Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 218
Filtrar
1.
Malar J ; 18(1): 270, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395048

RESUMO

BACKGROUND: Malaria preventive measures, including long-lasting insecticide-treated bet nets (LLINs), indoor residual spraying (IRS), and controlling mosquito breeding sites, are key measures to achieve malaria elimination. Still, compliance with these recommended measures remains a major challenge. By applying a novel and comprehensive model for determinants of malaria prevention behaviour, this study tests how individual perceptions influence the intentions to use malaria preventive measures and explores strategies that stimulate their consistent use. METHODS: The study was carried out in the sectors of Ruhuha and Busoro, Rwanda during October and November 2017, and these were conducted into two phases. Phase one involved a questionnaire survey (N = 742), whereas Phase two employed a qualitative approach that included nine focus group discussions, seven key informant interviews, and three in-depth interviews. RESULTS: The findings of the quantitative study showed that participants very often use LLINs (66.6%), accept IRS (73.9%), and drain stagnant water in case of presence (62%). The intentions to use malaria preventive measures were consistently driven by perceived severity, perceived self-efficacy, perceived response efficacy, and subjective norms, and hindered by perceived barriers. The intentions were also positively associated with the actual use of LLINs, acceptance of IRS, and drainage of stagnant water. There is no evidence that either not having enough LLINs (ownership of at least one bed net in the household, here referred to as availability) or having sufficient LLINs (having one LLIN per two people in the household, here referred to as accessibility) moderated the relationship between behavioural intentions and actual use of LLINs. The qualitative study indicated that participants believed malaria risk to be high and perceived a high mosquito density. They also believed that repetitive malaria episodes are caused by the perceived low effectiveness of anti-malaria medications. Lack of LLINs increased the perceived added value of LLINs, and together with the increased malaria burden increased the perceived response efficacy. Participants highlighted the need to continuously mobilize and engage community members especially those who do not use LLINs when having one, and those who do not accept the spraying activities. CONCLUSION: Malaria prevention interventions should target individual perceptions to enhance consistent use of malaria preventive measures. Three strategies to improve consistent use and acceptance of these measures are highlighted: (1) ensure access to LLINs and regular spraying activities, (2) community mobilization and (3) citizen engagement in malaria prevention activities.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Malária/prevenção & controle , Percepção , Prevenção Primária/métodos , Adulto , Feminino , Humanos , Malária/psicologia , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Ruanda
2.
Malar J ; 18(1): 232, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296238

RESUMO

BACKGROUND: In a background of renewed calls for malaria eradication, several endemic countries in sub-Saharan Africa are contemplating malaria elimination nationally or sub-nationally. In Mozambique, a strategy to eliminate malaria in the south is underway in the context of low endemicity levels and cross-border initiatives to eliminate malaria in South Africa and Eswatini. In this context, a demonstration project aiming to interrupt malaria transmission through mass antimalarial drug administrations and intensified vector control programmes accompanied by community engagement and standard case management was implemented in the Magude District. To ensure the necessary uptake of these interventions, formative qualitative research explored the perceptions, beliefs, attitudes, and practices related to malaria, its prevention and control. The current article describes the results of this study. METHODS: Seventeen focus group discussions were conducted between September and October of 2015 with the community leaders (6), adult men (5), women of reproductive age (5), and traditional healers (1) in Magude prior to the implementation of the project interventions. Respondents discussed perceptions around malaria symptoms, causes, preventions, and treatments. RESULTS: Knowledge of malaria was linked to awareness of its clinical presentation, and on-going vector control programmes. Perceptions of malaria aetiology were fragmented but related mainly to mosquito-mediated transmission. Reported preventive measures mostly involved mosquito control although participants were aware of the protective limitations of vector control tools. Awareness of asymptomatic carriers and the risk of outdoor malaria transmission were varied. Fever and malaria-like symptoms triggered immediate care-seeking community at health facilities. The identified barriers to malaria treatment included fear/mistrust in Western medicine, distance to health facilities, and lack of transportation. CONCLUSIONS: Several constraints and opportunities will potentially influence malaria elimination in Magude. Malaria awareness, trust in health institutions, and the demand for chemoprophylaxis could facilitate new interventions, such as mass drug administration. A lack of awareness of asymptomatic carriers, inadequate understanding of residual transmission, and barriers to care seeking could jeopardize uptake. Hence, elimination campaigns require strong community engagement and grassroots mobilization.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Malária/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Entrevistas como Assunto , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Moçambique , Pesquisa Qualitativa , Adulto Jovem
3.
Malar J ; 18(1): 238, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307494

