeled national PfPR2_10 in 2000 was 43.93 % (95% CI:17.9 to 73.8%) and declined to 19.2% (95%CI 7.49 to 37.0%) in 2022. The smoothened estimates of PfPR2_10 indicate that malaria prevalence is very heterogeneous with hotspot areas concentrated on the southern shores of Lake Malawi and the country's central region. Conclusions The last two decades are associated with a decline in malaria prevalence, highly likely associated with the scale up of control interventions. The country should move towards targeted malaria control approaches informed by surveillance data.

High burden of asymptomatic malaria and anaemia despite high adherence to malaria control measures: a cross-sectional study among pregnant women across two seasons in a malaria-endemic setting in Ghana.

Anaemia remains a serious concern among pregnant women, and thus, it is closely monitored from the onset of pregnancy through to delivery to help prevent adverse maternal and neonatal outcomes. In malaria-endemic settings, continuous low-level carriage of P. falciparum parasites is common and its contribution to maternal anaemia should not be underestimated. In this study, we evaluated the impact of adherence to malaria control measures [number of antenatal clinics (ANC) attended, supervised intake of sulphadoxine pyrimethamine (SP), and use of insecticide treated bed nets (ITNs)] on asymptomatic malaria and anaemia outcomes among pregnant women on ANC in hospitals in the Central region of Ghana. The study was conducted during two seasons; October-November 2020 (dry season, n = 124) and May-June 2021 (rainy season, n = 145). Among the women, there was a high adherence to the control measures for both seasons (ANC ≥ 3 visits; ~ 82.0%, intake of SP; ~ 80.0% and ITNs use; ~ 75.0%). Asymptomatic P. falciparum carriage was high for both seasons (44.4% for the dry season; 46.9% for the rainy season). Correspondingly, the occurrence of anaemia was high for both seasons (57.3% for the dry season; 68.3% for the rainy season) and was strongly predicted by carriage of P. falciparum parasites. Despite the high adherence to ANC protocols, asymptomatic P. falciparum infection was common and contributed to the high burden of maternal anaemia. Our findings emphasize the need for improved control measures that can clear asymptomatic/sub-microscopic P. falciparum infection and protect against malaria-induced anaemia among pregnant women attending ANC in malaria endemic-settings.

Antenatal interventions to reduce risk of low birth weight related to maternal infections during pregnancy

BackgroundMaternal infections during pregnancy have been linked to increased risk of adverse birth outcomes, including low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), and stillbirth (SB). ObjectivesThe purpose of this article was to summarize evidence from published literature on the effect of key interventions targeting maternal infections on adverse birth outcomes. MethodsWe searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL Complete between March 2020 and May 2020 with an update to cover until August 2022. We included randomized controlled trials (RCTs) and reviews of RCTs of 15 antenatal interventions for pregnant women reporting LBW, PTB, SGA, or SB as outcomes. ResultsOf the 15 reviewed interventions, the administration of 3 or more doses of intermittent preventive treatment in pregnancy with sulphadoxine–pyrimethamine [IPTp-SP; RR: 0.80 (95% CI: 0.69, 0.94)] can reduce risk of LBW compared with 2 doses. The provision of insecticide-treated bed nets, periodontal treatment, and screening and treatment of asymptomatic bacteriuria may reduce risk of LBW. Maternal viral influenza vaccination, treatment of bacterial vaginosis, intermittent preventive treatment with dihydroartemisinin–piperaquine compared with IPTp-SP, and intermittent screening and treatment of malaria during pregnancy compared with IPTp were deemed unlikely to reduce the prevalence of adverse birth outcomes. ConclusionsAt present, there is limited evidence from RCTs available for some potentially relevant interventions targeting maternal infections, which could be prioritized for future research.

Pooled prevalence and risk factors of malaria among children aged 6-59 months in 13 sub-Saharan African countries: A multilevel analysis using recent malaria indicator surveys.

