Dataset Information

Ownership and Utilisation of Long-Lasting Insecticidal Nets in Tiko Health District, Southwest Region, Cameroon: A Cross-Sectional Study.

ABSTRACT:

Introduction

Malaria is and remains a serious health concern in Africa. In Cameroon, where malaria is endemic and a major public health problem, the major control measure put in place is the use of long-lasting insecticidal nets (LLINs). In the Tiko Health District (THD), the challenges have been to assess and to evaluate the ownership and utilisation of LLINs. This study sought to assess the ownership and utilisation rates of LLINs in the THD. Methodology. A cross-sectional survey involving 418 households was conducted in four health areas in the THD. A structured questionnaire was used to collect data on LLIN ownership and utilisation as well as sociodemographic characteristics.

Results

The ownership of at least one LLIN per household, coverage, and accessibility were, respectively, 89%, 56.2%, and 66.3%, while installing LLINs on all beds in the household, sleeping under LLINs the previous night (SULPN), and universal utilisation were 72%, 24.9%, and 14.1%, respectively. Factors significantly associated with the ownership of at least one LLIN per household were respondent's age and gender. Heat (21.1%) and forgetfulness (6.5%) were the main reasons postulated for irregular utilisation of LLINs.

Conclusion

The ownership LLINs failed to guarantee utilisation and definitely effective control of malaria in the THD, as expected. Continuous and appropriate use of LLINs is indispensable, in addition to periodic sanitation, booster campaigns of LLIN distribution, and evaluation research for effective prevention and control of malaria.

SUBMITTER: Fru PN

PROVIDER: S-EPMC7875632 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

Ownership and Utilisation of Long-Lasting Insecticidal Nets in Tiko Health District, Southwest Region, Cameroon: A Cross-Sectional Study.

Fru Paulette Ngum PN Cho Frederick Nchang FN Tassang Andrew N AN Fru Celestina Neh CN Fon Peter Nde PN Ekobo Albert Same AS

Journal of parasitology research 20210202

<h4>Introduction</h4>Malaria is and remains a serious health concern in Africa. In Cameroon, where malaria is endemic and a major public health problem, the major control measure put in place is the use of long-lasting insecticidal nets (LLINs). In the Tiko Health District (THD), the challenges have been to assess and to evaluate the ownership and utilisation of LLINs. This study sought to assess the ownership and utilisation rates of LLINs in the THD. <i>Methodology</i>. A cross-sectional surve ...[more]

PMID: 33623716

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Project description:BackgroundLong-lasting insecticidal nets (LLINs) are the most widely used malaria prevention and control intervention in Africa. However, their effectiveness may vary depending on their local geographic coverage, ownership and use at household level. This study aimed at assessing LLINs ownership and use following mass distribution campaign in western Kenya.MethodsA cross-sectional study was conducted in November 2017. A total of 160 households were randomly selected from 16 villages. Structured questionnaires were used to collect data on households' knowledge on malaria, LLINs ownership, utilization and their perceived benefits. Data was analyzed using IBM Statistical Package for Social Sciences (SPSS) version 21 for windows. Variables were presented as proportions and associations between variables tested using Pearson's chi-square test.ResultsMalaria was reported to be the most frequently occurring disease (87.5%) in the area. Children under 5 years of age were reported to be at higher risks of malaria infection (28.6%). Around 31% of the respondents reported to have at least one member of the household sick with malaria a week before the interview. Commonly cited signs and symptoms of malaria were; fever (24.1%), headache (17.7%), vomiting (14.5%) feeling cold (12.6%) and loss of appetite (10%). There were 382 reported LLINs among 753 occupants in the 160 households surveyed. The average LLIN ownership was 2.4 nets per household and 1.97 persons per LLIN. Among the surveyed households, 96.9% owned at least one LLIN and 64.1% owned at least one LLIN for every two people. Among those who owned LLINs, 98.1% reported using them the previous night. Ownership per household ranged from 0 to 6 with a mean of 2.39. More than three quarter of the nets were acquired through free mass distribution campaigns and 80% were acquired less than 6 months prior to the survey.ConclusionDespite high net coverage and use, a number of households experienced malaria episodes in the study area. There is need to investigate the likelihood of outdoor malaria transmission and assess the physical integrity of the existing LLINs and their insecticidal effectiveness in protecting household members against malaria.

