Health-seeking behaviour and cost of fever treatment to households in a malaria-endemic setting of northern Ghana: a cross-sectional study

ObjectivesTo examine the health-seeking behaviour and cost of fever treatment to households in Ghana.DesignCross-sectional household survey conducted between July and September 2015.SettingKassena-Nankana East and West districts in Upper East region of Ghana.ParticipantsIndividuals with an episode of fever in the 2 weeks preceding a visit during routine health and demographic surveillance system data collection were selected for the study. Sociodemographic characteristics, treatment-seeking behaviours and cost of treatment of fever were obtained from the respondents.ResultsOut of 1845 households visited, 21% (393 of 1845) reported an episode of fever. About 50% (195 of 393) of the fever cases had blood sample taken for testing by microscopy or Rapid Diagnostic Test, and 73.3% (143 of 195) were confirmed to have malaria. Of the 393 people with fever, 70% (271 of 393) reported taking an antimalarial and 24.0% (65 of 271) took antimalarial within 24 hours of the onset of illness. About 54% (145 of 271) of the antimalarials were obtained from health facilities.The average cost (direct and indirect) incurred by households per fever treatment was GH¢27.8/US$7.3 (range: GH¢0.2/US$0.1–GH¢200/US$52.6). This cost is 4.6 times the daily minimum wage of unskilled paid jobs of Ghanaians (US$1.6). The average cost incurred by those enrolled into the National Health Insurance Scheme (NHIS) was GH¢24.8/US$6.5, and GH¢50/US$11.6 for those not enrolled.ConclusionsPrompt treatment within 24 hours of onset of fever was low (24%) compared with the Roll Back Malaria Programme target of at least 80%. Cost of treatment was relatively high when compared with average earnings of households in Ghana and enrolment into the NHIS reduced the cost of fever treatment remarkably. It is important to improve access to malaria diagnosis, antimalarials and enrolment into the NHIS in order to improve the case management of fever/malaria and accelerate universal health coverage in Ghana.

Effects of Door-to-Door Hang-Up Visits on the Use of Long-Lasting Insecticide-Treated Mosquito Nets in the Democratic Republic of the Congo: A Cluster Randomized Controlled Trial

Malaria accounts for 14% of child deaths in the Democratic Republic of the Congo, and one of the key interventions used to prevent malaria is to distribute insecticide-treated bednets (ITNs), especially long-lasting insecticidal nets (LLINs). The global health community and the Roll Back Malaria initiative have been struggling to achieve universal health coverage using ITNs, and recent studies have reported mixed results about the effects of door-to-door visits and mass distribution campaigns. We aimed to compare LLIN use for those provided by door-to-door hang-up visits and by conventional fixed distribution from distribution centers accompanied by a mass distribution campaign. A cluster randomized control trial was conducted in rural areas of Maniema Province, Democratic Republic of the Congo (DR Congo). Cross-sectional surveys were conducted on 2120 and 2156 households, respectively, with at least one child aged less than five in 76 villages. We assessed the effectiveness of door-to-door hang-up visits on the use of LLINs by exploring the interaction between the “intervention group” and “time” using generalized estimating equation models. Increased LLINs use was observed in all age groups in both arms, but usage differences were not significantly different (relative risk (RR) of LLINs use among children < 5 in the intervention group versus the control group after adjusted for clustering: 1.06, 95% CI: 0.85–1.33). We conclude that the door-to-door hang-up visits are not sufficient to persuade individuals (pregnant woman, children < 5, or all study participants) to use LLINs, although it did appear to be effective for the youngest children in the household.

Predictors of knowledge and use of long-lasting insecticidal nets for the prevention of malaria among the pregnant women in Pakistan

Background Malaria is endemic to Pakistan with high prevalence among pregnant women and linked with maternal anaemia, intrauterine growth retardation, preterm birth, and low birth weight. The use of long-lasting insecticidal nets (LLINs) is a proven and cost-effective intervention preventing malaria among pregnant women. The present study aimed to explore predictors of knowledge and use of LLINs among pregnant women in Pakistan. Methods This was part of a quasi-experimental study of 200 pregnant women conducted in a rural district of Sindh province in Pakistan. Data were collected using Malaria Indicator Survey questionnaires developed by Roll Back Malaria Partnership to end Malaria Monitoring and Evaluation Reference Group. Pregnant women and mothers with newborns of six months of age were interviewed in their homes. Results The age of the women was from 18 to 45, two thirds of the respondents (72.5%) were uneducated and married (77%). Majority (92%) of the women had received antenatal care during pregnancy, and 29.5% women had received counseling on malaria during their antenatal care visits. Multiple linear regression showed that the type of latrine was the most significant (β = 0.285, p < 0.001) determinant of knowledge about malaria among pregnant women followed by the death of a newborn (β = 0.271, p < 0.001). The use of mobile phone was the most significant (β = 0.247, p < 0.001) predictor of usage of LLINs among pregnant women followed by the death of a newborn (β = 0.232, p < 0.05). Conclusions Maternal education, type of latrine, use of mobile phone, malaria during previous pregnancy and newborn death were strong predictors of knowledge and use of LLINs in pregnant women in Pakistan. There is a need to scale-up programmes that aim to create awareness regarding malaria among pregnant women. Mobile phone technology can be used to implement awareness programmes focusing on malaria prevention among women.

