Long-lasting Insecticide Research Articles

Usability of a digital tool to support long-lasting insecticide net distribution in Northern Bahr el Ghazal State, South Sudan.

Long-lasting insecticidal nets (LLINs) have been a widely used malaria prevention method for decades. In South Sudan, LLINs are typically distributed by volunteers who use paper-based systems to collect distribution data. Paper-based systems are simple to use but have a higher occurrence of data inaccuracies and can hinder the timely use of data for decision-making. In 2022, a digital tool was introduced to collect data during the LLIN campaign in Northern Bahr el Ghazal (NBeG). The tool aimed to improve the accuracy of data entry and enable data to be used in real-time for decision making during the campaign. The digital tool was developed with offline functionality and interoperability with DHIS2 tracker version 2.8 in DHIS2 version 2.38. This study assessed the usability of the tool according to user perspectives. A questionnaire containing open- and closed-ended questions was conducted with users of the digital tool, supervisors and other key stakeholders in five counties of NBeG. The questionnaire was administered using Malaria Consortium's Projects Results System Android mobile application. Usability was determined through a modified and validated System Usability Scale (SUS) approach. A total of 93 participants responded to the usability questionnaire. The mean (± standard deviation) usability score across 10 SUS-scoring items was60.91 (12.87), indicating a modest level of usability. The majority of users agreed the tool was useful for managing the LLIN distribution workflow, was easy to use, reduced workload, and supported stock management and real-time campaign monitoring. There was no significant difference in the usability scores across genders, roles, and counties. Respondents with experience of both paper-based and the digital tool tended to express a preference for the digital tool over paper-based systems. The majority of respondents also reported they would recommend the digital tool to colleagues. Digital tools are perceived to improve data collection during LLIN campaigns, even in remote areas where network coverage is challenging. Additional improvements can be implemented to overcome operational challenges and improve usability of the tool. Further study is needed to assess the impact of the digital tool on data quality and real-time data use.

Healthcare innovation adoption in Africa: the case of long-lasting insecticide nets in Ghana using protection motivation theory

Objective Studies have shown that healthcare innovation adoption is complex. Using Long-lasting insecticidal nets (LLINs), an innovation for malaria prevention, the study aimed to understand factors considered in the adoption of healthcare innovations in Africa. Methods and Measures Using qualitative methods, we interviewed 10 household heads in Ghana who had freely received LLINs during a malaria campaign. We analyzed our data using a deductive thematic analysis approach utilizing the protection motivation theory (PMT) as our framework. Results We found that the constructs of PMT: perceived severity, perceived vulnerability, perceived response efficacy, and perceived self-efficacy influenced the adoption of healthcare innovation (i.e. LLINs). We also found that misconceptions about malaria infection and prevention influenced the perceived response efficacy of LLINs which could undermine LLINs usage. Conclusion The constructs of PMT are important in the decision to use LLINs. Misconceptions about malaria infection and prevention could undermine the decision to use LLINs. Future studies should investigate ways to address these misconceptions.

A Five-Year Malaria Prevalence/Frequency in Makenene in a Forest-Savannah Transition Ecozone of Central Cameroon: The Results of a Retrospective Study.

Understanding the epidemiological features of malaria is a key step to monitoring and quantifying the impact of the current control efforts to inform future ones. This study establishes the prevalence and frequency of malaria in a forest-savannah ecozone for 5 consecutive years in Cameroon. A retrospective study was conducted in 3 health centers of Makenene from 2016 to 2020, a period covering the second long-lasting insecticide net mass distribution campaign. Malaria infectious records were reviewed from laboratory registers. The difference in exposure to malaria was estimated using a regression logistic model. A total of 13525 patients underwent malaria diagnostic tests, with a general malaria prevalence of 65.3%. A greater prevalence of malaria was observed in males (68.39%) compared to females (63.14%). The frequency of consultations in health centers was dominated by females, with a gender ratio (M/F) of 0.66. Annual trends in malaria prevalence slightly varied from 2016 to 2020, exceeding 60%: 65.2% in 2016; 66.7% in 2017, 68.1% in 2018, 63.2% in 2019, and 65.3% in 2020, with a significant seasonal variation (p < 0.0001). The highest malaria prevalence was observed during the short rainy season, no matter the year. Among positive cases, the most represented age groups were 6-15 (p < 0.0001), followed by those under 5, while the age group >25 years was the least represented. Close monitoring and additional intervention measures for malaria control are needed, as are more studies on vector bionomics and transmission patterns.

