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Factors Associated with Correct and Consistent Insecticide Treated Curtain Use in Iquitos, Peru.

ABSTRACT: Dengue is an arthropod-borne virus of great public health importance, and control of its mosquito vectors is currently the only available method for prevention. Previous research has suggested that insecticide treated curtains (ITCs) can lower dengue vector infestations in houses. This observational study investigated individual and household-level socio-demographic factors associated with correct and consistent use of ITCs in Iquitos, Peru. A baseline knowledge, attitudes, and practices (KAP) survey was administered to 1,333 study participants, and ITCs were then distributed to 593 households as part of a cluster-randomized trial. Follow up KAP surveys and ITC-monitoring checklists were conducted at 9, 18, and 27 months post-ITC distribution. At 9 months post-distribution, almost 70% of ITCs were hanging properly (e.g. hanging fully extended or tied up), particularly those hung on walls compared to other locations. Proper ITC hanging dropped at 18 months to 45.7%. The odds of hanging ITCs correctly and consistently were significantly greater among those participants who were housewives, knew three or more correct symptoms of dengue and at least one correct treatment for dengue, knew a relative or close friend who had had dengue, had children sleeping under a mosquito net, or perceived a change in the amount of mosquitoes in the home. Additionally, the odds of recommending ITCs in the future were significantly greater among those who perceived a change in the amount of mosquitoes in the home (e.g. perceived the ITCs to be effective). Despite various challenges associated with the sustained effectiveness of the selected ITCs, almost half of the ITCs were still hanging at 18 months, suggesting a feasible vector control strategy for sustained community use.

SUBMITTER: Paz-Soldan VA

PROVIDER: S-EPMC4788147 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Factors Associated with Correct and Consistent Insecticide Treated Curtain Use in Iquitos, Peru.

Paz-Soldan Valerie A VA Bauer Karin K Morrison Amy C AC Cordova Lopez Jhonny J JJ Izumi Kiyohiko K Scott Thomas W TW Elder John P JP Alexander Neal N Halsey Eric S ES McCall Philip J PJ Lenhart Audrey A

PLoS neglected tropical diseases 20160311 3

Dengue is an arthropod-borne virus of great public health importance, and control of its mosquito vectors is currently the only available method for prevention. Previous research has suggested that insecticide treated curtains (ITCs) can lower dengue vector infestations in houses. This observational study investigated individual and household-level socio-demographic factors associated with correct and consistent use of ITCs in Iquitos, Peru. A baseline knowledge, attitudes, and practices (KAP) s ...[more]

PMID: 26967157

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Project description:Dengue is one of the most important vector-borne diseases, resulting in an estimated hundreds of millions of infections annually throughout the tropics. Control of dengue is heavily dependent upon control of its primary mosquito vector, Aedes aegypti. Innovative interventions that are effective at targeting the adult stage of the mosquito are needed to increase the options for effective control. The use of insecticide-treated curtains (ITCs) has previously been shown to significantly reduce the abundance of Ae. aegypti in and around homes, but the impact of ITCs on dengue virus (DENV) transmission has not been rigorously quantified. A parallel arm cluster-randomized controlled trial was conducted in Iquitos, Peru to quantify the impact of ITCs on DENV seroconversion as measured through plaque-reduction neutralization tests. Seroconversion data showed that individuals living in the clusters that received ITCs were at greater risk to seroconverting to DENV, with an average seroconversion rate of 50.6 per 100 person-years (PY) (CI: 29.9-71.9), while those in the control arm had an average seroconversion rate of 37.4 per 100 PY (CI: 15.2-51.7). ITCs lost their insecticidal efficacy within 6 months of deployment, necessitating re-treatment with insecticide. Entomological indicators did not show statistically significant differences between ITC and non-ITC clusters. It's unclear how the lack of protective efficacy reported here is attributable to simple failure of the intervention to protect against Ae. aegypti bites, or the presence of a faulty intervention during much of the follow-up period. The higher risk of dengue seroconversion that was detected in the ITC clusters may have arisen due to a false sense of security that inadvertently led to less routine protective behaviors on the part of households that received the ITCs. Our study provides important lessons learned for conducting cluster randomized trials for vector control interventions against Aedes-transmitted virus infections.

