Low uptake of preventive interventions among malaria cases in Swaziland: towards malaria elimination

Makadzange, K; Dlamini, Nomcebo; Zulu, Z; Dlamini, Sabelo; Kunene, Simon; Sikhondze, Welile; Owiti, Philip; Geoffroy, Elizabeth; Zachariah, Rony; Mengestu, TK

doi:10.5588/pha.17.0016

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…Since this, their distribution has been restricted to vulnerable populations through antenatal clinics and, more recently, in a targeted approach to some of the high-risk populations identified in this study. In elimination settings, programs may be challenged by lower uptake of some interventions due to the perception that malaria is no longer a risk, which should be managed through targeted messaging and health promotion [ 67 ]. In contrast, IRS is currently a cornerstone of the malaria elimination strategy in Namibia, which used predominantly DDT for malaria vector control up till 2017.…”

Section: Discussionmentioning

confidence: 99%

Malaria risk factors in northern Namibia: The importance of occupation, age and mobility in characterizing high-risk populations

et al. 2021

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In areas of low and unstable transmission, malaria cases occur in populations with lower access to malaria services and interventions, and in groups with specific malaria risk exposures often away from the household. In support of the Namibian National Vector Borne Disease Program’s drive to better target interventions based upon risk, we implemented a health facility-based case control study aimed to identify risk factors for symptomatic malaria in Zambezi Region, northern Namibia. A total of 770 febrile individuals reporting to 6 health facilities and testing positive by rapid diagnostic test (RDT) between February 2015 and April 2016 were recruited as cases; 641 febrile individuals testing negative by RDT at the same health facilities through June 2016 were recruited as controls. Data on socio-demographics, housing construction, overnight travel, use of malaria prevention and outdoor behaviors at night were collected through interview and recorded on a tablet-based questionnaire. Remotely-sensed environmental data were extracted for geo-located village residence locations. Multivariable logistic regression was conducted to identify risk factors and latent class analyses (LCA) used to identify and characterize high-risk subgroups. The majority of participants (87% of cases and 69% of controls) were recruited during the 2016 transmission season, an outbreak year in Southern Africa. After adjustment, cases were more likely to be cattle herders (Adjusted Odds Ratio (aOR): 4.46 95%CI 1.05–18.96), members of the police or other security personnel (aOR: 4.60 95%CI: 1.16–18.16), and pensioners/unemployed persons (aOR: 2.25 95%CI 1.24–4.08), compared to agricultural workers (most common category). Children (aOR 2.28 95%CI 1.13–4.59) and self-identified students were at higher risk of malaria (aOR: 4.32 95%CI 2.31–8.10). Other actionable risk factors for malaria included housing and behavioral characteristics, including traditional home construction and sleeping in an open structure (versus modern structure: aOR: 2.01 95%CI 1.45–2.79 and aOR: 4.76 95%CI: 2.14–10.57); cross border travel in the prior 30 days (aOR: 10.55 95%CI 2.94–37.84); and outdoor agricultural work at night (aOR: 2.09 95%CI 1.12–3.87). Malaria preventive activities were all protective and included personal use of an insecticide treated net (ITN) (aOR: 0.61 95%CI 0.42–0.87), adequate household ITN coverage (aOR: 0.63 95%CI 0.42–0.94), and household indoor residual spraying (IRS) in the past year (versus never sprayed: (aOR: 0.63 95%CI 0.44–0.90). A number of environmental factors were associated with increased risk of malaria, including lower temperatures, higher rainfall and increased vegetation for the 30 days prior to diagnosis and residing more than 5 minutes from a health facility. LCA identified six classes of cases, with class membership strongly correlated with occupation, age and select behavioral risk factors. Use of ITNs and IRS coverage was similarly low across classes. For malaria elimination these high-risk groups will need targeted and tailored intervention strategies, for example, by implementing alternative delivery methods of interventions through schools and worksites, as well as the use of specific interventions that address outdoor transmission.