Long lasting insecticidal nets utilization and associated factors among households of West Arsi Zone, Oromia Region, Ethiopia

Long-lasting insecticide nets are often used as a physical barrier to prevent infection of malaria. In sub-Saharan Africa, one of the most important ways of lowering the malaria burden is the utilization of long-lasting insecticide-treated nets. However, there is no sufficient information on long-lasting insecticide utilization in Ethiopia. Therefore, the study was aimed to assess long-lasting insecticide net utilization and associated factors among households of West Arsi Zone, Oromia, Southern Ethiopia, 2023. A community-based cross-sectional study design was conducted in West Arsi Zone with a sample of 2808 households from May 01 to 30, 2023. Data were collected from households by using interviewer-administered structured questionnaires. Data were checked, coded, and entered into Epinfo version 7, cleaned, and analyzed by SPSS version 25. Descriptive analysis was used to present frequencies, proportions, and graphs. Binary logistic regression analysis was computed and the variables with p-values less than 0.25 were selected to be included in the multivariable model. The final model was interpreted using an adjusted odd ratio with a 95% confidence interval and p-value < 0.05 to declare the statistical association between the outcome and independent variables. About 2389 (86.2%) of households have long-lasting insecticide nets that can be used while sleeping. But the overall prevalence of long-lasting insecticide nets utilization was 69.9% with (95% CI 68.1–71.8). Being female as household head (AOR 1.69, 95% CI 1.33–4.15), number of separate rooms in the living house (AOR 1.80, 95% CI 1.23–2.29), duration of long-lasting insecticide nets used to be replaced (AOR 2.81, 95% CI 2.18–5.35), knowledge status of the respondents (AOR 3.68; 95% CI 2.48–6.97) were significantly associated with long-lasting insecticide nets utilization. The overall Household’s level of LLINs utilization was found to be low as compared to the national standard of Ethiopia, which is to be ≥ 85. The study identified that being female as household head, the number of separate rooms in the living house, the duration of long-lasting insecticide nets used to be replaced, knowledge status of the respondents were the predictors of long-lasting insecticide nets utilization among members of households. Thus, to improve the usage of LLINs, the West Arsi Zone Health Office and stakeholders should strengthen the long-term insecticide net utilization at the household level by educating the community with appropriate information.

Evaluation of an Attract-and-Kill Strategy Using Long-Lasting Insecticide Nets for the Management of the Brown Marmorated Stink Bug in Northern Italy.

The brown marmorated stink bug (BMSB), Halyomorpha halys (Stål) (Hemiptera: Pentatomidae), is causing extensive economic losses in tree fruit crops. Including attract-and-kill (AK) strategies targeting BMSBs in an integrated pest management framework could reduce the amounts of insecticides sprayed and benefit growers, consumers and the environment. This study evaluated the effectiveness of an area-wide AK strategy across an intensive fruticulture region of Northern Italy, comparing four paired pear sites with and without two AK stations ha-1. These stations consisted of long-lasting insecticide-treated nets containing alpha-cypermethrin, baited with the BMSB aggregation pheromone and synergist. BMSB abundance was estimated using black-standing monitoring traps, and fruit damage upon harvest was recorded across all sites. The AK stations did not decrease the BMSB abundance nor the fruit damage, while after harvest significantly lower BMSB captures were detected in the AK sites compared to the control sites. Whilst the lures' efficacy was corroborated by this research, the killing method requires improvement and refinement.

KNOWLEDGE EVALUATION OF MOSQUITO CONTROL PRACTICES WITHIN THE CENTRAL REGION OF JIGAWA STATE, NORTH-WEST NIGERIA

In order to mitigate and manage life-threatening mosquito-borne diseases such as malaria, Dengue, and lymphatic filariasis, both socio-demographic factors and the collective vector control knowledge within the community are pivotal. Hence, the objective of the current study is to evaluate the awareness and understanding of mosquito control practices in specific communities located in Jigawa State, North-west Nigeria. A cross-sectional study was conducted in which 60 structural questionnaires were distributed in the three selected communities. In each village, 20 questionnaires were randomly shared and captured information on Demographical characteristics, House characteristics, Use of mosquito net etc. Among the 60 respondents, only 17(28.3%) of the respondents were participating in community sanitation, majority of respondents 56(93.3%) were found to keep water at home. However, usage of long-lasting insecticide nets (LLINs) on daily basis were recorded significantly highest 48(80%). We therefore recommend promotion of the significance of environmental sanitation as a primary measure for controlling mosquito-borne diseases among them.

