Malaria Indicator Survey Research Articles

Predictive accuracy of the logit model to determine factors affecting delivery and postnatal care services utilization in Tanzania

PurposeThis paper examines factors affecting the delivery care (DC) and postnatal care (PNC) services utilization in Tanzania using the predictive accuracy of the binary logit model by including DC as among the predictors of PNC utilization.Design/methodology/approachThe study used secondary data from the Tanzania Demographic and Health Survey and Malaria Indicator Survey (2022) based on a sample of 13,266 women aged 15–49. Binary logit was used to analyze the association between independent variables and each binary dependent variable, followed by a stepwise likelihood ratio test for binary logistic regression analysis to select the most important predictors associated with DC and PNC. Odds ratios were used to predict the likelihood of the occurrence of significant explanatory variables in explaining the outcomes.FindingsThe results showed that the type of place of residence, wealth index, region, highest educational level, husband/partner’s level of education and respondent’s occupation were significant predictors of DC utilization. In contrast, the woman’s age, region, highest educational level, wealth index, DC and husband/partner’s educational level were significant predictors of PNC utilization. Public health interventions are needed to promote and increase the utilization of delivery and postal care services. The targets should be poor women and those residing in rural or remote areas.Originality/valueIncluding DC as a predictor variable (which was not used before) in PNC utilization improved the predictive power of the model and the robustness of the results.

The influence of malaria control interventions and climate variability on changes in the geographical distribution of parasite prevalence in Kenya between 2015 and 2020

BackgroundThe burden of malaria in Kenya was showing a declining trend, but appears to have reached a plateau in recent years. This study estimated changes in the geographical distribution of malaria parasite risk in the country between the years 2015 and 2020, and quantified the contribution of malaria control interventions and climatic/ environmental factors to these changes.MethodsBayesian geostatistical models were used to analyse the Kenyan 2015 and 2020 Malaria Indicator Survey (MIS) data. Bivariate models were fitted to identify the most important control intervention indicators and climatic/environmental predictors of parasitaemia risk by age groups (6–59 months and 5–14 years). Parasitaemia risk and the number of infected children were predicted over a 1 × 1 km2 grid. The probability of the decline in parasitaemia risk in 2020 compared to 2015 was also evaluated over the gridded surface and factors associated with changes in parasitaemia risk between the two surveys were evaluated.ResultsThere was a significant decline in the coverage of most malaria indicators related to Insecticide Treated Nets (ITN) and Artemisinin Combination Therapies (ACT) interventions. Overall, there was a 31% and 26% reduction in malaria prevalence among children aged < 5 and 5–14 years, respectively. Among younger children, the highest reduction (50%) and increase (41%) were in the low-risk and semi-arid epi zones, respectively; while among older children there was increased risk in both the low-risk (83%) and semi-arid (100%) epi zones. Increase in nightlights and the proportion of individuals using ITNs in 2020 were associated with reduced parasitaemia risk.ConclusionIncreased nightlights and ITN use could have led to the reduction in parasitaemia risk. However, the reduction is heterogeneous and there was increased risk in northern Kenya. Taken together, these results suggest that constant surveillance and re-evaluation of parasite and vector control measures in areas with increased transmission is necessary. The methods used in this analysis can be employed in other settings.

Determinants of malaria spread among under-five children in Nigeria: results from a 2021 Nigerian malaria indicator cross-sectional survey

BackgroundMalaria is a global disease burden, especially in Africa, with Nigeria having the highest prevalence of malaria, with approximately 50% affecting children. Children under five years of age are vulnerable to the risk of malaria spread. This research aimed to identify the determinants of malaria spread among children under the age of 5 in Nigeria.MethodsThis study used national malaria indicator survey data from 2021 (2021NMIS). The NMIS was implemented by the National Malaria Elimination Programme (NMEP), and data were collected between 12 October and 4 December 2021. This study included 3678 children, and data cleaning and analysis were performed via STATA version 17 software.ResultsThere was a positive association between Child’s age in months of 13–23 (AOR = 2.97; 95% CI = 1.62–5.45), 24–35 months (AOR = 2.64; 95% CI = 1.43–4.88),36–47 months (AOR = 2.18; 95% CI = 1.17–4.08) and months of 48–59(AOR = 2.82; 95% CI = 1.53–5.23), households headed by females (AOR = 0.71; 95% CI = 0.54–0.95),households with all children slept in mosquito nets last night (AOR = 2.43; 95% CI = 1.39–4.21), some children slept in the mosquito bed net (AOR = 2.83; 95% CI = 1.50–5.35) and households with no mosquito bed nets (AOR = 2.18; 95% CI = 1.22–3.88),mothers who agreed to have heard or seen malaria messages in the last 6 months (AOR = 1.32; 95% CI = 1.62–1.74),respondents with medium level of awareness of malaria prevention messages had (AOR = 2.35; 95% CI = 1.62–3.4), Children from North East (AOR = 0.7; 95% CI = 0.54–0.9), South-South (AOR = 0.65; 95% CI = 0.5–0.85) and South West (AOR = 0.52; 95% CI = 0.37–0.73) and malaria status of children under five years of age in Nigeria.ConclusionThe government and other concerned malaria prevention organizations should emphasize maternal education programs that are vital for malaria prevention, early symptom recognition, and timely treatment, empowering families to take proactive measures. Collaboration among health, education, and community organizations is also crucial for integrated malaria control and prevention.

