Long-lasting Insecticidal Nets Ownership Research Articles

Long-Lasting Insecticidal Net Ownership and Use in Mogode Health District, Cameroon.

Cameroon is a malaria-endemic country. Many control strategies including long-lasting insecticidal nets (LLIN) have been proposed to reduce the burden of malaria. The World Health Organization aims to achieve at least 80% of people sleeping under a LLIN. This study assessed the ownership and use of LLNs in the Mogode Health District (MHD). A community-based cross-sectional study was conducted in MHD in September 2021. Data on ownership and LLINs use were collected using structured questionnaires following the Roll Back Malaria guidelines. Univariate and multivariate analyses were performed to assess the determinants of ownership and failure to LLIN use. A total of 332 households were included from eight health areas. The proportion of households with at least one LLIN was 72.0% (238). However, 232 (70.0%) reported having used LLIN (sleeping under LLIN the previous night). Household heads with higher education were six times more likely to have owned LLINs than those with no education (adjusted odds ratio (AOR)=6.8; confidence interval (CI) 1.5, 31.0, p< 0.05). Additionally, household heads between the ages of 36-50 were 4.2 times (AOR= 4.2, CI 1.3-13.8, p< 0.05) likely to fail to use LLINs in households. However, households where heads had secondary education (AOR= 0.2, CI 0.1-0.6, p< 0.05), were negatively associated with failure to use LLINs. Ownership and use of LLINs in MHD remain challenging. Therefore, this finding will contribute to improving recommendations and updating strategies such as targeted messages aimed at raising awareness of malaria during mass LLIN distribution campaigns.

Low long-lasting insecticidal net use in malaria elimination areas in Southern Ethiopia: results from community based cross-sectional study

BackgroundDespite remarkable progress in malaria burden reduction, malaria continues to be a major public health problem globally. Ethiopia has been distributing long-lasting insecticidal nets (LLINs) for free and nationwide distribution was completed in 2016. However, evidence suggests that the utilization of LLINs varies from setting to setting and from time to time due to different factors, and up-to-date evidence is required for LLIN related decision-making. Hence, this study was designed to assess LLIN utilization and its determinants in the Southern Nations, Nationalities, and People’s Region (SNNPR) of Ethiopia.MethodsA community-based cross-sectional study was conducted in Southern Ethiopia in 2019. Using multi-stage sampling, a total of 2466 households were included. The region was stratified based on the annual malaria index as high, moderate, low, and free strata. Cluster sampling was then applied to select households from high, moderate, and low strata. Data on LLIN ownership, utilization and different determinant factors were collected using household questionnaire. SurveyCTO was used to collect data and data was managed using Stata 15. Descriptive statistics and multilevel mixed-effects logistic regression were performed to identify the determinants of utilization of LLINs. Effect measures were reported using adjusted odds ratio (AOR) with 95% CI.ResultsFrom a total of 2466 households, 48.7% of households had at least one LLIN. LLIN adequacy based on family size was 23% while it was15.7% based on universal access and 29.2% based on sleeping space. From 1202 households that possessed LLIN(s), 66.0% of households reported that they slept under LLIN the night preceding the survey. However, when the total population in all surveyed households were considered, only 22.9% of household members slept under LLIN the night preceding the survey. Malaria endemicity, educational status, wealth status, and knowledge about malaria were associated with LLINs utilization. In addition, reasons for non-use included perceived absence of malaria, side effects of LLIN, conditions of LLINs, inconvenient space and low awareness.ConclusionLow LLIN coverage and low utilization were noted. A low level of utilization was associated with malaria endemicity, wealth status and level of awareness. Distribution of LLIN and continuous follow-up with community awareness creation activities are vital to improve coverage and utilization of LLINs, and to ensure the country’s malaria elimination goal.

Malaria epidemics associated with low net use in preadolescent and young adult population in Dielmo (Senegal), a malaria pre-elimination area

BackgroundThe epidemic rebounds observed in 2010 and 2013 in Dielmo, a Senegalese village, during a decade (2008–2019) of universal coverage using a long-lasting insecticidal net (LLIN) strategy could have contributed to the resurgence of malaria. Thus, this study was undertaken to understand the implications of net ownership and use on malaria rebound events.MethodsA longitudinal study was carried out in Dielmo with 11 years of LLIN implementation from July 2008 to June 2019 with successive net renewals in 2011, 2014, 2016 and 2019. Quarterly cross-sectional surveys were performed to assess LLIN ownership and use by different age groups in the population. In addition, malaria incidence and transmission were assessed during the study period.ResultsOwnership of LLINs decreased significantly from 88% in the 1st year of net implementation to 70% during the first malaria upsurge and 72% during the second upsurge while net use decreased significantly from 66% during the 1st year to 58% during the first malaria upsurge and 53% during the second upsurge.Among young adults aged 15–29 years, net use decreased significantly from the 2nd year (51%) of net use to reach 43% during the first malaria upsurge and only 32% use during the second malaria upsurge. During the second malaria upsurge, net use was significantly lower among older children aged 10–14 years old than during the 1st year of net use (p < 0.001). During the first and the second malaria upsurges, the malaria incidence was significantly higher among children aged 10–14 years old (0.4 attacks per person-year) and young adults aged 15–29 years old (0.3 and 0.4 attacks per person, respectively) than during that the 1st year of net implementation (only 0.02 attacks per person-year for 10–14 year olds and 0.04 for 15–29 year olds; p < 0.001).ConclusionsThe first malaria upsurge occurred following a progressive decrease in net use after the 2nd year of their implementation with an important increase in malaria incidence among older children while the second malaria upsurge was significantly associated with the decrease of net use among older children and young adults. The regular use of nets in all age groups prevented the occurrence of a third malaria upsurge in Dielmo.Graphical