Assessment of Knowledge, Attitude, and Utilization of Long-Lasting Insecticidal Nets in Jigawa State: a cross-sectional study

Background: The sharing of long-lasting insecticide nets (LLINs), and utilization, alongside knowledge and attitude of the communities towards malaria, are vital to Malaria prevention, treatment, and control. This study intends to investigate the current state of knowledge, attitude, and usage of LLINs in Chamo town of Jigawa State, Nigeria. Methods: The study employed a cross-sectional survey with a semi-structured interview questionnaire. Results: Of the total 471 respondents interviewed, comprising males (39.7%) and females (60.3%). The respondents had a mean age of 35.2 (SD = 12.6), and more than half (n= 274; 58.5%) were between 20 and 40 years old. Most of the respondents (n = 390; 82.8 %) know LLINs. However, only 225 (47.8%) believed the role of LLINs in protecting one from a mosquito bite, and 353 (75.8%) of the respondents believed that malaria can be transmitted through a mosquito bite. Educational level, marital status, and occupation show a significant association with knowledge of LLIN use. Conclusion: We concluded that there was a general awareness of LLINs in the study area, and the majority had favorable knowledge regarding malaria transmission. However, nearly half of the participants have a favorable understanding of LLIN use.

Blood smears examination and prevalence of malaria in Addis Zemen Town, Northwest Ethiopia (2013–2021): a retrospective study

IntroductionIn Ethiopia, malaria is one of the major public health and socioeconomic problems, though tremendous efforts have been made. Currently, the country has a plan to eliminate malaria by 2030. To achieve this plan, epidemiological studies associated with malaria prevalence with gender, age groups, species types, and seasons are essential. Therefore, the aim of this study was to assess the prevalence of malaria from 2013 to 2021 in Addis Zemen town, Northwest Ethiopia.MethodsA retrospective study was conducted at assess the trend of malaria prevalence over the last nine years using recorded blood smear reports in the laboratory logbook from governmental health institutions. Trends in malaria cases and the proportion of genders, age groups, species, and seasons over time were compared. The data were analyzed using the SPSS-23 software package.ResultsThe overall malaria prevalence between 2013 and 2021 was 10.4%. From all confirmed cases, the minimum and maximum prevalence of malaria cases were recorded in 2018 (2%) and 2016 (33.2%) years, respectively. The infectious rate of males (59.3%) was significantly higher than that of females (40.7%) (p < 0.0001). In all survey periods, all age groups were infected by malaria parasites; the majority of the cases were between 15 and 45 years (57%) older than others. Statistically, a greater proportion of P. falciparum (80.1%) was recorded than P. vivax (18.5%) (p < 0.0001). Malaria cases were occurring throughout each month. The relative highest peaks of total malaria cases were observed during the months of September, October, and November. Seasonally, the highest infection rate was observed during spring (40.20%) compared to other seasons.ConclusionsIn conclusion, the study revealed that malaria transmission remained high, which affected males more than females and potentially reproductive ages. Two of the most important Plasmodium species were identified and found during all reviewed months and years, though P. falciparum was the most prevalent. Hence, the problem can be alleviated by using season-based long-lasting insecticide treated nets, regularly overseeing ongoing irrigation activity, overseeing the reduction of the water level of the Sheni River, health education, and providing immediate patient treatment.

Evaluation of Interactions between Malaria Vector Control Practices and Demographic Parameters in Selected Communities in Abia State, South-East, Nigeria

