Factors affecting treatment practices of patent medicine vendors for malaria in under-five children: implications for malaria control in Nigeria

Background: Patent medicine vendors (PMVs) are the most common source of antimalarial drugs and treatment for majority of Nigerians. The quality of their practice could have implications for malaria control. This study sought to explore the factors influencing the malaria treatment practices of PMVs for under-five children in Akwa Ibom State. Methods: A cross-sectional survey using an interviewer-administered questionnaire was conducted among 176 PMVs selected by simple random sampling from two local government areas (LGAs). In addition, four focus group discussions (FGD) were conducted to generate qualitative data. Quantitative data was analysed using SPSS version 20 while content analysis was done on the qualitative data. Results: Artemisinin Combination Therapy (ACT) was the most frequently recommended antimalarial treatment by PMVs (75.6%) for children as against chloroquine (17%) and Sulphadoxine/Pyrimethamine (2.8%). However, only 39.2% of PMVs recommended the appropriate antimalarial treatment (ACTs at the right dose for age), while 71% recommended referral for severe malaria. Factors found to be associated with appropriate management of malaria from quantitative analysis included Educational qualification, attending malaria training and their knowledge of malaria. The FGDs showed that severity of child's illness, parents/caregivers drug request and perceived ability of the parents/caregiver to afford the drugs influenced PMVs malaria treatment practices. Conclusion: Knowledge of malaria, severity of child's illness and parents' drug request influenced the treatment practices of PMVs. Training PMVs on appropriate malaria management and community health education/sensitization to leverage on the influence of client-demand on ACT use is recommended to improve PMVs treatment practice

Physicians' compliance with malaria treatment guidelines of under-five children in a secondary maternal and child care centre in Lagos State

Background: The global malaria agenda has the ultimate goal of eliminating malaria in all countries of the world by 2030 through universal access to malaria prevention, diagnosis and treatment. Presumptive treatment of malaria with Artemisinin Combination Therapy (ACT) has been associated with the development of resistance, therefore parasitological confirmation of all fevers is crucial in the context of eliminating malaria. This study assessed physicians' compliance with the national guidelines in the treatment of malaria among under-five (U-5) children and their prescription pattern in a Maternal and Child Care (MCC) centre in Lagos State. Methods: This was a descriptive cross-sectional study conducted as an exit interview among 427 mothers/caregivers of febrile U-5 children who were consecutively sampled.The data was collected using a pre-tested interviewer-administered questionnaire and a proforma. Epi-info version 7.2.1 was used to analyze the data and the level of significance was set as p<0.05. Results: Malaria Rapid Diagnostic Test (mRDT) was done for 75 17.6%) of the children and 37 (49.3%) was positive. Anti-malarial drugs were prescribed at consultation to 400 (93.7%) of the febrile children. Artemisinin Combination Therapy (ACT) was prescribed for 364 (91.0%) of the children. The most prescribed ACT was Artemether-Lumefantrine (AL) in 222 (60.9%). Conclusion: The physician's compliance with malaria treatment guidelines for febrile illnesses in U-5 children was poor with regards to parasitological confirmation before treatment. However, the use of ACTs was adhered to in almost all cases. Regular training workshops are recommended for health workers to improve adherence to parasitological confirmation before treatment

Le paludisme dans la communauté urbaine de Gamboma (Département des plateaux, République du Congo)