RESUMO

BACKGROUND: Reactive focal mass drug administration (rfMDA), or presumptive treatment without malaria testing of household members and neighbours of a passively identified malaria case, is currently being explored as a possible malaria elimination strategy in low transmission settings. One of the primary factors determining the effectiveness of rfMDA on reducing or interrupting transmission is achieving high coverage of the target population with drug administration. This study aims to explore the acceptability of rfMDA and identify facilitators and barriers to its potential implementation, as well as the community's general knowledge, attitudes and beliefs with regard to malaria elimination. METHODS: A qualitative study was performed using focus group discussions (FGDs) among villagers that received rfMDA through the National Malaria Control Programme in the low transmission setting of Eswatini as part of a 2-year clinical trial. FGDs were audio-recorded, transcribed and translated into English. All transcripts were managed in Dedoose and underwent qualitative content analysis. RESULTS: The majority of participants perceived their community to be at high risk of malaria. Witnessing others in their community suffer from malaria, proximity to Mozambique, various ecological factors, and the presence of mosquitoes contributed to this perception. The greatest motivator of participation in rfMDA was witnessing someone else suffer from malaria, since most participants had not personally experienced malaria themselves. Participants valued the education on rfMDA and on malaria in general, particularly when communicated by nurses and other health workers from the Ministry of Health. Participants were overwhelmingly motivated to participate in rfMDA in order to obtain protection from malaria. Most participants did not understand the concept of sub-clinical infection and, therefore, did not perceive the anti-malarial medication given in rfMDA to be a treatment medication. CONCLUSIONS: Perceived risk for malaria was a major driver of acceptability; therefore, future intervention campaigns could aim to better quantify risk to inform interventions and encourage uptake. There were misunderstandings about the asymptomatic reservoir of parasites in humans. Given that this phenomenon is the rationale for rfMDA, this misunderstanding could threaten the uptake of the intervention if it persists in the community. Using local authorities to deliver messaging, additional education on this concept with re-inforcement that risk of malaria is ongoing, even in the absence of frequent cases, may help to maximize and maintain acceptability.


Assuntos
Antimaláricos/uso terapêutico , Infecções Assintomáticas/psicologia , Malária/prevenção & controle , Administração Massiva de Medicamentos/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Malária/psicologia
4.
BMC Public Health ; 19(1): 695, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170964

RESUMO

BACKGROUND: Malaria remains endemic in Ghana despite several interventions. Studies have demonstrated very high levels of asymptomatic malaria parasitaemia in both under-five and school-age children. Mass testing, treatment and tracking (MTTT) of malaria in communities is being proposed for implementation with the argument that it can reduce parasite load, amplify gains from the other control interventions and consequently lead to elimination. However, challenges associated with implementing MTTT such as feasibility, levels of coverage to be achieved for effectiveness, community perceptions and cost implications need to be clearly understood. This qualitative study was therefore conducted in an area with on-going MTTT to assess community and health workers' perceptions about feasibility of scale-up and effectiveness to guide scale-up decisions. METHODS: This qualitative study employed purposive sampling to select the study participants. Ten focus group discussions (FGDs) were conducted in seven communities; eight with community members (n = 80) and two with health workers (n = 14). In addition, two in-depth interviews (IDI) were conducted, one with a Physician Assistant and another with a Laboratory Technician at the health facility. All interviews were recorded, transcribed, translated and analyzed using QSR NVivo 12. RESULTS: Both health workers and community members expressed positive perceptions about the feasibility of implementation and effectiveness of MTTT as an intervention that could reduce the burden of malaria in the community. MTTT implementation was perceived to have increased sensitisation about malaria, reduced the incidence of malaria, reduced household expenditure on malaria and alleviated the need to travel long distances for healthcare. Key challenges to implementation were doubts about the expertise of trained Community-Based Health Volunteers (CBHVs) to diagnose and treat malaria appropriately, side effects of Artemisinin-based Combination Therapies (ACTs) and misconceptions that CBHVs could infect children with epilepsy. CONCLUSION: The study demonstrated that MTTT was perceived to be effective in reducing malaria incidence and related hospital visits in participating communities. MTTT was deemed useful in breaking financial and geographical barriers to accessing healthcare. The interventions were feasible and acceptable to community members, despite observed challenges to implementation such as concerns about CBHVs' knowledge and skills and reduced revenue from internally generated funds (IGF) of the health facility.


Assuntos
Pessoal de Saúde/psicologia , Implementação de Plano de Saúde , Controle de Infecções , Malária/psicologia , Programas de Rastreamento/psicologia , Adulto , Anti-Infecciosos/uso terapêutico , Artemisininas/uso terapêutico , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Grupos Focais , Gana/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Malária/epidemiologia , Masculino , Programas de Rastreamento/métodos , Parasitemia/epidemiologia , Parasitemia/psicologia , Percepção , Pesquisa Qualitativa
5.
Malar J ; 18(1): 216, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238990

RESUMO

BACKGROUND: Slash and burn cultivators are a significant risk group for malaria in South-East Asia. As envisaged in the National Strategic Plan for Malaria Elimination, Bangladesh aims to achieve zero indigenous malaria transmission by 2030. For the national plan to move from malaria control to malaria elimination, targeting the population of slash and burn cultivators is of overriding importance. METHODS: The study used an explorative mixed method design to investigate the knowledge, attitudes, and practices (KAP) regarding malaria prevention and treatment in an endemic area of Bangladesh. Adult slash and burn cultivators in two sub-districts of the Rangamati District were selected and interviewed. Four focus group discussions were conducted, and this was followed by a cross-sectional quantitative survey with 200 participants. RESULTS: The respondents' general knowledge about malaria transmission and modes of prevention and treatment was good. However, there were some gaps regarding knowledge about specific aspects of malaria transmission and in particular about the increased risk associated with their occupation. Despite a much-reduced incidence of malaria in the study area, the respondents perceived the disease as life-threatening and knew that it needs rapid attention from a health worker. Moreover, the specific services offered by the local community health workers for malaria diagnosis and treatment were highly appreciated. Finally, the use of insecticide-treated mosquito nets (ITN) was considered as important and this intervention was uniformly stated as the main malaria prevention method. CONCLUSIONS: The findings from this study on promising KAP characteristics in the slash and burn cultivator population are reassuring that the goal of malaria elimination by the year 2030 can be achieved in Bangladesh.


