ITN Use Research Articles

Regional and socio-economic disparity in use of insecticide-treated nets to prevent malaria among pregnant women in Kenya.

Insecticide-treated net (ITN) use is among the most recommended strategies to prevent malaria in pregnancy. We analysed the regional and socio-economic patterns of ITN use among pregnant women in Kenya using data from the 2003, 2008 and 2014 Kenyan Demographic and Health Surveys (KDHSs). Inequality was assessed using four dimensions: economic status, education, place of residence and region. Both relative and absolute summary measures were applied. In addition, simple and complex summary measures, i.e. difference, population attributable fraction, population attributable risk and ratio were considered based on the number of subgroups in each variable. There was overt inequality in the use of ITNs among pregnant women, with greater use among the better-off group in 2003 and 2014. Greater ITN use was also observed among pregnant women with a higher level of education. Pregnant women from urban settings tended to use ITNs (slept under a net the night before the survey) more than their rural counterparts in the 2003 KDHS. There were significant regional variations across the three surveys in all inequality summary measures, except ratio in the 2014 survey. Significant inequality in ITN use among pregnant women was observed at a macro scale.

The Rate of Asymptomatic Plasmodium Parasitemia and Placental Parasitization in Urban and Rural Areas of Cross River State, Nigeria

Background: Malaria in pregnancy contributes to feto-maternal morbidity and mortality even in asymptomatic forms of the disease especially in malaria endemic regions such as Nigeria. Objective: To determine the rate of asymptomatic malaria parasitemia and placental parasitization among the rural and urban pregnant women and its feto-maternal effects in Cross River State, Nigeria. Methodology: This was a prospective study of 440 pregnant women in rural and urban settings. Participants completed structured questionnaire and also have their blood samples and placentas examined for presence of malaria parasites by microscopy and histology respectively. Maternal hemoglobin concentration, birth weight, neonatal length, Apgar score and other anthropometric measurements were obtained to assess feto-maternal effect of asymptomatic malaria parasitemia and placental parasitisation in pregnancy. Data were analyzed using SPSS version 21.0 and level of significance was set as 0.05. ResultsThe prevalence of asymptomatic malaria parasitemia was 40.2% while malaria placental parasitization was 70.2%. Based on residential status, 49.5% of rural residents had malaria parasitemia which is significantly higher than their urban resident counterparts 30.9% (p=0.000). The prevalence of placental parasitization was significantly higher among rural residents 80.9% than their urban resident counterparts 59.5% (p=0.000). Concerning obstetric outcome of patients with positive malaria placental parasitisation, preterm delivery, low 5th minutes Apgar score (<7), low birth weight (<2.5kg) and low neonatal length were significantly higher in pregnancy with positive placental parasitisation than in women with negative placental malaria parasitisation. Also, preterm delivery, anemia, low 5th minutes Apgar score (<7) and low birth weight (<2.5kg) were significantly higher in pregnancy with positive malaria parasitemia than women with negative malaria parasitemia. ConclusionAsymptomatic malaria parasitemia (40.2%) and malaria placental parasitization (70.2%) in this study is high and contributes to poor obstetric outcomes mostly in the rural areas. Rural pregnant women have the highest burden than the urban women. Promotion of the use of ITNs, IPT during pregnancy and other malaria preventive measures are necessary especially in rural areas where malaria burden is highest.

A Review of the Effectiveness of Adopted, Applied, and Recommended Malaria Control Techniques within the Southeast Region of Nigeria

Malaria is a parasitic disease endemic in tropical and subtropical regions of the world. Nigeria accounts for about 51 million cases globally and 207000 deaths annually. Different control measures have been adopted to control malaria in the south Eastern region of Nigeria. These measures includes vector control, chemotherapy etc. The most recommended is vector control and it is achieved through the use of insecticide treated nets, pesticides etc. ITNs are effective vector control tools and positively reduces mosquito abundance and serves as barrier to contacts with human hosts but the set back with the ITN use is the difference between ownership and usage . Most people who own ITNs don’t use it. Diagnosis of malaria is vital in the control and treatment of malaria however, in the south eastern part of Nigeria, outcome of studies revealed gap in microscopy expertise and it has led to lots of false positive results. Chemotherapy using ACT is currently subdued due to counterfeit anti malaria drugs in the markets. There are emerging malaria control methods but they are yet to be adopted and applied in the southeastern part of Nigeria. Currently the malaria control methods adopted in Southeastern Nigeria are effective but may not adequately lead to malaria control. It is imperative to augment with emerging malaria control methods or optimize current methods to achieve the desired results.

