ITN Utilization Research Articles

Prevalence and correlates of malaria and undernutrition among acutely febrile children visiting temporary malaria screening sites in war-torn areas of Northeast Ethiopia.

Malaria and undernutrition pose challenges for children in conflict-affected areas. Understanding the prevalence and risk factors for these issues in war-torn communities is important to effectively design aid efforts and select interventions. This study aimed to determine the prevalence and correlates of malaria and undernutrition among febrile children in northeast Ethiopia to help address these problems. A cross-sectional study was conducted from November 2022 to January 2023. Four hundred twenty-two children were enrolled using a systematic random sampling technique. Data on associated factor variables were collected via questionnaire. Capillary blood samples were collected from each child to prepare thick and thin blood films, which were stained with Giemsa and examined microscopically. Height and weight measurements were also taken using a meter and a standard calibrated balance. The data were analyzed in SPSS 26.0 using bivariable and multivariable logistic regression to determine associations between correlates, malaria infection, and undernutrition. Statistical significance was set at p < 0.05. The overall malaria prevalence among screened children at temporary sites in the conflict-affected areas of Northeast Ethiopia was 65.9% (278/422). Plasmodium falciparum, P. vivax, and mixed infections accounted for 74.1%, 19.8%, and 6.1% of the cases, respectively. The presence of stagnant water (P<0.01), improper utilization of ITN, inadequate number of ITNs per family size (P<0.01), and absence of environmental management (P<0.01) were independent predictors of malaria. On the other hand, the overall undernutrition prevalence was 54.7% (231/422), including 26.5% underweight, 16.8% stunted, and 11.4% wasted. Dietary diversity score (P<0.01), meal frequency (P<0.01), and confirmed malaria infection (P<0.01) were significantly associated with underlnutrition. Both malaria and undernutrition burdens were high among the children in this study. The findings suggest combined prevention measures for malaria and undernutrition should be strengthened in this region.

Asymptomatic and submicroscopic malaria infections in sugar cane and rice development areas of Ethiopia

BackgroundWater resource development projects, such as dams and irrigation schemes, have a positive impact on food security and poverty reduction. However, such projects could increase prevalence of vector borne disease, such as malaria. This study investigate the impact of different agroecosystems and prevalence of malaria infection in Southwest Ethiopia.MethodsTwo cross-sectional surveys were conducted in the dry and wet seasons in irrigated and non-irrigated clusters of Arjo sugarcane and Gambella rice development areas of Ethiopia in 2019. A total of 4464 and 2176 study participants from 1449 households in Arjo and 546 households in Gambella enrolled in the study and blood samples were collected, respectively. All blood samples were microscopically examined and a subset of microscopy negative blood samples (n = 2244) were analysed by qPCR. Mixed effect logistic regression and generalized estimating equation were used to determine microscopic and submicroscopic malaria infection and the associated risk factors, respectively.ResultsPrevalence by microscopy was 2.0% (88/4464) in Arjo and 6.1% (133/2176) in Gambella. In Gambella, prevalence was significantly higher in irrigated clusters (10.4% vs 3.6%) than in non-irrigated clusters (p < 0.001), but no difference was found in Arjo (2.0% vs 2.0%; p = 0.993). On the other hand, of the 1713 and 531 samples analysed by qPCR from Arjo and Gambella the presence of submicroscopic infection was 1.2% and 12.8%, respectively. Plasmodium falciparum, Plasmodium vivax, and Plasmodium ovale were identified by qPCR in both sites. Irrigation was a risk factor for submicroscopic infection in both Arjo and Gambella. Irrigation, being a migrant worker, outdoor job, < 6 months length of stay in the area were risk factors for microscopic infection in Gambella. Moreover, school-age children and length of stay in the area for 1–3 years were significant predictors for submicroscopic malaria in Gambella. However, no ITN utilization was a predictor for both submicroscopic and microscopic infection in Arjo. Season was also a risk factor for microscopic infection in Arjo.ConclusionThe study highlighted the potential importance of different irrigation practices impacting on submicroscopic malaria transmission. Moreover, microscopic and submicroscopic infections coupled with population movement may contribute to residual malaria transmission and could hinder malaria control and elimination programmes in the country. Therefore, strengthening malaria surveillance and control by using highly sensitive diagnostic tools to detect low-density parasites, screening migrant workers upon arrival and departure, ensuring adequate coverage and proper utilization of vector control tools, and health education for at-risk groups residing or working in such development corridors is needed.