Project description:BackgroundInsecticide-treated bed nets (ITNs) are widely used for the prevention and control of malaria. In Guatemala, since 2006, ITNs have been distributed free of charge in the highest risk malaria-endemic areas and constitute one of the primary vector control measures in the country. Despite relying on ITNs for almost 15 years, there is a lack of data to inform the timely replacement of ITNs whose effectiveness becomes diminished by routine use.MethodsThe survivorship, physical integrity, insecticide content and bio-efficacy of ITNs were assessed through cross-sectional surveys conducted at 18, 24 and 32 months after a 2012 distribution of PermaNet® 2.0 in a malaria focus in Guatemala. A working definition of 'LLIN providing adequate protection' was developed based on the combination of the previous parameters and usage of the net. A total of 988 ITNs were analysed (290 at 18 months, 349 at 24 months and 349 at 32 months).ResultsThe functional survivorship of bed nets decreased over time, from 92% at 18 months, to 81% at 24 months and 69% at 32 months. Independent of the time of the survey, less than 80% of the bed nets that were still present in the household were reported to have been used the night before. The proportion of bed nets categorized as "in good condition" per World Health Organization (WHO) guidelines of the total hole surface area, diminished from 77% to 18 months to 58% at 32 months. The portion of ITNs with deltamethrin concentration less than 10 mg/m2 increased over time. Among the bed nets for which bioassays were conducted, the percentage that met WHO criteria for efficacy dropped from 90% to 18 months to 52% at 32 months. The proportion of long-lasting insecticidal nets (LLINs) providing adequate protection was 38% at 24 months and 21% at 32 months.ConclusionsAt 32 months, only one in five of the LLINs distributed in the campaign provided adequate protection in terms of survivorship, physical integrity, bio-efficacy and usage. Efforts to encourage the community to retain, use, and properly care for the LLINs may improve their impact. Durability assessments should be included in future campaigns.

Project description:Introduction:A large proportion of the Ethiopian population (approximately 68%) lives in malaria risk areas. Millions of long-lasting insecticide treated nets (LLINs) have been distributed as part of the malaria prevention and control strategy in the country. This study assessed the ownership, access and use of LLNs in the malaria endemic southwest Ethiopia. Methods: A community-based cross-sectional study was conducted in southwest Ethiopia during October-November 2015, including 836 households from sixteen villages around Gilgel-Gibe dam area. Indicators of ownership, access and use of LLINs were derived following the Roll Back Malaria (RBM) guidelines. Factors associated with failure for both LLIN access and use were analysed at household level using a multivariate logistic regression model. Results: The proportion of households with at least one LLIN was 82.7% (95% CI: 80.0, 85.1). However, only 68.9% (95% CI: 65.6, 71.9) had enough LLINs to cover all family members (with ≥one LLIN for every two persons). While 75.3% (95% CI: 68.4, 83.0) of the population was estimated to have accessed to LLINs, only 63.8% (95% CI: 62.3, 65.2) reported to have used a LLIN the previous night. The intra-household gap (i.e., households owning at least one LLIN, but unable to cover all family members) and the behavioral gap (i.e., household members who did not sleep under a LLIN despite having access to one) were 16.8% and 10.5%, respectively. Age, marital status and education of household heads, as well as household size and cooking using firewood were associated with the access to enough LLINs within households. Decreased access to LLINs at households was the main determinant for not achieving ≥80% household members sleeping under a LLIN the previous night. Other associated factors were household size and education level of household head. Conclusions: LLIN coverage levels in study villages remain below national targets of 100% for ownership and 80% for use. The access to enough LLINs within the households is the main restriction of LLIN use in the study area.

Project description:Uganda is conducting a second mass LLIN distribution campaign and Katakwi district recently received LLINs as part of this activity. This study was conducted to measure the success of the campaign in this setting, an area of high transmission, with the objectives to estimate LLIN ownership, access and use pre and post campaign implementation.Two identical cross sectional surveys, based on the Malaria Indicator Survey methodology, were conducted in three sub-counties in this district (Kapujan, Magoro and Toroma), six months apart, one before and another after the mass distribution campaign. Data on three main LLIN indicators including; household LLIN ownership, population with access to an LLIN and use were collected using a household and a women's questionnaire identical to the Malaria Indicator Survey.A total of 601 and 607 households were randomly selected in survey one and two respectively. At baseline, 60.57% (56.53-64.50) of households owned at least one net for every two persons who stayed in the household the night before the survey which significantly increased to 70.35% (66.54-73.96) after the campaign (p = 0.001). Similarly, the percentage of the household population with access to an LLIN significantly increased from 84.76% (82.99-86.52) to 91.57% (90.33-92.81), p = 0.001 and the percentage of household population that slept under an LLIN the night before the survey also significantly increased from 56.85% (55.06-58.82) to 81.72% (76.75-83.21), p = 0.001.The LLIN mass campaign successfully achieved the national target of over eighty-five percent of the population with access to an LLIN in this setting, however, universal household coverage and use were fourteen and three percent points less than the national target respectively. This is useful for malaria programs to consider during the planning of future campaigns by tailoring efforts around deficient areas like mechanisms to increase universal coverage and behavior change communication.