Assuntos
Fazendeiros/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Malária/psicologia , Adulto , Bangladesh , Estudos Transversais , Feminino , Humanos , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
6.
BMC Med ; 17(1): 98, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31109328

RESUMO

BACKGROUND: Acute kidney injury (AKI) is a recognized complication of pediatric severe malaria, but its long-term consequences are unknown. METHODS: Ugandan children with cerebral malaria (CM, n = 260) and severe malaria anemia (SMA, n = 219) or community children (CC, n = 173) between 1.5 and 12 years of age were enrolled in a prospective cohort study. Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to retrospectively define AKI and chronic kidney disease (CKD). Cognitive testing was conducted using the Mullen Scales of Early Learning in children < 5 and Kaufman Assessment Battery for Children (K-ABC) second edition in children ≥ 5 years of age. RESULTS: The prevalence of AKI was 35.1%, ranging from 25.1% in SMA to 43.5% in CM. In-hospital mortality was 11.9% in AKI compared to 4.2% in children without AKI (p = 0.001), and post-discharge mortality was 4.7% in AKI compared to 1.3% in children without AKI (p = 0.030) corresponding to an all-cause adjusted hazard ratio of 2.30 (95% CI 1.21, 4.35). AKI was a risk factor for short- and long-term neurocognitive impairment. At 1 week post-discharge, the frequency of neurocognitive impairment was 37.3% in AKI compared to 13.5% in children without AKI (adjusted odds ratio (aOR) 2.31 [95% CI 1.32, 4.04]); at 1-year follow-up, it was 13.3% in AKI compared to 3.4% in children without AKI (aOR 2.48 [95% CI 1.01, 6.10]), and at 2-year follow-up, it was 13.0% in AKI compared to 3.4% in children without AKI (aOR 3.03 [95% CI 1.22, 7.58]). AKI was a risk factor for CKD at 1-year follow-up: 7.6% of children with severe malaria-associated AKI had CKD at follow-up compared to 2.8% of children without AKI (p = 0.038) corresponding to an OR of 2.81 (95% CI 1.02, 7.73). The presenting etiology of AKI was consistent with prerenal azotemia, and lactate dehydrogenase as a marker of intravascular hemolysis was an independent risk factor for AKI in CM and SMA (p < 0.0001). In CM, AKI was associated with the presence and severity of retinopathy (p < 0.05) and increased cerebrospinal fluid albumin suggestive of blood-brain barrier disruption. CONCLUSIONS: AKI is a risk factor for long-term neurocognitive impairment and CKD in pediatric severe malaria.


Assuntos
Lesão Renal Aguda/epidemiologia , Transtornos Cognitivos/epidemiologia , Malária/complicações , Malária/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Lesão Renal Aguda/complicações , Lesão Renal Aguda/psicologia , Criança , Pré-Escolar , Transtornos Cognitivos/etiologia , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Malária/patologia , Malária/psicologia , Malária Cerebral/complicações , Malária Cerebral/epidemiologia , Masculino , Prevalência , Estudos Prospectivos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/psicologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Uganda/epidemiologia
7.
Infect Dis Poverty ; 8(1): 39, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31130142

RESUMO

BACKGROUND: The island of Hispaniola, shared by Haiti and the Dominican Republic (DR), is the only remaining malaria-endemic island in the Caribbean and accounts for 95% of the lymphatic filariasis (LF) burden in the Americas. Both countries aim to eliminate the diseases by 2020. Migration from Haiti, where both diseases are more prevalent, may promote transmission in the DR. Historically, Haitian migrant labourers live in rural Dominican agricultural 'company towns' called bateyes, many of which received mass drug administration (MDA) for LF elimination. This study sought to determine the prevalence of malaria and LF in bateyes of the DR and to describe related risk factors for disease. METHODS: From March to April 2016, a cross-sectional, cluster survey was conducted across Dominican bateyes stratified into three regions: southwest, north and east. A household questionnaire (n = 776), captured demographics, ethnic origin, mobility patterns, malaria intervention coverage, and knowledge, and recent fever and treatment-seeking. Two individuals per household (n = 1418) were tested for malaria parasites by microscopy and rapid diagnostic test (RDT) and LF antigen by filariasis test strip (FTS). Population-level estimates and confidence intervals (CI) were computed adjusting for the survey design. Two-sided t-tests compared differences in knowledge scores. RESULTS: No (0%) blood sample was Plasmodium-positive by microscopy or RDT. Six individuals were FTS-positive (0.5%; 95% CI: 0.2-1.5), but none (0%) of these were microfilariae-positive. Most batey residents were born in the DR (57.8%), documented (85.0%), and permanent residents (85.1%). Very few respondents (9.4%) reported travel to Haiti in the past year. Overall, half (53.8%) of respondents owned a bed net, and 82.3% of net owners reported using it the previous night. Indoor residual spraying (IRS) differed by region (range: 4.7%-61.2%). Most of those with recent fever sought care (56.0%), yet only 30.5% of those seeking care were tested for malaria. Compared to Dominican-born populations, Haitian-born respondents more frequently reported recent fever, did not seek care for the fever, had not heard of malaria, and could not name symptoms or prevention methods. CONCLUSIONS: Malaria and LF transmission appear absent or extremely low in Dominican bateyes, which are a mixture of Haitian and Dominican residents. Travel to Haiti is rare, meaning risk of malaria and LF importation is low. Addressing identified gaps in intervention coverage, malaria knowledge, treatment seeking and service delivery will improve the quality of surveillance for these diseases, particularly among marginalized populations and promote island-wide elimination.