Factors Influencing Utilization of Insecticide-treated Nets among Pregnant Women and Children in Bayelsa and Rivers States, Nigeria

Aim: Globally, Pregnant women and under five years children are the most vulnerable group in malaria zones. This study aimed to assessed factors influencing utilization of ITNs among pregnant women and care givers of children in Bayelsa and Rivers States, Nigeria.&#x0D; Methodology: A pretest-posttest descriptive cross-sectional survey of 330 pregnant women and caregivers of children was conducted in Bayelsa and Rivers States using multi-stage random sampling technique. Pretest questionnaire was administered to sampled respondents. Health education intervention was done to motivate behavioral change wheel (BCW) of respondents. Posttest questionnaire was administered two (2) months after health education intervention.&#x0D; Results: Two hundred and eight (63.0%) of pre and 292(88.5%) of post intervention respondents strongly agreed that using ITNs was the best way to prevent malaria. Findings showed that educated respondents were 4 times more knowledgeable than their uneducated counterparts (O.R.: 4.300, 95% C.I.: 0.838-22.064; p-value: 0.058). Low proportion of post intervention respondents 131(39.7%) slept in the ITNs previous night when temperature was between 26 -240C compared to 224 (67.9%) pre intervention respondents when temperature was between 24 – 250C. Public health education on use of ITNs was statistically significan (t-test: 31.026; P &lt; .05). Being harmful and intolerance due to heat were the negative reasons for not using ITNs.&#x0D; Conclusion: The factor ‘heat’ during dry season stands as barrier in use of ITNs irrespective of health education intervention. It is recommended that Government policies on ventilated buildings be enforced, as well as improve on quality of the ITNs for hot weather tolerance.

Socio-demographic and economic inequity in the use of insecticide-treated bed nets during pregnancy: a survey-based case study of four sub-Saharan African countries with a high burden of malaria

Despite global investments in malaria eradication and mitigation efforts, including the dissemination of ITNs to vulnerable communities, the goal of widespread malaria control among pregnant women has yet to be realized in many African countries. One of the explanations forwarded for this is related to the adoption and regular use of ITNs by pregnant women. Based on the available DHS and MIS data from four malaria high burden African countries– according to WHO malaria report 2020– inequality was measured by applying both relative and absolute summary measures for the four dimensions of inequality: economic status, education, place of residence and region. By considering the number of subgroups in each variable, simple and complex summary measures were used.ITN utilization by pregnant women showed an increasing trend over time in all the four countries. There was also significant inequality (variability) in the ITN utilization among population groups. DRC, Mozambique and Uganda showed noticeable inequality that favors the richest population, whereas in Nigeria the inequality was observed among both the rich and the poor during different survey yearsIn conclusion, in all the four countries, there were significant regional variations or differences in ITN use among pregnant mothers across all dimensions of inequality in the survey years. Tailored cost-effective interventions could be considered to improve ITN utilization among pregnant women.

Contributing Factors of Anemia in Pregnancy in the Twifo Atti-Morkwa District in Ghana

The study determined the factors influencing anemia among pregnant women in the Twifo Atti-Morkwa District of Ghana. This study employed a hospital-based cross-sectional study design to assess the risk factors for anemia among pregnant women. About 430 pregnant women attending antenatal care services in all health facilities in the Twifo Atti-Morkwa district were used as respondents for the study. Data were collected quantitatively using a structured questionnaire. The questionnaire was administered using a face-to-face interview process. The data were analyzed using STATA version 15 (StataCorp, College Station, Texas 77845, USA). Pearson’s chi-square and binary logistic regression were used to find the variables significantly associated with anemia in pregnancy at a p-value of 0.05. The findings showed the respondents were within the age range of 15 to 45 years, with a mean age of 26.36 years. Only 49.07% of them had visited ANC at least 4 times. Additionally, 50.93% of them started ANC attendance in the first trimester of their pregnancy. The majority of them (89.77%) attended ANC regularly. Most of them indicated that they took routine ANC drugs, and among them, 91.75% took iron supplements, 87.63% took folic acid, and 49.74% took Sulfadoxine-pyrimethamine, and 66.75% took multivitamins. Despite the regular ANC attendance, high intake of iron and folic acid supplements, and high utilization of ITN, the prevalence of anemia in pregnancy at 36 weeks of gestation in the Twifo Atti-Morkwa district was high. Anemia at 36 weeks of gestation was significantly associated with factors such as the number of ANC visits, gravidity, gestational age at the start of ANC, malaria infection, and intake of food supplements. To address the burden of anemia in pregnancy in the district, it is vital to note that supplements alone are not adequate. There, therefore, is a need for intensive education on other strategies such as deworming, nutrition, and adherence to Sulfadoxine-pyrimethamine to improve general health in women before and during pregnancy.

