Use Of Long-lasting Insecticide-treated Nets Research Articles

Socioeconomic disparities in Plasmodium falciparum infection risk in Southern Malawi: mediation analyses

This study investigated the mediators of the association between socioeconomic position (SEP) and Plasmodium falciparum (Pf) infection in Southern region of Malawi. We utilized data from the 2014 International Center of Excellence for Malaria Research (ICEMR) surveys from Malawi in which blood samples of all individuals from selected households in Blantyre, Thyolo and Chikhwawa were tested for Pf parasitemia. We assessed household SEP and potential mediators – housing quality, food security, education status of household heads, and use of long-lasting Insecticide-treated nets (LLINs) and nutritional status. We conducted causal mediation analyses to assess the proportion of SEP effect that is attributed to each mediator and combination of mediators. The mediation analysis shows that during the rainy season, improved housing and educational attainment explained 39.4% and 17.0% of the SEP effect on Pf infection, respectively, and collectively 66.4%. In the dry season, housing, educational attainment, and LLIN usage collectively mediated 33.4% of SEP’s effect with individual contributions of 15.6%, 11.2%, and 3.8%, respectively. Nutrition also played a role, particularly for children, mediating 9.2% of SEP’s effect in the rainy season and 3.7% in the dry season. The study concluded that multifaceted interventions targeting housing, education, LLIN usage, and nutrition are vital to reducing socioeconomic disparities in Pf infection risk in the Southern region of Malawi.

Long-lasting insecticidal nets use and the prevalence of Plasmodium falciparum infection among pregnant women attending antenatal care at the Bonassama District Hospital, Littoral Region of Cameroon: a cross-sectional study

BackgroundMalaria during pregnancy continues to be a significant cause of morbidity and mortality for both infants and mothers, particularly in sub-Saharan African (SSA) countries, despite increased efforts to control it. The utilization of long-lasting insecticide-treated nets (LLINs) during pregnancy is a well-established strategy to reduce the prevalence of malaria. Nonetheless, inadequate adherence remains a persistent challenge in certain regions with high malaria endemicity. This research aimed to assess the effectiveness of long-lasting insecticidal nets in preventing asymptomatic malaria infections among pregnant women attending antenatal care at the Bonassama District Hospital in the Littoral Region of Cameroon.MethodsA hospital-based cross-sectional study was conducted from March to June 2022. Data on sociodemographic characteristics and LLIN usage were collected through a structured questionnaire, while asymptomatic malaria infections were identified using a PfHRP2/pLDH malaria qualitative rapid diagnostic kit. The relationship between categorical variables was analyzed using the chi-square test and logistic regression at a significance level of 5%.ResultsOut of the 411 pregnant women included in the study, 35.4% were diagnosed with malaria. The LLIN utilization rate was 65.1%. The risk of malaria infection was 2.7 times higher (AOR = 2.75, 95% CI = 1.83–4.14, p < 0.001) among women who did not consistently use LLINs compared to those who did. Pregnant women in their first trimester (AOR = 3.40, 95% CI = 1.24–4.64, p = 0.010) and second trimester (AOR = 1.90, 95%CI = 0.99–3.62, p = 0.055) were more likely to sleep under net when compared to those in the third trimester. Younger women 20–29 years (71.4%), those in the first trimester (69.6%) and those who had the nets before pregnancy (68.9%) were amongst those who frequently used use the nets. Among the reasons reported for not frequently using LLINs were heat (55.2%), suffocation (13.6%) and the smell of nets (8.4%).ConclusionThe use of LLIN was moderately high among the participants in this study, though still below national target. Age group, religion and gestation period were the major factors determining the use of LLINs. Considering the proven effectiveness of LLINs in reducing malaria morbidity and mortality, it is imperative for the National Malaria Control Programme (NMCP) to remain focused in promoting both LLIN ownership and utilization to achieve the national target of 100% and 80%, respectively.

Review on the impacts of indoor vector control on domiciliary pests: good intentions challenged by harsh realities.

