Can universal insecticide-treated net campaigns achieve equity in coverage and use? the case of northern Nigeria

<p>Abstract</p> <p>Background</p> <p>Insecticide-treated nets (ITNs) are effective tools for malaria prevention and can significantly reduce severe disease and mortality due to malaria, especially among children under five in endemic areas. However, ITN coverage and use remain low and inequitable among different socio-economic groups in sub-Saharan Africa, particularly in Nigeria. Several strategies have been proposed to increase coverage and use and reduce inequity in Nigeria, including free distribution campaigns recently conducted by the Nigerian federal government. Using data from the first post-campaign survey, the authors investigated the effect of the mass free distribution campaigns in achieving equity in household ownership and use of ITNs.</p> <p>Methods</p> <p>A post-campaign survey was undertaken in November 2009 in northern Nigeria to assess the effect of the campaigns in addressing equity across different socio-economic groups. The survey included 987 households randomly selected from 60 clusters in Kano state. Using logistic regression and the Lorenz concentration curve and index, the authors assessed equity in ITN coverage and use.</p> <p>Results</p> <p>ITN ownership coverage increased from 10% before the campaigns to 70%-a more than fivefold increase. The campaigns reduced the ownership coverage gap by 75%, effectively reaching parity among wealth quintiles (Concentration index 0.02, 95% CI (-0.02 ; 0.05) versus 0.21 95%CI (0.08 ; 0.34) before the campaigns). ITN use (individuals reporting having slept under an ITN the night before the survey visit) among individuals from households owning at least one ITN, was 53.1% with no statistically significant difference between the lowest, second, third and fourth wealth quintiles and the highest wealth quintile (lowest: odds ratio (OR) 0.87, 95% confidence interval (CI) (0.67 ; 1.13); second: OR 0.85, 95% CI (0.66 ; 1.24); third: OR 1.10 95% CI (0.86 ; 1.4) and fourth OR 0.91 95% CI (0.72 ; 1.15).</p> <p>Conclusion</p> <p>The campaign had a significant impact by increasing ITN coverage and reducing inequity in ownership and use. Free ITN distribution campaigns should be sustained to increase equitable coverage. These campaigns should be supplemented with other ITN distribution strategies to cover newborns and replace aging nets.</p

Malaria indicator survey: basic documentation for survey design and implementation

Overview of the MIS Documentation--April 2005 -- MIS Components--April 2005 -- Core Component 1: Household Questionnaire--April 2005 -- Core Component 2: Women's Questionnaire--April 2005 -- Core Component 3: Rationale--April 2005 -- Core Component 4: Interviewer's Manual--April 2005 -- Core Component 5: Supervisor's Manual--April 2005 -- Core Component 6: Guidelines for Interviewer Training--April 2005 -- Core Component 7: Household Listing Manual--April 2005 -- Core Component 8: Sampling Guidelines--April 2005 -- Core Component 9: Tabulations for Key Malaria Indicators--April 2005 -- Biologic Component 1: Anaemia Testing (Preliminary Draft)--February 2005 -- Biologic Component 2: Parasitaemia Testing Manual (To be Developed) -- Complementary Documents 1: A Field Guide to GPS Data Collection & GPS Cluster--Position Form--pril 2005 -- Complementary Documents 2: PDA Manual for Field Data Collection and Sampling--April 2005 -- Complementary Documents 3: Calculating the Cost of the Malaria Indicator Survey--April 2005Roll Back Malaria Monitoring and Evaluation Reference Group."July 2005..""The development of Malaria Indicator Survey: Basic Documentation for Survey Design and Implementation would not have been possible without the assistance of numerous individuals, institutions, organizations, and countries. We would especially like to thank the following for their technical contributions: MEASURE DHS, MEASURE Evaluation, the World Health Organization, the United Nations Children's Fund (UNICEF), and the U.S. Centers for Disease Control and Prevention. Experience gained from the Demographic and Health Surveys and UNICEF's Multiple Indicator Cluster Surveys has been instrumental in the design, testing, and documentation of the various components of the Malaria Indicator Survey package. We are especially grateful to various participants of the Roll Back Malaria Monitoring and Evaluation Reference Group's Household Survey Task Force for their guidance and regular feedback and to the U.S. Agency for International Development for funding the project." - p. ivPublished jointly by the World Health Organization, UNICEF, MEASURE DHS, MEASURE Evaluation, and the U. S. Centers for Disease Control and Prevention.Print version also available.System requirements: Adobe Acrobat reader required to view PDF document.Mode of access: World Wide Web as a series of linked .pdf files.Roll Back Malaria Monitoring and Evaluation Reference Group, World Health Organization, United Nations Children's Fund, MEASURE DHS, MEASURE Evaluation, and U.S. Centers for Disease Control and Prevention. 2005. Malaria Indicator Survey: Basic documentation for survey design and implementation. Calverton, Maryland: MEASURE Evaluation