Face aux pratiques thérapeutiques inadaptées et à la couverture sanitaire insuffisante, le paludisme reste une maladie mortelle en Afrique sub-saharienne. Notre étude a concerné la communauté urbaine de Gamboma. Elle a été menée du 18 mai au 22 juin 2017. L'étude a eu pour objectif d'évaluer le niveau de prise en charge du paludisme dans les formations sanitaires de la localité. La population visée est constituée de mères d'enfants de 0 à 5 ans et de femmes enceintes. Pour ce faire, les entretiens individuels ont été réalisés à l'aide d'un questionnaire sur un échantillon de 200 mères d'enfants et femmes enceintes. L'étude a montré que le niveau de prise en charge n'est pas satisfaisant dans les différentes structures sanitaires de Gamboma. Plusieurs difficultés réduisent la prise en charge de cas de paludisme (manque de financement, de moustiquaires imprégnées d'insecticide). Faute de moyens financiers, 67% des mères ont recours à l'automédication (moderne et traditionnelle) pour traiter les cas de paludisme. Seulement 20% ont recours à un centre de santé, 7,6% à la prière et 4,8% aux guérisseurs. Ces résultats suggèrent qu'une intensification de la communication auprès des populations ainsi qu'une participation active de celles-ci seraient utiles pour atteindre les objectifs visés par les autorités au Congo. Des efforts restent à faire pour relever la qualité du traitement préventif du paludisme et augmenter la disponibilité et l'utilisation des moustiquaires imprégnées d'insecticide

Prevalence and socio-demographic factors associated with malaria infection among children under five years in Tanzania

Malaria is one among four main infectious diseases leading in death for the under-five children in Africa. This study aim to determine prevalence of malaria and social demographic factors related with children under-five in Tanzania. The study used cross section data extracted from Tanzania demographic health survey collected from 2015 to 2016. A sample of 9,322 under five children with malaria rapid diagnostic test results was obtained from 10,899 households. Complimentary log-log model was used to determine factors associated with malaria among children under five years. The study reveals that malaria prevalence increases with increase in age, varies with place and zone of residence, being highest to the rural areas compared to urban. Complementary log-log model estimates has also indicated that Western zone was having a highest mean occurrence of children with malaria compared to all other zones whereas Zanzibar (Adjusted Parameter estimates = -4.521, CI: -5.92,-3.13) was having a lowest mean occurrence compared to Western zone and all other zones. The risk of malaria among under-five children was positively related with family wealth index. The results show that malaria decreases with an increase in wealth. Other explanatory variables which include; child sex, mother's age, marital status and education level, as well as mosquito net ownership were not statistically significant associated with malaria at 5% level. Therefore children's age, place of residence, zone of residence and wealth index are significant predictors of malaria in Tanzania. Particular emphasis on education and interventions across the groups need to be prioritized for continued improvements in targeting high prevalent areas to reduce malaria risks, especially to the children under-five years

Utilisation des mesures préventives contre le paludisme au cours de la grossesse chez les femmes enceintes à Libreville au Gabon

Contexte : Depuis le déploiement des mesures de prévention contre le paludisme chez la femme enceinte au Gabon en 2005, les taux de couverture en Traitement Préventif Intermittent à la Sulfadoxine-Pyriméthamine (TPI-SP) et Moustiquaire Imprégnée d'Insecticides à Longue Durée d'Action (MILDA) demeurent faibles comparativement aux objectifs visés par l'OMS. Il s'avère donc important de rechercher les facteurs qui influenceraient l'adhésion des femmes enceintes au TPI-SP et à l'utilisation des MILDA. Patientes et méthodes : Il s'est agi d'une enquête transversale menée de juillet 2013 à septembre 2014 chez des femmes enceintes vues en consultation prénatale (CPN). Des informations concernant leurs connaissances et pratiques vis-à-vis des mesures de prévention ont été recueillies à l'aide d'un questionnaire. La couverture en TPI-SP a été déterminée chez celles vues en fin de grossesse. Résultats : Au total, 122 femmes ont été incluses. Elles avaient déjà entendu parler du paludisme et connaissaient la MILDA comme moyens de prévention du paludisme. Seulement un quart (n = 31) des gestantes avaient entendu parler du TPI-SP. Enfin de grossesse, près de la moitié (48,4% ; n = 15) d'entre elles a reçu une chimio-prévention correcte (≥ 3 doses de TPI-SP), contre 25,2% (n = 23) de celles qui ne connaissaient pas cette méthode de prévention (p < 0,01). Seulement 40% des femmes ayant eu au plus trois CPN avaient reçu au moins trois doses de SP alors que cette proportion était de 72,9% (n = 35) chez celles qui avaient eu au moins quatre CPN (p < 0,01). Les femmes suivies en structure publique ont reçu moins de doses de SP comparativement à celles suivies en clinique privée, en dépit de la gratuité de la SP. Par contre, elles utilisaient plus fréquemment la MILDA. Conclusion : L'utilisation du TPI-SP n'est pas encore optimale. Il existe un écart entre la connaissance et l'utilisation des mesures préventives du paludisme. La faible participation aux CPN des femmes, des connaissances insuffisantes sur le paludisme et le TPI-SP ont un impact sur la couverture en moustiquaire et TPI-SP