Assessment of malaria transmission in Kenya using multilevel logistic regression

Background: Kenya has a lower malaria incidence in comparison to other African malaria-endemic nations. Malaria is a significant public health concern in the country. The malaria indicator survey (MIS) data were analyzed using the logistic regression model. Nonetheless, independent data may be the cause of most MIS's hierarchical structure. This approach does not consider any association between data points within a cluster, as it assumes that the individual malaria statuses are independent of their causes. The approach may lead to biased analysis conclusions. The primary goal of this research is to determine the impact of sample enumeration areas (SEAs) and SEA features on individual malaria rapid diagnostic test (RDT) results. We are interested in identifying key factors influencing household members' malaria RDT findings or Kenya's malaria prevalence and assessing variation. Methods: Our study utilized the robust 2020 Kenya National Malaria Indicator Surveys (KMIS) dataset, which is representative of the entire nation. This dataset, comprising 301 clusters (134 urban and 167 rural areas), was instrumental in applying several multilevel models, including random sample and sample Enumeration Area (SEA) effects. We also considered the weights used in the s survey design, which is used to adjust uneven probabilities of choice within clusters, further enhancing the reliability and relevance of our findings. The methods used in this study involved a rigorous analysis of the KMIS dataset, including applying multilevel models and considering survey design weights to ensure the robustness and strength of our results. ResultsThis study's findings are significant and crucial in understanding the prevalence of malaria in Kenya. The findings reveal that factors such as region, place of residence, mosquito bed net use, water source location, wealth index, age, household size, and altitude are significantly associated with malaria's prevalence.After accounting for these variables, systematic changes across SEAs accounted for approximately 47.1% of the remaining variability in malaria occurrence in the study locations. In contrast, the remaining 52.9% was projected to be unmeasured differences between individuals or family units. These findings provide a detailed explanation of the various processes that influence malaria prevalence in Kenya. Conclusions: The study's multilevel logistic regression model, which includes random effects, identified two SEA-level and eight individual/household risk factors for malaria infection. Thus, increasing the availability of insecticide-treated bed nets is one crucial element that public health policymakers should consider. Furthermore, health planners can organize spatially targeted initiatives to prevent malaria transmission with the help of spatial clustering data.

The Impact of Internal Migration on HIV/AIDS Transmission in Tanzania

This study examines the complex and dynamic relationship acting between the internal migration and the spread of HIV/AIDS in Tanzania. The study uses the Tanzania HIV/AIDS and Malaria indicators Survey (2011-2012) data extracted from the National Bureau of Statistics database. The study applied multivariate and logistic regression to analyze the determinants of HIV/AIDS prevalence in Tanzania. The study found that there are marginal differentials in the HIV/AIDS prevalence between migrants and non-migrants, but considering gender-wise differences the trend is substantially significant. The infection rate is higher to migrants aged thirty and above (17.3% for male and 17.5% for female) and with no education. The study also found that the HIV/AIDS prevalence is higher for non-agricultural occupations dominated by females while males account high percentage for non-working group. This study is important to government and stakeholders for addressing the dynamic interactions, policies and programs established to reduce the migration to the spread of the HIV/AIDS. Also, this study show how the different forms of migration influence the spread of HIV/AIDS. As a suggestion, the pilot program could be crucial and cost-effective for addressing factors contributing to the spread of HIV/AIDS.

