Retrospective evaluation of the effectiveness of indoor residual spray with pirimiphos‐methyl (Actellic) on malaria transmission in Zambia

Abstract Background Widespread insecticide resistance to pyrethroids could thwart progress towards elimination. Recently, the World Health Organization has encouraged the use of non-pyrethroid insecticides to reduce the spread of insecticide resistance. An electronic tool for implementing and tracking coverage of IRS campaigns has recently been tested (mSpray), using satellite imagery to improve the accuracy and efficiency of the enumeration process. The purpose of this paper is to retrospectively analyse cross-sectional observational data to provide evidence of the epidemiological effectiveness of having introduced Actellic 300CS and the mSpray platform into IRS programmes across Zambia. Methods Health facility catchment areas in 40 high burden districts in 5 selected provinces were initially targeted for spraying. The mSpray platform was used in 7 districts in Luapula Province. An observational study design was used to assess the relationship between IRS exposure and confirmed malaria case incidence. A random effects Poisson model was used to quantify the effect of IRS (with and without use of the mSpray platform) on confirmed malaria case incidence over the period 2013–2017; analysis was restricted to the 4 provinces where IRS was conducted in each year 2014–2016. Results IRS was conducted in 283 health facility catchment areas from 2014 to 2016; 198 health facilities from the same provinces, that received no IRS during this period, served as a comparison. IRS appears to be associated with reduced confirmed malaria incidence; the incidence rate ratio (IRR) was lower in areas with IRS but without mSpray, compared to areas with no IRS (IRR = 0.91, 95% CI 0.84–0.98). Receiving IRS with mSpray significantly lowered confirmed case incidence (IRR = 0.75, 95% CI 0.66–0.86) compared to no IRS. IRS with mSpray resulted in lower incidence compared to IRS without mSpray (IRR = 0.83, 95% CI 0.72–0.95). Conclusions IRS using Actellic-CS appears to substantially reduce malaria incidence in Zambia. The use of the mSpray tool appears to improve the effectiveness of the IRS programme, possibly through improved population level coverage. The results of this study lend credence to the anecdotal evidence of the effectiveness of 3GIRS using Actellic, and the importance of exploring new platforms for improving effective population coverage of areas targeted for spraying.

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Insecticide resistance in Anopheles stephensi in Somali Region, eastern Ethiopia

10.21203/rs.2.18020/v3 ◽

2020 ◽

Author(s):

Solomon Yared ◽

Araya Gebressielasie ◽

Lambodhar Damodaran ◽

Victoria Bonnell ◽

Karen Lopez ◽

...

Keyword(s):

Insecticide Resistance ◽

Anopheles Stephensi ◽

Mortality Rates ◽

Resistance Mechanisms ◽

World Health ◽

Malaria Vectors ◽

Resistance Locus ◽

Eastern Ethiopia ◽

Pyrethroid Insecticides ◽

Pirimiphos Methyl

Abstract Background The movement of malaria vectors into new areas is a growing concern in the efforts to control malaria. The recent report of Anopheles stephensi in eastern Ethiopia has raised the necessity to understand the insecticide resistance status of the vector in the region to better inform vector-based interventions. The aim of this study was to evaluate insecticide resistance in An. stephensi in eastern Ethiopia using two approaches: 1) World Health Organization (WHO) bioassay tests in An. stephensi; and 2) genetic analysis of insecticide resistance genes in An. stephensi in eastern Ethiopia. Methods Mosquito larvae and pupae were collected from Kebri Dehar. Insecticide susceptibility of An. stephensi was tested withmalathion 5%, bendiocarb 0.1%, propoxur 0.1%, deltamethrin 0.05%, permethrin 0.75%, Pirimiphos-methyl 0.25% and DDT 4%, according to WHO standard protocols. In this study, the knockdown resistance locus (kdr) in the voltage gated sodium channel (vgsc) and ace1R locus in the acetylcholinesterase gene (ace-1) were analysed in An. stephensi. Results All An. stephensi samples were resistant to carbamates, with mortality rates of 23% and 21% for bendiocarb and propoxur, respectively. Adult An. stephensi was also resistant to pyrethroid insecticides with mortality rates 67% for deltamethrin and 53% for permethrin. Resistance to DDT and malathion was detected in An. stephensi with mortality rates of 32% as well as An. stephensi was resistance to pirimiphos-methyl with mortality rates 14%. Analysis of the insecticide resistance loci revealed the absence of kdr L1014F and L1014S mutations and the ace1R G119S mutation. Conclusion Overall, these findings support that An. stephensi is resistant to several classes of insecticides, most notably pyrethroids. However, the absence of the kdr L1014 gene may suggest non-target site resistance mechanisms. Continuous insecticide resistance monitoring should be carried out in the region to confirm the documented resistance and exploring mechanisms conferring resistance in An. stephensi in Ethiopia.