Every 75 seconds, a child under five dies of malaria. Mainly children, aged between six months and five years, are at the highest risk for malaria. These children lost maternal immunity and did not yet developed specific immunity to the infection. Under the age of five, children bear the highest burden of malaria in Sub-Saharan Africa (SSA). Many individual and community level factors could contribute to malaria prevalence remaining high among under-five children in the region. Thus, this study aimed to assess the pooled prevalence of malaria among children aged 6-59 months and identify potential factors associated with malaria by using recent Malaria Indicator Surveys in 13 SSA countries. Data for this study were drawn from recent 13 Sub-Saharan African countries Malaria Indicator Surveys (MIS). A total weighted sample of 60,541 children aged 6-59 months was included. STATA version 14.2 was used to clean, code and analyze the data. Multilevel logistic regression was employed to identify factors associated with malaria. Adjusted odds ratio with 95% CI and a P value <0.05 was reported to indicate statistical association. Model fitness and comparison were done using Inter cluster correlation coefficient, Median odds ratio, proportional change in variance, and deviance. The pooled prevalence of malaria among children aged 6-59 months was found to be 27.41% (95% CI: 17.94%-36.88%). It ranges from 5.04% in Senegal to 62.57% in Sierra Leone. Aged 36-47 months (AOR = 3.54, 95% CI 3.21-3.91), and 48-59 months (AOR = 4.32, 95% CI 3.91-4.77), mothers attended primary education (AOR = 0.78, 95% CI 0.73-0.84), richer (AOR = 0.35, 95% CI 0.32-0.39), and richest household (AOR = 0.16, 95% CI 0.14-0.19), number of three and more under-five children (AOR = 1.35, 95% CI 1.26-1.45), improved floor material (AOR = 0.65, 95% CI 0.57-0.73), improved wall material (AOR = 0.73, 95% CI 0.64-0.84), improved roof material (AOR = 0.70, 95% CI 0.51-0.93), insecticide-treated bed net (ITN) use (0.56, 95% CI 0.51-0.62), not anemic (AOR = 0.05, 95% CI 0.04-0.06), rural resident (AOR = 2.16, 95% CI 2.06-2.27), high community ITN use (AOR = 0.40, 95% CI 0.24-0.63) and high community poverty (AOR = 2.66, 95% CI 2.53-2.84) were strongly associated with malaria. Almost 3 out of 10 children were infected by malaria in 13 SSA countries. Malaria infection remains one of the main killers of children aged 6-59 months in the SSA. This study revealed that older under-five children living in large families with low incomes in rural areas are most vulnerable to malaria infection. Our results clearly indicate that ITN utilization and improved housing are promising means to effectively prevent malaria infection among children aged 6-59 months. It is therefore important to note that households with low wealth quintiles and rural residents should be prioritized in any mass distribution of ITNs. This has to be accompanied by education using mass media to enhance community awareness.

Factors Influencing the Utilization of Insecticide Treated Bed Nets in the Prevention of Malaria in the Berekum East Municipality, Ghana

Introduction: The goal of the study was to assess the factors that influence the utilization of Insecticide Treated bed Nets (ITN) in the prevention of malaria in the Berekum East Municipality. &#x0D; Methods: Quantitative cross sectional design was used to conduct the study in the Berekum East Municipality. Total of 307 respondents aged between 20-60 years were randomly selected for data collection with the aid of a questionnaire. Data were analysed with Statistical Package for the Social Sciences (SPSS) version 23.0. Descriptive and logistic regression analyses were used to examine the factors influencing ITN use at 95% confidence interval.&#x0D; Results: The study found that 87.6% of the respondents owned ITN; however 28% of them used it regularly while 72% use it irregularly. Only 12.4% of the respondents did not use ITN because they did not have them. Majority of the respondents (94.4%) had sufficient knowledge about INT. The reasons that prevented the people from using the ITN included inconvenienced sleeping under them, skin rashes and heat intolerance. The key predictors of appropriate use of ITN were education level, the number of occupants per room, the structure of the room and the knowledge level and the availability of ITNs. Age range 20-30 year had odds ratio of 1.633 of using ITN than other age groups. Likewise, people with tertiary education had OR 2.036 ITN usage more than other educational categories.&#x0D; Conclusion: There was high ITN ownership with poor usage. Strengthening health education of the benefits and importance of ITN use will improve appropriate utilization of ITN among the people of Berekum Municipality.