Influence des facteurs climatiques sur la morbidité palustre à Tillabéry au Niger

Problématique : La transmission du paludisme dans les pays du Sahel est tributaire des facteurs climatiques. Au Niger, il y a un gradient de transmission qui est décroissant du Sud au Nord. L'objectif de l'étude est de décrire les relations entre les facteurs climatiques et le paludisme afin de mettre au point des stratégies de contrôle. Patients et méthodes : Il s'agit d'une étude analytique et rétrospective, utilisant les données de 2004 à 2013 (10 ans) de la commune urbaine de Tillabéry. Les données sanitaires sur le paludisme sont issues du Système National d'Information Sanitaire (SNIS) du Niger. Les données climatologiques étaient celles de la Direction de la Météorologie Nationale (DMN). La méthode statistique utilisée est le coefficient de corrélation "r" entre les variables climatiques et morbi-mortalité palustre.Résultats : L'analyse univariée montre que le nombre de cas de paludisme le plus élevé était observé au mois de septembre et l'humidité relative minimale la plus élevée au mois d'aout. L'analyse multivariée fait ressortir une corrélation forte et positive entre l'humidité relative minimale et la mortalité (r = 0,719), puis la morbidité (r = 0,674). Par contre la température était négativement corrélée à la mortalité (r = -0,386) et à la morbidité palustre (r = -0,363).Conclusion : Il ressort de cette étude que l'humidité relative minimale et la pluviométrie ont un réel impact sur les pics de morbidité et de mortalité palustre, par opposition à la température. Le pic de morbi-mortalité intervient en septembre, un mois après les fortes pluviométries et humidités relatives minimales du mois d'aout. Ces observations serviront à la planification de la lutte anti larvaire, anti-vectorielle, de la chimio-prévention et de la prise en charge par les programmes nationaux de lutte contre le paludisme

From malaria control to elimination in South Africa: the researchers' perspectives

Background: Global decline in malaria episodes over the past decade gave rise to a debate to target malaria elimination in eligible countries. However; investigation regarding researchers' perspectives on barriers and facilitating factors to effective implementation of a malaria elimination policy in South Africa (SA) is lacking. Aim: The aim of this study was to investigate the malaria researchers' knowledge, understandings, perceived roles, and their perspectives on the factors influencing implementation of a malaria elimination policy in SA. Setting: Participants were drawn from the researchers who fulfilled the eligibility criteria as per the protocol, and the criteria were not setting-specific. Methods: The study was a descriptive cross-sectional survey conducted through an emailed self-administered semi-structured questionnaire amongst malaria researchers who met the set selection criteria and signed informed consent. Results: Most (92.3%) participants knew about SA's malaria elimination policy; but only 45.8% had fully read it. The majority held a strong view that SA's 2018 elimination target was not realistic; citing that the policy had neither been properly adapted to the country's operational setting nor sufficiently disseminated to all relevant healthcare workers. Key concerns raised were lack of new tools; resources; and capacity to fight malaria; poor cross-border collaborations; overreliance on partners to implement; poor community involvement; and poor surveillance.Conclusion: Malaria elimination is a noble idea; with sharp divisions. However; there is a general agreement that elimination requires: (a) strong cross-border initiatives; (b) deployment of adequate resources; (c) sustainable multistakeholder support and collaboration; (d) good surveillance systems; and (e) availability and use of all effective intervention tools

Willingness to pay for insecticide-treated Nets in Berehet District, Amhara Region, Northern Ethiopia: Implication of Social Marketing

