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Number and type of nets and hammocks used at home, in forests, and on farms by study respondents
Source publication
Strengthening vector control measures among mobile and migrant populations (MMPs) is crucial to malaria elimination, particularly in areas with multidrug-resistant malaria. Although a global priority, providing access and ensuring high coverage of available tools such as long-lasting insecticidal nets (LLINs) among these vulnerable groups remains a...
Contexts in source publication
Context 1
... reported using a total of 3,366 nets/ hammocks. These included treated and untreated single and double bed nets; single and double, soft and hard LLIN bed nets; hammock nets with zipper and flip over; and hammocks without a net (Table 2). Of all net and hammock types used, 816 were used in the forest, 375 were used on a farm, and 2,854 were used at home. ...Context 2
... reported using the same net/hammock at one or more sleeping sites or owning, but not using nets. Thus, numbers in the "Total" column of Table 2 do not always equate to the sum of nets used at different sleeping sites. Results indicate that on average, each participating household used about two nets and a hammock. ...Context 3
... < 0.0001). However, this was low practical significance, as measured by small ES (ES Cramer's V = 0.13; difference between farm and home sleeping sites was not statistically significant), and therefore represents a weak association between sleeping sites and the number of owned hammocks with flip over (Table 2). Among the respondents who self-reported to have slept in either the forest or on a farm, 301 (43.2%) participants elected to answer an extended component of the survey relating to net/hammock usage and preference while sleeping in their respective remote sites away from their village-based home. ...Context 4
... reported using a total of 3,366 nets/ hammocks. These included treated and untreated single and double bed nets; single and double, soft and hard LLIN bed nets; hammock nets with zipper and flip over; and hammocks without a net (Table 2). Of all net and hammock types used, 816 were used in the forest, 375 were used on a farm, and 2,854 were used at home. ...Context 5
... reported using the same net/hammock at one or more sleeping sites or owning, but not using nets. Thus, numbers in the "Total" column of Table 2 do not always equate to the sum of nets used at different sleeping sites. Results indicate that on average, each participating household used about two nets and a hammock. ...Context 6
... < 0.0001). However, this was low practical significance, as measured by small ES (ES Cramer's V = 0.13; difference between farm and home sleeping sites was not statistically significant), and therefore represents a weak association between sleeping sites and the number of owned hammocks with flip over (Table 2). Among the respondents who self-reported to have slept in either the forest or on a farm, 301 (43.2%) participants elected to answer an extended component of the survey relating to net/hammock usage and preference while sleeping in their respective remote sites away from their village-based home. ...Similar publications
Abstract Background Insecticide-treated nets (ITNs) access-use has been pivotal monitoring indicator for malaria prevention and control, particularly in resource limited settings. The objective of the study was to compare ITN access-use based on universal household and population indicators and measures adapted to sleeping spaces. Methods A cross-s...
Objectives
To systematically review the literature on the unit cost and cost-effectiveness of malaria control.
Methods
Ten databases and gray literature sources were searched to identify evidence relevant to the period 2005 to 2018. Studies with primary financial or economic cost data from malaria endemic countries that took a provider, provider a...
Abstract Background Long-lasting insecticidal nets (LLINs) remain a cornerstone of malaria control, but strategies to sustain universal coverage and high rates of use are not well-defined. A more complete understanding of context-specific factors, including transmission intensity and access to health facilities, may inform sub-district distribution...
Background
Several studies that aim to enhance the understanding of malaria transmission and persistence in urban settings failed to address its underlining complexity. This study aims at doing that by applying qualitative and participatory-based system analysis and mapping to elicit the system’s emergent properties.
Methods
In two experts’ worksh...
Background
Malaria is transmitted when infected Anopheles mosquitoes take a blood meal. During this process, the mosquitoes inject a cocktail of bioactive proteins that elicit antibody responses in humans and could be used as biomarkers of exposure to mosquito bites. This study evaluated the utility of IgG responses to members of the Anopheles gamb...
Citations
... The researchers subsequently reviewed and finalized the translated version. Partially drawing from the malaria indicator survey of the World Health Organization (WHO) [30] and other relevant publications [13,26,31], the questionnaire comprised five parts, each with predefined choices from which the participants could select. ...