INTRIGUING PREDICTORS ASSOCIATED WITH MALARIA INFECTION AMONG PREGNANT WOMEN IN MT. ELGON SUB COUNTY, KENYA

Introduction: Universally, malaria continues to ravage the lives of innocent expectant women. In Kenya malaria prevalence among adult females is 28% while in Mt. Elgon Sub County, which is categorised under highland epidemic prone malaria area, prevalence of malaria in pregnancy (MiP) is uncertain. Therefore, this study sought to determine intriguing predictors associated with malaria infection among pregnant women in Mt. Elgon Sub-County.
 Methods: Cross-sectional analytical design was employed and mixed methods used for data collection. For quantitative data collection, semi-structured questionnaire was used to collect primary data from pregnant women who attended ANC in selected health facilities in the study area. Further, qualitative approach adopted interview guides that targeted key informants in the health facilities. Systematic random sampling method was used to select 392 participants for the study. Data was analysed by SPSS version 25.0. Bivariate logistic regression analysis was used to test the association between independent variable and dependent variable.
 Findings: Study results revealed that, the prevalence of MiP was 16.2%. Prevalence was higher among women aged less than 25 (67.3%, n=262) compared to those aged > 25 years (33.7%, n=137). The following five factors were statistically significantly associated with malaria prevalence in pregnancy: place of residence (OR: 5.7; 95%CI: 2.6 – 12.4; p < 0.0001); those who tested positive in the last 2 years (OR: 1.7; 95%CI: 1.0 – 2.9; p = 0.05); preferred shape of ITN’s (OR: 3.8; 95%CI: 1.5 – 9.7; p = 0.008);earth floor (OR: 1.8; 95%CI: 1.0 – 3.1; p = 0.03); mud wall (OR: 1.8; 95%CI: 1.0 – 3.1; p = 0.03). In conclusion, age group, place of residence, testing positive in the last 2 years, preferred shape of ITN, earth floor and mud wall were significant factors associated with MiP.
 Recommendations: To curb MiP, the study recommends Bungoma County government to promote use of ITNs and preferable rectangular ITN’s by ensuring they are translated to appropriate use; support regular indoor residual spraying with insecticides and educate the residents on the role of improved housing on malaria protection and empowerment of the community to adopt improved housing.

Effects of indoor air movement and ambient temperature on mosquito (Anopheles gambiae) behaviour around bed nets: implications for malaria prevention initiatives

BackgroundUntil recently, relatively little research has been done on how mosquitoes behave around the occupied bed net in the indoor environment. This has been partly remedied in the last few years through laboratory and field studies, most of these using video methods and mosquito flight tracking. Despite these recent advances, understanding of the mosquito-bed net environment system, and the principles that underlie mosquito behaviour within it, is limited. This project aimed to further understand this system by studying the effects of gently moving air (such as might be introduced through room design to make the indoor environment more comfortable and conducive to ITN use) and warmer vs. cooler ambient conditions on mosquito activity around ITNs and other bed nets.MethodsThe activity of colonized female Anopheles gambiae around an occupied untreated bed net set up in a mosquito-proof tent in a large laboratory space was recorded under different ambient conditions using a laser detection-video recording system. Conditions tested were ‘cool’ (23–25 °C) and ‘warm’ (27–30 °C) air temperatures and the presence or absence of a cross-flow produced by a small central processing unit (CPU) fan pointed at the side of the net so that it produced a ‘low-’ or ‘high-’ speed cross-draught (approx. 0.1 and 0.4 m/s, respectively). Near-net activity in recordings was measured using video image analysis.ResultsIn cool, still air conditions, more than 80% of near-net activity by An. gambiae occurred on the net roof. Introduction of the low-speed or high-speed cross-draught resulted in an almost total drop off in roof activity within 1 to 2 min and, in the case of the high-speed cross-draught, a complementary increase in activity on the net side. In warm, still conditions, near-net activity appeared to be lower overall than in cool, still air conditions and to be relatively less focussed on the roof. Introduction of the high-speed cross-draught in warm conditions resulted in a decrease in roof activity and increase in side activity though neither effect was statistically significant.ConclusionsResults are interpreted in terms of the flow of the stimulatory odour plume produced by the net occupant which, consistent with established principles of fluid dynamics, appears to rise quickly and remain more intact above the net occupant in cool, still air than in warm, still air. Cross-draught effects are ascribed to the changes they cause in the flow of the host odour plume as opposed to mosquito flight directly. The implications of these results for house designs that promote indoor air movement, on bed net design, and on other vector control measures are discussed. How mosquitoes approach a net is influenced both by indoor temperature and ventilation and their interaction. This system is in need of further study.