Predictors of Daily Utilization of Long-Lasting Insecticidal Nets for Malaria Prevention in Pregnancy among Antenatal Care Recipients in Southern Nigeria

Malaria remains a significant public health concern, particularly among pregnant women in sub-Saharan Africa. Long Lasting Insecticidal Nets (LLINs) have been recognized as an effective preventive measure against malaria transmission. However, the utilization of LLINs among pregnant women remains suboptimal. This study aimed to assess the level of daily LLIN utilization and identify its predictors among pregnant women receiving antenatal care in a tertiary healthcare centre in Southern Nigeria. A cross-sectional study was conducted among antenatal recipients at the University of Uyo Teaching Hospital in Uyo, AkwaIbom State. A total of 323 respondents were recruited for the study. Data were collected using a pre-tested semi-structured questionnaire. Multivariable logistic regression analyses were performed to identify predictors of daily LLIN usage. One hundred and twenty seven (39.3%) of the respondents had ever slept inside a LLIN during the index pregnancy, while 22.6% reported daily usage. LLIN ownership was reported by 47.7% of the respondents, highlighting a discrepancy between ownership and consistent use. Predictors of daily LLIN usage included LLIN ownership (aOR 3.83, 95% CI 1.95-7.48), absence of discomfort during LLIN use (aOR 9.33,95%CI 4.32-20.17), non-use of other malaria preventive measures (aOR 3.7,95% CI 11.51-8.93) and presence of mosquitoes in home dwelling (aOR 3.56 95%CI 1.35-9.37). Health education campaigns should emphasize the benefits of daily LLIN usage during pregnancy. Policy interventions are warranted to increase LLIN distribution and availability to pregnant women through antenatal care clinics.

Long-lasting insecticidal nets (LLINs) use among household members for protection against mosquito bite in Mogadishu districts.

Understanding long-lasting insecticidal nets (LLINs) utilization is important in monitoring and quantifying the impact of past and current prevention and control efforts of malaria. A cross-sectional study was carried out on a sample of 409 households in Mogadishu, to estimate the LLIN use and assess barriers to its utilization. A standardized questionnaire was used to collect data on demographics, malaria-related knowledge, and the use of preventive measures. LLINs use was assessed using multivariable generalized estimating equations with adjustment for clustering of study participants within the same household. Out of 409 households only 155 (37.9%) owned LLINs. Out of 237 owned LLINs, 199 (84.0%) were used. Median household size being 6.0 (3.0), intra-household net accessibility was low, with one net (42.6%) frequent. Most nets were from mass distribution (55.7%) and obtained '12 months ago'. Un-partnered respondents (unadjusted odds ratio [OR] 0.34, 95% CI 0.14, 0.82; p = 0.017) compared with partnered (married) respondents, large-sized household (adjusted OR 0.83, 96% CI 0.74-0.94; p = 0.002). There was marginal evidence of a greater odds of LLIN utilization among respondents knowledgeable of the correct cause of malaria, that is, mosquito bites (AOR 3.19, 95% CI 0.77, 13.2; p = 0.11) but was not statistically significant. Among households owning nets, most of the LLINs were hung the night prior to the survey (7.9% versus 98%) and was associated with greater marginal odds of utilization (p<0.001). Ownership of LLINs is insufficient in Mogadishu districts affecting household-level access and utilization. If this is not checked, this could weaken the progress made on malaria control efforts. LLIN utilization was modest and largely driven by recently acquired nets showing a desire to utilize them despite low coverage. These imply that mass and facility-based distribution, and awareness campaigns will remain relevant, but efforts for willingness-to-pay for LLINs should be strengthened to sustain coverage and replacements of worn-out nets.

