Use Of Long-lasting Insecticidal Nets Research Articles

Preserving nets, protecting children: an evaluation of factors influencing the utilization and physical integrity of long-lasting insecticidal nets among under-five children in Osun State, Nigeria.

Malaria remains a significant public health challenge in Africa where it is the most important vector-borne disease. Nigeria bears the largest burden, with pregnant women and children under 5years being more affected. Although, long lasting insecticidal nets (LLINs) remain effective for control, its use has been suboptimal. Hence this study assessed, household ownership, physical integrity and use of LLINs among children. A community-based, cross-sectional study was carried out among 1642 households using a multistage sampling technique in Osun State, Nigeria. A pretested, interviewer-administered questionnaire was used to obtain information on socio-demographic characteristics and use among under-fives. LLINs were inspected for physical integrity and cleanliness. A binary logistic regression analysis was conducted to identify factors influencing LLIN use by under-fives. The mean age of children was 32.2 ± 16.5months. Most households, 1586 (96.6%) had an LLIN while 165 (10.4%) did not hang their net. Holes were present in LLINs in 360 (22.7%) households and 196 (12.4%) had dusty or stained nets. Most households, (1259; 79.4%), had at least one LLIN for every 2 household members and survey participants reported that 1331 (83.9%) under-fives slept under an LLIN the night before the survey. Factors associated with reported LLIN use were; older parents/guardians aged 50-59years (AOR: 3.02; 95% CI 1.50-6.09), having a post-secondary education (AOR: 2.56; 95% CI 1.31-5.00), having LLIN obtained < 12months (AOR: 4.27; 95% CI 2.39-7.64), households with one LLIN for every 2 members (AOR: 1.65; 95% CI 1.15-2.37) and households with clean nets (AOR 2.75; 95% CI 1.89-4.00) had increased odds of reported LLIN utilization by under-five children. Although LLIN ownership and reported use were high in this study, gaps exist between ownership and reported use of LLINs. About one-fourth of LLINs had poor physical integrity. To maximize LLIN effectiveness in households, it is important to ensure the continued free distribution of nets and emphasize messages to parents/guardians on proper care, maintenance, and use of nets.

The challenge of improving long-lasting insecticidal nets coverage on Bioko Island: using data to adapt distribution strategies

BackgroundSince 2015, malaria vector control on Bioko Island has relied heavily upon long-lasting insecticidal nets (LLIN) to complement other interventions. Despite significant resources utilised, however, achieving and maintaining high coverage has been elusive. Here, core LLIN indicators were used to assess and redefine distribution strategies.MethodsLLIN indicators were estimated for Bioko Island between 2015 and 2022 using a 1x1 km grid of areas. The way these indicators interacted was used to critically assess coverage targets. Particular attention was paid to spatial heterogeneity and to differences between urban Malabo, the capital, and the rural periphery.ResultsLLIN coverage according to all indicators varied substantially across areas, decreased significantly soon after mass distribution campaigns (MDC) and, with few exceptions, remained consistently below the recommended target. Use was strongly correlated with population access, particularly in Malabo. After a change in strategy in Malabo from MDC to fixed distribution points, use-to-access showed significant improvement, indicating those who obtained their nets from these sources were more likely to keep them and use them. Moreover, their use rates were significantly higher than those of whom sourced their nets elsewhere.ConclusionsStriking a better balance between LLIN distribution efficiency and coverage represents a major challenge as LLIN retention and use rates remain low despite high access resulting from MDC. The cost-benefit of fixed distribution points in Malabo revealed significant advantages, offering a viable alternative for ensuring access to LLINs to those who use them.

