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The Impact of Malaria Control Interventions on Malaria and Anaemia in Children under Five after Ten Years of Implementation in the Hohoe Municipality of Ghana  [PDF]
Margaret Kweku, Eric Kwaku Appiah, Yeetey Enuameh, Martin Adjuik, Wisdom Takramah, Elvis Tarkang, John Gyapong
Advances in Infectious Diseases (AID) , 2017, DOI: 10.4236/aid.2017.73010
Abstract: Background: Malaria remains a dominant health issue among children in Ghana. We monitored the trend of long lasting insecticide net (LLIN) ownership and use and its impact on malaria and anaemia among children under five over the past decade in an area of intense, prolonged and seasonal malaria transmission. Methods: A total of 1717, 2155 and 1915 children were surveyed in June and 1717, 2155 and 1697 in November in 30 communities of the Hohoe Municipality in 2006, 2010 and 2015 respectively. The primary outcomes monitored were the trend of LLIN ownership, use and prevalence of malaria and anaemia through cross-sectional surveys. Findings: Results showed a significantly positive trend (p < 0.001) in ownership of LLIN at 20.8%, 64.8% and 83.2% for 2006, 2010 and 2016 respectively. The sharp increase in ownership between 2006 and 2010 accounted for a highly significant departure from trend (p < 0.001). Similarly, the prevalence of LLIN use was 15.1%, 42.2% and 68.3% for 2006, 2010 and 2016 respectively with a significant positive trend (p < 0.001). The prevalence of malaria parasitaemia in June showed no significant drop over the three years studied. Anaemia prevalence was 7.9%, 5.3% and 11.1% for 2006, 2010 and 2015 respectively—Anaemia significantly increased (p < 0.001) between 2010 and 2015 accounting for a significant departure from the initially decreasing trend (p < 0.001). Malaria parasitaemia over the November surveys was 40.4%, 33.2% and 26.6% for 2006, 2010 and 2016 respectively, depicting a significant decline over the years of the study (p < 0.001). A significant decrease (p = 0.006) in anaemia was observed at 12.0%, 4.3% and 8.9% for 2006, 2010 and 2015 respectively. A significant departure from the decreasing trend (p < 0.001) was noted with increasing anaemia between 2010 and 2016. Interpretation: Ownership of LLIN and its use together with other indicators of malaria prevalence generally improved five years after the implementation of a malaria control programme. Ten years after programme implementation, consistent improvement was only in LLIN ownership and use. Also malaria prevalence indicators improved in the post as compared to the pre-rainy season in the study communities.
Rapid Increase in Ownership and Use of Long-Lasting Insecticidal Nets and Decrease in Prevalence of Malaria in Three Regional States of Ethiopia (2006-2007)  [PDF]
Estifanos Biru Shargie,Jeremiah Ngondi,Patricia M. Graves,Asefaw Getachew,Jimee Hwang,Teshome Gebre,Aryc W. Mosher,Pietro Ceccato,Tekola Endeshaw,Daddi Jima,Zerihun Tadesse,Eskindir Tenaw,Richard Reithinger,Paul M. Emerson,Frank O. Richards Jr.,Tedros Adhanom Ghebreyesus
Journal of Tropical Medicine , 2010, DOI: 10.1155/2010/750978
Abstract: Following recent large scale-up of malaria control interventions in Ethiopia, this study aimed to compare ownership and use of long-lasting insecticidal nets (LLIN), and the change in malaria prevalence using two population-based household surveys in three regions of the country. Each survey used multistage cluster random sampling with 25 households per cluster. Household net ownership tripled from 19.6% in 2006 to 68.4% in 2007, with mean LLIN per household increasing from 0.3 to 1.2. Net use overall more than doubled from 15.3% to 34.5%, but in households owning LLIN, use declined from 71.7% to 48.3%. Parasitemia declined from 4.1% to 0.4%. Large scale-up of net ownership over a short period of time was possible. However, a large increase in net ownership was not necessarily mirrored directly by increased net use. Better targeting of nets to malaria-risk areas and sustained behavioural change communication are needed to increase and maintain net use. 1. Introduction Selective vector control with insecticide treated mosquito nets (ITNs) and indoor residual household spraying (IRS) continues to play a key role in malaria control. As a way to achieving the United Nations Millennium Development Goals (MDGs), the World Health Organization (WHO) recommends rapid scale up of three primary interventions: ITNs, more specifically long-lasting insecticidal nets (LLINs), IRS and early detection and effective treatment of malaria cases [1, 2]. In addition, intermittent preventive treatment for pregnant women (IPTp) is recommended in areas with moderate to high transmission. The three primary interventions (LLIN, IRS and early diagnosis and treatment) form the core approach to malaria