Effect of individual and community-level bed net usage on malaria prevalence among under-fives in the Democratic Republic of Congo

Levitz, Lauren; Janko, Mark; Mwandagalirwa, Kashamuka; Thwai, Kyaw L.; Likwela, Joris Losimba; Tshefu, Antoinette; Emch, Michael; Meshnick, Steven R.

doi:10.1186/s12936-018-2183-y

Cited by 58 publications

(77 citation statements)

References 28 publications

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“…These studies showed that increasing age, wealth, and individual bed-net use are protective, as are increasing community level bed-net use, lower average temperature and higher altitude [9][10][11][12] . However, these studies included only children under the age of five 9,10 , or were small and geographically limited 11,12 . A study of adults in the DRC conducted using data from the 2007 DHS identified several risk factors, such as younger age, male sex, and lower individual and community level wealth 13 ; however, no nationally representative risk factor studies of adults have been conducted since.…”

Section: Introductionmentioning

confidence: 99%

“…A small number of studies performed in the DRC have identified important risk factors for infection 4,9,10 . These studies showed that increasing age, wealth, and individual bed-net use are protective, as are increasing community level bed-net use, lower average temperature and higher altitude [9][10][11][12] . However, these studies included only children under the age of five 9,10 , or were small and geographically limited 11,12 .…”

Section: Introductionmentioning

confidence: 99%

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Spatial and epidemiological drivers of P. falciparum malaria among adults in the Democratic Republic of the Congo

Deutsch-Feldman¹,

Brazeau²,

Parr

et al. 2020

Preprint

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Background: Malaria remains a significant public health problem in sub-Saharan Africa. Adults are frequently infected and may serve as a reservoir for further transmission, yet we know relatively little about risk factors for adult infections. In this study, we assessed malaria risk factors amongst adults using samples from the nationally representative, cross-sectional 2013-2014 Demographic and Health Survey (DHS) conducted in the Democratic Republic of Congo (DRC). We further explored differences in risk factors by urbanicity. Methods: Plasmodium falciparum infection was determined by polymerase chain reaction (PCR). Covariates were drawn from the DHS to model individual, community, and environmental level risk factors for infection. Additionally, we used deep sequencing data to estimate the community-level proportions of drug resistant infections and included these estimates as potential risk factors. All identified factors were assessed for differences in associations by urbanicity. Results: A total of 16,126 adults were included. Overall prevalence of malaria was 30.3% (SE = 1.1) by PCR; province-level prevalence ranged from 6.7-58.3%. Only 17% of individuals lived in households with at least one bednet for every two people, as recommended by the World Health Organization. Protective factors included increasing within-household bednet coverage (PR = 0.85, 95% CI = 0.76 - 0.95) and modern housing (PR = 0.58, 95% CI = 0.49 - 0.69). Community level protective factors included: increased average education and wealth (PR = 0.77, 95% CI = 0.65-0.91; PR - 0.84, 95% CI = 0.80 - 0.89). Education, wealth, and modern housing showed protective associations in cities but not in rural areas. Conclusions: The DRC continues to suffer from a high burden of malaria; interventions that target high-risk groups and sustained investment in malaria control are sorely needed. Differences in risk factors by urbanicity may be due to differences in transmission intensity or access to resources.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spatial and epidemiological drivers of P. falciparum malaria among adults in the Democratic Republic of the Congo

Deutsch-Feldman¹,

Brazeau²,

Parr

et al. 2020

Preprint

Self Cite

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“…One of the most effective methods of the malaria vector control in Cameroon is the use of mosquito bed nets and depending on whether it is a long-lasting insecticidal one, further increases the vector control chances. Several studies have highlighted the importance of increased mosquito net usage and LLITN and their role in reducing the incidence of malaria in SSA (38)(39)(40)(41)(42)(43)(44). In this study, most urban-city centers and rural clusters household settlements in the North region had at least one mosquito net whether or not it was a treated (> 50% ), while the West and East regions recorded a low coverage for the above ITNs coverage category.…”

Section: Discussionmentioning

confidence: 79%

Geographically weighted regression modelling of the spatial association between malaria cases and environmental factors in Cameroon

