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Epidemiology of malaria as it relates to utilization of insecticide treated nets among pregnant women and under five years children in South-South Nigeria

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Pregnant mothers and children under five years are exposed to malaria infection. One of the WHO recommendations on prevention of malaria is the use of insecticide treated nets (ITNs). The use of ITNs is still low in Nigeria. Is to access challenges and improvement on use of ITNs among pregnant mothers and care givers of children under five in Bayelsa, Delta and Rivers state respectively. Review of articles related to use of ITNs among pregnant mothers and under five years children were adopted using The American Journal of Human Genetics among 28 studies. Malaria is responsible for 30% childhood and 11% maternal mortality despite the availability on use of ITNs. ITNs were 62.8% effective in reducing febrile episodes and 84.1% effective in reducing marked levels of malaria parasitemia. Mass distribution of bed-nets has increase ownership of ITNs resulting to 81.5% in Nigeria. Free ITNs has resulted in universal household ownership but the use of the nets is still very low in Nigeria. Malaria interventions are threatened by pyrethroids used in all ITNs. Irritation and suffocation are challenges to utilization of ITNs. In health promotion on use of ITNs, manufacturers’ improvement on quality of ITNs is an epidemiological factor that could enhance the use among the vulnerable groups.
International Journal of Community Medicine and Public Health | October 2020 | Vol 7 | Issue 10 Page 4157
International Journal of Community Medicine and Public Health
Odoko JO et al. Int J Community Med Public Health. 2020 Oct;7(10):4157-4163
http://www.ijcmph.com
pISSN 2394-6032 | eISSN 2394-6040
Review Article
Epidemiology of malaria as it relates to utilization of insecticide treated
nets among pregnant women and under five years children in
South-South Nigeria
Joseph O. Odoko1*, Ezekiel U. Nwose2, Samuel D. Nwajei1, Emmanuel A. Agege1,
John E. Moyegbone1, Eunice O. Igumbor1
INTRODUCTION
The world success on malaria elimination has been
reported to be slowed compared to initial progress.1 There
was no much difference of global malaria cases between
2010 to 2018 despite malaria intervention availability.2
This is especially in Africa, and Nigeria in particular
where it is a major public health problem.3,4 Among the
vulnerable population to malaria infection are pregnant
women and children under 5-years. These are the
subpopulation groups who are exposed to malaria related
anemia that highly contributes to death if effective
intervention is not taken.5
The 2016 report indicate that 99% of malaria cases in
sub-Saharan Africa are caused by Plasmodium
falciparum, P. vivax is the common parasite.6 WHO
recommends use of long-lasting ITNs (LLINs);
intermittent preventive treatment in pregnancy (IPTp)
with sulfadoxine-pyrimethamine (SP) and prompt
diagnosis as well as effective treatment among pregnant
women during antenatal care services.7 Yet, malaria
interventions are threatened by resistance of malaria
vectors to pyrethroids used in all ITNs , which has been
on the increase from between 2010 and 2016.8 It is agreed
that to achieve universal ITN coverage, affected countries
with malaria infections need to subscribe to supportive
ABSTRACT
Pregnant mothers and children under five years are exposed to malaria infection. One of the WHO recommendations
on prevention of malaria is the use of insecticide treated nets (ITNs). The use of ITNs is still low in Nigeria. Is to
access challenges and improvement on use of ITNs among pregnant mothers and care givers of children under five in
Bayelsa, Delta and Rivers state respectively. Review of articles related to use of ITNs among pregnant mothers and
under five years children were adopted using The American Journal of Human Genetics among 28 studies. Malaria is
responsible for 30% childhood and 11% maternal mortality despite the availability on use of ITNs. ITNs were 62.8%
effective in reducing febrile episodes and 84.1% effective in reducing marked levels of malaria parasitemia. Mass
distribution of bed-nets has increase ownership of ITNs resulting to 81.5% in Nigeria. Free ITNs has resulted in
universal household ownership but the use of the nets is still very low in Nigeria. Malaria interventions are threatened
by pyrethroids used in all ITNs. Irritation and suffocation are challenges to utilization of ITNs. In health promotion on
use of ITNs, manufacturers’ improvement on quality of ITNs is an epidemiological factor that could enhance the use
among the vulnerable groups.
