Household Predictors of Malaria Episode in Northern Uganda: Its Implication for Future Malaria Control

Abstract Background: Uses of indoor residual spraying (IRS), long-lasting insecticidal nets (LLINS) and treatment with artemisinin-based combination therapy (ACT) are greatly promoted in northern part of Uganda as mitigating strategies for malaria episodes. Unfortunately, the region still records the highest malaria prevalence of 63%. This study assesses household predicators of malaria in the region and their impact on malaria episodes at the household levels.Methods: A cross-sectional study was conducted in four districts of Gulu, Oyam, Kitgum and Agago covering sixteen villages in northern Uganda. In total, 193 households were surveyed. Data was collected through pre-tested structured questionnaire and systematically coded for analysis using R software.Results:Women headed 58% of the 193 households surveyed. Six hundred and five (605) individuals were declared to have spent the previous night in these households. On average, there were two bed nets per household and 502 (86%) spent the night prior to interview under a bed net. Overall, malaria episodes were strongly related to lack of bed nets or lack of use thereof, and directly linked to the number of individuals in a household. Children were prone to malaria more than adults by a ratio of 2:1. When given a choice between insecticides (IRS) and treated bed nets, 1 in 3 households preferred treated bed nets. At the same time, data suggests that bed nets were perceived unnecessary once IRS was applied. If true, the driving force to spraying insecticides indoor then becomes lack of a bed net. Conclusions:Household predicators of incidence of malaria in northern Uganda includes bed nets, use of treated bed nets, and indoor residual spraying with households not practicing any of these bearing the heaviest burden of malaria. Hierarchical clustering on principal components (HCPC) clusters households into four types in northern Uganda, 1) household that use bed nets and sleep in houses sprayed with insecticides; 2) households that use bed nets but no indoor residual spraying with insecticides; 3) households that have no bed nets and no indoor residual spraying; and 4) test bed nets before use. Malaria incidence was higher in children as compared to the adults.

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Household Predictors of Incidence of Malaria in Northern Uganda: Its Implication for Future Malaria Control

10.21203/rs.3.rs-74137/v1 ◽

2020 ◽

Author(s):

Richard Echodu ◽

William Sam Oyet ◽

Tereza Iwiru ◽

Felister Apili ◽

Julius Julian Lutwama ◽

...

Keyword(s):

Local Community ◽

Malaria Incidence ◽

Indoor Residual Spraying ◽

Community Setting ◽

Cross Sectional Study ◽

Bed Nets ◽

Northern Uganda ◽

Bed Net ◽

Test Bed ◽

Cross Sectional

Abstract Background: Use of indoor residual spraying (IRS), long-lasting insecticidal nets (LLINS) and treatment with artemisinin-based combination therapy (ACT) have been greatly promoted in northern Uganda but the region still records highest number of malaria cases with prevalence up to 63%. This study assesses household predicators of malaria in the region and its impact on incidence of malaria at household levels.Methods: A cross-sectional study was conducted in four districts of Gulu, Oyam, Kitgum and Agago covering sixteen known hyper-endemics villages with high malaria burden in northern Uganda. In total, 193 households were surveyed. Data was collected through pre-tested structured questionnaires and systematically coded and analyzed using R software.Results:Women headed 58% of the 193 households surveyed. Six hundred and five (605) individuals were declared to have spent a night in the 193 households surveyed. Nighttime is when mosquitoes mostly gain access to victims in the study area. On average, there were two bed nets per household and out of the 605 individuals declared, 502 502 (86%) spent the night prior to interview under a bed net. Despite this effort, these households still reported malaria incidences in the last three months. Overall, children were prone to malaria more than adults by a ratio of 3:2, and in general, malaria incidences were strongly related to lack of bed nets or use thereof, and also linked directly to the number of individuals in a house. Households without bed nets controlled malaria by means of IRS in combination with closing doors (with the hope of keeping mosquitos at bay), draining stagnant water pool where mosquitos lay their eggs, trimming mosquito covers (grass) around homestead and/or receiving treatment after malaria incidences. When given a choice between insecticides (IRS) and treated bed nets, 1 in 3 households preferred treated bed nets. At the same time, bed nets were perceived unnecessary once IRS was applied. If true, the driving force to spraying insecticides indoor then becomes lack of a bed net. Conclusions:Household predicators of incidence of malaria in northern Uganda includes bed nets, use of treated bed nets, and indoor residual spraying with households not practicing any of these bearing the heaviest burden of malaria. Hierarchical clustering on principal components (HCPC) clusters households into four types in northern Uganda, 1) household that use bed nets and sleep in houses sprayed with insecticides; 2) households that use bed nets but no indoor residual spraying with insecticides; 3) households that have no bed nets and no indoor residual spraying; and 4) test bed nets before use. An opportunity therefore arises for tailoring malaria messages to fit each cluster of households given that clustering here appears not to be random. Malaria incidence was higher in children as compared to the adults that necessities having guidelines for management of interventions in local community setting.