control in Ethiopia, where malaria transmission is unstable and seasonal, characterized by frequent and widespread focal epidemics. Malaria transmission mainly occurs in areas below 2,000 meters above sea level, which account for 75% of the country’s total landmass and in which approximately two-thirds of the population reside. Recognizing the low coverage and use of ITNs in the country, the Government of Ethiopia developed the National ITN Strategy in 2004 [3]. One year later, the Ethiopian Federal Ministry of Health (FMOH) set an ambitious national goal of full population coverage in malarious areas with a mean of two LLINs per household through distribution of about 20 million LLINs by the end of 2007. In addition, IRS as vector control tool was also to be scaled-up, particularly in epidemic-prone districts throughout the country. This effort also included the rapid scale-up of
Community awareness, perceptions, acceptability and preferences for using LLIN against malaria in villages of Uttar Pradesh, Indiaax  [PDF]
Ripu Daman Sood a,b , P.K. Mittal b , Neera Kapoor a , R.K. Razdan b ,V.K. Dua b & A.P. Dash
Journal of Vector Borne Diseases , 2010,
Abstract: Background & Objectives: Long-lasting insecticidal nets (LLINs) have been introduced in Indiarecently into the vector control programme. A study was undertaken to assess the communityperception regarding use of LLIN, their acceptability, collateral benefits, etc. in certain villages ofDistrict Gautam Budh Nagar, Uttar Pradesh, India where LLINs are in use by the community.Method: A randomized community-based survey was undertaken during April–May 2009 covering596 respondents in LLIN villages where LLINs have been distributed along with 307 respondentsin untreated net villages where untreated nets were distributed using structured questionnaire.Qualitative data were collected and the difference in proportion was calculated by z-test.Results: A substantial number of respondents had good knowledge of the symptoms of malaria.According to respondents, LLINs were very much effective in bringing down the malaria incidencein their families. About 98.3% of the respondents asserted the use of LLINs as their use not onlyreduced the number of mosquitoes as well as other non-target insects, but also reduced the malariaincidence. About 93.2% of the respondents were ready to purchase LLINs if available at nominalprices. All the respondents were satisfied about the performance of the LLINs in reducing themosquito nuisance, safety of use and collateral benefits in LLIN villages.Conclusion: LLINs are safe, socially acceptable and should be promoted for vector control toreduce the disease burden in the communities.
Dry Season Determinants of Malaria Disease and Net Use in Benin, West Africa  [PDF]
Nicolas Moiroux, Olayidé Boussari, Armel Djènontin, Georgia Damien, Gilles Cottrell, Marie-Claire Henry, Hélène Guis, Vincent Corbel
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0030558
Abstract: Background To achieve malaria eradication, control efforts have to be sustained even when the incidence of malaria cases becomes low during the dry season. In this work, malaria incidence and its determinants including bed net use were investigated in children of under 5 years of age in 28 villages in southern Benin during the dry season. Methods and Findings Mean malaria clinical incidence was measured in children aged 0–5 years by active case detection in 28 villages of the Ouidah-Kpomasse-Tori Bossito sanitary district between November 2007 and March 2008. Using Poisson mixed-effect models, malaria incidence was assessed according to the level of transmission by different vector species, and Long-Lasting Insecticide-treated mosquito Nets (LLIN) use and ownership. Then, a Binomial mixed-effect model was developed to assess whether nighttime temperature (derived from MODIS remote sensing data), biting nuisance and LLIN ownership are good predictors of LLIN use >60%. Results suggested that Anopheles funestus (Incidence Rates Ratio (IRR) = 3.38 [IC95 1.91–6]) rather than An. gambiae s.s. is responsible for malaria transmission. A rate of LLIN use >60% was associated with a lower risk of malaria (IRR = 0.6 [IC95 0.37–0.99]). Low nocturnal temperature and high biting nuisance were good predictors of LLIN use >60%. Conclusions As recommended by the Malaria Eradication (MalERA) Consultative Group on Modelling, there is a need to understand better the effects of seasonality on malaria morbidity. This study highlights the need to take into account the specificity of malaria epidemiology during the dry-hot season and get a better understanding of the factors that influence malaria incidence and net use. These findings should help National Malaria Control Programmes to implement more effective and sustainable malaria control strategies in Africa.