BACKGROUND: Understanding the feasibility of achieving widespread coverage with Insecticide-Treated Nets has to be preceded by learning how people value the Insecticide-Treated Nets and estimating the potential demand and willingness to pay so that sustainability of the intervention can beassured. The objective of this study was to determine willingness to pay for Insecticide-Treated Nets among households in Berehet District, Northern Ethiopia.METHODS: A community-based cross-sectional study was conducted using both quantitative and qualitative methods in fiverandomlyselected Kebeles fromJanuary-February 2012. Open ended contingent valuation technique with follow-up method was used. Qualitative data were collected through focus group discussions and observation methods. Binary logistic regression was used to determine the association between dependent and independent variables. RESULTS: The average number of individuals per Insecticide-Treated Nets was 3.83.Nearly 68.5% persons had willingness to buy Insecticide-Treated Nets if they have access to these Nets. The median maximum price a person is willingness to pay for blue rectangular Insecticide-Treated Net was 20 ETB. People had willingness to pay 30 ETB for blue and white conical insecticide-treated nets.Working on knowledgeof malaria (OR=0.68, CI (0.47, 0.98; p<0.05), perceived benefit of Insecticide-Treated Nets (OR=0.28, CI (0.2-0.4; p<0.05), perceived susceptibility (OR=0.64(0.44-0.93; p<0.05) and perceived severity of malaria (OR=0.65(0.47-0.91, p<0.05) had significant association with a willingness to pay Insecticide-Treated Nets. Respondents who prefer kebele/place/ to buy Insecticide-Treated Net for rectangular shape had a significant association with a willingness to pay for Insecticide-Treated Nets (OR=1.92, CI= 1.07-3.92).CONCLUSIONS: Promotions, products, price and place had significant association with willingness to pay for Insecticide-Treated Nets. Designing a social marketing strategy helps ensure sustainable supply of Insecticide-Treated Nets and proper use of Insecticide-Treated Nets

Piloting a new approach for capacity building in entomology and vector control at the level of national malaria control programmes

Following a survey of entomology capacity in the African Region in 1999; a commitment to strengthen capacity was made and the African Network on Vector Resistance to Insecticides (ANVR) was launched in 2000. Its aim was to facilitate Member States to build capacity in vector control and to collaborate with institutions to standardize methods and approaches. In 2006 ANVR assessed capacity with regard to national malaria control programmes. This assessment provided data on the capacity of countries across the Region to undertake vector surveillance. Recommendations to improve the situation followed and in 2007; through the Bill and Melinda Gates Foundation; a project to strengthen infrastructure and capacity was begun. This article outlines the impressive results of the project and its wider implications for adopting similar approaches across the Region

Knowledge and utilization of malaria preventive measures among pregnant women at a tertiary hospital in Nigeria's federal capital territory

Objective: To determine the knowledge and utilization of malaria preventive measures as well as barriers to the utilization of these measures by pregnant women. Materials and Methods: The study was a prospective cross-sectional survey involving pregnant women at the booking clinic of the University of Abuja Teaching Hospital between May and August 2010. Close-ended pre-tested structured questionnaires were administered by interviewer method to 403 consecutive consenting women. Results: The knowledge of malaria and its preventive measures in pregnancy was 71.5. There was a statistically significant association between knowledge of malaria and educational status (X2 = 16.053; P = 0.035). Intermittent preventive treatment was used by 15.9 of the respondents. Insecticide-treated net ownership was 42.6; however; its use declined from 28.5 before pregnancy to 24.6 during pregnancy. Conclusion: There is adequate knowledge about malaria and its preventive measures in pregnancy; but the utilization of these measures is poor. There is need for concerted efforts at addressing the barriers to utilization of these effective interventions

Impact of Health Education Intervention on Malaria Prevention Practices among Nursing Mothers in Rural Communities in Nigeria