... For individuals who are unable to set up nets at their workplaces, the distribution of insecticidal hammock nets could be beneficial, especially given the low usage of mosquito repellents [46]. However, migrants typically exhibit reluctance in utilizing hammock nets [19,31]. ...
Background
Typically mobile and vulnerable, migrants face significant barriers to access to routine malaria prevention, diagnostics and treatment, which leads to unchecked malaria transmission, particularly in border regions with a high population displacement. This study aimed to investigate the demographic and socioeconomic obstacles to access to malaria services among Myanmar migrants residing in the Thailand–Myanmar border areas.
Methods
A cross-sectional study was conducted in early 2024 across three districts near the Thailand–Myanmar border. Quantitative data were collected from Myanmar migrants using standardized questionnaires through structured surveys. Data analysis included descriptive statistics and simple and multiple logistic regression models.
Results
Out of 300 participants, approximately a quarter (27.3%) reported adequate access to comprehensive malaria services, including prevention, diagnostics, treatment and malaria-related health information. In multiple logistic regression models, factors associated with inadequate access included Myanmar migrants aged over 60 years (aOR: 7.63, 95% CI 1.74–20.58), accompanied by one to three family members (aOR: 3.33, 95% CI 1.06–8.45), earning monthly incomes below 3000 THB (aOR: 5.13, 95% CI 1.38–19.09) and 3000 to 6000 THB (aOR: 3.64, 95% CI 1.06–12.51), belonging to the Karen ethnicity (aOR: 2.13, 95% CI 1.02–3.84), with poor perception toward malaria (aOR: 2.03, 95% CI 1.03–4.01) and with poor preventive and health-seeking practices (aOR: 5.83, 95% CI 2.71–9.55).
Conclusions
A significant proportion of Myanmar migrants encounter demographic and socioeconomic barriers to access to routine malaria services in Thailand. Tailored interventions are required to expand such access, including the recruitment of worksite health volunteers, strengthening the role of ethnic health organizations across the border and collaboration with private sector stakeholders (e.g. farm/company owners) to distribute preventive tools and ensure timely referral of suspected malaria cases to health facilities.
... For the subsequent elimination phase, besides incorporating prior objectives, all populations in active foci of malaria receive coverage to target early interruption of transmission. Before the introduction of LLINs and LLHNs in 2009 [34], the ITN that provides an outer protective layer, enveloping each person sleeping under one, was the most popular protective measure in Vietnam against mosquito bites [35]. Although LLINs are similar to ITNs, they differ in the scale of distribution to households, allowing for extensive coverage of communities residing in areas of transmission [27]. ...
Malaria is a potentially fatal infectious disease that poses a persistent global public health threat. The vast majority of mortality and morbidity in humans is the consequence of infection with either of two species of Plasmodium parasite, P. falciparum and P. vivax, that invade red blood cells. Transmission of these microscopic pathogens occurs via the bite of infectious female Anopheles spp. mosquitoes in tropical regions, including those neighboring the Mekong River. In response to widespread resistance to the first-line antimalarial drug artemisinin in Southeast Asia, in 2017 the World Health Organization launched the Mekong Malaria Elimination Program, aiming to coordinate and advance the six Greater Mekong Subregion countries towards malaria-free status by 2030. Vietnam has been particularly visionary, as long ago as 1991 implementing the National Malaria Control and Elimination Program to address the chronic burden of malaria outbreaks in the country’ southwest corner. Over time, epidemiological factors such as geography, socioeconomic status, and demographics have significantly influenced the stratification of malaria in the Mekong Delta. Therefore, it is imperative to conduct a comprehensive critical evaluation of the efficacy of the ongoing program by comparing national and regional perspectives. Over the past decade, Vietnam’s national program has demonstrated significant progress in achieving the globally established goals for malaria eradication. However, persistent challenges related to resource allocation, staffing by trained personnel, and financial support highlight the need for further improvement if the ambitious 2030 target of malaria elimination is to be met.
... Koenker et al. [21]. This result was consistent with that of Magloire et al. in Cameroon [33] and Sara et al. in Vietnam [35]. Additionally, Kim et al. used a human-centered design to determine consumer preferences for ITNs in Ghana and found that polyethylene ITNs were perceived as rough and warm, while polyester ITNs were perceived as softer and less warm [36]. ...