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Analysis of Immunity to Febrile Malaria in Children That Distinguishes Immunity from Lack of Exposure

Infection and Immunity ◽

10.1128/iai.01358-08 ◽

2009 ◽

Vol 77 (5) ◽

pp. 1917-1923 ◽

Cited By ~ 76

Author(s):

Philip Bejon ◽

George Warimwe ◽

Claire L. Mackintosh ◽

Margaret J. Mackinnon ◽

Sam M. Kinyanjui ◽

...

Keyword(s):

Cell Surface ◽

Antibody Response ◽

Observational Studies ◽

Asymptomatic Infection ◽

Bed Nets ◽

Bed Net ◽

Red Cell ◽

Vaccine Trials ◽

Net Use ◽

Malaria Episodes

ABSTRACT In studies of immunity to malaria, the absence of febrile malaria is commonly considered evidence of “protection.” However, apparent “protection” may be due to a lack of exposure to infective mosquito bites or due to immunity. We studied a cohort that was given curative antimalarials before monitoring began and documented newly acquired asymptomatic parasitemia and febrile malaria episodes during 3 months of surveillance. With increasing age, there was a shift away from febrile malaria to acquiring asymptomatic parasitemia, with no change in the overall incidence of infection. Antibodies to the infected red cell surface were associated with acquiring asymptomatic infection rather than febrile malaria or remaining uninfected. Bed net use was associated with remaining uninfected rather than acquiring asymptomatic infection or febrile malaria. These observations suggest that most uninfected children were unexposed rather than “immune.” Had they been immune, we would have expected the proportion of uninfected children to rise with age and that the uninfected children would have been distinguished from children with febrile malaria by the protective antibody response. We show that removing the less exposed children from conventional analyses clarifies the effects of immunity, transmission intensity, bed nets, and age. Observational studies and vaccine trials will have increased power if they differentiate between unexposed and immune children.

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Community Knowledge, Perceptions, And Practices Regarding Malaria and Its Control In Jabi Tehnan District, Amhara Region, Northwest Ethiopia

10.21203/rs.3.rs-489446/v1 ◽

2021 ◽

Author(s):

Abebe Asale ◽

Zewdu Abro ◽

Bayu Enchalew ◽

Alayu Tesager ◽

Aklilu Belay ◽

...

Keyword(s):

