Lelisa Sena

Malaria and under-nutrition: a community based study among under-five children at risk of malaria, south-west Ethiopia.

Background The interaction between malaria and under-nutrition is not well elucidated in Ethiopia. The objective of this study was to assess the magnitude of under-nutrition and its correlation with malaria among under-five children in south-west Ethiopia. Methods This cross-sectional study was undertaken during March–February, 2009 as part of the baseline assessment of a cluster randomized trial around Gilgel Gibe Hydroelectric dam, south-west Ethiopia. A total of 2410 under-five children were included for anthropometric measurement and blood investigation for the diagnosis of malaria and anemia. The nutritional status of children was determined using the International Reference Population defined by the U.S National Center for Health Statistics (NCHS). Blood film was used to identify malaria parasite and haemoglobin concentration was determined by Hemo Cue analyzer (HemoCue Hb 301, Sweden). Results Significant proportion (40.4%) of under-five children were stunted (height-for-age<−2SD). The prevalence of under-weight was 34.2%. One third and one tenth of the children had anemia and malaria parasite respectively. Older children were more likely to have under-nutrition. There was no association between malaria and under-nutrition. Children who had malaria parasite were 1.5 times more likely to become anaemic compare to children who had no malaria parasite, [OR = 1.5, (95% CI: 1.1–2.0)]. Conclusion In this study, there is no association between malaria and under-nutrition. Children who have malaria are more likely to be anaemic. Malaria prevention and control program should consider nutrition interventions particularly anemia.

Predictors of long-lasting insecticide-treated bed net ownership and utilization: evidence from community-based cross-sectional comparative study, Southwest Ethiopia

BackgroundMalaria is the notorious impediment of public health and economic development. Long-lasting insecticide-treated bed nets/insecticide-treated bed nets (LLINs/ITNs) are among major intervention strategies to avert the impact the disease. However, effectiveness of LLINs/ITNs depends on, inter alia, possessing sufficient number, proper utilization and timely replacement of nets. Thus, the World Health Organization (WHO) recommends surveys to evaluate possession and proper use of LLINs/ITNs by households.MethodsA cross-sectional comparative household survey was conducted during peak malaria transmission season using interviewer-introduced questionnaires in southwest Ethiopia. A study site was selected from villages around a man-made lake, Gilgel-Gibe (GG) and a control site, with similar geographic and socio-economic features but far away from the lake, was identified. A total of 2,373 households from randomly selected cluster of households were included into the study and heads/spouses of the households responded to interviews. Binary and multinomial logistic regressions were used to identify predictors of LLIN ownership and utilization.ResultsLLIN/ITN ownership among the study populations was 56.6%, while 43.4% of households did not own a net. A higher proportion of households in GG reported owning at least one LLITN/ITN compared to control village (OR =2. 2, P <0.001) and more households in GG reported having only one LLITN/ITN in contrast to households in the control village (OR = 2.1, P <0.001). The mean number of LLINs/ITNs owned was 1.6 for GG residents and 1.8 for control village with a mean difference of -0.26 (95% CI = - 0.34, -0.19). The age of household heads, household relative wealth index (RWI), distance to nearest health service and accessibility to transportation showed a significant association with ownership of LLINs/ITNs. The probability of owning two or more LLINs/ITNs was positively associated with age of household head. Marital status of household heads, RWI, distance to nearest health service, accessibility to transport, residence and household size showed a significant association with utilization of LLINs/ITNs.ConclusionAttention needs to be given to the poor, distant and inaccessible households in the efforts of malaria intervention programmes, such as free distribution of LLINs/ITNs. Well-tailored information, education and communication is needed to address the problem of non-users.

The effect of household heads training on long- lasting insecticide-treated bed nets utilization: a cluster randomized controlled trial in Ethiopia

BackgroundLong-lasting insecticide-treated bed nets (LLITN) have demonstrated significant impact in reducing malaria-related childhood morbidity and mortality. However, utilization of LLITN by under-five children is not satisfactory in many sub-Saharan African countries due to behavioural barriers. Previous studies had focused on the coverage and ownership of LLITN. The effect of skill-based training for household heads on LLITN utilization had not yet been investigated. A cluster-randomized trial on the effect of training of household heads on the use of LLITN was done in Ethiopia to fill this knowledge gap.MethodsThe study included 22 (11 intervention and 11 control) villages in southwest Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. All households in each group received free LLITN. Data were collected at baseline, six and 12 months of the follow up periods. Utilization of LLITN in the control and intervention villages was compared at baseline and follow up periods.ResultsA total of 21,673; 14,735 and 13,758 individuals were included at baseline, sixth and twelfth months of the project period. At the baseline survey, 47.9% of individuals in the intervention villages and 68.4% in the control villages reported that they had utilized LLITN the night before the survey. At the six month, 81.0% of individuals in the intervention villages and 79.3% in the control villages had utilized LLITN. The utilization of LLITN in all age groups in the intervention villages was increased by 17.7 percentage point (95% CI 9.7-25.6) at sixth month and by 31.0 percentage point (95% CI 16.9-45.1) at the twelfth month. Among under-five children, the LLITN utilization increased by 31.6 percentage point (95% CI 17.3-45.8) at the sixth month and 38.4 percentage point (95% CI 12.1-64.7) at the twelfth months of the project period.ConclusionHousehold level skill-based training has demonstrated a marked positive effect in the utilization of LLITN. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITN should be accompanied by a skill-based training of household heads to improve its utilization.Trail registrationAustralian New Zealand Clinical Trials Registry (ACTR number: ACTRN12610000035022).