Project description:IntroductionLong-term disease surveillance data provide a basis for studying drivers of pathogen transmission dynamics. Dengue is a mosquito-borne disease caused by four distinct, but related, viruses (DENV-1-4) that potentially affect over half the world's population. Dengue incidence varies seasonally and on longer time scales, presumably driven by the interaction of climate and host susceptibility. Precise understanding of dengue dynamics is constrained, however, by the relative paucity of laboratory-confirmed longitudinal data.MethodsWe studied 10 years (2000-2010) of laboratory-confirmed, clinic-based surveillance data collected in Iquitos, Peru. We characterized inter and intra-annual patterns of dengue dynamics on a weekly time scale using wavelet analysis. We explored the relationships of case counts to climatic variables with cross-correlation maps on annual and trimester bases.FindingsTransmission was dominated by single serotypes, first DENV-3 (2001-2007) then DENV-4 (2008-2010). After 2003, incidence fluctuated inter-annually with outbreaks usually occurring between October and April. We detected a strong positive autocorrelation in case counts at a lag of ∼ 70 weeks, indicating a shift in the timing of peak incidence year-to-year. All climatic variables showed modest seasonality and correlated weakly with the number of reported dengue cases across a range of time lags. Cases were reduced after citywide insecticide fumigation if conducted early in the transmission season.ConclusionsDengue case counts peaked seasonally despite limited intra-annual variation in climate conditions. Contrary to expectations for this mosquito-borne disease, no climatic variable considered exhibited a strong relationship with transmission. Vector control operations did, however, appear to have a significant impact on transmission some years. Our results indicate that a complicated interplay of factors underlie DENV transmission in contexts such as Iquitos.

Project description:BackgroundMalaria is a leading cause of outpatient visits and deaths among children in Guinea. Despite several mass distribution campaigns of insecticide-treated nets (ITNs) in Guinea, ITN ownership and use remain low. Identifying the underlying factors affecting household ITN ownership and ITN usage among those with access will allow the Guinea National Malaria Control Programme to develop targeted initiatives to improve bed net ownership and usage.MethodsTo understand national and regional drivers of ITN ownership and use, multivariable binary logistic regression models were applied to data from the 2018 Demographic and Health Survey to identify risk factors of household ITN ownership and risk factors of ITN use among individuals with access. Akaike Information Criterion (AIC) was used for model parameter selection. Odds ratios were estimated with corresponding 95% confidence intervals.ResultsThe proportion of households in Guinea with at least one ITN was 44%, ranging from a low of 25% in Conakry to a high of 54% in Labé. Use of ITNs among those with access was 66.1% nationally, ranging from 35.2% in Labé to 89.7% in N'zérékoré. Risk factors for household ITN ownership were household size, marital status of the household head, education level of the household head, and region. For ITN use among those with access, risk factors were age, wealth quintile, marital status, and region. In the seven regions of Guinea and capital of Conakry, risk factors for household ITN ownership were household size in Boké, Faranah, and Kankan; education level of the household head in Boké, Faranah, and N'zérékoré; age of the household head in Conakry and Labé; children under five in the household in Kankan; and wealth quintile in Mamou. For ITN use among those with access, risk factors were marital status in Conakry, Faranah, Kindia, Labé, Mamou, and N'zérékoré; place of residence in Labé; children under five in the household in Labé; wealth quintile in Mamou; and age in Faranah and N'zérékoré.ConclusionsThis analysis identified national and region-specific factors that affect ownership and use among those with access in Guinea. Future ITN and social-behavioural change campaigns in Guinea may particularly want to target larger households, households without children, and areas with lower perceived risk of malaria if universal coverage and usage are to be achieved for optimal malaria prevention.