Prevalence and risk factors for malaria in pregnancy in Vanga, Democratic Republic of Congo.

The Democratic Republic of Congo (DRC) is the second most malarious country in the world, but little information is available on malaria control measures in pregnancy. We conducted a longitudinal study among 395 women pregnant with singletons in the Vanga and Mayoko health facilities, Vanga Health Zone, Kwilu Province. We recruited 406 pregnant women between April and October 2019. Malaria prevalence at recruitment was 18.8% in Vanga and 30.1% in Mayoko (difference p<0.01). At delivery, malaria prevalence in placental samples was 9.7% in Vanga and 17.7% in Mayoko (difference p=0.04). The overall prevalence of anemia (< 11 g/dl hemoglobin) in both sites was high at recruitment (68.8%) and at delivery (62.9%). Malaria infection rates in the mother were high but decreased between first ANC contact and delivery - from 24.2% to 13.6%. It is unclear whether regular use of ITNs and uptake of IPTp-SP have contributed to that decrease.

Insecticide-treated net ownership, utilization and knowledge of malaria in children residing in Batoke\u2013Limbe, Mount Cameroon area: effect on malariometric and haematological indices

BackgroundInsecticide-treated nets (ITNs) are the most widely used interventions for malaria control in Africa. The aim of this study was to assess the ownership and utilization of ITNs and the knowledge of malaria and their effects on malariometric and haematological indices in children living in the Mount Cameroon area.MethodsA community-based cross-sectional study involving a total of 405 children aged between 6 months and 14 years living in Batoke–Limbe was carried out between July and October 2017. A semi-structured questionnaire was used to document demographic status, knowledge on malaria and ITN ownership and usage. Venous blood sample was collected from each child to determine the prevalence and intensity of parasitaemia by Giemsa-stained microscopy and full blood count by auto haematology analysis to obtain white blood cell (WBC) and red blood cell (RBC) counts, haemoglobin (Hb) level, haematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC). A multilinear regression model was used to determine the relationship between haematological parameter as dependent variable and the independent variables.ResultsThe overall prevalence of parasitaemia, anaemia, knowledge about malaria, ITN ownership, usage and effective usage was 46.7%, 54.7%, 40.7%, 78.8%, 50.9% and 29.9%, respectively. The prevalence of parasitaemia was significantly higher (P < 0.001) in children who ineffectively utilized ITNs (54.9%) than effective users (27.3%). Having knowledge of malaria, negatively correlated with WBC counts (P = 0.005), but positively correlated with Hb levels (P < 0.001), RBC counts (P < 0.001), Hct (P < 0.001), MCV (P < 0.001) and MCH (P < 0.001). ITN use positively correlated with WBC counts (P = 0.005) but negatively with Hb levels (P = 0.004), RBC counts (P = 0.006), and MCH (P < 0.001). Meanwhile, parasitaemia negatively correlated with Hb levels (P = 0.004), RBC counts (P = 0.01), Hct (P = 0.04) and MCHC (P = 0.015).ConclusionThere is need for more sensitization on the benefits of using the ITNs to meet up with the intended and expected impact of the free distribution of ITNs.

Determinants of the varied profiles of Plasmodium falciparum infections among infants living in Kintampo, Ghana

