The effect of household heads training on long-lasting insecticide-treated bed nets utilization: a cluster randomized controlled trial in Ethiopia

<p>Abstract</p> <p>Background</p> <p>Long-lasting insecticide-treated bed nets (LLITN) have demonstrated significant impact in reducing malaria-related childhood morbidity and mortality. However, utilization of LLITN by under-five children is not satisfactory in many sub-Saharan African countries due to behavioural barriers. Previous studies had focused on the coverage and ownership of LLITN. The effect of skill-based training for household heads on LLITN utilization had not yet been investigated. A cluster-randomized trial on the effect of training of household heads on the use of LLITN was done in Ethiopia to fill this knowledge gap.</p> <p>Methods</p> <p>The study included 22 (11 intervention and 11 control) villages in southwest Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. All households in each group received free LLITN. Data were collected at baseline, six and 12 months of the follow up periods. Utilization of LLITN in the control and intervention villages was compared at baseline and follow up periods.</p> <p>Results</p> <p>A total of 21,673; 14,735 and 13,758 individuals were included at baseline, sixth and twelfth months of the project period. At the baseline survey, 47.9% of individuals in the intervention villages and 68.4% in the control villages reported that they had utilized LLITN the night before the survey. At the six month, 81.0% of individuals in the intervention villages and 79.3% in the control villages had utilized LLITN. The utilization of LLITN in all age groups in the intervention villages was increased by 17.7 percentage point (95% CI 9.7-25.6) at sixth month and by 31.0 percentage point (95% CI 16.9-45.1) at the twelfth month. Among under-five children, the LLITN utilization increased by 31.6 percentage point (95% CI 17.3-45.8) at the sixth month and 38.4 percentage point (95% CI 12.1-64.7) at the twelfth months of the project period.</p> <p>Conclusion</p> <p>Household level skill-based training has demonstrated a marked positive effect in the utilization of LLITN. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITN should be accompanied by a skill-based training of household heads to improve its utilization.</p> <p>Trail registration</p> <p>Australian New Zealand Clinical Trials Registry (ACTR number: <a href="http://www.anzctr.org.au/ACTRN12610000035022.aspx">ACTRN12610000035022</a>).</p

The effect of household heads training about the use of treated bed nets on the burden of malaria and anaemia in under-five children: a cluster randomized trial in Ethiopia

<p>Abstract</p> <p>Background</p> <p>Long-lasting insecticide-treated bed nets (LLITN) have demonstrated a significant effect in reducing malaria-related morbidity and mortality. However, barriers on the utilization of LLITN have hampered the desired outcomes. The aim of this study was to assess the effect of community empowerment on the burden of malaria and anaemia in under-five children in Ethiopia.</p> <p>Methods</p> <p>A cluster randomized trial was done in 22 (11 intervention and 11 control) villages in south-west Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. The burden of malaria and anaemia in under-five children was determined through mass blood investigation at baseline, six and 12 months of the project period. Cases of malaria and anaemia were treated based on the national protocol. The burden of malaria and anaemia between the intervention and control villages was compared using the complex logistic regression model by taking into account the clustering effect. Eight Focus group discussions were conducted to complement the quantitative findings.</p> <p>Results</p> <p>A total of 2,105 household heads received the intervention and the prevalence of malaria and anaemia was assessed among 2410, 2037 and 2612 under-five children at baseline, six and 12 months of the project period respectively. During the high transmission/epidemic season, children in the intervention arm were less likely to have malaria as compared to children in the control arm (OR = 0.42; 95%CI: 0.32, 0.57). Symptomatic malaria also steadily declined in the intervention villages compared to the control villages in the follow up periods. Children in the intervention arm were less likely to be anaemic compared to those in the control arm both at the high (OR = 0.84; 95%CI: 0.71, 0.99)) and low (OR = 0.73; 95%CI: 0.60, 0.89) transmission seasons.</p> <p>Conclusion</p> <p>Training of household heads on the utilization of LLITN significantly reduces the burden of malaria in under-five children. The Ministry of Health of Ethiopia in collaboration with other partners should design similar strategies in high-risk areas to control malaria in Ethiopia.</p> <p>Trial registration</p> <p>Australia and New Zealand Clinical Trials Register (ANZCTR): <a href="http://www.anzctr.org.au/ACTRN12610000035022.aspx">ACTRN12610000035022</a></p