Utilization of long lasting insecticidal net among children aged less than five years in a tertiary health facility in south-west Nigeria

ABSTRACT Introduction Long-lasting insecticidal nets (LLINs) are the most widely used vector control interventions for preventing malaria transmission. The study sought to determine the regular use of LLIN, factors associated with the usage and the effect of regular LLIN utilization on the development of malaria among under-five children. Methods This was a hospital-based cross-sectional observation study. We enrolled consecutive caregivers with their children aged 6 to 59 months who presented with fever in the absence of a localizing sign. A structured questionnaire was used to obtain information about the level of utilization of LLIN. Malaria parasitemia was detected using the P. falciparum rapid diagnostic test kit and/or microscopic examination of blood. Results A total of 303 children/caregivers pair was studied. The mother’s mean (SD) age was 37.17 (6.75) years, while the children was 24.36 (16.63) months. The majority (183; 60.4%) of the children were male. Parental awareness of LLIN was high (96.7%), LLIN ownership was 72.3%, however, only 119 (39.3%) were regular user of LLIN. Factors significantly associated with regular LLIN use were younger age, parental awareness, ownership of LLIN, source of acquisition of LLIN and permanently hanging the LLIN on sleeping space (p = 0.031, 0.010, 0.000, 0.006 and 0.000 respectively). Using binary logistic regression, the child’s age, source of LLIN and hanging the LLIN permanently on the bed remained statistically significant to the regular use of LLIN (p = 0.046, 0.035 and 0.000 respectively). The frequency of malaria was significantly higher among the children who did not use and those who uses LLIN irregularly (97.1% versus 32.9%, p = 0.000). Conclusions Regular use of LLIN is low in the study area. Hanging the insecticidal bed-net permanently on the bed/sleeping space promotes its regular usage. The frequency of malaria was reduced among the children using the LLIN regularly.

Ownership and use of long-lasting insecticidal nets three months after a mass distribution campaign in Uganda, 2021

BackgroundUganda conducted its third mass long-lasting insecticidal net (LLIN) distribution campaign in 2021. The target of the campaign was to ensure that 100% of households own at least one LLIN per two persons and to achieve 85% use of distributed LLINs. LLIN ownership, use and associated factors were assessed 3 months after the campaign.MethodsA cross-sectional household survey was conducted in 14 districts from 13 to 30 April, 2021. Households were selected using multistage sampling. Each was asked about LLIN ownership, use, duration since received to the time of interview, and the presence of LLINs was visually verified. Outcomes were having at least one LLIN per two household members, and individual LLIN use. Modified Poisson regression was used to assess associations between exposures and outcomes.ResultsIn total, 5529 households with 27,585 residents and 15,426 LLINs were included in the analysis. Overall, 95% of households owned ≥ 1 LLIN, 92% of the households owned ≥ 1 LLIN < 3 months old, 64% of households owned ≥ 1 LLIN per two persons in the household. Eighty-seven per cent could sleep under an LLIN if every LLIN in the household were used by two people, but only 69% slept under an LLIN the night before the survey. Factors associated with LLIN ownership included believing that LLINs are protective against malaria (aPR = 1.13; 95% CI 1.04–1.24). Reported use of mosquito repellents was negatively associated with ownership of LLINs (aPR = 0.96; 95% CI 0.95–0.98). The prevalence of LLIN use was 9% higher among persons who had LLINs 3–12 months old (aPR = 1.09; 95% CI 1.06–1.11) and 10% higher among those who had LLINs 13–24 months old (aPR = 1.10; 95% CI 1.06–1.14) than those who had LLINs < 3 months old. Of 3,859 LLINs identified in the households but not used for sleeping the previous night, 3250 (84%) were < 3 months old. Among these 3250, 41% were not used because owners were using old LLINs; 16% were not used because of lack of space for hanging them; 11% were not used because of fear of chemicals in the net; 5% were not used because of dislike of the smell of the nets; and, 27% were not used for other reasons.ConclusionThe substantial difference between the population that had access to LLINs and the population that slept under LLINs indicates that the National Malaria Control Programme (NMCP) may need to focus on addressing the main drivers or barriers to LLIN use. NMCP and/or other stakeholders could consider designing and conducting targeted behaviour change communication during subsequent mass distribution of LLINs after the mass distribution campaign to counter misconceptions about new LLINs.

LLIN Evaluation in Uganda Project (LLINEUP2)—Factors associated with coverage and use of long‑lasting insecticidal nets following the 2020–21 national mass distribution campaign: a cross-sectional survey of 12 districts