Keywords: Malaria epidemic, Global reports, ITNs, Mass distribution, Ownership, Utilization
1Department of Public and Community Health, Novena University, Ogume, Nigeria
2School of Community Health, Charles Sturt University, Orange, NSW Australia
Received: 19 June 2020
Revised: 06 August 2020
Accepted: 09 September 2020
*Correspondence:
Dr. Joseph O. Odoko,
E-mail: odokojosy@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20204390
Odoko JO et al. Int J Community Med Public Health. 2020 Oct;7(10):4157-4163
International Journal of Community Medicine and Public Health | October 2020 | Vol 7 | Issue 10 Page 4158
program to reach global malaria targets for 2020 and
beyond (Figure 1).6
Figure 1: Global malaria target for 2020-2030 relative
to 2015.
Adapted from ‘The E-2020 initiative of 21 malaria-eliminating
countries: 2019 progress report’.8
There has been decline in malaria infection in Africa due
to increase investment to eliminate malaria but sustaining
it has been a difficult issue for indigenous malaria cases
in African countries.9 WHO recommend one ITN for
every two people at risk of malaria; hence Nigeria has
been involved in free mass distribution of LLINs to
vulnerable populations.3 The renewed target for roll back
malaria (RBM) in Nigeria now includes to control
malaria with targeted key performance indices including
80.0% of children <5years and pregnant women to
use ITN.10
74% of ownership of ITNs in households through
mass distribution.11
Despite the evidence that the use of ITNs decreases
malaria related mortality and morbidity, its use is still low
as reported by the 2013 Demographic Health survey in
Nigeria.4 There is evidence that ITNs coverage or
ownership seems to have achieved the RBM target.
However, utilization is quite low and a far cry as most of
the owners are not utilizing their nets due to various
factors.12 A study to identify factors that are meant to be
eliminated for effective utilization of ITNs among
pregnant mothers and care givers of under five years
children in Bayelsa State, Delta State and Rivers State
within South-South Nigeria will go a long way to
influence stake holders in promoting the health of the
vulnerable population against malaria infection.
GLOBAL MALARIA CASES AND MORTALITY
Global report on malaria in 2015 indicates that malaria
infections were about 212 million cases and had caused
429,100 deaths. Majority of the affected populations are
more of children and pregnant mothers.13 In 2016, 91
countries experienced 216 million malaria cases, with 5
million cases higher than the previous year. The mortality
rate due to malaria was recorded at 445, 000 deaths which
was similar to figures reported in 2015.6 These indices
show that the global burden of malaria did not seem to be
a continuous or consistent declining trend in the past
decade. Indeed, the 2017 data appear worse than 2015
(Figure 2).5 It is acknowledged that cases of malaria
reduced globally between 2010 and 2018 from 71 to 57
cases per 1000 population at risk. That of 2014 to 2018
which was 57 cases 85% higher among 20 countries in
Africa Region and India.7,8
Figure 2: Numbers of malaria cases and deaths at
baseline, 2015 vs. 2017.
Figure 3: Increase in ITN distribution by healthcare
venue.
Prevention of malaria with use of ITNs
WHO recommends use of LLINs, IPTp and SP as well as
prompt diagnosis and effective treatment of malaria
% Reduction in case
incidence No of malaria-free
countries
40
10
75
20
90
35
2020 2025 2030
0%
1%
2%
3%
4%
5%
6%
7%
Immunization Public health
centres Antenatal
care
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International Journal of Community Medicine and Public Health | October 2020 | Vol 7 | Issue 10 Page 4159
infections as main stay among pregnant women during
antenatal care services.7 In 2016 intervention against
malaria infection with the use of ITNs shows that 54% of
people at risk of malaria in sub-Saharan Africa were
sleeping under it. This ITNs utilization rate is not near the
goal of universal access.6 Between 2016 and 2018, 578
million ITNs were distributed by producers worldwide,
out of which 50% went to Africa and India. The African
countries include Côte d’Ivoire, Democratic Republic of
Congo, Ethiopia, Ghana, Nigeria, Uganda and the United
Republic of Tanzania. Globally, 80% of ITNs were
distributed through mass distribution campaigns, 10% in
antenatal care facilities and 6% as part of immunization
programs (Figure 3).8
Challenges in progress of malaria control as it concerns
ITNs
Lack of sustainable and predictable international and
domestic funding, humanitarian crisis in malaria endemic
territories, poor climate conditions, emergence of parasite
resistance to antimalarial treatment and mosquito
resistance to insecticides are noticed in some countries.6
Malaria intervention are threatened by resistance of
malaria vectors to pyrethroids used in all ITNs, which has
been on the increase from between 2010 and 2016.8
Irrespective of the slow progress in elimination of
malaria, there is hope of progress and lessons to be learnt
in countries. For instance, Algeria in Africa is among the
few countries that have reported zero indigenous cases for
a minimum of two consecutive years (Figure 4), and are
certificated malaria free.5
Countries
2010
2011
2012
2013
2014
2015
2016
2017
2018
Paraguay
(America)
Algeria (Africa)
El Salvador
(America)
China (Western
Pacific)
Figure 4: Countries that have achieved malaria-free
status in ≥2 years.