Geographically weighted logistic regression model for identifying risk factors for malaria infection among under-5 children in Ghana

Malaria remains a significant public health challenge globally, particularly affecting children under-5 years of age due to their underdeveloped immune systems. Identifying the risk factors associated with malaria infection in this vulnerable group is crucial for improving policy formulation and creating effective training programs. However, there is limited information on how the relationship between malaria risk and associated factors varies across different regions, especially among children in Ghana. This is important because understanding these spatial variations can enhance targeted interventions including area remediation and resource allocation. To address this gap, a geographically weighted logistic regression (GWLR) model was developed to identify spatially varying risk factors for malaria infection among children under five in Ghana. The model was built on the premise that the relationship between malaria and potential risk factors is not uniform across geographic areas. Data from the Ghana Malaria Indicator Survey collected through the demographic and health survey program were used for analysis. The study found that the GWLR model fit the data better than the conventional binary logistic regression (BLR) model, based on the information criterion used and mode evaluation metrics. The results indicated that risk factors for malaria such as a child's age, anaemia status, dwellings sprayed, place of residence, electricity access, NHIS (National Health Insurance Scheme) coverage, age of the household head, and household wealth index, were non-stationary across the study area. These findings underscore the importance of spatially tailored interventions to reduce malaria risk in children under-5. The results contribute to the body of literature on malaria risk factors and provide valuable insights for Ghana's national malaria control policies, potentially enhancing the effectiveness of future public health strategies.

Factors Associated with the Access and Use of Improved Latrine Facilities in Tanzania

Access to improved latrine facilities is a basic human right and fundamental to good health. Inadequate sanitation practices cause serious health problems especially transmission of diarrhea. The study aimed to determine associated factors with access to and use of improved latrine facilities in Tanzania. The data for this study was obtained from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2022 TDHS-MIS) by visiting https://www.dhsprogram.com. Data were analyzed using STATA Version 16, whereby a multilevel logistic regression model was chosen as the statistical approach. The study revealed that overall 67.76% of the households had access to improved latrines. The study revealed that head of households with higher education, rich 55+ years and with television had higher odds of using improved toilets compared to others. The study concludes that more than half of the households in Tanzania had access to an improved latrine which is not common in most developing countries, especially in sub-Saharan Africa, and thus can be used as a reference for learning. This implies the government and stakeholders’ interventions have brought positive changes. Hence, the need of policy enforcement in specific areas as well as government and stakeholders creating awareness campaigns to enable more households’ access to improved latrine in both rural and urban areas

Impact of mass media campaigns on knowledge of malaria prevention measures among pregnant mothers in Uganda: a propensity score-matched analysis

BackgroundUganda grapples with a considerable malaria burden, reporting prevalence rates of over 33% in some regions. To address this, the Uganda Ministry of Health employs audiovisual platforms for disseminating malaria prevention messages. However, the impact of these messages on pregnant women’s knowledge of malaria prevention remains insufficiently explored. This paper therefore emphasizes the influence of audiovisual messages on the knowledge of malaria prevention measures among pregnant women in Uganda.MethodsSecondary data obtained from the Uganda Malaria Indicator Survey (MIS) 2018–2019 was used for this analysis. Women aged 15–49 were included in the study. A total of 8868 women were selected using a two-stage sample design. The two stages of selection included clusters and households. Women who were currently pregnant were included in the study, resulting in a weighted sample of 721 women. Propensity score-matched analysis was used to evaluate the impact of access to malaria messages on knowledge of prevention measures.ResultsThe study revealed that 39% [95% CI 34.0–44.2] of pregnant women were exposed to malaria messages before the survey. Those exposed had a 17.2% higher knowledge [ATT = 0.172; 95% CI 0.035–0.310] of using mosquito nets for prevention compared to those unexposed. Among women exposed, radios accounted for most form of access to mass media campaigns [64.8, 95% CI 57.0–71.8] followed by interpersonal communication [45.0, 95% CI 37.6–52.6], community health workers [38.8, 95% CI 29.6–48.8], community events [21.4, 95% CI 15.8–28.3], and social mobilization [18.3, 95% CI 12.7–25.8].ConclusionResults highlight the importance of radios in spreading important malaria prevention messages to pregnant women. Being exposed to these messages is linked to increased awareness and knowledge about the proper use of insecticide-treated bed nets (ITNs) for preventing malaria. This finding underscores the importance of evaluating different channels for mass media campaigns to ensure the effective delivery of information about malaria prevention to the intended audiences.