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Insecticide Resistance in Anopheles stephensi in Somali Region, Eastern Ethiopia

10.21203/rs.2.18020/v2 ◽

2020 ◽

Cited By ~ 1

Author(s):

Solomon Yared ◽

Araya Gebressielasie ◽

Lambodhar Damodaran ◽

Victoria Bonnell ◽

Karen Lopez ◽

...

Keyword(s):

Insecticide Resistance ◽

Anopheles Stephensi ◽

Mortality Rates ◽

Resistance Mechanisms ◽

World Health ◽

Malaria Vectors ◽

Eastern Ethiopia ◽

Pyrethroid Insecticides ◽

Pirimiphos Methyl ◽

Health Organization

Abstract Background: The movement of malaria vectors into new areas is a growing concern in the efforts to control malaria. The recent report of Anopheles stephensi in eastern Ethiopia has raised the necessity to understand the insecticide resistance status of the vector in the region to better inform vector-based interventions. The aim of this study was to evaluate insecticide resistance in An. stephensi in eastern Ethiopia using two approaches: 1) World Health Organization (WHO) bioassay tests in An. stephensi and 2) genetic analysis of insecticide resistance genes in An. stephensi in eastern Ethiopia. Methods: Mosquito larvae and pupae were collected from Kebridehar. Insecticide susceptibility of An. stephensi was tested with malathion 5%, bendiocarb 0.1%, propoxur 0.1%, deltamethrin 0.05%, permethrin 0.75%, Pirimiphos-methyl 0.25% and DDT 4%, according to WHO standard protocols. Results: All An. stephensi samples were resistant to carbamates, with mortality rates 23% and 21% for bendiocarb and propoxur, respectively. Adult An. stephensi was also resistant to pyrethroid insecticides with mortality rates 67% for deltamethrin and 53% for permethrin. Resistance to DDT and malathion was detected in An. stephensi with mortality rates of 32% as well as An. stephensi was resistance to pirimiphos-methyl with mortality rates 14%. Analysis of the voltage gate sodium channel gene (vgsc) revealed the absence of kdr L1014 mutations. Conclusion: Overall, these findings support that An. stephensi is resistant to several classes of insecticides, most notably pyrethroids. However, the absence of the kdr L1014 gene may suggest non-target site resistance mechanisms. Continuous insecticide resistance monitoring should be carried out in the region to confirm the documented resistance and exploring mechanisms conferring resistance in An. stephensi in Ethiopia.

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Improving Implementation of 10 STSB (Steps to Successful Breastfeeding) through BENEFIT (Breastfeeding Exclusively in Health Facility) Intervention in East Java, Indonesia

Amerta Nutrition ◽

10.20473/amnt.v5i2sp.2021.10-18 ◽

2021 ◽

Vol 5 (2SP) ◽

pp. 10

Author(s):

Mellysa Kowara

Keyword(s):