Introduction: The World Health Organization recommends insecticide-treated mosquito nets (ITNs) as one of the main interventions to control malaria spread. The leading driver of this intervention is use of ITN; however, socio-demographic characteristics factors, access and possession of ITN could also influence its usage. Therefore, the present study aimed to document the factors associated with using ITNs to eliminate malaria in Burkina Faso. This study's findings would be useful to the National Malaria Control Programme and other stakeholders engaged in the promotion of ITNs to fight malaria cases.
Methods: Data were collected from a quasi-experimental cross-sectional study in Burkina Faso. An analytical approach including a descriptive and an explanatory component was used. For the descriptive aspect of the analysis, possession, access, and use of ITNs were described. The factors associated with ITN use were assessed using univariate and multivariate binary logistic regression analyses, with the level of significance at 5%. The data were analyzed using Stata 16.1 software.
Results: The results of the saturated model showed that the type of textile of the IBD (polyester: odds ratio (OR) = 1.23; 95% confidence interval (CI) [1.13, 1.33]) and age of the IBD (6–11 months, OR = 0.91, 95% CI [0.83, 0.997]; ≥ 12 months OR = 0.52, 95% CI [0.401, 0.675]) are influential factors for the use of ITNs. On the other hand, the level of ITN possession (excessive ITNs; OR = 0.66; 95% CI [0.597, 0.74]) and the household poverty quintile showed a positive correlation with the use of ITNs (mean OR = 0.791, 95% CI [0.694, 0.902]; rich OR = 0.656, 95% CI [0.573, 0.751], and very rich OR, = 0.557, 95% CI [0.484,0.641]).
Conclusion: There is a strong association between ITN use, type of textile, age of ITNs and number of ITNs in possession. Strengthening health education on the benefits and importance of ITN use will improve the appropriate use of ITNs among the population of Burkina Faso.
... Current regional efforts to address this high-risk population of forest-goers include research on targeted chemoprophylaxis, vector control methods to target outdoor transmission such as insecticide-treated hammock nets, assessing and improving active surveillance, and efforts to understand zoonotic crossover of simian malaria including phylogenetic analysis and evaluating ecological associations, such as deforestation [3,6,14,15]. It is critical to identify additional details about subpopulations within these forest-going groups in order to tailor approaches in Indonesia and similar settings in Southeast Asia. ...
... The majority of forest-goers slept in a structure such as a barrack or hut when working in the forest, and only 17% reported using bed nets (one of whom used a hammock net). Studies in other countries in Asia Pacific have found hammock nets to be acceptable to forest-goers; hammock nets should be piloted in Aceh with close attention to acceptability, feasibility, and effectiveness [15,34]. There were large gaps in utilization of mosquito repellents and coils or wearing covering clothes (i.e., clothes that cover arms and legs). ...
Background
A major challenge to malaria elimination is identifying and targeting populations that are harbouring residual infections and contributing to persistent transmission. In many near-elimination settings in Southeast Asia, it is known that forest-goers are at higher risk for malaria infection, but detailed information on their behaviours and exposures is not available.
Methods
In Aceh Province, Indonesia, a near-elimination setting where a growing proportion of malaria is due to Plasmodium knowlesi, a case–control study was conducted to identify risk factors for symptomatic malaria, characteristics of forest-goers, and key intervention points. From April 2017 to September 2018, cases and controls were recruited and enrolled in a 1:3 ratio. Cases had confirmed malaria infection by rapid diagnostic test or microscopy detected at a health facility (HF). Gender-matched controls were recruited from passive case detection among individuals with suspected malaria who tested negative at a health facility (HF controls), and community-matched controls were recruited among those testing negative during active case detection. Multivariable logistic regression (unconditional for HF controls and conditional for community controls) was used to identify risk factors for symptomatic malaria infection.
Results
There were 45 cases, of which 27 were P. knowlesi, 17 were Plasmodium vivax, and one was not determined. For controls, 509 and 599 participants were recruited from health facilities and the community, respectively. Forest exposures were associated with high odds of malaria; in particular, working and sleeping in the forest (HF controls: adjusted odds ratio (aOR) 21.66, 95% CI 5.09–92.26; community controls: aOR 16.78, 95% CI 2.19–128.7) and having a second residence in the forest (aOR 6.29, 95% CI 2.29–17.31 and 13.53, 95% CI 2.10–87.12). Male forest-goers were a diverse population employed in a variety of occupations including logging, farming, and mining, sleeping in settings, such as huts, tents, and barracks, and working in a wide range of group sizes. Reported use of protective measures, such as nets, hammock nets, mosquito coils, and repellents was low among forest-goers and interventions at forest residences were absent.
