Utilisation of malaria preventive measures during pregnancy and birth outcomes in Ibadan, Nigeria

<p>Abstract</p> <p>Background</p> <p>Malaria remains a major public health problem in sub Saharan Africa and the extent of utilisation of malaria preventive measures may impact on the burden of malaria in pregnancy. This study sought to determine the association between malaria preventive measures utilized during pregnancy and the birth outcomes of birth weight and preterm delivery.</p> <p>Methods</p> <p>This cross sectional survey involved 800 mothers who delivered at the University College Hospital, and Adeoyo Maternity Hospital, Ibadan. Data obtained included obstetric information, gestational age, birth weight and self reported use of malaria prevention strategies in index pregnancy.</p> <p>Results</p> <p>Most (95.6%) mothers used one or more malaria control measures. The most commonly used vector control measures were window net (84.0%), insecticide spray (71.5%) and insecticide treated bed nets (20.1%), while chemoprophylactic agents were pyrimethamine (23.5%), Intermittent Preventive Treatments with Sulphadoxine-Pyrimethamine (IPTsp) (18.5%) and intermittent chloroquine (9.5%) and 21.7% used herbal medications. The mean ± SD birthweight and gestational age of the babies were 3.02 kg ± 0.56 and 37.9 weeks ± 2.5 respectively. Preterm delivery rate was 19.4% and 9% had low birth weight.</p> <p>Comparing babies whose mothers had IPTsp with those who did not, mean birth weight was 3.13 kg ± 0.52 versus 3.0 kg ± 0.56 (p = 0.016) and mean gestational age was 38.5 weeks ± 2.1 versus 37.8 weeks ± 2.5 (p = 0.002).</p> <p>The non-use of IPTsp was associated with increased risk of having low birth weight babies (AOR: 2.27, 95% CI: 0.98; 5.28) and preterm birth (AOR: 1.93, 95% CI: 1.08, 3.44). The non use of herbal preparations (AOR: 0.55, 95% CI: 0.36, 0.85) was associated with reduced risk of preterm birth. The mean ± SD birth weight and gestational ages of babies born to mothers who slept under ITNs were not significantly different from those who did not (p = 0.07 and 0.09 respectively).</p> <p>Conclusions</p> <p>There is a need for improved utilisation of IPTsp as well as discouraging the use of herbal medications in pregnancy in order to reduce pregnancy outcome measures of low birth weight and preterm deliveries in this environment.</p

Socially marketed insecticide-treated nets effectively reduce Plasmodium infection and anaemia among children in urban Malawi

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73394/1/j.1365-3156.2006.01684.x.pd

Interpreting household survey data intended to measure insecticide-treated bednet coverage: results from two surveys in Eritrea

BACKGROUND: As efforts are currently underway to roll-out insecticide-treated bednets (ITNs) to populations within malarious areas in Africa, there is an unprecedented need for data to measure the effectiveness of such programmes in terms of population coverage. This paper examines methodological issues to using household surveys to measure core Roll Back Malaria coverage indicators of ITN possession and use. METHODS: ITN coverage estimates within Anseba and Gash Barka Provinces from the 2002 Eritrean Demographic and Health Survey, implemented just prior to a large-scale ITN distribution programme, are compared to estimates from the same area from a sub-national Bednet Survey implemented 18 months later in 2003 after the roll-out of the ITN programme. RESULTS: Measures of bednet possession were dramatically higher in 2003 compared to 2002. In 2003, 82.2% (95% confidence interval (CI) 77.4–87.0) of households in Anseba and Gash Barka possessed at least one ITN. RBM coverage indicators for ITN use were also dramatically higher in 2003 as compared to 2002, with 76.1% (95% CI 69.9–82.2) of children under five years old and 52.4% (95% CI 38.2–66.6) of pregnant women sleeping under ITNs. The ITN distribution programme resulted in a gross increase in ITN use among children and pregnant women of 68.3% and 48% respectively. CONCLUSION: Eritrea has exceeded the Abuja targets of 60% coverage for ITN household possession and use among children under five years old within two malarious provinces. Results point to several important potential sources of bias that must be considered when interpreting data for ITN coverage over time, including: disparate survey universes and target populations that may include non-malarious areas; poor date recall of bednet procurement and treatment; and differences in timing of surveys with respect to malaria season

Gains in awareness, ownership and use of insecticide-treated nets in Nigeria, Senegal, Uganda and Zambia