Preventive programs in public health: seminar presentations on HIV, malaria and visual impairment

Preventive programs are standardized behavioral interventions that either stop or reduce course of diseases. Indeed, it is known that much of public health programs are synonymous to preventive medicine, which constitute major theme in primary healthcare. The objective of this study was to provide preliminary summaries of research programs, which determined nutritional status on visual impairment (VI) among children, utilization of ITNs and reduction of HIV/AIDS infection in Nigeria. The studies adopted intervention approaches. In Delta state, antioxidant vitamins and ferrous sulphate were administered to participants, to assess impact on visual impairment. In health education on utilization of ITNs in Bayelsa and Rivers states; as well as on HIV/AIDS infection in Northern Nigeria. Statistically, the studies followed a quantitative method. Baseline percentages of vitamin A and C deficiencies, anaemia, and VI differed with respective post-intervention levels. Post-intervention result showed that 92.1% owned ITNs, improved knowledge of causes and consequences of malaria. On HIV, community-based television, and radio awareness programs on the use of condom influenced the reduction of HIV/AIDS infection by up to 30%. In conclusion, the preliminary reports indicate that antioxidant vitamins and iron supplementation ameliorated anaemia and VI. Public health awareness campaign influenced behavioural change wheel on use of ITNs as well as use of condom for the reduction of HIV/AIDS infection in Nigeria.

Factors associated with ownership and utilization of insecticide treated nets among children under five years in sub-Saharan Africa

BackgroundInsecticide-treated net (ITN) is a cost-effective means to control malaria and morbidity in under-five children. This study synthesizes the factors associated with using the ITN as a malaria prevention tool in sub-Saharan Africa.MethodsThere was an advanced search of four electronic databases, including PubMed Central, CINAHL, EMBASE, and Google Scholar, and identified articles between 2016 to April 2021. Following the title, abstract and full-text reading, 13 articles were deemed appropriate for this review. All the researchers developed, discussed, and accepted a matrix to extract relevant information from the studies. A convergent synthesis was adopted and allowed for integrating qualitative, quantitative, and mixed-method studies and transforming them into qualitative findings.ResultsHousehold and caregiver related factors that influenced utilization of the ITN were, Household heads having two or more sleeping places, a knowledge that ITN prevents malaria, the presence of hanging ITNs, high literacy, living female-headed households, birth spacing, unmarried mothers, and antenatal clinic attendance promoted utilization. Perceived malaria risk was a critical determinant of ITN ownership and utilization. Some factors that hindered the use of the ITN included hotness of the weather, absence of visible mosquitoes, cost, inadequate number, rooms designs, unaffordability, insufficient knowledge on causes of malaria, and poor attitude to use. Specific ITN factors that hindered use were color, chemicals use, odor, and shape.ConclusionIt is important to use integrated multi-sectoral and culturally appropriate interventions to encourage households to prioritize and utilize the ITN in under-5 children.

Dry-season transmission and determinants of Plasmodium infections in Jawi district, northwest Ethiopia