Adapted from ‘The E-2020 initiative of 21 malaria-eliminating
countries: 2019 progress report’.
AFRICA: SUB-SAHARAN MALARIA CASES AND
MORTALITY
So much can be said of malaria in Africa e.g. 15 countries
in Sub-Saharan Africa responsible for about 80% of the
world malaria infection.3 Malaria has been identified for
decades as a public health problem in Sub-Saharan
Africa. It has caused a high rate of and death among
women of child bearing age and children under one year
old in Africa. One of the five highest deadly diseases in
Sub-Saharan Africa is malaria.14 According to the WHO
2017, there were 216 million cases of malaria in the
world and 445,000 deaths took place in 2016 of which
90% of the deaths occurred in Africa continent and 80%
of the reported case is from Sub-Saharan Africa. All ages
and sexes are affected by malaria, although low immunity
level among pregnant mothers and under five years
children has been an underlining factor responsible for
high rates of death.15 Plasmodium falciparum is the most
highly rated parasite over P. vivax that causes malaria
infection in Africa. In fact, WHO reported that
In every 50 seconds, a child dies of malaria hence a
constraint to socio-economic development.16
Malaria is wide spread among 76 countries in Africa
and Asia.8,17
In the 2019 global malaria report,19 countries in sub-
Saharan Africa and India contributed 85% of the
global burden. In other perspectives, Africa
contributed 93% (Table 1); while Nigeria is one of 6-
countries that accounted for 54% of all malaria cases
(Figure 5).7
Figure 5: Nigeria as most affected global cases.
Table 1: Global malaria cases according to WHO
report of 2019.
Year
Estimated
cases (millions)
95% CI
Estimates
2010
251
231 - 278
2017
231
211 - 259
2018
228
206 - 258
Distribution of occurrence of malaria-2018 cases
(%)
African region
93.0
South-East Asia
3.4
Eastern Mediterranean
2.1
Rest of World
1.5
Total
100.0
Nigeria
25%
DR Congo
12%
Uganda
5%
Cote
d'Ivoire
4%
Mozambiq
ue
4%
Niger
4%
Rest of
World
46%
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International Journal of Community Medicine and Public Health | October 2020 | Vol 7 | Issue 10 Page 4160
Policy on malaria prevention with the use of ITNs in
Africa
WHO in 1992 emphasize that ITNs is the best and
reliable preventive strategy against malaria burden.
Ghana as a signatory to the May 2006 Abuja Declaration.
As part of the objective of the RBM, agenda was to raise
ITNs ownership to 80% and utilization to 60% by 2010.
Further target set for 2015 was to achieve 100%
ownership and 80% usage.14
The WHO recommends utilization of ITNs as the main
strategy towards control of malaria by all ages and sexes.
Distribution of free ITNs should be the main intervention
in national malaria control strategy in all Sub-African
countries. WHO target of 85% coverage is a vital key
performance index to distribution of ITNs supply.
Adjunct to this recommendation is one ITN for every two
people who are at risk of malaria.3 The Abuja declaration
in 2000 by African leaders for the provision of 60% of
ITNs for African children by 2005 is yet to be achieved
by Sub-Saharan countries, despite their effort to meet
universal coverage.18 Most countries are below the set
target of protection coverage.16
Constraints and achievements in Malaria Control with
the use of ITNs in Africa
Funding of malaria programs by donors has been scarce
in Sub-Saharan African countries. Thus, making the fight
against malaria a difficult task. Poor awareness or
knowledge about malaria preventive measures, and
misunderstanding between couples on use of ITNs is
reported in previous investigations.19 Factors identified as
challenges for ownership ITNs include, but not limited
to:16
Awareness or knowledge: level of understanding on
use of bed nets,
Demographic factors: age, sexes, marital status, and
occupation
Access to healthcare: distance to nearest antenatal
care,
Affordances: access and cost including availability of
transport as well as house-hold size
Studies from Africa reveal that ownership of bed nets
cannot be interpreted as utilization of the ITNs. The latter
makes it far from meeting the target of universal
coverage. Utilization of ITNs has been reported to be as
low as 9.6%. Reasons for non-utilization of ITNs in
Africa are perceived un-comfortability and hotness
created by ITNs, low understanding of malaria
prevention. Inadequate separate sleeping rooms, poor
quality of ITNs and inadequate ITNs to the house hold
members.14
The issue of poor quality underpins failure rates. Re-
emergence of malaria has been experienced in Senegal,
Western Kenya, Gambia, Benin, Tanzania and Uganda
where ITNs have been utilized. These situations warrants
the need to study the main challenge of resistance to ITNs
of the mosquitoes that causes malaria.20 In Sub-Saharan
Africa, it is estimated that the population of users of ITNs
have gone up from less than 2% in 2000 to 67% in 2015.