Abstract Background In April 2000, the Roll Back Malaria (RBM) "Abuja Summit" set a target of having at least 60% of pregnant women and children under five use insecticide-treated nets (ITNs). Thereafter, programmes were implemented to create demand, reduce taxes and tariffs, spur the commercial market, and reach vulnerable populations with subsidized ITNs. Using national ITN monitoring data from the USAID-sponsored AED/NetMark project, this article examines the extent to which these activities were successful in increasing awareness, ownership, and use of nets and ITNs. Methods A series of surveys with standardized sampling and measurement methods was used to compare four countries at two points in time. Surveys were conducted in 2000 and again in 2004 (Nigeria, Senegal, Zambia) or 2006 (Uganda). They contained questions permitting classification of each net as untreated, ever-treated or currently-treated (an ITN). Household members as well as nets owned were enumerated so that households, household members, and nets could be used as units of analysis. Several measures of net/ITN ownership, plus RBM ITN use indicators, were calculated. The results show the impact of ITN activities before the launch of massive free net distribution programmes. Results In 2000, treated nets were just being introduced to the public, but four to six years later the awareness of ITNs was nearly universal in all countries but Nigeria, where awareness increased from 7% to 60%. By any measure, there were large increases in ownership of nets, especially treated nets, in all countries. All countries but Nigeria made commensurate gains in the proportion of under-fives sleeping under a net/ITN, and in all countries the proportion of pregnant women sleeping under a net/ITN increased greatly. Conclusion A mix of demand creation, a strengthened commercial sector, reduced taxes and tariffs, and programmes making ITNs available at reduced prices resulted in impressive gains in awareness, ownership, and use of nets and ITNs in Nigeria, Senegal, Zambia, and Uganda between 2000 and 2004–2006. None of the countries reached the ambitious Abuja targets for ITN use, but they made substantial progress towards them.</p

How antimalarial drug resistance affects post-treatment prophylaxis

Slowly eliminated antimalarial drugs suppress malaria reinfections for a period of time determined by the dose, the pharmacokinetic properties of the drug, and the susceptibility of the infecting parasites. This effect is called post-treatment prophylaxis (PTP). The clinical benefits of preventing recrudescence (reflecting treatment efficacy) compared with preventing reinfection (reflecting PTP) need further assessment. Antimalarial drug resistance shortens PTP. While blood concentrations are in the terminal elimination phase, the degree of shortening may be estimated from measurements of in-vitro susceptibility and the terminal elimination half-life. More information is needed on PTP following intermittent preventive treatments, and on the relationship between the duration of PTP and immunity, so that policy recommendations can have a firmer evidence base

The effect of monthly sulfadoxine-pyrimethamine, alone or with azithromycin, on pcr-diagnosed malaria at delivery: A randomized controlled trial

10.1371/journal.pone.0041123PLoS ONE77

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

Real-time PCR/MCA assay using fluorescence resonance energy transfer for the genotyping of resistance related DHPS-540 mutations in Plasmodium falciparum

BACKGROUND: Sulphadoxine-pyrimethamine has been abandoned as first- or second-line treatment by most African malaria endemic countries in favour of artemisinin-based combination treatments, but the drug is still used as intermittent preventive treatment during pregnancy. However, resistance to sulphadoxine-pyrimethamine has been increasing in the past few years and, although the link between molecular markers and treatment failure has not been firmly established, at least for pregnant women, it is important to monitor such markers. METHODS: This paper reports a novel sensitive, semi-quantitative and specific real-time PCR and melting curve analysis (MCA) assay using fluorescence resonance energy transfer (FRET) for the detection of DHPS-540, an important predictor for SP resistance. FRET/MCA was evaluated using 78 clinical samples from malaria patients and compared to PCR-RFLP. RESULTS: Sixty-two samples were in perfect agreement between both assays. One sample showed a small wild type signal with FRET/MCA that indicates a polyclonal infection. Four samples were not able to generate enough material in both assays to distinguish mutant from wild-type infection, six samples gave no signal in PCR-RFLP and five samples gave no amplification in FRET/MCA. CONCLUSION: FRET/MCA is an effective tool for the identification of SNPs in drug studies and epidemiological surveys on resistance markers in general and DHPS-540 mutation in particular

Reproductive health issues in rural Western Kenya

<p>Abstract</p> <p>Background</p> <p>We describe reproductive health issues among pregnant women in a rural area of Kenya with a high coverage of insecticide treated nets (ITNs) and high prevalence of HIV (15%).</p> <p>Methods</p> <p>We conducted a community-based cross-sectional survey among rural pregnant women in western Kenya. A medical, obstetric and reproductive history was obtained. Blood was obtained for a malaria smear and haemoglobin level, and stool was examined for geohelminths. Height and weight were measured.</p> <p>Results</p> <p>Of 673 participants, 87% were multigravidae and 50% were in their third trimester; 41% had started antenatal clinic visits at the time of interview and 69% reported ITN-use. Malaria parasitemia and anaemia (haemoglobin < 11 g/dl) were detected among 36% and 53% of the women, respectively. Geohelminth infections were detected among 76% of the 390 women who gave a stool sample. Twenty percent of women were underweight, and sixteen percent reported symptoms of herpes zoster or oral thrush in the last two months. Nineteen percent of all women reported using a contraceptive method to delay or prevent pregnancy before the current pregnancy (injection 10%, pill 8%, condom 0.4%). Twenty-three percent of multigravidae conceived their current pregnancy within a year of the previous pregnancy. More than half of the multigravidae (55%) had ever lost a live born child and 21% had lost their last singleton live born child at the time of interview.</p> <p>Conclusion</p> <p>In this rural area with a high HIV prevalence, the reported use of condoms before pregnancy was extremely low. Pregnancy health was not optimal with a high prevalence of malaria, geohelminth infections, anaemia and underweight. Chances of losing a child after birth were high. Multiple interventions are needed to improve reproductive health in this area.</p