Malaria, transmitted by Anopheles mosquitoes has become a debilitating and burdensome disease in Sub-Saharan Africa and conventional practices such as Long-Lasting Insecticide Treated Nets (LLITNs), and Indoor Residual Spraying (IRS) and unconventional practices are usually employed as malaria vector control measures. Hence, the objective of this paper was to evaluate the interactions that exist between these control practices and demographic parameters in selected communities across Ikwuano, Osisioma and Ohafia Local Government Areas (LGAs) of Abia State, South-East, Nigeria using multi-stage sampling technique with five hundred and ten structured questionnaires. Data obtained reveals that the predominant control practices were IRS (325; 63.7%), although it was used in combination with other control methods. This was followed by screening of windows with net (221; 43.3%), whereas only a few respondents used LLITNs. Respondent’s LGA, level of education, type of dwelling structure and household size had significant relationship with most of the malaria vector control practices/perceptions (P &lt; 0.05). However, gender had no significant relationship with any of the malaria vector control practices/perceptions (P &gt; 0.05). Effectiveness (306; 60.0%) was the major reason behind choice of method practiced. Respondents also chose methods that were cheap (175; 34.3%) and prevented contact with mosquitoes (154; 30.2%), but attested to not being aware of any recent Government/Non-Governmental (NGO) mosquito control intervention (386; 75.7%). Considering the low ownership and usage of LLITNs in Abia, efforts should be made towards more distribution. Control programs are advised to consider LGA, level of education, household size, and type of dwelling structure during the design and deployment of interventions.

Implementation and effectiveness outcomes of Community Health Advocacy Teams to improve long-lasting insecticide net distribution and use in six districts in Ghana: A one-group pre-post-test study.

Malaria remains a leading cause of illness and death especially among children and pregnant women in Ghana. Despite the efforts made by the National Malaria Elimination Programme (NMEP), including distribution of Long-Lasting Insecticide Nets (LLINs) to households through periodic Point Mass Distribution (PMD) campaigns and continuous channels (antenatal, schools and postnatal), there is a gap between access and use of LLINs in Ghana. An effective and functional community-based group that would seek to improve the effectiveness of LLIN distribution before, during, after PMD Campaigns and continuous distribution at the community level could help address this gap. This paper assesses the implementation outcomes and short-term effectiveness of the pilot implementation of co-created community health advocacy teams (CHAT) intervention in Ghanaian communities to plan and implement campaigns to increase LLIN use. The study employed a one-group pre-post study design and measured implementation outcomes (acceptability, appropriateness, and feasibility) and effectiveness outcomes (LLIN awareness, LLIN access, willingness to purchase LLIN, and LLIN use) among 800 community households. The CHAT intervention was implemented for four months across six districts in the Eastern and Volta regions of Ghana. The data were downloaded directly from REDCap and analyzed statistically (descriptive and McNemar test of association) using SPSS 22 software. After the implementation period, the majority of respondents in all six districts indicated that the CHAT intervention was acceptable (89.8%), appropriate (89.5%), and feasible (90%). Also, there was a significant association between baseline and end-line assessment on all four effectiveness outcome measures. Household members' awareness of, access to, willingness to purchase, and use of LLINs increased significantly over the four-month period that the CHAT intervention was implemented. The study concludes that CHAT is an acceptable, appropriate, and feasible intervention for supporting the National Malaria Programme in LLIN PMD and for engaging in Social and Behaviour Change Communication activities through the continuous channels of distribution. Additionally, the CHAT demonstrates short-term effectiveness outcomes in terms of creating LLIN awareness, providing access to LLIN, and encouraging Ghanaian community members to be willing to purchase and use LLINs. Although the activities of CHAT members were largely voluntary, integration into the existing primary health care system will make it sustainable.

Physical integrity and bioefficacy of used long-lasting insecticidal nets in Makenene, Centre Region of Cameroon.

Long-lasting insecticide nets (LLINs) are the recommended tools against mosquito-borne diseases. However, their physical integrity and bioefficacy in the field could be affected by several factors. This study evaluated the physical integrity and bioefficacy of nets used in Makenene since 2016. Cross-sectional field surveys were carried out after 6 y. A questionnaire was first administered to the heads of households, and then the physical integrity of the LLINs was determined by calculating the proportional hole index (pHI). WHO cone bioassays were conducted to determine the bioefficacy of LLINs currently being used against wild strains of Anopheles gambiae s.l., Culex pipiens s.l., and laboratory-reared pyrethroid-susceptible strain of Anopheles coluzzii (Ngousso). Of the 167 LLINs examined in households, 39.5% were fairly good, 26.4% were acceptable, and 34.1% were damaged. The most torn faces of the nets were the sides used for entering and exiting. None of the 30 LLINs used for WHO cone bioassays was still effective against An. gambiae s.l. and Cx. pipiens s.l. while up to 85.7% of these LLINs were at least effective against the susceptible strain after 24 h, with a significant difference observed when comparing the mortality rates between wild and laboratory-susceptible strain of Anopheles (P-value < 0.01). Anopheles gambiae s.l. were all (100%) identified as An. gambiae s.s. by PCR. The LLINs distributed in Makenene since the 2016 campaign are only effective on susceptible strain and should be replaced for a better control of residual malaria transmission and the nuisance by Culex mosquitoes in the locality.