BackgroundUnderstanding why some infants tolerate infections, remaining asymptomatic while others succumb to repeated symptomatic malaria is beneficial for studies of naturally acquired immunity and can guide control interventions. This study compared demographic, host and maternal factors associated with being either parasite negative or having asymptomatic infections versus developing symptomatic malaria in the first year of life.MethodsA birth cohort (n = 1264) was monitored longitudinally over two years for malaria infections in Kintampo, Ghana. Symptomatic and asymptomatic infections were detected actively through monthly home visits, complemented by passive case detection. Light microscopy was used to detect parasitaemia. Based on data from a minimum of eight monthly visits within the first year of life, infants were classified into one of four groups: “parasite negative”, “only-asymptomatic”, “only-symptomatic” or “alternating” i.e., sometimes symptomatic and other times asymptomatic. The host and maternal characteristics and demographic factors in relation to these four groups were compared.ResultsThe parasite negative group formed 36% of the cohort, whilst the only-symptomatic were 35%. The alternating group were 22% and the only-asymptomatic were 7% of the cohort. There were significant associations between residence, socio-economic status (SES), parity, IPTp doses, delivery place of infant and having or not having malaria parasites. Maternal factors such as early commencement and frequency of ante-natal care (ANC) were significantly higher in the parasite negative group compared to all others. ITN use in pregnancy increased the odds of infant having only asymptomatic infections (“protected against disease”). Placental malaria was more common in the groups of infants with symptomatic malaria. Urban residence was significantly higher in the parasite negative group, while birth in the malaria transmission season were significantly more common in the alternating and parasite negative groups. Risk factors for infants with symptomatic malaria included low SES, birth in private maternity homes, sickle cell normal variant, lower MUAC, reported intake of anti-malarials and increased morbidity before the first microscopic infection was detected.ConclusionStrengthening ANC by encouraging early and regular attendance, the use of IPTp, maternal bed nets and improving the nourishment of infants help reduce the frequency of symptomatic malaria over the first year of life.

Factors associated with the use of insecticide-treated nets: analysis of the 2018 Burkina Faso Malaria Indicator Survey

BackgroundSleeping under an ITN reduces contact with mosquitoes through the combination of a physical barrier and an insecticidal effect, which reduces the incidence of malaria. The 2016–2020 Burkina Faso National Malaria Strategic Plan aims to have at least 90% of the population, 100% of children under age 5, and 100% of pregnant women sleep under an ITN.MethodsThe analysis examines individual, household, and community-level factors associated with ITN usage. According to the 2017–18 Burkina Faso MIS, 58% of individuals in households that own at least one ITN reported that they slept under an ITN on the night before the survey.ResultsThe use of ITNs was significantly associated with individual, household, and community-level variables that included age, gender, age of household head, number of sleeping rooms, wealth, malaria prevalence, residence, and region.ConclusionsThe results highlight areas of intervention at the individual, household, and community levels that can increase ITN use.

Factors associated with use of insecticide-treated net for malaria prevention in Manica District, Mozambique: a community-based cross-sectional survey

BackgroundInsecticide-treated net (ITN) use is crucial for preventing malaria infection. Despite significant improvements in ITN access and use over the past two decades, many malaria-endemic countries in sub-Saharan Africa have not yet reached global targets for universal coverage of ITNs. To reduce the gaps in ITN use, it is important to understand the factors associated with ITN use. The goal of this analysis was to determine the factors associated with ITN use in Manica District, Mozambique.MethodsA cross-sectional community-based survey was conducted from October to November 2019. Households were randomly selected, and all members of selected households were eligible to participate. Data on socio-demographic characteristics, housing construction and the ownership, use and characteristics of ITNs were collected using structured questionnaires. Factors independently associated with ITN use were identified using generalized estimating equations multivariate logistic regression.ResultsOf the 302 households surveyed, 209 (69.2%) owned at least one ITN and 176 (58.3%) had one ITN for every two household members. The multivariate analysis indicated that the odds of ITN use was significantly lower among individuals in households with 3 or more members. However, the odds of ITN use was significantly higher among older age groups, poorer households, and as the number of ITNs in a household increased.ConclusionsThe findings of this analysis highlight the need for behaviour change communication strategies targeting young people and ITN distribution campaigns targeting larger households to increase ITN ownership, thereby improving ITN use in Manica District.

Knowledge, Attitude and Practices towards Malaria and the Use of Insecticide-Treated Net among Rural Dwellers in Mubi North Local Government Area, Adamawa State, Nigeria

Malaria continues to be a critical health issue globally with more cases from the WHO African region and has remained endemic in Nigeria despite the possession of insecticide-treated nets. This present study aimed to explore the knowledge, attitude and practice regarding malaria and the use of ITNs as a malaria prevention strategy among rural dwellers in Mubi North Local Government Area, Adamawa State, Nigeria. A systematic questionnaire was used to get responses from a total of 304 households from January to March 2020 with only one adult interviewed per household. The respondents were the heads of the household. In their absence, a responsible adult above eighteen years, chosen by the family was interviewed. 99.3% (302) of the respondents agreed that malaria is caused as a result of a mosquito bite. The majority (90.8%) of them also agreed that ITN prevents mosquito bites, while 86.8% of them had ITNs. The study participants identified Fever (82.2%) and Headache (33.9%) as the most common evidence of malaria. Our study participants applied various preventive measures against mosquito bites such as the use of ITNs (86.5%), clearing breeding sites around their homes (28.3%), use of insecticidal sprays (18.8%), and wearing protective clothing’s (6.9%). This study has shown that respondents had good knowledge and attitude towards malaria and ITN, and also employed various measures to reduce the prevalence of malaria in the area.

