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Non-adherence to long-lasting insecticide treated bednet use following successful malaria control in Tororo, Uganda

Indoor residual spraying (IRS) and long-lasting insecticide-treated bednets (LLINs) are common tools for reducing malaria transmission. We studied a cohort in Uganda with universal access to LLINs after 5 years of sustained IRS to explore LLIN adherence when malaria transmission has been greatly red...

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Autores principales: Rek, John, Musiime, Alex, Zedi, Maato, Otto, Geoffrey, Kyagamba, Patrick, Asiimwe Rwatooro, Jackson, Arinaitwe, Emmanuel, Nankabirwa, Joaniter, Staedke, Sarah G., Drakeley, Chris, Rosenthal, Philip J., Kamya, Moses, Dorsey, Grant, Krezanoski, Paul J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714220/
https://www.ncbi.nlm.nih.gov/pubmed/33270743
http://dx.doi.org/10.1371/journal.pone.0243303
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author Rek, John
Musiime, Alex
Zedi, Maato
Otto, Geoffrey
Kyagamba, Patrick
Asiimwe Rwatooro, Jackson
Arinaitwe, Emmanuel
Nankabirwa, Joaniter
Staedke, Sarah G.
Drakeley, Chris
Rosenthal, Philip J.
Kamya, Moses
Dorsey, Grant
Krezanoski, Paul J.
author_facet Rek, John
Musiime, Alex
Zedi, Maato
Otto, Geoffrey
Kyagamba, Patrick
Asiimwe Rwatooro, Jackson
Arinaitwe, Emmanuel
Nankabirwa, Joaniter
Staedke, Sarah G.
Drakeley, Chris
Rosenthal, Philip J.
Kamya, Moses
Dorsey, Grant
Krezanoski, Paul J.
author_sort Rek, John
collection PubMed
description Indoor residual spraying (IRS) and long-lasting insecticide-treated bednets (LLINs) are common tools for reducing malaria transmission. We studied a cohort in Uganda with universal access to LLINs after 5 years of sustained IRS to explore LLIN adherence when malaria transmission has been greatly reduced. Eighty households and 526 individuals in Nagongera, Uganda were followed from October 2017 –October 2019. Every two weeks, mosquitoes were collected from sleeping rooms and LLIN adherence the prior night assessed. Episodes of malaria were diagnosed using passive surveillance. Risk factors for LLIN non-adherence were evaluated using multi-level mixed logistic regression. An age-matched case-control design was used to measure the association between LLIN non-adherence and malaria. Across all time periods, and particularly in the last 6 months, non-adherence was higher among both children <5 years (OR 3.31, 95% CI: 2.30–4.75; p<0.001) and school-aged children 5–17 years (OR 6.88, 95% CI: 5.01–9.45; p<0.001) compared to adults. In the first 18 months, collection of fewer mosquitoes was associated with non-adherence (OR 3.25, 95% CI: 2.92–3.63; p<0.001), and, in the last 6 months, residents of poorer households were less adherent (OR 5.1, 95% CI: 1.17–22.2; p = 0.03). Any reported non-adherence over the prior two months was associated with a 15-fold increase in the odds of having malaria (OR 15.0, 95% CI: 1.95 to 114.9; p = 0.009). Knowledge about LLIN use was high, and the most frequently reported barriers to use included heat and low perceived risk of malaria. Children, particularly school-aged, participants exposed to fewer mosquitoes, and those from poorer households, were less likely to use LLINs. Non-adherence to LLINs was associated with an increased risk of malaria. Strategies, such as behavior change communications, should be prioritized to ensure consistent LLIN use even when malaria transmission has been greatly reduced.
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spelling pubmed-77142202020-12-09 Non-adherence to long-lasting insecticide treated bednet use following successful malaria control in Tororo, Uganda Rek, John Musiime, Alex Zedi, Maato Otto, Geoffrey Kyagamba, Patrick Asiimwe Rwatooro, Jackson Arinaitwe, Emmanuel Nankabirwa, Joaniter Staedke, Sarah G. Drakeley, Chris Rosenthal, Philip J. Kamya, Moses Dorsey, Grant Krezanoski, Paul J. PLoS One Research Article Indoor residual spraying (IRS) and long-lasting insecticide-treated bednets (LLINs) are common tools for reducing malaria transmission. We studied a cohort in Uganda with universal access to LLINs after 5 years of sustained IRS to explore LLIN adherence when malaria transmission has been greatly reduced. Eighty households and 526 individuals in Nagongera, Uganda were followed from October 2017 –October 2019. Every two weeks, mosquitoes were collected from sleeping rooms and LLIN adherence the prior night assessed. Episodes of malaria were diagnosed using passive surveillance. Risk factors for LLIN non-adherence were evaluated using multi-level mixed logistic regression. An age-matched case-control design was used to measure the association between LLIN non-adherence and malaria. Across all time periods, and particularly in the last 6 months, non-adherence was higher among both children <5 years (OR 3.31, 95% CI: 2.30–4.75; p<0.001) and school-aged children 5–17 years (OR 6.88, 95% CI: 5.01–9.45; p<0.001) compared to adults. In the first 18 months, collection of fewer mosquitoes was associated with non-adherence (OR 3.25, 95% CI: 2.92–3.63; p<0.001), and, in the last 6 months, residents of poorer households were less adherent (OR 5.1, 95% CI: 1.17–22.2; p = 0.03). Any reported non-adherence over the prior two months was associated with a 15-fold increase in the odds of having malaria (OR 15.0, 95% CI: 1.95 to 114.9; p = 0.009). Knowledge about LLIN use was high, and the most frequently reported barriers to use included heat and low perceived risk of malaria. Children, particularly school-aged, participants exposed to fewer mosquitoes, and those from poorer households, were less likely to use LLINs. Non-adherence to LLINs was associated with an increased risk of malaria. Strategies, such as behavior change communications, should be prioritized to ensure consistent LLIN use even when malaria transmission has been greatly reduced. Public Library of Science 2020-12-03 /pmc/articles/PMC7714220/ /pubmed/33270743 http://dx.doi.org/10.1371/journal.pone.0243303 Text en © 2020 Rek et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Rek, John
Musiime, Alex
Zedi, Maato
Otto, Geoffrey
Kyagamba, Patrick
Asiimwe Rwatooro, Jackson
Arinaitwe, Emmanuel
Nankabirwa, Joaniter
Staedke, Sarah G.
Drakeley, Chris
Rosenthal, Philip J.
Kamya, Moses
Dorsey, Grant
Krezanoski, Paul J.
Non-adherence to long-lasting insecticide treated bednet use following successful malaria control in Tororo, Uganda
title Non-adherence to long-lasting insecticide treated bednet use following successful malaria control in Tororo, Uganda
title_full Non-adherence to long-lasting insecticide treated bednet use following successful malaria control in Tororo, Uganda
title_fullStr Non-adherence to long-lasting insecticide treated bednet use following successful malaria control in Tororo, Uganda
title_full_unstemmed Non-adherence to long-lasting insecticide treated bednet use following successful malaria control in Tororo, Uganda
title_short Non-adherence to long-lasting insecticide treated bednet use following successful malaria control in Tororo, Uganda
title_sort non-adherence to long-lasting insecticide treated bednet use following successful malaria control in tororo, uganda
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714220/
https://www.ncbi.nlm.nih.gov/pubmed/33270743
http://dx.doi.org/10.1371/journal.pone.0243303
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