Plasmodium vivax and Plasmodium ovale in the Malaria Elimination Agenda in Africa

In recent times, several countries in sub-Saharan Africa have reported cases of Plasmodium vivax (Pv) with a considerable number being Duffy negative. Current efforts at malaria elimination are focused solely on Plasmodium falciparum (Pf) excluding non-falciparum malaria. Pv and Plasmodium ovale (Po) have hypnozoite forms that can serve as reservoirs of infection and sustain transmission. The burden of these parasites in Africa seems to be more than acknowledged, playing roles in migrant and autochthonous infections. Considering that elimination and eradication is a current aim for WHO and Roll Back Malaria (RBM), the inclusion of Pv and Po in the elimination agenda cannot be over-emphasized. The biology of Pv and Po are such that the same elimination strategies as are used for Pf cannot be applied so, going forward, new approaches will be required to attain elimination and eradication targets.

Malaria Morbidity and Mortality Among Patients Admitted at a Tertiary Hospital in Congo DRC and Their Correlates: a Cross-sectional Study

Background: In the last two decades, there has been tremendous financial support, political will, and commitment to global malaria elimination focusing on endemic areas. This commitment and support have enabled a few countries to eliminate malaria, while others are making remarkable progress towards elimination. Nevertheless, in the Democratic Republic of the Congo (DRC), the status of Roll Back Malaria (RBM) impact indicators is unclear even though the country is one of the high burden malaria countries in the world. The study aimed to determine malaria morbidity and mortality at Kinshasa Referral General Hospital (KRGH) or the status of RBM impact indicators and factors associated with it.Methods: The study recruited 870 patients admitted at the KRGH in 2017 and 2018. Patient distribution by cause of admission was analysed. Malaria morbidity, mortality, and case-fatality-rates were estimated. A logistic regression model using malaria morbidity/mortality as the dependent variable was developed.Results: The morbidity rate was higher in 2018 than in 2017. Mortality and case-fatality-rates were comparable for the two years. Inpatients with low socioeconomic status (SES) were more than twice at risk of malaria morbidity/mortality than inpatients with high SES. The same results were found among city outskirts dwellers vis-a-vis city residents, with city residents faring better. Conclusion: Malaria morbidity and mortality in DRC were still high at the time of the study, affecting mostly people with low SES. Funding policies in the health sector need to be adjusted for DRC to address the current situation. Access to malaria health care services including drugs for low SES communities should be given priority.

Knowledge Attitude and Practices Towards the Use of Insecticide Treated Mosquito Nets Among Pregnant Women in Lukolo Health Center III Jinja District.

Background: There are an estimated 25 million pregnancies in sub-Saharan Africa at risk of malaria, the consequences of which can be serious for both mother and fetus in terms of morbidity and mortality. The Government of Uganda (GOU) through the Ministry of Health (MOH) and implementing partners like the Global Fund and the Roll Back Malaria initiative were compelled to try to maximize the use of Insecticide Treated Mosquito Nets (ITNs) to mitigate the effects of malaria among vulnerable populations. Methodology: A descriptive cross-sectional survey was used which involved both qualitative and quantitative methods of data collection and it involved 126 (one hundred twenty-six) respondents using self-administered questionnaires. Data collected was thematically presented and analyzed using descriptive frequencies and percentages using Microsoft excel. Results: This study showed that pregnant mothers' knowledge of the use of insecticide-treated nets was good. However, the respondents' attitude towards the use of Insecticide-treated nets was poor/ negative as up-to 60% of them felt putting on the mosquito net was inconveniencing, 67% didn't think that it was important to sleep under an ITN when one had taken Fansidar at ANC. Also, the practice of pregnant mothers towards the use of ITNs was not good too as only (43%) of the mothers had ITNs. A big number (71%) couldn't afford them, and (10%) believed they didn't need them. Important to note too, most (57%) mothers continued to use ITNS even when they had holes as, (3%) used it for other things like catching white ants. Conclusions and recommendations: The majority of the pregnant mothers' knowledge of the use of insecticide-treated nets was good as mothers could identify that malaria is transmitted by mosquitoes. The government, through the Ministry of Health, should intensify the free distribution of nets by conducting frequent mass distribution campaigns in the country.