Receipt of antimalarials among children aged 6–59 months in Nigeria from 2010 to 2021

BackgroundNigeria has the highest malaria burden globally, and anti-malarials have been commonly used to treat malaria without parasitological confirmation. In 2012, Nigeria implemented rapid diagnostic tests (RDTs) to reduce the use of anti-malarials for those without malaria and to increase the use of artemisinin-based combination therapy (ACT) for malaria treatment. This study examined changes in anti-malarial receipt among children aged 6–59 months during a 12-year period of increasing RDT availability.MethodsA cross-sectional analysis was conducted using the Nigeria Malaria Indicator Survey (NMIS) data from 2010 (before RDT implementation in 2012), 2015, and 2021. The analysis assessed trends in prevalence of malaria by survey RDT result, and fever and anti-malarial/ACT receipt in the 2 weeks prior to the survey. A multivariable logistic regression was used to account for the complex survey design and to examine factors associated with anti-malarial receipt, stratified by survey RDT result, a proxy for recent/current malaria infection.ResultsIn a nationally-representative, weighted sample of 22,802 children aged 6–59 months, fever prevalence remained stable over time, while confirmed malaria prevalence decreased from 51.2% in 2010 to 44.3% in 2015 and 38.5% in 2021 (trend test p < 0.0001). Anti-malarial use among these children decreased from 19% in 2010 to 10% in 2021 (trend test p < 0.0001), accompanied by an increase in ACT use (2% in 2010 to 8% in 2021; trend test p < 0.0001). Overall, among children who had experienced fever, 30.6% of survey RDT-positive and 36.1% of survey RDT-negative children had received anti-malarials. The proportion of anti-malarials obtained from the private sector increased from 61.8% in 2010 to 80.1% in 2021 for RDT-positive children; most of the anti-malarials received in 2021 were artemisinin-based combinations. Factors associated with anti-malarial receipt for both RDT-positive and RDT-negative children included geographic region, greater household wealth, higher maternal education, and older children.ConclusionFrom 2010 to 2021 in Nigeria, both malaria prevalence and anti-malarial treatments among children aged 6–59 months decreased, as RDT availability increased. Among children who had fever in the prior 2 weeks, anti-malarial receipt was similar between children with either positive or negative survey RDT results, indicative of persistent challenges in reducing inappropriate anti-malarials uptake.

Determinants of the optimal uptake of sulfadoxine–pyrimethamine doses for intermittent treatment of malaria in pregnancy in urban Nigeria

Malaria is a leading cause of maternal and child mortality in urban Nigeria. Intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp–SP) during pregnancy can prevent malaria but uptake is suboptimal. This cross-sectional study analyzed secondary data on 1159 urban Nigerian women from the 2015 Malaria Indicator Survey using descriptive statistics and logistic regression. The primary outcome was optimal IPTp–SP uptake (≥ 3 doses). 67% of women took any SP during pregnancy but only 39% took ≥ 3 IPTp–SP doses as recommended. Region and wealth index significantly predicted optimal IPTp–SP uptake while education did not. Women from lower-income regions in the urban areas were less likely to receive optimal IPTp–SP. Strategies to increase IPTp–SP uptake in urban Nigeria should target low-income regions and women of lower socioeconomic status. Logistic regression identified actionable factors for improving antenatal malaria prevention. Optimal IPTp–SP uptake remains suboptimal across urban Nigeria, threatening maternal and child health.

Application of multivariate binary logistic regression grouped outlier statistics and geospatial logistic model to identify villages having unusual health-seeking habits for childhood malaria in Malawi

BackgroundEarly diagnosis and prompt treatment of malaria in young children are crucial for preventing the serious stages of the disease. If delayed treatment-seeking habits are observed in certain areas, targeted campaigns and interventions can be implemented to improve the situation.MethodsThis study applied multivariate binary logistic regression model diagnostics and geospatial logistic model to identify traditional authorities in Malawi where caregivers have unusual health-seeking behaviour for childhood malaria. The data from the 2021 Malawi Malaria Indicator Survey were analysed using R software version 4.3.0 for regressions and STATA version 17 for data cleaning.ResultsBoth models showed significant variability in treatment-seeking habits of caregivers between villages. The mixed-effects logit model residual identified Vuso Jere, Kampingo Sibande, Ngabu, and Dzoole as outliers in the model. Despite characteristics that promote late reporting of malaria at clinics, most mothers in these traditional authorities sought treatment within twenty-four hours of the onset of malaria symptoms in their children. On the other hand, the geospatial logit model showed that late seeking of malaria treatment was prevalent in most areas of the country, except a few traditional authorities such as Mwakaboko, Mwenemisuku, Mwabulambya, Mmbelwa, Mwadzama, Zulu, Amidu, Kasisi, and Mabuka.ConclusionsThese findings suggest that using a combination of multivariate regression model residuals and geospatial statistics can help in identifying communities with distinct treatment-seeking patterns for childhood malaria within a population. Health policymakers could benefit from consulting traditional authorities who demonstrated early reporting for care in this study. This could help in understanding the best practices followed by mothers in those areas which can be replicated in regions where seeking care is delayed.

