Application of loop analysis for evaluation of malaria control interventions

Background: Despite continuous efforts and recent rapid expansion in the financing and implementation of malaria control interventions, malaria still remains one of the most devastating global health issues. Even in countries that have been successful in reducing the incidence of malaria, malaria control is becoming more challenging because of the changing epidemiology of malaria and waning community participation in control interventions. In order to improve the effectiveness of interventions and to promote community understanding of the necessity of continued control efforts, there is an urgent need to develop new methodologies that examine the mechanisms by which community-based malaria interventions could reduce local malaria incidence. Methods: This study demonstrated how the impact of community-based malaria control interventions on malaria incidence can be examined in complex systems by qualitative analysis combined with an extensive review of literature. First, sign digraphs were developed through loop analysis to analyse seven interventions: source reduction, insecticide/larvicide use, biological control, treatment with anti-malarials, insecticide-treated mosquito net/long-lasting insecticidal net, non-chemical personal protection measures, and educational intervention. Then, for each intervention, the sign digraphs and literature review were combined to analyse a variety of pathways through which the intervention can influence local malaria incidence as well as interactions between variables involved in the system. Through loop analysis it is possible to see whether increases in one variable qualitatively increases or decreases other variables or leaves them unchanged and the net effect of multiple, interacting variables. Results: Qualitative analysis, specifically loop analysis, can be a useful tool to examine the impact of community-based malaria control interventions. Without relying on numerical data, the analysis was able to describe pathways through which each intervention could influence malaria incidence on the basis of the qualitative patterns of the interactions between variables in complex systems. This methodology is generalizable to various disease control interventions at different levels, and can be utilized by a variety of stakeholders such as researchers, community leaders and policy makers to better plan and evaluate their community-based disease control interventions

Knowing the Consequences of Unprotected Sex with Seroconcordant Partner Is Associated with Increased Safer Sex Intentions among HIV-positive Men in Kathmandu, Nepal

Unprotected sexual intercourse among HIV-positive people can adversely affect their own health by increasing their exposure to multiple strains of HIV-1 or other sexually transmitted infections (STIs). The study explored the relationship between knowledge of Nepalese HIV-positive men about the consequences of having unprotected sex with seroconcordant partners and their intention to practise safer sex with such partners. In total, 166 participants recruited conveniently in the Kathmandu Valley, Nepal, were interviewed. Each participant reported intention to practise safer sex with seroconcordant partners, know-ledge about the consequences of having unprotected sex with seroconcordant partners, perceived partner-related barriers to condom-use, belief that condoms interfere with sex, and condom-use self-efficacy. Of the 166 participants, 50.6% intended to practise safer sex every time they have sex with seroconcordant partners. Results of multiple logistic regression analysis showed that the participants who were aware of the possibility of HIV superinfection [adjusted odds ratio (AOR)=2.93, 95% confidence interval (CI) 1.16-7.34, p=0.022)] or that the presence of STIs in HIV-positive persons increases progression of HIV disease (AOR=2.80, 95% CI 1.08-7.26, p=0.033) were more likely to intend to practise safer sex with seroconcordant partners. Similarly, the participants who were employed or who had lower levels of belief that condoms interfere with sex were more likely to intend to practise safer sex. The findings suggest that improving the knowledge of HIV-positive persons about the consequences of having unprotected sex with seroconcordant partners might improve their intention to practise safer sex with such partners

Nutrition Training Improves Health Workers' Nutrition Knowledge and Competence to Manage Child Undernutrition: A Systematic Review.

Medical and nursing education lack adequate practical nutrition training to fit the clinical reality that health workers face in their practices. Such a deficit creates health workers with poor nutrition knowledge and child undernutrition management practices. In-service nutrition training can help to fill this gap. However, no systematic review has examined its collective effectiveness. We thus conducted this study to examine the effectiveness of in-service nutrition training on health workers' nutrition knowledge, counseling skills, and child undernutrition management practices. We conducted a literature search on nutrition interventions from PubMed/MEDLINE, CINAHL, EMBASE, ISI Web of Knowledge, and World Health Organization regional databases. The outcome variables were nutrition knowledge, nutrition-counseling skills, and undernutrition management practices of health workers. Due to heterogeneity, we conducted only descriptive analyses. Out of 3910 retrieved articles, 25 were selected as eligible for the final analysis. A total of 18 studies evaluated health workers' nutrition knowledge and showed improvement after training. A total of 12 studies with nutrition counseling as the outcome variable also showed improvement among the trained health workers. Sixteen studies evaluated health workers' child undernutrition management practices. In all such studies, child undernutrition management practices and competence of health workers improved after the nutrition training intervention. In-service nutrition training improves quality of health workers by rendering them more knowledge and competence to manage nutrition-related conditions, especially child undernutrition. In-service nutrition training interventions can help to fill the gap created by the lack of adequate nutrition training in the existing medical and nursing education system. In this way, steps can be taken toward improving the overall nutritional status of the child population