Bed-nets Hour Density after a Usage of Three Years of Long-lasting Insecticide-treated Nets in Malaria re-elimination Areas in Ngadirejo Village, Purworejo District, Indonesia

Background: Malaria, caused by the genus Plasmodium, is still a global health problem. Its transmission and spread are strongly influenced by the presence of the Anopheles vector. One of the efforts to reduce cases is the distribution of long-lasting insecticide-treated nets to the residents of malaria-endemic areas. This study aims to measure the density of mosquitoes perched on insecticide-treated bed nets after three years of usage. Method: A cross-sectional study was conducted to observe mosquitoes perching on insecticide-treated bed nets at night and calculation of mosquito density data in units of mosquitoes/LLINs/hour. Results: The number of mosquito bites before bedtime in respondents reached 72.5%, while the number of bed nets infested with mosquitoes reached 74.4%. The density of mosquitoes perched varied between 1 and 10 mosquitoes/LLINs/hour with the highest density proportion of 3 mosquitoes/LLINs/hour. Conclusion: LLINs that have been used for three years were found to be less effective at killing and preventing mosquitoes. It is advisable to re-dip with the insecticide doses to match the local vector susceptibility level by officer assistance so that the mosquito nets still function properly

Factors associated with anemia among pregnant women attended antenatal care: a health facility-based cross-sectional study.

A health facility-based cross-sectional study was conducted from 1 February 2020 to 2 March 2020 among 420 pregnant women. The data were collected by systematic random sampling technique, entered into a computer using EpiData 3.5, and analyzed using the Statistical Package of Social Sciences 23.0 version. Bivariate and multivariable logistic regression analyses were done to estimate the crude and adjusted odds ratio with a CI of 95% and a P-value of less than 0.05 considered statistically significant. Frequency tables, figures, and descriptive summaries were used to describe the study variables. The overall prevalence of anemia was 32.9% (95% CI: 28.6-37.4), and it was higher in rural than urban pregnant women (45 vs. 23%), respectively. In multivariable analysis women who are found in the age group of greater than or equal to 30 years (AOR=3.45, 95% CI=1.22-9.78), rural residency (AOR=3.51, 95% CI=1.92-6.42), low family income (AOR=3.10, 95% CI=1.19-8.08), multiparty (AOR=2.91, 95% CI=1.33-6.38), a short interpregnancy gap (AOR 3.32, 95% CI=1.69-6.53), not taking iron and folate (AOR=4.83, 95% CI=2.62-9.90), third trimester of pregnancy (AOR=3.21, 95% CI=1.25-8.25), poor minimum dietary diversity score (AOR=3.54, 95% CI=1.58-7.95), undernourished (AOR=4.9, 95% CI=2.19-7.64), poor knowledge of anemia (AOR=3.19, 95% CI=1.72-5.93), consumption of coffee always after meal per day (AOR=3.24, 95% CI=1.42-7.42), having a history of irregular menstruation, and antepartum hemorrhage were significantly associated with anemia in pregnant women. This study showed that the prevalence of anemia in pregnant women in this study area was a moderate public health problem. The author suggest emphasizing the education and counseling of women on the advantage of taking the supplemented iron and folic acid. Health care providers should have to advise women to stay for at least 2 years before the next pregnancy to reduce the risk of adverse maternal and infant outcomes. Awareness creation in the community on the utilization of insecticide-treated bed nets is also needed.

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

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

Evaluation of the factors that contribute to high prevalence of malaria in HIV Patients in Bushenyi District, Uganda

Malaria remains the single main cause of ill health and death among HIV/AIDS patients in resource-poor countries worldwide. Malaria still remains a challenging infection affecting the lives of several HIV-infected persons in Uganda. Statistics from the Ministry of Health show that malaria is still the leading cause of death in Uganda, accounting for over 27% of deaths. Malaria prevalence in HIV-positive patients in Kyamuhunga Health Centre III is thought to be at 7.8% of the HIV-positive patients attending the clinic on a daily basis. This study therefore aimed at assessing the factors contributing to the high prevalence of malaria among HIVpositive patients attending the HIV Clinic at Kyamuhunga Health Centre III in Bushenyi District. The study covered a sample of eighty (80) respondents to gather primary data. A simple random sampling method was used to gather responses from patients. Questionnaires and an interview guide were used as data collection tools. Results indicated that the majority of the participants were female patients and malaria was dominant among HIV-positive patients aged 38-47 years. It was noted that the odds of having malaria also increased among patients with lower levels of education. It was also noted that more odds of having malaria were found among the majority of patients who were farmers and unemployed participants. Malaria infection was acquired with repeated exposure to malaria parasites especially for patients who did not use insecticide treated mosquito nets. It is noted that HIV-positive patients with malaria greatly acquired unbalanced immunity with relatively low CD4+ cell count and unbalanced hemoglobin levels, greatly affected by body pain and weakness, fever, headache, and variety issues of vomiting. Paracetamol, use of treated mosquito nets, clinical examination, and patient follow-up was shown to provide a beneficial effect in preventing malaria infection among HIV-positive patients. In conclusion, malaria infection is acquired from repeated exposure to malaria parasites especially for patients who did not use Treated mosquito nets which increased the susceptibility to new malaria infections among HIVpositive patients. The researcher, therefore, recommends that comprehensive health education, antiretroviral therapy, and malaria preventive materials such as insecticidetreated bed nets should be provided to reduce the prevalence of malaria among HIV-positive patients. Keywords: Malaria, HIV patients, Treated mosquito nets, Antiretroviral therapy.