Quality Assurance (QA) Tool in Public Health Campaigns: A Look at the 2017 LLIN Replacement Campaign in Nigeria
Jalal-Eddeen Abubakar Saleh, Wondimagegnehu Alemu, Akubue Augustine Uchenna, Abdullahi Saddiq, Rex Mpazanje, Bala Mohammed Audu
Open Access Library Journal (OALib Journal) , 2018, DOI: 10.4236/oalib.1104701
Background: Although there are various malaria intervention measures, the long-lasting insecticidal nets (LLIN) are considered as the most cost-effective intervention measure for malaria endemic countries. In line with the Global Technical Strategies, and as recommended by the World Health Organization (WHO), the other available malaria preventive measures to achieve malaria control and elimination in especially the malaria endemic countries include the intermittent prophylactic treatment in pregnancy (IPTp), intermittent prophylactic treatment in infants (IPTi), indoor residual spray (IRS), seasonal malaria chemoprophylaxis (SMC), and recently the use of malaria vaccine. This study examines the role of quality assurance (QA) tool as deployed by WHO in the 2017 LLIN replacement campaigns in the states that implemented the campaign in Nigeria—Adamawa, Edo, Imo, Kwara, and Ondo. For the purpose of this study, the QA tool examined four components during the campaign—logistics, strategies, technical, and demand creation. Methods: This is a cross-sectional study using the QA checklist developed and applied by the WHO professional officers intra campaign between April and December 2017. In each of the states, a total of six LGAs were randomly selected using the EPI risk status (AFP performance indicators and the routine immunization coverage). The findings from the QA checklist tool were analyzed using the SPSS version 24 and the results discussed accordingly. Results: The results looked at general and specific issues across the five states. While the general issues are more in Kwara state in comparison to the other four states—logistics (15%), strategies (12%), technical (13%), and demand creation (7%), the specific issues are almost same across the five states; these specific issues are poor crowd control (12%), early closure of distribution sites (14%), mix-up of data at the distribution sites (15%), poor communication medium between supervisors and teams at the field (11%), safety concerns by the recipients (10%), lack of adequate knowledge on the LLIN usage (9%), inadequate LLIN storage sites (13%), and inadequate plans for LLIN movement between the distribution points (16%). In spite this; all the five states had at least 80% in the area of programme ownership. Conclusion: On the overall, the study further underscores the importance of using quality assurance checklists in public health campaigns as they help ensure that campaigns meet the minimum required standard.
