Spatio-temporal malaria transmission patterns in Navrongo demographic surveillance site, northern Ghana

The relationship between entomological measures of malaria transmission intensity and mortality remains uncertain. This is partly because transmission is heterogeneous even within small geographical areas. Studying this relationship requires high resolution, spatially structured, longitudinal entomological data. Geostatistical models that have been used to analyse the spatio-temporal heterogeneity have not considered the uncertainty in both sporozoite rate (SR) and mosquito density data. This study analysed data from Kassena-Nankana districts in northern Ghana to obtain small area estimates of malaria transmission rates allowing for this uncertainty.; Independent Bayesian geostatistical models for sporozoite rate and mosquito density were fitted to produce explicit entomological inoculation rate (EIR) estimates for small areas and short time periods, controlling for environmental factors.; Mosquitoes were trapped from 2,803 unique locations for three years using mainly CDC light traps. Anopheles gambiae constituted 52%, the rest were Anopheles funestus. Mean biting rates for An. funestus and An. gambiae were 32 and 33 respectively. Most bites occurred in September, the wettest month. The sporozoite rates were higher in the dry periods of the last two years compared with the wet period. The annual EIR varied from 1,132 to 157 infective bites. Monthly EIR varied between zero and 388 infective bites. Spatial correlation for SR was lower than that of mosquito densities.; This study confirms the presence of spatio-temporal heterogeneity in malaria transmission within a small geographical area. Spatial variance was stronger than temporal especially in the SR. The estimated EIR will be used in mortality analysis for the area

Eff ects of vector-control interventions on changes in risk of malaria parasitaemia in sub-Saharan Africa: a spatial and temporal analysis

Background In the past decade, decreases in clinical episodes and deaths due to malaria have been mainly associated with the expansion of vector-control measures, such as insecticide-treated bednets and indoor residual spraying. Malaria indicator surveys gather information about key malaria indicators through national representative household surveys. We aimed to estimate changes in risk of malaria parasitaemia at high spatial resolution in sub-Saharan Africa, and to quantify the eff ects of malaria interventions at national and subnational levels. Methods In this spatial and temporal analysis, we analysed data from the six sub-Saharan countries that had publicly available data from two malaria indicator or demographic and health surveys with malaria measurements done in 2006–08 and 2010–12: Angola, Liberia, Mozambique, Senegal, Rwanda, and Tanzania. We used Bayesian geostatistical models to estimate the present malaria risk and to establish the change relative to the period between the last two national surveys. We applied Bayesian variable selection procedures to select the most relevant insecticide-treatedbednet measure for reducing malaria risk, and did spatial kriging over the study region to produce intervention coverage maps. We estimated the contribution of bednets and indoor residual spraying on changes in malaria risk, after adjustment for climatic and socioeconomic factors. Spatially varying coeffi cients of intervention coverage enabled estimation of their eff ects at subnational level. Findings In all countries, the probability of decrease in parasitaemia varied substantially between regions. Insecticidetreated bednets were an important intervention for reducing malaria risk, according to diff erent defi nitions of coverage. An overall eff ect of insecticide-treated bednets at country level was signifi cant only in Angola (–0·64, 95% credible interval –0·98 to –0·30) and Senegal (–0·34, –0·64 to –0·05); however, in all countries, we detected signifi cant eff ects of bednets and indoor residual spraying at local level. Interpretation The described methodology is useful for the identifi cation of regions where changes in malaria risk have taken place, and to describe the geographical pattern of malaria. Intervention eff ects vary in space, which might be driven by local endemicity levels. The produced maps provide a visual aid for national malaria control programmes to identify where targeted strategies and resources are most needed or likely to have the greatest eff ect on reducing the risk of parasitaemia

Malaria health seeking practices for children, and intermittent preventive treatment in pregnancy in Wakiso District, Uganda

Background: Timely health care among children with suspected malaria, and intermittent preventive treatment (IPTp) in pregnancy avert related morbidity and mortality in endemic regions especially in sub-Saharan Africa. Malaria burden has steadily been declining in endemic countries due to progress made in scaling up of such important interventions. Objectives: The study assessed malaria health seeking practices for children under five years of age, and IPTp in Wakiso district, Uganda. Methods: A structured questionnaire was used to collect data from 727 households. Chi-square and Fisher’s exact tests were performed in STATA to ascertain factors associated with the place where treatment for children with suspected malaria was first sought (government versus private facility) and uptake of IPTp. Results: Among caretakers of children with suspected malaria, 69.8% sought care on the day of onset of symptoms. The place where treatment was first sought for the children (government versus private) was associated with participants’ (household head or other adult) age (p < 0.001), education level (p < 0.001) and household income (p = 0.011). Among women who had a child in the five years preceding the study, 179 (63.0%) had obtained two or more IPTp doses during their last pregnancy. Uptake of two or more IPTp doses was associated with the women’s education level (p = 0.006), having heard messages about malaria through mass media (p = 0.008), knowing the recommended number of IPTp doses (p < 0.001), and knowing the drug used in IPTp (p < 0.001).  Conclusion: There is need to improve malaria health seeking practices among children and pregnant women particularly IPTp through programmes aimed at increasing awareness among the population. Keywords: Health seeking behaviour; intermittent preventive treatment; malaria; children; pregnancy; Uganda

Geographical variations of the associations between health interventions and all-cause under-five mortality in Uganda