Assuntos
Filariose Linfática/epidemiologia , Filariose Linfática/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Malária/epidemiologia , Malária/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos de Helmintos , Antígenos de Protozoários , Criança , Pré-Escolar , Estudos Transversais , República Dominicana/epidemiologia , Filariose Linfática/sangue , Feminino , Haiti/etnologia , Humanos , Malária/sangue , Malária/prevenção & controle , Masculino , Administração Massiva de Medicamentos , Pessoa de Meia-Idade , Mosquiteiros , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Fatores de Risco , Inquéritos e Questionários , Migrantes , Adulto Jovem
8.
Malar J ; 18(1): 92, 2019 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-30902055

RESUMO

BACKGROUND: Adequate knowledge of malaria prevention and control can help in reducing the growing burden of malaria among vulnerable groups, particularly pregnant women and children aged under 5 years living in malaria endemic settings. Similar studies have been conducted but with less focus on these vulnerable groups. This study assessed knowledge of malaria prevention and control among the pregnant women and non-pregnant mothers of children aged under 5 years in Ibadan, Oyo State, South West Nigeria. METHODS: In this cross sectional study, data on socio-demographic, clinical and knowledge on malaria prevention was collected using interviewer administered questionnaires from consenting study participants attending Adeoyo maternity hospital between May and November 2016. Data was described using percentages and compared across the two maternal groups in the study population. Knowledge scoring from collected data was computed using the variables on causes, symptoms and prevention of malaria and thereafter dichotomised. Multivariate analyses were used to assess the interactive effect of socio demographic and clinical characteristics with malaria knowledge. Level of statistical significance was set at p < 0.05. RESULTS: Of the 1373 women in the study, 59.6% (818) were pregnant women while 40.4% (555) were mothers of children aged under 5 years. The respondents mean age was 29 years ± 5.2. A considerable proportion of both the pregnant women (n = 494, 60.4%) and the non-pregnant mothers of children aged under 5 years (n = 254, 45.8%) did not have correct knowledge on malaria prevention measures based on our assessment threshold (p < 0.001). Having a tertiary level education was associated with better knowledge on malaria (4.20 ± 1.18, F = 16.80, p < 0.001). Multivariate analyses showed that marital status, educational attainment, gravidity, and HIV status were significantly associated with knowledge of malaria prevention and control. CONCLUSION: The findings indicate that socio-demographic factors such as marital and educational status greatly influence knowledge on malaria prevention and control measures. Key health stakeholders and authorities need to implement strategies and direct resources to improve the knowledge of mothers on malaria prevention and control. This would stem the tides of malaria related deaths among pregnant women and children aged under 5 years.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Malária/psicologia , Mães/psicologia , Adulto , Pré-Escolar , Estudos Transversais , Humanos , Lactente , Recém-Nascido , Malária/prevenção & controle , Análise Multivariada , Nigéria , Gestantes/psicologia , Adulto Jovem
9.
Malar J ; 18(1): 41, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30786906

RESUMO

BACKGROUND: The levels of insecticide-treated net use among pregnant women and uptake of intermittent preventive treatment in pregnancy, have been sub-optimal in Nigeria. Previous studies have reported positive correlations between knowledge, attitude and practice of malaria preventive measures. It has also been reported that information and motivation, act through a mediator (behavioural skills), to cause a health behaviour change. The aim of this study was as such to develop, implement, and assess the effects of a health educational intervention based on the information-motivation-behavioural skills (IMB) model on the levels of knowledge, motivation, and behavioural skills for ITN use and IPTp uptake among pregnant women in a hospital in north-eastern Nigeria. METHODS: This was a randomized controlled parallel-group trial in which 372 antenatal care attendees were randomly assigned to either an intervention or control group after collecting baseline data using a structured questionnaire. The intervention group received a 4-h health education on malaria, guided by a module developed based on the IMB theory, while the control group received health education on breastfeeding for a similar duration and by the same facilitator. Follow-up data were subsequently collected at 2 months and at 4 months post-intervention using the same questionnaire. The generalized linear mixed models analysis was used to determine the between-group and within-group effects of the intervention. The intention-to-treat analysis was used after missing data had been replaced. This was followed by a sensitivity analysis, where the analyses were repeated without replacing the missing values. RESULTS: The intervention was significant in achieving a 12.75% (p < 0.001), 8.55% (p < 0.001), and 6.350% (p < 0.001) higher total knowledge, motivation, and behavioural skills scores respectively, for the intervention group over the control group. The sensitivity analysis revealed no great differences in the effect sizes, even when missing data were not replaced. CONCLUSION: The intervention module was effective in improving knowledge, motivation and behavioural skills. It is as such recommended to be adopted and incorporated into the routine antenatal health education schedules. It is also recommended that booster doses of the module be given say 2 months after the first dose to sustain levels of motivation and behavioural skills. Trial registration Pan African Clinical Trial Registry, PACTR201610001823405. Registered 26 October 2016, http://www.pactr.org.


Assuntos
Antimaláricos/uso terapêutico , Terapia Comportamental/métodos , Transmissão de Doença Infecciosa/prevenção & controle , Educação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Malária/prevenção & controle , Malária/psicologia , Adolescente , Adulto , Controle de Doenças Transmissíveis/métodos , Feminino , Humanos , Malária/tratamento farmacológico , Malária/epidemiologia , Pessoa de Meia-Idade , Nigéria/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/psicologia , Inquéritos e Questionários , Adulto Jovem
10.
Malar J ; 18(1): 27, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30683091