The Biodiversity of Anopheles and Malaria Vector Control in Indonesia: A Review

Malaria is a re-emerging vector-borne disease. Malaria is caused by Plasmodium parasites namely P. falciparum, P. malariae, P. vivax, P. ovale, and P. knowlesi. The parasite is transmitted by mosquitoes from the genus Anopheles. The genus Anopheles comprises more than 480 described species worldwide and many more are yet to be described. It is known that there are more than 100 species of Anopheles that can transmit malaria parasites to humans. The present review aims to assess studies on the biodiversity of Anopheles as a malaria vector and its control in Indonesia. The results showed that a total of 80 species of Anopheles mosquitos are reported in Indonesia, and at least 31 species of Anopheles mosquitoes have been reported as malaria vectors in Indonesia. Several efforts to decrease the number of malaria cases are the distribution and wide-scale use of Long-Lasting Insecticide Treated Bednets (LLIN), Indoor Residual Spraying (IRS) applications, larvae control, and environmental management. Vector control and entomological surveillance of malaria are one of the main domains for achieving malaria elimination. In conclusion, a combination of national policies, local-specific, habitat-specific, and community participation approaches are needed for effective malaria vector control in Indonesia.

Evaluating long-lasting insecticide netting against spotted lanternfly adults in grapes, 2020 and 2021

Evaluating long-lasting insecticide netting against spotted lanternfly adults in grapes, 2020 and 2021

Non-contact detection of pyrethroids widely used in vector control by Anopheles mosquitoes.

Pyrethroids are the most widely used insecticides to control vector borne diseases including malaria. Physiological resistance mechanisms to these insecticides have been well described, whereas those for behavioral resistance remain overlooked. Field data suggest the presence of spatial sensory detection by Anopheles mosquitoes of the pyrethroid molecules used in insecticide-based control tools, such as long-lasting insecticide nets or insecticide residual spraying. This opens the way to the emergence of a wide range of behavioral adaptations among malaria vectors. However, the spatial sensory detection of these molecules is controversial and needs to be demonstrated. The goal of this study was to behaviorally characterize the non-contact detection of three of the most common pyrethroids used for malaria vector control: permethrin, deltamethrin an ⍺-cypermethrin. To reach this goal, we recorded the behavior (takeoff response) of Anopheles gambiae pyrethroid-sensitive and resistant laboratory strains, as well as field collected mosquitoes from the Gambiae Complex, when exposed to the headspace of bottles containing different doses of the insecticides at 25 and 35°C, in order to represent a range of laboratory and field temperatures. We found the proportion of laboratory susceptible and resistant female mosquitoes that took off was, in all treatments, dose and the temperature dependent. Sensitive mosquitoes were significantly more prone to take off only in the presence of ⍺-cypermethrin, whereas sensitive and resistant mosquitoes showed similar responses to permethrin and deltamethrin. Field-collected mosquitoes of the Gambiae Complex were also responsive to permethrin, independently of the species identity (An. gambiae, An. coluzzii and An. arabiensis) or their genotypes for the kdr mutation, known to confer resistance to pyrethroids. The observed ability of Anopheles spp. mosquitoes to detect insecticides without contact could favor the evolution of behavioral modifications that may allow them to avoid or reduce the adverse effect of insecticides and thus, the development of behavioral resistance.

Assessment of long-lasting insecticide nets coverage, utilization, and associated factors among households in malaria elimination districts of Arsi Zone, Oromia Region, Ethiopia: A cross-sectional study.