BackgroundIn 2020–2021, long-lasting insecticidal nets (LLINs) were distributed nationwide in Uganda during the COVID-19 pandemic. A cross-sectional survey was conducted in 12 districts to evaluate the impact of the campaign 1–5 months after LLIN distribution.MethodsDuring April–May 2021, households were randomly selected from target areas (1–7 villages) surrounding 12 government-run health facilities established as Malaria Reference Centres; at least 50 households were enrolled per cluster. Outcomes included household ownership of LLINs distributed through the universal coverage campaign (UCC) (at least one UCC LLIN), adequate coverage of UCC LLINs (at least one UCC LLIN per 2 residents), and use of LLINs (resident slept under a LLIN the previous night). Multivariate logistic regression models were used to identify household- and individual-level factors associated with outcomes, controlling for clustering around health facilities.ResultsIn total, 634 households, with 3342 residents and 1631 bed-nets, were included. Most households (93.4%) owned at least 1 UCC LLIN, but only 56.8% were adequately covered by UCC LLINs. In an adjusted analysis, the factor most strongly associated with adequate coverage by UCC LLINs was fewer household residents (1–4 vs 7–14; adjusted odds ratio [aOR] 12.96, 95% CI 4.76–35.26, p < 0.001; 5–6 vs 7–14 residents; aOR 2.99, 95% CI 1.21–7.42, p = 0.018). Of the 3166 residents of households that owned at least one UCC LLIN, only 1684 (53.2%) lived in adequately covered households; 89.9% of these used an LLIN the previous night, compared to 1034 (69.8%) of 1482 residents living in inadequately covered households. In an adjusted analysis, restricted to residents of inadequately covered households, LLIN use was higher in children under-five than those aged 5–15 years (aOR 3.04, 95% CI 2.08–4.46, p < 0.001), and higher in household heads than distantly-related residents (aOR 3.94, 95% CI 2.38–6.51, p < 0.001).ConclusionsUganda’s 2021–21 campaign was successful, despite the COVID-19 pandemic. In future campaigns, strategies should be adopted to ensure high LLIN coverage, particularly for larger households. A better understanding of the drivers of LLIN use within households is needed to guide future interventions, educational messages, and behaviour change communication strategies; school-aged children and distantly-related residents appear vulnerable and could be targeted.

Blood-feeding patterns of Anopheles vectors of human malaria in Malawi: implications for malaria transmission and effectiveness of LLIN interventions

BackgroundAccess to human hosts by Anopheles mosquitoes is a key determinant of vectorial capacity for malaria, but it can be limited by use of long-lasting insecticidal nets (LLINs). In Malawi, pyrethroid-treated LLINs with and without the synergist piperonyl butoxide (PBO) were distributed to control malaria. This study investigated the blood-feeding patterns of malaria vectors and whether LLINs containing pyrethroid and PBO led to a reduction of human blood feeding than those containing only pyrethroids.MethodsMosquitoes were sampled inside houses from May 2019 through April 2020 by aspiration, pyrethrum spray catch, and light trap methods in two sites. One site (Namanolo, Balaka district) had LLINs containing only pyrethroids whereas the other (Ntaja, Machinga district) had LLINs with both pyrethroids and PBO. Anopheles species, their blood-meal host, and infection with Plasmodium falciparum were determined using PCR methods.ResultsA total of 6585 female Anopheles were sampled in 203 houses. Of these, 633 (9.6%) were blood-fed mosquitoes comprising of 279 (44.1%) Anopheles arabiensis, 103 (16.3%) Anopheles gambiae 212 (33.5), Anopheles funestus, 2 (0.3%), Anopheles parensis and 37 (5.8%) were unidentified Anopheles spp. Blood meal hosts were successfully identified for 85.5% (n = 541) of the blood-fed mosquitoes, of which 436 (81.0%) were human blood meals, 28 (5.2%) were goats, 11 (2.0%) were dogs, 60 (11.1%) were mixed goat-human blood meals, 5 (0.9%) were dog–human, and 1 was a mixed dog-goat. Human blood index (fraction of blood meals that were humans) was significantly higher in Namanolo (0.96) than Ntaja (0.89). Even though human blood index was high, goats were over-selected than humans after accounting for relative abundance of both hosts. The number of infectious Anopheles bites per person-year was 44 in Namanolo and 22 in Ntaja.ConclusionAlthough LLINs with PBO PBO may have reduced human blood feeding, access to humans was extremely high despite high LLIN ownership and usage rates in both sites. This finding could explain persistently high rates of malaria infections in Malawi. However, this study had one village for each net type, thus the observed differences may have been a result of other factors present in each village.

Assessment of knowledge about malaria and LLIN ownership and its use in Bankura, West Bengal, India.

Community participation is one of the key factors for implementation and success of a public health programme which depends upon knowledge about that disease. Therefore, understanding the community knowledge about malaria is important for designing sustainable control programmes. This study was conducted to assess the knowledge about malaria, to evaluate long lasting insecticidal nets (LLINs) distribution and their use by LQAS method in endemic areas of Bankura district, West Bengal state, India Methods: It was a community based cross-sectional survey conducted in Bankura during December 2019-March 2020. Structured questionnaire under four categories: socio-demographic variables, knowledge of malaria, owner ship of LLINs and its use were used for the interview. Ownership of LLINs and its use were analysed by LQAS method. Data were analysed by binary logistic regression model and chi-squared test. Out of 456 respondents, 88.59% had good knowledge, 97.37% had good ownership of LLIN and 78.95% used LLINs properly. The knowledge about malaria was significantly associated with education level (p-value<0.0001). Out of 24 lots studied, 3, 2, 4 lots were underperforming with respect to knowledge, ownership of LLIN and its use, respectively. The study population had a good knowledge about malaria. In spite of good coverage of LLIN distribution, the use of LLINs was not up to the mark. LQAS analysis showed underperformance in few lots about knowledge, ownership of LLIN and its use. The IEC and BCC activities about LLIN should be done to achieve the impact of this intervention at the community level.