RESUMO

BACKGROUND: Malaria control remains a leading health challenge in Mozambique. Indoor residual spraying (IRS) is an effective strategy to control malaria transmission, but there are often barriers to reaching the coverage necessary for attaining maximum community protective effect of IRS. Mozambique recorded a high number of household refusals during the 2016 IRS campaign. This study sought to evaluate household and community factors related to the acceptability of IRS to inform strategies for future campaigns in Mozambique and the region. METHODS: A cross-sectional, qualitative study was conducted in eight urban and rural communities in two high malaria burden provinces in Mozambique. Data were collected through in-depth interviews with community members, leaders, sprayers, and representatives of district health directorates; focus group discussions with community members who accepted and who refused IRS during the 2016 campaign; systematic field observations; and informal conversations. Data were systematically coded and analysed using NVIVO-11®. RESULTS: A total of 61 interviews and 12 discussions were conducted. Community participants predominantly described IRS as safe, but many felt that it had limited efficacy. The main factors that participants mentioned as having influenced their IRS acceptance or refusal were: understanding of IRS; community leader level of support; characteristics of IRS programmatic implementation; environmental, political and historical factors. Specifically, IRS acceptance was higher when there was perceived community solidarity through IRS acceptance, desire to reduce the insect population in homes, trust in government and community satisfaction with past IRS campaign effectiveness. Participants who refused were mainly from urban districts and were more educated. The main barriers to acceptance were associated with selection and performance of spray operators, negative experiences from previous campaigns, political-partisan conflicts, difficulty in removing heavy or numerous household assets, and preference for insecticide-treated nets over IRS. CONCLUSIONS: Acceptance of IRS was influenced by diverse operational and contextual factors. As such, future IRS communications in targeted communities should emphasize the importance of high IRS coverage for promoting both familial and community health. Additionally, clear communications and engagement with community leaders during spray operator selection and spray implementation may help reduce barriers to IRS acceptance.


Assuntos
Anopheles , Controle de Doenças Transmissíveis/métodos , Conhecimentos, Atitudes e Prática em Saúde , Inseticidas , Malária/prevenção & controle , Controle de Mosquitos , Animais , Participação da Comunidade , Estudos Transversais , Grupos Focais , Humanos , Malária/psicologia , Moçambique , Resíduos de Praguicidas , Pesquisa Qualitativa
11.
PLoS One ; 14(1): e0210221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30629651

RESUMO

INTRODUCTION: In Ethiopia, the burden of malaria during pregnancy remains a public health problem. Having a good malaria knowledge leads to practicing the prevention of malaria and seeking a health care. Researches regarding pregnant women's knowledge on malaria in Ethiopia is limited. So the aim of this study was to assess malaria knowledge and its associated factors among pregnant woman, 2018. METHODS: An institutional-basedcross-sectional study was conducted in Adis Zemen Hospital. Data were collected using pre-tested, an interviewer-administered structured questionnaire among 236 mothers. Women's knowledge on malaria was measured using six malaria-related questions (cause of malaria, mode of transmission, signs and symptoms, complication and prevention of malaria). The collected data were entered using Epidata version 3.1 and exported to SPSS version 20 for analysis. Bivariate and multivariate logistic regressions were computed to identify predictor variables at 95% confidence interval. Variables having P value of <0.05 were considered as predictor variables of malaria knowledge. RESULT: A total of 235 pregnant women participated which makes the response rate 99.6%. One hundred seventy two pregnant women (73.2%) of mothers had good knowledge on malaria.Women who were from urban (AOR; 2.4: CI; 1.8, 5.7), had better family monthly income (AOR; 3.4: CI; 2.7, 3.8), attended education (AOR; 1.8: CI; 1.4, 3.5) were more knowledgeable. CONCLUSION AND RECOMMENDATION: Majority of participants had good knowledge on malaria. Educational status, household monthly income and residence werepredictors of malaria knowledge. Increasing women's knowledge especially for those who are from rural, have no education, and have low monthly income is still needed.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Malária/epidemiologia , Gestantes/psicologia , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Escolaridade , Etiópia/epidemiologia , Feminino , Humanos , Malária/parasitologia , Malária/psicologia , Pessoa de Meia-Idade , Gravidez , Cuidado Pré-Natal , População Rural , Inquéritos e Questionários , Adulto Jovem
12.
Malar J ; 17(1): 476, 2018 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-30563514

RESUMO

BACKGROUND: Gaps remain in understanding the role of caregiver responses on time to seek appropriate care. The objective of this study was to describe caregiver responses to illness and the impact of these responses on time to seek appropriate care among children with malaria. METHODS: A case-control study of 325 children with severe (cases) and 325 children with uncomplicated (controls) malaria was conducted in Jinja, Uganda. Caregivers' responses to their children's illnesses and time to seek appropriate care were documented. Responses included staying at home, seeking care at drug shops, and seeking care at public health facilities classified into two types: (1) health facilities where caregiver initially sought care before enrollment, and (2) health facilities where children were provided appropriate care and enrolled in the study. Weighted Cox regression was used to determine risk factors for delays in time to seek appropriate care within 24 h of illness onset. RESULTS: Children staying home on self-medication was the most common initial response to illness among caregivers of controls (57.5%) and cases (42.4%, p < 0.001), followed by staying at home without medication (25.2%) and seeking care at drug shops (32.0%) for caregivers of controls and cases, respectively. Seeking care at drug shops was more common among caregivers of cases than of controls (32.0% vs. 12.3%; p < 0.001). However, compared to public health facilities, drug shops offered sub-optimal services with children less likely to have been examined (50.0% vs. 82.9%; p < 0.001) or referred to another facility (12.5% vs. 61.4%; p < 0.001). Upon adjustment for known risk factors for delay, initially seeking care at a drug shop (HR 0.37, p = 0.036) was associated with delay in seeking care at a health facility where appropriate care was provided. In contrast, those initially seeking care at public health facility before enrollment were more likely to subsequently seek care at another public health facility where appropriate care was provided (HR 5.55, p < 0.001). CONCLUSION: Caregivers should be educated on the importance of promptly seeking care at a health facility where appropriate care can be provided. The role of drug shops in providing appropriate care to children with malaria needs to be reviewed.