Malaria is a major global public health problem, with a particular burden of disease in sub-Saharan Africa including Ethiopia. Access to Long Lasting Insecticide Nets (LLINs) for at-risk populations, ensuring its appropriate utilization and identifying the barriers are important for malaria prevention, control and elimination. This study aimed to assess coverage, utilization and associated factors of Long Lasting Insecticide Nets (LLINs) among households in the Arsi Zone of Oromia Region, Ethiopia. Community-based cross-sectional study was conducted from October to December 2021. Multi-stage sampling technique was used to recruit 1250 households from five districts out of 21 Malarious districts in the Zone. Proportional allocations of households were done in each sampled kebeles and simple random sampling was used to draw the study participants. Data were collected by trained data collectors using a pre-tested structured questionnaire and observation. The collected data were exported to and analyzed using SPSS version 23. Variables with a p-value below 0.2 at bivariable logistic regression analysis were entered into the multivariable logistic regression model. We presented findings using an adjusted odds ratio with 95%CI at a p-value of less than 0.05. Out of the total of 1250 households 99.5% of surveyed owned LLINs and 27.1% of them had slept under the net the night before the survey. The factors associated with LLIN usage included being in the age range of 40 to 49 years (AOR; 1.82, 95%CI 1.01-3.25), preference for conical-shaped LLINs (AOR = 2.36; 95% CI: 1.33-4.18), not believing LLINs expired within 6 months (AOR 3.75, 95% CI 2.31-6.09), reporting a mosquito bite as a mode of malaria transmission (AOR = 2.46; 95%CI: 1.01-5.98), employed (AOR = 9.0; 95%CI: (4.22-20.02) and type of sleeping bed (AOR =: 17.4; 95% CI, 11.74-26.03). On the other hand, households with two and above sleeping rooms were less likely to use LLINs (AOR = 0.46; (95% CI: 0.23-0.88). Even though the ownership of Long Lasting Insecticidal Nets was high, the actual utilization was very low. Promoting the usage of LLINs utilization among those at most risk, through intensified health education activities will be helpful.

Intermittent Preventive Treatment and Long-Lasting Insecticide Nets use among pregnant Women attending Traditional Birth Homes in Ibadan, Nigeria

Intermittent Preventive Treatment and Long-Lasting Insecticide Nets use among pregnant Women attending Traditional Birth Homes in Ibadan, Nigeria

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.

Pilot implementation of community health advocacy teams to improve the effectiveness of long-lasting insecticide net distribution through both campaigns and continuous channels in Ghana: a qualitative study of opportunities and barriers to implementation.

In Ghana, the National Malaria Elimination Programme (NMEP) distributes long-lasting insecticide net (LLIN) to households for free through the periodic point mass distribution (PMD) campaign and continuous distribution to populations most vulnerable to malaria. It is known that the existence of effective and functional community-based groups could influence positive behaviours regarding health interventions promoted through health campaigns. However, there is no evidence of functional community-based groups that aim to improve the effectiveness of LLIN distribution campaigns by transitioning into primary healthcare delivery. This study aimed to explore the opportunities and barriers to the pilot implementation of co-created community health advocacy teams (CHATs) to improve the effectiveness of LLIN distribution through both campaigns and continuous channels in Ghana. A qualitative research approach was used among 43 CHAT members across six communities in the Eastern and Volta regions of Ghana. The CHAT constitutes significant community actors whose roles are centred on key elements of community/social mobilisation and capacity building, all nested in social and behaviour change communication (SBCC) strategies. The CHATs were pilot implemented in all study communities for 4 months after which we identified opportunities and barriers during implementation. CHAT members participated in six focus group discussions which were audio recorded, transcribed verbatim, and analysed thematically using the NVivo 13. CHATs were instrumental in sensitising community members through SBCC strategies. Moreover, there were changes in the behaviour of community members who were receptive towards and participated in CHAT activities. Community members were accurately informed about malaria (e.g., causes and preventive measures). However, the CHAT experienced barriers during implementation, including a lack of financial support to aid in transportation, organisation of meetings, and outreach activities. Additionally, the level of participation by CHAT members in activities and the medium of communication among members were key areas of concern. The CHATs would be instrumental in promoting LLINs' use during and after PMD campaigns through community outreaches. It is therefore necessary to provide resources to support their operations and a good network to address communication barriers. Finally, continuous capacity strengthening of CHAT members by the NMCP is important.