Project description:BackgroundEven though malaria is preventable, it remains the leading cause of under-five morbidity and mortality in low-and middle-income countries. Despite the World Health Organization (WHO) recommendations, its advantage, and its free-of-cost access, the utilization of insecticide-treated nets (ITN) is still low in East Africa. Therefore, this study aimed to assess ITN use and associated factors among households having under-five children in East Africa.MethodsThe most recent Demographic and Health Survey (DHS) datasets of East African countries were used. A total of 174,411 weighted samples was used for analysis. Given the hierarchical nature of DHS data, a multilevel binary logistic regression model was fitted to identify factors associated with ITN use. Four models were fitted and a model with the lowest deviance value was chosen as the best-fitted model for the data. Variables with a p-value < 0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel binary logistic regression analysis, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) was reported to declare the statistical significance and strength of association.ResultsIn this study, the proportion of ITN use among households having under-five children in East Africa was 46.32% (95% CI 46.08%, 46.55%), ranging from 11.8% in Zimbabwe to 70.03% in Rwanda. In the multivariable analysis, being in the age group 25-34 years, married, widowed, and divorced, primary and post-primary education, wealthy households, having a lower household size, many under-five children, having media exposure, and male-headed households were associated with higher odds of ITN use. Moreover, respondents from a rural place of residence, communities with a higher level of media exposure, communities with lower poverty levels, and communities with higher education levels had higher odds of ITN use.ConclusionIn this study, the proportion of ITN use was relatively low. Both individual and community-level factors were associated with ITN use. Therefore, giving attention, especially to those who had no formal education, the poor, younger age groups, and households with the large family size is advisable to increase awareness about ITN use. Moreover, media campaigns regarding ITN use should be strengthened.

Project description:Previous studies measuring the health-related quality of life (HRQoL) of individuals with dengue focused on treatment seeking populations. However, the vast majority of global dengue cases are unlikely to be detected by health systems. Representative measurements of HRQoL should therefore include patients with disease not likely to trigger treatment-seeking behavior. This study based in Iquitos, Peru used the Quality of Wellbeing Scale-Self Administered, a survey that enquires about not only physical health, but also psychological health, self-care, mobility, and usual social activities, and rates HRQoL between 0 (death) and 1 (optimum function), to evaluate the impact of dengue on HRQoL. In order to enroll treatment and non treatment-seeking participants, three modalities of participant recruitment were used. In addition to clinic and community-based febrile surveillance, a contact-cluster methodology was also employed to identify infected individuals less likely to seek treatment. We measured changes in HRQoL and identified common areas of health impairment in 73 virologically confirmed dengue cases at 3 time points during the participant's illness; the early-acute (days 0-6 post symptom onset), late-acute (days 7-20), and convalescent illness phases (days 21 +). Participants reported HRQoL related impairments at significantly higher frequency during the early-acute versus convalescent illness phase (Fisher's exact: P<0.01). There was substantial heterogeneity in scores during each illness phase with median scores in the early-acute, late-acute and convalescent phases of 0.56 (IQR: 0.41-0.64), 0.70 (IQR: 0.57-0.94), and 1 (IQR: 0.80-1.00), respectively. In all illness phases participants recruited in clinics had on average the lowest HRQoL scores where as those recruited in the contact clusters had the highest. Only 1 individual who was recruited in the contact-clusters had no reduction in HRQoL score during their illness. These data illustrate that dengue should be considered as a disease that may have significant implications for not only physical health but also psychological health and social functioning. The impact of dengue on the HRQoL of non-treatment-seeking individuals, although lower than the impact among treatment-seeking individuals, is not necessarily trivial.

Dataset Information

Factors Associated with Correct and Consistent Insecticide Treated Curtain Use in Iquitos, Peru.

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Factors Associated with Correct and Consistent Insecticide Treated Curtain Use in Iquitos, Peru.

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