Use Of Insecticide-treated Nets Research Articles

Prevention of Malaria in Pregnant Women and Its Effects on Maternal and Child Health, the Case of Centre Hospitalier de Kingasani II in the Democratic Republic of the Congo

This study aimed to evaluate scientific evidence of the benefit of the use of insecticide-treated nets (ITNs) and Intermittent preventive treatment (IPT) on the birth weight of newborns and the hemoglobin level of the mother when used to prevent malaria during pregnancy. This cross-sectional analytical study was conducted on 467 hospitalized women in the Maternity Ward of Centre Hospitalier de Kingasani II, in the Democratic Republic of the Congo. Data were collected using a structured questionnaire that was pre-tested during a face-to-face interview. Apart from basic statistics, the chi-square test was used to compare proportions. Multivariate analysis (logistic regression) was used to identify variables significantly associated with the 95% confidence interval (CI). The ITN ownership rate was 81% (95% CI: 77–84) and the ITN use rate was 66% (95% CI: 62–70). Sixty-five percent (95% CI: 60–69) reported having received at least three doses of IPT during pregnancy with sulfadoxine-pyramethemine (IPTp-SP). There was a statistically significant difference in hemoglobin levels between hospitalized women who did not use the ITN (9.4 g/dL IIQ: 8.7–9.9) and those who did (11 g/dL IIQ: 9.8–12.2). The non-use of the ITN was associated with low birth weight (aOR = 3.6; 95% CI: 2.1–6.2; p < 0.001) and anemia in pregnant women (cOR = 2.41; 95% CI: 1.16–5.01; p = 0.018). The use of ITN and taking at least three doses of ITP during pregnancy are associated with good birth weight. The number of doses of IPTp received during antenatal care is associated with the maternal hemoglobin level in the third trimester of pregnancy.

A dynamic game of lymphatic filariasis prevention by voluntary use of insecticide treated nets

Lymphatic filariasis (LF) has been targeted for elimination as a public health concern by 2030 with a goal to keep the prevalence of LF infections under the 1% threshold. While mass drug administration (MDA) is a primary strategy recommended by WHO, the use of insecticide treated nets (ITN) plays a crucial role as an alternative strategy when MDA cannot be used. In this paper, we use imitation dynamics to incorporate human behavior and voluntary use of ITN into the compartmental epidemiological model of LF transmission. We find the equilibrium states of the dynamics and the ITN usage as it depends on epidemiological parameters and the cost of ITNs. We investigate the conditions under which the voluntary use of ITNs can keep the LF prevalence under the 1% threshold. We found that when the cost of using the ITNs is about 105 smaller than the perceived cost of LF, then the voluntary use of ITNs will eliminate LF as a public health concern. Furthermore, when the ITNs are given away for free, our model predicts that over 80% of the population will use them which would eliminate LF completely in regions where Anopheles are the primary vectors.

Insecticide-treated bed nets and residual indoor spraying reduce malaria in areas with low transmission: a reanalysis of the Maltrials study

BackgroundThe malaria incidence data from a malaria prevention study from the Rift Valley, Central Ethiopia, were reanalysed. The objective was to investigate whether including an administrative structure within the society, which may have required consideration in the protocol or previous analysis, would provide divergent outcomes on the effect measures of the interventions.MethodsA cluster-randomized controlled trial lasting 121 weeks with 176 clusters in four groups with 6071 households with 34,548 persons was done: interventions combining indoor residual spraying (IRS) and insecticide-treated nets (ITNs), IRS alone, ITNs alone and routine use. The primary outcome was malaria incidence. A multilevel negative binomial regression model was employed to examine the impact of the kebele (smallest administrative unit) and the proximity of homes to the primary mosquito breeding sites as potential residual confounders (levels). The study also assessed whether these factors influenced the effect measures of the interventions.ResultsThe study's initial findings revealed 1183 malaria episodes among 1059 persons, with comparable effects observed across the four intervention groups. In the reanalysis, the results showed that both ITN + IRS (incidence rate ratio [IRR] 0.63, P < 0.001) and ITN alone (IRR 0.78, P = 0.011) were associated with a greater reduction in malaria cases compared to IRS (IRR 0.90; P = 0.28) or the control (reference) group. The combined usage of IRS with ITN yields better outcomes compared to the standalone use of ITN and surpasses the effectiveness of IRS in isolation.ConclusionThe findings indicate that implementing a combination of IRS and ITN and also ITN alone decrease malaria incidence. Furthermore, there was an observed synergistic impact when ITN and IRS were used in combination. Considering relevant social structures as potential residual confounders is of paramount importance.Trial registration: PACTR201411000882128 (08 September 2014).