Baseline characterization of entomological drivers of malaria transmission in Namibia: a targeted operational entomological surveillance strategy

BackgroundNamibia’s focus on the elimination of malaria requires an evidence-based strategy directed at understanding and targeting the entomological drivers of malaria transmission. In 2018 and 2019, the Namibia National Vector-borne Diseases Control Program (NVDCP) implemented baseline entomological surveillance based on a question-based approach outlined in the Entomological Surveillance Planning Tool (ESPT). In the present study, we report on the findings of the ESPT-based NVDCP on baseline vector species composition and bionomic traits in malaria endemic regions in northern Namibia, which has the aim of generating an evidence base for programmatic decision-making.MethodsNine representative sentinel sites were included in the 2018 entomological surveillance program (Kunene, Omusati, Oshana, Ohangwena, Oshikoto, Otjozondjupa, Kavango West, Kavango East and Zambezi); the number was reduced to four sites in 2019 due to limited funding (Ohangwena, Kavango West, Kavango East, and Zambezi). In the 2018 baseline collections, multiple sampling methods (human landing catches, pyrethroid spray catches, U.S. Centers for Disease Control and Prevention light traps [CDC-LTs], resting boxes [RBs] and larval sampling) were utilized to evaluate indoor/outdoor human biting rates, resting behaviors and insecticide resistance (IR). CDC-LTs and RBs were not used in 2019 due to low and non-representative sampling efficacies.ResultsOverall, molecular evidence demonstrated the presence of three primary mosquito vectors, namely Anopheles arabiensis, rediscovered Anopheles gambiae sensu stricto and Anopheles funestus sensu stricto, alongside Anopheles squamosus and members of the Anopheles coustani complex. Vectors were found to bite throughout the night (1800 hours 0600 hours) both indoors and outdoors, with An. arabiensis having the highest biting rates outdoors. Low numbers of indoor resting Anopheles point to possible low indoor residual spraying (IRS) efficacy—with An. arabiensis found to be the major vector species resting indoors. The IR tests demonstrated varying country-wide resistance levels to the insecticide deltamethrin, with the resistance levels confirmed to have increased in 2019, evidence that impacts national programmatic decision-making. Vectors demonstrated susceptibility to the insecticides dichlorodiphenyltrichloroethane, bendiocarb and Actellic 300CS in 2018, with mosquitoes from only one site (Kavango West) demonstrating possible resistance to DDT. Targeted and question-based entomological surveillance enabled a rapid and focused evidence base to be built, showing where and when humans were being bitten and providing entomological data on long-lasting insecticidal nets, IRS efficacy and insecticide resistance, which the Ministry of Health and Social Services-Namibia can use to further build a monitoring and evaluation framework for understanding the drivers of transmission.ConclusionIdentification and characterization of species-specific bionomic traits allows for an understanding of where and when vector human contact may occur as well as the potential impact of interventions. Low indoor resting rates as well as the presence of insecticide resistance (and the increase in its frequency) point to the need for mosquito-behavior-directed and appropriate interventions as well as the requirement for a resistance mitigation strategy. The ESPT-based question- and minimal essential indicator-based operational research strategy provides programs with directed and focused data for facilitating decision-making while requiring limited funding and capacity.Graphical

MODELLING OF ACCESS TO MOSQUITO TREATED NET IN NIGERIA: USING MULTILEVEL LOGISTIC REGRESSION APPROACH

This research examined the current status of access to Mosquito Treated Net (MTN) for children under five years in Nigeria. Despite the National malaria elimination programme recommendation of long-lasting insecticide treated net as the cornerstone of malaria prevention in Nigeria, there exist disparity in access to this MTN. The data for the study was extracted from the 2018 National Demographic Health Survey (NDHS). Descriptive statistic was adopted to describe and explain the effects of the variances present in the study on the variables of interest using STATA15 software are presented. The results reveal that out of the 8627 household with under five children considered in the analysis 7431 (86.14%) have access to MTN while 1196 (13.86%) have no access to MTN at the time of data collection. The wealth index of parents, educational attainment and regions were found to be the major determinants of under-5 access to MTN in Nigeria. The results also reveals that the null random intercept model best fit the data. The intra- class-correlation coefficient reveals a regional variation in the numbers of under-5 that have access to MTN across geopolitical zones in Nigeria. The result shows a statistically significant result for the random intercepts at 5% level of significance with a variation of 0.044154. The estimate of the intra-class-correlation coefficient indicates a total variability of 0.2051(20.51%). The research concludes that wealth index, educational attainment and region are the major determinants of access to MTN in Nigeria.