Socio-demographic and economic inequity in the use of insecticide-treated bed nets during pregnancy: a survey-based case study of four sub-Saharan African countries with a high burden of malaria

Despite global investments in malaria eradication and mitigation efforts, including the dissemination of ITNs to vulnerable communities, the goal of widespread malaria control among pregnant women has yet to be realized in many African countries. One of the explanations forwarded for this is related to the adoption and regular use of ITNs by pregnant women. Based on the available DHS and MIS data from four malaria high burden African countries– according to WHO malaria report 2020– inequality was measured by applying both relative and absolute summary measures for the four dimensions of inequality: economic status, education, place of residence and region. By considering the number of subgroups in each variable, simple and complex summary measures were used.ITN utilization by pregnant women showed an increasing trend over time in all the four countries. There was also significant inequality (variability) in the ITN utilization among population groups. DRC, Mozambique and Uganda showed noticeable inequality that favors the richest population, whereas in Nigeria the inequality was observed among both the rich and the poor during different survey yearsIn conclusion, in all the four countries, there were significant regional variations or differences in ITN use among pregnant mothers across all dimensions of inequality in the survey years. Tailored cost-effective interventions could be considered to improve ITN utilization among pregnant women.

Perceptions on use of insecticide-treated bed nets to prevent malaria: a qualitative assessment in two rural districts of Zambézia province in Mozambique.

Malaria prevention in Africa merits particular attention as the world strives toward a better life for the poorest. The insecticide-treated bed nets (ITNs) are one of the malaria control strategies that, due to their cost effectiveness, are largely used in the country. Data on the actual coverage and usage of bed nets is unreliable, as it is based only on administrative data from distributed ITNs. This study assesses knowledge about malaria and bed net use in two areas of high malaria transmission. A qualitative study was conducted in 6 (six) rural communities in two malaria high-burden districts in Zambézia province. About 96 adults were recruited from the communities and enrolled to participate in focus group discussions. Data were transcribed verbatim, coded, and thematically analyzed using Nvivo11.0. Participants mentioned the mosquito as the only cause of malaria and that the use of bed nets was highlighted as the most proficient protection against mosquito bites and malaria. Children and pregnant women were described as being the priority groups to sleep under a bed net protection in the household. The use of bed nets was common among households, although not sufficient for the number of household members. In addition, the preservation of the nets was considered inadequate. The findings of this study highlight the need to increase public knowledge about malaria and nets and to strengthen the communication and logistics component of the net distribution campaign to ensure that households have enough nets for their members and use them appropriately.

Determinants of malaria infections among children in refugee settlements in Uganda during 2018–2019