Arthropod vectored diseases have been a major impediment to societal advancements globally. Strategies to mitigate transmission of these diseases include preventative care (e.g. vaccination), primary treatment and most notably, the suppression of vectors in both indoor and outdoor spaces. The outcomes of indoor vector control (IVC) strategies, such as long-lasting insecticide-treated nets (LLINs) and indoor residual sprays (IRSs), are heavily influenced by individual and community-level perceptions and acceptance. These perceptions, and therefore product acceptance, are largely influenced by the successful suppression of non-target nuisance pests such as bed bugs and cockroaches. Adoption and consistent use of LLINs and IRS is responsible for immense reductions in the prevalence and incidence of malaria. However, recent observations suggest that failed control of indoor pests, leading to product distrust and abandonment, may threaten vector control programme success and further derail already slowed progress towards malaria elimination. We review the evidence of the relationship between IVC and nuisance pests and discuss the dearth of research on this relationship. We make the case that the ancillary control of indoor nuisance and public health pests needs to be considered in the development and implementation of new technologies for malaria elimination.

Long-Lasting Insecticide-Treated Nets Combined or Not with Indoor Residual Spraying May Not Be Sufficient to Eliminate Malaria: A Case-Control Study, Benin, West Africa.

In sub-Saharan Africa, despite the implementation of multiple control interventions, the prevalence of malaria infection and clinical cases remains high. The primary tool for vector control against malaria in this region is the use of long-lasting insecticide-treated nets (LLINs) combined or not with indoor residual spraying (IRS) to achieve a synergistic effect in protection. The objective of this study was to assess the effectiveness of LLINs, with or without IRS, protected against Plasmodium falciparum infection and uncomplicated clinical cases (UCC) of malaria in Benin. A case-control study was conducted, encompassing all age groups, in the urban area of Djougou and the rural area of Cobly. A cross-sectional survey was conducted that included 2080 individuals in the urban area and 2770 individuals in the rural area. In the urban area, sleeping under LLINs did not confer significant protection against malaria infection and UCC when compared to no intervention. However, certain neighbourhoods benefited from a notable reduction in infection rates ranging from 65% to 85%. In the rural area, the use of LLINs alone, IRS alone, or their combination did not provide additional protection compared to no intervention. IRS alone and LLINs combined with IRS provided 61% and 65% protection against malaria infection, respectively, compared to LLINs alone. The effectiveness of IRS alone and LLINs combined with IRS against UCC was 52% and 54%, respectively, when compared to LLINs alone. In both urban and rural areas, the use of LLINs alone, IRS alone, and their combination did not demonstrate significant individual protection against malaria infection and clinical cases when compared to no intervention. In the conditions of this study, LLINs combined or not with IRS are not effective enough to eliminate malaria. In addition to the interventions, this study identified factors associated with malaria in Benin as housing design, neglected social groups like gender-marginalised individuals and adolescents, and socio-economic conditions acting as barriers to effective malaria prevention. Addressing these factors is crucial in order to facilitate malaria elimination efforts in sub-Saharan Africa.

Analysing the progress in service delivery towards achieving universal health coverage in Nigeria: a scoping review

BackgroundAttainment of universal health coverage (UHC) requires optimal utilization of health services. Poor coverage and inequitable access to healthcare could hinder improvement in service delivery towards UHC. The study analyzed the progress in service delivery coverage and equity in access to care within the Nigerian health systems based on the tracer indicators of the WHO framework for monitoring UHC.MethodsWe searched the literature in databases: PubMed, Scopus, Directory of Open Access Journals, Google Scholar, Science Direct and websites of relevant health Ministries, Agencies, and Organizations between March to December 2022. Search terms were identified in four broader themes: Service delivery coverage, equity, UHC and Nigeria. Data were collected through a review of 37 published articles (19 peer-reviewed articles and 8 grey documents). We synthesized the findings in thematic areas using the WHO framework for monitoring UHC.ResultsThe findings show a slow improvement in service delivery coverage across the UHC tracer indicators; reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases and service capacity and access. With regards to equity in access to care across the tracer indicators, there has been a great disparity in the utilization of healthcare services among rural dwellers, lower educational level individuals and those with poor socio-economic status over 20 years. However, there was remarkable progress in the ownership and use of long-lasting insecticide-treated nets among rural and lowest-wealth quantile households than their urban counterpart.ConclusionThere is poor coverage and persistent inequitable access to care among the tracer indicators for monitoring progress in service delivery. Attaining UHC requires concerted efforts and investment of more resources in service delivery to address inequitable access to care and sustainable service coverage for improved health outcomes.

