treatment 'serif'">Despite low endemicity, malaria remains a major health problem in urban areas where a high proportion of fevers are presumptively treated using anti-malarial drugs. Low acquired malaria immunity, behaviour of city-dwellers, access to health care and preventive interventions, and heterogenic suitability of urban ecosystems for malaria transmission contribute to the complexity of the malaria epidemiology in urban areas. The study was designed to identify the determinants of malaria transmission estimated by the prevalence of anti-circumsporozoite (CSP) antibodies, the prevalence and density of Plasmodium falciparum infection, and the prevalence of malarial disease in areas of Ouagadougou, Burkina-Faso. Thick blood smears, dried blood spots and clinical status have been collected from 3,354 randomly chosen children aged 6 months to 12 years using two cross-sectional surveys (during the dry and rainy seasons) in eight areas from four ecological strata defined according to building density and land tenure (regular versus irregular). Demographic characteristics, socio-economic information, and sanitary and environmental data concerning the children or their households were simultaneously collected. Dependent variables were analyzed using mixed multivariable models with random effects, taking into account the clustering of participants within compounds and areas.
Meili Baragatti, Florence Fournet et al ; 2009 doi:10.1186/1475-2875-8-13
To assess the knowledge, attitude and practice (KAP) regarding malaria and their determinants in a rural population of northern Ethiopia. The study was conducted in the district of Samre Saharti, Tigray, northern Ethiopia. A structured questionnaire collecting socio-demographic and malaria-related KAP information was administered to the mothers from a representative sample of households. A total of 1652 questionnaires were available for analysis. Most of the respondents (92.7%) were able to mention at least one symptom of malaria. Mosquito as a cause of malaria was recognized by nearly half of the respondents (48.8%). Most of the households had a bed net (85.9%). To have a literate person at home, to belong to the lowland stratum, to have received some type of health education and to own a radio were associated with the knowledge of malaria. A strong association remained between living in the lowland stratum, to own a radio and to live close to the health post and the use of ITN. Being a housewife, lack of health education and to live further than 60 minutes walking distance to the health post were related to a delay on treatment finding.
Johan Paulander, Henrik Olsson et al; 13 January 2009
sick 'serif'">Over 40 countries in sub-Saharan Africa have recently revised their national uncomplicated malaria treatment policies replacing either chloroquine (CQ) or sulphadoxine-pyrimethamine (SP) with artemisinin-based combi- nation therapy (ACT). These policy changes have been made in response to growing evidence of the adverse consequences of malaria treatment failures and the need to limit the future spread of drug resistance .Following the recognition that morbidity and mortality due to malaria had dramatically increased in the last three decades, pills in 2002 the government of Zambia reviewed its efforts to prevent and treat malaria. Convincing evidence of the failing efficacy of chloroquine resulted in the initiation of a process that eventually led to the development and implementation of a new national drug policy based on artemisinin-based combination therapy (ACT). All published and unpublished documented evidence dealing with the antimalarial drug policy change was reviewed. These data were supplemented by the authors' observations of the policy change process. The information has been structured to capture the timing of events, the challenges encountered, and the resolutions reached in order to achieve implementation of the new treatment policy.
Naawa Sipilanyambe, Jonathon L Simon et al; 2008, 7:25 doi:10.1186/1475-2875-7-25
check 'serif'">Over the last decade a number of reviews have firmly established the burden of malaria in pregnancy as a priority public health issue. One intervention widely promoted to tackle this burden in malaria endemic areas in sub-Saharan Africa is intermittent preventive treatment for pregnant women (IPTp). Delivery of two doses of intermittent preventive treatment of malaria during pregnancy (IPTp) is a key strategy to reduce the burden of malaria in pregnancy in sub-Saharan Africa. However, troche different settings have reported coverage levels well below the target 80%. Antenatal implementation guidelines in Tanzania recommend IPTp first dose to be given at the second antenatal visit, case and second dose at the third visit. This investigation measured coverage of IPTp at national level in Tanzania and examined the role of individual, facility, and policy level influences on achieved coverage. Three national household and linked reproductive and child health (RCH) facility surveys were conducted July-August 2005, 2006, and 2007 in 210 clusters sampled using two-stage cluster sampling from 21 randomly selected districts. Female residents who reported a live birth in the previous year were asked questions about malaria prevention during that pregnancy and individual characteristics including education, pregnancy history, and marital status. The RCH facility serving each cluster was also surveyed, and information collected about drug stocks, health education delivery, and the timing of antenatal care delivery by clinic users.
Tanya Marchant, Rose Nathan et al; 2008, 7:260 doi:10.1186/1475-2875-7-260
diagnosis 'serif'">Despite investments in providing free government health services in Uganda, and many caretakers still seek treatment from the drug shops/private clinics. The study aimed to assess determinants for use of government facilities or drug shops/private clinics for febrile illnesses in children under five. Infant and child mortality rates due to febrile illnesses are high in resource poor countries, especially in sub-Saharan Africa. With the millennium development goal number four, many countries have targeted to reduce under-five mortality of the 1990 level by two thirds by 2015. In Uganda, there is a high disease burden from febrile illnesses with malaria contributing 30 – 50% of outpatient burden and 35% of hospital admissions. Those affected by malaria are mostly women and children under five years. Much of the effort at health facility level has been to improve quality and reduce costs of care in government facilities. In 2001, the government removed user fees from all the government health facilities except for the private wing in the district hospitals and there was a rapid increase in utilization of care. Studies have demonstrated that even after removal of user fees quality of care was maintained.
Elizeus Rutebemberwa, George Pariyo et al; 2009, 8:45 doi: 10.1186/1475-2875-8-45