Relative effects of climate factors and malaria control interventions on changes of parasitaemia risk in Burkina Faso from 2014 to 2017/2018

BackgroundIn Burkina Faso, the prevalence of malaria has decreased over the past two decades, following the scale-up of control interventions. The successful development of malaria parasites depends on several climatic factors. Intervention gains may be reversed by changes in climatic factors. In this study, we investigated the role of malaria control interventions and climatic factors in influencing changes in the risk of malaria parasitaemia.MethodsBayesian logistic geostatistical models were fitted on Malaria Indicator Survey data from Burkina Faso obtained in 2014 and 2017/2018 to estimate the effects of malaria control interventions and climatic factors on the temporal changes of malaria parasite prevalence. Additionally, intervention effects were assessed at regional level, using a spatially varying coefficients model.ResultsTemperature showed a statistically important negative association with the geographic distribution of parasitaemia prevalence in both surveys; however, the effects of insecticide-treated nets (ITNs) use was negative and statistically important only in 2017/2018. Overall, the estimated number of infected children under the age of 5 years decreased from 704,202 in 2014 to 290,189 in 2017/2018. The use of ITNs was related to the decline at national and regional level, but coverage with artemisinin-based combination therapy only at regional level.ConclusionInterventions contributed more than climatic factors to the observed change of parasitaemia risk in Burkina Faso during the period of 2014 to 2017/2018. Intervention effects varied in space. Longer time series analyses are warranted to determine the differential effect of a changing climate on malaria parasitaemia risk.

MATHEMATICAL MODELING OF THE SPREAD OF VECTOR BORNE DISEASES WITH INFLUENCE OF VERTICAL TRANSMISSION AND PREVENTIVE STRATEGIES

This work is aimed at formulating a mathematical model of the spread of vector-borne diseases with influence of vertical transmission and preventive strategies. Vector borne diseases are caused by viruses, bacteria, and parasites typically conveyed by mosquitoes. Certain illnesses transmitted by vectors include West Nile Virus, Malaria, Zika virus, Dengue fever, Rift valley fever, and Viral encephalitis induced by pathogens like bacteria, viruses, and parasites. The positive solutions of the model are presented and the theory of basic reproduction number  was used to study the model dynamical behaviour. When reduces; the diseases are wiped out of the population with time and vice versa. The disease free and endemic equilibria states of the model were determined and investigated to be locally and globally stable.We incorporated the use of Insecticide –Treated Nets (ITN), Indoor Residual Sprayings (IRS) and condom usage as preventive measures in the presence of treatment. Numerical simulations show that complete intervention measures, that is, the use of ITN, IRS and condom usage while placing the infected on treatment have valuable impact on the spread of vector-borne diseases.

Utilization of malaria preventive strategies among pregnant women at Adeoyo Maternity Teaching Hospital, Ibadan, Nigeria

INTRODUCTION: Malaria in pregnancy is associated with a high rate of maternal and perinatal morbidity and mortality. Utilization of preventive strategies during pregnancy is an integral part of controlling the burden of malaria in pregnancy. This study evaluated the malaria preventive strategies utilized and the prevalence of asymptomatic malaria among pregnant women at Adeoyo Maternity Teaching Hospital (AMTH), Ibadan, Nigeria.&#x0D; METHODS: A facility-based descriptive cross-sectional study among 223 pregnant women in Adeoyo Maternity Teaching Hospital, Ibadan, Nigeria. Information on socio-demographic and obstetric characteristics, malaria symptoms, and the preventive strategies utilized were obtained using a structured questionnaire. Descriptive and bivariate analysis using chi-square test and multivariate analysis at 95% confidence interval and p&lt; 0.05 was used to determine the predictors of asymptomatic malaria infection in relation to socio-demographic characteristics and malaria preventive strategies utilized.&#x0D; RESULTS: The mean age was 30±5 years. More than half (53.4%) of them used insecticide-treated nets consistently, 49.3% sprayed the room regularly with insecticides, while the majority (88.3%) reported they maintained a clean environment. However, 11.7% tested positive for the malaria parasite. Consistency in the use of insecticide-treated net (ITN) and participants age were factors associated with malaria occurrence (p=0.01). The use of ITN and being &gt;30 years of age are protective factors against having malaria infection among pregnant women (AOR= 0.34; 95%, CI=0.14-0.84) and (AOR=0.31; 95% CI=0.13-0.76) respectively.&#x0D; CONCLUSION: Irrespective of all other malaria preventive strategies adopted by pregnant women, consistent use of ITN was independently a protective factor against developing malaria in pregnancy.