Vector Control ◽

Malaria Control ◽

Community Education ◽

Indoor Residual Spraying ◽

Community Empowerment ◽

Malaria Episode ◽

Malaria Vectors ◽

Bed Nets ◽

Health Seeking ◽

Malaria Parasites

Abstract Background: Key program components of malaria control in Ethiopia include community empowerment and mobilization, vector control using long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS), prompt diagnosis and treatment, and disease surveillance. However, the effectiveness of these interventions is often undermined by various challenges, including insecticide and drug resistance, the plasticity of malaria vectors feeding and biting behavior, and certain household factors that lead to misuse and poor utilization of LLINs. The primary objective of this study was to document households’ perceptions towards malaria and assess the prevalence of the disease and the constraints related to the ongoing interventions in Ethiopia (LLINs, IRS, community mobilization house screening). Method: The study was conducted in Jabi Tehnan district, Northwestern Ethiopi,a from November 2019 to March 2020. A total of 3,010 households distributed over 38 kebeles (villages) were randomly selected for socio-economic and demographic survey. Focus group discussions (FGDs) were conducted in 11 different health clusters taking into account agro-ecological differences. A total of 1,256 children under 10 years of age were screened for malaria parasites using microscopy in order to determine malaria prevalence. Furthermore, five-year malaria trend analysis was undertaken based on data obtained from the district health office to understand the disease dynamics.Result: Malaria knowledge in the area was high as all FGD participants correctly identified mosquito bites during the night as sources of malaria transmission. Delayed health seeking behavior remains a key behavioral challenge in malaria control as it took patients on average 4 days before reporting the case at the nearby health facility. On average households lost 2.53 working days per person-per malaria episode and theey spent US$ 18 per person perepisode. Out of the 1,256 randomly selected under 10 children tested for malaria parasites, 11 (0.89%) were found to be positive. Malaria disproportionately affected the adult segment of the population more, 50% of the total cases reported from households whose age was 15 and beyond. The second most affected group was the age group between 5 and 14 years followed by children under 10, with 31% and 14% burden,respectively.Conclusion: Despite the achievement of universal coverage in terms of LLINs access, utilization of vector control interventions in the area remained low.Using bed nets for unintended purposes remained a major challenge. Therefore, continued community education and communication work should be prioritised in the study area to bring about the desired behavioral changes.

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Effect of bed net colour and shape preferences on bed net usage: a secondary data analysis of the 2017 Malawi Malaria Indicator Survey

Malaria Journal ◽

10.1186/s12936-020-03499-9 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Donnie Mategula ◽

Latif Ndeketa ◽

Judy Gichuki ◽

Boston Zimba ◽

Wilson Ching’ani ◽

...

Keyword(s):

Universal Access ◽

Secondary Analysis ◽

Secondary Data ◽

Paediatric Population ◽

User Preferences ◽

Outcome Variable ◽

Bed Nets ◽

Bed Net ◽

Previous Night ◽

Malaria Indicator Survey

Abstract Background Malaria remains a significant cause of morbidity and mortality in the paediatric population in Malawi. Insecticide-treated bed nets are a key vector malaria control intervention, however, advancement towards universal access is progressing slowly. Malawi Malaria indicator surveys (MMIS) show diverse user preferences of bed net shape and colour. The objective of this work was to understand if bed net shape and colour preferences affect usage. Methods This is a secondary analysis of data from households that participated in the 2016–2017 MMIS. The main outcome variable was net usage defined, at net level, whether someone slept under a particular net on the night before the survey. The main exposure variables were preference attributes, whether a particular net is of a preferred colour or shape as defined by the household respondent. Both bivariate and multivariate logistic regression analyses were done to determine the association between the exposure and outcome variables. Results A total of 3729 households with 16,755 individuals were included in this analysis. There were a total 7710 bed nets in households that participated in the survey of which 5435 (70.5%) of these nets had someone sleep under them the previous night before the survey. Bed nets that are of a preferred shape have 3.55 times higher odds of being used than those not preferred [AOR 3.55 (95% CI 2.98, 4.23; p value < 0.001)]. Bed nets that are of a preferred colour have 1.61 times higher odds of being used than those that are not of a preferred colour [AOR 1.61 (95% CI 1.41, 1.84; p value < 0.001]. Conclusions The results indicate that if a bed net is of a preferred colour or shape, it is more likely to be used. Bed net purchase by malaria stakeholders need to balance more factors on top of preferences such as price and efficacy.

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Knowledge, Attitudes, and Practices about Malaria and Its Control in Rural Northwest Tanzania

Malaria Research and Treatment ◽

10.4061/2010/794261 ◽

2010 ◽

Vol 2010 ◽

pp. 1-9 ◽

Cited By ~ 23

Author(s):

Humphrey D. Mazigo ◽

Emmanuel Obasy ◽

Wilhellmus Mauka ◽

Paulina Manyiri ◽

Maria Zinga ◽

...