Assessing the quality of service of village malaria workers to strengthen community-based malaria control in Cambodia

BackgroundMalaria continues to be a major public health problem in remote forested areas in Cambodia. As a national strategy to strengthen community-based malaria control, the Cambodian government has been running the Village Malaria Worker (VMW) project since 2001. This study sought to examine the nature and quality of the VMWs\u27 services.MethodsData collection was carried out in February and March 2008 through interviews with one of the two VMWs who takes the lead in malaria control activities in each of the 315 VMW villages (n = 251). The questionnaire addressed 1) the sociodemographic characteristics of VMWs, 2) service quality, 3) actions for malaria prevention and vector control, and 4) knowledge of malaria epidemiology and vector ecology.ResultsVMWs were effective in conducting diagnosis with Rapid Diagnostic Tests (RDTs) and prescribing anti-malarials to those who had positive RDT results, skills that they had acquired through their training programmes. However, most other services, such as active detection, explanations about compliance, and follow-up of patients, were carried out by only a small proportion of VMWs. The variety of actions that VMWs took for malaria prevention and vector control was small (average action index score 12.8/23), and their knowledge was very limited with less than 20% of the VMWs giving correct answers to six out of seven questions on malaria epidemiology and vector ecology. Knowledge of vector breeding places and malaria transmission were significant determinants of both the quality of VMWs\u27 services and the variety of their actions for malaria prevention and vector control.ConclusionsVMWs\u27 services focused primarily on diagnosis and treatment. Their focus needs to be broadened to cover other aspects of malaria control in order to further strengthen community-based malaria control. VMWs\u27 actions and knowledge also need substantial improvement. Strengthening training programmes can help achieve better performance by VMWs

Perceived Family Support and Depression among People Living with HIV/AIDS in the Kathmandu Valley, Nepal

Background: Depression is emerging as a highly prevalent psychiatric condition among people living with HIV/AIDS (PLWHA). Perceived family support (PFS) buffers depression among chronic disease patients. However, a similar relationship among PLWHA is unexplored. Objective: To examine the relationship between PFS and depression among PLWHA in the Kathmandu Valley, Nepal. Methods: In this cross-sectional study, depression was measured by Beck Depression Inventory Ia. Perceived family support was measured by Nepali Family Support and Difficulties Scale. The status of depression was compared between 208 PLWHA and 208 HIV-negative participants. The relationship between PFS and depression was examined only among PLWHA. Results: Among each of the 208 participants, the number of depressed PLWHA (n ¼ 61,29.3%) was higher than that of HIV-negative participants (n ¼ 13,6.2%; P \u3c .001). Perceived family support had a negative association with depression in PLWHA (adjusted odds ratio [AOR] ¼ 0.20, 95% confidence interval [CI] ¼ 0.08-0.53). Conclusion: In Nepal, PLWHA display a higher level of depression than HIV-negative people, and a lower level of PFS is associated with depression among PLWHA. Improved family support might be helpful in reducing depression among Nepalese PLWHA

Knowing the Consequences of Unprotected Sex with Seroconcordant Partner Is Associated with Increased Safer Sex Intentions among HIV-positive Men in Kathmandu, Nepal