Insecticide treated eaves screens provide additional marginal protection compared to untreated eave screens under semi-field conditions in western Kenya.

Human habitats remain the main point of human-vector interaction leading to malaria transmission despite the sustained use of insecticide-treated nets and indoor residual spraying. Simple structural modifications involving screening of doors, windows and eaves have great potential for reducing indoor entry of mosquitoes. Moreover, insecticide treatment of the screen material may provide additional benefit in mosquito population reduction. Four huts, each constructed inside a semi-field structure, were used in the study. Two had untreated eave and door screens and screened air cavities in place of windows (experiment 1) or were similar but with the eave screens treated with Actellic® 300CS insecticide (experiment 2). The other two huts remained unscreened throughout the study. Two hundred, 3-day old adults of F1 generation Anopheles funestus collected by aspiration or F0 reared from An. arabiensis larvae or An. arabiensis (Dongola strain) were released in each semi-field structure at dusk and recaptured the following morning. A single volunteer slept in each hut under an untreated bednet each night of the study. Recaptured mosquitoes were counted and recorded by location, either indoor or outdoor of each hut in the different semi-field structures. Based on modelled estimates, significantly fewer, 10% An. arabiensis from Ahero, 11% An. arabiensis Dongola strain and 10% An. funestus from Siaya were observed inside modified huts compared to unmodified ones. Treating of eave screen material with Actellic® 300CS significantly reduced indoor numbers of An. arabiensis from Ahero, to nearly 0%, and An. arabiensis Dongola strain, to 3%, compared to huts with untreated eave screens, while eliminating An. funestus indoors. These modifications cost US$180 /structure and have been observed to last more than 15 years in a different location. Eave, door and window screening are effective ways of reducing mosquito entry into houses. Additionally, treatment of eave screen material with an effective insecticide further reduces the Anopheles population in and around the screened huts under semi-field conditions and could greatly complement existing vector control efforts.

Pregnancy-related malaria prevention with insecticide-treated nets (ITNs) : a review of the relevant literature

Introduction: Every year, an estimated 125 million pregnancies are at risk of contracting malaria. Malaria poses a risk to both the mother and the fetus since pregnant women are more likely to get it than non-pregnant women. Newborns, fetuses, and pregnant women are all susceptible to malaria infection. It is frequently associated with anemia, intrauterine growth restriction (IUGR), and issues such as low birth weight and trans placental parasitemia. From the first point of contact, insecticide-treated nets (ITNs) can help shield the pregnant mother and her unborn child from malaria. Methods: A range of English-language journal articles and case studies were reviewed in the development of this literature review  that were released after 2018 in the field of study. Electronic searches were performed on a number of databases, including ScienceDirect and PubMed. Results: A screening procedure was carried out on 189 articles to show that the sources used were relevant and useful. Ultimately, it was determined that 5 papers would serve as the sources for this literature study. ITNs are an effective way to reduce the negative outcome for pregnant mothers who catch malaria during pregnancy, as our assessment of the literature has shown. Studies demonstrate the efficacy of ITNs in reducing the likelihood of unfavorable consequences for expectant mothers who catch malaria during pregnancy.  Conclusion: the efficiency of ITNs in reducing the likelihood that pregnant women who catch malaria during pregnancy will experience unfavorable outcomes. Encouragement of husbands and other important family members to support their spouses' use of ITNs . Reiterating the policy's emphasis on malaria prevention education as a critical element is required to boost the use of free ITNs in healthcare settings

Preventing malaria in pregnancy: knowledge and practices of pregnant women in an urban hospital in Kumasi, Ghana