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Section: Discussionmentioning

confidence: 99%

Malaria risk factors in northern Namibia: The importance of occupation, age and mobility in characterizing high-risk populations

et al. 2021

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“…There are proven malaria prevention measures, including use of long lasting insecticidal nets (LLINs), that are recommended for travellers from low to high malaria endemic areas [9]. However, residents of malaria endemic countries in sub-Saharan Africa often do not use LLINs while travelling away from home, which presents a challenge to malaria control and elimination efforts [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Challenges and opportunities for use of long-lasting insecticidal nets to prevent malaria during overnight travel in Uganda: a qualitative study

Ekusai-Sebatta

Arinaitwe

Mpimbaza

et al. 2021

Preprint

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Background. Travel is a well-recognized risk factor for malaria. Within sub-Saharan Africa, travellers from areas of lower to higher transmission intensity are potentially at high risk of malaria. Long-lasting insecticidal nets (LLINs) are the primary tool for prevention of malaria, and their widespread use has contributed to substantial reductions in malaria burden. However, travellers often fail to use LLINs. To further explore the challenges and opportunities of using LLINs, we interviewed travellers in Uganda. Methods. In August and September 2019, 20 participants attending outpatient clinics at Naguru General Hospital in Kampala with a history of travel out of Kampala within the previous 60 days were purposively selected. Data were collected through in-depth interviews and analysed thematically using NVivo 12. Results Of the 20 participants, 13 were male. Thirteen of the participants (65%) tested positive for malaria by microscopy. A total of 25% of the participants reported use of LLINs during travel. The main reasons for travel were to attend social events (weddings, funerals, overnight prayers) and for work. Travelers who attended social events reported using LLINs less commonly than those who travelled for work. Challenges to using LLINs during travel included: 1) limited access to LLINs, 2) inability to plan ahead for travel, 3) lack of space or ability to hang LLINs while traveling, 4) impression that LLINs in lodging places were unhygienic, 5) cultural beliefs discouraging use of LLINs during social events, 6) participation in overnight ceremonies and 7) doubts about efficacy of LLINs. Positive factors influencing use of LLINs during travel included knowledge regarding malaria prevention and good affordability and availability of LLINs. Conclusion Despite good traveller knowledge regarding malaria control measures, use of LLINs was limited. Use of LLINs in the prevention of malaria among travellers from low to high transmission settings needs to be prioritized. This calls for increased availability of LLINs and promotion of appropriate malaria prevention messages by the government to facilitate their adoption by overnight travellers.

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“…Dlamini N et al found particular implementation issues for case detection and follow-up at the borders in Swaziland, 7 and Makadzange et al found low uptake of preventive practices and low awareness of risks amongst travellers returning to Swaziland. 11 When malaria cases are at low levels, there is a risk that competency among frontline health staff, such as in community health centres, hospitals and in the private sector, diminishes. This was found in Swaziland and Botswana (Makadzange et al, Moakofhi et al), 11,12 and has the potential to undermine progress towards elimination and prevention of the re-establishment of malaria.…”

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confidence: 99%

“…11 When malaria cases are at low levels, there is a risk that competency among frontline health staff, such as in community health centres, hospitals and in the private sector, diminishes. This was found in Swaziland and Botswana (Makadzange et al, Moakofhi et al), 11,12 and has the potential to undermine progress towards elimination and prevention of the re-establishment of malaria. In addition, successfully implemented malaria control interventions, such as indoor residual spraying (IRS) and other vector control programmes, can result in changes in vector epidemiology and behaviours.…”

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confidence: 99%

To reach elimination one needs to think and act locally, to support the global vision

Whittaker

2018

public health action

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Low uptake of preventive interventions among malaria cases in Swaziland: towards malaria elimination

Cited by 4 publications

References 9 publications

Malaria risk factors in northern Namibia: The importance of occupation, age and mobility in characterizing high-risk populations

Malaria risk factors in northern Namibia: The importance of occupation, age and mobility in characterizing high-risk populations

Challenges and opportunities for use of long-lasting insecticidal nets to prevent malaria during overnight travel in Uganda: a qualitative study

To reach elimination one needs to think and act locally, to support the global vision

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