Modification of nets into pyrethroid treated bed nets has
help to reduce vector increase, number of infection rates
in Anopheles populations leading to decline in malaria-
associated cases and death rates in African countries.20
However, the study in Benin, Equatorial Guinea and
Malawi have shown that distribution and utilization of
new ITNs provide more advantages to reduce malaria
burden despite pyrethroid ITNs resistance than use of old
ITNs.21 Therefore, it must be acknowledged that
regardless of poor quality, ownership and utilization of
the available ITNs is a sine qua non.
NIGERIA: MALARIA CASES AND MORTALITY
Epidemiology on utilization of ITNs among pregnant
mothers and under five children in Nigeria
Nigeria is among 11 countries that account for 70% in the
world malaria deaths rate.22 Malaria is a major public
health problem in Nigeria and it is responsible for 30%
childhood and 11% maternal mortality, despite the
availability of effective interventions.4 100% of the
Nigerian populations are at risk of malaria infection.
Nationally, the malaria burden accounts for 60% of
outpatient visits to health facilities.23 Malaria infection is
endemic in Nigeria, and everybody is at risk with a
prevalence of 919 per 10,000 (9%) of population.10
Nigeria leads other ten African countries with a high
burden of malaria and accounted for 25% of total malaria
cases (Figure 5), and 19% of malaria deaths worldwide in
2017.24
According to the statistics of the Nigerian National
Malaria Control program, the burden of malaria includes
60% of outpatient visits to health facilities (Figure 6); and
an estimated annual loss of 132 billion Naira in the form
of treatment and prevention costs, and loss of man-hours,
amongst other losses.25 The geographic spread of the
malaria burden is heterogeneous in the country, with the
highest prevalence among children ages 6 to 59 months in
the North Central, North East and North West regions,
and the lowest prevalence in the South East region.23
Policy of malaria prevention on use of ITNs in Nigeria
The Government of Nigeria, through the National Malaria
Elimination Programme (NMEP) and in collaboration
with partners, is scaling up malaria prevention and
treatment interventions in line with the goals of the
National Malaria Strategic Plan (NMSP) 2014-2020.
NMEP employs a mixed-model approach for ITN
distribution that includes free mass distribution
campaigns and continuous distribution of ITNs to
supplement the mass campaigns. Continuous distribution
relies on several routine health service delivery channels:
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immunization campaigns; antenatal care (ANC); the
integrated maternal, newborn, and child health week;
school-based distribution; community-based distribution;
and, distribution through the commercial sector.23 as
previously indicated in the narrative (Figure 3), the
majority of households receive free ITNs from different
venues and through mass distribution campaigns.23
For instance, the Rivers State government of Nigeria has
distributed more than two million nets, during the
Immunization Plus days, and stand-alone campaigns, in
its effort to meet the target of providing two ITNS per
household in the State. Although, the usage of the nets is
still very poor.25 Another report indicates high proportion
of households in two other states (87% in Bauchi and
72% in Cross River) had at least one ITN during mass
distribution between 2010 and 2011.26
Figure 6. Statistics of malaria burden in Nigeria.25
Challenges in malaria control with the use of ITNs in
Nigeria
Despite the common occurrence of malaria during
pregnancy, there was a limited knowledge and use of
recommended anti-malarial intervention by women
attending antenatal clinics. Many pregnant women who
due to poverty and/or lack of education do not go for
antenatal care and have no access to preventive malaria
care. These categories of women may present when the
disease is severe. Inconsistent and/or inappropriate use of
bed-nets has been reported to be a challenge.4 In Rivers
State, it was discovered that a large proportion of the nets
were not used over beds and mattresses, but as screens for
windows and doors; probably to escape the discomfort
from heat that is a common complaint amongst users of
the net.25
Further, the more disadvantaged households were less
likely to have a ITN,26 and only one-third of those who
owned bed-nets slept under the net during the night
preceding the survey, thus, highlighting the alarming gap
between net ownership and utilization. The most common
reason, given for not using the nets was suffocation or hot
condition due to lack of proper air circulation in the net.