Field evaluation of Icon Life, a long-lasting insecticidal net (LLIN) against Anopheles culicifacies and transmission of malaria in District Gautam Budh Nagar (Uttar Pradesh), India  [PDF]
P.K. Mittal, Ripu Daman Sood, Neera Kapoor, R.K. Razdan & A.P. Dash
Journal of Vector Borne Diseases , 2012,
Abstract: Background & objectives: In the present study, Icon Life net, a long-lasting polyethylene net, 100 denier andbursting strength of minimum 280 kpa incorporated with deltamethrin @ 65 mg/m2 was evaluated for its efficacyin reducing the density of malaria vector Anopheles culicifacies and impact on malaria prevalence in a malariaendemic area of District Gautam Budh Nagar, India.Methods: Wash resistance of Icon Life LLIN was determined up to 20 serial washings using An. culicifacies incone bioassays under field conditions. Efficacy of Icon Life LLIN was determined in the field in three sets ofvillages in District Gautam Budh Nagar (Uttar Pradesh), India, selected randomly for the intervention withIcon Life LLIN, untreated nets and a control without any intervention for the period of August 2008–July 2009.Entomological and malariometric indices in all the three villages were compared during pre- and post-interventionperiods for one year against An. culicifacies. A survey was also conducted in the village provided with Icon LifeLLIN to assessing the perception of community regarding acceptance of these nets by the community.Results: In cone bioassays on Icon Life LLIN with An. culicifacies, >95% knockdown within 1 h and 100%mortality after 24 h exposure were reported even after 20× serial washings under field conditions. Results ofthe field study revealed reduced entry rate, resting density and parity rate of An. culicifacies in the village withIcon Life LLIN when compared to no net and untreated net villages. Number of malaria cases reported wereless in the Icon Life LLIN used villages when compared to other two villages. The community compliance andacceptance was high and no adverse health events were reported by the households using these nets.Conclusions: Icon Life LLIN is an effective intervention for the control of An. culicifacies transmitted malariain India. Long-term studies are indicated for the duration of effectiveness and to ascertain the epidemiologicalimpact of the use of Icon Life nets.
Community Based Distributors and Increased Ownership of the Long Lasting Insecticidal Nets in Rural Area of Jos Plateau State
EA Envuladu, ME Banwat, LA Lar, AI Zoakah
Jos Journal of Medicine , 2011,
Abstract: Background: The risk of malaria infection depends on the risk of being bitten by an infected mosquito, which itself depends on levels of transmission and exposure. The risk of infection leading to severe malaria disease depends on a person's immune status and access to treatment. Long lasting insecticidal nets (LLINs) have been one of the main strategies for malaria transmission reduction. LLIns are low cost and highly effective way of reducing the incidence of malaria in people who sleep under them. By preventing malaria, LLINs reduces the need for treatment and the pressure on health services. This study set out to assess the effectiveness of community based distribution in increasing ownership of LLIN in the community. Methods: it was an interventional study with a study and control group using pregnant women in Dorowa Babuje as the study group and pregnant women in Vwang as the control group, baseline data was generated using an interviewer administered questionnaire in both the study and the control group. In the study group, the women were allowed to select among them those that served as community based distributors (CBDs) who were pregnant women themselves that could read and write and understood English, Hausa and the native language Birom. Subsequently, the women were sensitized about malaria, the importance of LLINs as a means of preventing malaria and how to care for the nets. The CBD then distributed the nets to the women while in the control group, after generating the data, the women were sensitized just like the study group and informed on the possible places they could obtain the LLINs but the LLIns were not distributed them. After a period of four months, using the same interviewer administered questionnaire, data was generated in both the study and the control group to compare the pre and the post intervention result and at the end of the study period, free LLINs were then distributed to the control group. Result: Education was seen to have a statistical significant influence in the ownership of the LLINs at pre-intervention in both the study and the control groups. Ownership of LLINs increased statistically significantly in the study group from 9.8% to 97.6% (P<0.0001) at post-intervention. In the control group, there was no statistically significant difference in the level of ownership of LLIN at the end of the study period (P=0.389). The ownership of the LLINs was increased 89.8% (AF=89.8%) due to the community based distributors that shared the LLINs to the pregnant women in the community. Conclusion: The distribution of the LLIN at the community level with the involvement of the community people has lead to the significant increase in the ownership of LLIN.