Prevalence of Malaria Parasitemia and Perceptions of the Use of Long-Lasting Insecticide Nets in a Sample of Pregnant Women in a Malaria-Endemic Nigerian Community

Objectives: The objectives of the study were to evaluate the prevalence of malaria and the perception on the use of long-lasting insecticide-treated nets (LLINs) among pregnant women attending antenatal care at Neni Community Health Center, Anaocha Local Government Area, Anambra State, Nigeria. Methods: A sample of 364 pregnant women were randomly selected for the study. Malaria parasitemia and the use of LLINs were critically evaluated among pregnant women in the study area. Two milliliters of venous blood samples was collected by a medical laboratory scientist from each pregnant woman; it was stored in an ethylenediaminetetraacetic acid container. This was done under sterile conditions and examined for malaria parasites using Giemsa-stained thin and thick blood films under a microscope. Interviews and observations were used to collect information from pregnant women regarding their sociodemographic characteristics and use of LLINs. The level of statistical significance was set at Ρ ≤0.05. Results: The prevalence of malaria in relation to parity indicated that primigravidae had the highest proportion (46.2%). In terms of gestational stage, malaria infection was highest among women in their first trimester (37.2%). Based on occupational status, farmers recorded the highest prevalence of 40.7%. There was a significantly higher proportion of pregnant women who were aware of LLINs (χ2 = 25.36, P &lt; 0.05), chose antenatal classes as a source of information on awareness of LLINs (χ2 = 27.33, P &lt; 0.05), and had reasons for noncompliance with LLINs (χ2 = 25.71, P &lt; 0.05). Conclusions: This study reveals a relatively high prevalence of malaria parasitemia and low compliance with the use of long-lasting insecticide nets among pregnant women attending antenatal care at Neni Community Health Center in Anambra State, Nigeria.

Bifurcation analysis and global sensitivity index for malaria disease transmission dynamics: Information and treated bed nets control

Malaria is known globally as the foremost cause of death in children and adults. Several intervention strategies and controls have been implemented and proposed, among which is Long Lasting Insecticide Treated Nets (LLINs). Malaria cases have been reported to reduce by [Formula: see text] due to the use of LLINs. However, the laid-back behaviors of humans negatively impact its effective use through improper handling and exposure to direct sunlight. To this end, a mathematical model is formulated to investigate the influence of individual response to information on the transmission dynamics of malaria infection in both human and mosquito populations. The threshold for the effective reduction of the prevalence of malaria through a behavioral change in the use of LLINs in response to the created awareness is determined in this study. The point of departure of this study from other studies is that it incorporates information/awareness as a dynamic variable to investigate the impact of LLINs on malaria. The equilibrium points of the model are analyzed using stability theory and the associated basic reproduction number [Formula: see text]. The implicit function theorem is used to determine the direction of bifurcation. We use Latin hypercube sampling (LHS) to test the most sensitive parameters in the basic reproduction number. The correlation between the [Formula: see text] and parameters is displayed using Scatter plots. The mathematical analysis shows that the direction of bifurcation is supercritical, which suggests that we only need to bring [Formula: see text] below unity for disease eradication. The study also revealed that an increase in awareness of the use of LLINs has an impact on reducing malaria transmission.

Prompt treatment-seeking behaviour varies within communities among guardians of children with malaria-related fever in Malawi

BackgroundIn Malawi, malaria is responsible for 40% of hospital deaths. Prompt diagnosis and effective treatment within 24 h of fever onset is critical to prevent progression from uncomplicated to severe disease and to reduce transmission.MethodsAs part of the large evaluation of the malaria vaccine implementation programme (MVIP), this study analysed survey data to investigate whether prompt treatment-seeking behaviour is clustered at community-level according to socio-economic demographics.ResultsFrom 4563 households included in the survey, 4856 children aged 5–48 months were enrolled. Out of 4732 children with documented gender, 52.2% were female and 47.8% male. Among the 4856 children, 33.8% reported fever in the two weeks prior to the survey. Fever prevalence was high in communities with low socio-economic status (SES) (38.3% [95% CI: 33.7–43.5%]) and low in areas with high SES (29.8% [95% CI: 25.6–34.2%]). Among children with fever, 648 (39.5%) sought treatment promptly i.e., within 24 h from onset of fever symptoms. Children were more likely to be taken for prompt treatment among guardians with secondary education compared to those without formal education (aOR:1.37, 95% CI: 1.11–3.03); in communities with high compared to low SES [aOR: 2.78, 95% CI: 1.27–6.07]. Children were less likely to be taken for prompt treatment if were in communities far beyond 5 km to health facility than within 5 km [aOR: 0.44, 95% CI: 0.21–0.92].ConclusionThe high heterogeneity in prevalence of fever and levels of prompt treatment-seeking behaviour underscore the need to promote community-level malaria control interventions (such as use of long-lasting insecticide-treated nets (LLINs), indoor residual spraying (IRS), intermittent preventive therapy (IPT), presumptive treatment and education). Programmes aimed at improving treatment-seeking behaviour should consider targeting communities with low SES and those far from health facility.