Conclusions
Second residences in the forest and gaps in use of protective measures point to key malaria interventions to improve coverage in forest-going populations at risk for P. knowlesi and P. vivax in Aceh, Indonesia. Intensified strategies tailored to specific sub-populations will be essential to achieve elimination.
... WHO highly recommends using nets while sleeping, especially among the population in high-risk areas for malaria transmission. Apart from conventional untreated mosquito nets, there are two types of nets recommended by WHO-ITNs and LLINs [37]. ...
... The use of LLIN including insecticide-treated hammock net is one of the front-line interventions of global malaria prevention. Although few studies have found LLINs significantly prevent malaria, further study is critical to find out the comparative efficacy of this net [37]. ...
Malaria is the leading cause of death globally, especially in sub-Saharan African countries claiming over 400,000 deaths globally each year, underscoring the critical need for continued efforts to combat this preventable and treatable disease. The objective of this study is to provide statistical guidance on the optimal preventive and control measures against malaria. Data have been collected from reliable sources, such as World Health Organization, UNICEF, Our World in Data, and STATcompiler. Data were categorized according to the factors and sub-factors related to deaths caused by malaria. These factors and sub-factors were determined based on root cause analysis and data sources. Using JMP 16 Pro software, both linear and multiple linear regression were conducted to analyze the data. The analyses aimed to establish a linear relationship between the dependent variable (malaria deaths in the overall population) and independent variables, such as life expectancy, malaria prevalence in children, net usage, indoor residual spraying usage, literate population, and population with inadequate sanitation in each selected sample country. The statistical analysis revealed that using insecticide treated nets (ITNs) by children and individuals significantly decreased the death count, as 1,000 individuals sleeping under ITNs could reduce the death count by eight. Based on the statistical analysis, this study suggests more rigorous research on the usage of ITNs.
... The qualitative findings suggested that people were usually excluded from malaria prevention, mostly due to work-related activities despite expressing a willingness to use distributed LLINs. The use of LLINs in this group of individuals (farmers, gold miners, etc.) is usually low, as stated by studies in central Vietnam [30] and Myanmar [31]. When the possession of LLINs is high, the use of LLINs should be promoted in the community. ...
Different villages in a township or an area exhibit different malaria endemicities. This study aimed to investigate malaria preventive practices among people residing in different villages with stratified malaria endemicity in a township in Myanmar. Quantitative data were collected using standardized questionnaires by conducting face-to-face interviews, and qualitative data were obtained through in-depth interviews using a guideline. Quantitative data were analyzed using descriptive statistics and logistic regression models, whereas thematic analysis was used to visualize qualitative data. A total of 360 respondents with similar characteristics participated in the quantitative study. Knowledge regarding malaria and the availability of health information exhibited insignificant differences. Malaria preventive practices were considerably poor among people from moderate- and high-endemic villages (p < 0.05). Adult male farmers or gold miners with low annual family incomes reported poor preventive practices in both moderate- and high-endemic groups. People could not practice some malaria preventive measures because of a lack of resources, e.g., a lack of mosquito repellents. To eliminate the disparities of preventive practices in different malaria-endemic settings, heath-awareness-raising activities should be increased, especially in moderate- and high-endemic villages.
... Locations elsewhere striving to reduce forest malaria in southeast Asia can use chemoprophylaxis as a strategy, which the authors mention is already being rolled out on an emergency basis among forest goers in Cambodia and Laos, using artesunate-mefloquine and artesunate-pyronaridine, respectively. Emergency measures have furthermore enabled the widescale rollout of insecticide-treated hammock nets among forest goers, 8 and we recommend this mechanism enable the deployment of additional vector control interventions proven to be safe that could be efficacious outdoors. Implementation strategies can also be informed by this study, where the use of smart directly observed therapy, entailing observation of prophylaxis intake by a forest volunteer, enabled high levels of adherence (97% for artemether-lumefantrine and 98% for multivitamin through self-reporting, with similar results confirmed among a subset of participants on the basis of plasma lumefantrine and desbutyl-lumefantrine concentrations). ...