BackgroundMalaria remains a serious global public health problem, and continues to have a devastating impact on people’s health worldwide. Continuous monitoring and evaluation of current malaria transmission status in different seasons is a mainstay for the success of ongoing intervention strategies for malaria. The purpose of this study was to assess the dry-season transmission and determinants of malaria in Jawi district, northwest Ethiopia.MethodsA community-based cross-sectional study was conducted from January 13 to February 11, 2020; among selected Kebeles in the Jawi district. A multistage sampling technique was used in this study. Random and systematic sampling techniques were carried out to select Kebeles and each household, respectively. Light microscopy and CareStart™ Malaria HRP2/pLDH (Pf/Pv) Combo RDT were implemented to determine the prevalence of malaria. Moreover, associated risk factors in the prevalence of malaria were assessed by using a bivariate and multivariate logistic regression model.ResultsA total of 219 study participants were enrolled in this study. Of the total enrolled individuals, malaria cases were found among 36 individuals with a positivity rate of 16.4% (95% CI 11.4–21.5). Plasmodium falciparum was the predominant species with an estimated prevalence of 87.0% in the study areas. Interrupted utilization of ITN (AOR = 4.411, 95% CI 1.401–13.880), using over 3 years older ITNs (AOR = 9.622, 95% CI 1.881–49.214), travel history (AOR = 12.703, 95% CI 2.441–66.114), living in a house with holes on the wall (AOR = 3.811, 95% CI 1.010–14.384), and living in a house with an eave (AOR = 4.23, 95% CI 1.065–16.801) significantly increased the probability of malaria positivity rate.ConclusionMalaria is still an important public health burden among individuals in the Jawi district. Interrupted utilization of ITNs, using over 3 years older ITNs, living in a house with holes on the wall, living in a house with an eave, and travel history were identified as the risk factors of malaria. Therefore, the District health office and Health extension workers should promote daily utilization of good ITNs and improve housing conditions to reduce malaria prevalence.

Insecticide-treated net ownership, utilization and knowledge of malaria in children residing in Batoke\u2013Limbe, Mount Cameroon area: effect on malariometric and haematological indices

BackgroundInsecticide-treated nets (ITNs) are the most widely used interventions for malaria control in Africa. The aim of this study was to assess the ownership and utilization of ITNs and the knowledge of malaria and their effects on malariometric and haematological indices in children living in the Mount Cameroon area.MethodsA community-based cross-sectional study involving a total of 405 children aged between 6 months and 14 years living in Batoke–Limbe was carried out between July and October 2017. A semi-structured questionnaire was used to document demographic status, knowledge on malaria and ITN ownership and usage. Venous blood sample was collected from each child to determine the prevalence and intensity of parasitaemia by Giemsa-stained microscopy and full blood count by auto haematology analysis to obtain white blood cell (WBC) and red blood cell (RBC) counts, haemoglobin (Hb) level, haematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC). A multilinear regression model was used to determine the relationship between haematological parameter as dependent variable and the independent variables.ResultsThe overall prevalence of parasitaemia, anaemia, knowledge about malaria, ITN ownership, usage and effective usage was 46.7%, 54.7%, 40.7%, 78.8%, 50.9% and 29.9%, respectively. The prevalence of parasitaemia was significantly higher (P < 0.001) in children who ineffectively utilized ITNs (54.9%) than effective users (27.3%). Having knowledge of malaria, negatively correlated with WBC counts (P = 0.005), but positively correlated with Hb levels (P < 0.001), RBC counts (P < 0.001), Hct (P < 0.001), MCV (P < 0.001) and MCH (P < 0.001). ITN use positively correlated with WBC counts (P = 0.005) but negatively with Hb levels (P = 0.004), RBC counts (P = 0.006), and MCH (P < 0.001). Meanwhile, parasitaemia negatively correlated with Hb levels (P = 0.004), RBC counts (P = 0.01), Hct (P = 0.04) and MCHC (P = 0.015).ConclusionThere is need for more sensitization on the benefits of using the ITNs to meet up with the intended and expected impact of the free distribution of ITNs.

Patterns and correlates of ownership and utilization of insecticide-treated bed-nets for malaria control among women of reproductive age (15-49 years) in Malawi.