Improving malaria preventive practices and pregnancy outcomes through a health education intervention: A randomized controlled trial

BackgroundThe prevalence of malaria in pregnancy and its complications, remain very high in Nigeria. This study aimed to determine the effects of a malaria health educational intervention based on the information-motivation-behavioural skills (IMB) model on malaria preventive practices and pregnancy outcomes.MethodsThe study was a randomized controlled parallel-group study, where 372 randomly selected antenatal care attendees were randomly assigned to one of either two groups after collecting baseline data. The intervention group then received a four-hour health education intervention in Hausa language, which was developed based on the IMB model, while the control group received a similarly designed health education on breastfeeding. Follow up data were then collected from the participants at a first (2 months post-intervention) and second (4 months post-intervention) follow up, and at the end of their pregnancies.ResultsFor both groups, reported ITN use had increased from baseline (Intervention: Often–14.0%, Almost always–9.1; Control: Often–12.4%; Almost always 16.1%) to the time of second follow up (Intervention: Often –28.10%, Almost always–24.5; Control: Often–17.2%; Almost always 19.5%). Reported IPTp uptake at second follow up was also higher for the intervention group (Intervention: Two doses–59.0%, Three doses 22.3%; Control group: Two doses–48.4%, Three doses–7.0%). The drop in the haematocrit levels was greater for the control group (32.42% to 30.63%) compared to the intervention group (33.09% to 31.93%). The Generalized Linear Mixed Models (GLMM) analysis revealed that the intervention had significantly improved reported ITN use, reported IPTp uptake, and haematocrit levels, but had no significant effect on the incidence of reported malaria diagnosis or babies’ birth weights.ConclusionsThe intervention was effective in improving ITN use, IPTp uptake, and haematocrit levels. It is, therefore, recommended for the modules to be adopted and incorporated into the routine antenatal care programmes in health centres with predominantly Hausa speaking clients.Trial registration: Pan African Clinical Trial Registry, PACTR201610001823405. Registered 26 October 2016, www.pactr.org.

Malaria Preventive Practices among Pregnant Women in the Niger Delta Region of Nigeria: A Comparative Study

Background: Malaria has a deleterious effect on pregnancy leading to serious pregnancy complications and adverse pregnancy outcomes. Use of effective malaria preventive practices during pregnancy mitigates the harmful effect of the disease on pregnancy. Aim: To determine the malaria preventive practices used by pregnant women in three states (Rivers, Delta, Akwa Ibom) of the Niger Delta region of Nigeria. Materials and Methods: A cross-sectional study was carried out in public health facilities in three states of the Niger Delta, Nigeria to assess the preventive practices of pregnant women over a six month period. A total of six health facilities was selected from each state giving eighteen health facilities from the three states. Approximately 100 to 200 consenting pregnant women were recruited over a period of one to two weeks from each facility. Information was obtained with pretested questionnaires by trained personnel with the aid of Open Data Kit (ODK) on android phones. The data was analyzed using Statistical Package for the Social Sciences (SPSS) version 22 and results were presented in prose and frequency tables. A p-value of <0.05 was considered statistically significant. Results: There were 2,960 participants (mean age 29.6 ± 4.93) with 2844 (96.08%) being married. Over half 53.01% (1569) had tertiary education, majority 35.37% (1047) of them were traders and business women. Preventive practices employed included window nets use 42.3% (2059), insecticides 28.9% (1411), bed nets 27.9% (1360), and others. There were 59.14% (1100) that received medications for prevention out of which 79.83% (918) received IPTp-SP. Only 33.6% (993) slept under the net the night before the interview. Conclusion: In the Niger Delta region, uptake of IPTp is above 70% and provided a significant prophylactic benefit compared to those that did not take. However ITN use was very low in the area whereas IRS was not in use at all. The need for continuous enlightenment and awareness of the importance of these practices especially ITN use in the study area is very imperative.