Characterisation of Anopheles species composition and genetic diversity in Meghalaya, northeast India, using molecular identification tools.

Malaria in India is declining, in part due to the use of long-lasting insecticide-treated nets (LLINs) and vector control. Historically, the north-eastern region of India has contributed ~10%-12% of the nation's malaria burden. The important mosquito vectors in northeast India have long been considered to be Anopheles baimaii and An. minimus, both associated with forest habitats. Local deforestation and increased rice cultivation, along with widespread LLIN use, may be changing vector species composition. Understanding if and how vector species composition is changing is critical to successful malaria control. In Meghalaya state, malaria is now at a low level of endemicity with occasional seasonal outbreaks. In a biodiverse setting like Meghalaya, where >24 Anopheles mosquito species have been recorded, accurate morphological identification of all species is logistically challenging. To accurately determine Anopheles species richness in the West Khasi Hills (WKH) and West Jaintia Hills (WJH) districts, adult and larval mosquitoes were collected and identified using molecular methods of allele-specific PCR and cytochrome oxidase I DNA barcoding. In 14 villages across both districts, we identified high species richness, 19 species in total. Molecular findings indicated that An. minimus and An. baimaii were rare, while four other species (An. maculatus, An. pseudowillmori, An. jeyporiensis and An. nitidus) were abundant. Anopheles maculatus was highly prevalent in WKH (39% of light trap collections) and An. pseudowillmori in WJH (45%). Larvae of these four species were found in rice fields, suggesting that land cover change is influencing species composition change. Our results suggest that rice fields might be contributing to the observed abundance of An. maculatus and An. pseudowillmori, which could be playing a role in malaria transmission, either independently due to their high abundance, or in combination with An. baimaii and/or An. minimus.

Assessing afebrile malaria and bed-net use in a high-burden region of India: Findings from multiple rounds of mass screening.

A key obstacle in the fight against malaria is afebrile malaria. It remains undiagnosed and, therefore, is invisible to the health system. Apart from being a serious illness, it contributes to increased transmission. Existing studies in India have not adequately reported afebrile malaria and its determinants, including the use of long-lasting insecticide-treated nets (LLINs). This study used six waves of mass screening, which were conducted by the state government in the high-malaria-burden region of Chhattisgarh, a state in India, in 2020, 2021, and 2022. Each round of data collection included more than 15000 individuals. Descriptive statistics were used to analyse key indicators of malaria prevalence and LLIN use. Multivariate analyses were performed to identify the determinants of afebrile malaria and LLIN use. Malaria prevalence in the afebrile population varied from 0.6% to 1.4% across the different waves of mass screening. In comparison, malaria positivity among febrile individuals was greater than 33% in each wave. Afebrile malaria contributed to 19.6% to 47.2% of the overall malaria burden in the region. Indigenous communities (scheduled tribes) were more susceptible to malaria, including afebrile malaria. Individuals using LLINs were less likely to be affected by afebrile malaria. Overall, 77% of the individuals used LLINs in early monsoon season, and in winter the rate was lower at 55%. LLIN use was significantly associated with the number of LLINs the households received from the government. Although fever continues to be a primary symptom of malaria, afebrile malaria remains a significant contributor to the malaria burden in the region. The free distribution of LLINs should be expanded to include high-burden populations. Global policies must include strategies for surveillance and control of afebrile malaria in high-burden areas.