Malaria is a major public health concern in Malawi. This study explored the patterns and correlates of ownership and utilization of ITNs for malaria control among women of reproductive age in Malawi. Data were derived from the multi-stage cross-sectional Malaria Indicator Survey (MIS) conducted in 2017, which followed ITN distribution in 2012 and 2015. Of the 3860 sampled women aged 15-49 years, 88% (3398/3860) and 64% (2473/3860) reported that they owned and utilized ITNs, respectively. Adjusted multivariate logistic regression analysis showed that the odds of ownership of ITNs were significantly low among women with no education (AOR = 0.36, CI = 0.18-0.72), those with primary education (AOR = 0.50, CI = 0.27-0.94) and poor women (AOR = 0.70, CI = 0.51-0.97). Similarly, the odds of utilization of ITNs were significantly low among women with no education, (AOR = 0.40, CI = 0.26-0.63), primary education (AOR = 0.53, CI = 0.36-0.78) and poor women (AOR = 0.70, CI = 0.51-0.97). Furthermore, the odds of utilization of ITNs were significantly low among women living in households without a radio (AOR = 0.79, CI = 0.67-0.93) and those who have not seen or heard a malaria message in the last 6 months (AOR = 0.74, CI = 0.64-0.87). In order to prevent malaria morbidity and mortality among women of reproductive age, especially those from poor households, the Malawi government and relevant stakeholders need to continue the free distribution of ITNs to the poor and encourage social behaviours that promote the ownership and utilization of ITNs.

Determinants of malaria among under-five children in Ethiopia: Bayesian multilevel analysis

BackgroundIn Ethiopia, malaria is one of the public health problems, and it is still among the ten top leading causes of morbidity and mortality among under-five children.However, the studies conducted in the country have been inconclusive and inconsistent. Thus, this study aimed to assess factors associated with malaria among under-five children in Ethiopia.MethodsWe retrieved secondary data from the malaria indicator survey data collected from September 30 to December 10, 2015, in Ethiopia. A total of 8301 under-five-year-old children who had microscopy test results were included in the study. Bayesian multilevel logistic regression models were fitted and Markov chain Monte Carlo simulation was used to estimate the model parameters using Gibbs sampling. Adjusted Odd Ratio with 95% credible interval in the multivariable model was used to select variables that have a significant association with malaria.ResultsIn this study, sleeping under the insecticide-treated bed nets during bed time (ITN) [AOR 0.58,95% CI, 0.31–0.97)], having 2 and more ITN for the household [AOR 0.43, (95% CI, 0.17–0.88)], have radio [AOR 0.41, (95% CI, 0.19–0.78)], have television [AOR 0.19, (95% CI, 0.01–0.89)] and altitude [AOR 0.05, (95% CI, 0.01–0.13)] were the predictors of malaria among under-five children.ConclusionsThe study revealed that sleeping under ITN, having two and more ITN for the household, altitude, availability of radio, and television were the predictors of malaria among under-five children in Ethiopia. Thus, the government should strengthen the availability and utilization of ITN to halt under-five mortality due to malaria.

Assessment of Malaria Vector Control Measures (ITNs &amp; IRS) Utilization and Factors Affecting it in Adama District, East Shoa Zone, Oromia Region Ethiopia, 2018

About 75% of landmass of Ethiopia is malaria-endemic, and 65% (58.5 million) of the population is estimated to be at risk of malaria infection. Malarious areas are targeted to receive key malaria control interventions (LLITNs and IRS) and we aimed to assess the utilization of ITN/IRS and factors affecting it. We conducted Community based Cross sectional study in Adama district from January 1-30, 2018 among 818 households using Multi stage sampling system followed by Simple random sampling method in selecting districts and camps. Bi-variate and multivariate logistic regression was used to calculate the association. Of 818 visited HHs 73% were utilizing ITN regularly and sprayed by IRS in the past one year. The prevalence rate of malaria was found to be six percent. Having good awareness about malaria transmission and control measures (AOR 1.4 (1.1-2), sharing one bed with a member of 3-5 compared to not sharing (AOR=0.7 (0.4-0.9), family head educational level of higher level compared to illiterate (AOR=4.8, 95% CI 1.1- 6.6), Employed family head Compared to Farmers (AOR=8.1, 95% CI 7.8-10.7) are significantly associated with ITN utilization. ITN utilization was influenced by Lack of knowledge, lack of education and family sharing one bed. Increasing the knowledge of community on malaria transmission and prevention methods including ITN proper usage is important.

Malaria screening at the workplace in Cameroon.