Barriers of persistent long-lasting insecticidal nets utilization in Northwest Ethiopia: a qualitative study

BackgroundMalaria continues a significant public health challenge in Ethiopia, with Long-Lasting Insecticidal Nets (LLINs) proving effective in reducing transmission. Despite their effectiveness, consistent LLIN utilization is influenced by various factors. While previous research has quantitatively analyzed LLIN ownership and usage, there is a lack of in-depth examination of the behavioral, sociocultural, socioeconomic, and distribution-related factors affecting their sustained use. This study aimed to explore barriers to persistent LLIN use among communities in northwest Ethiopia.MethodsThe study area found in Northwest Ethiopia, specifically in East Belessa District, is located at 12° 14’ 60.00” N latitude and 37° 44’ 59.99” E longitude, with an altitude between 1,200 and 1,800 m above sea level. Thirty-nine community members from five focus group discussions, along with five key informants, were interviewed between February 1st and 30th, 2020, about their use of Long-Lasting Insecticidal Nets (LLINs). An interpretive description approach was employed to explore local contexts and factors affecting LLIN utilization. Focus group participants were selected based on residency status, pregnancy, caretaking of under-five children, and experience with LLINs. Key informants included health extension workers and the woreda malaria officer. Data were organized and analyzed using Open Code Version 4.03 software, with coding and theme identification conducted accordingly.ResultsAll 44 community members from the five focus group discussions and the five key informants participated fully in the study. The study categorized its findings into three main themes: knowledge of malaria and Long-Lasting Insecticidal Nets (LLIN) use, perception of malaria threat, and barriers to sustained LLIN utilization. It identified factors spanning individual, socio-cultural, institutional, and socio-economic realms that impede consistent LLIN usage. Key hindrances include cultural misinterpretations, discomfort from heat and bed bugs, diverse net shapes, insufficient sleeping spaces, lack of awareness, inadequate distribution, neglect of vulnerable groups, misuse of non-sleeping purposes, hesitancy to hang nets, and restricted accessibility.ConclusionsThis study reveals that practical concerns, including inadequate access to LLINs, distribution issues, discomfort from net shape and warmth, and unintended uses for non-malaria purposes, impact LLIN utilization. Socio-cultural norms, housing conditions, and varied understanding of malaria also contribute to inconsistent LLIN use. Strategies like providing compatible nets and comprehensive education could improve the Long-Lasting Insecticidal Nets program’s effectiveness in the area.

Long lasting insecticidal nets (LLINs) intervention impact on use, misuse and challenges in malaria and lymphatic filariasis transmission

To assess the effectiveness and misuse status of Long Lasting Insecticidal Nets (LLINs), intervention, a study was conducted in areas of malaria and lymphatic filariasis endemicity from November 2021 to August 2022. A preliminary survey preceded a cross-sectional survey of the misuse of LLINs. Considering the outcome of the former, 57 households misusing LLINs were reported. Thirty (30) cohorts each from LLIN misusing and LLIN non misusing households served as permanent cohorts for mosquito collections (60 rooms in 60 households in 3 sentinel villages). The study also investigated the status of LLIN usage and non usage. Mosquitoes caught with Aspirators and Pyrethrum Knockdown (PKD) techniques were identified using standard morphological keys. Among those who used LLIN, 68.42% used it for other purposes than vector control while 31.58% didn’t utilize it for mosquito control. About 59.65% didn’t know the effect of using it for purposes other than malaria/LF control while 40.35% were familiar. Of 8,180 endophilic mosquitoes caught and assessed for parity, infection/infectivity status, 60.07% (4,914/8,180) and 39.93% (3,266/8,180) represented LLIN misusing and LLIN non-misusing catches respectively. Overall, insignificantly higher catches were made in LLIN misusing cohorts than LLIN non misusing cohorts (63.54% versus 36.45%, 58.89% versus 41.11%, 58.86% versus 41.18%) for 2015, 2016 and 2017 respectively. Specifically, malaria/LF vector densities showed that Anopheles gambiae s.l. (82.53% versus 74.04%) was the highest followed by An. funestus s.l. (10.15% versus 12.19%) and Culex quinquefasciatus (6.82% versus 3.83%) while other species were rarely present. The physiological, infection (0.28% versus 0.49%) and infectivity (0.00% versus 0.00%) statuses with Wuchereria bancrofti were insignificant between the cohorts (p&gt;0.05). None of the Anopheles assessed for Plasmodium sporozoite were positive for both cohorts. The percentage level of LLIN household use was 43.33% while 41.03% slept under LLIN daily, 58.97% slept sometimes. Obstacles to LLIN use included hot/heat (56.86%), dislike (21.57%), lack of protection (11.86%) and ineffectiveness (9.80%). The role of significant misuse of LLIN was highlighted by the study. The results indicated the intensity of filariasis transmission by transmitting vectors was higher than that of malaria and re-emphasis the need to promote positive attitude towards the use of LLIN for control of the two diseases.