Project description:BackgroundThe need to develop new products and novel approaches for malaria vector control is recognized as a global health priority. One approach to meeting this need has been the development of new products for indoor residual spraying (IRS) with novel active ingredients for public health. While initial results showing the impact of several of these next-generation IRS products have been encouraging, questions remain about how to best deploy them for maximum impact. To help address these questions, a 2-year cluster-randomized controlled trial to measure the impact of IRS with a microencapsulated formulation of pirimiphos-methyl (PM) in an area with high ownership of long-lasting insecticidal nets (LLINs) was conducted in a high-transmission district of central Mozambique with pyrethroid resistant vectors. Presented here are the results of the vector surveillance component of the trial.MethodsThe 2 year, two-armed trial was conducted in Mopeia District, Zambezia Province, Mozambique. In ten sentinel villages, five that received IRS with PM in October-November 2016 and again in October-November 2017 and five that received no IRS, indoor light trap collections and paired indoor-outdoor human landing collections catches (HLCs) were conducted monthly from September 2016 through October 2018. A universal coverage campaign in June 2017, just prior to the second spray round, distributed 131,540 standard alpha-cypermethrin LLINs across all study villages and increased overall net usage rates in children under 5 years old to over 90%.ResultsThe primary malaria vector during the trial was Anopheles funestus sensu lato (s.l.), and standard World Health Organization (WHO) tube tests with this population indicated variable but increasing resistance to pyrethroids (including alpha-cypermethrin, from > 85% mortality in 2017 to 7% mortality in 2018) and uniform susceptibility to PM (100% mortality in both years). Over the entire duration of the study, IRS reduced An. funestus s.l. densities by 48% (CI95 33-59%; p < 0.001) in indoor light traps and by 74% (CI95 38-90%; p = 0.010) during indoor and outdoor HLC, though in each study year reductions in vector density were consistently greatest in those months immediately following the IRS campaigns and waned over time. Overall there was no strong preference for An. funestus to feed indoors or outdoors, and these biting behaviours did not differ significantly across study arms: observed indoor-outdoor biting ratios were 1.10 (CI95 1.00-1.21) in no-IRS villages and 0.88 (CI95 0.67-1.15) in IRS villages. The impact of IRS was consistent in reducing HLC exposures both indoors (75% reduction: CI95 47-88%; p = 0. < 0.001) and outdoors (68% reduction: CI95 22-87%; p = 0.012). While substantially fewer Anopheles gambiae s.l. were collected during the study, trends show a similar impact of IRS on this key vector group as well, with a 33% (CI95 7-53%; p = 0.019) reduction in mosquitoes collected in light traps and a non-statistically significant 39% reduction (p = 0.249) in HLC landing rates.ConclusionIRS with PM used in addition to pyrethroid-only LLINs substantially reduced human exposures to malaria vectors during both years of the cluster-randomized controlled trial in Mopeia-a high-burden district where the primary vector, An. funestus s.l., was equally likely to feed indoors or outdoors and demonstrated increasing resistance to pyrethroids. Findings suggest that IRS with PM can provide effective vector control, including in some settings where pyrethroid-only ITNs are widely used. Trial registration clinicaltrials.gov , NCT02910934. Registered 22 September 2016, https://www.clinicaltrials.gov/ct2/show/NCT02910934.

Project description:BackgroundLong-lasting insecticidal nets (LLINs) are expected to last for at least 3 years, but whilst this may be achieved from an insecticidal perspective, physical protection is frequently compromised much earlier because of the rapid accumulation of holes during use. To understand why LLINs are so susceptible to loss of physical integrity, thousands of hole damage sites in LLINs retrieved from the field in Africa and Asia were forensically studied to identify the persistent underlying causes.MethodsA total of 525 LLINs consisting of six different brands from five different countries across Africa and Asia were collected from the field after 1 to 3 years in use. More than 42,000 individual sites of hole damage were analysed based on the morphology and size of each individual hole, aided by optical microscopy (OM) and scanning electron microscopy (SEM). The fracture morphology enabled positive identification of the underlying mechanisms of the damage.ResultsAcross all LLINs and geographical settings, mechanical damage is the primary cause of holes and loss of physical integrity in LLINs (63.14% by frequency and 81.52% by area). Snagging is the single most frequent mechanical damage mechanism, whilst the largest sized holes in LLINs result from seam failure and tearing. Abrasion and hole enlargement are also responsible for a progressive loss in the physical integrity of nets. Collectively, these five modes of mechanical damage can be expected to result from normal use of LLINs by households. Evidence of deliberate cutting, burn holes and rodent damage was observed to a lesser degree, which LLINs are not designed to withstand.ConclusionsLoss of physical integrity in LLINs is an inevitable consequence of using a vector control product that has an inherently low resistance to mechanical damage during normal use. To improve performance, new specifications based on laboratory textile testing is needed, to assess the resistance of LLIN products to the primary causes of mechanical damage when in use, which are snagging, tearing, abrasion and hole enlargement. Seam construction also needs to meet a revised minimum standard to reduce the risk of a rapid loss of physical integrity during use.

Dataset Information

Ownership and Utilisation of Long-Lasting Insecticidal Nets in Tiko Health District, Southwest Region, Cameroon: A Cross-Sectional Study.

Introduction

Results

Conclusion

Publications

Ownership and Utilisation of Long-Lasting Insecticidal Nets in Tiko Health District, Southwest Region, Cameroon: A Cross-Sectional Study.

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