Exploring The Experiments of Mass Distributions of Bed Nets in The Community to Prevent Malaria in Kisantu Health Zone, Democratic Republic of Congo: A Qualitative Study

Despite its discovery more than a century, malaria remains a of public health problem. One of the pillars in the strategy to fighting it is the use of the mosquito net, which remains the only significant tool of prevention. This study is to evaluate the knowledge, perception and experiments of the mass campaign distribution of the mosquito nets in the community one year after the distribution. A qualitative study, centered on households, was carried out in the community of Kisantu Health Zone (KHZ) in the end of clinical trial in 2019. The semi-structured interviews with community leaders and individual focus groups with women having at least one child, were selected in six villages of the of KHZ. Among the respondents, the all had a good level of knowledge of mosquito nets, namely the proper definition of a mosquito net, the correct mode of installation in a sleeping space and that the occurrence of such holes in a mosquito net could be repaired but that was grounds for its inefficiency. The minority either cleaned the mosquito net with powdered laundry soap, and spread out to dry under the sun. The undesirable events related to the use of long-lasting insecticide-treated nets (LLINs) as well as occurrence of holes was quoted by a minority of the respondents as grounds of the weak use of LLINs in households. After one year of distribution, majority possession and the minority gave up use because of attrition or an adverse effect allotted to the use of LLINs.

An evaluation of LLIN ownership, access, and use during the Magude project in southern Mozambique.

The Magude Project assessed the feasibly of eliminating malaria in a low transmission setting in southern Mozambique using a package of interventions. This study measured the ownership, access and use of long-lasting insecticide treated nets (LLINs) and inequalities in these indicators across household wealth, size and population subgroups, to understand the protection that LLINs provided during the project. Data were obtained from various household surveys. At least 31% of the nets distributed during the 2014 and 2017 campaigns were lost during the first year post-distribution. Most nets (77.1%) present in the district were Olyset Nets. LLIN access never exceeded 76.3% and use varied seasonally between 40% and 76.4%. LLIN access limited LLIN use during the project, especially during the high transmission season. LLIN ownership, access and use were lower in harder-to-reach localities, in poorer and larger households. Children and women below 30 had poorer access to LLINs than the overall population. Net use was lowest among school-aged children and young adults, especially among young males, and highest in children under 5, pregnant women, in older adults and in households that received indoor residual spraying (IRS). This study revealed that LLIN mass-distribution campaigns alone are not sufficient to achieve the high level of net protection needed during elimination programs and that reviewing the LLIN allocation scheme, top-up distributions and/or community engagement campaigns is needed, also to reduce inequalities in populations' access to LLINs.

Behavioral interactions of bed bugs with long-lasting pyrethroid-treated bed nets: challenges for vector control

BackgroundWidespread vector control has been essential in reducing the global incidence and prevalence of malaria, despite now stalled progress. Long-lasting insecticide-treated nets (LLINs) have historically been, and remain, one of the most commonly used vector control tools in the campaign against malaria. LLINs are effective only with proper use, adherence, retention and community adoption, which historically have relied on the successful control of secondary pests, including bed bugs. The emergence of pyrethroid-resistant bed bugs in malaria-endemic communities and failure to control infestations have been suggested to interfere with the effective use of LLINs. Therefore, the behavioral interactions of bed bugs with commonly used bed nets should be better understood.MethodsTo investigate the interactions between bed bugs (Cimex lectularius L.) and LLINs, insecticide-susceptible and pyrethroid-resistant bed bugs were challenged to pass through two commonly used LLINs in two behavioral assays, namely host (blood meal)-seeking and aggregation-seeking assays. The proportions blood-fed and aggregated bed bugs, aggregation time and mortality were quantified and analyzed in different bed bug life stages.ResultsOverall, both the insecticide-susceptible bed bugs and highly resistant bed bugs showed a varying ability to pass through LLINs based on treatment status and net design. Deltamethrin-treated nets significantly impeded both feeding and aggregation by the susceptible bed bugs. While none of the tested LLINs significantly impeded feeding (passage of unfed bed bugs through the nets) of the pyrethroid-resistant bed bugs, the untreated bed net, which has small mesh holes, impeded passage of fed bed bugs. Mortality was only seen in the susceptible bed bugs, with significantly higher mortality on deltamethrin-treated nets (63.5 ± 10.7%) than on permethrin-treated nets (2.0 ± 0.9%).ConclusionsCommonly used new LLINs failed to prevent the passage of susceptible and pyrethroid-resistant bed bugs in host- and aggregation-seeking bioassays. The overall low and variable mortality observed in susceptible bed bugs during both assays highlighted the potential of LLINs to impose strong selection pressure for the evolution of pyrethroid resistance. Already, the failure to control bed bug infestations has been implicated as a contributing factor to the abandonment or misuse of LLINs. For the first time to our knowledge, we have shown the potential of LLINs in selecting for resistant secondary pest populations and so their potential role in stalling malaria control programs should be further investigated.Graphical The emergence of pyrethroid-resistant bed bugs in malaria-endemic communities may interfere with the effective use of pyrethroid-impregnated bed nets. We assessed the interactions of two bed bug strains with commonly used bed nets using two behavioral assays, namely host (blood meal)-seeking by unfed bed bugs and aggregation-seeking by freshly fed bed bugs. These assays assessed the passage of bed bugs through various bed nets in response to host cues and aggregation stimuli, respectively. Conditioned paper is a section of file folder paper that has been exposed to bed bugs and has been impregnated with feces and aggregation pheromone; it is attractive to aggregation-seeking fed bed bugs. An unconditioned ramp is a similar section of file folder paper that allows bed bugs to traverse the bed net and gain access to a blood-meal source.