Adapting malaria indicator surveys to investigate treatment adherence: a pilot study on Bioko Island, Equatorial Guinea

BackgroundAdherence to anti-malarial treatment regimens is an important aspect of understanding and improving the impact of malaria case management. However, both adherence to artemisinin-based combination therapy (ACT) and the factors driving it vary widely. While many other evaluation activities have been conducted on Bioko Island, until now adherence to anti-malarial treatments, and in particular ACT has not been evaluated.MethodsThe implementation of a malaria indicator survey (MIS) conducted on Bioko in 2023 was leveraged to evaluate adherence to ACT provided to individuals testing positive following the survey. A follow-up team visited the targeted households, physically observed treatment blisters where possible, and provided messaging to household members on the importance of adhering to the treatment guidelines to household members. The team used survey data from the targeted households to make messaging as relevant to the household’s particular context as possible.ResultsOverall ACT adherence on Bioko Island was low, around 50%, and this varied demographically and geographically. Some of the highest transmission areas had exceptionally low adherence, but no systematic relationship between proper adherence and Plasmodium falciparum prevalence was detected. Estimates of adherence from follow-up visits were much lower than survey-based estimates in the same households (52.5% versus 87.1%), suggesting that lack of proper adherence may be a much larger issue on Bioko Island than previously thought.ConclusionRepresentative surveys can be easily adapted to provide empirical estimates of adherence to anti-malarial treatments, complementary to survey-based and health facility-based estimates. The large discrepancy between adherence as measured in this study and survey-based estimates on Bioko Island suggests a health facility-based study to quantify adherence among the population receiving treatment for symptomatic malaria may be necessary.

Mass media exposure and sociodemographic factors associated with malaria vaccine awareness among women of childbearing age in Ghana

BackgroundThe development, approval and adoption of the malaria vaccine has provided effective supplemental protection against malaria for children in Ghana. However, heightened awareness of the new vaccine will play a critical role in its mass deployment and acceptance among potential recipients. This study therefore determined the sociodemographic characteristics associated with malaria vaccine awareness and ascertained the influence of traditional media exposure on awareness in Ghana.MethodsThe study used the Demographic and Health Survey 2019 Malaria Indicator Survey Data. After necessary recoding, chi-square and complex survey bivariate/multivariate logistic regression analyses were performed using STATA 18.0.ResultsAmong the participants, 35.65% (95% CI: 33.83%–37.51%) had heard about the malaria vaccine. Positive predictors of awareness included higher education attainment (AOR = 1.92, 95% CI: 1.28–2.88), rural residency (AOR = 1.28, 95% CI: 1.05–1.56) and being in the northern part of the country (AOR 1.54, 95% CI: 1.14–2.07). Other positive predictors of awareness were Guan ethnicity (AOR = 1.75, 95% CI: 1.09–2.81), malaria health education (AOR = 1.73, 95% CI: 1.45–2.07) and radio set ownership (AOR = 1.39, 95% CI: 1.19–1.62). Television ownership (AOR = 0.84, 95% CI: 0.69–1.01) showed no significant relationship with awareness.ConclusionThe general nationwide awareness has not yet reached a desirable level. This study suggests that, the awareness drive, preferably through radio campaigns, must target individuals with less than tertiary education and urban communities. Awareness campaigns on televisions should be evaluated and possibly redesigned for effectiveness.

The prevalence of low birth weight and its associated maternal factors among women of reproductive age who gave birth to live babies within five years preceding the survey in Tanzania: an analysis of data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicators Survey