BackgroundWhile 5% of 247 million global malaria cases are reported in Uganda, it is also a top refugee hosting country in Africa, with over 1.36 million refugees. Despite malaria being an emerging challenge for humanitarian response in refugee settlements, little is known about its risk factors. This study aimed to investigate the risk factors for malaria infections among children under 5 years of age in refugee settlements in Uganda.MethodsWe utilized data from Uganda’s Malaria Indicator Survey which was conducted between December 2018 and February 2019 at the peak of malaria season. In this national survey, household level information was obtained using standardized questionnaires and a total of 7787 children under 5 years of age were tested for malaria using mainly the rapid diagnostic test. We focused on 675 malaria tested children under five in refugee settlements located in Yumbe, Arua, Adjumani, Moyo, Lamwo, Kiryadongo, Kyegegwa, Kamwenge and Isingiro districts. The extracted variables included prevalence of malaria, demographic, social-economic and environmental information. Multivariable logistic regression was used to identify and define the malaria associated risk factors.ResultsOverall, malaria prevalence in all refugee settlements across the nine hosting districts was 36.6%. Malaria infections were higher in refugee settlements located in Isingiro (98.7%), Kyegegwa (58.6%) and Arua (57.4%) districts. Several risk factors were significantly associated with acquisition of malaria including fetching water from open water sources [adjusted odds ratio (aOR) = 1.22, 95% CI: 0.08–0.59, P = 0.002], boreholes (aOR = 2.11, 95% CI: 0.91–4.89, P = 0.018) and water tanks (aOR = 4.47, 95% CI: 1.67–11.9, P = 0.002). Other factors included pit-latrines (aOR = 1.48, 95% CI: 1.03–2.13, P = 0.033), open defecation (aOR = 3.29, 95% CI: 1.54–7.05, P = 0.002), lack of insecticide treated bed nets (aOR = 1.15, 95% CI: 0.43–3.13, P = 0.003) and knowledge on the causes of malaria (aOR = 1.09, 95% CI: 0.79–1.51, P = 0.005).ConclusionsThe persistence of the malaria infections were mainly due to open water sources, poor hygiene, and lack of preventive measures that enhanced mosquito survival and infection. Malaria elimination in refugee settlements requires an integrated control approach that combines environmental management with other complementary measures like insecticide treated bed nets, indoor residual spraying and awareness.Graphical

High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study.

Malaria in pregnancy contributes to substantial morbidity and mortality among women in Uganda. However, there is limited information on the prevalence and factors associated with malaria in pregnancy among women in Arua district, northwestern Uganda. We, therefore, assessed the prevalence and factors associated with malaria in pregnancy among women attending routine antenatal care (ANC) clinics at Arua regional referral hospital in north-western Uganda. We conducted an analytic cross-sectional study between October and December 2021. We used a paper-based structured questionnaire to collect data on maternal socio-demographic and obstetric factors and malaria preventive measures. Malaria in pregnancy was defined as a positive rapid malarial antigen test during ANC visits. We performed a modified Poisson regression analysis with robust standard errors to determine factors independently associated with malaria in pregnancy, reported as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). We studied 238 pregnant women with a mean age of 25.32±5.79 years that attended the ANC clinic, all without symptomatic malaria. Of the participants, 173 (72.7%) were in their second or third trimester, 117 (49.2%) were first or second-time pregnant women, and 212 (89.1%) reported sleeping under insecticide-treated bednets (ITNs) every day. The prevalence of malaria in pregnancy was 26.1% (62/238) by rapid diagnostic testing (RDT), with the independently associated factors being daily use of insecticide-treated bednets (aPR 0.41, 95% CI 0.28, 0.62), first ANC visit after 12 weeks of gestation (aPR1.78, 95% CI 1.05, 3.03), and being in the second or third trimester (aPR 0.45, 95% CI 0.26, 0.76). The prevalence of malaria in pregnancy among women attending ANC in this setting is high. We recommend the provision of insecticide-treated bednets to all pregnant women and early ANC attendance to enable access to malaria preventive therapy and related interventions.

Accounting for complex intracluster correlations in longitudinal cluster randomized trials: a case study in malaria vector control