 Background: Malaria in pregnancy (MiP) is a public health concern in Ghana. The current national control program seeks to have 85% of pregnant women sleeping under insecticide treated nets (ITNs). It also seeks to achieve 100% intake of at least 2 doses of Sulfadoxine-Pyrimethamine (SP). In order to achieve these aims, it is important that pregnant women have good knowledge of malaria and subscribe to good preventive practices. This cross-sectional study sought to evaluate the knowledge and practices on malaria prevention among pregnant women in an urban setting of Ghana. Methods: This was a hospital-based study which involved 185 pregnant women visiting an urban hospital for antenatal care in Kumasi, Ghana. Data was collected via structured interviewer administered questionnaires. Univariate and bivariate analyses were conducted to assess the participants’ knowledge and practices on malaria prevention. Results: The women demonstrated good knowledge of MiP, with 76% of them having an excellent knowledge score. Familiarity with ITNs (99.5%) was higher than IPTp-SP (86.5%). There was a statistically significant association between tertiary education and high total knowledge score (X2 =31.912, df = 18, p = 0.023).  ITN usage was poor (55.1%), with common challenges being difficulty in hanging nets, nets being deemed too hot, and unpleasant smell of the nets. 66.5% of the women had taken at least 2 SP doses. Conclusion:  Although there was good knowledge, ITN use and SP coverage were below national targets. More studies should be conducted to explore the factors underlying poor ITN use and SP intake.

Mosquito control exposures and breast cancer risk: analysis of 1071 cases and 2096 controls from the Ghana Breast Health Study

Epidemiologic data on insecticide exposures and breast cancer risk are inconclusive and mostly from high-income countries. Using data from 1071 invasive pathologically confirmed breast cancer cases and 2096 controls from the Ghana Breast Health Study conducted from 2013 to 2015, we investigated associations with mosquito control products to reduce the spread of mosquito-borne diseases, such as malaria. These mosquito control products were insecticide-treated nets, mosquito coils, repellent room sprays, and skin creams for personal protection against mosquitos. Multivariable and polytomous logistic regression models were used to estimate odds ratios (ORadj) and 95% confidence intervals (CI) with breast cancer risk-adjusted for potential confounders and known risk factors. Among controls, the reported use of mosquito control products were mosquito coils (65%), followed by insecticide-treated nets (56%), repellent room sprays (53%), and repellent skin creams (15%). Compared to a referent group of participants unexposed to mosquito control products, there was no significant association between breast cancer risk and mosquito coils. There was an association in breast cancer risk with reported use of insecticide-treated nets; however, that association was weak and not statistically significant. Participants who reported using repellent sprays were at elevated risks compared to women who did not use any mosquito control products, even after adjustment for all other mosquito control products (OR = 1.42, 95% CI=1.15–1.75). We had limited power to detect an association with repellent skin creams. Although only a few participants reported using repellent room sprays weekly/daily or < month-monthly, no trends were evident with increased frequency of use of repellent sprays, and there was no statistical evidence of heterogeneity by estrogen receptor (ER) status (p-het > 0.25). Our analysis was limited when determining if an association existed with repellent skin creams; therefore, we cannot conclude an association. We found limited evidence of risk associations with widely used mosquito coils and insecticide-treated nets, which are reassuring given their importance for malaria prevention. Our findings regarding specific breast cancer risk associations, specifically those observed between repellent sprays, require further study.

Impact of Malaria Interventions on Anaemia amongst Pregnant Women in Ghana: A Secondary Analysis of Data

Abstract Background: There is limited published literature available on the impact of insecticide-treated nets (ITNs) and sulphadoxine-pyrimethamine (Sp) as an intermittent preventive treatment for malaria in pregnancy (IPTp) on anaemia amongst pregnant women in Ghana. Materials and Methods: The data from the United States Agency for International Development Malaria Indicator Survey in Ghana for 2016 and 2019 was used and analysed. Key variables, including anaemia status, ITN usage and IPTp-Sp uptake, were analysed using descriptive statistics, Chi-square and logistic regression. Results: The pregnant women who took IPTp-Sp had a 17% lower likelihood of anaemia compared to non-users. In 2019, with increased ITN usage at 57.1%, anaemia prevalence decreased to 54.5%. Pregnant women combining ITN use and IPTp uptake had a 96% lower likelihood of anaemia than those who did not. The women aged 30–39 and ≥40 being 53%–69% less likely to be anaemic, respectively, than those &lt;20 years (adjusted odds ratio = 0.47 [95% confidence interval: 0.27–0.79]). Education, parity and socio-economic status also influence anaemia risk. Conclusion: IPTp-Sp usage reduced anaemia risk in pregnancy. Combining ITN use and IPTp further decreased anaemia likelihood. Enhancing the uptake of these interventions amongst pregnant women is crucial for improving maternal health outcomes. The findings have relevance for malaria-endemic countries.