The mosquito vectors that sustained malaria transmission during the Magude project despite the combined deployment of indoor residual spraying, insecticide-treated nets and mass-drug administration.

The "Magude project" aimed but failed to interrupt local malaria transmission in Magude district, southern Mozambique, by using a comprehensive package of interventions, including indoor residual spraying (IRS), pyrethroid-only long-lasting insecticide treated nets (LLINs) and mass-drug administration (MDA). Here we present detailed information on the vector species that sustained malaria transmission, their association with malaria incidence and behaviors, and their amenability to the implemented control interventions. Mosquitoes were collected monthly between May 2015 and October 2017 in six sentinel sites in Magude district, using CDC light traps both indoors and outdoors. Anopheles arabiensis was the main vector during the project, while An. funestus s.s., An. merus, An. parensis and An. squamosus likely played a secondary role. The latter two species have never previously been found positive for Plasmodium falciparum in southern Mozambique. The intervention package successfully reduced vector sporozoite rates in all species throughout the project. IRS was effective in controlling An. funestus s.s. and An. parensis, which virtually disappeared after its first implementation, but less effective at controlling An. arabiensis. Despite suboptimal use, LLINs likely provided significant protection against An. arabiensis and An. merus that sought their host largely indoors when people where in bed. Adding IRS on top of LLINs and MDA likely added value to the control of malaria vectors during the Magude project. Future malaria elimination attempts in the area could benefit from i) increasing the use of LLINs, ii) using longer-lasting IRS products to counteract the increase in vector densities observed towards the end of the high transmission season, and iii) a higher coverage with MDA to reduce the likelihood of human infection. However, additional interventions targeting vectors that survive IRS and LLINs by biting outdoors or indoors before people go to bed, will be likely needed to achieve local malaria elimination.

Qualitative study on the use and maintenance of long-lasting insecticidal nets (LLINs) in Bouaké (Côte d’Ivoire), 17 months after the last mass distribution campaign

BackgroundThe use of long-lasting insecticide-treated nets (LLINs) is one of the main malaria prevention method promoted by the World Health Organization (WHO) in Côte d'Ivoire. LLIN-coverage has reached 95% since 2015 and nearly 16 million LLINs were distributed in 2017. Despite these efforts, malaria incidence at the national level remains high (120‰ in 2012 to 164‰ in 2017) although this could be partly explained by increased screening efforts. This study aimed at determining what preventative measures were used against mosquito bites, as well as LLIN maintenance practices used by the inhabitants of the city of Bouaké, capital city of the Gbêkê region with a malaria incidence of 257‰ in 2017.MethodsA descriptive qualitative investigation took place in Bouaké, in four neighbourhoods that were selected through purposive sampling based on their social composition. Data were collected using an interview guide based on convenience sampling.ResultsThe results of the study reveal that LLINs are the most reported used malaria prevention measure (66.4%). Environmental health (28.8%) came second in their declarations, smoke coils (23.5%) third and aerosol cans (18.8%) last. The percentage of respondents who answered that they had slept under an LLIN the previous night was 53%. 57.7% reported that they wash their LLINs, 12.1% that they do not wash them, and 4% that they replace dirty LLINs with new ones. The LLINs washing methods described by the respondents did not comply with the WHO recommendations and there was no mention of LLINs repairs.ConclusionDespite mass distributions of LLINs in Côte d'Ivoire, this key malaria control tool remains under-used by the population. Regarding LLIN maintenance, more than half of the population reports that they wash their nets while not complying with recommended practices or repairing them.