Reduction of Malaria by Insecticide-Treated Mosquito Nets in Potiskum, Yobe State, Nigeria

Aims: The study was conducted to assess prevalence of malaria pre- and post-distribution of insecticide treated nets (ITNs) in Potiskum Local Government Area, Yobe State, Nigeria. Study Design: Retrospective and cross-sectional. Place of Study: Potiskum Local Government Area, Yobe State, Nigeria. Materials and Methods: Prevalence of malaria infection in ten political wards pre-distribution of ITNs was investigated using secondary data sources from Roll Back Malaria and Integrated Disease Surveillance and Response offices. Thin and thick blood smears used to evaluate malaria prevalence post-distribution of ITNs were prepared from blood samples of 520 patients seeking medical attention from the General Hospital, Potiskum. Questionnaires were also handed out to the same set of patients. Results: Prevalence of malaria infection pre- and post-distribution of ITNs in the study area was 57.9% and 22.9% respectively. Respondents to the questionnaire (n = 216) had mosquito nets, of whom 85% owned long-lasting ITNs and the remaining, conventional nets, but 35% used ITNs in their homes and 63% of those owning ITNs received them free-of-charge from local health centers. Conclusion: If the impact of ITNs as an effective malaria vector control measure must be sustained, there should be a corresponding awareness program, which should be aimed at encouraging proper and constant use of ITNs.

Knowledge of Malaria and Utilization of Its Preventive Measures among Pregnant Women Attending Antenatal Care at a Tertiary Hospital in Port-Harcourt, Nigeria

Background: Prevention of malaria is a major priority for the roll back malaria partnership which recommends three-pronged approach for reducing the burden of malaria among pregnant women. The WHO framework for malaria prevention during pregnancy in areas of stable malaria transmission recommends IPT, use of ITN, and case management of malaria illness. Objective: This study sought to determine the knowledge of malaria and its preventive measures among pregnant women, assess their utilization of malaria preventive measures and attitude to treatment. To ascertain whether there exists any relationship between their knowledge and practice of prevention. Methodology: An institutional based, cross-sectional study was carried out. 385 consenting participants, between 18-48 years, were interviewed using a structured questionnaire. Information on socio-demographic characteristics, knowledge of malaria and its preventive measures, use of IPT and ownership/use of ITN, and attitude to treatment were recorded. Data were entered into Excel spreadsheet and analyzed with SPSS version 20. Associations between different variables were determined using Fisher’s exact test or Chi-square test, as appropriate, and logistic regression used to test statistical significance at P<0.05. Results: Of the 385 women, 307 (79.7%) had excellent (18.7%) and good (61%) knowledge, while 78 (20.3%) had average (16.6%) and poor (3.6%) knowledge. There was no difference in association of Knowledge with age, marital status, education, occupation, and parity. Of the 385 women, 61.3% were using IPT for chemoprophylaxis, 66.2% were using insecticide spray or repellants and 71.4% owned mosquito net; of these, 84% owned insecticide treated nets, but only 65.8% were using it in this current pregnancy. Reasons for not using nets ranged from unavailable 49.0%, discomfort due to heat 32.9%, fear of suffocation 6.9%, Spouse’s disapproval 3.9% and 1.0% ineffective. There was statistically significant difference between knowledge and use of IPT, ITN and insecticide sprays. Conclusion: There was adequate knowledge of malaria in pregnancy and its preventive measures, but utilization of these measures needs improvement. Efforts should be made to address barriers to utilization.

Disease and Human Capital Accumulation: Evidence from the Roll Back Malaria Partnership in Africa*

We estimate the effects of a large-scale anti-malaria campaign on a rich set of human capital outcomes in 27 Sub-Saharan African countries. Using pre-campaign malaria risk as treatment probability, we exploit quasi-experimental variation in period and cohort exposure to anti-malaria campaigns. A conservative interpretation of our results shows a globally positive impact malaria aid: campaigns reduced the probability of infant mortality (1 percentage point) and birth (0.4 p.p.) and increased educational attainment (0.4 years) and the likelihood of adult paid employment (6 p.p.). These findings demonstrate how the effects of sweeping disease reduction efforts extend beyond health outcomes.

The World Health Organization’s changing goals and expectations concerning malaria, 1948-2019

From its inception, in 1948, the World Health Organization made control of malaria a high priority. Early successes led many to believe that eradication was possible, although there were serious doubts concerning the continent of Africa. As evidence mounted that eradicating malaria was not a simple matter, the malaria eradication programme was downgraded to a unit in 1980. Revived interest in malaria followed the Roll Back Malaria Initiative adopted in 1998. This article presents an historical account of the globally changing ideas on control and elimination of the disease and argues that insufficient attention was paid to strengthening health services and specialized human resources.