Factors Associated with Sustained Use of Long-Lasting Insecticide-Treated Nets Following a Reduction in Malaria Transmission in Southern Zambia

Pinchoff, Jessie; Hamapumbu, Harry; Tamaki, Kunihiko; Simubali, Limonty; Stevenson, Jennifer; Norris, Douglas E.; Colantuoni, Elizabeth; Thuma, Philip E.; Moss, William J.

doi:10.4269/ajtmh.15-0093

Cited by 28 publications

(30 citation statements)

References 36 publications

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“…The uptake and use of currently recommended malaria interventions with demonstrated protective effects, such as IRS and ITNs, are critical for sustaining malaria control and mitigating malaria disease resurgence [29]. Likewise, in order for new vector control interventions, including those under development such as spatial repellents, to be viable complementary tools towards malaria elimination, these products must be accepted in endemic communities.…”

Section: Discussionmentioning

confidence: 99%

“…Until new products are available for NMEPs to deploy, ensuring the sustainability and use of ITNs and IRS is vital to maintaining their impact against malaria. This requires a better understanding of region-specific cultural and demographic factors that influence community use and acceptance of vector control interventions [29]. Low community acceptance resulting in low compliance renders interventions far less efficacious than their demonstrated or theoretical effect [30].…”

Section: Introductionmentioning

confidence: 99%

“…This method is especially important for providing appropriate information for developing tailored messages and approaches in Behavior Change Communication (BCC) and education campaigns [34]. The presence or absence of mosquitoes in homes can also influence use and uptake of interventions, therefore combining entomological data with KAP surveys can provide further insight into health-seeking behavior as well as how best to implement and sustain interventions [29,35].…”

Section: Introductionmentioning

confidence: 99%

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Knowledge, attitudes and practices assessment of malaria interventions in rural Zambia

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Background: Despite rapid upscale of insecticide-treated nets (ITNs) and indoor residual spraying (IRS), malaria remains a major source of morbidity and mortality in Zambia. Uptake and utilization of these and novel interventions are often affected by knowledge, attitudes and practices (KAP) amongst persons living in malariaendemic areas. The aims of this study were to assess malaria KAP of primary caregivers and explore trends in relation to ITN use, IRS acceptance and mosquito density in two endemic communities in Luangwa and Nyimba districts, Zambia. Methods: A cohort of 75 primary caregivers were assessed using a cross-sectional, forced-choice malaria KAP survey on ITN use, IRS acceptance and initial perception of a novel spatial repellent (SR) product under investigation. Entomological sampling was performed in participant homes using CDC Miniature Light Traps to relate indoor mosquito density with participant responses. Results: Ninety-nine percent of participants cited bites of infected mosquitoes as the route of malaria transmission although other routes were also reported including drinking dirty water (64%) and eating contaminated food (63%). All caregivers agreed that malaria was a life-threatening disease with the majority of caregivers having received malaria information from health centers (86%) and community health workers (51%). Cumulatively, self-reported mosquito net use was 67%. Respondents reportedly liked the SR prototype product but improvements on color, shape and size were suggested. Overall, 398 mosquitoes were captured from light-trap collections, including 49 anophelines and 349 culicines. Insecticide treated nets use was higher in households from which at least one mosquito was captured. Conclusions: The current study identified misconceptions in malaria transmission among primary caregivers indicating remaining knowledge gaps in educational campaigns. Participant responses also indicated a misalignment between a low perception of IRS efficacy and high stated acceptance of IRS, which should be further examined to better understand uptake and sustainability of other vector control strategies. While ITNs were found to be used in study households, misperceptions between presence of mosquitoes and bite protection practices did exist. This study highlights the importance of knowledge attitudes and practice surveys, with integration of entomological sampling, to better guide malaria vector control product development, strategy acceptance and compliance within endemic communities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Knowledge, attitudes and practices assessment of malaria interventions in rural Zambia

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“…The parasite prevalence as measured by active surveillance using a Pfhrp2 RDT declined over the past decade, from 9.2% in 2008 to less than 1% in 2013. 22 Artemisinin combination therapy with artemether-lumefantrine was introduced as first-line antimalarial therapy in Zambia in 2002 and into the study area in 2004. 23,24 Long-lasting insecticide-treated nets (LLINs) were widely distributed in the study area in 2007, and more than 11,000 LLINs were distributed from nine health centers in the catchment area of Macha Hospital in 2012, with additional LLINs distributed in 2014.…”

Section: Methodsmentioning

confidence: 99%

Efficiency of a Malaria Reactive Test-and-Treat Program in Southern Zambia: A Prospective, Observational Study

