Possession, Attitudes and Perceptions of Insecticide-treated Bed Nets among Pregnant Women in a Post Conflict District in Northern Uganda.

Background: The use of insecticide-treated bed nets (ITNs) is one of the main strategies to control malaria in Uganda. The Uganda’s Ministry of Health had set a target of 50% of households to be covered with ITNs by the year 2007. This study aims at determining ITN possession, attitudes and perceptions among pregnant women who were living in internally displaced persons’ (IDP) Camps where buildings offered little or no protection against mosquitoes in Gulu district. Methods: A cross sectional study was conducted in 20 randomly selected IDP camps in Aswa and Omoro counties, Gulu district, Northern Uganda. Probability proportion to size cluster sampling technique was used to determine the numbers of expectant mothers in the selected camps. Consecutive sampling method was used by moving to the next nearest household until the required numbers of respondents were generated from each camp. Data was collected using well designed pretested questionnaires. The questionnaires were administered by trained research assistants who were fluent in the local language (Acholi). Results: ITN possession: 42% of respondents (95% CI 0.39 – 0.46) possessed ITN. 98% of the respondents reported that it was good to use ITN. 97% of the respondents perceive ITN as being effective at preventing mosquitoes bites which transmit malaria. 96% of the respondents who owned ITN were willing to continue using ITNs. Factors associated with ITN possession were; Having attended antenatal services (aOR 1.92, 95% CI 1.24 – 2.98, P-value 0.004); Having attained formal education (aOR 1.55, 95% CI 1.03 - 2.35, P-value 0.036); Willingness to buy ITN (aOR 1.98, 95% CI 1.22–3.21, P-value 0.006) and Willingness to recommend ITN use to others (aOR 3.77, 95% CI 1.12 – 12.77, P-value 0.033). Conclusion: Majority of the respondents had positive attitudes and perceptions towards ITN use. However, more than half of the respondents lacked ITN which was below the target set by Uganda Ministry of Health. Therefore government and other stakeholders should scale up free ITN distributions among the vulnerable groups if the Ministry of Health and the Roll Back Malaria Global Partnership Target is to be achieved.

Assessment of anti mosquito measures in households and resistance status of Culex species in urban areas in southern Ghana: implications for the sustainability of ITN use

OBJECTIVE@#To determine resistance status of Culex species to different class of insecticides and assess the major anti-mosquito strategies employed by urban households and their possible effects on malaria acquisition.@*METHODS@#Structured questionnaires were randomly administered to obtain information on demographic characteristics, measures that people use to prevent mosquito bites and their perception of where mosquitoes breed in their communities. Adult susceptibility assays were also carried out using WHO discriminating dosages of four insecticides from different chemical classes against Culex species.@*RESULTS@#Majority of respondents (54.75%) preferred the use of domestic insecticides in the form of aerosols and coils. Among households that used domestic insecticides, the use of coil was most frequent (62.9%) with a mean (95% CI) of 9.18 (8.99, 9.37) coils per week. Strong level of pyrethroid-resistance and multiple insecticide resistance in Culex species were also detected in some of the study sites.@*CONCLUSIONS@#The excessive use of domestic insecticides and high level of resistance in Culex species observed in the study area has implications for the ITN component of the nation's malaria control program in more subtle ways. People will lose interest in the use of ITN when it fails to protect users from bites of resistant Culex species. Excessive use of domestic insecticides may also select resistance in both malaria vectors and Culex species. On this account we recommend that nuisance mosquitoes must be controlled as part of malaria control programs to improve acceptance and utilization of ITN.

Evaluation of Field Performance of Insecticide-Treated Mosquito Nets in North-Western Burkina Faso.

Aims: The aim of the study was to evaluate the field performance of insecticide-treated mosquito nets (ITNs) in north-western Burkina Faso. Study design: Cross-sectional survey. Place and Duration: The study took place between September and November 2008 (end of rainy season) in rural north-western Burkina Faso. Methodology: Standard WHO bioassays were performed on field-collected ITNs from three areas of different insecticide pressure: semi-urban Nouna town, three villages with cotton agriculture, and three villages without cotton agriculture. Data on age and washing frequency of ITNs was collected, and deltamethrin content was determind by HPLC. Results: The mean age of field-collected ITNs was 2.1 years. The mosquito mortality rate (Anopheles gambiae sl.) after 24 hours was 4% for the negative controls, 90% for the positive controls, and 73% for field-used ITNs. Differences in mosquito mortality between sub-areas disappeared after controlling for confounding variables. Conclusion: This study demonstrates that under real life conditions, deltamethrin still shows some level of effectiveness despite ongoing insecticide pressure. However, deltamethrin resistance has been observed in other parts of the country and thus close surveillance of ITN efficacy is needed. More frequent replacement of ITNs is also recommended.

Use and Effects of Malaria Control Measures in Pregnancy in Lagos, Nigeria

In Nigeria, malaria causes up to 11% of maternal mortality. Our main aim was to find out the most common mosquito control measures employed by the pregnant women in Lagos and their effects on malaria infection. The study was carried out over a period of 6 months during which trained interviewers administered questionnaires to 400 pregnant women. The prevalence of malaria was 8.4%. There was no significant association between the prevalence of malaria and age, level of education, or occupation of the participants. Pregnant women in the age range 26-30 had the mean parasite density (409.9+/-196.80). Insecticide spray (32.8%), mosquito coil (27.5%), and insecticide-treated nets (ITN) (15.5%) were the major mosquito control measures employed by the participants while the prevalence of infection among them were 2.3%, 6.2%, and 3.2%, respectively (P<0.05). Only 18.3% of the women had taken more than one dose of intermittent preventive treatment (IPT), while another 11.8% had taken a single dose. The infection rate among them was 4.1% and 6.4%, respectively. Malaria prevalence was highest among those who had not received any dose of IPT (10%). This study showed that the use of ITN and IPT among the pregnant women were still unacceptably low. It also showed that the use of insecticide spray which was the most common malaria control measure adopted by the participants was effective despite the fact that it is not a National Malaria Control Policy. We recommend that a sustained integrated mosquito management and public education should be strengthened in Nigeria.