Determinants of Bed Net Use in Southeast Nigeria following Mass Distribution of LLINs: Implications for Social Behavior Change Interventions.

Millions of long-lasting insecticide treated nets (LLINs) have been distributed as part of the global malaria control strategy. LLIN ownership, however, does not necessarily guarantee use. Thus, even in the ideal setting in which universal coverage with LLINs has been achieved, maximal malaria protection will only be achieved if LLINs are used both correctly and consistently. This study investigated the factors associated with net use, independent of net ownership. Data were collected during a household survey conducted in Ebonyi State in southeastern Nigeria in November 2011 following a statewide mass LLIN distribution campaign and, in select locations, a community-based social behavior change (SBC) intervention. Logistic regression analyses, controlling for household bed net ownership, were conducted to examine the association between individual net use and various demographic, environmental, behavioral and social factors. The odds of net use increased among individuals who were exposed to tailored SBC in the context of a home visit (OR = 17.11; 95% CI 4.45-65.79) or who received greater degrees of social support from friends and family (ptrend < 0.001). Factors associated with decreased odds of net use included: increasing education level (ptrend = 0.020), increasing malaria knowledge level (ptrend = 0.022), and reporting any disadvantage of bed nets (OR = 0.39; 95% CI 0.23-0.78). The findings suggest that LLIN use is significantly influenced by social support and exposure to a malaria-related SBC home visit. The malaria community should thus further consider the importance of community outreach, interpersonal communication and social support on adoption of net use behaviors when designing future research and interventions.

Appearance and impact of post-operative intracranial clips and coils on whole-brain CT angiography and perfusion.

BACKGROUND: To evaluate the effect of vascular clips and endovascular coils placed for intracranial aneurysms and arteriovenous malformations on whole-brain computed tomography (CT) angiography and perfusion. METHODS: A 320-detector row dynamic volume CT system imaged 11 patients following surgical placement of vascular clips or endovascular coils. The extent of clip and coil subtraction by automated software was evaluated using CT digital subtraction angiography and CT perfusion. Impact on CT perfusion values by retained intracranial devices was compared to age- and gender-matched controls. RESULTS: Clip and coil subtraction on CT angiography was graded as good in 8 and moderate in 3 cases. A residual neck and additional aneurysm were noted in 1 of 11 patients. Post-procedural axial slice level CT perfusion values decreased in reliability with increasing proximity to the metallic devices secondary to beam hardening. However, the intracranial devices did not affect axial slice level CTP values of cerebral blood volume, cerebral blood flow and mean transit time outside of the level of the device. Time to peak values was globally decreased outside of the immediate vascular intervention region. CONCLUSIONS: Advances in CT technology have provided clinically useful subtraction of intracranial clips and coils. While CT perfusion values were altered in device subtraction areas and within beam hardening artifact areas; they can provide valuable postoperative information on whole-brain hemodynamics. In selected cases, the combination of CT angiography and whole-brain CT perfusion can offer an alternative to conventional angiography that is a more invasive option.