Health Facility ◽

Exclusive Breastfeeding ◽

Post Partum ◽

Phase 1 ◽

World Health ◽

Breastfeeding Support ◽

Cross Sectional ◽

Skin Contact ◽

Management Procedures ◽

Critical Management

ABSTRAKLatar Belakang: Peningkatan cakupan ASI eksklusif dapat dilakukan dengan menerapkan 10 LMKM di fasilitas kesehatan. Berdasarkan hasil penilaian program 10 LMKM tahap 1 menunjukkan perlunya penguatan 10 LMKM terutama langkah 1 dan 2 sebagai prosedur pengelolaan kritis (Critical Management Procedural). Untuk menindaklanjuti temuan tersebut maka dijalankan Project BENEFIT untuk meningkatkan penerapan dari langkah-langkah tersebut. Proyek tersebut dilaksanakan pada tahun 2019 hingga 2020 di 5 kabupaten/kota di Jawa Timur yaitu Bondowoso, Jember, Probolinggo, Trenggalek dan Surabaya.Tujuan: Penelitian ini bertujuan untuk mengevaluasi implementasi penguatan 10 LMKM yang dilakukan melalui proyek BENEFITyang berfokus pada penguatan langkah 1 dan 2 di fasilitas kesehatan di Provinsi Jawa Timur dan bagaimana pengaruhnya terhadap penerapan langkah lainnya serta pencapaian dalam indikator menyusui. Metode: Studi crossectional dilakukan pada 720 responden yang terdiri dari 143 pimpinan fasilitas kesehatan dan 577 ibu nifas (untuk validasi data). Pengumpulan data dilakukan dengan menggunakan kuesioner yang diadaptasi dari BFHI Unicef/WHO yang mengevaluasi penerapan keseluruhan langkah dalam 10 LMKM menggunakan aplikasi KoBo ToolBox pada periode Juli-September 2020. Hasil: Terdapat peningkatan dalam penerapan 10 LMKM terutama langkah 1 dan 2. Langkah 1 yaitu tersedianya kebijakan tertulis pemberian ASI eksklusif menunjukkan peningkatan kepatuhan yang signifikan (66,4 menjadi 72,82; α= 0,015). Sedangkan untuk tahap 2 (pelatihan dukungan menyusui bagi petugas kesehatan dan non-kesehatan) menunjukkan peningkatan yang signifikan dalam pelaksanaannya (69,5 menjadi 77; α = 0,015). Prosedur manajemen kritis berperan sebagai landasan yang mempengaruhi praktik dukungan menyusui di fasilitas kesehatan. Berdasarkan hasil monitoring dan evaluasi menunjukkan adanya perbaikan pada praktik dukungan menyusui selama perawatan ibu di fasilitas kesehatan seperti cakupan IMD (71,2%) baik pada persalinan normal maupun seksio sesarea, rawat gabung (69,1%) dan praktik menyusui bayi baru lahir. (73,5%). Kesimpulan: Intervensi BENEFIT yang berfokus pada penguatan langkah 1 dan 2 dalam 10 LMKM sebagai prosedur manajemen kritis mampu meningkatkan kepatuhan implementasi keseluruhan langkah 10 LMKM. Sebagai landasan untuk melaksanakan langkah-langkah lainnya, penguatan 10 LMKM terutama langkah 1 dan 2 terbukti dapat meningkatkan praktik dukungan menyusui di fasilitas kesehatan oleh seluruh staf.Kata Kunci: Menyusui, 10 LMKM, BENEFIT ABSTRACTBackground: 10 Steps to Successful Breastfeeding (STSB) was implemented as an attempt to improve the coverage of exclusive breastfeeding in healthcare facilities. Results of the phase 1 Baby-Friendly Hospital Initiative (BFHI) assessment necessitated further strengthening for steps 1 which is the availability of an exclusive breastfeeding policy and step 2 which entails training provision for maternal and child health officer. These two steps are regarded as critical management procedures which act as a foundation for the implementation of subsequent steps. To follow up on these findings, Project BENEFIT was implemented to improve steps 1 and 2. The project was carried out between 2019 and 2020 in 5 districts in East Java, namely Bondowoso, Jember, Probolinggo, Trenggalek and Surabaya. Objectives: This objective of this study is to evaluate the implementation of the BENEFIT project and how it affects the implementation of other steps as well as how it impacts breastfeeding indicators.Methods: This cross-sectional study was conducted on 720 respondents consisting of 143 health facility leaders and 577 post-partum mothers to validate response. Data was collected using a questionnaire adapted from Baby Friendly Hospital Initiation (BFHI) guidelines by World Health organization (WHO) and United Nations Children Emergency Fund (UNICEF) using the KoBo ToolBox application between July and October 2020. Results: There was an improvement in the implementation of steps 1 and 2. A significant increase in compliance was found for Step 1 (66.4 to 72.82 α = 0.015) and step 2 (69.5 to 77.9, α = 0.15). Subsequent monitoring and evaluation also showed moderate improvement on breastfeeding support practice in health facilities such as coverage of skin-to-skin contact (71.2%) both on normal and section-caesarean delivery, rooming-in (69.1%) and the practice of breastfeeding newborn (73.5 %). Conclusion: The BENEFIT project assisted in the increased compliance for steps 1 and 2 STSB, which further improved breastfeeding support practices by all healthcare facility staff members for other steps. Keywords: Breastfeeding, 10 STSB, BENEFIT