Knowledge of risks of malaria in pregnancy on use of ITNs among pregnant women in northern Ghana

Abstract Background Every year malaria in pregnancy causes 10,000 maternal mortalities worldwide, 20% of stillbirths, 11% of all new-born deaths and 900,000 low-birth-weight babies in sub-Saharan Africa. Maternal knowledge of malaria risks in pregnancy plays a significant role in malaria prevention. However, it is unknown if this preventable loss of lives and morbidities are caused by lack of knowledge, lack of prevention tools or both. We measured the pregnancy-related risks of malaria knowledge and bed net availability and use among pregnant women in Ghana. Methods We interviewed 770 pregnant women who attended antenatal care in 37 primary care clinics in Ghana from January through May 2019. We integrated this data in a sequential explanatory design with qualitative insights from 6 focus groups with 8 pregnant women each. Results 697/770 questionnaires were analyzed. 67% have general knowledge on malaria prevention but only 19% knew the specific risks on pregnancy outcomes. ITNs were owned by 89%, but only 75% reported to regularly use them. There was a statistically significant correlation between specific risks of malaria knowledge and ITN use (P&amp;lt;.001, OR = 2.0, CI:1.3-3.0). Other factors associated with ITN use were higher income, owning an ITN, higher parity, formal education, religion, and age. Reasons for non-adherence to ITN use include inappropriate hanging infrastructure, discomfort with using an ITN, and use of other prevention alternatives. Conclusions The study demonstrates that maternal knowledge on the risks of malaria in pregnancy significantly influenced their adherence to the use of insecticide-treated bed nets. Key messages The use of ITNs as a prevention method for malaria correlates to the knowledge of mothers about risks of malaria in pregnancy. Antenatal care malaria prevention efforts should focus more on teaching the specific risks of malaria in pregnancy.

A multicenter study of the prevalence and risk factors of malaria and anemia among pregnant women at first antenatal care visit in Ghana.

BackgroundMalaria in pregnancy remains a major public health problem in Africa and Ghana and has been associated with a variety of pregnancy-related adverse complications. The development of effective and timely health policies for the prevention and control of malaria and anemia in pregnancy; requires current and consistent data on the prevalence and risk factors. We report the prevalence and risk factors of malaria and anemia from three major hospitals across three regions in Ghana.MethodsThis multicenter cross-sectional study comprising a total of 628 pregnant women was conducted at the antenatal care units of the Achimota Hospital in the Greater Accra Region (n = 199), St. Michael’s Hospital in the Ashanti Region (n = 221), and Effia Nkwanta Regional Hospital in the Western Region (n = 211). Questionnaires were administered to obtain socio-demographic, obstetrics and clinical data. Venous blood, stool and urine samples were collected for hematological profile and parasite identification using microscopy. Risk factors were evaluated using logistic regression models.ResultsThe overall prevalence of P. falciparum malaria was 8.9%. Factors independently associated with malaria were self-reported mosquito exposure (moderate exposure: aOR = 3.11, 95% CI (1.12–8.61) and severe exposure: aOR = 10.46, 95% CI (3.86–28.34)) and non-use mosquito repellents (aOR = 3.29, 95% CI (1.70–6.39)). Multiparty (parity of 2: aOR = 0.19, 95% CI (0.05–0.70) and parity ≥3: aOR = 0.11, 95% CI (0.03–0.45)) and age (20–30 years old: aOR = 0.22, 95% CI (0.09–0.56)) reduced the odds of infection. The overall prevalence of anemia was 42.4%. The prevalence of mild, moderate and severe anemia were 35.7%, 6.1% and 0.6%, respectively. The use of water other than purified water (tap water: aOR = 3.05, 95% CI (2.06–4.51) and well water: aOR = 2.45, 95% CI (1.35–4.44)), increasing gestational age (second trimester: aOR = 2.05, 95% CI (1.41–2.97) and third trimester: aOR = 7.20, 95% CI (3.06–16.92)) and malaria (aOR = 2.40, 95% CI (1.27–4.53)) were independent risk factors for anemia.ConclusionsAlthough the prevalence of malaria is relatively low, that of anemia remains high. We recommend increasing efforts to make ITNs more available to strengthen malaria prevention. Public health education programs could help improve uptake and proper use of ITNs. To help reduce anemia in pregnancy, women should be empowered economically and interventions that reduce malnutrition should be encouraged. Women should be educated on early initiation of antenatal care to enhance surveillance, identification and treatment of anemia.