... Prevention measures such as LLINs and diagnosis and treatment kits can be made available closer to mining sites. Additionally, careful attention must be given to the design and material of LLINs and other vector control interventions, which play a significant role in user preferences and appear to drive net use [35]. In French Guiana, Malakit targets gold miners working illegally with free malaria self-diagnosis and self-treatment kits for P. falciparum [36]. ...
Background
Roraima state is the northernmost state in Brazil and the primary border-crossing point between Brazil and Venezuela. The uncontrolled surge of malaria in Venezuela, coupled with mass migration of Venezuelans to neighbouring countries and the upward trend in informal mining in the state, pose a serious threat to the broader region, especially to migrant, indigenous and mining populations, jeopardizing malaria elimination efforts. This study describes changes in the epidemiological profile of malaria in Roraima state related to time, place and populations at risk from 2016 to 2020.
Methods
De-identified malaria surveillance data were obtained from the Malaria Epidemiological Surveillance System from 2016 to 2020. Pearson’s chi-square tested differences between imported and autochthonous cases. Multivariable logistic regression was used to identify risk factors for imported versus autochthonous cases by demographic characteristics.
Results
Odds of being an imported case were higher for Plasmodium falciparum cases (AOR = 2.08). However, as the number of cases from Venezuela decreased in 2020 following closure of the border, the proportion of P. falciparum cases increased markedly, from 6.24% in 2019 to 18.50% in 2020. Over the 5-year period, the odds of being an imported case among miners were about nine times higher than the general population (AOR = 8.99). The proportion of total malaria cases that were among indigenous people increased from 33.09% in 2016 to 54.83% in 2020. Indigenous children had a higher burden of malaria with over 40% of cases in children 0 to 9 years old, compared to 8% in non-indigenous children 0 to 9 years old. In some municipalities, place of infection differed from place of notification, with a large proportion of cases in these municipalities reporting in Boa Vista.
Conclusions
Malaria remains a serious threat in Roraima state, especially among high-risk populations, such as miners, migrants, and indigenous people. As malaria cases have increased among indigenous people and miners, and the proportion of P. falciparum cases has increased, elimination efforts require understanding of these risk factors to tailor interventions appropriately. Furthermore, cross-border surveillance systems need to be urgently strengthened at formal and unofficial border points, especially since the border with Venezuela reopened in July 2021.
... Householder's perceptions of LLINs were clearly related to the physical characteristics of the LLINs with dirty LLINs and rough (polyester LLINs) were more likely to be discarded when damaged in this setting. User preference for polyester LLINs has been seen in other studies as they are softer to the touch: Tanzania [50], India and Nepal [51] Madagascar [52] and Vietnam [53]. It has been found in the discussion that older people with many people within household keep bed nets the longest. ...
Background
Between 2000 and 2019, more than 1.8 billion long-lasting insecticidal nets (LLINs) were distributed in Africa. While the insecticidal durability of LLINs is around 3 years, nets are commonly discarded 2 years post distribution. This study investigated the factors associated with the decision of users to discard LLINs.
Methods
A mixed-method sequential explanatory approach using a structured questionnaire followed by focus group discussions (FGDs) to collect information on experiences, views, reasons, how and when LLINs are discarded. Out of 6,526 households that responded to the questionnaire of LLINs durability trial, 160 households were randomly selected from the households in four villages in Bagamoyo Tanzania for FGDs but only 155 households participated in the FGDs. Five of the household representatives couldn’t participate due to unexpected circumstances. A total of sixteen FGDs each comprising of 8–10 adults were conducted; older women (40–60 years), older men (40–60 years), younger women (18–39 years), younger men (18–39 years). During the FGDs, participants visually inspected seven samples of LLINs that were “too-torn” based on Proportionate Hole Index recommended by the World Health Organization (WHO) guidelines on LLIN testing, the nets were brought to the discussion and participants had to determine if such LLINs were to be kept or discarded. The study assessed responses from the same participants that attended FGD and also responded to the structured questionnaire, 117 participants fulfilled the criteria, thus data from only 117 participants are analysed in this study.