Keyword(s):

Indoor Residual Spraying ◽

Education Level ◽

Bed Nets ◽

Bed Net ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Attitudes And Practices ◽

Significant Difference ◽

Household Heads ◽

Knowledge Attitudes And Practices

Background. We assessed community knowledge, attitudes, and practices on malaria as well as acceptability to indoor residual spraying. Material and Methods. A cross-sectional survey was done in a community in Geita district (northwest Tanzania). Household heads (n=366) were interviewed Results. Knowledge on malaria transmission, prevention, and treatment was reasonable; 56% of respondents associated the disease with mosquito bites, with a significant difference between education level and knowledge on transmission (P<.001). Knowledge of mosquito breeding areas was also associated with education (illiterate: 22%; literate: 59% (P<.001). Bed nets were used by 236 (64.5%), and usage was significantly associated with education level (P<.01). The level of bed net ownership was 77.3%. Most respondents (86.3%) agreed with indoor residual spraying of insecticides. Health facilities were the first option for malaria treatment by 47.3%. Artemether-lumefantrine was the most common antimalarial therapy used. Conclusions. Despite reasonable knowledge on malaria and its preventive measures, there is a need to improve availability of information through proper community channels. Special attention should be given to illiterate community members. High acceptance of indoor residual spraying and high level of bed net ownership should be taken as an advantage to improve malaria control.

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Community knowledge, perceptions, and practices regarding malaria and its control in Jabi Tehnan district, Amhara Region, Northwest Ethiopia

Malaria Journal ◽

10.1186/s12936-021-03996-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Abebe Asale ◽

Zewdu Abro ◽

Bayu Enchalew ◽

Alayu Teshager ◽

Aklilu Belay ◽

...

Keyword(s):

Community Education ◽

Indoor Residual Spraying ◽

Northwest Ethiopia ◽

Primary Objective ◽

Malaria Episode ◽

Malaria Vectors ◽

Bed Nets ◽

Health Seeking ◽

District Health ◽

Malaria Parasites

Abstract Background Use of long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS), community-based malaria education, prompt diagnosis and treatment are key programme components of malaria prevention and control in Ethiopia. However, the effectiveness of these interventions is often undermined by various challenges, including insecticide and drug resistance, the plasticity of malaria vectors feeding and biting behaviour, and certain household factors that lead to misuse and poor utilization of LLINs. The primary objective of this study was to document households’ perceptions towards malaria and assess the prevalence of the disease and the constraints related to the ongoing interventions in Ethiopia (LLINs, IRS, community mobilization house screening). Methods The study was conducted in Jabi Tehnan district, Northwestern Ethiopia, from November 2019 to March 2020. A total of 3010 households from 38 villages were randomly selected for socio-economic and demographic survey. Focus group discussions (FGDs) were conducted in 11 different health clusters considering agro-ecological differences. A total of 1256 children under 10 years of age were screened for malaria parasites using microscopy to determine malaria prevalence. Furthermore, 5-year malaria trend analysis was undertaken based on data obtained from the district health office to understand the disease dynamics. Results Malaria knowledge in the area was high as all FGD participants correctly identified mosquito bites during the night as sources of malaria transmission. Delayed health-seeking behaviour remains a key behavioural challenge in malaria control as it took patients on average 4 days before reporting the case at the nearby health facility. On average, households lost 2.53 working days per person-per malaria episode and they spent US$ 18 per person per episode. Out of the 1256 randomly selected under 10 children tested for malaria parasites, 11 (0.89%) were found to be positive. Malaria disproportionately affected the adult segment of the population more, with 50% of the total cases reported from households being from among individuals who were 15 years or older. The second most affected group was the age group between 5 and 14 years followed by children aged under 5, with 31% and 14% burden, respectively. Conclusion Despite the achievement of universal coverage in terms of LLINs access, utilization of vector control interventions in the area remained low. Using bed nets for unintended purposes remained a major challenge. Therefore, continued community education and communication work should be prioritized in the study area to bring about the desired behavioural changes.

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Anopheline and human drivers of malaria risk in northern coastal, Ecuador: a pilot study

Malaria Journal ◽

10.1186/s12936-020-03426-y ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

James A. Martin ◽

Allison L. Hendershot ◽

Iván Alejandro Saá Portilla ◽

Daniel J. English ◽

Madeline Woodruff ◽

...