Long-Lasting Insecticidal Net Campaigns for Malaria Control Considering Prioritization and Equity

Malaria remains a significant public health concern in several developing countries. Tropical weather, coupled with poor environmental and socioeconomic conditions, increases mosquito activity and disease transmission in impoverished nations. The most effective strategy to prevent and control malaria is the use of long-lasting insecticidal nets, or LLINs. Ensuring that LLINs are effectively and equitably distributed to those who need them most is crucial yet challenging, especially since financial and health resources are scarce in endemic countries. Through a real-world case study conducted in the Brazilian Amazon, which accounts for 99% of malaria cases in Brazil, we propose a Malaria Vulnerability Index (MVI). This composite index encompasses epidemiological, socioeconomic, and environmental factors. Using the MVI, we developed a prioritization-based location-allocation model to maximize the benefits of targeting the most vulnerable municipalities for malaria interventions. Our mathematical model relies on discrete coverage levels, which makes the allocation of LLINs more flexible while ensuring community-wide protection. We also explore the theoretical relationship between our proposed model and classical demand covering problems. Finally, we discuss some approaches to delivering more equitable solutions by minimizing the number of underserved areas. Our results include comparisons between various malaria interventions and provide practical insights. In particular, we show that we can drastically reduce the number of underserved areas without compromising the effectiveness of the LLINs allocation through lexicographic optimization. The results also reveal that with investment levels up to 50% of the ideal, we can fully protect the endemic area after 2 years of successive interventions.

Toward Malaria Elimination: Understanding Awareness, Prevention, and Health-Seeking Patterns in Odisha, India.

Given India's goal of eliminating malaria by 2030, this study aimed to investigate community perspectives on malaria in highly endemic areas of Odisha, a region historically prone to malaria. The research explores self-reported malaria events, community knowledge, attitudes, practices, health-seeking behaviors, and access to healthcare services. A community-based cross-sectional survey conducted among 387 households between November 2022 and May 2023 served as an extension of our recent project, monitoring malaria elimination efforts in remote and challenging-to-reach communities in Odisha. The participants, who had a mean (SD) age of 41.7 (13.17) years, were predominantly male (88.4%). Self-reported malaria in the last 12 months prior to the survey was 6.2%, with half of the patients opting for primary health centers for treatment, averaging a 5-day recovery per episode. The median cost per malaria treatment episode was U.S. dollars 20.17. A significant majority (79.8%) demonstrated a strong awareness of malaria symptoms and transmission, with 83.3% expressing a favorable attitude toward disease prevention. Notably, 65.1% reported consistent use of long-lasting insecticidal nets. However, nearly half of the participants reported inadequate larval source management and indoor residual spraying services. Although there were slight variations in knowledge, attitude, and practice scores among demographic groups, the overall understanding of and approach to malaria were consistent in the study population, with no statistically significant differences (P >0.05). The study findings offer hope, suggesting that with sustained dedication and focused surveillance, malaria could become a thing of the past.

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

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

Long-Lasting Insecticidal Net Coverage and Utilization in Burla Town of Sambalpur District: A Cross-Sectional Study.