Evaluation of long-lasting insecticidal net distribution through schools in Southern Tanzania

Universal coverage with effective vector control remains the mainstay of malaria vector control in sub-Saharan Africa. Tanzania has utilized a number of mechanisms for the maintenance of long-lasting insecticidal net (LLIN) coverage over time. Schools have been identified as one potential channel for continuous distribution of LLIN. This research aims to evaluate an annual school-based LLIN distribution programme in Tanzania that began in 2013, called the School Net Programme (SNP). Following each of the first four rounds of SNP distribution, a household survey was conducted in intervention and comparison districts in Southern and Lake zones of Tanzania (N = 5083 households). Measures of ownership, access and use were compared between intervention and comparison districts. Determinants of reach were assessed in intervention districts. Population access to an LLIN increased from 63.1% (95% CI: 58.8, 67.5) to 76.5% (95% CI: 72.9, 80.0) in the intervention districts between the first and last surveys. Access also rose in the comparison districts from 51.4% (95% CI: 46.9, 55.9) to 79.8% (95% CI: 77.3, 82.0) following mass distribution and implementation of school-based distribution during the study period. LLIN use increased in intervention districts from 44.9% (95% CI: 40.5, 49.3) to 65.6% (95% CI: 59.4, 71.8) and from 57.2% (95% CI: 49.7, 64.7) to 77.4% (95% CI: 69.3, 85.5) specifically amongst primary school-aged children. Households reached by the SNP were wealthier households with children enrolled in school. The SNP in Tanzania was able to maintain population level LLIN ownership, use and access in the absence of mass distribution. The SNP successfully reached households that housed school-aged children. Alternative delivery strategies may need to be considered to reach households without children enrolled in schools that experienced fewer benefits from the programme.

Malaria frontline project: pre-intervention Malaria baseline assessment in Kano and Zamfara States, August 2016.

IntroductionIn 2016, the Centers for Disease Control and Prevention and the Government of Nigeria initiated the Malaria Frontline Project in Kano and Zamfara States. The project goal is to improve the quality and coverages of malaria interventions adapting polio program strategy. We conducted a baseline assessment of malaria interventions.MethodsTwenty-four primary health centers per State were selected using probability sampling. Health workers (HW) were purposively sampled to assess their knowledge of national malaria control guidelines. Clients were selected for exit interview to assess health workers´ adherence to the national guidelines. WHO cluster methodology was used to survey heads of household and women of reproductive age on knowledge of malaria prevention, Long Lasting Insecticidal Net (LLIN) ownership and use.ResultsOf the 158 HW interviewed, 94.3% knew the correct criteria for malaria diagnosis, 86.1% reported using artemisinin-based therapy to treat uncomplicated malaria. About 45% of HW reported prescribing artemisinin-based combination therapy (ACT) for uncomplicated malaria in first trimester of pregnancy and 39% prescribed quinine. Only 73.9% of fever cases were referred to laboratory as recommended by the national guideline. Households with one LLIN per 2 persons (Kano: 27.1%; Zamfara: 30.0%), LLIN use (Kano: 70.8%; Zamfara: 81.6%) and IPTp1 (Kano: 38.6%; Zamfara: 33.3%).Conclusionmost clinicians have knowledge of national guidelines, but fewer adhere to guidelines in practice. Population LLIN ownership, LLIN use among pregnant women and IPTp are lower than the national targets of 58%, 83% and 75% respectively for 2016. We recommend improving health workers´ technical capacity and adherence to national malaria guidelines.

Ownership and Utilisation of Long-Lasting Insecticidal Nets in Tiko Health District, Southwest Region, Cameroon: A Cross-Sectional Study.

Introduction Malaria is and remains a serious health concern in Africa. In Cameroon, where malaria is endemic and a major public health problem, the major control measure put in place is the use of long-lasting insecticidal nets (LLINs). In the Tiko Health District (THD), the challenges have been to assess and to evaluate the ownership and utilisation of LLINs. This study sought to assess the ownership and utilisation rates of LLINs in the THD. Methodology. A cross-sectional survey involving 418 households was conducted in four health areas in the THD. A structured questionnaire was used to collect data on LLIN ownership and utilisation as well as sociodemographic characteristics. Results The ownership of at least one LLIN per household, coverage, and accessibility were, respectively, 89%, 56.2%, and 66.3%, while installing LLINs on all beds in the household, sleeping under LLINs the previous night (SULPN), and universal utilisation were 72%, 24.9%, and 14.1%, respectively. Factors significantly associated with the ownership of at least one LLIN per household were respondent's age and gender. Heat (21.1%) and forgetfulness (6.5%) were the main reasons postulated for irregular utilisation of LLINs. Conclusion The ownership LLINs failed to guarantee utilisation and definitely effective control of malaria in the THD, as expected. Continuous and appropriate use of LLINs is indispensable, in addition to periodic sanitation, booster campaigns of LLIN distribution, and evaluation research for effective prevention and control of malaria.