Deutsch-Feldman

Hamapumbu

Lubinda

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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To improve malaria surveillance and achieve elimination, the Zambian National Malaria Elimination Program implemented a reactive test-and-treat program in Southern Province in 2013 in which individuals with rapid diagnostic test (RDT)-confirmed malaria are followed-up at their home within 1 week of diagnosis. Individuals present at the index case household and those residing within 140 m of the index case are tested with an RDT and treated with artemether-lumefantrine if positive. This study evaluated the efficiency of this reactive test-and-treat strategy by characterizing infected individuals missed by the RDT and the current screening radius. The radius was expanded to 250 m, and a quantitative polymerase chain reaction (qPCR) test was performed on dried blood spot specimens. From January 2015 through March 2016, 145 index cases were identified at health centers and health posts. A total of 3,333 individuals residing in 525 households were screened. Excluding index cases, the parasite prevalence was 1.1% by RDT (33 positives of 3,016 participants) and 2.4% by qPCR (73 positives of 3,016 participants). Of the qPCR-positive cases, 62% of 73 individuals tested negative by RDT. Approximately half of the infected individuals resided within the index case household (58% of RDT-positive individuals and 48% of qPCR-positive individuals). The low sensitivity of the RDT and the high proportion of secondary cases within the index case household decreased the efficiency of this reactive test-and-treat strategy. Reactive focal drug administration in index case households would be a more efficient approach to treating infected individuals associated with a symptomatic case.

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“…In Nchelenge District, Zambia, CDC light traps were placed overnight in the three following scenarios: outdoors where humans congregate, outdoors next to animal pens, and outdoors with a commercial human analogue bait (BG Lure ® , BioGents). Households were selected using a similar sampling frame to that of other studies under the ICEMR program (Pinchoff et al 2015, Stevenson et al 2016b). Collections were performed over a 2-week period in August 2016 at eight households (4 inland along a stream and more than 3 km from Lake Mweru and 4 lakeside, close to Lake Mweru) for a total of 74 trap nights.…”

Section: Methodsmentioning

confidence: 99%

Genetic diversity ofAnopheles coustaniin high malaria transmission foci in southern and central Africa

Ciubotariu

Jones

Tamaki

et al. 2020

Preprint

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24Despite ongoing malaria control efforts implemented throughout sub-Saharan Africa, 25 malaria remains an enormous public health concern. Current interventions such as indoor 26 residual spraying with insecticides and use of insecticide-treated bed nets are aimed at 27 targeting the key malaria vectors that are primarily endophagic and endophilic. While these 28 control measures have resulted in a substantial decline in malaria cases and continue to 29 impact indoor transmission, the importance of alternative vectors for malaria transmission 30 has been largely neglected. Anopheles coustani, an understudied vector of malaria, is a 31 species previously thought to exhibit mostly zoophilic behavior. However, recent studies 32 from across Africa bring to light the contribution of this and ecologically similar 33 anopheline species to human malaria transmission. Like many of these understudied 34 species, An. coustani has greater anthropophilic tendencies than previously appreciated, is 35 often both endophagic and exophagic, and carries Plasmodium falciparum sporozoites. 36These recent developments highlight the need for more studies throughout the geographic 37 range of this species and the potential need to control this vector. The aim of this study was 38 to explore the genetic variation of An. coustani mosquitoes and the potential of this 39 Anopheles species to contribute to malaria parasite transmission in high transmission 40 settings in Nchelenge District, Zambia, and the Kashobwe and Kilwa Health Zones in 41 Haut-Katanga Province, the Democratic Republic of the Congo (DRC). Morphologically 42identified An. coustani specimens that were trapped outdoors in these study sites were 43 analyzed by PCR and sequencing for species identification and blood meal sources, and 44 malaria parasite infection was determined by ELISA and qPCR. Fifty specimens were 45 confirmed to be An. coustani by the analysis of mitochondrial DNA cytochrome c oxidase 46 subunit I (COI) and ribosomal internal transcribed spacer region 2 (ITS2). Further, 47 maximum likelihood phylogenetic analysis of COI and ITS2 sequences revealed two 48 distinct phylogenetic groups within this relatively small regional collection. Our findings 49 indicate that both An. coustani groups have anthropophilic and exophagic habits and come 50 into frequent contact with P. falciparum, suggesting that this potential alternative malaria 51 vector might elude current vector controls in Northern Zambia and Southern DRC. This 52 study sets the groundwork for more thorough investigations of bionomic characteristics and 53 genetic diversity of An. coustani and its contribution to malaria transmission in these 54 regions.55 56

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Factors Associated with Sustained Use of Long-Lasting Insecticide-Treated Nets Following a Reduction in Malaria Transmission in Southern Zambia

Cited by 28 publications

References 36 publications

Knowledge, attitudes and practices assessment of malaria interventions in rural Zambia

Knowledge, attitudes and practices assessment of malaria interventions in rural Zambia

Efficiency of a Malaria Reactive Test-and-Treat Program in Southern Zambia: A Prospective, Observational Study

Genetic diversity ofAnopheles coustaniin high malaria transmission foci in southern and central Africa

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