This has largely been attributed to the hot tropical climate
of the sub-Saharan African region and agrees with
findings from other studies done in different African
countries where low bed net utilization has been
reported.27
Expectation of progress in malaria control with use of
ITNs
The efficacy and cost effectiveness of ITN in reducing
malaria has led to free or highly subsidized ITN to
pregnant women and under five children. Following the
recommendation by the WHO, the ITNs distributed by
the National Malaria Elimination Programme have been
LLIN brands. Household ownership of at least one LLIN
in Nigeria increased from 44% in 2010 to 69% in 2015.
This was the result of routine and periodic mass
distribution for rapid scale-up of LLINs in the
communities.24 ITNs coverage or ownership seems to
have achieved the RBM target.
Reports have indicated that sleeping regularly under ITNs
is the most effective way to prevent malaria among
children and that ITN was 62.8% success in reducing
febrile episodes, but more effective in reducing marked
levels of malaria parasitaemia.10
However, utilization is quite low and a far cry as most of
the owners are not utilizing their nets. Previous study
report shows that patient experience of discomfort, heat,
irritation and suffocation limits utilization, while
affordances and quality are further barriers to utilization.
It behooves on ITNs manufactures to improve the quality
of nets, while healthcare workers and government
agencies vigorously increase the campaign of creating
more awareness on how best to use the ITNs among
pregnant mothers.12
Figure 7: Effectiveness of ITNs in reducing febrile
episode vs mal parasitaemia.10
DISCUSSION
The objective of this epidemiological narrative review is
to articulate what is known regarding challenges and
0%
10%
20%
30%
40%
50%
60%
Outpatient Childhood
death Infant death Maternal
death
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Malaria parasitaemia Febrile episodes
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necessary improvement on use of ITNs among pregnant
mothers and care givers of children. The main aim of
developing strategies to prevent malaria infection is
because of evidence of high rate of malaria cases and
mortality in the world. Global malaria data released in
2019 indicate public health epidemiology that requires
concerted and enhanced effort to improve the situation,
especially in Nigeria that contributes a quarter of the
world’s burden. This is regardless of global report
indicating that progress in controlling malaria infection
has been stalled.28
Identified slow progress on malaria elimination is due to
factors such as poor funding in investment of malaria
control by many donor countries and agencies, emerging
of resistance to malaria commodities such as pyrethroid
ITNs by malaria vectors, poor attitude to effective
utilization of insecticide nets by owners of bed nets,
inadequate distribution of nets to vulnerable groups such
as pregnant mothers and children under five years. World
Health Organization best recommended strategy for
prevention of malaria is adoption of use of LLINs, and
two doses of SP for pregnant mothers and children under
five years.
Universal coverage on use of ITNs has been low due to
poor utilization by those who owns the nets encouraging
increase of malaria infection. Poor use of ITNSs increases
incidences of malaria episode, maternal and fetal anemia,
placental parasitemia, low birth weight and neonatal
mortality. Therefore, various State government should
contribute immensely for continuous distribution of ITNs
at various household and rigorous health education on
utilization to be the watch guide to health workers. This
translates to potential health promotion strategy of
monitoring pregnant mothers as well as care-givers to
change their attitude in the use of LLINs. By further
interpretation, antenatal clinics and immunization sites
constitute one of the avenues for such health promotion
vis-à-vis educational campaign.
CONCLUSION
As a result of various factors that have been a hindrance
to effective utilization of ITNs, WHO and regional
leaders should sustain the policy of free distribution of
nets to households. Perhaps, lessons need to also be learnt
from countries like Algeria and Paraguay that have
achieved malaria-free status. While manufacturers need to
improve on the quality of their products, monitoring of
utilization of the distributed nets is a sine qua non to
progress towards malaria-free target.
ACKNOWLEDGEMENTS
Author acknowledged all staff and research scholars of
department of public and community health, Novena
University, Ogume, Delta State as well as the Provost and
colleagues at Bayelsa State College of Health Technology
for their contributions towards the success of this work.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: Not required
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Cite this article as: Odoko JO, Nwose EU, Nwajei
SD, Agege EA, Moyegbone JE, Igumbor EO.
Epidemiology of malaria as it relates to utilization of
insecticide treated nets among pregnant women and
under five years children in South-South Nigeria. Int
J Community Med Public Health 2020;7:4157-63.