Evaluation of the Public Perception Regarding Malaria during Pregnancy among Expectant Mothers at Bitereko Health Center III in Mitooma District

Evaluation of the Public Perception Regarding Malaria during Pregnancy among Expectant Mothers at Bitereko Health Center III in Mitooma District

The Presence of Malaria Infection among Pregnant Women: Insights from Jinja Regional Referral Hospital

Malaria, transmitted by female Anopheles mosquitoes and caused by plasmodium, manifests in symptoms like fever, chills, vomiting, and anemia, posing heightened risks to pregnant women and young children. This study investigated malaria prevalence and contributing factors among pregnant women attending antenatal clinics at Jinja Regional Referral Hospital from January to June 2019, employing a retrospective cross-sectional approach utilizing existing records. Throughout the study period, the prevalence of malaria infection remained consistently low at 20%. Socioeconomic status emerged as a significant factor affecting malaria treatment, with lower economic standing correlating with higher incidence. While 80% of participants exhibited knowledge about malaria-related complications and preventive measures such as using insecticide-treated mosquito nets and eliminating stagnant water, 20% lacked this crucial awareness. Notably, a disparity was observed in malaria cases between well-educated and less educated attendees at the health unit, with fewer instances among the more educated individuals. Maternal complications primarily centered around anemia, while occurrences of low birth weight and stillbirth were relatively uncommon, attributed to prompt diagnosis and treatment. The study highlighted fluctuating malaria prevalence, indicating the need for extensive awareness campaigns, particularly concerning intermittent preventive treatment during pregnancy (IPT1 and IPT2). Collaborative efforts involving the community, government, hospitals, and even spouses are crucial to disseminate crucial information. Encouraging the consistent use of insecticide-treated mosquito nets during pregnancy should be emphasized, although this aspect wasn't specifically addressed in the study. Keywords: Malaria infection, Maternal mortality, Pregnant women, Antenatal care.

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.

Decline of Malaria Incidence in Three Villages of Thar Desert, India: The Impact of Use of Insecticide-Treated Nets.

Malaria is the most important tropical and parasitic disease in the world. Endophagy of many malaria vectors advocates that impeding their entry into houses and preventing their contact with the occupants from infective bites could protect them against malaria. The study was carried out in Jaisalmer District, India and three villages were selected as test villages and three as control. Cross-sectional malaria prevalence surveys and mosquito collections were conducted in all the study villages. Insecticide-treated nets (ITNs) were tied below the beds for personal protection against the mosquito bite. Door and window curtains along with partition curtains were treated with insecticide for baring the entry of mosquito vectors. Plasmodium vivax and P. falciparum were reported from the study villages. Higher malaria cases were detected in the control villages than the insecticide-treated bed net-distributed villages. The percentages of reduction of mosquito density in the houses of the ITNs distributed villages were significantly higher than the control villages. The insecticide activity was decreased slowly, and the knockdown time (KD50) values were found to be increased with the duration of usage of net. The KD50 of Anopheles subpictus s.l. was found to be more than the An. stephensi. Rooms where the ITNs were found to be significantly lower per man-hour density of mosquitoes. The use of alternative forms of ITNs shows a potential for preventing malaria and are making a significant contribution to the mosquito control. Effective use of ITNs could be helpful in the malaria elimination in India by 2030.

A Sensitivity Analysis of a Mathematical Model for the Transmission of Endemic Malaria under Periodic Climatic Conditions

We perform sensitivity analysis on a periodic mathematical model of endemic malaria transmission to determine the relative importance and impact of model parameters to disease transmission and prevalence. In this analysis, two sets of baseline parameter values are compiled: one for areas that exhibit high transmission rate and another one for areas with low transmission rates. Sensitivity indices for the basic reproductive number and the endemic equilibrium points are computed. The study established that in areas of low transmission, the reproductive number is most sensitive to the mosquito biting rate, but the equilibrium proportion of the infectious humans is most sensitive to the human recovery rate.  Sensitivity analysis on all state variables was conducted. The results indicated that the most influential factors in the transmission and persistence of malaria in the society are those related to vectorial competence. These findings suggests that strategies that target the vector characteristics such as the mosquito biting rate and those that target the human recovery rate can be very successful in controlling malaria. These strategies include the use of insecticide-treated mosquito nets, indoor residual spraying, prompt diagnosis and treatment of infectious individuals. However, a combination of intervention strategies is more effective than application of a single intervention.