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Insecticide resistance in dengue vectors from hotspots in Selangor, Malaysia

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009205 ◽

2021 ◽

Vol 15 (3) ◽

pp. e0009205

Author(s):

Rosilawati Rasli ◽

Yoon Ling Cheong ◽

M. Khairuddin Che Ibrahim ◽

Siti Futri Farahininajua Fikri ◽

Rusydi Najmuddin Norzali ◽

...

Keyword(s):

Aedes Aegypti ◽

Insecticide Resistance ◽

Vector Control ◽

Aedes Albopictus ◽

World Health ◽

Dengue Vector ◽

Organophosphate Insecticide ◽

Potential Threat ◽

Pyrethroid Insecticides ◽

Dengue Vector Control

Background In Malaysia, dengue remains a top priority disease and usage of insecticides is the main method for dengue vector control. Limited baseline insecticide resistance data in dengue hotspots has prompted us to conduct this study. The present study reports the use of a map on the insecticide susceptibility status of Aedes aegypti and Aedes albopictus to provide a quick visualization and overview of the distribution of insecticide resistance. Method and results The insecticide resistance status of Aedes populations collected from 24 dengue hotspot areas from the period of December 2018 until June 2019 was proactively monitored using the World Health Organization standard protocol for adult and larval susceptibility testing was conducted, together with elucidation of the mechanisms involved in observed resistance. For resistance monitoring, susceptibility to three adulticides (permethrin, deltamethrin, and malathion) was tested, as well as susceptibility to the larvicide, temephos. Data showed significant resistance to both deltamethrin and permethrin (pyrethroid insecticides), and to malathion (organophosphate insecticide) in all sampled Aedes aegypti populations, while variable resistance patterns were found in the sampled Aedes albopictus populations. Temephos resistance was observed when larvae were tested using the diagnostic dosage of 0.012mg/L but not at the operational dosage of 1mg/L for both species. Conclusion The present study highlights evidence of a potential threat to the effectiveness of insecticides currently used in dengue vector control, and the urgent requirement for insecticide resistance management to be integrated into the National Dengue Control Program.

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Selective sweep suggests transcriptional regulation may underlie Plasmodium vivax resilience to malaria control measures in Cambodia

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1608828113 ◽

2016 ◽

Vol 113 (50) ◽

pp. E8096-E8105 ◽

Cited By ~ 24

Author(s):

Christian M. Parobek ◽

Jessica T. Lin ◽

David L. Saunders ◽

Eric J. Barnett ◽

Chanthap Lon ◽

...