Background Vector-borne diseases continue to significantly contribute to mortality and morbidity, especially in developing nations. Vector management is a key pillar in combating these diseases, and long-lasting insecticidal nets (LLINs) are cost-effective tools. The Government of India, under the National Vector Borne Disease Control Programme (NVBDCP), has distributed LLINs for free to increase coverage and utilization. This study aims to estimate the coverage and utilization of LLINs in Burla town. Method This cross-sectional study was conducted from October to December 2022 in Burla town of Sambalpur in Odisha, India. The estimated sample size was 510 households, assuming 50% coverage. Multi-stage cluster sampling was adopted to select the Anganwadi centers and households. A pretested questionnaire was utilized for data collection by trained personnel through Epicollect5 (Centre for Genomic Pathogen Surveillance, Oxford, UK). Logistic regression was used to identify predictors for LLIN usage. Results The survey covered 516 households with 2,541 individuals and 1,165 nets. Household-level coverage was 94.2%, and regular utilization was 45.74%. Skin reactions (35.7%) were the most common reason for non-usage, followed by low mosquito density (12%). Logistic regression showed that the number of rooms (adjusted odds ratio (AOR) = 0.663, p = 0.012), number of bed nets (AOR = 2.757, p < 0.001), knowledge of malaria (AOR = 2.92, p = 0.04), adopting other measures for mosquito control (AOR = 0.295, p < 0.001), and washing the net (AOR =1.92, p = 0.028) significantly predicted sleeping under mosquito net. Conclusion Our study has depicted high coverage of LLINs in Burla town, but utilization needs further improvement. Counseling regarding proper use can decrease the skin reactions responsible for non-usage. Regular health education programs are required to emphasize the benefits of LLIN use, along with regular monitoring and supervision.

Combined use of long-lasting insecticidal nets and Bacillus thuringiensis israelensis larviciding, a promising integrated approach against malaria transmission in northern Côte d'Ivoire

BackgroundThe recent reduction in malaria burden in Côte d’Ivoire is largely attributable to the use of long-lasting insecticidal nets (LLINs). However, this progress is threatened by insecticide resistance and behavioral changes in Anopheles gambiae sensu lato (s.l.) populations and residual malaria transmission, and complementary tools are required. Thus, this study aimed to assess the efficacy of the combined use of LLINs and Bacillus thuringiensis israelensis (Bti), in comparison with LLINs.MethodsThis study was conducted in the health district of Korhogo, northern Côte d'Ivoire, within two study arms (LLIN + Bti arm and LLIN-only arm) from March 2019 to February 2020. In the LLIN + Bti arm, Anopheles larval habitats were treated every fortnight with Bti in addition to the use of LLINs. Mosquito larvae and adults were sampled and identified morphologically to genus and species using standard methods. The members of the An. gambiae complex were determined using a polymerase chain reaction technique. Plasmodium infection in An. gambiae s.l. and malaria incidence in local people was also assessed.ResultsOverall, Anopheles spp. larval density was lower in the LLIN + Bti arm 0.61 [95% CI 0.41–0.81] larva/dip (l/dip) compared with the LLIN-only arm 3.97 [95% CI 3.56–4.38] l/dip (RR = 6.50; 95% CI 5.81–7.29; P < 0.001). The overall biting rate of An. gambiae s.l. was 0.59 [95% CI 0.43–0.75] biting/person/night in the LLIN + Bti arm against 2.97 [95% CI 2.02–3.93] biting/person/night in LLIN-only arm (P < 0.001). Anopheles gambiae s.l. was predominantly identified as An. gambiae sensu stricto (s.s.) (95.1%, n = 293), followed by Anopheles coluzzii (4.9%; n = 15). The human-blood index was 80.5% (n = 389) in study area. EIR was 1.36 infected bites/person/year (ib/p/y) in the LLIN + Bti arm against 47.71 ib/p/y in the LLIN-only arm. Malaria incidence dramatically declined from 291.8‰ (n = 765) to 111.4‰ (n = 292) in LLIN + Bti arm (P < 0.001).ConclusionsThe combined use of LLINs with Bti significantly reduced the incidence of malaria. The LLINs and Bti duo could be a promising integrated approach for effective vector control of An. gambiae for elimination of malaria.

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

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

Knowledge and Practices of Women Regarding Malaria and Its Prevention: A Community-Based Study in an Area under Malaria Elimination Programme in Iran.

Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are two core interventions for control and prevention of malaria infection. This descriptive cross-sectional study aimed to determine the knowledge and practices of women regarding malaria and its preventive measures in a malarious area in the Jask County, southeast of Iran. Data was collected from 400 households through a two-stage random cluster sampling method in six villages. Pre-tested structured questionnaire was used to collect data. During the survey, visual observations were also made by the interviewers to check use of LLINs and IRS. The data were analyzed by SPSS software version 21. The majority of households had a high level of knowledge about symptoms (98%, n=392) and transmission (74.5%, n=298) of malaria. The main preventive measures against malaria were: LLINS (39.5%, n=158), IRS (32%, n=128), and screens on doors/windows (16.7%, n=67). In addition, participants with primary or higher educational level reported that they practice more malaria preventive measures, compared to those who were illiterate (OR=3.3, 95% CI= 1.6-6.6, p=0.0001, Table 6). In spite of positive perceptions about IRS and LLINs, only 35.5% (n=142) and 17% (n=68) of households used IRS and LLINs, respectively. According to the results of this study, despite a high level of knowledge about malaria and its preventive measures, a small number of participants use LLINs and IRS for malaria prevention. Therefore, implementation of effective educational interventions is recommended to improve preventive practices against malaria in the study area.

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

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

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.

Malaria infection and predictor factors among Chadian nomads’ children

BackgroundIn Chad, malaria remains a significant public health concern, particularly among nomadic populations. Geographical factors and the mobility of human populations have shown to be associated with the diversity of Plasmodium species. The study aims to describe the malaria prevalence among nomadic children and to investigate its associated factors.MethodsA cross-sectional study was conducted in February and October 2021 among nomadic communities in Chad. Blood sample were collected and tested from 187 Arab, Fulani and Dazagada nomadic children aged 3–59 months using malaria rapid diagnostic test (RDT). A structured electronic questionnaire was administered to their parents to collect information about the socio‑economic data. Malaria testing results were categorized according to the SD BIOLINE Malaria Ag Pf/Pan RDT procedures. Logistic regression analysis was used to determine key risk factors explaining the prevalence of malaria. STATA version IC 13 was used for statistical analysis.ResultsThe overall malaria prevalence in nomadic children was 24.60%, with 65.20% being Plasmodium falciparum species and 34.8% mixed species. Boys were twice as likely (COR = 1.83; 95% CI, 0.92–3.62; p = 0.083) to have malaria than girls. Children whose parents used to seek traditional drugs were five times more likely (AOR = 5.59; 95% CI, 1.40–22.30, p = 0.015) to have malaria than children whose parents used to seek health facilities. Children whose parents reported spending the last night under a mosquito net were one-fifth as likely (AOR = 0.17; 95% CI, 0.03–0.90, p = 0.037) to have malaria compared to children whose parents did not used a mosquito net. Furthermore, Daza children were seventeen times (1/0.06) less likely (AOR = 0.06; 95% CI, 0.01–0.70, p = 0.024) to have malaria than Fulani children and children from households piped water as the main source were seven times more likely (AOR = 7.05; 95% CI, 1.69–29.45; p = 0.007) to have malaria than those using surface water.ConclusionsMalaria remains a significant public health issue in the nomadic communities of Chad. Community education and sensitization programs within nomad communities are recommended to raise awareness about malaria transmission and control methods, particularly among those living in remote rural areas. The National Malaria Control Program (NMCP) should increase both the coverage and use of long-lasting insecticidal nets (LLINs) and seasonal malaria chemoprevention (SMC) in addition to promoting treatment-seeking behaviors in nomadic communities.

An evaluation of LLIN physical integrity and population attitudes towards net use, care and handling during the Magude project in southern Mozambique

BackgroundThe Magude Project assessed the feasibility of eliminating malaria in Magude district, a low transmission setting in southern Mozambique, using a package of interventions, including long-lasting insecticidal nets (LLINs). As the efficacy of LLINs depends in part on their physical integrity, this metric was quantified for Olyset® Nets post mass-distribution, in addition to net use, care and handling practices and other risk factors associated with net physical integrity.MethodsNets were collected during a cross-sectional net evaluation, nine months after the Magude project commenced, which was 2 years after the nets were distributed by the National Malaria Control Programme (NMCP). The physical integrity of the nets was assessed by counting and sizing the holes at different positions on each net. A structured questionnaire was administered to assess how the selected net was used and treated (care, wash and repair). Net bio-efficacy was assessed following the standard World Health Organization (WHO) cone bioassay procedures.ResultsOut of the 170 Olyset® Nets included in the analysis, 63.5% had been used the night before. The main reason for not using a net was the notion that there were no mosquitoes present. The average number of people using each net was 1.79. Two thirds of the nets had only been washed once or twice since distribution. Most nets (80.9%) were holed and 18% were torn, but none of the risk factors were significantly associated with net integrity, except for presence of mice in the household. Less than half of the participants noticed holes in holed nets, and of those only 38.6% attempted to repair those. None of the six nets that were tested for bio-efficacy passed the WHO threshold of 80% mosquito mortality.ConclusionOverall the majority of Olyset® Nets were in serviceable condition two years post-distribution, but their insecticidal effect may have been lost. This study—together with previous evidence on suboptimal access to and use of LLINs in Magude district—highlights that LLINs as an intervention could have been optimized during the Magude project to achieve maximum intervention impact.