BackgroundThe effectiveness of malaria vector control interventions is often evaluated using cluster randomized trials (CRT) with outcomes assessed using repeated cross-sectional surveys. A key requirement for appropriate design and analysis of longitudinal CRTs is accounting for the intra-cluster correlation coefficient (ICC). In addition to exchangeable correlation (constant ICC over time), correlation structures proposed for longitudinal CRT are block exchangeable (allows a different within- and between-period ICC) and exponential decay (allows between-period ICC to decay exponentially). More flexible correlation structures are available in statistical software packages and, although not formally proposed for longitudinal CRTs, may offer some advantages. Our objectives were to empirically explore the impact of these correlation structures on treatment effect inferences, identify gaps in the methodological literature, and make practical recommendations.MethodsWe obtained data from a parallel-arm CRT conducted in Tanzania to compare four different types of insecticide-treated bed-nets. Malaria prevalence was assessed in cross-sectional surveys of 45 households in each of 84 villages at baseline, 12-, 18- and 24-months post-randomization. We re-analyzed the data using mixed-effects logistic regression according to a prespecified analysis plan but under five different correlation structures as well as a robust variance estimator under exchangeable correlation and compared the estimated correlations and treatment effects. A proof-of-concept simulation was conducted to explore general conclusions.ResultsThe estimated correlation structures varied substantially across different models. The unstructured model was the best-fitting model based on information criteria. Although point estimates and confidence intervals for the treatment effect were similar, allowing for more flexible correlation structures led to different conclusions based on statistical significance. Use of robust variance estimators generally led to wider confidence intervals. Simulation results showed that under-specification can lead to coverage probabilities much lower than nominal levels, but over-specification is more likely to maintain nominal coverage.ConclusionMore flexible correlation structures should not be ruled out in longitudinal CRTs. This may be particularly important in malaria trials where outcomes may fluctuate over time. In the absence of robust methods for selecting the best-fitting correlation structure, researchers should examine sensitivity of results to different assumptions about the ICC and consider robust variance estimators.

Malaria and Its Prevention: Socio-acceptability in the Application of Insecticides-treated Bed Nets Among Household Heads in the Rural Village Community of Mazabuka, Zambia

Introduction: Malaria poses immerse public health challenges in the world as it is still causing significant morbidity and mortality especially in endemic regions such as Zambia. One of the effective tools in preventing malaria is the application of insecticide-treated bed nets (ITNs). This study aims to explored the socio-acceptability of malaria and ITNs among rural village community of Mazabuka, Zambia. Methods: A semi-structured questionnaire was administered to 177 respondents via two different approached methods; focus group discussions and one-to-one interviews to assess the level of KAP of the respondents about malaria and ITNs. Results: Most of the respondents (98.7%) possessed ITNs that were provided free of charge by the Ministry of Health Zambia. Overall, the knowledge and attitude of respondents on malaria and ITNs were at moderate levels of 68.1% and 71.8%, respectively. In contrast, the level of practice was poor with only 36.2% of positive response. Although 92.1% of the respondents answered correctly on the association between malaria and mosquito bites, myths and misconceptions were still common as some of them still attributed malaria to drinking dirty waters (32.8%), bad weather (15.8%), witchcraft (3.4%), and bathing dirty water (19.8%). The practice was significantly associated with knowledge (p=0.003), but not attitude (p=0.230). Logistic regression analysis revealed that respondents with high knowledge level and tertiary education were more likely to use ITNs correctly (OR=2.957; OR=21.739, respectively). Conclusion: The present study showed that the knowledge gaps were remained among the villagers as misconceptions and their believe of myths were still exist.

A study on mosquitoes composition and malaria transmission in some communities in Doma Local Government Area of Nasarawa State, Nigeria

The paucity of information on malaria vectors in rural areas continues to pose a problem in the public health sector in Nigeria. Thus, the study on mosquitoes composition and malaria transmission in some communities in Doma Local Government Area (LGA) of Nasarawa State, Nigeria was carried out between April and July 2021. Indoor resting mosquitoes were collected using standard pyrethrum spray catch (PSC) from 0600 to 0900 hours. The mosquitoes collected were transferred into a well labelled petri-dish and transported to the laboratory for processing. A total of 1,317 mosquitoes were collected which spread across Iwashi 1,132 (85.9%) and Ruttu 185 (14.0%) communities. The results obtained indicate that the Anopheles mosquitoes had a higher abundance of 1,020 (77.4%) mosquitoes of which females constituted 886 (67.3%) of the population collected while the anopheline males accounted for 134 (10.2%). The abundance of mosquitoes in relation to groups, species and sex respectively varied significantly (p &lt; 0.05). A zero (0.0%) sporozoite rate was recorded from the 654 female Anopheles gambiae s. l. dissected, although oocyst was seen in the alimentary canal of 78 (11.9%) mosquitoes which may be an indicator of possible potential transmission. The results obtained from this study call on all the inhabitants of the two selected communities as well as Doma LGA at large to always clear all potential mosquitoes breeding sites. Also, members of the communities should ensure proper protection against vector-human contact by sleeping under insecticide treated bed nets.