BackgroundInfant survival is an important factor in any community’s health. Low birth weight affects babies not only during their infancy but also has long-term consequences for their health as adults. Unfortunately, Sub-Saharan Africa as a region is still dealing with the burden of Low birth weight (LBW), and Tanzania as a part of this region is no exception. So this study aimed to determine the Magnitude of Low Birth Weight and Its Associated Maternal Factors among Women of Reproductive Age who gave birth to live babies.MethodsThe study used analytical cross-sectional study design to analyze secondary data from the Tanzania Demographic and Health Survey and Malaria Indicators Survey 2015–2016. A total of 4,644 women of reproductive age who gave birth to live babies within five years preceding the survey were included in the study. Both bivariate and multivariable logistics regression analyses were used to assess maternal factors associated with low birth weight.ResultsThe prevalence of LBW was 262(6.2%). After adjusting for confounders, the maternal factors associated with LBW were Age group of a pregnant woman [Less than 20 years (aOR = 1.907 CI = 1.134–3.205) in reference to those aged more than 34years], Number of ANC visits made [Inadequate visits (aOR = 1.612 CI = 1.266–2.05)], parity [para 2–4 (aOR = 0.609 CI = 0.453–0.818), para 5+ (aOR = 0.612 CI = 0.397–0.944)] and area of residence [Unguja (aOR = 1.981 CI = 1.367–2.87).ConclusionThe prevalence of low birth weight in Tanzania remains high. Women’s age, parity, number of Antenatal care visits (ANC), and area of residence were found to be maternal factors associated with LBW. Thus, early prenatal diagnosis of risk factors for low birth weight in high-risk pregnant women may help to reduce the LBW burden in Tanzania and its detrimental effects.

National genomic profiling of Plasmodium falciparum antimalarial resistance in Zambian children participating in the 2018 Malaria Indicator Survey.

The emergence of antimalarial drug resistance is a major threat to malaria control and elimination. Using whole genome sequencing of 282 P. falciparum samples collected during the 2018 Zambia National Malaria Indicator Survey, we determined the prevalence and spatial distribution of known and candidate antimalarial drug resistance mutations. High levels of genotypic resistance were found across Zambia to pyrimethamine, with over 94% (n=266) of samples having the Pfdhfr triple mutant (N51I, C59R, and S108N), and sulfadoxine, with over 84% (n=238) having the Pfdhps double mutant (A437G and K540E). In northern Zambia, 5.3% (n=15) of samples also harbored the Pfdhps A581G mutation. Although 29 mutations were identified in Pfkelch13, these mutations were present at low frequency (<2.5%), and only three were WHO-validated artemisinin partial resistance mutations: P441L (n=1, 0.35%), V568M (n=2, 0.7%) and R622T (n=1, 0.35%). Notably, 91 (32%) of samples carried the E431K mutation in the Pfatpase6 gene, which is associated with artemisinin resistance. No specimens carried any known mutations associated with chloroquine resistance in the Pfcrt gene (codons 72-76). P. falciparum strains circulating in Zambia were highly resistant to sulfadoxine and pyrimethamine but remained susceptible to chloroquine and artemisinin. Despite this encouraging finding, early genetic signs of developing artemisinin resistance highlight the urgent need for continued vigilance and expanded routine genomic surveillance to monitor these changes.

Female genital mutilation and its associated factors among adolescent girls and young women in Tanzania: analysis of the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2022 TDHS-MIS)

IntroductionThe morbidity and mortality associated with Female Genital Mutilation (FGM) have been clearly documented. Controlling and eventually eradication this practice is very important. Despite a loud call from the WHO and other international organisations, there are extensive nationalities and societies from both developed and developing countries still practising FGM. Understanding the current magnitude and associated factors in Tanzania may bring more light for possible interventions intended to control FGM. This study is timely for this aim.ObjectiveTo determine the prevalence of female genital mutilation and its associated factors among adolescent girls and young women in Tanzania.MethodsSecondary data analysis was conducted on data from the 2022 Tanzanian Demographic and Health Survey. The weighted sample included in this study was 2965 adolescent girls and young women aged 15–24 years. Data analysis was performed using Stata 18.0 software. The strength of the association was assessed using the adjusted odds ratio (aOR) along with its corresponding 95% confidence interval (CI).ResultsThe overall prevalence of FGM among adolescent girls and young women in Tanzania was 4.9% (95% CI = 3.37, 6.97). The prevalence varied significantly across the zones, ranging from < 1% in both Zanzibar and Southern zones to 19.7% in the Northern zone. Moreover, the results revealed that factors associated with FGM were rural areas (aOR = 2.09, 95% CI = 1.80, 5.44); no education (aOR = 11.59, 95% CI = 4.97, 27.03); poor (aOR = 2.41, 95% CI = 1.20, 4.83); unskilled manuals (aOR = 3.76, 95% CI = 1.97, 7.15); continued FGM (aOR = 3.86, 95% CI = 1.62, 9.18); FGM required by religion (aOR = 8.5, 95% CI = 3.15, 22.96) and watching television at least once a week (aOR = 0.20, 95% CI = 0.70, 1.56) among adolescents and young women in Tanzania.ConclusionFemale genital mutilation among adolescent girls and young women aged 15–24 years in Tanzania has decreased slightly between 2015/16 and 2022 from 5.9% to 4.9% respectively. This was mostly associated with education level, place of residence, occupation, wealth index, mass media exposure, attitudes towards FGM. More tailored programs focusing on high prevalence zones targeting adolescent girls and young women are needed to end female genital mutilation by 2030.

