A qualitative study on the use of long-lasting insecticidal nets (LLINs) for the prevention of malaria in the Peruvian Amazon.

BACKGROUND: Malaria is a huge global health burden due to its mortality, morbidity and cost to economies. It is necessary to eliminate the disease in all countries where possible to achieve the World Health Organization target of > 90% reduction by 2030. Successful previous campaigns suggest elimination is feasible in Peru. However, the incidence has recently been rising, focalized to the region of Loreto. Currently, the distribution of long-lasting insecticide-treated nets (LLINs) is a major part of Peru's malaria control strategy, however these may be having a limited effect in Loreto, because of the recent behavioural adaption of the mosquito vector, Anopheles darlingi, to earlier biting times, as well as local perceptions and practices towards LLINs. It was, therefore, necessary to investigate how perceptions, practices and lifestyle factors affect the efficacy of LLINs in Loreto. METHODS: Qualitative research was carried out in 5 rural communities along the Iquitos-Nauta Road in Loreto, which have increased exposure and have received nets in a distribution scheme prior to the study. Twenty semi-structured interviews as well as observations of the bed nets were conducted in participants' homes, using a topic guide. Thematic content analysis was used to produce the findings. RESULTS: All participants viewed malaria prevention as a high priority, and the use of bed nets was deeply embedded in the culture. They expressed preference for LLINs over traditional-type nets. However there were too few LLINs distributed, participants did not maintain the nets correctly, washed them too frequently and did not repair holes. The earlier mosquito biting times were also problematic. Additionally, poor housing construction and proximity to mosquito breeding sites further increased transmission. CONCLUSION: The positive findings in attitudes of the respondents can be used to improve malaria control in these communities. Interventions providing education on effective LLIN use should be implemented. A change in strategy away from vector control methods is also necessary, as these do not provide long-term protection due to the adaptability of An. darlingi. Interventions focusing on parasite control are recommended, and socio-economic factors which increase malaria risk should be addressed.

Taking innovative vector control interventions in urban Latin America to scale: lessons learnt from multi-country implementation research.

Prior to the current public health emergency following the emergence of chikungunya and Zika Virus Disease in the Americas during 2014 and 2015, multi-country research investigated between 2011 and 2013 the efficacy of novel Aedes aegypti intervention packages through cluster randomised controlled trials in four Latin-American cities: Fortaleza (Brazil); Girardot (Colombia), Acapulco (Mexico) and Salto (Uruguay). Results from the trials led to a scaling up effort of the interventions at city levels. Scaling up refers to deliberate efforts to increase the impact of successfully tested health interventions to benefit more people and foster policy and program development in a sustainable way. The different scenarios represent examples for  a 'vertical approach' and a 'horizontal approach'. This paper presents the analysis of a preliminary process evaluation of the scaling up efforts in the mentioned cites, with a focus on challenges and enabling factors encountered by the research teams, analysing the main social, political, administrative, financial and acceptance factors.

Bio-efficacy, physical integrity, community usage and washing practices of mosquito nets treated with ICON MAXX long-lasting insecticidal treatment in India

BACKGROUND New brands of potential long lasting insecticide nets (LLINs) and LLIN treatment kits require field evaluation before they are used in a vector control programme. OBJECTIVES The aim of this study was to evaluate the bio-efficacy, usage, washing practice and physical integrity of nets treated with LLIN treatment kit, ICON MAXX in a phase III field trial in Odisha state, India. METHODS A total of 300 polyester nets treated with ICON MAXX and 140 polyester nets treated conventionally with lambda-cyhalothrin CS 2.5% ITNs were distributed. The bio-efficacy was evaluated with WHO cone bioassay. The chemical analysis of netting pieces was done at the beginning, after 12 and 36 months of the trial. FINDINGS After one year of distribution of nets, the bioassay showed 100% mortality on both ITNs and ICON MAXX treated nets. At 36 months, the overall pass rate was 58.8% and the mean lambda-cyhalothrin content of LLINs was 34.5 mg ai/m2, showing a loss of 44.4% of the original concentration. CONCLUSION ICON MAXX treated LLIN was found to retain bio-efficacy causing 97% knockdown of Anopheles stephensi up to 30 months and met the WHOPES criteria. However, the desired bio-efficacy was not sustained up to 36 months.