Unprotected sexual intercourse among HIV-positive people can adversely affect their own health by increasing their exposure to multiple strains of HIV-1 or other sexually transmitted infections (STIs). The study explored the relationship between knowledge of Nepalese HIV-positive men about the consequences of having unprotected sex with seroconcordant partners and their intention to practise safer sex with such partners. In total, 166 participants recruited conveniently in the Kathmandu Valley, Nepal, were interviewed. Each participant reported intention to practise safer sex with seroconcordant partners, knowledge about the consequences of having unprotected sex with seroconcordant partners, perceived partner-related barriers to condom-use, belief that condoms interfere with sex, and condom-use self-efficacy. Of the 166 participants, 50.6% intended to practise safer sex every time they have sex with seroconcordant partners. Results of multiple logistic regression analysis showed that the participants who were aware of the possibility of HIV superinfection [adjusted odds ratio (AOR)=2.93, 95% confidence interval (CI) 1.167.34, p=0.022)] or that the presence of STIs in HIV-positive persons increases progression of HIV disease (AOR=2.80, 95% CI 1.08-7.26, p=0.033) were more likely to intend to practise safer sex with seroconcordant partners. Similarly, the participants who were employed or who had lower levels of belief that condoms interfere with sex were more likely to intend to practise safer sex. The findings suggest that improving the knowledge of HIV-positive persons about the consequences of having unprotected sex with seroconcordant partners might improve their intention to practise safer sex with such partners

Quality of Life and Mental Health Status of Arsenic-affected Patients in a Bangladeshi Population

Contamination of groundwater by inorganic arsenic is one of the major public-health problems in Bangladesh. This cross-sectional study was conducted (a) to evaluate the quality of life (QOL) and mental health status of arsenic-affected patients and (b) to identify the factors associated with the QOL. Of 1,456 individuals, 521 (35.78%) were selected as case and control participants, using a systematic random-sampling method. The selection criteria for cases (n=259) included presence of at least one of the following: melanosis, leucomelanosis on at least 10% of the body, or keratosis on the hands or feet. Control (nonpatient) participants (n=262) were selected from the same villages by matching age (\ub15 years) and gender. The Bangladeshi version of the WHOQOL-BREF was used for assessing the QOL, and the self-reporting questionnaire (SRQ) was used for assessing the general mental health status. Data were analyzed using Student's t-test and analysis of covariance (ANCOVA), and the WHOQOL-BREF and SRQ scores between the patients and the non-patients were compared. The mean scores of QOL were significantly lower in the patients than those in the non-patients of both the sexes. Moreover, the mental health status of the arsenic-affected patients (mean score for males=8.4 and females=10.3) showed greater disturbances than those of the non-patients (mean score for males=5.2 and females=6.1) of both the sexes. The results of multiple regression analysis revealed that the factors potentially contributing to the lower QOL scores included: being an arsenic-affected patient, having lower age, and having lower annual income. Based on the findings, it is concluded that the QOL and mental health status of the arsenic-affected patients were significantly lower than those of the non-patients in Bangladesh. Appropriate interventions are necessary to improve the well-being of the patients

Content Analysis of Primary and Secondary School Textbooks Regarding Malaria Control: A Multi-Country Study

BACKGROUND: In tropical settings, malaria education at school is potentially useful, but textbook content related to malaria education has so far received little attention. This study aimed to examine whether school textbooks contain sufficient knowledge and skills to help children in primary and lower secondary schools and their family members to cope with malaria. METHODOLOGY/PRINCIPAL FINDINGS: This was a descriptive, cross-country study. We collected textbooks that were used by children in grades one to nine from nine countries endemic for malaria: Laos, Cambodia, Nepal, Bangladesh, Sri Lanka, Zambia, Niger, Benin, and Ghana. Two reviewers per country identified descriptions about malaria by seeking the term "malaria" or a local word that corresponds to malaria in languages other than English. The authors categorized the identified descriptions according to the content of the descriptions. Additionally, the authors examined whether the identified contents addressed life skill messages. Of a total of 474 textbooks collected, 35 contained descriptions about malaria. The most commonly included content was transmission mode/vector (77.1%), followed by preventive measures (60.0%), epidemiology (57.1%), cause/agent (54.3%), signs/symptoms (37.1%) and treatment (22.9%). Treatment-related content was not included in any textbooks from four countries and textbooks failed to recommend the use of insecticide-treated bed nets in five countries. Very few textbooks included content that facilitated prompt treatment, protection of risk groups, and use of recommended therapy. CONCLUSION/SIGNIFICANCE: Textbooks rarely included knowledge and skills that are crucial to protect schoolchildren and their families from malaria. This study identified the need for improvement to textbook contents regarding malaria

Barriers for pregnant women living in rural, agricultural villages to accessing antenatal care in Cambodia: A community-based cross-sectional study combined with a geographic information system

Article describes how morbidity and mortality is still a major public health issue in low- and middle-income countries such as Cambodia. This study examines the barriers for pregnant women living in rural, agricultural villages