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

Abstract

BackgroundLong-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.MethodsA 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.ResultsA 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.ConclusionTraining 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.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000035022

Intersectoral collaboration for the prevention and control of vector borne diseases to support the implementation of a global strategy: A systematic review

“…Most studies reported more than one outcome as shown in S4 and S5 Tables. Of the 25 studies involving intersectoral collaboration which measured pre-post-outcomes compared against disease indicators, such as the number of cases or incidence or prevalence of malaria (15 studies) [ 4 , 30 – 43 ], dengue (four studies) [ 44 – 47 ], schistosomiasis (two studies) [ 48 , 49 ], zika (one study) [ 50 ], Japanese encephalitis (one study) [ 51 ], and leishmaniasis (one study) [ 52 ]. Amongst the 16 studies which measured vector variables (adult density, pupae or larval indices) as outcomes eleven studies were dengue [ 44 , 46 , 47 , 53 – 60 ], followed by two studies on schistosomiasis [ 48 , 49 ], and one on malaria [ 4 ] and on Chagas diseases [ 61 ].…”

Prevalence and Factors Associated with Anemia Among Children Under 5 Years of Age—Uganda, 2009

“…[35][36][37][38] Malaria prevention and effective treatment measures have dramatically expanded in the past decade. Although the UMIS was the first national survey to assess malaria prevalence in Uganda, the prevalence of malaria likely decreased during this interim given the rapid scaleup of malaria control activities.…”

Efficacy and safety of artemisinin combination therapy (ACT) for non-falciparum malaria: a systematic review

“…Because most studies have been carried out in endemic settings, one must be careful transferring these results directly to non-immune travellers with imported non-falciparum malaria. On the other hand, European treatment guidelines are mainly based on data from studies carried out in endemic areas, since there is a paucity of original prospective treatment data for non-immune patients[ 21 ]. It must be acknowledged that in most settings, there are too few participants for large-scale trials assessing ‘one size fits it all’ strategies for non-falciparum malaria in and outside endemic areas.…”

“…Hence, there might be a compelling rationale to treat all (including returning travellers) diagnosed with malaria with an ACT irrespective of malaria species[ 21 ]. More or less identical first-line treatments based on ACT for all malaria species would not only simplify treatment schemes and avoid ineffective CQ treatment of unrecognized P. falciparum infection, but also offer logistical benefits in terms of pharmacological management, whilst the need to eliminate P.vivax / P.ovale hypnozoites outside endemic areas has to be accounted for.…”