Mass use of insecticide-treated bednets in malaria endemic poor countries: public health concerns and remedies

Ehiri, John E.; Anyanwu, Ebere C.; Scarlett, Henroy

doi:10.1057/palgrave.jphp.3190001

Cited by 10 publications

(7 citation statements)

References 9 publications

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“…While it is important for the government of Rwanda to minimize access barriers for vulnerable populations such as pregnant women and children and ensure the universal coverage of LLIN, tackling the question of how to enhance correct use of LLIN is regarded as a priority. As reported elsewhere, the promotion of LLIN usage has become a key malaria control strategy since it has been proven to be cost effective [ 13 , 14 ]. In our context, promoting LLIN usage must be accompanied by measures to control bedbugs.…”

Section: Discussionmentioning

confidence: 99%

Factors impeding the acceptability and use of malaria preventive measures: implications for malaria elimination in eastern Rwanda

Ingabire

Rulisa

Kempen

et al. 2015

Malar J

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BackgroundLong-lasting insecticidal nets (LLIN), indoor residual spraying (IRS) and malaria case treatment with artemisinin-based combination therapy (ACT) have been proven to significantly reduce malaria, but may not necessarily lead to malaria elimination. This study explored factors hindering the acceptability and use of available malaria preventive measures to better inform area specific strategies that can lead to malaria elimination.MethodsNine focus group discussions (FGD) covering a cross-section of 81 lay community members and local leaders were conducted in Ruhuha, Southern Eastern Rwanda in December 2013 to determine: community perceptions on malaria disease, acceptability of LLIN and IRS, health care-seeking behaviours and other malaria elimination strategies deployed at household and environmental levels. Discussions were recorded in Kinyarwanda, transcribed into English and coded using Nvivo 10 software.ResultsParticipants ranked malaria as the top among five common diseases in the Ruhuha sector. Participants expressed comprehensive knowledge and understanding of malaria transmission and symptoms. The concept of malaria elimination was acknowledged, but challenges were reported. Sleeping under a bed net was negatively affected by increase of bedbugs (and the associated irritability) as well as discomfortable warmness particularly during the dry season. These two factors were reported as common hindrances of the use of LLIN. Also, widespread use of LLIN in constructing chicken pens or as fences around vegetable gardens was reported.Participants also reported that IRS appeared to lead to an increase in number of mosquitoes and other household bugs rather than kill them. Prompt health centre utilization among participants with presumed malaria was reported to be common particularly among subscribers to the subsidized community-based health insurance (CBHI) scheme. In contrast, the lack of CBHI and/or perceptions that health centre visits were time consuming were common reasons for the use of over-the-counter medicines for malaria management.ConclusionIn this study, identification of behavioural determinants in relation to LLIN use, IRS acceptability and health care seeking is a critical step in the development of effective, targeted interventions aiming to further reduce malaria transmission and elimination in the area.

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Section: Discussionmentioning

confidence: 99%

Factors impeding the acceptability and use of malaria preventive measures: implications for malaria elimination in eastern Rwanda

Ingabire

Rulisa

Kempen

et al. 2015

Malar J

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“…Epidemiological evidence, arising mainly from studies in the countries of SubSaharan Africa, suggests that sleeping under LLINs is a cost-effective and efficacious method of controlling malaria. For this reason, promotion of LLIN use has become a key malaria control strategy [12].…”

Section: Introductionmentioning

confidence: 99%

Perception and affordability of long-lasting insecticide-treated nets among pregnant women and mothers of children under five years in Ogun State, Nigeria

Adeneye

Jegede

Nwokocha

et al. 2014

Journal of Infection and Public Health

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Despite the distribution of long-lasting insecticide-treated nets (LLINs) in Nigeria, access to and use of LLINs continues to be minimal. Little is also known about the perceived fair price people are willing to pay for LLINs in Ogun State, South-West Nigeria. Data were collected using semi-structured questionnaire among pregnant women attending antenatal clinics and mothers of under-five children in randomly-selected malaria holo-endemic communities of Ijebu North and Yewa North local government areas of Ogun State. Results showed that only 23.6% of 495 respondents owned and were using LLINs. One of the main reasons for non-use of LLINs was unaffordability of LLIN cost. 84.2% of the 495 respondents were willing to pay at a hypothetical price of N800.00 (US$5.00) for a LLIN, 15.6% were unwilling and 0.2% was indifferent to buying it at the price. Their willingness to pay was significantly determined by education and occupation (p=0.00). Health education strategies need to be developed to increase awareness and demand for LLINs. However, there is the need to take into account preferred access outlets and the diversity in willingness to pay for LLINs if equity to access is to be ensured in the study communities.