Efficacy of chlorfenapyr-pyrethroid and piperonyl butoxide-pyrethroid long-lasting insecticidal nets (LLINs) compared to pyrethroid-only LLINs for malaria control in Côte d’Ivoire: a three group, cluster randomised trial

BackgroundThe massive scale-up of long-lasting insecticidal nets (LLIN) has led to a major reduction in malaria burden in many sub-Saharan African (SSA) countries. The World Health Organization (WHO) has recently issued a strong recommendation for the use of chlorfenapyr-pyrethroid LLINs compared to standard pyrethroid-only LLINs in areas of high insecticide resistance intensity. However, there is still a lack of conclusive evidence on the efficacy of piperonyl butoxide-pyrethroid (PBO-py) LLINs, especially in West Africa, where vector composition and resistance mechanisms may be different from vectors in East Africa.MethodsThis is a three-arm, superiority, triple-blinded, cluster randomised trial, with village as the unit of randomisation. This study conducted in Côte d’Ivoire will evaluate the efficacy on epidemiological and entomological outcomes of (1) the control arm: MAGNet® LN, which contains the pyrethroid, alpha-cypermethrin, (2) VEERALIN® LN, a net combining the synergist PBO and alpha-cypermethrin, and (3) Interceptor® G2 LN, which incorporates chlorfenapyr and alpha-cypermethrin, two adulticides with different mechanisms of action. A total of 33 villages with an average of 200 households per village will be identified, mapped, and randomised in a ratio of 1:1:1. Nets will be distributed at a central point following national guidelines with 1 net for every 2 people. The primary outcome of the trial will be incidence of malaria cases (confirmed by rapid diagnostic test (RDT)) in a cohort of 50 children aged 6 months to 10 years in each cluster, followed for 12 months (active case detection). Secondary outcomes are cross-sectional community prevalence of malaria infection (confirmed by RDT) in the study population at 6 and 12 months post-intervention (50 randomly selected persons per cluster), vector density, entomological inoculation rate (EIR), and phenotypic and genotypic insecticide resistance at baseline and 12 months post-intervention in 3 sentinel villages in each treatment arm.DiscussionIn addition to generating further evidence for next-generation LLINs, this study will also provide the first evidence for pyrethroid-PBO nets in a West African setting. This could further inform WHO recommendations on the pragmatic use of pyrethroid-PBO nets.Trial registrationClinicalTrials.gov NCT05796193. Registered on April 3, 2023.

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

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

Factors associated with the use of long-lasting insecticidal nets in pregnant women and mothers with children under five years of age in Gaza province, Mozambique.

Malaria remains a major public health concern worldwide. Malaria is endemic in Mozambique, with seasonal fluctuations throughout the country. Although the number of malaria cases in Mozambique have dropped by 11% from 2020 to 2021, there are still hotspots in the country with persistent high incidence and low insecticide-treated bed net usage. The aim of this study is to evaluate the factors associated with the use of long-lasting insecticidal nets by pregnant women and women with children under 5 years old in two hotspot districts in the Gaza province, Mozambique. A descriptive, qualitative cross-sectional study was conducted between June 15th and 21st 2022. An in-depth interview process was conducted with pregnant women and mothers with children under five years old, exploring their beliefs, experiences, and perception of messages conveyed by health professionals when long-lasting insecticidal nets were being supplied. A total of 48 women participated (24 pregnant women and 24 women with children under 5 years). Most participants recognized the protective effects of long-lasting insecticidal nets in preventing malaria, and understood that women and children were high risk groups. The nets were reported to cause side effects and difficulty breathing by 100% of pregnant women, while 54.2% of mothers with children under 5 reported no side effects. The majority of women in both groups reported that their health professionals did not educate them about how to use or handle the nets properly. Only 16.7% of mothers with children under 5 received correct handling instructions. Providing clear, culturally sensitive, and practical information on the correct use of LLINs, as well as regular monitoring of their proper use, would be a great step forward for Mozambique's national malaria program.