A high-throughput HPLC method for simultaneous quantification of pyrethroid and pyriproxyfen in long-lasting insecticide-treated nets

Long-lasting insecticide-treated nets (LLINs) play a crucial role in preventing malaria transmission. LLINs should remain effective for at least three years, even after repeated washings. Currently, monitoring insecticides in LLINs is cumbersome, costly, and requires specialized equipment and hazardous solvents. Our aim was to develop a simple, high-throughput and low-resource method for measuring insecticides in LLINs. To extract insecticides, polyethylene-LLIN samples were heated at 85 °C for 45 min in a non-hazardous solvent mix containing dicyclohexylphthalate as an internal standard. The extraction solvent was reduced from 50 to 5 ml using a 0.2 g sample, 90% smaller than the recommended sample size. By optimizing HPLC chromatography, we simultaneously detected pyrethroid and pyriproxyfen insecticides with high sensitivity in LLIN's extract. The method can quantify levels ≥ 0.0015% permethrin, 0.00045% alpha-cypermethrin and 0.00025% pyriproxyfen (w/w) in polyethylene, allowing for insecticide tracking before and after the use of LLINs. This method can be used to assess LLINs with 1% pyriproxyfen (pyriproxyfen-LLIN) or 2% permethrin (Olyset® Net), 1% pyriproxyfen and 2% permethrin (Olyset® Duo), or 0.55% pyriproxyfen and 0.55% alpha-cypermethrin (Royal Gaurd®). One can run 120 samples (40 nets) simultaneously with high precision and accuracy, improving throughput and reducing labour, costs, and environmental impact.

A qualitative study of the acceptability of remote electronic bednet use monitoring in Uganda

BackgroundDistribution of long-lasting insecticide treated nets (LLINs) is the most widely used intervention for the prevention of malaria but recall and social desirability biases may lead to challenges in accurately measuring use of bednets. SmartNet is a remote electronic monitor that provides objective measurements of bednet use over weeks at a time. Assessing local acceptability is important when implementing innovative global health technologies such as SmartNet. This study draws on established models such as the Technology Acceptance Model (TAM) and Theoretical Framework of Acceptability (TFA) to assess acceptability of SmartNet in Ugandan households.MethodsSemi-structured qualitative interviews were conducted at weeks one and six following installation of SmartNet in ten households in Western Uganda. Heads-of-households answered open-ended questions addressing the main acceptability domains of the TFA and TAM models (i.e. perceived ease of use, ethicality, etc.). Responses were digitally recorded, transcribed, coded and analyzed using a thematic analysis approach.ResultsSeven out of ten households interviewed reported no difference in use between SmartNet and a standard LLIN. Households stated the large size, soft fabric, and the efficacy of SmartNet relative to a standard LLIN contributed to perceived usefulness and perceived ease of use. Opportunity costs of the novel monitoring system expressed by households included difficulty washing nets and dislike of blinking lights on the device. Barriers to SmartNet use focused on questions of the ethics of bednet use monitoring, discomfort with technical aspects of the device and a poor understanding of its function amongst others in the community. However, explaining SmartNet to other community members resolved these concerns and often resulted in interest and acceptance among peers.ConclusionObjective monitoring of bednet use with SmartNet appears acceptable to these households in Uganda. Use of SmartNet seems to be similar to behaviors around use of standard LLINs. Viewpoints on many aspects of SmartNet were generally favorable. Concerns around ethicality of bednet monitoring are present and indicate the need for continuing community education. The device will continue to be optimized to make it more acceptable to users and to accurately reflect standard LLIN use to improve our understanding of prevention behaviors in malaria endemic settings.