Results
In FGDs, integrity of LLIN influenced the decision to discard or keep a net. Those of older age, women, and householders with lower income were more likely to classify a WHO “too-torn” net as “good”. The common methods used to discard LLINs were burning and burying. The findings were seen in the quantitative analysis. For every additional hole, the odds of discarding a WHO “too-torn” LLIN increased [OR = 1.05 (95%CI (1.04–1.07)), p < 0.001]. Younger age group [OR = 4.97 (95%CI (3.25–7.32)), p < 0.001], male-headed households [OR = 6.85 (95%CI (4.44 –10.59)), p < 0.001], and wealthy households [OR = 3.88 (95%CI (2.33–6.46)), p < 0.001] were more likely to discard LLINs.
Conclusion
Integrity of LLIN was the main determinant for discarding or keeping LLINs and the decision to discard the net is associated with socioeconomic status of the household, and the age and gender of respondents. WHO “too torn” nets are encouraged to be used instead of none until replacement, and disposal of nets should be based on recommendation.
... A set of factors relates to the acceptability or appropriateness of specific bed net characteristics. For certain populations, the uptake of ITNs relates to product features such as smell, colour, texture, size, or how the design of nets meets user preference and expectations, i.e. privacy, ease of use, type of material considering climatic conditions, and net size in relation to housing size and structures [16,[37][38][39][40][41][42][43][44]. In Southeast Asia, the standardized design and features of LLINs were found challenging for uptake by indigenous populations who make up the majority of at-risk populations in the remaining endemic areas. ...
... In Myanmar, ITN use was limited by the hard material of ITNs, the limited choice in net size to accommodate variable family sizes and sleeping places, and the inadequate height of the net for people to sit comfortably [46]. In Vietnam, limited ITN use was linked to hard netting [41], the design of ITNs that was uncomfortable for users who slept on the floor (without a bed), and limited choices for net size for varied family and house size [47,48]. These studies suggest a more appropriate ITN design and features that are better adapted to climatic conditions, variable family structures and sleeping places could increase the acceptance and appropriate use in minority populations. ...
... Despite this, the study findings are still relevant for Vietnam. The NMCP has continued to include ITN distribution as an important element of vector control in the elimination strategies to 2030, and recent studies in ethnic minority settings have continued to report on limited uptake of bed nets [41,47]. ...
Background
Despite freely distributed insecticide-treated nets (ITNs) and health information campaigns to increase their use among populations at risk, malaria transmission persists in forested areas in Vietnam, especially among ethnic minority communities. A mixed-methods study was conducted in four villages of Ca Dong and M’nong ethnicity in Central Vietnam between 2009 and 2011 to assess factors limiting the uptake of ITNs.
Methods
The mixed-methods research design consisted of a qualitative study to explore the context and barriers to ITN use, and a cross-sectional household survey (n = 141) to quantify factors for limited and appropriate net use.
Results
The Ca Dong and M’nong’s livelihood was dependent on swidden farming in the forest. Poverty-related factors, including the lack of beds, blankets, the practice of sleeping around the kitchen fire and deteriorated ITNs due to open housing structures, were reasons for alternative and non-use of ITNs. When household members stayed overnight in plot huts at fields, ITNs were even more unavailable and easily deteriorated. 72.5% of households reported having received one net for every two persons, and 82.2% of participants reported to have used ITNs the night before the survey. However, only 18.4% of participants were estimated to be effectively protected by ITNs after accounting for the availability of torn ITNs and the way ITNs were used, for example as blankets, at both village and fields. Multi-variable logistic regression showed the effect of four significant factors for appropriate ITN use: i) being female (AOR = 8.08; p = 0.009); ii) aware of mosquito bites as the sole cause of malaria (AOR = 7.43; p = 0.008); iii) not sleeping around the kitchen fire (AOR = 24.57; p = 0.001); and iv) having sufficient number of ITNs in the household (AOR = 21.69; p = 0.001).
Conclusion
This study showed how social factors rooted in poverty and swidden agriculture limited the effective use of ITNs, despite high coverage, among ethnic minority populations in Central Vietnam. An in-depth understanding of the local context is essential to develop specific indicators for measuring ITN use.