Spatiotemporal analysis of insecticide-treated net use for children under 5 in relation to socioeconomic gradients in Central and East Africa

BackgroundInsecticide-treated net (ITN) use is the core intervention among the strategies against malaria in sub-Saharan Africa (SSA) and the percentage of ITN ownership has increased from 47% in 2010 to 72% in 2017 across countries in SSA. Regardless of this massive expansion of ITN distribution, considerable gap between ownership and use of ITNs has been reported. Using data from more than 100,000 households in Central and East Africa (CEA) countries, the main aim of this study was to identify barriers associated with low ITN use and conduct geospatial analyses to estimate numbers and locations of vulnerable children living in areas with high malaria and low ITN use.MethodsMain sources of data for this study were the Demographic and Health Surveys and Malaria Indicator Surveys conducted in 11 countries in CEA. Logistic regression models for each country were built to assess the association between ITN ownership or ITN use and several socioeconomic and demographic variables. A density map of children under 5 living in areas at high-risk of malaria and low ITN use was generated to estimate the number of children who are living in these high malaria burden areas.ResultsResults obtained suggest that factors such as the number of members in the household, total number of children in the household, education and place of residence can be key factors linked to the use of ITN for protecting children against malaria in CEA. Results from the spatiotemporal analyses found that although total rates of ownership and use of ITNs across CEA have increased up to 70% and 48%, respectively, a large proportion of children under 5 (19,780,678; 23% of total number of children) still lives in high-risk malaria areas with low use of ITNs.ConclusionThe results indicate that despite substantial progress in the distribution of ITNs in CEA, with about 70% of the households having an ITN, several socioeconomic factors have compromised the effectiveness of this control intervention against malaria, and only about 48% of the households protect their children under 5 with ITNs. Increasing the effective ITN use by targeting these factors and the areas where vulnerable children reside can be a core strategy meant to reducing malaria transmission.

Sustaining LLIN coverage with continuous distribution: the school net programme in Tanzania

Most malaria-endemic countries have struggled in the past decade to establish effective national-scale continuous distribution mechanisms for long-lasting insecticidal nets (LLINs). Since the implementation of the Tanzania National Voucher Scheme in 2004 and mass-distribution campaigns in 2009–2011 and 2015–2016, Tanzania has been committed to finding new and innovative ways of achieving and maintaining universal bed net coverage. Planning for the School Net Programme (SNP) began in 2011 and in 2013, the country piloted a SNP in three regions. Nets were distributed annually to children attending schools in selected primary and secondary grades. Intra-family re-distribution was assumed, and hence the family as a whole, rather than just the children themselves, were the targeted beneficiaries. The programme has since expanded to 14 regions and has seen six rounds of annual distribution. In its fifth year, 3 million nets were distributed at a cost of USD 3.64 per net and USD 0.60 per person-year of protection (including the net). ITN access and use were maintained at a high level (~ 50–75%) over the first 4 years of distribution within selected evaluation areas, even in the absence of a mass distribution event. Net distribution through primary schools has proven to be a feasible and effective strategy for maintaining consistently high coverage in Tanzania.

Indoor residual spraying for malaria control in sub-Saharan Africa 1997 to 2017: an adjusted retrospective analysis

BackgroundIndoor residual spraying (IRS) is a key tool for controlling and eliminating malaria by targeting vectors. To support the development of effective intervention strategies it is important to understand the impact of vector control tools on malaria incidence and on the spread of insecticide resistance. In 2006, the World Health Organization (WHO) stated that countries should report on coverage and impact of IRS, yet IRS coverage data are still sparse and unspecific. Here, the subnational coverage of IRS across sub-Saharan Africa for the four main insecticide classes from 1997 to 2017 were estimated.MethodsData on IRS deployment were collated from a variety of sources, including the President’s Malaria Initiative spray reports and National Malaria Control Programme reports, for all 46 malaria-endemic countries in sub-Saharan Africa from 1997 to 2017. The data were mapped to the applicable administrative divisions and the proportion of households sprayed for each of the four main insecticide classes; carbamates, organochlorines, organophosphates and pyrethroids was calculated.ResultsThe number of countries implementing IRS increased considerably over time, although the focal nature of deployment means the number of people protected remains low. From 1997 to 2010, DDT and pyrethroids were commonly used, then partly replaced by carbamates from 2011 and by organophosphates from 2013. IRS deployment since the publication of resistance management guidelines has typically avoided overlap between pyrethroid IRS and ITN use. However, annual rotations of insecticide classes with differing modes of action are not routinely used.ConclusionThis study highlights the gaps between policy and practice, emphasizing the continuing potential of IRS to drive resistance. The data presented here can improve studies on the impact of IRS on malaria incidence and help to guide future malaria control efforts.