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“…Insecticide-treated bednets (ITNs) are recognized as important tools for reducing malaria transmission in malaria-endemic regions. [1][2][3] The effectiveness of ITNs at reducing malaria transmission relies on their ability to act as chemical as well as physical barriers. Over time, the accumulation of holes, rips, and tears as well as depletion of insecticide potency, reduces the efficacy of ITNs.…”

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confidence: 99%

A Comparison of Surface and Total Deltamethrin Levels of Insecticide-Treated Nets and Estimation of the Effective Insecticidal Lifetime

Green

Maxyay

Pongvongsa³

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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The ability to anticipate the useful lifetime of an insecticide-treated mosquito net (ITN) would provide a proactive approach for planning net distribution programs. Therefore, we used an exponential decay model of deltamethrin depletion to predict the effective insecticidal lifetime of PermaNet® 2.0 nets used in the Lao PDR. Residual deltamethrin was measured using two nondestructive analytical field methods; X-ray fluorescence (total levels) and a colorimetric field test (surface levels) at 12 and 24 months postdistribution. The model assumes that the 12-month depletion rate can be used to predict future levels. The median total and surface deltamethrin levels for the Lao nets at 12 months were 31.2 and 0.0743 mg/m2, respectively. By defining a failed net as having total deltamethrin levels of less than 15 mg/m2 or a surface level less than 0.0028 mg/m2, it was predicted that 50% of the group of nets will fail at about 27 months after distribution. Insecticide-treated bednets (ITNs) are recognized as important tools for reducing malaria transmission in malaria-endemic regions.1–3 The effectiveness of ITNs at reducing malaria transmission relies on their ability to act as chemical as well as physical barriers. Over time, the accumulation of holes, rips, and tears as well as depletion of insecticide potency, reduces the efficacy of ITNs. Although the accumulation of holes results in decreased personal protection, the presence of remaining insecticide still has the potential to reduce malaria.4 It has been suggested by mathematical models that 94% of transmission can be prevented if 80% of the population continues to use these nets.4 Thus, monitoring insecticide levels along with physical integrity are important in recognizing when an ITN is no longer effective. Although damage to the nets can be visually ascertained, monitoring insecticidal potency is often assessed by using mosquito bioassays or chemical techniques. Mosquito bioassays, such as the WHO Cone Test, are the “Gold Standard” for assessing ITNs. Although mosquito bioassays are important elements in evaluating net efficacy, it is difficult to compare net performance across geographical regions where mosquito behavior and insecticide resistance are quite variable. Therefore, this report focuses on measuring surface and total residual insecticide levels by chemical means as a practical way to monitor and predict net longevity. The chemical techniques used to measure insecticide levels usually result in the partial destruction of an ITN. Spectroscopic methods such as X-ray fluorescence (XRF)5,6 and surface level measurements such as the colorimetric field test for cyanopyrethroids (CFT)7 provide alternative insecticide analysis techniques that are nondestructive to the net, thus allowing the same net to be monitored for insecticide levels over time. The XRF method measures the total (TL) amount of insecticide per area and the CFT measures available insecticide on the net surface (SL) via an abrasion technique using filter paper. Deltamethrin adhered to the filter paper is measured using a colorimetric cyanopyrethroid analysis method.7 The deltamethrin molecule contains both cyano and bromine groups, thus allowing it to be detected by the CFT and XRF, respectively.5,7 In this report, we describe the use of both XRF and CFT methods were on the same net after 12 and 24 months of use. The objectives of this report are to apply an exponential decay model for predicting the effective longevity of ITNs based on TL and SL deltamethrin measured after 12 months of use. The model is based on an assumption that by 12 months, factors contributing to insecticidal loss, such as washing and storage habits have become routinely established, thereby resulting in a depletion rate constant, from which future levels can be predicted.

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Mass use of insecticide-treated bednets in malaria endemic poor countries: public health concerns and remedies

Cited by 10 publications

References 9 publications

Factors impeding the acceptability and use of malaria preventive measures: implications for malaria elimination in eastern Rwanda

Factors impeding the acceptability and use of malaria preventive measures: implications for malaria elimination in eastern Rwanda

Perception and affordability of long-lasting insecticide-treated nets among pregnant women and mothers of children under five years in Ogun State, Nigeria

A Comparison of Surface and Total Deltamethrin Levels of Insecticide-Treated Nets and Estimation of the Effective Insecticidal Lifetime

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