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.

Heritability of biting time behaviours in the major African malaria vector Anopheles arabiensis

BackgroundThe use of insecticide-treated nets for malaria control has been associated with shifts in mosquito vector feeding behaviour including earlier and outdoor biting on humans. The relative contribution of phenotypic plasticity and heritability to these behavioural shifts is unknown. Elucidation of the mechanisms behind these shifts is crucial for anticipating impacts on vector control.MethodsA novel portable semi-field system (PSFS) was used to experimentally measure heritability of biting time in the malaria vector Anopheles arabiensis in Tanzania. Wild An. arabiensis from hourly collections using the human landing catch (HLC) method were grouped into one of 3 categories based on their time of capture: early (18:00–21:00), mid (22:00–04:00), and late (05:00–07:00) biting, and placed in separate holding cages. Mosquitoes were then provided with a blood meal for egg production and formation of first filial generation (F1). The F1 generation of each biting time phenotype category was reared separately, and blood fed at the same time as their mothers were captured host-seeking. The resultant eggs were used to generate the F2 generation for use in heritability assays. Heritability was assessed by releasing F2 An. arabiensis into the PSFS, recording their biting time during a human landing catch and comparing it to that of their F0 grandmothers.ResultsIn PSFS assays, the biting time of F2 offspring (early: 18:00–21:00, mid: 22:00–04:00 or late: 05:00–07:00) was significantly positively associated with that of their wild-caught F0 grandmothers, corresponding to an estimated heritability of 0.110 (95% CI 0.003, 0.208). F2 from early-biting F0 were more likely to bite early than F2 from mid or late-biting F0. Similarly, the probability of biting late was higher in F2 derived from mid and late-biting F0 than from early-biting F0.ConclusionsDespite modest heritability, our results suggest that some of the variation in biting time is attributable to additive genetic variation. Selection can, therefore, act efficiently on mosquito biting times, highlighting the need for control methods that target early and outdoor biting mosquitoes.

Measuring quality of facility-based ITN distribution in Ghana

BackgroundContinuous distribution channels are effective methods to deliver malaria interventions such as insecticide treated nets (ITNs) to pregnant women attending antenatal care clinics and children under five attending immunization visits. Facility-based and provider-based checklists were used during supportive supervision visits to measure the quality of facility-based services and interventions. This study looks at ITN distributions at health facilities in Ghana, with the aim of providing insights on how quality can be measured and monitored.MethodsVarious quality improvement approaches for malaria services occur in Ghana. Selected indicators were analysed to highlight the similarities and differences of how the approaches measured how well the channel was doing. Generally, the approaches assessed (1) service data management, (2) logistics data management, and (3) observation of service provision (ITN issuance, malaria education, ITN use and care education). Two approaches used a binary (Yes/No) scale, and one used a Likert scale.ResultsResults showed that most data reported to the national HMIS is accurate. Logistics data management remained an issue at health facilities, as results showed scores below average across facility stores, antenatal care, and immunization. Though the supervision approaches differed, overall results indicated that almost all eligible clients received ITNs, data were recorded accurately and reported on-time, and logistics was the largest challenge to optimal distribution through health facilities.ConclusionThe supervision approaches provided valuable insights into the quality of facility-based ITN distribution. Ghana should continue to implement supportive supervision in their malaria agenda, with additional steps needed to improve reporting of collected data and increase the number of facilities visited for supportive supervision and the frequency. There were various supervision approaches used with no clear guidance on how to measure quality of facility-based ITN distribution, so there is also need for the global community to agree on standardized indicators and approaches to measuring quality of facility-based ITN distribution. Additionally, future studies can review the effect of multiple rounds of supervision visits on the quality of ITN distribution as well as understand the facilitators and barriers to scaling up supervision of facility-based ITN distribution.