Malaria is the most prevalent parasitic endemic disease in Africa; which is preventable; treatable and curable. This study aims to assess the effect of health education intervention on the knowledge; attitude; and prevention practices amongst mothers of under-five children in a rural area of Ogun State; Nigeria. Materials and Methods: The study design was a quasi-experimental study carried out in Ijebu North Local Government Area of Ogun State. A multistage random sampling technique was used in choosing the required samples and a semi-structured questionnaire was used to collect relevant information. A total of 400 respondents were recruited into the study with 200 each in both the experimental and control groups and were followed up for a period of 3 months. Results: There was no statistically significant differences observed between the experimental and control groups. Knowledge of indoor spraying increased from 14.7 to 58.2 (P 0.001) and window and door nets increased from 48.3 to 74.8 (P 0.001). The proportion of those with ITN use increased from 50.8 to 87.4 (P 0.001) while those with practice of maintaining clean environment also increased from 40.4 to 54.5 (P 0.001). There were no significant changes in all the practice of malaria prevention methods in the control group. Conclusion: This suggests that malaria control can be significantly improved in rural areas; if the caregivers are adequately empowered through appropriate health education intervention though change in attitude and belief may require a longer and persistent effort

Effect of intermittent preventive treatment of malaria on the outcome of pregnancy among women attending antenatal clinic of a new Nigerian teaching hospital, Ado-Ekiti

Background: Malaria is a public health problem globally especially in the Sub-Saharan Africa and among the under five children and pregnant women and is associated with a lot of maternal and foetal complications. Objective: The study was on the effect of intermittent preventive treatment of malaria in pregnancy on the prevalence of malaria in pregnancy and the outcome of pregnancy. Materials and Methods: In a descriptive cross-sectional study, a semi-structured questionnaire was administered to women admitted in Ekiti State University Teaching Hospital labour ward, Ado-Ekiti. About 4,200 women participated in the study and the inclusion criteria were women who were booked in the hospital, attended at least four antenatal clinic visits, and consented to the study while the exclusion criteria were those who didn't book in the hospital and failed to give their consent. Results: The study revealed that about 75% of the pregnant women studied had access to intermittent preventive treatment of malaria. Among the women attending the antenatal clinic that received sulphadoxine-pyrimethamine (SP), about 78% of them took two doses of SP. The prevalence of clinical malaria was statistically higher in women who did not receive intermittent preventive treatment with SP during pregnancy (44.7% vs. 31.3%, P = 0.0001) and among women who had one dose of the drug instead of two doses (40.0% vs. 28.7%, P = 0.0001). There was no statistical significant difference in the mean age in years (31.53 ± 5.238 vs. 31.07 ± 4.751, P = 0.09 and the gestational age at delivery (38.76 ± 1.784 vs. 38.85 ± 1.459, P = 0.122) between the women who did not receive SP and those who had it. There was a statistical significant difference in the outcome of pregnancy among women who had Intermittent Preventive Treatment in pregnancy (IPTp) and those who did not viz.-a-viz. in the duration of labor (8.6 ± 1.491 vs. 8.7 ± 1.634, P = 0.011) and the birth weight of the babies (3.138 ± 0.402 vs. 3.263 ± 0.398, P = 0.0001)

Community participation in malaria control in olorunda local government area, osun state, southwestern Nigeria

Malaria is a major health burden in developing countries and needs multiple strategies for its control. Community participation as one of the strategies for malaria control promotes self-awareness and confidence; causes the people to examine the problems and to think positively about the solutions. The study was aimed at assessing the level of community participation in malaria control in Olorunda local government area of Osogbo; Osun state; Nigeria. The study employed a cross-sectional descriptive design. Multi-staged sampling technique was used to choose 550 respondents. An interviewer-administered semi-structured questionnaire was used to elicit information from the respondents. Most of the respondents (65.0) fell between the age ranges 20-39 years; with a mean age of 32.85 + 12 years. Almost all (98.4) respondents had knowledge of malaria with most of them (88.0) correctly aware that mosquito bite could lead to malaria fever. Respondents stated that stagnant pool (92.6) and refuse dump (89.0) could predispose to malaria. About two-thirds (60.6) of the respondents participated in the control of the breeding sites of mosquitoes on specific days for environmental sanitation. The association between community participation in health talk and community participation in malaria control was statistically significant (p