Identification and characterization of Anopheles Breeding habitats in Dabakala, Central-East Cote d'Ivoire

Malaria prevention in Côte d'Ivoire is mainly based on the use of long-lasting insecticide-treated nets. Faced with the resistance of vectors to insecticides, the use of anti-larval proves to be of interest. This study conducted in the Dabakala health district aims to identify Anopheles breeding sites and their Physico-chemical characteristics influencing the productivity of larvae. Prospects were carried out in the urban and rural areas during the rainy season (July 2020) and the dry season (February 2021). Out of 102 potential breeding sites listed, a total of 53 were positive, including 38 sites of Anopheles and 15 of other Culicinae. In both urban and rural areas, most Anopheles breeding sites were observed during the rainy season, while the density of Anopheles larvae was higher in the dry season. These highest densities were observed, in rural areas in rice fields essentially, and in the urban regions in temporary water impoundments, water wells, and rice fields. The temperature, pH, and depth of water were positively correlated with the density of Anopheles larvae. This study allowing the identification of favorable periods and sites of Anopheles breeding in the Dabakala district can help to design a strategy for the control of Anopheles larvae.

Rural-Urban Differentials in Access to Behaviour Change Communication and Use of Long-Lasting Insecticide-Treated Nets and Artemisinin-Based Combination Therapy in Southeast Nigeria.

As Malaria continues to take a heavy toll on the life and economy of Nigerians, The National Malaria Elimination Programme uses behaviour change communication (BCC) to promote the use of Long-Lasting Insecticide-treated Nets (LLIN) and Artemisinin-based Combination Therapy (ACT) to combat malaria. This study examined the impact of BCC on the use of LLIN and ACT in Southeast Nigeria. A structured questionnaire was used to gather data from 480 respondents in urban and rural communities across five states. Analysis of data was done using percentages, chi-square and logistic regression. Findings showed weak effect of BCC on LLIN and ACT use despite achieving high (93.75%) exposure. Only 45.1% and 45.7% of the respondents used LLIN and ACT respectively. Urban residents were found to sleep under LLINs and use ACTs more than rural dwellers. Regression results showed that newspapers (OR=1.341) and the Internet (OR=3.216) increased the odds of LLIN use in the rural areas and magazines (OR=1.837) in the urban areas. Television (OR=2.375; P=0.002) and the Internet (OR=6.063; P=0.001) increased the odds of ACT use in the urban areas. Education was found to be a positive predictor of LLIN use in the rural (OR=4.645; P=0.011) and urban areas (OR=6.102) as well as ACT use in the rural (OR=7.268; p=0.002) and urban areas (0R=6.145; P=0.009). Access to behaviour change communication though very high has not achieved the desired behaviour change. The National Malaria Elimination Programme should produce appropriate messages to address barriers to LLIN and ACT use.

Classifying Features Persuading the Use of Long Lasting Insecticide Treated Nets (LLINs) and Its Implications in Exterminating the Incidence of Malaria-Death in Ghana

This is a cross-sectional quantitative study purported to identify features deemed to persuade the usage of LLINs in exterminating incidences of malaria-death in Ghana. The population consisted of mothers and caregivers of children under five in Asamankese a district in the Eastern region of Ghana. Questionnaires were developed based on the profile and the set of study objectives, it sought information on socio-economic variables, knowledge level on LLINs, and influence of climatic and environmental factors on LLINs usage. Data were coded and keyed into SPSS version 20. Frequencies, percentages, means, standard deviations, graphs and tables were used to explore the data. Chi-square test was used to do further investigation. It was revealed that LLINs usage was influenced by a group of features including: background characteristics of household; socio-economic variables, environmental variables and knowledge on importance of LLINs. There was an association between LLINs usage and monthly income of caregivers (p&lt;0.05). Furthermore, there was a significant relationship (p&lt;0.05) between environmental features and LLINs usage. There was a relationship (p&lt;0.05) between one’s knowledge and use of LLINs. In addition, there was a relationship between usage and the number of times per month visits were made to the hospitals for health care. Environmental factors permitted the use of LLINs, Eighty-six (86%) of the respondents who used LLINs did use it because the weather aided them. It is recommended that behavior change education be intensified in the region so that more people can accept and adopt a lifestyle that will protect them from the deadly malaria diseases. Efforts must be made by the major players in the health sector to make the net readily available in the communities at low prices to enable the ordinary Ghanaian to purchase it.