WHO antenatal care policy and prevention of malaria in pregnancy in sub-Saharan Africa

BackgroundThe WHO 2016 antenatal care (ANC) policy recommends at least eight antenatal contacts during pregnancy. This study assessed ANC8 uptake following policy implementation and explored the relationship between ANC attendance and intermittent preventive treatment in pregnancy (IPTp) coverage in sub-Saharan Africa following the rollout of the World Health Organization (WHO) 2016 ANC policy, specifically, to assess differences in IPTp uptake between women attending eight versus four ANC contacts.MethodsA secondary analysis of data from 20 sub-Saharan African countries with available Demographic Health and Malaria Indicator surveys from 2018 to 2023 was performed. The key variables were the number of ANC contacts and IPTp doses received during a participant's last completed pregnancy in the past two years. Pooled crude and multivariable logistic regression models were used to explore factors associated with attendance of at least four or eight ANC contacts as well as receipt of at least three doses of IPTp during pregnancy.ResultsOverall, only a small proportion of women (median = 3.9%) completed eight or more ANC contacts (ANC8 +). Factors significantly associated with increased odds of ANC8 + included early ANC attendance (AOR: 4.61: 95% CI 4.30—4.95), literacy (AOR: 1.20; 95% CI 1.11—1.29), and higher wealth quintile (AOR: 3.03; 95% CI 2.67—3.44). The pooled estimate across all countries showed a very slight increase in the odds of IPTp3 + among women with eight (AOR: 1.06; 95% CI 1.00—1.12) compared to those with four contacts. In all but two countries, having eight instead of four ANC contacts did not confer significantly greater odds of receiving three or more doses of IPTp (IPTp3 +), except in Ghana (AOR: 1.67; 95% CI 1.38—2.04) and Liberia (AOR: 1.43; 95% CI 1.18—1.72).ConclusionEight years after the WHO ANC policy recommendation, all countries still had sub-optimal ANC8 + coverage rates. This paper is a call to action to actualize the vision of the WHO and the global malaria community of a malaria free world. Policies to improve ANC and IPTp coverage should be operationalized with clear actionable guidance and local ownership. Study findings can be used to inform multi-level policy, programmatic, and research recommendations to optimize ANC attendance and malaria in pregnancy prevention, thus improving maternal and child health outcomes, including the reduction of malaria in pregnancy.

GIS-based spatiotemporal mapping of malaria prevalence and exploration of environmental inequalities

Malaria poses a significant threat to global health, with particular severity in Nigeria. Understanding key factors influencing health outcomes is crucial for addressing health disparities. Disease mapping plays a vital role in assessing the geographical distribution of diseases and has been instrumental in epidemiological research. By delving into the spatiotemporal dynamics of malaria trends, valuable insights can be gained into population dynamics, leading to more informed spatial management decisions. This study focused on examining the evolution of malaria in Nigeria over twenty years (2000–2020) and exploring the impact of environmental factors on this variation. A 5-year-period raster map was developed using malaria indicator survey data for Nigeria’s six geopolitical zones. Various spatial analysis techniques, such as point density, spatial autocorrelation, and hotspot analysis, were employed to analyze spatial patterns. Additionally, statistical methods, including Principal Component Analysis, Spearman correlation, and Ordinary Least Squares (OLS) regression, were used to investigate relationships between indicators and develop a predictive model. The study revealed regional variations in malaria prevalence over time, with the highest number of cases concentrated in northern Nigeria. The raster map illustrated a shift in the distribution of malaria cases over the five years. Environmental factors such as the Enhanced Vegetation Index, annual land surface temperature, and precipitation exhibited a strong positive association with malaria cases in the OLS model. Conversely, insecticide-treated bed net coverage and mean temperature negatively correlated with malaria cases in the same model. The findings from this research provide valuable insights into the spatiotemporal patterns of malaria in Nigeria and highlight the significant role of environmental drivers in influencing disease transmission. This scientific knowledge can inform policymakers and aid in developing targeted interventions to combat malaria effectively.