Malaria remains a major health problem in Cameroon; It accounts for 38% of consultations, 24% of deaths and 36.8% of absenteeism in the country. The negative economic impact of malaria has encouraged a new control approach targeting companies. In this regard, a cross sectional study was conducted from February 2015 to June 2017 in 14 companies in the town of Douala. This study aimed at determining the prevalence, control practices of employees and identifying associated factors with malaria. A total of 2705 workers were interviewed and systematically screened for malaria using LED fluorescence microscopy (CyScope®). All positive cases were given a malaria treatment. The prevalence of malaria and asymptomatic malaria was 30.1% and 28.9% respectively; asymptomatic malaria accounted for 95.7% of all positive diagnostic test. Malaria infection was significantly higher in employees aged 36–60 years (30.5%) and having completed primary studies (36%). ITNs ownership and utilization were 86.36% and 77.23% respectively. The risk for malaria infection has significantly decreased with age and educational level while the employees’ level of education and size of households were significantly associated with the regular utilization of ITNs. This is the first study assessing malaria prevalence and risk factors in workplace in Cameroon and using a novel diagnostic tool. This study outlines a high prevalence of malaria infection, especially asymptomatic carriage, high rates of ITNs ownership and utilization, as well as the influence of level of education, age and household size as associated factors. Active case detection of asymptomatic carriers through systematic screening of employees at workplace and their treatment is feasible with the Cyscope microscope and could be a good complement to ongoing control strategies.

Prevalence and Associated Factors of Malaria among Febrile Children in Afar Region, Ethiopia: A Health Facility Based Study.

Malaria is a major public health problem in Sub-Saharan Africa including Ethiopia and it affects children under five and pregnant mothers. Theprevalence of malaria is not well studied though the burden is expected to be high in low lands of Afar region.Therefore, this study attempts to assess the prevalence and associated factors of malaria among under five children in the pastoral community. Cross-sectional study design was employed from April 15th to 15th May 2018 on a sample of 484 under-five children who visited the randomly selected health facilities of Dubti district, Afar region.The study participants were recruited randomly with the basic assumption that their arrival at health facilities is random. The main outcome variable was parasitological confirmed malaria among under five children and it was measured using either microscopy blood film examination. Binary logistic regression model was done to measure the association between confirmed malaria infection and its predictors. Independent variables with p-value less than 0.25 in the bivariate analysis were entered into multivariable logistic regression analysis model. Statistical significance level was declared at p-value less than 0.05. The prevalence of malaria among febrile under-five children was 64% (95% CI 59.5%-68.4%). Of these, more than half (66.5%) and one-fifth (22. 2%) of the cases were caused by p.falciparum and p.vivax respectively. The multivariable logistic regression analysis showed thatliving in rural residence [AOR=1.77: 95% CI 1.10-2.85], having educated mother [AOR=0.406: 95% CI 0.26-0.63], age of child ([AOR=2.98: 95% CI 1.41-6.32], sex of child [AOR=1.99: 95% CI 1.29-3.08], not sleep under ITN [AOR=9.10: 95% CI 1.01- 82.58], ITN availability [AOR=2.23: 95% CI 1.01- 4.89] and history of malaria infection among family members [AOR=9.10: 95% CI 1.01-82.58] were the independent predictors of malaria infection among under five children. The overall prevalence of malaria among under-five children was high compared to the national prevalence of malaria among the general population. Health care providers (HCPs) should educate parents/guardians regarding proper utilization of ITN at night. In addiotion, they should provide early treatment for febrile family members to halt the transmission of malaria. The regional government should give due attention to supply of ITN and enhance the awareness of the community. Additional longitudinal studies are recommended.

Barriers in distribution, ownership and utilization of insecticide-treated mosquito nets among migrant population in Myanmar, 2016: a mixed methods study