Effect of training on the use of long-lasting insecticide-treated bed nets on the burden of malaria among vulnerable groups, south-west Ethiopia: baseline results of a cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>In Ethiopia, the utilization of long-lasting insecticide-treated bed nets (LLITN) is hampered by behavioural factors such as low awareness and negative attitude of the community. The aim of this study was to present the design and baseline results of a cluster randomized trial on the effect of training of household heads on the use of LLITN.</p> <p>Methods</p> <p>This baseline survey was undertaken from February to March, 2009 as part of a randomized cluster trial. A total of 11 intervention and 11 control <it>Gots </it>(villages) were included in the Gilgel Gibe Field Research Centre, south-west Ethiopia. House to house visit was done in 4135 households to collect information about the use of LLITN and socio-demographic variables. For the diagnosis of malaria and anaemia, blood samples were collected from 2410 under-five children and 242 pregnant women.</p> <p>Results</p> <p>One fourth of the households in the intervention and control <it>Gots </it>had functional LLITN. Only 30% of the observed LLITN in the intervention and 28% in the control <it>Gots </it>were hanged properly. Adults were more likely to utilize LLITN than under-five children in the control and intervention <it>Gots</it>. The prevalence of malaria in under-five children in the intervention and control <it>Gots </it>was 10.5% and 8.3% respectively. The intervention and control <it>Gots </it>had no significant difference concerning the prevalence of malaria in under-five children, [OR = 1.28, (95%CI: 0.97, 1.69)]. Eight (6.1%) pregnant women in the intervention and eight (7.2%) in the control <it>Gots </it>were positive for malaria (P = 0.9). Children in the intervention <it>Gots </it>were less likely to have anaemia than children in the control <it>Gots</it>, [OR = 0.75, (95%CI: 0.62, 0.85)].</p> <p>Conclusion</p> <p>The availability and utilization of LLITN was low in the study area. The prevalence of malaria and anaemia was high. Intervention strategies of malaria should focus on high risk population and vulnerable groups.</p

Malaria and Under-Nutrition: A Community Based Study Among Under-Five Children at Risk of Malaria, South-West Ethiopia

BACKGROUND: The interaction between malaria and under-nutrition is not well elucidated in Ethiopia. The objective of this study was to assess the magnitude of under-nutrition and its correlation with malaria among under-five children in south-west Ethiopia. METHODS: This cross-sectional study was undertaken during March-February, 2009 as part of the baseline assessment of a cluster randomized trial around Gilgel Gibe Hydroelectric dam, south-west Ethiopia. A total of 2410 under-five children were included for anthropometric measurement and blood investigation for the diagnosis of malaria and anemia. The nutritional status of children was determined using the International Reference Population defined by the U.S National Center for Health Statistics (NCHS). Blood film was used to identify malaria parasite and haemoglobin concentration was determined by Hemo Cue analyzer (HemoCue Hb 301, Sweden). RESULTS: Significant proportion (40.4%) of under-five children were stunted (height-for-age<-2SD). The prevalence of under-weight was 34.2%. One third and one tenth of the children had anemia and malaria parasite respectively. Older children were more likely to have under-nutrition. There was no association between malaria and under-nutrition. Children who had malaria parasite were 1.5 times more likely to become anaemic compare to children who had no malaria parasite, [OR = 1.5, (95% CI: 1.1-2.0)]. CONCLUSION: In this study, there is no association between malaria and under-nutrition. Children who have malaria are more likely to be anaemic. Malaria prevention and control program should consider nutrition interventions particularly anemia

Evaluation of energy, protein, and selected micronutrient density of homemade complementary foods consumed by children between 6 months and 23 months in food insecure woredas of Wolayita zone, Southern Ethiopia

