Assessment of Knowledge and Attitude Regarding Risk Factors of Malaria Among Caregivers of Under-Five Children in the Buea Health District, South West Region, Cameroon

Aims: The study measured the level of knowledge and attitudes towards malaria and examined associated factors among caregivers of under-five children. Study Design: The study was community-based, descriptive cross-sectional. Place and Duration of Study: The study was carried out in Buea Health District (BHD) from February to June 2020. Methodology: Data were obtained through face-to-face interviews with the caregivers of under-fives. The above mean scores were used to determine the level of knowledge. The attitude levels were measured by using 3-point Likert scales. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with knowledge and attitude. SPSS software version 20.0 was used for analysis. Results: Out of the 390 respondents, 69.5% of them had a neutral attitude. Meanwhile, 27.7 % of participants carried a favorable attitude towards malaria and only 2.8 % of them had an unfavorable attitude, Caregivers of under-five children who scored below the mean score were 25.1 % which was considered having poor knowledge and above the mean score was 74.9% which was considered good knowledge. In the multivariable logistic analysis, caregivers with a primary school level of education were 4.1 times (AOR = 4.1, CI = 1.486-11.102) times more likely of receiving a high malaria knowledge score as compared to those with no formal education. Factors associated with caregiver's attitude level towards malaria risk were educational level and marital status which showed significant associations in the univariate analysis Conclusion: Caregivers of under-fives displayed a good knowledge of malaria risk factors. However, in these endemic areas for malaria, caregiver attitude was found to be unenthusiastic and unresponsive, and this poses additional challenges in reaching the malaria elimination goal. Thus, suggesting that educational messages during the campaign should be contextual to reach out to local communities to trigger a positive behavioural change.

Pediatric Malaria Incidence and Risk Mapping With and Without Clinical Data in Sussundenga Municipality, Mozambique

BackgroundMalaria is a parasitic borne disease that affects red blood cells. The disease is preventable, detectable and treatable and more common in poor resource settings. It causes socioeconomic impacts, representing a large burden on the revenue of countries where it is endemic. Malaria is undoubtedly one of the main public health concerns impacting on families and the economy in Mozambique. Although the entire population of Mozambique is at risk of malaria, children and pregnant women have higher risk owing to lower immunity. Age category plays a significant important role in malaria occurrence and can affect the course and progression of the disease and correct treatment. Very few studies in pediatric malaria exists in Mozambique and the existing uses a simplistic and coarse grouping. Malaria risk is rarely uniform, whether considering households in a village, villages in a district or districts in a country. The knowledge of malaria pediatric incidence and, the need to evaluate the local heterogeneity by generating malaria risk maps can improve the understanding of pediatric malaria being the objective of this study. Materials and MethodsA retrospective study was conducted using existing malaria positive data from 2018 to 2019 at Rural Sussundenga Hospital (RSH) in Sussundenga municipality. Attributable factor of the disease and incidence were calculated. Proportion of gender, age category and location were tested using G test. For malaria risk mapping, ten malaria factors (anthropic, sociodemographic, climatic and clinic) were used to produce two maps one using malaria incidence and other without. Bioclimatic, Diva GIS 7.4.0 and, Landsat 8 image were used to produce the map.Results and conclusionThe findings revealed that of the, 42,248 patients who visited the local hospital f, 51.2 % tested positive for malaria with an incidence of 45.7 per 100 persons. There is a difference between residential areas in malaria incidence, with both maps showing malaria risk in Nhamazara, Nhamarenza and Unidade communities. This implies that malaria high risk areas seem to be located in high populated areas and areas close to water bodies. Relevant information is provided for effective planning in malaria intervention.

Knowledge and Social Beliefs of Malaria and Prevention Strategies Among Itinerant Nomadic Arabs, Fulanis and Dagazada groups in Chad: A Mixed Method Study

Background: Nomadic populations in Chad are at increased risk of contracting malaria because of their lifestyle. Being highly mobile they are often excluded from disease control programs, and access to preventive measures and treatment is more difficult. Effective malaria control interventions take account of local modes of transmission, patterns of care-seeking behavior and community perceptions of cause and prevention practices. There is currently little information about malaria knowledge and perceptions among nomadic groups in Chad, or their awareness of malaria control interventions and this study sought to address this knowledge gap. Methods: A mixed methods study, including a cross-sectional survey with men and women (n = 78) to determine the level of knowledge and use of malaria prevention strategies among Arabs, Peuls and Dagazada nomadic groups. Three focus group discussions were conducted with women to explore their representation of malaria and knowledge of preventive methods. Key informant interviews were held with leaders of nomadic groups (n = 6) to understand perception of malaria risk among itinerant communities.Results: nomads are aware of the risk of malaria, recognize the symptoms and have local explanations for the disease. Reported use of preventive interventions such as Seasonal Malaria Chemoprophylaxis (SMC) for children and Intermittent Preventive Treatment (IPT) of malaria in pregnancy was very low. However, 42.3% of respondents reported owning at least one LLIN and 60% said they slept under an LLIN the night before the survey. In case of a malaria episode, nomads seek clinicians, informal drug sellers in the street or market for self-medication, or traditional medicine depending on their financial means. Interviews with nomad leaders and discussions with women provide key themes on: (i) social representation of malaria risk and (ii) social representation of malaria and (iii) perspectives on malaria prevention and (iv) malaria treatment practices.Conclusion: The nomadic groups included in this study are aware of risk of malaria and their level of exposure. Local interpretations of the cause of malaria could be addressed through tailored and appropriate health education. Except for LLINs, malaria prevention interventions are not well known or used. Financial barriers lowered access to both mosquito nets and malaria treatment. Reducing the barriers highlighted in this study will improve access to the healthcare system for nomadic groups, and increase the opportunity to create awareness of and improve uptake of SMC and IPT among women and children.