BackgroundSleeping under insecticide-treated mosquito nets/long-lasting insecticidal nets (ITNs/LLINs henceforth referred to as ITNs) is one of the core interventions recommended by the World Health Organization to reduce malaria transmission and prevent malaria in high-risk communities, such as migrants, by preventing mosquito bites. The malaria burden among the migrant population is a big challenge for malaria elimination in Myanmar. In this context, this study aimed to assess the ownership and utilization of ITNs and to understand the barriers to distribution and utilization of ITNs among the high-risk migrant communities in the Regional Artemisinin Resistance Initiative (RAI) project areas of Myanmar.MethodsA sequential mixed methods study (quantitative component: cross-sectional study involving analysis of secondary data available from a survey conducted among migrant households in the RAI project areas of Myanmar in 2016 followed by a descriptive qualitative component in 2018). A total of 17 focus group discussions (involving 121 participants) with different groups of migrants and 17 key-informant interviews with key programme stakeholders were conducted in 4 selected townships of RAI project areas.ResultsOf 3230 migrant households, 63.3% had at least one ITN while 36% had sufficient ITNs (i.e., 1 ITN per 2 persons). Regarding ITN utilization, about 52% of household members reported sleeping under an ITN the previous night, which is similar among under-fives and pregnant women. Over half of all bed nets were ITNs, with nearly one-third having holes or already undergone repairs. The qualitative findings revealed that the key challenges for ITN utilization were insufficient ITNs in households and dislike of ITNs. The barriers to ITN distribution were incomplete migrant mapping due to resource constraints (time, money, manpower) and difficulties in transportation and carrying ITNs.ConclusionThis study highlights poor ownership and utilization of ITNs among migrants in the RAI project areas of Myanmar and barriers to their ownership and utilization. To achieve universal coverage and utilization, more programmatic support by the programme is needed to carry out complete migrant mapping and continuous ITN distribution in remote locations.

Malaria knowledge and bed net use in three transmission settings in southern Africa

BackgroundInsecticide-treated nets (ITNs) reduce malaria morbidity and mortality in endemic areas. Despite increasing availability, the use of ITNs remains limited in some settings. Poor malaria knowledge is a barrier to the widespread use of ITNs. The goal of this study was to assess the levels of malaria knowledge and evaluate factors associated with bed net use among individuals residing in three regions of southern Africa with different levels of malaria transmission and control.MethodsA cross-sectional study was conducted on a sample of 7535 residents recruited from 2066 households in Mutasa District, Zimbabwe (seasonal malaria transmission), Choma District, Zambia (low transmission) and Nchelenge District, Zambia (high transmission), between March 2012 and March 2017. A standardized questionnaire was used to collect data on demographics, malaria-related knowledge and use of preventive measures. Multivariate logistic regression analyses were used to assess determinants of bed net use.ResultsMost of the 3836 adult participants correctly linked mosquito bites to malaria (85.0%), mentioned at least one malaria symptom (95.5%) and knew of the benefit of sleeping under an ITN. Bed net ownership and use were highest in Choma and Nchelenge Districts and lowest in Mutasa District. In multivariate analyses, knowledge of ITNs was associated with a 30–40% increased likelihood of bed net use after adjusting for potential confounders across all sites. Other factors significantly associated with bed net use were age, household size and socioeconomic status, although the direction, strength and size of association varied by study site. Importantly, participants aged 5–14 years had reduced odds of sleeping under a bed net compared to children younger than 5 years.ConclusionRelevant knowledge of ITNs translated into the expected preventive behaviour of sleeping under a bed net, underscoring the need for continued health messaging on malaria prevention. The implementation and delivery of malaria control and elimination interventions needs to consider socioeconomic equity gaps, and target school-age children to ensure access to and improve utilization of ITNs.

The interruption of Onchocerca volvulus and Wuchereria bancrofti transmission by integrated chemotherapy in the Obongi focus, North Western Uganda.

InterventionFew studies have documented the interruption of onchocerciasis and Lymphatic Filariasis (LF) by integrated chemotherapy in Uganda. The study describes the interruption of transmission of the two diseases co-endemic in Obongi focus, north western Uganda. Base line data for Onchocerciasis and LF were collected in 1994 and 2006, respectively. Annual mass drug administration for onchocerciasis (Ivermectin) and Lymphatic Filariasis (Ivermectin + albendazole) was conducted for 20 and 6 years, respectively. Thereafter, assessments by skin snip, larval searches in rivers and human landing catches were performed. Children <10 years were screened for IgG4 antibodies using Ov16 ELISA technique in 2013. LF Pre-TAS and TAS1 were conducted in sentinel sites. ITN coverage and utilization for the implementation unit was also reported.Intervention coverageOnchocerciasis treatment coverage was <80% but improved with the introduction of CDTI in 1999. While for LF, effective coverage of >65% was achieved in the six treatment rounds. Household ownership of ITN’s and utilization was 96% and 72.4%., respectively.ImpactParasitological examinations conducted for onchocerciasis among 807 adults and children, revealed a reduction in mf prevalence from 58% in 1994 to 0% in 2012. Entomological monitoring conducted at the two sites had no single Simulium damnosum fly caught. Serological analysis using Ov16 ELISA for onchocerciasis revealed that out of the 3,308 children <10 years old screened in 2013, only 3/3308 (0.091%) positive cases were detected. All Ov16 positive children were negative when tested for patent infection by skin snip PCR. A reduction in LF microfilaria prevalence from 2.5% (n = 13/522) in 2006 to 0.0% (n = 602) in 2014 was observed. LF TAS1 conducted in 2015 among 1,532 children 6–7 years, all were negative for antigens of W. bancrofti.ConclusionThe results concluded that interruption of onchocerciasis and LF has been achieved.