Patterns of anti-malarial drug treatment among pregnant women in Uganda

BACKGROUND: Prompt use of an effective anti-malarial drug is essential for controlling malaria and its adverse effects in pregnancy. The World Health Organization recommends an artemisinin-based combination therapy as the first-line treatment of uncomplicated malaria in the second and third trimesters of pregnancy. The study objective was to determine the degree to which presumed episodes of uncomplicated symptomatic malaria in pregnancy were treated with a recommended anti-malarial regimen in a region of Uganda. METHODS: Utilizing a population-based random sample, we interviewed women living in Jinja, Uganda who had been pregnant in the past year. RESULTS: Self-reported malaria during the index pregnancy was reported among 67% (n = 334) of the 500 participants. Among the 637 self-reported episodes of malaria, an anti-malarial drug was used for treatment in 85% of the episodes. Use of a currently recommended treatment in the first trimester was uncommon (5.6%). A contraindicated anti-malarial drug (sulphadoxine-pyrimethamine and/or artemether-lumefantrine) was involved in 70% of first trimester episodes. Recommended anti-malarials were used according to the guidelines in only 30.1% of all second and third trimester episodes. CONCLUSIONS: Self-reported malaria was extremely common in this population and adherence to treatment guidelines for the management of malaria in pregnancy was poor. Use of artemether-lumefantrine combined with non-recommended anti-malarials was common practice. Overuse of anti-malarial drugs, especially ones that are no longer recommended, undermines malaria control efforts by fueling the spread of drug resistance and delaying appropriate treatment of non-malarial febrile illnesses. Improved diagnostic capacity is essential to ultimately improving the management of malaria-like symptoms during pregnancy and appropriate use of currently available anti-malarials

The use of schools for malaria surveillance and programme evaluation in Africa

Effective malaria control requires information on both the geographical distribution of malaria risk and the effectiveness of malaria interventions. The current standard for estimating malaria infection and impact indicators are household cluster surveys, but their complexity and expense preclude frequent and decentralized monitoring. This paper reviews the historical experience and current rationale for the use of schools and school children as a complementary, inexpensive framework for planning, monitoring and evaluating malaria control in Africa. Consideration is given to (i) the selection of schools; (ii) diagnosis of infection in schools; (iii) the representativeness of schools as a proxy of the communities they serve; and (iv) the increasing need to evaluate interventions delivered through schools. Finally, areas requiring further investigation are highlighted

Fine resolution mapping of population age-structures for health and development applications

The age-group composition of populations varies considerably across the world, and obtaining accurate, spatially detailed estimates of numbers of children under 5 years is important in designing vaccination strategies, educational planning or maternal healthcare delivery. Traditionally, such estimates are derived from population censuses, but these can often be unreliable, outdated and of coarse resolution for resource-poor settings. Focusing on Nigeria, we use nationally representative household surveys and their cluster locations to predict the proportion of the under-five population in 1 × 1 km using a Bayesian hierarchical spatio-temporal model. Results showed that land cover, travel time to major settlements, night-time lights and vegetation index were good predictors and that accounting for fine-scale variation, rather than assuming a uniform proportion of under 5 year olds can result in significant differences in health metrics. The largest gaps in estimated bednet and vaccination coverage were in Kano, Katsina and Jigawa. Geolocated household surveys are a valuable resource for providing detailed, contemporary and regularly updated population age-structure data in the absence of recent census data. By combining these with covariate layers, age-structure maps of unprecedented detail can be produced to guide the targeting of interventions in resource-poor settings