Tewara

Mbah-Fongkimeh²,

Zhaolei

et al. 2019

Preprint

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Background Cameroon has witnessed a 131,000 increase in malaria cases, according to a recent report addressing the malaria burden and control strategies in endemic regions. Studies have illustrated the association between malaria cases and environmental factors in Cameroon but limited in addressing how these factors vary in space for timely interventions. Thus, we want to find the spatial variability between malaria hotspot cases and environmental predictors using Geographically weighted regression (GWR) spatial modelling technique. Methods The global Ordinary least squares(OLS) tool in the modelling spatial relationships tool in ArcGIS 10.3. was used to select candidate explanatory environmental variables for a properly specified GWR model. The local GWR model used the OLS candidate variables to examine, predict and explore the spatial variability between environmental factors and malaria hotspot cases generated from Getis-Ord Gi* statistical analysis. Spatial maps of mosquito bed net ownership and GWR outputs were also created for public health surveillance. Results The OLS candidate environmental variable coefficients were statistically significant for a properly specified GWR model (adjusted R2 = 22.3% and p < 0.01). The GWR model identified a strong association between malaria cases and rainfall, vegetation index, population density, and drought episodes in most hotspot areas and a weak correlation with aridity and proximity to water (adjusted R2= 24.3%). The mosquito bed nets analysis maps demonstrated an overall low coverage(<50%) of household ownership. Conclusion The generated GWR maps suggest that for policymakers to eliminate malaria in Cameroon by 2030, there should be the creation of outreach programs that will target malaria hotspots locations, intensify free insecticidal net distribution, allocate specific funding, establish vaccination campaigns and carry out further investigations in areas where the environmental variables showed strong spatial associations with malaria hotspot cases.

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“…In DRC, studies from 2013 have shown no significant difference in the odds of malaria infection between people owning a permethrin LLIN and those without a net, while those with deltamethrinand alpha-cypermethrin-treated nets had significantly reduced odds of malaria infection [16,17].…”

Section: Introductionmentioning

confidence: 99%

Intensity of pyrethroid resistance in Anopheles gambiae before and after a mass distribution of insecticide-treated nets in Kinshasa and in 11 provinces of the Democratic Republic of Congo

Watsenga¹,

Agossa

Manzambi

et al. 2020

Preprint

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Background: Between 2011 and 2018, an estimated 134.8 million pyrethroid-treated long-lasting insecticidal nets (LLINs) were distributed nationwide in the Democratic Republic of Congo (DRC) for malaria control. Pyrethroid resistance has developed in DRC in recent years, but the intensity of resistance and impact on LLIN efficacy was not known. Therefore, the intensity of resistance of Anopheles gambiae sensu lato (s.l.) to permethrin and deltamethrin was monitored before and after a mass distribution of LLINs in Kinshasa in December 2016, and in 7 sites across the country in 2017 and 11 sites in 2018.Methods: In Kinshasa, CDC bottle bioassays using 1, 2, 5, and 10 times the diagnostic dose of permethrin and deltamethrin were conducted using An. gambiae s.l. collected as larvae and reared to adults. Bioassays were conducted in four sites in Kinshasa province six months before a mass distribution of deltamethrin-treated ITNs and then two, six, and ten months after the distribution. One site in neighbouring Kongo Central province was used as a control (no mass campaign of ITN distribution during the study). Nationwide intensity assays were conducted in six sites in 2017 using CDC bottle bioassays and in 11 sites in 2018 using WHO intensity assays. A sub-sample of An. gambiae s.l. was tested by PCR to determine species composition and frequency of kdr-1014F and 1014S alleles. Results: In June 2016, before LLIN distribution, permethrin resistance intensity was high in Kinshasa; the mean mortality rate was 43% at the 5× concentration and 73% at the 10× concentration. Bioassays at 3 time points after LLIN distribution showed considerable variation by site and time and there was no consistent evidence for an increase in pyrethroid resistance intensity compared to the neighbouring control site. Tests of An. gambiae s.l. in 7 sites across the country in 2017 and 11 sites in 2018 showed all populations were resistant to the diagnostic doses of 3 pyrethroids. In 2018, the intensity of resistance varied by site, but was generally moderate for all three pyrethroids, with survivors at ×5 the diagnostic dose. Anopheles gambiae sensu stricto (s.s.) was the most common species identified across 11 sites in DRC, but in Kinshasa, An. gambiae s.s. (91%) and Anopheles coluzzii (8%) were sympatric.Conclusions: Moderate or high intensity pyrethroid resistance was detected nationwide in DRC and is a serious threat to sustained malaria control with pyrethroid LLINs. Next generation nets (PBO nets or bi-treated nets) should be considered for mass distribution.

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Effect of individual and community-level bed net usage on malaria prevalence among under-fives in the Democratic Republic of Congo

Cited by 58 publications

References 28 publications

Spatial and epidemiological drivers of P. falciparum malaria among adults in the Democratic Republic of the Congo

Spatial and epidemiological drivers of P. falciparum malaria among adults in the Democratic Republic of the Congo

Geographically weighted regression modelling of the spatial association between malaria cases and environmental factors in Cameroon

Intensity of pyrethroid resistance in Anopheles gambiae before and after a mass distribution of insecticide-treated nets in Kinshasa and in 11 provinces of the Democratic Republic of Congo

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