Assuntos
Cuidadores/estatística & dados numéricos , Malária/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Comportamentos Relacionados com a Saúde , Instalações de Saúde/estatística & dados numéricos , Humanos , Lactente , Malária/psicologia , Masculino , Fatores de Risco , Uganda
13.
Malar J ; 17(1): 406, 2018 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-30390652

RESUMO

BACKGROUND: As malaria is among the leading public health problems globally, early diagnosis and treatment of cases is one of the key interventions for its control and elimination. Nevertheless, little is known about early treatment-seeking behaviour for malaria of people in Ethiopia. This study was conducted to investigate early treatment-seeking behaviour and associated factors among febrile patients in Dera district, one of the malaria hotspot districts in Ethiopia. METHODS: An institution-based, cross-sectional study was conducted among malaria-suspected febrile patients in Dera district, Amhara Regional State, Ethiopia from September to December 2017. The study used the lottery method to select sample health facilities, and participant allocation to facilities was done in proportion to client flow to the respective health facilities. Data were collected by interview. Thus, binary logistic regression model was fitted to the data. Crude and adjusted odds ratios with the respective confidence intervals and p-values were computed. An explanatory variable with a p-value ≤ 0.05 was considered statistically significant. SPSS version 20 was used for the analysis. RESULTS: A total of 680 respondents completed the study with a response rate of 96.6%. The study revealed that 356 (52.4%) participants sought treatment within 24 h of fever onset, and patients who: knew the advantage of sleeping under nets [AOR 95% CI 2.8 (1.70-4.60)]; knew mosquito breeding sites [AOR 95% CI 1.9 (1.10-3.30)]; had good, overall knowledge about malaria [AOR 95% CI 2.7 (1.56-4.76)]; had previous history of malaria [AOR 95% CI 3.26 (1.64-6.49)]; were at a distance of < 6 km from a health centre [AOR 95% CI 2.5 (1.72-3.60)]; and, had family size < 5 [AOR 95% CI 2.1 (1.43-3.20)], were more likely to seek treatment within 24 hof fever onset. CONCLUSION: A low proportion of malaria-suspected patients sought treatment within 24 h of fever onset compared to the national target. Awareness about the advantage of sleeping under nets, knowledge about mosquito breeding sites and malaria itself, previous history of malaria, distance from the health centres, and family size were found to be predictors of early treatment-seeking behaviour for malaria. Strengthening strategies tailored to increasing awareness for communities about malaria prevention methods and early treatment-seeking behaviour is essential.


Assuntos
Febre/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Malária/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Etiópia , Feminino , Febre/prevenção & controle , Humanos , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Malar J ; 17(1): 425, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30442132

RESUMO

BACKGROUND: A multi-country, community-based trial on scheduled screening and treatment for malaria in pregnancy was conducted in Benin, The Gambia and Burkina Faso. Despite standardized procedures and outcomes, the study became subject to rumours and accusations of placenta being sold for mystical and financial gain by trial staff, leading to drop-out rates of 30% and the consequent halting of placental biopsy sampling in Benin. This paper explores the role of socio-cultural beliefs related to placenta and identified additional factors contributing these rumours. METHODS: A qualitative comparative emergent-theory design was used to assess social factors related to trial implementation and uptake in the three countries. Data from participant observation, informal conversations, group discussions and interviews were triangulated and analysed with NVivo Qualitative Analysis software. RESULTS: Despite similar sociocultural beliefs about the sacred nature of the placenta in all three study countries, these beliefs did not affect participation rates in Burkina Faso and The Gambia and placenta-related rumours only emerged in Benin. Therefore, the presence of beliefs is not a sufficient condition to have generated placenta-selling fears. The rumours in Benin reflected the confluence of placenta-related beliefs and factors related to the implementation of the trial (including a catalysing adverse event and miscommunication during the informed consent procedure). Furthermore, distinct socio-political factors contributed to the emergence of rumours, including the historical distrust in governmental organizations and the tense relationship between some of the actors involved in the trial. CONCLUSION: Transdisciplinary social science research designs should accompany the implementation of the trial. The integration of multiple stakeholders' knowledge and involvement is required to define and solve upcoming barriers.


Assuntos
Biópsia/psicologia , Medo , Malária/psicologia , Placenta , Complicações Parasitárias na Gravidez/psicologia , Benin , Biópsia/economia , Feminino , Humanos , Consentimento Livre e Esclarecido , Malária/parasitologia , Gravidez , Complicações Parasitárias na Gravidez/parasitologia
15.
Malar J ; 17(1): 396, 2018 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-30373591