Keyword(s):

Indoor Residual Spraying ◽

Human Behaviour ◽

Bed Nets ◽

Bed Net ◽

San Jose ◽

Cross Sectional ◽

Net Use ◽

Biting Rate ◽

Human Landing ◽

Asymptomatic Infections

Abstract Background Understanding local anopheline vector species and their bionomic traits, as well as related human factors, can help combat gaps in protection. Methods In San José de Chamanga, Esmeraldas, at the Ecuadorian Pacific coast, anopheline mosquitoes were sampled by both human landing collections (HLCs) and indoor-resting aspirations (IAs) and identified using both morphological and molecular methods. Human behaviour observations (HBOs) (including temporal location and bed net use) were documented during HLCs as well as through community surveys to determine exposure to mosquito bites. A cross-sectional evaluation of Plasmodium falciparum and Plasmodium vivax infections was conducted alongside a malaria questionnaire. Results Among 222 anopheline specimens captured, based on molecular analysis, 218 were Nyssorhynchus albimanus, 3 Anopheles calderoni (n = 3), and one remains unidentified. Anopheline mean human-biting rate (HBR) outdoors was (13.69), and indoors (3.38) (p = 0.006). No anophelines were documented resting on walls during IAs. HBO-adjusted human landing rates suggested that the highest risk of being bitten was outdoors between 18.00 and 20.00 h. Human behaviour-adjusted biting rates suggest that overall, long-lasting insecticidal bed nets (LLINs) only protected against 13.2% of exposure to bites, with 86.8% of exposure during the night spent outside of bed net protection. The malaria survey found 2/398 individuals positive for asymptomatic P. falciparum infections. The questionnaire reported high (73.4%) bed net use, with low knowledge of malaria. Conclusion The exophagic feeding of anopheline vectors in San Jose de Chamanga, when analysed in conjunction with human behaviour, indicates a clear gap in protection even with high LLIN coverage. The lack of indoor-resting anophelines suggests that indoor residual spraying (IRS) may have limited effect. The presence of asymptomatic infections implies the presence of a human reservoir that may maintain transmission.

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The impact of stopping and starting indoor residual spraying on malaria burden in 14 districts of Uganda

10.21203/rs.3.rs-126095/v1 ◽

2020 ◽

Author(s):

Jane Namuganga ◽

Adrienne Epstein ◽

Joaniter Nankabirwa ◽

Arthur Mpimbaza ◽

Moses Kiggundu ◽

...

Keyword(s):

Malaria Incidence ◽

Critical Role ◽

Scale Up ◽

Indoor Residual Spraying ◽

Fold Increase ◽

Bed Nets ◽

Malaria Burden ◽

Vector Control Intervention ◽

Using Data ◽

The Impact

Abstract The scale-up of malaria control efforts has led to marked reductions in malaria burden over the past twenty years, but progress has slowed. Implementation of indoor residual spraying (IRS) of insecticide, a proven vector control intervention, has been limited and difficult to sustain partly because questions remain on its added impact over widely accepted interventions such as bed nets. Using data from 14 enhanced surveillance health facilities in Uganda, a country with high bet net coverage yet high malaria burden, we estimate the impact of starting and stopping IRS. We show that stopping IRS resulted in a 5-fold increase in malaria incidence within 10 months, but reinstating IRS led to an over 5-fold decrease within 8 months. In areas where IRS was initiated and sustained, malaria incidence dropped by 85% after year 4. IRS could play a critical role in achieving global malaria targets, particularly in areas where progress has stalled.

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Accounting for regional transmission variability and the impact of malaria control interventions in Ghana: A population level mathematical modelling approach.