Keyword(s):

Plasmodium Vivax ◽

Malaria Control ◽

Histone Deacetylases ◽

Transcriptional Control ◽

Selective Sweep ◽

Malaria Incidence ◽

Population Level ◽

Control Measures ◽

Effective Population ◽

Species Specific

Cambodia, in which both Plasmodium vivax and Plasmodium falciparum are endemic, has been the focus of numerous malaria-control interventions, resulting in a marked decline in overall malaria incidence. Despite this decline, the number of P. vivax cases has actually increased. To understand better the factors underlying this resilience, we compared the genetic responses of the two species to recent selective pressures. We sequenced and studied the genomes of 70 P. vivax and 80 P. falciparum isolates collected between 2009 and 2013. We found that although P. falciparum has undergone population fracturing, the coendemic P. vivax population has grown undisrupted, resulting in a larger effective population size, no discernable population structure, and frequent multiclonal infections. Signatures of selection suggest recent, species-specific evolutionary differences. Particularly, in contrast to P. falciparum, P. vivax transcription factors, chromatin modifiers, and histone deacetylases have undergone strong directional selection, including a particularly strong selective sweep at an AP2 transcription factor. Together, our findings point to different population-level adaptive mechanisms used by P. vivax and P. falciparum parasites. Although population substructuring in P. falciparum has resulted in clonal outgrowths of resistant parasites, P. vivax may use a nuanced transcriptional regulatory approach to population maintenance, enabling it to preserve a larger, more diverse population better suited to facing selective threats. We conclude that transcriptional control may underlie P. vivax’s resilience to malaria control measures. Novel strategies to target such processes are likely required to eradicate P. vivax and achieve malaria elimination.

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Preference of place of delivery and its determinants: a cross-sectional study in Chukha district, Bhutan

Bhutan Health Journal ◽

10.47811/bhj.05 ◽

2015 ◽

Vol 1 (1) ◽

pp. 23-29

Author(s):

Kencho Wangdi ◽

Mongal S. Gurung ◽

Dorji Pelzom ◽

Tashi Dema ◽

Sonam Wangdi

Keyword(s):

Maternal Mortality ◽

Health Facility ◽

Rural Areas ◽

Maternal Mortality Ratio ◽

Cross Sectional Study ◽

World Health ◽

Sectional Study ◽

Cross Sectional ◽

Mortality Ratio ◽

At Home

Introduction: The estimated global maternal deaths in 2013 was 289000. In Bhutan, Maternal Mortality Ratio has remarkably declined from 770 deaths per 100,000 live births in 1984 to 86 in 2012. However, the maternal mortality ratio still remains high and a high proportion of delivery still take place at homes (26%) despite of adopting 100%institutional delivery policy ever since 2005. This study was carried out to determine the important factors that prevent women from coming to the health facilities for safe delivery. Methods: A cross-sectional study among the women who delivered in Chukha District in 2013 was carried out after seeking ethical approval from Research Ethics Board of Health and World Health Organization. Chukha is a district with the second highest number of population in Bhutan where 55.7% of the people live in rural villages. Results: Out of 899 eligible listed women, 78.1% participated in the study and among the participants 11.5% had delivered at home. The number of home deliveries was higher in rural areas, 17.3%, as compared to urban places, 6.4%. Women who were delivering for third or more times are 2.42 times more likely to give birth at home compared to women who were delivering for the first time. Women residing at places more than three hours away from the health facility were 2.58 times more likely to give birth at home compared to women residing less than three hours away. During their last pregnancy, 99.4% of the participants have sought at least one ANC. Conclusions: This study suggests that the two most important factors associated with home delivery are the distance to health facility from their residences and the parity.

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Estimating malaria incidence from routine health facility-based surveillance data in Uganda

Malaria Journal ◽

10.1186/s12936-020-03514-z ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Adrienne Epstein ◽

Jane Frances Namuganga ◽

Emmanuel Victor Kamya ◽

Joaniter I. Nankabirwa ◽

Samir Bhatt ◽

...