Utilization of insecticide treated nets among pregnant women and mothers with under five children in Ikot Omin Community, Calabar, Nigeria

Malaria is mostly endemic in tropical environments and has caused several still births and deaths particularly among children. Effective control of malaria infection reduces maternal and infant morbidity and mortality rate in pregnant women and children (0-5yrs). A promising strategy has been the utilization of insecticide treated nets among these groups of persons. A mixed method study was carried out in Ikot Omin community in Cross River State, Nigeria to authenticate the effectiveness of the net utilization. Four specific objectives were developed to guide the study. Data were elicited from 225 respondents through the use of structured questionnaires and focus group discussions. The quantitative and qualitative data were analyzed using SPSS 16.0 and thematic analysis methods respectively. The results showed that the prevalent harsh and dry weather condition was the major barrier to utilization of ITN in the community. A focused communication strategy to address this challenge has been suggested. The possibility of provision of steady light supply through the use of solar power in the homes by those who can afford it can be explored as a remedy for promoting consistent use of ITN by pregnant women and under five children in this community.

Concurrent Plasmodium infection, anemia and their correlates among newly diagnosed people living with HIV/AIDS in Northern Ethiopia

The magnitude of concurrent malaria infection and the impact it has on hematological abnormalities, such as anemia in people living with HIV/AIDS, is not well studied in Ethiopian set up. In this cross sectional study, therefore, we assessed the prevalence of concurrent malaria infection and anemia among highly active anti-retroviral therapy (HAART) naive people living with HIV/AIDS between October, 2012 to May, 2013 in Northern Ethiopia. After obtaining consent, socio demographic, clinical, immunological and behavioural data was obtained. The overall prevalence of concomitant malaria infection was 17.4%. Rural residents and low to middle income class clients were more frequently co-infected with malaria (p<0.0001). Utilization of insecticide treated nets (p=0.0002) and co-trimoxazole intake (p=0.006) were protective factors against Plasmodium infection. The overall prevalence of anemia was also high (43%), being significantly higher (91.3%) in malaria positive people living with HIV/AIDS compared to malaria free HIV patients (32.8%) (p<0.0001). Female gender (p=0.011), history of opportunistic infections (P=0.0027) and late HIV stages (III and IV) (p=0.0001) were also significantly associated with anemia in HIV patients. In conclusion, concurrent malaria represents a common condition and there was a significant difference in the odds of anemia between malaria positive and negative people living with HIV/AIDS in Northern Ethiopia indicating a need for routine screening of people living with HIV/AIDS living in malaria endemic-areas and close monitoring of co-infected patients. Indeed utilization of ITNs, malaria prophylaxis and early HIV diagnosis are highly encouraged in people living with HIV/AIDS.

Improvement of Community Health Outcomes in Kitgum District: Contributions of a Maternal Newborn and Child Health Project from June 2011 to July 2016

The East African Maternal Newborn and Child Health (EAMNCH) project implemented in Kitgum District of Uganda with a goal to improve MNCH. The evaluation was conducted as a cross-sectional assessment that utilised both quantitative and qualitative data collection methods. The projects contribution to the goal included a 4% reduction in stunting levels, 5.9% increase in the number of women delivered by a skilled Birth attendant, 12.6% increment in pregnant women accessing Iron folic supplements and a 7% increment in utilization of ITN during pregnancy. Evidence from the quantitative household survey, key informant interviews and focus group discussions supported the contribution of project interventions to the reduction in infant and under-five child morbidity, reduction in maternal morbidity as well as mortality within the project areas.