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

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

Dynamics of Plasmodium falciparium and Plasmodium vivax in a micro-ecological setting, Southwest Ethiopia: effects of altitude and proximity to a dam

BackgroundRefining the spatial and temporal data on malaria transmissions at a defined ecological setting has practical implications for targeted malaria control and enhancing efficient allocation of resources. Spatial and temporal distribution of P. falciparium and P. vivax were explored around the Gilgel Gibe Hydroelectric Dam (GGHD) in southwest Ethiopia.MethodsA review of confirmed malaria episodes recorded over eight years at primary health services was conducted. Using individual identifiers and village names malaria records were cross-linked to location and individual records of Gilgel Gibe Health and Demographic Surveillance System (HDSS) data, which had already been geo-referenced. The study setting was categorized in to buffer zones with distance interval of one kilometer. Similarly, altitude of the area was categorized considering 100 meters height intervals. Incidence rate ratios were estimated using Poisson model for the buffer zones and for the altitudinal levels by adjusting for the underlying population density as an offset variable. Yearly temporal variations of all confirmed malaria cases were also evaluated based on the Poisson model using STATA statistical software version 12.ResultsA considerable proportion (45.0%) of the P. falciparium episodes were registered within one kilometer radius of the GGHD. P. falciparium showed increment with distance from the GGHD up to five kilometers and with altitude above 1900 meters while P. vivax exhibited the increase with distance but, decrease with the altitude. Both species showed significantly higher infection among males than females (P <0.01). Temporally, malaria episodes manifested significant increments in the years between 2006/7 to 2009/10 while reduction of the malaria episodes was indicated during 2004/5, 2005/6 and 2010/11 compared to 2003/4 (P <0.01). On average, P. vivax was 52% less than P. falciparium over the time period considered. P. vivax was significantly higher in the years 2004/5 to 2007/8 and 2010/11 (P <0.001).ConclusionsSpatial and temporal variations of malaria were observed. The spatial and temporal variations of malaria episodes were also different for the two main malaria species in the area.

Predictors of academic performance with due focus on undernutrition among students attending primary schools of Hawa Gelan district, Southwest Ethiopia: a school based cross sectional study

BackgroundMore than a quarter of children living in Sub-Saharan Africa are underweight. Nutritional deficiency in children increases the risk of infection and affects their mental development. However, there was scarcity of research findings that clearly indicate determinants of academic performance. Therefore, this study was aimed at determining predictors of academic performance with due focus on undernutrition among students attending primary schools.MethodsSchool based cross sectional study was conducted in February, 2016 among 630 randomly selected students attending primary schools in Hawa Galan woreda. Data were collected through parents/guardians interview, anthropometric measurement of children and school record review. Data were entered into Epidata version 3.1 and analyzed with SPSS Version 20. Anthropometric data were analyzed by WHO Anthro plus software. Pearson’s correlation analysis was performed to determine correlation between academic performance and undernutrition. Logistic regression analysis was also performed to assess predictors of academic performance and p < 0.05 was used to declare significant association.ResultPrevalence of stunting, wasting and underweight in this study were 20.6%, 12.7% and 14.3% respectively. This study found a significant correlation between underweight (r = 0.222, P = 0.040), stunting (r = 0.214, P = 0.034) and academic performance. Multiple logistic regression analysis also indicated that being female [AOR 1.48; 95% CI (1.16, 3.82)], attending above grade 4 [AOR 2.12; 95% CI (1.98, 4.87)], having educated parents [AOR 2.18; 95% CI (1.43, 4.72)], coming from households with monthly income of more than 2000ETB (~USD91) [AOR 2.85; 95% CI (2.01, 5.21)] and having no parental support during homework [AOR 0.57; 95% CI (0.19, 0.98)] were significantly associated with students’ academic performance.ConclusionStunting and underweight were found to be correlated with academic performance of students attending primary schools. Nutritional interventions should be considered in the study area. Parents should be encouraged to be involved in their children’s schooling.