RESUMO

BACKGROUND: There is limited information on uptake of malaria testing among migrants who are a 'high-risk' population for malaria. This was an explanatory mixed-methods study. The quantitative component (a cross sectional analytical study-nation-wide migrant malaria survey in 2016) assessed the knowledge; health-seeking; and testing within 24 h of fever and its associated factors. The qualitative component (descriptive design) explored the perspectives of migrants and health care providers [including village health volunteers (VHV)] into the barriers and suggested solutions to increase testing within 24 h. Quantitative data analysis was weighted for the three-stage sampling design of the survey. Qualitative data analysis involved manual descriptive thematic analysis. RESULTS: A total of 3230 households were included in the survey. The mean knowledge score (maximum score 11) for malaria was 5.2 (0.95 CI 5.1, 5.3). The source of information about malaria was 80% from public health facility staff and 21% from VHV. Among 11 193 household members, 964 (8.6%) had fever in last 3 months. Health-seeking was appropriate for fever in 76% (0.95 CI 73, 79); however, only 7% (0.95 CI 5, 9) first visited a VHV while 19% (0.95 CI 16, 22) had self-medication. Of 964, 220 (23%, 0.95 CI 20, 26) underwent malaria blood testing within 24 h. Stable migrants, high knowledge score and appropriate health-seeking were associated with testing within 24 h. Qualitative findings showed that low testing within 24 h despite appropriate health-seeking was due to lack of awareness among migrants regarding diagnosis services offered by VHV, delayed health-seeking at public health facilities and not all cases of fever being tested by VHV and health staff. Providing appropriate behaviour change communication for migrants related to malaria, provider's acceptance for malaria testing for all fever cases and mobile peer volunteer under supervision were suggested to overcome above barriers. CONCLUSIONS: Providers were not testing all migrant patients with fever for malaria. Low uptake within 24 h was also due to poor utilization of services offered by VHV. The programme should seriously consider addressing these barriers and implementing the recommendations if Myanmar is to eliminate malaria by 2030.


Assuntos
Testes Diagnósticos de Rotina/estatística & dados numéricos , Febre/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Malária/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde , Migrantes , Estudos Transversais , Febre/diagnóstico , Febre/epidemiologia , Malária/epidemiologia , Malária/psicologia , Mianmar/epidemiologia , Prevalência , Migrantes/estatística & dados numéricos
16.
Malar J ; 17(1): 360, 2018 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-30314439

RESUMO

BACKGROUND: Severe malaria in children is often associated with long-term behavioural and cognitive problems. A sizeable minority of children go on to experience repeated malaria due to the high transmission and infection rates in the region. The purpose of this study was to explore caregivers' experiences of parenting a child with a history of severe malaria followed by repeated episodes of uncomplicated malaria in comparison to healthy community children. METHODS: Thirty-one caregivers were enrolled in the study. These included caregivers of children previously exposed to severe malaria and who had experienced repeated uncomplicated malaria attacks (SM with RMA, n = 15), caregivers of children exposed to severe malaria who did not experience repeated episodes (SM, n = 10), and caregivers of healthy community children (CC, n = 6) were purposively selected. RESULTS: Thematic-content analysis generated eight areas of concern, six of which were noted only by caregivers of children with SM or SM with RMA: (1) a sense of helplessness; (2) challenges with changes in behaviour; (3) responses to a child's behaviour; (4) family life disruptions, including breakdown of relationships and inadequate male-spouse involvement in child care; (5) disagreements in seeking healthcare; (6) societal burden; and two by caregivers of children with SM, SM with RMA and also CC; (7) concern about academic achievement; and, (8) balancing work and family life. CONCLUSIONS: The study findings suggest that severe malaria, especially when followed by repeated malaria episodes, affects not only children who have the illness but also their caregivers. The effects on caregivers can decrease their social functioning and isolate them from other parents and may disrupt families. Interventions to support caregivers by counselling the ongoing problems that might be expected in children who have had severe malaria and repeated episodes of malaria, and how to manage these problems, may provide a way to improve behavioural and mental health outcomes for those children and their caregivers.


Assuntos
Cuidadores/psicologia , Malária/psicologia , Pais/psicologia , Idoso , Feminino , Humanos , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Uganda , Adulto Jovem
17.
Malar J ; 17(1): 382, 2018 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-30352592

RESUMO

BACKGROUND: Liberia is a West African country that needs substantial investment to strengthen its National Malaria Control Programme (NMCP), which was disrupted during the 2014-2016 Ebola epidemic. As elsewhere, Liberian pregnant women are especially vulnerable to malaria. Understanding prevention and treatment-seeking behaviours among the population is crucial to strategize context-specific and women-centred actions, including locally-led malaria research, to improve women's demand, access and use of NMCP strategies against malaria in pregnancy. METHODS: In 2016, after the Ebola crisis, a qualitative inquiry was conducted in Monrovia to explore populations' insights on the aetiology, prevention and therapeutics of malaria, as well as the community and health workers' perceptions on the utility of malaria research for pregnant women. In-depth interviews and focus group discussions were conducted among pregnant women, traditional community representatives and hospital staff (n = 38), using a feminist interpretation of grounded theory. RESULTS: The narratives indicate that some Liberians believed in elements other than mosquito bites as causes of malaria; many had a low malaria risk perception and disliked current effective prevention methods, such as insecticide-treated nets; and some would resort to traditional medicine and spiritual care to cure malaria. Access to clinic-based malaria care for pregnant women was reportedly hindered by lack of financial means, by unofficial user fees requested by healthcare workers, and by male partners' preference for traditional medicine. The participants suggested that malaria research in Liberia could help to design evidence-based education to change current malaria prevention, diagnostic and treatment-seeking attitudes, and to develop more acceptable prevention technologies. CONCLUSION: Poverty, insufficient education on malaria, corruption, and poor trust in healthcare establishment are structural factors that may play a greater role than local traditional beliefs in deterring Liberians from seeking, accessing and using government-endorsed malaria control strategies. To increase access to and uptake of preventive and biomedical care by pregnant women, future malaria research must be informed by people's expressed needs and constructed meanings and values on health, ill health and healthcare.