... With particular reference to malaria issue in South-South Nigeria, previous review has indicated the need for health promotion among all stakeholders on use of ITNs [13]. In line with the a recent narrative review [5], there are consistent reports that Nigeria contributes the highest proportion of malaria incidents relative to other countries ( Figure 1). Therefore, while there have been several studies on malaria at different localities [6][7][8][9], there is on-going need to evaluate landmark achievements. ...
... Attributions of malaria burden and prevalence in Nigeria[5,10]. ...
... Epidemiology is the study of determinants and distribution of diseases occurring in human population and it revolves around the questions of who, where, when, what and how about a disease. This has been a special theme of focus of research work in the department of department of public and community of the university [1][2][3][4]. ...
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Background: The long-lasting insecticidal nets (LLIN) are effective against prevention of malaria and its utilization has been proven to save lives. Despite the mass distribution of LLIN, Nigeria remains the country with the highest malaria burden in Africa. The awareness of LLIN in Nigeria is high, but the utilization is low. The aim of this work is to describe factors associated with the utilization of LLIN among women of child-bearing age (WCBA) in Igabi, Kaduna, Nigeria. Methods: A cross-sectional survey was conducted among 630 WCBA selected using a multi-stage sampling at 63 randomly selected villages in Igabi Local Government Area of Kaduna State. Trained female data collectors administered pre-tested structured questionnaires adapted from the Malaria Indicator Survey. Information collected were demographic profile, knowledge of LLIN as a preventive strategy for malaria, and LLIN ownership and utilization. LLIN utilization was assessed by identifying household members that slept under the hanged LLIN the night before the survey. Questions on the awareness of LLIN, ability to define what it is, use of LLIN, what differentiates LLIN from other bed nets, and duration of use before replacement, were scored and categorized as good, average and poor knowledge of LLIN. Results: A total of 629 WCBA was sampled, their mean age (± SD) was 29.3 (± 6.2) years, 22.0% were pregnant, 40.5% had no formal education, 41.1% were employed, and 47.7% lived in rural communities. Awareness and good knowledge about LLINs for the prevention of malaria was 96.0% and 24.0%, respectively. The proportion of women who slept under a LLIN the night before the survey (utilization) was 70.0% and slightly higher (74.0%) among pregnant WCBA. Women who lived in rural communities were more likely to utilize LLINs compared to their urban counterparts (OR 3.4; 95% CI 2.3-4.9). Younger women (aged < 30 years) were less likely to utilize LLINs compared to the older women (OR 0.7; 95% CI 0.5-0.9). Conclusions: The knowledge of LLIN among WCBA was poor, but LLIN utilization was moderate. Living in rural communities and older WCBA were significant characteristics associated with LLIN utilization. Strategies that will improve the utilization of LLIN among the young and urban WCBA should be the focus of the Malaria Elimination Programme (MEP).
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Background To reduce the malaria burden in Nigeria, the country is scaling up prevention and treatment interventions, especially household ownership and use of insecticide-treated nets (ITNs). Nevertheless, large gaps remain to achieve the goals of the National Malaria Strategic Plan 2014–2020 of universal access to ITNs and their increased use. To inform the targeting of intervention strategies and to maximize impact, the authors conducted a sub-national profiling of household ITN ownership and use in the general population to identify key predictors of ITN ownership and use, and the sub-groups that are at higher risk of low ITN coverage and use. Methods The authors conducted a secondary analysis of data from the 2015 Nigeria Malaria Indicator Survey. Using the Chi square automatic interaction detector (CHAID) and multiple logistic regression analysis, the authors examined the key predictors of ITN ownership and use in the general population throughout Nigeria. Results The CHAID models identified region of the country as the best predictor of household ownership of at least one ITN and its use in the general population, with higher ownership and use observed in the northern regions. The odds of a household owning an ITN were five times greater in the North West region compared with the North Central region (odds ratio [OR] = 5.47, 95% confidence interval [CI] 4.46–6.72, p < 0.001). The odds of ITN use were two times greater for those living in the North West region compared with the North Central region (OR = 2.04, 95% CI 1.73–2.41, p < 0.001). Other significant predictors were household size, head of household education level, household wealth quintile, and place of residence. The CHAID gain index results identified households in the South West, North Central and South Central regions with low ITN ownership, and the general population in the South South, South East and North Central regions with low ITN use. Conclusions This study reveals regional differences in ITN ownership and use in Nigeria. Therefore, the findings from this analysis provide evidence that could inform the NMEP to better target future campaign and routine distribution of ITNs, to achieve universal access and increased use by 2020 in Nigeria.
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Background: Malaria causes significant morbidity and mortality each year. In the past few years, the global malaria cases are declining and endemic countries are heading towards malaria elimination. Nevertheless, reducing the number of cases seems to be easy than sustained elimination. Therefore to achieve the objective of complete elimination and maintaining the elimination status, it is necessary to assess the gains made during the recent years. Main text: With inclining global support and World Health Organisation (WHO) efforts, the control programmes have been implemented effectively in many endemic countries. Given the aroused interest and investments into malaria elimination programmes at global level, the ambitious goal of elimination appears feasible. Sustainable interventions have played a pivotal role in malaria contraction, however drug and insecticide resistance, social, demographic, cultural and behavioural beliefs and practices, and unreformed health infrastructure could drift back the progress attained so far. Ignoring such impeding factors coupled with certain region specific factors may jeopardise our ability to abide righteous track to achieve global elimination of malaria parasite. Although support beyond the territories is important, but well managed integrated vector management approach at regional and country level using scrupulously selected area specific interventions targeting both vector and parasite along with the community involvement is necessary. A brief incline in malaria during 2016 has raised fresh perturbation on whether elimination could be achieved on time or not. Conclusions: The intervention tools available currently can most likely reduce transmission but clearing of malaria epicentres from where the disease can flare up any time, is not possible without involving local population. Nevertheless maintaining zero malaria transmission and checks on malaria import in declared malaria free countries, and further speeding up of interventions to stop transmission in elimination countries is most desirable. Strong collaboration backed by adequate political and financial support among the countries with a common objective to eliminate malaria must be on top priority. The present review attempts to assess the progress gained in malaria elimination during the past few years and highlights some issues that could be important in successful malaria elimination.
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Introduction Insecticide treated bed net (ITN) is one type of cost-effective vector control approach for the prevention of malaria. It has to be treated with insecticide and needs ongoing treatment with chemicals. Malaria infcetion during pregnancy is a amajor health problem in Ethiopia. Little is known about the utilization of ITN by pregnant women in the study area. This study was aimed to assess utilization and associated factors of insecticide-treated nets among pregnant women in Adis Zemen Hospital. Methods This hospital based cross-sectional study was conducted in Adis Zemen from May 1 to 30, 2018, among 226 pregnant mothers. After obtaining informed consent, data were collected using a pretested structured questionnaire via face to face interview. To reach the study unit, a systematic random sampling technique was used. The collected data were entered, cleaned, checked using Epi data version 3.1, and finally analyzed using SPSS version 20. Binary and multivariable logistic regressions were computed to identify significantly associated variables at 95% confidence interval. Result A total of 226 pregnant mothers attending antenatal clinics participated in making the response rate 100%. Among a total 226 subjects, 160(70.8%) of mothers had good utilization of insecticide bet net. Mothers who had an educational status of college and above were 2.8 times more likely to utilize insecticide-treated bed net than mothers who could not read and write (AOR; 2. 8: CI; 1.9, 6.5). Mothers whose age was >30 were 70% times less likely utilized insecticide-treated bed net than mothers whose age was 30 and less (AOR;.3: CI;.2,.6). Conclusion and Recommendation Utilization of insecticide-treated bed net by pregnant women is low in the study area. The participants' age, educational status, household monthly income, and husband educational status were significantly associated with utilization of insecticide-treated bed net. Different stakeholders shall give a special attention to awareness creation on advantageous of insecticide bed net.
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Background Malaria contributes significantly to under-5 morbidity and mortality in Sub-Saharan African countries including Nigeria. The rollback malaria (RBM) initiative and millennium developmental goal 6 are the programs targeted at reduction in malaria burden. The target year here is 2015; it would be needful to determine the impact of these programs on lives of at-risk population. Objectives To determine caregivers’ perception and utilization of insecticide-treated mosquito net (ITN) for their children/wards under 5 years of age. Methods It was a cross-sectional, descriptive, hospital-based study conducted at Federal Teaching Hospital, Abakaliki, between April 1, 2014, and October 31, 2014. A structured questionnaire was used to assess caregivers’ perception and utilization of ITN. Relevant information collected from the respondents included awareness of what ITN is and its use, ownership, source and utilization of ITN, and frequency of antimalaria use for febrile episodes. Data were analyzed using Statistical Package for the Social Sciences (SPSS) Windows Program (SPSS Inc., Chicago, IL, USA) version 20.0 while the level of statistical significance was set at P < 0.05. Results A total of 410 caregivers were interviewed; 362 (88.3%) were mothers. Three-hundred and eighty-four (93.7%) participants knew that ITN prevents mosquito bite that cause malaria infection, 81.2% (333/410) have at least one ITN in their homes, but only 215 (52.4%) use the ITN every night. Caregivers who used ITN regularly used antimalaria for their under-5 quarterly (34.9%) and rarely (33.9%). A significant relationship existed among socioeconomic class, knowledge of ITN, source of knowledge of ITN, frequency of anti-malaria use, and utilization of ITN. Conclusion The study observed that awareness and ownership of ITN are high among study participants, but its utilization was suboptimal compared to RBM target for 2010 (80.0%). Health education and free distribution of ITNs should be further strengthened particularly among mothers of childbearing age and younger children.