Lots Quality Assurance Survey (LQAS) as a Strategy to Achieving Quality LLIN Campaigns: The Nigerian Experience
Jalal-Eddeen Abubakar Saleh, Akubue Augustine Uchenna, Dr. Abdullahi Saddiq, Alemu Wondimagegnehu, Rex Mpazanje, Dr. Bala Mohammed Audu
Open Access Library Journal (OALib Journal) , 2018, DOI: 10.4236/oalib.1104484
Background: Nigeria, in its quest to scale up coverage and utilization of LLINs as a strategy for malaria control, had the first long lasting insecticidal net (LLIN) mass campaign across the country between 2009-2013. The NMEP with support from its RBM partners successfully distributed over 57.7 million LLINs during the period representing over 90% of the national target. In spite this, and to achieve universal coverage, the country maintained a continuous distribution through multiple channels and in particular the antenatal care outlets and the expanded programme on immunization. The Nigerian government, with support from the Global Fund and through the National Malaria Elimination Programme (NMEP), Catholic Relief Services (CRS), and the Society for Family Health (SFH) and with technical support from the World Health Organization, once again launched the LLIN replacement campaign in some states across the country. Methods: A cross-sectional survey was conducted in five states that conducted the LLIN replacement campaign using the lots quality assurance survey (LQAS) tool developed by the World Health Organization. The period of the survey across the states is between August and December 2017. The LQAS questionnaires were administered to households (HHs) by the WHO field officers trained on the use of the tool at least one week after the campaign. A total of 240 HHs were selected from 24 settlements (clusters) in 24 wards of six LGAs (lots) from each of the five (5) states that rolled out the campaign. Data collected were double entered, cleaned, crosschecked, and the results analysed using the SPSS version 24. Results: With a total of 9740 people surveyed from 1200 HHs across the five states, the average redemption rate was 95.5% (95% CI, 91.6% - 98.8%), average retention rate was 98.4% (95% CI, 97.0% - 99.8%), average hanging rate was 82.6% (95% CI, 80.0% - 85.5%), and an average card ownership of 83.5% (95% CI, 78.6% - 88.2%). While the main source of information 35.4% (95% CI, 21.8% - 49.0%) about the LLIN campaign was the health workers, the reasons for those missed out were mainly due to team performance 32.2% (95% CI, 26.8% - 37.4%) and net cards not issued 27.4% (95% CI, 23.2% - 32.0%). Similarly, the Pearson correlation (0.942, α 0.017, p < 0.05, 2-tailed test), the ANOVA test (F value of 23.751, α 0.017, p < 0.05), and Regression analysis (R-square 0.888 and Durbin-Watson 2.487), all shows significant relationships between LLIN redemption and usage with a resultant rejection of the Null Hypothesis. Conclusion: The outcome of this research underscores the need to adopt and scale up the use of the LQAS tool to assess the quality of LLIN campaigns within the shortest possible time. While the LQAS has been in use by the WHO Expanded Programme on Immunization cluster during polio campaigns, this is the first time that the tool was deployed by the WHO malaria unit as a strategy to identify post LLIN campaign gaps immediately after implementation. The scaling up of this strategy would undoubtedly improve LLIN campaigns that would be conducted in the remaining states across the country so as to ensure that Nigeria achieve LLIN universal access in line with the Global Technical Strategy (GTS) framework toward malaria elimination.
Household bednet ownership and use in Ghana: Implications for malaria control  [PDF]
Jones K. Adjei,Stephen Obeng Gyimah
Canadian Studies in Population , 2012,
Abstract: The distribution of insecticide bednets has become a key malaria control strategy in endemic regions. The literature, however, points to a gap between availability and use. Using nationally representative household data from Ghana, this study investigates the factors that associate with household bednet ownership and use among minor children. The results indicate that more than half of Ghanaian households do not own any bednet; while among those who do, household crowding and other socio-demographic factors tend to impede their use. This notwithstanding, the analysis suggests that scaling up bednet distribution could facilitate increased use amongvulnerable populations.
Scaling Up Towards International Targets for AIDS, Tuberculosis, and Malaria: Contribution of Global Fund-Supported Programs in 2011–2015  [PDF]
Itamar Katz,Ryuichi Komatsu,Daniel Low-Beer,Rifat Atun
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0017166
Abstract: The paper projects the contribution to 2011–2015 international targets of three major pandemics by programs in 140 countries funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the largest external financier of tuberculosis and malaria programs and a major external funder of HIV programs in low and middle income countries.
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