Assuntos
Pesquisa Participativa Baseada na Comunidade/estatística & dados numéricos , Malária/psicologia , Percepção , Pesquisa Qualitativa , Adulto , Cidades , Cultura , Feminino , Teoria Fundamentada , Humanos , Libéria , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
18.
Rev Salud Publica (Bogota) ; 20(1): 82-88, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30183889

RESUMO

OBJECTIVE : To describe the condition of malaria in the District 5 of San Andres de Tumaco-Nariño-Colombia, with regards to knowledge, attitudes, perceptions, and community practices. METHODS : A cross-sectional study was conducted between January and May 2014. Logistic analysis of the CAP-PP survey of the Pan American Health Organization (PAHO) was carried out. Statistical modeling was adjusted through the logarithm of likelihood test, the Pseudo R2, the Akaike's Information Criterion (AIC) and the Bayesian Information Criterion (BIC). Results. The variables that influence the disease of malaria are: taking medicines, malaria tests and vector control by spraying at home. It is important to keep clean ditches around the house in order for people to be protected against the disease. CONCLUSION : Although the population reported having knowledge, attitudes, community practices, and perceptions about the issue, these do not generate protection against the disease. Variables such as carrying out activities in the family and ignorance about the name of the mosquito that transmits malaria must be taken into account for the formulation of community intervention plans.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Malária/prevenção & controle , Saúde da População Urbana , Teorema de Bayes , Colômbia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Malária/psicologia , Masculino
19.
Malar J ; 17(1): 291, 2018 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-30097031

RESUMO

BACKGROUND: Portfolio effects were first described as a basis for mitigating against financial risk by diversifying investments. Distributing investment across several different assets can stabilize returns and reduce risks by statistical averaging of individual asset dynamics that often correlate weakly or negatively with each other. The same simple probability theory is equally applicable to complex ecosystems, in which biological and environmental diversity stabilizes ecosystems against natural and human-mediated perturbations. Given the fundamental limitations to how well the full complexity of ecosystem dynamics can be understood or anticipated, the portfolio effect concept provides a simple framework for more critical data interpretation and pro-active conservation management. Applied to conservation ecology purposes, the portfolio effect concept informs management strategies emphasizing identification and maintenance of key ecological processes that generate complexity, diversity and resilience against inevitable, often unpredictable perturbations. IMPLICATIONS: Applied to the reciprocal goal of eliminating the least valued elements of global biodiversity, specifically lethal malaria parasites and their vector mosquitoes, simply understanding the portfolio effect concept informs more cautious interpretation of surveillance data and simulation model predictions. Malaria transmission mediated by guilds of multiple vectors in complex landscapes, with highly variable climatic and meteorological conditions, as well as changing patterns of land use and other human behaviours, will systematically tend to be more resilient to attack with vector control than it appears based on even the highest quality surveillance data or predictive models. CONCLUSION: Malaria vector control programmes may need to be more ambitious, interpret their short-to-medium term assessments of intervention impact more cautiously, and manage stakeholder expectations more conservatively than has often been the case thus far.


Assuntos
Anopheles/fisiologia , Malária/prevenção & controle , Controle de Mosquitos/métodos , Mosquitos Vetores/fisiologia , Animais , Anopheles/parasitologia , Malária/psicologia , Mosquitos Vetores/parasitologia
20.
Malar J ; 17(1): 290, 2018 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-30097037

RESUMO

BACKGROUND: In Ethiopia, malaria has declined in the last decade; only a small number of cases have been reported, primarily from hotspots. The contribution of house proximity to water bodies and the role of migration in malaria transmission has not yet been examined in detail in northwest Ethiopia. Individual and household-level environmental and socio-demographic drivers of malaria heterogeneity were explored contextually in meso-endemic villages around Lake Tana, northwest Ethiopia. METHODS: A health facility-based paired age-sex matched case-control study involving 303 matched pairs was undertaken from 10 October 2016, to 30 June 2017. Geo-referencing of case households, control households, proximate water bodies, and health centres was carried out. A pretested and structured questionnaire was used to collect data on socio-demography, household assets, housing, travel history, and malaria intervention measures. Medians (interquartile range) were computed for continuous variables. Pearson's Chi square/Fisher's exact test was used to detect significant differences in proportions. Principal component analysis was performed to estimate household wealth. Stratified analysis was used to confirm confounding and interaction. A multivariable conditional logistic regression model was used to detect risk factors for malaria. RESULTS: Of 303 malaria cases, 59 (19.5% [15.4-24.3]) were imported malaria cases whereas 244 (80.5% [75.7-84.6]) were locally acquired malaria cases. In bivariate analysis, marital status, educational status, and bed net ownership were significantly associated with malaria cases. In multivariable adjustment, travel to malarious lowlands in the preceding month (adjusted mOR = 7.32; 95% CI 2.40-22.34), household member's travel to malarious lowlands (adjusted mOR = 2.75; 95% CI 1.02-7.44), and inadequate health information on malaria (adjusted mOR = 1.57; 95% CI 1.03-2.41) were predictors of malaria. Stratified analysis confirmed that elevation of households and travel to malarious lowlands were not effect modifiers. Travel to malarious lowlands had a confounding effect on malaria but elevation of households did not. CONCLUSIONS: In this study, travel to farms in the lowlands and inadequate health information on malaria were risk factors for malaria in villages around Lake Tana. This evidence is critical for the design of improved strategic interventions that consider imported malaria cases and approaches for accessing health information on malaria control in northwest Ethiopia.


Assuntos
Malária/epidemiologia , Malária/psicologia , Viagem/estatística & dados numéricos , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Etiópia/epidemiologia , Feminino , Humanos , Incidência , Disseminação de Informação , Modelos Logísticos , Malária/parasitologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA