Association Between Recent Overnight Travel And Use Of Long-Lasting Insecticidal Nets In Rural Uganda: A Prospective Cohort Study In Tororo

Abstract

Background: The burden of malaria in Uganda remains high, but has become increasingly heterogenous following intensified malaria control. Travel within Uganda is recognised as a risk factor for malaria, but behaviours associated with travel are not well-understood. To address this knowledge gap, malaria-relevant behaviours of cohort participants were assessed during travel and at home in Uganda.Methods: Residents from 80 randomly selected households in Nagongera sub-county, Tororo district were enrolled into a cohort to study malaria in rural Uganda. All participants were given long-lasting insecticidal nets (LLINs) at enrolment and were evaluated every 4 weeks at the study clinic. Participants were asked if they had travelled overnight from their home, and if so, a questionnaire was administered to capture information on travel details and behaviours. Behaviour while at home was assessed using a similar questionnaire during two-weekly home visits. Behaviours while travelling vs at home were compared using generalized estimating equations adjusting for repeated measures in the same individual. Results: Between October 2017 and October 2019, 527 participants were enrolled and assessed for travel. Of these, 123 (23.2%) reported taking 211 overnight trips; 149 (70.6%) trips were within Tororo. Participants were less likely to use LLINs when travelling than when at home (41.0% vs. 56.2%, relative risk [RR] 0.73, 95% CI: 0.60-0.89, p=0.002); this difference was noted for women (38.8% vs 59.2%, RR 0.66, 95% CI 0.52-0.83, p=0.001) but not men (48.3% vs 46.6%, RR 0.96, 95% CI 0.67-1.40, p=0.85). In an adjusted analysis, factors associated with LLIN use when travelling included destination (travelling to districts not receiving indoor residual spraying [IRS] 65.8% vs Tororo district 32.2%, RR 1.80, 95% CI 1.31-2.46, p<0.001) and duration of travel (>7 nights 60.3% vs one night 24.4%, RR 1.97, 95% CI 1.07-3.64, p=0.03).Conclusions: Travellers, particularly women, were less likely to use LLINs when travelling than when at home. LLIN adherence was higher among those who travelled to non-IRS districts and for more than one week, suggesting that perceived malaria risk influences LLIN use. Strategies are needed to raise awareness of the importance of using LLINs while travelling.

East Africa International Center of Excellence for Malaria Research: Impact on Malaria Policy in Uganda

“…The LLIN mass campaign strategy, as proposed by Yeka et al in 2012, 4 has materialized into three serial universal LLIN coverage campaigns since 2013, and NMCD has provided platforms and collaborated with PRISM to ensure evaluation of these campaigns. 6,49 The LLINEUP and LLINEUP2 cluster-randomized trials provide substantive evidence that NMCD values and supports use of locally generated research findings to inform planning and design of each universal LLIN campaign. 6,49 Preliminary work done in preparation for the LLINEUP2 study entailed demonstration of the feasibility of using routine health facility-based surveillance data to generate malaria incidence estimates.…”

“…6,49 The LLINEUP and LLINEUP2 cluster-randomized trials provide substantive evidence that NMCD values and supports use of locally generated research findings to inform planning and design of each universal LLIN campaign. 6,49 Preliminary work done in preparation for the LLINEUP2 study entailed demonstration of the feasibility of using routine health facility-based surveillance data to generate malaria incidence estimates. 48 UMSP data collected at the MRC level can be modeled to evaluate and inform deployment of other malaria control interventions, including vaccine rollout and chemoprevention, and has provided a platform to compare data from research trials, with longitudinal routine health facility-based surveillance data providing a wide evidence base for malaria policy and program planning in Uganda.…”