Reduced exposure to malaria vectors following indoor residual spraying of pirimiphos-methyl in a high-burden district of rural Mozambique with high ownership of long-lasting insecticidal nets: entomological surveillance results from a cluster-randomized trial

BackgroundThe need to develop new products and novel approaches for malaria vector control is recognized as a global health priority. One approach to meeting this need has been the development of new products for indoor residual spraying (IRS) with novel active ingredients for public health. While initial results showing the impact of several of these next-generation IRS products have been encouraging, questions remain about how to best deploy them for maximum impact. To help address these questions, a 2-year cluster-randomized controlled trial to measure the impact of IRS with a microencapsulated formulation of pirimiphos-methyl (PM) in an area with high ownership of long-lasting insecticidal nets (LLINs) was conducted in a high-transmission district of central Mozambique with pyrethroid resistant vectors. Presented here are the results of the vector surveillance component of the trial.MethodsThe 2 year, two-armed trial was conducted in Mopeia District, Zambezia Province, Mozambique. In ten sentinel villages, five that received IRS with PM in October–November 2016 and again in October–November 2017 and five that received no IRS, indoor light trap collections and paired indoor-outdoor human landing collections catches (HLCs) were conducted monthly from September 2016 through October 2018. A universal coverage campaign in June 2017, just prior to the second spray round, distributed 131,540 standard alpha-cypermethrin LLINs across all study villages and increased overall net usage rates in children under 5 years old to over 90%.ResultsThe primary malaria vector during the trial was Anopheles funestus sensu lato (s.l.), and standard World Health Organization (WHO) tube tests with this population indicated variable but increasing resistance to pyrethroids (including alpha-cypermethrin, from > 85% mortality in 2017 to 7% mortality in 2018) and uniform susceptibility to PM (100% mortality in both years). Over the entire duration of the study, IRS reduced An. funestus s.l. densities by 48% (CI95 33–59%; p < 0.001) in indoor light traps and by 74% (CI95 38–90%; p = 0.010) during indoor and outdoor HLC, though in each study year reductions in vector density were consistently greatest in those months immediately following the IRS campaigns and waned over time. Overall there was no strong preference for An. funestus to feed indoors or outdoors, and these biting behaviours did not differ significantly across study arms: observed indoor-outdoor biting ratios were 1.10 (CI95 1.00–1.21) in no-IRS villages and 0.88 (CI95 0.67–1.15) in IRS villages. The impact of IRS was consistent in reducing HLC exposures both indoors (75% reduction: CI95 47–88%; p = 0. < 0.001) and outdoors (68% reduction: CI95 22–87%; p = 0.012). While substantially fewer Anopheles gambiae s.l. were collected during the study, trends show a similar impact of IRS on this key vector group as well, with a 33% (CI95 7–53%; p = 0.019) reduction in mosquitoes collected in light traps and a non-statistically significant 39% reduction (p = 0.249) in HLC landing rates.ConclusionIRS with PM used in addition to pyrethroid-only LLINs substantially reduced human exposures to malaria vectors during both years of the cluster-randomized controlled trial in Mopeia—a high-burden district where the primary vector, An. funestus s.l., was equally likely to feed indoors or outdoors and demonstrated increasing resistance to pyrethroids. Findings suggest that IRS with PM can provide effective vector control, including in some settings where pyrethroid-only ITNs are widely used.Trial registrationclinicaltrials.gov, NCT02910934. Registered 22 September 2016, https://www.clinicaltrials.gov/ct2/show/NCT02910934.

Coverage outcomes (effects), costs, cost-effectiveness, and equity of two combinations of long-lasting insecticidal net (LLIN) distribution channels in Kenya: a two-arm study under operational conditions

BackgroundMalaria-endemic countries distribute long-lasting insecticidal nets (LLINs) through combined channels with ambitious, universal coverage (UC) targets. Kenya has used eight channels with variable results. To inform national decision-makers, this two-arm study compares coverage (effects), costs, cost-effectiveness, and equity of two combinations of LLIN distribution channels in Kenya.MethodsTwo combinations of five delivery channels were compared as ‘intervention’ and ‘control’ arms. The intervention arm comprised four channels: community health volunteer (CHV), antenatal and child health clinics (ANCC), social marketing (SM) and commercial outlets (CO). The control arm consisted of the intervention arm channels except mass campaign (MC) replaced CHV. Primary analysis used random sample household survey data, service-provider costs, and voucher or LLIN distribution data to compare between-arm effects, costs, cost-effectiveness, and equity. Secondary analyses compared costs and equity by channel.ResultsThe multiple distribution channels used in both arms of the study achieved high LLIN ownership and use. The intervention arm had significantly lower reported LLIN use the night before the survey (84·8% [95% CI 83·0–86·4%] versus 89·2% [95% CI 87·8–90·5%], p < 0·0001), higher unit costs ($10·56 versus $7·17), was less cost-effective ($86·44, 95% range $75·77–$102·77 versus $69·20, 95% range $63·66–$77·23) and more inequitable (Concentration index [C.Ind] = 0·076 [95% CI 0·057 to 0·095 versus C.Ind = 0.049 [95% CI 0·030 to 0·067]) than the control arm. Unit cost per LLIN distributed was lowest for MC ($3·10) followed by CHV ($10·81) with both channels being moderately inequitable in favour of least-poor households.ConclusionIn line with best practices, the multiple distribution channel model achieved high LLIN ownership and use in this Kenyan study setting. The control-arm combination, which included MC, was the most cost-effective way to increase UC at household level. Mass campaigns, combined with continuous distribution channels, are an effective and cost-effective way to achieve UC in Kenya. The findings are relevant to other countries and donors seeking to optimise LLIN distribution.Trial registrationThe assignment of the intervention was not at the discretion of the investigators; therefore, this study did not require registration.

Factors associated with utilization of LLINs among women of child-bearing age in Igabi, Kaduna State, Nigeria

BackgroundThe long-lasting insecticidal nets (LLIN) are effective against prevention of malaria and its utilization has been proven to save lives. Despite the mass distribution of LLIN, Nigeria remains the country with the highest malaria burden in Africa. The awareness of LLIN in Nigeria is high, but the utilization is low. The aim of this work is to describe factors associated with the utilization of LLIN among women of child-bearing age (WCBA) in Igabi, Kaduna, Nigeria.MethodsA cross-sectional survey was conducted among 630 WCBA selected using a multi-stage sampling at 63 randomly selected villages in Igabi Local Government Area of Kaduna State. Trained female data collectors administered pre-tested structured questionnaires adapted from the Malaria Indicator Survey. Information collected were demographic profile, knowledge of LLIN as a preventive strategy for malaria, and LLIN ownership and utilization. LLIN utilization was assessed by identifying household members that slept under the hanged LLIN the night before the survey. Questions on the awareness of LLIN, ability to define what it is, use of LLIN, what differentiates LLIN from other bed nets, and duration of use before replacement, were scored and categorized as good, average and poor knowledge of LLIN.ResultsA total of 629 WCBA was sampled, their mean age (± SD) was 29.3 (± 6.2) years, 22.0% were pregnant, 40.5% had no formal education, 41.1% were employed, and 47.7% lived in rural communities. Awareness and good knowledge about LLINs for the prevention of malaria was 96.0% and 24.0%, respectively. The proportion of women who slept under a LLIN the night before the survey (utilization) was 70.0% and slightly higher (74.0%) among pregnant WCBA. Women who lived in rural communities were more likely to utilize LLINs compared to their urban counterparts (OR 3.4; 95% CI 2.3–4.9). Younger women (aged < 30 years) were less likely to utilize LLINs compared to the older women (OR 0.7; 95% CI 0.5–0.9).ConclusionsThe knowledge of LLIN among WCBA was poor, but LLIN utilization was moderate. Living in rural communities and older WCBA were significant characteristics associated with LLIN utilization. Strategies that will improve the utilization of LLIN among the young and urban WCBA should be the focus of the Malaria Elimination Programme (MEP).

Improving long-lasting insecticidal nets use in Kayange community of north-western Burundi: a pilot study exploring the use of quality improvement methodologies in low-resource community settings

Quality improvement (QI) approaches have demonstrated a lot of promise in improving clinical care processes, both in high-resource and low-resource settings. However, most examples of QI initiatives in healthcare in...

PO 7151 COMPARING TWO BED NET DELIVERY MODELS IN’RURAL DISTRICTS OF MOZAMBIQUE

BackgroundThe use of long-lasting insecticidal nets (LLINs) is associated with a reduction in malaria transmission. In 2015, a new delivery strategy (intervention) for universal coverage campaign was tested and compared with standard strategy (control). The objective is to compare two bed net delivery models in rural districts of Mozambique.MethodsTwo districts served as intervention, and two as control. The following study design was used: 1) before and after; and 2) cost-effectiveness analysis. Three core implementation strategies were tested: 1) use of coupons during household registration, 2) use of stickers to identify registered houses, and 3) a new LLINs allocation criterion. The main endpoints measured were: i) percentage of distributed LLINs; ii) LLINs ownership and use coverage; iii) percentage of households that achieved universal coverage; iv) incremental cost-effectiveness ratio (ICER); v) incremental net benefit (INB).ResultsApproximately 88% (302,648) of LLINs were distributed in intervention districts compared to 77% (219,613) in control districts [OR: 2.14 (95% CI: 2.11–2.16)]. Six months after the 2015 campaign, 98.8% of the 760 households surveyed in the intervention districts had at least one LLIN; 89.6% of the 787 households surveyed in the control districts had at least one LLIN [OR: 9.7, (95% CI: 5.25–22.76)]. Near 95% and 87% of respondents who had at least one LLIN, reported having slept under the LLIN the previous night in the intervention and control districts, respectively [OR: 3.2; (95% CI 2.12–4.69)]; 71% of the households surveyed achieved universal coverage in the intervention districts against 59.6% in the control districts [OR: 1.6; (95% CI: 1.33–2.03)]. ICER per distributed LLIN was US$ 0.68. INB was positive.ConclusionIntervention districts had greater LLINs availability, greater LLINs ownership and use coverage, and a better progression toward reaching universal coverage targets. The new strategy was more cost-effective than the previous strategy.