Validity and reliability of a Hausa language questionnaire assessing information, motivation and Behavioural skills for malaria prevention during pregnancy

BackgroundMany studies on malaria knowledge, attitude and practice among pregnant women have been conducted in Hausa speaking communities in Nigeria. Despite this, no standard and uniform instrument for assessing this important public health problem has been developed in the Hausa language, even though it is widely spoken. The aim of this study was to develop and validate a questionnaire in Hausa language assessing information, motivation, and behavioural skills for malaria prevention during pregnancy.MethodsThe questionnaire was first developed in English language, and then assessed for its contents by a team of experts. It was then forwardly translated to Hausa, and backwardly translated again to English by independent language experts. These two English versions were then compared by a Public Health expert, following which the questionnaire was administered to 190 Hausa speaking antenatal care attendees. Exploratory factor analysis was performed on the data collected. Sixty three out of the 190 respondents were invited after 2 weeks to answer the same questionnaire, following which reliability tests were performed.ResultsThe questionnaire showed good internal consistency, with Cronbach’s alpha values of 0.859, 0.890 and 0.773 for information, motivation and behavioural skills constructs respectively. The motivation and behavioural skills constructs were able to delineate their items into three and two sub-sections respectively. The factor loadings for the two constructs ranged from 0.610 to 0.965. As for test retest reliability, the Krippendorff’s alpha values for the items of the motivation section ranged from 0.941 to 0.996; that for behavioural skills ranged from 0.810 to 0.953, while for frequency of ITN use, it was 0.988. The Cohen’s kappa values for the information section ranged from 0.689–0.974, except the item for ‘fever’ (zazzabi) which was 0.382, and was as such reworded to a simpler terminology ‘hotness of the body’ (zafin jiki).ConclusionsThe Hausa language IMB questionnaire on malaria in pregnancy demonstrated good validity, and a high level of reliability. It is as such recommended for use among Hausa speaking communities to ensure uniformity and objectivity.

Malaria Preventive Practices among Pregnant Women in Akwa Ibom State, Southern Nigeria

Background: Malaria is a serious public health problem in developing countries with Africa bearing most of its burden. Pregnant women are more susceptible to malaria and it is one of the leading causes of maternal and perinatal mortality/morbidity. Use of effective malaria preventive measures during pregnancy reduces its burden and complications.&#x0D; Aim: This was to determine malaria preventive practices used by pregnant women in Akwa Ibom state, Nigeria.&#x0D; Materials and Methods: It was a cross sectional study of pregnant women attending public and private health facilities in Akwa Ibom state. An informed written consent was obtained from the participants. Stratified sampling method was used in selecting the health facilities and the study participants. Information was obtained with pretested questionnaires by trained personnel with the aid of Open Data Kit (ODK) on android phones. Data was managed with SPSS 22.0 and P-value of &lt;0.05 was considered statistically significant.&#x0D; Results: There were 935 participants in the study. Their mean age was 28.52 ± 5.09 years with 879 (94.0%) being married. Most had secondary and tertiary degrees: 451(48.2%) and 440(47.1%). Majority of them were traders/business women and self-employed (58.2%) while 7% were unemployed. Malaria preventive practices were use of window net, bed net and insecticides accounting for 659(71%), 447(48.2%) and 207(22.3%) respectively. There were 612 (65.5%) participants that received malaria drugs for prevention with 452(73.9%) receiving Intermittent Preventive Treatment in Pregnancy (IPTp) with Sulfadoxine-Pyrimethamine (SP). Only 296 (31.7%) of them slept under bed nets the night before the interview.&#x0D; Conclusion: Common preventive practices employed by pregnant women were IPTp with SP, window nets, ITNs and modified IRS. Majority of the women utilized widow nets, though not as effective as ITNs. Efforts should be intensified concerning awareness creation about the benefits of ITN use during pregnancy.