Keyword(s):

Travel Time ◽

Health Facility ◽

Health Management ◽

Malaria Incidence ◽

Additive Models ◽

Surveillance Data ◽

Health Management Information System ◽

Care Seeking ◽

Catchment Areas ◽

Over Time

Abstract Background Accurate measures of malaria incidence are essential to track progress and target high-risk populations. While health management information system (HMIS) data provide counts of malaria cases, quantifying the denominator for incidence using these data is challenging because catchment areas and care-seeking behaviours are not well defined. This study’s aim was to estimate malaria incidence using HMIS data by adjusting the population denominator accounting for travel time to the health facility. Methods Outpatient data from two public health facilities in Uganda (Kihihi and Nagongera) over a 3-year period (2011–2014) were used to model the relationship between travel time from patient village of residence (available for each individual) to the facility and the relative probability of attendance using Poisson generalized additive models. Outputs from the model were used to generate a weighted population denominator for each health facility and estimate malaria incidence. Among children aged 6 months to 11 years, monthly HMIS-derived incidence estimates, with and without population denominators weighted by probability of attendance, were compared with gold standard measures of malaria incidence measured in prospective cohorts. Results A total of 48,898 outpatient visits were recorded across the two sites over the study period. HMIS incidence correlated with cohort incidence over time at both study sites (correlation in Kihihi = 0.64, p < 0.001; correlation in Nagongera = 0.34, p = 0.045). HMIS incidence measures with denominators unweighted by probability of attendance underestimated cohort incidence aggregated over the 3 years in Kihihi (0.5 cases per person-year (PPY) vs 1.7 cases PPY) and Nagongera (0.3 cases PPY vs 3.0 cases PPY). HMIS incidence measures with denominators weighted by probability of attendance were closer to cohort incidence, but remained underestimates (1.1 cases PPY in Kihihi and 1.4 cases PPY in Nagongera). Conclusions Although malaria incidence measured using HMIS underestimated incidence measured in cohorts, even when adjusting for probability of attendance, HMIS surveillance data are a promising and scalable source for tracking relative changes in malaria incidence over time, particularly when the population denominator can be estimated by incorporating information on village of residence.

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Evaluation of malaria microscopy diagnostic performance at private health facilities in Tanzania

Malaria Journal ◽

10.1186/s12936-019-2998-1 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 4

Author(s):

Billy Ngasala ◽

Samweli Bushukatale

Keyword(s):

Health Facility ◽

Malaria Parasite ◽

Health Facilities ◽

World Health ◽

Substantial Agreement ◽

Kappa Score ◽

Cross Sectional ◽

Parasite Detection ◽

Malaria Microscopy

Abstract Background The World Health Organization (WHO) recommends use of parasitological diagnosis of malaria for all age groups in all malaria transmission settings. Many private health facilities rely on malaria microscopy for malaria diagnosis. However, quality of malaria microscopy is affected by number of factors including availability of skilled laboratory microscopists and lack of quality assurance systems in many malaria endemic countries. This study was carried out to assess quality of malaria microscopy in selected private health facilities in Tanzania. Methods A cross sectional study was conducted from August to September, 2017. A total of 40 private health laboratories in five regions were invited to participate in the study. Data were collected by distributing standardized pre-validated malaria slide-panels to each health facility. Sensitivity, specificity, and strength of agreement (with kappa score) were calculated to assess performance in detecting and quantification of Plasmodium species. Results Among the 40 health facilities, 31 (77.5%) returned their results to the reference centre (Muhimbili University of Health and Allied Sciences). Overall, the measures of malaria diagnostic accuracy were high, i.e. the sensitivity and specificity of malaria parasite detection by microscopy in the health facilities were 84.3% (95% CI 77–90) and 90.8% (95% CI 83.3–95.7), respectively. There was substantial agreement in parasite detection with (Kappa value: 0.74 (95% 0.65–0.83). However, only 17.8% (24 of 134) of blood slides were interpreted correctly at the health facilities in terms of parasite density counts. Conclusion Although there was substantial agreement between the private health microscopists and experienced microscopists in malaria parasite detection, there was poor performance in parasite counts. This calls for regular in-service training and external quality assessments at private health facilities to enhance the skills of private health facility microscopists in malaria microscopy.