Motuma Adimasu Abeshu,1,2 Abdulaziz Adish,3 Gulelat D Haki,4 Azeb Lelisa,5 Bekesho Geleta6 1John Snow, Inc, 2Addis Ababa University, Center for Food Science and Nutrition, 3Micronutrient Initiative Africa, Addis Ababa, Ethiopia; 4Department of Food Science and Technology, University of Botswana, Gaborone, Botswana; 5Micronutrient Initiative Ethiopia, 6Ethiopian Public Health Institute, Addis Ababa, Ethiopia Abstract: Complementary feeding should be timely, adequate, and given in a way that is appropriate for the age of the child, applying responsive feeding to fill the gap between what is provided by breastfeeding and the total nutritional requirements of the infant. The purpose of this&nbsp;study was to assess nutrient composition and evaluate adequacy of observed nutrient densities (energy, protein, calcium [Ca], iron [Fe], and zinc [Zn]) in homemade complementary foods for children of age 6&ndash;23&nbsp;months, in comparison to the desired levels in food insecure woredas of the Wolayita zone, Southern Ethiopia. A cross-sectional weighed food record method was&nbsp;used to assess the energy and micronutrient compositions of homemade complementary foods and evaluate adequacy of observed nutrient densities in relation to the desired levels. Multistage sampling was used to locate the children. Observation and measurement of complementary food preparations throughout the day was made. Representative portions from the diets were sampled for further laboratory analysis and to evaluate adequacy of observed nutrient levels. More than 20 different complementary food types (mostly an extension of family foods) prepared from various food items were observed. Dietary diversity of the foods was very poor. The average dietary diversity score was only 2.54, while animal-source foods and vitamin A-rich fruits and vegetables were virtually absent. The energy and protein compositions of the diets, however, were sufficient. Energy density of 0.92&nbsp;kcal/g, 1.24&nbsp;kcal/g, and 1.41&nbsp;kcal/g and protein density of 3.41&nbsp;g/kcal, 2.18&nbsp;g/kcal, and 2.48&nbsp;g/kcal were observed in the diets of 6&ndash;8-month, 9&ndash;11-month, and 12&ndash;23-month age categories, respectively. The diets were poor in micronutrients. The observed nutrient density for Ca and Zn (mg/100&nbsp;kcal) was significantly lower (P=0.000) than the desired levels. Similarly, the Fe level in the diets for 6&ndash;11&nbsp;month old children was significantly lower than the desired nutrient density levels even when high bioavailability was accounted for. On the contrary, adequate nutrient density in the diets for 12&ndash;23&nbsp;month old &shy;children was observed even when low bioavailability for Fe was accounted for. The complementary foods were energy dense. Micronutrients densities observed (Ca, Zn, and Fe), however, were very low as they continue to be the &ldquo;problem nutrients&rdquo;. Keywords: food insecure, nutrient density, homemade, estimated daily nutrient intak

Assessment of caregiver’s knowledge, complementary feeding practices, and adequacy of nutrient intake from homemade foods for children of 6-23 months in food insecure woredas of Wolayita zone, Ethiopia

Complementary feeding should fill the gap in energy and nutrients between estimated daily needs and amount obtained from breastfeeding from 6 month onwards. Homemade complementary foods, however, are often reported for inadequacy in key nutrients despite reports of adequacy for energy and proteins. The aim of this study was to assess caregiver’s complementary feeding knowledge, feeding practices, and to evaluate adequacy daily intakes from homemade complementary foods for children of 6 – 23 months in food insecure woredas of Wolayita zone, Ethiopia.A cross sectional study assessing mothers/caregiver’s knowledge and complementary feeding practice, adequacy of daily energy and selected micronutrient intakes using weighed food record method. Multi-stage cluster sampling method was also used to select 68 households.Caregivers had good complementary feeding knowledge. Sixty (88.2%) children started complementary feeding at 6 months and 48 (70.6%) were fed 3 or more times per day. Daily energy intake however was significantly lower (P<0.05) than estimated daily needs, with only 151.25, 253.77 and 364.76 (kcal/day)for 6–8, 9–11 and 12–23 months, respectively. Similarly, Ca and Zn intakes (mg/day) were below the daily requirements (p=0.000), with value of 37.76, 0.96; 18.83, 1.21; 30.13, 1.96; for the 6-8, 9-11 and 12-23 months, respectively. Significant shortfall in daily intake of Fe (p=0.000) was observed among the 6-8 and 9-11months (3.25, 4.17mg/day, respectively), even accounting for high bioavailability.The complementary foods were energy dense. Daily energy, Ca, Zn and Fe (except 12 – 23 months) intake, however, was lower than estimated daily requirements