Asymptomatic Malaria among Pregnant Women Attending Ante-Natal Clinic in Osogbo, Nigeria

Background: Pregnant women are in danger from malaria infection during pregnancy, which is a serious public health issue. A key obstacle to eradicating malaria is the reservoir host for the parasite, and is also regarded as one of the main obstacles to eliminating malaria. This study assessed the prevalence of asymptomatic malaria and associated factors among pregnant women attending antenatal clinics in Osogbo, Southwestern Nigeria. Methods: A hospital-based cross-sectional study was conducted between July and October 2020 to assess the prevalence and predictors of asymptomatic malaria among 294 consenting pregnant women. Socio-demographic data, Intermittent Preventive Treatment in pregnancy with SP (IPTp-SP), and information on insecticide-treated nets use were collected using a structured questionnaire. SD BIOLINE Malaria rapid diagnostic test kits and Giemsa-stained blood smear microscopy were used to diagnose Plasmodium infections. Anaemia status was determined using microhematocrit centrifugation. Data were analysed using SPSS version 20.0 statistical software. In all comparisons, p-values ≤ 0.05 were considered statistically significant. Results: The prevalence of asymptomatic malaria infection was 20.4% (60/294) and 23.5% (69/ 294) using microscopy and RDT, respectively. Among those infected, 76.7% were anaemic (p=0.001). Asymptomatic malaria was significantly associated with not using insecticide-treated bed nets (ITN). Secundigravida women and being in third-trimester pregnancy were significant determinants of pregnancy-associated malaria. Conclusion: This study showed that malaria and anaemia are still prevalent among pregnant women in Southern Nigeria, and it is a significant concern for public health. Improved access to intermittent preventive treatment with sulphadoxine-pyrimethamine and the use of long-lasting insecticidal nets should be encouraged to help further diminish the risk of malaria infection amongst pregnant women in the region.

Mutations Linked to Insecticide Resistance Not Detected in the Ace-1 or VGSC Genes in Nyssorhynchus darlingi from Multiple Localities in Amazonian Brazil and Peru.

Indoor residual spray (IRS), mainly employing pyrethroid insecticides, is the most common intervention for preventing malaria transmission in many regions of Latin America; the use of long-lasting insecticidal nets (LLINs) has been more limited. Knockdown resistance (kdr) is a well-characterized target-site resistance mechanism associated with pyrethroid and DDT resistance. Most mutations detected in acetylcholinesterase-1 (Ace-1) and voltage-gated sodium channel (VGSC) genes are non-synonymous, resulting in a change in amino acid, leading to the non-binding of the insecticide. In the present study, we analyzed target-site resistance in Nyssorhynchus darlingi, the primary malaria vector in the Amazon, in multiple malaria endemic localities. We screened 988 wild-caught specimens of Ny. darlingi from three localities in Amazonian Peru and four in Amazonian Brazil. Collections were conducted between 2014 and 2021. The criteria were Amazonian localities with a recent history as malaria hotspots, primary transmission by Ny. darlingi, and the use of both IRS and LLINs as interventions. Fragments of Ace-1 (456 bp) and VGSC (228 bp) were amplified, sequenced, and aligned with Ny. darlingi sequences available in GenBank. We detected only synonymous mutations in the frequently reported Ace-1 codon 280 known to confer resistance to organophosphates and carbamates, but detected three non-synonymous mutations in other regions of the gene. Similarly, no mutations linked to insecticide resistance were detected in the frequently reported codon (995) at the S6 segment of domain II of VGSC. The lack of genotypic detection of insecticide resistance mutations by sequencing the Ace-1 and VGSC genes from multiple Ny. darlingi populations in Brazil and Peru could be associated with low-intensity resistance, or possibly the main resistance mechanism is metabolic.