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Estimating the incidence of typhoidal Salmonella from cross-sectional serology using antibody dynamics following infection

10.1101/2021.10.20.21265277 ◽

2021 ◽

Author(s):

Kristen Aiemjoy ◽

Jessica C Seidman ◽

Senjuti Saha ◽

Sira Jam Munira ◽

Mohammad Saiful Islam Sajib ◽

...

Keyword(s):

Blood Culture ◽

Enteric Fever ◽

Rank Order ◽

Population Level ◽

Incidence Rates ◽

Clinical Severity ◽

Igg Antibody ◽

Two Phase ◽

Cross Sectional ◽

Catchment Areas

The incidence of enteric fever, an invasive bacterial infection caused by typhoidal Salmonellae, is largely unknown in regions lacking blood culture surveillance. New serologic markers have proven accurate in diagnosing enteric fever, but whether they could be used to reliably estimate population-level incidence is unknown. We collected longitudinal blood samples from blood culture-confirmed enteric fever cases enrolled from surveillance studies in Bangladesh, Nepal, Pakistan and Ghana and conducted cross-sectional sero-surveys in the catchment areas of each surveillance site. We used ELISAs to measure quantitative IgA and IgG antibody responses to Hemolysin E (HlyE) and S. Typhi lipopolysaccharide (LPS). We used Bayesian hierarchical models to fit two-phase power-function decay models to the longitudinal sero-responses among enteric fever cases and used the joint distributions of the peak antibody titers and decay rate to estimate population-level incidence rates from cross-sectional serosurveys. The longitudinal antibody kinetics for all antigen-isotypes were similar across countries and did not vary by clinical severity. The incidence of typhoidal Salmonella infection ranged between 41.2 per 100 person years (95% CI: 34.0-50.1) in Dhaka, Bangladesh to 5.8 (95% CI: 4.8-7.1) in Kavrepalanchok, Nepal and followed the same rank order as clinical incidence estimates. The approach described here has the potential to expand the geographic scope of typhoidal Salmonella surveillance and generate incidence estimates that are comparable across geographic regions and time.

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Factors associated with health facility deliveries among mothers living in hospital catchment areas in Rukungiri and Kanungu districts, Uganda

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03789-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Richard K. Mugambe ◽

Habib Yakubu ◽

Solomon T. Wafula ◽

Tonny Ssekamatte ◽

Simon Kasasa ◽

...

Keyword(s):

Health Facility ◽

Rural Areas ◽

Health Workers ◽

Facility Delivery ◽

Health Facilities ◽

Public Facility ◽

Health Facility Delivery ◽

Cross Sectional ◽

Factors Associated ◽

Catchment Areas

Abstract Background Health facility deliveries are generally associated with improved maternal and child health outcomes. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we assessed the factors associated with health facility deliveries among mothers living within the catchment areas of major health facilities in Rukungiri and Kanungu districts, Uganda. Methods Cross-sectional data were collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data were collected on the place of delivery for the most recent child, mothers’ sociodemographic and economic characteristics, and health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of health facility deliveries as well as factors associated with private versus public utilization of health facilities for childbirth. Results The majority of mothers (90.2%, 806/894) delivered in health facilities. Non-facility deliveries were attributed to faster progression of labour (77.3%, 68/88), lack of transport (31.8%, 28/88), and high cost of hospital delivery (12.5%, 11/88). Being a business-woman [APR = 1.06, 95% CI (1.01–1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02–1.17)] favoured facility delivery while a higher parity of 3–4 [APR = 0.93, 95% CI (0.88–0.99)] was inversely associated with health facility delivery as compared to parity of 1–2. Factors associated with delivery in a private facility compared to a public facility included availability of highly skilled health workers [APR = 1.15, 95% CI (1.05–1.26)], perceived higher quality of WASH services [APR = 1.11, 95% CI (1.04–1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78–0.92)], and availability of caesarean services [APR = 1.13, 95% CI (1.08–1.19)]. Conclusion Health facility delivery service utilization was high, and associated with engaging in business, belonging to wealthiest quintile and having higher parity. Factors associated with delivery in private facilities included health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

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