Recent Change of locality as Risk Factor for Malaria Fever among New Residents of Ahoada East Local Government Area in Southern Nigeria

Relocation which is a well-known determinant of malaria in non-immune travelers to malarious areas; has also been found to be a risk factor for malaria among semi-immune persons who change locality within endemic regions. Further research evidence suggests that the higher transmission intensity at the travel location is an underlying factor which may indicate exposure to new variants of P falciparum for which specific immunity is lacking. This study was conducted to determine if recent change of locality increased the risk of malaria fever among semi-immune National Youth Service Corps members serving in a district in southern Nigeria.Method: Ninety six corps members who had just been posted to Ahoada-East LGA in southern Nigeria and 83 others that had been in service for six months; were followed up for malaria fever in a prospective cohort design over a 3 month period from September 2010 to December 2010. Active surveillance was used to obtain reports of fever among the cohort; followed by medical examination at designated local health facilities.Results: No significant differences in age and use of protection against malaria were found between the study groups. The incidence proportion of malaria for the recently relocated group (34) was significantly higher than that of the resident group (15.7). Recent change of locality was more associated with malaria fever (RR 2.19; 95 CI 1.243.88; AR 54.4).Conclusion: The recent change of locality within an endemic region; which serves as an indicator of exposure to new variants of P falciparum; for which specific immunity is lacking; is a significant risk factor for malaria fever. Protection against malaria is recommended for semi-immune individuals moving to new locations with significant risk of malaria transmission

Prevention of Congenital Transmission of Malaria in Sub-Saharan African Countries: Challenges and Implications for Health System Strengthening

Objectives: Review of burden of congenital transmission of malaria; challenges of preventive measures; and implications for health system strengthening in sub-Saharan Africa. Methods. Literature from Pubmed (MEDLINE); Biomed central; Google Scholar; and Cochrane Database were reviewed. Results. The prevalence of congenital malaria in sub-Saharan Africa ranges from 0 to 23. Diagnosis and existing preventive measures are constantly hindered by weak health systems and sociocultural issues. WHO strategic framework for prevention: intermittent preventive therapy (IPT); insecticide-treated nets (ITNs); and case management of malaria illness and anaemia remain highly promising; though; specific interventions are required to strengthen the health systems in order to improve the effectiveness of these measures. Conclusion. Congenital malaria remains a public health burden in sub-Saharan Africa. Overcoming the challenges of the preventive measures hinges on the ability of national governments and development partners in responding to the weak health systems

Preventing malaria during pregnancy: factors determining the use of insecticide-treated bed-nets and intermittent preventive therapy in Juba

The study was carried out among 334 pregnant and newly delivered women seen at Juba Teaching Hospital in 2009. The objective was to assess the coverage of insecticide-treated bed-nets (ITN) and Intermittent Preventive Therapy (IPT) among these women and the factors associated with their use. Overall 87of the women used ITN and 61used IPT. ITN use was positively associated with buying nets; indoor spraying of insecticide and higher household income. IPT use was positively associated with more frequent antenatal clinic visits; indoor spraying and buying ITN

Review of Temephos Discriminating Concentration for Monitoring the Susceptibility of Anopheles labranchiae (Falleroni; 1926); Malaria Vector in Morocco

In Morocco; the resistance monitoring of Anopheles labranchiae larvae to temephos is done using discriminating concentration of 0.125?mg; which is half of the WHO recommended dose for Anopheles. However; this dosage seemed to be too high to allow an early detection of the resistance and its revision was found necessary. The present study was carried out during May-June 2008 and 2009 in nine provinces from the north-west of the country. The aim was to determine the lethal concentrations LC100 of temephos for the most susceptible populations and to define the discriminating dosage as the double of this value. The bioassays were conducted according to WHO standard operating protocol to establish the dose-mortality relationship and deduct the LC50 and LC95. The results of this study indicated that the LC100 obtained on the most susceptible populations was close to 0.05?mg/L. Therefore; the temephos discriminating dosage for susceptibility monitoring of An. labranchiae larvae in Morocco was set to be 0.1?mg