10.21203/rs.2.22332/v1 ◽

2020 ◽

Author(s):

Timothy Awine ◽

Sheetal P Silal

Keyword(s):

Malaria Control ◽

Malaria Incidence ◽

Protective Efficacy ◽

Indoor Residual Spraying ◽

Information Management System ◽

Control Measures ◽

Bed Nets ◽

Model Parameters ◽

Insecticide Treated Bed Nets ◽

The Impact

Abstract Background Assessing the effectiveness of malaria control measures in Ghana will require taking transmission dynamics of the disease into account given the influence of climate variability in the region of interest. The impact of preventative interventions on malaria incidence and the prospects of meeting program timelines in Ghana have been investigated using mathematical models based on regionally diverse climatic zones. Methods An ordinary non-linear differential equation model with its associated rate parameters was developed incorporating the transitions between various disease compartments for three ecological zones in Ghana. Model parameters were estimated using data captured on the District Health Information Management System in Ghana from 2008 to 2017.The impact of insecticide treated bed nets and indoor residual spraying on the incidence of malaria were simulated at various levels of coverage and protective effectiveness in each ecological zone. To fit the model, Approximate Bayesian Computational sampling approach was adopted. Results Increasing the coverage levels of both long lasting insecticide treated bed nets or indoor residual spraying activities without a corresponding increase in their proper use or patronage does not impact highly on averting predicted incidence of malaria in Ghana. Improving on the protective efficacy of long lasting insecticide treated bed nets through proper usage could lead to substantial reductions in the predicted incidence of malaria. Similar results were obtained with indoor residual spraying across all zones. Conclusions Projected goals set in the National Strategic plan for malaria control 2014-2020 as well as WHO targets for malaria pre-elimination by 2030 are only likely be achieved if a substantial improvement in treated bed net usage is achieved coupled with targeted deployment of indoor residual spraying with high efficacy.

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Long Lasting Insecticide-treated Bed Net Ownership, Utilization and Associated Factors Among School-age Children in Dara Mallo and Uba Debretsehay Districts, Southern Ethiopia

10.21203/rs.3.rs-46180/v1 ◽

2020 ◽

Author(s):

Zerihun Zerdo ◽

Hilde Bastiaens ◽

Sibyl Anthierens ◽

Fekadu Massebo ◽

Matios Masine ◽

...

Keyword(s):

Controlled Trial ◽

Statistical Significance ◽

Malaria Prevention ◽

Education Level ◽

Sub Saharan Africa ◽

School Age Children ◽

Bed Nets ◽

Southern Ethiopia ◽

Bed Net ◽

Previous Night

Abstract Background Malaria is one of the major causes of morbidity and mortality among school-aged children (SAC) in Sub-Saharan Africa. SAC account for more than 60% of the reservoir of malaria transmission, but they were given less emphasis on prioritizing malaria prevention interventions. This study was aimed at assessing the ownership of bed nets, its utilization and factors associated with ownership of bed nets by households and bed net utilization among SAC in malaria prone areas of Dara Mallo and Uba Debretsehay districts in Southern Ethiopia, October to December 2019. Methods This study is part of baseline assessment in a cluster randomized controlled trial. The data were collected through interview and observation following structured questionnaire from 2261 SAC households. Univariable and multivariable logistic regressions were used to assess the association between bed net ownership or utilization and potential predictor variables. Odds Ratio (OR) and corresponding 95% Confidence Interval (CI) were used to determine the strength and statistical significance of association. Results The ownership of at least one bed net by households of SAC was about 19.3% (95% CI: 17.7%-21.0%). It was affected by living in altitude ranged from 1100 to 1250 meters above sea level with Adjusted OR (AOR) of 0.5 (95%CI: 0.3–0.9) and presence of child age less than 5 years (AOR = 2.1; 95%CI: 1.2–3.7). About 7.8% (95% CI: 6.7%-10.0%) of all SAC participated in the study and 40.4% (95% CI: 57.4% − 66.7%) of children in households owning at bed net passed the previous night under bed net. Bed net utilization by SAC conditional to its presence was lower among children age > 9 years (AOR = 0.2; 95%CI: 0.03–0.8); higher in children with mothers who had an education level above grade six (AOR = 5.2; 95%CI: 1.8–17.0); and when the household size to bed net ratio was ≤ 2 (AOR = 37.8; 95%CI: 4.1–1106). Conclusion Ownership of bed net was lower than universal coverage of at least one bed net for two individuals. It is important to monitor replacement needs and educate mothers with low education level and their SAC on the benefit of consistent utilization of bed nets.

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