Low use of long-lasting insecticidal nets for malaria prevention in south-central Ethiopia: A community-based cohort study.

IntroductionA decline in malaria morbidity and mortality has been documented in Ethiopia since 2005 following a scale-up of the distribution of long-lasting insecticidal nets (LLINs). However, universal access to LLINs ownership and use has not yet been achieved. This study aimed to determine ownership and use of LLINs over time in south-central Ethiopia.MethodsA cohort of 17,142 individuals residing in 3,006 households was followed-up from October 2014 to January 2017 (121 weeks). New PermaNet2.0 LLINs were given to households in October 2014. Once per week, the LLIN use status was documented for each individual. A survey was conducted after 110 weeks of LLIN distribution to determine LLIN ownership. A multilevel negative binomial regression model was fitted to identify significant predictors of LLIN use.ResultsAt baseline, the LLIN ownership was 100%. After 110 weeks only 233 (8%) of the households owned at least one LLIN. The median proportion of LLIN use per individuals during the study period was only 14%. During the first year (week 1–52) the average LLIN use per individuals was 36% and during the second year (week 53–104) it was 4.6%. More frequent LLIN use was reported among age group [5–14 years (adjusted IRR = 1.13, 95% CI 1.04–1.22), 15–24 years (adjusted IRR = 1.33, 95% CI 1.23–1.45), ≥25 years (adjusted IRR = 1.99, 95% CI 1.83–2.17)] compared to <5 years, and household head educational status [read and write (adjusted IRR = 1.17, 95% CI 1.09–1.26), primary (adjusted IRR = 1.20, 95% CI 1.12–1.27), secondary or above (adjusted IRR = 1.20, 95% CI (1.11–1.30)] compared to illiterate. Having a family size of over five persons (adjusted IRR = 0.78, 95% CI 0.73–0.84) was associated with less frequent use of LLINs compared to a family size of ≤5 persons.ConclusionsThe study showed a low LLIN ownership after 110 weeks and a low LLIN use during 121 weeks of follow-up, despite 100% LLIN coverage at baseline. The study highlights the need to design strategies to increase LLIN ownership and use for setting similar to those studied here.

Long-lasting insecticidal net use and asymptomatic malaria parasitaemia among household members of laboratory-confirmed malaria patients attending selected health facilities in Abuja, Nigeria, 2016: A cross-sectional survey.

IntroductionIn Nigeria, malaria remains a major burden. There is the presupposition that household members could have common exposure to malaria parasite and use of long-lasting insecticidal net (LLIN) could reduce transmission. This study was conducted to identify factors associated with asymptomatic malaria parasitaemia and LLIN use among households of confirmed malaria patients in Abuja, Nigeria.MethodsA cross-sectional survey was conducted from March to August 2016 in twelve health facilities selected from three area councils in Abuja, Nigeria. Participants were selected using multi-stage sampling technique. Overall, we recruited 602 participants from 107 households linked to 107 malaria patients attending the health facilities. Data on LLIN ownership, utilization, and house characteristics were collected using a semi-structured questionnaire. Blood samples of household members were examined for malaria parasitaemia using microscopy. Data were analyzed using descriptive statistics, Chi-square, and logistic regression (α = 0.05).ResultsMedian age of respondents was 16.5 years (Interquartile range: 23 years); 55.0% were females. Proportions of households that owned and used at least one LLIN were 44.8% and 33.6%, respectively. Parasitaemia was detected in at least one family member of 102 (95.3%) index malaria patients. Prevalence of asymptomatic malaria parasitaemia among study participants was 421/602 (69.9%). No association was found between individual LLIN use and malaria parasitaemia (odds ratio: 0.9, 95% confidence interval (95%CI): 0.6–1.3) among study participants. Having bushes around the homes was associated with having malaria parasitaemia (adjusted OR (aOR): 2.7, 95%CI: 1.7–4.2) and less use of LLIN (aOR: 0.4, 95%CI: 0.2–0.9). Living in Kwali (aOR: 0.1, 95% CI: 0.0–0.2) was associated with less use of LLIN.ConclusionHigh prevalence of asymptomatic malaria and low use of LLIN among household members of malaria patients portend the risk of intra-household common source of malaria transmission. We recommend household health education on LLIN use and environmental management. Study to explore the role of preventive treatment of household members of confirmed malaria patient in curbing transmission is suggested. Strategies promoting LLIN use need to be intensified in Kwali.