To reduce the under-five mortality (U5M), fine-gained spatial assessment of the effects of health interventions is critical because national averages can obscure important sub-national disparities. In turn, sub-national estimates can guide control programmes for spatial targeting. The purpose of our study is to quantify associations of interventions with U5M rate at national and sub-national scales in Uganda and to identify interventions associated with the largest reductions in U5M rate at the sub-national scale.; Spatially explicit data on U5M, interventions and sociodemographic indicators were obtained from the 2011 Uganda Demographic and Health Survey (DHS). Climatic data were extracted from remote sensing sources. Bayesian geostatistical Weibull proportional hazards models with spatially varying effects at sub-national scales were utilized to quantify associations between all-cause U5M and interventions at national and regional levels. Bayesian variable selection was employed to select the most important determinants of U5M.; At the national level, interventions associated with the highest reduction in U5M were artemisinin-based combination therapy (hazard rate ratio (HRR) = 0.60; 95% Bayesian credible interval (BCI): 0.11, 0.79), initiation of breastfeeding within 1 h of birth (HR = 0.70; 95% BCI: 0.51, 0.86), intermittent preventive treatment (IPTp) (HRR = 0.74; 95% BCI: 0.67, 0.97) and access to insecticide-treated nets (ITN) (HRR = 0.75; 95% BCI: 0.63, 0.84). In Central 2, Mid-Western and South-West, largest reduction in U5M was associated with access to ITNs. In Mid-North and West-Nile, improved source of drinking water explained most of the U5M reduction. In North-East, improved sanitation facilities were associated with the highest decline in U5M. In Kampala and Mid-Eastern, IPTp had the largest associated with U5M. In Central1 and East-Central, oral rehydration solution and postnatal care were associated with highest decreases in U5M respectively.; Sub-national estimates of the associations between U5M and interventions can guide control programmes for spatial targeting and accelerate progress towards mortality-related Sustainable Development Goals

Measuring health facility readiness and its effects on severe malaria outcomes in Uganda

There is paucity of evidence for the role of health service delivery to the malaria decline in Uganda We developed a methodology to quantify health facility readiness and assessed its role on severe malaria outcomes among lower-level facilities (HCIIIs and HCIIs) in the country. Malaria data was extracted from the Health Management Information System (HMIS). General service and malaria-specific readiness indicators were obtained from the 2013 Uganda service delivery indicator survey. Multiple correspondence analysis (MCA) was used to construct a composite facility readiness score based on multiple factorial axes. Geostatistical models assessed the effect of facility readiness on malaria deaths and severe cases. Malaria readiness was achieved in one-quarter of the facilities. The composite readiness score explained 48% and 46% of the variation in the original indicators compared to 23% and 27%, explained by the first axis alone for HCIIIs and HCIIs, respectively. Mortality rate was 64% (IRR = 0.36, 95% BCI: 0.14-0.61) and 68% (IRR = 0.32, 95% BCI: 0.12-0.54) lower in the medium and high compared to low readiness groups, respectively. A composite readiness index is more informative and consistent than the one based on the first MCA factorial axis. In Uganda, higher facility readiness is associated with a reduced risk of severe malaria outcomes

Quantitative feature extraction for machine learning analysis of resting-state fMRI data

Joint posterior distributions of the fitted statistical models. (DOCX 32 kb

Households experiencing catastrophic costs due to tuberculosis in Uganda : magnitude and cost drivers

Funding: This survey was funded by CDC (grant number 3U2GGH001180-03S1) toWHO, a USAID Uganda WHO Grant (PIO grant AID-617-10-17-00001) and alsofunding from Doctors with Africa, CUAMM.Background: Tuberculosis (TB) patients in Uganda incur large costs related to the illness, and while seeking and receiving health care. Such costs create access and adherence barriers which affect health outcomes and increase transmission of disease. The study ascertained the proportion of Ugandan TB affected households incurring catastrophic costs and the main cost drivers. Methods: A cross-sectional survey with retrospective data collection and projections was conducted in 2017. A total of 1178 drug resistant (DR) TB (44) and drug sensitive (DS) TB patients (1134), 2 weeks into intensive or continuation phase of treatment were consecutively enrolled across 67 randomly selected TB treatment facilities. Results: Of the 1178 respondents, 62.7% were male, 44.7% were aged 15-34 years and 55.5% were HIV positive. For each TB episode, patients on average incurred costs of USD 396 for a DS-TB episode and USD 3722 for a Multi drug resistant tuberculosis (MDR TB) episode. Up to 48.5% of households borrowed, used savings or sold assets to defray these costs. More than half (53.1%) of TB affected households experienced TB-related costs above 20% of their annual household expenditure, with the main cost drivers being non-medical expenditure such as travel, nutritional supplements and food. Conclusion: Despite free health care in public health facilities, over half of Ugandan TB affected households experience catastrophic costs. Roll out of social protection interventions like TB assistance programs, insurance schemes, and enforcement of legislation related to social protection through multi-sectoral action plans with central NTP involvement would palliate these costs.Publisher PDFPeer reviewe

Birth, stillbirth and death registration data completeness, quality and utility in population-based surveys: EN-INDEPTH study

Birth registration is a child’s first right. Registration of live births, stillbirths and deaths is foundational for national planning. Completeness of birth registration for live births in low- and middle-income countries is measured through population-based surveys which do not currently include completeness of stillbirth or death registration. Methods: The EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017–2018). In four African sites, we included new/modified questions regarding registration for 1177 stillbirths and 11,881 livebirths (1333 neonatal deaths and 10,548 surviving the neonatal period). Questions were evaluated for completeness of responses, data quality, time to administer and estimates of registration completeness using descriptive statistics. Timing of birth registration, factors associated with non-registration and reported barriers were assessed using descriptive statistics and logistic regression