An urban-to-rural continuum of malaria risk: new analytic approaches characterize patterns in Malawi

Background The urban–rural designation has been an important risk factor in infectious disease epidemiology. Many studies rely on a politically determined dichotomization of rural versus urban spaces, which fails to capture the complex mosaic of infrastructural, social and environmental factors driving risk. Such evaluation is especially important for Plasmodium transmission and malaria disease. To improve targeting of anti-malarial interventions, a continuous composite measure of urbanicity using spatially-referenced data was developed to evaluate household-level malaria risk from a house-to-house survey of children in Malawi. Methods Children from 7564 households from eight districts throughout Malawi were tested for presence of Plasmodium parasites through finger-prick blood sampling and slide microscopy. A survey questionnaire was administered and latitude and longitude coordinates were recorded for each household. Distances from households to features associated with high and low levels of development (health facilities, roads, rivers, lakes) and population density were used to produce a principal component analysis (PCA)-based composite measure for all centroid locations of a fine geo-spatial grid covering Malawi. Regression methods were used to test associations of the urbanicity measure against Plasmodium infection status and to predict parasitaemia risk for all locations in Malawi. Results Infection probability declined with increasing urbanicity. The new urbanicity metric was more predictive than either a governmentally defined rural/urban dichotomous variable or a population density variable. One reason for this was that 23% of cells within politically defined rural areas exhibited lower risk, more like those normally associated with “urban” locations. Conclusions In addition to increasing predictive power, the new continuous urbanicity metric provided a clearer mechanistic understanding than the dichotomous urban/rural designations. Such designations often ignore urban-like, low-risk pockets within traditionally rural areas, as were found in Malawi, along with rural-like, potentially high-risk environments within urban areas. This method of characterizing urbanicity can be applied to other infectious disease processes in rapidly urbanizing contexts.

Proximity of Residence to Irrigation Determines Malaria Risk and Anopheles Abundance at an Irrigated Agroecosystem in Malawi

As countries of sub-Saharan Africa expand irrigation to improve food security and foster economic growth, it is important to quantify the malaria risk associated with this process. Irrigated ecosystems can be associated with increased malaria risk, but this relationship is not fully understood. We studied this relationship at the Bwanje Valley Irrigation Scheme (800 hectares) in Malawi. Household prevalence of malaria and indoor Anopheles density were quantified in two cross-sectional studies in 2016 and 2017 (5,829 residents of 1,091 households). Multilevel logistic regression was used to estimate the association between distance to the irrigation scheme and malaria infection and mosquito density. The prevalence of malaria infection was 50.2% (2,765/5,511) by histidine-rich protein 2–based malaria rapid diagnostic tests and 30.1% (1,626/5,403) by microscopy. Individuals residing in households within 3 km of the scheme had significantly higher prevalence of infection (adjusted odds ratio [aOR] = 1.41; 95% confidence interval [CI] 1.18, 1.68); school-aged children had the highest prevalence among age groups (aOR = 1.34; 95% CI 1.11, 1.63). Individuals who reported bed net use, and households with higher socioeconomic status and higher level of education for household head or spouse, had lower odds of malaria infection. Female Anopheles mosquitoes (2,215 total; Anopheles arabiensis, 90.5%, Anopheles funestus, 9.5%) were significantly more abundant in houses located within 1.5 km of the scheme. Proximity of human dwellings to the irrigation scheme increased malaria risk, but higher household wealth index reduced risk. Therefore, multisectoral approaches that spur economic growth while mitigating increased malaria transmission are needed for people living close to irrigated sites.

Investigating differences in village-level heterogeneity of malaria infection and household risk factors in Papua New Guinea

Malaria risk is highly heterogeneous. Understanding village and household-level spatial heterogeneity of malaria risk can support a transition to spatially targeted interventions for malaria elimination. This analysis uses data from cross-sectional prevalence surveys conducted in 2014 and 2016 in two villages (Megiar and Mirap) in Papua New Guinea. Generalised additive modelling was used to characterise spatial heterogeneity of malaria risk and investigate the contribution of individual, household and environmental-level risk factors. Following a period of declining malaria prevalence, the prevalence of P. falciparum increased from 11.4 to 19.1% in Megiar and 12.3 to 28.3% in Mirap between 2014 and 2016, with focal hotspots observed in these villages in 2014 and expanding in 2016. Prevalence of P. vivax was similar in both years (20.6% and 18.3% in Megiar, 22.1% and 23.4% in Mirap) and spatial risk heterogeneity was less apparent compared to P. falciparum. Within-village hotspots varied by Plasmodium species across time and between villages. In Megiar, the adjusted odds ratio (AOR) of infection could be partially explained by household factors that increase risk of vector exposure, such as collecting outdoor surface water as a main source of water. In Mirap, increased AOR overlapped with proximity to densely vegetated areas of the village. The identification of household and environmental factors associated with increased spatial risk may serve as useful indicators of transmission hotspots and inform the development of tailored approaches for malaria control.