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Background: There has been a roll back mosquito (RBM) program in Nigeria. This study was carried out to determine the effectiveness and utilization of insecticide treated nets (ITNs) among pregnant women in Bayelsa State, Nigeria.Methods: A descriptive survey design was used to assess usage and patient experience. A total of 250 completed survey were returned out of 260 questionnaires distributed. Statistical analysis was in frequency counts and percentages.Results: Over 55% of respondents are aware that the best way to prevent malaria in pregnancy is to always sleep in ITNs. 20% of the respondents lack ITNs due to non-availability in the clinic or unaffordability in the market. Among those that own ITNs, only 31% utilize it every day. Suffocation and skin irritation were reasons for non-utilization. On effectiveness, among those who use their ITNs, 24.3% never suffered malaria or mosquito bite.Conclusions: ITNs utilization seems to have reached the RBM target. However, the study shows patient experience that use of ITNs seems to have limited effectiveness in prevention of malaria during pregnancy, while affordances and quality are barriers to utility. Ministry of Health and especially antenatal and community healthcare workers need to intensify health education campaign to improve attitude and practice of ITNs utility among pregnant mothers. Manufacturers of ITNs also need to improve on the quality of ITNs to reduce skin irritation or suffocation in order to encourage usage among pregnant mothers.
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In most parts of sub-Saharan Africa, malaria is still the most important vector borne disease, severely affecting people´s lives and causing economic loss. Malaria vector control to date almost exclusively relies on long lasting insecticide treated nets (LLINs) and indoor residual spraying (IRS), while other approaches such as larviciding are less implemented. Rising resistances against commonly used insecticides and changes in vector behavior and genetics slow down further reductions in malaria transmission. There is an urgent need for the implementation of additional approaches to appropriately react to vector adaptations. One promising option is the targeting of vector larvae with biological larvicides. During a three-year field trial (EMIRA – Ecologic Malaria Reduction for Africa), evidence was generated on the feasibility, effectiveness, acceptability, and cost of biological larviciding in North-Western Burkina Faso. Here, possible ways on how to further increase cost effectiveness and community support for future programs are presented. Reducing the need for frequent retreatment of vector larvae habitats is a major cost saver for material and workforce. Additional expenditure reductions could be achieved through targeting multiple disease vectors, which in some cases share vector breeding and resting sites. Due to limited overlap in mosquito breeding preference, major cost savings are expected to originate in infrastructural synergy effects. The development of new approaches to further cut down program costs could be a powerful contributor to promote vector larvae control and techniques that target several diseases at once.
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Introduction Malaria remains one of the top five killer diseases in sub-Saharan Africa (SSA) and its burden is skewed towards pregnant women and children under five. Insecticide Treated Bed-Net (ITN) usage is considered one of the most cost-effective, preventive interventions against malaria. This study sought to assess ownership, usage, effectiveness, knowledge, access and availability of ITNs among mothers with children under five in the Hohoe municipality. Methods In August 2010 a cross-sectional survey was carried out in 30 communities, selected using the WHO 30 cluster sampling technique. In the selected communities, mothers/caregivers with children under five years were selected using the snowball method. Data were collected through questionnaires and direct observation of ITN. Descriptive statistics was used to analyse the data collected. Results A total of 450 mothers/caregivers were interviewed and their mean age was 30 ± 7 years. ITN ownership was 81.3%, and usage was 66.4%. The majority (97.8%) of the mothers/caregivers said ITNs were effective for malaria prevention. Awareness about ITNs was high (98.7%) and the majority (52.9%) had heard about ITNs from Reproductive and Child Health (RCH) Clinic and antenatal care ANC clinic (33.6%). Over 60% of the ITNs were acquired through free distribution at RCH clinics, clinic and home distribution during mass immunization sessions. The majority of the mothers/caregivers (78.6%) knew the signs and symptoms of malaria, what causes malaria (82.2%) and who is most at risk (90%). Conclusion Behaviour change communication strategies on ITN use may need to be further targeted to ensure full use of available ITNs.