Examining the paradox: increased malaria risk in children under 5 in female-headed households in Nigeria

BackgroundNigeria is facing a severe malaria crisis, accounting for a significant proportion of global cases and deaths of malaria. This study aimed to investigate the differences between female-headed households (FHHs) and male-headed households (MHHs) and their impact on malaria risk among children under five (U5) in Nigeria.MethodsData from the 2021 Nigeria Malaria Indicator Survey (NMIS) were used for this cross-sectional study. A representative sample of 10,988 households was analysed, with key variables subjected to frequency calculations, descriptive statistics, and bivariate analyses using t-tests and chi-square analyses to compare the differences between FHHs and MHHs.ResultsAmong all participants, 92.1% (N = 10,126) reported residing in male-headed households, while 7.8% (N = 862) reported living in female-headed households. MHHs were significantly more likely to own insecticide-treated bed nets (ITNs) than FHHs (64.7% vs. 53.6%, P < 0.001). U5 children in MHHs had a greater likelihood of sleeping under a bed net the night before the survey than U5 children in FHHs (35.3% vs. 30.0%, P < 0.05). The prevalence of fever in the previous two weeks among U5 children was similar in MHHs and FHHs (35.4% vs. 31.4%), and the testing rates for malaria among U5 children who experienced febrile episodes were higher in MHHs than FHHs (22.4% vs. 15.4%, P < 0.05). Although not statistically significant, FHHs exhibited a higher percentage of U5 children testing positive for malaria compared to MHHs (87.8% vs. 78.9%). On the other hand, FHHs had higher education levels, overall wealth index scores, and a larger presence in urban areas compared to MHHs (P < 0.001). Moreover, FHHs reported higher adherence to malaria prevention awareness (P < 0.001).ConclusionIn Nigeria, FHHs enjoy relatively better socioeconomic conditions and stronger awareness of malaria prevention compared to their male-headed counterparts. Contrary to expectations, FHHs are at an increased risk of malaria in children under 5 years old. This phenomenon is associated with entrenched gender inequality and the challenges women face in accessing critical assets. As women in FHHs bear the responsibility of income generation while caring for their children, it is crucial to prioritize interventions that address malaria management in FHHs to reduce both malaria incidence and mortality rates.Graphical

Spatial distribution and determinants of intermittent preventive treatment for malaria during pregnancy: a secondary data analysis of the 2019 Ghana malaria indicators survey

BackgroundMalaria during pregnancy is associated with poor maternal, foetal, and neonatal outcomes. To prevent malaria infection during pregnancy, the World Health Organization recommended the use of intermittent preventive therapy with sulfadoxine-pyrimethamine (IPTp-SP) in addition to vector control strategies. Although Ghana’s target is to ensure that all pregnant women receive at least three (optimal) doses of SP, the uptake of SP has remained low; between 2020 and 2022, only 60% of pregnant women received optimal SP during their most recent pregnancy. This study sought to map the geospatial distribution and identify factors associated with SP uptake during pregnancy in Ghana.MethodsSecondary data analysis was conducted using the 2019 Ghana Malaria Indicator Survey dataset. The data analysed were restricted to women aged 15–49 years who reported having a live birth within the two years preceding the survey. A modified Poisson regression model was used to determine factors associated with SP uptake during pregnancy. Geospatial analysis was employed to map the spatial distribution of optimal SP uptake across the ten regions of Ghana using R software.ResultsThe likelihood that pregnant women received optimal SP correlated with early initiation of first antenatal care (ANC), number of ANC contacts, woman’s age, region of residence, and family size. Overall, the greater the number of ANC contacts, the more likely for pregnant women to receive optimal SP. Women with four or more ANC contacts were 2 times (aPR: 2.16; 95% CI: [1.34–3.25]) more likely to receive optimal SP than pregnant women with fewer than four ANC contacts. In addition, early initiation and a high number of ANC contacts were associated with a high number of times a pregnant woman received SP. Regarding spatial distribution, a high uptake of optimal SP was significantly observed in the Upper East and Upper West Regions, whereas the lowest was observed in the Eastern Region of Ghana.ConclusionsIn Ghana, there were regional disparities in the uptake of SP during pregnancy, with the uptake mainly correlated with the provision of ANC services. To achieve the country’s target for malaria control during pregnancy, there is a need to strengthen intermittent preventive treatment for malaria during pregnancy by prioritizing comprehensive ANC services.